. . ■ , • . ■ J ^ m CS>V: Jra MI 2a Sffi '^v: ■ v. <<'<* :*/;.*;> fliJMfa&W**^^ lb B i i SURGEON GENERAL'S OFFICE LIBRARY. ANNEX | Section,... NLM001373962 i s :■ A CLINICAL MATERIA MEDICA. A COURSE OF LECTURES DELIVERED AT THE HAHNEMANN MEDICAL COLLEGE, OF PHILADELPHIA, BY THE LATE E. A. FARRINGTON, M.D. REPORTED PHONOGRAPHICALLY AND EDITED WITH THE ASSISTANCE OP THE LECTURER'S MANUSCRIPT, BY CLARENCE BARTLETT, M.D., AND REVISED BY S. LILIENTHAL, M.D. S WITH A MEMORIAL SKETCH OF THE AUTHOR, BY AUG. KORNDCERFER, M.D. SECOND EDITION. L.IBKAKY SURGEON GENCMlS OFFICE AUG.-5—1903 PHILADELPHIA: HAHNEMANN PUBLISHING HOUSE. 1890. WBK fzAGc 1530 Entered, according to Act of Congress, in the year 1890, By MRS. ELIZ. A. FARRINGTON, In the Office of the Librarian of Congress, at Washington, D. C. SHERMAN & C 0.; PRINTERS, PHILADELPHIA. PREFACE TO THE FIRST EDITION. During the year following the death of Dr. Farrington, the editor of this volume published several of the lectures here presented, in the Hahnemannian Monthly, North American Journal of Homoeopathy, and Monthly Homoeopathic Review. These were well received by the pro- fession. Some of them were, moreover, translated and published in German, French, and Spanish journals. A number of physicians expressed their desire to have the lectures appear in book form. The consent of Mrs. Farrington to such publication was therefore obtained, the Doctor's manuscript was placed at our disposal, and Dr. S. Lilien- thal kindly consented to revise the lectures after their completion in manuscript. In order that the work should be thoroughly representative of Dr. Farrington, those concerned in its preparation for the press decided that the author's style should be closely followed. These lectures are therefore presented exactly as delivered, excepting where a change was suggested by his manuscript or by his published writings. There have also been incorporated in the volume numerous abstracts from the comparisons in the " Studies in Materia Medica," published in the Hahnemannian Monthly in the years 1880, 1881, and 1882. These will be found in the lectures on Lachesis, Apis, Cantharis, and Sepia. The lecture on Moschus is essentially a reprint of the study of that remedy in the Hahnemannian for January, 1882. The editor feels no necessity for apologizing for this addition of the above-men- tioned matter to the lectures proper, for, as Dr. Korndcerfer truly .says in his memorial sketch of his deceased friend, they " belong to the classics of our school." The regret is that they cannot be incorporated in their entirety. The reader must remember that in a course consisting of seventy- two lectures, it would be utterly impossible to include a complete presentation of the homoeopathic materia medica. This fact was always kept in mind by Dr. Farrington. It was his aim, therefore, to present to his students, only such matter as would enable them to establish their knowledge of materia medica on such a firm foundation that their post-graduate study of that science would be a comparatively easy task. How well he succeeded in his object can be attested by the 4 PREFACE. many physicians whose fortune it was to receive instruction from his lips. It should be said of Dr. Farrington's manuscript, that it gave marked evidence of constant study. Interlineations and notes of refer- ence were frequently added. Erasures were few, for what he therein recorded was only placed there after having been thoroughly confirmed by the clinical experience of himself, or of some other competent observer. Fully did he realize the importance to homoeopathy, of a materia medica which should be, in all respects, perfect. Clarence Bartlett, M.D. 1506 Girard Avenue, Philadelphia, October 1st, 1887. PREFACE TO THE SECOND EDITION. When the first edition of this work was published, in the Autumn of 1887, a large number of copies were printed, sufficient, it was thought, to satisfy the demand for some time to come. So flattering was the reception accorded it, this large edition has been exhausted, and a new one has been called for. In the preparation of this the editor has had, as before, the assistance of the author's manuscript lectures, together with notes of students whose privilege it was to receive instruction from Dr. Farrington in more recent years than was accorded the editor. The result of this revision has been the addition of a number of symptomatic indications for drugs. These additions have been pretty evenly divided over the whole work. In presenting the second edition of Farrington's Clinical Materia Medica to the profession, the editor cannot refrain from expressing his admiration of the thoroughness of the work of its distinguished author. A review of the index shows that more than four hundred drugs were considered by him ; many of these received but minor mention, while others he treated of in extenso, as their importance warranted. The therapeutic index shows, moreover, that hardly a class of ailments to which humanity is liable but what has received more or less attention. The therapeutics of diseases like- scarlatina, diphtheria, and typhoid fever, as to be expected from their importance, were thoroughly considered. Others, but seldom met with in actual practice, were given but a passing notice. In all his teachings Dr. Farrington showed himself to be a practical physician, fully alive to the demands to be made upon the needs of the student on entering practice. ^October 1, 1890. C. B. CONTENTS. PAGE In Memoriam,..............9 Lecture I. Introductory,..........17 II. Animal Kingdom, ......... 25 III. The Ophidia—Lachesis,........33 IV. The Ophidia—Lachesis (continued),.....48 V. The Ophidia—Lachesis (continued),.....60 VI. Araclinida—Mygale, Lycosa tarentula, Tarentula Cuben- sis, Aranea diadema and Theridion curassavicum, . 70 VII. Cantharis,...........80 VIII. Hymenoptera—Apis mellifica,......93 IX. Moschus,...........109 X. Sepia,............116 XI. Sepia (continued),.........127 XII. Nosodes—Psorinum and Ambragrisea, .... 140 XIII. Secale cornutum,.....: . . . 146 XIV. The Vegetable Kingdom—Apocynacese ; Apocynnm can- nabinum, Oleander, Vinca minor and Alstonia scholaris, ] 53 XV. Gelsemium sempervirens, ....... 161 XVI. Nux vomica,..........168 XVII. Ignatia, Curare and the Juglandaceae,.....186 XVIII. Aracese—Arum triphyllum, Caladium, Dracontium and Pothos fcetida, . ......194 XIX. Anacardiaceaa—Anacardium orientale,.....202 XX. Khus toxicodendron,........208 XXI. Compositse—Arnica montana, Artemisia vulgaris, Absin- thium, Millefolium, Taraxacum, Eupatorium perfolia- tum, Artemisia abrotanum,.......221 XXII. Cina and Chamomilla,........229 XXIII. Melanthaceaa—Colchicum, Veratrum album, Veratrum viride and Sabadilla,........933 XXIV. Menispermacese—Cocculus indicus, . . . . 241 XXV. Papaveraeeae—Opium,........246 XXVI. Sanguinaria and Chelidonium,......255 XXVII. Cucurbitacese—Colocynth,.......265 XXVIII. Byronia alba,..........270 XXIX. Coniferse and Euphorbiacese—Abies nigra, Sabina juni- peris, Terebinthina, Pix iiquida and Thuja occidentalis, 284 XXX. Ranunculaceae—Aconitum napellus, . . • . 294 XXXI. Actea racemosa, Ranunculus bulbosus and Eanunculus sceleratus,..........306 XXXII. Helleborus and Staphisagna,......313 6 CONTENTS. PAGE Lecture XXXIII. Pulsatilla, ..........321 XXXIV. Rubiacese—Cinchona rubrum,......339 XXXV. Ipecacuanha and CofFea,........351 XXXVI. Scrophulariacese—Digitalis purpurea, Linaria vulgaris, Verbascum, Gratiola, Leptandra virginica and Eu- phrasia, ...........361 XXXVII. Baptisia tinctoria,.........372 XXXVIII. Solanacese—Belladonna,........377 XXXIX. Stramonium and Hyoscyamus,......394 XL. Tabacum, Dulcamara, Capsicum and Glonoin, . . . 403 XLI. Lycopodium clavatum,........409 XLII. The Umbelliferse, the Berberidacese—Berberis and Po- dophyllum, and Spigelia,.......416 XLIII. Mineral Kingdom—Selenium,......425 XLIV. Sulphur, . ........433 XLV. The Carbon Group—Carbo vegetabilis, . . . .449 XLVI. Carbo animalis, Graphites and Petroleum, .... 459 XLVII. Halogens and Spongia, . •......471 XLVIII. The Acids—Fluoric and Muriatic acids, . . .485 XLIX. Phosphoric and Sulphuric acids,......496 L. Nitric, Hydrocyanic and Picric acids,.....503 LI. Silicea,...........512 LII. Arsenicum album,.........519 LIII. Phosphorus,..........532 LIV. The Preparation of Antimony—Antimonium crudum and Antimonium tartaricum,......546 LV. The Preparations of Mercury,......554 LVI. The Noble Metals—Aurum, . . .... 568 LVII. The Preparations of Silver—Argentnm nitricum and Argentum metallicum, . . . . . . 574 LVIH. Platina, Palladium and Alumina,......581 LIX. Plumbum and Stannum, ... 590 LX. Cuprum and Zincum,........597 LX1. Ferrum and the Magnesia Salts — Magnesia carb. and Magnesia mur.,.........607 LXII. Baryta carb., Strontiana carb. and Lithium carb., . 616 LXIII The Ammonium Preparations—Ammonium carb., Am- monium mur. and Ammonium phos., .... 624 LXIV. Salts of Lime—Calcarea ostrearum,.....632 LXV. Calcarea phosphorica and Hepar,......643 LXVI. Preparations of Soda—Natrumcarb. and Natrum sulph, . 653 LXVII. Natrum muriaticum,........ 659 LXVIIL Borax veneta,..........669 LXIX. Salts of Potash—Kali bromatum and Kali hydriodicum, . 673 LXX. Kali bichromicum,........ 681 LXXI. Causticum,..........689 LXXII. Kali carb.,......... . 696 Index of Remedies,..... .......702 Therapeutic Index,...... . 736 ERRATA. Page 187, fourth line from the bottom, for "throat into the stomach" read " stomach into the throat." Page 392, fifth line from the bottom, for " Dolichoses " read "Dolichos." ju JVfemortam/ PBOFESSOR E. A. FAKRINGTON, M.D. BY AUG. KORNDCERFER M.D., PHILADELPHIA, PA. The subject of this sketch, Dr. Ernest A. Farrington, was born January 1, 1847, at Williamsburg, Long Island, N. Y., and died at Philadelphia, December 17, 1885. During his early years his family removed to Philadelphia, at which place he received his education, and rapidly rose to eminence in his profession. Having already, during his early childhood, given evidence of ex- ceptional intellectual ability, he passed through his school life with the highest commendation of his teachers. After his entrance to the High School he seemed to develop an intellectual capacity rarely witnessed in one so young. He grasped and utilized facts with such vigor that his teachers looked upon him as quite a phenomenal boy. Often have I heard his teachers, pro- fessors of the High School, remark upon his aptness, clearness of thought, and remarkable proficiency in the various studies embraced in the curriculum of the school. It may here be worthy of passing note, that, during his entire school and student life, he endeared himself to his teachers, not less by his genial manners, than by his remarkable intellectual qualities. Having completed the prescribed course at the High School, he made a most brilliant examination and was graduated, not only at the head of his class, but with the highest average to that time attained by any graduate of the institution. During the following summer he visited his birthplace, spending the summer there and in New York city. Early in the fall he re- turned to Philadelphia, there to resume his favorite occupation,study. From the Hahnemannian Monthly, January, 1886. 2 10 IN MEMORIAM. Under the preceptorship of his brother, H. W. Farrington, M.D., he, in the fall of 1866, matriculated in the Homoeopathic Medical College of Pennsylvania. Here, again, the characteristics of his early life became the remark of his fellow-students, and it was not long before he was looked upon as one of the brightest students of his class. His quickness of percep- tion, his ready memory, his devotion to study, and conscientious esti- mate of the responsibilities of his calling, marked him as one of the most promising students of our school. Coupled with all this, was an un- usually strong religious bent of mind. His religious views were, how- ever, of that happy type which but illuminate life's waySj never casting shadows of doubt or gloom. His highest aim was to do right because it was right; that he accomplished this, all who knew him will attest. When the Hahnemann Medical College of Philadelphia was char- tered, in 1867, it became a question of serious import to him as to whether he should continue in the College with which he was con- nected or join the new institution. After lengthened consideration, he decided to sever his relationship with the old College. He became the second matriculant of the Hahnemann Medical College of Philadelphia. Here, again, he won unstinted praise, and graduated March, 1868, having enforced the full conviction upon the minds of all, both Faculty and class, that he had no superior in the class of "'68." To the honor of all, let it be said that envy never tainted the commendation of one; every graduate delighted to accord to him his full meed of praise. He entered practice immediately after his graduation, establishing himself at the residence of his father, 1616 Mount Vernon Street. His arduous labors in the pursuit of knowledge, during the years of college-life, followed by even greater efforts during his early practice, made perceptible inroads upon his otherwise strong constitution ; this led him, during the summer of 1869, to take a short European trip from which he returned much improved in health. He reentered practice with renewed vigor, and speedily succeeded in securing a large and appreciative clientele. On the 13th of September, 1871, he consummated in marriage an engagement which had for some time existed with Miss Elizabeth Aitkin, of Philadelphia, an event which brought more than usual joy, as in his wife he found a most congenial and helpful spirit, both as to his professional and religious life. Four children, three boys and one girl, have blessed this union. Dr. Farrington was essentially a teacher among men. Already we IN MEMORIAM. 11 find him, in the spring of 1869, filling a lecturer's appointment as teacher of Forensic Medicine in the spring course of the Hahnemann Medical College. These lectures proved to be so satisfactory that the Faculty, on the resignation of the Professor of Forensic Medicine, after the session of 1869-70, elected him to fill the vacancy. Within two years, the chair of Pathology and Diagnosis becoming vacant, he was appointed to fill the same, and in 1874, upon the resignation of Dr. Guernsey, then Professor of Materia Medica, he was called to fill that most important chair. His ambition was now about to realize the attainment of its highest aim. This had really been his true field of labor—here his deepest studies were made; here was, indeed, his lifework. Possessed of superior analytical powers, he never felt satisfied to accept a view or theory save it were demonstrably true; he, therefore, made deep and thorough research and study upon every question in- volved in the subject of homoeopathy; the law, dosage and potency questions, all were subjects of much interest, but above all, his delight lay in the study of the Materia Medica. His daily association with Hering quickened this his natural desire, and he was soon recognized by that master spirit of our school as one well fitted to a place in the highest rank among the expounders of that most intricate science, Materia Medica. Hering delighted to say, " When I am gone, Farrington must finish my Materia Medica." His labors in this direction were not restricted to simply reviewing old provings, but were rounded out unto fulness by personally supervis- ing provings of both old and new drugs. While he certainly possessed a wonderful memory for symptoms, the most prominent feature of his teaching may nevertheless be said to have been his ability to thoroughly analyze the specific drug action, showing not only the superficial but also the deeper relationship of symptoms. Family and class relationships of drugs he studied with deepest interest. In fact, his "Studies in Materia Medica," a few of which have been published in the Hahnemannian Monthly, belong to the classics of our school. On his election to the chair of Materia Medica, he devoted much of his time to the development of a method which, while full and com- prehensive, would at the same time present a simplicity which would enable every student to intelligently study this most difficult subject. He infused such new life into this usually prosy subject, that it soon became the favorite hour with many, and to all an hour of interest and 12 IN MEMORIAM. profit. To the earnest student it became rather a recreation than a task. His analytical mind carried the student through labyrinths of symp- toms and mazes of modalities, with such clear and concise directions as to the way, that the thoughtful student might ever after feel able to traverse the same alone. His writings all bear the impress of a master mind. Already in 1871, scarcely three years subsequent to his graduation, we find him dealing with the philosophical elucidation of drug prescribing, in lan- guage indicating depth of knowledge rarely found even among our oldest practitioners. In illustration, permit a short quotation from his report of a case published in the Hahnemannian Monthly, April, 1871: " It is a singular fact that all of the tribe of Senecionidece, Ord. Compositoe which we have proved (Cina, Artem. vulg., Cham., Tana- cct., Arnic, Seuecio grac.) have relief from some form of motion. " The Artemisiavulgaris resembles the Cina in nervous troubles, but, as it is in conjunctive relationship, it cannot be used immediately before or after Cina. As a disjunctive relative, and hence one that follows well, tiilicea corresponds to the somnambulistic state, and Silicea, Nux vom. and Caust., to the irritation of the solar plexus giving rise to spasm. " The Absinthium (wormwood), another member of the Artemisise, when drunk in brandy (a famous drink used to stimulate the brain by actors, etc.), I have seen produce the delirium embriosorum, which was only relieved by pacing the floor, showing again the general relief from motion." Thus we find him, as a beginner in years, treating the Materia Medica as by the hand of a master. The literature of our school has been greatly enriched by his pen; for, though he did not strive to gratify ambition in giving to the profession massive volumes, he performed that which he felt duty to demand, i.e., gave of his time in work not only upon his lectures, but also to societies, and in our journal literature. The American Journal of Homoeopathic Materia Medica, the Hahne- mannian Monthly, the North American Journal of Homoeopathy, and other journals, have each received valuable articles from his pen. His Studies in Materia Medica alone, published in the Hahnemannian Monthly, aggregate about two hundred pages, and his comparisons, published as an appendix to the American Journal of Homoeopathic Materia Medica, from 1873 to 1875, embrace over 150 pages more. His other articles were numerous and instructive. Dr. Farrington was a homoeopathist by conviction. With him it was not a light thing to be a physician, and he could only practice that IN MEMORIAM. 13 which he could see to be true. Expediencies, for the sake of gaining the eclat of those who, through want of knowledge, grant unstinting praise to pleasant error, had no attraction for him. He preferred to sacrifice practice and to sustain his own sense of doing right rather than gain financial success by pandering to the ignorance of wealth, where it demanded departure from the law of cure in an experimental treatment of disease. The influence which such a mind must exert upon a profession can- not be overestimated. Essentially scientific in its bent, progressive in its character, earnest in its labors, logical in its reasonings, and philo- sophical in its judgments, the results reached even most persistent op- ponents were compelled to receive with respect. While thus a true and most consistent homoeopath, he necessarily became identified with every movement which might tend toward the advancement of learning. Especially did he desire to see medical education brought to a far higher level than has ever been attained in this country. Dr. Farrington was also an active participant in our County Society work. On the floor during debate, he was listened to with that atten- tion which ability only can command. In the Chair, which for three successive years he occupied, he presided with dignity and justice. He was also a member of the State Society and of the American Institute of Homoeopathy, which latter he joined.in 1872. For many years he was a member of its " Committee on Drug Provings," during which time he was also identified with its Bureau of Materia Medica. At the time of his decease he was chairman of that bureau. In 1884 the Institute appointed him a member of its Editorial Consulting Com- mittee on the new " Cyclopaedia of Drug Pathogenesy," etc. In December, 1879, when the Hahnemannian Monthly was purchased by the Hahnemann Club of Philadelphia, he was selected by his col- leagues of the Club as the sole editor of the journal, but on account of impairment of health and multiplicity of duties he felt impelled to de- cline the charge; though later, at the earnest solicitation of the Club, supplemented by that of the General Editor, he accepted the position of Contributing Editor, which position he filled until the time of his death; in fact, his last article, a book review, was written but a few weeks prior to his decease. Thus we find him throughout his life striving to accomplish the work which he valued so highly. No labor seemed too great, no effort too severe, so long as it tended to promote the advance toward that standard to which he felt the profession should aspire. An earnest 14 IN MEMORIAM. advocate of higher education in general, he especially longed for the time when the professional standard should be placed at its highest. Dr. Farrino-ton was not less esteemed for his generous friendship than for his professional ability. He was noticeably a man of strong convictions nevertheless, with such characteristic breadth of thought and liberality of mind that he never allowed the strongest antagonism in scientific views to chill a friendship once formed. His genial manners rendered him a most delightful companion, as all who ever had the opportunity to enjoy social intercourse with him will heartily attest. His last illness began about the 14th of December, 1884, prior to which time he had contracted a cold to which he gave slight heed. Subsequently, owing to necessary exposure in the performance of his professional duties, laryngitis set in ; he, nevertheless, delivered several lectures after the throat symptoms had assumed decided severity. During a lecture prior to the Christmas holidays, aphonia took the place of the existing hoarseness, rendering further lecturing impossible. It became necessary for him to secure a substitute during the month of January, 1885, but feeling much improved, he insisted upon resuming lectures during the month of February. He continued his duties in the. College until after the Spring examination. During this time the disease invaded the bronchia, developing into a severe bronchitis; this, however, yielded partially during the latter part of March and April. At this time the most careful physical examination did not reveal the slightest sign of lung involvement. He now felt convinced that a trip to Europe would materially advance his recovery. He therefore sailed for Europe, accompanied by his wife, on the 9th day of May. On the 31st of May he wrote from Paris : " I am about the same, as yet, but live in hope." Under the advice of Dr. Herrmann, of Paris, he con- cluded to " go to Baden-Weiler, a beautiful little town in the Black Forest, noted for-its mild climate, mountainous scenery, and restful surroundings." Here again disappointment came to him in that a wet season set in, which continued until his departure, although he remained for several weeks hoping for a favorable change. A stay of several weeks at Brighton, England, highly recommended by several English physicians, afforded no relief. Much discouraged he finally sailed for home. Disappointment and injury alone had resulted from his journey. He now began to feel that his race was nearly run; that the great work in which he had engaged must be laid aside, and hopes long enter- tained must be abandoned. The first realization brought a feeling of IN MEMORIAM. 15 bitter disappointment, which, however, speedily gave place to a calm conviction that the Lord's way was best. His mind seemed at perfect ease, and though he made fruitless efforts to obtain relief, he maintained an unwavering confidence in the law of cure. Some of his lay friends, seeing that homoeopathy must fail, strongly urged him to seek the advice of a prominent allopathist. This he positively refused, after- wards remarking to the writer: " If I must die, I want to die a Chris- tian." His faith in the law was unbounded; he believed it divine in origin, and therefore wholly true. In religious faith he was a Swedenborgian, holding devoutly to the views of that great expounder of God's law. In his church life, as in his professional, he showed that zeal and learning which soon made him a light among his brethren. He was loved and esteemed by his church as but few laymen at his age are loved. Conscientious, zealous and learned, he seemed destined to be a leader among men. He was early called to his work on earth—that work he faithfully performed. Early the call came to his work on high—confidently he entered thereon. Seeking higher planes of usefulness here, he looked forward to his higher field of labor there in pleasurable anticipation. A good man has been called away. May his living example inspire many to emulation. A CLINICAL MATERIA MEDICA. LECTUKE I. INTRODUCTORY. To-day we are to begin our study of Materia Medica. At the out- set, it will be necessary to give a rambling review of the subject. Before you begin the study of the details of a science, you must understand the construction of that science or art. Were it not for these under- lying laws which string together the Materia Medica into one consistent whole, you would have no need for lectures on the subject. The ten volumes of the Encyclopaedia of Materia Medica, issued by Dr. Allen, of New York, contain over nine thousand pages. These do not in- clude clinical symptoms, which would make several thousand more. Then recollect, each physician discovers something new each year, and so a great mass of knowledge is accumulated by a sort of compound multiplication. You can, therefore, well understand why the student might be startled at the idea of attempting to master such a conglom- eration, ^y or could he master it, were he to attempt to do so by memory alone. Man's mind is composed of more than memory. Memory is the impression made on the mind by a fact. Recollection is another qualification of the mind, which enables one to call up the facts which have been memorized. It is understood that nothing which we take into the memory is ever effaced. It remains there forever. It may be covered with figurative cobwebs and never brought to light, unless the mind is so drilled or so orderly arranged that it may be recalled when occasion requires. The mind should be so drilled and its various faculties so trained, that, when an external thing occurs similar to an internal fact, i.e., a fact memorized, at once that external thing awakens into recollection the fact or facts bearing on that subject. This is very apt to be so with our feelings, perhaps more naturally than with our intellects, because the latter require more cultivation. Many of us are 18 A CLINICAL MATERIA MEDICA. so strong emotionally that we may call up an emotion without any evi- dent effort of the will or any direction of the understanding. Let me give you an example. A man, on one occasion, was driving along a country road, and ran over a dog and horribly mangled the poor animal. This made him feel very sick. The event was apparently forgotten. Several years later, he was driving along the same road, never thinking of the incident, until he came to the spot where the accident happened, when immediately the same sensation of sickness occurred. Then, the impression which was made on his mind was recalled and at once awakened the emotions. Thus must be the intellectual mind of the man who would master the science of medicine. He must see his pa- tient; and when he sees his patient, it awakens in his mind the picture of the remedy. This has been termed instinct, but it is not. To do this, he must study persistently. You see a physican old in years, come into a sick-room. At once he says, this patient needs Sulphur. How did he know that? It was not second sight on his part; but through thirty or forty years' experience he had been studying Sul- phur, had been forming in his mind images of Sulphur, and living ideas of Sulphur. The moment he sees these in his patient, that moment he recollects Sulphur.' If he had not the idea of that remedy in his mind, he could not see it in his patient. Now, I ask of you not to try to jump over these years that must pass between the beginning and the ending of the art of medicine, and do not make yourselves prophets before your times. In order to bring some system out of this chaos of Materia Medica, it will be necessary to adopt some plan of study. What is that plan is asked by every student; one teacher answers in one way, another in another. The method may not be correct and yet its results may be good. It does well enough for a scaffolding by which you erect your building, after which the scaffolding is removed and the building re- mains. Some method must be adopted and that retained to the end. In analyzing the method which I have chosen to adopt, it may be well to begin at the beginning and carry you on until you may see what plan I propose for your adoption. It may not be clear at once. An abstract thing is not at once grasped by the mind. It requires to come up time after time. What seems difficult at first, is plain enough after a while. In the first place, I will begin by suggesting an analysis of the drug. We presume now that you have heard of some one substance which has been a popular remedy in your part of the country for yean?. You INTRODUCTORY. 19 think that it ought to be proved. You proceed to get the necessary material. First, you procure your drug. You prepare its tincture and then you potentize it. Now, it is a principle of homoeopathy to which there is no exception, that you shall learn the action of a drug on the healthy organism before you use it in practice. That is a rule which you cannot neglect. You cannot be too careful, otherwise you throw yourself into confusion, doubt and empiricism, and help to fill the Materia Medica with "bosh," of which there is enough already there. What you want to know is exactly what this medicine will do. What would you think of a machinist who undertook to build a machine when he did not know how the parts fitted together? What would you think of a physician who does not know the use of the tools he is about to employ ? You now intend to try the effects of this drug on some healthy person or persons. Will it produce alterations in the function or the nutrition of the body or of its organs? If so, a symptom or symptoms will be the result. Symptoms, then, are indications of alter- ations in the functions or the nutrition of a part or of parts of the body. I have been accused of stepping down from the lofty heights of pure homoeopathy and dressing myself in physiological livery. The statement made against me is that we cannot know what changes are taking place except through symptoms; therefore, if one begins to talk about altered tissue, he at once pollutes homoeopathy. This is true and it is false. It is true if you take this altered tissue alone. It is not true if you regard this altered tissue as a manifestation of the change in the vital force. I cannot see how there can be a symptom which is not at least the result of a change of function. I do not mean that you must give Bryonia because it acts on serous membranes. I do not mean that you must give Aconite because it produces dry skin, heat, etc. I do not say that you shall give Belladonna because it pro- duces hyperemia of the brain and dilatation of the pupil; but I do say that these drugs produce these effects, and if these effects are not alterations in function, what are they? We can know changes in the vital forces only by results, and these results are symptoms. Now you get symptoms in your provings. These symptoms you will find to be embraced under two grand classes, subjective and objective. The subjective symptoms are those which the prover himself experiences and which he has to express to you in certain language. The objective are those which apply directly to your senses. They are such as you may see, hear, touch, taste or smell. For instance, if you give the drug we are speaking of and the prover says he feels a pain over the right 20 A CLINICAL MATERIA MEDICA. eye, that is a subjective symptom. You cannot see it, touch it, taste it or feel it. It does not apply to your senses. You know what pain is; you have experienced it; you can appreciate it in your own mind. But if a boil is produced by this medicine; if there is a cloudy deposit in the urine, or if there are mucous rales or harsh sounds in the lungs; if the heart itself is altered in its action; if a wart appears on the skin, or if sweat breaks out, you have an objective symptom. Now, what will be the alteration in function which these objective and subjective symptoms express? They are decrease of function, increase of func- tion and alteration of function. If this drug produces photophobia, there is increase of function; if, on the other hand, it causes blindness so great that the patient can gaze at the sun, there is decrease of func- tion ; whereas, if it produces cloudiness of the cornea or visions of bright stars, there is an alteration of function. The prover may have in- creased urination, decreased urination or brick-dust sediment in the urine, this last being an alteration of function. So when we come to speak of a drug, and to tell you what its effect on the system is, we will have these three classes with which to deal, increase, alteration and decrease. You go on collecting these symptoms, both subjective and objective. If you are skilled in the analysis of the excreta of the body, you should make use of your knowledge to determine the elimi- nation of urates, phosphates, etc. These are facts, and, in their places, are invaluable. I would have you mind this expression, in their place valuable, out of place valueless and even harmful. An increase in the elimination of urea would weigh nothing in the balance against the mental state. All symptoms of the Materia Medica are not of the same value. They are relative in value. We include all the symptoms that we can observe. Then what have we? A mass of symptoms seeming to have no connection at all. They come from a human organism that is all order and perfection, and all the parts of which work in perfect harmony. When even one of these parts is out of order, there must be a certain clue to string these effects to- gether and picture a form of disease, and when you get this form of disease, what have you? A pathological state. I hope that no diploma will be granted to any man in this class who does not study pathology. When you have the changes in toto that this substance has made on the ■system, you have the pathology of the case. You have the totality of the effects on the system. This grand effect of the drug must be in the mind always, qualifying the individual symptoms of the drug. You may express this as you choose. Some call it the genius of the drug; INTRODUCTORY. 21 others speak of it as the general action of the drug. This you must have in your mind or the other symptoms are worthless. Did you not do this, you would be a mere symptomist, certainly a term of reproach. You must know what the whole drug does or you are not able to ap- preciate any one part of the drug. You can find twenty drugs with precisely the same symptoms. How will you decide between them ? Apparently they are all identical but not in their general action. How is this general action found ? By the study of the drug as a whole. But here is a place where physicians may go too precipitately and fall into pathology. They say that as Belladonna produces a picture of scarlatina and as Arsenicum produces a picture of cholera Asiatica even unto the growths found in the excrement, therefore these substances must be the remedies for these respective diseases. Baptisia produces a perfect picture of typhoid fever, therefore they say Baptisia must be the remedy in typhoid fever. As we carry out the view I expressed a few minutes ago, when we examine a patient for disease, we proceed in exactly the same way as we do in case of the proving. We note the changes we see and the sensations the patient feels; we look at his tongue, we examine his urine, we put all these together and we make a pathological picture of that man. Suppose you decide the case to be one of typhoid fever. That must not be valued except by comparison, showing how the present case differs from the general disease. If the genius of the case under treatment suits the genius of Baptisia, and, if you give that remedy, the patient will recover whether you call his disease typhoid fever or mumps. If the genius of Baptisia does not suit the genius of the case, then that remedy will do no good. If the patient has the Baptisia symptom, "thinks he is double, or all broken to pieces," that drug will not cure unless the genius of Baptisia is there too. I may be permitted to recall a remark of Carroll Dunham. At a certain con- sultation there was chosen for a patient a drug which seemed to have many of his symptoms; but when Dr. Dunham was asked for his opinion as to whether that drug was the similimum, he replied, "No, I think not, for the general character of Ignatia does not correspond with the general character of the patient which does correspond to Baryta. You will find his most prominent symptoms under Baryta." One physician decided for one drug, the other for another. Each went by his study of the drug; one understood Ignatia in part, the other by its totality. It is my duty to show you this winter the genius of each drug, and 22 A CLINICAL MATERIA MEDICA. the relations which drugs bear to one another. I cannot hope to give you all that is characteristic of each, but I think that I can give you an idea of its genius, and show you how drugs are related so that you may fill up the interstices at leisure. You must acknowledge that Materia Medica is the most important of all branches. You cannot understand it unless you have a thorough knowledge of the others. You must learn symptoms and not mere words, and you cannot put any idea into them until you know their meaning; and unless you can interpret symptoms, you can never learn the genius of a drug. ' Blood and bloodvessels. Lymph and its vessels. Nerves, brain, spine, and sympa- thetic; muscles, tendons, liga- ments. ' Connective tissue. Bones, cartilages, and joints. Serous and synovial membranes. Mucous membranes. Skin. Organs. We must understand a drug as analyzed according to the schema on the board. We must see how it affects the blood and bloodvessels, the lymph and lymph vessels, the nervous system, including, of course, the brain, spine, and sympathetic nervous system. The first of these divisions tells us something of the nutrition of the body. The second, the lymph, likewise tells us of nutrition and how well repair is going on. The muscles, ligaments, etc., speak to tell you how the human machine may move; and so you may go through the entire schema. You will note the deviations from the physiological under each of these headings. Under the conditions of the blood you will note increase, as in plethora or hypersemia, decrease as in anaemia or ischsemia, and alteration as in chlorosis or pyaemia. The same is true of the lymph, which may exhibit plus, minus, and change, and so on down the list. When you study the drug by this analysis, you quickly arrive at an idea of it as a whole, that is, you get the genius of the drug. But when you have done that you are not through with your difficulties. You must learn to tell one drug from another. Analysis of a medicine. INTRODUCTORY. 23 You go into a field and you see two or three hundred cattle. They all look alike to you, yet the man in charge of them knows each one. How does he know them? He knows them by certain distinctions which he has learned by familiarity with them. So can you know one drug from another by studying their points of difference. Drugs im- pinge in their resemblances, and separate in their differences. Thus we have another form of study, comparison of drugs. That is just as necessary to successful practice as is the first step, the analysis of the drug. Then again there are drugs which antidote each other. You may have made a mistake. Your patient may be too susceptible to the action of the remedy, and you require to modify its effects. It was only yesterday that I prescribed Nux vomica for a cold. It relieved the patient of his cold but he became almost crazy with headache. He had had an excess of Xux vomica, so I gave him Coffea, and in ten minutes his head was better. This was done by simply modifying the effects of Nux vomica, not by suppressing the symptom. Again, there are some remedies which, although they bear a strong resemblance to each other, seem as though they ought to be concordant remedies; yet they are inimical. So you study the Materia Medica, analyzing one drug after the other until you have analyzed all. Then you must arrange your remedies according to some system in your mind, and so be enabled to recall facts as you need them. If you only study one remedy, every case you see fits that remedy. If you have studied Aconite, every case will suggest Aconite. Thus, you must have Aconite by its confreres, side by side in your mind, before you can use them successfully in the sick room. This is done by systematizing your study. Now then, you will find that drugs hold certain relations to each other. You will find five relations. The first I have called the family relation, derived from their similarity in origin. When drugs belong to the same family they must, of necessity, have a similar action. For instance, the halogens, Chlorine, Iodine, Bromine, and Fluorine have many similitudes, because they belong to one family. So, too, with remedies derived from the vegetable kingdom. Take for instance, the family to which Arum triphyllum belongs. There you find drugs which resemble each other from their family origin. Take the Ophid- ians, and you will be perplexed to tell the differences between Lachesis, Elaps, and Crotalus. This resemblance through relationship is some- times so nearly identical, that these drugs do not follow each other well. 24 A CLINICAL MATERIA MEDICA. Take, for example, Ignatia and Nux vomica. Both come from the same order of plants; they do not follow each other well, and they do not antidote each other. Then we may have drugs which present marked similarities in action although dissimilar in origin. These are said to be " concordant." Drugs which hold a concordant relation may follow each other well. There is another relation, that of complement; that is, one drug completes a cure which the other begins, but is unable to effect. Such a relation exists between Belladonna and Calcarea. Next we have the relation of antidote, of which I spoke a few moments ago. Lastly, we have the relation of enmity, one that I am unable to explain to you. It is a fact that certain drugs, although resembling each other apparently, will not follow one another with any satisfac- tion. They seem to mix up the case. Such drugs are China and Psorinum, Apis and Rhus, Phosphorus and Causticum, and Silicea and Mercury. In carrying out these various ideas, we must study Materia Medica as a natural science, for such it must be intrinsically, although it is as yet undeveloped and unworthy of that dignified name in our present understanding of it. Nature's laws in no way dispute the known relations and actions of drugs. They rather harmonize with them. We are now ready to begin our study of the various drugs composing the Homoeopathic Materia Medica. For this purpose I have arranged the remedies in three grand divisions, according to the kingdom of nature from which they are derived, viz.: 1. Remedies derived from the animal kingdom. 2. Remedies derived from the vegetable kingdom. 3. Remedies derived from the mineral kingdom. There is also a fourth class of remedies, the nosodes or disease products. In our next lecture we will begin our study of drugs derived from the animal kingdom. LECTURE II. ANIMAL KINGDOM. To-day we begin our study of the medicines obtained from the animal kingdom. I desire to preface my lecture on these remedies, with a few remarks relating to their properties in general. Many of the animal poisons are distinguished by the violence and intensity of their action, and by the decided alterations which they produce in both structure and function. The blood is often changed in its composition and quality. The nervous system suffers and even the lower tissues are affected. The whole tendency of these remedies is to produce dis- eases, which are never of a sthenic character and always of a destructive form, tending thus to local as well as to general death of the body. We, therefore, look upon these poisons as medicines which suit deep- seated diseases, such, for example, as are accompanied by changes in the quality of the blood; such as profoundly affect the nervous centres. Consequently they are indicated in typhoid fevers, erysipelatous in- flammations, tuberculosis of different organs and tissues of the body, and many of those dyscrasise which underlie and qualify acute dis- eases. You will find if you devote time to the study of this portion of the Materia Medica, more time than we can spare or than these lec- tures will permit, that they are often necessary to arouse vitality and direct the vital forces into a proper channel. You will find, too, that these animal poisons are apt to affect the mind, especially the emotions. They arouse the lowest qualities in one's nature, and produce a condition which is truly shocking. Some of them arouse the filthiest lust, the most intense anger, and passions of a kindred nature. So we may find many of these drugs suitable for persons affected with insanity, whether it be the result of functional or organic cerebral changes; whether or not it be reflex from irregu- larities in bodily functions. You will see by the table which I have placed on the board that we have quite a number of remedies derived from the animal kingdom. 3 26 A CLINICAL MATERIA MEDICA. f Moschus, Castoreum, Mephitis, Oleum i animate, Hippomanes, Castor equi, Mammalia J Lac vaccinum, Lac defloratum, Lac caninum, Koumyss, Fel tauri, Fel vulpi, Pulmo vulpis. Vertebrata { Ophidia f Lachesis, Crotalus, Bothrops, Agkis- l trodon, Pisces Batrachia Radiata Elaps, Naja, Vipera. < Oleum jecoris aselli. < Bufo rana. Mollusca -! Sepise succus, Murex. - Corallium rubrum, Spongia, Medusa, Badiaga. Hemiptera < Coccus cacti, Cirnex. Hymenoptera j Apis mellifica, Yespa, Formica. Coleoptera ■! Cantharis, Doryphora. Orthoptera < Blatta. Arachnida < Tarentula, Mygale, Theridion, Aranea. Articulata { I have, for convenience of study, divided these animal substances according to their natural relations. We have first the Vertebrata. "Within this grand division of the animal kingdom we note the first class, the Mammalia, below this the Ophidia or great variety of serpents, then the Pisces or fishes, and, finally, the Batrachia. In the higher order of Mammalia we have quite a list of remedies already ; but these members of the animal kingdom compose only a small portion of it. There are many animal drugs of which we know nothing but their names; they have been used by one individual without any special proving. This is a field which has not been thoroughly investigated, and one, too, the investigation of which has encountered great opposi- tion. Especially has the Cimex lectularius, the common bed-bug, been condemned; but this opposition has extended to other remedies of the class. Prejudice goes far. I do not wish to sanction these medicines any more than they deserve. Our notions, our prejudices, and our ANIMAL KIN'GDOM. 27 appetites affect us all. Reviewing the Mammalia, we note first the Moschus, and here another and similar animal substance, the Castor emit. I mention these together that you may remember them as two sub- stances which act on the nervous system somewhat similarly. The origin of Moschus you all know; Castoreum is a similar product taken from the beaver, and is a very useful medicine for patients, especially women, who are nervous and do not react after typhoid fever. If, after the fever has spent its force, the patient remains irritable, with weak and exhausting sweat, Castoreum helps her at once. Next we have here the product from the animal which you all know as the skunk, Mephitisputorius. This Mephitis also acts powerfully on the nervous system. If taken in a low potency when one is ex- hausted, it tones up the nervous system and relieves the exhaustion. The main use of Mephitis, however, is in whooping-cough. It pro- duces a well-described hard cough, with well-marked laryngeal spasm and a distinct whoop. I have found, in using this medicine, that it often apparently makes the patient worse, while it really tends to shorten the course of the disease. When the catarrhal symptoms are slight, and the spasmodic whoop is marked, Mephitis is to be selected. The cough is worse at night and after lying down. There is a suffo- cative feeling; the child cannot exhale. It vomits its food, sometimes hours after eating. In whooping-cough you should compare with Mephitis, Corallium rubrum, which has, however, smothering before the cough, and great exhaustion afterwards. The gasping progresses into repeated crowing inspirations until the child becomes black in the face. Drosera should also be thought of. This remedy has spells of barking cough, which come so frequently as not to give the patient an opportunity to recover the breath. They are especially wTorse after 12 p.m. The child holds each hypochondrium during the cough, and if sputum is not raised, vomiting and retching ensue. The patient may have a diarrhoea with stools containing bloody mucus. Mephitis has also been recommended in the asthma of drunkards. It may also be used in the asthma of consumptives when Drosera fails. In the last-named condition, you may think also of liicmex and Sticta. The former of these is to be given when there is aggravation at 2 a.m. The latter remedy has been recommended by Dr. E. T. Blake, when the trouble is associated with splitting headache. Mephitis seems to have the power of enabling the patient to stand extreme cold. He feels less chilly than usual in cold weather. Washing in ice-cold water 28 A CLINICAL MATERIA MEDICA. causes a pleasant sensation. Other symptoms of the drug which are worthy of notice are the following: Wandering pains, with pressure to urinate; fine nervous vibrations reaching to the bones, causing anxiety; awakes at night with congestions to the legs (see Aurum); legs uneasy, as if they would become insensible; vivid fancies, unfit- ting him for mental labor; talkative, as if intoxicated; violent pain in the head after a fulness which was pressing upwards; head dull and numb; head feels enlarged ; heaviness and pressure in the back of the head, as from a finger pressing; redness and injection of the conjunctiva; dimness of vision ; letters blur and run together. Below, we have the Oleum animale. This is similar in its origin to Castoreum and Moschus. It is the secretion of the mare, which tends to excite the passion of the opposite sex. Next we have the Castor equi, which is the red substance growing on the inside of the legs of the horse. The principal use that has been made of this in medicine has been in sore nipples, when they are cracked and ragged, almost hanging in fact. Now we come to the milk preparations. I am not going to uphold these. You are to be the judges. No editor of a journal, however brilliant he may be, should decide for you. Try them, that you may know them by your own experience. I have been making experiments with them. The first is Lac vaccinum or cow's milk ; the next is Lac defloratum or skimmed milk. The latter has gained such a foot-hold that less objection has been made to it than to any of the others. It has been used largely in the treatment of diabetes. Patients are directed to drink a pint of milk morning, noon and night, while all food con- taining starch and sugar is prohibited. The quantity of milk just men- tioned is gradually increased until the patient consumes four or five quarts daily. Provings of Lac defloratum have been made. It has cured in- tense, headache, located principally in the fore-part of the head. The pains are of a throbbing character, and are associated with nausea, vom- iting and the most obstinate constipation. It is especially suitable in anaemic women. Remember these symptoms—anaemic women, throb- bing frontal headache, nausea, vomiting and obstinate constipation. Next we come to the dog's milk, Lac caninum. Of this, I can say nothing. It has been used largely in diphtheria by a New York phy- sician. Koumyss, another of the milk preparations, is certainly no humbug. It is prepared by fermentation from asses' milk. It is used largely on the plains of Asia. It is claimed that it is an excellent food ANIMAL KINGDOM. 29 for the weak and anaemic and especially for the consumptive. It is readily digested and is well tolerated by weak stomachs. Next we have two substances, Fel tauri and Fel vulpi which have been used in constipation and in accumulation of flatus in the intestines. Pulmo vulpis was introduced by Grauvogl, who acting according to the law of " Signature/, rerum" recommended Pulmo vulpis in asthma because foxes were long-winded. I give you this without indorsing it. We next come to the Ophidians. Here we have the large class of serpents, the consideration of which I will omit now, because we will take them up for study at our next meeting. Among the Pisces or fishes, I will mention only the cod-liver oil, or Oleum jecoris aselli. This is known as a great remedy in scrofulosis, tuberculosis, and debility. It is used, as you know, by physicians of both schools of practice. Many physicians claim that it acts physio- logically. This is a mistake It is a medicine. It does not act by the oil contained as Dr. Hughes claims. If it does, why is it that other oils do not produce as good effects? It is a compound drug and contains Iodine, Phosphorus, and other substances. Dr. Neidhard of this city has made provings of it. He gave the drug in the lower potencies to provers, until he obtained a list of symptoms which he found to be characteristic. I will here give you an outline of the symptoms. You may use it when there are chills running down the back, hoarseness, and soreness through the chest. How many times you will see these symp- toms as the beginning of tuberculosis ! There may be sharp stitching pains here and there through the chest; the patient complains of burn- ing pain in spots or in some one portion of the chest. Fever is particu- larly marked towards evening with burning of the palms of the hand. The cough is dry, with an expectoration of a somewhat slimy mucus such as we notice in, the initial stages of tuberculosis. These are symp- toms which have been noticed in the provings conducted by a con- scientious observer, Dr. Neidhard ; they are symptoms which, when occurring in the sick, have been cured by the drug. When they are present, you may give Oleum jecoris aselli either in potency or in the crude form, and give it, too, on a scientific basis. Next we come to Bufo rana, a variety of toad indigenous to South America. The surface of its body secretes an oily substance which has the reputation of being poisonous. The native women when tired of the importunities of their husbands, mix this oily secretion into their hus- bands' drink for the purpose of producing impotency. Provings have been made df Bufo, and it has been found to produce a very disgusting 30 A CLINICAL MATERIA MEDICA. set of symptoms. It causes a sort of imbecility, in which the person loses all decency. He becomes a confirmed masturbator and seeks privacy to indulge his vicious habit. Masturbation and even sexual- intercourse seem to cause convulsions which simulate those of epilepsy. The aura that begins the epileptic paroxysm starts from the genital organs. The patient may even be thrown into violent convulsions dur- ing coitus. That form of epilepsy for which Bufo has done the most is that which occurs from over sexual excitement or else seems to start from the solar plexus. These symptoms are often preceded by a singular irritability of the mind during which the patient talks incoherently, and is then vexed because his gibberish is not understood. The con- vulsions themselves are usually followed by profound sleep. Some years ago, Dr. Wm. Payne cured a case of peritonitis with this remedy in which there were repeated convulsions, finally followed by stupor, unconsciousness, cold limbs, copious sweat, etc. I have recently suc- cessfully treated a woman with this drug, the indications being spasms, with suppurating blisters on the skin, in the throat, and in the vagina. The abdomen was exceedingly sensitive, feeling to her as if the same sort of sores were also in the bowels. We may here institute comparisons between Bufo and its concordant remedies. Indigo is indicated in epileptiform spasms which seem to be refiex from the irritation of worms. It is often useful in children when they are aroused at night with this horrible itching at the anus. But it never does any good unless the patient is low-spirited or sad or timid. If he is vehement or excitable, recourse must be had to a vehement remedy like Nux vomica or Bufo. Artemisia vulgaris is an excellent remedy in epilepsy, especially when it has been caused by fright or some exciting mental emotion. The attacks are repeated one after the other, and fire followed by pro- found sleep. I may say that Bufo rana seems to cure blisters on the skin, such blisters as are termed bullae. These rupture, leaving a raw surface from which there oozes an excoriating ichorous fluid. From the Mollusca we obtain two remedies, Sepias succus and Mur ex. These I will leave for the present, as I shall have more to say of them by and by. From the Radiata we obtain four medicines, the first of which for mention is the Corallium rubrum or red coral. It has several uses, but I shall only mention two. Corallium rubrum is useful in a combination of syphilis and psora. There are smooth spots on the surface of the ANIMAL KINGDOM. 31 body, mostly on the palms of the hands. At first they are of a coral- red hue, but they finally become darker, and assume the well-known copper-color characteristic of syphilis. Corallium is also useful for chancres when they have this coral-red hue. The whooping-cough of Cor allium rubrum has been styled the min- ute-gun cough, the paroxysms, as already described, coming very close together. During the day the cough is short, quick and ringing in character; when night comes, decided paroxysms of whooping appear. These seem to take the child's breath completely away, so that when they have ceased, he falls back completely exhausted. In this whoop- ing-cough it is similar to Mephitis, which I have already described to you. Spongia we shall speak of along with the Halogens, Bromine, Iodine, etc. Medusa, or the jelly-fish, has effects which are nearly identical with those of TJrtica urens. It produces a nettle-rash, and also has som slight action on the kidneys. Badiaga, the fresh-water sponge of Russia, has two principal points of attack, the first of which is on the lymphatic glands. It causes an enlargement of these with induration. It has been successfully used in indurated buboes, especially when they have been maltreated. Here it is similar to Carbo animalis. It also has an action on the heart. It is of service in palpitation of that organ caused by any pleasant ex- citement; it is thus similar to Coffea and Phosphorus. It is not indi- cated in organic heart diseases. Nitrite of amyl is likewise indicated in functional cardiac affections. It acts paralyzingly on the vaso-motor nerves.. It is useful in conges- tions to various parts of the body, to the head or to the chest. The face becomes flushed, and even puffed and red. Respiration is greatly oppressed. The heart beats more frequently, but loses in force. A con- strictive sensation about the heart is experienced. The patient must sit up. The urine ordinarily contains a small quantity of albumen. So susceptible is the person, that the opening of a door causes flushing. Nitrite of amyl is indicated in flashes of heat at change of life. Next we come to the Articulata, insects whose bodies are in seg- ments, the wasps, bees, etc. We have in this group a great many reme- dies, some of which have been placed on the board. TotheHemiptera belong the Coccus cacti and the Cimex. Coccus cacti is a little insect infesting the cacti of South America. The principal use of the drug is in whooping-cough with morning 32 A CLINICAL MATERIA MEDICA. aggravation. The child awakens in the morning, and is immediately seized with a paroxysm of whooping-cough, ending in vomiting of clear ropy mucus, hanging in great long strings from the mouth. That is a symptom which you all should remember. I can assure you that it is a positive one, for with this condition present Coccus cacti has, when administered in the beginning, cut short the whole disease. Still further, Coccus cacti affects the chest. The apices of the lungs are sore, and the patient coughs up this ropy mucus. Kali bichromicum and Senega, are concordant remedies of Coccus cacti in these conditions. Kali bichromicum has a dry barking cough, worse in the morning. The expectoration is stringy, but it is yellow in color—not clear, as under Coccus cacti. Senega is useful in chubby children. It has tough expectoration, which is clear, like the white of an egg, but the cough is worse towards evening. The expectoration is difficult to raise. If the child is old enough, it will complain of a crushing weight on the chest. Cimex is a remedy that I have never used. It has been recom- mended in intermittent fever. From the Hymenoptera we obtain such important remedies as Apis mellifica, Vespa and Formica. This order we must leave for the present. The order Coleoptera gives us Cantharis; this we will have to leave for a future lecture. From this order we also obtain the Doryphora decem-lineata or potato-bug. This is highly poisonous, and has been used successfully in inflammations of a low grade; for instance, gon- orrhceal inflammation when the parts are purple or dark red. Under the order Orthoptera, we have one remedy mentioned, the Blatta or cockroach. This is the last agony of all. Journals have contained many accounts of cases of dropsy cured with it. Lastly, we have the Arachnida, or spiders, the consideration of which we shall leave for a future lecture. LECTURE III. THE OPHIDIA. In considering the remedies derived from the animal kingdom, first I shall speak, in extenso, of the large family, formally called Ophidians, or snakes proper. Of those we use in medicine, we have first the L,ach- esis trigonocephaly. This was proved by Dr. Hering, sixty years ago. Next we have the Crotalus horridus. There is also a South American species, proved by Dr. Muir, the Crotalus cascavella. This has a few symptoms which will not yield to the administration of the other spe- cies. Then there are the Naja tripudians, one variety of the cobra, and the Elaps corallinus, so called from the shape of the scales on the back, which have something the appearance of coral. Lastly, there is the Bothrops lanciolatus, a remedy which, for a year or more, I have vainly tried to procure. It causes symptoms similar to that peculiar condition known as aphasia. Of these poisons, the first four are com- monly used in medicine. To get an idea of a class of medicines derived from one source or similar sources, it is well to study them in a group, and see what symp- toms they have in common. The poison of the snake is generally held in a little sac behind the fangs. On the under surface of the fangs is a small groove, into which empties a little tube that conveys the poison from the gland. When they are not in use, they lie back on the roof of the mouth. • If the animal is excited, it opens its mouth, the fangs are pushed forwards, and at the same time, by muscular action, etc., a drop of the poison runs down the canal, and into the punctured wound. Now, what follows? That depends on various causes. The poison is more potent at some times than at others. The more angry the serpent is, the more active is its venom. If, in inflicting the wound, the fang passes through the clothing, some of the poison may thus be absorbed. Again, the power of resistance of the individual has some effect. You may divide the effects of the snake-poison into three sorts: First, that which may be compared to the action of a stroke of lightning or a dose of Prussic acid. Immediately after the bite, the patient starts up with a look of anguish on his face, and then drops dead. This rep- resents the full, unmodified, lightning rapidity of the poison. In the 34 A CLINICAL MATERIA MEDICA. second form, commonly, the part bitten swells and turns, not a bright red, but rapidly to a dark purplish color, the blood becomes fluid, and the patient exhibits symptoms like those characteristic of septicaemia. The heart-beat increases in rapidity, but lessens in tone and strength. The patient becomes prostrated, and covered with a cold clammy sweat. Dark spots appear on the body, where the blood settles into ecchymoses; the patient becomes depressed from weakness of the nervous system, or from poverty of the blood, and then sinks into a typhoid state, and dies. Or there follow nervous phenomena. The patient is seized with ver- tigo. Dark spots appear before the eyes; blindness; a peculiar tremor all over the body; face besotted; dyspnoea, or even stertor. Or it may assume a slower form. After the vertigo or trembling, the patient remains weak, and the place of poisoning becomes dark or gan- grenous. All the discharges, the sweat, the urine and the faeces, are offensive. Dysenteric symptoms of a typhoid character show themselves. The patient goes into a low state, and finally dies. These are all phases of one action of the drug, the power of the drug to affect the blood and the nerves. A small dose of Lachesis may make the prover feel as if he could study without fatigue. He grows loquacious, jumping from subject to subject. There is nervous excitement. A story, for instance, excites him unduly. Anecdotes move him to tears. Quickly the op- posite state appears. The nervous symptoms change to prostration, or even complete paralysis. Nerves especially affected by the snake-poisons seem to be the pneumogastric and spinal accessory; consequently, you expect to find, as eminently characteristic, symptoms of the larynx, of the respiration, and of the heart. All of the Ophidia cause choking, constrictive sensation coming from irritation of the pneumogastric. All of them have dyspnoea and heart-symptoms. It has been found that the snake-poisons coagulate the blood ; but soon the blood is so far decomposed that it has no longer the power to thicken. It becomes liquid, dark, and oozes from every orifice of the body. Thus are haemorrhages produced, which are characteristic. They are most noted under Lachesis and Crotalus; less in Elaps, least in Naja. You already see in what class of diseases you will find these poisons curative; in low grades of inflammation, in carbuncle, gan- grene, adynamic states, fever of typhoid type, etc. They produce a staining of the skin yellow. This is not jaundice, and must not be confused with that affection. It comes from the blood, and is due to the decomposition of that fluid, and not to the staining of the skin with bile. This is most marked in the Crotalus. Again, you LACHESIS. 