<"/y'«.- i. .^&S 3|jg£fi| Hi -.!>& PHPl i"H-Jp??lf§ NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland Gift of The National Center for Homeopathy ^Maesimund " Ibanrimq yarns Library ^ / r 19 M- C£ % 74 Gift of CONSUMPTION: ITS CAUSE AND NATURE BY ROLLIN R. GREGG, M. D., TO WHICH IS ADDED THE THERAPEUTICS or TUBERCULOUS AFFECTIONS. BY H. C. ALLEN, M. D. ANN AKI30E, MICHIGAN. Copyrighted by Hattie E. Gregg, 1889. All rights reserved. ANN ARBOR REGISTER Printing and Publishing Company. PREFACE. The germ theory of Koch, like many of its predecessors, utterly fails to account for the cause and nature of con- sumption. The bacillus tuberculosis may be an effect, but it cannot be a cause. Like many kindred pathological theories, it was not sufficiently comprehensive to satisfy Dr. Gregg, and for over twenty-five years, single handed and almost alone, like Harvey, Hahnemann and other dis- coverers, he faithfully labored to demonstrate a morbid process more uniform and general in its action — a path- ology that would account for the results found in Bright's disease and diphtheria, as well as in tubercular affections. In view of the facts which he collected from various sources, and which for the first time are presented in this volume, the contagious theory did not explain many of the preceding conditions of the tubercle, some of which even "anticipate it by half a life-time." His theory that the cause of consumption is "a loss of albumen from the blood and a consequent disproportion into which such loss must necessarily throw all the other constituents of the blood;" and the terrible bacillus is nothing but "a soften- ing or suppuration of the tubercle, a simple rod of fibrin." At the time of Dr. Gregg's death the therapeutics of tuberculosis was not completed — in fact only three reme- dies were partially written — and amidst many profes- sional duties the work has been very slowly accomplished. However, the remedies most frequently indicated are given, but many more may be required, in fact, in the treatment of this deep-seated constitutional affection, any or even every remedy in the Materia Medica may be called for in peculiar idiosyncrasies. It must always be borne in 4 PREFACE. mind in the selection of the exactly similar remedy, that a careful individualization of both patient and remedy is absolutely necessary to attain the required result. For no two patients are alike, hence no two cases of tuberculosis can be alike, aud it is the patient, not the tubprculosis, that we are to cure. This fact, upon which Hahnemann so strongly insisted, we are apt to overlook, and to this ch'vtU our failures are to be attributed. Next in importance to the selection of the perfectly sim- ilar remedy, is its repetition. If we would obtain the best curative results we must allow it time to do its perfect work. It requires time to change morbid action or to rebuild healthy tissue, and if improvement be ever so slow, if it only be in the right direction, the action of the remedy must not be interfered with. Study Hahnemann's rules carefully, and follow them implicitly, is the best rule of practice that can be given. H. C. Allen, M. D. Ann Arbor, June, 1*K!>. INDEX. Page. Introduction........................................ 9 I. Summary of the cause and nature of Consumption. 15 II. Discovery of the cause of Consumption............ 20 III. The composition of the human blood............... 22 IV. The circulation of the blood........................ 25 V. Nature and uses of the constituents of the blood- albumen, water, blood corpuscles, fibrin, fatty matters, salts, extractive matters............... 29 VI. The mucous membranes............................ 34 VII. The source of Albumen............................. 40 VIII. The bountiful supply of albumen to the mucous membranes..................................... 44 IX. Proof of the waste of albumen by the mucous mem- branes .......................................... 46 X. Why the mucous membranes are so prone to disease. 58 XI. The consequences of losing albumen................ 62 XII. Proof of the other constituents being left in excess in the vessels when albumen is lost—fibrin, salts, fatty matters, extractive matters................ 68 XIII. The excess of water and its effects................... 85 XIV. The excess of blood corpuscles, and the diseases re- sulting therefrom—negative testimony, identity of decolorized blood and tuberculous corpuscles, what becomes of the hsematin.................. 90 XV. Disposition of the excess of fibrin.................. 109 XVI. What results from an excess of fatty matters—how the excess of salts is disposed of, the excess of extractive matters.............................. 114 XVII. The contagious or germ theory of the origin of con- sumption ....................................... II? XVIII. The minute structure of tubercles.................. 133 XIX. Constituents of tubercles, and explanations regard- ing them—giant cells, transparent tubercular cells, yellow tubercular cells, tubercles of Gross, tubercles of Lsennec, yellow tubercles, the knot 6 INDEX. of Virchow, fibrous stage, inflammatory and sup- purative stages, cheesy stage, fatty degeneration, cretefication.................................... 139 XX. All classes of organized tissues but one nourished in excess in tuberculosis........................... 148 XXI. Thestagesof Consumption—letter to Dr. Formad... 159 XXII. Pneumonia and its relation to phthisis.............. 161 XXIII. Other sources of phthisis........................... 165 XXIV. Rational and scientific ground for hope that Con- sumption can be cured.......................... 169 XXV. Harsh and irritating medicines must be avoided — 176 Therapeutics of Tuberculosis........................ 181 Is Consumption contagious......................... 183 Geographical distribution of phthisis............... 185 Moisture—altitude.................................. 186 Climate............................................. 187 Closed establishments in phthisis................... 188 Life in the open air................................. 189 Personal Hygiene................................... 189 Bathing............................................ 190 Eating: How to eat; what to eat; and how to eat it. 190 Salisbury's meat diet............................... 191 The Homoeopathic treatment of phthisis............ 193 The Simillimum.................................... 195 The Three Mistakes............................... 196 Hahnemann's Three Rules.......................... 197 REMEDIES AND THEIR ABBREVIATIONS. Abrotanum, Abrot. Cinchona, Cinch. Acalypha indica, Acal. Cistus, Cist Acetic acid, Acet. ac. Coccus canti, Coc. c. Aconitum Napellus, Aeon. Cocculus, Coc. Actea racemosa, Act. Coffea, Coff. Agaricus, Agar. Colocynth, Col. Alumen, Alumen Conium, Con. Alumina, Alum. Corallorhiza, Cor. Aloe, Aloe Corallium rubrum, Cor. r. Ambra, Amb. Cuprum, Cup. Ammonium carb., Amm. c. Digitalis, Dig. Anacardium, Anac. Drosera, Dros. Anisum, Anis. Dulcamara, Dul. Antimonium tart., Ant. t. Elaps, Elaps Apis, Apis Erechthites, Erech. Aranea, Aran. Erigeron, Erig. Argentum nit., Arg. n. Euphrasia, Euph, Arnica, Am. Ferrum, Fer. Arsenicum, Ars. Ferrum iod., Fer. iod. Arsenic iod., Ars. iod. Ferrum phos., Fer. phos. Arum triphyllum, Arum t. Fluoric acid, Fl. ac. Asarum, Asar. Gelsemium, Gel. Aurum, Aur. Gettisburg, Gett. Badiaga, Bad. Graphites, Graph. Baptisia, Bap. Grindelia, Grind. Baryta carb., Bar. c. Hamamelis, Ham. Belladonna, Bell. Helix tosta, Helix Berberis, Berb. Helonias, Helon. Bismuth, Bis. Hepar, Hep. Borax, Bor. Hydrastis, Hyd. Bo vista, Bov. Hydrophobinum, Hydroph. Bromium, Brom. Hyoscyamus, Hyosi Bryonia, Bry. Hypericum, Hyper. Bufones, Bufo. Ignatia, Ign, Cactus, Cac. lodum, Iod. Cadmium sulph., Cad. s. Ipecacuanha, Ipec. iris Caladium, Calad. Iris versicolor, Calcarea, Cal. Kali bich., Kali b, Calcarea ars., Cal. a. Kali brom., Kali br, Calcarea phos., Cal. p. Kali carb., Kali c. Cannabis sat., Can. s. Kali iod.. Kali iod. Capsicum, Caps. Kali mur., Kali uiur. Carbo animalis, Carbo an. Kaolin, Kaolin Carbo veg., Carbo v. Kreosotum, Kreos. Causticum, Caust. Lachesis, Lach. Cepa (Allium), Cepa Lac caninum, Lac can. Chamomilla, Cham. Ledum, Led. Chelidonium, Chel. Lilium tig., Lll. Cina, Cina Lycopodium, Lye. s REMEDIES AND THj Malandrinum, Maland. Magnesia phos., Mag. p. Manganum, Mangan. Medorrhinum, Med. Melilotus, Mel. Mercurius, Mer. Millefolium, Millet". Moschus, Mosch. Muriatic acid, Mur. ac. Myrtus communis, Myr. Xatrum carb., Xat. c. Xatrum mur., Nat. m. Natrum sulph., Xat. s. Niccolum, Nic. Xitric acid, Nit. ac. Nux moschata, Xux m. Xux vomica, Xux v. Opium, Op. Oxalic acid, Ox. ac. Oxytropis, Oxyt. Petroleum, Petr. Pinus palustris, Pinus p. Pix liquida, Pix Platina, Plat. Phosphorus, Phos. Phosphoric acid, Phos. ac. Prunus spinosa, Prun. s. Psorinum, Psor. Pulsatilla, Puis. Pyrogen, Pyr. llauunculus bulb., Ran. b. Ranunculus seel, Ran. s. Rheum, Rheum Rhus tox., Rhus tox. Rumex, Rumex AND THEIR ABBREVIATIONS. Ruta, Sabina, Sambucus, Sanguinaria, Sanicula, Sarsaparilla, Secale, Senega, Selenium, Sepia, Silicea, Silphium, Sinapis nigra, Spigelia. Spongia. Squilla mar., Stannuin, Sticta pul., Staphisagria, Stramonium. Sumbul., Sulphur, Sulphuric acid, Syphilinum, Symphytum, Tabacum, Tarantula, Terebinth, Teucrium, Theridion, Thuja, Trillium, Tuberculinum, Veratrum, Zincum, Ruta Sab. Samb. Sang. San. Sars. Sec. Sen. Sel. Sep. SiJ. Silph. Sin. n. Spig. Spong. Squil. Stan. Stic. Staph. Strain. Sumb. Sulph. Sulph. ac. Syph. Svmp. Tab. Tar. Ter. Teuc. Ther. Thuja Tnl. Tub. Verat. Zinc. INTRODUCTION. It would seem that there has already been a surfeit of essays written and of books published upon consumption; but, notwithstanding this, the writing and publishing will and must go on, until the true nature of the disease has been fully fathomed. In a matter so important as a disease that carries off one-fifth of the people of the civilized world, there is and can be no stopping the research or writing upon the subject, until the truth and the whole truth in regard to it has been brought out. For this reason no apology is needed, nor will one be offered, for the appear- ance of the present volume. There have been many theories put forth to explain tubercles and their causes; but not one of them has stood the test of time and careful scrutiny, and none of them has been generally accepted as true. Several of them have, for a time, received a partial acceptance, and then, either through old facts being more carefully considered, or new ones found and applied to them, they have been discarded; only, however, to give place to others, that have finally shared the same fate. Strangely enough, in all the investigation and consider- ation of the subject, it seems never to have occurred to any one to account for anything in consumption but the tuber- cle; and, yet, there are many serious and alarming accom- paniments of the disease which are only secondary to the tubercle in their ominous indications, and which, indeed, are sometimes just as serious in what they mean. To illustrate: There is the great emaciation of consump- tion, which is almost as characteristic of the disease as the 2 10 INTRODUCTION. tubercle itself, appearing in many cases before it, and not infrequently progressing rapidly, or quite so, when the patient is eating heartily, digesting fairly well, and suffer- ing little, if any, to cause it. This is always an alarming condition. Then there is the too watery blood of the con- sumptive all the way through the disease, from its very inception to its close in death, and always preceding the tubercle, often for months and sometimes for many years. This, as we shall see, is one of the most important factors in the disease. The tubercle could seldom or never be produced without it. Next there are the night sweats, which are so characteristic of consumption, much more so than of many other diseases, and which also sometimes appear before the tubercle. Again, there is the fatty liver of the disease, which not often precedes the tubercle, but which remains to be accounted for just as much as the tubercle, in a theory that truly accounts for this patholog- ical formation. Finally, there are the scrofulously en- larged joints, and the thickened, curved and ridged finger- nails, besides other things, that are quite as characteristic of the consumptive subject as almost anything else in his disease; but which, it is repeated, nobody seems ever to have thought of taking into account, or, at least, of account- ing for the cause, in the many theories of tubercle. Now, all know that these several attendant conditions, or the most of them, are as much a part of consumption— each being a segment of the same circle—as is the tubercle itself. And it must be clear to all, that a true theory of tubercle and its cause, or causes, must also as truly account for all its characteristic accompaniments; and especially so for such as precede the tubercle, and are quite as signifi- cant; indeed, are almost its certain harbingers. By either one or two of these conditions, physicians, and even intelligent laymen, can often select in childhood those children who will be the future subjects of consump- tion. These two conditions are simply: first, the emacia- INTRODUCTION. 11 tion, or arrested development of the muscular system, shown by many such children in their small necks, puny arms, scrawny chests, bodies, etc.; and, secondly, by the evidences of a too watery state of the blood, shown by the pale skin and blue veins of such subjects. Does this not, therefore, show the necessity of knowing all that is possi- ble to know of the cause, or causes, of these conditions? In many of these very cases it is years, and sometimes half a life-time, before the first tubercle appears; some of the subjects going on until middle life, or later, before the dis- ease for which they were marked, or which they inherited at birth, develops. In the matter of treatment, moreover, does not all this show what a great advantage there would be in knowing, so long in advance, the cause, the precursor of tubercle, and that, unless arrested, it was certainly coming; so that by controling the former, the latter might be prevented from ever developing? Can there be reasonable hope of a generally successful treatment of consumption ever being established, without knowing the cause or causes of the attendants of tubercle, so many of which are its prece- dents and almost certainly lead up to it? The disease is a whole, in all its more prominent manifestations, and it must be studied as such, and treated accordingly, to attain the least success in either. But here the reader may say this is leading into as great or even greater complications than we now have. Not so, if we can find the true key to the subject. Nature is never complicated in her work, and only seems so to us when we fail to get the key to her operations. With this in hand, the most intricate prob- lems she presents can be solved, carefully examined, and reduced to the understanding of all of fair intelligence, as we shall see with the subject under consideration. There is a theory, or, rather, there is a great physiolog- ical and pathological fact underlying this whole subject, which is one of the most simple of all the facts in disease, 12 INTRODUCTION. and which accounts, not only for the various phenomena named, but also for much besides that it is important should be understood. This fact has been long known, but never before applied, except by the author in various papers; and it is one that cannot be gainsaid. Indeed, in what is to follow, the effort will be made not to present any facts but such as will stand the test of the most thorough scientific scrutiny. To present the disease as the author looks upon it, in what he regards as its only true light, and as a whole in its immediate cause and in all its results, it is necessary to step entirely outside of all the theories and speculations hitherto indulged in concerning it; in so far, at least, as their affording any aid in the solution of the subject. Facts that are simple, and that cannot be overturned or weakened in the force of their application, will neverthe- less be kept constantly aud prominently in view. We can- not understand the subject unless we simplify it far beyond what has ever before been attempted; and this will be the aim of this volume. The pathological fact alluded to as the cause of consump- tion, and the more salient points arising under it, will be presented as a summary in the first chapter, that the reader may have before him at the outset the essential or leading facts that are claimed; then all will be fully elaborated and proved in succeeding chapters. To do this, many numer- ous and important quotations will be given from the best authorities on the various points; and if this should seem superfluous, or prove to be tedious to the best educated professional readers, they must remember that all are not as well up in their reading as they; and those who are not, are persons who require all the facts they can get to fortify them in their knowledge and management of so formidable a disease as this has always proved to be, not only to the members of the medical profession, but to the highly educated as well. INTRODUCTION. 13 The symptoms and pathology of the disease are so elab- orately given in many works upon phthisis, that it seems superfluous here to repeat them. The cause, or causes, of the disease, are what we need to know more than all else, for in that lies our only hope of preventing the develop- ment of the disease in any case, or of properly managing it after it has begun. It is, therefore, the main object of this volume to show both the immediate and remote causes of phthisis, which are so little understood, instead of giving symptoms and pathological developments that are now known to all; and thereby lay the foundation for pre- venting the disease in many cases, so that nothing further shall be needed. CONSUMPTION. CHAPTER I. SUMMARY OF THE CAUSE AND NATURE OF CONSUMPTION. Having finally secured the last link that is thought requisite, in the long chain of positive as well as negative proof, to clear up the mystery which has so long hung over the cause and nature of Tubercle, I am now prepared to reaffirra, even more positively than ever before, that the Cause of Consumption is a loss of albumen from the blood through irritated and abraded mucous membranes. This is the key to all the characteristic conditions and developments of phthisis. It is a loss of albumen from the blood, through the mu- cous membrane of the kidneys, that causes Bright's disease of these organs, and that, in its chronic form, takes the life of almost every sufferer from that disease. If such, then, is the cause, and such the fatality of Bright's disease, which are well-known facts, it would seem that a similar, but more profuse waste of albumen through those still more vital organs, the lungs, must be equally serious in all its stages, and equally fatal in its results, if proper meas- ures are not speedily taken to stop such waste before fatal conditions have arisen. The expectoration of consumptives, and all their other catarrhal or mucous discharges, from whatever organ, is If) CONSUMPTION. mostly albumen, and a direct loss of so much of this con- stituent from the blood. Hence, it is the waste, in this manner, of a portion of this most indispensable element of animal life, that causes consumption and its many attend- ant phenomena—its tubercles, its great emaciation, its too watery blood, its night sweats, its dropsies, its fatty livers, its adhesions of the pleura, its enlarged joints, its thick- ened, curved and ridged finger-nails, etc. The albumen of the blood, in its natural state, is similar to the white of the egg, and furnishes almost the only nutrition for the whole muscular system; hence the great emaciation so characteristic of consumption, as one prom- inent result of its loss—the muscles being robbed of a large portion of their only food by its profuse waste. The loss of any portion of it, furthermore, throws all the constituents of the blood into a disproportion; in other words, destroys that proper proportion among them which nature is at the greatest pains to create, and which is so necessary to health to have maintained; and leaves a rela- tive excess in the circulation of all other constituents, which was not designed, and against the evil effects of which the system cannot fully protect itself while the waste is permitted to go on. The loss of one ounce of albumen, for instance, destroys nearly one pound of blood for all purposes of healthy nutrition, and leaves a relative excess in the blood-vessels of Water, Blood Corpuscles, Fatty Matters, . Fibrin, Salts, . 5? ounces. 7 ounces. 9 grains. 15 grains. 41 grains. The excess thereby left of these constituents is then the same as foreign matter in the blood, and is found deposit- ing in living tissues, creating diseases that correspond to the element thus disposed of, and the part in which depos- ITS CAUSE AND NATURE. 17 ited; or it is expelled from the system entire through every outlet that nature can command. The excess of water causes the blood to be too watery during the whole course of the disease, from the com- mencement of the waste of albumen through till the case closes in death; and it is this too watery condition of the blood which in turn causes "night sweats "; that is, nature is compelled to establish them, for the purpose of throwing off a greater or less portion of the excess of water, and thus do what it can to save the patient as long as may be from more immediately fatal results. Were this not done in this or other ways, the blood would soon become so very watery under the constantly accumulating excess of water —as is sometimes the case in Bright's disease—that all the blood corpuscles would speedily be destroyed, and most of the soft tissues of the whole body be washed to death. Dropsy, which usually comes in later, is still another, and the last conservative effort in this direction in the interests of life, as it, too, is a means of expelling a portion of the excess of water from the blood-vessels into the surround- ing tissues, and thus aids a little time longer in avoiding worse immediate consequences. The blood corpuscles left in excess, are decolorized by circulating in the still too watery blood, or serum, notwith- standing the night sweats and dropsy throw off a large portion of the excess of water; and these decolorized cor- puscles are then deposited in the capillaries or smallest blood-vessels, where they shrivel, to become the so-called tuberculous corpuscles, which are organized into tubercles, and which have no other origin but this. The excess of fatty matters causes the fatty livers so common in consumption, and other so-called fatty degen- erations, fatty tumors, and the like. The excess of fibrin causes those adhesions of the pleura, that is, of the surface of the lungs to the inner surface of the ribs, to the heart, or to each other, which M. Louis 18 CONSUMPTION. says are almost without exception in consumption, and which are often among the most serious of all its compli- cations. And, finally— The excess of the salts causes most forms of calculi, enlargements of the joints and bony tumors, so common in scrofulous and consumptive subjects, ossifications and other more or less similar morbid developments. Not a case of consumption, even in its first stage, or, indeed, in its first threatenings, can, therefore, be cured, nor can a rational hope of its cure be entertained, short of healing the mucous membranes and putting a stop to the further waste of albumen. And that all this can be done by judicious treatment, in the majority of cases, in the first stage of the disease—excepting in those who have in- herited feeble constitutions—there can fortunately be little ground for question. There is, in fact, one of the most hope-inspiring provisions to be found in all nature, bear- ing directly upon this very point, which shows conclusively that this can be accomplished, and which will be fully ex- plained in its proper place. No one can maintain vigorous health for a day, while sustaining a loss of this most essential of all the elements of animal life, viz., albumen; and none can live under its continued waste. This fact applies to all the mucous mem- branes. Consumption of the lungs may and does arise, or is often started, by the waste of albumen through the mucous membranes of any of the other organs possessing it. For instance, large numbers of confirmed dyspeptics ultimately die of consumption, as do many of those suffer- ing from chronic diarrhoea, chronic dysentery, and the like. The same is true, in a marked degree, of women suf- fering from chronic leucorrhcea. In all these cases albu- men is lost from the blood the same as through the kidneys or lungs; and the bloodcorpuscles left iu excess are decol- orized the same and deposited in the lungs, in many such cases, to commence the growth of tubercles. This explains ITS CAUSE AND NATURE. 19 why tubercles are quite often begun in the lungs, exciting a dry cough, before there has been any expectoration therefrom to account for them in that way. These views, or discoveries, it is the author's purpose to elaborate and prove, as fully as may be, in the following pages; and he asks that fair and candid consideration of them which the great importance of the subject demands. 20 CONSUMPTION. CHAPTER II. DISCOVERY OF THE CAUSE OF CONSUMPTION. September 21st, 1861, after several years of unsuccessful research for the proper explanation of a fact that occurs in the early stage of many consumptive cases, the author was first impressed with the conviction that a loss of albu- men from the blood, and the consequent disproportion into which such loss must necessarily throw all the other con- stituents of the blood, was the cause of consumption—the key to the production of tubercles and all their attending phenomena; and he has pursued this thought, or this solu- tion of the question, more or less persistently ever since, with unvarying confidence in its truth. It required all the time that could be commanded from the pursuit of active professional duties during the subse- quent five or six years, to collate the evidence necessary to sustain this view of the subject. In the meantime the contagious theory of the cause of tubercle had been more prominently than ever before brought forward in Europe, in opposition to all other theories; and this has finally ripened into the germ or bacillus theory. This contagious theory was then, and is now, felt and believed by the author to be a false issue as against the multitude of facts which had been collected and will be found in this volume, sustaining an entirely different view of the subject; that it did not, in the remotest degree, ex- plain the cause of the preceding and accompanying condi- tions of the tubercle, some of which not unfrequently anticipate it by half a life-time, even if it could with any DISCOVERY OF ITS CAUSE. 21 show of reason be assumed to explain anything else. But it was not until within the last two years, that the proof was secured to show that the so-called germ of the tuber- cle, the bacillus, is nothing but a result of the softening or suppuration of the tubercle, a simple rod of fibrin, as will be shown in a subsequent chapter; and, like all else, com- ing in as one of the consequences of the loss of albumen. It is ever thus that the truth seems compelled to wait upon error in all its hydra-headed forms, before the world is allowed to reap the great advantages that the former always brings. With what we know of the loss of albumen through the kidneys, and its uniformly fatal results in chronic Bright's disease, if it can be shown that an equal or greater loss of it is sustained through the lungs in consumption, we may well stop and consider whether this be not actually the cause of a scourge so terrible as to destroy one-fifth of the human race. That a large amount of albumen is expec- torated from the lungs by consumptives, and thereby lost from their blood, and also lost to their nutrition, will be proved beyond the possibility of question, when we reach the point for introducing the evidence. For a clear and correct comprehension of this claim, or theory, and all that is to follow in its proof, the reader must first have as accurate knowledge as may be obtained (if, perchance, he is without such knowledge now), of the composition of the blood, of the nature and uses of its several constituents, and of its capillary circulation; and should also know the structure of the mucous membranes, how albumen is conveyed to them for nutritive purposes, but there wasted in part through said membranes by dis- ease in such cases, to cause what is claimed. To aid all who may actually need, or wish it, in securing this knowl- edge of the basis of our work, the essential facts upon the points named will be presented in as clear a form as pos- sible, beginning with the composition of the blood. 22 CONSUMPTION. CHAPTER III. THE COMPOSITION OF HUMAN BLOOD. 1000 parts of healthy blood contain, of Albumen, . . 70. pari Water, . 403. Blood Corpuscles, . 512. Fibrin, 2.2 Fatty Matters, . 1.3 Salts, 6.03 " Extractive Matters, . 5.47 " Total, . 1000.00 The proportion of the corpuscles, and of the water, given in this table, is very different from that to be found in the tables of the books, for the reason that nearly all authors, in constructing their tables of the composition of the blood, give the proportion of the corpuscles as that of their dried residue, instead of in their moist state, thereby reducing their ratio to only about 131 in 1000 parts of blood, instead of 512 as it really is. Then these authors add the water dried out of the corpuscles to the water of the serum, bringing this up to 784 parts, instead of 403 parts; thus making an artificial division that does not exist in nature, and one that is fallacious and misleading. It certainly is not scientific to force a division, or partial decomposition of any natural substance, or compound, whose nature and relations we may wish to carefully examine, and then pro- ceed in our investigations under such dismemberment. We shall surely go wrong if we do. If we are to consider COMPOSITION OF HUMAN BLOOD. 23 the blood in all its bearings upon health and disease, we clearly must investigate it as it circulates in the blood- vessels, and not as something else that it may be changed into, by various processes; otherwise at the end of all our research we shall be no better, but actually worse off, than at the beginning. The proportion of the corpuscles given in the table is on the authority of that most reliable of all writers on physiological chemistry, Professor C. G. Leh- mann. Something should be said, moreover, of the proportion of fibrin given in the table. This seems very small for the work that fibrin will be shown to do, or the uses to which it is put. But its ratio is also given, by all authors, in the dried state; and as it is the lightest, or one of the lightest, of all known substances when dry, if its proportion were given in its moist state it would be much greater. Besides, the author of a late work upon Physiology says: " The average quantity by weight of fibrin in human blood is said to be .2 per cent., but the amount which can be obtained from a given quantity of plasma varies ex- tremely; the variation being due not only to circumstances affecting the blood, but also to the method employed." Still, it seems scarcely possible, that all the old and most careful chemists were entirely wrong in their analyses, especially when each corroborated the other so strongly; so, had they given us the proportion of the fibrin of the blood in the moist state, holding the amount of water that it needs to enable it to perform its highly important vital functions, and without which it cannot perform them at all, they would then have probably given nearly the right ratio of it. This would have brought its proportion up to perhaps ten or twelve in one thousand parts of blood; or, possibly, owing to the extreme lightness of dry fibrin in comparison with the other elements of the blood, and the much greater weight that the requisite amount of water would give it, as high as fifteen parts in the thousand of 24 CONSUMPTION. blood. Even at that, its ratio is very small, only one and five-tenths per cent. But, one explanation of this is, that the chauges which take place in the tissues that fibrin nourishes, are performed very slowly in comparison with many of the other soft parts; therefore, much less of their food is required daily, than that of parts in which changes go on much more rapidly, like the muscular and some other cells. Physically, the blood is divisible, as it circulates, into two very distinct and characteristic elements; viz., first, its corpuscles, or cells, amounting in the aggregate to a little over one-half, as already shown by the table; and, sec- ondly, the serum or the water of the blood, holding in solution the albumen, fibrin, salts, fatty and extractive mat- ters. After coagulation on being drawn, however, the fibrin and corpuscles are all or nearly all held in the clot, which, upon contracting, as blood-clots always do, the water, albumen, salts, fatty and extractive matters are mostly forced out of the clot and appear in the water around it, in which it floats readily if contained in some vessel so that it can. The fibrin and the corpuscles go together in the clot, and thus their separation is forced from the other constituents. CIRCULATION OF THE BLOOD. 25 CHAPTER IV. THE CIRCULATION OF THE BLOOD. The blood vessels, as all know, extend to and through every part and tissue of the animal organism (excepting through the cartilages) in almost infinite ramifications, carrying the blood into every organ, and the smallest sub- divisions thereof; and they are all, without exception, con- tinuous tubes, which go out from the heart as arteries, and back to it as veins, without there being in health the slight- est openings, or breaks, anywhere in their walls. That great arterial trunk, the aorta, sends off branches of arte- ries throughout its course, and these divide and subdivide into thousands, yes millions, of minute arteries which trav- erse every part of the soft tissues. The walls of all arteries possess, or are constituted of, three coats: an outer, middle, and inner coat. These three coats extend to the extreme terminations of the most mi- nute arteries, and there the outer and middle coats end, are left off, and the inner coat, and that alone, goes on a small fraction of an inch (about the tenth), continuing the ves- sels, without a break in their walls, into the commence- ment of the smallest veins. Then the outer and middle coats are again resumed and possessed by all the veins throughout their whole course back to the heart. The small fraction of an inch of the terminal arteries spoken of, which has but one coat, and that an exceed- ingly delicate one, constitutes what are called the capilla- ries, or capillary blood-vessels, and it is through the "fine, transparent, homogeneous membrane," constituting their 3 26 CONSUMPTION. walls, or, rather, through the walls of the thousands of these in every part, " that all the phenomena of nutrition and secretion are performed." These capillary vessels are also the parts in which all the initiatory steps are taken, for the growth and develop- ment of all tubercles; therefore they are so indissolubly connected with our subject that it becomes very necessary to fully understand them and their functions, hence a more complete description of them is quoted from Wilson's Anatomy. He says: "The arteries do not terminate directly in veins; but in an intermediate system of vessels, which, from their mi- nute size (about saVo of an inch in diameter), are termed capillaries, (capillus, a hair). The capillaries constitute a microscopic net-work, which is distributed through every part of the body, so as to render it impossible to introduce the smallest needle point beneath the skin, without wound- ing several of these fine vessels. It is through the medium of the capillaries, that all the phenomena of nutrition and secretion are performed. They are remarkable for their uniformity of diameter and for the constant divisions and communications that take place between them, without any alteration of size. They inosculate on the one hand with the terminal ramusculi of the arteries; and on the other with the minute radicles of the veins." Of the internal coat of the arteries, which constitutes the only coat of the capillaries, he says: " The internal coat is a thin serous membrane, which lines the interior of the artery, and gives it the smooth pol- ish which that surface presents. It is continuous with the lining membrane of the heart, and through the medium of the capillaries with that of the venous system." Gray, in his Anatomy, says of this one coat of the capil- laries: " The walls of the capillaries consist of a fine, transpar- ent, homogeneous membrane." CIRCULATION OF THE BLOOD. 27 We will now return to a further consideration of the blood, or to some important points in its circulation through this vast system of vessels, but more especially through the capillaries. It will be seen by the figures to be given in the next chapter of the size of the blood corpuscles, and the size of the capillary vessels as given by Wilson, that the two cor- respond very closely in their diameters, that of the latter being a little less than the larger corpuscles; while it might be added that Virchow says there are many capillaries in every part so small that no corpuscles ever enter them ex- cept when a part is congested. The blood corpuscles are simply floated in the serum, propelled by the strength of its current, and it is the force of the heart's action, as is fully understood, that drives the whole out and on through the minute divisions of the arte- ries, to and through the capillaries. And all the corpuscles, without exception, must, and do, pass through the capilla- ries, in a ceaseless round, in health, during the entire life- time of each; and, they being of about the same diameter of these minute vessels, have to pass through them gener- ally in single file. Indeed, many of the larger corpuscles are seen to roll up partially upon themselves, at their edges, as their disc shape permits of their doing, to enable them to pass through the smaller capillaries. And being semi-solid organized bodies, they never, in health, or while the vessels remain unbroken, do, or can, leave the latter, or escape into the tissues outside, but are kept in continual motion out and back from the lungs and heart, through the vessels in every part of the system. It is entirely different, however, with the serum, or watery part of the blood. The "transparent, homogeneous" walls of the capillaries, though "it is not possible to descry any porosity" in them, are nevertheless exceedingly porous to the water of the blood, and everything it holds in solution in it, as albumen, fibrin, salts, fatty matters, etc., and pass 28 CONSUMPTION. all readily and freely through them to the parts outside, to be there held in the small insterstitial spaces of all parts, and used in nourishing all tissues and repairing the waste that is constantly taking place in them. All the nutrition, for all kinds of tissues, is held in the serum of the blood, as already shown, and carried to them by the arteries, then through the walls of the capillary blood-vessels, as described, never a particle of it passing through the walls of any, even the smallest arteries, before reaching the capillaries, or through the coats of the finest veins. Even the walls of both arteries and veins have to be nourished by means of, and through the single coat of the capillaries that are profusely distribute i everywhere throughout said walls to afford them their nutrition. Arte- ries or veins appear not to have the power to take any nourishment for any portion of their structure from the current of blood that is passing through them. The abso- lutely essential thing in the nutrition of all parts appears therefore to be, that the nutriment must first be strained, so to speak, through the walls of capillary blood-vessels. And here, within these walls, as we shall see, is the growth of tubercles begun and maintained, no matter to what size they may grow. Hence the direct connection of the capil- laries with our subject, and the great importance of thor- oughly understanding all that is known about them. The walls of the capillaries are so exceedingly delicate and elastic that they are among the most distensible, or dilatable, of all the minute passages in the animal organ- ism. Under congestion from any cause, these walls are at once, or readily, distended into protuberant sacs, until the congestion is dispersed or ends in suppuration; all of which, as we shall see, has the most intimate bearing upon and relations with tubercles and their development. CONSTITUENTS OF THE BLOOD. 29 CHAPTER Y. NATURE AND USES OF THE CONSTITUENTS OF THE BLOOD. Having now passed in review the most essential points in the composition of human blood, and its capillary cir- culation, we will next consider the nature and uses of its several constituents, taking them in the order they stand in the table, and beginning with ALBUMEN. This is the most nutritious, and in other respects one of the most highly important, of all the constituents of the blood. It is, indeed, the one element upon which the whole muscular system almost solely depends for its nutri- tion. There is nothing else in the blood that can be used to repair and replace the muscular cells proper, as they are being worn out by use, and keep up their strength and ac- tivity. Carpenter, page 112, says: " The great mass of those tissues of the body which be- long to the cellular type is generated at the expense of albuminous matter." And on page 56, he also says: " It has been recently affirmed by Prof. Liebig, that the characteristic solid constituent of muscle, which has been usually known under the designation of fibrin, is in reality essentially conformable in all its chemical relations with coagulated albumen; and is at any rate much more nearly allied to it, than it is to the fibrin of the blood." 30 CONSUMPTION. The white of eggs is the purest form of albumen known in nature. That of the blood ranks next in purity, when it is separated from the other constituents; but as it circu- lates in the blood-vessels, it is dissolved and held in solu- tion in nearly six times its quantity of water, besides being intimately mixed and commingled with the salts, fibrin, blood corpuscles, and fatty and extractive matters. In one thousand parts of blood there are, as the table shows, seventy parts of albumen, while there are only six parts of salts, two parts and a fraction of fibrin, and one part and a fraction of fatty matters; and these with albu- men are all the nidritious elements there are in the blood. All three of the last named constituents combined furnish less than ten parts in the one thousand of blood, or less than one to the hundred, for nutritious purposes; so that albumen is and must be the sole element depended upon to primarily build up, keep in continual repair and maintain the strength and activity of the muscular system. It will therefore be seen what its continued daily loss, in any con- siderable quantity, must mean. WATER. Of the nature of the water of the blood, aside from any possible life-sustaining properties it may have received from having been under the influence of a vital force, it is unnecessary to say more than that it can be little, if any, different, when the other constituents are wholly separated from it, than chemically pure water found elsewhere. Its principal uses may also be summed up in a few words. It serves the purposes of a solvent for the other constitu- ents of the blood, excepting the corpuscles; supplies the proper amount of fluid to the tissues to keep them in a pliable, yielding and active state; and it floats the cor- puscles, carrying them through every blood-vessel, small as well as large, of the entire body; but it is not, in any proper sense, nutritious, that is, it is not used to make solid tissues. CONSTITUENTS OF THE BLOOD. 31 BLOOD CORPUSCLES. The blood corpuscles are minute, semi-solid, organized bodies, shut sacs or cells, each complete in itself and dis- connected from and independent of all the others as they circulate, flattened upon their opposite sides into more or less of the disc shape, of the Ww to the Ww of an inch in diameter, and about the tstbo- of an inch in thickness, each one of them being closely invested with a very delicate membrane, which constitutes its cell-wall, and in which is enclosed a gelatinous, granular substance called globulin. The principal, if not the only function of the corpuscles is to carry oxygen from the air which they meet in the lungs, to all parts and tissues of the body, and carbonic acid gas from all organs and parts back to the lungs, to be exhaled. But in and of themselves they furnish no nutri- ment to any class of tissues, any more than does the water. The duration of the life of each corpuscle, as nearly as can be determined, is about six weeks. In a healthy and unbroken state of the blood-vessels, never any of the cor- puscles leave the vessels, but keep up their ceaseless rounds, out through the system and back to the lungs, as shown, until each in turn completes its term of life, then dies, is broken down, dissolved in the serum and excreted into the bowels, to be carried off from there as worn out, useless or refuse matter; while new corpuscles are being constantly made by or in the lacteal vessels and lacteal glands, and passed on from these into the circulation through the thoracic duct and left subclavian vein, to take the place of those that are as constantly going to decay and dying of old age. The corpuscles are, as is so well known, red in color. In- deed, all the coloring matter of the blood, technically called hcemaiin, is, in health, confined within the corpuscles, leaving the serum colorless and transparent, when they are separated from it. There is one ivhite blood corpuscle to about every three 32 CONSUMPTION. hundred red blood corpuscles, in health, but in various diseases, and especially in consumption, the white corpus- cles are greatly increased, and the red ones decreased, for reasons to be given in the proper place. The white cor- puscles are not disc-shaped, like the red, but globular in form, and a trifle larger than the red ones. In every cubic inch of blood there are, upon what would appear to be as fair a calculation as can be made 63,488,- 000,000 blood corpuscles. These figures are obtained by squaring their average diameters, or 3,200ths of an inch, multiplying the product by their thickness, and dividing the final result by two, so as to give half the contents of the cubic inch of blood as corpuscles and half as serum, or about the proportions in which they naturally exist. By this the almost inconceivable number of corpuscles in a single cubic inch of blood will be seen. Then, when we remember that there are eighteen to twenty-four or more pounds of blood, or from nine to twelve quarts, according to size of person, in a healthy human system, the aggre- gate number of corpuscles that each person has in his blood reaches farther into infinity of numbers than many will care to go. FIBRIN. The fibrin of the blood is the food of the fibrous tissues, included in which are all the serous membranes; that is, the pleura, pericardium, peritoneum, membranes of the brain, etc., and the serous membranes covering the ends of the bones in all the joints. All connective tissues, the cords and tendons, and the like, receive their nutrition also from fibrin. The two parts and a fraction of fibrin, in one thousand parts of blood, afford the principal nutrition to all the extended membranes named, the connective tis- sues, cords, tendons, and whatever other fibrous tissues, properly so-called, there are in the system. Why so little fibrin furnishes food to such numerous tissues is explained in the fact already given, that all changes in them take CONSTITUENTS OF THE BLOOD. 33 place so very slowly that very little is required daily to keep up their activity. FATTY MATTERS. The fatty matters supply the material for the fatty tis- sues, and fatty deposits in the system, and all other natural demands of life for oily substances, as fuel for combustion to keep up the warmth of the body, lubricating material for various parts, etc., etc. SALTS. The salts furnish the principal nutriment for the bones, and a little saline matter to all other tissues, while both these and the fatty matters are drawn upon for the nutri- tion of the brain and nervous system. EXTRACTIVE MATTERS. The extractive matters, of which there are only five parts and a fraction in one thousand of blood, are regarded as mostly, if not wholly, effete matter, refuse, and therefore, of course,' not nutritious. Therefore, setting aside water, blood corpuscles and ex- tractive matters, as non-nutritious, we have, as before stated, less than ten parts to the one thousand of blood, or one to the hundred, all told, of nutritious material, besides albumen, to build up and keep in continual repair the entire animal organism, thus showing that the sole dependence of the muscular system for food is, and must be, upon the seventy parts of albumen in one thousand parts of blood. If such, then, is the importance of this constituent to animal life, can thinking men, whether in or out of the profession, contemplate such a profuse waste of it as will be shown to be sustained in consumption, without concern; even if, at first, they may not be able to see that it is the sole cause of all that is here claimed? It would certainly seem that men who do think, ought to consider and to con- sider deeply, in the interests of human health, such loss of one of the best elements of the blood, and the consequences to which it may lead. 34 CONSUMPTION. CHAPTER VI. THE MUCOUS MEMBRANES. The mucous membranes constitute the inner wall, or lin- ing, of all the internal cavities, which open upon the sur- face of the body; and all of them, without exception, waste albumen from the blood, not alone when disturbed by dis- ease, but, also, when irritated by harsh medicines, or even by simple mechanical means, as we shall see. These membranes extend into the deepest recesses, and through the most minute ramifications and subdivisions of those cavities, everywhere forming a perfect and continu- ous covering to protect the deeper tissues that lie beneath them, the same as the skin covers the exterior of the body, and protects the tissues that lie immediately under- neath it. They are analogous to the skin, and continuous with it, the one running into, and, as it were, becoming the other, at the apertures of all the natural outlets from the system. Wilson says: "Mucous membrane is analogous to the cutaneous covering of the exterior of the body, and resem- bles that tissue very closely in its structure." And in speaking of the skin he says: "It is continuous at the apertures of the internal cavities with the lining mem- brane of those cavities, the internal skin, or mucous mem- brane." It is the same with all the great and small divisions of the cavities named; this internal skin, or mucous mem- brane, lines and covers them in every part. It extends through the nostrils down into the lungs, on through the THE MUCOUS MEMBRANES. 35 most minute bronchial tubes, and out into the air-cells, com- pletely lining all their inner walls everywhere; from the mouth it spreads down through every part of the aliment- ary canal, and out from the latter through the great gall duct, on and up into the most minute ramifications of the bile ducts throughout all parts of the liver; and it covers equally well every part of the genito-urinary cavities, even to the urinary tubes in the kidneys, which, like the smallest bronchial tubes and bile ducts, are much too small to be seen with the unassisted eye. That this membrane is exceedingly delicate in the small- est bronchial tubes, air-cells, minute ducts of the liver, and urinary tubes of the kidneys, is true, but it is there never- theless, covering perfectly every part, and exercising the same protective care over the tissues beneath, preventing the delicate filaments of nerves, and the vast net-work of capillary blood-vessels, which are found in the greatest pro- fusion immediately in contact with its under surface, in those parts, from being in the least irritated or disturbed by the excretions or whatever else may naturally pass over its surface, just as effectually as does the thickest mucous membrane or the densest portion of the skin protect the delicate tissues that lie immediately beneath them. There is another highly important, indeed, most indis- pensable, function exercised by the mucous membranes. The tissues beneath them are, of course, divided into the finest of fibers, which intertwine with and cross each other at every conceivable angle, leaving everywhere between them small, in fact, very minute interstitial spaces, lymph spaces as they are called, which extend continuously but tortuously down into, and through, all the deeper tissues. And these spaces are kept constantly filled with nutritious material—the food for those tissues, in a fluid or semi-fluid state—a large portion of which is albumen; this being con- stantly poured out into those spaces from the blood, through the walls of the capillary blood-vessels, and held there for 3fi CONSUMPTION. the repair of all the cell structures of the various ports, as fast as they are worn out by the activity of the tissues. The important function just alluded to as exercised by the mucous membranes, is this: that they, in a healthy state, form an impervious covering like the skin, to the in- terstitial or lymph spaces spoken of, between the fibers of the tissues beneath them; in other words, cap them over, and prevent the flow and waste of the fluid, albuminous, nutritious material, held therein, to repair the tissues, as described. The skin subserves exactly the same purpose, for the surface of the body, that the mucous membranes do in the internal cavities named. Life could not be main- tained an hour but for this provision of nature. If a large portion of the skin be removed, as in extensive burns and scalds, or of the mucous membrane abraded, as in disease, the albuminous, nutritious fluid in question flows out from the interstitial spaces, thus uncapped, in great quantity, and is entirely lost to nutrition; the conse- quences being as great, yes, often much greater, than the loss of an equal quantity of blood. The entire removal of the mucous membrane from any one of the great tracts of it, namely, from the air-passages, alimentary canal, or urinary organs—even if this could be done without pain and without wounding any of the blood- vessels, so there would be no loss of blood—would cause death almost immediately, or, at the longest, in a few hours, simply from the waste of so large a quantity of albumen as would rapidly pour out at every point through the inter- stices of the tissues thus stripped of their natural covering, and its discharge and loss from the system. It is the abrasion of a portion, and often of but a small portion at a time, of the mucous membrane of one or both kidneys, that kills in Bright's disease; and just in that way, namely, by uncapping the interstices between the fibers of the various tissues composing the kidneys, which thereby allows the albumen to flow out, and be washed away in the THE MUCOUS MEMBRANES. 37 urine; more particular attention to which will be given after a few other points are settled. The removal of a tract of skin equal in amount to either of the great mucous tracts, or even much less than that of some of these, from the waste of albumen, would kill in the same way, and just as quickly. Indeed, in extensive burns and scalds of the surface, where they are not deep, and the patient endures the first shock well, and survives it, death frequently occurs from the exhaustion consequent upon such profuse discharges as are sustained through the scalded surface, much of which is albumen. It is simply a question of the great loss of a most vital fluid, just as much as is the opening of a large blood-vessel and the bleeding of one to death. The prevention of the outflowing of the fluid under con- sideration by the mucous membranes, in their healthy or natural state, appears to depend principally, if not wholly, upon the delicate superficial layer of those membranes, which covering corresponds exactly to the scarf skin of the surface of the body, except that it is everywhere more delicate than the latter; almost infinitely more so in the smallest bronchial tubes, air cells, tubes of the kidneys, etc. And here another comparison of injuries done to the mucous membranes, with the effect of disturbing the outer integuments of the body, presents itself. If a blister is raised upon the skin, no matter by what process, whether with common mustard, the Spanish fly, simple friction, scalds or burns, it fills, as is so well known, with an almost transparent, slightly yellowish fluid. This fluid is the serum of the blood, the only material upon which all the soft tissues beneath the skin depend for their nourishment, and contains albumen in nearly the proportion that it is found in the blood; that is, there are 60 parts of it to the 1000 of the fluid of the blister, while in the blood the albu- men is 70 parts to the 1000. And such blistering need only affect the scarf skin ; in other words, it only re- 38 CONSUMPTION. quires to raise that from its basement membrane or next layer of the skin beneath it, to have the blister fill imme- diately with this fluid containing the albumen in the pro- portion named. This scarf skin, technically called the epidermis on the surface of the body, and epithelium wher- ever found internally, is constituted solely of enormous numbers of exceedingly fine, delicate scales, like the scales of a fish, except that they are infinitely smaller, overlapping each other in every direction, several layers in thickness, covering all the mucous membranes even to the most deli- cate of them, as effectually as it does the skin; and it is to this coating that the retention of the serum of the blood, in its proper place, after it passes through the walls of the capillaries into the tissues, is mostly, if not entirely due. Wherever it is raised or abraded from its basement mem- brane, whether externally or internally, there is no possi- bility of avoiding a loss of that fluid and all the albumen the amount so wasted contains, because of the uncovering of the vast numbers of the little openings or spaces be- tween the fibers of the various tissues. As these spaces are kept constantly filled with the fluid in question, it must flow out when their cappings are removed, and will continue to flow until the abrasion is healed. And as there is noth- ing else that occupies those interstitial spaces but this albuminous fluid, or serum of the blood, it is an unavoid- able and self-evident fact that there can be no discharge or secretion through and from a mucous membrane, or from the skin, in consequence of irritations and abrasions of either of these surfaces, without its containing albumen. Such explicitness, by recapitulations, is given on all these points, because so much that follows rests directly upon them for a foundation. It should also be further explained, in this connection, that in raising a blister upon the skin, the fluid that fills it is almost always much more watery than is the secretion from a mucous membrane, when its epithelium is irritated THE MUCOUS MEMBRANES. 39 or removed. Hence, in the latter case, much more albu- men, that is, a much larger proportion of it to the whole discharge, is wasted, than is the case in an ordinary blister upon the skin. Therefore, let it be hereafter remembered that an exten- sive and protracted abrasion of the skin or mucous mem- brane more or less rapidly wastes, according to the extent of the abraded surface, the most highly nutritious and necessary constituent of the blood, and is certain death to every victim to it unless the injured part is healed and that waste stopped. Vigorous health cannot be maintained a day with an abraded mucous membrane; they are utterly incompatible conditions, and, unless the defect is remedied, premature death is inevitable. h' CONSUMPTION. CHAPTER VII. THE SOURCE OF ALBUMEN. The only source of the albumen of our systems, whether found in the blood, in the interstices of our tissues, being wasted by diseased mucous membranes, or constituting the tissues themselves, is in the food that we eat. There is, of course, no other possible origin for it. The white of an egg is, as before stated, the purest and most concentrated form of albumen known, and nothing is food for man that does not contain it, either pure or in considerable proportions, mingled with, or incorporated in, other wholsome ingredients. The digestive organs appear not to have the power to produce it out of other materials. They simply abstract it from the food eaten, and pass it into the blood-vessels, in the proper relative proportion to the other constituents of the blood; and never, in health, introduce more of it into the circulation than the ratio required, even though we should feed exclusively upon pure albumen. Carpenter says: "There is no reason whatever to believe, that albuminous compounds can be generated within the animal body by the transformation of substances belong- ing to an entirely different type." And the converse of all this is true, namely: if we ate only of pure albumen, the white of eggs, it is, in health, thoroughly digested, and only the exact relative proportion of it, to the other constituents, is permitted to go into the blood; if it did, a surfeit and clogging, and therefore dis- ease, would result. THE SOURCE OF ALBUMEN. 