35 may find that the skin is dry and harsh, as if there was no vitality in it, or it may be clammy, more characteristic of Lachesis. Thedischarges are foetid, even the formed fecal stools of Lachesis are horribly offensive. As the heart is weakened by all, we find as characteristic, running through them all, weak heart, cold feet, and trembling—not the trem- bling of mere nervousness, it is the trembling of weakness from blood- poisoning. The cold feet are not indicative of congestion, as you find under Belladonna. They are attendants upon a weakened heart. The heart symptoms of Naja greatly resemble those of Lachesis, but its cardiac symptoms point more markedly to the remote effects of car- diac valvular lesions; those of Lachesis more to the incipiency of rheu- matic disease of the heart. In Naja there is a well-marked frontal and temporal headache with the cardiac symptoms; the heart beats tumultuously. The patient awakes gasping for breath. Naja causes more nervous phenomena than any of the snake-poisons. Under Belladonna the head is hot, and the feet are cold, because the blood is surged toward the head. Under the snake-poisons the feet are cold, because the heart is too weak to force the blood to the periphery. All of the snake-poisons cause inflammation of the cellular tissue. Accordingly, we find them valuable when cellulitis arises in the course of typhoid fever, diphtheria, etc. In diphtheria, Crotalus has had more clinical experience in the per- sistent epistaxis. Elaps claims attention in cases of haemoptysis, when the blood dis- charged is dark in color, especially when the right lung is affected. Antidotes for these poisons are numerous. There is no doubt that alcohol is a powerful antagonist to the snake-venom. It is remarkable how much alcohol can be swallowed by persons bitten by serpents, without the manifestation of the usual physiological effects. Whiskey or brandy can be used and in large quantities, until it produces its own effects. Dr. Hering recommends radiating heat as an antidote. The part bitten should be held close to a hot fire. Ammonia and perman- ganate of potash have been recommended as antidotes, and cures have been claimed for each. Lachesis. Now let us consider Lachesis. First of all, in order that you may comprehend the subject, I wish to refer to those symptoms which are universal. We notice that Lachesis is especially suitable to persons who have a peculiar sensitiveness of the surface of the body. Even if the 36 A CLINICAL MATERIA MEDICA. patient is lying in a stupor and you touch him, as when you try to feel his pulse, he will show that he is disturbed thereby. Hard rubbing or pressure may cause no trouble at all. Dr. Hering, who first proved Lachesis, could never tolerate tight clothing about his neck. He always wore his collars loose. He noticed that during the proving, this symp- tom annoyed him more than usual, so he faithfully made note of the occurrence but did not place much value on it. Since then the symptom has been confirmed many times in practice, and has been found true, not only as a local symptom of the neck, but as a symptom of the body uni- versally. The explanation seems to be that there is an irritation of the peripheral nerves, and because of this the patient cannot bear touch or slight pressure. It is no evidence of inflammation, and must not be confounded with the inflammatory soreness of Aconite, Arnica or Bel- ladonna. This sensitiveness also differs from that of Apis, which has a bruised, sore feeling more acute than that of Arnica. It also differs from the sensitiveness of Nux vomica and Lycopodium which have it about the waist only after a meal. Next we find that the drug is prone to affect the left side of the body. Homoeopaths have been criticised for attributing to drugs the power of acting upon one side of the body in preference to another. The simple fact that disease chooses sides ought to be enough to lead one to believe that drugs may do the same. The left side of the body is more apt to be affected by drugs having a depressing action, because that side of the body is the weaker. Another peculiarity of Lachesis arising, probably, from its action on the pneumogastric nerves, is its influence on sleep. This is a universal symptom, that the patient is worse from sleep; he sleeps into an aggra- vation. This latter is more marked than the former. If it is true that the Lachesis has an influence on the centres of respiration, and is a weakening drug, we can understand why sleep should aggravate. During our waking hours we have some control over respiration. During sleep this voluntary control is lost. It is when this change takes place that the weakening effect of Lachesis is asserted. Lachesis is a very valuable remedy at the climaxis, for the reason that the woman has exhausted herself by frequent pregnancies and hard work. In this worn-out condition there occurs a sudden cessation of the menses. Non-appearing discharges make the Lachesis patient worse. Perhaps, before the climaxis, she was worse before than during the flow. The pulse is trembling. There are the peculiar headache, and the an- noying symptoms of the mind, showing that the Lachesis here presents LACHESIS. 37 no exception to the rule that it acts on debilitated and weakened persons. Now, let us consider some of the symptoms of Lachesis in detail: First, as to the mental symptoms. The patient is nervous, anxious, loquacious, jumping from subject to subject; sometimes with fear of being poisoned. Interesting stories excite immoderately and even in- tensify the bodily symptoms. He refuses the medicine you offer. Sometimes the anxiety assumes a peculiar type, and he imagines that he is dead, and preparations are being made for the funeral. The loquacity may be accompanied with sleepiness, and yet inability to sleep. Ideas chase each other so rapidly through the mind he cannot write them down. He sits up late at night, mental activity then being unusually increased. But this stage of excitement is commingled with another, which soon entirely supersedes it. The mind is weakened. The patient is able to think only with difficulty. He has to think how words are spelled. SulpJiur and Lycopodium also have thissymp- tom. Like Theridion and perhaps Moschus, there is vertigo, worse on closing the eyes; or the vertigo may be worse on sitting or lying down. In this vertigo, fainting, etc., you may compare Theridion. Here, too, the dizziness is worse with eyes closed; but a distinctive feature you will find is that vertigo, pains and nausea are intensely aggravated by noise. Both remedies have sun pains. Arsenic, Plydrocyanic acid, Digitalis, Veratrum alb., Camphor, you should compare in vertigo and fainting from cardiac weakness. Lauroeerasus or Hydrocyanic acid is needed in long-lasting faints ; there seems to be no reactive power; the face is pale blue, the surface cold. If fluids are forced down the throat, they roll audibly into the stomach. If the syncope is attendant upon some poison in the system, as scarlatina, the symptoms are similar, the eruption being livid, and, when pressed, regains its color very slowly. Digitalis also rivals the Ophidians in syncope, with the antecedent dim vision; the pulse is generally very slow, and the patient often complains of nausea and deathly weakness in the epigastrium. Camphor and Veratrum album display coldness and cold sweaty skin; in the latter remedy, the forehead is cold and sweaty. The face may be red while lying, but if raised, it turns pale and the patient faints; the pulse is thready. Camphor has icy surface, sudden sinking, as in Lauroeerasus, and although so cold he throws off clothing so soon as he is strong enough to move, even though he be still unconscious. 38 A CLINICAL MATERIA MEDICA. In ill-effects of the heat of the sun, compare Glonoine, Belladonna, Camphor, Natrum carb. and Theridion (see above). The first two, with bloated red face, paralytic weakness (Glon.), unconsciousness, etc., resemble Lachesis, but the latter displays the effects of heat upon one already exhausted. All the Ophidians are intolerant of warm, relaxing weather, and so we find many ailments returning in spring and summer. In the Lachesis case, the patient may be an inebriate or one prostrated by mental fatigue. The sun's heat makes him languid, dizzy, faint, or, if congestions ensue, the face is dark red, and looks at the same time sunken and cadaverous; the extremities are cold. Here Camphor may be demanded if vitality is ebbing away, the fainting spells growing worse, and the body icy cold and bathed iii cold sweat. Both Lachesis and Natrum carb. are useful when hot weather fatigues, in which case you should compare, also, Selenium and Natrum mur. Returning now, after this digression, to the mental symptoms of Lachesis, we find that the delirium is of a low, muttering type. At other times the patient seems to be going deeper and deeper into a torpid state, with coolness of the extremities, trembling of the hands and body. When asked to protrude the tongue, it comes out trem- blingly, or catches in the teeth, or, if he does get it out, it is trembling, and is usually coated dark brown, sometimes with little blisters on the tip. The lips crack and ooze dark blood. Loquacity is commonly followed by depression, and by weakness which amounts to a typhoid state; then he is delirious, the delirium not being of the violent Bel- ladonna type. The typhoid type is shown by the dark coating on the tongue; the paralytic state of the brain by the difficulty in protruding the tongue and its catching on the teeth. These symptoms show Lachesis to be an invaluable remedy in typhoid fever, and in fact in all diseases of a typhoid type. The loquacity just referred to is particularly characteristic. Another mental state which these typhoid patients may have as indicating Lachesis, is that they feel as if they were under the influence of some overwhelm- ing power. Diarrhoea is usually present, and is characterized by the horribly offensive odor to the stools. That is a characteristic of Lachesis, which will also aid you in diphtheria or scarlatina. Even when the stools are formed, and in every way natural in other respects, they give forth this horrible odor. Lachesis may also be indicated late in the course of typhoid fever, when the patient lies in a stupor with dropping of the lower jaw, and other symptoms indicative of im- pending paralysis of the brain. LACHESIS. 39 Let me now speak of some of the concordant remedies of Lachesis in these conditions. In the loquacity just mentioned, Lachesis should be compared with Stramonium and Agaricus. Stramonium you will distinguish from Lachesis by the reel face and the other evidences of great sensorial excitement. Mephitis, Actea racemosa and Paris quadrifolia also produce loquacity. Under Mephitis it is as if one were drunk. Under Actea racemosa the loquacity is usually associated with men- strual suppression, with puerperal mania or as a part of delirium tremens. Lachesis is also useful in this last condition I have named. Actea cures wild imaginings of rats, etc., sleeplessness, wild crazed feeling about the head, incessant talking with continual change of subject; the patient must move about. Lachesis has more marked trembling of the hands, diarrhoea and great exhaustion, with the loquacity and hallucinations. Paris quadrifolia causes a garrulity which is much like that pro- duced by tea, a sort of vivacity with love of prattling. In these typhoid types of fever you may compare Lachesis with Opium, Hyoscyamus, Arnica, Lycopodium, and Rhus toxicodendron. Opium is indicated in typhoid fever with this threatening paralysis of the brain, but the symptoms under it refer to a very different condition from that of Lachesis. The symptoms which indicate Opium in addi- tion to this dropping of the lower jaw are, unconsciousness, stertorous breathing, and a dark or brownish-red hue of the face. The darker red the face the more is Opium indicated. With Lachesis, the cerebral condition is due to the effect of the typhoid poison on the brain. With Opium, it is a secondary effect of the intense congestion of that organ. Hyoscyamus is perhaps more similar to Lachesis than is Opium. Here we find the lower jaw dropped, the patient is weak and trembling, and there is twitching of the muscles. This last is a necessary symp- tom of Hyoscyamus. Here, too, there is snoring breathing, as in Opium, with involuntary stool and great prostration. Arnica is also indicated when there is great congestion of the brain. The patient lies in a stupor, with lower jaw dropped and eyes fixed. The face is dark-red, and stool and urine are passed involuntarily. In addition to these symptoms, and separating it from the drugs just men- tioned, you find here and there on the body dark spots, irregular in outline and having a black and blue appearance, ecchymoses as they are called. Lycopodium is the complement of Lachesis, and is, therefore, more apt to be indicated after it than any remedy I have mentioned. The 40 A CLINICAL MATERIA MEDICA. symptoms which indicate Lycopodium are these: The patient lies in a stupor, with lower jaw dropped and rattling breathing. There is a rattling of phlegm in the throat during both inspiration and expira- tion, and the eyes are fixed and set, and are swimming in tears. Lyco- podium is the most important remedy we have in impending paralysis of the brain; by that I mean to say that it is the most frequently in- dicated. Leaving the mental symptoms of Lachesis and the indications of it and its analogues in typhoid fever, we will next consider its head symptoms. We find that it produces a headache worse in or over the left eye, of a throbbing character, with sharp pains, very severe, which may come at the climaxis, or as the accompaniment of an ordinary cold, relieved as soon as the coryza appears. There is a universal characteristic; so soon as a discharge is established the patient feels better. I have relieved dysmenorrhcea with Lachesis when there was a headache preceding the dysmenorrhcea, but relieved so soon as the flow was established. In catarrhal and rheumatic headaches you may compare Mercurius, Cinchona, Pulsatilla, Bryonia and Gelsemium. Cinchona relieves headache from suppressed coryza when the pain is worse from the least draught of air. Bryonia and Pulsatilla come into use when the checked catarrhal secretion is thick yellow and green respectively. Gelsemium when motility is lessened and the patient is drowsy, with neuralgic pains from occiput to forehead and face. The headache may also arise from disordered stomach or bowels; or may be an accompaniment of fevers and of diseases of zymotic origin. The patient has an upward tendency of the blood, with throbbing in the head, dark redness of the face, puffed face, confusion of the mind, all the way from simple confusion to absolute stupor, often accompa- nied, too, with partial blindness, palpitation of the heart and fainting. The pains about the head are briefly as follows: sharp sticking, which seems to concentrate at the root of the nose. At other times the pains go from the zygoma to the ear. This direction of the pains is charac- teristic. As a parallel of this shooting pain from zygoma to the ear, we have pains from the head, going down through and into the eyes. These are all characteristic pains of Lachesis. There is an additional one that I will now mention, which is probably of rheumatic origin • pains in the head, going down into the shoulders and neck of the LACHESIS. 41 affected side, and often accompanied with slight stiffness of the neck either catarrhal or rheumatic. You may have Lachesis indicated in more severe forms of head trouble; for instance, in inflammation of the membranes of the brain • sharp pains in the head, making the patient scream out; tongue show- ing papillae; strawberry tongue; patient rolls the head from side to side, and bores it into the pillow. Particularly useful is this when an exanthem, scarlatina, or erysipelas, has not developed or has been re- percussed. The patient is at first very drowsy, but unable to sleep ; trembling or palpitation of the heart. Soon stupor ensues, and he becomes heavy and sleepy, and you can rouse him with difficulty. In intense head pains, as in meningitis, you should remember the relation between Belladonna and Lachesis, the difference between these drugs being rather one of degree. Both are suited to meningitis from erisypelas, to scarlatina, apoplexy, etc.; but the former represents the initial stages of these diseases or states in which, even though there be stupor, still there are evidences of irritation and not wholly of depres- sion. Thus, the patient often starts from his heavy sleep, cries out grinds the teeth, awakens frightened, etc. His pulse is usually strong and the surface congestions are bright red, or if more intense, deep red, and livid. If there is an eruption, as in scarlatina, it is red, even if sparse, and vitality is not so low that the extremities are cool, the rash bluish, and the cellular tissue infiltrated and threatening an un- healthy suppuration, as in the snake-poison. Often, however, after the use of Belladonna we find evidence of cerebral exhaustion, or blood-poisoning, or impending paralysis, in which case Lachesis may be required. The patient still cries out in sleep or awakens frightened, the tongue still shows elevated papillae, the head is hot, and the face is red; but the pulse is quicker and more feeble, the feet are cool, the surface heat is irregularly distributed ; the mind is more befogged and drowsiness is stealthily creeping on, the inflamed part or the pseudo-membrane or the eruption, as the case may be, is becoming more purplish—these indicate the change. Considering the action of Lachesis on the special senses, we find the eyes to be affected by the drug. Dimness of vision is caused by it; dark spots appear before the eyes; sight suddenly seems to fade away; feeling of faintness and palpitation of the heart; with those, nervous trembling. Lachesis is one of the leading remedies for dim sight as an evidence of heart disease and vertigo. We may also use it with 4 42 A CLINICAL MATERIA MEDICA. good effect for what we may term retinal apoplexy. There it acts very well in causing an absorption of the blood. The nearest remedies to Lachesis in this condition of the retina, are Crotalus, Phosphorus, and Arnica. Scrofulous ophthalmia calls for Lachesis when the symptoms are de- cidedly worse after sleep. There are great photophobia and pains of a burning, stitching, shooting character, extending to the temples, top of the head and occiput. There are also itching and stinging in the eyes and lids, worse from touch. Vision is misty, with black flickering before the eyes. Crotalus may also be called for in keratitis when there are cutting pains around the eyes, lids swollen in the mornings, ciliary neuralgia with these cuttings, worse at menses. In diseases of the ear, Lachesis may be remedial for roaring and singing in the ears, and different sorts of tinnitus aurium, which are relieved by putting the finger in the ear and working it. This shows that the tinnitus is not congestive, but of catarrhal origin. The wax is altered in quality and becomes pasty and offensive. There is swell- ing between the ear and mastoid process with throbbing pain and stiff- ness. You may here compare Nitric acid, Capsicum, Aurum, Hepar, and Silicea. Elaps and Crotalus, like Lachesis, have an action on the ears. The former produces a catarrh with black cerumen in the ears, tinnitus au- rium, and otorrhcea. In Elaps, the discharge is yellow-green, liquid and bloody. Only Lachesis seems to have the Eustachian stoppage better from shaking the finger in the meatus. Crotalus causes a stuffed feeling in the ears, worse in the right, asso- ciated with a feeling as if hot ear-wax was trickling out. The face in the Lachesis patient varies, of course, with the condition that obtains in the system at the time. In many of the diseases in which the remedy is indicated the face has an earthy pallor. In exanthematic diseases it is apt to be bloated or puffed; bluish-red ; if the eruption comes out, it comes out sparsely and is of a dark color. Its expression is anxious and painful with the stupor; the face is disfigured, looks as after a debauch ; there are blue circles around the eyes. With abdominal troubles as in ague, the face is earthy gray. Lachesis also has convulsion of the face; lockjaw; distortion of the face; stretching the body backwards; screaming; feet cold and itch- ing. For swollen face, you may compare: Apis, Belladonna, Arsenic, LACHESIS. 43 Lycopodium, Hyoscyamus, Rhus tox., Pulsatilla, Stramonium, Kali carb., and Phosphorus. For sickly, pale, or earthy complexion : Arsenic, Bufo, Lycopodium, Carbo veg., Rhus tox., Cinchona, Phosphorus, and Phosphoric acid. Blue about the eyes: Arsenic, Cuprum, Phosphorus, Secale cornutum, and Veratrum album. Debauched look: Baptisia, Hyoscyamus, Carbo veg., Nux vomica, Sulphur, Opium, Nux moschata. In facial convulsions, compare: Nux vomica, Hyoscyamus, Bella- donna, Hydrocyanic acid, Lycopodium, Cicuta, Camphor, Phytolacca, Arsenicum. Apis, Arsenic and Kali carb. agree in puffing of the face even with- out any redness. In the first, there is also smarting of the eyelids, and a sensation of stiffness. In the second, it is noticed about the eyes, glabella and forehead (also Natrum ars.). Kali carb. has the well-known sacs of the upper lids, and also sudden swelling of the cheeks. The expression, complexion, etc., of Arsenic are very similar to those of the snake-poisons. The anxiety and pain are marked by more restlessness and irritability, fear of death, etc., and the sunken face is more completely Hippocratic, with pointed features, sunken eyes and cold sweat. When yellow or earthy, it is cachectic. If trismic symptoms are present, the patient will be found lying pale, and as if dead, though yet warm. Suddenly he arouses, and goes into severe convulsions only again to relapse into this sort of cataleptic rigidity. The eyes are partly open, with gum on the conjunctiva. Lycopodium has pale or yellow face, deeply furrowed, looking elon- gated. The convulsive movements are unique. All through the provings of this remedy you will note an alternation of contraction and expansion. And in the face you note : tongue pushed out and withdrawn, spasmodic trembling of the facial muscles, angles of mouth alternately drawn up and relaxed, alae nasi alternately ex- panded and contracted. The eyes may be partly open and covered with mucus,—a bad symptom, generally being indicative of brain ex- haustion. Phosjjhorus has a pale face, but it is distinguished by its ashy anaemic appearance. This should be remembered, since this remedy, like the Ophidia, has puffy face, sunken face, blueness around the eyes, and blue lips. Hyoscyamus is very similar to Lachesis in facial expression and in 44 A CLINICAL MATERIA MEDICA. the convulsive phenomena. It has a marked stupid, drunken look; the face is distorted and blue, or swollen and brown red ; starting ; twitchings of single groups of muscles are noted. Hunger appears before the attacks. Stramonium is readily distinguished by its swollen, turgid face, fright on awakening, renewal of spasms from light, and the contracted, gloomy expression, with wrinkling of the forehead. Hydrocyanic acid closely agrees in convulsive symptoms and in the color of the face. Like Elaps, it has fluids roll audibly into the stomach ; but the latter has it more as a spasmodic contraction of the sphincters, followed by sudden relaxation. In convulsions, the sur- face, in the acid, is pale-blue, and the muscles of the face, jaw and back are affected. Suddenly a shock is felt, which passes like light- ning from head to foot, and then comes the spasm. Here, the remedy is more like Cicuta and Helleborus than Lachesis. But Cicuta has, like the snake-poisons, great difficulty in breathing from spasm, and, more than any remedy, it produces staring; the spasm is followed by disproportionately severe weakness. Camphor is readily distinguished from Lachesis by the coldness and by the withdrawing of the lip, showing the teeth. Lachesis is indicated in erysipelas of the face. Characteristically, the disease will be most marked on the left side. The face at first may be quite bright red, but it soon takes on a dark bluish hue. There is considerable infiltration into the cellular tissue, so that we have putfi- ness of the eye of the affected side. Now the characteristic bluish face is the accompanying weakness. Even from the beginning, when the skin is yet red, the pulse, though accelerated, is weak, the feet are apt to be cool, and the head is affected sympathetically, so that the patient readily becomes drowsy, with muttering delirium or the opposite con- dition of pseudo-excitement, the loquacity, which I have already men- tioned, obtains. You must now distinguish this erysipelas of Lachesis from the reme- dies that are akin to it; among these is Belladonna. In its early symptoms, Belladonna bears no resemblance to Lachesis. But in the course of the disease, when the inflammation is so intense that the bloated face grows bluish red, threatening gangrene, or when the brain becomes affected, differentiation is necessary. Here, both have hot head and cold feet, delirium, dry tongue, etc. But Lachesis suits when the cerebral symptoms fail to yield to Belladonna, when the excitement gives way to muttering stupor, the pulse is weak and rapid, and the LACHESIS. 45 cool surface of the limbs is plainly due to fading vitality rather than to the upward tendency of the blood. Crotalus holds the same rela- tion to Belladonna. Apis mellifica is indicated in erysipelas when the affected parts ex- hibit a tendency to become ©edematous. If the face is involved, the eye-lids protrude like sacs of water. The face is usually of a pinkish hue, or it may be dark purplish, but it never has the deep bluish-black hue of Lachesis. Although there may be a similar destructive tendency, the condi- tion of nervous irritation produced by the bee-poison is very different from that of any of its congeners. It is a fidgety, nervous state, a fretted feeling, which deprives the patient of sleep though he feel sleepy. Rhus toxicodendron is suited to the vesicular form of erysipelas. The patient is drowsy as under Lachesis, little blisters form on and about the face, and the face is dark red, not the bluish-black of the Lachesis nor the purple of the intensified Apis case. If vesicles form in the Lachesis case, they quickly fill with pus. Speaking relatively, Rhus produces more vesication and burning-sting- ing itching; Lachesis, more bluish-red inflammation, with gangrenous tendency. Euphorbium, since it causes gangrene with erysipelas, anxiety as from poison, apprehensiveness, dim vision, etc., deserves your notice. The right cheek is of a livid or dark red hue, vesicles form as large as peas, and are filled with a yellow liquid. The pains are boring, gnawing and digging in character, and extend from the gum into the ear, with itching and crawling when pains are relieved. Lachesis may be indicated in prosopalgia when the pain is worse on the left side, and when there are tearing pains above the orbit and dig- . ging and screwing pains around the malar bone. Delirium appears as soon as the eyes are closed. The teeth decay and crumble. The gums are swollen and bluish, with throbbing pains. Lachesis may be successfully used in perio- dontitis and abscesses at the root of a filled tooth, as may also Mercu- rius, Hepar and Silicea. Of the allied remedies in toothache, none is so similar as Mercurius, which, like Lachesis, relieves when the gum is inflamed and the tooth decayed, with abscess at the root. It is said to have a direct action on the dentine. The pains are tearing and pulsating, and shoot into the face and ears. In Lachesis the gum is swollen, and at the same time 46 A CLINICAL MATERIA MEDICA. dark red and livid ; or it is tense and hot, and looks as if it would crack. Mercurius is markedly worse from warmth of bed. Lachesis often follows the latter, or is needed at once if the patient has been previously salivated. Only Mercurius has dirty gums, with white edges. In sore mouth, aphthae, etc., Lachesis should be compared with Bap- tisia, Nitric acid, Muriatic acid, Arsenic and Apis ; while Mercurius compares more with Carbo veg., Staphisagria, Kali chlor., Lodine, Sul- phuric acid, Nitric acid. Baptisia has blood oozing from the gums, which look dark red or purple, salivation, fcetor, offensive stools, and thus far is precisely like Lachesis. Both, too, are indicated in the stomacace attending the last stages of phthisis. Decide by general differences and also by the tongue, which, in the former, is yellow or brown down the centre, with red, shining edges. In the latter, it is red, dry and glistening, espe- cially at the tip, and has its sides and tip covered with blisters. Nitric acid causes an acrid saliva; the pains in the mouth are pricking in character, as from a splinter; the aphthae and gums are usually whitish ; raw places, with shooting pains. Muriatic acid presents deep, bluish ulcers, with dark edges; mucous membrane denuded in places, which latter are dotted with aphthae. Araenio looks very much like Lachesis, with livid, bleeding gums, edges of tongue blistered, or ulcerating diarrhoea. The burning is more intense, and is associated with restlessness, compelling motion in spite of the weakness. In gangrena oris it causes more acute pain, and heat in the mouth ; both have bluish or black sloughing ulcers. Arsenic has more mental irritability. Apis has blisters marking the border of the tongue, or in clusters. The mouth is usually rosy-red, swollen, and there are marked stinging pains; the margin of the tongue feels scalded, as does the mouth gen- erally. Carbo veg., Staphisagria, Sulphuric acid agree more with Mer- curius; the gums are white, spongy, ulcerated, rather than livid. Staphisagria may cause sores, which look bluish-red or yellow; especially is it needed after abuse of Mercury, or in syphilitic cases when the general debility is marked with sunken face, blue around the eyes, etc. Sulphuric acid requires great debility, yellowish- white gums, yellow skin; the patient is nervous and hasty, and con- LACHESIS. 47 stantly complains of trembling, which, however, is not observed by others. Salicylic acid causes the common canker sores, with burning soreness and foetid breath. Jjycopodium produces these sores near the fraenum of the tongue, Lachesis at the tip, and Nitric acid, Phytolacca, Natrum hypochlor., on the inner side of the cheeks. Phytolacca has some systematic resemblance to Lachesis here as well as in the throat (see next lecture). Both cause great weakness, dim vision, sunken face, blue around the eyes, sore mouth, tongue blist- ered along the edges, tip of tongue red, roof of mouth sore, profuse saliva. The poke-root may be distinguished by the great pain at the root of the tongue when swallowing. These pains are a part of the tired aching and soreness which are general over the body. Helleborus produces canker in the mouth, but the sores are yellowish, with raised edges. Returning to the subject of decayed teeth, it may be noted that Kreo- sote cures pains from teeth to left side of face; teeth decay rapidly,gums bl<^ed, the blood being dark ; but the accompanying facial pains are burni g, and the patient is excitable, nervous, even, as in children, thrown into convulsions. Thuja causes a decay just at the border of the gums, leaving the crown apparently sound. Gums dark-red in streaks. Teeth turn yel- low and crumble. LECTUEE IV. THE OPHIDIA. Lachesis (continued). Next we take the action of Lachesis on nose, throat, and chest, so far as catarrhs are concerned. Lachesis produces nasal catarrh, watery discharge from the nose, which is often preceded by throbbing head- ache, worse in the left temple and forehead, which is relieved as the coryza establishes itself. Accompanying this coryza are sometimes vesicles about the nose, redness, puffiness of the face and lids, creep- ing chills over the body, palpitation of the heart, and great relaxation 6f the whole system ; hence it is suitable for a cold which is apt to occur in relaxing weather, consequently in the spring of the year. Lachesis may also be used in ozaena of mercurial or syphilitic origin. Here you may compare Kali bichromicum which follows Lachesis well; and also Nitric acid, Mercurius, and Z/ac Caninum. The last-named drug cures syphilitic ozaena and angina when the corners of the mouth and alae nasi are cracked. The cold may extend to the throat, and then we will find that the tonsils are enlarged, particularly the left, or, in the sick, with ten- dency from the left to the right tonsil. The throat, when examined, exhibits a bluish-red hue, not bright or rosy-red, the patient com- plains of frequent sense of constriction, as though the throat was sud- denly closing up, or a sensation as though there was a lump in the throat which he must constantly swallow, but which as often re- turns. The throat externally is exceedingly sensitive to touch. Unless the tonsils are going on to suppuration, he will be better by swallow- ing solids, while liquids and empty swallowing increase the annoyance and pains. I except suppurating tonsils because, when they are large and stop up the fauces, nothing can be swallowed ; then the attempt to take anything is followed by a violent ejection of the same, through either the mouth or the nose. But with the ordinary catarrhal sore throat, when the tonsils are not parenchymatously swollen, the swal- lowing of food often relieves the irritation for awhile. The cold may travel farther down and involve the bronchial tubes, lachesis. 49 when a different class of symptoms may develop. The patient may suffer from tickling, irritating cough, which is especially apt to come on as he drops off to sleep, arousing him as if he was choking. He can bear nothing to touch the larynx or throat, so that he loosens his neck- band. These, briefly, are the catarrhal symptoms of Lachesis. But suppose, while we are considering this locality, we look to more serious affections which may manifest themselves in these parts, diph- theria, for example. Lachesis may be indicated in diphtheria of one or all of these parts. Symptoms for which you will be called upon to prescribe it are mostly those that I have already given you, with these points in addition: The discharge from the nose is thin, sanious, and excoriating; a really dangerous objective symptom. The throat is, if anything, a darker red than in the catarrhal state. The membrane is more on the left tonsil, or has an inclination to go from the left to the right. It early develops that gangrenous state which obtains in diph- theria, with the attendant foetid breath, and the increased danger of systemic infection. The tissues surrounding the throat are often infil- trated so that you have swelling of the glands about the neck, and also of the cellular tissue. The swelling may be so great that the neck becomes even with the chin and sternum. The lymphatic glands are swollen too, and have a dark-purplish hue, and threaten suppuration. When pus does form, it is not a laudable pus. The child is drowsy, even though feverish ; the heart, though beating more rapidly than natural, is evidently greatly weakened, as shown by the feebleness of the pulse and coolness of the extremities. This is the kind of diphtheria from which you can hope much from the use of Lachesis. The diph- theria may travel down the larynx, and the remedy still be indicated. You must not infer from what I have said that Lachesis is the remedy for laryngeal diphtheria; but when it has the characteristic symptoms which I mention, it may be needed; the patient arouses from sleep smothering, and has a diphtheritic, croupy cough. Crotalus and Naja, like Lachesis, have relieved in diphtheria. The former has been selected when the epistaxis is persistent; blood oozes from the mouth, not merely coming from the posterior nares but escap- ing from the mucous membranes of the nasal cavities. Naja has helped in cases just like Lachesis when the larynx is in- vaded ; the patient grasps at the throat, with sensation of choking, fauces dark-red, foetid breath, short, hoarse cough, with raw feeling in larynx and upper part of trachea. Lac caninum is very similar to Lachesis in diphtheria. So is Lyco- 50 A CLINICAL MATERIA MEDICA. podium. The latter remedy has aggravation of the symptoms from four to eight p.m. The right side is mostly affected ; the child awakes from sleep frightened or cross and angry. Apis is to be distinguished by the oedema of the throat, the stinging pains, the blisters on the border of the tongue, etc. Again, you may find Lachesis of great service in affections of the lungs. We may use it in asthma when there are present one or more of these few symptoms. The patient arouses from sleep with the asth- matic paroxysm, and cannot bear the least pressure about the neck or chest; finally, he coughs up a quantity of watery phlegm with great relief. This last is a neglected characteristic of Lachesis in asthma. I have succeeded with it in relieving an asthmatic for months. In pneumonia Lachesis may be useful, but not in the early stages of the disease. There is nothing in the provings of Lachesis to suggest that it will be useful in pneumonia. It does not cause the engorgement of the lungs, the fever or the fibrinous deposit. But it may be indicated in the later stages of the affection, when it assumes a typhoid form, especially when an abscess forms in the lungs. Brain symptoms, such as low muttering delirium, and hallucinations, appear. The sputum is frothy, mixed with blood, and purulent, and the patient is bathed in a profuse sweat. Sulphur is, perhaps, the better remedy to prevent suppuration when there are no typhoid symptoms, but be careful how you give Sulphur if tuberculosis has been developed by pneumonia. To do so is almost like giving a person running down hill another push. It will only hasten the end. In chest affections, Elaps is sometimes of great service. It, however, affects more the right than the left lung, in which the morning pain is severe enough to prevent the patient's getting up. Both apices are dis- eased. There is a feeling of coldness in the chest after drinking. The cough is accompanied with intense pains in the chest, worse in the right apex as if it were torn out, and the sputum consists of black blood. It also causes a sensation as if the heart were being squeezed. You may use Lachesis in phthisis, not to cure, but to relieve. Remember it when, in the course of typhoid fever or pneumonia, tubercles have been deposited in one or the other lung. You may use it in the advanced stages of tuberculosis of the lungs when the patient has a retching cough, which arouses him from sleep, and which ends in expectoration of tough, greenish muco-purulent matter, which is gagged and vomited rather than clearly expectorated ; when the patient LACHESIS. 51 sweats in every nap, the sweat being the most copious about the neck, shoulders and chest, and when the strength is greatly reduced and the pulse indicates extreme prostration. Next we turn our attention to the alimentary canal from the mouth down. I referred to the tongue in speaking of the typhoid condition. Lachesis is useful for weakness of digestion in patients who, from some vicious habits, from abuse of mercury, or of quinine, or of alcohol, have their stomachs so exhausted that even the plainest food causes indigestion. Acids especially disagree, although the plainest food will cause heavy feeling after eating. Sometimes a gnawing pain is relieved while eating or immediately after, but soon heavy, dragging feelings and other symptoms of indigestion show themselves. Among the crav- ings is that for oysters, which may sometimes not disagree. The liver is affected by Lachesis. Like all the snake-poisons, it causes jaundice. The usual symptoms are present; even when abscesses form it may be useful by reason of the tenderness on pressure, intol- erance of clothing, and deep throbbing on the right side. The bowel symptoms are not numerous, though they are important. We find diarrhoea caused by the drug, watery offensive stools, but more often constipation, with the peculiarity of the stools already mentioned. Especially may it be used in chronic diarrhoea with great debility and aggravation in spring weather. The tongue is smooth, red and shining. (Kali bi. has exactly the same kind of tongue.) The abdomen is bloated. The patient is worse from 'wines or acids. The patient is very sensi- tive to touch about the waist. In this form of dyspepsia it is very similar to Hepar. The latter remedy, however, has marked relief of the symptoms from the use of condiments. Under Hepar the plainest food disagrees. The cravings are unique. As if knowing instinctively what will "tone up" the stomach, the patient longs for condiments or wine. Eating relieves the relaxed feel- ing, but food annoys so soon as the digestive process begins its slow and imperfect work. The bowels move very sluggishly, even when the stools are soft. Cinchona, too, enfeebles digestion and induces great weakness and languor after meals. It also has a craving for coffee-beans. Fruits in- duce diarrhoea with abdominal fermentation. Both cause fulness after eating, but only Cinchona has sense of fulness to hurting, with little or no relief from belching. Bitter eructations, bitter taste belong to 52 A CLINICAL MATERIA MEDICA. each ; the latter has the altered taste after swallowing, food retaining its normal taste while being masticated. The discharges from the bowels are offensive, as is the flatus; yellow watery stools, undigested. But the marked aggravation at night, after a meal, and the resulting prostration, are riot at all like Lachesis. In dysentery, etc., when putrid or gangrenous changes occur, the choice is more difficult. Both have cadaverous-smelling discharges of a chocolate color, with coldness and great debility. And although the Cinchona is far preferable if the disease is of malarial origin, such a complication does not contraindicatethesnake-poison. The apparently close similarity is also enhanced by the nervous excitability in both. Light touch is distressing, the epigastrium is sensitive, and clothing annoys in each remedy. But this in Cinchona is an increased general sensibility, while in Lachesis there is general torpor, with hyperaesthesia of the cutaneous nerves. The former is suitable when the offensive discharges -follow a severe, rapidly exhausting inflammation, or when the frequency and quantity of the evacuations have greatly reduced the vitality, thus favoring retrogressive changes. If symptoms of hectic are present, the choice is rendered more certain. In addition, we may also refer to the well-known anaemic symptoms of Cinchona, paleness, ringing in the ears, easy fainting, etc., which show at once how it affects the blood. Mercurius presents many points of similarity with Lachesis. The latter frequently follows the former, and also antidotes its abuse. There are loss of appetite, coated tongue, nausea, with oppression, and epigas- tric tenderness. Pressure in the pit of the stomach produces a deadly faintness. The stomach hangs heavily, even after a light meal of food of ordinary digestibility. The sensitiveness of the stomach to the clothing is a part of a symptom which is completed by a similar tender- ness over both hypochondria, with fulness and upward pressure from the abdomen. The patient cannot lie on the right side. If hypochon- driacal, he is suspicious, anxious and restless at night, with vascular erethism and sweat. In fact, this erethism is directly contrary to the torpid Lachesis. In abdominal inflammations with suppuration, as in typhlitis, both remedies are useful and follow each other well. Mercurius has its ever- present perspiration without relief; stools slimy, or much straining with or without stool. Lachesis follows when the symptoms threaten a typhoid condition. The patient can lie only on the back with the knees drawn up; if he turns on to the left side, a ball seems to roll over in the abdomen. LACHESIS. 53 Tn rectum and anus, Mercurius has more persistent tenesmus; pro- trusion of the rectum, which looks inflamed and blackish ; Lachesis, more spasmodic tenesmus, with constriction of the anus, which tightly constricts the prolapsed rectum. Beth have chronic constipation. The former induces much straining, with tenacious or crumbling stools; chilliness during defecation. Arsenicum intensifies the gastric and systemic weakness to which we referred in the remedies just considered. While it is true that the pa- tient does not fully realize his want of strength, and hence does not so much care to lie quietly, yet nevertheless, his actual amount of vitality is seriously reduced. In a word, he is excessively weak without feeling so fatigued. Any exertion produces fainting. Taste is lost, oris bitter, sour, and putrid. Stomach feels swollen as if full of water. Craving for acids and for coffee; the latter, as in Lachesis, agrees with the pa- tient. There are burning feelings, red rough tongue, and anxiety and distress after eating, as subacute gastritis, which no remedy better pic- tures. Nausea is frequent, and often periodical (12 p.m.), and is ac- companied with great prostration. The vomiting is of many kinds, but is distinguished from the bilious, slimy, or bloody emesis of Lachesis by its irregular convulsive character, indicative of gastric irritability. Lachesis is adapted to the nervous weakness and trembling of drunk- ards ; spasm of the stomach, spasmodic constrictions, relieved tempo- rarily by eating; vomiting of bile or mucus; Arsenic to burning peri- odical pains, with sour acrid vomit, violent thirst, but vomits the water. Cadmium sulph., to nausea, yellowish or black vomit, saltish rancid belching, cold sweat of the face, burning, cutting in the stomach ; grip- ing in the lower part of the bowels, cramps after beer. Both induce marked sensitiveness to touch upon stomach or abdomen, spots of burn- ing soreness here and there over the swollen abdomen (peritonitis); offensive, bloody, chocolate-colored discharges, as in dysentery, with constriction in the bowels, cutting pains in bowels. But in Arsenic there is more lamenting with agonized expression ; restless moving de- spite the pains. The constriction of the intestines is torturing, the patient declares he cannot stand it, and rolls about in agony, despairing of his life. The extreme tenderness of the pit of the stomach denotes a more positive state of acute inflammation than Lachesis causes. In the vomiting of yellow fever Lachesis has, in addition, brown coating on the teeth, abdominal tenderness. Arsenic has also spasmodic protrusion of the rectum, very painful; tenesmus with burning; haemorrhoids, especially in drunkards; they 54 A CLINICAL MATERIA MEDICA. protrude at stool with burning. Alvine discharges are offensive, dark, sometimes involuntary, with great weakness and coldness. But Lachesis has less tenesmus recti, the distress there being attributable to a con- striction of the anus not found in the other drug. Arsenic, moreover, causes more acridity of the stools, with rawness and excoriations of the anus. All that I have here stated might be tersely described as a difference between two drugs, of which one causes intense irritability and acute inflammation of tissue, mental anguish, and extreme prostration ; the other, torpidity, with the loss of vitality, but associated with nervous excitability, constrictions, and cutaneous hyperaesthesia. Still, some minds require more attention to detail; and every one attains general mental impressions more accurately if they are formed with due atten- tion to particulars. When there is ulceration of the bowels, tendency to sloughing, with offensive, purulent, or bloody discharges, the two remedies are very nearly allied. Vitality is at a very low ebb, blood oozes from the cracked lips and tongue, and the extremities are cold. But even here the best distinctions are the mental irritability of Arsenic, and the in- tolerance of pressure of Lachesis. Carbo vegetabilis resembles Lachesis in weak digestion, complaints of drunkards, flatulent asthma, constriction of the oesophagus, annoy- ance from clothing about the waist, offensive, bloody, decomposed, purulent stools, collapse, etc. There is craving for coffee, but it does not relieve. Milk disagrees in both remedies ; but only the snake-poison has craving for it. The Carbo veg. has aggravation from fats, tainted meats, or fish, oysters, foods causing flatulency, ices, vinegar, and sour cabbage—the latter principally on account of the flatulency it causes. Eructations are sour, rancid. Both drugs have relief of flatulent distension from belching, but Lachesis has an ill feeling in addition, which is relieved. Both drugs experience freer breathing after belching. In Carbo veg. this is expressed as the lessening of a tension and upward drawing which marks the costal attachments of the diaphragm; in Lachesis there is a relief after eructations which seem to suffocate him. They come rapidly, and induce the ever-present Lachesis constriction of the throat. The latter remedy also has empty eructations, which intensify the pains. Carbo veg. has heavine-s, fulness, sleepiness, after eating, with fulness of the abdomen almost to bursting. Burning in the stomach is also increased. This heaviness is very characteristic, and is noted likewise in the abdomen, which seems to hang heavily; also in the head, which LACHESIS. 55 feels as heavy as lead. The burning is attended with a creeping feel- ing up to the throat. In Lachesis, the fulness and pressure is as from a load, and the sense of repletion induces lowness of spirits. There is, too, a feeling as if a lump was accumulating in the stomach and also in the bowels; burning, with hard abdominal distension, and. a feeling as if a stone was descending ; he must stand still or step cautiously. This lumping is presumably a part of the Lachesis constriction, which we have so often designated as highly characteristic. In Carbo veg. the flatus is more rancid, putrid, or, when passed per anum, burning, moist, offensive. Its incarceration with burning is a cause of many of the symptoms, and is more in quantity than in the snake-poison. It also causes a bearing down upon bladder and sacral region. Lachesis relieves a gnawing gastralgia, when eating, lessens the pain; Carbo veg. cures when there is burning, with a contractive cramp bending him double ; the pains are paroxysmal and take his breath. The burn- ing spreads up to the chest and down into the abdomen, seemingly following the sympathetic. Tenesmus recti is most prominent in the Carbo veg., anal constric- tion in the Lachesis. It is this latter symptom which explains, as we have before observed, the ineffectual urging to stool; while in Carbo veg. the urging is fruitless on account of the pressure of flatus. Both have bluish, protruding piles, as after debauchery. This constriction distinguishes them, as do also the headache and diarrhoea. In each there is throbbing headache, but Carbo veg. has more of the heaviness, and the diarrhoea is thin. In typhoid forms, whether the specific fever, or as a sequel to peri- tonitis, dysentery, etc., the Carbo veg. causes the more perfect picture of collapse, while in Lachesis the cardiac debility, drowsiness, cool ex- tremities, etc., indicate failing vitality, but not so near death as the fol- lowing symptoms belonging to the former: Tympany; legs cold, espe- cially to the knees; pulse filiform ; breath cool; absence of discharges from the bowels; or involuntary, putrid, bloody, purulent diarrhoea. In hernia, Carbo veg. has anxiety, as in Arsenic, but with uneasi- ness rather than restless change of place; and it resembles Lachesis in the annoyance of the clothing, foulness of parts if strangulated, etc. There is, however, more meteorism and foetid flatus. Graphites has anxiety, melancholy; tip of tongue blistered ; feeling of a lump in the left side of the throat, over which the food seems to pass with difficulty ; on empty deglutition, a constrictive retching from oesophagus up to larynx ; must loosen the clothing after eating; 56 A CLINICAL MATERIA MEDICA. gastralgia, relieved by eating; chronic gastritis, especially after abuse of alcoholic drinks. Sensation of a lump in the stomach ; flatulent distension of the abdomen, with congestion to the head; foetid flatus. Suffbcati ye spells arousing from sleep, must jump out of bed; compelled to eat something. Offensive stools. But this remedy causes more flatulency than Lachesis. The gastralgic pains are burning and griping, and the feeling of a lump in the stomach is accompanied with a constant beating; the heartburn is rancid. The suffocative spells are usually worse after 12 p.m. instead of during or after a sleep at any time; and the constriction noticed on falling asleep is of the chest instead of the larynx. The offensive movements from the bowels are half digested, dark and pappy, indicating the imperfect digestion which is so characteristic of this remedy. There is some resemblance in the constitutional symptoms of Graph- ites and Lachesis, since both are needed at times in the phlegmatic. But the former has as a distinguishing group: fat, cold and costive; skin herpetic, rough and disposed to crack and ooze a glutinous fluid. Aside, then, from a few resemblances to the snake-poison, Graphites belongs more with Arsenic, Nux vom.and Lycopodium. The first two it resembles in gastritis and gastralgia; the latter in flatulency. Sulphuric acid somewhat resembles the snake-poisons, especially in the ailments of drunkards. Its corrosive effects, however, are distinc- tively prominent, as shown in the violent inflammation of the alimen- tary canal. But the nervous system is so involved that several symp- toms look like those of Lachesis; as epigastrium sensitive, constrictive feeling in the bowels, griping,cutting, twisting, with faint-like nausea; trembling, pale face,apprehensiveness; fluttering pulse; cramps in the pharynx ; he cannot swallow ; oesophageal stricture ; great weakness, etc. Both likewise crave brandy. The acid acts well when the patient is weak, emaciated, complains of trembling, but it is more subjective than objective. He is anxious and restless, must do everything hurriedly. The face is pale, and sometimes presents dry, shrivelled spots, especially when the haemorrhoids are worse. Eructations are sour. The stomach feels relaxed and cold. Wine may palliate and spirituous liquors aggravate, as in Lachesis. But the peculiarity of the acid is, that the stomach rejects cold water unless it is mixed with brandy. The abdominal muscles are spasmodi- cally retracted. Stools are yellow, like Lachesis, but present a chopped appearance, and are stringy. The watery diarrhoea is very offensive. Piles are moist, burn, and may prevent defecation. LACHESIS. 57 As the acid causes croupous formations, it should be remembered with Lachesis when the stools indicate such a condition in the intestine. The acid also resembles Elaps ; drinks chill the stomach. But only the former has the relief from the admixture of spirit. Colchicum deserves mention here, especially since, like Lachesis, it causes coldness or cold feeling in the stomach (Elaps), intolerance of pressure of clothing (in provings, but not confirmed), burning in stomach, vomiting and purging, spasms of sphincter ani, urging to stool, offensive flatus, offensive diarrhoea, sensitiveness to least touch, very much exhausted, slow breathing, feeble pulse. But there is gen- erally present nausea, worse from the smell of food ; if the patient sits or lies very quietly, the vomiting is suppressed (like Veratrum). Senses too acute; a bright light, touch, or strong odors irritate him (likeNux vom.). Vomiting and purging as in cholera morbus; the sphincter ani contracts after each stool, with fruitless urging. The similarity, then, exists chiefly in the sensitiveness to touch and constrictions of sphinc- ters with weakness, other symptoms being so different as to render a choice easy. (See also below.) In cholera, Lachesis has been employed when the vomiting was re- newed by the least motion, and the nausea was attended with a great flow of saliva. As Colchicum has precisely the same symptoms, other indications must decide. In reflex irritation, as Convulsions, with variegated, slimy stools in teething children, and rolling of the head, Colchicum resembles Podo- phyllum. Belladonna, Lachesis, Rhus tox., and Baptisia constitute a group serviceable in peritonitis, enteritis, etc. Belladonna differs from all in the character of the inflammation. It is only when the affection becomes asthenic that the others are needed. Lachesis follows Belladonna when, especially in children with inflam- matory diarrhoea, constipation suddenly sets in with abdominal swell- ing and tenderness, particularly at one spot; or, if suppuration ensues and Mercurius fails; or, again, if gangrene threatens. Rhus tox. requires drowsiness, the fever remaining high or increas- ing; restlessness; tongue dry, parched, brown, with red triangular tip; diarrhoea slimy, watery or putrid, yellowish-brown and bloody, involuntary during sleep; generally it is accompanied with tearing down the thighs, while Lachesis has painful stiffness from loins into thighs. In typhlitis, in which affection either may follow Belladonna, 5 58 A CLINICAL MATERIA MEDICA. Rhus tox. has relief from pressing the swelling gently from below upwards; Lachesis, intolerance of touch. In periproctitis, Rhus tox. may be needed if the inflammation is of traumatic origin ; Lachesis, if an abscess forms and fails to point, the suVrounding tissues present a purplish hue. Colchicum compares with Lachesis when the prostration is extreme, with coma, hot abdomen and cold extremities; thready pulse; if raised, the head falls back and the jaw drops ; the face is hippocratic, the tongue is protruded with difficulty, and the bowels move involuntarily. But the tympany is more marked in the former; and the stools contain white flakes or shreds; the tongue is either thickly coated brown, or it is bright red, except at the root, where it is coated. According to provings and cases of poisoning, Colchicum does not cause sensitive abdomen below the epigastrium. Arnica deyelops a profound stupor, with blowing respiration, dry tongue, brown down the middle, distended abdomen, and involuntary faeces and urine. It may be distinguished by the ecchymoses, and the bruised aching, inducing restlessness, which latter is relieved if the patient's clothing is smoothed down and his position changed. Among the remedies causing constriction of the anus, the following are worthy of notice : Bellad., Caustic, Nitric ac, Nat. mur., Ignat., Kali bich., Opium, Plumbum, Mezereum, Coccul. The first has : pressing and urging toward anus and genitals, alter- nating with contractions of the anus; spasmodic constriction of anus as in dysentery. The second, Causticum, causes fruitless urging to stool, with anxiety and red face. Nitric acid causes sticking in the rectum, as from a splinter; the constriction occurs during stool and lasts for hours afterwards ; the rectum feels as if torn. Natrum mur. has sensation of contraction in the rectum during stool, the faeces tear the anus; frequent ineffectual urging; spasmodic con- striction of the anus. Ignatia induces a proctalgia; contraction, with cutting, shooting pains ; contraction of anus worse after stool. Symptoms are incon- sistent, irregular, fitful, as in hysteria. Kali bich. has sensation of a plug, similar to Lachesis; diarrhoea, of a brown, frothy water, spurting out in the early morning and followed by tenesmus ani. LACHESIS. 59 Opium, anus is spasmodically closed during the colic, with obstinate constipation. Plumbum is very similar. But all these are readily distinguished by the characteristic symptoms of Lachesis : Tormenting urging in the rectum, but on account of con- striction of the anus it becomes so painful he must desist; protruded piles, with constricted anus. Much nearer, and indeed almost identical here, is Mezereum; after the stool, the anus is constricted around the protruded rectum. In other respects, however, the two remedies are widely different. Kali bichromicum must also be remembered as a relative of Lachesis in dysentery. Both have red, cracked, smooth tongue; blackish stools ; hence in severe or typhoid cases and further, they follow each other well. The offensive odor of the discharges distinguishes the latter; the jelly-like mucus, sometimes stringy, the former. A peculiar feature of Cocculus is tenesmus recti after stool, with faintness, and yet peristalsis is lessened. (Compare Ignatia.) So characteristic is this offensiveness of the faecal movements in La- chesis that it becomes highly indicative of the drug in low forms of disease. You may confidently give Lachesis when this sort of stool exists. The rectum and anus are affected so that there is constant tormenting urging in the rectum, but not for stool. It is merely a spasmodic condition of the bowels with an unduly irritable sphincter. Another symptom is, the patient is desirous of straining at stool, but cannot do it for pain in the sphincter ani; the rectum protrudes and is held by the constricted sphincter; after stool there is often a sensation in the rectum as from the beating of little hammers. These symptoms are common enough in dyspeptics, particularly in those who have abused alcohol. In peritonitis, Lachesis is indicated late when the fever still continues and is worse after 1 p.m. and at night. The slightest touch to the sur- face of the body is intolerable. Typhoid symptoms complicate the case. It may even be indicated when there is typhlitis after the formation of pus. It follows, particularly, Belladonna, Bryonia or Mercurius corrosivus. It is also similar to Rhus tox., but it has more typhoid symptoms than has that remedy, and so comes in later in the case. LECTUKE V. THE OPHIDIA. Lachesis (continued). Lachesis causes in the male an increased lasciviousness with dimi- nution of the physical powers. The mind is a prey to all sorts of allurements, but erections and emissions are imperfect. Upon the female organs, Lachesis acts very powerfully. It seems to have special affinity for the ovaries, particularly the left ovary; ovaritis, ovaralgia, tumor, may be relieved when there are tenderness to pressure of the clothing and other characteristic symptoms of the drug. Menses scanty, feeble, blood lumpy, black, and very offensive; pains in the hips, bearing down in the left ovary,—all better when the flow is established. The uterus is intolerant of the least pressure. Lachesis may be used in puerperal metritis, especially when the lochial discharge is foetid. The face is purple and the patient uncon- scious. It may even be indicated in ovarian tumors when the disease shows a tendency to extend from left to right, even when suppuration has taken place. It is especially called for after Hepar or Mercurius when there is great adynamia. In syphilis, Lachesis is called for as an antidote to Mercury or when the chancre becomes gangrenous. Its characteristics are its peculiar sore throat, the blue surroundings of the ulcers, nightly bone-pains, violent headache, and the phagedenic chancre. The syphilitic ulcers on the legs are flat and have blue surround- ings ; caries of the tibia; the parts are sensitive and livid ; ulcers in the throat; bone-pains at night; all after abuse of Mercury. The bluish ulcers ally it with : Hejxtr, Asafoetida, Lycopod., Silicea, Arsenic. The pimples, blisters, or pustules surrounding the ulcers ally it with : Arsenic, Phosphorus, Lycopodium, Mercurius, LTepar, Silicea, etc. The burning in the areola with : Arsenic, Lycopodium, Mercurius, Silicea. The offensive pus with : Arsenic, Asafoetida, Lyco- podium, Silicea, Sulphur, Hepar. The ulcers, being flat, with : Arsenic, Asafoetida, Lycopodium, Mercurius, Silicea, Phospjhoric Acid, etc. If LACHESIS. 61 they become black or gangrenous, with : Arsenic, Secalec, Silicea, Plum- bum, Carbo veg., Euphorbia, Muriatic acid. But Lachesis has the burning most marked when the ulcer is touched. The surrounding skin is mottled. Ulcers on the legs tend to spread superficially (rather than deeply, as, for example, in Kali bich.), the discharge is scanty, and the strength is failing. Dark blisters surround the ulcers and the skin around is dead. Sometimes the discharge ceases, the patient is stupid, cold, the leg becomes cedematous, and a bluish-red swelling along the course of the veins shows that phlebitis exists. All this looks like Arsenic, Carbo veg., Bufo, Secale c, Cinchona, etc. But Arsenic presents more vascular excitement and nervous irritability with the prostration. Carbo veg. induces still greater prostration than Lachesis, cold sweat, cool breath, collapse. The ulcer has a cadaverous odor. In mild cases there is no resemblance at all between the two; for the Carbo veg. causes much burning, rawness in the folds of the skin ; bor- ders of ulcer hard, but not oversensitive, as in Lachesis. Hepar should be remembered as a concordant of Lachesis, and espe- cially because it is so useful after abuse of mercurials. The areola of the ulcer is very sensitive, but there is a sore, bruised feeling, along with hyperaesthesia. And although the suppurating part may turn bluish, and the patient experience weakness, yet there are no evidences of loss of vitality and gangrene, such as suggest the later indicated drug, Lachesis. Lycopodium is a complement of the snake-poison. If syphilitic ulcers appear in the throat, they are dark grayish-yellow, worse on the right side. The forehead exhibits a coppery eruption and the face is sallow, often furrowed, but lacks the small red bloodvessels Avhich shine through the yellow skin, in Lachesis. Chancres are indolent. Condylomata are pediculated. Ulcers on the legs refuse to heal, with tearing burning, worse at night; they are made worse by poultices or by any attempt to dress them. The pus is often golden-yellow. Flatulent dyspepsia. Nitric acid, should it seem similar in phagedenic chancre, ulcers on the tibia, etc., may easily be distinguished by the irregular edges of the ulcer, which also presents exuberant, easily-bleeding granulations; and its mouth and throat symptoms, by the cracks of the commissures of the lips, sensation of a splinter in the throat, etc. Kali iodatum exhibits quite a different train of symptoms from La- chesis: Gnawing, boring bone-pains; throbbing and burning in nasal and frontal bones; greenish-yellow, excoriating ozaena; papules ulcer- 62 A CLINICAL MATERIA MEDICA. ating and leaving scars; rupia; chancres with hard edges and curdy pus; ulcers deep-eating; violent headache, much more severe than in the snake-poison, and causing hard lumps on the head. Tendency to interstitial infiltration of soft tissues and also of bones, thus more ex- tended than with Lachesis, which infiltrates only the soft tissues. In the uterine and ovarian symptoms of Lachesis, your attention is directed to the following comparisons : Platina has profuse, dark menses, instead of scanty ; and the hauteur is much more pronounced. The nymphomania is accompanied with titillation and tingling of the genitals or with vaginismus. In ovarian affections this drug has relieved after Lachesis failed ; as in suppuration of the ovary, the pus having been evacuated under the action of the latter. The pains are burning, with violent bearing down. Palladium has relieved induration and swelling of the right ovary, as has Lachesis. Mentally the two are widely different. The former develops an egotism which manifests itself in the patient's concern for the good opinion of others; consequently her pride is often injured. Mental emotions aggravate the ovarian pains, as in the snake-poison, but in a different way. The Lachesis patient is ecstatic or at least ex- citable; the relating of stories moves her to tears. The Palladium patient is easily agitated in society; a lively conversation or some evening entertainment increases her pains and tries her mentally and bodily. In ovarian affections, Apis stands closely allied to Lachesis. But it acts more on the right ovary than on the left. There is a bruised, sore feeling, or stinging, burning. At other times the pains are described as lancinating. In prolapsus uteri or during the menses, the bearing down seems to be in the right ovary; pains followed by a scanty dark mucus. Both have pains from left to right ovary ; but in Apis this is ex- perienced while stretching. There is also a strained feelino- in the ovarian region, very characteristic. The pains may ascend in either; but in Apis they are in the right ovary, with pain also in the left pec- toral region, and cough. Mentally there is considerable similarity. (See Mind.) Both have jealousy, with talkativeness and increased sexual desire; restlessness, with bustling manners. Arsenic affects the ovaries and uterus, and has metrorrhagia of dark blood; increased sexual desire. But this powerful agent affects more the right ovary, with marked burning, tensive pains and restlessness LACHESIS. 63 which is somewhat relieved by constantly moving the feet; menstrual colic, better from warm applications. Lycopodium reverses the Lachesis direction of pains, shooting from right to left. Its gastro-enteric symptoms are also always present. Graphites also affects more the left ovary, and also relieves when pains in the right ovarian region are followed by a discharge from the vagina, but constitutionally this drug and Lachesis differ. A marked symptom of Lachesis is the relief of pain when the blood flows. Compare: 3Ioschus, drawing, pulling at beginning of menses, ceasing with the menstrual flow. Zincum, relief of boring in left ovary (just like Lachesis). Platina and Ammonium carb. have pains continue with the flow; the former even with a profuse discharge; the latter with flow between pains. Now, the heart, circulation and fevers. Lachesis, as I have already intimated, affects the circulation markedly; it causes flushing of heat, as at the climaxis, rush of blood headward, with coolness of the feet, palpitation of the heart, with feeling of constriction about the heart as if tightly held in cords. These latter symptoms, with the oppressions of the chest, the dyspnoea on awakening, inability to lie down, have led to the use of Lachesis in hydrothorax and hydropericardium when dependent on organic disease of the heart. Lachesis is indicated in general dropsy when the urine is dark, almost blackish, and contains albumen, and the skin over the cedematous parts is dark bluish-black. I remember a man, sixty years of age, who had just this sort of dropsy, and continued to live for six months under the action of Lachesis, and whose death, when it came, was painless. It is especially useful in the ascites after scarlatina and the ascites of drunk- ards when the above symptoms are present. In renal and vesical affections, Lachesis is to be selected more by the general than by the local symptoms. For instance, in albuminuria or morbus Brightii, the respiratory symptoms, aggravation after sleep, and blue surface are more characteristic than the urinary symptoms. In cystitis the drug is indicated when the offensive mucus introduces the universal characteristic of tendency to putrescence. And the more this off'ensiveness of the urine is disproportionately intense, when compared with the time of the vesical retention of the mucus, the more likely is Lachesis the remedy. In haematuria, the drug, like its powerful rival Crotalus, is called for when the symptoms occur as an evidence of blood degeneration, as in 64 A CLINICAL MATERIA MEDICA. low fevers; hence there is the characteristic deposit of disintegrated blood-cells, of fibrin, etc., presenting the appearance of charred straw. In albuminuria after scarlatina, there is dropsy from delayed desquama- tion, and the urine is black or contains black spots. This spotted ap- pearance is precisely like Helleborus. Other remedies causing black urine are Colchicum, Natrum mur., Carbolic acid and Digitalis. Apis, Ammonium benz., Arsenicum, Benzoic acid, Arnica, Opium, Carbo veg., Kali carb. and Terebinthina produce dark turbid urine. Only Lachesis, however, has the foaming urine and the general characteristics already referred to. Helleborus is to be distinguished by the sensorial apathy, muscular weakness, pale puffed face, and jelly-like mucous diarrhoea which accompany its dropsy. The patient may breathe better when lying down, which is the converse of Lachesis and Arsenicum. Digitalis, with blackish, scanty turbid urine, faintness from weak heart, with bluish face, looks very much like Lachesis here. In the latter, there is more laryngeal constriction, as well as oppression and constriction of the chest; in the former, the suffocative constriction is as if the internal parts of the chest had grown together. Digitalis has also sinking or faintness at the stomach, as if life was becoming ex- tinct. Terebinthina has urine smoky and turbid, depositing a sediment like coffee-grounds. It is often indicated in dropsy after scarlatina. The sediment contains disintegrated blood corpuscles; haematuria. Dyspnoea; the patient must be propped up in bed. There is great drowsiness. The tongue is dry and glossy. Clinically, Terebinthina has proved useful in the early stages of renal disease, when congestion predomi- nates ; that is, before renal casts appear in any great quantity. It causes more intense burningand pain in the back than Lachesis, and the urine may have a violet odor, in typhoid fevers, both renal and alvine dis- charges resemble those of Lachesis. Foetid stools, haemorrhages from the bowels, caused oy ulceration ; the blood is dark, sooty, and looks like coffee-grounds. Foetid urine; disintegrated blood in the urine. In addition, Terebinthina causes stupor, dry, smooth, glossy tongue and great weakness. But it is distinguished by a preponderance of tympanites, with burning, which is accompanied with a smoothing of the tongue, as if it had lost its papillae. Apis simulates Lachesis in post-scarlatinal dropsy; for both reme- dies have albuminuria, scanty urine, which is dark from decomposed blood, and dyspnoea. But Apis usually requires thirstlessness, pale LACHESIS. 65 waxen skin and an eruption here or there resembling nettle-rash, red pimples or an erysipelatous rosy appearance of the anasarcous limbs. In cases of renal disease the urine may be scanty and albuminous with- out blood, the remedy being required on account of its well-defined heart symptoms, or its mental restlessness, etc. Thus far it needs no differentiation here. But if the urine is dark, turbid, blood-mixed, depositing a coffee-like sediment, if there is orthopncea with cold legs, bronchial catarrh, great difficulty in breathing until phlegm is raised, spasmodic constriction of the larynx, the choice may demand further comparison. Arsenicum cures when the urine looks like dark dung- water, renal casts are abundant. The dyspnoea is noticed more when the patient attempts to lie down in the evening and again arousing him after 12 p.m. ; it is relieved by the expectoration of mucus. In Lachesis the dyspnoea is worse when, after lying down, he drops off to sleep; relief follows the hawking loose or coughing up of a small amount of thick adherent mucus, and there is far more annoyance from the con- tact of the clothing than there is with Arsenicum. In the latter, the clothing is torn loose lest its pressure smother the patient; in the former, there is added a cutaneous hyperaesthesia. Colchicum causes an intense congestion of the mucous membrane of the stomach and bowels, and also of the kidneys. The urine is dark, turbid, bloody and as black as ink, containing albumen. Dropsy. But it is readily distinguished from Lachesis by the prominence of the irri- tation of the sphincter vesicae with tenesmus of the bladder after urina- tion. It is especially indicated in gouty patients, who at the same time suffer from a nervous weakness, which is combined with hyper-sensi- tiveness. If this latter symptom seems to resemble Lachesis, we may readily distinguish by the general effects of Colchicum ; oversensitive- ness to touch (except perhaps the tympanitic abdomen), senses too acute, especially over-affected by strong odors; gastric symptoms are promi- nent; mental labor fatigues, causing inability to fix the thoughts or to think connectedly; headache, skin of scalp feels tense; coated tongue, nausea; great weakness, yet easily irritated by external impressions. A peculiarity of Colchicum is that if there are copious salivation and urinary secretion, the stools are scanty and attended with tenesmus, and vice versa. I need not dwell upon the fevers of Lachesis, because I mentioned them in speaking of the mental symptoms of the drug. I may, however, speak of the intermittent fever, it being indicated in cases which recur in the spring time in spite of the use of quinine in the fall. The chill 66 A CLINICAL MATERIA MEDICA. comes on at one or two o'clock in the afternoon; during the chill, and here is a symptom which is characteristic, the patient feels that he must have clothing piled on him, not so much to keep him warm as to keep him still. (Desire to be held is also under Gelsemium). The fever is characterized by burning pungency, by the oppression of -the chest and the heart, and by the associated drowsiness or loquacity. Carbo veg., like Lachesis, has annual return of the paroxysms, loquacity during hot stage, thirstlessness during the fever, oppressed breathing. The patient is very weak from protracted disease and abuse of quinine. But the thirst is most during, not before the chill; the chill is often accompanied with cold breath, coldness of the knees, even when wrapped up in bed. Flushes of burning heat in the eve- ning attacks, without thirst. Flatulency. One-sided chills, left side generally. Collapse more marked. Capsicum agrees in : thirst before chill; desires warmth ; chill begins in the back; irregular, intermittent pulse. But with the red pepper the chill commences in the back, and spreads thence; the thirst con- tinues into the chill, and drinking aggravates (see Elaps). The patient is relieved by hot applications, as by jugs of hot water to the back. Menyanihes is preferable when the disease manifests itself as cold- ness of the tip of the nose, ear-lobes, and tips of fingers and toes. Feet to knees icy cold. Hands and feet icy cold, rest of the body warm. When Lachesis is called for in such irregular cases, with cold nose, etc., the livid skin and great weakness, as shown by the filiform pulse, are sufficiently distinctive. Agreeing more accurately are the following, all of which produce weak or thready pulse, coldness or blueness of the skin, and of course, the greatest prostration : Carbo veg. (see above). Veratrum album; but the chill is associated with thirst; and (if internal) runs downward, not upward. Skin blue, cold, inelastic; hands blue; face, mouth and tongue cold; breathing oppressed and labored; heart weak. Heat has no palliative effect; cold, clammy sweat, worse on the forehead. Arsenic, external heat relieves; mouth and tongue cold ; face blue; single parts of the surface blue. Anxious restlessness despite the great debility; cold, clammy sweat. Suffocative attacks of breathing. Camphor, icy-cold surface, but hot internally, so he throws off the clothing; face deathly pale; limbs blue; generally hot breath. Spasms; or, if conscious, voice altered. Sopor follows. Hydrocyanic acid, marble coldness of the whole body. Pulse feeble LACHESIS. 67 or imperceptible. Long-lasting faints. Drinks roll audibly down the oesophagus. Clutches at the heart as if in distress. Spasms, especially muscles of back and jaw are stiff. Helleborus, muscles relaxed ; suddenly he falls, with coldness, cold sweat on the forehead; slow pulse. Horrible convulsions, with ex- treme coldness. Rheumatic pains in the knees. Digitalis, like the snake-poison, weakens the heart. The skin is very cold. Copious sweat, but heart symptoms are not relieved. Pulse intermits every 3d, 5th, or 7th beat; very slow pulse. It will be remembered that Lachesis has oppression of the chest, with cold feet. As the latter becomes warmer, the oppression lessens. Secale c, cold surface; sunken, pale face and blue lips. Will not be covered. Tingling in the limbs; holds the hands with the fingers widely spread apart. Cold, clammy sweat. Speech feeble, stuttering. Hyoscyamus resembles Lachesis in chill up the back, objective cold- ness of the body, convulsions, delirium, But the chill is worse at night, and spreads from the feet to the spine, and thence to neck. The lowering of the temperature is accompanied with slow arterial action, drowsiness, or with delirious and excited talk, picks at the bed-cloth- ing, fears being poisoned, hallucinations, fibrillary twitchings, etc. Lachnanthes, like Lachesis, causes glistening eyes during the chill, icy coldness of the body, relieved by warmth. But only the former has brilliant eyes, circumscribed red cheeks, with the fever and delirium. Lycopodium follows Lachesis. It is needed in fevers when the patient becomes drowsy or stupid; coldness, as if lying on ice. One foot warm, the other cold—an important symptom. Feels as if the blood ceases to circulate. In intermittent fever the chill begins in the back, as in Lachesis. It is worse from 4 to 8 p.m., or at 7 p.m. ; hands and feet numb and icy cold. Sour eructations or vomit are almost invariably present, especially between chill and heat. Thirst mostly after the sweat. Desires only hot drinks. Apis here, as in many other instances, favors the snake-poison. Both are suited to old or to maltreated cases; afternoon chill, oppres- sion of the chest, nose cold, pulse fluttering, skin of hands and arms blue, and general appearance of collapse. But the bee-poison has aggravation from heat, Lachesis not; the former has much more marked the oppression of the chest, with consequent smothering. The tongue is red, raw, and covered on tip and borders with vesicles. Thirst during and not before chill. Urticaria. 68 A CLINICAL MATERIA MEDICA. Cuprum combines coldness with convulsive phenomena. Icy cold- ness of the whole body. Severe cramps in the extremities, with cold sweat, blue surface; also collapse. Urine suppressed. Employed successfully in the cold stage of cholera, after Camphor; but also use- ful in other forms of collapse. For instance, it has antidoted snake- bite, with cramps, delirium, and finally torpor. Lachesis may also be indicated in scarlet fever, but not in the Syden- ham variety of the disease, but in those forms which have a malignant tendency. The child is drowsy and falls readily into a heavy sleep. The rash comes out very imperfectly or very slowly, and has a dark purple hue. It maybe interspersed with a miliary rash. It is apt to be complicated with a membranous deposit in the throat having the character I have already described to you when speaking of the remedy in diphtheria. The cellular tissue of the throat is inflamed, and threatens suppuration. The cervical glands are swollen. On looking into the throat, you find it to be dark red with a dirty white deposit on the tonsils, especially the left. The tongue is coated dirty yellow at the base, and the red papillae show prominently through this coat- ing. The pulse is weak and the surface of the body cool. There is apt to be dark blood oozing from the mouth and nose. The majority of physicians make a mistake in beginning their treatment of scarlatina. A mistake in the beginning means one of two things, a long, tedious illness, or a short one ending with death. The mistake made is to give Belladonna in every case. Let us look for a moment at the differences between Belladonna and Lachesis. Both remedies have the strawberry tongue, the throbbing headache, the red face and the high fever. Belladonua is only indicated in the sthenic type when there is an active delirium. The throat is bright red in color. The pulse is full and bounding. The rash is bright red and smooth. The general symptoms of Lachesis have been so far included in what has been said that they need not be dwelt upon. In carbuncle and in cancer, however, we think of it when the surface is swollen around the carbuncle, and pus forms very slowly. Lachesis, given under these circumstances, increases the quantity and improves the quality of the pus. The patient's strength will improve greatly. In malignant pustule, Lachesis may be used, but you should accom- pany the remedy with brandy. That is an experience of Dr. Dunham. I will next say a few words respecting the modalities of Lachesis. Modalities, as you know, express the mode or manner by which syrnp- LACHESIS. 69 toms are qualified. They are therefore important in the study of drugs and especially in differentiating allied remedies. Two medicines, for instance, may induce supraorbital pains of a shooting character. But if one has the pains modified by pressure, the other by sleep, we are thus enabled to distinguish them in practice. Modalities then qualify symptoms, and are as essential as adjectives to nouns. Care must be exercised, however, that they be not substituted for the symptoms they modify. Too often we see cases reported, the only homoeopathic resem- blance between which and the remedy selected is a mere modality, as, for instance, worse after sleep. The modalities of Lachesis, then, are as follows: Worse.—During sleep, especially the throat symptoms, choking, which arouses him ; worse after sleep, especially in the morning. Time of Day.—Generally worse from noon until 12 p.m. Still there are some prominent symptoms aggravated in the morning and forenoon. This is partly owing to the bad effects of awaking, though as some symptoms appear later in the morning, we may ascribe them to causes then at work. For instance, the patient has vertigo on awaking, yet this returns, on closing the eyes, at 11 a.m. Headache in the left frontal eminence in the morning. Weakness in the morning on rising. Finger tips numb. On sitting up quickly in the morning, breathing becomes slow, difficult and whistling. In the evening and before 12 p.m., we find the following especial exacerbations : Throat sensitive; craves oysters; diarrhoea; dry, hack- ing cough. Chill beginning some time between noon and 2 p.m., but fever is marked evening and night; worse before 12 p.m. Temperature, Weather, etc.—Worse in the cold air, from change of temperature and in the warmth of the bed (see below under Motion, etc.). Worse from getting wet, wet weather, windy weather. Worse before a thunderstorm. Worse from sun. Worse in the spring. Better often from warmth, wrapping up, near the stove, etc. Excessively cold or excessively warm weather causes debility. Motion, Rest, Position, etc.—Worse on and after rising from bed ; worse while sitting and better after rising from a seat; better lying in bed on the painless side, but worse from warmth of bed (see above under Temperature) and from lying on the painful side. Some symp- toms are better from moving, but not if continued long. Touch, Pressure, Jnjuries, etc.—Almost invariably worse from touch, however slight. Useful for the bad effects of injuries, as penetrating wounds, with much haemorrhage or gangrene. LECTURE VI. ARACHNIDA. Of the Arachnida or spider poisons used in medicine, I shall call your attention to the following: 1. Mygale lasiodora. 2. Lycosa tarentula. 3. Tarentula Cubensis. 4. Aranea diadema. 5. Aranea scinencia. 6. Theridion curassavicum. The action of the drugs in this group is a two-fold one; they all poison the blood, and they all act prominently on the nervous system, producing spasmodic diseases, as chorea and hysteria. Among other nervous symptoms produced by them are anxiety, trembling, great rest- lessness, oversensitiveness and nervous prostration. Most of the spider poisons develop a constitutional state or dyscrasia, rendering them useful in chronic and deep-seated diseases. Taking up the study of these drugs seriatim, we come first to the Mygale Lasiodora. The Mygcde lasiodora is a large black spider, native in the island of Cuba. It was first proyed by Dr. Houard, of this city. It is one of our best remedies for uncomplicated cases of chorea. The patient is apt to be low-spirited and depressed. She complains of dull pain in the forehead. She has constant twitching of the muscles of the face. The head is often jerked to one side, usually to the right. There are also twitchings and jerkings of the muscles of one arm and leg, usually the right. Control over the muscles is lost. The patient attempts to put the hand up to the head, when the hand is violently jerked backward. An effort to talk is made, and words are jerked out. I can recall one case of chorea in which, under the use of this remedy, the convulsive symptoms were speedily removed, and the patient, a little girl, remained well for several years. Dr. J. G. Houard, to whom I just referred as having proved this drug, has given me the following symptoms indicating its use: The muscles of the face twitch, the mouth ARACHNIDA. 71 and eyes open and close in rapid succession ; cannot put the hand to the face; it is arrested midway and jerked down. Gait unsteady; legs in motion while sitting, and dragged while attempting to walk; constant motion of the whole body The most similar remedy to Mygale in chorea is Agaricus* which also has these angular choreic movements. But as a distinctive symp- tom, we have itching of the eyelids or of different parts of the body, as if they had been frost-bitten. The eyelids are in constant motion. The spine is sensitive to touch. Cimicifuga racemosa is to be employed in chorea when the move- ments affect mostly the left side and when the disease is associated with myalgia or rheumatic ailments, or occurs reflexly as a result of uterine displacements. Tarentula\s indicated in chorea affecting the right arm and right leg. The movements exist even at night. Ignatia is called for in chorea of emotional origin. Zizia may be used in cases in which the choreic movements continue during sleep. The Stramonium chorea is characterized by the following symptoms: Features continually changing; now he laughs and now appears astonished; tongue protruded rapidly ; head thrown alternately back- wards and forwards; spasmodic twisting of the spine and whole body ; the extremities are in constant motion, though not always jerked, for sometimes their motion is rotatory, gyratory, even graceful. The muscles of the whole body are in constant motion. There may even be stammering. If the mind is affected, the patient is easily frightened ; he awakes from sleep as if terrified; or he often assumes an attitude of prayer, with fervent expression and clasped hands. He frequently lifts the head from the pillow. Returning now to Mygale, I give you the following symptoms addi- tional to those already described that have been produced by the drug: Delirious talk about business; restlessness all night; fear of death ; despondency, with anxious expression ; nausea, with strong palpitation of the heart, dimness of sight, general weakness; tremulousness of the * By a very ingenious selection of Agaricus, by Dr. Korndoerfer, in the case of a two-year old child, who had evident meningitis, and who was not relieved by Apis, Sulph., etc., the rolling of the head ceased, alarming forewarnings of imbecility happily vanished, and the patient fully recovered. I used the drug in a case of typhoid, in which the child rolled her head and bit her night-gown. Some improvement followed. Tarentula was then given, with slight aggravation, followed by lasting improvement. The two should be remembered in impending imbecility. E. A. F. 72 A CLINICAL MATERIA MEDICA. whole body in the evening ; severe chill, thirty minutes, then fever, with trembling; pain in the head in the morning, worse in the eyes and from temple to temple. There is a very novel use that may be made of Mygale. This remedy, after having been given to a boy for some time, produced, during the spasmodic symptoms, violent erections of the penis. Unfortunately, the penis, when erect, was curved, not straight, and consequently the patient suffered great pain. Dr. Williamson, by whom this observa- tion was made, was then led to the use of the remedy in chordee with success. He used it in a low potency. It has since been used high with equal success. Lycosa Tarentuia. In poisoning by the bite of the Tarentula, the symptoms are strik- ingly similar to those of the Ophidia. The bitten part becomes swollen and discolored, the lymphatic glands are enlarged. By convey- ance of the poison to the neck, the cellular tissue there is affected, giving rise to a swelling of a dark red or purplish hue. Choking seems imminent when epistaxis, with discharge of dark clots, appears and relieves the symptoms. Evidence of cerebral congestion is given by the violently throbbing carotid arteries. But with all these symp- toms there is a pale, earthy hue to the face. The fauces appear swollen and purplish, and there is a difficulty of swallowing which is of a para- lytic origin. The patient has burning thirst for large draughts of water. The stools are dark and foetid, and the urine scanty and voided with difficulty. Thus far, there is but little to aid us in distinguishing the condition from a Lachesis case. But there are added other symptoms, nervous phenomena which typify the drug. Nervous symptoms are present in all the spider poisons, but Tarentula applies, more than other members of the group, to hysteria. There is marked spinal irri- tation, and what I have found to be very characteristic is great excita- bility of the terminations of the nerves. The patient keeps the hands in constant motion, trying to work off this over-excitability. The playing of a lively piece of music excites her, and starts her to acting like one crazy. When there are no observers, she has no hysterical attacks. As soon as attention is directed to her, she begins to twitch, etc. When she has headache, it is better from boring the head into the pillow. Rubbing seems to relieve. Tarentula seems to act on the uterus and ovaries. It is palliative in enlargement of these organs. There is pain in the uterine region, asso- ARACHNIDA. 73 ciated with constrictive headache. There is also burning pain in the h vpogastrium and hips, with sensation as of a great weight in the pelvis. The menses are profuse, and are followed by pruritus vulvae. The patient feels sore and bruised all over, particularly when moving about. She longs for sleep, but is so nervous that she cannot sleep. Now let us study for a moment the concordant remedies of Tarentula; and first Kali bromatum. We have no remedy in the materia medica which has so many reflex symptoms as Kali bromatum. Any little irri- tation, such as dentition or indigestion in children, may bring on convulsions. The symptom, however, to which I wish to attract par- ticular attention is peripheral irritation, with relief from motion or using the part affected. Crocus deserves mention because of the hysterical state it is capable of exciting, together with choreic symptoms. It causes jumping, dancing, laughing, desire to kiss everybody, contractions of single groups of muscles. She is angry, and then suddenly repents; or, angry and talkative, laughing alternately. As in Tarentula, music affects her. Hearing one sing, she begins involuntarily to join in ; but there is not the subsequent relief from music which is noticed in the spider-poison. Actea racemosa resembles the spiders in producing sleeplessness, restlessness, trembling and fear of death; and too, these evidences of nervousness are often, in the Actea, as in Tarentula, reflex from uterine affections. The former has : After going to bed, jerking, commencing on the side on which she is lying, compelling change of position, ner- vous shuddering and nervous chills. Mentally the two drugs differ. Actea causes nervousness; she feels as if the top of the head would fly off; delirium with jumping from subject to subject; sees strange objects; great apprehensiveness, as a concomitant of uterine irritation; pains darting into the eye-ball, through to the occiput. Feels grieved, troubled, with sighing; next clay, tremulous joy, mirth, and playfulness. This head symptom of Actea is not quite the same as that of Theridion, under which remedy, the patient's head feels as if she could lift it off. Hyoscyamus is useful in well-marked local jerkings and twitchings of sets of muscles. The patient is sleepless and nervous ; or sobs and cries in sleep. The head falls from side to side. Talkativeness; she laughs at everything in a silly manner. Stuttering. Mental excite- ment ; she is nervous, suspicious, troublesome, but not maniacal. Causticum bears some resemblance in causing restless moving at night; she can find no quiet position. Intolerable uneasiness in the limbs in the evening. Anxiety and timidity in the evening. Tremb- 6 74 A CLINICAL MATERIA MEDICA. ling. Uneasy at night; she awakes from a short sleep, anxious, scarcely allowing her to remain in one place ten minutes; she is obliged to turn her head involuntarily from one side to the other, until, exhausted, she falls asleep. During sleep, she has many motions with her arms and legs. She jerks, mostly the right side of the body. Convulsive motions of mouth and eyes, with sleeplessness and restlessness, after repelled eruptions. It is especially suited to rheumatic patients, or to those who also suffer from paretic affections, especially of one side of the face or of the tongue; the mouth, in consequence, is distorted. Belladonna produces a bodily inquietude, indicating it in chorea. The patient is obliged to move to and fro, especially to move the hands and feet; cannot stay long in any position. The predominant jerking is backwards, although this may alternate with a forward bending. There is a boring of the head in the pillow, not mere rubbing against the pillow, as in Tarentula. Belladonna also has constrictions, hyperes- thesia, mania, with laughing, dancing, wild crying, etc. But it is distin- guished by the intensity of its symptoms; there are violent congestions, throbbing of the carotids, wild look, dilated pupils and injected eyes. In hysterical states Ignatia, though agreeing in many respects with Tarentula, has a well-defined individuality of its own. The nervous system is over-impressionable, incoordinate in function and contradictory in action. The patient is extremely susceptible to emotional influences. Fear and grief affect her seriously; the least contradiction offends; she is readily chagrined, and so is often reduced to grief and tears by the slightest causes. Her mental states, however, are not usually exhibited in violence and rage. On the contrary, she nurses her troubles in seclu- sion and silence, and broods over them until they prey upon her whole system. She thus grows more and more nervous, and, at the same time, more and more weakened. The heart beats nervously, with variable pulse ; she frequently sighs heavily and deeply ; suffers from goneness at the stomach, with qualmishness and flat taste in the mouth; feeling of a lump in the throat, swelling sympathetically with the intensity of her mental disturbances. Sleeplessness or violent startings of the limbs. Grief, fright, disappointed love or some other similar causes, may develop hysterical or choreic paroxysms. The moods change with wonderful rapidity; now she laughs and jokes, when, quickly, she bursts into tears. Her manner becomes hurried, so that everything is performed hastily, and hence imperfectly and awkwardly. She is afflicted with intense headaches. These are characterized by a predominance of pres- sure; the pain goes to the eye, which feels as if pressed out; or, to ARACHNIDA. 75 the root of the nose; or again, it is confined to one small spot, like a nail pressing; hence the name, clavus hystericus. At the height of the paroxysm, she becomes restless and chilly, and often describes a peculiar perversion of vision ; she sees fiery zigzags when looking out of the line of vision (see Theridion). Finally, a profuse flow of color- less urine terminates the attack. While, then, both remedies induce sadness, indifference, profound melancholy and hysterical states, only Ignatia has the introverted state of mind ; only Tarentula, the cunning attempts to feign paroxysms and wild dancing. Platina should not be confounded with the spider-poisons here, because it develops a different form of hysteria. True, there are pres- ent deranged coordination of functions, anxiety, trembling, fear of death, which seems to the patient to be imminent; also alternation of depression with gayety and laughter; sexual excitement and convul- sions. But the patient assumes a hauteur, a self-exaltation, which is foreign to the other drugs considered. Her mental disturbances de- velop into a condition of self-esteem during which she looks disdain- fully down on all around her. Her paroxysms of laughter are not only loud and boisterous but ill-timed, coming on even under circumstances of a sad nature. The headaches are of constrictive character, as in Tarentula; but there is, in addition, a squeezing, cramplike pain, with numbness, and the pains gradually increase and as gradually decrease. Indurated uterus belongs to the symptoms of both. Palladium is readily distinguished by its unique mental phenomena. The patient is not haughty, but she is irritable, and is, unfortunately, given to strong and violent language. Music, society, or animated conversation excites her, and produces pains in the right ovary; the following day she feels correspondingly used up. Her egotism is dis- played in a fondness for the good opinion of others, hence she is con- tinually getting "slighted." The uterine symptoms are character- ized by a weakness, as if the womb were sinking; empty feeling in the groins, as if eviscerated. Moschus repeats the scolding of Palladium; but the patient keeps it up until her lips turn blue, her eyes stare, and she falls in a swoon to the floor. She suffers from sudden suffocation from closure of the glottis or cramp of the chest; palpitation. She also has faint spells, tremulousness of the whole body; coldness of the body, hysterical headache, with fainting spells, copious pale urine; fear of death, like Platina and Tarentula, but with pale face and fainting; she talks only 76 A CLINICAL MATERIA MEDICA. of approaching death. Vertigo, nausea, dim vision. Vertigo, objects turn in a circle. (Musk relieves when Theridion produces vertigo; worse when eyes were closed.) Headache, as from a weight pressing here or there on the head. An oft-observed symptom with the nervous is fidgetiness of the legs, at times preventing sleep. In addition to Tarentula, the following remedies may be studied in this relation. Zinc induces moving of the feet for hours after retiring, even con- tinuing in sleep. Asafoetida has several times relieved restlessness, as has also Ammo- nium carb.; Actea rac. has already been mentioned. Arsenic, so useful in stubborn cases of chorea, has the following: Uneasiness in the legs; has to change the position of his feet all the time, or to walk about for relief. Mephitis has relieved uneasiness in the legs, as if they would become insensible. Sticta pulmonaria has produced a sensation as though the legs were floating in the air. One prover became so lively, that she lay down on a lounge and began to kick, exclaiming that she felt as if she wanted to fly away. This excitability reminds us of the desire to jump which Tarentula causes. [Compare Stramonium, Agaricus, Cicuta, Natrum mur., which latter has: jumping high up, regardless of near objects. Hyoscyamus and Crocus.] Asarum induces a feeling as if the body was hovering in the air. It also causes shivering and coldness from any emotion. But it offers no essential similarities with Tarentula, though it does offer some slight resemblance to Theridion. For it so affects the nerves that, like the latter, noises become intolerable. Still the distinction is evident. Asarum is so sensitive, that on merely thinking of the scratching of silk, and, nervous-like, the patient is continually impelled to this thought, a thrill runs through her. Although I have tabulated several drugs as bearing symptomatic resemblance to the Spiders, only the following hold any intimate rela- tionship: Ignatia, Moschus, Actea rac, Agaricus, Stramonium, Belladonna, Magnesia Mur. (the latter in uterine cramps). Tarentula Cubensis. The Tarentula Cubensis, the hairy spider, causes a perfect picture of carbuncle even to the sloughing. It may be used effectually when ARACHNIDA. 77 there are great prostration and diarrhoea with intermitting fever of evening exacerbation. In relieving the atrocious pains accompanying this condition, it acts almost like magic. It should therefore be com- pared with Lachesis, Anthracinum, and Silicea. Aranea Diadema. Aranea was suggested by Grauvogl as one of the remedies for what he called the hydrogenoid constitution, this being a constitution which could not tolerate moisture. Under Aranea, all the symptoms are worse during damp weather or from dwelling in damp localities. Especially is this true with what we may call chronic intermittent fever for which Aranea is the remedy when the symptoms are aggravated during every change to clamp weather. The patient may feel very comfortable on a sunny day, but as soon as it becomes damp then he gets sick. During this aggravation he complains of chilliness, followed by little or no fever. The chill is apt to be typical, occurring at the same hour every other day, every week, or at some regular period. You find also that the spleen is enlarged and the patient is subject to haemorrhages. The patient may or may not have been previously treated with quinine. Cinchona and Chininum sulphuricum are both very similar to Aranea diadema in the periodical return of symptoms. They are both in- dicated in cases of swollen spleen, and of ague from living in damp places, etc. Cedron, of which it has been asserted that it will relieve the bite of the rattlesnake and modify hydrophobia, may also be regarded as an analogue of Aranea diadema and of the spider poisons generally. It is said to act best in nervous, excitable and even voluptuous patients, espe- cially females. The febrile and neuralgic symptoms return with clock- like regularity. It is used in ague contracted in warm countries, or in low, marshy lands, in which latter respect it offers some similarity to Aranea. But the former remedy has won favor mainly in hot climates, while the latter works well in chills contracted in cold and wet locali- ties. The chill predominates, heat being slight or wanting. In Cedron, on the contrary, there is congestion to the head, flying heat in the face alternating with chill, and dry heat, with full, quick pulse. Aranea also cures diarrhoea, and these patients are often troubled with this disorder. The stools are watery, and are associated with great rumbling in the bowels, as if considerable fermentation were going on within. The sleep is restless, and the patient, on awaking, has a symp- tom which is quite common to all medicines that affect the cerebro- 78 A CLINICAL MATERIA MEDICA. spinal nerves, and that is, some part of the body feels as if it were swollen. For example, on awaking from sleep, the arms or hands feel as if they were enormously large, far larger than natural. Aranea is useful in toothache, especially worse in damp weather, and also as soon as the patient gets into bed. Here it reminds you of Mercurius. There is a symptom of Aranea which I have not had the opportunity of observing in practice, and that is numbness of the parts supplied by the ulnar nerve. Aranea also attacks the bones. It is especially indicated in disease of the os calcis, when the patient complains of boring, digging pain in that bone. This may be due to a simple periostitis, or it may be asso- ciated with caries. Sometimes there is a sensation as if the bones felt like ice. This is purely subjective. Theridion Curassavicum. Theridion compares with the Tarentula, in headache, nervousness, hysteria. According to provings, there is a similar restless, busy state ; he desires to occupy himself, though he finds pleasure in nothing. But there is a strong distinctive characteristic in the sensitiveness to noise. This qualifies the vertigo, headache, and even the gastric ailments. Vertigo and nausea, worse when the eyes are closed, from motion and from noise. Every sound penetrates the teeth. Every penetrating sound and reverberation penetrates through the whole body. Head- ache worse if others walk over the floor. We have relieved most in- tense headache with the Theridion, when this hypersensitiveness was present, as well as nausea and aggravation from motion. The general accompaniments are true spider-effects: weakness, trembling, coldness and anxiety. Hysteria, too, has yielded to the Theridion; time passes too quickly; hilarity; talkativeness; feels as if her head did not belong to her, as if she could lift it off. Luminous vibrations before the eyes. Sensitive to light; if she looks into the light, dark vibrations are pro- duced; double vision. Faints after every exertion. Anxiety about the heart, with sharp pains through the left chest, or to the left shoulder. Bites the point of the tongue during sleep,—all with weak- ness, chilliness ; or easily excited, cold sweat. Nausea and vanishing of thoughts, greatly intensified by closing the eyes. Theridion is very similar to Spigelia, which has sharp neuralgic pains over the left eye. Under Spigelia, however, the pain comes up from the nape of the neck, and over the head, then settling over the ARACHNIDA. 79 left eye. The Spigelia sick headache is very apt to follow the sun, be- ginning in the morning, reaching its acme at noon, and gradually sub- siding at sunset. The antidote to Theridion when it causes this head- ache is Moschus. Another use you may make of Theridion is in the sea-sickness of nervous women. They shut their eyes to get rid of the motion of the vessel, and they grow deathly sick. The spine is very irritable. We have what is known as spinal irri- tation. Examination reveals great sensitiveness between the vertebrae. So great is this hypersesthesia that the patient sits sideways in a chair in order to avoid pressure of the back of the chair against the spine. A rather peculiar employment of Theridion, but one which I think I have had occasion to confirm, is its use in phthisis florida. It is claimed that the drug tends to stay and, in some cases, stop the fearful progress of this fatal affection. One symptom I know is good, violent stitches high up in the left chest through to the back. Dr. Baruch succeeded in removing this symptom with the Theridion after other physicians had utterly failed. Myrtus communis and Pix liquida vie with Theridion in pains in the upper left chest. The first has pain through to the shoulder-blade, a symptom which it often relieves even in consumptives. Pix selects a spot at the third left costal cartilage, where it joins with the rib. [If it fails, consult Anisum stellatum, which affects either side at the third rib.] Rales, through the lungs and muco-purulent sputum, are further symptoms of the tar. Dr. Baruch has also made use of Theridion in scrofulous diseases of bones, particularly after Sulphur, Calcarea, Lycopodium and the ordi- nary remedies have failed. I think that it may even cure ozsena with caries since it attacks the bones and so often removes the following: Discharge from the nose, yellowish or yellowish-green, thick and offensive. LECTURE VII. CANTHARIS. The remedy which I propose to bring before you for study to-day is Cantharis, the so-called Spanish fly. It is my purpose to speak of the more important symptoms produced by the drug, comparing it superficially with quite a number of others having effects similar to it. First of all, for sake of completeness, let me give you notes on two other drugs, the Lytta vittata and the Cantharis strygosa. The first of these is the potato-fly, not the potato-bug, the pharmacopceial name of which is Doryphora. The potato-fly acts much like Cantharis when applied to the skin. It produces first a dermatitis, which is soon followed by the formation of vesicles. The affected parts become red, almost ery- sipelatous in appearance. The vesicles finally rupture, leaving an ulcerated surface. Finally, death of the part may ensue. The Cantharis strygosa is a species of Cantharis, which infests the cotton plant. This, too, has vesication for its characteristic. There are other varieties of this Cantharis, among which are the C. cinerea, C. marginata, C. atrata, C. nuttalli and 3fylabis cichorii et Phalateria; these last two being imported from China. Cantharis or Spanish fly has long been used by allopaths as a counter- irritant ; when applied to any part of the surface of the body, it excites a violent inflammation. This inflammation begins, of course, with erythema, rapidly advancing to vesication. The blisters thus formed are filled with a yellowish-white serum. As the inflammation pro- gresses, they enlarge, and their contents assume a purulent character. Finally, death of the part ensues, presuming, of course, that the appli- cation is continued long enough. At other times, large blisters termed bullae may form. These are sometimes as large as a silver half-dollar. They are raised above the surface, and are filled with a fluid which is excoriating. This irritating property of Cantharis is the foundation- stone of the whole proving. The pains incident to this kind of inflam- mation are, of course, very severe. They are of a burning character. At times when the nerves seem to be implicated in the inflammatory process, there will be sharp lancinating pains along the course of the nerve. CANTHARIS. 81 Still, Cantharis is not the only drug that has these highly irritating effects when applied to the skin or taken internally. Thus from external use the following will, sooner or later, cause vesicles to develop on the skin: Varieties of Cantharis, Formica; varie- ties of Rhus, Anacardium orientate et occidentale; Ranunculous plants, as Clematis, Ranunculus bulb., Ranunculus sceleratus, Pulsatilla, Aconite, Caltha, He'leborus, Actea spic, Aracese, especially Arum mac, Arum tri., Paladium, Pix, Terebinthina, Thuja, Nuxjuglans, Chininum sulph. ; several species of plumbago; Allium sat; Euphorbious plants, particu- larly Croton tig., Hura, Euphorbia corol., Euphorbium offlc, Manci- nella, Sinapis, Piper nigrum, Capsicum, Mezereum, Thapsia garganica, Chloral, Cotula maruta, Drosera, Podophyllum, Chimaphila, Oleander, Chelidonium, Cochlearia arm., Veratrum album, Camphor, Picric acid, Ammonium causticum, Calcarea caustica, Sulphur, Sulphuric acid, Kali sulphide, Nitric acid, Arsenic preparations, Carbolic acid, Mer- cury, Cuprum arsenicosum, Antimonium tart, etc. Rhus tox. and Anacardium cause vesication, with much redness of the skin and infiltration. The latter adds loss of appetite and other gastric symptoms as essential concomitants. The former causes red skin and numerous vesicles, surrounded with a red rim from infiltra- tion. A well-defined advance-line of inflammation marks the progress of the disease. The predominant sensations are itching or tingling; while in Cantharis burning and smarting, as from salt, are leading sensations. The latter, in some cases, when topically employed, in- duces an eczematous eruption around the plaster, and in others the vesicated surface assumes a soft, pultaceous, almost gangrenous appear- ance ; but the skin is not the reddish-brown of Rhus. Croton tiglium gives rise to myriads of small, terribly itching vesi- cles on a red base. When the genitals are attacked, there is pain on urinating, and some of the blisters become large, others break, leaving a red, moist surface. The vesicles may develop into pustules, which finally break and form grayish crusts. Hura Brasiliensis, a near relative of the former, also produces red vesicles. Both of these remedies cause a tension of the skin, a hide- bound feeling, which is best confirmed in Croton; but Hura carries this feature into its vesication, for the blisters become so tense that, on opening, their serous contents fairly burst forth. A characteristic of this remedy is a sensation as of a splinter under the thumb-nails. The eruption prefers projecting portions of bone, as the skin over the malar bones. 82 A CLINICAL MATERIA MEDICA. Formica, locally applied, sets up inflammatory redness, with itching and burning, slight exudation and desquamation. The urine is albu- minous and bloody, and there is much urging to urinate. Clematis crispa is food for the Spanish fly. The Clematis erecta we know irritates the skin to the production of burning vesicles, which pustulate and discharge a yellowish corrosive ichor. Urine is dis- charged in drops, or intermittingly, from a narrowed urethra. Ranunculus bulbosus and Ranunculus sceleratus act similarly. In the former the vesicles may become blue-black, or they may discharge a secretion, which becomes horny. The latter raises blisters, which leave a raw surface with acrid discharge, and resembles Cantharis in pemphi- gus. In blueness, Ranunculus bulbosus rather resembles Lachesis; the latter causes deep-seated bluish blisters (which appear after scratch- ing). In horny crusts it resembles Antimonium crudum. The several species of Spurge have caused vesication. And the variety called Euphorbium officinarum has been employed in vesicular erysipelas; red cheeks, covered with yellow vesicles as large as peas (from an application of the juice); violent fever. Like the Hura, this plant and the Euphorbium cyparissias have an affinity for the malar region. Cantharis attacks the surface of the nose (like Graph.). Euphorbia peplus also attacks the nose, as well as cheeks. Mancinella is so irritating that even the water dropping on the skin from the leaves may raise blisters, but the accompanying erythema far exceeds that of Cantharis. It resembles the blush of scarlatina, and has been used in that disease. Thapsiagarganica, an umbelliferous plant, closely resembles Croton. It, however, causes more pustules, and these fill rapidly with pus. Mezereum develops numerous small vesicles, with intolerable itch- ing ; but the secretion quickly forms into thick, high scabs, from beneath which an acrid pus oozes. Capsicum, Camphor, Terebinthina, Pix and Piper nigrum vesicate very slowly. Several of them are used rather as rubefacients. The first may be distinguished by the fact that the blisters appear on sur- faces which have been wet with sweat, and the sensation is a pungent burning, while in the fly it is a smarting burning, as from salt. Camphor, topically, causes an erysipelatous dermatitis, with bright redness, and, eventually, blisters (from concentrated solution). We generally think of it when there has been a retrocession of skin disease, with its well-known symptoms of collapse and convulsions. Pix and Terebinthina cause violent itching, especially the former. CANTHARIS. 83 The skin becomes cracked .under Pix, with sleeplessness, and bleeding when scratched. Potash preparations favor more a papular than a vesicular eruption, the latter form being mediate between the papule and the pustule. Kali sulphide and Kali nitricum develop papular vesicles when locally applied. Kali bromatum causes vesicles about the hair follicles (from internal use). Kali bichromicum induces an eruption, which presents a vesicle with depressed centre; it suppurates, and on healing leaves a cicatrix. Kali hydriodicum causes papular vesicles (from internal use); the resulting vesico-pustules contain minute quantities of iodine. None of these, therefore, resembles the superficial blister of the fly. Chloral is capable of producing several forms of eruption. Its vesi- cles are surrounded with a marked capillary hyperaemia. Chininum sulphuricum has caused an erythematous appearance strongly resembling scarlet fever, but it also forms confluent vesicles, which ulcerate or dry into crusts. Pemphigus, also, may appear. In pemphigus, Cantharis compare", with Causticum, Rhus, Ranun- culus sceleratus, etc. The following have induced this form of eruption, and deserve a trial: Caltha, Nitric acid, Copaiva, Sulphuric acid, Chin- inum sulphuricum, Carboneum oxygen. In Caltha, the bullae are surrounded by a ring, and itch a great deal. On the third clay they are transformed into crusts. Copaiva affects mucous membranes, then the stomach and bowels, and, later, the skin. A red, miliary rash forms on a red base; urti- caria; pemphigus, with excessive offensive discharge. Carboneum oxygen is prone to excite vesication along the course of nerves (sciatic, trigeminus, etc.), and hence resembles herpes zoster—a disease which Cantharis has occasionally cured. It also causes "large and small vesicles of pemphigus." Cantharis has a most remarkable affinity for the urinary organs. Marked symptoms of the kidneys and bladder may even result from the use of the drug externally. The same is true when the drug is taken internally. Let us now look at some of its symptoms. We find dull aching pains in the region of the kidneys. At other times violent cutting, burning pains extend from the kidneys down either ureter to the bladder. The parts externally over the region of the kidneys are very sensitive to touch. There is persistent and violent urging to urinate. Often, too, these cutting pains extend along the spermatic cords to the testicles and down the penis, attended by drawing up of the testicles. At other times there is irritation in the glans penis, ex- 84 A CLINICAL MATERIA MEDICA. hibited in children by frequent pulling at that organ. This pain in the glans penis may not be of an acute nature, but may be simply an uneasy, uncomfortable sensation. When in children you notice this symptom, Cantharis is generally indicated ; at other times you may think also of Mercurius solubilis; of course, the symptom may be a habit which the child has been allowed to practice. That, of course, does not call for these remedies. Coming to the bladder itself, we find here, too, extreme superficial sensitiveness over the hypogastrium (especially when the bladder is dis- tended with urine), and almost unbearable tenesmus vesicae. Some- times the patient will have the desire to urinate every two or three minutes. The urine does not pass freely or copiously, but dribbles away in drops, with burning, cutting pains, almost setting the teeth on edge. The pains could not be worse if the urine were molten lead. This burning and urging continue after urination, so that the poor sufferer is really in constant torture. Exacerbations come on every few minutes as endeavors to urinate become too urgent to resist. The urine itself shows changes in its composition. Blood is more or less thoroughly mixed with it, according to the part of the urinary tract from which the haemorrhage proceeds. The urine, however, is of a deep red color, independently of its containing blood, and deposits a sediment of mucus. Fibrinous casts of the lining membranes of the parts through which it passes, the tubules of the kidney, the ureters and the bladder are observed under the microscope. This is the picture of the effects of Cantharis as they attain their maximum. From these extreme symptoms you have all grades of severity down to the slightest irritation at the neck of the bladder, with aggravation after micturition. Sometimes we find an urethritis with the urinary symptoms I have already mentioned, and a gonorrhceal discharge of mucus or of puru- lent matter. Now these symptoms characterize Cantharis, and indicate it in quite a variety of affections. You would expect it to be of use in inflamma- tion of the kidneys, particularly in acute inflammation of one or the other of these organs rather than in chronic Bright's disease. We find, too, that Cantharis is a valuable remedy in the passage of renal calculi, especially when the pains are very violent. It has been stated in controversy that it was nonsense to talk about relieving the pains from the passage of renal calculi by homoeopathic medication. The ureter is a narrow tube and the stone is frequently large, and it is CANTHARIS. 85 said that this cannot be passed without pain. This is a mistake. The indicated remedy may so lessen local irritability, that the pain attendant on the passage of renal calculi may be greatly modified. Often, you find Cantharis indicated in gravel in children, when they have this irritation extending down the penis, with almost constant pulling at that organ. Cantharis you will find indicated in acute cystitis more frequently than all other remedies put together. It is also indicated in haematuria of inflammatory origin. It also has a secondary action producing retention of urine, an effect due to the severity of the preexisting symptoms. In gonorrhoea, Cantharis is indicated when there is most intense irrita- tion, not a simple discharge with the necessary burning, smarting and tingling, etc. Chordee is present. There is marked sexual erethism. It is also indicated in cases in which the disorder has been suppressed by the use ot injections, and the disease involves the neck of the bladder. Now, a word in relation to the remedies acting on the urinary organs in a manner similar to Cantharis. Cannabis sativa is very similar to Cantharis in its urethral phe- nomena. It has the same yellow purulent discharge from the urethra. There seems to be more burning and smarting under Cannabis, while there is more tenesmus under Cantharis. The glans penis is dark red and swollen. Chordee may be present. Cannabis sativa may be in- dicated in simple acute nephritis, but it is not likely to be of much use in Bright's disease of the kidneys. It has, however, drawing pain in the region of the kidneys, extending into the inguinal glands, with anxious nauseous sensation in the epigastrium. Cannabis indica is much used in Asiatic countries. It produces the most wonderful mental phenomena, far exceeding Opium in its effects. The two central points of the mental phenomena of this Cannabis indica are delusions as to distance and as to time. Time and space seem to be greatly extended. For example, the patient tells you that he is hungry, that he has eaten nothing for six months, when the dishes from which he has just partaken are yet by his bedside; or, on looking out the window he tells you that objects, but a few feet off, are many yards distant. But it is the urinary symptoms of Cannabis indica that concerns us more particularly just now. It is very similar to Cantharis, and is said to be even superior to that drug for gonorrhoea when the chordee is well marked. In renal disease, Cannabis is indicated when uraemia sets in, 86 A CLINICAL MATERIA MEDICA. attended by severe headache, with a sensation as if the vertex was opening and shutting. If delirium appears, it is associated with the delusions respecting time and space just referred to. Equisetum hyemale is a plant growing in water. It contains a large quantity of silicic acid. It acts very similarly to Cantharis on the kid- neys and bladder. There are, however, less escape of blood and less tenesmus vesicae than may be found under Cantharis. The urine is less scalding and does not contain so many fibrinous flakes. Cantharis is not called for as often as Equisetum, when there is an excess of mucus in the urine. The bladder is tender and sore, with severe dull pain, which does not lessen after urination. There is constant desire to urinate, sometimes with a feeling of distension in the bladder and with profuse urination. During urination, a burning pain is felt in the urethra. Equisetum has won most favor in enuresis. It has proved curative in these cases even when vesical irritation is marked, especially in women, and the urine contains blood and albumen. Linaria is another drug which has produced and cured enuresis with frequent painful urging to urinate, causing the patient to rise at night. Eupatorium purpureum is similar to the Equisetum in vesical irrita- bility of women, for which condition it is used by Dr. Richard Hughes, of England. It causes frequent and painful urging with either exces- sive or scanty flow of high-colored urine containing mucus. Petroselinum, one variety of the parsley, is a very handy remedy when indicated. It is indicated by the sudden urging to urinate. In the case of a child, it will be suddenly seized with the desire to urinate. If he caunot be gratified immediately, he will jump up and down with pain. You will find Petroselinum useful in gonorrhoea with this sudden urging and strangury. Cannabis, Cantharis and Mercurius have all that sudden urging to urinate, but it is strongest under Petro- selinum. Clematis erecta is to be selected when there is mucus in the urine, but not pus; when the urine flows by fits and starts, or the patient has to wait a long time before his efforts to urinate are successful, with in- tense pains along the urethra at the glans penis. Clematis is to be thought of in the beginning of inflammatory stricture. It will cure the trouble then, but not when it has become fully developed. Conium is useful in urethral and bladder diseases, when there is pus in the urine. Otherwise it is like Clematis. It has "passage of the urine by fits and starts." Doryphora is indicated in urethritis in children under ten years of CANTHARIS. 