41 Again, all the constituents, for the healthy nutrition of every tissue of the animal body, may be drawn from pure albumen, as we see is the case with the chick in its shell. Its only sustenance, until it escapes from its embryonic prison, is albumen, and yet it comes out a perfectly developed creature, its brain and nervous system, its eyes and sight, ears and hearing, lungs, its digestive and other organs, all fully developed and in the highest state of activity for all immediate needs and purposes, while muscles, bones, feathers, beak, etc., are fully nourished, in perfect order and ready for use. This is what albumen, as food, and its due proportion in the blood means; and this shows its vast importance to us in retaining life, health and activity. It is equally true that every tissue of the human body would be fully and properly nourished on an exclusive diet of albumen; though, as just stated, no more of it would, or probably could be introduced into the blood in health, than just what would be requisite in conjunction with the other con- stituents, to keep everything evenly balanced and moving harmoniously ; while the material for all the other con- stituents would be drawn, as is the case with the chick, from that portion of the albumen taken as food, which is not passed into the blood as such, but is first fully digested and changed in its character as required. The stomach and other digestive organs even in the most vigorous constitutions, might, and no doubt would, in a not very long time, become surfeited on an exclusively albuminous food, as they do when restricted too closely to one or two articles of diet, for too long a time; but health would be maintained, and life sustained much longer on pure albumen than they could be upon any other one arti- cle of food. And every organ and tissue would receive its due proportion, and the exact kind of nutriment needed for the performance of all its work, so long as the digestive organs retained their power to fully digest it. 4 42 CONSUMPTION. Whenever the requisite amount of albumen for the uses of the system is selected from whatever kinds of food we may eat, and properly prepared by the digestive organs—if it needs other preparation than its mere selection—it is passed into the general circulation together with the proper quantity of water, salts, fatty matters, etc., held in solu- tion in the water of the serum, as described, and is thus sent out through the arteries to the capillaries in every part of the system. And when it reaches the latter vessels it exudes, water and all, through their single delicate coat, as already explained, into the interstitial spaces between the capillaries, and is there held for the nutrition of every grade of tissues demanding it—for the constant reproduc- tion of the cells composing those tissues, as fast as they are worn out, die, are absorbed, and required to be replaced. It is the same with the albumen carried to the mucous membranes. Health requires it absolutely to be held in the interstices of the membranes, and for exclusively nutri- tious purposes. If it is wasted through irritation or abra- sion thereof, all their tissues are robbed of so much of their necessary food, their functions are deranged, and activity impaired; but these are by no means the worst results from such waste, as we shall have ample proof. When albumen is secreted and therefore wasted by a dis- eased mucous membrane, the supply of it in the blood is drawn upon to take the place in and among the tissues, of that which is wasted, as the tissue must have it for constant use, but a portion of this is in turn wasted; and so the drain goes on, constantly drawing upon and reducing its quantity in the general circulation, and leaving a constantly accumulating excess of the other constituents in the blood- vessels, such excess irritating, congesting or otherwise dis- turbing many, or all, organs and parts of the system, day after day, and month after month in chronic cases, until the irritated membrane is healed, or death, through more or less protracted, diversified and terrible sufferings, closes THE SOURCE OF ALBUMEN. 43 the scene. And this is what the waste of albumen, through irritated or abraded mucous membranes, means. To sum up, then, what can not be exaggerated or given too great a prominence in the well-being of mankind by any amount of recapitulation, it is repeated that, the only source of the albumen wasted or lost to nutrition and the whole system, by diseased mucous membranes, is that portion of it which should be held in them to repair or renew their worn out tissues, and keep all their functions in a healthy and vigorous activity; the only source of the albumen which should be retained in those membranes, is the supply of it in the blood; and the only source of that in our blood, is in the food that we eat; which being prepared for the various uses of the system, by a most complicated digestive pro- cess, and, therefore, through great labor and expenditure of force, the fruits of such labor, either as to the constituents themselves that result from it, or that proportion among them which must be maintained to ensure health, can not be destroyed without greatly deranging, if not directly- abstracting just that amount of force from the other invol- untary, or from the voluntary forces of the system, or from both, in addition to all the other evils done. In short,, the consequences of such drainage of one of the best ele- ments of the blood, must act and react upon one another and the system, in many ways, to impair and finally destroy all its vital activities. 44 CONSUMPTION. CHAPTER VIII. THE BOUNTIFUL SUPPLY OF ALBUMEN TO THE MUCOUS MEMBRANES. We are now brought to consider the bountiful supply of albumen furnished to the mucous membranes. There is a greater profusion of capillary blood-vessels distributed in, or just beneath, all mucous membranes, and especially in the lungs, than in any other tissues of the whole animal body, excepting the glands, and one of the coats of the eye; and they are fully as profuse in the former as in these latter named parts. Gray's Anatomy says: "The number of the capillaries and the size of the meshes, determine the degree of vas- cularity of a part. The closest network and the smallest interspaces are found in the lungs and in the choroid coat of the eye. In the liver and lung, the interspaces are smaller than the capillary vessels themselves. * * * As a general rule, the more active the function of an organ is, the closer is its capillary net, and the larger its supply of blood; the network being very narrow in all growing parts, in the glands, and in the mucous membranes." Hence, it will be seen that, by the great vascularity of the mucous membranes, and the profusion of blood that must flow to them in consequence, albumen must be carried and exuded through the walls of their capillaries into the interstices of the tissues that compose them, as freely as to any, even to the most vascular of all the organs, and much more freely than it is to most parts of the body. The much greater activity of the mucous membranes, than THE SUPPLY OF ALBUMEN. 45 of most other parts, both in regard to the nutrition carried on by their several tissues as well as immediately beneath them, and the highly important, yes, absolutely indis- pensable, functions they perform, necessarily demand the bountiful supply of albumen shown; and proves still fur- ther the serious consequences that must follow its waste, in crippling and deranging those functions, to say nothing of all else that is claimed. It is, therefore, to the three points, namely, the composition of the blood, its circulation, espe- cially through the capillaries, and to the general work of nutrition, that we must constantly refer to prove and estab- lish all that is asserted. It will thus be seen that our subject is based solely upon the best known facts of both anatomy and physiology, and the fairest and plainest deductions from those facts. And it is believed that the most rigid, but just scrutiny of all the points to be presented, in proof of the claim, will only the more firmly establish the fact of the loss of albumen from the blood, through diseased mucous membranes, as being the true cause, not alone of that terrible scourge here especially under consideration, but of many of the other worst forms of both acute and chronic diseases; that the whole is founded upon the strictest of scientific princi- ples, and fully as well, if not better proved than almost any other equally complicated subject throughout the whole realm of scientific research. There is a vast amount of proof in the aggregate, however, bearing upon the various points, that must be here excluded as it cannot be given within the limits assigned for this treatise; but what is deemed most essential will be presented. 4»i CONSUMPTION. CHAPTER IX. PROOF OF THE WASTE OF ALBUMEN BY THE MUCOUS MEMBRANES. All the mucous membranes, whether of the largest or smallest cavities, the most minute tubes of the lungs or kidneys, the air-cells of the lungs, etc., without exception, waste albumen from the blood when disturbed by actual disease, or by catarrhal or local congestions affecting them, when irritated by harsh medicines, or, indeed, by the sim- plest mechanical means. All kinds of irritation thereof alike produce this one result, whatever else may follow. Even in a perfectly healthy state, the mucous membranes secrete a very small amount of albumen. They are kept constantly moistened and in a pliable condition, by a secre- tion of mucus upon their free surfaces, which contains albumen, or is an albuminous compound. Carpenter says of mucus: Its "chief organic constituent is a substance termed mucin, to which the characteristic properties of the secretion are due. This appears to be an albuminous compound, altered by the action of an alkali; for, as Dr. Babington has shown, any albuminous fluid may be made to present the peculiar viscidity of mucus by treating it with liquor potassa?." But the quantity of it secreted in health is so slight—it being very difficult to obtain a sufficient quantity even to make a chemical test—that little or no actual waste is thereby sustained. At least nature, with all her proverbial economy and accuracy, must have made provision for what is used in that way. THE WASTE OF ALBUMEN. 47 Whenever the mucous membranes, on the contrary, are irritated by disease, by colds or by much milder means, the amount of mucus secreted becomes greatly increased, and contains more albumen, which is a direct loss or waste, as we have seen, of one of the most highly nutritious ele- ments of the whole animal organism; it is, in consequence, a cause of great debility, and, if lost in any considerable quantity, through prolonged periods of time, is the source of the most serious chronic diseased conditions that afflict humanity; and when discharged in great quantity and rapidly, of the most violent acute diseases. In speaking of the healthy and diseased secretions of mucous membranes, Professor C. G. Lehmann, in his most valuable of all works upon Physiological Chemistry, Vol. I, page 307, says: "In the normal condition no albumen seems to pass 'into the secretions, as for instance the saliva, gastric juice, bile, mucus, etc., for although they do, indeed, exhibit traces of protein compounds, these latter differ from ordinary albumen. * * * This substance may, how- ever, occur in any of these fluids in morbid conditions of the secreting organ; and Julius Vogel has especially shown that the mucous membranes may secrete albumen in addi- tion to the ordinary mucous corpuscles when abnormally excited." Again, on page 84, Vol. II, same work, under the head of Mucus, and after pointing out many obstacles in the way of obtaining a correct analysis of this secretion, he says: "But even if the chemist should succeed in overcoming all these difficulties, his labors would be of no avail, in consequence of the impossibility of obtaining the fluid in a normal condition; for this juice is secreted in such small quantities on all the mucous membranes, as long as they continue in a normal state, that only the merest traces of it can be obtained. We also know how easily the mucous membranes may become diseased, and how much the mucus 4S CONSUMPTION. differs in these cases from the normal secretion. Daily experience shows how rapidly the number of the so-called mucous corpuscles increases with the slightest irritation of the mucous membrane; and we know from the researches of Julius Vogel, that an irritated mucous membrane secretes not only such corpuscles, but also an albuminous, coagulable matter, however much it may be disposed to form true transudations and exudations." And again, on page 88, Vol. II, Lehmann further says: " We have already referred to the observation of Julius Vogel, which admits so readily of confirmation, that the mucus secreted in catarrhal irritation of the mucous mem- brane, exhibits a varying quantity of albumen." This is deemed sufficient proof of the general fact, that in catarrhal disease of any and all the mucous membranes, there is a secretion by them of albumen. We will now proceed to the proof of its loss through spe- cial organs. Of these the lungs will be taken first, as they rank first in our investigations. The following proof that great quantities of albumen must be discharged from the lungs by consumptives, is found in Copland's Medical Dictionary. This author, under the article in his work entitled Expectoration, on page 982, Vol. I, says: "This word [expectoration], which signifies the act of discharging any substance from the chest, is now usually applied to the matter so discharged. The secretion which moistens the surface of the bronchi is a colorless and some- what viscid fluid, consisting chiefly of the serum of the blood, and a modified, peculiar, or slightly glutinous form of albumen. It is so scanty in health as to be seldom or very rarely excreted; but in disease, its quantity varies very much, it being commonly—occasionally remarkably— increased, excepting at the outset of some inflammatory or exanthematous complaints, when it is diminished, and then only for a short time. Its quality, or appearance, is also THE WASTE OF ALBUMEN. 49 extremely different, in different maladies, and even in different stages of the same malady, seated in, or implicat- ing the respiratory or circulating organs; particularly as regards the quantity and condition of the animal matter or albumen which it contains." Again, on page 983, same volume, this author further says: " The form of the sputum [expectoration] is important, and is chiefly owing to the manner in which the morbid secretion is excreted, and to the quantity and modi- fication of the albumen existing in it. When it is frothy, it may be inferred to have been expectorated with difficulty and with severe cough; it is then generally fluid, glairy, transparent, contains albumen and runs into one mass in the containing vessel, to the sides of which it adheres slightly, as in catarrh, the early stages of bron- chitis, etc. When it is viscid, opaque, somewhat frothy and thick, it is usually brought up with much cough, con- tains much more albumen, adheres closely to that previ- ously expectorated and to the sides of the vessel." From this accurate description of the expectoration, who can fail to see that patients in consumption must daily throw off large quantities of albumen during the active stages of their disease? All must know that in the early stages of phthisis, the expectoration is generally more or less frothy, fluid, glairy and transparent; while, as the dis- ease advances, it often, if not always, becomes viscid, opaque and thick, and "adheres closely to that previously expectorated, and to the sides of the vessel," and, of course, "contains much more albumen." There is another fact which must not be overlooked in this connection, namely, that the abnormal discharges of albumen from the system in phthisis, commence with the very first catarrhal discharge from the mucous membrane of the nostrils or other organs, or parts of the system lined with this membrane, which show catarrhal secretions; such discharges generally precede, and always usher in 50 CONSUMPTION. consumption of the lungs, so that we have the loss of albu- men going on, often long, and invariably some time before any tuberculous action is manifest; therefore, the proper relation of cause to effect, in point of time or occurrence, is maintained. All authorities upon the subject speak of an unusual sensitiveness of the mucous membranes of con- sumptives, to disease, or of a catarrhal irritability of these surfaces showing itself long before the proper tuberculous action sets in; and from the quotations which we have given from Lehmann, we see that the mucous or catarrhal secretions in all of these cases, must, without exception, contain albumen; that this must necessarily be a waste of this important constituent from the blood, we shall see further on. Furthermore, we see how usually consumption follows and is apparently developed, or, at least has its origin in protracted irritation of organs which are possessed of a mucous membrane, other than the lungs. Large numbers of dyspeptics, for instance, die of consumption of the lungs, while it not uncommonly follows chronic disease of the bowels, or intestines, as chronic diarrhoea, chronic dys- entery and the like; so it also frequently succeeds acute attacks of these organs, as a result of the exhausting action set up thereby, and it is well known to every accurate observer, how liable consumption is to follow female dis- eases, or be developed by them. In all these instances we find that the waste of albumen is begun by other organs, and that with many it is suffi- ciently profuse and debilitating to exhaust the vitality to such an extent as to eventually permit of the whole disease being transferred to, or concentrated upon, the lungs, there to finish its work. That these are not mere assertions, unsupported by proof, will be seen by the following from Lehmann, where in speaking of "Vomited Fluids," he says: "Albumen occurs only in very small quantities when the THE WASTE OF ALBUMEN. 51 fluid is acid, but in larger quantities when there is an alka- line reaction." Besides, we know from what this author says of the amount of albumen thrown out by all mucous membranes when under irritation, that dyspeptics, and those suffering from chronic catarrh of the stomach, no less than others, must suffer a great loss of albumen in the quantities of mucus they so frequently throw off from that organ. Of the waste, or excretion, of albumen by the intestines, Leh- man says, Vol. I, page 309: "At the commencement of dysentery, the intestinal dis- charges consist chiefly of epithelium, and of a fluid poor in albumen, and mixed with a little true fecal matter; when the process assumes a well-marked croupous character, the evacuations consist chiefly of a mixture of blood and puru- lent matter, in which we can detect fibrinous exudations, blood corpuscles, cylindrical epithelium and pus-corpuscles. When the disease runs a less severe course, clots of glossy mucus from the follicles of the colon predominate; * * * * the fluid is extremely rich in albumen, being a true exudation of the blood-plasma." Again he says: "It is in dysentery that it [albumen] is secreted in the largest quantity from the intestine; the dejections in this disease are often so rich in albumen, that, on the addition of nitric acid, or, on boiling after neutralization with ammo- nia, the whole fluid solidifies. Coagulable albumen is also very often found in the puffy or fluid evacuations which sometimes occur in Bright's disease. It is constantly pres- ent in tolerably large quantities in the fluid stools in typhus." As was said of the mucus vomited from the stomach, so must it be with all mucus discharges from the bowels; they waste the albumen of which they are almost wholly constituted, and this in addition to all that pours out in a nearly pure state, and is found by the ordinary tests. 52 CONSUMPTION. Before leaving this part of our subject, there is an- other point claiming our attention. Lehmann says, as has been seen, that "at the commencement of dysentery, the in- testinal discharges consist chiefly of epithelium"; while at another point he says: "EpitheVnd structures occur in the stools in all cases of diarrhoea; in typhus, cholera and dysen- tery, the diarrhoea causes a rapid desquamation of the epi- thelium, which for the most part hangs together in masses." Here, then, we have the proof of what has already been stated, namely, that the mucous membranes are often stripped of their epithelium by disease, the same as the outer integument of the body is of its scai'f-skin by scalds and burns, and it is after this is done, that albumen is most freely wasted. Such destruction, or stripping off of its epithelium by disease, is alike common to the mucous membrane of all organs possessing this lining. Of the secretions by the mucous membrane of the female genital organs, the following is deemed sufficient for our purposes here: Copland, in his Medical Dictionary, Vol. II, page 821, gives a table of one hundred and eleven cases of leucorrhcea, for the purpose of showing the "character" of the discharges, etc.; and of this number no less than eighty-four are distinctly mentioned as having albuminous discharges, while eleven cases had an "aqueous discharge," and sixteen an " opaque discharge streaked." If, in these twenty-seven cases, mucus formed any part of the dis- charges, we know by what has preceded that they also wasted albumen from the system. In regard to the discharge of albumen by the kidneys in albuminuria, or Bright's disease, the facts are too well known to require any special proof upon the subject; still, the following from Lehmann, Vol. I, page 308, may not be out of place at this point, in order to bring this branch of our subject (upon which so much rests), by comparison, directly before the mind of the reader. He says: "The occurrence of albumen in the urine may be coin- THE WASTE OF ALBUMEN. 53 cident with very different pathological conditions, although its presence was formerly made to constitute a special dis- ease. * * * * In many acute and chronic diseases, unconnected with affections of the kidneys, albumen not unfrequently appears for a short time in the urine, as, for instance, in inflammation of the thoracic organs, acute articu- lar rheumatism, intermittent fevers, typhus, measles, chol- era, insufficiency of the valves or contraction of the orifices of the heart, also in chronic affections of the liver, and in pulmonary and peritoneal tuberculosis, especially towards the fatal termination of these diseases. * * * * It is, however, in affections of the kidneys, whether acute or chronic, that albumen appears most constantly in the urine. Bright's disease is a term of very wide significance, but if we limit it as much as possible, and merely include under the term a degeneration of the tissue of the kidney, more especially of the cortical substance, whether of a fatty or other character, we may regard the presence of albumen in the urine as a constant symptom of this disease. But in transitory renal catarrh, such, for instance, as occurs in erysipelas nearly as frequently as after scarlatina, albumen, together with the well-known epithelial cylinders of Bel- lini's ducts, is found as constantly in the urine as in inflam- matory affections of the kidneys, where it is associated with the fibrinous plugs from the same ducts, as in true Bright's disease." And again he says, on the same page: "It is worthy of notice that a little albumen, together with mucus corpuscles, is found in uncomplicated severe catarrhs of the mucous membrane of the bladder." And further: "The observations already made in reference to the occurrence of albumen in the urine apply almost equally to its appearance in the solid excrements. Albumen is always found in the excrements in diarrhoea depending upon intestinal catarrh, and in diseases complicated with this affection; * * * * hence, we find that, not only in 54 CONSUMPTION. dysentery and cholera, in which so much stress has been laid on the discharge of albumen, but, also, sometimes in Bright's disease, albumen, together with entire patches of cylindrical epithelium, (in some cases the entire thimble- like coverings of the intestinal villi,) is discharged in masses by the rectum." To show that the discharge, or waste, of albumen from the system, in all the instances given, is abnormal and of very serious import, the following, from the same author, Vol. I, page 308, is quoted: " In the physiological or normal condition, no albumen is contained in the excretions, and its appearance indicates either disease of the excreting organ, or a complete altera- tion in the composition of the blood." It will have been seen that the abnormal discharge of albumen has been constantly spoken of as being lost from the blood. That this is the case, is beyond question, as may be seen from the following. Carpenter says, in his Physiology: "The quantity of albumen in the blood seems to vary less than that of most of its constituents. [This of course refers to its quantity in healthy blood.] The proportion which it bears to the water of the serum, is, of course, elevated by anything which diminishes the latter; and thus we find it high in cholera after profuse discharges of fluid from the in- testinal canal, and in other cases in which there has been an unusual drain upon the liquid part of the blood, provided that albumen does not pass off with if, as sometimes hap- pens. Where some special cause is in operation which favors the escape of the albumen from the circulating current (as happens in various forms of albuminuria, but especially in the advanced stage of Bright's disease) the amount of albumen in the serum is reduced below the normal stand- ard * # * According to Andral the diminution in the amount of albumen contained in the serum, is exactly pro- proportional to the quantity contained in the urine." THE WASTE OF ALBUMEN. 55 Watson, in speaking upon the same subject, under the head of Bright's disease, says: " Now, Dr. Christison has made out the very interesting fact, that there is a definite inverse ratio between the coagulability of the urine and the density of the serum. The more albumen there is in the former of these fluids, the less is there in the latter, and the lower is its specific gravity. So that the deficiencies of the one fluid balance the superfluities of the other." If the albumen discharged in the urine, in consequence of disease of the kidneys, in Bright's disease, is a loss or abstraction of just that amount of this important constitu- ent of the blood from the blood-vessels, of course, the abnormal secretion and discharge of albumen by the mucous membrane of all the other organs possessing this lining, must be a like waste from the blood. Indeed, this must be an absolutely fixed fact in nature, for there is no other possible source from which the albumen can be drawn, in any such case, but from the blood. But if proof of this should be deemed necessary, we have it in the following, in regard to Tuberculosis. Wood, in the article in his Practice, upon Tuberculosis, which he uses synonymously with scrofula, on page 114, Vol. I, says: "From the experiments of M. Dubois, of Amiens, it would appear that the blood in scrofulous cachexia has a smaller proportion of coagulable matter in relation to the serum, and that the serum itself is of less specific gravity than in health. * * The blood is, therefore, watery and impoverished, and incapable of supplying the nutritive function sufficiently." Now, when it is remembered that albumen is the only coagulable matter in the blood—fibrin being properly a fibrillating material, and, of course, not included in this remark of the author—we see that a " smaller proportion of coagulable matter" means a smaller proportion of albu- men. Besides, our author says the serum is of less spe- 56 CONSUMPTION. cific gravity than in health; but no diseased action of which we have any knowledge, will reduce the specific gravity of the serum below the healthy standard, excepting the loss of albumen. And, in addition, we know that the blood can not become "watery and impoverished " through diseased action, except by a loss of some portion of its albumen. The ingestion of too much watery food, or of too much fluids, stale vegetables and poor diet generally, would produce a similar result, without disease having had any agency, as a cause, in impoverishing the blood, but this would be only temporary, unless such matters were habitu- ally used in place of proper food. In such cases albumen is deficient in the blood because deficient in the food. But what can be the necessity for giving quotations from even the best authors, or presenting an argument to prove that it is albumen in the form of mucus which is secreted by irritated mucous membranes, or pure albumen that escapes through those membranes, when abraded of their epithe- lium; or what the need to prove that such waste is a loss of it from the blood? All that should be required is a statement of the bare fact that there is absolutely nothing but the serum of the blood, consisting of four hundred and three parts of water, to seventy parts of albumen, six parts of salts, two and two-tenths parts of fibrin, and one and three-tenths parts of fatty matters, that occupies the interstitial spaces described beneath the mucous membranes; consequently there is nothing else which can, by possibility, be secreted by, or pour through them, so long as the blood- vessels beneath remain broken, so that actual hemorrhage can not occur. And the discharges through an irritated, or even through an abraded mucous membrane, being almost always much thicker and more tenacious than the watery contents of a blister upon the skin, (which consists of the serum of the blood with all its constituents in about their natural proportion as above given,) it must be seen that such discharges can not be anything else but albumen, THE WASTE OF ALBUMEN. 57 with often, no doubt, a slight admixture of salts, fibrin and fatty matters. But the exceedingly small quantity of the last three, in comparison with albumen and water, make it certain that they can form but a very small fraction of such discharges, and these are so thick they can not contain but a small portion of water; so, I repeat, that the mucus secretions can be nothing but albumen. And that this is drawn from the blood and lost to it, is just as absolutely certain, as is the character of the dis- charge, there being nothing else in the blood that corres- ponds to it in the least particular but albumen, which does correspond in every respect; while, as we have also seen, there is no other possible source from which this can pri- marily be drawn, except from the blood-vessels. It is the same with the fluid that fills the blister upon the skin; there is no other source from which it can be drawn, except from the blood-vessels, but here it is so much of the serum of the blood with its full proportion of water that is secreted and not all albumen, as is so com- monly the fact with the secretion or waste by the mucous membranes; thus, in the latter case, making the waste of albumen much greater from the same amount of discharge, than in the case of scalds and burns. 5 58 CONSUMPTION. CHAPTER X. WHY THE MUCOUS MEMBRANES ARE SO PRONE TO DISEASE. If it should be asked why the mucous membranes are so prone to obstinate and protracted chronic disease, the answer would not seem to be difficult, for, First. Whatever else the consumptive may have inherited of actual disease, or a tendency to it, he inherits a char- acteristic weakness of the mucous membranes, or a great liability to catarrhal irritations arising therein upon slight provocations, as from moderate as well as from severe colds, and the like, the effects of which may continue through long periods of time, and in spite of many reme- dies. Secondly. When chronic skin diseases are treated locally, and thereby removed from the surface, no other result fol- lows, except that they are driven inwardly to locate upon the mucous membranes, where they go on into immediate chronic catarrhal disease; or if the vitality be strong, they are then forced into a more or less dormant condition, there to lie as a hidden enemy, to spring into activity as soon as from any cause the strength of his life forces are reduced so they can no longer hold this secret and powerful enemy in subjection. No fact in the whole range of disease is better known than that if the eruption of small-pox, scarlet fever, measles, etc., is suppressed, if not speedily restored to the skin, it kills the patient in every instance; and when such eruption is suppressed, it is always translated pri- marily to some one or more of the mucous membranes, and AFFECTIONS OF MUCOUS MEMBRANES. ~o9 from that surface carries on its work of death. Wood, in speaking of the "anatomical characters," observed in the autopsies of those dying of small-pox, says: "The only characteristic alterations are those upon the skin and mu- cous surfaces." And every observing physician knows the same to be true of the premonitory irritations, no less than of the resulting conditions of the mucous surfaces from measles or scarlet fever, in cases of death. The reason for this is that the mucous membranes correspond more closely in structure to the skin than to other tissues, and the dis- ease, when suppressed, seizes upon the nearest similar in- ternal surface. Thirdly. Notwithstanding the fact is universally known that death is inevitable under every suppression of the acute eruptive diseases named, unless very soon restored to the surface, physicians of other schools appear never to hesitate to suppress by external treatment every chronic- skin disease they are called upon to treat, apparently not. knowing the terrible wrong they are thereby inflicting upou their patients. Indeed, notwithstanding the overwhelming proof and warnings given by Hahnemann, of the frightful results of suppressing chronic skin eruptions, thereby pro- ducing in the various cases every form of internal chronic disease, from insanity and idiocy to consumption and can- cer, still the great majority of the physicians of our own school, of late years, seem to hesitate as little as do those of other schools in imitating the bad example. It is delib- erately preparing the ruin, through untold suffering, of hundreds and thousands of those who appeal to them for help in their troubles. Can any physician, who thinks for himself, suppose for an instant, that nature is so constituted as to allow the tak- ing of the life of every patient who is unfortunate enough to have an acute eruptive disease suppressed—this dis- ease being of only a few days' or weeks' duration— while she will permit the suppression, more or less sud- 60 CONSUMPTION. denly, without harm coming of it, of a chronic skin disease of years' duration? Consider a fair example. A great many children inherit the taint of scrofula or tuberculosis, from scrofulous or tuberculous parents; this taint fre- quently develops in such children during infancy, child- hood or youth, into some of the many forms of eczema, psori- asis, herpes, or some other equally obstinate chronic cutane- ous disease; and when it does come to the surface in any form of chronic skin eruption, can any one think that this taint, which extends into a preceding generation for its starting point—often, indeed, having its origin several generations previously—is cured and eradicated from the systems of such victims, by a few days or weeks of external applications, when a similar treatment which would sup- press any acute cutaneous eruption, would speedily take life? No, it is preposterous to suppose that the acute eruption will show such violent and fatal results when sup- pressed, and the chronic no such action whatever. But, says the critical reader, chronic cutaneous diseases are often speedily removed from the skin by external treat- ment and no harm comes of it for months, and often not for years. Very true of some such cases, while it is equally true that in some other like cases the results are nearly as speedy and terrible as when the eruption of small-pox, measles or scarlet fever, is suppressed. And why this dif- ference in the time of development of the disease inter- nally, in the two classes of eruptions when suppressed? We shall now see. Chronic cutaneous diseases are generally so much slower in all their actions that, when suppressed, they give time for the system to accommodate itself to their internal pres- ence and irritations, and the gradual changes wrought by them, hence cannot generally kill so quickly as do the acute skin eruptions when suppressed. But the time gained is often at the expense of greatly prolonged suffering, and in the one case as in the other, death at the end. Still" AFFECTIONS OF MUCOUS MEMBRANES. 61 there are numerous cases on record where the suppression of a chronic skin disease has taken life as quickly as does the translation internally of an acute eruption. In this connection does anybody believe that a part of these chronic cases can show such terrible consequences, and others go on through life and never show the least bad results? And this brings up another point for explanation. There are some cases where the patient possesses natur- ally a strong constitution, or a great tenacity of life, who may have a chronic skin disease suppressed, and not for years, if ever, show the slightest internal result therefrom. This, however, is not found as commonly as is supposed, when proper vigilance is exercised in the examination of such cases; but when it does occur, what is the explana- tion? Simply this: the strong vitality of such subjects forces the suppressed disease into a dormant state in their systems, so that it can show but little, if any, activity for years, and possibly not for a life-time. In some, too, the disease is forced into partial dormancy, and does not show bad results in a long time; but when it does become aroused by great exposures, excesses, advancing years, or what- ever exhausts the vitality so that it can no longer hold the disease dormant, then it locates upon some one of the mu- cous membranes, irritates and abrades that, wastes albu- men, and produces some of the consequences arising legiti- mately therefrom. 62 CONSUMPTION. CHAPTER XL THE CONSEQUENCES OF LOSING ALBUMEN. The first thing to consider under this head, is the waste of the large amount of the most nutritious element of the blood; and, secondly, the fact that such waste of one impor- tant constituent must necessarily throw the whole into a disproportion that was not intended, and against which there is and can be no remedy except to arrest the progress of the waste, and thus remove the cause of all that follows. If albumen, as has been shown, serves such highly impor- tant purposes in the system, its daily loss in any considera- ble amount, month after month, must lead to the most serious consequences, no matter from what organ it is dis- charged. But it is to Bright's disease of the kidneys, that we must turn for a clear understanding of this whole subject, and for the most indisputable proof of the fatal consequences that must always follow the continued and protracted waste of albumen from the system by diseased action. As is so well known to the profession, and to many intelligent lay- men, Bright's disease consists in the discharge of albumen from the kidneys; and the consequences of such waste, in the chronic form of the disease, are among the most terri- ble, and also among the most absolutely hopeless of any affection that occurs in the whole realm of disease. It almost invariably proves fatal to every victim. And we here repeat, that the hopelessness of cure, the almost uni- versally fatal results in this disease, are primarily due entirely to the waste of albumen as described, from the CONSEQUENCES OF LOSING ALBUMEN. 63 blood and tissues that need it, this being the sole original cause of all that follows. Can it, then, be reasonably supposed that if the waste of this constituent through the kidneys, be so invariably fatal, the same element can be lost from the blood in still greater quantity through those more vital organs, the lungs, and not be equally serious, equally fatal? It is absurd to think otherwise. It is worse than folly, it is criminal to hesitate a moment in deciding a question of such momentous conse- quences to mankind. It is a matter that admits of abso- lutely no question, when once fully and clearly understood. Why, even its profuse waste through that comparatively non-vital part, the skin, in extensive but superficial scalds, or burns, where the patient might recover but for such less, is a well known and well established fact. Of course there are, and necessarily must be, marked differences in many of the symptoms, and especially in the secondary conditions which arise, when albumen is lost through different organs. These differences must corres- pond, more or less, to the nature and functions of the organs through which albumen is lost; but in gravity of results there can not be marked exceptions for the same amount wasted through whatever organ or part. At least the exceptions, if any, are, that the less vital a part or organ, the less serious the results for the quantity lost, or, in other words, the longer the system might be able to withstand the drain, other things being equal, the more delayed would be the serious or necessarily fatal complica- tions; while the more vital the part or organ, the more certainly and speedily fatal the result. It is under this idea that when albumen is lost through the lungs and kid- neys, there is no such thing as life being preserved, unless THAT WASTE IS STOPPED. Turning now to special diseased conditions, or the results arising from the loss of albumen as their cause, we find that as it furnishes almost the sole nutrition for the muscular 64 CONSUMPTION. system, its continued daily loss in appreciable amount, must necessarily rob the muscles of a portion of their nourishment, and they must manifest the fact in a marked manner. And this is exactly what does transpire in a way not to be misunderstood, as will be seen by the following: Emaciation of the whole muscular system is one of the most reliable characteristics of consumption. It is, indeed, so characteristic that in the early stage of the disease, in many cases it affords a more certain diagnostic sign of the threatening of that affection, than any other indication. Sometimes, in fact, the physician would be unable to deter- mine the true nature of the coming lesion, until the dis- ease had made considerable progress, were it not for the characteristic emaciation. And, it is repeated, the waste of the nutrition of the muscles, in other words, of albumen, is the cause of the emaciation, and often before there has been any febrile disturbance, or other suffering, to account for such a result, and when the appetite and digestion are good, or at least fair. Emaciation in Bright's disease, it should be explained, is not often as extreme as in consumption, although the cause of both is the waste of the same element of the blood, for the reason that in the former there is not usually so great a loss of albumen as in the latter disease, and for the further reason that in Bright's disease the blood is left more watery than in consumption, as will soon be shown, and because of which such patients must earlier become dropsical or bloated, thus covering or preventing in part the appearance of emaciation which is so prominent a char- acteristic of consumption. To present the further specific effects of the loss of albu- men in their clearest scientific light, and show how it is that this causes tubercles, and therefore consumption, it becomes necessary to recur to the composition of the blood, the table of which is here re-inserted, that it may be directly before the mind, without the necessity of referring to it: CONSEQUENCES OF LOSING ALBUMEN. 65 1000 parts of healthy blood contain, of parts. Albumen, . 70. Water, . 403. Blood Corpuscles, . . 512. Fibrin, 2.2 Fatty Matters, . 1.3 Salts, 6.03 Extractive Matters, . 5.47 The economy everywhere displayed by nature, in the use of her forces and products is proverbial, and there can not be less care exercised in the delicate machinery of life and health, than in grosser things; hence it must be seen that, if she decreed that healthy blood must possess the con- stituents named, and in the proportions given, it was because they were required for use in just those propor- tions, to build up the human system and maintain it in health. It is self-evident, where such a complicated sys- tem of organs as those of digestion is created, and all com- pelled to work in harmony with each other through their numerous functions and laws, that the product of such work, so carefully supervised at every step, can not be used in any other ratio of its several parts than was designed, and maintain health. There must be almost a mathemati- cal certainty about this. Under the head of "Nutrition and Growth," Kirke and Paget say: "In order that the process of nutrition may be perfectly accomplished certain conditions are necessary. Of these the most important are: 1st. A right state and composition of the blood, from which the materials for nutrition are derived. 2d. A regular and not far distant supply of such blood. 3d. A certain influence of the nervous system. 4th. A natural state of the part to be nourished." And further on they say: " How precise must that adaptation of the blood to the 66 CONSUMPTION. whole body be, by which in health it is always capable of maintaining not only the whole number of different organs and tissues, but all the different parts of every one of them." If, then, such great care is necessary in the production of the blood in the first place, and such a perfect adapta- tion to its purposes, in its "state and composition," any- thing that deranges such composition, or destroys the ratio among its constituents, as does the loss of albumen, will be a cause of most serious disturbance to the animal econ- omy, and unless the evil is remedied, and the disease cured, must work disease and ultimately death to every individual suffering from it. There is absolutely no other way for escape. The mere palliation of, or temporizing with, such an enemy to life, only serves to hasten the fatal issue. In accordance, then, with the proportion among the sev- eral constituents of the blood given in the table, the loss of every ounce of albumen therefrom, must necessarily leave a relative excess in the blood-vessels of Water, 5| ounces. Blood Corpuscles, . . 7 " Fibrin, . . . .15 grains. Fatty Matters, . . . 9 " Salts, . . . 41 Extractive Matters, . 37 By this it will be seen to what extent, and the exact ratio in which the proportion of the blood constituents is de- stroyed, by a given loss of albumen. Every ounce of it abnormally discharged through any mucous membrane, in addition to wasting that much of nutritious material, actually destroys nearly one pound (fifteen ounces) of blood, for all purposes of healthy nutrition. This furnishes a still more prominent reason than before given for the great derange- ment to nutrition which is always manifested in consump- tion. Under the natural appetite of hecdth, that is, if a consumptive should eat no more than the system demands CONSEQUENCES OF LOSING ALBUMEN. 67 in perfect health, the emaciation in many cases would pro- gress more rapidly than it does; but a compensating balance, or preservative process, is established in many, by exciting a greater appetite than that of health, till the powers of digestion are more of less exhausted, so that the individual may be preserved longer, often much longer than he could be without it. This is, of course, not the case with all, but it is with many, and, other things being equal, such patients live longer than those similarly diseased but whose appetites are not thus abnormally excited. 68 CONSUMPTION. CHAPTER XII. PROOF OF THE OTHER CONSTITUENTS BEING LEFT IN EXCESS IN THE VESSELS WHEN ALBUMEN IS LOST. It must not be expected that the other constituents of the blood can be shown to be in excess in the blood-vessels in their exact representative proportions to a given amount of albumen that is lost. This cannot and could not by the utmost scrutiny be done, for the simple and sufficient reason that such excess is not all retained in the vessels, but is excreted, in some instances, no doubt, nearly as fast as albumen is wasted, while in all, or nearly all, there is a daily expulsion of as much of the excess as the vital pow- ers of the individual system can thus dispose of. The very necessities of life demand this. No person could live a week under the free loss of albumen, were not a greater or less portion of the excess of other constituents daily expelled. As before asserted, this excess is "found depositing itself, or being deposited, in living tissues, causing diseases that correspond both to the nature of the constituent so disposed of, and the part in which deposited; or, it is expelled from the system entire through every avenue of escape that nature can command, thereby causing many characteristic diseases. There are necessarily great differ- ences in these respects with different persons, as is the case in other diseased conditions. While one would have greater power to excrete the excess of one or two of the constituents of the blood, another would get rid of some of CONSTITUENTS LEFT IN EXCESS. 69 the others more easily, and so on. One would be able to expel daily so much of the excess of water, for instance, through the kidneys, or, by ordinary perspiration, or by night sweats, that dropsy, from its effusion into the tissues would be delayed much longer, than with another having less power over that element; or it would not appear at all where that power is very active. Some will throw off more of the excess of blood corpuscles by means of haemorrhages; while another class have more power to decol- orize and dissolve the corpuscles and then excrete the debris through the bowels, thus in both of these classes, delaying the development or progress of tubercles longer than would be the case with others. Often, if not generally, those who have the least power to excrete the excess of water from the blood-vessels, have a much greater portion of the excess of the corpuscles dissolved by the greatly diluted serum, than do those who expel the water readily. This is one of the reasons, at least, as we shall see, why tuber- cles are seldom prominently developed in those suffering from Bright's disease; their blood being so much more watery usually, than with other losses of albumen, in consequence of the kidneys being so obstructed that they cannot excrete what they should, of even the natural refuse water, to say nothing of that left in excess, and the blood, thereby, becoming so very watery that its corpuscles are dis- solved and thrown off, so that few or none of them are left to be changed to tuberculous corpuscles. Still, tubercles are not unknown in connection with that disease. It is the same with the fibrin, fatty matters, and the salts. One person will excrete more of the surplus of one of these elements than another, and we find the results cor- responding thereto. Some consumptives have "fatty livers," and some do not, and thus it is that these diseases show within certain limits every conceivable difference and variety. Again, in discussing and presenting the proof of an 70 CONSUMPTION. excess of the various constituents, it must be understood that it is a relative excess of them, as compared with the quantity of albumen left in the vessels, that is referred to, not an absolute excess, beyond what should be in health. The loss of albumen could not, of course, increase the quan- tity of the others, excepting relatively, as compared with the reduced amount of the former left in the circulation, and this is the sense in which the terms "excess," "surplus," and "increase" are used in these pages. Everybody knows that the blood of all consumptives is too watery. That the blood of consumptives contains an excess of, or too much, water, throughout the whole course of their dis- ease, from its very first or incipient manifestation, all the way through to the close of life; and that, too, however heartily they may eat, or how well they may digest their food, must be too well known to all to really require much if any proof upon the subject. The various expressions, "poor," "thin," "watery," or the like, as applied to their blood, have probably been used almost universally since the days of Hippocrates, certainly much longer than the comparatively brief recollection of any now living. There- fore, this part of our subject would seem to be so well understood that proofs would appear superfluous; neverthe- less, it may be as well that some be given. We have already seen that Wood says the serum of the blood in all tuberculous diseases "is of less specific gravity than in health"; and that: "The blood is there- fore watery and impoverished, and incapable of supplying the nutritive function sufficiently." There is no other dis- eased action known which renders the blood so watery except the loss of albumen. Copland, in his Medical Dictionary, Vol. Ill, page 1210, says of the blood in "Tubercular Consumption": " At an early period, or even before the disease has fully declared itself, the blood is thinner or poorer than in health." CONSTITUENTS LEFT IN EXCESS. 71 But what is more to the purpose, he gives on the same page a table in which are condensed the results of twenty- two analyses by Andral and Gavaret, wherein the average proportion of water in the blood of the cases of consump- tion they examined is given at 809.7 to the 1000; the pro- portion in healthy blood being given by Kirke and Paget at 784., and by other authors at 783., to the 1000. Of course, it must be understood that in all these instances the water naturally belonging to, or in, the corpuscles, is included in the figures given with the water of the serum proper, as heretofore stated, all these analyses of both the healthy and diseased blood being made after the same method, and not by first separating the corpuscles with their natural supply of water, and leaving the water of healthy serum at 403. as in the tables presented herein. Therefore, taking the analyses given by Andral and Gav- aret as that of the consumptive's blood generally, as correct, we have the proof of the great excess of water in his blood, and know that the consequences must be very serious. In Bright's disease, for reasons hereafter given, the dif- ference is still greater, if we compare the specific gravity of the blood in it, with that in health, as will be seen by the following from Watson, page 882: "The average specific gravity of healthy serum is 1030; but in Bright's disease it descends to 1024, 1020, and even to 1013." This is in comparison with pure water at 1000. The specific gravity of the serum in health being almost wholly due to the albumen it contains, the excess of water in the blood in this disease as compared to the albumen remain- ing, is as one-fifth to less than one-third of the whole amount in healthy serum, or from 80 to nearly 150 parts of it in excess, according to the figures given by Watson. Many other authors give about the same proportion as Watson, hence on this point it seems unnecessary to quote 72 CONSUMPTION. them; and what is here given would seem to be all the proof that can be reasonably required of the excess of water that is left in the blood by a loss of albumen in con- sumption and Bright's disease; while it can not be fairly questioned that a corresponding excess of it must be left in all cases where albumen is lost through other mucous membranes than those of the lungs and kidneys. The red blood corpuscles being organized and colored bodies, or cells, that are readily decolorized but not easily broken down, or dissolved, all, or nearly all, the general as well as the specific facts in connection with their being left in excess in the blood-vessels, will be entirely different from that of any and all other constituents. For instance, they must find their outlet from the system in one of three ways, namely: first, by congesting in and rupturing the small, or smallest, blood-vessels, and flowing off in haemorrhages, as red corpuscles and found as such; or, secondly, they are decolorized by circulating in a blood that is too watery, and are then deposited, not, however, as red corpuscles, but as pus or tuberculous corpuscles, as will be shown; or, thirdly, they are both decolorized and entirely dissolved, as generally happens to them in a very watery blood, when they are excreted from the sys- tem, not as corpuscles of any kind, but as a substance without organization and in solution in the excess of water that has destroyed them; whereas all the other constitu- ents, without exception, are found in the vessels unchanged in their nature, or nearly so, by any condition of disease, and they are promptly excreted through the walls of the capillaries, without rupturing them, into living tissues, or for entire expulsion from the system, when they are also found little if at all changed in their nature. Therefore the latter, especially the excess of them, is always easily traced, and medical literature abounds in the proof that they are to be found in excess in all those dis- eases, wherein it has been proved that albumen is lost. CONSTITUENTS LEFT IN EA'CESS. 73 But this is not so easily done when the excess of a constitu- ent has to be entirely changed in its character in order to rid the circulation of it, as is so often the case with the red corpuscles. Though proof is not entirely wanting that they are found in excess in the vessels in the early stages of some cases where albumen is lost, as will be seen by the following from Lehmann, Vol. II, page 605: "It will be long before we can hope to establish any fixed relations of comparison between definite physiological pro- cesses and the increase or diminution of the number of blood corpuscles in morbid blood. We constantly find the blood-cells augmented in plethora, in the earlier stages of heart disease, in spinal irritation (Popp), and in cholera (C. Schmidt)." "***** During the first eight or ten days of typhus, the blood corpuscles are always increased; but subse- quently to that period, at least until the twenty-first day, their number is considerably diminished." "***** In spined irritation, Popp found 120.5 per M. as the lowest number, and 140.5 per M. as the maximum (his mean normal number being 120); in plethora he found the corpuscles much less increased than in spinal irritation." In typhus, as we have seen, there is a large amount of albumen lost through the mucous membrane of the intes- tines, to account for the increase of the red corpuscles, "dur- ing the first eight or ten days," while their subsequent decrease is just as satisfactorily accounted for on the ground that the blood is made so watery in eight or ten days' profuse loss of albumen, that they cannot longer resist its effects, and large numbers of them are decolor- ized, and disappear as colored corpuscles, but are found as colorless ones. Both plethora and heart-disease are very commonly pre- ceded and attended by quite free and often profuse mucus discharges from some of the organs lined with a mucous membrane, by which albumen is more or less freely wasted, 74 CONSUMPTION. and which would account for the increase of the red cor- puscles in those diseases. And nothing is a more common result in Bright's disease than some form of disease of the heart, while one author asserts that in plethora, or at least that corpulent people are frequently found to dis- charge albumen from the kidneys. And, finally, in regard to spinal irritation, not one of the many disturbances or actual diseased conditions of other organs than the lungs, that precede consumption, is more common than irritability of the spine, or spinal nerves. And this always occurs before the disease becomes concen- trated in the lungs, that is while the red corpuscles are found in excess in the vessels, and before the blood becomes so watery as to decolorize them to a great extent and change them into tuberculous corpuscles. The increase of blood corpucles in cholera, which, like all the other instances, is only a relative increase compared to the other constituents remaining in the vessels, is not due to a loss of albumen in this disease, but the profuse discharges of water, albumen as well as all the other constituents be- sides water being augmented because of its loss. This is another proof of the proper proportion among the constitu- ents of the blood being always destroyed when a portion of any one of them is lost. And incidentally in this connection, the fact may as well be mentioned that the common occurrence of dysentery, in a week or ten days after cholera, is, no doubt, to expel the excess of corpuscles left in the vessels by its watery discharges. Congestions of the liver which are quite common after it, and of other organs, are also, no doubt, due to the same fact. Of an excess, and often of a great excess, of colorless corpuscles in the blood of consumptives, and other sub- jects who lose albumen, and that, too, from a decoloriza- tion of the red ones, there is, happily, no such want of proof, as of the increase of the latter, for it abounds in profusion in the works of many authors. And such of CONSTITUENTS LEFT IN EXCESS. 75 their testimony as may be needed can be no more appro- priately introduced than by giving the following from Leh- mann, Vol. II, page 611, which proves what has been claimed in the preceding pages, of the readiness with which the red corpuscles are decolorized. He says: " As the red corpuscles are rendered invisible by the addition of water to the blood, we may in this manner form an approximate estimate of the quantity of the color- less corpuscles." And again, on page 614, same Vol., after speaking of other points in regard to the water of the blood, he says: " This leads us to revert to the relation which the amount of water in the serum and in the blood generally bears to the number of blood corpuscles. It is a striking phenome- non, that ordinarily blood in which the serum contains much water, presents few corpuscles; we observe this * * * * especially in morbid blood." And that he alludes in this to the red corpuscles is seen by the following, which closes the same paragragh: "The conditions which give rise to a diminution of the solid constituents of the serum (albumen and salts), gen- erally, at the same time, also occasion a diminution of the colored blood-cells." Again he says, on page 615: "Even in the beginning of most diseases, especially those of an acute character, we find the blood more watery than usual, except during the first ten days of typhus [just the time that he says the red corpuscles are found increased in this disease], during cholera, and scarlatina, and measles, in their first stages. * * * * Hence, it must be concluded that immediately after the primary invasion of certain diseases, the blood corpuscles are destroyed in large numbers, * * * * and that their products of meta- morphosis are retained for some time in the serum." If the red corpuscles are decolorized or wholly destroyed in consequence of, or by, a too watery serum in one class 76 CONSUMPTION. of diseases, they must be equally so by a too watery serum in any other disease, and that this is so in consumption is proved by the following from Copland's Medical Diction- ary, Vol. Ill, page 310, where, in speaking of the blood in consumption, he says: " At an early period, or even before the disease has fully declared itself, the blood is thinner or poorer than in health; the colorless globules are more or less abundant, and the red globules less numerous." And in another paragraph, on the same page, he further says: " Andral and Gavaret state that, in all periods of this disease, excepting the last, the fibrin seems on the increase, and the red corpuscles are on the decrease, progressively throughout"; the decrease of the red corpuscles being attended by the increase in the colorless ones, as seen by the preceding quotation. In his article on Scrofula and Tubercles, same Vol., page 817, this author also says: " Under the microscope, some of the corpuscles appear devoid of color at the edges only, some entirely colorless." This shows the commencement, as well as the comple- tion of the decolorizing process, and proves that it must be a progressive work with each corpuscle until completed. Carpenter says, page 188: "A marked increase in the proportion of the colorless corpuscles * * * * shows itself, especially in the blood of cachectic subjects, in whom (particularly those of a tuberculous diathesis) it seems to take place independently of inflammation." This is thought to be all the proof that can be required of the relative increase of the red corpuscles in all cases where albumen is lost, and of the prompt decolorization of them, by a two watery serum, which causes them to decrease, so early and so rapidly, in such diseases, and become changed thereby into the colorless corpuscles, thus CONSTITUENTS LEFT IN EXCESS. 77 accounting for the great increase in the latter; but were more testimony required on these points it could be given in still greater amount from the same and from other authors. FIBRIN. With the fibrin there are no such difficulties as with the corpuscles, in the way of finding it in excess in the blood, or tracing it after being expelled from the vessels whether into living tissues or into the excretions, when left in ex- cess in the serum by a loss of albumen, for it is seldom or never but little if at all changed under any of these cir- cumstances. We have already seen in the quotation from Copland under the head of Excess of Corpuscles, that he says on the authority of Andral and Gavaret that: "the fibrin seems on the increase * * * * progressively throughout," in the blood of those suffering from consumption. He further says in the same paragraph: " If the tubercles be in a crude, unsoftened state, the in- crease of fibrin is only small, and its whole amount maybe estimated at about four * * * * As the tubercles soften, the quantity of fibrin slightly increases, and the corpuscles decrease. Upon the formation of vomicae, or cavities in the lungs, the fibrin is somewhat farther increased—to 5.5 according to Andral—but it never reaches the amount ob- served in pneumonia." That the figures given in this quotation really prove the increase of fibrin in the blood of consumptives to be very great, although the author speaks of it as "small" when at four, will be seen, when it is stated fchat on the preceding page he gives a table of the normal proportion of all the constituents of healthy blood, in which he places fibrin at 2.2 in 1000 parts of blood. Hence four parts would repre- sent it as almost doubled, while 5.5 show it a good deal more than doubled. This same author says in Vol. II, page 740, Medical Dic- tionary, under Bright's disease: 78 CONSUMPTION. " The proportion of fibrin in the blood is commonly in- creased in the early stage of the chronic malady, although not so greatly as in the acute form. Dr. Christison con- siders the quantity of dry fibrin to vary in healthy blood from 25 to 52 parts in ten thousand; but in the acute state, or stage of the disease, he has seen as high as 82, and as low as 30 parts." Lehmann, Vol. I, page 634, says of the blood in Bright's disease: " Such blood contains on an average more fibrin than in the normal state, while it is only in inflammatory affections of the kidneys, that is to say, in its first stage, that there is any great augmentation of fibrin." And it should here be added that it is in the acute form of Bright's disease that albumen is generally much more profusely wasted than in its chronic form. Virchow gives us the following significant fact in his Cellular Pathology, page 199, which applies forcibly here. He says: " Now it is a very remarkable fact, * * * * that it is very rarely that a considerable increase of fibrin takes place without a simultaneous increase in the colorless blood corpuscles^ In presenting this proof of the relative increase of fibrin in the blood in those diseases where albumen is lost from it, I do so with the full knowledge that all pathologists and chemists without exception, claim that such increase is caused by inflammation arising in any part of the system, in connection with those diseases. But that there must be a great error in this claim, handed down from one author to another, would appear to be self-evident from the fol- lowing statement of facts connected therewith: Fibrin is one of the natural constituents of healthy blood. It is produced in the lacteal glands, or the lacteal vessels, or both, from materials furnished to them by en- tirely healthy digestion, and is passed along through the CONSTITUENTS LEFT IN EXCESS. 79 thoracic duct into the blood in its natural proportion to the other normal constituents. Neither health nor life could be maintained a day without it. Years ago I wrote, in con- nection with much more upon this point, as follows: How unreasonable it seems, then, to assume and assert, as all pathologists and physiologists do, that fibrin is increased, that is, actually produced by inflammation, in any part of the system in which this may arise. In other words, that a healthy constituent of animal life can be actually organ- ized or produced, indiscriminately, by unhealthy action; aud this, too, in parts of the system, or in tissues where we have no evidence that the fibrin-producing function exists. How can such a thing be possible? A healthy and there- fore natural constituent of the blood, or a normal ingredient in any department of organic creation, produced by an un- healthy and unnatural process is an abnormity which nature must abhor, and an absurdity upon its face, as it seems to us, for science to pretend to teach. Nor is jiroof wanting that it is a loss of albumen, and not a supervention of inflammation that causes the increase of fibrin in the blood, as will be seen by the following from Watson, page 883, where he says; after speaking very fully of the qualities of the urine in all stages and conditions of Bright's disease, that: "In general the albumen is plenti- ful and almost constant in the outset of the malady. * * * * * And another fact, which it is essential for you to know and to remember, is, that, in any stage of the disease, the supervention of febrile disturbance, from local inflam- mation, or whatever cause, tends to renew for the time, those qualities of the urine which belong to the early period." If this be true, then,—and there seems to be no doubt of Watson's entire conviction of its truth, from the earnest manner in which he calls attention to it by saying it is essential " to know and to remember"—we have the fact established, that there is a renewal of the loss of albumen 80 CONSUMPTION. in the urine, in amount corresponding with the first stage of albuminuria, whenever in any of its stages there arises febrile disturbance from inflammatory action. How per- fectly and fully this corroborates all that is above claimed upon this subject. Here we find a marked increase in the loss of albumen jrom the blood, at the very time in the dis- ease, when all observers say there is an increase of fibrin in the blood, and assert that to inflammation such increase is due. While we reassert that this augmentation of fibrin is solely due to the increased loss of albumen which Wat- son, as we see, tells us occurs in this disease whenever in- flammation arises, thereby simply leaving the former, no less than all the remaining constituents of the blood, in so much excess of what the system can use for nutritious pur- poses; and this fact which this author furnishes us, is one of the most convincing evidences of the truth of our posi- tion that we have anywhere met. If it is a fact, also, that fibrin is augmented in the serum whenever inflammation supervenes in phthisis, as many authors assert, we find it to be explained upon the same basis as the foregoing, that is, that there is an increased loss of albumen, in this case through the mucous mem- brane of some porUon of the air passages, by catarrhal secretions, in consequence of inflammatory action arising therein. For have we not already given proof from one of the best authorities, that viscid, thick expectoration, con- taining much albumen, characterizes inflammation of the lungs? And if so, then is there not an increased loss of albumen in this very identical kind of expectoration, which so commonly arises whenever inflammation begins in the course of consumption, and at a time, too, when the surplus fibrin is found in the blood? Again we ask, do not these facts fully account for the excess of the latter, upon per- fectly rational grounds, in all cases named belonging to this class, and without resorting to any hypothesis whatever, just the same as the similar facts did the like condition, in CONSTITUENTS LEFT IN EXCESS. 81 connection with Bright's disease? And so it must be with all other diseases where albumen is lost. Again, if fibrin were increased by inflammation we should have to say, also, that it increased the water, colorless blood corpuscles, salts and fatty matters, where these were found in excess along with the fibrin, which certainly no one would think of doing, and which shows even more conspic- uously that there has been a great error in the teachings upon this subject. SALTS. Of a relative increase, or excess, of the salts in the blood, in all diseases where albumen is lost, the proof is equally conclusive, as will be seen by the following quotations. Lehmann, Vol. I, page 623, says: " In diseases, the alkaline salts of the blood undergo con- siderable fluctuations; but on this point most of the blood analyses hitherto made are very imperfect; this much only is certain, that in severe inflammations these salts are very much diminished, and that in the acute exanthemata and in typhus they are very much increased. Moreover, C. Schmidt has especially noticed that there is a considerable diminution of the soluble salts in the serum of cholera blood, and an augmentation in dysentery, Bright's disease, and all forms of dropsy and hydraemia. Finally, it has been found by Leonard and Folley, as well as by Salvagnoli and Gozzi, that the salts are often increased to twice their nor- mal quantity in several endemic diseases, namely, dysen- tery, malaria, the malignant forms of intermittant fever, scurvy, etc." On page 634, same Vol., this author further says: "In dysentery the blood is poor in corpuscles. The fibrin is generally, although not always, somewhat in- creased. All the solid constituents of the serum are de- creased, but especially the albumen. The salts on the other hand, are considerably increased in quantity." " In Bright's disease the blood presents not only a con- 82 CONSUMPTION. siderable diminution in the number of cells, but likewise a great loss of the constituents of the serum. The cholesterin as well as the salts of the serum are, however, augmented." And again on page 635, same Vol., in speaking of the blood in typhus, he says: " The salts and extractive matters are relatively increased, rather than absolutely diminished." Carpenter, page 190, endorses Lehmann's conclusions as follows: " Little is known with certainty regarding the variations of the alkaline salts in the blood in different diseases. The analyses which have been made, however, are considered by Prof. Lehmann to indicate that in very severe inflam- mations they are very much diminished; whilst they are much increased in the acute exanthemata, and in typhus, dysentery, Bright's disease and all forms of dropsy and hydraemia; and are often doubled in quantity in diseases depending upon malarious influences, such as endemic dysentery, malignant forms of intermittent fever, etc." FATTY MATTERS. As to an excess of fatty matters found in the blood in diseases where albumen is lost, Carpenter says, page 190: "The proportion of fatty matter in the serum, and espe- cially of the cholesterin, has been found by M. M. Bec- querel and Rodier to undergo an increase at the commence- ment of most acute diseases, and they have also observed an increase of fat, and especially of cholesterin, in chronic diseases of the liver, in Bright's disease of the kidneys and in tuberculosis. The quantity of fat in the blood some- times undergoes such an augmentation as to give to the serum a constant 'milkmess.'" Lehmann says on this subject, Vol. I, page 620: " The most careful investigations regarding the quantity of fat contained in the serum in different diseases have been instituted by Becquerel and Rodier; from their re- searches it follows that almost from the beginning of every CONSTITUENTS LEFT IN EXCESS. 83 acute disease there is an augmentation of the fats in the blood, and especially of the cholesterin. In chronic diseases the fats and principally the cholesterin are especially increased in hepatic affections, as for instance, icterus and cirrhosis, as well as in Bright's disease, tuberculosis and cholera." In speaking of the condition of the blood in Bright's disease, Vol. II, page 541, Wood says: " The serum sometimes appears milky in consequence of the presence of oily matter." Like the fibrin and salts, the fatty matters are often found in the excretions, etc., when left in excess in the blood by a loss of albumen. In Vol. II, page 89, Lehmann says: "Fat occurs only in very small quantities in normal mucus, although the quantity increases in proportion to the occurrence of albumen and larger quantities of mucus corpuscles." In Vol. I, page 536, the same author also says: "According to Heinrich, the amount of fat in the faeces is increased by morbid action in wasting diseases, such as pulmonary phthisis, Bright's disease, and diabetes Mellitus." Of the excretions of the kidneys in Bright's disease, Wood says, Vol. II, page 540: " The urine is often turbid or opalescent from the pre- sence of oily matter." EXTRACTIVE MATTERS. Notwithstanding that so little is known of the nature and uses of the extractive matters, and that chemists and phys- iologists have given so little attention to them in compari- son with the other constituents of the blood, we are yet not without proof that they too are found in excess in diseases where albumen is lost, as will be seen by the following. Lehmann, Vol. I, page 621 says: " Amongst the diseases in which the extractive matters are increased, we may especially notice puerperal fever (Scherer) and scurvy." 84 CONSUMPTION. In both of these diseases albumen is often if not always wasted from the blood in the mucus discharges so com- monly attending them, if it is not in its purer state, as in Bright's disease and phthisis. In speaking of the changes of the blood in typhus the same author says, same Vol., page 635: "The salts and extractive matters are relatively increased rather than absolutely diminished." In a note, in Vol. II, page 542, and on the authority of the London Medical Gazette, Wood says of the condition of the urine in Bright's disease that: "Dr. G. Owen Rees has generally found one of the ex- tractive matters of the blood, in these cases, along with the albumen. * * * * It diminishes along with the albu- men in convalescence." Here, then, we have a most important fact proved, in this connection, namely: that when the waste of albumen diminishes, and ceases in returning health, the throwing off of the extractive matters also diminishes and ceases; thus showing conclusively that the excess of the latter and the abnormal appearance of them in the urine depend exclusively upon the loss of the former, leaving them in excess in the blood, and the system expelling more or less of such excess through the kidneys to prevent in the first place, and as far as this could be done, their too great accumulation in the blood-vessels, and secondly, to avoid the necessity of their being poured out into living tissues, where they would cause serious diseases and dangerous complications that would make it impossible for any one to recover who was once attacked with the disease even in its milder forms. And so it is, and must be, with all the other constituents, and in all the other diseases where albumen is lost, their excess shows itself with its escape from the blood, and ceases with the cessation of its waste. EA'CESS OF WATER AND ITS EFFECTS. 85 CHAPTER XIII. THE EXCESS OF WATER AND ITS EFFECTS. The excess of water left in the blood-vessels, by the loss of albumen, being nearly six ounces for the waste of one ounce of the latter, causes the blood to be too watery dur- ing all the time such loss is being sustained. Hence the consumptive's blood is necessarily poor, thin, watery, as it is variously expressed, from the commencement to the close of his disease. But as this excess could not be allowed to go on accumu- lating in the vessels from day to day, without soon destroy- ing all the corpuscles circulating in it, and actually " wash- ing all the tissues to death," our vital forces, which are constantly on the alert to save life as long as they can, set to work to expel as much as possible of this excess of water in every way that opportunity offers. We consequently find the kidneys of the consumptive almost always more active, than with people in health, the urine being voided more frequently and in greater abundance than is natural. Often, too, the same class of patients, especially in the early stages of their disease, perspire very easily and pro- fusely upon slight exercise, which affords another means of their expelling surplus water. As their disease pro- gresses, however, and they lose greater quantities of albu- men, and the system cannot relieve itself of the excess of water fast enough by the processes named, or the powers of life are partially exhausted in that direction, then another action is set up, or a new factor is brought into the case, and night sweats are established. And, finally, as an in- 86 CONSUMPTION. creasing loss of albumen is going on, and all their methods are insufficient to rid the blood of the rapidly increasing excess of water, this is then poured out into the muscular system, causing general dropsy, or, into the cavity of the abdomen or that of the chest, causing large accumulations of it there, as the patient rapidly nears his end. Such is the general course in the majority of cases, but, there are individual deviations from it, according to the natural powers possessed by each for ridding themselves of surplus water, just as there are deviations in various persons, to the usual progress of every known disease with which they may be attacked. Some discharge more, and some less water through the kidneys; some have more, others less, profuse night sweats; and some have general dropsy appear much earlier than others, while in a few this does not show at all, for the reason that they are able to the close of life to get rid of such excess by other means, so that it does not require to be effused into the tissues. Let it, therefore, be henceforth remembered, that the night sweats and dropsies of consumption are not the un- mixed evils they have hitherto been thought to be. But for them, death would occur in such cases much sooner than it does, from the blood becoming so watery as to wash organs and tissues beyond the power of performing their functions; and would, besides, dissolve all the blood cor- puscles, thus preventing oxygen being carried to any part or organ beyond the air-cells, and destroying the only means of the system for ridding itself of that deadly poison—carbonic acid gas. Night sweats and dropsies are to some extent the measure of the progress of the disease, acting as a safety valve in retarding the fatal issue long beyond the time it would or could be delayed without them; while the loss of albumen is their only primary cause, as it is of all else, (as in Bright's disease), that fol- lows in such cases, up to and including death. EXCESS OF WATER AND ITS EFFECTS. 87 Dropsy almost always appears much earlier in Bright's disease than in consumption. Indeed, it not unfrequently happens that the physician has his attention first called to the true nature and gravity of the case of a patient suffer- ing from Bright's disease, by an early appearance of drop- sical bloating of his face. The reason for this is obvious, and requires to be considered to show why there should be such a difference between this and consumption, when the two diseases are so nearly identical in their cause. In the early stages of most, if not all cases of Bright's disease, the kidneys are greatly congested, so that none of the excess of water left in the blood, nor, indeed, but little of the natural refuse water of health, can be excreted. Some- times an ounce, or less, is all that is discharged in twenty- four hours, for weeks, and even months together. Then, as the disease advances, these organs become shrivelled, or otherwise destroyed to such an extent, that they cannot perform their functions any better than when greatly con- gested. Therefore, it is a physical impossibility for them to excrete from the blood-vessels but very little of the refuse water they should, to say nothing of the excess of it that is daily accumulating from the continued loss of albu- men. Moreover such patients perspire but little, usually, in comparison with consumptives, seldom have night sweats at all, consequently their blood becomes more watery than in almost any other known disease, and dropsy necessarily appears early. In consumption, on the contrary, the kidneys are almost universally healthy, at least exceedingly active in ridding the system of a great portion of the excess of water, while daily and nightly perspiration carries off another large portion, and the appearance of dropsy is much longer de- layed. It will not be without interest in this connection to cite another class of cases of dropsy, resulting from a loss of albumen through another set of organs, viz.: hydrocepha- 88 CONSUMPTION. lus, or dropsy of the brain in children, in connection with stomach and bowel diseases. Here albumen is lost in the mucus vomited from the stomach, or discharged from the bowels, and a portion of the excess of water left is poured out into the venticles of the brain. But here the effused water greatly hastens death, in consequence of its being forced into so small a space, and so fatally pressing upon the most vital organ of the body and speedily arresting all its functions. The tubercles so universally found in the brain in such cases, are the excess of blood corpuscles, decolorized, as will be shown in the next chapter, and deposited, along with the excess of water, thus having their share in the fatal work. Among the curious efforts that the vital force sometimes puts forth to rid the system of a portion of the excess of water, the following cases are given as illustrations: Some fifteen years ago, a patient came under my care for treat- ment for chronic nasal catarrh and catarrhal irritation of the throat, from both of which parts there was a good deal of mucus secretion, and therefore, of course, a waste of albumen. His kidneys were very active, and while there was but little general perspiration, the palms of his hands would perspire profusely for hours together, almost every day, the water oozing out in little beads or small drops, which would reappear almost as fast as wiped away. Another case of chronic nasal catarrh came under my care a few months since, where, for hours in succession, sometimes at night, at other times during the day, there was a constant dropping of water from the left ear. The cure of the nasal disease, and stopping the loss of albumen, also cured these unpleasant symptoms in both cases, with- out any treatment being addressed especially to them. Again, excessive perspiration by the feet, and of the genital organs, especially of males, affords the means by which not a few who are losing albumen through some one or more of their mucous membranes, expel a greater or EXCESS OF WATER AND ITS EFFECTS. 89 less portion of the water that is thereby left in excess in their blood. And now, in concluding this important and interesting branch of our subject, the question remains to be asked: Can there be a reasonable doubt, that the foregoing fully accounts for the various phenomena named, of the ab- normal discharge of water from the system, upon strictly scientific principles ? If not, then bow important that such excretions of water be not interfered with, except by reme- dying the cause, i. e., by healing the mucous membranes, and stopping the further waste of albumen. The suppression of night sweats, for instance, by "sour drops" (dilute Sulphuric acid), or by other means, with the loss of albu- men still allowed to go on, and in fact increased by such harsh agents as will be seen in a subsequent chapter, must greatly hasten the exudation of the water into the tissues, or into the cavity of the chest or abdomen, thus causing general, or chest or abdominal dropsy, and thereby neces- sarily hasten death. 7 90 CONSUMPTION. CHAPTER XIV. THE EXCESS OF BLOOD CORPUSCLES, AND THE DISEASES RESULTING THEREFROM. According to the table given there would be seven ounces of blood corpuscles left in excess in the blood-vessels, for every ounce of albumen lost therefrom through diseased mucous membranes. And it must be remembered that while they live and maintain their organization, and while the vessels continue healthy, or remain unbroken, the cor- puscles never leave the vessels, but are kept in continual motion on a ceaseless round through them, carrying oxy- gen one way and carbonic acid gas the other. And further, that each corpuscle has a life of about six weeks' duration, then dies, and, in health, is entirely dissolved in the serum and excreted as refuse or worn out matter. When left in excess, however, much of such excess has to be disposed of by other and different processes now to be shown. Of course an excess of them cannot be allowed to go on accumulating in the circulation from day to day, month after month, as in that case the vessels would soon become so filled with them that the serum could not float them, and there would be dangerous and fatal congestions arising everywhere; or they would distend the whole cir- culatory system to the point of ruptures and necessarily fatal haemorrhages. Consequently nature is on guard here also to avoid these extremes of evil, and preserve life as long as possible, that time may be afforded to reach and control the true cause of it all, by healing the mucous mem- branes. EXCESS OF BLOOD CORPUSCLES. 91 Among other processes which nature sets up in the ear- lier stages of such cases, to rid the system of an excess of corpuscles, is that of haemorrhages from non-vital parts, congestions and the like. Hence it is that during the vigor of childhood and youth of many scrofulous subjects, and those who in after years go into consumption, we see haem- orrhages from the nose, often profuse, developed as com- mon occurrences. The minute vessels in, or just beneath, the mucous membrane of the nostrils, become congested in such cases, and remain so, until their walls give way under the continued pressure and let out the surplus corpuscles deposited, or stagnated in them. Other organs and parts also frequently expel a portion, greater or less, of the ex- cess of corpuscles in various cases. In the female system, after puberty, the surplus corpuscles are frequently ex- pelled from the circulation through excessive menstrual haemorrhages. Bleeding hemorrhoids, haemorrhages from the bowels or liver, vomiting blood from the stomach,. when the cause is not some mechanical injury, bleeding of the gums and haemorrhages from the throat, aid many per- sons in getting rid of the excess of the corpuscles, and save them from worse conditions and often from speedily fatal results, should such excess not find an outlet from the system, but be retained in the circulation, or deposited in some of the most vital organs, as, for instance, in the lungs or brain. When the forces of life have been so far overcome, either through the steady and onward progress of the dis- ease, or the wrong methods so commonly used to suppress these haemorrhages (instead of healing the mucous mem- branes), that they cannot throw off the surplus corpuscles through the less vital parts named, we see many of these victims having more or less violent haemorrhages from their lungs, and then their disease is concentrated in one of the most vital of all the organs of the body, and gener- ally, with the final fatal consequences which all so fully 92 CONSUMPTION. understand. It has long been known that children who suffer much from nose-bleed are many of them victims to consumption in after life, and now we see the reasons why, and the connection between the two conditions. Frequently, too, congestions and abscesses are produced during the periods named, to aid in ridding many systems of such excess of corpuscles. Boils are a very common method for casting them out through the skin, hence should of course, never be interfered with except by curing their cause. If suppressed without curing their cause, then haemorrhages, internal congestions or the development of tubercles must necessarily sooner or later occur as a con- sequence, in many cases. I have known in the course of my practice, several cases of consumption, and other in- ternal tuberculous diseases, follow immediately upon the suppression of boils, where the patients had been pre- viously entirely free from such maladies. And the exact opposite of this I have seen many times, namely, where the cure of bronchitis, congestion of the lungs, threatened con- sumption and the like, was attended, or immediately fol- lowed, by the eruption of boils in greater or less numbers. How common, too, to see eruptions of boils follow fevers and other acute diseases during convalescence therefrom; while not unfrequently a crop of boils, or successive crops of them, will apparently run off malarial or typhoid poisons from the system, and thus save the patient from a course of fever. In all these cases albumen is of course wasted from the blood, by the internal action of the disease irritat- ing or abrading some of the mucous membranes, when its loss is unavoidable. Again, the eruption of boils after extensive scalds and burns, and severe or protracted blistering by the Spanish fly, or other agents, must have a similar immediate cause in an excess of blood corpuscles that must in some way have an outlet from the blood-vessels; but with this differ- ence in the primary cause, that in such cases, where there EXCESS OF BLOOD CORPUSCLES. 93 is no internal disease, the albumen is lost through the great and extensive injury and abrasion of the skin, which must necessarily lead to such loss as has been shown. Can there be a question, then, that all these points have a most im- portant, yes, vital meaning; that boils should be promoted and never suppressed, so long as their primary cause con- tinues, or till that is cured? The change in the color of the corpuscles from the blood- red which is natural to them, and which they retain in boils and abscesses during their early stages, to the yellow color of these gatherings, or their discharges when fully matured, will soon be explained. All the results named transpire in the various cases, while the system still retains the power to cast out most of the excess of water from the vessels, and thereby keep the blood at, or near, its normal density; but when, from any cause, whether from the partial loss of such power, or the increased and increasing waste of albumen, most of the surplus water is not expelled, but retained in the vessels and the serum is thereby rendered much more watery than natural, then entirely different processes are set up to get rid of, or to expel the excess of corpuscles from the circula- tion. But to understand these points fully it becomes necessary to here, diverge and recall some of the more essential facts of the true nature of the corpuscles. We have seen that the blood corpuscles are shut sacs; and that each and every one of them has its own separate, individual cell-wall, which consists of an exceedingly thin and delicate membrane, holding within it a semi-fluid gran- ular substance called globulin and also all the haematin or coloring matter of the blood. They are created to live in a fluid—the serum—of the density or specific gravity of about 1,028, as compared with pure water at 1,000. The density of the serum is almost solely due to the albumen held in solution in it. Hence, when a portion of this is lost, and the excess of water is wholly or even only in part 94 CONSUMPTION. retained, the specific gravity of the serum is reduced below the normal standard, and must necessarily seriously affect the corpuscles which have to live and float continuously in it. And the effect must be just in proportion to the loss of albumen, and the unnaturally watery condition of the me- dium in which they have to live. It can require no argument to prove that if a thing is created to live in a certain medium, this cannot be changed and the creature continue in health. A salt water fish, or other salt water animal, cannot live in fresh water; it is utterly impossible in the nature of things, though sea water contains only about three and a half per cent of saline matter in mid ocean, and much less near land. Even the coarsest and hardiest plants, and those lowest in the scale of creation, die almost at once if their surroundings are much changed from what is natural to them; and suffer in health just to the extent that such change is carried. It is a matter of almost mathematical exactness. How soon trees and plants that are natural to a comparatively dry soil die if transplanted to a moderately wet one, and vice versa. Then how must it be with the infinitely more delicate blood corpuscles? It is the same with us. We are created to live in a cer- tain medium, the air, which holds suspended in it a certain amount of water in the form of vapor or invisible moisture. Increase this moisture to any considerable extent, or even only moderately, and have this increase continuously main- tained, we should die prematurely, solely in consequence of it, while we may continue in perfect health during our allotted time, other things being normal, if the moisture is kept within the limits of its natural standard. When it is too great, and so continues, our systems absorb the mois- ture; the excretion of even the refuse water, by perspira- tion, etc., is seriously checked; we become dropsical or are bleached in consequence; that is, become pale, sicken and die. EXCESS OF BLOOD CORPUSCLES. 95 Exactly these things are repeated upon the blood cor- puscles when the serum of the blood is rendered too watery from any cause, whether the loss of albumen, or the con- tinued ingestion of too much watery food, as is often the case with those in great poverty; and the effect is in just the proportion that the serum is thereby made too watery. Indeed, this whole matter is governed by a law of nature, and there is no possible escape from it. The law is that of Endosmosis, and the conditions for its active manifestation are as follows: Place a partition of an animal membrane perpendicularly across and down through an open mouth vessel, a tea cup or common goblet, for in- stance, and make it water-tight where the edges of the membrane join the cup, so that no fluid can pass from one side to the other of the membrane, except as it passes through it. Then pour pure water in upon one side, and salt water, or a solution of sugar, or albumen, upon the other, and the pure water immediately begins to transude the membrane, passing through it into the salt water, or other solution upon the other side. And the demands of this law are so inexorable as to overpower and annul the law of gravity. That is, the pure water will continue to pass through the membrane until it raises the fluid in the salt water side above its own (pure water) level. In fact if a sufficient quantity of it is added, it would cause that upon the opposite side to pour over the top of the vessel, or it might thus be raised to a great height in a sufficiently deep vessel. Another example of the operation of the law of Endos- mosis, which corresponds better with the effect that dilute serum has upon the blood corpuscles is as follows: Fill a bladder or section of animal intestine with salt water, a solution of albumen or sugar, and tie tightly so that nothing can escape, then immerse it in pure water, and the latter will pass through its walls, under the direction of the law, until it fills the bladder or intestine to the point of bursting. 96 CONSUMPTION. Were either only partially filled with the agents named, the transuding process would still go on until rupture of the sac occurred. It is simply a question cf a less dense fluid passing into one more dense whenever and wherever the opportunity offers. While the foregoing is transpiring, a small fraction of the salt water or other agent, will pass through the mem- brane into the pure water, as is proved by the latter being given a slightly saltish taste, and this is called E.rosmosis. But the quantity passing this way is almost infinitely less than that passing in the opposite direction. The blood corpuscles are similarly affected when they have to circulate in a serum made too watery by a loss of a portion of its albumen; seldom, however, to so great an extent, as the serum is never reduced to, or nearly to pure water; and still other results and changes, that correspond to their specific nature, are wrought upon them. These changes, which constitute the transformation, in color, form and all other outward appearances, of the blood cor- puscles into the so-called tuberculous corpuscles, and the development of tubercles therefrom, we must follow closely and with great care, if we would understand the most essential, or at least, the most intricate and interesting points in our whole subject. And to fully understand it all we must recall the more prominent characteristics of the blood corpuscles. They are as stated, shut sacs of a blood-red color, in- vested with a delicate membrane, flattened upon their opposite sides into more or less of the disc shape; and they all have to pass through the capillary blood-vessels in single file, the minute size of most, if not all these vessels forbidding the corpuscles from passing side by side or grouped together. In many of these vessels the larger corpuscles have to partially roll up upon themselves, to pass through. Consequently, when they circulate in a serum, that is EA'CESS OF BLOOD CORPUSCLES. 97 diluted or thinned by a loss of albumen, and absorb the water therefrom, as described in the case of the bladder or section of intestine, they are distended by it to more or less of the globular form. Under this form their rolling up upon themselves is rendered impossible, so the larger ones cannot pass through the capillaries, but become lodged or congested in them, and cause an obstruction to the further circulation of corpuscles through those capillaries, until such obstruction is, by some process, removed. But this is by no means all that happens to the cor- puscles under such conditions, nor are these claims based upon guess-work, or theory, for all the best authors assert that when blood is drawn and poured into pure water, the law at once commences its work upon the corpuscles, as may be distinctly seen by the microscope, they absorb water, and are distended to the full globular form by it, when their coloring matter is dissolved out of them and diffused through the water to finally settle at the bottom of the vessel in an impalpable powder, leaving the corpuscles colorless and nearly transparent. They are then, of course, entirely destroyed as blood corpuscles, are dead, and like all animal tissues in the first stage of their decomposition, become viscid, or sticky, which is another great hindrance to their passing the capillaries when circulating within the body. And as the process of distension goes on, their cell walls are soon ruptured, letting out the other contents, globulin, etc., and all are completely dissolved and held suspended in the water that has destroyed them. That precisely these changes are wrought upon the red corpuscles when they have to circulate within the system, in a serum thinned, or diluted, by a loss of a large portion of its albumen, is proved by the following from Carpenter's Physiology: " A very rapid disintegration of the Red Corpuscles appears sometimes to take place when a morbid poison is present in the blood, or when its composition has been se- 98 CONSUMPTION. riously affected by the loss of its other constituents. Thus Dr. C. J. B. Williams mentions a case of Albuminuria proving fatal in six days, with effusion of pus into the joints the day before death, in which the coloring matter was found to be dissolved in the liquor sanguinae, scarcely any perfect corpuscles being left." It is not often, however, that the serum becomes so greatly diluted as in this case; in consumption, seldom or never, so much so, as it does in the ordinary cases of Bright's disease, because of the greater facilities the sys- tem retains for the expulsion of the excess of water in the former disease, as already shown; consequently the cor- puscles are not distended to the point of bursting, or at least, but a small portion of them are; but they are dilated, have their coloring matter washed out of them, and become viscid or sticky as described. Then when these glutinous corpuscles come to pass through the capillaries a new diffi- culty arises, in addition to their globular form and inability to lessen their width. Their viscidity causes them to ad- here to the inner walls of the capillaries when brought into contact therewith, and often to become permanently congested therein. Other corpuscles follow and become fastened to those already arrested in their course, until a capillary is obstructed beyond its power of finding relief. Then from the force of the current of blood behind, given to it by the heart's action, more corpuscles are crowded into it, until the walls of the vessel are distended into a protuberant sac, and all possibility of any further circula- tion of corpuscles through it destroyed. Often, if not al- ways, it must happen that corpuscles which have not yet been decolorized, are arrested by the obstruction and held with the rest. The diluted serum goes on, however, perco- lating through the vessel among them, until they are decol- orized as the others had been before their deposit. The distention of one capillary, as described, necessar- ily presses upon and narrows the channel through many EA'CESS OF BLOOD CORPUSCLES. 99 adjoining capillaries (they lie so close together in most of the soft tissues, it must be remembered, that the finest needle's point cannot penetrate among them without wound- ing several) so they become all the more readily ob- structed, and thus the congestion goes on extending out- wardly from capillary to capillary to any size that an abscess or a tubercle is ever known to reach; for if such congestion is not now soon arrested and dispersed, either an abscess or a tubercle, according to circumstances soon to be noted, will be the inevitable result. Many capillaries more or less remote from each other, and yet within certain distances, may become congested at, or near the same time, and the congestion go on extending laterally from each capillary until all become united in one general mass, and thus greatly enlarge its dimensions. The corpuscles being colorless and transparent in the fully distended and decolorized state, a congested mass of them would be translucent—the tissues in which they are embed- ded not permitting full transparency—in its early stage; but as it increases in size, to considerable proportions, the cen- tral portions of it must be severely pressed upon—forming as it does in resisting tissues—until the serum can no longer percolate through among the corpuscles, and the fluid they retain may be, so to speak, pressed out of them; or it may, indeed, be given up by them under the law of endosmosis, to the surrounding tissues, for these are more dense than the present contents of the corpuscles. The latter then shrivel more or less, as the case is acute or chronic, or the mass becomes an abscess or a tubercle, lose their transparency and become yellowish white. All nu- trition for the walls of the capillaries and other tissues in- cluded in the mass being now cut off, they are absorbed, and the corpuscles come together forming an abscess if the case has developed rapidly enough for that, or a tubercle if of slower growth. If there has been quite rapid loss of albumen in acute 100 CONSUMPTION. disease, and the corpuscles are deposited rapidly, but in comparatively small numbers, a small acute abscess will be the result, and the corpuscles will not be much shrivelled; if deposited rapidly and in great numbers, a large acute abscess will be the consequence, with many, if not most, of the corpuscles scarcely, if at all shrivelled; if slowly, but in great quantity, in any given part, a chronic abscess like the lumbar abscess which is always tuberculous, or a chronic abscess of the lungs, is the result, and most of the corpuscles will be much shrivelled. Finally, if they are deposited both slowly and in small quantity in any part, as in consumption and scrofula, thus giving the corpuscles the greatest time and opportunity to yield up all the surplus water that has worked so many changes in and upon them,. they shrivel to the fullest extent, and become the so-called tuberculous corpuscles, presenting every feature of the latter, the same size, and the identical color—a dirty yel- lowish white, and often a light gray—with all the various forms in which they are ever found, as "angular," "gnawed," "elongated," "star-shaped," etc., etc., and every other char- acteristic, chemical or otherwise, that tuberculous corpus- cles are known to possess. All this shows the direct connection there is between both the acute and the ordinary chronic abscesses of the lungs, and tubercles, or the tuberculous destruction of these organs which so often follows the former. The abs- cesses exhaust the vital vigor of the lungs when the case degenerates into tuberculous action by the decolorized cor- puscles being deposited at various points, and going on slowly to the organization of tubercles. It will, of course, be understood that the much slower deposit of the corpuscles to constitute tubercles, their con- sequent much slower growth, and usually, their much smaller size as compared with abscesses, allows of their con- tinuing their growth and maintaining their organization much longer, often for months and sometimes even for EA'CESS OF BLOOD CORPUSCLES. 101 years, than it is possible for ordinary abscesses to continue. But when they do finally suppurate, the process and results are very similar to the abscess. Congestion and inflamma- tion set in around and within them, the walls of the capil- laries and the other involved tissues become absorbed, or softened, so as to give way and allow the corpuscles to come or flow together, making a tuberculous abscess, and its contents then soon find an outlet from the system. Let it be understood that neither imagination nor theory has been drawn upon in this case more than any other, to constitute tubercles as described, for it is a fact that they are all without exception, and wherever developed, found to be made up of a great number of granules, as Virchow calls them, each of which granules consists of a little nest of tuberculous corpuscles, inclosed in a protuberant sac of very delicate walls, and corresponding exactly, in every re- spect, with a distended capillary blood vessel, wall and all, filled with decolorized blood corpuscles, as described, after they have shrivelled. The following figure from Virchow must settle the matter beyond question. That the tubercle is often translucent, or, in fact, trans- parent in its very earliest stages, just as the fully decol- orized blood corpuscles would make it, when first deposited, and then becomes yellowish and opaque as the corpuscles always do when they give up the most of the water that has distended them and shrivel, is proved by the following from Gross' Pathological Anatomy, where he says of the nature of tubercle: 102 CONSUMPTION. " In certain parts of the body, as for example, in the peritoneum, we can detect nature, as it were, in the very act of her work, and distinctly examine this substance as it is about being converted from the fluid into the solid state. In several cases of chronic inflammation of this membrane, I (Gross) have discovered tubercles in every possible stage of development, some of them—evidently deposited only a day or two before the individuals expired—being of a soft viscid consistence, and perfectly transparent appearance; others semi-concrete, yellowish, and consequently more or less opaque; and lastly, another set, perfectly dense and firm like fibro-cartilage, organized and covered by an acci- dental serous membrane of the most delicate texture." Why, the similarity of this description to that of the growth of tubercle in the preceding pages is so close, that even those most recently deposited were " of a soft viscid consistence," he says, which exactly correspond to the sticky corpuscles after they are decolorized and destroyed as blood corpuscles. When the blood corpuscles are de- posited in the tubercle in any numbers, before they are decolorized, as often happens, such tubercle would not, of course, be transparent. And it seems needless to add that Gross' teaching of the nature and cause of tubercle was that of the profession of his day, which is not at all like Virchow's, and does not correspond in the least particular with what has been given in the preceding pages. But he unquestionably gave the facts exactly as he saw them after the tubercle was organized, and of what great value they are in this connection has been seen. NEGATIVE TESTIMONY. It has always hitherto been taught under every previous theory of the cause of tubercles, that they were primarily organized, and continued their growth entirely outside of all blood vessels, simply because they were found developed outside of and around arteries and veins of the medium and larger sizes. But one of the strongest possible points EXCESS OF BLOOD CORPUSCLES. 103 of negative proof that could be given to show that they must commence their growth within the capillaries, as is claimed in the preceding pages, is found in the most signi- ficant fact that, tubercles have never yet been found in cartilages, and there are no blood vessels entering cartila- ges, by which the decolorized blood corpuscles would be carried into them to be deposited to make tubercles. Ther.e are, however, little canals ("canaliculi"), running every- where through the cartilage, which can, and do, carry every- thing that is in solution in the blood, to every part of them, and which must and would carry the matter of tubercle into them to be there organized, the same as in bones and all other parts, if that matter were held in solution in the serum, as every previous theory of tubercle has invar- iably taught, was the case. It must be self-evident, there- fore, to every thinking mind, that it is to the blood corpu- cles, which are the only part of the blood that never does or can enter the cartilages, that we must look for the pro- duction of tubercles. Another almost equally significant fact in this connec- tion is this: that tubercles are most frequently found in- vading and destroying parts where the capillaries are most numerous, or lie closest together, as in the lungs, in which the "interspaces are smaller than the capillary vessels themselves;" and less and less frequently where the capil- laries are less numerous, or lie further apart, until we come to the bones which are the least frequently ravaged by tubercles of any vascular tissue; and finally to the car- tilages with no capillaries and no tubercles. All this, too, corresponds exactly with what Virchow says is the actual method of development and growth of tubercles in all parts where they do grow, as is seen by the microscope, not- withstanding his theory of their cause is so entirely differ- ent from that here presented. He says in his Cellular Pathology: " Now, the reason why I think that the name of tubercle 104 CONSUMPTION. must be specially retained for this formation as being ex- tremely characteristic of it, is this, that the tubercle— granule—never attains any considerable size, and that a tuber never arises out of it. Those which are wont to be termed large tubercles, and attain the size of a walnut, or a Borsdorf apple—as for example in the brain—are not sim- ple tubercles. You will generally find the tubercles in the brain described as being solitary, but they are not simple bodies; every such mass (tuber) which is as large as an apple, or even not larger than a walnut, contains many thousands of tubercles; it is, in fact, quite a nest of them which enlarges, not by the growth of the original focus (granule), but rather by the continual formation and ad- junction of new foci (granules) at its circumference. If we examine one of these perfectly yellowish-white, dry, cheesy tubera we find immediately surrounding it a soft, vascular layer, which marks it off from the adjoining cere- bral substance—a closely investing areola of connective tissue and vessels. In this layer lie the small, young granules, now in greater, now in less number. They es- tablish themselves externally [to the previously existing ones] and the large tuber grows by the continual apposi- tion of new granules (tubercles), of which every one singly becomes cheesy; the whole mass, therefore, cannot in its entirety be regarded as a simple tubercle. The tubercles themselves remain really minute or as we are wont to say miliary. Even when on the pleura, by the side of quite small granules, large yellow plates, looking as if they were deposited upon the surface, are met with; these too are not simple tubercles, but masses composed of a large aggre- gate of originally separate granules." Virchow, in giving this minute description of tubercles, of course, recorded exactly what he saw with the micro- scope, as to their internal structure, and their method of growth, without reference to, and independent of any and all theories of their cause, and in that respect it must be EXCESS OF BLOOD CORPUSCLES. 105 entirely reliable. So whenever found, and whatever their shape, whether in mass like a walnut or in thin plates, their intimate structure is the same, and exactly as though made up of capillaries filled, as claimed, with decolorized blood corpuscles. In fact there is nothing in the whole range of diseased developments in any organ or tissue of the animal body that corresponds in the least to his portrayal of the exact make-up of tubercles, except the capillaries filled with the changed blood corpuscles, and this it does fully and perfectly in every respect. In such case the growth must necessarily be, as he says it is, upon and from the surface, not internally, "by the continual formation and adjunction of new foci (granules) at its circumference"; these foci, or granules, being the capillary blood-vessels congested with blood corpuscles that have had their haematin mashed or dissolved out of them, when the resemblance is com- plete down to the most minute detail. And thus the tuber- cle grows outwardly from capillary to capillary to any known size they ever attain, and the larger ones contain many thousands of " granules," capillaries filled with the decolorized corpuscles. When the tubercle suppurates, too, the walls of the "granules" give way, are absorbed or dissolved, and the contained corpuscles flow together pre- cisely as has been described of the congested capillaries and their contents, therefore how can it be otherwise than that the two are one and the same thing? IDENTITY OF DECOLORIZED BLOOD AND TUBERCU- LOUS CORPUSCLES. Tubercles have been long known to be constituted almost wholly—aside from the involved healthy tissues—of almost infinite numbers of very minute granular cells, called tuber- culous corpuscles, varying in diameter from about ttdW to rsW of an inch, which destroy any and every part of an organ in which deposited, unless they are soon absorbed. The resemblance between these and decolorized blood cor- puscles has been in part already pointed out. The two 8 106 CONSUMPTION. are identical in color, being nearly colorless and transpar- ent in their distended state, and varying from a yellowish white to a very light yellowish gray, as both do when shrivelled; in form they are also identical, both assuming the exact shapes, as angular, elongated, star-shaped and the like, upon giving up the water that distended them; and they correspond equally well in size, the blood cor- puscles when distended to the globular form being from about the Wocr to the ->zs^ of an inch in diameter, as are the tuberculous corpuscles in their distended state, while when shrivelled both vary from about ^\s to asVir of an inch in size, measuring from those that are the most shrunken to the longest diameter of those that are star- shaped, elongated, etc. But these are by no means all, nor are they the most important points of resemblance between the two. The internal structure of the two, down to the most minute detail, is the same. Both are constituted, for instance, almost wholly of minute granules, ten to thirty or more, which are also identical in form, color and structure, in- vested with and held together by a cell wall, a transparent membrane of equally delicate structure. Their chemical composition and reactions are also alike. Both contain fatty matter, "partly in very fine granules and partly in vesicles," and the same salts, as the chlorides, phosphates, and the like; while the action of acetic acid upon the one is identical to what it is upon the other. But the most striking and most characteristic, perhaps, of all their resemblances is that neither has a nucleus, and yet these are the only two exceptions, the only two kinds of cells, in the great number and variety of cell-structures throughout all animal life that are destitute of nuclei. What can all this mean, then, except that the tiro are the SAME? WHAT BECOMES OF THE H/EMATIN. The haematin, or coloring matter, which is washed out EXCESS OF BLOOD CORPUSCLES. 107 of those corpuscles that are decolorized, is unquestionably disposed of as follows: The young and more vigorous of scrofulous subjects, many of whom go into consumption in after years, are marked upon the face and hands with the so-called sun-spots or freckles. These are from a de- posit of haematin in spots, often in quite large patches, just beneath the scarf-skin of the hands and face, and sometimes upon other parts of the body; at least the so-called moth spots of such subjects, are no doubt from the same cause. In the less vigorous and older of these subjects, or in those where their disease has advanced to the point of exhausting their vital force, so that they can no longer throw the surplus haematin to the surface and rid the cir- culation of it through that comparatively non-vital part, the skin, it is then thrown off, as long as it can be, through the internal or more vital organs or parts; through the kidneys,. for instance, giving the deep or dark color to the urine, so nearly universal in such cases; through the bowels, caus- ing the too deep color, dark brown, etc., so common to the faecal discharges, in disease, even up to those that are almost black; and it is also no doubt disposed of in other ways, in too deeply colored diseased products. It is a well settled fact in pathology that many, if not all, diseased formations possessing colors ranging all the way from light yellow up to and through all the shades of red, even to the black, are colored by haematin, or a material very similar to it. What then, is more natural, than that this should be from the surplus haematin washed out of decolorized corpuscles? Such colored products are cer- tainly not found in health, but often, if not always, when there is evidence of a watery state of the blood, or this is a deranged state. When the blood is in a healthy or nor- mal condition, no such colored abnormal products can, by any possibility, appear. Another point in this connection also demands attention. 108 CONSUMPTION. In malignant cases of typhoid and scarlet fever, and in other cases of malignant acute diseases, purple spots called petechias, purpura, etc., are developed upon various parts of the body. And in these cases we have the positive evidence of a profuse waste of albumen, and of the blood being in a more or less dissolved state; therefore such spots also owe their origin to the coloring matter dissolved out of the decolorized corpuscles. DISPOSITION OF EXCESS OF FIBRIN. 