87 age, when the trouble has been provoked by local irritation. In these cases, think also of Hyoscyamus. Capsicum is sometimes useful in gonorrhoea, especially in fat persons of lax fibre and of rather indolent disposition. The discharge is of a thick yellow character. The patient complains of fine stinging pains in the meatus urinarius, and stitches in the urethra between the acts of micturition. Copaiva and Cubeba have been so abused by allopaths that I think we are too apt to neglect them. Copaiva causes a urethritis with burn- ing at the neck of the bladder and in the urethra. The discharge is of a milky color and of corrosive character. The meatus urinarius is tumid and inflamed. Cubeba causes cutting and constriction after micturition. The dis- charge is of a mucous nature. Both Copaiva and Cubeba are useful in the irritation attending thickening of the lining membrane of the bladder. Neither remedy has as violent an action as has Cantharis. Thuja gives us symptoms of continued or oft-repeated gonorrhoea. The patient has continued desire to urinate. The urging is violent, yet he passes only a few drops of bloody urine at a time; or, if these do not pass, there is intense itching. The urethral discharge is thin and green. Warty excrescences appear on the genitals and about the anus. At night there are painful erections which drive away sleep. In Cantharis the erections prevent urination; this is not the case in Thuja. Argentum nitricum follows Cannabis in gonorrhoea when the dis- charge becomes purulent and the urethra feels sore and swollen. Mercurius solubilis and corrosivus follow when the discharge becomes worse at night and is green and purulent. The corrosive mercury causes the more violent tenesmus, burning and swelling, hence it is very similar to Cantharis. The meatus urinarius is very red. Mercurius solubilis has more burning between micturition than has Cantharis. Chimaphila, too, has been found useful in such cases. It produces frequent urination at night with increasing debility. In irritation of the neck of the bladder, you may use quite a number of remedies, some of which I shall mention: Erigeron, with or without bloody urine. Pulsatilla is indicated when micturition is followed by cutting pains and there are pressure and soreness over the pubes. Under Ferrum phos. the symptoms are worse the longer the patient stands, and better after urination. 88 A CLINICAL MATERIA MEDICA. The Digitalis patient finds relief on lying down, as that position relieves much of the pressure from the neck of the bladder. Sulphur comes in to remove the remnants of a gonorrhoea. Ipomea nil, which is one variety of the morning-glory, was a remedy used by the late Dr. Jacob Jeanes, for the passage of stone from the kidney to the bladder, when he had the following symptom present: Severe cutting pain in either renal region, extending down the ureter on the corresponding side. The distinctive feature which separates it from other remedies is, that these pains excite nausea. Hydrangea has also been used for the intense pain attending gravel and calculus. Sarsaparilla is useful for gravel in children, when they scream or cry with pain after passing urine. Then there is found a grayish sand in the diaper. Ocinum may be employed in renal colic when there is considerable haemorrhage; when the urine not only has a sediment, as under Pareira brava, but contains considerable blood. Terebinthina, like Cantharis, has marked action on the kidneys; but it differs from that remedy, in that the urine is always dark, cloudy and smoky, from admixture of blood. This is due to congestion of the kidneys. Cochlearia armoracea, or the horse-radish, is a valuable drug. It produces burning and cutting in the glans penis during and after uri- nation, with a great deal of strangury. The urine becomes thick like jelly on standing. Then we have the Uva ursi. This remedy finds no equal when cys- tic and urethral symptoms are referable to stone in the bladder. Now you have as symptomatic of the drug, burning, scalding urination; the flow of urine stops suddenly as if a stone had rolled in front of the internal orifice of the urethra. When the urine passes, it is ropy from the admixture of mucus and blood. It seems to diminish inflamma- tory thickening of the cystic walls, and relieves suffering until the stone can be removed by operation. Similar to this is Pareira brava, which is a grand drug in gravel and in cystic calculus, when the patient has to get down on all fours to urinate. The tenesmus is great. The urine passes in drops. Pains shoot from the kidneys down the thighs, and even into the feet. The urine deposits a copious lithic acid sediment and also blood. This brings to my mind Berberis vulgaris. This suits when there is kidney affection, with sharp stitching pains radiating from the* renal CANTHARIS. 89 region in all directions, particularly downward and forward, filling the whole pelvis with pain. There are pains in the loins and in the hips. The urine when passed is more slimy than is the Pareira brava urine, and deposits copiously a loamy sediment having a yellowish turbid appearance. Berberis is an excellent remedy in case of stone in the pelvis of the kidney or in the ureter. Now, you see the difference between the two remedies. Pareira has pain going down the thighs, Berberis only in the hips and loins. You may expect to be called upon to use Camphor when strangury, retention of urine, etc., have resulted from the abuse of Cantharis. In some cases Kali nitricum may be substituted for Camphor when renal symptoms have been produced by Cantharis. Apis, too, is stated to have relieved the cystitis caused by the Spanish fly. Aconite frequently suits the incipiency of renal and cystic affections, which, unmodified, progress into a, Cantharis condition. The urging to urinate, the dysuria and haematuria are accompanied by an anxious restlessness and high fever altogether different from the expression of Cantharis. Just as Cantharis acts on the tissues, producing inflammation, so does it excite the brain. Thus we find the patient violent at times, with paroxysms of rage, tearing clothing and biting at any one who ap- proaches him. He bites like a dog. The slightest touch aggravates the symptoms, as does also any dazzling object as a looking-glass or glass of water. These symptoms greatly resemble those of hydrophobia. They also point to Cantharis as a remedy useful in puerperal con- vulsions and inflammation of the brain. The eyes are bright, the pupils widely dilated, and the face is pale or yellowish, and bears an expression of deep-seated suffering. These symptoms, indicative of inflammatory action in and about the brain, find their nearest concordant in Belladonna, which has the ma- jority if not all the symptoms above mentioned. The intolerance of water even is present under Belladonna. The difference between the two remedies is found in the expression of the face, Belladonna having a bright-red face with throbbing carotids; Cantharis usually exhibiting a face that is pale, yellow and wrinkled, with a constant frown and ex- pression of extreme suffering. Almost always when Cantharis is the remedy you find dysuria present. Camphor and Arsenicum are also nearly related to Cantharis. In 7 90 A CLINICAL MATERIA MEDICA. all three of the drugs the anxiety, restlessness, and the suffering face indicate the severity of the disease or sinking of the vital forces. Arsenicum closely resembles Cantharis in violent inflammations, with intense burning, agony, thirst, and subsequent collapse. The two drugs may also meet in uraemia. Arsenicum, however, lacks the sexual erethism, and its delirium is associated with a tendency to self- mutilation or to suicide. The patient exhibits fear of death; restless- ness often alternates with the stupor. Camphor, like Cantharis, causes delirium, convulsions, sexual mania, priapism, strangury, internal burning with external coldness, hyper- aemia or inflammation of internal parts, as brain, stomach, bladder, etc. The coldness, and sinking of vital forces in Camphor, are usually re- garded as its most characteristic effect, the symptoms of excitement being reactionary. In Cantharis, on the contrary, the principal effects are those of excitement, coldness expressing the result of its prolonged or continued action. Practically, you may decide for Camphor when delirium, mania, or convulsions exist with coldness and extreme pros- tration, especially if caused by a suppressed eruption. On the mucous surfaces, we find Cantharis causes just as violent an inflammation as it does on the skin. We find it indicated in inflamma- tion of the throat of a diphtheritic character, accompanied by severe burning and raw feeling in the throat, great constriction of the throat and larynx, this constriction amounting almost to suffocation on any attempt to swallow water. By the way, even the bladder-symptoms are aggravated by water. It seems as if the sight of water brings about a constriction of the sphincter muscles. Cantharis has been used very successfully in diphtheria with these throat symptoms and the dysuria present, and when the debility is very marked. While Belladonna has constriction of the throat, worse from swal- lowing liquids and intense inflammation of the throat, it lacks the burning, vesication, etc., so characteristic of the Spanish fly. Much more nearly related to Cantharis in its throat symptoms are Mercurius corrosivus, Arsenic, Arum triphyllum, Diffenbachia, and Capsicum. On the alimentary tract, we find Cantharis producing inflammation of the stomach with the same character to the symptoms already men- tioned, rawness, great thirst with aversion to drinks and vomiting. It is of use in dysentery. The discharges are bloody and slimy, and are mixed with flakes that look like scrapings of the intestines. These, I believe, are not really portions of the bowel or pieces of the CANTHARIS. 91 mucous lining, but are fibrinous formations, resulting from the inflam- mation. Tenesmus is marked and is almost always associated with dysuria. The pains in the abdomen are colic-like, doubling the pa- tient up. They are of a cutting, burning or lancinating character. In dysentery, Cantharis has several concordant remedies. One of these is Colocynth, which has colicky pains, doubling the patient up. The stools are bloody and slimy, and are made worse by any attempt to eat or drink. They also contain the so-called scrapings of the intes- tines. Colocynth differs from Cantharis in this: these colicky pains under Colocynth cease after stool, and the patient is relieved by bend- ing double and by pressing firmly against the abdomen. Looking at the two remedies from a pathological stand-point, Cantharis has more inflammation and Colocynth more nervous symptoms. Another remedy very similar to Cantharis is Colchicum. This remedy has tympanitic distension of the abdomen. The discharges from the bowels are composed of white jelly-like lumps, and are followed by violent tenesmus and constriction of the anus, tormenting the patient more than the urging during stool. Another concordant remedy is Capsicum, which is good for dysentery occurring in moist weather. It is best indicated in stout flabby per- sons. The pains and other symptoms are increased by the slightest draft of either warm or cold air. The drinking of water causes shud- dering and increases the pains. Sulphur you will find best adapted to chronic or persistent cases; especially when the tenesmus continues from one evacuation to another (here k is like Nux), or when the blood and tenesmus have abated, but the stools are still slimy, with frequent sudden urging. Zincum sulphuricum has several times cured subacute cases of dysen- tery. The pains are referred to the sides of the abdomen, probably in the colon. Kali bichromicum follows Cantharis when, though the "scrapings" continue, the discharges become more jelly-like. We have yet to speak of Cantharis in its action on the sexual organs. Cantharis inflames the sexual appetite, producing a violent almost insa- tiable desire for coitus, with erections so violent and so persistent as to amount to priapism. Even sexual intercourse does not always reduce the erections. These symptoms indicate the drug in chordee during the course of gonorrhoea. They also point to its use for uncontrollable passion, whether the result of mental disease or not. This priapism of Cantharis should not be confounded with that of 92 A CLINICAL MATERIA MEDICA. a new drug, Picric acid. Under this remedy the priapism is associ- ated with spinal disease, as myelitis, meningitis or locomotor ataxia. Erections are violent, the penis is distended almost to bursting. Cantharis also acts on the female genital organs, producing nympho- mania, for which condition it may be one of the remedies. We may also make use of Cantharis in labor. The drug has the property of expelling moles and other foreign materials from the uterus. We may make use of this effect in cases of retained placenta, either after labor at full term or after a miscarriage. Cantharis is a useful remedy in erysipelas, especially when of the vesicular form. The erysipelatous inflammation begins on the nose, either with or without vesicles. It then spreads to one or the other cheek, with formation of vesicles which break and discharge an ex- coriating fluid. Graphites also has erysipelas, commencing on the nose. It is better adapted to the chronic disease. Cantharis should be remembered as of use in burns about the face when blisters form, and cosmoline is offensive to the patient. In burns you may compare Cantharis lotion with Sapo soda, Soda bicarb., Arsenic, and Carbolic acid,—the last named when the affected parts ulcerate. LECTURE VIIL HYMENOPTERA. From the order Hymenoptera, we derive Apis mellifica, Vespa, Crabro, Formica rufa, and Bombus. The local effects of the poisons from these insects are well known. The skin becomes red and swollen, with burning pain; finally even sloughing may ensue. In suscep- tible persons, or after the inception of considerable quantities of the poison, general symptoms may develop, such as fainting, prostration, chills, and coldness; great restlessness, or insensibility,and even death may result. The stings of neuter and female ants (Formica, not Termites, which latter are neuropterous) contain a poison, the chief ingredient of which is called Formic acid. This highly irritating acid is also found in the glands attached to the hairs of stinging nettles, in some caterpillars and in old oil of turpentine. Apis Mellifica. For this remedy we have two names, according to the manner in which the preparation is made. It is either Apis mellifica, the honey- bearing bee, or Apium virus, the poison of bees. The original prepar- ations of the remedy were made in this manner: A large white dish was placed under a bell jar, in which there was a perforation through which a stick was inserted. Several hundred bees were then placed beneath the jar. The stick was then moved about, and, irritating the bees, caused them to sting the jar and the dish. After a while the bees were allowed to escape, and on the bell jar and plate were seen numerous specks. Alcohol was poured over these, and thus we obtained. a powerful extract of the poison of the bee. This is Apium virus. Subsequently the whole bee was used. Triturations were made of the entire insect. Thus we obtain Apis mellifica. The symptoms of the two preparations have not been separated. Apis mellifica is a compara- tively new remedy, and is an invaluable acquisition to our materia medica. In order to understand its symptomatology, let us look at its toxicology. Take, if you choose, a sting on the hand or finger as an illustration. Just after the sting, which causes a sharp sticking or 94 A CLINICAL MATERIA MEDICA. burning pain, there commences, quite promptly, swelling of the part, which swelling at the start is extremely sore. The part feels as if it had been bruised or pounded. The swelling at first is of a rosy pinkish hue. It spreads very rapidly ; the pains become intense. They are of a burning, stinging, or shooting character, seldom throbbing. Heat of the part increases with the burning and stinging pains. This may end very speedily in resolution or it may go on. If it pursues the latter course, you will notice that this redness, this rosy appearance becomes more intense, in fact assumes an erysipelatous appearance. Still later, it changes its color and takes on a pale but bluish hue, the swelling pits on pressure showing that the parts are edematous. After a while, if. the condition of the system is such as to permit, gangrene of the part takes place. The inflammation produced by Apis is not then of a sthenic type. It is not, for instance, such as would be cured by Aconite, quick, sudden swelling of the part coming on rapidly and ending in resolution ; not such as would be cured by Belladonna, bright red swelling with throbbing pains, but ending either in resolution or suppuration; but it is such as goes on to destruction of tissue. In one case where the sting was on the hand, the patient suffered also from a carbuncle on the back of the neck. Apis attacks the vital forces as is shown by the following character- istics of the drug: The patient feels strangely as if about to die and yet there is no fear of death, thus differing from Aconite and Arsenicum ; the brain is tired as if gone to sleep; prostration even to faintness as after exertion ; the body feels bruised ; nervous trembling; great pros- tration as in diphtheria, even in the beginning of the disease; delirium low and muttering; sensorial apathy ; a happy expression ; tongue can hardly be protruded; face expressive of anxiety as from visceral dis- ease; loss of consciousness especially in eruptive diseases; the mind is weakened; awkwardness, lets fall what she is carrying and laughs in a silly manner at the mishap. • Apis maybe employed in states of mind resembling hysteria. The fidgetiness, restlessness, excitability, and ill-timed laughing, together with fickleness at work, have led to its successful use for nervous girls. In ^addition, it has been observed that they are awkward, dropping things, and then laughing in a silly way at their clumsiness. The sexual passion is too active, and they are prone to jealousy. The confusion of mind and unconsciousness just noted indicate the remedy in severe adynamic forms of disease, such as malignant scarla- APIS. 95 tina, diphtheria, typhoid fever, etc. Also a complete stupor after apoplexy is said to have yielded to it when Opium failed. In scarlatina the fever runs high, and the attending restlessness is one of nervous agitation. Mouth and throat are very red, with blisters on the borders of the tongue; and swollen puffy fauces; burning sting- ing, and a scalded, raw feeling in mouth and throat. The skin pricks as from needles, the rash being interspersed with a miliary eruption. There is always puffiness of some part of the surface. Prostration is early. Urine scanty or suppressed. High fever and drowsiness. In typhoid fever the delirium is of the muttering kind. The weak- ness is so great that the tongue is protruded with difficulty, and the muscles are so relaxed that the patient slides down in bed. The tongue is blistered, dry, cracked, and even ulcerated. Very important is the soreness of the swollen abdomen to touch. In meningitis or in meningeal irritation Apis holds a prominent position as a curative agent. It is often the remedy, no matter what the ailment, when shrill outcries in sleep lead to the suspicion of cerebral irritation. Such cases frequently begin with the nervous fidgetiness so characteristic of the bee-poison, and advance to more serious conditions. In tubercular meningitis, or in acute cerebral effusions, a suppressed or undeveloped eruption is a good guide to the choice of Apis. We may profitably compare Apis here with : Belladonna, Helleborus, Arsenicum, Bryonia, Zinc, Sulphur, Cuprum, Glonoine, Lachesis, Rhus, Hyoscyamus, Natrum mur., Bovista, etc. Belladonna is doubtless frequently employed when Apis would suit better. A little care, however, will enable the practitioner to distinguish the fidgety nervousness of the latter from the more intense cerebral irri- tation of the former. The congestions of the former are more violent, with throbbing of the carotids, injected red eyes; and a drowsiness, broken by starts and frightened outcries. The adynamia is much less than in the Apis. If the disease is scarlatina, the rash is smooth and bright red, not miliary. The skin is hot and the face red, or in some cases pale; but not pale and cedematous as in Apis. The cervical glands may be swollen, but there is not the cellular infiltration, with an erysipelatous blush as in the bee-poison. If there is meningeal irritation, Belladonna is needed when the symp- toms are intense; Apis when the nervous agitation predominates, with the shrill cry, which betokens stabbing, piercing pains or excitement. In meningitis, Belladonna is decreasingly indicated as the symp- 96 A CLINICAL MATERIA MEDICA. toms of effusion increase; while Apis is increasingly indicated, so long as symptoms of irritation obtain and the cephalic cry is marked. Helleborus claims precedence when the irritation of Apis gives place to mental torpor, with want of reaction. The forehead is wrinkled, the pupils dilated, and the lower jaw tends to drop; the sopor is com- plete. Automatic motions of one arm and one leg; forehead is bathed in cold sweat. It may bring about reaction so that another remedy will cure. In typhoid fever they differ widely. Apis, though it has great weakness, apathy and stupor, has a dry blistered tongue and ex- quisite soreness of the abdomen. Helleborus has complete sensorial apathy, dark, sooty nostrils, slow pulse, no response to touch or pressure. Bryonia bears some slight resemblances, especially as, like Apis, it may be needed for cerebral effusions following suppressed exanthemata. But the sensorium is benumbed, though the senses are not so perverted as in either Apis or Helleborus. There is a constant chewing motion ; face dark red, lips parched; when offered drink it is taken hastily and impatiently. If the child is moved it screams with pain. Later, when the sensorial depression amounts to sopor, Helleborus follows well, even if the chewing motion and hasty drinking continue. Apis fol- lows, if sopor ensues with a more shrill cephalic cry than in either of the other remedies. Cuprum compares with Apis when meningitis results from a sup- pressed exanthem; but the symptoms are quite diverse. Copper causes loud screaming, followed by violent convulsions; the thumbs are clenched and the face is pale, with blue lips; eyeballs constantly rotat- ing. If convulsions occur in the Apis case, they are less violent, con- sisting of restlessness and twitching of one-half of the body; the other, being lame, trembling. Much more closely related in suppressed eruptions is Sulphur. The two follow each other well. Glonoine, like Apis, has the cephalic cry ; sensation as if the head was enormously expanded, etc. Spasmodic vomiting of cerebral origin is most prominent in the former, as is also intense congestion and throbbing. Zincum produces cerebral irritation ; child awakes with fear, rolls the head; cries out and starts in sleep. Constant fidgety motion of the feet. Anaemic children, too enervated to develop an exanthem. In typhoid states, the prostration is very great, with impending cerebral paralysis. Unconsciousness, blue hands and feet, with coldness, weak APIS. 97 pulse; lower jaw dropped. Here the Oxide has been successfully employed. Rhus tox., though incompatible with Apis, has many similar symp- toms. In scarlatina, for instance, both suit in adynamia, swollen throat, erysipelatous inflammation of the skin of the neck, miliary rash, drowsiness, oedema. In Rhus, however, the eruption is darker, the erysipelas dusky red, and there is great bodily restlessness—not the fidgetiness of Apis. Arsenicum is similar to Apis in many respects. Both have anxious change of place, fear of death, restlessness; great weakness. (See also in several instances anon.) But although irritability of mind is in both, it is more an anxiety and fear in Arsenic; more a nervous rest- lessness in Apis. If they meet in cerebral affections, as possibly they may, especially in hydrocephaloid, Arsenic is to be selected by hot skin, pale and hot face. Child lies in a stupor ; suddenly it twists its mouth and a jerk goes through the body; or the child lies as if dead, with half-open eyes, gum on the conjunctivae, and no response to touch of the eyelids Hyoscyamus and Lachesis are similar in jealousy. Natrum mur., Bovista, Laches., Aethusa, Ignatia, Nux vom., have awkwardness ; the first is most similar to Apis. I have already hinted that Apis might be of use in dropsies. The symptoms calling for it are briefly these. In general dropsies we find it indicated by the peculiar appearances of the surface of the body. There is a sort of waxen hue to the skin ; the skin has a transparent look, with a whitish or perhaps a slightly yellowish tinge. The urine is scanty, and there is almost always absence of thirst. The character- istic symptoms are the transparency of the skin and the thirstlessness. Now as to cause. Apis is especially useful in dropsies of renal origin, whether the result of scarlatina or not. The urine is scanty and high iy albuminous, and contains casts of the uriniferous tubules. There is a swelling about the eyelids. The surface of the body feels sore and bruised ; in some cases the pain is of a burning character. If the dropsy is of cardiac origin, the feet are cedematous, especially after walking. This is attended with almost intolerable soreness and burning. Even when the dropsy has invaded the chest and we have hydrotho- rax, Apis may be the remedy, especially when the trouble is of cardiac origin. The patient is unable to lie down. He has the same constric- tive feeling about the chest that we find under Lachesis. He has a dry cou^h, which seems to start from some place in the trachea or larynx, 98 A CLINICAL MATERIA MEDICA. usually the trachea, the cough not ceasing until a small quantity of phlegm is loosened. Thus far the remedy is exactly like Lachesis. But Apis has in addition to these symptoms a mental symptom which comes from the chest, and that is a constant feeling as though he could not live. It is not that feeling of dyspnoea, but it seems to be a sort of anguish of mind that the patient cannot understand how it would be possible for him to get another breath, so great is this suffocative feeling. Often associated with these chest symptoms, the patient has a strange feeling as though he was going to die, but to distinguish it from Aconite in febrile states and Arsenic in hydrothorax, there is no fear of death. In pleuritis with exudation, Apis is one of the best remedies we have to bring about absorption of the fluid. Apis and Sulphur will cure the majority of these cases. Apis also acts on the synovial membranes, giving you a perfect pic- ture of synovitis, particularly when it affects the knee. It is indicated when there are sharp, lancinating, stinging pains shooting through the joint, with aggravation from the slightest motion. Bryonia affects the joints and their synovial membranes, but the pains are more stitching, with tension; better from warmth of bed, Apis being better from cold applications. Iodine is useful in dropsy of the knee, and has followed Apis well, especially in scrofulous children (Compare also Kali iod.). We have still another form of dropsy in which Apis is a remedy, that is, dropsy of the brain, what used to be called hydrocephalus. It is not so often indicated in the true hydrocephalus, that is when from some mechanical cause there is inflammation set up in the membranes of the brain, followed by accumulation of serum in the brain ; but it is in tubercular meningitis in which this remedy is useful. Apis is here indicated in the first stage. The symptoms which call for it are these: The child bores its head backwards into the pillow, and rolls it from side to -ide; every little while the child arouses from sleep with a shrill, piercing cry. This peculiar shriek is due to pain. In addition to this cry, the child is usually convulsed; one side of the body is convulsed and the other lies as if paralyzed. Strabismus shows itself. The pulse i- rapid and weak, and the urine is scanty. Now there is no remedy which can do any good in this stage if Apis does not. In some cases, there is a peculiarity of Apis which I should mention, and that is slow- ness of action. Sometimes you will have to wait three or four days APIS 99 before you notice any effects from its administration. The favorable action of the remedy is first shown by increased flow of urine. In dropsies, Apis may be compared first of all with Arsenicum album, which has the same transparency of the skin, and is also of use in dropsies of renal, cardiac or hepatic origin. The differences between the two remedies are these: First, Arsenicum has intolerable thirst, usually drinking but small quantities at a time, because water annoys the stomach. Eating and drinking cause vomiting. I have seen cases in which even a single teaspoonful of medicine provoked vomiting. The patient exhibits marked restlessness. Another remedy for comparison is Apocynum cannabinum. This is much used in the West for general dropsies, for swelling of any part of the body, ascites, hydrothorax, etc., usually without any organic disease as a cause. The patient cannot tolerate any food. Food or water is immediately ejected. There is a sunken, gone, exhausted feeling at the pit of the stomach. The next remedy similar to Apis is Acetic acid. This is useful in dropsies when the face and the limbs too have this waxen or alabaster appearance. It is especially indicated when the lower parts of the body, the abdomen and limbs are swollen ; hence it is useful in ascites. Thus far it is similar to Apis. But it has thirst, which Apis has not, and there is almost always gastric disturbance present, sour belching, water-brash and diarrhoea. Acetic acid is an undeservedly neglected remedy in dropsy. You see how it stands between Apis and Arsenicum. It differs from both of these remedies in the preponderance of gastric symptoms. Now, in hydrocephalus, the most similar remedy to Apis in the stage of exudation is Sulphur. Sulphur is indicated more on general prin- ciples than for its particular affinity for the meninges. Tubercular meningitis cannot occur in an otherwise healthy child. There must be a diathesis at the bottom of the trouble. Sulphur helps in the same stage as Apis when Apis fails to bring about a reaction, particularly when the child is scrofulous and has other Sulphur symptoms. The child lies in a stupor, with cold sweat on the forehead, with jerking of the limbs, particularly of the legs, with spasms of the big toes and sometimes of the thumbs also. The urine is suppressed. Sulphur is all the more indicated if there had been a retrocession of some eruption before the disease had displayed itself. Helleborus is also similar to Apis in hydrocephalus. Apis is useful while there is still some irritation of the brain as indicated by the 100 A CLINICAL MATERIA MEDICA. cephalic cry. Hellebore is indicated when torpor predominates, when the child lies wholly unconscious. The eyes do not react to light. The urine is suppressed. There is automatic motion of one side of the body. You will notice, too, a peculiar corrugation of the muscles of the forehead, particularly the occipito-frontalis. In milder cases, before the stupor is profound, you will find Helleborus indicated by these symptoms. This corrugation of the muscles of the forehead is present, together with a constant chewing motion of the mouth. The child seems to have no wants. It asks for nothing; yet, when given water, it drinks with avidity. Now, a word respecting the differences between Belladonna and Apis. Belladonna is not usually indicated in tubercular meningitis. It is the remedy above all others for the simple meningitis, but not for the tubercular form of the disease. Belladonna is the very essence of acuteness in its symptomatology. Every symptom appears suddenly and with great intensity. Tubercular meningitis is a slowly developed disease. However, if the premonitory symptoms are violent, you may use Belladonna in tubercular meningitis in the stage of hyperaemia with acute pains, restless, tossing about, crying out in sleep, and boring the head into the pillow, but it ceases to be the remedy when the exu- dation is established. The range of Belladonna is at an end when that of Apis begins. There is another remedy which sometimes comes in between Bella- donna and Apis, and that is Bryonia, which acts on serous mem- branes, causing copious exudation. It is indicated after Belladonna. The child becomes more stupid from increased pressure on the brain. The face suddenly flushes up and then pales off, usually a bad symp- tom. The child crys out, particularly when moved in the least; this is a characteristic symptom. The child is stupid, the abdomen dis- tended, and the tongue is usually coated white down the middle. So much for Apis and its concordant remedies in dropsies. The next use we may make of Apis is in erysipelas. It is useful in erysipelas, particularly of the face, when it commences under the right eye or about the eye, and spreads thence across the face to the left side, the parts quickly becoming cedematous, and at first assuming a pinkish rosy hue. The soreness becomes more severe, and burning stinging pains follow. There is high fever, with dry skin and usually thirst. Now, if the disease is not checked, and the face assumes a pur- plish livid hue, Apis may be indicated in phlegmonous erysipelas, which APIS. 101 dips deeply in the connective tissue and ends in the destruction of the part. The concordant remedies of Apis in erysipelas are several. First of all, Belladonna. The difference lies in this : Belladonna is indicated in bright red swelling of the face (the smooth form of ery- sipelas). There is not much tendency to oedema or to the formation of vesicles. The pains are almost always acute, with throbbing in the affected parts. The brain almost always sympathizes markedly, giving you throbbing in the head, visions as soon as the patient closes his eyes. The patient jerks in his sleep. The pulse is full and hard. Another remedy, and one, too, more similar to Apis than the Bella- donna, is Rhus tox. You should be particular in differentiating these remedies, because they are inimical, and one cannot be given after the other. Under Rhus tox. the color of the face is dark red, and not the bright red of Belladonna, nor the rosy or purplish livid hue of Apis. There is almost always a formation of blisters, which burn and sting, and which are distinguished from those of Apis by the preponderance of itching. Under Rhus tox. the disease usually travels from left to right when attacking the face. Lachesis may be similar to Apis in some cases when the face is bluish. But the other symptoms will enable you to decide. Apis may be of use in urticaria, when there suddenly appear on the surface of the body long pinkish-white blotches raised above the skin. The itching, burning and stinging are almost intolerable. They may come as a result of cold or during the course of intermittent fever. Here Apis is similar to Arsenicum, which also produces hives, and to Urtica urens. This last remedy is indicated in hives when they are in not so large welts as in Apis. The itching and burning are intol- erable. It is especially indicated when the disease has been produced by eating shellfish. Terebinthina is also useful in urticaria after eating shellfish. Kali bromatum is indicated when the hives occur with nervous dis- eases. Rhus tox. when they are an accompaniment of ague or rheumatism. Bovista when they are attended with diarrhoea, the stools being fol- lowed by tenesmus and burning. Pulsatilla comes in when the hives are of gastric or uterine origin. Calcarea ostrearum is especially suited to chronic cases; and Sepia is indicated when the trouble is worse in the open air. (Also Rumex crispus.) 102 A CLINICAL MATERIA MEDICA. Apis may also be used in variola when there are intense itching and swelling. Apis may be used in rheumatism whether it is of articular or mus- cular origin. It is more frequently indicated in articular or what is commonly called acute inflammatory rheumatism. You will find the affected parts feeliug very stiff and exceedingly sore to any pressure, and often with a sensation of numbness. The joint or joints affected are swollen and give the patient a kind of " stretched-tight feeling." The swelling is rather pale red in color, and there is often some fluctuation about thejoint. There are burning, stinging pains, worse on any motion. The paralytic weakness of Apis is that form which is so common a result of animal poisons, and compares with the sudden and violent effects of certain vegetables and minerals. It has often been successfully employed in paralysis following devitalizing affections, such as diph- theria, typhoid fever, and also when meningeal effusions remain after inflammations. In all such cases suppressed or preexisting exan- themata constitute a leading indication for the bee-poison, and the re- appearance of skin symptoms calls for its discontinuance so long as the improvement thus instituted lasts. Sulphur is a great aid here. In these cases of prostration the patient is either nervous, restless and oversensitive, or hot and drowsy, whether thirsty or not. Apis is useful in febrile conditions. It produces an intermitting type of fever, and it may, therefore, be used in intermittent fever. It is par- ticularly useful when the chill comes at three o'clock in the afternoon. There may be thirst or there may not. But there is oppression about the chest, with a feeling as if it was too full, which it really is, there being congestion of the thoracic viscera. This chill is followed by burn- ing heat of the whole body, with increase of this oppressive feeling of the chest. The heat is followed by sweat, which may, however, be im- perfect. There is never any thirst during the sweat. That is charac- teristic. During the apyrexia many characteristic symptoms are present. The patient often complains of pains under the ribs on either side. The feet are swollen and oedematous, the skin is sallow or waxen, the urine is scanty, and urticaria is present. So you see that it is indicated in rather severe forms of the affection, when excessive use of quinine has spoiled the case, and in chronic forms which have undermined the general health and produced disease of the liver, spleen, etc. The most similar concordant to Apis here is Natrum mur. This is indicated in exactly the same type of intermittent fever as Apis- the difference between the two remedies lies in the time of appearance of APIS. 103 the chill, at ten o'clock in the morning in the case of Natrum mur., and at three o'clock in the afternoon in the case of Apis. In typhoid types of fever, Apis is sometimes indicated. We select it first of all by the mental state. The delirium is not of an active type; the patient lies in a stupor, with muttering; the face is either flushed red, or, more frequently, pale and waxen—at other times there is a happy expression to the face. The skin in this type of fever we will find to be burning hot in some places, while in others it is unnaturally cool; the cutaneous surface is almost always dry; should there beany sweat it is almost always of a transient character; the prostration is so great that the patient slides down in bed; he cannot exercise sufficient muscular force to retain his position on the pillow. The tongue is dry and red, and, like that of Lachesis, it catches oil the teeth when the attempt is made to protrude it, and trembles; you often find, too, that there may be a whitish or darker coating on the dorsum of the tongue, while the edges, especially about the tip, will be red and covered with little blisters and vesicles. In these cases Apis resembles Muriatic acid, which has this prostra- tion, but it has the characteristic acid diathesis. In scarlatina, Apis, as you may have already anticipated from what I have said of the remedy, may be indicated. It is not often the remedy in the Sydenham variety of the disease, in which Belladonna is so fre- quently indicated; but it is of use where the eruption is interspersed with a miliary rash. Here, too, we find the same defective effort on the part of nature to get up a fever. The body is very hot in some places and cool in others. The rash is deep-red in color, very much like that of Belladonna, but differing from that remedy, you remember, in the presence of this miliary eruption which Belladonnadoes not pro- duce. The child is drowsy, sleeping most of the time, or he is drowsy but cannot sleep. This symptom you must remember, because it is identical thus far with one of Belladonna. Associated with this sleepy or wakeful state the patient is fidgety and restless. You notice, too, that he is peevish, and manifests every symptom of being very irritable. This restless state of Apis must be distinguished from those of Rhus tox and Belladonna. In Rhus tox. it is a general restless state of the whole body, and mind too. The patient lies first on one side of the body and then moves to the other. This is not associated with the Arsenic anxiety. The general feeling is a desire to move about. In Apis it comes from a general nervous feeling. The inability to go to sleep in Belladonna comes from inflammation 104 A CLINICAL MATERIA MEDICA. or congestion of the brain. The hyperaemia gives you this drowsy state, and the brain is so exhausted that the patient cannot go to sleep. In addition to the symptoms already mentioned for scarlatina, we have Apis further indicated when the condition advances to effusion of serum about the brain. The throat symptoms are unimportant. You often find diphtheritic patches on the tonsils. The throat inside is swollen and rosy-red, while externally it is engorged, with erysipela- tous blush to it. Apis may also be used late in the disease for the sequelae, that is, when the kidneys become affected and dropsy appears with albuminuria. Again, we find Apis indicated in diphtheria, and I think that the remedy is indicated in the genuine disease. From the very beginning the child is thoroughly prostrated. There is not much fever; in fact, there is a suspicious absence of heat. The pulse is rapid but not strong. At first you find the throat having a varnished appearance, as though the tonsils and fauces particularly were coated with a glossy red varnish. The membrane forms on either tonsil, oftener on the right than on the left, and it is thick, looking like wash-leather. The tongue is often swollen, so that the child can scarcely swallow. If the child is old enough, he will complain of a feeling of fulness in the throat which necessitates swallowing, but makes it very difficult. The explanation of this is found in the next symptom; that is, the uvula is swollen and oedematous, consequently there is a feeling of fulness. If you examine the throat thoroughly, you will find the rim of the glottis swollen, red and oedematous, making the breathing very difficult. Breathing is labored, owing to the narrowing of the entrance of the larynx. In some of these cases the breath is very foetid, while in others there is little or no fcetor. In still other cases you will find as characteristic of Apis a red rash over the surface of the body, and this rash at first makes you think you have a case of scarlatina. We find the external throat swollen and erysipelatous. Now, there are several remedies similar to Apis in diphtheria. One of them is Arsenic. Arsenicum is indicated in rather severe cases of diphtheria, as you might expect, when the throat is very much swollen inside and outside, when the membrane has a dark hue, and there is great fcetor. There is thin excoriating discharge from the nose. The throat is oedematous, just as it is in Apis; the patient is restless, especially after midnight; the urine is scanty, and the bowels are either constipated or else there is offensive watery diarrhoea. In still other cases, when, despite the dark purplish hue of the apis. 105 throat, and the great swelling and great prostration, there is not much pain, Natrum arsenicosum is the remedy. Here, the uvula hangs down like a sac of water. Still another remedy is Kali permangan. This remedy, which is seldom used in the high potencies, is indicated when the throat inside and outside is swollen, the membrane in the throat is horribly offen- sive, the throat oedematous, and thin discharge from the nose. The great characteristic is the extreme fcetor. Apis causes an irritation of the mucous lining of the larynx and trachea, and also soreness in the chest-walls. It has been found most useful when laryngeal symptoms accompany erysipelas, oedema of the throat, glottis, or larynx, or suppression of eruptions; less often in simple laryngitis or laryngeal catarrh. Difficult breathing, and especially the unique symptom, " he does not see how he can get another breath," has led to the successful em- ployment of the drug in hydrothorax, hydropericardium, oedema pul- monum and asthma. The lancinating, darting pains, palpitation, orthopncea, etc., have rendered Apis valuable in cardiac inflammations and dropsy. Essen- tial symptoms seem to be oedema or sudden mucous swelling, dyspnoea, and sudden, lancinating or stinging pains; restlessness and anxiety. Compare: Lachesis, Arsenic, Sulphur, Belladonna, Kali carb., Spigelia, Digitalis, Asparagus, Ajjocynum cannabin. Arsenic has many resemblances. So apparently alike are the rest- lessness, changing of place, and dyspnoea, that the two are often mis- applied, the one for the other. The best distinction lies in the fidgety restlessness peculiar to Apis. If dropsy obtains, both may be needed in pale, tensely swollen limbs, but Apis often has a redness, itching or erysipelatous condition present, as well as thirstlessness. Belladonna is too often mistaken for Apis in laryngeal affections. The latter has the most oedematous swelling, with consequent dyspnoea; the former most spasmodic constriction. In cardiac affections Arsenic, Apocynum cannabinum, Digitalis, and Asparagus, bear some similarities with Apis, especially with great de- bility and dropsy. Apjocynum cannabinum is needed when the pulse is small and weak, heart-beat irregular, now weak, now stronger; sinking at the epigastrium. Asparagus suits in the aged, with weak pulse and pain about the left acromion. Digitalis causes a doughy appearance of the skin ; pulse slow or weak, quickening with every bodily move- ment; gone, deathly sick feeling at the epigastrium soon after eating. 8 106 A CLINICAL MATERIA MEDICA. The cough of Apis is a not uncommon symptom, when this remedy is needed. It resembles more or less, Lachesis, Carbo veg., Rumex, B-Iladonna, Chamomilla, Crotalus horridus, Nux vomica, Bryonia, Ig- natia, Arsenic, Hyoscyamus. Lachesis, Nux, Bryonia, and Hyoscyamus agree in adherent mucus. But Lachesis has intolerance of touch, even of clothing, about neck, a symptom not marked in Apis, except with the sense of suffocation. Rumex has a teasing, persistent cough, aggravated by cool air, or by anything which increases the volume or rapidity of the inspired air. Chamomilla differs mentally. Nux vomica cures cough from adherent mucus high up in the trachea; but there is a rough, scraped feeling in the throat. Bryonia adds epigastric irritation to the suprasternal, and the pains in the trachea and chest-walls are sharp, stitching, as well as bruised, aching. Ignatia induces a nervous cough, and the more the patient coughs, the more annoying is the irritation. Arsenic causes more a burning tickling in the fossa; but since it so often concurs with Apis, it should be compared with the latter, especi- ally when cough accompanies dropsy, heart disease, etc. Arsenic, then, is really a concomitant. Belladonna, may be misapplied for Apis, but we ought to be able to distinguish the former by its greater constriction of the throat, and deeper inflammatory redness. Carbo veg. agrees in hoarseness, rawness, and tickling cough, but the irritation is as from vapor of sulphur. Now, the action of Apis on the genital organs. Apis is often indi- cated in diseases of the female organs. Nearly all the provers experi- enced symptoms referable to the uterus and ovaries. It must be given cautiously during pregnancy, because if given in low potency and fre- quent doses it may bring about a miscarriage, especially before or at the third month, because Apis produces bearing down in the uterus. We may use it in amenorrhcea when we have congestion to the head as a result, with bearing down in the uterine region without the ap- pearance of the menses. Particularly is it indicated in girls at the age of puberty, when they are somewhat hysterical with this amenorrhcea; they are nervous and awkward; it is not a natural awkwardness, but one that comes from incoordination of the muscles. With these symptoms there is flushing of the face. We may also use Apis in affections of the ovaries, especially of the apis. 107 right. It holds the same relation to the right ovary as Lachesis does to the left. It is indicated in ovaritis with extreme soreness in the right inguinal region, together with burning or stinging sensations, and some tumefaction detected either over the pelvis or more charac- teristically through the rectum or vagina. In ovarian cysts, Apis is an excellent remedy to control the trouble, especially in the incipient stages. We have here, in addition to the burning and stinging pains, numbness down the thigh and over the right side of the body, feeling of tightness across the chest, with cough. This is not a symptom of lung disease, but is reflex from the uterus. Now there is a combination of honey with salt, known as Mel cum sale. This was for years a popular remedy in Germany for bladder troubles and for diseases peculiar to women. I have used this remedy in prolapsus uteri and even in chronic metritis, especially when asso- ciated with sub-involution and inflammation of the cervix. The special symptom which leads you to the remedy is a feeling of soreness across the hypogastrium from ilium to ilium. Apis may be of use in diseases of the eyes. I have had several cases of asthenopia cured by this remedy when reading causes smarting in the eyes, with lachrymation and itching of the eye-lids and some burn- ing and stinging. Apis is also a remedy for staphyloma, whether of the cornea or sclerotic. In external diseases of the eye, Apis is not without value. The eyes are over sensitive to light. The conjunctiva is reddened or puffy and chemosed. Still this swelling of the palpe- bral conjunctiva under Apis is more from congestion than from a true chemosis as under Rhus tox., which is very similar, especially in oedematous swelling of lids; chemosis; hot, gushing lachrymation; erysipelas. But Apis has less tendency to the formation of pus—a symptom highly characteristic of Rhus. In the former the pains are stinging, the time of exacerbation is evening, and cold water relieves the inflamed lids. If erysipelatous, the lids are a blue-red, looking watery, as if semi-transparent. In the latter, the pains are worse at night, particularly after midnight; warmth relieves; the erysipelatous lids are of a dusky red, and together with the cheeks are studded with small watery vesicles. The pains are usually drawing, tearing; though in erysipelas they may be burning, stinging, but with more itching than the bee-poison. The eyelids often feel heavy and stiff. Arsenic compares with Apis in hot tears, violent pains, oedematous lids. But the lachrymation is more acrid. The oedematous lids are pale, not blue-red. The palpebral conjunctiva and edges of lids are 108 A CLINICAL MATERIA MEDICA. very red. The restlessness is more pronounced. Relief is usually ob- tained from warm applications, though the scrofulous patient can open his eyes in the open cool air, but not in the room, even if dark. Worse at and after 12 p.m. To return to the eye symptoms of Apis, the lids are swollen, red and oedematous. There is burning of the tarsi, with agglutination of the lids. Sudden and very severe pains shoot through the eyes, and these are relieved by the application of cold water. The eyes are generally worse in the first part of the night. Apis is often indicated in scrofu- lous ophthalmia, in which affection it is often followed by Kali bichro- micum. It now only remains for me to speak of the intestinal symptoms of Apis. It may be of value in diarrhoea, such, for instance, as comes on during the course of typhoid fever or scarlatina, or as the result of the debilitating influence of continued heat. You will find it useful in the diarrhoea of children who are very much debilitated. There is generally present irritability of the brain, with the condition known as hydrocephaloid. The symptoms are much like those indicating Apis in hydrocephalus. The child wakens up with a scream. The stools are thin, watery, yellow in color, and usually worse in the morning. At every motion of the body the bowels move as though the anus had no power. The stools may or may not be offensive. It differs from Bryonia, which has morning diarrhoea, worse from motion; in that under Apis the motion aggravates, not because of its general effects, but because the anus is so uncertain. In bad cases you will find the urine scanty. Apis may also be thought of in panaritium. The finger swells rapidly, with tense glossy-red surface and violent burning stinging pains. In this respect Apis is very similar to Sulphur, and may be followed by Sulphur when its action is imperfect. Apis is antidoted by Plantain and Lachesis, and is complementary to Natrum mur. Ledum was proposed by Teste as an antidote for stings of insects. Dr. Drysdale has cured nightly itching of the feet with it. In closing, let me ask you to remember the relation of Apis to Arsenic, Acetic acid, Belkidonna, Rhus and Sulphur. Remember also its inim- ical relation to Rhus tox. LECTUKE IX. MOSCHUS. The order of Ruminantia furnishes us with an article called Musk, which is obtained from the Moschus moschiferus, or musk-deer. It is found in a sac just back of the umbilicus, and probably consists of a secretion from the preputial follicles. The second word, " moschiferus," is a necessary qualification, since several of the musk-deer, as the tragulus Javanicus and the meminna Indica, are unprovided with the musk-bearing pouch. So penetrating is the odor of this substance, that it is with great difficulty removed from a room, even after extensive cleansing and alterations. Moschus is of some value in nervous affections, and also in several grave forms of disease. Injected into the veins of animals, it has pro- duced narcotism with muscular spasm, bloody stools and finally death. Wood regards its action on man as feeble and uncertain, though he admits its clinical worth when the nervous system is exhausted, with accompanying restlessness, etc. Ringer regards it as ill adapted to medicine on account of its sickening odor. Bartholow, Flint, Ham- mond and Rosenthal do not use it in hysteria. German writers, Jolly, for instance, admit a temporary benefit from its use in hysteria. Like some American authorities they employ it more confidently in pneu- monia and in spasmus glottidis. Trousseau, with characteristic con- servatism, rejects the overdrawn laudations of older writers, and pro- ceeds, in his own unique fashion, to define its accurate application to diseases. In our own school, precise prescribing has had its influence in more clearly defining the powers of Musk, and in thus limiting its action within reasonable bounds. The experiments of Joerg and Sunderlin, which Allen has seen fit to incorporate in the Encyclopoedia, are con- sidered by some to be contradictory. Still, they are not opposed to other provings obtained with potencies or by inhalation, and so are of value and deserve to be retained. Homoeopathieally employed, Moschus is of use in various affections when the nervous symptoms predominate. The disease, in consequence, 110 A CLINICAL MATERIA MEDICA. does not follow its normal course, but remains uncured or develops serious symptoms, indicating nervous exhaustion. It is also sometimes called for in hysteria and hypochondriasis. Moschus, then, produces numerous symptoms referable to the nervous system. The following are especially worthy of note : Excited as from alcohol; pulse full and more frequent; temperature slightly elevated; congestion to the brain; raves, speaks rapidly and confusedly; scolds until lips are blue, face pale, and she falls uncon- scious; anxiety; starts at any noise; anxious about death. Anxiety, with fainting; faints, with coldness, pale face, full unconsciousness; hysteria; delirium as from alcohol; sleeplessness; muscular twitch- ing; ataxia; face wears an expression of surprise: convulsions, more tonic than clonic. Hysteria, especially for the paroxysm, even if insensible. Cries one moment and bursts into uncontrollable laughter the next. Accompaniments: Palpitation of the heart, as from anxious expecta- tion. Nervous, busy, but weak; soon drops things. Tremulous nerv- ousness. Fainting spells, with pale face and coldness. Sleepy during the day. Ru Brain and medulla. Eupatorium perf. 1 „ Eupatorium purp. J , Taraxacum.—Liver. We will now proceed to study the first one of these. Arnica Montana. Arnica montana is commonly called leopard's bane. The tincture of Arnica montana should be prepared from the roots of the plant rather than from the flowers, because the latter are infested by a little insect, the bodies of which, together with the eggs, considerably 222 A CLINICAL MATERIA MEDICA. modify the action of the pure drug, and, of course, add symptoms which are foreign to the genuine effects of Arnica. We also find an essential oil in the flowers differing somewhat from that found in the roots. I hardly know why the plant has been called the leopard's bane, for it is hardly poisonous. While there have been a few cases of death resulting from its extravagant use, most of them have been traced to preparations in which the flowers were used, so that it is not unlikely that the fatal result was due to the insects. The species which is officinal in our materia medica, the Arnica montana, does not grow in this country, but is indigenous to Europe. Its essential oil contains an imperfectly known alkaloid called Arnicin, and a starchy substance known as Inulin. To properly understand Arnica as a whole you must know that it affects the bloodvessels. Exactly how it does this, I can hardly tell you as it is not clearly defined in my own mind ; but the results I can tell you. It so affects the bloodvessels, particularly the capillaries, that dilatation of the smaller bloodvessels and extravasation of blood becomes possible. This weakening of the capillary walls, which ad- mits of this extravasation of blood, explains the application of Arnica to trauma. It also explains the application of the drug to typhoid conditions. Now keep before your minds, that Arnica so alters the capillaries that blood may ooze through their walls, and you will un- derstand its symptoms. There seems to be a venous stasis producing an extravasation of blood. This form of oozing; cannot occur from a healthy vessel. Arnica is applicable to both the acute and chronic effects of injuries. The acute injuries for which it is useful are the following: Simple bruises in which there are well-marked ecchymoses; concussions of the brain or spine or both. We have no remedy which equals Arnica in these last-named cases. Even compression of the brain comes within the range of Arnica, whether this compression be the result of a dis- placed fragment of bone in cranial fracture, or the result of effusion of blood within the cranial cavity. Arnica cannot, of course, cure in the former of these cases; an operation is demanded in order to obtain permanent relief. You may use Arnica in injuries of the muscles from a strain or from a sudden wrench, as in case of heavy lifting, and in haemorrhages of mechanical origin. Fractures of the bones may call for the use of Arnica both externally and internally to relieve the swelling and tumefaction of the limb, and also to relieve the twitching of muscles, a reflex symptom of the fracture. ARNICA MONTANA. 223 In chronic effects of injury we may use Arnica when diseases which may even be entirely foreign in their appearance to the ordinary symptomatology of the drug may be traced to a traumatic origin. No matter what that disease may be, whether of the brain, eyes, lungs or nerves, if the injury is the exciting cause, the administration of Arnica is proper. Again, as Arnica undoubtedly acts on the muscular tissue itself, we may use it for the consequences of diseases in the muscle; for instance, when one has been working very laboriously, and in consequence the whole body feels sore and bruised as if pounded; or again, when heavy work may have caused hypertrophy of the heart. This last-named is not strictly a disease, but it ends in disease. The heart is a muscle that grows under the stimulus of exercise as much as does the biceps of the arm. As a result of the cardiac hypertrophy, the patient com- plains of swelling of the hands on any exertion. The hand becomes redder than natural, and swells when the arm is permitted to hang down. The pulse you will find to be full and strong. When the heart has reached this stage of hypertrophy, there are local symptoms in ad- dition to those mentioned. The heart feels as though tightly grasped with the hand. The whole chest feels sore and bruised, and he cannot bear his clothing to touch it. This will at once suggest to you Cactus, which has that constriction about the heart. Cactus, however, does not have a traumatic origin for its symptoms. The sensitiveness of the chest suggests Lachesis, but it is a different symptom under Arnica which has not that sensitiveness of the per- ipheries of the nerves that Lachesis has ; but it is a true soreness from fulness of the bloodvessels. Other remedies to be compared with Arnica in this hypertrophy of the heart are: Rhus tox., especially if there is a rheumatic diathesis, Arsenicum, if it has resulted from climbing high places. Bromine has also been successfully used in this condition. Now let me give you the typhoid symptoms of Arnica, which, al- though very different from those just mentioned, depend upon a similar condition of bloodvessels. The changes in the bloodvessels by the typhoid poison favor the formation of ecchymoses here and there over the body. There is also a passive congestion of the brain. This is shown by drowsiness and indifference to those about him and to his condition. The patient falls 224 A CLINICAL MATERIA MEDICA. asleep while answering questions, just as we find in Baptisia. With these symptoms you almost always find the head hot and the body not hot. I put it that way for brief. The symptom in the materia medica reads, " the head is hot and the body cool, or at least not hot," implying that there is a difference in temperature between the head and the rest of the body. That symptom has been so often confirmed that it is well for you to remember it. The patient complains of a bruised feeling all over the body, so that the bed feels too hard to him. He is restless and tosses about the bed to find a soft spot on which to rest; and yet the fault is not with the bed, it is with himself. Sugil- lations from hypostasis appear on the back. The lungs become af- fected—and here, too, the same character of Arnica shows itself. There is a cough, with expectoration of mucus and blood. If the patient is still sufficiently conscious he will complain of sore bruised feeling in the walls of the chest. As the case progresses still further, Arnica may yet be called for, when the pressure of the blood in the brain is sufficient to cause apoplectic symptoms. The breathing be- comes heavy, and even stertorous. The lower jaw drops. Petechia appear on the skin, and both stool and urine are passed involuntarily, the patient, of course, being in a stupor. These are the typhoid symp- toms of Arnica. Now for the muscular symptoms. Arnica develops a true myalgia. The pains occur in the muscles of any part of the body. They are of traumatic origin, or they come from over-exertion, and are accom- panied by this sore, bruised feeling, which is so necessary to the choice of the drug. In rheumatism, you may employ Arnica, not for true inflammatory rheumatism, but for the local rheumatism which occurs in winter weather, and which seems to be the combined effect often of exposure to dampness and cold and strain on the muscles from over-exertion. The affected parts feel sore and bruised. Any motion, of course, ag- gravates this sensation. There are sharp, shooting pains, which run down from the elbow to the forearm, or which shoot through the legs and feet. The feet often swell and feel sore and bruised. In cases of injuries, the drugs to be thought of in connection with Arnica are these: First, Rhus tox., which, as I have already told you more than once, is preferable to Arnica when the ligaments of a joint, rather than the soft parts, are involved in an injury. It acts on the fibrous structures. Arnica is suited more to tumefaction of the other tissues. ARNICA MONTANA. 