109 CHAPTER XV. DISPOSITION OF THE EXCESS OF FIBRIN. In the disposition of the excess of fibrin left in the blood by a loss of albumen, we find the most remarkable and reliable evidence, to be found anywhere in diseased action, if not equal to anything found in health, of the preservative care that nature is constantly exercising over us in health as well as in disease. It has often been said that fever is a purifying process to rid the system of effete or morbid matters, and'that other diseased conditions have a similar purpose; but the proof of this is not so easily established. It is a complicated subject, and just what the morbid matters are that require to be expelled it is very difficult, if not impossible, in the present state of our knowledge to always make out. Not so, however, in regard to the excess of fibrin, or a portion of it; for in the formation of abscesses, or the deposit of a mass of tubercle, whether small or large, fibrin is poured out into the tissues around the gathering mass and condenses into a firm, dense and impervious wall for the resulting cavity. An excess of fibrin gives a greater coagulability, or plasticity to the blood than it possesses in its natural state. Of this Carpenter says: "This increased plasticity of the blood, however, may frequently be regarded in the light of an 'effort of Nature' to antagonize the consequences of that depression or posi- tive destruction of the vitality of the solid tissues which seems to form an essential part of an inflammatory condi- tion; and thus it is, that whilst the central part of a mass 110 CONSUMPTION. of tissue, in which the inflammation has been most intense, suffers complete death, and is carried away in the suppu- rative process, the peripheral part, in which the violence of the inflammation has been less, becomes infiltrated with plastic matter poured out from the blood, and forms the solid and impermeable wall of the abscess." But for this provision or "effort of Nature," death would occur from the simplest abscess, or even from a common boil; first, either from the extensive diffusion of the pus through all the adjoining tissues, thus poisoning vital parts and even the blood itself, or, secondly, from the inability of the blood-vessels that are thus cut off by the suppuration, to close, which would allow the patient to bleed to death in spite of anything that could be done by art to prevent it. On this point the same author says: "The results of deficiency of coagulating power in the blood are fearfully seen in that continued and uncontrolla- ble flow which takes place in purpura, the blood not being able to form a clot sufficient to fill up even the wound made by the scratch of a pin; in the want of circumscrip- tion of collections of pus within an abscess, allowing its infiltration through tissues that were previously healthy, and thus occasioning a widespread destruction of organ- ized texture, which is characteristic of certain forms of inflammation"; and "in the want of a corresponding lim- itation between the living and the dead parts in gangrene, so that haemorrhage takes place on the separation of the slough, the vessels not having been previously obstructed by coagula." Every tubercle, however large or small, and wherever deposited, whether in the lungs or other organs, is closely invested by a portion of the excess of fibrin, evidently poured out around it for the express purpose of having it condense into the firm wall described, before the tubercle suppurates, thus circumscribing and localizing as much as possible the destruction of tissue by its suppuration, and DISPOSITION OF EXCESS OF FIBRIN. Ill preventing the diffusion of the pus through a large portion of a lung or other part, to fatally poison everything with which it comes in contact. And, besides this, we find the other equally, if not more important protection afforded by the said wall, in the fact that it condenses firmly around every blood-vessel, thereby tying each one of them, so to speak, while at the same time they are plugged by coagula of fibrin forming within them, thus doubly guarding against fatal haemorrhages when the abscess bursts. All the smaller and medium sized vessels involved in a mass of tubercle are almost universally closed in this way, while in the great majority of cases the larger and even the largest vessels are as effectually taken care of in the same man- ner. But for this preservative care exercised over them, every patient would speedily bleed to death upon the burst- ing of even the smaller or smallest abscesses. Time, and often a long period of time, is thus ensured, in which we may bring to bear the proper curative means to stop the loss of albumen, and thereby stop all that usually fol- lows from that cause in such cases, and so restore the patient to health. But we must be sure that it is the proper curative treatment that is adopted, and not some- thing that will aggravate every feature of the case. Such preservative efforts so constantly and, for a time, so effectually exercised over us should give mankind greater confidence in Nature, or the life principle within us, than has ever hitherto been manifested; and should teach us to avoid violence in trying to remedy mere effects, but to reach and control the primary and true cause of all by healing the mucous membranes, and thus preventing the further waste of albumen. Another portion of the excess of fibrin in these cases is disposed of in the organization of "false membranes" forming adhesions upon the pleurae and other parts. M. Louis says of such adhesions in the lungs of consump- tives : 112 CONSUMPTION. "Nothing was so frequent as the adhesion of the lungs to the pleurae; for in a hundred and twelve cases there only existed one in which the two lungs were free in the whole of their extent. We have only found the right lung com- pletely without adhesions eight times; the left only seven, and in these cases there were either no tuberculous exca- vations or only those of very limited dimensions." Carpenter says of false membranes and adhesions: " We see the consequences of excess of the proportion of fibrin, and of that increased plasticity (or tendency to fibrillate) which usually accompanies its augmentation, in the tendency to form those plastic effusions which are so characteristic of the inflammatory state, and which, if poured out upon serous or mucous surfaces, constitute 'false membranes' and 'adhesions,' or if infiltrated into the substance of living tissues, occasion their consolida- tion." Even such a disposition of the excess of fibrin is by no means the unmixed evil that it might seem, and which it has been hitherto generally regarded; for, if it was not expelled from the blood, into, or, upon some part or parts, but allowed to accumulate in the blood-vessels, clots of it technically called "emboli," and "thrombi," would soon form and rapidly increase in size by more of it adhering or attaching to them, until a large artery or one of the cavities of the heart would be filled, with almost instantly fatal results. This actually and not unfrequently appears in some cases of tuberculosis and in malignant cases of diphtheria, when the patient always dies suddenly. The same cause also not uncommonly terminates life suddenly in other diseases, as in apoplexy, inflammation and enlarge- ment of the heart following inflammatory rheumatism, and the like. Hence if the excess of fibrin was not poured out from the blood-vessels to form false membranes and adhe- sions in consumption, most consumptives would die sud- denly and in the early stage of their disease, from such DISPOSITION OF EXCESS OF FIBRIN. 113 clots forming iu the circulation: Another fact to induce us to place more trust in Nature's modus operandi. As diphtheria has been heretofore mentioned, it may be well to say that the membrane in this, and also in mem- braneous croup, which is the cause of so much danger in both diseases, is constituted almost solely of fibrin, and from an excess of it left in the blood by a loss of albumen, through the mucous membranes, and when the clots form in the vessels that so suddenly take life, it is because, first, either the fibrin is brought so rapidly into a relative excess by a profuse and rapid loss of albumen; or, second, the excretion of it is interfered with to such an extent that the circulation cannot rid itself of it, and it coagulates because of its great excess therein. 114 CONSUMPTION. CHAPTER XVI. WHAT RESULTS FROM AN EXCESS OF FATTY MATTERS. M. Louis says of his extensive examinations of the dead of consumption: " The fatty transformation of the liver was the most fre- quent, and at the same time, most remarkable alteration of this organ. It existed in one-third of the cases (forty out of one hundred and twenty). In this condition it was pale, almost always of a light brownish-yellow color, spotted with red externally and internally. It retained its natural form; but its volume was nearly always augmented and at times double its usual dimensions. * * * * Its consistence (with the exception of cases where the alter- ation was but slightly pronounced) was greatly dimin- ished; it easily yielded to traction, and was sometimes much softened. In very advanced cases the scalpel and hands were greased as by ordinary fat substances. When the morbid change was less evident, we ascertained its ex- istence by placing a thin section of the liver on a piece of paper and exposing it to the flame of a candle; a very slight heat melted a small quantity of fat, saturated the paper, and thus demonstrated its presence." Of the cause of all this he says: "The causes of the fatty transformation of the liver appear to us equally as obscure as those of other chronic diseases." The cause, however, is not obscure when it is once estab- lished to be a loss of albumen through the mucous mem- RESULTS FROM EA'CESS OF FATTY MATTERS. 115 branes, leaving a relative excess of fatty matters in the blood-vessels. Such excess cannot, of course, be allowed to go on accumulating in the blood any more than could the excess of fibrin, or all nutrition would soon be de- stroyed; hence it is poured out, or deposited in the liver in the cases named, to rid the circulation of its injurious presence; and herein lies the explanation of the so-called fatty transformation and fatty degeneration of various tis- sues and organs, which has hitherto been regarded as one of the greatest mysteries in disease. Of course, the pres- ence of the accumulating fat upon the natural tissues of an organ would necessarily cause these to be absorbed and give place to the encroaching substance, and so an organ may be changed in part, or almost wholly to fat, without our having to resort to a mere assumption of the metamor- phosis of all kinds of tissues into fat. The question remains to be properly settled why the two-thirds of M. Louis' cases did not show fatty livers, or what became of the excess of fat in such cases. Albumen was lost in these just as certainly as in the other cases, and, if there is any truth in the foregoing theory, the fatty matters were left in the same relative excess in the blood. Well, here is the solution of this point. Nothing is more common than for consumptives to throw off oily matters in their expectoration, by the bowels and through the kid- neys; while not a few have oily perspiration, and it is in these several wrays that those who do not have fatty livers, or other fatty deposits in the system to use up the fat, dis- pose of their excess of fatty matters. Some years ago I was consulted by a young lady who had suffered several years from a severe chronic nasal catarrh, and the one symptom of which she complained more than all the rest was an almost constant oily secre- tion upon the nose and adjoining portions of the cheeks. It could often be seen, and always felt, greasing the fingers when passed over it. And only very recently, in carefully examining every feature of a case of very large ovarian 116 CONSUMPTION. tumor, I found the patient's urine completely covered with a thick film of oily matter. This patient has had for years, and now has, much throat and bronchial irritation, with wheezing or rattling cough and considerable expecto- tion, therefore has long been and is now losing considera- ble albumen. HOW THE EXCESS OF SALTS IS DISPOSED OF. The excess of salts, of which there are 41 grains left in the blood for the loss of each ounce of albumen, is dis- posed of similarly to the excess of fatty matters; that is, by deposit in living tissues, causing the so-called ossifica- tions found in various parts, or it is thrown off in the expectoration, through the bowels, or by the kidneys. The urine of consumptives is almost always heavily loaded with salts, thus relieving their systems of a great portion of the excess of salts, and it is not uncommon for them to throw up actual calcareous concretions of considerable size, or even branches of them that have formed in the bronchial tubes, while nothing is more common in scrof- ulous as well as consumptive subjects than an enlarge- ment of the ends of the bones in both the small and large joints, by which a greater or less portion of the excess of the salts in their system is constantly being disposed of. Bony tumors in scrofulous subjects, afford another means for ridding their blood of a greater or less portion of the excess of salts. Calcareous concretions, or chalky deposits in the joints, is the way in which another class of patients dispose of the excess of salts in their blood. This is not an uncom- mon occurrence, and is, in fact, an almost every day expe- rience in practice. THE EXCESS OF EXTRACTIVE MATTERS. The extractive matters being regarded as mostly if not wholly refuse matters, little being known of their com- position, it is impossible to determine as yet to what dis- eases or diseased conditions their excess leads; though there can be little doubt that they must produce disturb- ances or diseases characteristic of their composition. CONTAGIOUS OR GERM THEORY. 117 CHAPTER XVII. THE CONTAGIOUS OR GERM THEORY OF THE ORIGIN OF CONSUMPTION. Consumption is an inheritable disease, and is inherited in many cases. All the arguments that it is possible to bring forward cannot overturn this clinical observation of centuries. Contagious diseases, on the contrary, are not inherited. Small-pox, scarlet fever, measles, whooping- cough, cholera, etc., are not inheritable diseases and are never inherited. If a child has either of the first three in utero, as is sometimes claimed, but which is very rare if it occurs at all; nevertheless the child does not inherit the disease but has it by communication from the mother's blood, goes through it as in extra-uterine life, and that is the end of it. Even in that most virulent of all contagious poisons, viz., syphilis, the primary disease is not inherited, but only the secondary or tertiary form of it, and in that form it is not communicable by contagion or contact. Or, if by possibility, the child does have the primary disease during uterine life, it is because of the mother's having it in the primary form at the same time and communicating it to the child directly through the blood, as claimed for small-pox, scarlet fever, or measles; but this is not inher- iting it, as is the case with consumption. In case of the child's having primary syphilis develop soon after birth, and not before, it is then infected from the mother by direct contact during birth, so in any event the primary disease is not inherited in that form any more than any of the other contagious diseases. And here it is well to 118 CONSUMPTION. bear in mind that when syphilis is inherited in the second- ary or tertiary form, it is a certain cause of consumption with many of the victims, which is another and strong proof that phthisis does not have one special or specific cause. Again, if there is a specific germ of tubercle, all tuber- cles must be produced by such germs, and never by any- thing else. It would be falsifying the whole logic and economy of nature to say otherwise. Corn, oats or barley cannot produce wheat, nor can the latter produce any of the others; nor can anything in all nature, or any combi- nation of things, produce any of these grains, excepting the specific germ that was created to produce each of its kind. The virus of small-pox cannot produce scarlet fever or measles, or vice versa, and neither of these diseases can be produced by anything but its own specific virus; hence it is repeated that if the tubercle has a germ in any case, it has it in all cases and must always be produced by that specific germ and never otherwise. Do we not all know, on the contrary, that it has numerous primary or remote causes? And when the effects of these primary causes are scrutinized it will be seen that in all cases they act in producing catarrhal irritations of the mucous membranes, a waste of albumen, and through this the tubercles. Noth- ing is much more common than the fact that many pri- mary syphilitic subjects, after their disease has been sup- pressed, sooner or later go into consumption; but this is because the poison in such cases locates upon the mucous membrane of the lungs, greatly irritates it and thus leads on to consumption; and the same is often true of those who inherit the secondary or tertiary form of syph- ilis. So common is it that syphilitic subjects, whether through inheritance or otherwise, have consumption, that it has led some able writers to assume that this poison through remote inheritance if not of recent origin, is the cause of all tubercles. But this is, of course, an error, CONTAGIOUS OR GERM THEORY. 119 although it is a fact that suppressed primary syphilis, and the inherited secondary and tertiary forms of it, will and do often produce tuberculosis in such subjects; this also destroys all claim to the latter having a specific contagion or a germ of its own to always cause it. But we have much more direct evidence to overturn this germ theory of the cause of tubercles, as will be seen in the following: In 1878 the Queen of England commissioned Prof. Andrew Clark, F. R. C. P., of London, to accompany the Marquis of Lome and family on their official voyage out to Canada that year. After completing the duties of that mission, Prof. Clark visited New York and delivered a lecture to the physicians of that city, on the " Varieties of Pulmonary Phthisis," in which the following positive statements were made: " You know that some years ago Villemin experimented upon rabbits, producing what was then called tuberculosis. At that time, with the assistance of two colleagues, I was also experimenting, and I discovered that not tuberculous mat- ter merely, but almost any matter injected into the neck of the rabbit would be followed by symptoms which some would call acute tuberculosis; that is to say, the inocula- tion of pus into the neck of the rabbit was followed in eight or nine days by an eruption of little bodies resem- bling tubercles, scattered throughout the body. You also know that nine-tenths of those who have written upon the subject yet believe, both in England and in this country, that it is acute tuberculosis, and I introduce the subject for the purpose of entering my protest against such views. Now, in all the animals the phenomena observed were as follows: There was, after the inoculation, a little fever; and I defy anybody to cut an animal, however slightly, without producing a little fever. After eight or nine days there was an eruption of what, we will admit for the mo- ment, was tubercles. Following this peculiar eruption, if 120 CONSUMPTION. the rabbits were kept in tolerably favorable circumstan- ces, the entire process of so-called tuberculosis passed away, and the health of the animal was entirely restored. Now, it seems if we are to call that acute tuberculosis, we are using language wrongly, for there is nothing in this disease which attacks adults or children that prevents ill effects upon the system. It develops the phenomena of fever, which fever progresses more or less regularly, and at the end of three to six weeks the case terminates in death. With this brief reference to acute tuberculosis, I will dismiss this portion of the subject."—Nciv York Med- ical Record, December 14, 1878. Here, at last, then, tubercle stands before us stripped of all its mystery, in so far as the claim of its being repro- duced alone by itself, or caused by any one specific taint or poison; and Prof. Clark and his colleagues deserve the thanks of the profession for their work, and the candid enunciation of the results thereby obtained. The battle is almost won in any contest with nature, when the glamour of mystery that want of knowledge throws around most subjects, is once dispelled. Bear in mind the full force and significance of the lan- guage quoted, viz.: "Not tuberculous matter merely, hut almost any matter injected into the neck of the rabbit, would be followed by symptoms which some would call acute tuberculosis." Common pus is especially spoken of as causing such a state of the system; and right here comes up a point of great interest, for common pus, that is, its corpuscular element, is nothing more nor less, in any case, than red blood corpuscles that have stagnated, or been congested in the smallest blood-vessels of a part, and been decolorized either before or after their deposit, but not given time or opportunity to shrivel, the same as are all tuberculous corpuscles, so-called, when the blood corpus- cles have been similarly congested in the capillaries, but time and opportunity given them to shrivel. CONTAGIOUS OR GERM THEORY. 121 It Ea afters not, with reference to our present inquiry, whether Prof. Clark was right or wrong in denying that the conditions produced were acute tuberculosis. The point is, he says he " discovered" that whether he inocu- lated with "tuberculous matter," "common pus," or "almost any matter," " in all the animals," the results were the same. If tuberculous matter did not produce tuberculosis, or if any other matter did, in either case the whole claim of a specific nature, or poison, in tubercle, falls to the ground —a fact, certainly, of the utmost importance to know on a subject involving the lives of one-fifth of our race, and one which has hitherto been obscured by so much guessing. This, then, remands this whole subject of tubercle to the domain of reason and the stern logic of facts, of which sufficient is already known for its complete and proper solution. Tubercle constitutes but one factor in the dis- ease we call consumption, as night sweats do another, fatty livers another, adhesions of the pleura another, the great and characteristic emaciation another, and so on; and the logic of them all, and of their combination to make one general whole, nothing does or can explain but the waste of albumen. Again, October 18, 1882, Prof. H. F. Formad, of the University of Pennsylvania, read a paper, by invitation, before the Philadelphia County Medical Society, on " The Bacillus Tuberculosis and some Anatomical Points which Suggest the Refutation of its Etiological Relation with Tuberculosis," published in the Philadelphia Medical Times of November 18, 1882. After stating that he had examined " microscopically the tissues of about five hun- dred animals" for the National Board of Health, "and also those of a similar or still larger number of various animals used by members" of his "classes in experimen- tal pathology in the University laboratory during the last five years," he divides all animals into two classes, the scrofulous and non-scrofulous, as follows: 9 122 CONSUMPTION. "To the scrofulous class belong unquestionably the tame rabbit and guinea pig, and all animals in close confine- ment; while to the non-scrofulous belong the cat, dog and animals at large." Then he says if the scrofulous animals are inoculated, or have introduced under their skin, any kind of matter, whether tuberculous, diphtheritic or whatnot, even to "chem- ically clean powdered glass," and survive the first results of the experiment, large numbers of them die of tubercu- losis. But inoculating the non-scrofulous animals in the same way, that is, under the skin, even with pure tuberculous pus, will not produce tuberculosis. This class requires the introduction of the inoculating material into the peri- toneum, or the anterior chamber of the eye, whether it be tuberculous pus or the so-called bacilli tuberculosis, in order to produce tubercles in them. And here, again, if other kinds of matter be introduced into the same parts, even to common sand, the results are the same as if tuber- culous matter were used. This, as will be seen, utterly annihilates all claim to there being a specific cause of tubercles. His statements are so positive and unequivocal that liberal quotations are given from them, and even the whole lecture might be quoted with advantage, so import- ant and so directly applicable is it to our subject. In a well sustained argument showing the great liability of injuries to the serous membranes resulting in tuberculosis, among many other things he says: " True tuberculosis can be produced in non-scrofulous animals through simple injuries of serous membranes; and this seems to be also well established for men." ******* " The second exceptional point in the etiology of tuber- culosis is the occurrence of miliary tuberculosis secondary to simple inflammation of serous membranes in normal non-scrofulous beings. Experiments, clinical observations, and autopsies sustain this fact. At the same time it ap- CONTAGIOUS OR GERM THEORY. 123 pears that inflammatory processes affecting parts of the body other than serous surfaces do not lead to tuberculosis in non-scrofulous subjects. I will recall here that the an- terior chamber of the eye, which is occasionally used as a point for inoculation with tubercular virus, is also a serous sac. Of the same character is the choroid coat, of which ophthalmoscopic examination reveals tubercles so beauti- fully in cases of miliary tuberculosis." " There are cases on record of traumatic injuries of the eye-ball in non-scrofulous persons, in which general tuber- culosis was a consequence." 7^ 7f> ~ *F 'I* *r» " First Litten, clinician to the Charite" in Berlin, and subsequently other clinicians and pathologists, called attention to the important fact that true miliary tubercu- losis may be caused directly by acute pleurisy and perito- nitis in persons not predisposed to phthisis, and without any cheesy masses being found in any part of the body. * * * * Again, it is a well-known fact—any text-book of pathological anatomy gives it—that inflammatory products in serous membranes give rise occasionally to peculiar nodular formations, the so-called pseudo-tubercle. * * * * Moreover, it is also well established that primary true tubercle occurs in the organized inflammatory products of serous membranes." ******* " Koch has unquestionably produced tuberculosis in the peritoneum of his cats and dogs." And he "could just as well have used some sand for inoculation, and saved his valuable cultures of the bacillus tuberculosis for inocula- tion into some other parts of the bodies of the non-scrofu- lous dogs, cats, rats, etc." " Why did Dr. Koch inoculate the latter named animals only in the peritoneum and anterior chamber of the eye, while scrofulous animals (rabbits and guinea pigs) he inoculated indiscriminately in any part of the body? This is a mystery. Let us try to solve it." 124 CONSUMPTION. " I wish to mention some of our experiments in connec- tion with tuberculosis." " The experiments on diphtheria, of Prof. H. C. Wood and myself, have shown that those rabbits which did not succumb to the disease within a few days, nearly all died of tuberculosis in the lapse of four to six weeks or more. In order to see whether the diphtheritic material acted specifically in the production of tubercle, or whether the latter was merely the result of inflammatory process, we experimented by inoculating rabbits with non-tubercular and perfectly innocuous foreign material, such as pieces of glass, metal, wood, etc. The result was, in the majority of cases, cheesy, suppurating masses at the seat of inocula- tion, followed in the course of a month or more by death from tuberculosis." " To-day I can safely testify that Dr. Wood and myself have seen die of tubercular disease proper more than one hundred rabbits out of five or six hundred operated upon, without a single one of these animals having been know- ingly inoculated with tubercular matter of any kind, and without any intention on our part to study tuberculosis in them. All rabbits and guinea pigs subjected to injury in any part of the body in the various experiments and sur- viving the immediate or acute effects of the latter, had, with only a few exceptions, but one fate, viz., to die of tu- berculosis, provided they lived long enough after a trauma- tic interference to develop the lesion in question." " These facts were also particularly well brought forward by the results of a carefully conducted series of one hun- dred special experiments on tuberculosis, executed by Dr. O. C. Robinson, in the Pathological Laboratory of the Uni- versity of Pennsylvania:" " In non-scrofulous animals, viz., other than rabbits and guinea pigs, neither Robinson nor Wood and myself, nor any other experimenter, ever succeeded in producing tuber- culosis by inoculation, unless done in the peritoneum or anterior chamber of the eye." CONTAGIOUS OR GERM THEORY. 125 " No one, including Koch, ever produced tuberculosis in animals not predisposed to it, by inoculation into the skin, for instance. Koch's records of his own experiments prove this, and show that whenever he desired to produce tuber- culosis in the rabbit or guinea-pig by means of his bacillus, he inoculated indiscriminately into any part of the body; but if he wanted to demonstrate the effects of his parasite in the non-scrofulous animals, he promptly inoculated into the anterior chamber of the eye, or preferably into the peritoneum. After what has been explained in connection with inflammation in serous membranes, it is evident that these experiments do not prove that the bacillus is the cause of tuberculosis." Here are many things to consider, but Prof. Formad's statement of facts is so clear and explicit that a general recapitulation cannot be necessary. There are a few points, however, to which special attention should be given. "Koch's records of his own experiments prove" that he could not produce tuberculosis "in the non-scrofulous animals," " by means of his bacillus," unless he inoculated into the peritoneum or eye. Again, no "experimenter ever succeeded in producing tuberculosis " in " non-scrofulous animals" by inoculation with tuberculous or whatever kind of matter, " unless done into the peritoneum or anterior chamber of the eye." And yet, the insertion of "pieces of glass, metal, wood, etc.," into the same parts would produce tuberculosis just as readily as would tubercular pus or the bacillus tuberculosis; while the simple insertion of the same non-tubercular materials under the skin of scrofulous animals produced identically the same results that the tuber- cular matter had upon that class. Could anything more positively and absolutely prove the non-specific character of tubercular matter, or the bacillus tuberculosis as an in- fectious agent, than this? If wood, glass, etc., produce exactly the same results as the so-called parasite of tuber- cles, when used in the same way, medical men had better 126 CONSUMPTION. give their time to other things than to waste it trying to prove that tuberculosis is a specific contagious disease. Another fact to consider is the great number of animals, a thousand or more, operated upon and examined by Prof. Formad. This effectually precludes the possibility of mis- takes to which a few experiments might lead or with which they might be reasonably charged. Think of this: " More than one hundred rabbits out of five or six hundred oper- ated upon," dying of tuberculosis, "without a single one of these animals having been knowingly inoculated with tuber- cular matter of any kind, and without any intention on our part to study tuberculosis in them." And "all rabbits and guinea-pigs subjected to injury in any part of their bodies in the various experiments, and surviving the immediate or acute effects of the latter, had, with only a few exceptions but one fate, viz., to die of tuberculosis, provided they lived long enough after a traumatic interference to develop the lesion in question." Many of these developments it must also be borne in mind, were the result of inoculation with diphtheritic membrane, in their study of that poison. If this does not effectually dispose of the germ theory of the origin of tubercles, then nothing ever can or ever will. But the critical reader may say of all this, that it proves too much for the good of this volume; and ask what be- comes of the claim, that it is a waste of albumen from the blood that causes tuberculosis, if tubercles are so readily produced by the simple insertion of any form of non-tuber- cular matter, either under the skin of some animals or into the peritoneum of all others. This is not an idle question, and can be settled only by candor and a strict adherence to the truth, or to all the facts bearing upon it. It is a common, if not a general thing, for experimenters upon animals, in their efforts to produce tubercles, to first poorly feed, and also to keep in close confinement for a considerable time, the animals upon which they intend to operate. Prof. Formad says on this point: CONTAGIOUS OR GERM THEORY. 127 " Non-scrofulous men or animals may acquire the pre- disposition to tuberculosis through mal-nutrition and con- finement." ********* " The first experiments to produce artificially and inten- tionally a scrofulous condition in the cat and dog were made by Dr. A. C. Robinson, in.the Pathological Labora- tory of the University of Pennsylvania, in 1880. This he accomplished by keeping the animals in close confinement and on rather poor diet for eight months. Injuries on the skin of the neck which previously had healed promptly, now repeated, gave rise to a bad cheesy suppuration, and within three months the animals died. Autopsy revealed miliary tuberculosis of nearly all organs." " I have lately repeated this experiment on cats. Taking a piece from the upper lip of one of them, the connective tissue was found normal on microscopic examination. One year later, this cat having been kept in confinement and poorly nourished, again a part of the lip was examined, and I found the connective tissue similar to that of a scrof- ulous animal, the lymph spaces being filled with many cells. No injury had previously been inflicted on the lip. The cat had been inoculated with diphtheritic and erysipe- latous matter several times, both in the thigh and the back, which ultimately led to a cheesy mass at the seat of inocu- lation. Finally the cat was accidentally killed, and miliary tubercles were demonstrated in lungs, liver, kidneys, spleen and lymphatic glands. Three other experiments, in which the animals were not kept so long a time, failed. One of a number of well-fed dogs which I have kept for the past eighteen months (tumor experiments) was accidentally killed, and microscopic examination showed the impair- ment of the connective tissue of the described scrofulous character to a moderate degree." ********* " It is highly probable from the above experiments on animals that the normal man may acquire a scrofulous anat- 12S CONSUMPTION. omy if ill-nourished, from a long continued disorder of the digestive tract, from the deficiency of food or exercise, etc., this condition predisposing to tubercular disease. A cold or bronchitis, which in former days passed off rapidly, now in his debilitated system hangs on and leads to phthisis." Well, it cannot require either evidence or argument to show the consequences upon animals of a " poor diet" and " close confinement," continued for from eight months to a year, and even longer in some cases. Among the certain and inevitable effects of such treatment are emaciation and a too watery state of the blood, just the same as when albu- men is lost. And why? For the simple and sufficient reason that poor food and a deficiency of even that does not furnish the animal with enough albuminous matter to supply the blood with its requisite quantity of albumen; therefore, this is primarily deficient therein in all such cases, with many of the consequences to which its waste leads, the serum being made or left very watery thereby. And the blood corpuscles, or the older and weaker of them, can no more live and keep healthy in this too watery me- dium, than the salt water fish can live and keep healthy in fresh water, or in that which is deficient in salt below what its nature requires. Such corpuscles, therefore, are bloated or become dropsical, are distended to the globular form, have their haematin taken out of them, are left colorless, become sticky in the change, lodge in the capillaries in consequence, distend these into protuberant sacs under the force of the circulation from behind, then slowly give up the excess of water that has wrought these destructive changes in them, and shrivel to become the so-called tuber- cular corpuscles—the capillary sac so filled, or a very few of these together, constituting the miliary tubercle, while large numbers of adjoining capillaries filled in the same way constitute tubercle in mass, to any size that the latter is ever known to grow. It matters not whether it is pur- posely depriving the animal of albuminous food, or whether CONTAGIOUS OR GERM THEORY. 129 it is a waste of albumen in catarrhal discharges from the mucous membranes, that causes its deficiency in the blood, thus leaving this too watery, the results must of course, be the same upon the corpuscles circulating in this thinned serum, and the consequences to them wholly due to that in either case. And this brings up another matter of importance. Every observing physician knows that either men or ani- mals poorly fed finally become very catarrhal, if not made so at first by such treatment as many are; hence, in their catarrhal discharges, in addition to the fact of its being already deficient in the blood in consequence of poor feed- ing, all such persons waste albumen; so here we have a double cause for the deficiency, and results to correspond. What physician, especially in city practice, has not seen babies become catarrhal that are brought up on the bottle with both stale and too watery milk, and seen many of them go down with dropsy of the brain, a purely tubercular dis- ease (Wood), if they do not perish in the catarrhal stage of the quicker acting disease, viz., cholera infantum? Prof. Formad says, as will be seen in the last paragraph quoted from him, that the "normal man," that is "ill-nourished," contracting " a cold or bronchitis, which in former days passed off rapidly, now in his debilitated system hangs on and leads to phthisis." In this case we know there is a profuse waste of albumen in the expectoration from the cold and bronchitis, therefore here again the evidence is made complete on this point. Is there, then, no such thing as the bacillus tuberculosis, about which so much has been said and written? There is what has been called bacillus tuberculosis, but let us see how simple this whole question is made by a few plain facts. Every tubercle is encased in a dense impervious wall of fibrin. Besides this there are partitions, bands, cords, and threads of fibrin running through every tubercle, and in addition there are also flakes of it in many of them. 130 CONSUMPTION. In all instances this fibrin exits in threads woven and bound together to make the walls around, and the parti- tions, bands and cords of it through tubercles. When the tubercle softens under suppuration much of this organized fibrin is first disintegrated into the separate threads that compose it, and then these threads, under the further rot- ting by the suppurative process, are broken up into short sections, which have recently been dignified with the title bacilli tuberculosis, whereas, they are nothing but pieces of the threads of fibrin broken up in a somewhat peculiar manner, by, or under the slow rotting of the tubercle. The author has taken fibrin from a perfectly healthy animal's blood, washed the clot until there was nothing else left in it but fibrin, placed it under a microscope and has seen it to consist of nothing but threads in enormous numbers; then he put it into a small quantity of distilled water to rot, rotted it slowly, and thereby obtained precisely similar forms, to what Professor Eberth of Germany obtained from the sputa of consumptives and labelled, bacilli tuberculosis. Now, there is no mistake about any part of these state- ments. There is fibrin in and about every tubercle as asserted; this fibrin is much of it disintegrated and sepa- rated into its individual threads by the suppuration of the tubercle; and then the threads, or many of them, are broken up a little later into short pieces, which then cor- respond in every particular to the bacilli tuberculosis. The author has seen a specimen of said bacilli, prepared by Professor Eberth, who is one of the highest authorities upon the subject; has also rotted fibrin slowly in a small quantity of water as stated, thus breaking up the threads of it in a similar manner to the suppuration cf tubercle, compared the two, and found them identical in color, length, size, a partially frayed out appearance at the ends of many of them, and the same of some of them at points along their sides, etc. These statements, therefore, are not mere assertions, but demonstrated and established facts, CONTAGIOUS OR GERM THEORY. 131 and when in connection with the facts asserted by Profes- sors Clark and Formad, after such extended investigations, viz., that tubercles are readily produced by " almost any matter," wood, sand, powdered glass, diphtheritic mem- brane, or what not, introduced under the skin of scrofulous animals, or into the peritoneum or the anterior chamber of the eye of non-scrofulous animals, it is not too much to say that the whole claim of tuberculosis being contagious, or the tubercle having its specific germ, is completely over- turned, rests upon no scientific basis whatever, and all the literature with which the profession has been flooded within the last few years, sustaining that claim, is worse than useless. "Here is another significant fact. Not one of all the investigators and advocates of the germ theory of the ori- gin of tubercles, has ever told us there were fibrin forms in tuberculous pus, corresponding in appearance to their bacilli tuberculosis, or made the slightest allowance for their presence; and yet such forms are present therein in every instance. Why this silence? Simply because they did not stop to consider that such forms of fibrin were present, and mistook them for something else, which, under the craze to account for all diseases by means of bacteria, they elevated into the position of germs of tubercles. The fibrin threads always, and without exception, break up into sections, or pieces, under rotting, no matter where or how this rotting is carried on, and these pieces are the bacilli of the germ theorists. The suppuration of the tubercle is a rotting process and always performed slowly, because of too little fluid to hasten it, as in the case of rotting fibrin in plenty of water, or in acute abscesses. Hence the results from disintegrating the fibrin threads is somewhat differ- ent in the former, from the two latter instances, although as previously said, the slow rotting of pure healthy fibrin in but little water will bring the same results upon some or much of it, as is done by the slow suppuration of tubercles. 132 CONSUMPTION. Finally, the reader must not forget that the conditions which certainly lead to tubercles in many cases, exist long prior to the tubercles, or any possible germs of them; and that these conditions are produced by causes as different from the assumed bacilli tuberculosis as it is possible to conceive. There is the debility, the emaciation, and the too watery blood, that no specific germ ever did or could produce, which for years or more, and not infrequently half a life-time precede the tubercles, and which have their ample cause in a waste of albumen from the blood in catarrhal or mucous discharges. Again, there is the fact that the blood corpuscles cannot live and keep healthy in this too watery serum, or only the younger and strongest of them can exist for a time, while the weaker and older ones, or those past middle life, must be and are decolorized into so-called tuberculous corpuscles, which are deposited to make the tubercles, and which, as we have seen, no amount of argument can disprove, but everything sustains. Indeed, the germ theorists reverse and invert the whole order of nature, for their so-called germs do not appear until the fruit, viz., the tubercle, has ripened, in fact not until it has begun to decay; and then we find them to be nothing but pieces of broken threads of fibrin, or the most natural and simple results, not causes, that can be con- ceived of. Is it any wonder that Professors Clark and Formad found, after such careful and extensive investiga- tions, that the facts in the causation of tubercles were wholly at variance with the claims of the theorists? Entered according to Act of Congress, in the year 1883, by Rollin R. Gregg, M. D., of Buffalo, N. Y.. in the Office of the Librarian of Congress, at Washington, D. C. A SIMPLE SOLUTION OF THE MYSTERY OF TUBERCLE. Chyle-Corpuscles, Red Blood-Corpuscles, and Tubercular CorpusrU's, shown to be all one and tJie same tinder different conditions. BY ROLLIN R. GREGG, M. D., BUFFALO, N. V. A group of chyle-gran- ules, as first made in the lacteals, from the albu- men and oily matters furnished to them as digestion progresses. A compact group of A chyle-corpuscle after Lhyle-granules ready to receiving cell-wall, but receive cell-wall. I still showing its granular ________________________f character.________ All blood-corpuscles are made out of chyle-cor- puscles, and in the way here illustrated. I Disc face and edge of arterial blood-corpuscle. Disc face and edge of v I Disc face and edge of arterial blood-corpuscle. • Disc face and edge of venous blood-corpuscles. Up to this point all the figures illustrate healthy action, or the making, and the normal disintegration of blood-corpuscles at the end of their natural life, as daily carried on in all of us to keep us in health. The average duration of the life of the blood-corpuscles is six weeks, when they die of old age, and must be broken down and cast out of the vessels to avoid theirclogging the circulation, or becoming putrid, to irritate, or poison, every part. The succeeding figures illustrate the same red blood-corpuscles decolorized prematurely, by the too watery blood of the consumptive, or by chronic inflammation, or by both, thus destroying them too rapidly, that is, many of them in middle life, when, in such case, they become the so-called tubercular corpuscles, which are then congested in mass, have fibrin poured out and organized around them, and are thus made into tubercles, which excite inflammation and destroy the lungs, or whatever other part they are deposited in. These three figures show the blood-corpuscles fully decolorized and brought back to their identical appearance as chyle-corpuscles and chyle-granules, as they all are after their death of old age; and also illustrate their beinK broken down, in the exact inverse order of their being made, to be cast out from the blood vessels into and through the bowels as refuse matter. A red blood-corpuscle losing color, as they all do while dying, or after their death, whether of old age or disease. A tubercular corpuscle, showing its granules; or the red blood-corpuscle decolorized by circulat- ing in the too watery blood of the consump- tive, or by chronic in- flammation, either of which brings it back to what it was as a chyle- corpuscle just after re- ceiving cell-wall, and it is then called a tubercu- lar corpuscle. A distorted tubercular corpuscle, its distortion owing to pressure in the tubercular mass. They take various forms under such pressure. In the last stage of con- sumption, or sooner, if the blood becomes very watery, many of the blood-corpuscles are en- tirely decolorized, leav- ing them transparent, and these constitute the gray tubercles of Laen- nec. Those decolorized by chronic inflammation make the yellow tuber- cle. A tubercular corpuscle that has had its cell-wall dissolved away, thus showing the same gran- ular mass and identical granules that it had as a chyle-corpuscle just be- fore receiving cell-wall to become a chyle-cor- puscle. Here, again, the blood- corpuscles are shown breaking down in the inverse order of their being made, as all or- ganic nature does when undergoing natural de- cay. A chyle-corpuscle hav - ing lost its granular ap- pearance, and assuming color, to become a red blood-corpuscle, as all chyle-corpuscles do in health. Tubercular granules, or a tubercular corpuscle broken up into its gran- ules, which are the same granules that the corpus- cle started with as a chyle-corpuscle, to be- come a red blood-corpus- cle. Chyle-granules and tubercular granules are all identically the same, the first at the beginning of their healthy life, the last at its premature close by chronic or subacute dis- ease. MINUTE STRUCTURE OF TUBERCLES. 133 CHAPTEE XVIII. THE MINUTE STRUCTURE OF TUBERCLES. Proof of a most remarkable character, considering that it is given to establish an entirely different view of the cause, origin, and production of tubercle, from the one here advocated, may be drawn from the following, from Vir- chow's Cellular Pathology, page 522. He says: " The tubercle-granule never attains any considerable size, and a tuber never arises out of it. Those which are wont to be termed large tubercles, and attain the size of a walnut or a Borsdorf apple, as for example, in the brain— those are not simple tubercles. You will generally find the tubercles in the brain described as being solitary, but they are not simple bodies; every such mass (tuber) which is as large as an apple, or even not larger than a walnut, contains many thousands of tubercles; it is quite a nest of them which enlarges, not by the growth of the original focus (granule), but rather by the continual formation and ad- junction of new foci (granules) at its circumference. If we examine one of these perfectly yellowish white, dry, cheesy tubera, we find immediately surrounding it a soft, vascular layer which marks it off from the adjoining cere- bral substance—a closely investing areola of connective tissue and vessels. In this layer lie the small, young granules, now in greater, now in less number. They estab- lish themselves externally (to the previously existing ones) and the large tuber grows by the continual apposi- tion of new granules (tubercles), of which everyone singly becomes cheesy; the whole mass, therefore, cannot in its entirety be regarded as a simple tubercle. 134 CONSUMPTION. "The tubercles themselves remain really minute, or, as we are wont to say, miliary. Even when on the pleura, by the side of quite small granules, large yellow plates, look- ing as if they were deposited upon the surface, are met with; these too are not simple tubercles, but masses com- posed of a large aggregate of originally separate granules." AVe see by this, that tubercles are not simple or solitary bodies, as they have usually been described. Each " mass (tuber) which is as large as an apple, or even not larger than a walnut, contains many thousands of tubercles; it is quite a nest of them which enlarges, not by the growth of the original focus (granule), but rather by the continual formation and adjunction of new foci (granules) at its cir- cumference." Now this is precisely the way a tubercle must grow, by the deposit in the capillaries, of the decol- orized blood corpuscles, as we claim. One, or a few ad- joining capillaries are first filled with the corpuscles to the extent which they will hold. These being distended by the congestion, press upon each other, and upon those imme- diately surrounding them, which obstructs the latter, so that the viscid corpuscles more readily secure a lodgement therein. And so it extends outwardly, from capillary to capillary, and this necessarily involves a growth at and upon the circumference of the mass, as Virchow says is the case. The known diminutive size of the capillary blood-vessel would allow of many thousands of them, each filled with all the corpuscles it would hold, being contained within the size of a walnut or apple, and these constitute the so-called foci, or granules of Virchow. Again, as will be seen by reference to the quotation, he says: "If we examine one of these perfectly yellowish white, [the exact color again of decolorized blood corpuscles in their shrivelled state] dry, cheesy tubera, we find, immediately surrounding it, a soft, vascular layer, which marks it off from the adjoin- ing cerebral substance,—a closely investing areola of con- MINUTE STRUCTURE OF TUBERCLES. 135 nective tissue and vessels. In this layer lie the small, young granules, now in greater, now in less number." Here, again, is accurately described what would happen in the growth of tubercle, by the deposit of surplus blood corpuscles in the capillaries. The small, young granules would necessarily be found at the surface of the mass, in the vascular layer which invests it, for all the capillaries which were within the space occupied by the mass are already filled, and no more of the changed blood corpuscles can be carried in there, to be deposited, therefore they must be left in the vessels at the surface, if at all. The vascular layer, which marks the mass off from the adjoin- ing substance of an organ, is an adventitious growth of vessels, similar to those frequently, if not always, found existing in or around morbid growths, and affords more capillaries than naturally exist in the parts, to receive the corpuscles, and in this way aid in getting rid of more of their excess than could otherwise be done. This would, perhaps, be more especially the case in parts where the capillaries are naturally farther removed from each other (as in the brain, where Virchow describes this method of growth) than is the case in tissues which contain them in greater abundance, or in which they exist nearer together, as in the lungs. And this would necessitate the growth of the "tuber by the continual apposition of new granules," filled capillaries, "of which every one" would "singly be- come cheesy," and " remain really minute, or, as we are wont to say, miliary." Whatever the form in which the tubercle may grow, whether in masses of globular or irregular outline, or in plates, the same fact holds good. On the pleura and peri- toneum, it would be in plates which would be no thicker than the depth of capillaries in these thin membranes would allow, when filled, and in these cases, too, the tuber- cle would be " composed of a large aggregate of originally separate granules." 136 CONSUMPTION. To show still further the granular character of tubercle, and that the granules of blood corpuscles must be the source of this, we quote the following from Wood, volume I, page 116. He says: "The microscopic constitution of tubercle has been defini- tively ascertained by M. Lebert, whose statements have been essentially confirmed by subsequent observers. The constituents, before the softening of the tubercle, are: 1st —a hyaline, formless substance; 2d—molecules or molecu- lar granules in great numbers; and, 3d—peculiar and char- acteristic corpuscles; the two latter being held together by the translucent material first mentioned. The corpuscles are quite distinct from all others. They are seldom per- fectly round, but are irregularly polyhedral with rounded angles, approaching sometimes the spherical, and some- times the oval form. Their diameter varies from about fAt to sitVtf of an inch. Within the transparent envelope is a somewhat translucent matter, probably of a solid con- sistence, in which are embedded from three to ten or more granules. Water does not change them. Acetic acid ren- ders them more transparent, and enables us to determine positively that they contain no nucleus; by which circum- stance, as well as by their shape, and their much smaller size, they are readily distinguishable from pus corpuscles. In only one instance did Lebert ever detect a nucleus. These peculiar corpuscles are found in all varieties of tubercle. They are numerous and closely compacted to- gether, and to this circumstance probably owe their irre- gular form. " When the tubercle softens, the cementing hyaline sub- stance liquifies, and the corpuscles thus set free imbibe apparently a portion of the liquid, become somewhat larger, and assume a spherical shape. In the progress of the change, the cell wall ultimately dissolves, and the included granules are liberated, thus increasing this constituent of the tuberculous mass." MINUTE STRUCTURE OF TUBERCLES. 137 Nothing could more definitely portray the character of tubercle than this, and when properly dissected, and its full meaning seen, no one point can be stronger in proof of our position. We see that the constituents of tubercle, before softening, are: "1st—a hyaline formless substance; 2d—molecules or molecular granules in great numbers; and, 3d—peculiar and characteristic corpuscles; the two latter being held together by the translucent material first mentioned"— and that, "when the tubercle softens, the cementing hyal- ine substance liquifies, and the corpuscles thus set free imbibe apparently a portion of the liquid, become some- what larger, and assume a spherical shape. In the prog- ress of the change, the cell wall ultimately dissolves, and the included granules are liberated, thus increasing this constituent of the tuberculous mass." How exactly does this result, upon what Wood calls the characteristic tuber- culous corpuscles, correspond with the result which would be wrought, by like means, upon the decolorized blood corpuscles, which had been deposited, and shrivelled by giving up the great bulk of the water which distended them. This class of corpuscles must first be expanded to the spherical shape, by the action of a fluid upon them of less density than their own contents, and finally, as this more dilute fluid accumulates within them, they must burst, or their cell walls be dissolved, thus liberating their included granules into the surrounding matter. And if it is true that the granules which are liberated by dissolving or bursting the cell walls of the characteristic tuberculous corpuscles, increases this identical constituent of the tuber- culous mass, or rather, if the granules so liberated are identical with the molecules or molecular granules, which Wood says exist in such great numbers in tubercles before the softening of these, the question is, how came they here free and independent of those corpuscles which furnish the like granules upon bursting, under the process of suppura- 10 138 CONSUMPTION. tion? Is it not clear that like corpuscles had had their cell walls dissolved, or burst, and thus yielded their gran- ules, before the deposit of either to make the tubercle? Such is the fact, and such is precisely what our theory calls for. Some of the decolorized blood corpuscles, that is, a greater or less number of them according to their weakness by age, etc., and according to the extent to which the serum is diluted, or the length of time they have to circulate in diluted serum before they can secure their deposit in the capillaries, must inevitably be burst, or have their cell walls dissolved, which would liberate the included granules into the serum, and then these would be deposited along with the corpuscles which were strong enough to resist the agencies that destroyed their fellows, or which were depos- ited so soon after being decolorized that time was not afforded for their bursting, and in this way, the two to- gether make the tuberculous mass of molecular granules and characteristic corpuscles, as Wood describes it. Therefore, we would ask: Can it be possible, that such a chain of evidence as we have presented upon this sub- ject, all pointing in the same direction, and without any conflicting testimony upon a single link in the entire chain, is to be found anywhere in Nature without its indicating a great truth? If so, it would be but a hollow mockery of all of man's most earnest and candid investigations into those things in this life, which concern him more than all else besides. CONSTITUENTS OF TUBERCLES. 139 CHAPTEE XIX. CONSTITUENTS OF TUBERCLES, AND EXPLANA- TIONS REGARDING THEM. The great diversity of opinion, and the numerous con- tradictions of each other by the best pathologists and mi- croscopists about the constituents of tubercles, and their proper explanation, have so complicated the subject and confused all, that the following attempt is made to clear up and simplify these matters as much as possible. GIANT CELLS. Giant cells of tubercles are capillary blood-vessels con- gested with fully decolorized, transparent, blood corpus- cles, and distended by them into protuberant sacs. They may also consist, in some cases, of similarly decolorized blood corpuscles escaped through the broken walls of a capillary into the lymph spaces of a part and there embed- ded, or, perhaps, be enveloped more or less completely in an adventitious and very delicate membrane of fibrin, with threads of the latter extending off into the surrounding interspaces, to furnish the so-called processes of giant cells. Still, there can be little doubt that the collapsed walls of the capillary at each end of where the latter is distended into the protuberant sac, and also the collapsed walls of other capillaries anastomosing with the former at or near the sac, have been taken for said processes. TRANSPARENT TUBERCULAR CELLS. Transparent tubercular cells are red blood corpuscles de- colorized to transparency by circulating in the too watery 140 CONSUMPTION. serum of the consumptive, then congested in the capilla- ries to constitute tubercles. YELLOW TUBERCULAR CELLS. Yellow tubercular cells are red blood corpuscles that have first been congested in the capillaries before losing their color, then decolorized by the inflammation they excite and thus changed to a yellow color. The haematin is not so fully taken out of them by the inflammatory decolorizing process, as it is by their continuing on in the rounds of the circulation in a much too watery serum, consequently they are left more yellow. It should be further stated that the transparent cells after remaining incorporated in a tubercle a short time, begin to give up to the surrounding tissues, through endosmosis, the excess of water that has so fully decolorized them, and then they also become yellowish, but not so yellow as those decolorized by inflammation. It is these more fully decolorized blood corpuscles that make the gray tubercular matter, or that having something of the color of old ashes, which is so commonly expectorated by consumptives in the advanced stages of their disease. TUBERCLES OF GROSS. The perfectly transparent tubercles of Gross are those constituted of perfectly transparent tubercular cells, "evi- dently deposited only a day or two before the indivi- duals expired." That is to say they are formed of blood corpuscles entirely decolorized in the serum of the last stage of phthisis, when it becomes more watery than at any other time in the disease. These tubercles are then " of a soft, viscid consistence and perfectly transparent appear- ance." TUBERCLES OF LyENNEC. The grey or semi-transparent tubercles of Laennec are those that generally form earlier in the disease than the foregoing, or before the serum becomes so exces- sively watery; and consist of similarly decolorized blood corpuscles, but with the color not so completely taken out CONSTITUENTS OF TUBERCLES. 141 of them as in the above instance, thus leaving the tuber- cles partially opaque or translucent. Or the perfectly transparent tubercles of Gross become semi-transparent if they have time, but not many days, to give up the great excess of water that has decolorized them, and shrink enough to destroy their transparency. In this last case, when time is given, and with grey tubercles generally, fibrin is poured out from its excess in the blood into and around the tubercle, there to organize and hold all in a firm mass. YELLOW TUBERCLES. Yellow tubercles are such as are constituted of blood cor- puscles first congested in the capillaries, then decolorized to yellow by inflammation, as already said of yellow tuber- cular corpuscles. THE KNOT OF VIRCHOW. The tubercle granule, or knot of Virchow, is the individ- ual capillary filled with blood corpuscles decolorized to yellow by inflammation. It is the same thing, in fact, as the semi-transparent giant cell of other authors, the only difference being in the way the blood corpuscles are decol- orized. Every yellow tubercle of much size is made up of thousands upon thousands of these granules. Besides the decolorized blood corpuscles there are several other kinds of cells incorporated in a tubercular mass. For instance, there are: 1st. Proliferated and worn out, or dead cells from the epithelial lining or inner walls, of the blood-vessels. 2d. Proliferated and dead endothelial cells, or cells of all the kinds that are cast loose at their death into the lymph spaces outside of the blood-vessels, and then carried along in said spaces to the tubercle, where their further progress is obstructed, and they become incorporated in it. 3d. Proliferated and worn out connective tissue cells, which are all embraced in the preceding, said cells being all expelled into the lymph spaoes when dead. 142 CONSUMPTION. 4th. Proliferated and cast-off epithelial cells from the inner walls of the air cells and small bronchial tubes, in all cases where tubercles form in the lungs. There is often a great profusion of these in tubercles in the lungs. 5th. All tubercles that form in the glands contain, of course, great numbers of proliferated and worn-out gland cells; and those that form in the brain contain brain cells, etc., etc. The word " proliferated " in the foregoing means, of course, that all the cells named are, in these cases, grown in excess of the requirements of the various parts in health. Being grown in excess of what is natural, they must be cast off in excess when they are worn out and die, hence there is a great excess of them to be incorporated in tuber- cles; and by my letter to Dr. Formad, in the March, 1883 number of The Advance it will be seen how all these cell structures secure the nutriment to grow them in excess. FIBROUS STAGE. The fibrous stage of tubercle is the first stage where- in the fibrin is extravasated from its excess in the blood and organized through and around it, holding its con- stituent elements in a firm resisting mass like concrete albumen, or often almost of a cartilaginous consistence. This is also the so-called crude stage of tubercles. As it ripens, however, or especially when inflammatory action is excited by it to lead on to softening or suppuration, then the organized fibrin permeating the mass is absorbed from, or broken up by suppuration in the central portions of the tubercle, while that upon its surface, with more poured out and added to it, condenses to form the impervious wall of the resulting abscess to thus shut off its poisonous contents from percolating in every direction into the interstices of the healthy tissues. But for this provision the smallest tubercle in a lung would, upon suppuration, spread its poison in every direction, and speedily destroy that entire lung. CONSTITUENTS OF TUBERCLES. 