225 Calendula is to be thought of when the injury causes a torn or ragged wound, possibly with loss of substance. Calendula removes the inflammatory condition of the part, and so permits of healthy granulation. Hypericum is to be substituted for Arnica when the nerves have been injured along with the other soft parts. Nothing equals Hypericum in case of mashed finger. It relieves the pain and promotes healing. It often follows Arnica in concussion of the spine. Dr. Ludlam, of Chi- cago, is very partial to Hypericum in this trouble of the spinal cord. He has relieved some severe cases with it. Another drug yet is Staphisagria. This is the remedy for smooth clean cuts, such as are made by the surgeon's knife, and hence it is called for in symptoms which are traceable to surgical operations. Even if the symptoms which follow are not apparently connected with the symptomatology of Staphisagria, you may expect, when they arise from this cause, to obtain relief by its administration. Ledum is useful after Arnica when the latter remedy fails to relieve the soreness. It is also suited to injuries inflicted by pointed instru- ments, therefore in punctured wounds. Symphytum officinale is the proper remedy for bone injuries. For example, when a blow on the eyes injures the orbital plates of the frontal bone. It may also be administered in case of irritable stump after amputation ; and also for irritability of bone at point of fracture. If the latter condition is the result of impaired nutrition, Calcarea phos. should be prescribed. Arnica may be used as a preventive of pyaemia. It is thought by some physicians that this remedy promotes the evacuation of pus, that it promotes the appearance of pus on the surface of a sore. With the object of preventing pyaemia, some surgeons use Arnica after opera- tions, applying it locally and giving it internally at the same time. This property of Arnica to prevent pyaemia lies at the foundation of the stereotyped practice among physicians of giving this drug to women after delivery. It tends to relieve the soreness following par- turition and promotes proper contraction of the uterus and expulsion of coagula and of any portions of the membranes that may have been retained. Arnica has an action on the skin, producing crops of boils all over the body. They begin with soreness and go on to suppuration, and are followed by another crop. It may also be used in boils and abscesses which have partially matured but which, instead of dis- 226 A CLINICAL MATERIA MEDICA. charging, shrivel up by reason of absorption of the contained pus. Arnica given internally and applied externally redevelops the abscess. Further, in connection with the action of Arnica, I would call your attention to the effects of the drug on the gastro-intestinal tract. We find it indicated in dyspepsia, when, after a meal, there is impending apoplectic congestion of the brain with throbbing headache and drowsiness; and also, when there is some difficulty in the digestion of food ; there are foul breath, slimy yellow coating of the tongue, eructa- tion of gas tasting like rotten eggs, tympanitic distension of the ab- domen and foul-smelling stools. Arnica may be called for in cholera infantum, diarrhoea, or dysen- tery; the stools have a foul odor and are slimy, bloody, and even purulent, and are accompanied by great urging and straining to stool. The dyspeptic symptoms just mentioned will be present, and there are sharp, stitching pains through the abdominal walls. The patient is thirsty, and yet he does not know what he wants to drink. I should like, in closing my remarks on Arnica, to mention its use in whooping-cough. It is indicated in children who have a violent tickling cough, which seems to be excited whenever the child becomes angry. The child loses it breath when it cries. Before a paroxysm it begins to cry. Why? The lungs and trachea are sore. The little sufferer knows what is coming and dreads it; that is the interpreta- tion of the symptom. The expectoration is frothy, slimy, and always mixed with blood. In compression of the brain from apoplectic extravasation of blood, Arnica may be used when associated with the hemiplegia; there is an aching soreness all over the body. Bed-sores form very readily. Artemisia Vulgaris. Artemisia vulgaris, another member of the order Compositae, is a very serviceable remedy in epilepsy, when the attacks have been brought on by violent emotions, and especially by fright; when the attacks come in closely repeated-seizures, that is to say, when there are several convulsions coming close together, and then a long interval of rest. The paroxysms are usually followed by sleep. Again, Artemisia vulgaris seems to be of some use in that form of epilepsy known as "petit mal." The patient is walking in the street, when, suddenly, he stops, stares into vacancy, mumbles a few words possibly, regains a normal condition, and then goes his way totally unconscious of anything unusual having elapsed. absinthium, millefolium, taraxacum. 227 Artemisia has, like other members of the order (Cina more promi- nently than any of the others), an effect on the eye. We find under the drug this symptom : "Colored light produces dizziness;" for ex- ample, when seated near a stained-glass window the patient becomes dizzy. In addition to this it causes a well-developed asthenopia of this kind: On attempting to use the eyes the patient experiences pain in them, together with blurring of the vision, the latter symptom being momentarily relieved by rubbing the eyes. This is easily explained; the asthenopia is due to muscular defect and error of accommodation. By rubbing the eyes, the accommodation is temporarily restored. Absinthium. Absinthium, another form of wormwood, is of interest to you not only as a medicine, but also because you will meet with cases of its abuse in those who indulge in it as a drink. The first effect of Absinthe is an exhilaration of the mind soon followed by damaging results, among which is a horrible delirium. In this delirium the patient is obliged to walk about. You will note this symptom running through all the remedies of the order. Chamomilla and Cina have relief from moving about; and Artemisia has desire to move about; and here under Absinthium the patient walks about in distress, seeing all sorts of visions. The use we may make of Absinthium is in the sleepless- ness of typhoid fever when there is congestion at the base of the brain. Millefolium is of interest to you as being a remedy in haemorrhages from the lungs or bowels, of mechanical origin. The flow of blood is usually bright red. It is distinguished from Aconite by the absence of anxiety. Taraxacum, or the ordinary dandelion, is a decided liver remedy. If given long enough, it will produce a free flow of bile. The symptoms to guide you in its selection are these: The tongue is mapped, and there are bitter taste in the mouth, chilliness after eating or drinking, pain and soreness in the region of the liver and bilious diarrhoea. The use of this drug in typhoid fever was mentioned in a recent lecture. 228 A CLINICAL MATERIA MEDICA. Eupatorium Perfoliatum, or the bone-set, is a popular remedy in malarial districts for chills and fever. In this disease it is indicated by the following symptoms : The chill begins from seven to nine a.m. with thirst. It first appears in the back and is accompanied by aching in the limbs, as though every bone in the body were being broken. This is followed by high fever with increase of the aching, and this by sweat, which is said by some to be scanty and by others profuse. In some cases there is a double periodicity; the chill comes in the morning of one day and in the evening of the next. Eupatorium purpureum has been used for chill beginning in the back. I do not know of any symptoms distinguishing it from Eupa- torium perfoliatum. You may also think of Eupatorium perfoliatum in influenza with hoarseness worse in the morning, and cough with extreme soreness along the trachea and even to the finest ramifications of the bronchial tubes. With this there will be the ordinary symp- toms, aching all through the body, etc. Artemisia Abrotanum. Artimisia abrotanum is suited to suddenly appearing cases of spinal inflammation and to chronic myelitis. There are sudden aching pains in the back which are relieved by motion, and numbness and paralysis. It is especially called for in rheumatic patients. LECTURE XXII. CINA AND CHAMOMILLA. Cina. The medicinal virtues of Cina are largely although not entirely due to a poisonous active principle which it contains ; that active principle is Santonine, the central point of action of which is on the abdominal ganglia, whence are reflected nervous impressions to all other parts of the body, but principally to the brain and spine. As a result of this primary action on the abdominal ganglia, we have as reflex symptoms, convulsive twitchings and jerkings of the limbs and even violent spasms, these latter usually being of a tonic character. Strabismus also is present. Under the influence of Cina, the face is pale, and by the way, it con- tinues so, even if there be fever. Ipecacuanha and Bryonia also have this symptom partially. With the pale face of Cina, there are usually associated dark rings about the eyes. The pupils are dilated. The child grinds its teeth during sleep. It also picks or bores at the nose with the finger. The sleep is restless and attended by crying out. This is the general action of Cina. You now know what you may expect of the drug. Taking these symptoms into account, we are led to the use of Cina for the presence of worms in the alimentary tract. The most careful analysis of clinical experience has demonstrated that Cina is most powerful for the elimination of thread-worms. The sickly appearance of the face, the blue rings about the eyes, and the grinding of the teeth associated with canine hunger, give a perfect picture for the drug. Cina so far corrects the abdominal organs and so far tones up the abdominal ganglia, that the mucous membrane of the alimentary tract pours forth a normal secretion, so that the worms no longer having a proper pabulum on which to subsist, die and are expelled. This, then, is the use of Cina. In theoxyuris, those little worms which appear about the anus and get into the rectum, Cina is of no avail, because the symptoms caused by them are not the symptoms of Cina. For these, we have another group of remedies. Aconite when the child is feverish and cannot sleep. When the child is simply much excited, you may give Ignatia. 230 A CLINICAL MATERIA MEDICA. Indigo is the best remedy when convulsions result from the worms. If all these fail, think of Quassia. Caladium seguinum is the best remedy when the worms, in little girls travel over the perineum and get into the vagina. The irritation they produce, may thus excite masturbation. We may also make use of Cina in affections of the eyes, especially in asthenopia from defective accommodation. When the patient attempts to read, his eyes begin to ache, the letters become blurred and a cloud comes over the eye-sight. Relief is obtained by rubbing the eyes. The same condition I have already told you, is found under Artemisia vulgaris. A verv peculiar effect on the eye produced by Santonine is, that objects look yellow. Cina being a spasmodic remedy, we expect it to be useful in whoop- ing-cough, in which disease, it is indicated when the paroxysms come regularly through night or day and are accompanied by tonic convul- sions. Just after a paroxysm, a gurgling sound is heard. Cina may also be used in cough reflex from the irritation of worms. As a concomitant of all these conditions, we find the temperament of Cina. It is indicated in children who are irritable, nervous and peevish. They are obstinate and permit no one to approach them. Cina seems to have some effect on the bladder, producing wetting of the bed at night. The urine is white and turbid and sometimes has a very strong odor. Cina is not often used in intermittent fever, but it is sometimes in- dicated by thirst during the chill and occasionally during the fever also. Pale face is present even during the hot stage. There are also vomiting, canine hunger, and clean tongue. Like many of the other members of the order Compositae, the Cina patient finds relief from moving about. Chamomilla Matricaria. The Chamomilla of the homoeopathic materia medica is the German variety, the Chamomilla matricaria. The drug acts best apparently upon patients with a morbidly sensitive nervous system. It is like Cofifea, Ignatia and Belladonna then, in so far as it lessens nervous excitability. Slight impressions produce distress and anguish of mind; pains often result in fainting. Here it is similar to Vdlerian, Hepar and Veratrum album. It is especially applicable to these symptoms when they appear after long-continued use of narcotics. CHAMOMILLA. 231 In every disease in which Chamomilla is indicated, we notice this peculiar excitability. The patient, whether it be child or adult, a woman in labor or with toothache, is cross and excitable. Unless this mental state is present, Chamomilla will most likely fail you. When violent emotions, as anger, affect the viscera, as, for example, the liver with jaundice, you may think of the drug under considera- tion. In this condition it stands related to a few drugs. Staphisagria is indicated in children when colic follows a fit of anger. Bryonia has gastro-enteric symptoms after anger. Under this remedy, however, the symptoms are associated with chilliness, under Chamomilla with heat; under Bryonia the face is dark red, under Chamomilla it is hot. The Bryonia tongue is coated white, that of Chamomilla yellow. Continuing the nervous symptoms of Chamomilla, we find thedrug useful for insomnia of children, when they start during sleep and the muscles of the face and hands twitch. With these symptoms there is apt to be colic; the face is red, especially one cheek, and the head and scalp are bathed in a hot sweat. A word of explanation is here nec- essary: Sometimes, during an attack of fever in a child, the cheek on which it lies becomes red ; now that is not a Chamomilla symptom. These nervous symptoms of Chamomilla are generally reflex from the abdomen. There is very little evidence of delirium in these cases. When brain complications are present Chamomilla ceases to be the remedy, and Belladonna comes in. When, during dentition, Chamomilla fails, Belladonna is the remedy, because it is suited to a farther advanced state. This same nervous state of Chamomilla may be applied to the use of the drug in rheumatism. Rheumatic pains drive the patient out of bed and compel him to walk about. He is thirsty, hot, and almost beside himself with anguish. The analogous remedies here are Rhus, which lacks the excitement of Chamomilla; Ferrum metallicum, which has rheumatism better from moving about slowly; Veratrum album, which has maddening pains, compelling the patient to walk about. With the latter remedy there is not the feverishness and excitement which characterize Cham- omilla. Chamomilla also acts on mucous membranes, causing symptoms of catarrh. It is indicated in the catarrhs of children, when the nose is "stopped up," and'yet there is a dropping of hot, watery mucus from the nostrils; there are sneezing and inability to sleep, and with these 232 A CLINICAL MATERIA MEDICA. a dry, teasing cough, which keeps the child awake, or may even occur during sleep; or there is rattling cough, as though the bronchi were full of mucus. Especially is Chamomilla useful in colds brought on by cold windy days. Nux vomica is also indicated in catarrhs, when there is a " stopped- up" feeling in the nose, but there is no secretion whatever. Sambucus is indicated in catarrh, when the child starts up suddenly as if suffocating. Sticta suits a hard, dry, barking cough ; the nose is " stuffed up " and dry; the real condition is this, the nasal secretion dries so rapidly that it cannot be discharged. Chamomilla has a number of gastric symptoms. It is useful in biliousness produced by anger. We find it also indicated in gastral- gia, especially wdien the food eaten seems to lie like a load in the stomach. There is distension of the hypochondria; the tongue is coated yellowish-white, and there is a bitter taste in the mouth ; there are colicky pains in the abdomen, which are relieved by drinking a cup of coffee. Chamomilla produces a diarrhoea with hot, yellowish-green stool, looking like chopped eggs, and often mixed with bile, causing sore- ness at the anus, and having an odor of sulphuretted-hydrogen; it is especially worse towards evening; it is apt to occur during dentition. Chamomilla is here frequently followed by Sulphur, because both remedies produce the same stools with soreness of the stomach. If there is much tenesmus with these symptoms Mercurius is the remedy. If the stool is worse in the morning, and comes with a gush, we should think of Podophyllum. Chamomilla is an invaluable remedy in the lying-in room ; it is in- dicated when labor pains begin in the back and pass off down the inner side of the thighs. There is great nervous excitement; the labor seems exceedingly painful; after the labor is over, the lochial flow seems to be dark and too profuse, and the after-pains are violent and intolerable. Chamomilla may be used in threatening abortion caused by anger, when the pains are of the character just described, and there is a flow of dark blood. Viburnum is useful in threatening miscarriage when these pains come down the lower part of the abdomen and go into the thighs. It will stop the pains, even if it cannot prevent the miscarriage. LECTURE XXIII. MELANTHACE^]. Veratrum alb. Melanthaceae. Mind. Abdomen. Veratrum viride.—Circulation. Sabadilla. 1. Nerves. Colchicum. < 2. Abdomen. 3. Fibrous tissues. 4. Organs. From the Melanthacece we obtain the following medicines: Veratrum album, Veratrum viride, Sabadilla, and Colchicum. Of these, drugs, I may say that I am pretty well persuaded that the Veratrum album and ATeratrum viride are pretty well understood, and are, therefore, not easily misapplied. I am also well persuaded that Colchicum has not the place in practice it deserves. True, it comes to us from the allopathic school as a remedy highly recommended for gout. We ought not, however, from the exorbitant use of the drug by that school, to go to the opposite extreme, and neglect it as a remedy alto- gether. Colchicum. The symptoms of Colchicum I have arranged under four headings. The first, the nerves, includes typhoid conditions and debility. You must know that the drug tends to produce great prostration, and from this arises the great danger in administering it in large doses as a routine remedy in gout and rheumatism. While the paroxysms of pain may be relieved thereby, there is apt to be induced a condition of debility which runs the patient into other and new dangers. Let us see how we can use this effect of the drug under our law of cure. We find it indicated in debility, particularly in debility following loss of sleep; for instance, when one does not retire as early as usual in the evening, so that he is deprived of a portion of his accustomed sleep, and he awakens the next morning feeling tired and languid ; he can 16 234 A CLINICAL MATERIA MEDICA. hardly drag one leg after the other; the appetite is gone; bad taste in the mouth and nausea are present. The debility, then, starts from or involves digestion as a result of loss of sleep. You can see how close this comes to the Nux vomica condition. The debility, however, is greater even than that of Nux vomica. There seems, at times, to be a dislike of all foods; the odor of food cooking makes the patient feel sick; he becomes irritable; every little external impression annoys him ; here it is precisely like Nux vomica. As another form of debility or debilitating fever, we find Colchi- cum indicated at times in typhoid fever. Now, the position of Col- chicum in typhoid fever is between Arsenicum and Cinchona. First, we find that the patient's intellect is beclouded. Although his mind is befogged, he still answers your questions correctly, showing you that he is not in a complete stupor. Unless questioned concerning it, he says nothing about his condition, which does not seem dangerous to him. There is not that fearfulness, that dread of death, which characterizes some other drugs indicated in typhoid fevers. The pupils are widely dilated, and very imperfectly sensitive to light. There is a cold sweat on the forehead ; here you will at once note a resemblance to Veratrum album. When the patient attempts to raise the head from the pillow, it falls back again and the mouth opens wide. Yon thus see how weak are the muscles in the Colchicum case. The face has a cadaverous appearance. The features are sharp and pointed, the nose looks as though it had been pinched or tightly squeezed, and the nostrils are dry and even black. The tongue is heavy and stiff, and is protruded with difficulty. In extreme cases it is bluish, par- ticularly at the base. There is almost complete loss of speech, and the breath is cold. There are often nausea and vomiting, the latter being attended with considerable retching. These symptoms are as- sociated with restlessness and cramps in the legs. Coming to the abdominal regions, we find the body hot while the extremities are cold. Tympanites is exceedingly well marked. Stools are watery and frequent, and escape involuntarily. These are the symptoms which lead you to Colchicum in typhoid states. They greatly resemble those calling for Arsenicum and Cinchona. They resemble Arsenicum in the intensity of the debility and Cinchona in the tympanitic condi- tion. Colchicum seems to stand between the two, combining the rest- lessness and debility of Arsenic with the tympany of Cinchona. You will notice that the Colchicum symptoms are principally abdominal. Some of them suggest Veratrum album. You must, therefore, place COLCHICUM. 235 this remedy in your mind by the side of Colchicum that you may make the necessary distinction between the two. Carbo vegetabilis is allied to Colchicum in the coldness of the breath, in the tympany, and in the great prostration. But Carbo veg. seems to suit when there is giving out of the vital forces. The patient lies cold and almost pulseless. The pulse feels much like a slight ripple beneath the examining finger; there is no decided pulsation. The feet and the legs below the knees are cold, or there may be coldness of the knees and feet, the parts between them not being cold. Then the watery stool is not so characteristic of Carbo veg., the discharges being either absent or, if present, dark brown and horribly offensive. Next we come to the abdominal symptoms. The tympany and the diarrhoea have been mentioned already. In addition to these symptoms we have others which strongly point to the drug as a possible remedy in cholera. There are nausea and vomiting, the nausea seeming to be pro- voked by the smell of food. Whenever the patient sits up, the nausea and vomiting become worse. The matters vomited are watery and bilious. When dysenteric symptoms are present, the stools are fre- quent, watery and bloody, and contain shreds which were formerly supposed to be portions of the lining membrane of the bowel, but which are now known to be a plastic formation from exudation. Tenes- mus is violent, and is followed by spasm of the sphincter ani. If you have a case of dysentery with these symptoms, Colchicum will help you out. If there is tympany also, all the more is it indicated, being then far preferable to Cantharis, Mercurius or a y other remedy in our materia medica. The third heading on the board is " Fibrous tissues." This brings us to the consideration of Colchicum in rheumatism and gout. Now., Colchicum has a special affinity for the fibrous tissues. I include under this term the tendons and aponeuroses of muscles, ligaments of joints, and even the periosteum. The swelling produced by it is either dark red or pale in color, with no particular tendency to suppuration, and extremely sensitive to touch, and with a strong tendency to shift from joinftojoint. In rheumatism proper, Colchicum is indicated when it begins in one joint and travels thence to another, or in one side of the body and then flies to the other. The pains are worse in the evening. The joint is extremely sensitive to the slightest motion. The urine is dark red and scanty, just such as you would expect to find in gout or rheumatism. You will find such patients exceedingly irritable. Every little external impression, as light, noise or strong odors annoys them, 236 A CLINICAL MATERIA MEDICA. and pain seems to be unbearable. The only difference between these symptoms and those of gout is that in the latter the great-toe is in- volved, and that the paroxysms occur in the night. Sometimes we have metastasis of rheumatism or gout to the chest. Even then Colchicum may be the remedy. In valvular heart disease or pericarditis following rheumatism, it is indicated by violent cutting and stinging pains in the chest, particularly about the heart, with great oppression and dyspnoea. There is also the sensation as if the chest were being squeezed by a tight bandage. Colchicum stands almost alone in gout and rheumatism. There are no remedies similar to it in action here. Colchicum is sometimes indicated in dropsy with suppression of urine. The dropsy is particularly liable to appear as hydrothorax. What urine does pass contains blood, and is almost as black as ink, and is loaded with albumen. Hence you see that it is indicated in dropsy depending upon Bright's disease. Here it resembles, quite closely, Lachesis, which also has this black urine. It also resembles Terebinthina, which causes congestion of the kidneys with rupture of the fine capillaries, and consequent pouring out of blood into the pelvis of the kidneys. The urine contains tube-casts. It is smoky in appearance, and has a dirty pinkish deposit. Thus you have seen when Colchicum may be used in rheumatism, when in typhoid fever, and when in simple debility. The prostration which I spoke of as following the protracted use of Colchicum may be utilized in this way: when after frequent acute attacks of gout the patient becomes greatly weakened. In affections of the heart Colchicum is closely allied to Spigelia. When Colchicum has been abused, Spigelia is the remedy to be used as an antidote. Veratrum Album. Veratrum album is not a difficult remedy to understand. It has been used since the clays of Hahnemann for cholera Asiatica, cholera morbus and other abdominal affections. Its symptoms in this relation are well known, but unless you are careful you will neglect an equally important use of the drug, and that is in mental symptoms. In poisoning with Veratrum, there are very few symptoms referable to the brain. It seems to act prominently on the abdominal organs, acting probably through the splanchnic nerves. When these nerves are paralyzed, the bloodvessels become over-charged with blood and pour forth their serum. veratrum album. 237 In this respect it is similar to Elaterium. The prostration, the coldness and the terrible sinking sensation that belong to Veratrum all start from these nerves. But Veratrum may affect the brain as well. Even then the symptoms are not unlikely to be associated with coldness, weak- ness, etc. We may have Veratrum album indicated in delirium. That you should notice particularly, as, in this respect, it becomes closely allied, apparently, to Belladonna. The delirium is associated with restless- ness, with desire to cut and tear the clothing, loquacity, and rapid, earnest, loud talking; he strikes those about him ; anxiety ; frightened at imaginary things; lasciviousness; lewdness in talk; he springs out of bed and rushes about the room as if thereby to obtain relief. Thus far the symptoms are such that you can with difficulty only distinguish them from those of Belladonna and Stramonium. The distinction lies here: Veratrum album has coldness of the surface of the body with cold sweat on the forehead. Sometimes the face is red and the lips are blue, and there is tingling through the limbs. Veratrum album is also suitable for women when they seem to have abnormal mental impressions arising from disturbance in the sexual sphere; in nymphomania, for instance. The patient is lewd to an extreme. She rushes about the room endeavoring to kiss every one. These attacks are especially prone to appear before each menstrual period. She is constantly framing lies of the most outrageous character. Veratrum is also to be thought of when after fright, there is great coldness of the body with diarrhoea. Gelsemium also has diarrhoea after fright. Under Veratrum, it is associated with coldness and pros- tration. Now for some of the abdominal symptoms. Veratrum album is indicated in affections of the bowels, in cholera morbus, cholera infan- tum and cholera Asiatica and in intussusception of the bowels. The stools in the diarrhoea calling for Veratrum are profuse, watery and greenish, containing sometimes little flakes that look like spinach. At times, too, they are bloody, and are always associated with sharp cutting pains in the abdomen, and often, too, with cramps in the limbs. There is great weakness and almost fainting with every effort at stool. There is very little vomiting. Cold sweat on the forehead is present. In the various choleraic affections, Veratrum is indicated by the following symptoms : Vomiting and purging at the same time, colicky pains through the abdomen with cramps, especially in the calves of 238 A CLINICAL MATERIA MEDICA. the legs, profuse watery stools, ricewater stools as they are called. They are attended with great prostration and cold sweat, especially on the forehead. It is useless to give Veratrum in choleraic affections unless there is pain. The patient is worse at night. Emaciation is rapid. The first remedy to consider here in its relation to Veratrum album is Camphor. Like the former remedy, it produces coldness and symp- toms of collapse. Camphor is better suited to cholera when the dis- charges are scanty and the nausea marked. Sometimes the upper lip will be drawn upwards, showing the teeth, making the nauseous ex- pression of the face more hideous. The entire body is cold. The voice is squeaky or high-pitched. Jatropha curcas produces an even closer picture of cholera than does Veratrum. It causes vomiting of ropy albuminous matters with purging. Podophyllum resembles Veratrum album, in that it produces a per- fect picture of cholera morbis. It is especially indicated when the case is characterized by absence of pain. Herein, it is very different from Veratrum. The attacks generally come on during the summer. The stools are watery and come out with a gush and a splutter like water from a hydrant. There is marked loathing of food. The bowels are more apt to move after midnight and towards morning. The stools are very liable to change color. There is a remedy which is, I think, better suited to the summer complaint of children than is Veratrum. I refer to Iris versicolor. It produces marked inflammatory symptoms, with excoriated raw feeling at the anus. The patient is worse at two or three o'clock in the morn- ing. There are nausea and sour and sometimes bilious vomiting. The stools are either watery,, or are yellowish-green and mixed with bile or oily particles. Pulsatilla is called for in after-midnight diarrhoea caused by a diet of pastry, etc.; or by eating ice-cream immediately after a meal. Crotum tiglium comes in when the movements are yellowish or yel- lowish-green, pouring out with a rush or splutter, like water from a hydrant. They are provoked by every attempt to eat or drink. Elaterium is the remedy for profuse watery stools when they are of an olive-green color. I have often found Veratrum album useful for cardiac debility fol- lowing acute diseases, when the heart muscle becomes so weak that the pulse is thread-like. The patient faints on moving. On lying down, VERATRUM VIRIDE AND SABADILLA. 239 the face is red ; on sitting up, it turns deathly pale. Often you will find the hands cold and clammy. Veratrum Viride. Although the name of this drug is similar to that just considered, you must not reason thereby that it produces the same symptoms. Veratrum viride produces congestion of the base of the brain and of the upper portion of the spinal cord. It thus interferes with the function of the pneumogastric nerves. At first it seems to produce engorgement of the lungs, just such as we witness in the beginning of pneumonia. This is associated with a high degree of arterial excite- ment. If these symptoms go on unchecked, we have dizziness and faintness on attempting to sit up, nausea, cold sweat and orthopncea, and in fact every symptom of paralysis of the heart from over-exer- tion of that organ. Thus you will see that Veratrum viride comes in as an invaluable remedy in those violent congestions which precede pneumonia. It may even abort the whole disease. Areratrum viride also produces oesophagitis, in which disease it may be indicated even when the disorder has arisen from traumatic causes. It is called for by the difficulty of swallowing and the fiery burning pains in the oesophagus. In chorea it is also indicated, when, in addition to the choreic twitchings, there is violent congestion of the nerve centres. Given in a low potency it relieves the congestion, and therefore the nervous disturbances. We may even depend on Veratrum viride in puerperal convulsions. The cerebral congestion is profound. The patient lies in a condition like that of apoplexy. Between the convulsions she is not conscious, but lies in a deep sleep. The face is red, the eyes are injected and there is violent convulsive twitching, In some cases Gelsemium helps when there is a dull, drowsy state of mind. Sabadilla. Like Veratrum album, Sabadilla is a useful remedy on account of its mental symptoms. It may be used with success in cases of imag- inary disease. For example, the patient imagines that she is pregnant when she is merely swollen from flatus : or that she has some horrible throat disease which will surely end fatally. Thuja has the symptom, imagines herself double or treble, or that 240 A CLINICAL MATERIA MEDICA. she is made of glass, and is in constant fear of being touched lest she be broken. Sabadilla is useful in influenza. There are violent spasmodic sneez- ing and lachrymation on going into the open air; the throat also is affected, giving you a perfect picture of tonsillitis. The difficulty begins on the left side, and extends to the right; the pain is worse on empty swallowing. Sometimes there is a sensation as of a thread or string in the throat, or else a sense of constriction in the throat, as if it was tied by a string. We may also make use of Sabadilla in worms, when there are nausea and vomiting associated with a peculiar colic, as though the bowels were being whirled around like a wheel. LECTUEE XXIV. MENISPERMACE^E. The menispermacece is not a very large order of plants, there being derived from it but one remedy that we shall consider in this course of lectures. That remedy is Cocculus indicus. The name given to the order has been derived from the shape of the seeds. Cocculus Indicus. Cocculus indicus owes its properties to an active principle called Picrotoxine, this term being derived from two words meaning, when combined, " bitter poison." You will notice by the schedule on the board that I have arranged the symptomatology of the remedy under two heads, first the nerves, and secondly, the organs in general. f Cerebro-spinal. I Debility. ' Typhoid. Spasms. Now, whatever individual characteristics you may have for a drug in an individual case, these characteristics should agree with the gen- eral effects of the drug; otherwise, you are making a partial selection. To illustrate: Under Belladonna, you know of the symptom, " sleepy, but cannot get to sleep;" that is characteristic of the remedy. But we find the same symptom under Cinchona, Ferrum, and Apis. How are you to distinguish between them? By taking the general effect of Belladonna as a groundwork, into which the particulars must fit. Now, we shall find under Cocculus symptoms that are under many other drugs, but in no other drug do they hold the same relation as they do here. What, then, is the general effect of Cocculus indicus? This effect is the well-known action of the drug on the cerebro-spinal system, it having very little influence on the nerves and the ganglionic system. How can you find this out? Not very easily, I confess, Cocculus Indicus. 1. Nerves. 2. Organs. 242 A CLINICAL MATERIA MEDICA. but yet this has been done, by studying the drug as a whole, by endeavoring to discover, by means of physiology, pathology, or any other science that bears on the subject, on what portions of the body it acts, what functions it alters, and what tissues it changes. Then you have a strong basis on which to build your symptomatology. Cocculus acts on the cerebro-spinal system, producing great debility of these organs; the action of the drug on the brain itself I will ex- plain to you when I come to speak of its use in typhoid fever. We will now consider the remedy as it affects the spinal cord. It causes a paralytic weakness of the spine, and especially of its motor nerves; thus we find it a certain or frequent remedy in paralysis originating in disease of the spinal cord. Especially is it indicated in the begin- ning of the trouble, whether it results from functional or from severe organic disease of the cord; whether the disease be spinal irritation from loss of seminal fluid, softening of the spinal cord, or locomotor ataxia. It is especially indicated in these cases when the lumbar region of the spine is affected; there is weakness in the small of the back, as if paralyzed; the small of the back gives out when walking. There is weakness of the legs; and by legs I mean the entire lower extremities; the knees give out when walking; the soles of the feet feel as if they were asleep; the thighs ache as if they had been pounded ; first one hand then the other goes to sleep; sometimes the whole arm falls asleep, and the hand feels as if swollen. These symp- toms lie at the foundation of the symptomatology of the whole drug ; they all seem to depend upon spinal weakness. We find these symp- toms common enough in women with menstrual difficulties, when the back gives out in the morning, after venereal excesses, and also from loss of sleep. There is a concomitant symptom which you almost always find associated with those just mentioned, and that is a feeling of hollow- ness in some one of the cavities of the body, either in the head, chest, or abdomen. It is more than a weakness; it is an absolute feeling as though the parts were hollow. Talking tires these patients very much. The debility of Cocculus is of spinal origin. Especially is it apt to follow loss of sleep; the patient cannot sit up even one or two hours later than usual in the evening without feeling languid and exhausted throughout the entire day following. Let me next enumerate the typhoid symptoms of Cocculus ; under this heading I shall speak of those of the brain. You would not COCCULUS indicus. 243 expect Cocculus to be indicated in a case of typhoid fever when the changes in or ulceration of Peyer's patches were marked, or where there were profuse diarrhoea, pneumonia, and similar complications. But in the nervous type of the fever, when the cerebro-spinal system is bearing the brunt of the disease, Cocculus becomes one of the reme- dies that will help us through the case. The symptoms indicating it are the following: The patient complains of great vertigo, and this is made worse when sitting, or when attempting to change from a re- clining to a sitting posture. It is often associated with nausea, inclina- tion to vomit, and even fainting. Bryonia also has this symptom. So far as the symptom itself is concerned, there is no difference between Bryonia and Cocculus, yet, if you examine the case thoroughly, you will find that in Cocculus it is weakness of the cerebro-spinal nerves that gives origin to it. There is great confusion of the mind; a sort of bewildered, heavy state might better explain what I mean. It re- quires a great effort to speak plainly. In some cases they cannot find • the words they wish, to convey their meaning. Generally, such patients lie quietly wrapped in thought; the eyelids are heavy, as though they could hardly be lifted. Here is a symptom reminding you of Gel- semium. If the patient is still conscious enough to describe to you his condition, he will complain of a feeling of tightness of the brain, as though every nerve in the head were being drawn up tightly. At other times, he has this empty, hollow, vacant feeling in the head. Any attempt to move the patient produces faintness or even fainting away. The tongue is usually coated white or yellow; there is bitter taste in the mouth. The abdomen is greatly distended and tympanitic; this tympanites under Cocculus is not the same as under Cinchona, Carbo veg., Colchicum, Sulphur, or even Lycopodium. There are several origins of tympanites. It may come from the bloodvessels, from the air swallowed with the food, from changes in the food itself, and also from its retention. The latter condition is the cause of the tympany under Cocculus indicus. It is not to be thought of as a remedy when flatus results from decomposition of food. That calls for Carbo veg. Cocculus has considerable oppression of the lungs, this being of nervous origin. It is usually referred by the patient to the walls of the chest. The patients are sleepless, or at least business thoughts crowd on the mind and keep them in a half-waking state, here again resembling Bryonia. These are the symptoms which lead you to Cocculus indicus in typhoid states. The next division for consideration is " Spasms." Cocculus indicus 244 A CLINICAL MATERIA MEDICA. is useful in spasmodic affections when the patient is greatly debilitated as to the cerebro-spinal nervous system. Irritable weakness is the con- dition which gives rise to the spasms, for which Cocculus is the remedy. It is especially useful when spasmodic symptoms ensue as a result of prolonged loss of sleep. This condition we meet with more frequently in women than we do with men. The former are also more subject to spinal weakness. You may also use Cocculus for spasms after sup- pressed menses. The eyes are usually closed during these convulsions, and there is rapid oscillation of the eyeballs beneath the closed lids. But the woman must be of a weak, nervous temperament, or Cocculus is decreasingly indicated. Under the heading " Organs " we still have a word to say about Cocculus. First, as to the headache. Some years ago there was an epidemic of spotted fever in this city. During that epidemic many children died, especially in its earlier days. After a while there was discovered a symptom characteristic of the epidemic, and that was in- tense headache in the occipital region, in the lower part of the back of the head, and in the nape of the neck. The intense headache was manifested in various ways. Children in a stupor would manifest it by turning the head back, so as to relieve the tension on the membranes of the brain ; others, who were conscious, would put their hands to the back of the head ; while still others complained of pain in the back of the head, as if the part were alternately opening and closing. That symptom was under Cocculus. There were very few fatal cases after Cocculus was used. Occipital headaches are hard to cure. Cocculus is a good remedy. Gelsemium is another. In the latter there is pas- sive arterial congestion, by which I mean that the arterial blood flows freely to a part, the pulse being full and round, and not hard and tense, as under Belladonna or Aconite. There is often thick speech, too, with Gelsemium. Still another remedy for occipital headache is the Juglans cathartica, sometimes called Juglans cinerea, or the butternut. This I consider to be the best remedy for sharp pains in the occipital region. We have already anticipated some of the symptoms of Cocculus pertaining to the female genital organs. Still there are others. The menses are either profuse, and coming too often and with a gush, and very debilitating, or they are tardy in their appearance, and the patient suffers each month from what has been termed menstrual colic. We have a little group of remedies, of which Cocculus is one, for this condition. The others are Pulsatilla and Chamomilla. First let me COCCULUS INDICUS. 245 describe the symptoms of Cocculus. This remedy is indicated by a colic, in which the pain is as if there were sharp stones rubbing against each other in the abdomen. There is very often with this colic excessive distension of the abdomen from accumulation of flatus. The colic is especially liable to come on at night and awaken the patient. It is relieved by belching, but returns again from the re-accumulation of flatus. The patient is, of course, irritable. Under Chamomilla the menstrual flow is very dark. The mental symptoms described to you in my lecture on that drug are necessarily present. Pidsatilla has scanty menstrual flow, coming by fits and starts, grip- ing pains doubling the patient up; but the disposition is mild and tearful. Cyclamen is similar to Pulsatilla. It has chilliness with the pains ; crying, tearful mood; dyspepsia, made worse by eating fat food and pastry; scanty menses ; menstrual colic. But we make the distinction here: Cyclamen does not have relief in the cool air or in a cool room, aud in many cases Cyclamen has thirst. The resemblance between Cocculus and Cyclamen is that both remedies suit a depressed condi- tion of the cerebro-spinal nervous system. Those of Cyclamen are these: The patient feels dizzy; is weak from any motion; is highly anaemic; and usually worse when sitting up. These symptoms are usually associated with dimness of vision. We also find under Cycla- men this flatulent colic, arising of wind in the bowels,- coming on at night, and only relieved by getting up and walking about. Compare also, in menstrual colic, Ignatia and Nux vomica. LECTUEE XXV. PAPAVERACE^E. We now proceed to study the Papaveraceoe, an order of plants from which we obtain Opium, Sanguinaria Canadensis, and Chelidonium majus. As an order, they act on the circulation of the blood, tending to produce narcosis of a greater or less degree by exciting a fulness of the bloodvessels of the brain. The effect thus produced on the sen- sorium ranges all the way from sleepiness to stupor. This, you know, is eminently true of Opium, and, to a less degree, of Sanguinaria and Chelidonium. We will now take up the study of these drugs sericdim. Opium. Brain. Emotions. Spasms. Paralysis. Marasmus. Opium. { Constipation. Bladder. Sleep. Chest. Lungs. Heart ^ Defective reaction. Opium is obtained, as you probably know, from the unripe capsules of the poppy plant, Papaver somniferum. The unripe capsules are usually employed in its manufacture, because they give the most soporific effect. In some respects Opium is the most remarkable drug in our materia medica. You know that many drugs exert many of their effects owing to active principles which they contain. Thus Belladonna contains Atropine; Stramonium, Solanine; Nux vomica, Strychnine, etc.; but Opium seems to contain an endless number of these, and yet each succeeding year seems to add to the list. Let me enumerate them—they are as follows : Morphine, Protopine, Pseudo-morphine, Methylnornarcotine, Codeine, Deuteropine, Apocodeine, Laudanine, OPIUM. 247 Thebain, Codamine, Cotamine, Papaverine, Hydrocotamine, Rhceadine, Apomorphine, Rhceagenine, Desoxy morphine, Dimethylnornarcotine, Nornarcotiue, Mecondine, Thebenine, Cryptopine, Laudanisine, Narceine, Narcotine, Meconic acid, Lanthopine, Lactic acid. These various alkaloids are derived from Opium, by more or less complicated processes. They all have more or less narcotic properties akin to those of Opium itself. The action of some of these alkaloids is well-known, while of the action of others we are as yet ignorant. Morphia (used principally in the form of the sulphate) is probably the best understood of these. It is largely used by old-school phy- sicians in hypodermic medication for the relief of pain. But we may make use of it as a homoeopathic remedy. In such violent diseases as cancer Morphia has been successfully given for one of its secondary symptoms, extreme susceptibility to pain; pains are so violent as to threaten convulsions, or cause twitching and jerking of the limbs. Under these circumstances Morphia is a homoeopathic remedy. It does not cure, but relieves the pains, not as an opiate by stupefying the patient, but according to the law of homoeopathy. Morphia has the property of producing tympany. This is a very important fact for you to bear in mind, as you may find it necessary to differentiate incipient peritonitis from Morphia effects. Codeine, another of these alkaloids, is a useful drug in the treatment of phthisis. It is indicated in that dry, teasing cough which annoys the patient night and day. Furthermore Codeine has caused and cured twitching of the muscles, especially of the eyelids. This is a very annoying symptom; it is sometimes relieved by Crocus. Apomorphia causes and cures vomiting. Now this vomiting is not of the kind for which you give Ipecac, Tartar emetic, Lobelia, etc. It is a reflex vomiting usually from the brain. Apomorphia produces vomiting if injected hypodermically, long before it can have any local action on the stomach. You may utilize this effect of the drug in vomiting of cerebral origin, and also in that annoying disease from 248 A CLINICAL MATERIA MEDICA. which many people suffer, and for which they get little sympathy, seasickness. In these cases of cerebral vomiting you may also think of Belladonna, Glonoin, and Rhus tox. There are several others of these alkaloids of which we have some provings, but nothing that has been definitely described. There are, also, numerous preparations made from Opium ; these are largely used in allopathic practice; we have nothing, however, to do with them, except to undo the mischief they produce. The various preparations of Opium enter into the composition of cough-mixtures and soothing- syrups, used largely in popular practice. Their effects are decidedly pernicious, especially in children. A prominent old-school authority says that the use of soothing-syrup for children is decidedly reprehen- sible. It stunts their growth, makes them irritable and cross, and interferes sadly with the brain development. Nux vomica is one of the antidotes in cases of injury from anodyne preparations. Still better, perhaps, as an antidote, is Chamomilla, which is suited when opiates have been given for some time, and have produced their sec- ondary effects ; the little one is wakeful; slight pains are unbearable. When this condition is present, Chamomilla is your remedy, whether the patient be child or adult. No drug is more freely abused by both allopath and homoeopath (!) than is the one we are studying to-day. I would that I had both opportunity and ability to convince the practitioner of the old school of medicine of the absurdity of his indiscriminate use of opiates, and I could hope still more earnestly to dissuade homceopathicians from hiding their ignorance under the anodyne effects of an occasionally interpolated dose of morphine or laudanum. The one class ignorant of any other means of assuaging pains, and the other class too lazy to study their cases, seek relief for their patients in anodynes. Call them to task for their unscientific practice and they meet you with the re- mark, " My duty is to relieve the sick." Let me rejoin, " At any cost? Must you do what you know to be wrong? " "No, but how do you make it wrong ? " Let me reply by a brief resume of the modus operandi of Opium, and then if this question is not answered I make no further objections to anodynes. In small doses, Opium has primarily a transient exhilerating effect. It seems, however, to affect the emotional more than the intellectual sphere. The mind feels as if floating in the air, unincumbered by the laws of space and gravity. The imagination has full play. If now the dose is increased, either in quantity or by frequent repetition, OPIUM. 249 there follows a sleepy state. This sleep varies all the way from a pleasant feeling of easy drowsiness to the most profound stupor. This narcotic and anodyne effect of Opium is the result of the increased circulation of blood in the brain. This it does, not only by increas- ing the amount of blood supplied to the brain but also by interfering with its return to the heart. Let me digress for a few moments and speak of the physiological explanation of sleep. Hammond has shown that during this state, the quantity of blood circulating in the cranial cavity is greatly diminished. If you give Opium to produce sleep, what do you do? Do you produce anaemia of the brain ? No, just the reverse. I ask you then, is the administration of opiates for their anodyne effects at all rational ? Returning to the effects of Opium, the face becomes deep red and swollen from the distension of the bloodvessels. The more profound the stupor, the darker red is the face. It may even become of a brownish hue. The pupils become contracted. The pulse is full and slow. Respiration is deep, and as the stupor grows in intensity it becomes heavier and finally stertorous. What is the meaning of this stertor? It means that as the poisonous effects of Opium increase, a paretic and finally a paralytic condition of the muscles of the uvula and cheeks appears. These parts, thus being thoroughly relaxed, flap back and forth with each respiration. The pulse is full, round and slow, showing you that the heart is acting with the full volume of blood, but not with its usual speed. As the case goes on hour after hour, you find a picture of complete paralysis developed. The prac- tical application of this I will give you when speaking of typhoid fever. The sphincters lose their control, so that there is involuntary escape of urine and faeces. The lower jaw drops and finally death ensues. In these fatal cases autopsies show the cerebral convolutions to be flattened, the vessels of the cerebro-spinal axis engorged with blood, and effusion of serum beneath the arachnoid and in the ventricles of the brain. These are the symptoms of acute Opium poisoning. Now these phenomena depend upon the action of Opium on the nerves. From irritation comes the first brief excitation. From the subsequent paralyzing action come the drowsiness, muscular relaxa- tion and coma. From the beginning, the cerebral vessels are surcharged with blood, and this gradually increases until sopor ensues. Now, gentlemen, let me ask, is it rational practice to assuage pain with a sub- 17 250 A CLINICAL MATERIA MEDICA. stance which paralyzes and so relieves by taking away, not the disease, BUT THE ABILITY TO FEEL, THE CONSCIOUSNESS OF SUFFERING ? What are the effects produced by the habitual use of the drug ? The first effect is one that I have already described to you, one of dreamy imaginative activity of the emotional mind. Later, as the use of the drug is continued, every tissue of the body becomes affected. The skin grows dry and sallow and hangs in folds, the limbs emaciate, and the intellect becomes dulled. The best antidote to Opium is strong black coffee, given repeatedly until there is some sign of reaction. In addition to that you should use electricity. You should also remove any of the poison that may be in the stomach by means of an emetic or the stomach-pump, and you should force the patient to walk about to prevent stupor. Opium has been so far described that you can readily see in what classes of disease it is indicated. You see the picture of Opium in typhoid fever with profound cere- bral congestion resulting in paralysis of the brain, dropping of the lower jaw and stertorous breathing. Often when Opium is called for in this disease, the body is bathed in a hot sweat. This sweat is not critical. It is of bad omen. It is a symptom of approaching death in that it is a result of paralysis of the sweat glands. This symptom is also found under Stramonium. In typhoid fever with threatening paralysis of the brain, you should remember Lachesis, the symptoms of which I described to you when lecturing on that drug; also Hyoscyamus, which has the stertorous breathing; but there are differences, as you will learn in a future lecture. In one case where a profound coma failed to yield to Opium, Apis restored the patient. Opium must be considered in the treatment of apoplexy. It is quite natural to suppose that a remedy producing such fulness of the cere- bral bloodvessels might, in persons predisposed, readily cause their rup- ture, and the consequent symptoms of extravasation of blood into the cerebral substance. Opium is to be thought of by the color of the face, by the stertorous breathing, and by tetanic rigidity of the body. Especially is it indicated in the apoplexy of drunkards. Opium fol- lows Belladonna in apoplexy. In apoplexy occurring in drunkards, you should also think of Baryta carb. and Lachesis. OPIUM. 251 Arnica suits in apoplexy when the pulse is full and strong, the paralysis is on the left side and there is stertorous breathing. Apis is called for when the coma fails to yield to opium. For apoplexy with convulsions, think of Belladonna, Hyoscyamus, Lachesis, and Opium. For apoplexy followed by paralysis, Arnica, Belladonna, Lachesis, Nux vomica and Rhus. When followed by idiocy, Helleborus. Opium is useful in mania a potu or delirium tremens. Especially is it indicated in " old sinners," in those whose long lives of excess have thoroughly destroyed their constitutions; in those who have had the disease time after time. It takes but a small quantity of liquor to throw them again into the delirium. The face wears a constant ex- pression of fright or terror. They have visions of animals springing up from various parts of the room. They imagine that they see ghosts, devils, etc., with whom they converse, though they are terrified by the subjects of their visions. If they succeed in obtaining sleep, it is of the stertorous character already referred to. There are several remedies which, if given soon enough, will enable you to carry your patients with delirium tremens safely through the attack. I have already mentioned Opium ; another is Lachesis; espe- cially is this indicated when the patients have visions of snakes and other hideous objects, sensation in the throat as if choking, and spring- ing out of sleep suddenly as if from a dream. Another remedy is Stramonium, to which you will be guided by the violence of the symptoms. The patient starts up from sleep in perfect horror, with visions of animals coming towards him from every corner of the room ; he makes efforts to escape; his face is bright red. Still another remedy is Cannabis indica, or the hashisch. This is one of the best. It has thus far been given only in low potency. The symptoms which seem to characterize it are, errors of perception as to space and as to time. In other cases, we have to use Arsenic when there is fear of death and the patient will not permit himself to be left alone. A remedy often forgotten, but useful, nevertheless, is Calcarea ostre- arum. The minute the patient closes his eyes he sees visions com- pelling him to open then again in affright. You may use Opium in cholera infantum when the face is red or pale, and is associated with fatally advancing stupor; the pupils react either not at all to light or else very sluggishly. The disease seems to 252 A CLINICAL MATERIA MEDICA. begin by involving the brain; as yet there is neither diarrhoea nor vomiting; the child appears as if it had been drugged. Opium adminis- tered in a case like this will restore the patient to consciousness. Diar- rhoea sets in, and the disease proceeds naturally to recovery. This remedy may also be given when there is lack of vitality and the well- selected remedy refuses to act. The patient is either sluggish or drowsy. It is just as useful in these cases as are Carbo veg., Sulphur, Valerian, Ambra grisea, Psorinum, or any of the other drugs called for in defec- tive reaction. In still other cases of cholera infantum, Opium is indicated when, after the diarrhoea has lasted awhile, stupor sets in. There is a remedy which I wish to give you here, but with some caution, because it is what has been termed a breech-presentation, that is, it was used clinically before provings of it were made. That remedy is Ferrum phos. It is called for in cholera infantum when the discharges from the bowels are frequent; within twenty-four hours the child is greatly reduced, and falls into a stupor, with red face, dilated pupils, rolling of the head, and soft, full-flowing pulse. We know that Iron has that kind of a pulse; we know that congestion belongs to all the preparations of Iron. In one of my cases with the above symptoms, Belladonna and Sulphur were each given in turn, but failed. I then gave Ferrum phos., and in twelve hours the child returned to consciousness, and is alive to-day. You may also use Opium in suppuration of the lungs occurring in those greatly addicted to the use of intoxicating liquors; breathing is labored, and is attended with rattling and snoring. Cough is very difficult, and is attended with smothering spells; the face becomes blue during the cough. Another affection of the lungs occurring in drunkards, namely, haemoptysis, calls for Opium when the chest is hot and the limbs are cold; the cough is violent, and is attended with an expectoration of frothy mucus and blood; the patient is drowsy with the cough. Antimonium tartaricum also has cough with drowsiness and gaping. We find Opium sometimes indicated in spasms, especially when they occur as the immediate result of fright or anger ; or, when a nursing infant has a convulsion after its wet-nurse has been frightened; the body is in a condition of tetanic rigidity ; the spasm is ushered in with a loud shriek; there is foaming at the mouth ; the face becomes dark red, or even purple, and the body is often bathed in a hot sweat; deep, snoring sleep follows the spasm. Opium causes and cures constipation ; a constipation in which there OPIUM. 