143 INFLAMMATORY AND SUPPURATIVE STAGES. The inflammatory and suppurative stages of tubercles are, of course, what the terms signify; that is, first, the inflammation that congestion or the presence of foreign matter in living tissues, is so liable to excite; and, second, the suppuration that inflammation, whether acute or chronic, so commonly produces. CHEESY STAGE. The cheesy stage of tubercles is the ripened stage of many of them; and yet it is not the suppurative stage of such. This comes when the organized fibrin, or the natural tissues—as the walls of the capillaries, the nerves, connec- tive tissue, muscular fiber, etc., held within the tubercular mass- -are all, or nearly all, absorbed out of it, to bring the decolorized blood corpuscles and such other dead cells as may be mingled with them together in a friable or crum- bling mass like old rich cheese. This is also called the caseation of tubercles. Many tubercles, however, go on rapidly to suppuration,, and into a semi-fluid condition, without ever really presenting the cheesy stage. FATTY DEGENERATION. The fatty degeneration of tubercles results from a de- posit, in the first instance, of a portion of the excess of fatty matters left in the blood by a loss of albumen in the tubercles, along with the decolorized blood corpuscles that principally constitute them; or, secondly, there is a deposit later, of some of this excess of fat, and an absorption, under pressure or otherwise, of more or less of the decolorized blood corpuscles; or, thirdly, there is an absorption of more or less of the other elements of the decolorized blood cor- puscles, but leaving their fatty constituents as a fatty de- posit. Some one of these, or all combined, cause the fatty degeneration of tubercles. Of course, it is not a supposable case that dead and decaying blood corpuscles, or other dead cells, in a dead mass like a tubercle, can set up organic 144 CONSUMPTION. action and generate oil, or fatty matters of any kind out of the chemical ingredients of these dead cells. This cannot be possible, hence fatty degeneration must result in one or all the ways stated. CRETIFICATION. The cretification of tubercles like the foregoing, is brought about in a somewhat similar manner; that is, a portion of the salts always found in excess in the blood in such cases, is deposited at first, or later, along with the decolorized blood corpuscles in such quantity as to give the tubercle a fragile, brittle, or chalky appearance; or, the organic matters are absorbed from the corpuscles, thereby leaving their mineral ingredients in the place formerly occupied by tubercle. It is a significant fact, too, in this connection, that laud- able pus, the corpuscles of which are also blood corpuscles decolorized by acute or sub-acute inflammation, not unfre- quently becomes cheesy, or undergoes fatty degeneration or cretification in the same manner, and for similar reasons that tubercular corpuscles pass through these changes; and shrivelled pus corpuscles have many times been mis- taken for tubercular corpuscles. In fact nobody can now tell the difference between shrivelled pus corpuscles and tubercular corpuscles, unless they go behind the mere ap- pearances to the eye and consider how the two originated. As already said, the impervious wall of the tubercular abscess, as such, is constituted of the excess of fibrin in the blood in all such cases, extravasated freely upon and all around the tubercle, where it condenses and organizes into this impervious wall. This is one of the greatest of all the great conservative principles of nature. But for it, as before said, the smal- lest tubercle in a lung or other organ, would, on suppura- ting, destroy that entire lung or organ, by allowing the liquid poison of the resulting pus to percolate in every direction through the interstices of the tissues—or the CONSTITUENTS OF TUBERCLES. 145 lymph spaces—to the most remote parts, carrying to the en- tire organ irritation, inflammation, mortification and death. Even when a tubercle forms in the most remote part of an organ, as in the apex, or near the outer surface of a lung, and has to point towards, and find an outlet for its pus at considerable distance, in a bronchial tube of suffi- cient size to carry it off; or, when one forms in either ex- tremity of the liver, and points towards the gall bladder or gall duct to find its outlet; or, when tubercles develop in the loins to produce psoas abscess, and find an outlet for their pus away down on the thigh: in all these, and every other instance, fibrin is extravasated from its excess in the blood, step by step, in advance of the progress of the abs- cess towards its final outlet, and there organizes into the impervious wall of the fistulous canal, to safely conduct off all the pus and poison, and not allow any of it to escape and burrow in the interstices of any of the surrounding healthy tissues. Not even so much as the millionth of an inch is anywhere left unguarded or uncovered, to allow the least particle of the liquid poison to spread or go else- where, than where it must, to find its exit from the system. In all other abscesses, whether acute or chronic, internal or external, it is the same. It is even so with common boils. In boils, fibrin is poured out beneath and all around them up to the skin, and condenses into a firm wall, which holds the pus as in a saucer or cup when it forms. Then said wall firmly contracts upon itself, and towards the surface, and thus lifts or forces the matter out through the opening in the skin that suppuration finally brings. But for this impervious wall the smallest boil, or even a pustule on the back of the neck would in every instance take life. It would be much easier for the fluid parts of the pus, and even for the dead and putrifying blood cor- puscles, (or, at least, the granules of the latter when the cell wall gives way to release them), to percolate or burrow and dissipate themselves into and through the lymph spaces 146 CONSUMPTION. in every direction, were these spaces not closed by the ex- travasated and organized fibrin, than to force themselves through the tough skin by the slow process of suppuration. Indeed there would seldom or never be an opening made through the skin by suppuration, if the contents of boils or abscesses could spread at will into the lymph spaces and thus be carried deeper into the system. And in that case death would be certain. For the same reasons, the smallest pustule on the cornea would destroy the entire eye from the pus percolating through the interstices of the coats of the eyeball; thence it would also be carried to the optic nerve and into the brain, and in every such case take life. The vaccine pustule would destroy an entire arm and prob- ably life, but for this wise provision. The same fact holds also in diphtheria. In every case of deep or superficial ulceration, or abscesses, in this dis- ease, fibrin is extravasated in the same manner and for the same purposes, to guard life in every possible way from the diffusion of accumulating or resulting poisons into deeper and more vital parts or organs. But all the great scientists of the world, now giving attention to these subjects, utterly ignore—let us hope not through ignorance—this greatest of all the preservative principles of nature, in guarding animal life; and here, as elsewhere, they call all the gran- ules and fibrils that the extravasated fibrin must organize into before they can coalesce to form the membranous wall of protection, bacteria. Surely a sadly unscientific over- sight, by scientific men. In conclusion, nothing in all nature, nothing in all science, nothing, indeed, in all theology, tells more uner- ringly of a God, or of a Supreme Intelligence beyond that planned all this, than does this great conservative principle of the extravasation and organization of fibrin in the ways and for the purposes stated. No " clashing of atoms with each other and their environment through countless ages," or even for a few generations, in any form of animal life, CONSTITUENTS OF TUBERCLES. 147 ever developed that principle or guided to its perfect work- ing. Theirs/ boil that ever formed was guided by it to as successful an issue and expulsion of its festering contents as any that form at the present time. And the first animal that was ever injured, to the extent of having suppuration result therefrom, was as thoroughly protected against the spreading of the pus back into its system to take its life, as those injured in the present generation. Therefore, will physicians and scientists heed this great principle, reason upon, and take advantage of it, as becomes intelligent men ? 148 CONSUMPTION. CHAPTER XX. ALL CLASSES OF ORGANIZED TISSUES BUT ONE NOURISHED IN EXCESS IN TUBERCULOSIS. LETTER TO DR. FORMAD. Deak Sir:—I have read your paper in the Philadelphia Medical Times of November 18, 1882, with much interest; and am pleased to see that you have entered the lists in so earnest and able a manner, to oppose the hasty and errone- ous conclusions of Professor Koch on the cause of tuber- culosis. It is to be hoped that you and other earnest workers in this field will be able to stem the torrent of Kochism now flooding the world, and prevent this new fallacy on phthisis from being fastened upon the profes- sion for a generation or more, as others have been before it. You speak of American "work in pathology" not being "sufficiently recognized and encouraged" here at home. This is, unfortunately, too true, and leads me to ask; why cannot an organization of some kind be effected in this country, by investigators and pathologists, to push " the good, honest work of Americans," and make it felt the world over? A combination of earnest workers could accomplish much in this direction, whereas individuals, working separately and without concert, can do little or nothing, excepting to simply record their observations and deductions for future compilers, and thereby receive little or no benefit to themselves while they live, from their hard work. A community of interests, and the importance of the subject, ought to stimulate them to combine at once to advance American ideas and discoveries. EA'CESS IN ORGANIZED TISSUES. 149 Having said this much in a general way, will you pardon the liberty I take in offering a few plain, common sense suggestions, which seem to me to simplify and clear up this whole subject of tuberculosis in a most remarkable manner? Assuming in advance that your pardon is granted I will proceed. Each and every class of organized tissues of the whole animal body, viz.: cerebral, nervous, glandular, lymphatic, epithelial, endothelial, connective, serous, osseous, all, in fact, with barely one exception, are nourished in excess in tuberculosis. The one exception is muscular tissue. This emaciates or shrinks to almost nothing in protracted cases of con- sumption, as you already know. Even the muscles of the heart and the muscular coat of the stomach and intestines are almost equally emaciated and skrunken with the ex- ternal muscular system. Now why is this? The answer follows: 1st. The excessive emaciation of the muscular tissues is simply due to a waste of albumen in the expectoration, and other catarrhal or mucous discharges of consumptive sub- jects, which takes away just so much of the only food of the muscles, until these are all, whether internal or exter- nal, starved down to almost nothing. 2d. All the other tissues being nourished in excess, is because the waste of albumen leaves a relative excess in the circulation, of the other constituents of the blood that go to nourish these tissues; hence they are all over-fed and grow in excess in consequence. That the muscles are for some reason starved, you do not need to be told; and that albumen is their only, or almost only food, you must also know, or will concede if you now have doubts of it, when you fully consider all the facts bearing upon the subject. Of the fact of the excess- ive nutrition and over growth of all the other tissues let us consider a few examples. 150 CONSUMPTION. The excessive nutrition of cerebral tissue, or of the brain, in tuberculosis, is shown and proved by the large heads and precocious minds of scrofulous children, or the children generally of tubercular parents; it is also equally well shown in the unnaturally acute and active minds of many adult tubercular subjects. The excessive nutrition of nervous tissues outside of the brain; that is, of the spinal cord and nervous system at large, is shown by the exalted nervous action, or extreme nervousness and restlessness of many of such subjects; also by their neuralgias, over sensitiveness to pain, etc. The excessive nutrition of the glandular tissues, is shown by the enlargement of the glands everywhere, which is so characteristic of scrofulosis or tuberculosis. The same of the lymphatics. The excessive nutrition of the epithelial tissues, is shown in the thickening, curving and ridging of the finger and toe nails, which is almost universal in scrofulous and tuberculous subjects; also by their being so prone to warts and other epithelial excrescences. Moreover it is a fact as you know, that many of such subjects cast off an excessive amount of epidermic cells from all, or some portions of the surface of the body, notably from the hands and feet, be- yond what those in health do; also that there is a greater or less proliferation of epithelial cells on all the mucous surfaces internally in these subjects; and often a too rapid growth of the hair. The excessive nutrition of endothelial cells is shown by their proliferation all through the body, of which you give the best evidence I have ever seen, and of which I will soon speak more fully. The same of the over growth of connective tissues, to which I will also give more atten- tion with the above. The excessive nutrition of the serous tissues is shown by the almost invariable thickening of the pleurae in con- sumption, and by the adhesions of some portions of their EXCESS IN ORGANIZED TISSUES. 151 contiguous surfaces in nearly all cases; also by the thick- ening in many instances of other serous membranes. The excessive nutrition of the osseous tissue is shown in the large joints of scrofulous and tuberculous patients, also by bony tumors, internal ossifications, etc. The un- naturally large " shovel teeth," so common in scrofulous people or those of tubercular tendency, shows that even the teeth of such subjects are often nourished in excess, and that the nutriment therefore must be left in excess in the blood from some cause. Moreover the lungs themselves, or their constituent tissues, are nourished in excess in phthisis. You speak of the " irregular thickenings " of the walls of the air-cells, therein, which is true; and we all know of the prolifera- tion and much too rapid desquamation of epithelial cells, within the alveoli, to block up many of them. Well, it requires no argument to prove that there must be, in both of these instances, an'excess of nutriment to cause these excessive growths. Nothing can grow in excess without an excess of materials on which to feed. And so we might go on and descend into greater details on all these points, and introduce new ones, but this can not be necessary. We will, therefore, return to the sub- ject of a proliferation of endothelial and connective tissue cells. You speak of the lymph spaces between the bundles of connective tissue fibrils, everywhere throughout the body, being narrower both in scrofulous subjects and in scrofu- lously inclined animals, than in the non-scrofulous. Also of " the filling of the lymph spaces with desquamated and germinating endothelial cells," or "free, round and irregu- lf r cells," in larger quantity in the scrofulous than in the non-scrofulous, which " are frequently seen to block up the lymph spaces." Carrying out the idea of all systems of tissues being nourished in excess in tuberculosis, excepting the muscu- 152 CONSUMPTION. lar, and applying the facts as they exist, we see that the reason of the greater number of cells in the lymph spaces is a proliferation and too rapid desquamation of the endo- thelial and, perhaps, some other cells, into those spaces, to block them up, the same as we see the air cells of the lungs in consumptives more or less blocked up by a proliferation and casting loose into them of the epithelial cells, and because their food is also left in excess. The narrower lymph spaces in scrofulous people than in the non-scrofulous is owing to an excessive growth and consequent thickening of the connective tissue fibrils in the former, from the same general cause; which thicken- ing must necessarily crowd much upon those spaces and narrow them. This applies to consumptive subjects, or those who are inclined that way from losing albumen through some one or more of the mucous membranes. What, now, of the naturally narrower lymph spaces you point out in healthy rabbits and guinea pigs, as scrofu- lously inclined animals (though not from losing albumen), than is found in the cat, dog, etc., as non-scrofulous ani- mals? Please consider the following points in connection therewith. Vegetable food does not contain as much albumen as does animal food; but it does contain more of other ingre- dients required to nourish other tissues than the muscular. Hence the rabbit and guinea pig, as herbivorous animals, would have those other tissues, or many of them, nour- ished more by vegetable food; and hence the larger or thicker connective tissue fibrils, and the smaller lymph spaces between them, in those animals, than in the cat or dog, as carnivorous or omnivorous animals. If the latter, however, are fed with too much vegetable and too little animal food, they get too little albumen and too much of other food constituents for their nature, which changes them to a similar condition of herbivorous ani- mals, with reference to the connective tissue bundles; that EA'CESS IN ORGANIZED TISSUES. 153 is, the fibrils of these receive too much nourishment, the same as if albumen were lost, and are thickened thereby, which crowds upon and narrows the spaces between them as just stated. And the latter being now filled with endo- thelial cells is because these receive an excess of nutrition and proliferate in consequence, as in cases of actual scrofu- losis, which has already been sufficiently explained. Again, under emaciation from loss of albumen, the lymph spaces are narrowed more or less by the general shrinkage of the muscular tissues, which aids in lessening the size of the interspaces between the fibrils of all tissues where there are muscles. And this also would account, in part at least, for the lessening of said spaces in animals that are gradually starved, but not losing albumen. They do not get enough of it, or of any other food, and this brings up some of the conditions that a loss of albumen would entail. Should it appear to you that there is a glaring omission in this summing up, viz., in not including the so-called adipose tissues, the answer is easy: I do not regard the simple natural deposit of fatty matters in various parts of the body as organized tissue. But there is much more to consider on this point. Active nutrition in the muscular system gives warmth to the body, but under a waste of albumen there is not active nutrition in the muscles, hence a lack of heat. Then, a too watery blood, as in all cases where albumen is lost, in itself induces cold, or allows of the blood being easily chilled. All this demands a more rapid consuming of the fatty matters of the blood than is natural, to keep up the heat, and this, together with the hectic fever, burns up the fats, so there are none left for deposit, excepting such as may be unnaturally deposited in the liver, etc., to cause the so- called fatty degenerations thereof. And hence the entire absence of natural accumulations of fat in such cases. Giving a little attention now to the classified constitu- 11 154 CONSUMPTION. ents of the blood, by name, and as left in excess by a loss of albumen, we find the following: The excess of water thus left causes the too watery blood of all consumptives; and in consequence thereof, leads to the diureses, night sweats, and dropsies of such subjects. The excess of blood corpuscles causes all their primary haemorrhages; and, later, all their tubercular corpuscles, by the former, or the red blood corpuscles being decolor- ized into the latter through the too watery serum, or by their congestion and decolorization through the inflamma- tion which they excite. You say so truly and positively: " We can certainly not have the parasites more pernicious than the living cells of our own body prove to be in the case of tuberculosis;" and will see how strongly the above fact as to the disposition that is made of our blood cor- puscles, when brought into excess, corroborates your asser- tion. The excess of fibrin causes the thickening of some or all the serous membranes, adhesions of the pleurae, etc. The excess of fatty matters causes the fatty livers, and other fatty degenerations in consumption; also, in con- nection with seme of the salt phosphates, their excess over nourishes the brain and nervous system, causing the pre- cocious minds, restlessness, nervousness, etc. And an un- naturally large portion thereof is burned to keep up the required heat in such cases, as just shown. The excess of salts causes the enlarged joints and large bones of many such subjects, bony tumors, internal ossifi- cations, calcareous concretions, chalky deposits, etc. And the excess of some one or more of these, or of some vital compounds of the blood that have not yet been classi- fied, is what causes the excessive development of the glands and other tissues not above accounted for. Thus, as you will see, this whole question of tubercu- losis and scrofulosis, and every pathological or abnormal EA'CESS IN ORGANIZED TISSUES. 155 physiological, and abnormal anatomical development in connection therewith, is one of a waste of one of the con- stituents of the blood, by catarrhal disease of the mucous membranes (or a deficiency of that constituent through poor or deficient feeding); and the leaving thereby of all the other constituents in a relative excess in the circula- tion. Or the loss of the one constituent starves one sys- tem of tissues and leaves an excess of all the other con- stituents to overgrow every other class of tissues. What else could so well account for it all? Deficient feeding, or poor food, both cause a too watery blood, which always decolorizes the red corpuscles too rapidly, and changes them into leucocytes, or tubercular corpuscles; and this was why you had the final develop- ment of tubercles in all or many animals so treated, with- out their losing albumen to bring it about. Poor people living on stale vegetables or other poor food may and do. have tubercles developed in the same way. It is a ques- tion of deficient supply of albumen in these cases, instead of a loss of it, that brings similar results. This brings me to speak upon another point to which you allude. You say: "In all scrofulous beings all the or- gans supposed to be concerned in the production of white blood corpuscles were disproportionately large, in relation to the size of the animals." And then incidentally you refer to the spleen and some other glands as being the manufacturing organs of said corpuscles. In one sense the glandular organs named do make white blood corpuscles, but out of what? They simply decolor- ize the old and worn-out, or otherwise useless red blood corpuscles, into white blood corpuscles, then disintegrate them to get them out of the circulation to avoid their con- gesting any part or organ, or poisoning the system through putridity, as they would if not rapidly disintegrated and excreted. And herewith ends the tale of the production of white blood corpuscles by said organs. 156 CONSUMPTION. Nature's exact adaptation of means to ends, her accuracy and certainty in all things, when not thwarted by disease, the absolute and constant dependence of life upon the proper performance of the functions of the blood corpus- cles, and the rapidity with which they must be made to keep up their full supply—all render it clear and certain that the mesenteric glands make the red corpuscles of the blood out of the pure, fresh chyle, direct from the first and best efforts of digestion, and brought to them by over four millions of lacteal vessels; and not from impure blood in the liver, or from a small supply of it in the spleen or other glands. And when they get old or become useless, they are decolorized by the spleen and liver and perhaps other glands, as above asserted. Hence the greater num- ber of white blood corpuscles observed in the splenic and hepatic veins than in other parts. Now, another point. Nature being always consistent with herself, and doing things on exact principles, we see that when the blood corpuscles are left in excess by a loss of albumen, she has more work to do in decolorizing and breaking down the surplus corpuscles than in health. Therefore she enlarges the spleen and other glands that do this work; and finds the food to so enlarge them in the excess of gland-making material that is left by the same cause. This larger development enables said glands to do much of this extra work, and thus ensures its being done, to avoid extensive congestions by what would be the too rapidly accumulating corpuscles, if they were not destroyed faster than in health. As it is, even then, many of them are not entirely destroyed, but changed into leucocytes and tubercular corpuscles. Why not, then, take the universally enlarged glands of scrofulous animals as the " anatomical anomaly " or " ana- tomical criterion," by which to distinguish them from the non-scrofulous, as to take the narrower lymph spaces for such criterion? Or why not take the larger and more EA'CESS IN ORGANIZED TISSUES. 157 active brains of tubercular human subjects, or the enlarged joints, proliferating epithelial cells, thickened serous mem- branes, etc., as the distinguishing anatomical characteristic, instead of confining it to the lymph spaces narrowed and filled with " free, round and irregular cells " ? When there is a too rapid growth of cells to nourish any tissue in excess, there is also a too rapid desquamation of the same cells, when they get old and worn out, which fill and clog the lymph spaces, air cells, or other small cavities, as you found them in the former. Were they not dis- posed of, when old, in the same ratio of rapidity as made, in the first instance, or nearly so, excrescences or tumors would be grown everywhere that such cells proliferate. The red marrow of the bones, to which you incidentally allude, is from a portion of the excess of red corpuscles, or from the haematin dissolved out of said excess, or both, being held in the marrow and coloring it too highly. Another point ought to be touched upon. You say: "No inflammation, no tuberculosis." Yellow tubercles are generally preceded by inflammation, but gray or semi- transparent tubercles are not, and why? In the last stage of phthisis the blood becomes so watery that many of its red corpuscles are decolorized to entire transparency on their rounds in the circulation, then congested in the cap- illaries of a part and make a " knot," or transparent tuber- cle, without preceding inflammation. In yellow tubercles, on the contrary, there is congestion of a part by a surplus of red corpuscles, which excites inflammation, and this decolorizes them into yellow tubercles. Now, in regard to the bacteria theory as the cause of tubercles. You will be enabled to see from all that pre- cedes, even more clearly, perhaps, than before, how shallow and utterly worthless that theory is to explain it all; and how absurd the claim of infectiousness by bacteria. What a terrible wrong, too, that error is going to work against many consumptives, and which, as you say, has already 158 CONSUMPTION. been begun, by some of them being more or less shunned and neglected, for fear of contagiousness by parasites. " The therapeutics of phthisis also must be governed in a great measure by the view taken of the etiology of the disease," you say. Very true, and if the views herein pre- sented as to the cause and nature of consumption are cor- rect, you will see how entirely its treatment must be changed from prevailing methods. In other words, that everything in treatment, whether medicinal or topical, in the least irritating to the mucous membranes, must be avoided; and only curative measures that will heal the irritations and abrasions of those surfaces should be em- ployed, and thereby stop the icaste of albumen, which is the immediate cause, when all effects must inevitably cease. Again, and in conclusion, it will not have escaped your attention, that the foregoing facts, and deductions there- from, will not only correct many errors of pathology, but, what is of almost equal value, will serve to correct many errors in physiology as well, besides furnishing us many new truths therein, and at the same time greatly broaden our views on both these important branches of scientific medicine. E. E. Gregg, M. D. Buffalo, N. Y. STAGES OF CONSUMPTION 159 CHAPTEE XXI. THE STAGES OF CONSUMPTION. There are two theories generally put forth by authors as to the proper division of the different stages of phthisis. One of these is, to divide the whole course of the disease into two stages; the other, and more generally accepted, into three. The first stage in the former view embraces the time from the beginning of the catarrhal period to the primary deposit of tubercles, and even through this period until they begin to suppurate; then making of the second stage all of that time from the beginning of suppuration in the tubercles to the close of the case. The other view is to divide the time into three stages: first, from the be- ginning of the catarrhal period to the commencement of the deposit, or formation, of tubercles; second, from the beginning of the organization of tubercles, at least in mass, to the commencement of suppuration; and third, from the commencement of suppuration in them till death. That classification of the stages of consumption, how- ever, which divides them into three instead of two, as by some authors, as will be seen, is manifestly the most proper. Under a division into three stages we have the purely catarrhal stage of phthisis, running all the way from a few weeks only, in some cases, to many years in others wherein the disease is yet confined to some one or more of the mucous membranes, and the catarrhal or mucous discharges therefrom, with the debility, irritations and disturbances that flow directly from that cause. Next we have the stage of deposit of tubercle, that is, that period embraced between the times of the beginning of 160 CONSUMPTION. their deposit and the commencement of their suppuration as just said, or the breaking down of the tissues in which they become embedded. This may also extend from a few weeks only, to years, though it is usually of shorter dura- tion than the catarrhal stage. Third and lastly, we have the suppurative stage extending from the time suppuration begins, in or around the tubercle in mass, to the end of life. As a rule, this is the shortest of the three stages, though we have, in various cases, every conceivable devia- tion from a uniform progress of the disease; and in this last stage, as will be understood, there is extensive destruc- tion of one or both lungs, simply from the breaking down of the tuberculous masses, carrying away all lung or other tissue involved in them. In this stage we also frequently find the mesenteric glands of the intestines partly or wholly destroyed by the deposit of tubercles in them and their consequent ulceration. The various stages, of course, run almost imperceptibly into each other; still in theory, at least, as will be seen, there is a distinct line of demarkation between them. The catarrhal stage, or action, runs into and all the way through the other stages, wasting albumen more and more freely as the disease progresses; but it becomes mostly or wholly concentrated in the lungs in the second and third stages instead of being scattered upon other mucous surfaces, as is so often the case during the first stage. The stage of deposit also runs into the suppura- tive stage; that is, the deposit of tubercle goes on more and more rapidly as the disease progresses, and albumen is more freely wasted, until death closes the scene. It is only in this way that the substance of the lungs is more rapidly destroyed towards the close of life than before. Often every part of lung tissue becomes filled with the rapidly increasing tuberculous matter, decolorized blood corpuscles, etc., and gives way in every direction under the accumulating mass. PNEUMONIA AND PHTHISIS. 161 CHAPTEE XXII. PNEUMONIA AND ITS RELATION TO PHTHISIS. It is a well known fact that phthisis immediately follows, or dates its beginning, soon after an attack of pneumonia, and, in many cases, apparently, as a more or less direct result of it, where the latter does not prove fatal at the time. What, then, are the relations between the two dis- eases, and why does the latter predispose to the former? These are important questions, and, if it be possible, should be fully and satisfactorily settled. Let us, therefore, try to solve them. We have seen by a preceding quotation from Copland's Medical Dictionary, describing the expectoration from the lungs in diseases thereof, that: "when it is viscid, opaque, somewhat frothy and thick, it is usually brought up with much cough, contains much more albumen, and adheres closely to that previously expectorated and to the sides of the vessel." Physicians of experience do not need to be told how accurately this describes the expectoration in the early stages of pneumonia. We see, then, that there must be a large waste of albumen from the blood (according to facts already laid down), in pneumonia, and that all the other constituents of the blood must be left in a corres- pondingly large relative excess in the blood-vessels, in consequence of such waste of one of its elements. Consider, also, other facts. The five ounces and over of blood corpuscles left in a relative excess in the circula- tion for every ounce of albumen lost in cases of pneu- monia, provides the means, that is, the surplus blood cor- 1152 CONSUMPTION. puscles with which one or both lungs are more or less extensively congested in this disease. That excess, more- over, furnishes the blood that is thrown off in the rust- colored sputa of all these cases, and that also which is discharged in actual hemorrhages in some of them, both of these methods relieving the congestion of the lungs by so much blood as is discharged in that way. In case the congestion goes on to an abscess, then the blood corpuscles so congested are decolorized by the inflammation, and on the bursting of the abscess are discharged as pus corpus- cles and thus expelled from the system. Of course, the intense fever, dyspepsia and danger are in consequence of the congestion and inflammation of so vital an organ, and if the case results in an abscess the symptoms and danger are all greatly increased. The relative excess of water, left by the loss of albumen, furnishes the fluid for the night sweats that very com- monly arise in pneumonia, after the inflammatory period subsides; and, other things being equal, their severity is measured by the amount of albumen lost. It is the same with the dropsy that sometimes follows severe cases of pneumonia, the excess of water providing the fluid for that, as well as for the night sweats. There is always a large excess of fibrin in the blood in pneumonia; and where considerable of this is not thrown off in the thick, tough expectoration of the disease, as it commonly is, and there found by the microscope, then it goes on increasing in the blood, until the excess gets to be such that it is in part, at least, thrown out on the surface of the pleura, where it excites inflammation, when we have the complication of pleurisy with the pneumonia, or pleuro- pneumonia, as it is called. Considerable of the excess of fibrin is also used, or gotten rid of from the circulation, by being secreted into and around the congested mass, where it organizes into the dense impervious wall of the result- ing abscess, if the case comes to that, and thus prevents PNEUMONIA AND PHTHISIS. 163 the spread of the pus throughout the entire lung to wholly destroy it. The excess of the salts is, more or less of it, discharging through the kidneys, in the urine, through the bowels, and also some of it, no doubt, through the lungs in the expectoration, especially when the sputa tastes salty or brackish. When not so discharged, but held in the circulation, or deposited in the congested part, these salts must necessarily add to the severity of the disease, be- cause of their irritating qualities. The fatty matters left in the excess are, more or less of them, also often discharged through the bowels, the kid- neys, and in the expectoration, but when not so disposed of, they, too, must disturb the system and aggravate the disease in their own characteristic way. Now all this, as will readily be seen, is in direct line as far as it goes with the beginning and development of phthisis, excepting that it is acute instead of chronic action; and if the pneumonia had been so severe as to greatly weaken the lungs, beyond their power of full recovery, we can see that the waste of albumen must go on through them, in a chronic way, and thus more or less speedily lead to consumption. Or, if this is not conceded, the following must certainly be acknowledged, viz.: That pneumonia very commonly occurs in those who are already more or less predisposed to phthisis, but whose vitality had thus far been able to hold their taint in subjection. Let such an one, then, have an attack of the former disease, to greatly weaken his lungs, and life-force as well, the latter can no longer resist this taint, and it must then be aroused to go on in its legitimate work. Or, again, in those who have had a chronic skin disease suppressed, but with a vital force of sufficient strength to hold that in a dormant condition, if they are attacked with pneumonia, and both life and lungs much weakened, they can no longer resist their taint, or that humor, and it is aroused, goes to work on the mucous membrane of the lungs, leads directly on to 164 CONSUMPTION. catarrhal secretions and the waste of albumen, and there and thus finishes up its work. So we see what are and must be the relations existing between pneumonia and phthisis. In conclusion of this matter, the author has no hesita- tion in saying that, under these facts and the proper treat- ment of the disease in accordance therewith, instead of the death rate of pneumonia reaching fifty per cent, or more, as it often does, such rate can be reduced below ten, yes, often below five per cent., where there is no delay in administering the right treatment from the beginning. This estimate is based upon an experience of over thirty years of practice, in which pneumonia has borne its usual proportion, and in which actual results in its treatment warrant the assertion. Therefore, the author is not indulg- ing in theorizing here any more than in the plainest and best proved facts presented in this volume. OTHER SOURCES OF PHTHISIS. 165 CHAPTEE XXIII. OTHER SOURCES OF PHTHISIS. There are many other sources of phthisis, besides direct inheritance. Suppressed skin eruptions, as in diseases pre- viously named, and among the most prolific of such sources is the suppression of other forms of disease from various other organs. To illustrate: Of the great numbers of women daily treated locally for diseases peculiar to their sex, a large proportion soon begin, or within a year or two after the removal of their primary disease, to manifest nasal or bronchial catarrh, chronic sore throat, dry cough, pains in the chest or other pulmonary symptoms, either one or all of which, sooner or later, develop into phthisis. In no case is the removal of a female disease by local treatment, a curative process. The chief cause of such complaints is almost invariably a scrofulous or tuberculous taint inherited from one or both parents; or it may be an inherited humor of the blood, as that of psoriasis, herpes, eczema, and the like. During the vigor of childhood and youth such inherited taint or humor, may be, and often is, held entirely dormant in the system, until, through de- pressing causes, the vitality becomes so much exhausted or weakened that it can no longer hold the taint in check, when it becomes aroused and locates upon the mucous membrane of the female organs in these cases, with the various results that are too well known to require a specific description here. How is it possible, then, to suppose that local treatment in these cases, can cure; that is, eradi- cate a cause that had its beginning in the preceding gen- 166 CONSUMPTION. eration, perhaps dates back several generations in its ori- gin, and permeates the entire constitution of the patient? It is simply absurd. Such treatment can result only in disaster to the patient. All that is accomplished in such cases by local treat- ment, if the primary disease be removed, is simply this: Through the violent irritations of cauterization, the harsh or stimulating injections and the like, a reaction is finally aroused in these organs, which subdues the further action of the cause or taint, in that locality, or drives it out when not being cured, it must go elsewhere; and very commonly it is the lungs to which it is transferred, there to sooner or later begin its legitimate work of wasting albumen and producing tubercles. The author has seen large numbers of such cases, and in all instances where he has been con- sulted in time to save the patient from death, and control the lung disease, the whole morbid condition, or the cause of it, has been translated or driven back to the female or- gans, there to manifest itself in the same way, and gener- ally with the precise symptoms, as in the first instance. Therefore, in all this we have the positive, yes, double proof of what is here claimed. So, no part of the argu- ment or assertions in the foregoing, is theory, but all is actual fact demonstated by hundreds of cases; and not only that, but it may be proved over and over again by any physician who will rightly treat and cure the lung cases, that so commonly follow in the wake of suppressed female diseases. Another fruitful source of phthisis is in suppressed stomach diseases. The majority of confirmed dyspeptics ultimately die of consumption. Through harsh and irri- tating medicines, alcoholic stimulants, etc., taken into the stomach, reaction is finally established in that organ, the disease in part or wholly driven therefrom and to the lungs to there finish up in tubercles. Here, too, the author has seen many cases to prove this fact, and in many cases OTHER SOURCES OF PHTHISIS. 167 has seen the dyspepsia return with all its primary symp- toms, if, and when the lungs were cured of their disease. Again, consumption may, and often does, have its origin in suppressed chronic diarrhoea, suppressed hemorrhoids, suppressed fistula in ano, etc. A case in point of sup- pressed hemorrhoids will be given. A year ago I was called out of the city to see a gentleman, suffering from disease of the lungs. Upon examination by percussion and ausculation, the lower third of the right lung was found almost wholly congested and quite painful; there had been night sweats, often very profuse, for two months; he was so debilitated as to be confined entirely to his house, with not a few other attendant symptoms common to such cases. He was about fifty years of age, and had never before had even the slightest threatening of any such symptoms. Upon thorough inquiry as to what might have been the cause of so unexpected an attack, it was learned that a year before he had made a pilgrimage to a specialist in Cincinnati to be treated for hemorrhoids. The treatment consisted in piercing the tumors with needles and then charging them with strong currents of electricity. The tumors were thus speedily removed, and the cause driven out of those parts; only, however, to be developed in the lungs upon the first favoring opportuninity that occurred threafter. This man must inevitably have died of consumption in a year at most, had the case not been reached and controlled as it was. He had had night sweats for three or four months, with other serious symptoms, but is now fully restored. Also, phthisis not unfrequently has its origin in sup- pressed inflammation of the eyes, both of the acute and chronic form, as I have seen in numerous cases; while the suppression of common boils will often be followed with consumption of the lungs or bowels, or serious threat- enings of it, as has also been seen in many cases. In all these instances it is simply the suppression of a taint in its action on a non-vital organ and driving it in on a vital organ. 168 CONSUMPTION. In conclusion of this chapter, it may be asked: " Must, then, all these other diseases, herein named, be left without treatment and allowed to develop into their worst phases in their original seat, for fear of being driven to the lungs?" By no means. Their local treatment must be wholly avoided, and they treated by internal medication upon the tongue with the appropriate and exactly indi- cated remedies, to eradicate the taint from the system that generally causes them, and so not only thoroughly cure the primary affections, in all curable cases, but avoid all risk of suppressing them, to be followed by much more formidable and iucurable diseases. The physician can be guilty of nothing more criminal in his profession than to treat any disease locally and thereby suppress it. ITS CURABILITY. 169 CHAPTEE XXIV. RATIONAL AND SCIENTIFIC GROUND FOR HOPE THAT CONSUMPTION CAN BE CURED. I shall not throw distrust upon what I feel to be the great truths embodied in the preceding pages, by coupling with them an indiscriminate claim that consumption in any and all its forms and stages can be cured. Nevertheless, I am able, as I candidly and conscientiously believe, to fur- nish a rational ground for hope in the cure of this terrible scourge, in the earlier stages, of a large majority of cases; and a hope, too, that has never hitherto been presented to the world, and never before, I believe, even casually con- sidered by the profession. It is as follows: If the cause of consumption is the loss of albumen from the blood through irritated and abraded mucous mem- branes, as must be conceded on the evidence presented to be at least highly probable, then the curing of the cause, that is, properly healing all the mucous surfaces that are diseased, must of necessity put a stop to the further pro- duction of tubercles and the whole category of attending conditions and sufferings. Of this there can be no reas- onable question, provided always, of course, that the real cause has been fathomed and is the loss of albumen as de- scribed. This brings us to consider the curability of the mucous membranes, that is, the facility, rapidity, and certainty with which they may be thoroughly healed and thus stop the loss of albumen. And of all this being susceptible of speedy accomplishment, in the early stages of these cases, 12 170 CONSUMPTION. there would, fortunately, appear to be no serious ground to question, if well settled physiological facts bearing upon these points may be relied upon. Carpenter says of the healing of mucous membranes, when injured or diseased: "Their regeneration, after loss of substance by disease or injury, takes place with great rapidity." Furthermore, it was shown, when describing the mucous membranes, that the retention of the albumen in its proper place in the interstices of these and the deeper tissues, for nutritious purposes, was mostly, if not wholly, due to the superficial layer of these membranes, the epithelium, or that which corresponds to the scarf skin of the surface; and that this delicate covering was made up wholly of mi- nute flattened cells, like the scales of a fish, lying upon each other, two or three thicknesses in depth. Of the regenera- tion of this, the same author (Carpenter) says: " The epithelium of most parts of the surface of mucous membranes, appears to be frequently exuviated and re- newed." Other authors state that of all the cell structures of the animal body, the epithelial cells of the mucous membranes are reproduced with as great or greater rapidity than those of any of the other tissues. Such, indeed, must be the fact, if Gray's statement before quoted is true, namely: " As a general rule, the more active the function of an organ is, the closer is its capillary net and the larger its supply of blood; the net-work being very narrow in all growing parts, in the glands, and in the mucous mem- branes." The constant reproduction of the epithelial cells, by or upon the basement membrane of the mucous surfaces, to take the place of those that are as constantly going to decay (having gone through their natural life and usefulness) and being cast off as worn-out matter, is an imperative necessity to the continued existence of animal life; and ITS CURABILITY. 171 this necessity Nature has met and ensured in the pro- vision that more blood shall flow through the mucous membranes, than most other parts, to furnish the material out of which the cells in question are grown. Besides this she has further provided that in case of irritation from any cause arising in these membranes, a still greater quan- tity of blood than natural shall flow there, greatly dis- tending the vessels, thus doubly ensuring the presence of an ample supply of material, with which all damage or injuries may be repaired, and the further waste of albu- men stopped. In these indisputable physiological facts, we have the proof upon which to found a rational and even a scientific hope that consumption, in the first stages of a majority, and possibly a large majority of those directly and cer- tainly threatened with it, may be cured. That there are some naturally of such feeble vitality and so little tenacity of life, having no reserve forces to protect them against anything serious that may assail them, and that there are others of such evil and perverse habits, or so reckless of consequences that they can not be cured, is beyond ques- tion: but these are certainly a minority, and they ought not to dispel the great hope there is for the majority to be cured during any period of the truly catarrhal stage of their malady, before the commencement of the deposit of tubercles. Hence it is my sincere belief that very many can be cured after the commencement of the deposit of tubercles, if not in large masses, and before such inflam- mation is excreted in the tissues around them as must nec- essarily end in suppuration and considerable destruction of lung substance. Before the deposit of tubercle all that requires to be done, it must be remembered, is to heal the mucous mem- branes by judicious treatment, and thus restore them to their normal condition. This necessarily stops the further waste of albumen, and if the theory is true, puts an end at once 172 CONSUMPTION. to the possibility of any tubercular matter being produced, to be deposited to destroy the lungs. It would also end the cough and expectoration, the rapidly progressing ema- ciation, the debility, the night sweats, and every other serious symptom of the case, and leave the patient with no other prospect than to get well. At the same time while the facts given warrant our taking so hopeful a view of the curability of consumption in its early stages, it should be understood that it is not assumed to be a mere holiday task to heal the mucous membranes. With many it appears to be very speedily accomplished under the administration of the proper remedies; while with many others, a very large majority, in fact, of those who have inherited the taint of, or tendancy to, consumption, it remains a long, careful and discriminating treatment to heal those surfaces; and espe- cially so when we desire to heal them so effectually that their taint will not become aroused and set to work again upon the first severe cold, or other trying ordeal through which they may be compelled to pass. Even were the loss of albumen not the cause of tuber- cle, it must be conceded by all, that stopping the waste of so highly nutritious and necessary an element of the blood for the nutrition of most of the soft tissues, as this has been shown to be, would, nevertheless, be of the utmost importance, to arrest this cause of emaciation and debility, and would, let its cause be what it may, leave the patient with so much more strength and vigor to combat the progress of tubercle. After the production and deposit of tubercle, there are two most important purposes to be accomplished before the patient can be cured, namely: the mucous membranes must not only be healed, but the tubercle, or tubercles, must be absorbed before health can be restored. Here is a double and most difficult task to perform, first because the vital forces are almost always much more exhausted after than at any time before the deposit of tubercle, ITS CURABILITY. 173 making it all the more difficult to arouse sufficient energy in the system to stay so formidable a disease; and sec- ondly, becuuse we have so much dead and malignant mat- ter occupying the delicate tissues of the most vital organs, constantly irritating them to excite inflammation, and which must be absorbed before such a thing can be thought of as restoring health to the sufferer. But here again philosophy comes to our rescue and furnishes reliable ground for hope in the cure of many of this class of cases, which we can not find in any other direction. For instance, with morbid growths, as well as with morbid deposits, where the growth or accumu- lation has not assumed too great proportions, or destroyed the parts in which embedded, cutting off their nutrition, or stopping the production of the material on which they depend for their development, will necessarily arrest the further increase of the morbid mass, and then the absorb- ents around and in the mass, which are almost universally active under such circumstances, will set to work vigor- ously and pick up and carry off, by minute particles, the accumulation, until the whole is removed. These facts are too well known to require proof. And they apply just as fully and forcibly to tubercles, as to any other kind of morbid matter or growth. Therefore, it is again repeated, if the loss of albumen through diseased mucous membranes is the cause of their existence, or production, the stoppage of such loss by heal- ing those membranes, must necessarily cut off the further production of tuberculous matter in every such case, so the tubercles could not by any possibility grow larger; when the absorbents would continue their natural activity, even without any extraneous aid, and remove all that had been deposited, provided its mass was not so great as to unavoida- bly excite inflammation, suppuration and destruction of the parts in which embedded, before thejr can complete their beneficent work. This encouraging outlook for such pa- 174 CONSUMPTION. tients is based solely upon the unaided natural activity of the absorbents, under the circumstances given; but when the belief is stated, that judicious medical treatment may be made to greatly stimulate and increase the activity of the absorbents in their work of taking up and carrying off the accumulated matter of tubercle; and also that such treat- ment may be made to keep down inflammation around the tubercle much longer than it would be if nothing was done in that direction, thus giving so much more time to accom- plish the object desired, how much may we not hope for being consummated in the cases of this class, which have been hitherto looked upon so hopelessly? Certainly, we should not despair of the curability of consumption, under such a showing, even in such patients. My own experience would fully warrant my assuming that a majority of them, to say the least, with due care, and with caution and obedi- ence on their part, may be saved. Of the third stage of consumption, little, if any, hope is to entertained of its cure, and especially if a tuberculous mass of any considerable size has suppurated, and broken down a corresponding amount of lung substance, in either lung. The breaking down of several small tuber- cles, even if quite small, but destroying and carrying away lung tissue, is equally hopeless. It is not, however, re- garded as impossible that some patients may be cured wherein there has been a softening of one or two small tubercles, and the leaving of small cavities in the lungs, but no certain reliance can be placed upon permanent relief being given in such cases. Many cases of consumption, where symptoms were un- mistakable and of great severity, both in the first and sec- ond stages, might be given as permanently cured under the principles laid down in the preceding pages; but it can not be necessary to take time and space in their rehearsal, to enforce the argument presented, so fully has this been already sustained by proof from the best authorities, or from reliable observations that are familiar to all. ITS CURABILITY. 175 It is thought that facts and principles like those given, that apply equally to the treatment of all cases, and which afford such reliable grounds for hope, that nearly all can be cured if taken in time, will be of much more interest and importance to all sufferers, than any mere detail of symptoms which might or might not correspond with these cases. What the world needs to know more than all else in this connection is, the cause of consumption, so as to avoid the disease where possible; and whether it can be cured, or what reason there is to hope for this in any of its stages, when it is actually upon one. And it would seem that both of these questions had now been pretty fully and satisfactorily answered. 176 CONSUMPTION. CHAPTEE XXV. HARSH AND IRRITATING MEDICINES MUST BE AVOIDED. One thing imperatively demanded, if we wish to cure consumption, is, that all harsh, strong or irritating medi- cines must be scrupulously avoided. The necessity for this will be seen from the statement of a few plain, simple facts. It has already been shown that the slightest irrita- tion of a mucous membrane causes a secretion and waste through it of albumen. It will be remembered that Leh- mann said: "Daily experience shows how rapidly the number of the so-called mucous corpuscles increases with the slightest irri- tation of the mucous membranes; and we know from the researches of Julius Vogel, that an irritated mucous mem- brane secretes not only such corpuscles, but also an albu- minous, coagulable matter, however much it may be disposed to form transudations and exudations." Even the comparatively slight mechanical irrritation of the throat with a feather, causes its mucous membrane to secrete an abnormal quantity of mucus, which is in itself albuminous, and with it also a waste of albumen in a more or less pure state, as proved by the above quotation. Then what may not be the injurious effects of "burning out" the ab- normally and often excessively sensitive throat of a consump- tive, with some violent cautery, like the nitrate of silver, or of gargling it daily with some harsh, irritating medicinal agents, as is often done? By these various means, it is an actual and undeniable fact that ounces of albumen, either HARSH MEDICINES MUST BE AVOIDED. 177 in the mucus, or that which is more or less pure, are often wasted every twenty-four hours, in addition to that which is lost through the specific effect of the patient's disease, and which is the sole primary cause of all his troubles. How absurd, then, to add, in this or any other way, to the cause of the existing evils. Again, no limit can be placed upon the great injury done a consumptive by strong, harsh, or irritating medicines which may be taken into his stomach. All medicines with- out exception which may be classed as irritative in their results, are especially so upon the mucous membranes. Hence the large number that are emetic, cathartic, diuretic, expectorant, etc., in their action, must be avoided. Their effects are, indeed, so violent upon the mucous membranes that they will often, when taken into the system, injure and cause a loss of albumen, through a remote membrane, with which they do not come in direct contact at all, as will be seen in the following from that most reliable author, Watson. He says, in speaking of albumen in the urine: " Albumen has also been detected in the urine under that general state of irritation produced occasionally by mercury, or by a blister to the skin." Here we see that even a blister applied to the surface of the body, will cause a loss of albumen through the kidneys, either from the trifling amount of its material that is ab- sorbed into the blood, or by the reflex action of its irritation through the nervous system. And it should be borne in mind that this result is, or may be, brought about when the kidneys are themselves healthy. What may not be the effect, then, upon the highly sensitive and irritated lungs of a consumptive, by introducing harsh and powerful medicines into his stomach ? The results must be serious in most, if not all, cases. Indeed, we know they are, from what is so well known of the effects of expectorants. Any of these taken into the stomach very frequently, cause a 13 178 CONSUMPTION. profuse secretion and expectoration of mucus from the lungs. Dunglison says of expectorants: " There is probably no such thing as a direct expecto- rant. They all act through the system, or by impressions made on parts at a distance, which, through the medium of general, continuous, or contiguous sympathy, excite the secretory vessels of the air-passages into action." How responsive, then, are the lungs in health, to such agents, which directly irritate other and remote parts, and how much more so must be lungs already diseased ! And when we reflect that the sole direct cause of the consumptive's disease is a loss of albumen from the blood through some one or more tracts of mucous membrane, but more conspicuously that of the lungs; that all the mucus that the expectorants cause to flow is only a loss of so much more albumen, and that with every abnormal dicharge of mucus there is a waste of albumen, often in large amount, in its more or less pure state; we see what irritating medi- cines must necessarily do in hastening the sufferer to his grave. And in the foregoing no account is taken of the quantity of albumen caused to be lost through the direct effects of the irritants upon the mucous membranes of the stomach and intestinal canal generally; nor the great danger of hastening the inflammation and suppuration of tubercles, after they are deposited by the expectorants, exciting a greatly increased flow of blood to the lungs, to furnish the material for the increased mucus, and which must of neces- sity cause active congestion in the obstructed vessels about every tubercle. INHALING REMEDIES. For the reasons just given, no medicines of any kind, name, or nature, should ever be inhaled into the lungs. The lungs were made to inhale air and nothing else. And he who violates this organic principle of Nature will surely be made to pay the penalty. Anything taken into the lungs HARSH MEDICINES MUST BE AVOIDED. 