253 is inertia of the rectum and the entire intestinal tract; there is no in- clination whatever for the bowels to move; thus the bowels become impacted with faeces; flatus accumulates in the upper portion of the intestines and presses upwards against the chest. This symptom is very common after diseases that are debilitating or long lasting. In such cases I have been in the habit of giving Opium in repeated doses until colicky pains are produced ; this indicates restoration of peris- taltic action of the bowels. I then order an injection of cocoa-nut oil or soap and water to soften down the faecal masses, when an easy evacuation of the bowels follows. The Opium stool in its complete picture consists of little hard, dry, black balls. This form of consti- pation reminds us of that of Alumina, Plumbum and Bryonia. Bryonia has constipation with inertia of the rectum; the stools are large and dry. Plumbum closely resembles Opium, but there is some spasmodic constriction of the anus; the stools consist of hard black balls. Alumina has inertia of the rectum, but usually attended with soft faeces. In tympanites or accumulation of flatus, compare Opium with Tere- binthina, Lycopodium, Carbo veg., Colchicum, and Raphanus. The characteristic symptom calling for the last-named remedy in tympanites is, that the patient passes flatus neither upwards nor down- wards for days. Opium may be used in bladder troubles, especially in retention of urine. It is indicated when this retention has resulted from fright, and when it follows parturition. This last-named symptom I have twice confirmed. In this retention of urine after labor, compare with Opium Hyoscy- amus, Causticum, and Arsenicum. In suppression of urine you may think of Stramonium, Zingiber, Lycopodium, and Pulsatilla. The power of Opium to cause shrivelling of every fibre of the body suggests its use in marasmus in children. The patient is wrinkled and looks like a little dried-up old man ; the characteristic Opium stupor is present. When the above-named condition has been produced by Opium, Sulphur, Argentum nitricum, or Sarsaparilla may be used as an anti- dote. Muriatic acid is the remedy for the continued muscular debility following the use of Opium. We may find Opium indicated in that very dangerous condition, 254 A CLINICAL MATERIA MEDICA. strangulation of the bowels. There are violent colicky pains and vom- iting of matters having a faecal odor. In colic, it may be given when there is great tympany; there is a great deal of belching without relief. Sometimes we find Opium useful in metrorrhagia, whether after labor or not. The patient is restless ; the sheets feel hot to her; she is sleepy, but cannot sleep. In fevers other than typhoid, it may be given when the chill is accompanied by heat of the head and great drowsiness; the body is burning hot, even when covered with a copious sweat; desire to un- cover; unconsciousness; feels as if his legs belonged to some one else. (Comp. Baptisia and Stramonium.) Puerperal fever sometimes calls for Opium, especially when caused by fright. There is overexcitement of all the senses; even distant sounds annoy the patient; the discharge from the uterus is very foetid. The case approaches a condition of stupor. In haemorrhage from the uterus, compare Belladonna, which has a flow of bright blood feeling hot to both physician and patient. Hyoscyamus also has this. But under this remedy there is a great deal of spasmodic jerking of the body. You will see from what I have said that Opium is an invaluable remedy for the bad effects of fright, whether that emotion produces convulsions or diarrhoea. Gelsemium, Pulsatilla, and Veratrum, you will recall as being useful in diarrhoea after fright. For the chronic effects of fright, you should remember Natrum mu- riaticum, Silicea, and Phosphoric acid. Opium, like Bovista and Arnica, is useful for the bad effect of in- halation of charcoal vapors. In spasms of the lungs, compare Moschus and Ipecac. Drosera is likewise indicated in the spasmodic cough of consump- tion, coming on in the evening, perhaps again after midnight. Every effort to raise a little phlegm ends in retching and vomiting. LECTUEE XXVI. SANGUINARIA AND CHELIDONIUM. Before proceeding with our study of Sanguinaria, I will say that there is a variety of the poppy plant which grows in Mexico called the Argemone Mexicana. It is used in Mexico in much the same manner as we use Opium. It causes cutaneous eruptions and has been used in the expulsion of tape-worm. The juice of the plant when collected and dried haa much the appearance of gamboge. I mention this, not because it is a matter of importance, but as a piece of information that may in time prove beneficial. We will now take up the study of another member of the Papaver- aceae, the Sanguinaria Canadensis, or blood-root. This is a plant which is readily recognized by the character of its root, which, when cut, is red, and exudes a fluid having the appearance of blood, hence the plant has been aptly named " blood-root." The seeds of Sangui- naria are somewhat narcotic. You can see a resemblance between it and Opium, not in the completeness of its symptomatology, but a family resemblance sufficient to place it by the side of Opium, yet having differences so great that there can be no danger of confound- ing the two drugs. In extreme narcosis from Sanguinaria we find languor and torpor, dilated pupils, with disordered vision and irregu- lar pulse. The symptoms are not unlike those which follow poison- ing with Stramonium. In studying the drug we may save all un- necessary multiplication of symptoms by attention to the following schemse: r Belladonna, ") Compare with Sanguinaria Canadensis, { Iris versicolor, t^ n. . }■ In headache. Paulhnia, Melilotus, J Veratr. viride, "") Phosphorus, T r ' V In pneumonia. Antim. tart., Sulphur, J 256 A CLINICAL MATERIA MEDICA. Sanguinaria Canadensis irritant to ■( Circulation. r Brain: Anxiety, irritability. Nose: Faint from odors. Ears: Sensitive to sudden sounds. C Headaches. Vertigo. Haemorrhages. Climaxis. Fever. Menstruation. Phthisis fluorida. Local congestions. r Dry feeling or rawness. Cough. Croup. Ulceration. Polypi. Diarrhoea. ^ Pneumonia. Glands: Salivation. Skin: Acne, ulcers. Muscles: Rheumatism, myalgia, languor, nausea, faintness. Mucous membranes: < Sanguinaria is in the first place an irritant, whether taken into the mouth, applied to the skin, or when carried by the blood to other tis- sues. For the primary and most important effect of the drug, then, we have irritation of tissue. For instance, the brain is irritated by San- guinaria. This is mentioned first because of the predominant impor- tance of all mental symptoms, be they emotional or be they intellec- tual. Anxiety is almost always present with the Sanguinaria symp- toms. This anxiety, however, is not an isolated symptom. It appears qualifying the headaches, the gastric difficulties, the heart and chest symptoms, and in fact all the ailments in which Sanguinaria is ap- plicable. Like almost all anxiety, it is accompanied by irregularities or disturbances in the circulation. There is also an irritability of temper which makes the patient morose, irritable, peevish or excitable. Then we note, too, that the ears are irritated by the drug. Primarily, this irritation comes from the irritating action on the circulation. It causes increased redness of the external ear, with humming and roar- SANGUINARIA. 257 ing in the ears from increased circulation of blood through the aural structures. It also produces a hyperexcitation of the auditory nerves with the following symptoms as characteristic: Painful sensitiveness, especially tq sudden sounds; sensation as if the patient were in a rail- road car or in some vehicle which was moving and jarring her, with a feeling as if all about her were talking rapidly and confusedly; the patient desires to be held in order to remove this nervous vibratory sensation through the body. Thus you see the primary irritating effect on the ear reflected through the entire nervous system producing these symptoms, which, by the way, are not uncommon in women about climaxis. Sanguinaria is equal to Glonoin in these cases. This desire to be held reminds one of Gelsemium, which has heart disease with tremor of the whole body and desire to be held still. Next we come to the nasal symptoms. The sense of smell is usually increased; hence we notice a peculiar susceptibility to odors, which causes the patient to feel faint. This is not an uncommon symptom in " rose-cold." It also belongs to hysteria, and places Sanguinaria by the side of Phosphorus, Ignatia, Valerian, Nux vomica and similar remedies. Next we come to the disturbances in the circulation. We find these first exhibited in the vertigo, there being a rush of blood to the head with this dizziness; the patient feels sick and faint, as if she would fall when she attempts to rise from a sitting posture. Then, too, we have the circulatory disturbances represented in the sick-headache, and Sanguinaria has no equal in sick-headache, espe- cially in that form which is so common in this country as to receive the name of " American sick-headache." The patient suffers from rush of blood to the head, and this causes faintness and decided nausea, the nausea even continuing until vomiting sets in. The pains, which are of a violent character, begin in the occipital region, spread thence over the head, and settle over the right eye. They are of a sharp, lancinating character, and at times throbbing. At the height of the disease the patient can bear neither sounds nor odors. Mark the effect on the auditory and olfactory nerves. She can not bear any one to walk across the floor, for the slightest jar annoys her. As the head- ache reaches its acme nausea and vomiting ensue, the vomited matters consisting of food and bile. The patient is forced to remain quiet in a darkened room. The only respite she has is when sleep comes to relieve her. Sometimes the pain is so violent that the patient goes out of her mind, or she seeks relief by pressing against her head with her 258 A CLINICAL MATERIA MEDICA. hands or by pressing the head against the pillow. This is the Sangui- naria sick-headache in its completeness. Not only does the remedy palliate, but it cures. Studying Sanguinaria with its concordant remedies, ypu will find coming into your mind most prominently Belladonna as affecting the right side, as having throbbing pains, cerebral congestion and intoler- ance of light and noise. You see that the two remedies are very similar. Practically speaking, Sanguinaria is the more useful of the two in the gastric form. In Belladonna, you almost always find cold feet with the hot head, which may not necessarily be present under Sanguinaria. Then again, the Belladonna patient is not relieved by lying down, but by sitting propped up, while Sanguinaria has relief from lying down. Then Belladonna has not so characteristically as Sanguinaria the direction of the pains; that is, the "pain coming from the occiput over the head, etc.," is not quite so prominent under Belladonna as it is under Sanguinaria. Melilotus, one variety of the clover, produces a most violent cerebral congestion with headache, which drives the patient almost frantic. It really seems to the patient that the brain would burst through the forehead. The throbbing pain is almost as violent as it is under Glonoin. In one proving of this drug, a lady had this congestive headache with prolapsus uteri and violent palpitation of the heart. Still another drug closely allied to Sanguinaria is Iris versicolor. This drug is useful for sick-headaches, particularly when they are periodical in their appearance, recurring, for instance, every Sunday. This is because the strain of the preceding six days has been relieved and now the patient feels the effects of the strain and has this sick- headache. It is especially suited to school teachers, college professors, students, etc. The pains are intense and of a throbbing character and supraorbital. They often affect the eyes and cause temporary blind- ness. At the height of the headache vomiting often ensues, the vomited matters being bitter or sour, or both. I wish also to mention Paullinia sorbilis. This has some little his- tory. A number of years ago there appeared a specific, in the form of pills, for sick-headache, the principal ingredient of which was this Paullinia. It proved itself to be an efficacious remedy. The objection I have to the drug is that it must be given in large doses, consequently I do not think that it has a true symptomatic relation to the ailment for which it was recommended. Its active principle is said to be identical with Caffeine and Theine. SANGUINARIA. 259 Continuing our study of the effects of Sanguinaria on the circula- tion, we find it sometimes indicated for haemorrhages, not very fre- quently it is true, yet when the symptoms call for it you should bear it in mind. It is especially indicated in metrorrhagia occurring at climaxis. The blood is bright red, clotted and frequently offensive. Especially is it to be used when the metrorrhagia is accompanied by the form of sick-headache which I have already described, and by flushing of the face and flushes of heat which are incident to change of life in women. The face becomes scarlet. This high color passes off with moisture and faint, weak, sick feeling. Here then you must place Sanguinaria with Glonoin, Nitrite of Amyl and Lachesis. The menstrual flow of Sanguinaria is bright red, clotted and offensive, later becoming dark and losing its offensiveness. Still another fact which illustrates these irregularities of the circu- lation, is the application of Sanguinaria to phthisis florida. In detail- ing to you the symptoms calling for this remedy in phthisis florida, I will also mention the character of the cough and also the application of the drug in pneumonia, because the symptoms in each case are sim- ilar although belonging to different diseases. You find the patient suffering from hectic fever. The fever usually comes at about two or four o'clock in the afternoon ; the cheeks have a bright circumscribed flush. The cough is usually dry at first, and seems to be excited by tickling or crawling in the larynx and upper portion of the chest, probably in the trachea, and perhaps in the beginning of the bronchial tubes. There is a great deal of burning and fulness in the upper part of the chest, as if it were too full of blood, which it really is. The patient complains of sharp stitching pains, especially about the right lung and in the region of the nipple. These pains are in all proba- bility myalgic. The muscles of the chest are, of course, sore with this pain. There is also great dyspnoea. Thus early in the disease, San- guinaria, by calming the circulation, by removing the congestion of the chest, by lessening the hectic fever, will save your patient from what would end fatally in a few months. When pneumonia calls for Sanguinaria, we have, in addition to the symptoms already mentioned, rust-colored sputum with the cough (just as you find in the stage of rdd hepatization), a very distressing amount of dyspnoea, and the hands and feet burning hot, or else just the reverse, cold. Sometimes, even before the amount of hepatization will account for it, you have failure of the heart's action. The heart becomes weak and irregular in its action. There is a weak, faint feel- 260 A CLINICAL MATERIA MEDICA. ing about the heart. The patient is faint. He is covered with sweat and he suffers from nausea. Localized congestions are frequent enough in the symptomatology of Sanguinaria. You have seen how it causes cerebral congestion, circumscribed redness of the cheeks, etc. You may also use it for a teasing cough compelling the patient to sit up at night. The cough ceases so soon as the patient passes flatus by the bowels. Connected with this form of cold, there is a feeling as of a warm current running from the chest to the stomach. The disease may be transferred from the chest to the abdomen, the whole difficulty ending in diarrhoea. Sanguinaria resembles several drugs in pneumonia. It bears a re- semblance to Veratrum viride in the engorgement of the lungs and in the intensity of the symptoms. Veratrum viride has, more marked than Sanguinaria, arterial excitement. As yet, hepatization has not taken place. Veratrum viride given then lowers the pulse, reduces the congestion and modifies the pneumonia. It also resembles San- guinaria when the engorgement is so profound as to threaten the death of the patient. The pulse becomes rapid and quivering, the face livid, and every symptom of approaching paralysis of the lungs is present. When hepatization has taken place, Veratrum viride is not indicated. Phosphorus resembles Sanguinaria in pneumonia. Its symptoms I will mention when I lecture on that drug. Antimonium tartaricum resembles Sanguinaria when the face becomes livid, the blood is surcharged with carbon, rattling cough, etc. Sulphur resembles Sanguinaria during the stage of resolution when the hepatized lung does not break down properly, and the sputum becomes purulent. In these cases, either remedy is indicated, Sangui- naria being preferable when the expectoration is very offensive, even to the patient himself. Returning to Sanguinaria and reviewing its action on the mucous membranes, we find that it has a highly irritating effect, causing at first extreme dryness, whether it be the conjunctiva, the mucous membrane of the mouth, nose or any other mucous surface. Alternating with this dryness and indicating the drug in another phase of the case, is rawness with burning, as though the mucous membrane was denuded of its epithelium. This is common enough in catarrhs. You find the nose sore and raw with fluent excoriating coryza. The cough is as I have described, and seems to depend upon this dryness or irritation of the mucous surfaces. When the laryngeal mucous membrane is affected, we have very dis- CHELIDONIUM. 261 tressing symptoms. There is aphonia and, in addition, a feeling of swelling in the throat as though the patient would choke. Sanguina- ria is indicated in laryngeal catarrh, whether it be from phthisis or from simple cold or exposure. The croup for which we may use Sanguinaria is one in which there may be a formation of pseudo-membrane with dryness, burning and swollen feeling in the throat, and metallic croupy cough which cannot be characterized by any other words than wheezing-whistling. It is too shrill to be only " wheezing," and it is too moist to be " whistling" alone. If it is associated with the dryness and burning, and some of the other catarrhal symptoms, Sanguinaria will quickly cure the entire affection. Sometimes we have ulceration of the mucous surfaces with the quali- fying symptoms already mentioned. Another effect on the mucous surfaces is the formation of polypi. These may be found in the nose or in any other part of the body. San- guinaria is especially useful for mucous polypi when they bleed pro- fusely. When occurring in the nose, they are associated with the form of coryza already referred to. There is also profuse salivation, show- ing that the drug irritates the salivary glands. The skin is also affected under Sanguinaria. It produces acue on the face, particularly in women who have scanty menstruation and are subject to irregular distribution of blood. Lastly, we find the drug affecting the muscles, inflaming them, and giving a picture of acute muscular rheumatism. The pains are erratic, sharp and stitching, with great soreness and stiffness of the muscles, especially those of the back and neck. Sanguinaria exhibits a special affinity for the right deltoid muscle. The pains are intense. San- guinaria holds the same relation to the right deltoid that Ferrum does to the left. So much for Sanguinaria Canadensis. Chelidonium Majus. f Liver, Lungs, Heart. i Neuralgia, Toothache. Chelidonium. -I Eyes, Kidneys, Fistula. Joints, Diaphragm. Skin, Chills and Fever. 262 A clinical materia medica. r Antim. tart. Mercurius. \ Kali carb. Bryonia. Lycopodium. I will be brief in my remarks on Chelidonium, as we have not the time to exhaustively treat of the drug. It is a unique remedy, pos- sessing points of similarity with its congeners, Sanguinaria and Opium, and also to Nux, Mercurius, Phosphorus and Kali carb. The plant yields an acrid, yellow, bitter juice, which, when applied locally, pro- duces inflammation and even vesication. The principal value of Che- lidonium lies in its action on the liver, lungs and kidneys. The patient is low-spirited, inclined to weep, but knows no reason therefor; rest- less, must move from place to place, with mental anguish; headache, with coldness extending from the neck into the occiput; the head is so heavy he can scarcely raise it from the pillow; pressure in the occi- put towards the left ear. It may be indicated in many affections of the first-named organ from a simple congestion to a positive inflam- mation. It produces pains in the right hypochondrium all the way from a simple soreness to the most aggravating variety of sharp stitch- pains, which shoot from the liver down into the stomach, or down into the back from the posterior aspect of the liver. There is marked pain under the angle of the right shoulder-blade. That is the key-note for the drug in hepatic disease. In addition to this you have the usual hepatic symptoms, swelling of the liver, chills, fever, jaundice, yellow- coated tongue, bitter taste in the mouth, tongue taking the imprint of the teeth, as you find under Mercury, and desire or craving for milk, which exceptionally agrees. There is usually also a craving for acids and for sour things, as pickles and vinegar. The stools are character- istically profuse, bright yellow and diarrhceic, of they may be clayey. These are the symptoms of Chelidonium, and they are very definite. Let me tell you how to apply them. You may use the drug in simple biliousness, in hepatic congestion or inflammation, and also in pneu- monia with bilious symptoms, in what has been termed bilious pneu- monia. The symptoms indicating it in the latter affection I will give you presently. This pain, under the angle of the right scapula of Chelidonium, brings to mind pains of a similar character found under other reme- Compare with Chelidonium Majus, CHELIDONIUM. 263 dies. Chenopodium has dull pain lower than the angle of the right scapula and nearer the spinal column. Ranunculus bulbosus has pain along the whole inner edge of the left scapula, at times extending below its inferior angle and through the left chest. Lobelia syphilitica has pain under, not below, the inner border of the left scapula, worse after weeping. Angustura has sharp cutting pain from just beneath the right scapula to the breast, near the nipple. Bryonia is very similar to Chelidonium in hepatic affections. Both remedies have sharp stitching pains, both have pain under the right shoulder blade, both have bitter pain in the mouth and yellow-coated tongue and both have swelling of the liver. But Bryonia differs in its stool which is either hard, dry and brown or, if loose, it is papescent and profuse and associated with a colic very much like that of Colo- cynth. Sometimes the stools have an odor of old cheese. Lycopodium, which bears some resemblance to Chelidonium, is easily differentiated, especially in the rumbling of flatus in the left hypochondrium, in the sour rather than the bitter taste, in the sour vomiting, in the fulsomeness after partaking of small quantities of food, and in the character of the pains, which are dull and aching under Lycopodium, and sharp and lancinating under Chelidonium. You may use Chelidonium in neuralgia of the face. The pains go from the right cheek bone into the teeth or into the eye, or the pain may be located in the supra-orbital nerves. This neuralgia will not yield to Chelidonium, however, unless you have some of the hepatic symp- toms of the drug present. It is a neuralgia dependent on disorder of the liver, and not an idiopathic prosopalgia. Chelidonium is useful, as I have already intimated, in bilious pneu- monia. It is also indicated in the capillary bronchitis of children when these hepatic symptoms are present, especially when it follows measles in whooping cough. The face in these cases, is apt to be deep red. There is great oppression of the chest as shown by the efforts to breathe and the fan-like expansion of the alse nasi (a Lycopodium symptom, by the way) one hot and one cold foot (another Lycopodium symptom) and stitching pain under right scapula. The cough is usually loose and rattling. The expectoration is not easily raised. Mercurius is sometimes indicated in bilious pneumonia. It differs from Chelidonium in the character of the stool more than in anything else. The Mercury stool is slimy and is attended with great tenesmus 264 A CLINICAL MATERIA MEDICA. both before, during and after the stool, while in Chelidonium it is quite free. The Mercurius expectoration is apt to be blood-streaked, and there are sharp pains shooting through the lower portion of the right lung to the back. That last symptom may be in Chelidonium, too. Antimonium tartaricum has yellow skin, urine and vomit, etc. (in bilious pneumonia); stinging under right false ribs, frothy yellow tenacious sputum, rattling in chest with suffocation, fan-like motion of alae nasi, great oppression, strong heart beat. Kali carb. is a remedy often forgotten in pneumonia. It is not in- dicated in the beginning, but later, when there is copious exudation into the lungs, with great rattling of mucus during the cough. The symptoms are worse towards two or three o'clock in the morning. The expectoration contains little globules of pus. There may even be cyanotic symptoms with puffiness over either eyelid. LECTUEE XXVII. CUCURBITACEJE. 1. Colocynthis cucumis. 2. Bryonia alba. 3. Citrullus (Water-melon). The seeds are Cucurbitaceae. ^ diuretic. 4. Cucnrbita (Squash). 5. Momordica balsamum.—Flatulency. 6. Elaterium momordica.—Bowels and fever. To-day we begin our study of the Cucurbitaceae. This order gives us some six or eight drugs, and also some edible substances. Among the latter are the water-melon, canteloupe, and cucumber. The seeds of some of these have diuretic properties, and those of the water-melon have been used as a cure for worms. Of the medicinal substances obtained from this order we may say that they all act prominently on the alimentary tract. They seem to have in common a cathartic action. They probably act paralyzingly on the vaso-motor nerves of the abdomen. They produce griping pains, gushing watery diarrhoea. This last symptom is most promi- nent under Elaterium. Let us now enumerate these medicines. Fifth on the list is the Momordica Balsamum; of this we have but one characteristic symptom, and that is accumulation of flatus in the splenic flexure of the colon. It is a very convenient thing to know this. For instance, if, during the course of a more or less chronic disease, this one symptom becomes very annoying, and you do not want to destroy the action of the drug you are giving, you simply interpolate a dose of Momordica, which removes the symptom and enables you to go on with the treatment as before. Elaterium,, another member of the order, has been used principally, in our school of medicine, in a peculiar form of diarrhoea. Like all the Cucurbitaceae, it acts powerfully on the alimentary tract, producing a sudden and enormous effusion of serum into the bowels. Thus it causes a watery diarrhoea, the stools flowing out very profusely. The 18 266 A CLINICAL MATERIA MEDICA. characteristic symptom of the drug, and the one which will lead you to its selection in cholera infantum, is watery stools of an olive-green color, coming out with a gush. Thus, you see, it is comparable with Croton tiglium, Podophyllum, and Veratrum album, and remedies of that type. It is readily distinguished from Croton tiglium, which is adapted to a profuse, yellow watery stool, which is provoked every time the pa- tient eats or drinks. Podophyllum has, as you all know, the morning aggravation to dis- tinguish it. The remaining medicines belonging to the Cucurbitaceae are the Citrullus, or water-melon; the Cucurbita, or squash, the seeds of which, as well as those of the pumpkin, have been used for taenia; the Colocynth, and the Bryonia alba ; the last two named being drugs of great importance; we will therefore proceed to their consideration in extenso. COLOCYNTHIS CUCUMIS. f 1. Nerves. I ^euralSia- I Cramp. Colocynthus. I 2. Bowels. 3. Urine. 4. Gout. The Colocynthis cucumis furnishes us with a gourd about the size of an orange with a smooth marbled green surface. When dried it appears of a brownish color. It is not indigenous to this country, but is imported from Syria and Turkey. Often, however, it is found in the market, pealed and dried, looking like a pithy ball, full of seeds and very light in weight. It is inodorous, but it has an intensely bitter taste. Like the other members of this group, Colocynth causes violent intestinal irritation, first watery evacuations and later of mucus and blood. The pains are atrocious, griping, cutting, etc. But this is not all. The drug also affects the nervous system powerfully, whence comes its beneficial effects in the treatment of various neuralgias. In its neurotic symptoms, Colocynth is closely allied to Dioscorea villosa. Furthermore, this remedy so long restricted to the relief of colic alone, has lately wrought cures in certain deep-seated ovarian diseases, as ovarian tumors. Colocynth acts directly on the ovaries, and also COLOCYNTHIS CUCUMIS. 267 upon the epididymis. It is a mistake to assert, as was done formerly, that it can cause no inflammatory action; for in a case of poisoning, the autopsy revealed freshly-glued intestines, thus showing an inflam- matory exudate. It is indicated in affections of the ovaries by stitch- ing pains as from a needle deep in the right ovarian region, and crampy pains relieved by bending over or from pressure. Two cases of ovarian tumor have been reported as cured by Colo- cynth on these symptoms. I well remember having cured a lady from ovarian colic from which she had suffered for three years, with Colocynth. The pains in this case were of a griping character and were relieved by bending double. There were no organic changes present. Now let us examine the action of Colocynth on the abdomen and its contents with the concomitant symptoms: Persistent bitter taste; violent thirst; empty eructations; nausea; vomiting of a bitter fluid or of food ; griping pains which force him to bend double or to press firmly against the abdomen. This griping is the well-known key-note of the drug, and it is indicatory whether it be of local origin or reflex, whether arising from flatus, undigested food, or cold ; or whether resulting from violent emotions, as in what has been termed " nervous colic." The stools may be fluid, copious, faecal, flatulent and papes- cent; or slimy and bloody and preceded by severe tenesmus; but in every case there is this griping which more often precedes the stool and is relieved afterwards. Sometimes, however, it continues after stool. These evacuations are provoked by the slightest food or drink, as is also the pain. In some instances the griping develops into cut- ting, stabbing pains, which spread all over the abdomen and down into the pelvis. They are relieved by the emission of flatus or by stool. This pressure of flatus may incommode the bladder, relief, how- ever, instantly following borborygmi. The urine is foetid and deposits a mucous sediment. Leaving Colocynth for a while Ave will now compare it with some of its concordant remedies. In the bad effects of anger, Colocynth is closely allied to Chamomilla and Staphisagria and, more remotely, to Causticum. It resembles Chamomilla in the violence of its emotions. Both drugs may be used in children when violent emotions produce cramps and even bilious stools. Chamomilla differs from Colocynth in the violence of its con- gestive symptoms, hot sweat on the head, etc. The characteristic Chamomilla temperament also helps you to decide. 268 A CLINICAL MATERIA MEDICA. Staphisagria is sometimes to be substituted for Colocynth in the effects of violent emotion in women and children when the violent abdominal cramps fail to yield to that remedy. In its abdominal and gastro-enteric symptoms you should compare it with Aconite, Veratrum album, Bovista, Croton tiglium, Elaterium, and Mercurius. Veratrum album has abdominal pains forcing the patient to bend double, but he must walk about for relief. He also has cold sweat on the forehead. It is especially suitable in ileus or intussusception of the bowels. The colic of Bovista finds relief from bending double after eating. The urine is red. Croton tiglium has these pains with profuse watery diarrhoea. The stools are yellowish, brownish or green in color and profuse, coming out with a gush as water from the hydrant. They are aggravated after nursing or eating. As shown by the symptoms, Colocynth is a remedy sometimes needed in summer complaint and in dysentery. It differs from Croton tiglium which has stools whenever the patient eats or drinks, in that these movements are profuse and watery, and gushing like water from a hydrant. Elaterium again changes the picture by producing olive- green stools, profuse and gushing. Croton tig., it is true, causes green stools, but they are a brownish green. Colocynth differs from Mer- curius because the tenesmus, etc., cease after stool in the former. It differs from Nux vomica also, for though the pain ceases after stool in Nux, the movements are scanty and there is frequent ineffectual urging. The griping already referred to, is not, in Colocynth, confined to the intestinal tract. We may confidently employ the remedy when the griping involves the bladder in some forms of strangury or of spasm of that viscus, and also in menstrual colic, whether uterine or ovarian. All that is requisite is that the nervous element shall pre- dominate over the inflammatory, with the relief from bending double and from firm external pressure. Transferring this " nervous action" of the drug to the "voluntary system," to the cerebro-spinal system, we find symptoms like the fol- lowing : Left sided tearing crampy pains after vexation or mortified feelings; boring, tearing pains in the head, boring stitches, sharp cut- ting pains in the eyeballs and extending thence up into the head; worse at rest and on stooping, and better from firm pressure and from COLOCYNTHIS CUCUMIS. 269 walking; eye, on stooping, feels as if it would fall out; profuse acrid tears. These symptoms suggest Colocynth as a remedy in gouty and bilious headaches, and also in the intense pains of iriti-', ciliary neu- ralgia and glaucoma. Here we may compare Chamomilla, Cedron, Spigelia and Prunus spinosa. Chamomilla also has left-sided tearing headache from anger, bilious- ness, etc., but it has more red face, hot sweat, etc. Cedron has periodical pains about the eyes; it is usually, however, supraorbital, and it may be of malarial origin. Spigelia is very similar to Colocynth. The eye feels too large; the pains are stabbing, tearing and radiating; they are aggravated by pressure and motion ; Colocynth finding relief by walking in a warm room, and on pressure. Prunus spinosa has more crushing pain; a feeling as if the parts were pressed asunder. Colocynth has proven useful in hip diseases, especially of the right side; dull stitches during walking, must stand still; followed by heaviness and sensibility of the affected parts ; crampy pain as though the parts were screwed in a vise; lies on the affected side with the knee drawn up. In studying these symptoms we also see the appli- cation of the drug to sciatica; pains extending down the sciatic nerve to the knee or even to the heel, aggravated by any motion. The attacks of pain are followed by numbness of the whole limb and par- tial paralysis. If the case is of long continuance, the nutrition of the limb is defective. Sometimes the cramps in the leg are so severe that the patient feels as if the whole leg were fastened down by iron bands. The pains are usually worse at night. Gnaphalium is very similar to Colocynth in sciatica. It has intense neuralgic pains along the course of the sciatic nerve, alternating with numbness. In cramps of the muscles you should compare Colocynth, Nux vomica, Veratrum album and Cholos terrapince. In rheumatism, Colocynth may be useful, especially for the stiffness of the joints following the acute disease. If, however, there are concretions in the joints, you should think of Causticum and Guaiacum. Guided by its constrictive qualities, physicians have used Colocynth in paraphimosis. Colocynth is antidoted by Coffee, Camphor and Staphisagria. LECTUEE XXVIII. BRYONIA ALBA. 1. Blood. 2. Serous membranes. 3. Muscles. 4. Skin. Bryonia. -{ a. Rash; Measles. 6. Scarlatina. c. Suppressed eruptions. 5. Mucous membranes. 6. Organs. There are three species of the Bryonia; so nearly identical are they that Allen has classed them under one heading in his Encyclopaedia. It is one of the oldest remedies in the homoeopathic materia medica, and is one of the best proved. Bryonia alba grows plentifully in England and on the continent of Europe. The tincture is prepared from the roots. It is a polychrest, suitable to mauy kinds of disease. To give you all its symptoms, even all its characteristic symptoms, would take two or three hours of steady hard work. I will endeavor in the hour before us to so far explain the action of Bryonia that you may be able to apply the drug and, as I have often said before, sup- ply the deficiences at leisure. We find Bryonia indicated first of all in changes in the blood; in changes affecting its quantity, its quality and its circulation. For ex- ample, it is indicated in febrile conditions; in fevers of an intermit- ting type although not frequently; in those of a remitting type, very often; sometimes, too, in synochal fever; and also in rheumatic, gas- tric, bilious, traumatic and typhoid fevers. The symptoms which characterize its fevers are in general these: There is an increased ac- tion of the heart, giving rise to a frequent hard tense pulse, very much as you find under Aconite. There is actually an increase in the force and power of the heart's action. This action is augmented by any movement of the body, consequently the patient is anxious to keep perfectly quiet. Then you find that there is almost always intense BRYONIA. 271 headache with these fevers. This is usually of a dull throbbing char- acter or there may be sharp stabbing pains in the head. This is almost always associated with sharp pains in or over the eyes. All of these parts are exquisitely sensitive to the least motion. The patient will avoid moving the eyes, for instance, because it aggravates the pain. The least attempt to raise the head from the pillow causes a feeling of faintness and nausea. The mouth is very dry and the tongue is coated in the milder forms of fever as, for instance, in the synochal fever or in the light gastric type of fever. The coating on the tongue is white, and is especially marked down the middle. The edges of the tongue may be perfectly clean. As the fever grows in intensity, it approaches more a typhoid type. Bilious symptoms predominate. This white tongue becomes yellowish and is associated with a decidedly bitter taste in the mouth. There are splitting headache, tenderness over the epigastrium, with stitches, soreness or tenderness in the right hypochondrium. As the typhoid symptoms increase, the tongue be- comes more and more dry, but still maintains its coating. If the fever is of an intermittent type, you will always find the chill mixed with heat, that is, during the chill the head is hot, the cheeks are a deep red and there is decided thirst, which is generally for large quantities of water at long intervals. In some cases it may be a continuous thirst. The pulse is hard, frequent and tense. The sweat is provoked by the least exertion and has either a sour or an oily odor. In typhoid fever, Bryonia is indicated in the early stages and by the following symptoms : There is some confusion of the mind ; the sensorium is depressed but there are no perversions of the senses. During sleep there is delirium, which is usually of a mild character. On closing his eyes for sleep, he thinks he sees persons who are not present. On opening them, he is surprised to find that he is mistaken. Sometimes this delirium is accompanied or preceded by irritability. This speech is hasty, as you find under Belladonna. As the disease increases, some little heaviness almost approaching stupor accompanies sleep. The patient has dreams, which have for their subject the oc- cupation of the day. Frequently with this delirium, the patient suf- fers from an agonizing headache. This is usually frontal. If the patient is able to describe it to you, he will tell you that his head feels as if it would burst. No better term than " splitting headache " could be used to describe it. It is congestive in its character. The face is usually flushed and of a deep red color. This is intensified like all the other symptoms of the drug, by any motion of the head, and is 272 A CLINICAL MATERIA MEDICA. often accompanied by nose-bleed. The epistaxis is particularly liable to come on at three or four o'clock in the morning, and is frequently preceded by a sense of fulness in the head. In very severe cases, you will notice that the patient puts his hand to his head as if there were some pain there, and his face is expressive of pain. Yet so stupid is he, that he makes no complaint other than that expressed by these automatic movements. Another symptom to be noted in these typhoid fevers, is the dryness of the mucous membranes, especially those of the mouth and stomach. This is the result of deficient secretion. In no cases is the condition more apparent than in typhoid states. The mouth is dry, asl have already intimated, and yet there may be no thirst. If there is thirst it seems to have the character I mentioned in speak- ing of intermittent fever. The patient drinks large quantities but not very frequently. After drinking water or while attempting to sit up, the patient has a deathly nauseated feeling and sometimes even vomits. At other times he complains of a heavy pressure in the stomach, as if a stone were lying there. This symptom is no doubt due to the same pathological condition wc found in the mucous membrane of the mouth. The secretion of gastric juice is deficient, consequently food lies un- digested in the stomach. The bowels are usually constipated when Bryonia is called for. When they do move, the stools are large, hard and dry and either brown or black in color. They are expelled with difficulty owing to the atony of the rectum. Sometimes, in well- advanced cases of typhoid fever, you will find soft, mushy stools, calling for Bryonia. There is a symptom which sometimes accompa- nies typhoid fever at about the end of the first week of the fully de- veloped fever, and that is a form of delirium in which the patient expresses a continual " desire to go home." He imagines that he is not at home and longs to be taken there in order to be properly cared for. This symptom is a strong indication for Bryonia and frequently disappears after two or three doses of the remedy. In these febrile conditions, it is necessary to place Bryonia in its proper relations with its concordant remedies. First of all Aconite. Aconite bears an intimate relation with Bryonia in all these types of fever except gastric, intermittent and typhoid fevers. Aconite has not in its totality any special relation to any of these, however incor- rectly it maybe given to lessen the temperature. The symptomatology of Aconite is opposed in every respect to that of typhoid fever. In gastric fever, it may be given in the beginning when there is the full pulse, hot and dry skin and restlessness, indicating that drug; but as BRYONIA. 273 the fever advances, it is then not indicated unless there are bilious com- plications. Then it is an all sufficient remedy. The distinctions that you are to make between Aconite and Bryonia are as follows : In the first place, they hold the relation of Aconite and Bryonia and not Bryonia and Aconite; that is to say, Aconite is given earlier in the case than is Bryonia. Aconite suits the hyperaemia, the congestion or even the chill which precedes an inflammatory fever. Bryonia is in- dicated later when Aconite fails. The mental symptoms of the two drugs are so distinct that you ought not to confuse them. Aconite demands that the mind be excited, that the patient be restless, tossing about the bed, full of fears. He imagines that he is going to die. The Bryonia patient may suffer just as much as the one to whom you would give Aconite, but he is perfectly quiet. He is quiet because motion aggravates his symptoms. Early in typhoid fever, and sometimes in rheumatic, you may have Bryonia indicated by this symptom : The patient is restless and tosses about the bed impelled by nervousness, and yet he is made worse by the motion. Still another remedy to be thought of in connection with Bryonia in these fevers is Belladonna, and particularly in the beginning of typhoid fever. Now there is really nothing in the symptomatology of Bella- donna which would call for it in a well-advanced case of typhoid type of fever. Only in the beginning could you confuse it with Bryonia. In the first place it has erethism. Here you distinguish it by its de- lirium, which is of a violent character. The patient jerks his limbs and starts during sleep. He springs up from sleep in affright. As soon as he closes his eyes, he sees all sorts of objects and people, which disappear as soon as the eyes are opened. Belladonna, then, has more cerebral erethism, and more violence in its delirium than has Bryonia. With the Belladonna headache there are throbbing pains, and the patient may be obliged to sit up rather than keep perfectly quiet in order to obtain relief. Another remedy to be compared with Bryonia is Rhus tox. This is often indicated in typhoid fever. You all know the historic fact that Hahnemann during one of the war epidemics of typhus cured many cases with these two remedies. Since the days of Hahnemann, this use of these remedies has become universal. Remember, how- ever, that they are not specifics. Each epidemic may so change in character as to require other remedies. Rhus tox. is indicated, when there is marked restlessness. The patient first lying on one side, changes to the other. For a few moments, he feels better in his new 274 A CLINICAL MATERIA MEDICA. position. Then his side begins to ache and back he turns again. Like Bryonia, it has nose-bleed, which nose-bleed relieves the patient's symptoms, and the headache I described to you last month as " a sen- sation as though a board were strapped tightly across the forehead." There are rheumatic aching pains through the joints and muscles of the limbs. The tongue differs from that of Bryonia. It is brown and dry and even cracked, and has a red tip. That is also an excel- lent indication for Sulphur. With Rhus tox., there is frequently diarrhoea from the very beginning. Bryonia usually has constipation. I just referred to the symptom under Belladonna—"The patient sees persons and objects on closing the eyes ; these disappear as soon as the eyes are opened." Both Calcarea ostrearum and Cinchona have this symptom. Under the latter remedy, however, it does not occur in typhoid fever, but after haemorrhage. Next, I wish to talk about the action of Bryonia on serous mem- branes. Bryonia acts powerfully on these, producing inflammation. Hence we are called upon to prescribe it when the meninges of the brain and spinal cord, the pleura and the peritoneum, and the synovial membranes are inflamed. The indications for Bryonia in these serous inflammations are particularly to be looked for after exudation has taken place. There are sharp stitching pains, worse from any motion. The fever may still be high or it may have been partially subdued by the remedy which preceded. Comparing Aconite with Bryonia once more, you will see the same rule applicable here as before; Bryonia is indicated after and not be- fore Aconite. Take for purpose of illustration a typical case of pleu- risy. In the beginning of the disease when fever is high you select Aconite, but just so soon as the fever commences to decrease, and as effusion begins, as indicated by the friction sounds, Aconite ceases to be of any benefit and Bryonia comes in as an all sufficient remedy. It is customary with some physicians to give Aconite for the fever and Bryonia for the pleuritic trouble. But this is useless. Bryonia is adapted to the whole case. It has not the same restlessness which demands Aconite. The patient is quiet and is full of pain. He lies on the affected side. Why? Because by the pressure thus exerted on the ribs, he moves the affected parts less than he would were he lying on the sound side. When the meninges of the brain are affected, Bryonia is a valuable drug, but here, except in some rare cases, it follows Belladonna rather than Aconite. Belladonna ceases to be the remedy in meningitis, BRYONIA. 275 whether tubercular or otherwise, when effusion within the ventricles or beneath the membranes commences. Tt then gives place to Sulphur in some cases, Apis in others, and Bryonia in still others. Bryonia is indicated when meningitis follows the suppression of some eruption, as that of scarlatina or measles. The child's face is pale, or else it is red and pale alternately, the tongue white. The child screams out sud- denly as if it was in great pain, which it really is. These pains are of a sharp lancinating character and are especially manifested on mov- ing the patient. There is marked squinting with one or both eyes. The bowels are usually constipated, the abdomen distended and the child has well-marked sensorial depression which seems to border on stupor. If you arouse the child and offer him drink, he takes it im- petuously or hastily, just as under Belladonna. The latter remedy has more rolling of the head. For sake of convenience we will next study the catarrhs of Bryonia and the effects of the drug on the lung structure. We find Bryonia indicated in nasal catarrh when there is either great dryness of the mucous membrane of the nose or (more frequently), when the discharge is thick and yellow. It is also indicated when the discharge has been of the character just indicated and has been suddenly suppressed. As a result, there is dull throbbing headache just over the frontal sinuses. Lachesis is also useful for suppressed coryza. But it has not so marked the aggravation from motion; nor has it that yellow discharge. The treatment of colds is a severe test of the skill of a physician. If you can successfully treat them, you must understand homoeopathy well. They are the most difficult class of cases we have to contend with. There are two reasons for this. One is the patients are constantly ex- posed, and the other is that they are not watched sufficiently closely. If you are given the opportunity to watch the cases carefully, so that you may prescribe as the indications change, you will cure promptly. We may also use Bryonia in pneumonia. The type of the disease in which it is indicated is in the true croupous form. Just as we found Bryonia indicated in pleurisy with effusion, so is it of use in pneumonia after the croupous exudation has taken place. Usually when it is called for there is also some pleuritis, hence it is applicable to pleuro- pneumonia. It is not indicated in the beginning of the disease because the exudation does not occur in that stage. It is indicated after Aconite, with the following easily understood condition. The fever still con- tinues, but the skin is not so hot, the face so red and the patient so restless as when Aconite was indicated. The patient is more pacific, 276 A CLINICAL MATERIA MEDICA. and his face and whole demeanor are expressive of anxiety. I would have you discriminate between this condition and that calling for Aconite. It is not so much the mental anxiety that Aconite pictures as it is an expression of pulmonary oppression. That you must remem- ber. The cough which under Aconite was of a dry teasing character, with frothy sputa, perhaps still remains troublesome, but it is looser and more moist. There is very little expectoration yet, but what little there is, is either yellowish or streaked with blood. Owing to the ac- companying inflammation of the pleura, sharp pleuritic stitches are felt in the chest. They are worse on the left side. The patient com- plains of heavy pressure just over the sternum. The pulse is full, hard, and tense. The urine is dark-red and scanty. Still another remedy that ought to be thought of along with Bry- onia in pneumonia is Antimonium tartaricum. It is indicated in pneu- monia that begins as a bronchitis and extends downwards. It is especially suited to cases that begin on the right side, and that have these sharp stitching pains, high fever, great oppression of the chest, as in Bryonia. But it is called for more in catarrhal than in croupous pneumonia. Mucous rales are heard distinctly in the chest. You should also recall Sanguinaria and Chelidonium. Several other remedies than Bryonia have these pains in the chest- walls. Gaultheria has pleurodynia, with pain in the anterior medias- tinum. Ranunculus bulbosus is decidedly the best remedy for intercostal rheumatism ; it has sharp, stitching pains, and a sore spot'm the chest, and these are worse from any motion (even breathing), pressure, or change of temperature. The dyspnoea in these cases is sometimes dis- tressing. Arnica is sometimes of use when the sore and bruised feeling: of the chest predominates. Rhus radicans is called for in pleurodynia when the pains shoot into the shoulder. Senega acts best in fat persons of lax fibre. It is useful in cold when there are much pain and soreness in the thoracic walls, and much mucus within. There is hoarseness; the throat is so dry and sensi- tive that it hurts the patient to talk; the cough often" ends with sneez- ing. Rumex crispus has sharp, stitching or stinging pains through the left lung ; it is indicated more in the early stages of phthisis. When the patient turns the left side feels sore. BRYONIA. 277 Trifolium pratense has hoarseness and choking spells at night with the cough. The neck is stiff; there are cramps in the sterno-cleido- mastoid muscles which are relieved by heat and friction. Actea racemosa has pleurodynia; worse in the right side, especially in nervous women. In bronchitis, Bryonia is indicated with this same pressure over the sternum ; the dyspnoea is great; the cough is dry, and seems to start from the stomach. Sometimes a little tenacious blood-streaked sputum is raised. The cough is worse after a meal, when it may even end in vomiting. During the cough the patient presses his hand against his side to relieve the stitching pain. Returning now to the action of Bryonia on the serous membranes, we find it producing synovitis. The affected joint is pale-red and tense. There is, of course, effusion into the synovial sac. There are sharp, stitching pains, aggravated by any motion. Bryonia is indi- cated in these cases whether the synovitis be of rheumatic or traumatic origin. The nearest concordant remedy to Bryonia here is Apis, which is an excellent remedy for synovitis, particularly of the knee-joint. Sharp, lancinating, and stinging pains, and effusions into the joint, are fur- ther indications for the remedy. Apis seems to be preferable to Bry- onia when this synovitis is of scrofulous origin, or at least appears in a scrofulous constitution. Apis also has another kind of inflamma- tion, which ends in thickening of the serous sac and of the tissues and cartilages about the joints, giving you the well-known white swelling. You should also remember Sulphur in these cases. This remedy supplements Bryonia and Apis, and urges them on when they fail to do their work. We come next to the study of Bryonia in its action on the muscular system. It is one of the few drugs which produce a positive inflam- mation of the muscular substance; consequently, you expect to find the drug of use in muscular rheumatism. The muscles are sore to the touch, and at times swollen, and, as you might expect, there is ag- gravation of the pains from the slightest motion. Bryonia may also be indicated in articular rheumatism. We find that the fever is not very violent, and the pains and swelling either shift not at all or else very slowly. The local inflammation is vio- lent; that is characteristic of Bryonia. The parts are very hot, and dark- or pale-red. The pulse in these cases is full and strong, and the 278 A CLINICAL MATERIA MEDICA. tongue is either uniformly white or, more characteristically, dry and white down the centre. The bowels are constipated. It is needless for me to say that the pains are worse from motion. The difference between Bryonia and Rhus is principally this: Rhus is suitable for rheumatism after exposure to wet, especially when one is overheated and perspiring. Then, too, the Rhus patient finds relief from moving about. Rhus attacks the fibrous tissues, the sheaths of the muscles, Bryonia the muscular tissue itself. The difference between Ledum and Bryonia may be described in this way : Ledum is useful for rheumatic or gouty inflammation of the great toe ; instead of tending to copious effusion the effusion is scanty, and tends to harden into nodosities. In hot swelling of the hip and shoulder joints, Ledum should be remembered as more successful than Bryonia. Actea spicata has a special affinity for the smaller joints. It has this characteristic: The patient goes out feeling tolerably comfortable, but as he walks the joints ache and even swell. Viola odorala has a specific action on the right wrist. Caulophyllum is especially suited to rheumatism of the phalangeal and metacarpal joints, particularly in females. In Colchicum we have marked aggravation in the evening; the affected joints are swollen an I dark red. It is especially useful for weak debilitated persons, or in those who despite local rheumatic in- flammation, exhibit general symptoms of torpor. The stomach is generally affected; nausea when smelling food. The urine is scanty and red, and burns in passing along the urethra. The pains are of a tearing or jerking character, and appear as if in the periosteum. The pains are superficial in summer and deep in winter. Bryonia has great oppression under the sternum, worse from motion ; sharp stitches in the cardiac region, pericardial effusion, with strong pulse. Colchi- cum has pericardial effusion, fulness aud oppression while lying on the left side, compelling him to turn over. The pulse is small, weak, and accelerated. The Colchicum pains appear about the neck and shoulders, or, in a small part of the body at a time, and then shift quickly. Guaiacum is useful in chronic forms of rheumatism when the joints have become distorted by the concretions. It is also indicated in pleu- risy during the second stage of phthisis with muco-purulent sputum. Arctium lappa may also be compared with Bryonia in rheumatism. It cures soreness of the muscles, dull pains, all worse from motion; BRYONIA. 279 high-colored urine. All the provers were so weary and sleepy, they could not work. Next we will study the alimentary canal. We have already spoken of Bryonia here so frequently that its symptoms require but a passing notice. There are the dryness of the mucous lining throughout; the white coating of the tongue, the characteristic thirst, a feeling as though a stone or heavy weight were lying clogged in the stomach, the hard dry, brown stool, passed with difficulty owing to the hardness of the faecal matter, atony of the rectum, and intolerance of vegetable food. The symptoms are all worse in summer. It seems that the Bryonia patient cannot tolerate the heat of the sun. The liver also is affected. We find it congested, or even inflamed. The gastric symptoms just mentioned complicate the case. The peritoneum covering the liver is inflamed, consequently there are sharp stitches in the right hypochon- drium, worse from any motion and better when lying on the right side. In jaundice from duodenal catarrh, you may give Bryonia, especially when the trouble has been brought on by a fit of anger. Although the patient appears hot, he complains of feeling chilly. Chelidonium is an admirable remedy for very similar symptoms to Bryonia ; sharp pains in the region of the liver, shooting in every direc- tion, up into the chest, down into the abdomen ; well-marked pain under the scapula, even going through the chest like a rivet; and diar- rhoea with either clay-colored or yellowish stools. It differs from Bryonia particularly in the character of the stool. Bryonia is also similar to Kali carb., which is indicated in bilious affections when there are these sharp pains in the right hypochondrium, shooting up into the chest; often there is sharp pain, coming from the lower lobe of the right lung. The difference between these pains and those of Bryonia is that these are not necessarily made worse by motion. Yucca filamentosa is an admirable remedy for biliousness, with pain going through the upper portion of the liver to the back. There is bad taste in the mouth ; the stools are diarrhoeic and contain an excess of bile. A great deal of flatus passes by the rectum. Chamomilla, like Bryonia, is indicated in biliousness following anger. With Bryonia there is apt to be chilliness with the anger; with Cham- omilla the patient gets hot and sweats. Berberis vulgaris also has sharp stitching pains in the region of the liver; but the pains shoot downwards from the tenth rib to the um- bilicus. The bowels I have said, are usually constipated under Bryonia, but 280 A CLINICAL MATERIA MEDICA. in some cases the reverse condition obtains. Bryonia is indicated in diarrhoea when the attacks are provoked by indulgence in vegetable foods or stewed fruits, and also by getting overheated in the summer time. The movements are especially worse in the morning after rising when beginning to move around, thus distinguishing it from Sulphur and making it akin to Natrum sulph. In other cases, the patient is seized with sudden griping pains, doubling him up, with copious pasty stools. Sometimes the stools are dark green, from admixture of bile. They have the odor of old cheese. We next come to the action of Bryonia on the different organs. The mental symptoms have been pretty thoroughly described to you in speaking of typhoid fever. I will merely say here that the patients are irritable and easily angered. This is present with the bilious symp- toms, with the headache; and with the dyspepsia; in fact, it is charac- teristic of the remedy. The headache of Bryonia, I have also told you, is worse from any motion ; even a movement of the eyeballs aggravates the pain. The pain begins in the occiput, or else in the forehead going back into the occiput. It is worse when awaking in the morning, and after violent fits of anger. The nearest remedy that we have to Bryonia here is Gelsemium, which has headache with this soreness of the eyes on moving them. Natrum mur. has headache, with beating as from little hammers, with aggravation on moving the head and eyes. With the occipital headache of Bryonia we should also compare Petroleum, which has throbbing occipital headache; and Juglans cathartica for occipital headache with pains of a sharp character. Carbo veg. and Nux vomica have occipital pains with bilious attacks. On the external head, we find Bryonia developing an oily perspira- tion with a sour odor. A similar symptom referred to the face is found under Natrum mur. Bryonia is a valuable remedy in diseases of the eyes, not when the external coats of the eye are affected, however. It is to be thought of for metastasis of rheumatism to the eyes. The pains are violent and shoot through the eyeball into the back of the head, or up toward the vertex. It is aggravated by any motion of the head or eyes. There is also a sensation of tension as if the eyeballs had been put on a stretch. Now you know from what I have said, that Bryonia is BRYONIA. 281 indicated in inflammation of the serous membranes with effusion. Bryonia ought both symptomatically and pathologically be a remedy in glaucoma. The tension of the eyeball is greatly increased. Hot tears flow from the eyes. Photophobia and diminution of vision are present. The toothache of Bryonia is of rheumatic origin and comes from cold. You will frequently find it in teeth showing no signs of decay. We are therefore led to presume that it is the nerve that is affected. More than one tooth may be involved and relief is momentarily ob- tained by firm pressure of the head against the pillow, or by the application of cold. Toothache in children from decayed teeth, with relief from the application of cold water finds its best remedy in Coffea. Kreosote has neuralgia of the face with burning pains increased by motion and by talking, especially in nervous irritable persons whose teeth decay rapidly. In aphthous sore mouth, Bryonia may be used. The child seizes the nipple, but drops it and cries, but—notice the characteristic dry- ness—when its mouth becomes moistened by the milk it nurses well enough. The characteristic urine of Bryonia is dark, almost brown red, without any deposit. The changes in its appearance are due to excess of coloring matters. Bryonia has some action on the female genital organs. It is indi- cated in menstrual difficulties when the flow is dark red and profuse, hut more especially when it has been suppressed and we have what has been termed vicarious menstruation. Here you should compare Pulsatilla and Phosphorus, especially if the suppression of the flow produces haemoptysis or haematemesK Senecio if the patient has cough with bloody expectoration. Hamamelis, Ustilago and Millefolium for haematernesis. Bryonia is indicated in the lying-in chamber. For years I have been accustomed to using Bryonia for the so-called milk fever. I con- sider it indicated more than any one remedy because the symptoms are those of Bryonia. There is not very marked fever, there is this tension of the breast with headache, tearing in the limbs and the pa- tient is weary and wants to keep still. In threatening mammary abscess, Bryonia is indicated when there are sharp stitching pains, tension of the breast, and pale red color to the swelling. 19 282 A CLINICAL MATERIA MEDICA. In incipient mammary abscess you should compare first of all Bella- donna, which is useful when the symptoms are violent; redness shoots out in radii from the central point of the inflammation. Phytolacca is an excellent remedy when from the beginning the breasts show a tendency to cake. Especially is Phytolacca the remedy when suppuration threatens. When the child nurses, pain goes from the nipple all over the body, streaking up and down the spine; exces- sive flow of milk. Phellandrium aquaticum is an excellent remedy when pains course along the'milk ducts between the acts of nursing. Croton tiglium, when there is paiti from the nipple through to the back when the child nurses, as though it were being pulled by a string. Bryonia is to be remembered in measles. Here it is indicated prin- cipally by the tardy appearance of the rash. There is a hard dry cough which makes the child cry. The child doubles up as if to resist the tearing pain which the effort at coughing causes. There may be little or no expectoration. The eyes are inflamed. In other cases, the eruption suddenly disappears when cerebral symptoms appear. The child is drowsy. Its face is pale and there is twitching of the muscles of the face, eyes and mouth. Any motion causes the child to scream with pain. In other cases instead of these cerebral symptoms you have inflammatory diseases of the chest, bronchitis or even pneumonia. In scarlatina, Bryonia is not often indicated, but when it is, you find some one or all of these symptoms to guide you. The rash has not that smooth character observed under Belladonna. It is inter- spersed with a miliary rash. The eruption comes out imperfectly and the chest and cerebral symptoms just mentioned are present. Now while all the senses are benumbed in these cases there are no absolute hallucinations of the senses as under Belladonna, the patients do not hear voices talking to them as under Anacardium; they do not awaken from sleep clinging to those about them, as with Stramonium or Cuprum. When an eruption has been suppressed and the brain affected in consequence, you may also look to Cuprum, which is the remedy when the symptoms are violent. The child starts up during sleep. There are decided perversion of the senses, and the spasms characteristic of Cuprum. Zincum is to be preferred if the child is too weak to develop an eruption. The eruption comes out sparingly. The surface of the body is rather cool. The child lies in a stupor, grating its teeth ; it BRYONIA. 283 starts up during sleep. Squinting and rolling of the eyes are observed and there is marked fidgetiness of the feet. Ipecac, is to be thought of when the chest is affected from the reces- sion of the rash of measles, when there is difficulty in breathing, cough, etc. Tartar emetic ought to be given in preference to Bryonia when the disease is variola. Bryonia is complementary to Alumina. It is antidoted by Chamomilla, Nux vomica, Pulsatilla, Rhus and Senega. It antidotes Rhus tox., Rhus venenata and Chlorine. LECTUEE XXIX. CONIFERS AND EUPHORBIACE^l. Conifers. Abies Nigra.—Stomach. Sabina Juniperus.—Abortion. Pinus Sylvestris.—Infantile atrophy. Terebinthina. Kidneys, bladder, etc. Mucous membranes. Uterus. Typhoid states. Renal dropsy. Compare Arsenicum, Cantharis, Copaiva, Camphor, Phosphorus. Pix Liquida.—Lung ; Eruptions. Compare Anisum stellatum. Thuja. < r Nervous system. Sycosis. Syphilis. Variola. Marasmus. Compare Pulsatilla, Kali bichromicum, Spigelia, Mercurius, Nitric acid, Natrum sulph., Euphrasia, Staphisagria. The large order of Coniferae or cone-bearing plants is the subject for our study to-day. From this order we obtain the different varieties of pine, hemlock, and spruce from which the different preparations of turpentine have been obtained. The principal remedies of this group you will see in the schedule on the board. They are the Abies nigra, or black spruce; the Sabina juniperus, one form of the juniper from which the oil of savin, a well-known remedy for the production of abortion, has been taken; the Pinus sylvestris, a variety of the pine; ABIES NIGRA, SABINA, AND TEREBINTHINA. 285 Terebinthina, or turpentine, obtained from many of the pines; Pix liquida, or pitch; and Thuja occidentalis, the arbor vitae or the tree of life. Abies Nigra. I cannot forbear mentioning a symptom of this Abies nigra, a symptom, too, that has been frequently confirmed. I refer to the application of the drug in dyspepsia when the patient complains of a feeling as though he had swallowed some indigestible substance which had stuck at the cardiac extremity of the stomach. That is the main symptom and the keynote of the drug. There are also present the low-spiritedness, the hypochondriasis, and the constipation incident to dyspepsia. Sabina Juniperus. I am also obliged to slight Sabina juniperus for want of time. You know of it as a remedy in the treatment of uterine disease, and as a remedy to prevent impending abortion, especially at the third month. The symptoms indicating it here you will learn from the Professor of Gynaecology, Dr. Betts. I shall only say in brief that they are: Pain which commences in the small of the back and goes around and through the pubes, drawing-aching pains which are so common in abortion, and pains which run through from sacrum to pubis. This last symptom is very characteristic of Sabina. In addition to these pains there is a bright red clotted flow of blood, increasing with every motion. You may also use Sabina in post-partum haemorrhage when the placenta is retained and the symptoms just mentioned are present. Terebinthina. Terebinthina, or turpentine, is a drug that has been much abused by old-school physicians; therefore, it has been greatly neglected by hom- oeopaths. In the revulsion from the misconception of the old-school physicians, we often avoid a drug altogether. All that I have time to say concerning Terebinthina is, that its main action is on the kidneys and bladder. When you find metritis, peritonitis, typhoid fever or scarlatina, or, in fact, any serious disease of low type, with the follow- ing renal symptoms, Terebinthina comes in as your remedy: Dull pains in the region of the kidneys, burning in the kidneys, pains ex- tending from the kidneys down through the ureters, burning during micturition, strangury, albuminous urine, and very characteristically 286 A CLINICAL MATERIA MEDICA. the urine is dark, cloudy and smoky-looking, as though it contained decomposed blood, which it really does. The real pathological con- dition of the kidneys in this case is not one of acute Bright's disease, nor one of croupous formation in the kidneys, but one of renal con- gestion, with oozing of blood into the pelvis of the kidney. When the above urinary symptoms are present, you may give Terebinthina with confidence, no matter what the patient's disease may be. Terebinthina often acts powerfully on mucous membranes. It produces burning in the air-passages, with thin expectoration, very difficult of detachment. Pix Liquida. Pix liquida has but two symptoms worthy of note. One proceeds from its action on the lungs. You may give it with confidence in suppurative processes affecting the left lung, with pain at the third left costal cartilage. Anisum stellatum has the same pain, but here it is referred to the right third costal cartilage. The above symptoms of Pix and Anisum have stood the test of experience over and over again. Remedies having pains in the left side of the chest, and which are here worthy of mention, are: Myrtus communis (upper part), Sumbul (many pains), Fluoric acid, Oxalic acid, Actea rac. (under nipple), Lilium (through the heart or through the mamma to the back), Kali carb., Sulphur (through to back), Sarsaparilla (from back through to left chest), Pulsatilla nuttal. (left side, under arm near to the back), Guaiacum (stitches at about upper three ribs, purulent sputum), The- ridion, Phosphorus and Silicea. Pix liquida also causes an eruption, especially on the dorsum of the hands; cracks, itches intolerably at night, and bleeds when scratched. Thuja Occidentalis. The remainder of the hour we will devote to Thuja occidentalis, the last member of this group, and we will have ample time to consider it fully. The history of the introduction of this drug is a little novel. Hahnemann received in his office on one occasion a patient who com- plained of some symptoms about the genital organs, which were, to say the least, suspicious. There was a thick purulent discharge from the urethra, with burning on urinating. There were also small pimples, attended with itching, about the glans penis, and some swelling of the parts. Hahnemann charged his patient with having contracted gonor- THUJA. 287 rhcea. This was stoutly denied by the patient, who, by the way, was a theological student. However, on the principle prevailing in every court to consider a man innocent until he has been proved guilty, Hahnemann determined to give the young man no medicine, and directed him to report in three days. At the end of that time he came back well. Hahnemann was puzzled. He questioned the patient closely, but found no cause. The young gentleman remembered, how- ever, that as he sauntered through a garden a few days before, he picked some leaves of the arbor vitae and chewed them. This led Hahnemann to investigate the properties of Thuja, when he discovered that the theological student had told the truth. However, Thuja must not be immolated in sycosis, because it has other interesting actions on the system, especially upon the nervous system. While you must remember that these nervous phenomena may rest on a sycotic basis, you should also know that they may exist without the presence of any such taint. Grauvogl tells us of the hydrogenoid constitution in which the poison of gonorrhoea acts most virulently. If one with this constitution contracts the disease, he is more apt to retain the constitutional taint. This constitution may even exist independent of a sycotic taint. In its victims vaccination is most injurious. When you find a patient suffering from vaccination, the virus being pure, you may set that patient down as belonging to the hydrogenoid constitution. We have two antidotes to these bad effects of vaccination, Silicea, which suits almost any of the symptoms, even convulsions, and Thuja, especially if diarrhoea results and the vaccine pustules are very large. It was on account of this last-named symptom that Bcenninghausen recommended Thuja in variola. He gave it just so soon as the vesicles began to turn into pustules, and he claimed to have thereby prevented scarring. But to return to a study of the action of Thuja on the nervous system. The patient exhibits a manner which is hurried and impa- tient. He talks hurriedly. His movements are unnaturally active and hurried. His temper is easily aroused. Even trifles make him angry and excited. Some of the gentler emotions are awakened. For instance, music causes weeping and trembling about the feet. There is a form of insanity or mania in which you will find Thuja the only remedy, and that is one in which there is the fixed idea in the patient's mind, that he is made of some brittle substance, and he will not permit himself to be approached for fear that he will be broken. This is not the Antimonium crudum condition. It is not an irritability of mind 288 A CLINICAL MATERIA MEDICA. that drives any one and every one away, will not permit one's self to be even looked at, but it is a symptom that comes from some fixed delusion as to his bodily composition. Another singular characteristic of Thuja is one that was first met with in an old maid. She experienced a sensation as though a living child were in the abdomen. This symptom has suggested the use of Thuja in pseudo-cyesis. With these symptoms of the nervous system indicating the drug in melancholia, and other forms of insanity, we find that there are many disturbances in the circulation, ebullition of blood, in other words. Still further as illustrating the action of this drug on the nervous system, we find various forms of neuralgia occurring. Thus it is in- dicated in the form of headache known as clavus, in which the patient has a sensation as though a nail were being driven into the vertex, or into one or the other of the frontal eminences. Thuja may also be used in neuralgia, affecting either head or face or both. The pains are of an intense stabbing character, and are well-nigh unbearable. If the patient sits up these pains almost drive him to distraction; they may even produce unconsciousness. He, therefore, maintains the horizontal posture. The pains seem to begin about the face, about the malar bones and eyes, and go back towards the head. It is a neuralgia which reminds us of that of Spigelia, but which we distin- guish from that of the last-named remedy by the direction of the symptoms. In Spigelia the pains begin in the back of the head and come forward. After detailing to you these unique nervous symptoms, I pass to state the application of the drug to sycosis. Remember that these nervous phenomena may or may not have a sycotic basis. Thuja is a remedy which tends to alter the sycotic constitution, to change the soil on which this poison grows. There are two elements which make up disease; they are the elements of the disease itself, and those of the constitution in which it grows. The sycotic constitution to which I have referred, modifies every subsequent disease, and that, too, whether there be any urethral discharge or not. In gonorrhoea you may use Thuja when the discharge is thin and greenish, and there is scalding pain during urination. After urina- tion there is a sensation as if there were a drop of urine remaining behind. AVarts or condylomata appear on the genitals, at the anus, about the perineum and upon mucous surfaces. I have treated one case in which the wart formed on the centre of the tongue. This was THUJA. 289 speedily cured by Thuja. These warts may have a seedy look, or they may be of a cauliflower shape. Cauliflower-like excrescences are especially apt to grow from the cervix uteri. In other cases, these warts are moist and ooze a glutinous fluid. Sometimes we find ulcers about the genitals, and these bear very much the appearance of chan- croids. They have a dirty yellow base with hard edges. Very char- acteristic are such ulcers if they seem to have originated from warts. Sometimes we note deep fissures, or furrows about the anus, on the perineum, scrotum or glans penis. These are quite deep and are covered with pus. There is sweet smelling sweat about the genital organs. The testicles are often involved, one or the other of these organs being drawn up iu consequence of contraction of the cremaster muscle. The testicle is swollen and aches as if bruised. There may be balanorrhoea, that is purulent inflammation of the inner surface of the prepuce, and of the sulcus back of the corona glandis. In the female organs we find the cauliflower excrescences which I have already mentioned, fungus growths of venereal origin about the genitals, condylomata with thick green leucorrhcea, corresponding to the thin greenish-yellow gleet of the male. Again, if a gonorrhoea be checked by injection, by cold or by any other influence, constitutional symptoms may arise which call for Thuja. Especially is this remedy indicated if the complication be articular rheumatism, or prostatitis. The hair becomes dry and splits at the ends, the scalp scaly and covered with dry scurf. Thuja is even the remedy when iritis appears, especially when ac- companied by condylomata on the iris. The eyelids are inflamed and have a warty look also. Ozaena may be an additional complication. When Thuja is indi- cated the discharge is thick and green. A very common symptom indicative of a sycotic taint, for which you may use Thuja, is decay at the root of the teeth, the crowns of the teeth being apparently normal. Other symptoms worthy of mention are pustules, which have considerable resemblance to those of Tartar emetic, and chilliness during, urination, nervousness and restlessness during both night and day. There is further a singular property of Thuja, that of softening hard tissue, tissue naturally hard, as the nails. Herein lies the expla- nation of the ability of the drug to remove warts; it softens them and causes their absorption. Thuja has a specific action in sclerotitis. 290 A CLINICAL MATERIA MEDICA. Thuja is also a remedy in scrofula and marasmus. Such cases are not necessarily sycotic, but they have just such constitutions as favor the growth of this taint. The stools are watery, gurgling, forcibly expelled, and are daily worse after breakfast, and accompanied by much loud flatus; tinea ciliaris, dry branlike scales; eyelashes irregu- lar and imperfect; children are pot-bellied; scream on awaking, and are a long time becoming fully awake. I propose now to devote the remaining moments of the hour to the consideration of the remedies similar to Thuja in the above mentioned conditions. One of the nearest allies to Thuja is Pulsatilla, in that it has ozaena with thick greenish discharge. In gleet, also, the remedies have the same discharge, it being thicker under Pulsatilla. Their too, gonorrhceal rheumatism, orchitis and prostatitis, are just as character- istic of Pulsatilla as of Thuja. Kali bichromicum is useful in ozaena occurring in sycotic constitu- tions, the discharge being yellowish or more often greenish. The nose feels unnaturally dry. Dark greenish plugs are hawked up from the post-nasal space. Nitric acid resembles Thuja in the condylomata or warts. It is also of use in ulcers, when they are ragged in outline, and in enlarged tonsils, whether these affections be of syphilitic or of gonorrhceal origin. Nitric acid also has moist fissure at the anus (which is also present, as you know, under Thuja), balanorrhoea and thin greenish leucorrhcea. Nitric acid has, however, to distinguish it from Thuja, more aching pains in the bones, especially in those localities devoid of muscular-tissue cov- ering, as along the tibia, and over the sternum and cranium. Stajmisagria suits long filiform condylomata. The system generally is depraved, as shown in the sallowness of the face, the dark rings about the eyes, the spongy gums, the yellowish white skin, and the great debility. It is especially indicated when there has been previous mercurialization. There is generally induration of one or the other testicle. I would like to mention here Jacaranda. This is a South American plant that was first proved by Muir. It is an excellent remedy for balanorrhoea, and for red chancroid or chancroid-like sores about the penis. It has been proved conclusively to be a good remedy. Corallium rubrum is an excellent remedy for chancre-like sores that are very red. Mercurius resembles Thuja in the iritis, in the balanorrhoea, and in the green urethral discharge and in the rheumatism. The difference EUPHORBIACEjE. 291 lies here: In Mercurius, sweating aggravates the symptoms, as does also the warmth of the bed. Thuja has this symptom which is not often met with, but which saved a life for Bcenninghausen, namely, uncovered parts of the body only, sweat. Sabina is useful for condylomata which itch and burn, especially in women. Euphrasia is called for when the condylomata are large and look like a cock's comb. Cinnabaris is an excellent remedy when there is a combination of syphilis and sycosis. The figwarts are apt to be fan-shaped. There is a great deal of itching, especially about the joints. The complement of Thuja in these sycotic troubles is Natrum sulph. Sarsaparilla is indicated when a sycotic eruption consisting of little spots scarcely raised above the skin, often scaling a little, but looking like the roseola of syphilis, and itching intolerably, and worse in the spring; also when a moist eruption appears on the scalp, the pus from which causes inflammation of any part which it touches. Sycotic headache is found under Sarsaparilla. The pain begins in the back of the head, and comes forward and settles at the root of the nose, with swelling of the nose; moist eruption about the genitals, or between the scrotum and the thighs. Peholeum also has this last-named symptom; and in addition another, namely, membranous shreds about the anus. EUPHORBIACEJE. The Euphorbiaceae as an order contain an acrid principle which in some cases is oily in character, in others resinous; in case it is the latter, it escapes from the plant as a milky juice drying into a gum. These oils or gums have two properties. If applied to the skin they produce redness and vesication. The vesicles fill with yellowish- white serum, and may even suppurate and form scabs of a honey color. They all act more or less intensely as purgatives, producing a watery diarrhoea, associated with colic, tenesmus, flatulence, burning, nausea and vomiting. The medicines we derive from this order are the Cro- ton tiglium, Jatropha curcas, Yucca filamentosa, Euphorbium officin- arum, Euphorbia corollata, Mercurialis perennis, Hippomane man- cinella and Ricinus communis. Croton tiglium produces a diarrhoea with yellowish watery stool pouring out like water from a hydrant, often associated with nausea and vomiting. This nausea is of a very aggravating character, and is 292 A CLINICAL MATERIA MEDICA. attended by faintness and loss of sight. Colic appears and is better from warm drinks. The stool returns with any effort to eat or drink. The nearest analogue to Croton tig. is Jatropha curcas, which pro- duces a perfect picture of cholera Asiatica, with great prostration and simultaneous vomiting and purging. The vomited matters look like rice-water or the white of an egg. There are also cramps in the calves and coldness of the body. The next similar drug is the Euphorbia corollata. This produces vomiting and purging, just like the previous remedy, with cold sweat all over the body. It has, more marked than the other members of this group a peculiar mental state—the patient wants to die. Cascarilla has its abdominal symptoms relieved by warm drinks. But it seems to be useful in a different class of cases from the forego- ing remedies. WTe use it when there are knotty stools covered with mucus, and associated with colic and burning just like the others. This remedy also has frequent pale red haemorrhages from the bowels. These haemorrhages do not consist of a simple oozing of blood, such as often follows a stool when haemorrhoids are present, nor is it a haemorrhage from the bowels from hepatic disease, but it comes from disease of the bloodvessels. Yucca filamentosa has a predominance of the bilious symptoms over the gastric and intestinal. It has frontal or temporal headache, fre- quent flushing of the face, yellow or sallow face, and tongue coated yellow or yellowish-white, and taking the imprint of the teeth. There are also dull aching about the centre of the liver, poor appetite, dis- tended abdomen which is sensitive to the touch, colic or colicky pains, tenesmus with frequent passage of flatus, frequent watery or yellowish- brown stools. Now let us study the action of these remedies on the skin. When Croton tiglium is applied to the skin it produces an erythema, which is soon followed by a group of vesicles which are almost confluent, and which burn and itch most intolerably. If the action of the drug is allowed to continue, these vesicles form a yellowish scab much resem- bling that of milk-crust, in which disease it may be indicated, espe- cially when the bowel-symptoms suit. Hippomane mancinella was first proved by Dr. Muir. Its power of producing vesicles has been utilized in scarlet fever. Its symptoms are these: Delirium ; sore throat, with inability to swallow on account of the constriction in the throat and oesophagus; burning of the eyes, made worse by closing the lids. EUPHORBIACE^. 293 Yucca produces an erythematous redness of the skin. In two provers it produced a burning and swelling of the prepuce, with red- ness of the meatus urinarius. An examination of allopathic text- books will show you that Yucca has been recommended for gonorrhoea. Euphorbium ojficinarum differs somewhat from the others. Like them, it produces an erythematous and vesicular eruption. Its chief value, however, arises from its action on the bones. It is used in dis- eases of these structures with burning pain, especially after the abuse of mercury. Ricinus communis has the effect of increasing the quantity of milk in nursing women. It is here similar to Urtica urens, which is an excellent remedy for absence of milk after confinement. Castor oil, when abused, is antidoted by two medicines, according to the respective characteristics, Bryonia and Nux vomica; Bryonia from a specific relation to the symptoms of Ricinus, and Nux from its relation to drastic remedies in general. LECTURE XXX. RANUNCULACE^E. Aconite. Helleborus niger. Clematis erecta. Paeonia. Pulsatilla. Hydrastis. Staphisagria. Actea racemosa. Actea spicata. Radix coptidis. Ranunculus bulb. Ranunculus sceler. To-day we have on the board the Ranunculacece, an order of plants containing many medicines. It receives its name from the different varieties of the butter-cup. As a whole, the order seems to possess an acridity, and some of its members are slightly narcotic. From this order we obtain Aconite, Actea racemosa, Actea spicata, Radix coptidis, Ranunculus bulbosus, Ranunculus sceleratus, Hepatica, Pulsatilla, Hydrastis Canadensis, Clematis erecta, Staphisagria, Helleborus and Paeonia. We will have time to study only the principal of these. We will first consider Aconite. Aconitum Napellus. Aconitum napellus is the monkshood. Aconite itself means without dust. The plant has been so named from the botanical fact that it grows on dry rocks, with scarcely enough earth about to enable it to take root. This shows the hardiness of the plant. It is called the monkshood because of the shape of the flowers, which turn over and give the ap- pearance of a hood thrown over the head. Aconitum napellus contains an active principle called Aconitine, crystalline in some instances and amorphous in others. In the root of the Aconitum napellus is another principle called Napelline. Aconitine is also contained in one variety Ranunculaceae. ACONITE. 295 of the Staphisagria, the larkspur. It is also said that Helleborus con- tains Aconitic acid. I have heard, but with how much truth I cannot say, that some of the inhabitants of Persia eat the tops of the Aconitum ferox. It is also asserted (this, too, I cannot vouch for) that, in some parts of Switzerland, Aconite is grown in rows along the streets, and the tops are cut off and used as greens. This illustrates the fact that plants alter their properties from domestication. When taken in poisonous doses, Aconite acts as a depressant to the cerebro-spinal nervous system. It produces a sensation of numbness attended with pricking and tingling in the extremities, and even com- plete anaesthesia. At first the emotions are not at all impaired. It also affects the circulatory system. After the first sensation of diffused warmth is experienced, there follows an intense internal heat and pro- fuse hot sweat. At other times the skin becomes covered with a miliary rash, which itches intensely. The pulse and respirations are greatly accelerated. Secondarily, the surface of the body becomes cool, with cold clammy sweat, the pulse grows feeble, and death ends the scene. Aconite differs in its action on the nerves from Cocculus indicus, which early disturbs consciousness. This drug, moreover, produces a complete motor and not sensory paralysis. It differs also from Gelse- mium, Conium and Nux vomica, which early destroy motor rather than sensory activity. As regards its symptoms of collapse, they resemble those of Camphor, and more nearly Veratrum album. But only Ve- ratrum has the characteristic purging and vomiting, with cold sweat on the forehead. Both Aconite and Nux cause tetanic convulsions, but they are only partial in Aconite, and are accompanied by great muscular weakness. Aconite produces two different sets of symptoms, entirely distinct in their character, and as separate as though the drug were composed of two substances, each developing its own symptoms. The second set of symptoms, that which is most thoroughly known, is the tendency of Aconite to develop fever and inflammation. This it does through its action on the sympathetic nervous system. We find it indicated in genuine inflammatory fever, in what is called synochal fever, otherwise termed sthenic fever. All these terms apply to a fever which has about it no quality of weakness or asthenia. The symptoms of the fevers calling for Aconite are these: There are usually dry heat of the skin, and full, hard, bounding pulse. This fever is usually associated with anxiety. The meutal symptoms and those which are local, Hahnemann 296 A CLINICAL MATERIA MEDICA. has told us, are the true guiding symptoms in the selection of Aconite. It cannot be the remedy unless there is present anxiety, restlessness and fear of death. The sweat which follows this fever is usually critical, and gives relief to all the symptoms. It is profuse, warm or even hot. It has been proven that Aconite does not produce any alteration in the quality of the blood; hence, you cannot expect it to be indicated in any form of fever in which there is a poison in the blood destroying that fluid or impairing its corpuscles, altering its plasma, or in any way changing its quality. The type of the Aconite fever is sthenic and continuous, and not intermittent or remittent. It has no symptom in its pathogenesis which points to intermittency. Beginning with the initial chill or chills, the dry heat follows and continues until sweat brings relief. Then the fever is over so far as Aconite is concerned. It has no typical return of these febrile attacks. Hence, you cannot give Aconite in intermittent fever. Then, again, it must be borne in mind that sometimes the fever is not the disease itself, but a symptom which is necessary for the proper development of the disease. You should no more attempt to lop off this fever by the administration of Aconite, than you would lop off one symptom in any other disease. When, then, fever is only a symptom, Aconite should not be given to control it. Take scarlatina for instance. The fever here may run high, the skin may be hot and dry, and the pulse hard. Superficially, Aconite appears to be indicated, yet you know, with the other symp- toms present, backache, vomiting, sore-throat and the existence of other cases of the disease in the neighborhood, that scarlatina is developing. You know, by removing this fever, you take away a symptom which is necessary for the proper development of the rash belonging to the disease. Therefore, Aconite is seldom to be thought of in scarlatina. There may be exceptional cases when the fever is disproportionately severe and the characteristic mental symptoms are present, in which case you may administer it, but nine cases out of ten would only be spoiled by the administration of Aconite. Again, a mistake is made in giving Aconite in typhoid types of fever to diminish the pulse and control the temperature. Aconite has no relation whatever to typhoid fever. It is here given from mere symp- tom practice and not through any knowledge of pathology and symp- tomatology. Let me beg of you not to commence this practice; it will only lead you to alternation. In traumatic or inflammatory fevers, Aconite must give way to other remedies unless this restlessness or anxiety is present. One of these ACONITUM. 297 remedies is Bryonia, which has full, hard pulse, increased action of the heart, dry skin and aggravation of all the symptoms by motion. The patient lies perfectly quiet. He is not at all restless. It is important that you distinguish between Aconite, Gelsemium and Apis in febrile states. I will therefore give you in detail the symp- toms and conditions which make the selection of one or the other of these remedies certain. If I repeat what has already been said, the repetition will only serve to impress the distinction between these remedies the more firmly in your minds. Aconite typifies the synochal fever; Gelsemium the remittent or intermittent; Apis the intermittent or typhoid. Aconite causes decided chill, followed by dry, hot skin and full, hard, bounding pulse; later, follows warm, profuse, critical sweat, with relief. Gelsemium causes partial chill, beginning in the hands or running up and down the spine; followed by general heat, most decided about the head and face. Sweat is gradual and moder- ate, but always gives relief. Apis causes a chill, which is followed by burning heat all over, or some places are hot and some cool. Heat is felt particularly in the abdomen. Skin is hot and dry, or alternately dry and moist. Sweat is absent or breaks out in spells, soon drying off. Under Aconite the pulse is, as stated, full, hard, bounding. Under Gelsemium it is full, flowing, but not hard. Under Apis it is accel- erated, full and strong, or fluttering, wiry and frequent. Aconite pre- supposes that the blood is not qualitatively altered. Gelsemium admits of any change which may favor depression. Apis tends towards tox- aemia, with a typhoid type. Aconite, therefore, is the remedy only when the fever is sthenic; such as arises from exposure to dry, cold winds; from exposure after overheating; from cooling suddenly when warm and sweating, etc. In bilious fever it is indicated in the early stages when of the sthenic type, especially because it acts on the liver. It is also the remedy in inflammatory fever, whether traumatic or not, the type agreeing; particularly in full-blooded, robust individuals, who readily suffer from sudden active congestions. It bears no relation to the intermitting type of fever; and, when given during such a fever, acts only by subduing the heart's action, and never curatively, hence never homceopathically. Neither does it hold any relation to typhoid fever. Gelsemium is the remedy when the fever develops under cir- cumstances which favor a paresis of motor nerves of both voluntary and involuntary muscles. It corresponds to that stage in which the blood- vessels are dilated and full, but lack the firmness and resistance of a fully developed sthenic inflammation. Such a form of fever is accom- 20 2ns A CLINICAL MATERIA MEDICA. panied by languor, muscular weakness, desire for absolute rest, and drowsiness. Under such conditions congestions might still be arterial, as under Aconite, but they exhibit a passivity which is sufficiently characteristic. The pulse is full, flowing, but not hard. So Gel- semium may be indicated in bilious fevers, the liver being passively con- gested. Again, it applies in typhoid forms, but never after the languor and drowsiness belonging to relaxation, and consequent passive con- gestion of the brain pass into great prostration and stupor. Apis has an apparent resemblance to the sthenic fever of Aconite in its hot skin, strong pulse, etc., and this is especially so in the beginning of erysipelatous inflammations, or, still more, in inflammation of serous or synovial membranes. But the tendency of the Apis is typhoid- ward or towards effusions; Aconite never either. Thus Aconite may suit the fever attending the initiation of a meningitis, pleuritis or synovitis; but its power ceases when the cri encephalique, dyspnoea and dull percussion, or puffy, doughy swelling about the joint, as the case may be, announces effusion. In its intermittent form of fever, Apis bears no resemblance to either Aconite or Gelsemium. Even in a rheumatic type in which Aconite and Apis both appear, the resem- blance is only superficial; for Apis either develops an erysipelatous inflammation, or causes burning-stinging pain and an exquisite sore- ness, all referable to the bloodvessels. In its lower forms Apis deserts Aconite and completely supersedes Gelsemium. It is indicated in genuine scarlatina, in diphtheria and in typhoid fever. There is a tendency to defibrination of the blood, and lastly to decomposition of the fluids. In such cases the anxious restlessness of Aconite and the irritability or drowsiness of Gelsemium are replaced by a fidgety rest- lessness and stupefaction. The excitement and delirium of Aconite and the semi-conscious muttering of Gelsemium are changed into a low muttering delirium and unconciousness. Arranging the respective symptoms according to the requirements of the Organon, we have each remedy characterized as follows: Aconite, anguish, despair, restless tossing about during the fever; fears he will die; throws off the clothes; pulse full, hard, bounding ; skin hot, dry. All ends in copi- ous sweats. Gelsemium, irritable, sensitive ; children sometimes wake- ful, nervous, even threatened with convulsions, or drowsy, eyelids heavy, look as if intoxicated ; want to remain perfectly quiet. Chill up and down the back, followed by fever with increased drowsiness; pulse full,.flowing. Sweat moderate, gradual, but giving relief. Apis mellifica, fidgety restlessness; wants to sleep, but so nervous, cannot; ACONITUM. 299 or low, muttering delirium ; sopor. Chill begins in the knees or ab- domen, three p.m.; heat, with dry skin or occasional transient spells of sweating; desire to uncover; great oppression of the chest; skin hot in some places and cool in others. Pulse accelerated and strong; or, as debility shows itself, wiry and frequent; intermittent, imper- ceptible. Belladonna comes in as another concordant remedy to Aconite. Belladonna, as we shall see in the future, does not act primarily on the vaso-motor nerves or sympathetic ganglia, hence it does not control the calibre of the bloodvessels. It acts primarily on the cerebro- spinal nervous system, hence we find it indicated in fevers which begin with symptoms of the brain and spinal cord. We find it indicated in fever which begins with the Aconite type, but which by extension, has involved the brain. Thus we often find Belladonna following Aconite well. Belladonna requires that brain symptoms, such as starting from sleep, throbbing headache, hot head and cold body and extremities be present. Veratrum viride takes the place of Aconite in fever marking the onset of pneumonia, when there is great arterial excitement. The breathing is labored and difficult. When synochal fever fails to yield to Aconite, the best remedy then is Sulphur. The symptoms that will lead you to the selection of this remedy are these: Despite the administration of Aconite, the dry heat persists. Either no perspiration shows itself, or, if any, it is simply transient. The patient, at first sleepless and restless, becomes drowsy and answers questions slowly or permits an interval to elapse between your questions and his reply. The tongue becomes dry and the speech a little thick. The patient gives evidence of falling into a typhoid state owing to the continued exhaustion from this heat. Ferrum phosphoricum, of which I have already spoken more than once, should be distinguished from Aconite. It acts upon the blood- vessels, producing a sort of semi-paretic state, in which they become dilated as in the second stage of inflammation. The pulse is full and rather soft, and not hard or tense, as with Aconite. It is indicated in congestions of any part of the body when the discharges from that part are blood-streaked. This may be applied to dysentery, to haemop- tysis, and to secondary pneumonia. Arsenicum album, like Aconite, causes intense fever, with anxiety, fear of death, and restlessness; but the fever and inflammation of Arsenic are such as belong to intense local disease, to inflammation 300 A CLINICAL MATERIA MEDICA. progressing to the destruction of the part, to fever of a typhoid type with putrid discharges, etc. Aconite may be used in inflammatory affections of the brain. You must, however, distinguish between an idiopathic cerebral inflamma- tion and one arising from deep-seated disease. Aconite can have but little influence over tubercular meningitis. But in meningitis or cere- bral congestion from lying with the head exposed to the direct rays of the sun, especially when asleep, it is the remedy, here being superior to either Glonoin or Belladonna. It may also be used when cerebral congestion results from a fit of anger. Aconite may further be indicated in sunstroke when the great heat has had a paralyzing effect on the circulation. At first the heart works harder. It then begins to lose its force and beat from 120 to 130 beats per minute. You may use Aconite in affections of the eyes, in conjunctivitis following surgical operations, or resulting from a foreign body in the eye. It is also indicated in inflammatory affections of the eyes, arising from exposure to dry cold winds. There is a great deal of heat and burning in the eye. The eye feels as if full of sand, and is exceed- ingly sensitive. The pains are so intense that the patient wishes to die; he declares that he cannot stand them. The eye-ball feels as if forced out of the orbit, and aches; this aching is worse when the affected part is moved or touched. Photophobia is intense. The pupils are contracted, and there is a blue circle around the cornea, and vio- lent aching in the balls as in episcleritis. Even glaucoma may de- mand Aconite when, in addition to the symptoms above enumerated, there are pains extending down the face, as in tic douloureux, especi- ally after exposure to intense cold or to cold winds or in rheumatic patients. If, however, Aconite does not relieve promptly, you must resort to other measures at once, as this disease may destroy sight in an incredibly short time. Sulphur is indicated in conjunctivitis from irritation of foreign bodies when Aconite fails. Spigelia has many pains similar to those of Aconite, especially in the left eye; but its inflammation is less general than in the case'of Aconite. The other action of Aconite is very different from that already con- sidered. These symptoms belong more to the cerebro-spinal nervous system. First, we will speak of the symptoms of the mind itself. We find Aconite useful for mental disease or hysteria when there is par- ACONITUM. 301 ticular aversion to excitement, especially to busy streets. The patients dare not cross these streets because of fear that something will happen to them. This symptom is perfectly normal under some circum- stances, but when extreme, denotes over-excitement of the brain, com- mon enough in hysterical patients. They are anxious. They show an intolerance of music. They can bear no sounds, so sensitive are the ears. They imagine that some part of the body is deformed, e.g., a limb displaced, lips too thick, features distorted, imagine they do all their thinking from the stomach. Sometimes such patients, during attacks of illness, have "spells" in which they predict the hour of death. You may sometimes note this symptom in puerperal fever. Coffea also has the symptom, predicts the hour of death. Further than this Aconite causes paralysis; a paralysis which may easily be remembered from two or three subjective symptoms; paralysis accompanied by coldness, numbness and tingling. Unless there is tingling in the affected part we seldom find Aconite indicated. Even paralysis of both legs, paraplegia, may yield to Aconite with this characteristic coldness of the limbs and tingling. We may also use Aconite in various forms of local palsies, as facial paralysis, when asso- ciated with the above-mentioned symptoms, and when traceable to ex- posure to dry cold winds. Cannabis indica and Staphisagria should be remembered in paralysis, with tingling in the affected parts; and Rhus tox., Sulphur, and Caus- ticum in paralysis from cold. The neuralgia for which Aconite is the remedy, is caused by expo- sure to dry cold winds. Especially is it indicated when there is vio- lent congestion of the affected part, which is usually the face. The face will be red and swollen. The pains drive the patient almost to despair. There is usually tingling in the affected part. You may here compare Spigelia, which is useful in left-sided prosopalgia, with severe burning, sticking pains. The patient exhibits intense excite- ment and great intolerance of the pains. Colchicum is likewise indicated in left-sided prosopalgia. The pains are associated with a paralytic weakness of the muscles, but lack the severity of those of Spigelia. Amyl nitrite may be needed rather than Aconite in prosopalgia with much local congestion. Aconite is a very important remedy in the treatment of affections of the heart. The symptoms indicating it in these cases are numerous and important, and necessarily so, since Aconite so disturbs the blood- 302 A CLINICAL MATERIA MEDICA. flow, and also exerts a special action on the heart and its nerves. There are congestions to both heart and lungs, palpitation with anxiety, cardiac oppression, and even syncope. The palpitation is worse when walking. Lancinating stitches occur and prevent the patient from assuming an erect posture or taking a deep inspiration. Attacks of intense pain extend from the heart down the left arm, and are associ- ated with numbness and tingling in the fingers. In hypertrophy of the heart, Aconite is indicated by this numbness and tingling in the fingers. It is in uncomplicated hypertrophy of the heart only that you should give this remedy. In hypertrophy from valvular disease it may do great harm. You should here com- pare Aconite with Arnica, Aurum, Rhus tox., and Cactus grandiflorus. Kalmia and Rhus also have numbness and tingling in the left arm with heart disease. Aconite may be used in the first stages of pneumonia when the fever is high and has been preceded by a chill. Symptoms of engorgement of the lungs are present. The cough is usually hard and dry and rather painful. At most, the expectoration is serous or watery, and a little blood-streaked, but not thick and blood-streaked. The patient is necessarily full of anxiety. Veratrum viride competes with Aconite in the incipiency of pneu- monia. It acts admirably when the pneumonic engorgement is severe, with violent excitement of the heart as indicated by rapid full pulse ; nausea; on rising, faintness; tongue red down the centre. Bryonia comes in to take the place of Aconite, especially when hepatization has commenced. The cough is still hard and painful, and is associated with thicker expectoration. The anguish is now traceable to oppression of breathing and not to the fever; the patient prefers to lie still rather than to be tossed about. Aconite may also be indicated in pleurisy, in the very beginning before there is any exudation; when there are sharp stitches on either side of the chest; when there are chills, followed by febrile action ; when the whole trouble has arisen from a checked perspiration or con- finement from the fresh air. In croup, whether catarrhal or membranous, you should give Aconite when the trouble has arisen from exposure to dry cold northwest winds. The patient is aroused from sleep with long suffocating attacks. The cough is of a hard, dry, barking character, and may be heard all over the house. There are great difficulty of breathing, anxiety, and high fever. ACONITUM. 303 Spongia is to be used when the breathing becomes "sawing." The cough is still barking, harsh, and rasping. It is especially indicated in light complexioned blue-eyed children, especially if the trouble is worse before midnight. Hepar should be given if the cough is worse towards morning, and is associated with rattling of mucus. Sambucus is called for when there is spasm of the glottis. The breathing is of a wheezing crowing character, and is worse after mid- night and from lying with the head low. In haemoptysis calling for Aconite the blood is bright red. The trouble is always associated with anxiety and with fever. In haemop- tysis you may compare with Aconite the following: Millefolium, which has haemoptysis, with profuse flow of bright red blood, but without fever. Ledum for haemoptysis of drunkards or persons of a rheumatic con- stitution. The blood is bright red and foamy. Cactus grandiflorus for haemoptysis with strong throbbing of thf heart. It has, however, less anxiety and less fever than has Aconite Aconite is frequently of use in abdominal diseases, especially in in- flammatory affections of these parts. You may use it in gastritis or gastric catarrh with the usual attendant symptoms, when the trouble has been caused by exposure; also by checking of acute eruptions, or by sudden chilling from drinking ice water. You may also give it in inflammatory colic, the pains from which force the patient to bend double, yet are not relieved by any position. (Compare Colocynth.) This symptom is invaluable in the beginning of inflammatory pro- cesses within the abdomen, and also in some cases of ovarian dysmenor- rhcea. Aconite may be used in dysentery, especially when the disease occurs in the autumn when warm days are followed by cold nights; the stools are scanty, bloody and slimy, with much tenesmus. In this disease, Aconite is followed very well by Mercurius. The diarrhoea of Aconite is of inflammatory origin. The stools are watery, slimy and bloody. It usually appears in summer as the result of indulgence in cold drinks or from checked perspiration. Cholera infantum calls for Aconite when the stools look like chopped spinach, and the inflammatory symptoms already mentioned, are present. You should also remember Aconite in incarcerated hernia when in- flammation has started up in the strangulated bowel, with burning 301 A CLINICAL MATERIA MEDICA. pain in the affected part. There are also vomiting of bile, great anxiety and cold sweat. In the incipiency of nephritis, whether Bright's disease or not, Aconite has relieved when the patient complains of sharp cutting pains, going in a circle from renal region around to the abdomen over each ilium. Coming now to the genital organs, we sometimes find Aconite indi- cated in dysmenorrhcea which has been supposed to result from thick- ening of the peritoneum over the ovaries. The characteristic colic, which I described a few minutes ago, is present. During pregnancy, Aconite may be administered for certain mental symptoms, such as fear of death, excitable temperament, etc. It may also be used for impending abortion caused by anger. During labor itself it may be given when the pains are unnaturally violent and frequent. The patient complains that she cannot breathe, that she cannot bear the pains. She is restless and anxious and the body is covered with a hot sweat. In the milk-fever, Aconite is to be given when the mammary glands are hot and swollen, and the skin hot and dry. These symptoms are associated with restlessness and anxiety. Suppression of the lochia is an indication for Aconite, when caused by some violent emotion, and when associated with high fever, thirst and anxiety. The mammae are lax and the abdomen distended and sensitive to touch. Aconite is not often indicated in puerperal fevers because they are generally of septic origin, but for one form of child-bed fever it is the only remedy capable of subduing the whole affair within a few hours. The nurse, perhaps, has carelessly exposed the patient after a hard labor, has bathed her with too cold water or thoughtlessly changed her clothing without the necessary precautions, and there follow hot fever, thirst, etc., eyes glaring and wild, a sharp, anxious expression ; abdomen distended and sensitive to touch, mammae lax and without milk; then you may give Aconite. While Aconite is not called for in scarlatina, still it may be used in that disease, when after the stage of desquamation, the child catches cold and acute Bright's disease results. The child starts up from sleep in perfect agony, with cold sweat on the forehead and with cold limbs. Dropsy is also present. In acute coryza you find Aconite indicated when the nasal mucous membrane is dry and hot, and when there is most violent throbbing ACONITUM. 305 headache, better in the open air. Or, the coryza may be fluent and hot with frequent sneezing. The muscles all over the body feel sore, so that sneezing forces him to support his chest; fever, etc.; all pro- voked, not by damp weather, not by exposure to any sort of atmos- phere capable of producing cold, as some teach, but by cold air, cold, dry winds, checked sweat. Here you may compare Nux vomica ; colds caused by ccld weather; nose stuffed and dry; throat feels rough as if scraped. Belladonna, if the head is intensely hot, throat red and tonsils swol- len. China, if there is headache from suppressed coryza, pains worse in the open air instead of better, as under Aconite. In skin diseases, Aconite is sometimes indicated. Though not a remedy for scarlatina, it is for scarlet-rash with high fever. In measles, it is early called for, when with the fever there are red eyes, restlessness, dry barking cough and itching and burning of the surface. Sulphur is the proper remedy when Aconite has been abused. LECTURE XXXI. ACTEA RACEMOSA, RANUNCULUS BULBOSUS AND RANUNCULUS SCEL. Actea Racemosa. We have in the homoeopathic materia medica, two varieties of the Actea, Actea racemosa, and Actea spicata. The last-named of these may be dismissed in a very few words. It acts upon the joints, espe- cially upon the smaller joints as those of the hands and feet. It is useful in rheumatism affecting these parts, especially if the hands and wrists are involved. Actea racemosa acts upon the cerebro-spinal nervous system, and especially on the motor nerves. It seems to have a decided influence over the nerves distributed to muscles, producing a perfect picture of myalgia. Actea racemosa is also valuable by reason of its reflex nervous symp- toms. It has neuralgia of any part of the body as a reflex symptom from uterine or ovarian disease. One of its most important symptoms arising from this cause is a sensation of heat on the top of the head just back of the centre. Other symptoms which you may note about the head are feeling as if the top of the head would fly off, sharp lan- cinating and neuralgiform pains in and over the eyes, supra-orbital pains shooting up to the top of the head. These symptoms indicate Actea racemosa in some of the diseases peculiar to women and in dis- eases of the eye proper. In any disease of the eye, when pains of the above-named character are present, Actea is one of the first remedies to be thought of. Spigelia has similar pains. Under this remedy the neuralgia comes and goes with the sun, that is it reaches its height at noon and subsides in the evening. The Actea pain is worse at night rather than during the day. The Spigelia pain begins in the back of the head and comes forwards and settles over one or the other eye. This remedy also has a sensation as if the eye-ball was enormously large. When, however, this last-named symptom is traceable to uterine displacement, Actea is preferable. ACTEA RACEMOSA. 307 Cedron is an invaluable remedy in neuralgiform affections when the pains involve the supra-orbital nerve and the eye, and are worse on the left side. The eye burns as if it were on fire. The pains recur regularly at the same hour each day. Another remedy to be mentioned in this connection is Kalmia lati- folia, which has supra-orbital neuralgia, worse on the right side. Actea may also be used for headache attended by a feeling as if the patient were going crazy. Especially is it of value when uterine symptoms are present. It is also called for when there is pain in the left infra-mammary region when dependent upon uterine disturbances. We come now to the action of Actea on the female sexual organs. It is indicated in labor or in threatened miscarriage when the pains fly across the abdomen from side to side (Lycopodium, from right to left; Ipecac, from left to right and associated with nausea). The pains seem to double the patient up. It may also be used in the early months of pregnancy for those pains in the abdominal walls which so distress the patient. When there is a great deal of soreness in the abdomen, the local ap- plication of a solution of Hamamelis is a good remedy. The labor-pains seem to be associated with fainting spells or with crying out in agony, so severe are they. In after-pains it is only useful when they are intense, when the patient is exceedingly sensitive and cannot tolerate them, and when they are worse in the groin. Actea may also be used in puerperal mania. The patient declares that she will go crazy, and her every action apparently indicates that she is keeping her word. She is suspicious. Her talk is nonsensical, and yet she seems to be conscious of what she is doing, and she says she cannot help it. Sometimes she has visions of rats, etc. These symptoms may also indicate the drug in delirium tremens. Here you may compare Lachesis, which has "awakening from sleep and springing from bed, not only with superhuman strength, but in great terror." Also Arsenicum, which often follows Lachesis when the patient is afraid to be left alone. Calcarea ostrearum, visions of rats and mice as soon as the patient closes her eyes. Another symptom that we find indicating Actea in labor is "rigors 308 A CLINICAL MATERIA MEDICA. or nervous chills" in the first stage of labor. Gelsemium is also useful in this condition. Actea racemosa does not cause phthisis, yet it may be one of the first remedies that we may use when the disease is not of hereditary origin, especially if the trouble has been brought on by exposure, or in any case in which the well-defined cough of Actea is present, and that is a dry, teasing cough, worse at night, with little or no sputum, and usually associated with pleurodynia. In pleurodynia associated with tuberculosis, you will find Guaiacum to be a remedy that rarely fails. You may use Actea in angina pectoris when the pains radiate all over the chest, and are associated with cerebral congestion and uncon- sciousness. The face is livid, and the arm feels as if bound tightly to the body. Another use that we may make of Actea is in that condition known as spinal irritation. Especially is it indicated when the upper and lower cervical vertebrae, particularly the latter, are sensitive to pressure; hence, the patient will not lean back in her chair because of the un- easiness which it produces. This symptom of Actea is usually reflex from uterine irritation. Now we have several remedies similar to Actea in spinal irritation. One of these is Natrum mur., which also produces sensitiveness between the vertebrae. The main distinction between it and Actea is that under it the patient finds relief from lying flat on the back, and that, too, even when there is a uterine displacement. Another indication calling for Natrum mur. is a partial paralysis from weakness of the spine. Especially is it indicated when these symptoms arise from grief, anger, etc. Physostigma, or the Calabar bean, develops a perfect picture of spinal irritation. It produces all sorts of burning and twinging sensations referable to the spinal column, with numbness of the feet and hands and other parts of the body, crampy pains in the hands, sudden jerking of the limbs on dropping off to sleep. The muscles of the back become rigid, and even a tetanic condition may ensue. Agaricus muscarius produces a perfect picture of spinal irritation, with well-marked tingling or formication in the back, with itching or burning of the skin as if frostbitten, twitching of the muscles, espe- cially of the eyelids, and sensations in different parts of the body as if needles of ice were being thrust into the skin. This spinal irritation may develop a partial paralysis, in which case RANUNCULUS BULBOSUS. 309 we have two remedies to fall back upon. One of these is Zincum, metal- licum. This produces a perfect picture of irritable spine, with aching in the back at about the last dorsal vertebra, which is worse from sitting than from either walking or lying. Along with this it produces weak- ness of the legs, especially at noon, when the patient is hungry. You should also remember that the spinal symptoms of Zinc are made worse by wine. The second remedy is Cocculus indicus. This we use in females with weak spine when there is paralytic aching in the small of the back. The patient feels as if she could scarcely walk. Along with these symptoms there is also an empty, gone feeling in the abdomen, which feels as if hollow or empty. Among men we do not find these symptoms present except as a result of sexual excesses, in which case Nux vomica is the remedy. Kobalt is of use for spinal irritation from sexual excesses when this symptom is present: Backache worse when sitting, with weakness in the legs. Ranunculus Bulbosus. Ranunculus Bulbosus. Serous membranes. Muscles. Effects of alcohol. Skin. Compare [with Aconite, Arnica, Cactus, Bryonia, Rhus, Arsenic, Mezereum. We have two varieties of the Ranunculus to consider to-day. These are the Ranunculus bulbosus and the Ranunculus sceleratus. Now, both of these plants possess a juice or sap which is exceedingly irritating to the skin. When applied locally, it produces erythema followed later by an eruption which at first is vesicular in its character and attended by burning, smarting and itching. If the symptoms con- tinue by reason of the intensity of the action of the drug, ulceration and even gangrene of the parts follow, the gangrene being associated with fever and delirium. This is an extreme picture, yet it is one which may follow the prolonged use of some of the species of the Ranunculus plants. We shall now consider the Ranunculus bulbosus, and first as to its action on serous membranes. We may think of Ranunculus bulbosus in inflammation of serous membranes, particularly of the pleura or peritoneum, when there are acute stabbing pains in the chest in the 310 A CLINICAL MATERIA MEDICA. case of pleuritis, and accompanied by an effusion of serum into one or the other cavity, according as it is one or the other membrane in- flamed. Accompanying this effusion we find great anxiety, dyspnoea and distress, caused partly by the accumulation of fluid and partly by the anxiety from the pains themselves. Now these are symptoms not commonly known among physicians, yet you will find that here Ranunculus will serve you as well as Apis, Bryonia or Sulphur, or even better than these, if the character of the pains just described is present. The second heading in die schema on the board is " Muscles." We find Ranunculus acting here as a curative agent. It is especially in- dicated in rheumatism of the muscles, particularly in muscles about the trunk. Intercostal rheumatism yields far more quickly to this drug than to any other. There is usually a great deal of soreness to touch, and the muscles have a bruised feeling as if they had been pounded. I know that Aconite, Arnica or Bryonia is often given when Ranun- culus is indicated. Aconite may be the remedy in pleurodynia when there is high fever (which is not often), especially if you can trace the trouble to expo- sure to cold after being overheated. Ranunculus bulbosus may also be used in the case of persons who are subject to stitches about the chest in every change of weather. Again, it may be used for sore spots remaining in and about the chest after pneumonia. The characteristic sensation attending the Ranunculus soreness is a feeling of subcutaneous ulceration, which is purely subjective. This symptom is also characteristic of Pulsatilla. Again, Ranunculus may be used for pains about the lungs from adhesions after pleurisy. The rheumatic pains of Ranunculus are worse in damp weather and particularly from a change of weather or change of temperature. Even a rheumatic headache having this aggravation, may call for Ranunculus, We may also find it indicated in diaphragmitis when there are sharp shooting pains from the hypochondria and epigastrium through to the back. Another remedy that I have found of service in this latter disease is Cactus grandiflorus, which is an excellent remedy for sharp pains in the diaphragm, particularly if there is a feeling as though a band were tied around the waist just marking out the attachments of the diaphragm to the borders of the ribs below. RANUNCULUS scleratus. 