179 besides air, and especially the vapor of irritating drugs inhaled for the purpose of causing a free expectoration, must waste albumen, the same as expectorants, and just to the extent that the expectoration is increased thereby, and here again add just so much to the existing cause of all the patient's suffering and danger. The risks of exciting con- gestion and inflammation would be just as great, or greater, than with expectorants. Again it is repeated, were the cause of consumption not a loss of albumen, so much of it as is wasted by adminis- tering harsh and powerful medicines, as expectorants, by inhalation or otherwise, robs the system of its best mate- rial for keeping up its strength and activity, hence debility and exhaustion must necessarily all the sooner appear and progress with greater rapidity. So look upon and questiou causes as we may, there can not be two opinions among those who know anything of the great importance of albu- men to animal life, that the waste of any considerable por- tion of it from the blood daily, no matter how brought about, must lead to most serious consequences. Secondly. The excesss of the other constituents left by the loss of albumen, then becomes foreign matter, which is either found depositing in living tissues, creating more or less irritation or disturbance therein, or causing actual disease; or it is expelled from the system entire through every outlet that the powers of life can command. A por- tion of the excess of some of the constituents is sometimes used up by an increased nutrition of parts or organs, tha is, by abnormal enlargements or morbid growths, as is often manifested by the enlarged glands, and other growths or excrescences, in scrofulous subjects and in the early s tages of consumption. THE THERAPEUTICS OF TUBERCULOUS AFFECTIONS. BY H. C. ALLEN, M. D. IS CONSUMPTION CONTAGIOUS? Koch's discovery of bacilli in the sputa of tuberculous persons has been confirmed by many observers, but that they are the cause of tuberculosis, as asserted by Koch, is not generally believed. Spina, of Vienna, with Learning, Formad, and many others in this country, while agreeing in always finding bacilli in the sputa, deny that they are always found in the tuberculous organs of man. Spina never found them in tubercles to which the air had no access; and in this agreeing with Gregg that "the bacilli of tuberculosis are the result, not the cause, of the disease." Another decade may number the bacillus, as a cause of tuberculosis, among the discarded theories and confirm the fibrin theory of Gregg. So much has been written in har- mony with the popular belief of the communicability of phthisis, that in addition to what appears on page 117, we append the conclusions to which Learning, after years of study, has arrived: "If it were not for the adoption of Professor Koch's theo- ries, as well as the acknowledgment of his discoveries of bacilli by gentlemen of high scientific attainments, such as Professor Biihle, of Bonn, and others, controversy would be unnecessary; but, as it is, we must examine the subject critically but dispassionately. "Fibroid phthisis is not included in the form of consump- tion claimed to be propagated by bacilli. The germ theo- rists assume that all forms of phthisis are tubercular. But a large number of cases are fibroid, pure and simple, in which the diathesis is gouty or rheumatic, and not scrofu- lous. These ought to be exempt from suspicion even. Again, a vast majority of cases of tuberculated phthisis, that is with excavations, commence with plastic exudation 1*4 CONSUMPTION. within the pleurae. These, on account of bronchial com- plications, are called by Niemeyer "catarrhal pneumonia," and he says " the great fear is that they may become tuber- cular." This fear is born of experience, and should direct us to proceed energetically, at the same time judiciously, to remove the plastic exudation while it is easy of accom- plishment. It may be well to state here that we make a distinction between tuberculosis and tuberculated phthisis. Tuberculosis is the systemic disease which gives birth to true tubercle—the military tubercle of Bayle. Tubercu- lated phthisis is a term used for convenience and denotes the result of cheesy degeneration, in which cavities take place as a result of tuberculosis or other causes of necrosis of the lungs. "The number of uncomplicated cases of tubercular phthi- sis—that is, of tubercle forming into concretions or nodules and being encapsulated, with no pleuritic adhesions and without fibroid in the lung, is extremely small. In a prac- tice of more than thirty years in dispensary, hospital, and private, I cannot remember more than a very few cases. Laennec and Louis evidently refer to these cases under the term of latent phthisis and acute phthisis. "This small number, commencing centrally in the lungs and not involving the pleura, are the only ones which could have had a parasitic origin. But even in these it is doubt- ful whether bacilli had anything to do. "I do not doubt the discovery of bacilli in great abundance in tuberculous cavities and in the sputa of tubercular con- sumptives, as well as in the adjacent tissues, but I cannot accept the inference that they are the essential causes of tubercle. They may find in a tuberculous cavity a fit soil or home where they may grow and multiply. "But the bacillus is not necessary to explain the occur- rence, cause, and course of phthisis—fibroid or tubercular. As has been stated, all but a very small number of cases commence as fibroid—that is, with plastic exudation within the pleura, in which the bacillus is not a factor. This primary condition of phthisis may be the result of de- pressed vital power from various causes, long-continued GEOGRAPHICAL DISTRIBUTION. 185 and violent emotion, anxiety, worry, grief, or disappoint- ment, more than from catarrhal causes. Or it may, but in a less degree, be the result of adhesions from acute pleur- isy, which are a physical cause of vital depression. A mother, after watching her children, three or four in number, through scarlatina of a severe type, began to cough, lose weight, and finally died of phthisis. She was well when the children were taken ill; she was a loving, anxious mother, and as they were attacked successively the time of her anxiety was prolonged. The children all recov- ered, but the mother was sacrificed. She was not aware of having taken cold. The cough was so insidious that no one could tell when it commenced. Had there been the same prolonged anxiety over a case of phthisis, followed by inconsolable despair at the loss of the loved one, it would have seemed to prove the communicability of consumption. But scarlatina germs do not originate phthisis, nor do bacilli. Even in the ordinary forms of tubercular phthisis, for a considerable time the disease is simply fibroid—preventable phthisis. GEOGRAPHICAL DISTRIBUTION OF PHTHISIS. According to Hirsch's great work, " Hand-book of Geo- graphical and Historical Pathology," recently issued by the New Sydenham Society, perhaps the best authority extant on the subject, the effect of climatic influence on the production, continuance or mortality of phthisis is much less than is generally accredited. While we are prone to consider it chiefly confined to the temperate zone, and largely the outgrowth of the higher civilization of the Anglo-Saxon race, he claims it to be "a disease of all times, all countries, and all races." The Esquimaux of the polar region, the Negro of the tropics, the inhabitants of the West Indies, and the people of the South Sea Islands, suffer more from its ravages, in proportion, than the Anglo- Saxon of the temperate regions of Europe or America. It 186 CONSUMPTION. is even more rapidly fatal in the tropics than elsewhere. After an extensive examination of facts, extending over a number of years, Hirsch arrives at the following: Phthisis prevails everywhere; but it is rare in polar regions and high latitudes. Heat and cold per se have no influence whatever. Dampness, when combined with frequent and extreme oscillations of temperature, predisposes to the dis- ease; but humidity of air is not so prominent a factor as dampness of soil. Occupation is important only as it tends to good or bad hygienic surroundings; while over crowd- ing, imperfect ventilation, and defective hygiene, are the chief factors known to us at present. Moisture. The effect of moisture is also greatly over estimated; at least, statistics prove it to be a much less prominent factor in the production of phthisis than is generally supposed. It may surprise many to learn, that the mortality from consumption is as great in sunny Italy as in damp and foggy England. And those who maintain that cold and dampness are the chief causes of this affection, will have difficulty in accounting for the almost complete immunity enjoyed by the people of the Hebrides and the Faroe and Shetland Islands. Altitude. The following are the conclusions at which Dr. Dennison has arrived, on the effects of altitude and a rarified atmos- phere in the prevention or cure of phthisis: "The preferable climate for the treatment of phthisis is distin- guished by the five following attributes, named in the order of their importance: "1. Dryness as opposed to moisture. 2. Coolness or cold preferable to warmth or heat. 3. Rarefaction as opposed to sea level pressure. 4. Sunshine as opposed to cloudiness. 5. Variability of temperature as opposed to equability." To these five principal characteristics are added five subordi- nate ones, as follows: CLIMATE. 187 "6. Marked diathermancy of air to be preferred to the smoky atmosphere of cities, or the dense air strata of moist currents. 7. Radiation and absorption of heat by rocks and sandy loams better than latent absorption by water and damp clay soils. 8. Mountainous configuration of country (quick drainage) contrasted with the flatness, etc., of level stations. 9. Frequent electrical changes of atmosphere, also moderate winds (except in quite cold weather) preferable to continuous stillness of air. 10. Inland altitudes, contrasted with sea air." Climate. The best climate for the tubercular patient is that in which is obtained the greatest freedom from mental and physical sufferings; a climate that is adapted to the pecu- liarities of each individual case. In other words, climate, like the homoeopathic simillimum, to be either preventive or curative must be carefully individualized; must be selected, not for consumption, but to meet the needs of the patient. As generally practiced, the climatic treatment of the phthisical patient is little else than a farce; at most, a dangerous and costly experiment. Some physicians send their patients south, and others north; some to the sea shore, others to the mountains; some will advise a sea voy- age, others an equestrian trip across the continent. There is no system, no method, no rule; the whims or taste or convenience of the patient being often a sufficient excuse for selection of the climate. The only general rule that can be given with comparative safety is, that, whether cold or warm, the atmosphere should be dry. For example: An atmosphere in which animal food, when hung in the open air and unprotected, will become dry and may be pre- served indefinitely. In such a climate cases of phthisis, unless in the last stages, are often held in check, improved or completely restored. Another requirement, and one absolutely essential to permanent curative results is, that whatever climate be selected, when found to agree, should be made the perma- nent future residence. One objection to the winter resorts 188 CONSUMPTION. of the South is, that they are only sought for temporary convenience, to be abandoned on the approach of spring for the colder and more agreeable watering places of the North. Our experience in the treatment of phthisis is, that it is not so much a change of climate that is needed as life in the open air. And this leads us to the consideration of the Closed Establishments foe Phthisis. About thirty years ago, Dr. Brehmer, in a series of arti- cles, announced his belief in the curability of phthisis by purely hygienic measures, and the establishment of a San- itarium at Gorbersdorf, in Silesia, under his management was the first practical result. But perhaps the most noted one is that at Falkenstein, near Francfort, under Dr. Dett- weiler and there are several of lesser note in successful operation. The objects sought to be attained are: First. Best, mental and physical, in the open air. Second. Respiratory gymnastics, which might be made to include the use of the pneumatic cabinet. Third. Strict, systematic dietetic regulations. Fourth. Personal hygiene; hydropathy. The resort should be located at a medium altitude and surrounded by a pine or fir forest, so as to be protected from high winds, the severe storms of winter and the hot sun of mid-summer, as exposure to the latter is found to induce haemorrhage in those predisposed to the diathesis. It is reported that 25 per cent, of the patients admitted to these "closed establishments" are permanently cured and relief obtained and life prolonged in a much larger percent- age of cases. When we consider that only undoubted and desperate cases are likely to apply, this certainly speaks vol- umes for hygiene and tends to confirm Dr. Gregg's theory of disease of the mucous membranes, as the true cause of tuberculosis. The patients are compelled to live in the open air from seven to ten hours daily, and enter, on the understanding, that they are to remain until cured. PERSONAL HYGIENE. 189 Life in the Open Air. Many a tuberculous patient, even in the advanced stages, has been completely restored to health by "life on the ranch." The day is spent in laborious exercise in the sad- dle, and at night wrapped in his blanket with the saddle for a pillow, he sleeps the sleep of the just. Says the great anatomist, Langenbeck: "1 am sure now of what I suspected long ago, viz.: That pulmonary diseases are nearly exclusively (if we except tuberculous tendencies inherited from parents, I say quite exclusively) produced by the breathing of foul air. The lungs of all persons, minors included, who had worked for some years in close workshops and dusty factories, showed the germs of the fatal disease; while even confirmed ine- briates, who had passed their days in open air, had preserved their respiratory organs intact, whatever inroads their excesses had made on the rest of their system. If I should go into practice, and undertake the cure of a consumptive, I should begin by driv- ing him out, and prevent him from entering a house for a year or two." PERSONAL HYGIENE. One of the most potent causes in the production and maintenance of catarrhal affections of the mucous mem- branes of the respiratory tract, is the habit of wetting the hair before brushing or combing and allowing it to dry by evaporation. These persons would not think of wetting the feet three or four times a day, and allowing them to dry in the same way, and yet the effect is practically the same. Persons subject to nasal catarrh, especially, can rarely be cured while this vicious practice is maintained. And since Gregg has shown that the loss of albumen from the weakened and diseased mucous membranes is the primary cause of consumption, its importance cannot be over-estimated. Catarrhal affections are rarely found in persons who do not suffer from impaired digestion, hence perfect digestion is one of the first objects to be attained in the prevention or cure of consumption. 190 CONSUMPTION. Bathing. A sponge bath every morning with water which has stood in the rooom over night, is one of the best preven- tions of "taking cold" from the least exposure to atmospheric changes. It should be taken rapidly with a bathing sponge or washing cloth and, after drying, followed by a brisk rubbing with a crash towel until a healthy glow is obtained. If a full bath should prove too much of a drain on the vitality, i. e., if it be followed by chilliness or deficient reaction, then it should be confined to the chest, arms and shoulders; or it may be taken two or three times a week instead of every day. If possible it should always be taken in a warm room. EATING: HOW TO EAT; WHAT TO EAT; AND WHEN TO EAT IT. Rapid eating is without doubt the bane of our boasted civilization. To this pre-eminently American habit is due the imperfect mastication, partial insalivation, impaired digestion, faulty assimilation and mal-nutrition of many of the grave lesions we are called upon to treat. Instead of spending from forty to sixty, the average time in which a full meal is disposed of is from fifteen to twenty minutes. As it cannot be thoroughly masticated in that time, it is " bolted" and washed down with water, tea, coffee, cocoa, wine, beer, etc., and as none of these are digesting fluids, the result is acid fermentation, yeasty products, and the formation of flatus. Diet. Like everything pertaining to the cure of the sick or the maintenance of health, must be individualized, for it is impracticable if not impossible to prescribe a fixed diet that will agree with all patients. When a diet is found which perfectly agrees with the patient, eat that and noth- ing else. Yet it is often not so much a question of what SALISBURY'S METHOD. 191 to eat as how to eat it. We have found the following rules practical, though the list might be much extended: Eat slowly; masticate thoroughly; food well masticated is virtually half digested. The more saliva used, the more gastric fluid secreted; consequently the more perfect digestion. It is not the quantity of food so much as the quality and method of eating that is needed; the person who ob- tains the most nutrition from the least food has best learned the art of living. If the time for eating is limited, eat less, but eat it well; a small meal thoroughly masticated is far better than a large one hurriedly bolted. Drink nothing at meals or for at least a half hour before, and during digestion, i. e., from one and a half to two hours after eating. When sitting down to a meal, if thirsty, a swallow of water held in the mouth for a minute will cool the mouth and throat and allay thirst. When one can no longer eat without drinking, it is na- ture's hint to stop eating. The best time to dine is, when for an hour or two after eating, comparative or entire rest, both mental and physi- cal, can be taken; never eat when mentally or physically exhausted. Salisbury's Meat Diet. After a series of the most thorough experiments in the effect of diet in the cause and cure of disease, Dr. J. H. Salisbury comes to this conclusion: "No one can hope to treat consumption successfully by change of climate or by medicinal remedies. It is a disease arising from long- continued, unhealthy alimentation, and can only be cured by the removal of its cause. This cause is fermenting food, and the products of this fermentation (carbonic acid gas, alcoholic and vinegar yeast, and vinegar) are the more important factors in developing the peculiar symptoms and 192 CONSUMPTION. pathological conditions in this complaint, which is gen- erally though erroneously believed to be incurable. " Consumption of the bowels can be produced at any time in the human subject, in from 15 to 30 days, and con- sumption of the lungs within three months, by special, ex- clusive and continued feeding upon the diet that produces them." And adds: "If the directions here given are faithfully followed and persisted in, consumption in cdl its stages becomes a curable disease." Drinks.—" Drink from half a pint to a pint of hot water from one to two hours before each meal and on retiring, for the purpose of washing out the slimy, yeasty stomach before eating and sleeping. Drink a cup of clear tea, coffee or beef tea (the latter free from fat) toward the close of each meal, sipping slowly. During the interval between two hours after and one hour before each meal, drink hot water or beef tea if thirsty. Food meats.—"Eat the muscle pulp of lean beef, chopped fine, made into cakes and broiled. This pulp should be as free as possible from connective or glue tissue, fat, car- tilage, fascia?, tendon, etc. Steaks cut from the centre of the round are the richest and best; and the beef should be procured from well fatted animals from four to six years old, and the pulp should not be pressed too firmly together before broiling. "Make the cakes from half an inch to an inch thick. Broil slowly over a fire free from flame and smoke, and season to taste. Celery may be used as a relish. No other meats allowed until the stomach becomes clean, the urine clear — three pints or more daily—with a sp. gr. of 1015 or 1020, and the cough and expectoration cease to be trou- blesome. Then broiled lamb, mutton, game, chicken, oys- ters, and codfish broiled or baked, and a soft boiled egg at breakfast, if it does not color the urine, may be allowed. Bread.—" Toast, boiled rice or cracked wheat may be eaten in proportion of one part (by bulk) to from four to six parts of meat. Bread should be made from gluten, HOMOEOPATHIC TREATMENT. 193 white or Graham flour, raised with yeast and free from sugar. Bathing.—" Take a soap and hot water bath twice a week for cleanliness, after which oil the entire body with gly- cerine and water, rubbing in well. Every morning sponge off with a little hot water, wiping dry and rubbing tho- roughly. Avoid washing in cold water, that there may be no unnecessary expenditure of nervous force in the resto- ration of vital warmth. Clothing.—" Wear flannel next the skin and dress with comfortable warmth. Change all clothing worn during the day on retiring, so that it may be thoroughly aired for the following morning. Underclothing should be changed every other day. Exercise.—"Drive daily in the open air as much as possible, without fatigue. If not able to drive, the body and limbs should be rubbed and kneaded for ten minutes three times a day by some one who has suf- ficient strength to do it thoroughly. Meals.—" Should be taken at regular intervals, and it is best to eat alone or with others who are on the same diet. After the system is in good running order more than three meals may be allowed if desired; a broiled steak, with a cup of tea, hot water or beef tea, may be taken midway between breakfast and dinner, and dinner and supper." THE HOMCEOPATHIC TREATMENT OF PHTHISIS.- The curability of consumption and kindred affections hitherto considered incurable, is a question of serious im- port to every follower of Hahnemann. Is it possible by any method of hygiene, or any system of medical treat- ment with which we are at present conversant, to curtail the terrible ravages of this scourge of the human race? The lines of demarkation between the curable and the incurable were never intended by Nature to be marked by a diagnosis; and as believers in a law of cure, it is our duty to carefully select and conscientiously apply the similli- 194 CONSUMPTION. mum instead of folding our arms after making a fatal prognosis. J. C. Burnett, M. D. says: " The limits of the curable and incurable are not represented by any fixed lines; what is curable to-day may be incurable to-morrow, and what we of this generation deem incurable, may be con- sidered very amenable to treatment in the next genera- tion." In a thoughtful essay delivered before the New York County Society on " Homoeopathy in its Relation to Malig- nant Diseases," by J. S. Mitchell, M. D., the author says: "Homoeopathy has wiped out all symptoms of syphilis, save the lightest, and absolutely shorn the disease of its ancient terrors. It has shown that persons who have been reared under its benign influence are rarely subject to in- flammatory rheumatism at any period of life. It has almost obliterated puerperal fever from the families of our adherents, and it has vastly diminished the prevalence of all the grave lesions, such as phthisis and Bright's disease." After twenty-five years of careful study and investigation of the etiology, pathology and treatment of consumption R. R. Gregg, M. D., says: "While I indulge in no wild hopes for myself nor offer indiscriminate encouragement to mislead others in the curability of consumption in its advanced stages, I nevertheless assert with emphasis, that a far greater proportion of cases in the first stage ought to be cured than ever has been. Indeed, I feel no hesitation in saying that a majority of cases in the purely catarrhal stage before the organization and deposit of tubercles ought to be and can be cured, provided they are correctly treated. To accomplish this, however, the patient as well as the physician, has his part to do. Especially must he forego all exhausting mental and physical labor, care and anxiety as far as possible; he must also avoid all injurious habits that may have had to do with the causing of his disease. In no other way can the complete curative action of medicines be obtained and maintained to the final cure." " In the second stage of phthisis or that of tubercular HOMOEOPATHIC TREATMENT. 195 deposit, before the suppurative process begins, a much smaller proportion of cases is curable; and yet here, under favoring circumstances, many have been cured. The exact simillinmm, carefully selected and rightly administered, will often surprise the physician with its beautiful curative action, even in this stage." " In the third stage of tubercular phthisis, that is, after tubercles of large size have softened, broken down the lung tissue and large cavities formed, very few are curable. Such cases are sometimes reported in the periodicals as having been cured after large cavities have formed; but it has always seemed to me that it was more probably chronic lobular pneumonia that had caused the breaking down of lung substance in these rather than primary tubercle, or at least the cases were more or less modified by the pneu- monic process." The Simillimum. Pulmonary tuberculosis, like many malignant affections, is rarely cured in its later stages, after extensive cavities have formed. But the skillful application of the similli- mum will often correct the constitutional ailments and pre- vent the development of phthisis. Hitherto many methods of treatment, each based upon the supposed etiology or pathology of the affection, but each directed at the disease instead of the patient, has been proclaimed, only to meet the ignominious fate of its prede- cessors. The individuality of the patient has been largely if not entirely overlooked. It is the patient that is to be cured; and as no two patients are alike, it is worse than useless to subject all patients to the same treatment. Hence, neither change of climate, closed establishments, special diet, the movement cure, Oxygen treatment, elec- tricity, nor personal hygiene in any form will alone suffice. Each of these in its individual sphere will accomplish something, for each has more or less effect on the activity of cell-life. But have we not now sufficient data to warrant us in 196 CONSUMPTION. saying, that by a judicious individualization of all these agents, combined with the correcting of the underlying psoric diathesis by the exactly similar remedy, we may be able to control and eventually eradicate not only phthisis but its malignant allies, cancer and Bright's disease? And this will be brought about as C. W. Eaton, M. D., says: "Not from any troop of new remedies, not from a new law of cure, not from any revolutionizing discoveries, but from the vantage ground of a better understood and closer ap- plied Homoeopathy are we to conquer the incurable. * * * There are many methods, but only one law; and chance, accident or exception are unknown to natural law, hence the indicated remedy must bear the brunt of the battle." There is no chronic affection in the homoeopathic treat- ment of which greater care should be taken, or the rules of the Master more accurately followed. No guessing can be tolerated. The symptoms of the case must be written with care and the constitutional peculiarities which antedated the localization of the disease especially noted, always bearing in mind that " the greater the value of a symptom for purposes of diagnosis, the less its value for the selection of the remedy." When the most similar remedy has been selected and administered, allow it plenty of time to do its perfect work, using placebo liberally if necessary. The Three Mistakes. In Chronic Diseases, Vol. I, page 152, Hahnemann says: " There are three mistakes which the physician cannot too carefully avoid: The first is to suppose that the doses which I have indicated as the proper doses in the treat- ment of diseases, and which long experience and close observation have led me to adopt, are too small; the second great mistake is the improper selection of the remedy; and the third mistake consists in not letting the remedy act a sufficient length of time. In the treatment of chronic diseases the too hasty repetition of the dose cannot be too carefully avoided. The whole cure fails if the antipsoric HOMOEOPATHIC TREATMENT. 197 remedies which have been prescribed are not allowed to act uninteruptedly to the end." Hahnemann's Three Rules. The following practical rules of Hahnemann for the treatment of chronic diseases are condensed from Hering: Bide I.—The characteristics of the drug must be similar to the characteristics of the case. " In making this com- parison, the more prominent, uncommon and peculiar feat- ures of the case are especially and almost exclusively con- sidered and noted; for these in particular should bear the closest similitude to the symptoms of the desired medicine, if that is to accomplish the cure." " The symptoms of a case and the symptoms of a remedy must not only be alike, one by one, but they must also be of the same rank. In the arrangement of symptoms after the examination of a case, the value, the importance, the rank of the symptoms must be considered, for in a careful comparison of several remedies having the same similarity it is this rank of value which often decides the selection of the curative remedy. Bute II.— This rule of practice is based upon Hahne- mann's theory of chronic disesses; viz.: "all chronic dis- eases progress from without inwardly, from the less to the more essential parts of our body, from the periphery to the central organs, and generally from below upwards." Hence, in the selection of a remedy, one should be chosen which acts in the opposite direction—"from within outward, from above downward, from the brain and nerves outward and downward to the most outward and lowest of all organs, the skin." Hahnemann's antipsoric remedies all have this pecu- liarity as characteristic — the evolution of effects (symp- toms) from within outward. Hence, all symptoms of the sick having such a direction, from without inwards; and all symptoms of remedies from within outwards — the opposite direction — are always to be considered of the highest rank or value in the choice of the simillimum. Bule III.— The symptoms recently developed are the 198 CONSUMPTION. first to yield; older symptoms disappear later. Or, as Hering says: "In diseases of long standing, when the symptoms or groups of symptoms have befallen the sick in a certain order, succeeding each other, more and more being added from time to time to those already existing, in such cases this order should be reversed during the cure; the last ought to disappear first and the first last." The following are the advantages of this rule: 1. " When examining the patient, care must be taken to ascertain, as far as possible, the order, according to time, in which the symptoms made their first appearance. 2. "Arrange the recorded symptoms according to their value or rank, not neglecting any, either objective or sub- jective, but placing in the foreground and giving promi- nence to those which were the latest to appear; and to those especially should the remedy be similar. 3. " If the patient has been drugged our antidotes, to be most effectual, must be directed especially against those last given. 4. " In every chronic case, after the simillimum has had time to improve the case and ceases to do any further good, a new examination must be made, and in this, partic- ular attention paid to new symptoms; and in the choice of a remedy these new symptoms must be carefully noted, as generally they are of leading or high rank. 5. "If we thus succeed in restoring a chronic case of long standing, the symptoms disappearing in the reverse order of their appearance, the case can be dismissed as cured without any danger of returning; if not, we had better tell the patient, even if he be satisfied with a partial cure, that before long he may be sick again. "Without this third rule, the homoeopathic healing art would be a most imperfect one. But this enables the true Homoeopath, not only to cure the most obstinate chronic diseases — even those usually pronounced incurable—but also when discharging the case to make a certain prognosis, whether the patient will remain cured, or whether the disease, like a half-paid creditor, will return at the first opportunity. This is prevision applied to the cure of •chronic diseases." ACALYPHA INDICA. 199 ACALYPHA INDICA. An East Indian member of the Euphorbiaceae family, introduced, proved and applied in tubercular haemoptysis by Dr. Tonnere, of Calcutta, to whom it was recommended by a native for jaundice, but when given for jaundice pro- duced haemoptysis in a number of cases. The symptoms have been verified by Drs. Payne, Cooper, Holcombe and others, not only in haemoptysis but in haemorrhages from any mucous membrane having the characteristics of Acaly- pha. Its range of action is necessarily limited by meagre and imperfect provings. Characteristic. Haemoptysis: of pure, bright red blood in the morning; dark, clotted lumps in the evening. Pro- gressive emaciation (Iod.) Aggravation. In the morning: Haemorrhage. Larynx and Trachea. Constant irritation in trachea, producing dry, fatiguing cough, worse at night but appar- ently not affected by position. Cough. Violent; dry; irritating; worse at night and followed, but not relieved, by expectoration of blood. Lungs. Constant and severe pain in chest, worse left side. Dullness on percussion. Tubercular deposits in left lung. Pulse small, depressed, from 100 to 120. Expectoration. Of pure, bright red blood in the morn- ing; dark lumps (clotted) in the evening. Haemoptysis. The clinical verifications of Acalypha have thus far been confined to haemorrhages occurring in tubercular affections. Aconite, Erechthites, Melilotus, Millefolium, and many other remedies have bright red blood in haemorrhages, 200 CONSUMPTION. but none of them have the morning exacerbation, the bright red blood in morning and dark, lumpy blood in evening. Relation. Acalypha follows Calcarea well. It is fol- lowed by Carbo veg., Fer. phos., Iodine. ACETIC ACID. Like Ferrum, Phosphorus and Sulphur, Acetic acid in unskilful hands, is a dangerous remedy in tubercular affections of the air passages. All the acids, and especially Acetic acid, whether given internally or applied externally to control the profuse night sweats, are prone to produce haemorrhage in the consumptive. Hence, the single dose and the dynamized remedy are the safest. Too frequent repetitions are dangerous. Characteristic. Face: pale, waxen, alabaster-like; sunken, emaciated (Fer.—pale, wrinkled, prematurely old, especially in nursing children, Abrot.) Febrile heat intense; skin hot and dry, but no thirst, during fever, (Ign.). Intense, burning, insatiable thirst; drinking large quantities of cold water neither affects the stomach nor relieves the thirst (unquenchable thirst, but water disturbs the stomach and produces vomiting, Ars.): in Bright's disease, chronic diarrhoea, diabetes, dropsy, polyuria. Hectic fevers, with cough, dyspnoea, diarrhoea and pro- fuse, drenching night sweats which are not very exhaust- ing. (Sec. Cinch., Fer., Phos., Stann.) Emaciation of upper parts of body; lower parts dropsi- cal (Lye.—Sec, Iod.) Aggravation. The symptoms of Arnica, Lachesis, and Belladonna, especially the headache of the latter, which becomes unbearable. Lying on the back, cannot sleep from difficult breathing. ACETIC ACID. 201 Ameliorations. Sleeps better lying on the belly. Larynx and Trachea. Hoarse; hissing respiration with rattling in larynx; membranous croup with same res- piration ; loses breath on going up stairs (Cal.) Respiration labored, difficult; cannot sleep lying on the back (loses breath at once on lying down, Ars.—severe dyspnoea on lying down, Spong.) Frequent inclination to take a deep breath (Bry.) which relieves. Cough. Hoarse, croupy; has a hollow sound during in- halation (croupy cough during inhalation, Spong.); in the evening with coldness; at night hectic, dry skin, delirium; titillating, with purulent sputum; dry, with dyspnoea and oppressive breathing; with hectic, emaciation, diarrhoea, night sweats and oedema of feet and legs. Croup, in scrof- ulous children; entire face or only left cheek bright red. Chest and Lungs. Haemoptysis; coughs pure blood and bloody mucus. Violent burning pain in chest and stomach, followed by coldness of skin and cold sweat on forehead; much aggra- vated by lying on the back. Chronic bronchitis. Chronic laryngitis. Haemorrhages; active or passive, from nose, lungs, stom- ach, bowels, uterus. Hydrothorax. Phthisis Florida: fibrous phthisis. Relation. It antidotes all the anaesthetic vapors, and the fumes of charcoal. Also Aeon., Coff., Hep., Ign., Op., Sep., Steam., Ted)., Alcohol. Follows well after Cinch, in haemorrhages and night sweats. Disagrees after Bor., Canst, Ban. b. and Sars. 202 CONSUMPTION. ACONITUM NAPELLUS. The indications for the use of Aconite in tubercular affections are largely of a negative character, for Hahne- mann has clearly pointed out that there is scarcely a trace of a constitutional dyscrasia to be found in its pathogenesis. Yet it is often well to know when not to give a remedy. To give Aconite for every acute exacerbation of a febrile character that occurs in the course of the ever changing phases of this disease, is to do the patient more harm than good, unless it corresponds to the totality of the symptoms, which it rarely ever can. Dunham says: "There is no resemblance in the symp- toms of Aconite to the features of any dyscrasia"; hence, as a rule, it can only be given with advantage for tempo- rary aggravations, and these have reference almost solely to the cause, as fright, exposure to cold winds, etc. Characteristic. Aconite is most frequently indicated in recent cases of illness occurring in young persons, especially in girls of a full plethoric habit and who lead a sedentary life; persons who are easily and readily affected by sudden atmospheric changes. On rising from a recumbent posture the red face becomes deathly pale, or he becomes faint or giddy and inclines to fall over; in consequence, he fears to rise again. These symptoms are often accompanied by vanishing of sight and unconsciousness. Great fear and anxiety, with consequent nervous excita- bility; afraid to go out; to cross a street or go into a crowd where there is any excitement or many people. The coun- tenance is expressive of constant fear; life is rendered mis- erable by it. For the effects of mental shock. Increased sensibility; the whole body is sensitive to touch. Many of the symptoms are accompanied by shivering (Caps.—pains accompanied by chills, Puis.). ACONITUM NAPELLUS. 203 It is also peculiar of Aconite that the urine scarcely ever contains a sediment, at least none that can be considered characteristic. There is a group of symptoms so characteristic of Aconite that Hahnemann said: " Aconite should not be given in any case which does not present a similar group of symptoms." These are the symptoms of the mind and disposition, viz.: restlessness, anxiety and uneasiness of mind and body, causing tossing and sighing and frequent change of posture; forebodings, anticipations of evil, anguish of mind, dread of death and even distinct anticipations of its occurrence.—Dunham. In order to banish from our conscientious mode of treatment all of that quackery which is only too glad in selecting its remedy to be guided by the name of the disease, we must take care that whenever we give Aconite the chief symptoms of the malady, that is, of the acute disease, shall be such as are to be found in the strongest similarity of those of Aconite.—Hahnemann. Aconite produces all the morbid symptoms the like of which are wont to appear in persons who have had a fright combined with vexation; and for these symptoms it is the best remedy.—Hahne- mann. Always in choosing Aconite as a homoeopathic remedy, a special regard must be paid to the symptoms of disposition and mind, for these above all must be similar.—Hahnemann. Hence, Aconite is indispensable to treatment after fright and vexation during menstruation, which without this soothing rem- edy is often instantaneously suppressed by such moral shock. —Hahnemann. Tuberculous patients are easily shocked and menstrua- tion suppressed in consequence, especially in young girls. It happens that Aconite is frequently indicated at the very be- ginning of some acute affections, and that if properly used in such cases it will often cut short the career of the disease. From these facts has arisen a fashion of giving Aconite almost as a routine prescription in the beginning of all acute cases indiscriminately; particularly if the cases are supposed to be characterized by that protean phantom of the pathologist—Inflammation. Great mis- chief often results from this practice: negatively, inasmuch as it causes the loss of valuable time during which the true specific remedy which should have been given at the very first might have been acting; and positively, inasmuch as the Aconite often, when 204 CONSUMPTION. improperly administered, does real mischief, exhausting the nervous power of the patient and adding to a prostration which is already probably a great source of danger.—Dunham. Aconite should never be given to save time. * * * * It were better to give nothing, because Aconite if given in a case which does not call for it might do mischief; as, for example, in the be- ginning of typhoid fever, in which it will unfavorably influence the entire course of the disease unless symptoms call for it, which they rarely ever can do.—Dunham. This remark of Dunham's in regard to the administration of Aconite in typhoid conditions is equally applicable to the febrile conditions occurring during the course of tuber- culous affections. Aconite should rarely, if ever, be given for the acute febrile congestions so often met with during the progress of the disease. The simple fact of a rapid pulse and a high fever temperature is not a sufficient indi- cation for Aconite if the mental restlessness so character- istic of this remedy be absent. Neither should this remedy be given first to subdue fever and then some other selected to meet the case. Neither should it be alternated with other drugs for the purpose of controlling these febrile attacks, but the remedy must be chosen, in the totality of whose symptoms a similar febrile condition exists to that found in the patient, as each remedy produces a fever characteristically its own. It is a well-established etiological fact that the children of tuberculous parents are subject to frequent attacks of croup, and this simple fact should place the physician on his guard when prescribing for the adult. If in childhood the patient had been subjected to frequent and alarming attacks of inflammatory croup, it is another evidence that Aconite should not be depended upon for the febrile con- ditions above mentioned. Aggravation. In the evening; night; especially after midnight; in a warm room; from taking cold; drinking cold water; from tobacco smoke; lying on either side; on coming from the open air into a warm room (Bry., Ran. b., —from warm to cold air, Phosph., Rumex). ACONITUM NAPELLUS. 205 Ameliorations. In the open air; while at rest (except at night in bed); from perspiration; from wine; lying on the back. The amelioration of the cough from lying on the back is very characteristic of Aconite and should always be borne in mind. Cause. Where the cough is aggravated by dry, cold west or north-west winds; riding against a cold wind (Hep.); or when it occurs during hot days with cool nights; often when made worse by getting wet, especially getting the feet wet; from suppressed perspiration; by uncovering or sitting in a draught; rheumatic exposure of any kind; by fright. Throat. Great dryness of throat, especially on waking; voice husky; sneezing, hawking, and sensation of lump in throat. Feeling of splinter in throat, (Nit. ac, SiL). Copious, thick, tenacious mucus in throat evening and morning. Thick mucus dropping from posterior nares, (Hyd., Spig.). Uvula swollen, elongated, with fauces and pharynx injected dark red. Burning in throat; constriction of throat; scraping dry- ness and constriction in the throat, causing constant hawk- ing and spitting. Rawness in the throat and posterior nares, compelling him to clear the throat frequently. Larynx and Trachea. Larynx sensitive to inspired air, as if its mucous membrane were divested of its coating; tickling in the larynx, provoking cough; pain in larynx on coughing. Sensitiveness of larynx to touch, (Lach., Iod.). Raw feeling in throat, larynx and trachea, provoking fre- quent short cough. Hoarseness: In the morning; all day; voice hoarse and rough; partial or complete loss of voice, sudden aphonia. Cough. Short; dry; hoarse; loud; forcible; excited by scratching in throat; from irritation in larynx. Child grasps its throat every time it coughs, (Cepa.). 206 CONSUMPTION. Frequent dry cough, with raw pain in chest and smart- ing in larynx. Violent cough, with painful shooting in different parts of chest, compelling him to lie always on the back and pre- venting his lying on the side, (relief on right side, Phos.). Cough; from talking or singing (Dros., Phos.), or sen- sation as of loose skin hanging in throat (sometimes feels as if a tough membrane moved about but would not loosen, Kali c.) Cough and loud breathing during expiration; every ex- piration ending with a hoarse, hacking cough. The cough is nearly always dry, and, as a rule, unat- tended by expectoration. Lungs. Stitches about the chest; tightness, constric- tion, oppression of the chest. Stitches in the chest, with cough, aggravated by every inspiration, worse left side (Am.—right side: Bry., Kali a). Lancinating pains through the chest; breathing difficult; burning in the lungs; as if a hot fluid would come into the mouth. Expectoration. Often wanting; thin; frothy; white mucus; streaked with florid blood; of thin fluid; of sweet- ish-salt taste like blood; brownish-red, rust colored; viscid mucus. Haemoptysis: florid blood (Fer. phos., Millef., Ipec, Melil.) from hemming, slight cough or easy hawking; with great anxiety; great fear of death; rapid pulse; from men- tal excitement; with stitches in the chest; after exposure to dry cold winds (of florid blood in those subject to local congestions and red flushed face, Fer., but the anxiety and mental fear of Aconite is wanting). Relation. After Aconite the following act well: Am., Bell, Bry., Hep., Ipec, Pinus pal, Puts., Sej)., Spong'., Sulph. Aconite is often indicated after: Am., Coff., Sulph., Verat Complementary to Coffea, in fever, restlessness, intoler. ance of pain; to Sulphur high, in all cases. ALUMINA. 207 ALUMINA. In the advanced stages of tubercular affections, Alumina is rarely, if ever, called for. But in the various scrofulous derangements of the mucous membranes, especially those of weak digestion and imperfect assimilation in which the first symptoms of this insidious disease are manifested, it is one of our most useful and most frequently indicated remedies. Even in pre-natal life, the gastric and abdomi- nal symptoms of the mother, the constipation from com- plete inactivity of the rectum, the drain on the vital forces from the persistent albuminous mucous leucorrhoea, call for Alumina as a constitutional remedy. Also, for the long train of symptoms which characterize chronic catarrhal affections of the mucous membranes, and the consequent loss of albumen, this powerful anti-psoric vies with Calca- rea in frequency of indication in early life, and surpasses it in old age. From its symptoms, it is peculiarly adapted to prevent the development of consumption by correcting the psoric diathesis out of which it grows, rather than cur- ing the disease after it has fully developed. Characteristic. Is best adapted to persons of dark complexion; spare, dry, thin subjects of scrofulous habit, who suffer from chronic diseases, especially catarrhal affec- tions of the mucous membranes (light, fair complexion, stout and fleshy, Cal.); anxious, mild, tearful, or excitable disposition; constitutions deficient in animal heat; old people, dry, withered looking (young, withered, prema- turely old, Abrot.); hypochondriacs. Skin: dry, tettery, itching eruption, worse in winter, (Petr.); intolerable itching of the whole body when get- ting warm in bed (Sulph.—worse while undressing or be- ing uncovered, Rumex); scratches until it bleeds which then becomes painful (after scratching, burning, Rhus.) Appetite for fruit and vegetables; potatoes disagree; for starch, chalk, clean rags, charcoal, cloves, acids, tea or coffee grounds, etc., etc. 208 CONSUMPTION. Aversion: to meat, which is tasteless; to beer. Chronic eructations lasting for years, especially in the aged; sour; bitter, after potatoes. Constipation: of nursing children due to artificial food; no desire for and no ability to pass stool until there is a large accumulation; with great straining, must grasp the seat of closet tightly; stool hard, knotty, covered with mucus; or soft, clayey, adhering to parts (Plat.); total inactivity of rectum. Diarrhoea whenever she urinates. Urine voided while straining at stool; or, cannot pass urine without such straining (see Aloe.). After menses; exhausted physically and mentally (the flow weakens her, she can hardly speak, Carbo an.—during the effort, is so weak she is scarcely able to stand, Coc.) Leucorrhoea; acrid, profuse, transparent, running down to the heels in large quantities; often only in the daytime; relieved by cold bathing. Aggravation. In cold air; out doors; while sitting or stooping. Skin symptoms; worse at new or full moon, and in winter. All mental symptoms worse in morning on waking. Amelioration. In warmth; in mild weather; walking or standing erect. Larynx and Trachea. Voice: rough; thick; husky; has a nasal twang. Hoarseness: afternoons, evenings, with roughness and dryness of throat; evening and night, especially toward morning; disappearing while walking in the open air (com- ing and going, Puis.). Sudden, complete aphonia, (Tuber- culinum). Rawness in the larynx on awaking. Talking; produces hoarseness, especially in lively com- pany. Throat dry, voice husky on waking; uvula elongated. Thyroid cartilage painful to touch. Clergyman's sorethroat (Arg. n., Arum, Kali b., Lye), ALUMINA. 209 Respiration. Breathing: asthmatic, rattling, worse coughing; wheezing, with sensation of tightly adhering mucus in larynx, not removed by hawking or cough; ar- rested by copious, thick, tenacious, salty mucus; short, when lying on the back, relieved by turning on the side; worse from over-exerting voice, getting tired. Oppressed; worse sitting stooped, better straightening up, or walking in the open air. Cough. From talking (Anac.) or singing; caused by constant tickling, from elongated uvula; dry, hacking, with frequent sneezing (Sen., Squil.); dry at night, with dry- ness of throat; from sensation of loose skin hanging in throat (feels as if a tough membrane were moved about, but would not loosen, Kali c.). Cough: Every morning a long attack of dry cough, end- ing in difficult raising of a little white mucus; soon after waking in the morning; with tearing pain and involuntary emission of urine, in old or withered looking people (com- pare, Caust. Fer. phos.). Cough; easily excited by irritating things, salt, vinegar, mustard, pepper, wine, etc. Cough; sudden, violent, irrepressible in the evening while sitting; with shooting pain in vertex. Chest and Lungs. Talking causes soreness in chest; lifting produces or aggravates soreness in left chest; riding in carriage produces pain in chest. Oppression; of chest, with constriction of oesophagus; with spasmodic pains in stomach and hypochondria. Constricted sensation, with apprehension; worse sitting bent or stooping, better walking. Oppressive pain in chest, violent, worse at night. Con- gestion of blood to chest and head, with redness of face and one ear, caused by suppressed hemorrhoidal flow. Shooting stitches right to left in afternoon, worse going down stairs. 210 CONSUMPTION. A stitch from left side of abdomen to middle of chest, when stooping. Stitches extending from left side of vulva to chest. Chilliness in chest. Chest feels as if too large, too full of blood (Melilotus). Expectoration. Sputum: saltish, thick, tenacious; dif- ficult to detach; of a putrid taste. As a rule the cough is dry and the expectoration not marked or characteristic. Relation. Alumina and Bryonia are Complementary. Alumina is followed by: Bry., Sep. Alumina follows: Bry., Lach, Psor., Sulph., Tuber. It antidotes ailments from Lead: painter's colic. ARSENICUM ALBUM. There is scarcely a remedy in the entire Materia Medica that will yield more brilliant curative results in all stages of this affection—from the incipient symptoms of rapid emaciation, with or without the suspicious persistent cough, to the more advanced stages or even fully developed phthi- sis—than Arsenicum. Many cases of incipient phthisis, and not a few in the advanced stages attended with alarm- ing symptoms have been permanently cured with this grand anti-psoric of Hahnemann. But, to attain this result, there also are few remedies which must be used with greater caution. Here it is absolutely necessary that the implicit directions of Hahnemann as to dose and repetition must be carefully followed if we would avoid that worst of all complications a serious aggravation. If we would avoid a catastrophe when Arsenic is the simillimum, we must heed the emphatic warnings of Hahnemann on the too frequent administration of medicines, especially the long acting anti-psorics. Dr. Wurmb, of Vienna, in the Homceopathische Clinische ARSENICUM ALBUM. 211, Studien 1. p. 179, when writing of the deep-seated action of this remedy, says: " Arsenic is one of those few drugs whose action is distinguished not alone by its intensity, but equally by its extent; it involves the entire organism. Every system, every organ of the body, every nervous filament, is so subjected to its powerful influence that we are not able to say which of its symptoms are primary, which are secondary, and where the focus of its action chiefly lies. We see the entire nerve-life attacked in all directions, from the slightest excitement to the most violent irritation; from a mere sensation of weakness to actual paralysis; from the slightest irregularity in the vegetative sphere to a cachectic dyscrasia; yea, even to decom- position and destruction of the organic substance." From this profound, all-pervading action of Arsenic, af- fecting as it does every tissue and organ of the body, we have a powerful antidote, when indicated, for that consti- tutional dyscrasia which so frequently develops in tuber- cular diseases. And it is because of this peculiar action that the constitutional symptoms of Arsenic are of so much greater value than the local, in the selection of the remedy. Dunham says: " The fact cannot be too often called to mind, nor too strongly insisted upon, that our most characteristic indication for the use of a drug which presents well-defined general symptoms, as Arsenic does, and indeed as every well-proved drug does, are derived not from its local action upon any organ or system, not from a knowl- edge of the particular tissues it may affect, and how it affects them, but upon the general constitutional symptoms and their condi- tions and concomitants. If this were not so, in the presence of how many maladies, of the intimate nature of which we are wholly ignorant and which nevertheless we cure, should we be utterly powerless for good." Our want of success in tuberculosis is largely due to the fact that we pay too much attention to the local manifesta- tions of disease—the local symptoms of the drug—and overlook both the general symptoms of the patient and the constitutional action of the remedy. In this way we fail to grasp the secret of success, fail to obtain the true picture 212 CONSUMPTION. of the disease as embodied in the totality of symptoms, objective and subjective, and should not blame our law of cure if it decline to act under such an interpretation. Farrington, p. 506, says: "I want to introduce a caution in regard to Arsenic. It is not a remedy usually called for in the beginning of diseases. The ten- dency of the symptoms is deathward. If you give the drug too soon in a disease which tends deathward, you may precipitate the result which you are anxious to avoid. * * * You must be certain that the mental state is indisputably that of Arsenic, or you will do harm instead of good." Characteristic. Great prostration, lassitude, weak- ness, with more or less rapid sinking of the life forces. Of this peculiar feature of Arsenic Hahnemann observes: "Even circumstances that are in themselves not very important and would otherwise produce but little effect, occasion in the Arsenic patient a sudden and complete sinking of the forces." Hydrogenoid Constitution. Complaints return annually (Carbo v. Sulph. Thuja). The mental condition is peculiar and guiding: a. Depressed, melancholic, despairing, indifferent. b. Fearful, restless, anxious, full of anguish. c. Irritable, sensitive, peevish, easily vexed. d. Fear: of being alone; of death. Dread: of dying, when alone; on going to bed. Excessive anxiety; great anguish; extreme restlessness. Burning pains; the affected parts burn like fire. Burning unquenchable thirst for cold water; drinks often but little at a time; eats seldom but much. Burning thirst, without special desire to drink; the stomach does not seem to tolerate, because it cannot assim- ilate cold water; it is greatly longed for but patient cannot drink it. Desire for: sour things; beer; brandy; coffee; wine (stimulants); milk; warm food; fruits and vegetables. ARSENICUM ALBUM 213 Aversion to: sweats; gruel; meats; butter; fatty things; iarinaceous food; loathes even the thought of food. Diarrhoea after eating or drinking; dark color, offensive odor, usually watery, scanty, worse after midnight and fol- lowed by great prostration. Extreme exhaustion: from the slightest exertion. Fainting: from weakness; from coughing; from talking; from walking. From climbing mountains or other severe muscular exer- tion: great prostration; cannot sleep; asthma; want of breath; and many other chest complaints. Rapid emaciation although feeling well or fairly well (Iod., Nat. m.); loses flesh rapidly while eating well. This progressing emaciation, more or less rapid, when the patient is eating well and there is no sufficient cause for it, is pecu- liar to Arsenicum and to Iodine and Natrum mur. It is a suspicious symptom and should always attract the phy- sician's attention. Aggravation. General: at night, especially after mid- night (1 to 3 a. m.); from cold (except headache); cold drinks or cold food; lying on the affected, especially right side (Kali c.—relieved by lying on right side, Phos.); or lying with the head low (Spong.). Lying down greatly aggravates cough or breathing or both. Cold damp cellars aggravate or bring on asthmatic affec- tions (Aran.—asthma with every fresh cold, every change to damp weather, Nat. s.) Catarrh or cough at 5:30 p. m.; cough from 2 to 3 a. m. Amelioration. General: from warmth, except head- ache, which is relieved by cold bathing or cold air. Larynx and Trachea. Aphonia. Hoarseness, acute and chronic. Voice: hoarse; weak; trembling; very uneven, now strong, now weak; rough; hollow; complete loss of voice. Dryness of larynx and trachea, with burning. 16 214 CONSUMPTION. Sudden catarrh threatening suffocation at night. Sensation as if one were inhaling dust. Smoky sensation in larynx as of the vapor of sulphur, causes cough before going to sleep in the evening. Spasm of Glottis. Croup,with coryza; cannot breathe through the nose; worse at night, very restless. Symptoms simidating membranous croup; caused by suppressed or non-appearing eruption, especially urti- caria; suppressed itch (Caust.). Constant tittillation in the larynx, inducing cough, even when not inspiring. Respiration. Wheezing respiration, which ranges from a fine wheezing to a coarse rale (but not so coarse as that of Ant. t., Ipec. or Opium) often accompanied with cough and a frothy expectoration. Frequent oppressive shortness of breath in every posi- tion of the body, causing anxiety. Loss of breath immediately on lying down in the evening, with whistling, wheezing, and constriction in the trachea. Air passages seem constricted, cannot breathe freely; worse after midnight. Oppression; want of breath; a nocturnal asthma makes him spring up at midnight. Respiration; short, anxious, oppressed. Oppression worse: when walking fast; ascending; warm, tight clothing; in stormy weather, heavy air; but especially from changes of warmth and cold; taking cold in mid- summer. Asthmatic breathing: coming on suddenly at 12 p. m. ; must spring out of bed, and obtains relief by inclining chest forward. Cough. At night on lying down, and in the morning on rising; regularly every night and morning (evening when lying down, when warm in bed, Puis.—lying in bed, be- coming warm in bed, Nat. m.). ARSENICUM ALBUM. 215 Cough: from constant tittillation in larynx; by smoky sensation as of vapors of sulphur in larynx; when going into cold, open air; especially after drinking (Dros.—eat- ing or drinking, Phos.); with bloody sputum. Night cough; from 1-3 a. m.; must sit up as soon as it begins; asthmatic, with gasping for breath. Cough depending on organic lesions or deep-seated affec- tions: asthma; anaemia; cyanosis; hypertrophy of heart; attended with nervous irritability, exhaustion, collapse. Cough, with bloody sputa. Cough: short, deep, dry, unceasing, after midnight. The cough of Arsenic is not so distinctive or peculiar in itself as that of many other remedies. But its aggravations or ameliorations, the times or circumstances under which it occurs are always guiding. Chest and Lungs. Acute, sharp, stitching, fixed or darting pain in apex and through upper third of right lung (sharp, stitching pains through right lung, middle and lower third, Bry., Kali c). Stitches: in upper right chest; in left chest only during inspiration (more frequently in lower part or in left hypo- chondrium); in or under sternum from below up. Burning and heat in chest, sometimes extending below diaphragm to stomach. Chilliness in chest, evenings. Constriction of chest; when walking fast; when going up hill. Constriction of chest with great anxiety and restlessness, evenings; with oppressive anxiety at pit of stomach; burn- ing, or feeling as if excoriated and raw. Wheezing in chest with bruised pain between shoulders. Tightness of the chest, as if bound by a hoop (as if an iron hand prevented its normal movements, Cac.—see Am., Bufo, Iod., Lib, Nux m., Sulph.). Yellow spots on the external chest; upper part of chest yellow (Sep.). 216 CONSUMPTION. Great weakness in chest in attempting to move or sit up. Bellows murmur, either from thinness of the blood or thickening of the aortic valves, especially if accompanied by wheezing respiration or frothy expectoration forms an additional symptom for Arsenicum in the early stages of tuberculosis. Expectoration. Frothy saliva; frothy sputa; yellow mucus, enveloped in or mingled with froth; mucus, streaked or specked with blood. A frothy expectoration is the characteristic of Arsenic and in the frequency with which it will be called for when this symptom is present, it outranks all other rem- edies, although Aeon., Fer., Lach., Phos., Sil. and many others have it more or less prominently marked. Expectoration: white; gray; grayish-yellow; yellow; thick; bloody; blood-streaked; feted; dark; green or yel- lowish-green; brown or yellowish-brown; purulent. Expectoration: bitter, in the morning; salty by hawking. Tenacious mucus, difficult to dislodge, with rattling in chest (Kali b.). Haemoptysis at night, with burning heat over whole body (with red face and throbbing carotids, Melilotus). Foaming (frothy) bright red blood bursts forth in a stream, with slight hawking; ebullition, burning and full- ness in chest (Arm, Bell., Calc, Carbo v., Dul., Ipec, Led., Mel., Phos., Sec.) Haemoptysis: after loss of blood; burning heat all over, especially with pain between scapulae; in drunkards; sup- pressed menses; suppressed eruptions. Haemoptysis; hacking cough every morning, with expec- toration of bright red fluid blood, with burning in left chest. Relation. Arsenic is useful and often curative in pa- tients who have suffered or are suffering from: effects of excessive tobacco chewing; alcoholism in any form; abuse ARSENICUM IODATUM. 217 of Cinchona or Quinine; abuse of topical application of Iodine. Remedies which follow well; Aran., Cinch., Fer., Hep., Iod., Lye, Nux v., Sulph. Remedies which Arsenic follows: Aeon., Am., Bell, Ipec, Lack., Verat. Complementary: Ars. Iod., Carbo veg., Phosphorus. When Arsenic is repeated, it is always advisable to change the potency. ARSENICUM IODATUM. The Iodide of Arsenic has been used clinically, but em- pirically, in various tubercular affections, especially haem- orrhagic phthisis, and cures are reported by Drs. Niemeyer, Nankivell, Pope, H. V. Miller, Nichol and others. But its use appears to have been chiefly based upon the well-known indications of the two drugs of which it is composed, rather than upon any characteristics which it has yet produced on the healthy. The symptoms of many of the cases reported were those chiefly pathognomonic of phthisis, instead of pathogenetic of Arsenicum Iod., and the cases reported cured presented distinctive symptoms of Arsenic. More- over, the cases reported relieved or cured were treated with the lower potencies (first to sixth decimal), frequently repeated, and cod liver oil or other remedies were given at the same time, thus materially detracting from their clin- ical value. There is nothing distinctive, nothing scientific, in prescribing the Iodide of Arsenic for phthisis, any more than any other of the hundreds of "cure-alls" which from time to time have been lauded as specifics for this terribly fatal affection. It needs a careful proving. Characteristic. Affects — the right lung, especially upper and middle third (Ars.—middle and lower third, Kalic). ^ ^o, Wtn. 218 *£✓ 4* "*Y* £ COZW? U MPT ION. o^<- *~J< from belching or passing, Cinch. Flatulence, excessive accumulation of, Lye of stomach and bowels, excessive, Cinch. Fleshy, Bell, Cal. persons, who suffer from catarrhal, scrofulous or syphilitic affections, Kali b. CHAR A CTERISTIC. 391 Florid, sanguine temperament, Phos. Flushes, hot by day and cold at night, Lach. of heat, from chest to stomach or abdomen, Sang. of heat flying from head to stomach, Sang. of heat, followed by great nervous weakness and irreg- ular intermitting pulse, Dig. of heat, passing over the body, Sang. Fontanelles and sutures, delayed closing of, Cal. open, large heads, San, Sil. remain open too long, or close and re-open, Cal. p. Food, loathes even the thought of, Ars. extreme dislike to all, Fer. the simplest disagrees, Carbo v. Foot turns under in walking, Carbo an. hot, the other cold, one, Lye sweat, profuse, fetid, Lye Forces, rapid sinking of the life, Ars. sudden and complete sinking from slight causes, Ars. Forebodings, anticipations of evil, Aeon. Freckles, women with, Lach. hair, red, women with, Lach. Fretful, ill-humor, irritable, Kreos. Fright, persons who have had a, with vexation, Aeon. and vexation during menses, Aeon. Frightened, by an unusual sound, easily, Bor. by an anxious cry, the slightest noise, Bor. by sneezing, hawking, coughing, Bor. silk or paper, the mere rustling of, Asar, Bor, Taren. Full, always feels, Fer. Gangrene of the lungs, Carbo v. Gas, excessive accumulation in stomach and intestines, Carbo v. everything she eats or drinks appears to be converted into, Kali e Gastric disorder, sausage, after old, Bry. cabbage, cheese, fruit, milk, after Bry. 392 CONSUMPTION. Gastric, potatoes, after, Alum, Bry. salads, saurkraut, turnips, Bry. symptoms apt to predominate, Sang. Girls, blonde, red-cheeked, scrofulous, Brom. Glands, mammae, testes, atrophied, Kali i. burning pains in, Carbo an. cutting pains in, Carbo an. hardness of, stony, Con. hypertrophied, indurated, painful, Bad, Carbo an. Con, Iod. induration, after contusions, blows, falls, Con. injuries, the effects of old, Con. lancinating pains in, Carbo an. lymphatic, swollen, indurated, suppurating, in scrofu- lous or syphilitic, Carbo v. Kali i. malignant, simple affections are prone to become, Carbo an. of mammae and testes in persons of a scrofulous, tuber- culous or carcinomatous cachexia, Con. scrofulous, enlargement and induration of, Bad, Iod. stony, hard, unyielding, Brom, Carbo an, Cis, Con. suppurate; discharge, thin, corrosive, curdy, Kali i. swollen, after measles, scarlatina, diphtheria, Brom. the harder they feel, and the more other symptoms are wanting, the better indicated, Iod. women with a history of enlargement and induration of glands, Spong. Glandular affections, syphilitic, engrafted on a scrofulous base, Bad, Syph. Glandular and osseous diseases, predisposed to, Cal. p. swellings, with or without suppuration, Mer. Goitre, family history of, Iod, Spong. partially cured cases of, Iod. Gouty, Cal. p. Led. Greedy, miserly, Lye, Sep. CHA RA CTERISTIC. 393 Grief, ailments from, Cal. p. and sorrow, mental and nervous affections from long- lasting, Caust, Ign. and submissiveness, inclined to, Puis. or sorrow, chronic ailments after long-lasting, Ign, Op, Phos. ac, Lach. Grown too rapidly, youth who have, Phos. Gums, scorbutic, Mer. Habit, plethoric, full in young persons especially girls, of a, Aeon. scrofulous, spare, dry, thin, subjects of, Alum. Hematuria, Ars, Cal, Con, Hep, Kreos, Mill, Phos, Puis. Hemorrhage, atonic, from stomach, bowels, boronchi, lungs, Alumen. bloated, watery or bright red, Dul. blood dark or dark and clotted, Cinch. blood dark, incoagulable, Lach. blood light, non-coagulable, Alumen, Nit. ac. bright red, from all the orifices of the body, Ipec. bright, florid, Milk ears, with ringing in, Cinch. epistaxis, at night, blood light and hanging in clots from the nose like icicles, Mer. hot, clear blood, Dul. fainting, loss of sight, general coldness, with, Cinch. frequent and repeated, Phos. from all the mucous outlets of the body, Cinch. from nose, lungs, rectum, Kali i. in old women, Mer. injuries, after mechanical, Arn, Fer. p. Mill, Rhus. mechanical origin, especially from a fall, of, Mill. passive, yet bright red, Mill. post-climacteric, Lach. predisposes to, Acet. ac, Fer, Phos, Sulph. profuse, passive, dark, Kreos. 394 CONSUMPTION. Hemoeehage, sour things, longing for, Cinch. teeth, after extraction of, Alumen. typhoid, with fetid stools and great prostration, Kreos. vicarious, from nose, stomach, rectum, bladder, Phos. wet, < after getting, Dul. wounds, bleed profusely, Mill. wounds, small, bleed much, Fer, Kreos, Lach, Phos. Hemoeehagic tendency, general, Fer, Lach. Hemoptysis, Acal, Aeon, Arn, Cinch, Fer, Ham, Ipec, Kreos, Mer, Phos, Puis. in evening, dark, clotted lumps, Acal. in morning of pure, bright red blood, Acal. in young boys or girls subject to consumption, who are in the incipient stage of phthisis florida, Fer. suppuration of the lungs after, Mer. Haie and eyes black, Ars. i. Nit. ac. and eyes dark or black, Iod. bushy, dry, rough, lustreless, Psor. cut, complaints from having, Aeon, Bell, Hep, Rhus. dark, Arn, Bry, Caust, Dul, Sep. light, flaxen, Bell, Brom, Cal, Mer. persons with, who are easily excited, Con. matted at tips, sticks together, tangles easily, Bor, Lye, Psor. red, sandy, Phos, Puis. Haed, every thing on which he lies seems too hard, Arn. Hasty speach and hasty drinking, Hep. Head congested, hot, painful, Bell, Mel. sweats profusely while sleeping, wetting the pillow far around, Cal, Sil, San. thinks she can lift it off, Ther. Headache, must lie down in bed, Fer. burning vertex, Lach. commencing in the morning and gradually increasing till evening, Bry, Nat. m. constipation, with dull pain in forehead, from, Bry. CHA RA CTERISTIC. 395 Headache, eating and drinking, with aversion to, Fer. every two or three weeks for two, three, four days, Fer. ironing from, Bry. on coughing, Bry. pains hammering, beating, pulsating, Fer. Heart would cease beating if she ceased moving, fears, Gels. would stop beating if she moved, sensation as if, Dig. Heat, animal, constitutions deficient in, Alum. and cold, extremes of cause great debility, Lach. in the affected part, sensation of, Sulph. Heaviness of the whole body, great, Spong. Hectic, beginning at 2 or 3 p. m. daily, with circumscribed redness of cheeks, Sang. can bear only slightest coA^ering while fever is on, even in winter, Coral. can be covered and sleeps well after midnight, Coral. coming on at 9 or 10 a. m. lasting till midnight, Coral. complexion sallow, features sunken, Carbo v. intense nervousness and restlessness with, Coral. night sweats, exhaustive, profuse, putrid, sour, Carbo v. relieved without leaving prostration, Coral. with cough, dyspnoea, diarrhoea and night sweats, Acet. ac. Avith drenching night sweats, not exhausting, Acet. ac. with general heat or heat returning periodically dur- ing day, and great thirst in p. m, evenings and sometimes all night, Sil. Herpes circinnatus, in isolated spots on upper parts of body, Sep. in clusters or intersecting rings, Tell. Home, desires to get out of bed and go, Bry. Hot flushes during the day with weak faint spells, Sulph. weather, from cold drinks or ices in, Bry. weather complaints in, Kali b. 396 CONSUMPTION. Hunger, canine, alternating with loss of appetite, Fer. canine, the more he eats the more he craves, Lye ravenous, must eat every f eAv hours, is not satisfied, Iod. Hungry at night, feels he must eat or he would faint, awakens, Phos. but soon satisfied, soon filled up, Lye cannot wait for dinner, Sulph. in the middle of the night, must eat, Psor. Ichorous, suppurations, benignant change into, Carbo an. Ill, from very slight causes, persons who become, Carbo an. humor, paroxysms of peevish, Sep. when he is not, thinks he is very, Psor. Illness, anxiety about his, Nit. ac. Imagination, persons of vivid, Lach. Impending evil, apprehensive of, Kali i. Indifference, cool, to one's family, Fl. ac, Sep. Indolent, does not want to do anything, an exertion to think, Sep. Infiltration interstitial, enlargement of tissues by, Kali i. Intellectual development, young persons of brilliant, Bell. Intellectually keen, but weak in muscular development, persons who are, Lye Iodine, abuse of topical applications of, Ars. Irritable, Ant. t, Ars, Bry, Caust, Dul, Iod, Lye, Sil. and melancholic, Lye nervous, restless, easily startled, Psor. Irritability, with intolerable mental, cannot bear to be looked at, spoken to, approached or touched, Ant. t, Iod, Sil. excessive physical, Nit. ac. of mind and body, Phos. want of nervous, Carbo v. Iron hand, sensation as if the heart was grasped by an, Cae, Iod. Ischuria, in children from wading in cold water, Dul. CHAR A CTERISTIC. 397 Itching, intolerable of the whole body, when getting warm in bed, Alum, Psor, Sulph. scratches, until it bleeds, then becomes painful, Alum. so violent toward evening as to drive one wild, Kreos. Jerking pain in inner parts, Nit. ac. Joints unnaturally weak, Carbo an. Juncture of mucous surfaces, smarting and burning at, Nat. m, Sulph. Labor pains, cease from haemorrhage, Cinch. cannot bear to be touched, not even her hands, during, Cinch. Lachrymation, tears stream down the face whenever he coughs, Nat. m. Lachrymose, cannot help crying, Apis, Puis. Lactation, excessive causes weak digestion, Carbo v. Laughter or tears, easily moved to, Puis. Lean and stoop shouldered, persons who walk and sit stooped, Sulph. thin, predisposed to lung and hepatic affections, Iod, Lye, Phos, Sulph. Leaning forward, with elbows on knees >, Ars, Kali i. Legs, weak and crooked, Cal, Cal. p, Sil. Leucorrhoea, acrid, profuse, albuminous, Alum, Bor. appearing two weeks between the catamenia, Bor, Bov. running down to the heels in large quantities, Alum. warm water floAving down, with a sensation of, Bor. Liability to take cold in the open air, Kali b. Lids, bag-like swelling between upper lids and eyebrows, Kali e Life, young persons or girls who lead a sedentary, Aeon. the two extremes of, the aged and the young, Cal. Liquids only, can swallow, Bap, Kali brom. Listless, nervous, weak, Stan. Little things, greatly concerned about, Con. Looseness of bowels, chronic, patients disposed to, Nit. ac. 398 CONSUMPTION. Loquacity great, wants to talk all the time, jumps ab- ruptly from one idea to another, Lach. Love disappointed, ailmeuts from, Cal, p. Low spirited, feels like crying all the time, but crying makes her worse, Stan. Lung, affects the r. upper and middle third, Ars, Ars. i. lower lobe of right, Kali e lobe of left, Nat. s. upper and middle third, acts most on, Cal. third, affects the r. Bad. Lymphatic, best suits the, Bap. Manners, persons of easy, graceful, Phos. Marasmus from impaired nutrition, Iod, Nat. m. Measles, has been troubled eArer since with asthma or something else, Carbo v. Mechanical injuries, long impressed by even slight, Arn. Medicinal action, want of susceptibility to, Carbo v. Melancholy, sad, hopeless, Ars, Caust. religious, Mel, Psor. Membranes mucous, catarrhal affections of, Alum. and glands, increased secretion of, Dul. mucous, ulceration of, Bap. Memoey enfeebled, Con, Lach, Sulph. Menses, exhausted physically and mentally after, Alum. epistaxis and checked, or epistaxis when menses should appear, Bry. every two weeks, Cal. p. Trill. exhausted during flow can hardly speak, feels so, Carbo an. flow during the day, ceasing when lying down, Caust. intermits two or three days and then returns, Fer. laugh and cry immoderately during, nervous patients AA'ho, Fer. movement the least < flow, must keep perfectly still, Bry, Fer. CHAR A CTERISTIC. 399 Menses, scanty or suppressed, with amenorrhcea, anaemia, chlorosis, Cal. short, too feeble, too, Lach. suppressed from fright or shock, Aeon. from getting the feet wet, Puis. time, at regular, Lach. too early in young girls, Aoav bright red, Cal. p. too early, too profuse, and after ceasing a little is passed from time to time for days, Caust, Kreos. too early, too profuse, too long lasting, Cal, Cal. p. too late, flow scanty, slimy, intermittent, increases in p. m, evening chilliness, Puis. too late, in adults, at first bright, becoming dark, Cal. p. too soon, too profuse, too long lasting, with fiery red face and ringing in ears, Fer. too soon, last too long, flow dark, not profuse, Carbo an. Menstrual effort, the breasts become enlarged, sore, and painful, at every, Con. flow relapsing, least mental excitement causes profuse return, Cal, Sulph. always feels better during, if normal, Lach, Zinc. dark, lumpy, black, or acrid, Lach. pains all relieved by the, Lach. pale, watery, debilitating, Fer. Menstruation, feels badly a week before, Kali e after fright and vexation during, Aeon. vicarious, Bry, Phos, Psor. Mentally actiA-e and precocious, physically weak, Tub. Mental effects of injuries about the head, Nat. s. effort, inability to sustain any prolonged, Con. excitability, quick comprehension, Lach. irritability; passionate, spiteful; apprehension of im- pending evil, great, Kali i. irritability, laughing or weeping involuntary, Sep. Mercury, where syphilitics have been injured by, Lach. 400 CONSUMPTION. Metrorrhagia in cancer, pouring out freely and then ceasing for a time, Phos. Mind weakened and Avanders, Nit. ac. weak, inability to control or fix on anything, Bap. morose, obstinate, peevish, Dul, Kreos. Mortification, ailments from, Bry, Col, Staph. Motion, downward, dread of, Bor. Mountain climbing, asthma after, Ars. Mouth in last stages of phthisis, for the sore, Lach. Mucous membrane of air passages, great dryness of, Bell. catarrhal affections of, with copious secretion of clear, watery frothy mucus, Nat. m. great paleness of, especially of the mouth, Fer. Mucus, increased secretion of, from fauces and bronchi, Bap. Muscles easily strained from overlifting, Cal, Carbo an. rigid, firm, Arn, Caust, Sep. soft and flabby, Hep. Muscular fibre firm, Bry. Music, the soft, sad, strains make her sad, Nat. s. Nausea and vomiting, from the odor of cooking food, Colch, Stan. in the morning, Stan. Neck unable to support the head, Cal. p. Nervous, excessively, Bor. quick motioned, quick tempered, Sulph. Night, pains < at, in diseases of bones, periosteum, Mer. Night-watching, care, trouble, ailments from protracted, Caust, Coc. Nose, crops of small, intensely painful boils in, Tub. discharge in clear masses and violent pain from occi- put to forehead if discharge ceases, Kali b. dryness and pressive pain in root of, Alum, Kali b. dull heavy pressure in forehead and root of, Sticta. plugs, clinkers from post nares, Kali b, Sep. ropy, tough, green, bloody, offensive, Kali b. Nit. ae CHAR A CTERISTIC. 401 Numbness of limbs, sensation as if circulation ceased, Lye Nursing women, the hair falls out when touched, Nat. m. Obesity, inclined to, Kali e Obstinate, headstrong, cry when kindly spoken to, Sil. Occiput coldness on, Cal. p. Odor of body follows despite bathing or washing, Sulph. from the body produces nausea and disgust, Sulph. of stool follows him as if he had soikd himself, San, Sulph. Offensive, breath and sputa are very, Sang. Old men, debilitating diseases of, from enforced conti- nence or sexual excesses in youth, Con. people, diarrhoea and great weakness, with heaviness and trembling of limbs, Nit. ac. dropsies, paralyses, and diseases of, Kali e for the diseases of, Con, Alum. women, old maids, hypochondriacal, with rigid muscu- lar fibre, Con. One hand hot, the other cold, Dig. icy cold, the other warm, Cinch, Ipec. Organization, highly sensitive, Brom, Phos. Outlets of body, affections of mucous, Nit. ac. Over exertion, effects of, Mill. Overgrown boys with weak chests, Cal, Cal. p, Iod, Phos. very tall for age, Kreos, Phos. Overlifting, bad effects of overstraining, never recovered from, Carbo v. even slight, causes great debility, Carbo an. Over-sensitive, even cries when thanked, Lye, Puis. to either heat or cold, Ipec. to external impressions, light, noise, odors, Phos. Ozena, discharges, corroding, fetid, yellow, Nit. ac. green casts every morning, Nit. ac. obstructed, dropping of clear, bloody water, Nit. ac. Pains, acute in r. chest, < from slightest pressure on inter- costal spaces, and lying on 1. side, Phos. 402 CONSUMPTION. Pains, appear suddenly, disappear gradually, Pals. and disappear suddenly, Kali b. Bell, Mag. p, jNitac. borne, are not well, Nit. ac. burning, Apis, Ars, Carbo v, Phos, Sulph. chilliness accompanied with, the more severe the pain the harder the chill, Puis. cramping or drawing in inner parts, Sep. darting, springing, like chain-lightning and ending Avith a sharp vice-like grip, Cae erratic, rapidly shifting from one part to another, Puis. extend from other parts to back, Sep. gnawing here and there as from ulcers, Nit. ac. increase in proportion as affected parts are kept quiet, Dul, Rhus. in small spots, can be covered Avith the point of the finger, Kali b. migrate rapidly from one part to another, Kali b. nervous, cannot endure, Arn. neuralgic, every day at same hour, Kali b. sensitiveness, excessive to, Sep. shuddering, with, Sep. sleep during, Nit. ac. sore bruised feeling through body, as if beaten, Arn. sticking, pricking as from splinters, Nit. ac. stitching, darting, worse during rest, and when lying on the affected side, Kali e tearing, drawing, tensive, excited by slightest chill, Phos. tension, which increases until very severe and then " lets up with a snap," Puis. weather or temperature, on change of, Nit. ac. worse at night, Bry, Mer, Syph. Painlessness, with most complaints, Stram. Pale and delicate, complaints of persons who are, Led. and sallow, with pimples on forehead and nose, Sep. CHAR A CTERISTIC. 403 Pale, weak, delicate, irritable, wilful, Kreos. Palpitation < from least exertion, Iod. < from least motion, Dig.' Paralysis, of single parts; of r. side, Caust. Parts, become white, red, Fer. Parturition, complaints following, with backache, sweat- ing, weakness, Kali e Past troubles, constantly thinking about his, Nit. ac. Peevish, excessively, Ars, Dul, Fer, Hep, Caust, Kreos. angry at least trifle, Hep. Perception, quick, lively, Phos. Periosteum, bones, SAvelling of, pains worse at night, Kali i. Permanently improve, when well selected remedies fail to, Psor. Persons, catarrhal affections, predisposed to, Bor. complexion light, hair light, with, Bor, Cal. disputative, easity excited, fretful, Fer. dry, withered looking, Alum. mentally and physically changed by illness, Lach. pleasant, jovial when well, irritable when sick, Bell. who are extremely well or very sick, Bell. Perspire when Avalking in open air, tendency to, Caust. Perspiration, profuse attends nearly every complaint, but does not relieve, Mer. Phthisis, caused or < by mal-treated syphilis, Myr. of debauchees, drunkards, Cinch. Plethora, from sudden cessation of an accustomed dis- charge, Sulph. Plethoric, face red, Arn, Bell. Pleuritic effusion and dropsy in old women, Cinch. Pneumonia, abscess following hepatization in, Mer. catarrhal, acute degenerations following repeated at- tacks of, Ars. i. or pleurisy badly treated or neglected, Lye with haemoptysis and purulent expectoration, Lye 404 CONSUMPTION. Poison, diseases which depend on a virulent, Nit. ac. Post-Climacteric diseases of women, Kreos, Lach. Position, horizontal cannot sleep or breathe when lying in a, Ars. i. Posture, recumbent, on rising from, the red face becomes deathly pale, Aeon. on rising from, becomes faint or giddy, inclines to fall over, Aeon. potatoes disagree, Alum. Precocious mentally one of the first manifestations, Bell. Pregnancy, bathing, must close her eyes while, Phos. vomiting of, obstinate cases when Lactic acid or the best selected remedy fails, Psor. water unable to drink, during, Phos. Pressure as from a stone in pit of stomach > by eructa- tions, Ars, Bry, Cal, Mer, Nux, Sep. intolerance of, Bap. Prolapsus uteri in hot weather, Kali b. et vaginae, < during stool, Stan. Prostration and great weakness, after symptoms have dis- appeared, Ars, Brom. great from climbing mountains, or severe muscular exertion, Ars. great, with tendency to decomposition of fluids, Bap. Psorinum, Sulphur, or the indicated remedy fails to relieve or permanently improve, when, Tub. Puberty, girls at or near, tall, rapidly growing, Cal. p. Pulse, extremely slow when at rest, Dig. full, firm, globular, bounding, Bell. Pupils, chronic dilation of, in children at puberty, Cal. Pus, acrid, fetid, ichorous, yellow, tendency to disorganiza- tion, Kreos. offensive, becomes ichorous, or a bloody serum instead of pus, Carbo v. Quinine, abuse of, Ars, Fer, Puis. deafness after the abuse of, Cal. CHARACTERISTIC. 405 Raise a great deal, sensation as if he wanted to, Bap. Recovery, hopeless of, thinks he will die, Psor. Relapsing, complaints that are continually, Sulph. Restless, cannot get an easy position nor lie still a mo- ment at night, Caust. hot, kicks off the clothes at night, Sulph. mentally, physically too lifeless to move, Bap. must move, but motion does not relieve, Caust. Restlessness, extreme, Ars. Robust, best suits the, Bap. Rooms, wet and damp, from sleeping in, Ars. i. Rheumatism, chronic periosteal, of syphilitic or mercurial origin, Kali i. Sad, low-spirited, Psor. Saliva, coppery, fetid, profuse, Mer. metallic, soapy, stringy, bloody, tenacious < after midnight, Mer. Sallow people with cold extremities, haughty, violent dis- position when sick, Lye Salt in food, for the excessive use of, Phos. Satiety, constant sensation of, Lye of life, contemplates suicide, Nat. s. Scalp, itching of the, children when disturbed in sleep scratch the head on waking, Cal. sore, cold crawlings on, Cal. p. Scattered feels, and tosses about to get the pieces together, Bap. Scratch or injury maturates, the slightest, Cal, Cham., Graph, Hep, Sil. Sea bathing, bad effects of, Ars. Secretions, great foulness of, Carbo v. acrid and irritating, Nat. m. Self-willed, children who are, Cal. Senses, over-excitability of all the, Bell. Sensitive, nervous, threatened with delirium or convul- sions on slightest ailment, Bell. 28 406 CONSUMPTION. Sensitive to touch, to pain, to draughts of air, Cinch. to external impressions, cannot bear slightest draught of air, noise, cold, touch, etc., Hep. Sensitiveness to contact, extreme, dread of touch out of all proportion to actual pain, Hep. Sexual desire absent in fleshy people, Kali b. organs, affections beginning on r. side of, Spong. Sick Headache, begins in the morning, increasing during day, lasts till evening, sleep >, Sang. chronic, since some severe disease of youth, Sil. every week or every other week, Sulph. exhausting, prostrating, weakening, Sulph. occiput over the vertex and localizing over r. eye, Sang. of school girls, with diarrhoea, Cal. p, Nat. m. pain rises from nape to vertex, as if coming from spine, locating in r. eye > pressure and warmth, Sil. persons, with a history of chronic, Sang. relieved by rest and closing the eyes, Bry. rising on first opening the eyes in morning, when, Bry. seven days, occurs every, Sang. spirituous liquors, with intolerance of, Fer. stooping as if the brain would burst through the fore- head, when, Bry. vertex coldness on the < moving the head aud stoop- ing, Sep, Verat. vertex hot with cold feet and burning soles, Sulph. vertigo, heaviness, pressure, and rnsh of blood to head, with, Bry. vomiting, usually terminates in, Sang. Skin affections, especially of scalp, very sensitive, Hep. affections are moist, suppurative, sensitive to touch, and spread by means of new pimples just beyond the old margins, Hep. and muscles lax and flabby, Bor, Mer, Spong. CHARACTERISTIC. 407 Skin, cobweb, were lying on face or hands, sensation as if a, Bor, Graph. finger joints, severe itching on back of, Bor, Nat. a, Sep. harsh, dry, flabby or yellow, Nat. m. pallor of, Fer, Sang. thin, white, fair, delicate, Bell, Brom, Cal. Sleep, cannot go to, because she cannot get herself to- gether, Bap. unrefreshing, Cinch. Sleepless first part of night, sleeps late in morning, Puis. from intolerable itching, Psor. Sleeplessness, from severe muscular exertion, Ars. Slime and mucus, mouth full of, Nat. s. Slow to act, indecisive, Hep, Puis. Shivering, many symptoms are accompanied by, Aeon. Shock, mental, for the effects of, Aeon. Sbooting himself, must use self-control to prevent, Nat. s. Sinking, empty, "gone" sensation in the epigastrium, Stan. Soles, burning of, Graph, Lach, Lye, Sang, Sulph. Solid food gags, the least, Bap, Sil. Sore and bruised, parts rested on feel, Arn, Bap. mucous membranes are, Nat. m. Soreness < in joints and < from least motion, Cal. p, Bry, Dul, Rhus, Ruta. and aching, a general feeling of, from exposure to damp, cold, changeable weather, Cal. p. Sour, the child smells, Hep. Spasms of single muscles or of the whole body, Bell. Special senses seem too acute, all the, Cinch. Spirituous liquor intoxicates, smallest quantity of, Con. Splinter were being stuck into the affected parts on the slightest contact, sensitive as if a, Nit. ac. Spring, getting well in and returning in autumn, Cal. p. Squeezed, sensation as if the heart was, Cae, Iod, Sulph. Squirming in nostril as of a small worm, hay fever, Nat. m. 408 CONSUMPTION. Stairs, great weakness and loss of breath on going up, Cal, Iod, Mer. Standing is the most trying position, Sulph. Stature, the two extremes of—the tall and erect and short and stout, Cal. Stitching, tearing pains, Bry, Kali c. Sticking pain as if done with a blunt instrument, followed by a pain as if after a blow, Dul. Stomach about 11 a. m, weak, empty, " gone," faint sensa- tion in the, Sulph. distended, extremely sensitive, Kali c. fruits and cold drinks lie like ice on the, Elaps. pressure, painful on, Cal. swollen like a saucer turned bottom up, pit of, Cal. water, feels as if full of, Kali c. weak, sore, empty feeling at pit of, not > by eating, Carbo an. would burst after, eating or drinking sensation as if, Carbo v. Stone-cutters, chest complaints of, with total loss of strength, Sil. v Stool after, long-lasting rectal pain, Alumen, Nit. ac, Aloe. Stoop in walking and be hollow chested, inclined to, Phos, Sulph, Tub. Strained from lifting small weights, parts easily, Carbo an, Cal. Sucklings and children who become thick and gross as if fat, Cal. Sufferings of others, ailments from witnessing the, Caust. Suffocative attacks, nightly, wants doors and windows open, Sulph. Summer, after taking cold or getting hot in, Bry. Suppressed foot-sweat, diseases caused by, Sil. Suppuration, controls the process of, Sil. great tendency to, Hep. profuse, Mer. CHARACTERISTIC. 409 Suppuration, reducing profuse, Sil. Suppurates, every cut or slight injury, Bor, Cham, Hep, Sil. Sulphur or the indicated antipsoric fails to act, when, Psor. Sweat, all the complaints cease after the, Psor. debilitating, exhausting, fetid, profuse, Carbo an. drenching night, not very exhausting, Acet. ac. during sleep or exercise, Cinch. easily and take cold in consequence, persons who, Cal. eating when, Carbo an. exertion, on the slightest, Bry, Carbo an. Cinch, Fer, Hep, Phos, Psor, Sil, Stan. from least exertion, or has exhausting night, Psor. most profuse on, thighs and feet, Carbo an. knees, in hollow of, Carbo an. offensive night, Carbo an. profuse, sour or musty, debilitating and of an offensive, cadaverous odor, Sil, Stan. walking, when, Carbo an. without thirst, Cinch. < after midnight and from least exertion, Sil. yellow, stains the linen, Carbo an. Sweating and chilliness alternate, Caust. Swellings, cold, Mer. Symptoms return again and again, when patient seems to get almost well, Sulph. Sycosis for the cure of when symptoms agree, Nat. s. Thuja. Take cold easily, persons suffering with chronic disease, Cal, Kali c. Hep, Nat. s. Nit. ac, Phos. in the chest, patients nearly always; next attacks the nose without > to chest, Phos. Talking, fatigues and excites the pains, Sulph. Tall, slender, narrow-chested, adapted to the, Phos, Tub. and very erect when walking, standing or sitting, Cal. Teething children and old people, for, Nat. m. 410 CONSUMPTION. Tears or laughter, easily moved to, Lye, Puis. Temperature, excessive sensibility to changes of, Carbo v. Thirst, burning, without special desire to drink, Ars. in Bright's disease, chronic diarrhoea, dropsy, Acet. ac. drinks often but little at a time, Ars. drinking large quantities of cold water, neither affects the stomach nor relieves the, Acet. ac. for cold water, burning, Ars. great, for large quantities at long intervals, Bry. intense, burning, insatiable, Acet. ac. Thirstlessness with nearly all complaints, Puis. Thin, emaciated, unable to stand, children are, Cal. p. persons of rigid fibre, Nit. ac. Think, indisposed to, or want of power to, Bap. Three Persons, thought she was, and could not keep them, Bap, Petr. Throat and neck, thin and shrunken, Nat. m. pressure on the, no matter how little it is covered, Sep. Throbbing or pulsating in internal organs, sensation of, Sep. Thunder-storm, feels restless for days before and during a, Phos, Psor. Tired, always wishing they could get rested, Apis. Tobacco chewing, patients who suffer from effects of, Ars. Touch, bleeds easily from the slightest, Carbo v, Lach, Phos. great sensitiveness to, Aeon, Apis, Cinch, Lach. the whole body is sensitive to, Aeon. causes pain and makes patient shrink, Kali e startles, especially on feet, slightest, Kali e Touched, cannot bear to be, Kali e by persons coming near him, fears being, Arn. Tongue, coated golden yellow, Nat. m. coated thick yellow at base, Mer, Iod. coated thickly as if covered with fur < mornings, Mer. dirty yellow with foul breath, Mer. flabby, swollen, shows imprint of teeth, Mer. CHAR A CTERISTIC. 411 Tongue, foul very, but becomes clean at each menstrual flow, returning when flow ceases, Sep. moist, covered with mucus, Mer. slimy mucus, coated with, Nat. s. Torn, pain as if anus were, Nit. ac. Traumatism, mental, Nat. s. Trembling all over, Lach. nervous, great prostration, Apis. of the arms and legs, they feel as heavy as lead, Stan. Tubercular deposit in apex of lungs, usually left, Tub. Ulcers, base raw looking, Nit. ac. bleeding, easily, Nit. ac. burning, cancerous, gangrenous, Kreos. cancerous, bleed easily, are unhealthy, Kali e edges, irregular, zigzag, Nit. ac. mercury or syphilis after, engrafted on a scrofulous base, Nit. ac. pricking pains on contact in the, Nit. ac. putrefying, spongy, Kreos. Ulceration with burning pains, Carbo v. Uncovered, cannot bear to be, Hep, Nux, Psor. coughs when any part is, Hep. Uneasiness, the clothes cause an, Lach. Unpleasant impression, prostrated by the least, Phos. Upper part of body, heat of, coldness of lower, Arn. Urinating, backache > by, Lye child cries before, Bor, Lye Urine, can scarcely retain it a moment, Apis. cider barrel, like the remains of a, Nit. ac. cold when it passes, Nit. ac. intermitting Aoav of, flows in a full stream at first, then stops, flows again,etc. Con. involuntary, from paralysis with constant ineffectual urging, Caust. horses, strong smelling like, Nit. ac. incontinence of, with great irritation of parts, Apis. 412 CONSUMPTION. Urine, involuntary, when coughing, sneezing, walking, . Bry, Caust, Nat. m. Puis, Scilla, Taran, Verat. nocturnal, unconscious of it, Caust. passes so easily is not sensible of it, Caust. red sand in, Lye on child's diaper, Bor, Lye, Phos. scalds severely Avhen passed, Apis. scanty, dark brown, Nit. ac. scanty, suppressed, Bell. sediment scarcely ever contains a, Aeon. voided while straining at stool, Aloe, Alum. Urticaria, every time patient takes cold or is long ex- posed to co!d or damp, Dul. Uvula, bladder-like appearance of, much swelling but little redness, Kali b. Vaccination, bad effects of, Malan, Sil, Thuja. Vegetables and fruit, gardeners and fruit growers from handling cold, Cal, Mag. p. Zinc. Vehemence and anger, persons inclined to, Bry. Veins show through the skin, the distended, Carbo an. Venous capillaries, slightest irritation causes bleeding from, Carbo v. congestions, particularly of portal system, Sulph. plethora of elderly people, cheeks, lips and finger nails blue, Carbo an. Vertigo, ascending, a height, on, Bor, Cal, Fer. bed, when turning over in, as though contents of room were turning in a circle, Con. descending, with disposition to fall forwards, Fer. lying down, < when, Con. must keep the head perfectly still, Con. rising suddenly, things grow black, on, Fer. stairs, is dizzy, out of breath, has to sit down, on going up, Cal. walking over or crossing a bridge, on seeing running water, Fer. CHARACTERISTIC. 415 Vertigo, water with balancing sensation, as if on, Fer. Vexation and fright during menses, Aeon. Vexed, easily, Ars. Vertex, constant heat of, Sulph. Vital fluids, anaemia from loss of, Cinch, Fer, Kali e, Nat. m. ailments from loss of, Cinch, Fer, Phos. forces, weariness and complete prostration of, Nat. m. heat, lack of, especially in chronic diseases, Sep. in acute diseases, Led. persons deficient in, eA'en when taking active exer- cise, Sep, Sil. sinks to a minimum, Carbo an. symptoms are attended with coldness and lack of, Led. powers have become weakened, cachectic individuals whose, Carbo v. nearly exhausted, Carbo v. want of reactive, Carbo v. weakened resistance of, Carbo an. weak digestion from loss of, Carbo an. Cinch. Vomiting, midnight immediately after, Fer. painless of all solid food after eating, Fer. Walk, but cannot stand, patient can, Sulph. children have difficulty in learning to, Cal. slow in learning to, Cal. p. stooping like an old man, Sulph. Warmly, cannot cover up too, but it does not relieve, Caust. Warts, especially on eyelids, Caust, Thuja. large, jagged, pedunculated, Caust. moisture exuding, easily bleeding, Caust. small, all over the body, Caust. " Washerwoman's remedy," laundry work, complaints that are brought on or < by, Sep. Water cold, longed for but patients cannot drink it, Ars. 414 CONSUMPTION. Water, as soon as it becomes warm in stomach is thrown up, Phos. sight of causes vomiting, Phos. the stomach does not tolerate, because it cannot assim- ilate cold, Ars. Weak, so, drops into a chair instead of sitting down, Stan. Weakly, timid, retiring, Cal. scrofulous, with sallow, chalky complexion, Caust. Weakness and prostration, Phos. and emptiness in pit of stomach, at 10 A. m. Phos. and prostration generally, Kreos. cause, without any apparent, Psor. fluids, from loss of, Psor. great, when no organic lesion can be detected, Psor. joints of the body as if they would not hold together, of all the, Psor. obliges patient to lie down, though always better when walking sloAvly about, Fer. of chest, cannot bear to talk, Dig. remaining after acute disease, Psor. < in morning, Lach. the weaker the mind becomes, the more marked is the sexual excitement, Phos. would constantly sink down with, Lach: Weather, change of, great sensitiveness to, Cal, Phos. cold, bronchial, catarrhal, rheumatic complaints, in- cident to, Cal. p. cold, damp, affections brought on or < by, Bry, Dul. cold, damp, sudden changes occurring in hot, Dul. coldness < in cold wet, Elaps. is easily affected by stormy, Psor. must be Avrapped up to face even in hot, Hep, Psor. wears a fur cap, overcoat or shawl, even in hottest summer, Psor. worse in cold, damp, Aran. CHAR A CTERIST1C. 415 Weep, inclined to, music and like emotional causes impel him to, Kreos, Nat. s. Weeping, almost impossible to detail her ailments with- out, Puis. Weeps all day, cannot calm herself, < from 4 to 8 p. M, Lye Wildness and extreme irritability, with melancholy, Nat. s. Wind, dry, cold, west or northwest, cough or croup from exposure to, Hep. warm, moist, south, oversensitiveness, < in, Ipec. Winter, cough returns every, Psor. Women and children, for the diseases of, Puis. especially widows, for, Apis. Work, when once warmed up to it, gets on very well, Sil. Worms, but indicated remedy fails to relieve, Sulph. Yawning, continued, with respiratory affections, Brom. 416 CONSUMPTION. AGGRAVATION. Acids, from the use of, Sep. Afternoon and evening, in, Puis, Sep. from 4 to 8, Lye Air, in cold, Alum, Ars. i, Brom, Caust, Con, Kali c. cold, damp, Cal, Dul, Kali b. draughts of, Aeon, Bell, Cal, Cinch. draughts of cold, Caust, Cinch. going from cold into warm room, Bry, Caust. open, is intolerable, Phos. cold, dry, open, Carbo an. current, < from least, Mer. going from warm into cold, Con, Phos. Alcoholic drinks, acid drinks, cinchona, mercury, Lach. Alone, when, Phos. Alternate days, on, Cinch, Lye Ascending, from, Ars. i, Bor, Cal, Spong. Atmosphere, damp, at lake or seaside, in, Nat. s. Autumn, in warm days and cool damp nights, Mer. Bathing, from, Ant. e, Caust. Bed, by heat of, but relieved by rest in, Mer. becoming warm in, Nat. m. itching < when warm in, Mer, Psor, Sulph. rising up in, Con. Cellars, cold damp < or bring on asthmatic affections, Aran, Ars, Ars. i. working in damp, cold, Ars. i, Dul. Coition, after, Kali e Cold, from, Ars, Sil. on becoming, Caust, Kali e Cool Air, especially in evening, Mer. AGGRAVATION. 417 Cough < 10 to 12 a. m. Bell. Damp rooms or basements, living in, Aran, Ars. i, Nat. s. Dampness, exposure to, Cal. p, Dul, Mer. Dancing, Bor. Doors, out of, Alum, Kali c. Downward motion, Bor. Draught, by sitting in a, Aeon. Drinking, from, Bell, Dros, Nat. m, Phos, Psor. Drinks, cold from, Ars, Dig, Sil, Spong. Eating, Kali b. Kali c, Phos. food, after, especially warm, Kali e or drinking cold things, after, Lye Evening, before midnight, Aeon, Bry, Dul, Phos, Psor, Puis. and at night, especially after part of night, Nit. ac. Excitement, from, every, Spong. mental, Cal, Cal. p. Exertion, physical, Ars, Ars. i, Bry, Kali c. mental or physical, as walking, talking, writing, Cal. Nat. m. Exhaling, Kreos. Exposure, rheumatic, of any kind, Aeon. Fasting, before eating, Iod. Food, acid, Nat. m. cold, Ars, Puis. salty, sour, or spiced, Bor, Lye warm, Bry. Head, low, lying with the, Ars. Heat, bed, warmth of, becomes intolerable on account of burning of limbs, must throw off bed clothes, Led. of summer or autumn, protracted, sultry, Carbo v. Heated, becoming, Dig. Inspiration, deep, Bor, Nat. m. Labor, manual, Nat. m. Larynx, soreness of, by touch or pressure, Bap. Laughing, Dros, Phos, Stan. 418 CONSUMPTION. Light and odors, from, Phos. Lying down, Ars. i. Con, Dig, Dros, Hyos, Nat. m. Nit. ac. Puis, Sil. on side or turning in bed, Kreos. back, cannot sleep from difficult breathing, Acet. ac. either side, Aeon, Kreos. either side, but especially on painful, Kali e 1. or painless side, Puis. 1. side or back, Phos, Sep. right side, Ars, Ars. i, Mer, Stan. the affected, especially r. side, Ars. the painful side, Bor, Iod, Hep, Kali b. Kali c. with head low, Ars, Ars. i, Spong. Menses, during, Carbo an. Puis, Coc, Sil. Menstruation, before and during, Kali e Mercury, from abuse of, Nit. ac. Midnight, after, Aeon, Ars, Cal, Carbo an, Dros, Fer, Kali c, Sulph. from 2 to 4 a. in. Kali e or toward morning, Dig. or just before cough < at, Bell. Milk, from, Nit. ac. or fruit, from, Cinch. Morning, Acal, Bry, Cal, Carbo v. and evening, Kreos. from 2 to 5 a. m. Kali i. early, can't walk without great suffering, Caust. 2 to 3 a. m, tough mucus strangles him, Kali i. Moistening diseased parts, from, Lye Moon new or full, skin symptoms, worse at, Alum. during new, Sil. Motion, by, Bad, Bap, Bor, Bry, Cal, Cal. p, Kreos, Nat. m, Sil. Move, on beginning to, Fer. Mountains, climbing, Ars, Ars. i, Cal. Music, Kreos, Nat. s. AGGRAVATION. 419 Night, at, Ars. i. Bell, Brom, Cinch, Con, Mer. Nights, during hot days with cool, Aeon. Objects, bright, shining, looking at, Bell. Oysters, from, Lye Pains, from thinking of, Bap, Bar. c. Ox. ac, Oxyt, Helon. in limbs and bones are worse every evening and be- come intolerable at night, Kali i. Perspiration, from suppressed, Aeon. Perspiring, Mer. Pollutions, after involuntary, Kali e Pressure, by, Bell, Bap, Brom, Lach, Sep. < soreness of larynx, Bap. Quinine, abuse of, Carbo v, Fer, Puis. Reading, speaking, talking, Dros, Nat. m, Phos, Psor, Sil, Stan. Rest, during, Dul, Fer, Sep, Sulph. Room, on coming from open air into a warm, Aeon., Puis. close air of, Nat. m. Puis. Rooms, closed, warm, are intolerable, Apis. Sea Shore, or sea air at the, Nat. m. Sexual excesses, Cinch, Con, Fer, Phos, Sep. Shaving, after, Carbo an. Singing, Ars. i, Dros, Phos, Stan. Sit Up, gets faint or sick, cannot, Bry. Sitting, Avhile, Alum, Psor. Sleeping, after, Apis, Hep, Nit. ac, Lach. Smoke, dust, Brom. tobacco, Aeon. Smoking, tobacco, Lye, Spong. Snoav, melting, Cal. p. Stairs, going up, Ars. i, Cal, Spong. Standing, while, Sulph. Stooping, Avhile, Alum, Lye or lying on left side, Lye Stretching affected limbs, on, Sulph. arms out, from, Lye, Psor. 420 CONSUMPTION. Swallowing, empty, Nat. m. especially solid food, Hep. Sweets, Caust, Spong. Sun or stove, heat of, Lach, Nat. m. the hot, Bell. Symptoms of Arn, Bell, Lach, < by Acet. ac. < before midnight, are > after, Brom, Puis. Temperature, changes of, Nit. ac. changes in, especially extremes of, Lach. Thunder-storm, before and during a, Phos, Psor, Sep. Touch, Bap, Bell, Bor, Brom, Bry, Cal, Carbo an. Cinch, Hep, Lach. Twilight, in, Puis. Uncovering, by, Aeon, Bell, Hep, Mer, Sil, Psor. the head, Aeon, Bell, Rhus. cold air coming in contact with exposed parts. Mer. especially the head, Sil. Undressing, while, Hep, Kali b. Waking, mental symptoms worse in morning on, Alum., Lach. Washing, bathing, Sulph. Walking, from, Brom, Caust. eating, rising from a seat, while, Lach, Nit. ac. Warm room, Apis, Dig, Puis, Spong. or warm wind, Lye drinking anything, Stan. Warmth in general, Apis, Bry, Dig, Dros, Lye, Puis, Spong, Iod, Stan, Sulph. of bed, Mer, Sulph. Wet, getting the feet, Aeon, Puis, Rhus. Winds, raw, damp, from, Cal. dry, east, Aeon, Cal. p, Sep. riding against, Aeon, Bry, Hep. south or south-west, Carbo v, Euph, Ipec. west or north-west, dry, cold, Aeon, Bry, Hep, Spong, Wrapping up the head, cannot bear a hat on, Iod. AMELIORATION. 421 AMELIORATION. Active motion, during work, Mer. Air, cold, Carbo v. Led. if cool, in open, Phos. in dry, Cal. in open, Aeon, Apis, Kreos, Kali c, Nat, m. Puis. mountain, Nat. m. open, irresistable desire for, Kali i. warm, Kali c, Dul. Attack, feels > before, Psor. Atmosphere, dry, clear, whether hot or cold, Nat. s. warm, dry, summer, Cal. p. Back, lying on, Aeon, Bor. Bathing, cold, Apis, Nat. m. Bed, sitting up in or lying with head elevated, Ars, Ars. i., Spong. Belly, sleeps better lying on, Acet. ae Breakfast, after, Cal, Kali e Cold in general, from, Iod, Puis. eating or drinking cold things, Bry. cold water, sitting with hands or feet in, Led. on becoming, Lye things, from, Puis, Sec, Verat. food or drinks, from, Phos. water, by a swallow of, Caust. water, washing chest with, Bor. Constipated, feels better when, Cal. Coughing or hawking up mucus hoarseness momentarily, from, Stan. Dark in the, Con, Phos. Descendng on, Spong. 29 422 CONSUMPTION. Drawing up the limbs, Sulph. Eructations, Carbo v. Kali c. Nit. ac. Exercise, violent, Sep. Eating, after, especially a full meal, Iod. Fanned, from being, Bap, Carbo v. Cinch. Fasting, Nat. m. Heat, > all symptoms except gastric, Sil. Hot applications, Ars, Sep. drinks and food > cough, Sil. Lying down, Cal. p. Kali b, Psor, Spong. on the painful side, Cal, Bry, Ign, Puis. on back, or sitting up, Lye r. side, Bry, Nat. m, Sulph. Pork, butter, fat, Carbo v, Fer. Mesmerizing, by, Phos. Motion, Brom, Dul, Rhus. Moving about when out of doors, Lach. affected part, Fer. Perspiration, from, Aeon. > all the symptoms, Psor. Pressure, Bor, Kali b, Kreos, Nat. s, Sep. holding painful side with hand, Bor, Nat. s. of hand relieves pain in chest and sternum, Kreos, Sep. Rest, while at, Aeon, Bell, Bry, Cinch. in bed, Mer. Riding in a carriage, Nit. ac. Rubbing, Phos. Salivation, profuse, Mer. Sitting up, Bry, Lach, Nat. m. upright, or bent forward, and throwing head back, by Lach. Sleep, after, Phos. Shaving, after, Brom. Standing erect, Alum. Uncovering, Apis, Lye, Sec. AMELIORATION. 423 Uncovering the head, Iod. Walking, when, Alum, Con. slowly about, Fer. Warm, on becoming, Kali c. food and drinks, Lye in bed, after getting, Kali b. room or covering up, Bad, Bell, Psor. things, eating or drinking, Spong. Warmth, in general, Alum, Ars, Bad, Bell, Carbo an, Caust, Dul, Hep, Kali b. Kali c. Lye, Psor., Sil, Spong. especially wrapping up the head, Hep, Psor,, Sil. from, except headache, which is > by cold bathing or cold air, Ars. Watery phlegm, expectorating, relieves asthma. Wine, from, Aeon. Weather, in dry warm, Alum, Cal, Dul, Sulph. eruptions are > in cold, Kali b. in wet, damp, Caust, Hep. 424 CONSUMPTION. LARYNX AND TRACHEA. Air, sensitive to inspired, as if mucous membrane were divested of its coating, Aeon. feeling as though he cannot inspire enough, when going from the open air into a warm room, Bry. Aphonia, complete, Alum, Ars, Bell, Brom, Caust, Elaps, Fer, Kali c, Mer, Phos, Puis, Sulph. almost complete in the morning > by slight expecto- ration, Brom. cold, from driving in, Caust. coming and going, Lac. c. Puis. confused sounds uttered with pain, Bell. foreign body in larynx, sensation of, which he attempts to remove by hawking or coughing, Fer. muscles of larynx refuse to act, Caust. loud talking, from prolonged, Phos. loud word, unable to- speak a, Puis. morning, worse in damp, cool weather, Carbo v. nervous, returns at every emotion, Puis. painless, whisper, can talk only in a, Fer. roughness of the throat, with, Puis. singing, from over, Arum, Caust. squeezed, sensation external as if throat were, Fer. straining the voice before recovering from a pre- vious attack, from Mer. sudden, partial or complete loss of voice, Aeon, Caust. talking, burning sensation after, Fer. tickling in larynx, producing violent attack of cough loses breath, blood mounts to head, lachrymation, falls down exhausted, Fer. voice hoarse rough, nasal. Kali i. LARYNX AND TRACHEA. 425 Aphonia, A^oice fails or becomes a squeak when he tries to raise it, Caust. hoarse, shrill, varying in tone < talking, Alumen. feeble, husky, speaks in a piping, Bell. straining the, from, Caust. weak, with a sensation of general prostration and weakness, Sang. weakness of organs of speech and chest, cannot speak aloud, Hep. weak voice suddenly becomes loud and clear, while speaking, the, Bell. weather, in hot damp, Bell. with great prostration, Phos. violent sneezing, Kali e mucus in trachea and bronchi, Sulph. whisper, spoke in a, every attempt to speak audibly sent blood to face and tears to eyes, Mer. Bronchitis in children, from cold or damp air, with offen- sive night sweats, Dul. Burning in larynx and back part of tongue, Cal. p. scraping constriction of larynx, Spong. sensation in throat, larynx, trachea and bronchi, severe, Bor. raAvness and tickling in larynx, Mer. Catarrh, chronic, laryngeal or bronchial, with hoarseness, < on approach of warm Aveather, Kreos. sudden, threatening suffocation at night, Ars. Choking, on lying down, Kali b. and gagging unto vomiting, < in morning, Kal e awakens with, can scarcely breathe, Kali i. Clergyman's sore throat, Alum, Arum, Kali b. Lye Cold Air, > inspiring, Sang. Cold Sensation in larynx, Brom, Rhus, Sulph. in larynx, with cold feeling when inspiring after breakfast, Brom. 426 CONSUMPTION. Contraction of larynx, sensation of, Spong. Constriction of larynx, when talking, Dros. dryness, stinging and great rawness in throat, espec- ially pharynx and larynx, chills and rigors, Lach. in the throat, sensation, as if something prevented speaking, Puis. Constrictive pain in larynx, Caust. Coryza, lasting a long time after an attack of, Mang. redness about nose and upper lip, Cepa, Mer. Crawling in larynx which provokes hacking cough, Dros. sensation in lower part of larynx, trachea or upper bronchi towards evening, provoking cough, Kreos. Croup, cough loose in daytime, suffocative paroxysms at night, Lye cough, with deep, rough, barking, Hep. diphtheria, impending during, Lach. entire face or only left cheek, bright red, Acet. ac. exposure to dry, cold wind, cold air, after, Hep. habitual, in scrofulous teething children, Cal. head thrown back, child lies with, Hep. hoarseness or complete aphonia, Hep. last stages, in, when vital forces are exhausted, rapid sinking, cold SAveats, dropped jaw and rattling breathing, Phos. membranous, with hissing respiration, Acet. ac. midnight, < just before or towards morning, Hep. prophylactic, as a, to prevent frequent relapses, Phos. sleeps into attack, seemingly, or < after sleep, Lach. symptoms simulating membranous, caused by sup- pressed or non-appearing eruption, Ars. suffocating, awakens, grasps throat, Lach. whistling breathing, with loud, Hep. worse at night, very restless, Ars. Deafness, eustachean, Mang. Doors and windows opened, wants the, Carbo v. Down in larynx, sensation of, Hep. LARYNX AND TRACHEA. 427 Dryness in larynx and air passages, Caust. chronic, of the throat, with redness, soreness and swel- ling, Sang. drawing, tickling in larynx, burning when swallowing, Sulph. in bronchi in morning, Kali c. of larynx, with burning, Ars. Dry spot in larynx, where there is a crawling, with almost constant irritation to a dry cough, Con. Dust in larynx, trachea, lungs, sensation of, Ars, Cal. sensation as if one were inhaling, Ars. Empty feeling in chest, Stan. Epiglottis in constant motion to and fro, constant incli- nation to cough, Dros. Eruption, suppressed or non-appearing causing symptoms of membranous croup, Ars, Caust. suppressed, hoarse after, Dul. Expulsive coughs, a few, > for a moment, Stan. Fauces, rough, dry, scraping sensation deep in, Dros. Feather in larynx, exciting cough, sensation of, Dros. Feather-down in larynx, trachea, lungs, sensation of, Cal. Fishbone in throat as soon as he catches cold, with hawk- ing and scraping, sensation of, Kali c. Gagging and choking unto vomiting, especially in the morning, Kali e Glottis, spasm of, Ars, Bell, Kali i. Hair across base of tongue, which neither hawking, swal- lowing, nor eating relieves, Kali c. Hoarseness, air, in damp evening, Carbo v. open, especially in, Bry. and rawness in morning after rising, Carbo an. attacks, in sudden, Bell. cannot speak aloud, Carbo v, Caust, Phos, Sep. ceasing in morning after sneezing, Kreos. cough and rawness of laryux, trachea, with, Phos. from tickling in throat, with, Sep. 428 CONSUMPTION. Hoarseness, cough, with nightly, Cal. crying, especially when, Bell. deep and husky both in talking and singing, Cinch, disappearing while walking in the open air, Alum. dry, rough, barking cough, Brom. the larynx and trachea becomes, Cal, Lye, Sep. dryness, burning of throat and larynx, no thirst, Apis. evenings, with roughness and dryness of throat, Alum, nose-bleed at night, with, Carbo Ar. voice scarcely audible in, Brom, Carbo v. Hep. following croup, bronchitis or measlos, Carbo v. hawk and hem, can scarcely speak without, Cal. p. copious thick blue mucus in morning, Kali b. hollow and hoarse from accumulated mucus, Cinch. hyoid bone, painful soreness in region of, Brom. lasts all day, constant hemming and hawking, tough mucus is thrown off, Iod. lifting a heavy weight, with pain in larynx, when, Sil. measles as a sequel of, Bry, Dros. morning, in the, Aeon, Alum, Apis, Cal, Dig, Iod, Kali b, Nat. m. Nit., ac, Phos, Sil. of public speakers and singers from over use of vocal organs, Arn, Arum, Cal, Caust, Graph, Fer. p. often gets worse toward night, Phos. overheating, from, Brom. rawness, burning and soreness in chest, Caust. dryness in larynx and trachea, Lach. remaining after croup, Lye roughness in larynx, with deep, rough voice, which failed on exerting it, Carbo v. roughness and constriction of larynx, Mang. soreness in larynx, with, Sil. scratching and stinging in, with, Nit. ac. singers with, Ars. i. Arum, Bry. snoring inhalation with, Brom. soreness, tightness, and constriction about larynx, Iod. LARYNX AND TRACHEA. 429 Hoarsennss, swalloAv often to > the dryness and cough, must, Bell. swallowing, pain in larynx, when, Bell. sweat, Avith inclination to, Bry. talking, mucus adheres to larynx when, Psor. throat with severe burning in, Cal, voice, cracked, hollow, gives out, when singing or talk- ing, Spong. emptiness in chest on beginning to speak or sing, was constantly compelled to stop and take a deep breath, Stan. night, loss of during, Carbo an. rough as from phlegm, Mang. rough, with painful dryness of larynx, Bell. weakness of muscles of larynx, sense of utter, Caust. weather, in warm Avet, Carbo v. with accumulation of mucus, Nat. m. Kali b. with tickling in larynx, Iod. with pain on both sides of larynx > right, Nat. m. with roughness in throat, Hep. worse in morning, with constant scraping and desire to clear the throat, Caust. Irritation, in trachea, producing dry, fatiguing cough, worse at night, not affected by position, Acal. Laryngitis, hoarseness remaining after acute, Caust. Larynx, bending head backward, painful from, Lach. becomes raw and sore from clearing the throat so often in the evening, Carbo v. constant tillitation in the, inducing cough even Avhen not inspiring, Ars. constricted, with great dryness as if, Bell. dry cough, < after speaking, Mang. dryness, scraping, tickling in, Bad, Bell, Carbo v. lined with fur, feels as if, Phos. lump, small, in pit of throat, sensation like, feels as if it might loosen, but does not, Lach. 430 CONSUMPTION. Larynx, lump in throat, sensation of, Aeon, Kali c. upper part of trachea, in, Kali b. something runs from neck to, stops breathing, awakens him at night, sensation as if, Lach. raw, rough, as if lined Avith mucus, Cal. mucus in, either hard or soft, Dros. and trachea full of, Dul. bloody from, sometimes hawking, Kreos. in larynx, secretion of, causes cough, Kreos. much clear, albuminous, is brought up, Alumen. transparent, accumulation of in morning, Nat. m. tough, in the trachea, loosened only after frequent hawking, Bry. thick, dropping from posterior nares, Aeon, Hydr, Sep, Spig. necrosis of laryngeal cartilage, Cal. pain in, with desire to cough, and discharge of hard- ened mucus, Iod. raw in coryza, as if from ulceration, Kali i. pimples whitish, extending into, with severe pain on swallowing, the entire fauces studded with, Bor. plug in, sensation of, Spong. pressure, painful, mingled with stitches in region of sub-lingual glands, Iod. rattling in, during breathing and coughing, Brom. raw feeling in throat, larynx and trachea, Aeon. rawness in, on awaking, Alum. skin, sensation as from, in, Lach. sore, raAv sensation in clamp, changeable weather, in, Ars. i, Brom. smoke, sensation as if 1. were full of, Brom. suffocation, in sudden attacks of croup-like spasms, with threatening, Bell. sulphur, smoky sensation in 1. as of vapor of, Ars. , swollen, raw, sore, scraping, < pressing it, is obliged to swalloAv, Lach. LARYNX AND TRACHEA. 431 Larynx, talons striking in, sensation as from, < from, Lach. tearing in, in evening, extends to chest, excites, Bor. tickling in, with dry, hacking cough, Bry. tingling, and ulcerative pain in, Carbo v. touch, sensitive to, Apis, Con, Hep, Lach, Phos. sore to, Caust. Retching and vomiting, from efforts to clear the larynx or detach the mucus, Kali e Roughness, scraping, sc ratching in larynx as if from dust Alumen. in larynx, sensation of, Fer. soreness of throat and larynx, Sep. Scraping and hawking, constant, to remove mucus which collects in fauces, Kali e dry, parched sensation in, Kali e frequent cough completely dry, Nat. s. in throat causing rough barking cough, Hep. irritation in trachea and bifurcation of bronchi caus- ing dry cough, Bry. with irritation to cough, and dry cough in evening, Con. Small spot in larynx, pain in, Avorse from pressure, speak- ing, breathing, coughing, Hep. Sneezing, the laryngeal irritation causes, Carbo v. Soreness and sensation of dryness in, Nat. m. Splinter in throat, feeling of, Aeon, Nit. ac. Sticking pains in region of larynx, Nit. ac. Stitches with sore and raw sensation in larynx and trachea, Cinch. dull on both sides of larynx, extending to ear on swal- lowing, Mang. Stoppage in trachea, sensation of, Spong. Suffocates him, every drop, of liquid on the tongue, Apis. Suffocation and crawling sensation in larynx producing a paroxysmal, dry, hacking cough, Psor. from mucus in larynx, fears, Brom. 432 CONSUMPTION. Support the larynx on coughing or swallowing, patients involuntarily, Cepa, Dros. Talk, cannot, larynx is painful, Phos. Talking is very fatiguing, Psor. hurts, larynx so painful, must cease, Spong. must hawk and hem to clear the voice, when, Cal. p. or speaking debilitates, Cal. reading aloud, public speaking, causes a weak, exhaus- ted empty, "given out" sensation and produces hoarseness, Stan. Tickling and scraping in larynx, violent, causing dry cough, and bring tears to eyes, Puis. in larynx provokes hacking, constant, Aeon. Dros. Throat, copious, thick tenacious mucus in evening and morning, Aeon. and posterior nares, rawness in, compelling him to clear the throat frequently, Aeon. burning, scraping, dryness and constriction in, causing constant hawking and spitting, Aeon. Thyroid cartilage painful to touch, Alum. cartilage severe pain in region of, as if ulcerated, when coughing, Carbo v. Trachea, rough feeling in, obliging hawking, Kali i. scraping and ringing in, Kreos. scratching in, with pressure in chest and cough, Bor. so dry, it seems as if it would crack, Sang. Vapor in the trachea, sensation of, Bry. Voice, using the, produces weakness in the arms, between elbows and shoulders, which gradually extends over the Avhole body, Stan. bass, only able to speak in a, Dros. deep, becoming continually deeper, Iod. husky, hollow, Stan. faint weak, from ill effects of speaking, Nat. m. hoarse, deep, requires exertion to speak, Dros. weak, almost extinct, Fer. LARYNX AND TRACHEA. 433 Voice, hoarse and screeching, rarely failing, Dig. hollow without resonance, Dros. in morning > by hawking, Cal. with scraping in alrynx, Nat. m. nasal, or raised < in open air, Bry. broken, jerky, uncertain, Iod, Kali b. rough, hoarse, deep, Alum, Ars, Brom, Bry, Cal, Iod, Kali b, Kreos, Mer, Nat. m, Stan, Sulph. toneless, cracked, weak, Dros, Hep. uncertain, now strong, now weak, Ars. waking, husky on, Alum. weak and soft, scraped sensation in throat, Brom. whistling in larynx after lying doAvn evenings, Cal. whisper, descending into a fatiguing, Iod. 434 CONSUMPTION. RESPIRATION. Air in chest, sensation as if there was no, Kali c. must open window and get his face to fresh, Bap, Carbo v, Sulph. Anxious sensation in chest in evening in bed, Bell, Bor., Bry, Fer, Hep, Mer, Nat. m, Phos. Asthma, after eating, continual pressure, tension, and full- ness in stomach, Kali c. arsenic, from fumes of, Mer. at night, paroxysms return every two or three hours, or alternate with nightly diarrhoea, Kali e at 3 a. m. followed by frothy, foul sputa, Cinch. attacks gradually increasing and decreasing in in- tensity, Stan. awakening < on, Lach. bed, must spring out of, Ars. brought on by odor of flowers, freshly cut grass, dust, heat of sun or stove, can go about only after sun- down and on cloudy days (hay fever), Psor. catarrhal, every morning from ten to eleven, Fer. children, after a suppressed rash, of, Puis. cold, with every fresh, Nat. s. cough with profuse, purulent, sputa, Sil. covering of mouth or nose < from, Lach. damp weather, with every change to, Nat. s. diarrhoea, nightly, alternates with paroxysms of, Kali c. difficult, slow breathing, with, Fer. eating, talking or sleeping, < after, Lach. eruption, from suppressed, Dul. evening, in, especially after a meal, Puis. from 2 to 4 a. m, in terrible attacks, Kali e 4 to 5 a. m, symptoms of cold precede, Stan. RESPIRATION. 435 Asthma, from taking cold, cannot lie down, Spong. head back, must sit up and bend, Hep. hereditary, in growing youth of a deep-seated sycotic nature, Nat. s. humid, loose, rattling cough, copious sputa, Dul. humid, especially of children, Nat. s. in growing youth, rheumatic pains in chest, Kali i. in morning when waking, Con, Lach. liquid food, small quantities fill to repletion, Kali e lying down, < when, Sil. menses after, Lach, Nat. s, Spong. suppressed, with, Puis. midnight < after, Ars, Fer. moving the arms, < on, Lach. mucus, when chest is filled up with, Nat. s. as if larynx Avere filled with, towards evening or on waking from sleep at night, Cinch. must lean forward with head on knees, Ars, Kali e organic heart disease < from, Lach. of old people, with tickling cough, Con. particularly when talking with contraction of throat with every word uttered, Dros. pressure, tension, fullness in stomach after eating, Kali e rattling, great, and expectoration of large quantities of white mucus, Nat. s. " rose cold," especially after, < from odors, Sang. scabies, during, if itching ceases, Lach. severe, looks as if dying, Cinch. sibilant ronchi, with Spong. sitting or lying down, in the evening < when, Fer. spasmodic contraction, sensation of, when coughing or sneezing, Mer. spirituous liquors < after, Lach. suffocative attacks in evening in bed, Fer. tobacco smoke < from and in cold air, Mer. 436 CONSUMPTION. Asthma, touching the throat < on, Lach. uncover chest, must sit up and, Fer. walking, talking, reading or writing, > by, Fer. weather, worse in Avet, Dul. autumn and wet, Cinch. in paroxysms the face bluish-red, in wet, Con. with profuse watery mucus, Nat. m. young people, from bronchial catarrh, in Nat. s. Asthmatic paroxysms, in suffocative attacks, Bell. Awakens with suffocative sensation, Lach, Spong. Bed at night, must sit up in, Ars, Brom, Fer. Breath, arrest of, when lying in bed, Bor. bad offensive smelling Avhen coughing, Dros. breath, deep, frequent inclination to take a, which > Acet. ac, Bry, Mer. cannot take [a long, from stitches in chest, Bor, Bry. could not get a full, Bap. fetid, foul, offensive, Mer, Nat. m. frequent desire to take a deep, Kreos. oppressive, in every position of body, Ars. short and difficult, more, Cal. p. gasping for, on account of constriction of larynx, Sulph. labored and stridulous, Sang. loses, on turning in bed or when going to sleep, Carbo v. loss of, sudden, whlie walking slowly, Nit. ac. loss of on lying down in the evening, Ars. by every motion, Sep. must jump up and catch for, every time he has a stitch in r. side, Bor. obliged to take a quick deep, every three or five min- utes, followed by a stitch in r. side, Bor. oppression of, worse from 3 to 5 a. m. Kali e oppressed and painful, Cinch. short, difficult, caused by weakness of the respiratory organs with great emptiness of the chest, though without dyspnoea, Stan. RESPIRATION. 437 Breath, short on walking or going up stairs, Mer. and chest tired on waking, when walking, Carbo v. cannot get it completely, Kreos. with cold hands and feet, Carbo v. < by riding, lying down and light exercise, Psor. shortness of on bending arms, during sleep, in children, from every exertion, Lye on going up the slighest ascent, Cal. with constriction of chest, Con. shortness of, with anxiety of chest, Carbo v. after ascending steps, so that he cannot speak a word, Bor. as if lower portion of chest were held tightly, Kreos. causing anxiety, Ars. comes in wave-like expansions, Iod. had to get up, fearing he would be smoth- ered, Kali i. palpitation, vertigo and sensation of weak- ness on going up stairs, Iod. precedes paroxysm of cough, Caust. • unable to sit, must walk about constantly, Ars, Carbo v, Rhus. Avalking or taking the least exercise, Con. palpitation, anxiety on ascending steps, Nit. ac. with wheezing, whistling and constriction in the trachea, Ars. Breathing, air, better when walking in the open, Alum. air, worse in open, and when exercising arms, Nat. m. arrest of, on falling asleep her breath left her, threat- ened to suffocate, started up with a scream, Sulph. arrested by copious, tenacious, salty mucus, Alum. as if chest were constricted with an iron band, Cae. cheeks and hands livid, Sang. on lying down, Bap. waking him at night, Kali e 3o 438 CONSUMPTION. Breathing, arrested, with mucus in chest, Sep. when coughing, lifting, after running, lying on the back, Sil. when talking or walking rapidly, Caust, Sulph. awakes in the morning covered with sweat and great dyspnoea lasting for hours, Sep. awaking with anxiety, Cal. awoke with great difficulty of, Bap. as if from pressure of hand, Fer. back, lying on, cannot sleep from, Acet. ac. from want of power in lungs, not constriction, Bap. catching disappears when ascending stairs, Kreos. ceases entirely when falling asleep, Carbo v. Grind. constricted by cramps as if chest were, Lye difficult as from heaviness of chest, Fer. labored, cannot sleep lying on the back, Acet. ac. fanned, wants to be, but not hard as it takes the breath, Cinch. fullness of chest and palpitation on slightest motion, Carbo v. labored, after paroxysms of cough, Kali e hissing, with rattling in larynx, Acet. ac. liver, pain in, during, Cal. with pain in chest shooting to, Cal. p. mucus in chest, too much, with sensation of, Lye nocturnal tightness of, with heat, apprehensive anxiety restlessness, Cal. nose, loud, through the, Cal. oppressed in evening < going up stairs, Cae, Elaps. from fear of stitches in the chest, Bry. in the evening, Bap. relieved by throwing the shoulders back, Cal. short, from orgasm of blood, Fer. unable to take a long breath, frequent deep sigh- ing, Acet. ac, Cal, Sil. RESPIRATION. 439 Breathing oppressed, worse from deep inspiration or Avalking in the open air, Lye oppressive, in morning, or after eating, Carbo an. painful, caused by stitches in chest, compelling to sit up, Bry. rattling, Alum, Bell, Hep, Lye shocks, painful, in r. side of back during, Cal. short after coughing, always, Phos. when lying on the back, relieved by turning on the side, Alum. shortness of, < by slightest motion, Bry. especially in morning, Kali e when walking, as if the chest were full, Sep. shooting in 1. chest and r. temple, when, Cal. p. spine, pressive pain in when, Cal. stoppage of, walking against wind or stooping, Cal. suffocation, from dryness of the larynx, Kali c. suffocative, heavy, asthmatic, Iod. sulphur, as if the fumes of, had been inhaled, Brom, Phos, Puis. tightness of, out of breath from least exertion, Iod. tired, worse from getting, Alum. too rapid, even when at rest, Ars. i. uneasy, from pain across the chest, Fer. voice, worse from over-exerting the, Alum. warm room, < lying in > in open air, Apis. wheezing on first lying down, Ars. i. with sensation of tightly adhesing mucus in larynx not removed by hawking or cough, Alum. worse from drinking, motion, rapid walking, in the morning, Kali e Breathe with head low, cannot, Cinch. deeply, impelled to, yet it causes fatigue in head, neck, chest, back, abdomen, Carbo v. Chest feels bruised, beaten, as if, Kreos. a stitch in r. side of, when he speaks, Bor. 440 CONSUMPTION. Chest, did not expand enough, sensation as if, Con. expands with difficulty, Lye, Psor. oppressed feeling in after sunset, Nat. s. oppression of, with palpitation, Brom. from talking, Cinch. Constricted, air passages seem, < after midnight, Ars. Constriction impedes respiration, sensation of, Brom. Deep breath, desire to take a, during damp Aveather, Nat. s. constantly obliged to take a, especially while sitting, Lach. inclination to take a, increases constriction and causes a tearing pain in right chest, Sang. Difficult, as if a plug were sticking in the larynx and the breath could not get through on account of the constriction, Spong. is obliged to breathe deeply, which he cannot do on account of stitches in the chest, Bor. on ascending steps or from manual labor, Nat. m. with sensation of fullness in stomach extending up into chest, Nat. s. worse after midnight, Dros. Dust in lungs, with sensation of, in afternoon and even- ing, Bell, Hep. Dyspnosa, anxious, with palpitation, Psor. at night with desire for open air, fear of, Dig. ascending steps, on, Stan. back, when lying on, Puis. bending body forward, > by, Ars, Spong. breathe when standing up, can only, Can, s. chest in lower portion of the, in morning, Puis. clothes were too tight, was obliged to open them in order to breathe as usual, Stan. compelling slow walking, with great anxiety but not restless, Carbo v. constricted, as if throat and chest were, Puis. constriction of chest, with severe, Sulph. RESPIRATION. 441 Dyspnoea, deep breath, on taking a, Phos. evening when lying clown, in the, Puis, Stan, Sulph. from oppression of the chest, in evening when lying, < when sitting, Carbo Ar. motion, on the slightest, Stan. must get up to relieve, Hep, Spong. nausea, with transient, Phos. night, has to sit up to breathe at, Ars, Ars. i. Puis. open air, desire for, goes with head uncovered, Lye prostration, with extreme, Phos. pulsation all over the body, with, Kali e sighing, with frequent, Caust. sitting or lying down, when, Caust, Sinapis. sponge, as if breathing through a dry, Spong. stairs, Avhen going up hill or up, Ars. i, Cal. stitches in chest, with, Cal. intolerable in upper part of chest near axilla, > by pressure, Dros. when running or from any exertion, Bor. suffocating, with anxiety, Carbo an, Phos. tension, with, chest feels full and heavy as after a full meal, Phos. weakness, blood seems to rush to chest as if it would burst with sudden, Spong. with violent and irregular beating of the heart, Kali c. < sitting up to write, < the nearer the arms are brought to body, must keep arms spread wide apart, Psor. yawning, followed by, Sulph. Exhalation, when talking or coughing, as if something prevented, Dros. Exhaustion, great, after every exertion, especially of the chest, could scarcely talk, Spong. Expiration, loud breathing during, Aeon, Cal. Hay Asthma with violent attacks of sneezing, profuse coryza and lachrymation, Psor. 442 CONSUMPTION Inspire deep enough, cannot, Brom, Bry, Kreos. Inspiration, aching pain, severe, in infra-clavicular region over a small space in lungs which afterwards ex- tended to scapula, Dros. abdominal muscles, tearing or stitching as of needles, in, Cal. back, single severe stitches in upper part of, Cal. constant inclination to take a deep, Bry, Hep, Kreos. cutting pain at last ribs from within out, Cal. involuntary sighing, Bry, Cal. p, Ign, Kali c. loud, wheezing, anxious, with violent laboring of the abdominal muscles, < on, Spong. Mucous rattling in trachea, attacks of, Spong. Oppressed respiration, burning raw feeling in fauces, Bor. Oppression, heat and cold, from changes of, Ars. midsummer, from taking cold in, Ars. of chest, ascending a height, going up stairs, walking fast, exercising, Cal, Puis. of chest, asthmatic, with frequent yawning, Bap. severe toAvard evening, Sep. weather, in stormy, when walking fast, Ars. Pulled, sensation in 1. hypochondrium as if something, Bor. Rattling in chest, < after expectoration, Sulph. Respiration, lung sore during, Bap. sighs, irregular, chiefly of frequent deep, Dig. sleep, cannot, when he goes to sleep he stops breath- ing, and fears to sleep again because of another attack, Lach. Smoke, as if air passages Avere full of, Brom. Smothering, soon as patient closes his eyes feels as if he was, Carbo an. Sponge in throat, sensation of breathing through a, Brom. Starts from sleep, suddenly to get breath, Spong. Stitches into 1. chest, as with a knife, Bor. drawing, in r. chest, Bor, Kali e Stinging pressure in sternum, Bor. RESPIRATION. 443 Suffocating attacks after nursing, crying, being lifted out of cradle, Cal. p. Suffocation, cannot lie down from a sense of, must open doors and Avindows to obtain air, Lach. desperate fits of, must sit up in bed, Lach. paroxysms of painless, at night in sleep, Sulph. periodical attacks of, Cae threatened, just as falling asleep, Hep. Suffocative fits during an inspiration, frequent, Caust. oppressive, severe, from suspended respiration, Bad. nightly, as if lungs were paralyzed, or as if breathing through cotton. Throat, as if too narrow, the face hot and turgid, Sulph. ball in, sensation of, after sunset, Nat. s. contracts Avith every word he speaks, Dros. Tight, compressed, lungs felt, Bap. Tightness in chest as if full, not room to breathe, Cal. Tired sensation in chest, from rapid walking, Kali e Veins of forehead and temple distended, Sulph. Weakness and tired sensation in chest, from rapid walk- ing, Kali e Wheezing, with cough and a frothy expectoration, Ars. Yawn, frequent and fruitless attempts to, Lye child Avants to and cries because he cannot, Lye Yawning, frequent, asthmatic oppression of chest, Bap. 444 CONSUMPTION. COUGH. Abdomen, jarring of, during cough, Kreos. Aching pain in upper part of sternum, with, Fer. After meals with vomiting of all food taken, Fer. Afternoon and evening, < during, Bad. fever during, Bap. Air, < Avalking in open, Dig. < by going into open, Fer. p. "All gone," empty feeling in chest, sensation of, Nat. s. Attacks, in violent, followed by expectoration of black blood, with severe tearing pains in whole chest and especially at apex of r. lung, Elaps. Autumn, coming on in, Iod. Bed, every evening after lying some time in, Kali e Bitter taste of solid food, not of drink, Iod. Blood warm, bubbles up in chest and flows out of mouth, then coughs with more bright red sputa, Mill. Brandy-drinkers, spasmodic cough of, Fer. Breakfast, < during, > after, Alumen, Kali c. Bronchial glands, from enlargement of, Con. Chest, burning in as from something hot, Sil. and sternum, with pain in, has to press hand on it, Kreos. creeping and tickling in the, Caust. mucous rales in, most marked at night, Fer. p. stitches and bruised pain in, during cough, Kreos. with soreness in, at one point, as from an ulcer, Kali b. Chills and heat during cough, Kreos. Choking, from mucus in the throat when, > by sitting up or moving, sensations at night as if, Carbo v. from sticky mucus, Kali b. COUGH. 445 Cold, any part of body getting, from, Hep, Rhus. fluids, drinking <, Dig. open air, when going into, Ars, Hep, Con, Phos. Coldness with, in the evening, Acet. ac. Concussion in head, Avith, Apis. Concussive in paroxysm of three coughs, Stan. Constant, racking, Con, Tub. in the evening after lying down, Puis. dry, hacking, the entire day, Cal. short, hacking, tormenting, Pinus, Fer. p. when child is laid down, Sep. with expectoration of masses of black blood, Elaps. Constriction in larynx, sensation of, almost threatening suffocation, from touching the throat, Bell. Convulsive, can scarcely be controlled, Mer. Coryza, profuse, fluent, hoarseness with stitches in the throat on every paroxysm, Nit. ac. Cough, during, action of stomach reversed, Bell. anxiety, nausea, rattling, sneezing, vomiting, Iod. bleeding from nose or mouth, Bell, Dros. bloody taste in mouth, Bell, Kali b. burning pain in sternum extending to shoulders, Kali b. and stitches in chest, Iod. bursting pains in head and chest, Bry. catching for breath, Cal, Bry. chest, pain as if tearing something loose, Cal. and hypochondria, must support the, Dros. stomach, pressure in, Cal. brain, epigastrium, hypochondria, stitches in, Bry. muscles of, stitches in, Dros. or uterine region, stitches in, Bell. pain in > by pressure, Bry. right side of, in region of nipple, stitches in, Bor. smoke, as if full of, Brom. sore pain in, Brom. constriction of throat, Bell. 446 CONSUMPTION. Cough, during, convulsions, threatened, Bell. dullness and pressing headache, Brom. face blue and pale, Dros. flushed, hot, red, Bell. gagging, evening or night, Cal. heaviness and pains in chest, Kali b. lachrymation and contraction of eyes, Brom. mouldy taste, Bor. nausea and vomiting of food, Bry. night and day, from tickling in larynx, Avith red face and frontal headache, Bell. rattling in throat and chest, Cal, Kali b. in larynx, danger of suffocation from accumu- lated mucus, Brom. rush of blood to the chest, Bell. sneezing, lachrymation, toothache, Bry. Coughing of blood, after a fall, violent exertion, injury of lungs, Arn, Mill. Cramp in the chest, cannot speak on account of, Kali e Crawling and scraping in the throat, with, Con. sensation extending beneath the sternum, with, Sang. Crying, caused by, Hep. Daytime Avithout, night with expectoration, Caust. without, morning with expectoration, Sep. Debility, emaciation, hectic fever and complete cessation of menstrual Aoav, with great, Fer. Deep, hollow, spasmodic, from roughness and scraping in trachea, Dig. enough to start the mucus, sensation as if he could not, Caust. hollow, violent, shattering, strangling, Stan. seated affections or organic lesions, depending on, Ars. sounding, hoarse, barking, Dros. Dentition, during, Bell, Cal, Cham, Kreos. "Down," tickling in larynx as if caused by, Sulph. Drinking coffee, < by, Caust. COUGH. 447 Drinking, especially after, Ars, Bry, Con, Fer, Hep, Lye, Phos. Dry at night, loose during the day, Cal. with dryness of throat, Alum. waking with acute pains in chest, Kali c. after dinner, Kali b, Nux v. a long time in the evening in bed, before sleep, Sulph. and painful at times, at others with purulent, slimy, salty or offensive sputa, Carbo v. teasing, from great dryness of throat, from 2 to 4 or 3 to 5 A. m. Kali e a sequel of pertussis, Caust. as if coming from stomach, with a crawling and tick- ling at pit, Bry. awakening from sleep, not ceasing till he sits up in bed, and passes flatus upward and downward, Sang. both day and night, Sil. cachectic, as in old people, in the morning on rising and evening on lying-down, Bor. caused by raAvness in the larynx, Sulph. choking, with hoarseness and watery saliva, Sulph. constant, from tickling in throat-pit, Phos. croaking, barking, from tickling in larynx and pit of stomach, Nit. ac. disappears on sitting up in bed, but returns on lying doAvn, Puis. especially at night, Cal. hacking, incessant, short, Arn, Sticta. short < mornings, Tub. nervous, rough, Hep. hard, exhausting, beginning at 3 A. m, and repeated every half hour, Kali e troublesome at night but worse at 4 A. m. Kali c. hollow, from tickling in chest and upper anterior lobes of lungs, Myr. painful, later with bloody expectoration, Cinch. 448 CONSUMPTION. Dry, in early morning on rising and in evening in bed, Cal. irritating, could not cough deep enough to dislodge the mucus, Caust, Pinus. mid sternum, constant from irritation under, Mang. morning, or AArorse towards morning, Iod. and evening, with burning in chest, Kali c. Kali i. nearly ahvays, Aeon. rattling in chest, with, Nat. m. ringing, spasmodic, Apis. severe, shakes abdomen as if all would fall out, must support bowels, Carbo an. short, violent, Avith stitches in chest or 1. scapula, Sulph. continual tickling aud pain in larynx, as if from an ulcer, Kali b. spot in larynx, from, Con. stitches and burning in chest, Avith, Iod. tickling, troublesome at night at different hours, Cal. p. tobacco, pressure in throat, Avarm room, from, Iod. tormenting, chiefly at night, raising only Avith great difficulty a scanty, Avhite, frothy, gluey, or dirty- looking sputa, Cal. until midnight, nausea and bitter vomiting, Sep. with a taste of blood, Cinch. dyspnoea and oppressive breathing, Acet. ac. feeling of soreness in larynx, Kali i. shortness of breath, provoked by tickling in tra- chea, Psor. soreness in chest and rough feeling in throat, especially at night, Nat. s. while in bed in evening, Stan. Dry heat, subjective at night in bed, with, Iod. Dryness in larynx, from, Bell. of the throat, causing, Puis. roughness and constriction, with painful, Mang. Dust in the larynx, sensation of, Cal. COUGH. 449 During Cough, sore pain in epigastrium and abdominal muscles, Bry. and rawness in the, Cal. pain in hepatic region, Bor, Bry, inguinal hernia, Cal. head, sternum, pit of stomach, "seems to strike there," abdomen, hips or legs, Bell. palpitation or throbbing of arteries, Cal. sticking pain through right chest > by pressure, Bor. sulphur vapor in throat, sensation of, Brom. throat and larynx, ulcerative pain in, Kali b. tickling and burning in throat, Iod. urination, involuntary, Alum, Bry, Caust, Kreos, Nat. m, Phos, Puis, Sep, Spong. vomiting of sweetish matter, Cal. Eating, drinking < from, Cal, Caust, Cinch, Bry, Dig. or drinking, cold food or drink, from, Carbo v. Hep. Eczema, cough a few days before an erruption of, Led. Epigastrium through to spine, pain from, Phos. oppression at, or every inspiration causes, Kali b. Exanthemata, after variola, measles, scarlatina, Cal. Excited by nausea, creeping, tickling in stomach, Bry. Excruciating pain and anxiety, with, Brom. Expectorate, coughs a long time before he can, Psor. especially in young children and old people in threatened paralysis of vagi, Dul. Expectoration, with, of tough, transparent mucus, Fer. Expiration every, ending with a hoarse hacking, Aeon. Evening and night without, morning and day with expec- toration of dark blood, Sulph. always < in bed, in, Carbo v, Kreos. at six o'clock and lasts till daylight, recurs every, Con. immediately on lying down, in, Dros. not ceasing until cough loosens so as to expectorate a little phlegm, Sep. or after 12 p. m. <, Cinch. 450 CONSUMPTION. Evening till midnight < from, Caust. while sitting, sudden, violent, irrepressible, Alum. with pains in chest and throat, Psor. without, in morning with copious expectoration, Fer. Face, redness of and perspiration over whole body, Kali c. Fatiguing, not allowing him to speak an audible word, Mer. violent, every evening after lying in bed, Kali c. Feather in throat, especially in morning, Iod. Food or drink, least mouthful of causes, Kali b. Foreign body in larynx, sensation of, Bell. Frequent, dry, with raw pain in chest and smarting in larynx, Aeon. hacking, causing soreness in chest, Sil. with crawling in larynx after eating, Nit. ac. short, suppressed, Ars. i. with stitch in left side of chest, short breathed if coughing when standing, Nit. ac. Frightful, with expectoration and spitting of blood, Stan. Fugitive pains changing place every few hours or every day or two, Mer. Gagging, dry, with, Apis. and vomiting, with, Fer. dry, awakes with a, at 2 A. M, which causes, Kali e. retching and vomiting of ingesta and sour tasting mucus, Kali c. without nausea, with, Bry. Gags and vomits mucus, child coughs till breath is gone and then, Sep. Gout, cough a few days before an attack of, Led. Hacking, constant, with expectoration of blood, Kali b. from rawness, later copious green sputum, Kali i. teasing, dry, with dryness in throat, Sang. violent cough with slight expectoration of a mouldy taste and smell, Bor. with blood-spitting and great prostration, Cinch. dryness, slight, and stoppage of nostrils, Ars. i. COUGH. 451 Hemoptysis of bright blood, with, Mill. profuse Avithout fever, Mill. taste of blood in mouth before, Elaps, Ham. Hair lying from tip of tongue to trachea, causes, Sil. Harassing, titillating, in children as soon as the head touches the pillow at night, not during day, Dros. Hard Spells, in, not ceasing till masses of offensive sputa are expectorated, Carbo v. Harsh, irritating, with bloody or muco-purulent sputa, Phos. Head and chest would burst, as if, Mer. Headache, as if head and chest would fly to pieces, Bry. Heart, depending on hypertrophy of, Ars. Heated, becoming, <, Dig. Heaviness in chest, sensation of, Psor. Hectic, at night, dry skin, delirium, Acet. ac. with, emaciation, diarrhoea, night sweats and oedema of feet and legs, Acet. ac. Hemorrhoids from suppressed, Mill. Hoarse, crowing, suffocative, croup-like, Brom. racking, day and night, profuse purulent sputa, Ars. i. voice, soreness in trachea and chest after every, Stan. Hoarseness towards evening with a dry tickling, Caust. and rattling in chest, Sulph. retching, vomiting, epistaxis, diarrhoea, with, Mer. Hollow, deep, with whitish and greenish sputa, Kali i. spasmodic, in short, hard attacks, Carbo v. Horizontal position, coughs when he assumes a, Pinus. Improves to a certain point and remains stationary, getting neither better nor worse, Caust. Inability to lie on right side, Mer. Incessant, from irritation in a place low down in chest where from coughing it pains as if sore, Sil. Inclined to backache, especially in the coccyx, Caust. Increasing soreness of chest and larynx, Bapt. Inspiration during, cough has a hollow sound, Acet. ac. Involuntary stool and urine while coughing, Phos. 452 CONSUMPTION. Irritating, dry, violent, at night and followed but not re- lieved by haemoptysis, Acal. things, salt, vinegar, mustard, pepper, &c, easily ex- cited by, Alum. tormenting, gets nothing up, Kali e Irritation caused by empty swalloAving, Nat. m. in throat, from constant, Kali i. of pit of stomach, from, Bry, Puis. to cough, conies on so suddenly and violent that he can scarcely inhale at all, Sep. Itching behind sternum, low down in lungs, extends from bronchi to nasal cavity, Con, Iod. from throat to chest, Cae, Cal, Carbo v. Con, Iod. irritation in upper part of trachea, from, Arn. Laughing < from, Ars, Bry, Cinch, Dros, Kalic, Lach, Nit. ac, Phos, Stan. Larynx and trachea, from insupportable tickling in, Arn. hollow, racking from tickling in, Led. itching in, dry, spasmodic, from, Cae touching the, paroxysms when, Fer. p. Liver, with stitches in, Nat. m. Loose, often with muco-purulent expectoration, Ars. i. from tickling in throat, Nat. s. morning, less free during the day, Sticta. tight afternoons and evenings, Bad. racking, spasmodic, Psor. rales, with, until something is expectorated, Carbo an. skin, sensation of hanging in throat, Alum. with copious expectoration of mucus, Dule expectoration in morning and during the day, dry in the evening and at night, Puis. soreness and pressure in chest, Sulph. Loses breath before cough, Led. Loss of breath day and night, Nat. m. vital fluids, cough of those who suffer from, Fer. Loud, harsh in single coughs at different times, Kali e COUGH. 453 Lying down, only on, or < when, Alumen, Caust, Carbo v. Cinch, Con, Dros, Dul, Hep, Kali e always promptly relieved by, Mang. becomes unbearable, Avhen, Pinus. worse at night and in day time when, Nit. ac. with head low or on left side, Cinch. Measles, during or after, Bry, Cinch, Dul. after Avith bloody purulent expectoration, Mill, Dros. Menses, suppressed in, Mill, Puis. Midnight, or towards morning, <, Dig. worse after, or in the morning, Dros. Moist, barking, with sound of moisture in air passages, but no expectoration, Mer. rales are heard, but patient can't expectorate, Nat. m. Morning, cough excited by drinking, often > by eating, Fer. especially with expectoration of white mucus, tough as pitch, can be draAvn out into strings, Kali b. every, a long attack of dry cough ending with the dif- cult raising of a little white mucus, Alum. immediately after rising, Apis. on rising and nearly all day, Carbo an. at night on lying down, Ars. waking and in evening on lying down, with expec- toration of green, pus-like mucus, Psor. with dyspnoea, > by lying down, Kali b. toward, with tickling of larynx and bronchi, Sep. with vomiting of tenacious mucus, Sil. Mouldy taste in mouth every time she coughs, Led. Mucus, accumulation of in larynx, caused by, Kali b. of in throat, caused by, Caust. expectoration during the day, with, Bor. Nervous irritability, exhaustion, collapse, attending, Ars. when any one enters the room, Phos. Night and morning, regularly every, Ars. at, must sit up to expectorate, Fer. 31 454 CONSUMPTION. Night, in bed, compelling one to sit up at once, Bry. obstinate at, from 9 p. m. to 4 a. m. Apis. on lying down, and in the morning on rising,—only at; or only by day, Mer. when warm in bed, preventing sleep, Puis. while asleep, with expectoration only during day, Cal. with adhering mucus, Caust. worse at, and followed but not relieved by expectora- tion of blood, Acal. Pain in abdomen, which he must hold, with, Con. acute, in 1. hypochondrium, shooting upward, < lying on either side or walking, Bell. as if something were torn loose from larynx, with, Cal. base of 1. lung about last ribs, purulent sputum, Nat. s. chest and small of back, with, Mer. with, and profuse, thick yellow sputa, Cal. frightful, throughout lungs, as if tliey were torn out, with constant, Elaps. hips, and involuntary spurting of urine, with, Caust. larynx and sternum, with, Cinch. r. hypochondrium, with, Bor, Bry, Psor. passing or approaching persons, upon, Carbo v. Paroxysms in dry, constantly recurring, Elaps. as from taking cold, with excessive sensitiveness of nervous system as soon as the smallest portion of the body becomes cold, Hep. from tickling in throat, larynx or bronchi, Kali e 9 a. m. to 5 or 6 P. m, Mer. severe, short, continuous, Iod, Pinus. suffocation on swallowing, with sudden, Brom. Phlegm, loose, but cannot get it up, coughs, Sep. Piano, playing on the, Amb, Cal, Cham, Kreos. induced by, every note she struck seemed to vibrate in her larynx, Cal. Pleurisy or pneumonia, when congestion begins in oppo- site lung, Fer. p. COUGH. 455 Plug which moved up and down in throat, sensation of, Cal. or valve, burning and tickling in larynx like a, Sil. Press chest with hands for relief when coughing, must, Bry, Dros, Nat. s, Phos. Presses head with hands during each attack of spasmodic cough, prostration great after, Dig. Quinine takers, regular, spasmodic cough of, Fer. Racking, wearing in, consumptives, Sticta. Rawness in the larynx, dry caused by the, Bry, Sulph. and itching in throat-pit, Caust. in larynx and chest, with, Sil. Red face, with, Bell, Bry. Resonent, whistling, nausea and rattling in chest, Kali b. Retching, during cough, Kreos. and vomiting, with, Dros. Right side, with < by or impossibility of lying on, Mer. Rough, dry before midnight, Nit. ac. Roughness and crawling in throat, constant, Carbo v. Scraping, provoked by irritation low down in the trachea, with greenish, offensive, sweetish sputa, Stan. and rawness in larynx, Bell, Brom. and tickling in the throat-pit, Caust. Shakes the whole body, severe which, Arn, Phos. Shattering, spasmodic, in paroxysms of two coughs, Puis. Shooting pain in vertex, with, Alum. Short, concussive, with itching in the larynx, Cal. dry, spasmodic, Bell. deep, unceasing, after midnight, Ars. seems to come from the stomach, Sep. hacking, from rawness in the throat, Kali i. in the evening after lying down,-Sep. Shortness of breath and ptyalism, with, Mer. Sit up, as soon as it begins, must, Ars. Skin loose, hanging in throat, sensation of, from, Aeon. Sleep in sitting position, night after night, must, Pinus. nor lie down, can neither, < evening and night, Sticta. 456 CONSUMPTION. Sleep, slight,rday and night, preventing, Silph. at night, because of incessant, cannot, Sep. without waking during, Sep. Sleepiness, during cough, Kreos. Sneezing, causes, Bad, Bry, Cepa. and coryza, begins every morning before getting out of bed and lasts till 9 A. m.. with, Sep. attacks of cough ending in, Bell. dry, hacking, with frequent, Alum, Sen, Squil. Sore sensation in a streak down trachea, Caust. Soreness in abdomen, Avith, Carbo an. and dryness of the throat, with, Cal. p. roughness of larynx, Phos. of the chest and heat of the body when, Carbo v. Sounds and feels as if everything in chest was dry, Mer, Phos. loose, but nothing comes up, Dros. Spasmodic or convulsi\re in morning, with retching or de- sire to vomit, Kreos. every morning when dressing < by going into open air, Fer. p. from tickling in larynx, Fer. hollow, from tickling irritation under sternum, Phos. occasional severe paroxysms of, ejecting viscid mucus from broncial tubes, which sometimes fly forcibly from the mouth, Bad. two paryoxysms in rapid succession, Mer, Sulph. with involuntary urination, Nat. m. profuse secretion of mucus in larynx and trachea, Dul. Sputa is loosened, ceases as soon as the, Apis. Sternum, pressure on, with, Apis, Sticking in epigastrium, Phos. pain in r. chest and r. flank > by pressure, Bor. pains in the rectum while coughing, Nit. ac. Stitches, with pain through the head, Carbo v. COUGH. 457 Stitches in sides of chest, with, Bry, Cal. p. Cinch, Mer. over one eye, splitting headache and burning throat and larynx, Phos. Stooping to pick up anything, when, Caust. Stuffing, with pain in chest, Kali b. Suffocating, can hardly get breath, Iod. Suffocative and choking at 5 a. m. as from dryness of larynx, Kali e hoarse cough, producing shaking of the brain, as if brain were loose in the head, Carbo an, Carbo v. Sulphur, vapor of in larynx; smoky sensation of, Ars. suffocative, dry, spasmodic night, from, Cinch. fumes of, dry, itching, tickling, scratching in trachea and bronchi, from, Puis. Supra-Sternal fossa, from irritation in, Apis. Swallowed, loosens tenacious mucus, must be, Kali e tenacious mucus or pus must be, Arn, Caust, Dros, Kali s. Kali c, Sep. Swallow of cold water, > from, Caust. Sweat after the paroxysms of cough, Brom. Sweats when he coughs, Pinus. Sympathetic, during pregnancy, Con. Weakness in chest, must hold chest in both hands when coughing, for support, Nat. s. Weather, sudden changes from hot to cold, from, Dros. Talking, laughing or reading aloud, from, Aeon, Alumen, Alum, Bry, Carbo v, Caust, Cinch, Con, Dig, Dros, Mang, Hep, Pinus, Phos, Sulph. walking, deep inspiration, < from, Mang. Tea drinkers, excessive, spasmodic cough of, Fer. Tearing-out pain starting from ensiform cartillage, Kali e pain, with, and involuntary emission of urine, in old or withered looking people, Alum. Three or four coughs at a time, Bell. Throat, child grasps its, every time it coughs, Aeon. constrictive feeling in, Apis. 45s CONSUMPTION. Throat, excited by scratching, Aeon. scraping and scratching in during cough, Kreos. Tickling, back part of top of larynx in evening after lying down in bed, from, Bell. burning in larynx causing violent paroxysm of cough- ing, Bell. constant, at entrance of larynx, Sang. in right chest, or lying on right side, from, Carbo an. the chest, Cinch, Con, Iod. larynx and trachea, Aeon, Alumen, Ars, Brom, Kali c, Iod, Sang, Sticta. as if sugar Avere dissolving, from, Bad. larynx and upper anterior walls of thorax, Mer. or at the bifurcation of bronchi, Kali c. r. side of trachea, dry, severe, caused by, Sticta. the stomach, in, Lach, Nat. in. Sang. throat, or throat pit, Aeon, Apis, Bap, Brom, Con, Lach, Sang, Sil. throat-pit, unbearable, causing paroxysms of dry cough, Con. Tightness or constriction across upper third of lungs themselves, Phos. Tobacco smoke, tea, wine, brandy, quinine, < from, Fer. Tonsils, enlarged, or as if involuntary from habit, Cal. Touch of larynx, light, <, Cinch. Tough membrane, as if a, were moved about but would not loosen, Alum, Kali c. Two paroxysms, in, Mer, Puis. Uvula, tickling constant from elongated, Alum, Bap, Nat. m. Violin, on playing the, Kali e Violent headache, with, fluent coryza, evening fever, and oppression of chest, Con. but dry, Avith pain through r. chest, has to press chest with both hands for relief, Bor. first dry, afterward, profuse salty expectoration, Cal. COUGH. 459 Violent for years with inability to bring up the sputum, Ars i. hollow, racking, with sensation of soreness in chest and pain in r. chest, Caust. racking, tearing, worse from 2 to 5 A. m. Kali i. shaking, with bloody sputa mixed with clots, Nit. ac. shooting pain in chest preventing lying on side, Aeon. with discharge of yellowish pus, with stitches in 1. hypochondrium when breathing, Carbo v. painful shootings in different parts of chest, compelling to lie always on his back, Aeon. retching and difficult expectoration of viscid mucus, Kali b. Vomiting of food, with, Ars. i, Bry, Kali c, Nat. m. and retching in the evening, cough causing, Carbo v. Wakens from sleep at night, Sil, Sulph. about 10 or 11 p. m, occurs every 15 or 20 minutes, Bell. from sleep morning and evening, Caust. Wakened, < after being, Caust, Cinch, Lach. Waking in morning, evening on lying down, < after, Sil. Warm, to cold places, < going from, Carbo v. Con, Phos. Washing chest with cold water, > by, Bor. Weakness of voice and chest, Avith, Stan. of the chest, short cough as from, Stan. or soreness under sternum, with, Psor. Wheezing, Avhistling, spasmodic, with rattling in the larynx, Brom, Iod, Kreos. \ 460 CONSUMPTION. CHEST AND LUNGS. Anxiety and pressure of, amounting to suffocation, Phos. Apex of r. lung, acute darting pain in, Ars, Bell. Arms, rheumatic pains in, Avorse from motion, Kali e Asthma, inveterate, of old people, < early in morning, > by cold air, Carbo v. bed, has to get out of, and sit up for >, Ars, Carbo v. Back, rheumatic pains in, < from motion, Kali e Beaten, pain in side as if, or as from a blow, Cinch. Blood spitting, periodic attacks of, Kreos. Blunt knife, pain at 5fch and 6th ribs as if thrust in, Dul. Bronchi, sensation as of hot Avater trickling through, Hep. Bruised, cramping, constrictive sensation in chest, Fer. Chest, aching and tearing in, extending to hips, Carbo v. and head, congestion of, with redness of face and one ear, caused by suppressed hemorrhoidal flow, Alum. and ribs sore, as if bruised, Carbo v. blood, feels as if too full of, Alum, Mel, Sang. burning, cramping, stitching pains in, Sang. and heat in, extending below diaphragm to stom- ach, Ars. as from gloAving coals, Carbo v. cutting, oppressive pains in, Psor. from below up into throat, Cal. p. in 1, Myr.; in r. Bell. region of heart, Kali c. pain, paroxysms of, Puis. rising to face, Sulph. sensation in center of, Dros, Kreos. soreness, rawness, heaviness in, stitches in both sides of, Spong. CHEST AND LUNGS. 461 Chest, burning, stinging, like fire from chest to should- ers, Lach. with pressive pain, Carbo an. chilliness in, evenings, Alum, Ars. cold, great susceptibility to, Cal, Carbo v. Tub. coldness or heat in, sensation of, Apis, Sulph. from front to back, sensation of, Ars, Brom, Carbo an, Sulph. constricted sensation of, with apprehension, Alum. of, with anxiety and restlessness, evenings, Ars. contraction of and difficult breathing, > by lying down, Cal. p. Avhen Avalking fast, when going up hill, Ars. s. Hh burning as if excoriated or raw, Ars. oppressive anxiety at pit of stomach, Ars. depression of, supra-clavicular region, < r. side, Iod. of infra-clavicular region, < 1. side, Cal, Phos. empty sensation in, Phos, Sep, Stan, Tub. excoriated or raw sensation of, Ars. extremely sensitive, cannot bear auscultation or per- cussion, Cinch, Sulph. injuries, mechanical affections the result of, Arn. large, feels as if too full, too, Alum, Lye painfully sensitive to touch and on inspiration, the entire, Cal. sharp thrusts directly through the, from sternum to spine, while sitting, Con. sore and raw, especially infra-clavicular region, Cal. talking causes soreness in, Alum. weary on waking, feels, Carbo v. weakness of in attempting to move or sit up, Ars. cannot talk from, Hep, Stan. and exhaustion, sensation of, Brom. wheezing, with bruised pain between shoulders, Ars. yellow spots on the external, upper, Ars, San, Sep. Clavicle and 1. nipple, sore below, breathing difficult, Fer. 462 CONSUMPTION. Clavicular region, supra and infra, soreness of, Cal p. Congestion to chest < from emotion, Phos, Sep, Sulph. in chest from least motion or exertion Avith dyspnoea, nausea, fainting and great weakness, Spong. Constricted feeling, unable to breath deeply on account of pain and, Bry. Constriction, as if stopped and could get no air, Bry. ascending or walking, Avhen, Cal. Kreos, Led. sensation of, in lower part of chest, Cae spasmodic, of chest after talking, Hep. Cutting cramp through left chest to scapula, pain like a, Myr, Ther, Nat. m. Deep-seated catarrhal affection of the lungs, Dul. Depression, infra-clavicular, Cal, Phos. Drawing beneath 1. breast, sudden, on rising in bed, Stan. stitching pains in r. lung, Bor. Drinking cold water, pain in chest from, Carbo v. Dull, aching, in left chest near middle of sternum, Apis. pains all over lungs as if they had been overworked, with sensation of constriction of chest, Lye in chest, with soreness to touch, Cal, p. Fistule, anal, chest affections alternating with, Cal. p, Berb, Sil. Fluid, as if a hot, Avould come into the mouth, Aeon. Fullness, constriction or suffocation in chest, Apis. in chest, Avith anxiety, heat, palpitation, Nit. ac. Hemoptysis, alternating with coxalgia or rheumatism, Led. blood bright red, foamy, profuse, Led. light red, reneAvecl every 4, 6, 7 or 8 hours, Cal. or sulphur in mouth, with taste of, Ham. bubbling in chest, preceded by sense of, Fer. p. burning like fire, pain in lungs, with, Bufo. pain in a fixed point in chest from which blood seems to come, Led. cardiac troubles, Avith rattling and hissing in air pass- ages, from, Cae, Led. CHEST AND LUNGS. 463 Hemoptysis, coughs pure blood, or bloody mucus, Acet. ac. dark venous, raised without effort, mind calm, Ham. effort or hawking, coming on with slight, Fer. p. hard body in epigastrium, sensation of, then a, Hep. headache, beating, preceded or accompanied with, Led. lie doAvn, cannot, from dyspnoea from congestion, Ham. menses, after disturbed, mechanical injuries or former bleedings have weakened the lungs, Fer. p. midnight and in morning, at, Led. nausea, with, heavy oppressed breathing, livid face, small, frequent pulse, anxiety and debility, Fer. p. profuse, blood bright red, Fer. p. provoked by a dry, tickling, hacking cough, < from least exertion, Fer. p. stitches, severe in lower part of lungs, with, Ham. violent cough, tickling in larynx and trachea, with, Led. Hemorrhages, actiATe or passive, from nose, lungs, stom- ach, bowels, uterus, Acet. ac. Heat from a fire, pain after inhalation of, Carbo v. Heart, hypertrophy of, in young growing boys, from vio- lent gymnastics, Brom. in young growing girls, Caust. Heaviness and oppression of, anxious sensation of, Kreos. of chest, as if weight Avere lying on it, Mer, Phos. Hot water in 1. chest, sensation as if drops of, Hep. Ice, lump of, sensation as of, in r. chest, Sulph. Itching behind sternum, causing violent, racking, parox- ysmal cough, Iod, Kali e in the end of the nose is signal for cough to begin, Iod. Lancinating from middle of sternum to dorsal spine when sitting, going off when rising, Dul. Mucus, lungs were full of, sensation as if, Lye Oppression, as if breath could not be expelled, Dros. as from fullness of stomach, Cinch. evening when lying doAvn, Cinch. in morning on waking, Nat. s. 464 CONSUMPTION. Oppression, must sit up when coughing or expectorating, Phos. nausea, gaping, yawning, with convulsive pains in stomach after eating, Aran. of, as if constricted, as if too tight, Nat. m. or constriction as if clothes were too tight, Caust. rawness, with sensation of internal, Lye tearing, pressive pain Avith feeling of tightness under clavicles, Lye weather, during damp, Avet, Cal. with constriction of oesophagus, Alum. coryza, and pair ni C i . deep, difficult, respiration, Kali e distended abdomen, Kali e spasmodic pains in stomach, hypochondria, Alum. < by deep inspiration, in op m air, after eating, Lye Oppressive tearing pain in 1. chest, Carbo v. as if full oE wind > by eructation, Lach. Pain, acute, striking through chest from r. scapula, Mer. as if lower lobe of r. lung was adhering to ribs, Kali c. burning, violent, in chest and stomach, < by lying on the back, Acet. ac. clavicles, under r. shoulder when inhaling, Alumen. contractive, band-like around the chest, Sulph. constricting, spasmodic, in chest and bronchi, Spong. dull, heavy across upper part of chest, Fer. flying from one point to another, fugitive, Fer. fly to pieces, as if chest would, Bry, Sulph. in chest and stomach, violent burning, followed by coldness of skin, cold sweat on forehead,Acet. ac. in 1. lung, hard, heavy, constant, confined to larger bronchi, Carbo v. inter-scapular, cannot take long breath, Fer, Sulph. occurs in shocks or jerks, Stan. overlifting, from, Arn, Mill, Rhus, Sulph. r. chest, through to shoulder, in, Sang. CHEST AND LUNGS. 465 Pain, r. chest, lower third of, through to back, Kali c. r. lung, apex of, fine darting stitching from before backAvard, just under the clavicle, Bell. sharp, piercing, midway between sternum and r. nip- ple, Iod, Sang. sore, in upper chest on breathing, touching, or lifting anything heavy, Kali e upper part of r. chest, severe in, Bad. Painful side, lying upon, awakens from sleep, Bor, Kali c. spot size of a dollar, in 1. middle chest, Carbo v. Pains in, acute, upper [1, radiating backward to point of scapula of sound side, Myr. as if it were cut to pieces, Kali i. at 3d 1. costal cartilage where it joins the rib, Pix. 1. compel to change position, but without >, Caust. constant, and severe in, < left side, Acal. cutting, deep, close below clavicle, > by pressure, Dul. dull, oppressive in 1, < on inspiration, Bap. either side where 3d rib joins its cartilage, Anisum s. erratic, transient, fugitive, Fer, Puis. in evening after lying down, < lying on r. side, Kali c. lower chest, 1. side, extending into gastric region, Kali e oppressive, violent, worse at night, Alum. pressing, both sides of chest, < from inspiration, Con. rheumatic, worse from motion, Bry, Kali c. riding in carriage produces, Alum. sharp, when taking a long breath, Bap. sore, bruised, feeling in, Alum, Arn, Bad, Cal, Nat. m. stitching, running upwards, Brom. under last ribs of 1. side, from below upwards, Brom. upper middle, through to r. shoulder, < after eating or from talking, Nat. m. Palpitation, violent, cannot lie on r. side, Brom. and anxiety, lying on 1. side causes, Puis. violent, with stitches in 1. chest, Kali c. 466 CONSUMPTION. Paralysis of lungs, threatened Avith, great dyspnoea and long-lasting suffocative paroxysms, Lach. Paralytic drawing pain through 1. chest, towards scapula and into 1. arm, Brom. Paroxysms from one to two hours apart, Dros. Ppessed or screwed together, as if, Sulph. Pressing drawing pain across lower portion of chest, causes anxiety, Cinch. pain in 1. chest, acute, Myr. Pressive pain in, extending to back < r. side, Bell. upper r. chest extending to r. scapula, Alumen, Carbo v. Pressure, acute, sharp, aching, through apex of r. lung from before, backward beneath r. clavicle to scap- ula, with soreness and burning in throat, Bor. as from violent rush of blood and palpitation, bloody sputa; sudden prostration, Cinch. continuous, in 1. chest, sensation of, Lye heavy, on sternum Avhen turning in bed, Kreos. in whole 1. side of chest, Kali c. Nit. ac. on chest as of a heavy load, Nat. s. on well side, cannot bear, if made toward diseased side. Puis. pains in chest > by, Bry, Kreos, Dros. Pressing, pricking pains in upper part of chest, causing dyspnoea and deep breathing, Cae Prickings, fine, going from back to chest in evening, Bor. Rales, loud, coarse, anaemia, great debility, Cinch. as if lungs were full of mucus, especially in bronchial catarrh of infants, Lye Raw and sore from continual coughing, lungs feel, Nat. m. prevents lying down at night, as if, Caust. Rawness and soreness of chest, as if ulcerated, Nit. ac. in throat when coughing, Spong. Right chest in region of 3d rib, pain extended to back between shoulders on pressure, Dul. CHEST AND LUNGS 467 Rheumatism and pulmonary symptoms alternate, Led. Sharp, lancinating, in r. chest, with soreness, < afternoon and evening, Bad. pain in region of sixth rib, coming and going, takes away breath, < on deep inspiration, Cal. p. as if pierced by an instrument, in upper end of steruum and clavicle, Cal. p. through apex of 1. lung to 1. scapula, Kali b. base of r. lung to r. scapula, Kali b. Shoulders, rheumatic pains in, worse from motion, Kali c. Soreness, dryness, constriction, burning, sensation of, ex- tending to throat, Mer. Sore-spots in chest, especially over apex of 1. lung, Sulph. in middle of chest, sensation of, Nit. ac, Sep. in upper part of 1. lung going through to scapula, Sulph. chest, sub-claAricular region, apex of either lung; < Avhen lying on that side or pressing against 1. chest, Puis. Spring and autumn, attacks of severe cough every, Kreos. Stabbing in 1. side under short ribs during inspiration, Mer. Sternum, burning soreness or stitches in chest, under, Led. below, with a constant dull stitch in 1. shoulder, Caust. burning in upper part of, after coughing, Fer. and piercing soreness behind, Phos. during inspiration and when lifting, stitches in, Caust. from back to or from mid-sternum darting to between shoulders, Kali b. in or under, from below up, stitches in, Ars. 1. side of upper part of, from within out, in, Nit. ac. lower end of, soreness at, Nit. ac. on coughing, stitches in the, Bry. pains under or from, to 1. axilla, Bell. sore pain in, over clavicle and cervical glands, Cal. p. as if ulcerated under, Psor. to back or deep in chest, while walking, stitches, Kali i. 468 CONSUMPTION Sticking pain in 1. side of chest, running upwards towards 1. arm, Brom. pressure in 1. side of chest on deep breathing, Kali c. Stinging in 1. side of chest, Kali e STITCHES IN CHEST. Stitches, affected side, AA-hen lying on the, Cal. across chest, violent, passing off during motion, Dros. and sensation of soreness Avhen coughing, Fer. anterior and upper part, of chest to back, on sneezing or coughing, not breathing, Mer. chest extending to scrobiculus, in, Caust. concussive from hepatic region, Cal. descending deep in middle of chest, Kali c. from behind, forward in chest and back, Psor. going to back, deep in, Caust. in lower chest and scapula when breathing or cough- ing, Sep. in middle of, < during inspiration, Kreos. inspiration, deep in chest during, Caust. in upper part of, through to shoulders, Bry. nipple to umbilicus when breathing deeply, Caust. sharp, knife-like, to clavicle and shoulder, Stan. sides, on deep inspiration, and when coughing, Nat. m. soreness and burning pains in, Bry. through chest, from before backwards, Cal. violent in mid-sternum, extending to shoulders, Kali c. just above precordial region while at rest, Cinch. when sneezing or coughing, severe, must press chest with hands for, >, Dros. < during deep breathing and sudden motion, Cinch. < from any motion, but not > by rest, Kali c. < when lying, coughing, taking full breath, Bry, Puis. left chest. abdomen to 1. side of chest, from, Nat. s. acute, darting from left into right lung, Cal. CHEST AND LUNGS 469 Stitches, axilla knife-like, below 1, Stan. abdomen from 1, side of to middle of chest when stooping, Alum. below 1. breast, severe, unable to sleep or walk on ac- count of them, Carbo v. chest to back and below left mamma, Nit. ac. dull, deep in 1. chest under short ribs, Kali e painful, from within outward under 1. clavicle, > by pressure, Kali e extending from left side of vulva to, Alum. fine in 1. side of chest, Con. first in left then in right, Kreos. from left chest into throat, Cal. scapula into chest, cutting pains, Lye chest into left submaxillary gland, Cal. knife-like in 1. chest with every inhalation, Bor. left chest on every inspiration, > by rubbing, Cal. only during inspiration, Apis, Ars, Cal. p. upper chest to 1. scapula < breathing, yawning, coughing, quick motion, Myr. chest over heart, Kreos. with violent palpitation, Kali e side of, when breathing or lying on that side, Stan. > by lying on right side, Phos. extending to back, Lye in morning, < breathing, Nit. ac. middle of, when coughing or breathing, < lying down, Nit ac. shooting, to scapula < lying on back, when mov- ing arm, least motion, Sulph. upper chest to shoulder joint, Nat. m. with cough < by every inspiration, Aeon. piercing, penetrating in left side near nipple, Nat. s. sharp from loAver part of 1. breast to scapula, Sang. tearing in 1. side of chest, from behind forward, Bry. under 1. mamma extending upward, Kali e 32 470 CONSUMPTION. RIGHT CHEST. Stitches, abdomen to right side of chest from, Con. and pain in r. inguinal region, Avhen yawning, cough- ing, breathing deeply, Bor. at night while lying on the back, Nit. ac. between ribs of r. side, cannot lie on it, Bor. darting pains through central portion of lung, Sep. dull pain or numbness behind 3rd or 4th rib,r. side,Cal. from right side of abdomen to mamma, Bell. r. side of chest into scapula, Sulph. in cartilages of 1. 3d or 4th false ribs, not affecting respiration, Cinch. sides of chest, especially r. on inspiration, Kali c. region of r. nipple, every paroxysm of cough, Bor. r. side of chest, extending to back, Hep. lower half of r. lung in front, Bry. portion of r. lung, through to back, Kali e nipple, below r. from within out, on expiration, Bry. pleuritic, in r. side 7th to 8th rib, < least motion, Bad. in r. chest, cannot move or breathe Avithout a, Bor. raising the arm, sudden in r. side of chest from within outward, on, Bor. right side of abdomen through right lung, Bell. r. chest, scapula and larynx, as from a sliver, Nit. ac. about nipple, on every inspiration, not > by hard pressure, Con. between third and fourth ribs, Bry. dull shocks, deep in lower part of, Carbo v. interrupting breathing, Kreos. violent, evening after lying down, Nit. ac. r. side, through chest to or from scapula, Mer. to axilla, prevents bending forward and breathing, Cinch. sharp, burning, especially in r. lung, Carbo an. in r. chest,upper part,when walking rapidly, Brom. sharp through r. lung from nipple, Kali i. CHEST'AND LUNGS. 471 Stitches, shooting, r. to 1. in p. m, < going down sta irs, Alum. sudden, from within outward in r. side of chest, on raising the arm, Bor. tearing, sticking pains in r. chest, Carbo v. upper part of, to abdomen and back, Nit. ac. Supra-clavicular region, severe, sharp, lancinating pains in r. Bad. Suppuration of, after haemorrhages of pneumonia, Mer. Sweats profusely, especially about chest, Hep. on the back, debilitating, night and morning, Stan. musty, mouldy odor, of a, Stan, Sil. Sympathetic cough from induration or carcinoma of uterus, Carbo an. Con. Tenderness in 1. chest under third rib, with soreness, burning and smarting, < when coughing, Sang. Tension, sensation as from, Bap, Nat. m., Stan. as of a hoop about the chest, Lye, Sulph. Tightness of the, as if bound by a hoop, Ars, Arn, Bufo, Cae, Iod, Nux m, Sil, Sulph. and oppression of breathing going up stairs, Bor. oppression, constriction, as if pressed inwards from both sides, Aeon, Bap, Bell. must often take a deep breath, Caust, Phos, Stan. talking, even uttering a word, > when walking, Dros. Throbbing ache and stitching pain in 1. infra-clavicular region to scapula, < on deep inspiration, Myr. Waves, pain as if lung moved in, Dul. Weak, so, he cannot talk, Stan. Weakness of chest when talking, reading aloud, evening Avhen lying, Sulph. and fatigue of the chest, sensation of, Carbo v, Iod, Kali c, Nat. s, Stan. Weight on the chest and shoulders, clothes lie like a, Con. Whistling and rales in chest on inspiration, Nit. ac. Yelloav skin, conjunctivae, general icteroid symptoms, Mer. 472 CONSUMPTION. EXPECTORATION. Acid, milky, viscid, frothy, Sil. Acrid, fatty-tasting, Caust. yellowish mucus at times mixed with blood, Mer. After midnight and in the morning, Led. Balls, emitting a carrion-like odor when crushed, Hep. Biting, burnt taste, has a, like dregs of an old pipe, Puis. Bitter, in the morning, Ars. salty, nauseous, bilious taste, Puis. Blood, with taste of, Aeon, Cinch. black, coagulated, Kreos. bright red, clotted, offensive, Sang. dark lumps in eATening, Acal. thick, viscid or frothy, bright red, mixed with mucus and coagula, Arn. of, Avith a fatty, sweetish taste, Sulph. pure bright reel in morning, Acal, Fer, Fer. p, Iod. dark, coagulated, Brom, Puis. streaked Avith or mixed with coagulated brownish, Bry. Avhen coughing and hawking, Cal, Nat. m. Bloody or blood-streaked, Alumen, Ars, Ars. i, Brom, Bry, Cal, Con, Cinch, Fer, Kali c. Hep, Iod, Lach, Mer, Nat. m. Nit. ac, Sep. because of destroyed lung parenchyma, Mer. Blood-streaked with albumen, pus globules, Kali e spitting, periodical, Kreos. Bluish, granular, followed by attacks of dyspnoea and dry cough, Brom. Boiled starch, like, Cae, Dig. Breath, and taste occasionally fetid or putrid, Sep. sputa, fetid, offensive even to patient, Sang. EXPECTORATION. 473 Brown, like liver, Bry, Carbo v. Casts as from air cells, greenish white, Nit. ac. Cheese, taste of old, Cinch, Lye, Psor. Cold, often, Bry, Cor. r. Nit. ac, Phos. Copious, most abundant in the morning, Stan. green, fetid, purulent, Kreos, Sil. offensive, bloody, chiefly at night, Psor. thick yellow, globular mucus, Sulph. Creamy consistence, in later stages, of a, Caust. Darkish, semi-fluid, expelled with hacking cough, Arn. Deglutition, more painful during, Stan. Detach, scanty, difficult to, Alum, Caust, Hep, Kali b. Kali c, Stan. Dirty or muddy color flying when falling, somewhat re- sembling buckwheat batter, Phos. Discharge of an old catarrh, like the, Sulph. Egg, like the Avhite of, Nat. m, Silph, Stan. Epistaxis and blood-spitting alternate, Fer. at same time or following and > headache, Ferr p. Expectorate, inability to, can't cough deep enough, Caust. Falls to the bottom in Avater, with a trail of tough mucus like a falling star, Cal. Flat, unpleasant taste, of a, Bry. Free in morning or free at night but not in daytime, Sep. Froth, yellow mucus enveloped in or mingled with, Ars. Frothy sputa, Aeon, Apis, Ars., Fer, Lach, Phos, Sil. of pink mucus, blood-streaked, Ferr. p. pale red, rust colored, bloody, Phos. with yellow nucleus, Con. Globular, grayish lumps of thick mucus containing clots of blood, Stan. Granular day or evening, none night or morning, Cinch. Greasy offensive taste, of a, Sil. Green, gray, purulent, offensive, excessively fetid, Sep. greenish, pus-like, Ars, Carbo an. Kali i, Kreos, Puis. mucus, like matter, < morning and evenings, Psor. 474 CONSUMPTION. Greenish masses, of, Mang. lumps or plugs of a SAveetish taste, Sulph. Hemoptysis, anxiety with great, Aeon. after mechanical injuries, Arn. better walking slowly about, weakness compels to lie down, Fer. blood, bright red, frothy, Fer. p. clotted, mixed A\ith mucus or pus, Ars. i. Cinch. body, violent from lungs and all orifices of, Aran. bright red, pure, Ars. i. Bell. cheeks and forehead burning hot, Bell, Mel. chest, ebullition, burning and fullness in, Ars. death, great fear of, with, Aeon. drunkards, in, Ars. eruptions, suppressed with, Ars. excitement, mental, from, Aeon. exertion from severe, Fer. first dark, thin, light, watery, Fer. florid, hemming, slight cough, or easy hawking, from, Aeon. fluids, after loss of, Ars, Fer. foaming, bright red, bursts forth in a stream, with hawking, Ars. bright red Avith burning in chest, Ars. hands and feet cold, pulse irregular, but rapid and globular, Bell. heat, burning all over, with pain between scapulae, Ars. scanty, bright red, coagulated, Fer. inter-scapular pains, with, Fer. masturbation, with weakness or pressing cutting pains in chest, after, Con. menses, from suppressed, Ars, Fer, Puis. morning on rising, or morning and night, Fer. night, with burning heat over whole body, at, Ars. nursing, women exhausted by, Cinch. salty expectoration with, Cinch. EXPE CTORA TION. 475 Hemoptysis, stitching pains through r. lung, and dry in- cessant cough, always ceasing when lying down, Mang. vertigo, eyes feel enlarged, with, Cinch. warmth, sensation of ascending to head, Bell. weak, is very, particularly after talking, Fer. winds, cold, dry, after exposure to, Aeon. with tendency to copious expectoration, Stan. Heavy, night and morning, Ars. i. Hepatization, for the suppurate stage of, Lye Jelly-like lumps, falling in, Bry, Dig. Loaded with mucus, chest apparently, must cough long before expectorating, Dul. Loose, sounds, but no expectoration, Brom. unable to expectorate, SAvallows Avhat is raised, Con. Loosened, when, must be swallowed, Arn. unable to expectorate the, Kali c. Lumps, of small white or yelloAv, Bor. dark, black or bluish, Kali b. scanty, hard, tenacious yellow, a little sour, Sang. small, white or yellow, occasionally raises, Bor. thick, round, small, which fly in every direction, Lach. Masses, heavy, white, coming away in, Caust. hard, round, white, fly from mouth on coughing, Kali e of greenish yellow mucus, Lye yellow mucus, Con. resembling pus, Kali e Mornings, during day, but none during night, Cal. without, evenings Avith scanty, yellow, jelly-like, ex- pectorated with difficulty, Dig. Mouldy taste and mouldy smell, of a, Bor. Mucus, tenacious, difficult to dislodge, with rattling in chest, Ars, Kali b. copious accumulation of in trachea easily thrown off by coughing, Stan. lumps of tough, reddish or bloody, Mang. 476 CONSUMPTION. Mucus, pieces of hard, like starch, by hawking, Sulph. profuse, frothy, tenacious, suddenly spits up, Lach. scanty, or profuse purulent, with, Sil. tenacious, abundant expectoration of, > the rattling breathing, Hep. thick, or blood clots, Bry. mixed with clotted blood, hawked up in quanti- ties in the morning, Ars. i. white, like boiled starch, full of bubbles, Nat, m. streaked with blood, of, Bor. whole mouthful at a time, light rusty color, stringy and easily separated, Lye yelloAv, loosened with difficulty, Brom. Nummular, of thick yellow matter, Ars. i, Phos. Odor, that Avhich sinks has an offensive, Sil. dense, muco-purulent, pus globules, musty, fetid, Sil. Offensive, purulent, with straining even to vomiting, Lach. Profuse, of water mixed Avith light colored, stringy, taste- less mucus, containing a few pus globules, Silph. and rapidly prostrating, Tub. copious, albuminous mucus, exhausting and emacia- ting, Cal. mucus, cannot lie down, Spong. of viscid, bloody mucus, Mer. transparent, albuminous, Alumen, Apis. tastes salty in the morning, Sep. Purulent, mixed Avith blood and thin yellow pus, Kali e with exhausting night sweats and loose stool, Kali i. Pus in large quantities, Lye whitish yellow, profuse expectoration of, Kali e Pus-like, every cough brings up a mouthful of, Nat. s. gray, or yellow green, Stan. of an offensive taste and odor, Sulph. Putrid, salty taste, of a, Mer. Rusty, bloody, tenacious, Bry. Scabs, green, are coughed up, Kali e EXPECTORATION 477 Scanty, adhesive, coughs long before expectorating, Mang. infrequent, difficult to detach, Bry, Hep. thin, frothy, Avith streaks of blood, Fer. Slimy, whitish or black, Cinch. Soap-suds, looks like, Kali i. Sticky, cold mucus, Phos. Swallowed, must be, cannot be raised, Arn, Caust, Con, Dros, Kali c, Lach, Mur. ac, Sep, Spong, Zinc. Stringy, tasteless, floating in the thin watery mass, which may be slightly purulent, Silph. Suppuration of lungs or when neglected pneumonia de- generates into tuberculosis, Led. Sweats, night, profuse debilitating, Tub. and morning, profuse, debilitating, Mer. Sweetish, sour, salty, putrid, green during the day, Stan. Syrup-like, ropy, Carbo an. Taste, putrid, like rotten eggs, especially after measles or scarlatina, Con. extremely disagreeable, Alum, Carbo an. sweetish, putrid, sour, Avorse evening till midnight, Fer. Thick grayish, or greenish mucus, adheres to throat, Stan. Thin, watery, milky mucus mixed with pus globules, Sulph. Throat, leaves mouldy taste in, Bor. Tough as pitch, nearly strangles, Kali b. difficult to separate, Bry. glutinous, viscid; adhering to throat, mouth, lips; leaves the mouth in a long, stringy, tenacious mass, Kali b. Transparent, glairy slime, mixed with black dots or bloody, Arn. Viscid, loosened with difficulty, Cal, Bry, Mer, Sang. adheres to throat, detached with difficulty, the effort excites irresistable inclination to vomit, Stan. Yellow, more profuse in the morning, Cal. p. light or soft brick shade, Bry. of a foul taste, from the trachea, Stan. INDEX TO REPERTORY. Characteristic.................................... &'° Aggravation...................................... 41" Amelioration..................................... 421 Larynx and Trachea.............................. 4*^4 Respiration . . .................................... 4o4 Cough........................................... 444 During...................................... 4*& Dry......................................... 447 Chest and Lungs................................. 460 Stitches in chest.............................. 468 left chest................................. 468 right chest............................... 4'" Expectoration.................................... 4 / ~ Haemoptysis.................................. 4'4 <5 cr ^ 1 '* ,»'l' '£•!.£< &$$ &$■! ^^^v•.■^^.i.i;//i^^V*4^|J^V»,A■v.i :^^y/viWW:^f, /•«>. .V.J .-SJiXf.i.iX+.*.