311 Next you should remember Ranunculus bulbosus as a remedy for the bad effects of excesses in drink, in hiccough and even in epilepti- form attacks and delirium tremens. Lastly, we come to the action of the drug on the skin. Ranunculus bulbosus is useful in herpes zoster Or zona. Vesicles appear on the skin and are filled with serum, and burn. Sometimes these vesicles have a bluish-black appearance. Especially is Ranunculus indicated when the trouble follows the course of the supra-orbital or intercostal nerves and is followed by sharp stitching pains. Here you may compare Rhus tox., Arsenicum and Mezereum. Ranunculus may also produce pemphigus. Large blisters form which burst and leave raw surfaces. Again, you may use Ranunculus in eczema, attended by thickening of the skin and the formation of hard horny scabs. Here it is similar to Antimonium crudum, which also has horny ex- crescences or callosities on the soles of the feet. The ulcers which Ranunculus causes are flat and are attended with a great deal of stinging pain. The discharge is ichorous. Lastly, the action of Ranunculus on mucous membranes. It is one of the remedies which are useful in hay fever. You will find that there is smarting in the eyes; the eyelids burn and feel sore; the nose is stuffed up, especially towards evening, with pressure at the root of the nose and tingling and crawling sensation within its cavity. Some- times this sensation attacks the posterior nares, causing the patient to hawk and swallow, and endeavor in every way to scratch the affected part. Arsenicum and Silicea also have this symptom. You will notice, too, that there is with this hay fever, hoarseness, and very likely sharp stitching pains in and about the chest, general muscular soreness. The neck of the bladder may be affected, producing some burning in passing water. Sulphur does not follow Ranunculus well. Ranunculus Sceleratus. Ranunculus sceleratus. s 0, . ' (. Skin. Compare with Natrum m., Arsenicum, Taraxacum, Rhus tox. Ranunculus sceleratus is more irritating in its action than is the Ra- nunculus bulbosus. In its action on the skin it produces a vesicular 312 A CLINICAL MATERIA MEDICA. eruption with thin, yellow, acrid discharge, something like the Ranun- culus bulbosus. It also develops more markedly large isolated blisters. When these burst, an ulcer is formed, the discharge from which is very acrid, making the surrounding parts sore. In stomacace, and sometimes even in diphtheria or in typhoid fever, you will find Ranunculus sceleratus indicated by the presence of de- nuded patches on the tongue, the remainder of the organ being coated. Thus we have the condition known as mapped tongue. Natrum mur. has this symptom and so have Arsenicum, Rhus tox., and Taraxacum, but none of these remedies have the same amount of burning and raw- ness that Ranunculus sceleratus has. The acridity of the drug differ- entiates it from all others. Like Ranunculus bulbosus, the Ranunculus sceleratus may be indi- cated in ordinary catarrhs with sneezing, fluent coryza, pains in joints, and burning on urination. LECTURE XXXII. HELLEBORUS AND STAPHISAGRIA. Helleborus. < Helleborus. a • i f Sweet spirits of nitre, -r. . < Phosphoric acid, Depression. ) ,r y Opium. ( Apis, Digitalis, Zin- Dropsies. J cum (Brain), Tere- binthina. I propose considering first, to-day, Helleborus niger. This is also termed the Christmas rose, because it blossoms in midwinter. It has a dark brown root, which contains two active principles, Helleborin and Helleborein, and an acid supposed to be Aconitic acid. The latter is said to be the poisonous constituent of the plant. It is an active cardiac poison, and also causes violent purging, vomiting, abdominal pains, and finally collapse. This purgative action reminds one of Veratrum album, and the collapse, of Camphor, Carbo veg., China, etc. Veratrum album has not the apathy of Hellebore; Carbo veg. has cold feet and cold knees, rarely unconsciousness; Camphor has most prominently the coldness, sometimes with an internal feeling of heat, impelling the patient to throw off the clothes. The Helleborin is either inoperative, or, according to some authors, exerts a narcotic influence, and produces paresis of both sensation and motion. The action of Helleborus has beeu marked out for you on the board. It acts on the sensorium, blunting it, producing sopor; also typhoid symptoms, paralysis of muscles, collapse, and lastly dropsies. Before going any further I wish to say that by collapse I mean not a simple weakness, but a condition in which there is a positive diminution of temperature, so that the thermometer, instead of registering 98£° reg- isters 96°, or thereabouts, according to the intensity of the collapse. In its action on the sensorium we find that it blunts or depresses sensorial activity. This condition is exhibited in a variety of symp- toms; for instance, we note diminished power of the mind over the 21 314 A CLINICAL MATERIA MEDICA. body ; the patient is slow in answering questions, as though he did not comprehend what was afeked of him; he sees imperfectly, or does not seem to comprehend what he sees; hearing is imperfect; taste is absent, or nearly so; he has the desire to work or to occupy himself, but lacks the muscular strength to do so. So you see that all the senses are benumbed by the action of Helleborus. Even what has been termed the muscular sense is affected by it. Muscles do not obey the will readily unless the mind is strongly exerted. If, for instance, the pa- tient is holding anything in his hand and you speak to him, and so divert his mind, the muscles in action relax and he drops what he is holding. The heart muscle even does not escape these paretic effects, so we have slow action of that organ. The patient feels a heaviness or weight over the entire body. There is a pressing headache of a stupefying character. Sometimes there is a sensation as though the contents of the head were bulging at the forehead and eyes. Thus, you see that Belladonna is not the only remedy that has this sensation, as though the brain were being pushed through the forehead. The face is expressive of the stupidity under which the patient is laboring, We may find Hellebore indicated in typhoid fever, or in other con- ditions in which this sensorial depression, with the symptoms already enumerated, is present. In these cases you will also note the follow- ing symptoms: There is a dark soot about the nostrils; the nostrils are dry ; the tongue is yellow and dry, with red edges ; the breath is horribly offensive; drinks roll audibly into the stomach. The fever accompanying these symptoms is most marked in the afternoon, from 4 to 8 p.m. The face is at times pale and almost cold, and the pulse faint, weak, and almost imperceptible. There is also meaningless picking at the lips or clothing. In this sensorial depression Helleborus is similar to Phosphoric acid, Street spirits of nitre, and Opium. Like Phosphoric acid, it has sen- sorial depression, apathy, and perfect indifference. The patient is wholly indifferent as to his fate; he cares not whether he lives or dies. The difference between the two drugs is this: Under Phosphoric acid there is drowsiness from which the patient is easily aroused, and then is perfectly conscious; this is not the case with Helleborus, which has conditions more nearly approaching the stupor of Opium. Phos- phoric acid lacks the complete muscular relaxation belonging to Helle- borus. It also has not so marked black soot about the nostrils. Sweet spirits of nitre is a remedy recommended by Hahnemann in these cases of typhoid fever when the key-note to the whole case is sen- HELLEBORUS. 315 sorial apathy, there being, of course, no other symptoms present to in- dicate any other remedy. The patient seems to be in a sort of torpor, from which he may, by exertion, be aroused, but he falls immediately back into the same indifference. In these cases Hahnemann dissolved a few drops of the crude drug in a glass half-full of water and admin- istered it every two or three hours until reaction was manifested or some other drug indicated. You will find that Sweet spirits of nitre and Phosphoric acid differ from Helleborus in degree only, Sweet spirits of nitre having the apathy the lightest, Phosphoric acid comes next, while Helleborous has it most marked. Opium, the last drug on the list, you will recognize at once as similar to Helleborus. The cerebral congestion is more profound under the Opium. The breathing is loud and stertorous. This symptom is not marked in Helleborus. Then, too, the face is dark or brownish-red, or often blue. Under Helleborus the face is pale, and often cold or colder than natural, and at times livid and covered with a cold sweat. The pulse will help you to discriminate between these two remedies, it being full and slow under Opium, and small, weak, and almost imper- ceptible under Helleborus. Arnica is also to be thought of as a remedy producing this drowsy stupid state. Hydrocyanic acid and Cina also have the symptom, "drinks roll audibly into the stomach." Cina has it in whooping-cough. But when it occurs in approaching paralysis of the lungs and brain, Hydro- cyanic acid is the best remedy. In muscular exhaustion you may compare Helleborus with Muriatic acid, Opium, Gelsemium, Saponin, Conium, Curare, and Kali carb. - Next, we find Helleborus called for in meningitis when exudation has taken place. You have present all or some of the symptoms of sensorial apathy already mentioned, showing you the depressed condi- tion of the system. In addition you have shooting pains in the head. If the patient is a child, it will, of course, be unable to describe to you this last symptom, but you will notice by the sudden screaming or crying out that it has these sharp, shooting pains. The child bores its head into the pillow; the head is hot, and the forehead wrinkled from contraction of the corrugator siipercilli. There is automatic motion of one arm and one foot. This automatic motion may recur at regular intervals. I remember one case in which, every three minutes, the child's head was jerked to one side, the arm thrown up over the head ; it would next utter a half-pitiful cry, and then quiet down again. 316 A CLINICAL MATERIA MEDICA. Returning to the symptoms of Helleborus, the eyeballs are drawn upwards, so that you can scarcely see the cornea; the face flushes up, and then gradually pales off. When offered a drink of water the child seizes the proffered glass with avidity, as though it were thirsty; this it does, not only on account of the thirst, but also because of the ner- vousness. The bowels are usually constipated, or, if there is any stool, it is dark, scanty, and jelly-like. The urine is dark, scanty, and loaded with albumen. The nearest remedy to Helleborus in tubercular meningitis is Apis. This has symptoms of irritability more marked than under Helleborus, which has, characteristically, sensorial depression. In Apis we often find spasms of the flexors, so that the big toes are drawn upwards. This has not been noticed under Helleborus. Digitalis is very similar to Helleborus in these dropsies of the brain, in that both remedies cause great depression of the sensorium, both are suited to post-scarlatinal dropsy, and both cause meningitis with effusion. Digitalis is to be chosen by the scanty, albuminous urine, and by its characteristically slow pulse, which may be even slower than the beating of the heart. In addition to these symptoms there may be a cold sweat on the surface of the body. Zincum is useful in cases where one of the exanthemata has been checked, or has not been developed properly. The child is so ener- vated that it has not sufficient strength to develop an eruption. It arouses from sleep as if in fear; it has constant fidgety motion of the feet Other forms of dropsy in which Helleborus is indicated are general dropsy or anasarca, and especially ascites. Here you may give Helle- borus when the trouble has arisen from post-scarlatinal nephritis. The urine is dark and scanty, or smoky from the admixture of decomposed blood. On standing it deposits a sediment looking like coffee-grounds. The stool contains jelly-like mucus, and is passed with much straining. The nearest remedy here is Terebinthina, which cures dropsy de- pendent on congestion of the kidneys, as indicated by dull aching in the renal region and by the smoky-looking urine. As illustrative further of the depression of Helleborus, I may men- tion its successful employment by me in a case of shock from a blow on the head. Arnica had failed, and \he patient became drowsy; one pupil was larger than the other; the patient answered questions slowly as if comprehension was imperfect; one leg was dragged in walking. STAPHISAGRIA. 317 The pulse was scarcely fifty per minute. The patient was worse from 4 to 8 p.m. Staphisagria. Staphisagria. < V Colocynth. Causticum. 1. Blood.— Sycosis, Scurvy. 2. Loss of Fluids. 3. Organs. Similar to Nux vom , Mercurius, Thuja, Cistus Can., Colocynth, Chamom. Staphisagria is indicated in the first place in patients who appear pale, and are worn out and exhausted, especially as regards their ner- vous system. Both brain and spinal cord are weakened under its in- fluence. The face is rather sunken, the nose is peaked and pointed, and the eyes are sunken and surrounded by blue rings. Mentally, the Staphisagria patient as a child is rather impetuous and irritable, re- minding one strongly of Chamomilla. As an adult, the Staphisagria patient is hypochondriacal. There may be one of several causes pro- ducing this last-named mental state when this remedy is indicated. First, sexual excesses. We find it called for in these hypochondriacal moods after self-abuse, and also when this mental state occurs in young men and young women as a result of permitting the mind to dwell too much on sexual subjects. Owing to his bad habit the boy becomes apathetic and gloomy, and has this very complexion and sunken face that I have described. He rather prefers solitude, and is shy of the opposite sex. Locally, there is to be noted an irritability of the pros- tatic portion of the urethra. This state of affairs is seldom the result of excessive sexual intercourse. Platina was recommended by Grauvogl as a drug capable of curing spasms or convulsions, emaciation, and that train of symptoms follow- ing prepubic abuse of the sexual organs. Still another remedy is Caladium, which is to be thought of when from masturbation, the glans penis is as flabby as a rag. The prepuce, when it is withdrawn behind the glans penis, remains there, not having contractility enough to replace itself. Nocturnal emissions occur either without dreams or with dreams that are foreign to the nature of sexual subjects. 318 A CLINICAL MATERIA MEDICA. Other remedies indicated in this condition are Dioscorea and Gel- semium; and that well-known group to which I have already referred in a previous lecture, Nux vomica, Sulphur, Calcarea ostrearum and Lycopodium. Among the new remedies, Bromide of Potassium or Kali bromatum has been suggested. I have seen it do good when there was mental depression and weakness of the legs after self-abuse. In the female, in whom masturbation is not so common, we find ovarian symptoms resulting from the habit. Staphisagria becomes the remedy when these organs are in a state of irritability, especially in nervous excitable women. It may also be used in women of this class when these symptoms occur in the prolonged absence of their hus- bands. Still other mental symptoms belonging to Staphisagria, and symp- toms, too, of a different type from those just mentioned, are the fol- lowing : Easily excited to anger, sensitive to the least impression, takes offence at every little meant or unmeant insult. We have Staphisagria indicated in what I have already termed a mental colic; that is, crampy pains in the abdomen following a fit of anger, just as we found present under Chamomilla and Colocynth. Chamomilla is called for in these cases by the association with the colic of hot face, red cheeks and hot perspiration; and Colocynth, by the severe pains causing the patient to double up for relief. Staphis- agria is here complementary to Colocynth, stepping in to complete the cure when Colocynth is insufficient. We also find Staphisagria indicated in diseases of the skin and of the bones. This drug has Jong been used as a local wash to destroy lice or vermin. You may use Staphisagria internally when there ap- pears on the skin an eczematous eruption. This may occur on the head, face or any other part of the body, but especially on the former two. This eruption is usually dry, and formed of very thick scabs, and itches violently, this last being an indication for the local applica- tion of Staphisagria. The peculiarity of this itching is, that when scratching stops it in one place, it goes to another. At other times these scabs are moist, and are yellowish in color and very offensive, even breeding lice. Thus you see Staphisagria is suited to crusta lactea or eczema capitis. Again, this drug may be indicated in children who are weak and broken down as the result of a syphilitic or sycotic inheritance. In such children you almost always find the teeth decaying rapidly. Scarcely are the milk-teeth full grown, than they become black in STAFHISAGRIA. 319 creases or spots and crumble away. In this respect Staphisagria rivals Kreosote, than which there is no remedy serves better for the premature decay of the milk-teeth, when they first become yellow, then dark and finally decay. Next to these remedies you may think of Antimonium crudum, and in other cases still, Chamomilla and Cpffea. In the Staphisagria patient the gums are unhealthy, swollen, spongy and bleed easily when touched by the food or by the finger, this con- dition being associated with painful swelling of the submaxillary glands. It is especially indicated after the abuse of mercury. Staphisagria is useful in children suffering from inflammation of the eyes, particularly of the lids with hardened styes. For those little cystic tumors which form in the eyelids midway be- tween the inner and outer surfaces, Graphites is the proper remedy. These Staphisagria children have an eczematous eruption on the ears. Yellow scabs form about the ears. The exudation from these is bloody and seems to cause rawness of the skin. Still further, we find Staphisagria affecting the bones. It causes swelling of the periosteum with subsequent suppuration. It also produces on the skin fig-warts or condylomata. These are usually pediculated. This symptom places Staphisagria among the sycotic remedies. Thus we find it quite the companion of Thuja, being preferable to that remedy when there are present the form of eruption already mentioned, the crumbling of the teeth and the pedicu- lated condylomata. In some cases we find it indicated in syphilitic ulceration after the abuse of mercury, the discharge being thin and acrid. An examina- tion with the probe reveals diseased bone beneath. We have several remedies similar to Staphisagria in bone affections, whether of syphilitic or scrofulous origin. One of them is Stillingia. This is of great use in syphilitic affections of the long bones, such as the femur, tibia, humerus, etc., in periostitis or in ostitis, the pains being worse at night and in damp weather. In addition to this you almost always find an excoriating coryza, the well-known syphilitic ozaena. Another remedy is Mercurius. Still another is Kali hydriodicum, especially when there is a combination of syphilis and mercury in the case. Strontiana carb. is suited more to the scrofulous constitution. It is indicated in osteitis, particularly of the femur, with ulcers discharging 4 320 A CLINICAL MATERIA MEDICA. more or less broken-down bone. With the bone trouble there is apt to be a profuse exhausting diarrhoea almost such as would come with hectic fever. Another remedy is Chloride of Gold and Platinum which is useful for either caries or necrosis. Still another is Gettysburg Salts, which owes its effectiveness to the carbonate of lithia it contains. It is useful in caries of the vertebrae and of the hip-joint. Another use of Staphisagria is found in its application to gout. It is not so useful for the acute paroxysms as it is when gout becomes systemic; when urate of soda instead of being eliminated by the kid- neys is deposited in the various joints and organs of the body, pro- ducing arthritic nodes. It is also indicated in arthritic ophthalmia. The eyes burn and feel very dry, notwithstanding which there are smarting and profuse lachrymation. The pains go from the eyes into the teeth.. In these gouty affections of the eyes, Colocynth is also a good remedy. Upon the stomach and bowels Staphisagria acts, seeming to produce a relaxation of the stomach so that that organ appears to hang down flabby and weak. This same symptom you will find under Ipecacu- anha. There is a desire for brandy, wine or something stimulating. Such patients are subject to colic, which greatly resembles that of Colocynth. You must also remember Staphisagria as a remedy in colic follow- ing operations about the abdomen. In diarrhoea it is indicated when, in children, the disorder is asso- ciated with a peculiar form of stomacace; the tongue and gums are white and spongy, while there are cutting pains before and after stool, with a great deal of tenesmus of the rectum during stool, and escape of flatus, which is usually hot and smells like rotten eggs (here being similar to Chamomilla), stool being renewed by any attempt to take food or drink. On the female organs, Staphisagria causes prolapsus uteri, and this prolapsus is almost always associated with a flabby condition of the stomach. The whole abdomen—contents and parietes—feels as if it would drop, so relaxed is it. If you investigate thoroughly, you will find that disappointed love or permitting the mind to dwell on sexual subjects has favored this relaxation. The leucorrhcea which accom- panies this condition is yellow and excoriating. LECTURE XXXIII. Pulsatilla. ■{ PULSATILLA. Bloodvessels. Mucous membranes. Synovial membranes. I Organs. Compare with Bryonia, Nuxvom., Ant. crud., Ipecac, Sulph., Sulph. ac, Arsenic, Colchicum, Kali bi., Caulophyllum, Ignatia, Actea, Helo- nias, Hamamelis, Sepia. To-day we have to study Pulsatilla. The species which I shall consider is the Pulsatilla of Hahnemann, the Pulsatilla pratensis and not the American plant, the Pulsatilla nuttalliana. There is some little difference in action between the two drugs. The "pratensis" has been better proved. The corcordant remedies of this drug are almost without number. The reason for this is that it is a well-proved remedy, and one, too, that is often indicated. Its complementary remedies are Sulphuric acid and Lycopodium. Its antidotes are Chamomilla, Coffea, Ignatia and Nux vomica. The relation of Pulsatilla to Sulphuric acid calls for particular note. The latter remedy follows the former in gastric troubles. Pulsatilla also has an antidotal effect to Sulphuric acid. When this acid has been used for the cure of the appetite for liquor, Pulsatilla has been proposed as the remedy best suited for the diarrhoea which ensues. Pulsatilla pratensis is a pretty little flower belonging to the anemone. It has been called the wind-flower, and its name is in keeping with its symptoms, as they are as fickle as the wind. Changeableness of the symptoms is characteristic of the drug. This is especially marked in the haemorrhages, which now seemingly stop and in a few hours re- turn. It is also true of the diarrhoea, the stools continually changing their appearance—at one time being green, at another mixed with yellow, and at still another slimy. So, too, are the mental symptoms of the same fickle nature, the pa- tient now being irritable, then tearful, and again mild and pleasant. These are illustrations of the comparisons that I have stated. 322 A CLINICAL MATERIA MEDICA. Pulsatilla seems to be principally adapted to the female organism, although it also affects men as well as women. It is one of those reme- dies which we are apt to select by the predominance of the mental symptoms. It is especially indicated in patients of a mild, tearful disposition, having a rather slow, phlegmatic temperament. They are never irascible, although at times peevish. Thus, in the case of a child with gastric ailment, Pulsatilla may be used when it is peevish, pale, chilly, it is satisfied with nothing. That is not the Nux vomica condition, nor is it like Chamomilla, both of which remedies have de- cidedly more violence with their anger. The Pulsatilla woman is tearful, easily discouraged. Sometimes she is full of anxiety, with forebodings of some impending disaster. This anxiety comes from the epigastrium and is very likely associated with indigestion. It is often accompanied with chattering of the teeth, palpitation of the heart and flushes of heat. These are the main mental symptoms of Pulsatilla. They are present, more or less, in every disease in which it is the remedy. In these mental symptoms you should compare Sepia, which, you will recall, has a similar mental state; but it differs from Pulsatilla in the presence of irritability and anger. There is also indifference to her household affairs, to which she was formerly attentive. Natrum muriaticum also has tearful disposition similar to that of Pulsatilla, but with this difference: Consolation under Natrum mur. aggravates, while under Pulsatilla the patient seeks consolation. Stannum likewise has this tearful disposition. The patient is very much discouraged, or is tearful over his chest symptoms. He fears that he will go into a decline. The Ignatia patient is sad, but she hides her grief from others. Especially is Pulsatilla called for in eblorotic or anaemic women, when they complain always of a feeling of chill, and despite this chil- liness, they find relief for many of their symptoms in the open air. They cannot tolerate the close room. The pains from which they suffer seem to be accompanied by chilliness. This chilliness is more marked the more decided are the pains. The mental symptoms already mentioned are present. Especially is Pulsatilla the remedy when chlorosis has been complicated by the abuse of iron or quinine. Chlo- rosis, coming to you from allopathic hands after the failure of iron and quinine, showing you that these remedies are not suitable to the case, will find its first, if not its only remedy, in Pulsatilla. You will frequently find this hint of service to you in practice, not only in chlo- PULSATILLA. 323 rosis, but in other affections as well when they arise, not so much from local disease as from a general defective state of nutrition. The whole system is worn out. Every tissue is relaxed. She suffers from changes of position in the uterus. The menses are late and scanty, dark, clotted or changeable in character. Pulsatilla does not always cure after abuse of iron. But it stands in the same relation to this substance that Nux vomica does to the abuse of drastic purgatives, and Camphor to Cantharides. To understand how these phenomena of Pulsatilla are caused, whether in women, where they are most frequently met with, or excep- tionally in men, you must remember that the drug acts upon the vas- cular system, especially upon the right heart, and upon the veins and capillaries. Thus we find that whatever weakens the venous portion of the circulation, whatever retards the return of blood to the heart, must of course provoke just the class of symptoms for which Pulsa- tilla may be indicated. We know, for instance, that a warm, close room will provoke these symptoms. If you should sit in a close room or in one whose temperature is too high, the veins will become tor- tuous and there will be some oppression about the chest and retard- ation of the heart's action. These same symptoms occurring in disease suggest Pulsatilla. It acts on the right heart more than on the left, consequently, despite the chilliness which arises from the anaemia, the open air acts as a stimulus to the venous circulation, which improves the symptoms depending upon the sluggish flow of blood. You will find many symptoms throughout the entire body calling for Pulsatilla when there is this disturbance in the venous circulation. You will find in the chest a feeling of soreness referred to either sub- clavicular region, to the apex of one or the other lung, soreness which is felt when the patient lies on that side or presses against the left chest. This soreness seems to involve the muscular structures about the shoulder and even down the arm of the affected side. This symptom indicates venous congestion, or, at least, sluggish circulation through the upper part of the left lung. It has been a valuable symptom to me and to many physicians in the incipiency of tuberculosis, espe- cially in women of the Pulsatilla temperament. Along with this soreness in the lung there may be some cough with expectoration. Although there may be no symptoms indicating the positive existence of tubercular infiltration we will have other symtoms indicating the onset of the disease. Pulsatilla has several times relieved these cases. Then, too, we have Pulsatilla indicated in varicose veins, whether 324 A CLINICAL MATERIA MEDICA. occurring on the limbs or about the testicle (varicocele). The affected parts are bluish and annoy the patient by the soreness and stinging pains in them. The epistaxis, when Pulsatilla is indicated, is of a passive character. The flow comes steadily, but it is not bright red or does not come in gushes as it does in epistaxis dependent upon arterial lesions. It often occurs vicariously, taking the place of the menses. The same is true of the blood-spitting or haemoptysis, which is either associated with this soreness or passive congestion of the chest or is dependent upon suppressed menstruation. In these venous symptoms Pulsatilla has an important analogue, namely, Hamamelis, which vies with it here. Before Hamamelis was proved Pulsatilla was the only remedy we could depend upon in the class of symptoms enumerated. Hamamelis is the preferable drug in varicose veins unless constitutional symptoms call for Pulsatilla, espe- cially in the case of varicocele. Varicocele has been cured by Hama- melis applied externally and taken internally. The great character- istic of this drug, and that which makes its choice certain, is soreness of the affected part. It is a soreness which is not exactly the bruised feeling of Arnica; it is not the sensitive soreness of Lachesis; nor the stinging soreness of Apis ; but it is that sore feeling which belongs to venous congestion. You may apply Hamamelis successfully in any condition in which that is present. I have often made use of the drug in pregnancy, when varicose veins appeared over the abdomen, and when the patient could not make any motion without experiencing a bruised sore feeling. Hamamelis is not the panacea which druggists would have us believe. It does not cure everything, sprains, scalds, etc., but it does cure the class of symptoms I have mentioned. Another concordant remedy of Pulsatilla is Lilium tigrinum, which, like the former, affects the right heart, producing engorgement of the veins, relief in the open air, scanty menses, and taste of blood in the mouth. But it differs from Pulsatilla in the decided tendency to pro- lapsus uteri, with bearing down, relieved by supporting the abdomen, or by crossing the limbs. Also, when Lilium is indicated, there is present a sharp pain, extending from the left nipple through the chest to the back. Another analogue is Sepia, which has many of the Pulsatilla symp- toms. It, too, is indicated in anaemia and chlorosis, and it also has this mild tearful temperament, but there is a difference in the mental symptoms. With Sepia there may be irritability or vehemence at PULSATILLA. 325 times. The Sepia patient has complete aversion to her usual house- hold duties. Let us now consider the action of Pulsatilla on mucous membranes. This is easily remembered. It produces a catarrhal inflammation of the mucous membranes, and this ends in the production of bland yellow or yellowish-green mucus. Now you have an indication which you may apply to any mucous membrane. Conjunctivitis calls for Pulsatilla when the discharge is thick, yellow or yellowish-green, and bland ; hence, it is not indicated in the begin- ning, but during the course of the matured disease. It is an invalu- able remedy in the ophthalmia after measles and in purulent ophthal- mia, and in ophthalmia neonatorum, or the ophthalmia of the new born, whether these troubles are of gonorrhceal origin or not, when the discharge is of the character just described. Its analogue here is Argentum nitricum, which has the same symptoms precisely, only more marked. It is to be used after the failure of Pulsatilla. Mercurius corrosivus is suggested in cases which, despite Argentum nitricum, threaten to ulcerate and perforate the cornea. These are not by any means the only eye symptoms of Pulsatilla. Dr. George S. Norton, of New York, published in the Hahnemannian Monthly, some years ago, a paper on the use of this remedy in diseases of the eye. This paper covered some six or eight pages. In addition to the conjunctival inflammation just noticed, Pulsatilla causes : Obscu- ration of vision, with vertigo and nausea, diplopia, starry apparitions, circles of fire, etc. (these generally being reflex symptoms); pustules on the cornea, with very little dread of light, but with lachrymation, worse in the open air; pressing, stinging pains in the eye; lids swollen ; styes, relieved when in the open air; margin of lids inflamed and swollen, but not excoriated. Pulsatilla is also an excellent remedy in small central corneal ulcers, with no vascular supply, especially when occurring in scrofulous sub- jects. It may still further be used in lachrymation from disease of the lachrymal duct when the symptoms just enumerated are present. Pulsatilla also affects the nasal mucous membrane, and develops symptoms which indicate it in the advanced stages of a cold. It should not be given in the beginning of a cold unless the temperament and other symptoms decide, because the sneezing and the serous excoriating discharge are not characteristic Pulsatilla symptoms. But when you find a nasal catarrh "ripened," that is, when the nasal discharge is 326 A CLINICAL MATERIA MEDICA. thick, muco-purulent, yellowish or yellowish-green, and not excoriat- ing in the least, you have a perfect picture of Pulsatilla. In chronic nasal catarrh you may give Pulsatilla if the discharge is of this character. You must give the drug frequently and persistently, in order to cure. In addition to the symptoms already enumerated, there is still another, namely, loss of taste and smell. There is a remedy known as Cyclamen, which is very similar to Pulsatilla in its symptomatology. It seems to be suited to nasal catarrh when there are loss of taste and smell, and this thick discharge just like that of Pulsatilla; but it has, in addition, spasmodic sneezing. Penthorum sedoides is useful in the incipiency of coryza when there is rawness in the nose and throat. The patient complains of a constant wet feeling in the nose, but without coryza. Later, there is a forma- tion of thick purulent discharge, just as in Pulsatilla. Spigelia is one of our best remedies for catarrh of the posterior nares. The symptoms indicating it are profuse discharge of mucus through the posterior nares; nasal mucus passes off only through the posterior nares. This drug has accomplished some good cures in the hands of Dr. Aug. Korndoerfer. Hydrastis is also suited to post-nasal catarrh. The discharge is of a thin watery character, and is attended with a great deal of burning and rawness, together with a sensation as of a hair in the nostrils. Pulsatilla is an invaluable remedy in affections of the ears. In otitis externa you may use it when the external ear is hot, red, and swollen, and there are darting, tearing, pulsating pains, which are worse at night. In otitis media it is also useful when there is a profuse thick yel- lowish or yellowish-green discharge from the ear. Pulsatilla is one of our leading remedies in catarrhal otitis. There is deafness, with a feeling as if the ears were stopped up, with rushing noises in the ears, isochronous with the pulse. Silicea is the nearest remedy to Pulsatilla in catarrhal otorrhcea. Belladonna and Mercurius have a deeper action than Pulsatilla, acting on the cellular tissues. Chamomilla is similar to Pulsatilla in the ear symptoms, but the pains are more violent, and are attended with red cheeks ; the patient cannot bear pain. Plantago major is to be thought of when earache is associated with toothache. Tellurium causes catarrh of the middle ear, which may even involve PULSATILLA. 327 the internal ear or the brain, or even penetrate into the cells of the mastoid process and establish an abscess there. Pus forms in the middle ear, and finally, perforating the membrana tympani, escapes externally. In catarrh of the throat you will find Pulsatilla sometimes, though not frequently, the remedy. It would here be indicated by the appear- ance of the parts. There area marked redness of the tonsils and a varicose condition of the bloodvessels of the parts, and the fauces have a dark red or purplish hue. There are also stinging pains in the throat (here reminding you of Apis), worse usually from swallowing saliva or after eating food. Leaving the pharynx we next come to the stomach, of which organ Pulsatilla produces a catarrh. It is indicated in this disease when the tongue is coated with a thick rough white fur. The mouth is dry, and yet there is not much thirst, thirstlessness being a characteristic of the remedy. There are also nausea, and sometimes vomiting, the vomited matters consisting either of food or mucus, and also of bile. The food vomited may have been that eaten a long time before, thus showing the weak digestion of the remedy. A feeling of fulness and heaviness in the stomach after eating, sometimes associated with a feeling of rawness in the stomach as from ulceration. This last is merely a sub- jective symptom and is a common sensation in Pulsatilla. Usually there is diarrhoea, with slimy or watery stools, and worse after mid- night. Attending these gastric symptoms is heartburn, and not very often water-brash. When water-brash calls for Pulsatilla there is a putrid taste in the mouth in the morning, better after drinking. The patient craves lemonade. He may complain that his mouth is dry, yet it seems to contain plenty of mucus. Other symptoms experienced are feeling of weight in the epigastrium an hour after eating, relieved by eating again; feeling in the oesophagus as if food was lying there (also China, Abies); throbbing in the epigastrium; much flatulence which moves about, causing pinching pains and rumbling, worse on awaking or just after supper. Now these are the symptoms calling for this remedy in gastric catarrh. What are the exciting causes ? First of all and most important, it is called for when the trouble has arisen after partaking of fatty food or of pastry. It is also indicated in gastric catarrh arising from a mixed diet, as turkey, vegetables, coffee, etc.; also after chilling the stomach with ice-cream or ice-water, es- pecially if the stomach is warm. In still other cases it may be indi- 328 A CLINICAL MATERIA MEDICA. cated after getting wet, especially after getting the feet wet when sup- pression of the menses ensues. It will be well for you if now I differentiate this remedy from others commonly used in these dyspeptic symptoms. But let me say first that other remedies besides Pulsatilla, having aggravation from eating fatty foods are Ipecac, Thuja and Carbo veg. Arsenicum and Carbo veg. have aggravation from eating ice-cream, and Nux vomica and Ipecac, from partaking of a mixed diet, or aggravation from eating at night; you may think also of Cinchona; for desire for lemonade, of Cyclamen, Sabina and Belladonna; for nausea at the thought or smell of food, particularly if rich or fat, of Sepia and Colchicum; for vomiting of food long after eating, Kreosote. Bryonia we know produces a catarrh of the stomach with white coated tongue, putrid taste in the mouth and a feeling as of a heavy load in the stomach. It may also be indicated in gastric catarrh brought on by chilling the stomach, although it is more suitable when the trouble has been brought on by the heat of summer weather. Bryonia usually, however, has constipation as an accompanying symp- tom, or if it has diarrhoea, it has not this yellowish-green or watery stool. Instead of this, the stools are papescent and have a putrid or old cheese odor. Nux vomica resembles Pulsatilla. Both are serviceable in catarrh of the stomach arising from overeating or from a mixed diet. Espe- cially is Nux indicated after indulgence in alcoholic drink. Dryness of the mouth with little or no thirst and uncomfortable feeling about the stomach, are also found under Nux vomica. The bowels are con- stipated. While heartburn is characteristic of Pulsatilla, water-brash is characteristic of Nux vomica ; of course this last statement is only comparatively speaking. Antimonium crudum resembles Pulsatilla, but the tongue under this remedy is coated white as though it had been whitewashed. Vomiting predominates over the other symptoms. A slight quantity of food excites nausea and vomiting. It is an excellent remedy in children. Ipecacuanha is a first-class remedy in these gastric catarrhs caused by chilling the stomach with ice-water or by eating pastry, confec- tionery or other indigestible substances. Usually the tongue is clean. It seldom has the thick coating belonging to Pulsatilla or Antimo- nium crudum. Nausea predominates over every other symptom. Arsenicum is complementary to Pulsatilla when gastric catarrh arises from chilling the stomach with ice-cream or ice-water. PULSATILLA. 329 I mentioned for Pulsatilla, the sensation as of a stone in the epi- gastrium. You will find a similar symptom under Abies nigra, which has been successfully used in gastric troubles when the patient expe- riences after eating, a sensation as of a hard-boiled egg in the stomach. In symptoms of the bowels you may use Pulsatilla in constipation occurring in pregnant women or following the abuse of Cinchona and its preparations. The stools are large. You may also use it for diarrhoea when the stools are of a greenish- yellow or of a changeable color. It is usually caused by partaking of a mixed diet late the night before. The patient is worse after mid- night. Here you should compare Lis versicolor, which is one of the best remedies we have for cholera morbus, coming preferably at two or .three o'clock in the morning, with vomiting of food and sour and bilious matters, and purging at the same time. It differs from Veratrum album in the absence of coldness and symptoms of collapse. In cystitis or catarrh of the bladder we find Pulsatilla indicated when there is frequent urging to urinate from pressure on the bladder as if the bladder were too full. There is pain in the urethra. The urine itself is often turbid from the admixture of mucus. Clinically, we have not found Pulsatilla a first-class remedy in cystitis, but we have found it almost always the remedy in cystic symptoms accompanying pregnancy. It yields to Cantharis, Equisetum and Dulcamara in cys- titis. Gonorrhoea calls for Pulsatilla when the discharge is thick and muco-purulent and yellowish or yellowish-green. There are usually pains in the groins when this drug is indicated, and I have noticed, too, going across the hypogastrium from side to side. That symptom has sometimes been produced by Pulsatilla. After giving it a few times in these cases, the patient returns, complaining of this aching across the stomach. This symptom occurring thus, calls for the lengthening of the intervals between the doses, or else for its stoppage altogether. In suppression of gonorrhoea, Pulsatilla is indicated if orchitis, or rather epididymitis, ensues. The testicle is retracted. It is enlarged, very sensitive to the touch and dark red. There are sharp dragging pains following the course of the spermatic cord. Unless some other symptoms contraindicate it, Pulsatilla will restore the discharge and relieve the distressing pain, but the patient must be kept quiet and the scrotum must be supported in a suspensory. In some cases I have 22 330 A CLINICAL MATERIA MEDICA. used hot water locally as an adjuvant, While it seems to increase the swelling, it relieves the pain. In some cases there appears to be an absence of symptoms of a sub- jective character. All you can observe is this, the testicle is swollen and exquisitely sore to the touch. The gonorrhceal discharge has almost if not entirely ceased. In these cases Hamamelis is your remedy. Clemcdis is an excellent remedy for gonorrhceal orchitis when the testicle is indurated and is as hard as a stone. Rhododendron is also a useful remedy when the orchitis becomes chronic and the testicle is indurated exactly as under Clematis. Under Rhododendron, however, the testicle tends to atrophy. There is also a feeling in the gland as if it were being crushed. In induration of the testicle you may compare, at your leisure, Conium, Arnica, Staphisagria, Spongia, Aurum, besides the remedies already mentioned. You may give Oxalic acid when there are ter- rible neuralgic pains in the spermatic cords, worse from the slightest motion. Mercurius is called for when the glands are swollen, and when what little discharge remains is greenish, and when there is phimosis. Pulsatilla is of use in enlargement of the prostate. It is indicated by the mechanical symptom, " faeces, when they escape, are large and flat." Hydrocele, especially the congenital form, may yield to Pulsatilla. Next let us study Pulsatilla in its relation to the synovial mem- branes. Pulsatilla has not an affinity for the true serous membranes, as we found under Aconite and Bryonia, but it acts on the synovial sacs, which are slightly different from the pure serous membranes. Pulsa- tilla you find indicated in rheumatism of the joints, and in gouty, gon- orrhceal and traumatic synovitis. The joint is, of course, swollen, and the pains are of a sharp stinging character, and are accompanied by a feeling of soreness or of subcutaneous ulceration about the affected joint. The pains in these joint inflammations are usually erratic, now here and now there. The tearing pains in the joint force the patient to move the affected part. Pressure relieves. These tearing pains often extend down the limb, and are accompanied by jerking, probably through irritation of the muscular nerves, and are relieved by slowly moving about. I dwell upon these pains because they so frequently call for Pulsatilla. They are usually worse from warmth, and are re- lieved by cold. They are worse in the evening. PULSATILLA. 331 Pulsatilla really rivals Apis in synovitis, but the latter drug has more effusion than the former, and is indicated when there is a great deal of oedema about the joint. In rheumatism with erratic pains, you may compare Kali bichromi- cum, Sulphur and Bryonia. Kali bichromicum is called for in gonorrhceal rheumatism. The pains are better in a warm room. By reason of its action on the digestive organs, Pulsatilla becomes of value in gout or in the gouty diathesis, especially when the trouble has been brought on by indigestion. If the disease persists despite its use, Colchicum follows it well. Now let us consider the action of Pulsatilla on the various organs. We have already studied the mental symptoms of the drug. We have yet to speak of its headaches. These we may summarize as being mostly frontal and supra-orbital. They are generally of uterine, neu- ralgic, rheumatic or gastric origin. They are aggravated by mental exertion and by warmth. They are usually worse in the evening, although the gastric symptoms are worse in the morning. When of rheumatic origin, the pains are sharp and seem to go from the head into the face and almost drive the patient mad, so severe are they. In other cases they may be erratic, wandering from one part of the head to the other. In some cases the headache accompanies menstrual suppression. The head is hot. The pain in the head is better in the open air and is often accompanied by nose-bleed. In these headaches you should compare Pulsatilla with the follow- ing: Ranunculus bulbosus, headache on the vertex as if pressed asunder, worse in the evening and on going from cold to warm air and vice versa. Ranunculus sceleratus, gnawing in the vertex in a small spot. Cocculus indicus, pain in the occiput as if it was opening and shut- ting. Spigelia, sensation as if the head was open along the vertex. Carbo animalis, feeling in the vertex as if pressed asunder; must hold it together. Veratrum album, pressure on the vertex, with pain in stomach, head relieved by pressing the vertex, and aggravated by motion. Menyanthes, compressive headache in vertex and sensation when 332 A CLINICAL MATERIA MEDICA. ascending steps as if a weight pressed on the brain, with cold hands and feet. Phellandrium, pain as from a weight on the top of the head, with aching and burning in the temples and above the eyes, which are con- gested ; eyes water; can bear neither light nor sound. The eye symptoms and some of those of the ears have already been considered. We will now proceed with those of the latter organ that still remain. Pulsatilla has long been known as a remedy for otitis externa or inflammation of the external auditory meatus. The pains are very severe, as indeed they must be from the confined nature of the canal, surrounded as it is by bone. The external ear is swollen and red. The pains are usually worse at night. The trouble may end with otorrhcea, which has the character already described. We come next to the action of Pulsatilla on the female organism. It is here that Pulsatilla has won its laurels. We find it indicated in young girls at the age of puberty when the menstrual flow has either not established itself normally or even not at all. It is especially at this time that you may find this soreness of the apices of the lungs calling for Pulsatilla, and you know well that unless you remove this symptom and establish the menstrual flow, your patient will have some form of phthisis. When the menses are established they are apt to be too late and too scanty. The flow is fitful in its character, now coming on and now stopping, now appearing as dark clotted blood, and again as an almost colorless watery flow. It is preceded by men- strual colic. The pains are of a crampy, griping character, and so severe that the patient can hardly bear them. She almost smothers if the room is closed. She has the Pulsatilla temperament well- marked. Amenorrhcea may call for Pulsatilla when occurring dur- ing the ordinary period of menstruation, when it occurs as a result of -wet feet, and when nose-bleed acts vicariously for the menses. In some of these cases a single dose will bring on the menstrual flow, while in others you are obliged to give the drug repeatedly. During pregnancy you may find use for Pulsatilla. Soreness of the uterus and of the abdominal walls may call for it as well as for Hama- melis. Then again it may correct malpositions of the foetus in utero. Now I know that in making this statement I am venturing on de- batable ground. Now, I do not mean to say that Pulsatilla will make the foetus turn around. But I do mean to say that Pulsatilla will act on the muscular walls of the uterus, and stimulate their growth. PULSATILLA. 333 Sometimes the uterus in its growth during pregnancy develops more on one side than another. Hence there is irregularity in its develop- ment, and the foetus must assume an irregular position. Pulsatilla, by altering the growth of the uterus, permits the foetus to assume its proper position. During labor Pulsatilla is called for when the pains are slow, weak and ineffectual. Then again, we may find the pains spasmodic and irregular, and they may even excite fainting, as in Nux vomica. The patient feels as if smothering, and calls on you to open the windows. Again you may have it called for after labor when the placenta re- mains adherent. In these cases it will not only bring about release of the placenta, but it will so tone up the uterus as to avoid post-partum haemorrhage. Cantharis is also useful in this condition. Pulsatilla may also be used for after-pains, the temperament agree- ing. These pains, however, call more frequently for Chamomilla and Xanthoxylum. This last remedy in particular is a good one. Cuprum is a good remedy for severe crampy after-pains in women who have borne many children. Pulsatilla may also be useful for scanty or suppressed lochia. It may also be indicated as frequently as Hamamelis in phlegmasia alba dolens, or milk leg. The mammary glands are affected by Pulsatilla both before, during, and after pregnancy. It is indicated when mechanical irritation, as from carrying school-books, excites the flow of milk. After labor you may still give this remedy when the breast is swollen and painful and the flow of milk scanty or absent, the patient being gloomy and tear- ful. In this connection I may mention several remedies that are more important. I think that Urtica urens is the best remedy for non-ap- pearance of the milk without any other symptoms, there being no apparent reason for the agalactia. Still another remedy is Ricinus communis or castor oil. This has, when used externally, developed milk. It may also be successful when given internally in low potency. Still another remedy is Agnus castus, which is useful when the mind is greatly depressed. Causticum is called for in women of a rheumatic diathesis. The face is usually sallow and the patient gloomy and depressed. Now Pulsatilla, in its relation to diseases of women, has a great 331 A CLINICAL MATERIA MEDICA. many allies. First of all we may mention Actea racemosa or Cimici- fuga. This remedy resembles Pulsatilla because it acts on the uterus. Both remedies favor normal labor. Here Actea is probably the supe- rior of the two. It also resembles Pulsatilla in its action during labor, being indicated for labor-pains, which are very distressing. The symptoms, however, are not intermittent, but rather continuous. As to temperament, we find Actea racemosa differing from Pulsatilla. For instance, it is indicated in a high degree of nervousness, both during labor and out of labor, during which the woman has a horribly apprehensive mood. She has a dread or fear of something about to happen, and this haunts her from day to day. At other times she has a dread of undertaking anything, even ordinary work. Actea race- mosa is also indicated in any deviation from normal in the position of the uterus when there are sharp cutting pains across the hypogastrium from side to side. It is also to be used for neuralgias reflex from uterine irritation, and that, too, whether it be the nerves of the head, chest or limbs that are involved. Another remedy to be compared with Pulsatilla is Caulophyllum. This is a remedy that we have not had many years, and yet it is so useful that we would not now be able to get along without it. Its main characteristic is intermittency of pains. If they are neuralgic and reflex from uterine disorder, they are intermittent in character. They are usually sharp and crampy, and appear in bladder, groins and lower extremities'. During labor Caulophyllum is indicated when there is extreme uterine atony. The pains may be as severe as ever, yet there is apparently no expulsive effort. It is often indicated in nervous women in whom pain seems to be intolerable. The pains are spasmodic and fly about from place to place, now in the groins, then in the abdomen, and next in the chest, but not going in the direction of the normal pains. The patient seems to be exhausted. There is great exhaustion of the whole system. She can scarcely speak at times, so weak is the voice. These are symptoms which call for Caulophyl- lum. It has been used here by most physicians in the low potencies, although all potencies may be used. It may also be indicated during the last weeks of pregnancy when the patient suffers from false labor- pains, these consisting of painful bearing-down sensations in the hypo- gastrium. I have known a single dose to stop them after they had lasted for hours. I have next to speak of Helonias dioica, or the false unicorn, one of the order of Liliaceae. This is one of the new remedies, and it is one PULSATILLA. 335 which has proven itself worthy of a place by the side of the well-tried Pulsatilla. It is serviceable in females who are run down as to their nervous system; who are easily fatigued by any work and who com- plain of a tired backache, this tired feeling extending into the limbs. They seem to feel better when they are working than they did when they commenced to work. Now this is not the Rhus tox. condition. It is not due to a limbering up of stiff joints as under the latter remedy. The reason for the symptom is, that some of the languor passes off as the patient continues her labors. The backache is usually situated in the lumbar region just over the site of kidneys, or it may appear lower down and affect the sacral region. Pain, in either of these situations, may accompany uterine disturbances. You will find also that Helonias is useful for suppression of the menses (here it is quite akin to Pulsatilla), when the kidneys are congested. It seems as if the monthly congestion, instead of venting itself as it should through the uterine vessels, has extended to the kidneys, giving rise to albuminuria. The urine is scanty and turbid. Then, again, you find Helonias called for after confinement, when there is a tendency to prolapsus and other malpositions of the uterus. The patient complains of heaviness and dragging in the pelvic region. There is a sensitive- ness which has been expressed as "consciousness of the existence of a womb." You know that we are not conscious of our internal organs. They move and perform their respective functions without any sensa- tion. The minute your sensations tell you that you have a stomach or liver, that minute you begin to have disease there. Accompanying these symptoms of prolapsus and of uterine over-sensitiveness, you will notice too long-lasting lochia, if I may use that term. To be more exact, I should say that there is a sanguineous discharge, which continues for weeks after confinement. I can recall a case which I treated last winter. It was that of a lady who gave birth to a very large child, and suffered afterwards from prolapsus uteri. I gave her several remedies without relieving her, so that at the end of three months, she was still uncured. About this time she began to complain of tightness across the chest, with cough and some little bloody sputum. Her mother before her had died of phthisis after giving birth to twins, so I feared serious lung affection. Phosphorus did no good; Nux did no good. I studied up the case more thoroughly. She told me that she felt as though there was a heavy weight over the chest on the sternum and a feeling as though the chest had been gripped iu a vise with that sore feeling which follows. This annoyed her when she 336 A CLINICAL MATERIA MEDICA. awakened at night. These chest symptoms were symptoms that had been noticed in the male provers of Helonias. However, I gave that drug, which entirely removed that symptom and the prolapsus. Then, again, with the Helonias you frequently find a tendency to inflamma- tion of the vulva and vagina with formation of pus. You may also use it in ulceration of the cervix uteri. With this there is a leucor- rhcea which has a bad odor, and every little exertion tends to produce a flow of blood. With these symptoms there is almost always per- sistent itching about the genitals with or without the formation of blisters or sores. During labor itself we know little or nothing con- cerning the value of Helonias. A drug to be placed by the side of Helonias is Senecio aureus. This drug causes inflammation of mucous membranes, so that you find it useful when there is tendency to catarrh of the nose, throat and lungs, particularly in women. It is especially suited for nervous, excitable women who suffer much from sleeplessness, traceable to uterine irrita- tion, as from prolapse or flexion of the uterus. The patient suffers from scanty menstruation, and she is apt to be tearful. There is dry teasing cough, with stitching pains in the chest and blood-streaked sputum. The bladder sympathizes with the uterine disease. There is much pain at the neck of the bladder causing pain, burning and dysu- ria. After the onset of the menstrual flow the chest and cystic symp- toms become modified or cease, thus showing how intimately they are related to the irregularity in the menstrual effort. Another drug is the Aletris farinosa. This is one of the most bitter substances known. It is closely allied to Senecio and Helonias. In allopathic parlance it is a a tonic. It is especially useful in women who in addition to the uterine trouble and leucorrhcea, have extreme con- stipation, great effort being required to effect an evacuation from the bowels. There is great accumulation of frothy saliva. There must also be mentioned for Aletris as a remedy, weakness of digestion; food distresses the patient and lies heavily in the stomach. Cyclamen is very similar to Pulsatilla. They are both suited to chlorotic and anaemic women, and they both have some trouble with the digestion, and intolerance of fatty foods. The menstrual colic and irregularities are almost identical in the two drugs. The same kind of melancholy is common to both. Cyclamen may be distinguished from Pulsatilla by these symptoms : Generally, but not always, there is more thirst with the Cylamen patient. The Pulsatilla patient feels better in the open air, the Cyclamen does not. The Cyclamen patients suffer PULSATILLA. 337 from a peculiar kind of debility or torpidity, both of mind and body, with languor. They cannot think. They are better when aroused and forced to exercise. When they get up in the morning they feel so heavy and languid that they feel as though they could scarcely go through the day's duties, but when they once get to work they go on tolerably well until night time. That is Cyclamen, and it is very much like Helonias. They suffer, too, from dulness of the senses witirflickering before the eyes. You often find this in weak anaemic women. They see various colors before the eyes, very much as under Santonine. Sometimes they have half-sight. The indigestion with which they are troubled has this to characterize it: Formation of flatus which causes colic at night, forcing the patient to get up and walk about for relief. It yet remains for me to speak of Hydrastis canadensis. This is a remedy which acts even more powerfully on mucous membranes than does Pulsatilla. It causes catarrh of the mucous membranes of the nose, stomach, bowels, bladder, uterus and vagina, the discharge, how- ever, being more acrid than it is under Pulsatilla, and of a thick yellow or bloody appearance; in uterine affections Hydrastis is indicated for prolapsus uteri with ulceration of the cervix. The leucorrhcea is watery at times, and at other times thick, yellow and excoriating; this condition being associated with gone, weak feeling at the pit of the stomach and well-marked palpitation of the heart. The tongue is moist, and coated of a dirty yellow color, and takes the imprint of the teeth. The face is sallow, and the eyes are sunken and surrounded by dark rings. The bowels are apt to be constipated, the stools being coated with mucus or intermixed with mucus. Lastly, Lilium tigrinum, which helps in uterine complaints when there are sharp pains across the abdomen from one ilium to the other, but in addition there are marked bearing-down pains, making the pa- tient cross her limbs. She places her hand over the vulva to support the viscera. Pulsatilla cures a fever with these symptoms : The head is hot and the lips are dry. The patient is constantly licking his lips to moisten them, yet he does not wish to drink. It may also be used in intermit- tent fever after the abuse of quinine when thirst appears at two or three o'clock in the afternoon; then comes chill without thirst, and anxiety and oppression from venous congestion of the chest. The patient is sleepy, yet she cannot sleep. Sometimes one hand is hot and the other cold. 338 A CLINICAL MATERIA MEDICA. Pulsatilla is indicated in measles. I think that it is often given in the wrong place. It is indicated when the catarrhal symptoms are prominent and we have coryza and profuse lachrymation. The cough is usually dry at night and loose in the day time. The child sits up in bed to cough. It may also be used when there is earache. Do not give Pulsatilla in the beginning when the fever is high. You should begin the case with Aconite or Gelsemium. The eruption may come out to its full extent or it may have a dark appearance. Kali bichromicum is to be used when, instead of simple catarrh of the eyes, you have pustules developed on the cornea. The throat is swollen and pains go from the throat into the ears, the salivary glands are swollen, and there is catarrhal deafness. In neuralgia, Pulsatilla is indicated when the pains are jerking, erratic and paroxysmal, and as they continue they become more and more unbearable. Spinal irritation is also an indication for the drug. The neck, and in fact the whole body, feels as stiff as a board. The small of the back feels as if tightly bandaged. There are pains in the sacral region, worse on sitting and when bending backwards. The joints feel weak, as if they would become readily dislocated. Rest relieves these symp- toms, hence the patient is better after sleep. In backache, worse from sitting, you may think of Zincum, Kobalt, Sepia and Cannabis indica. The sleep symptoms of Pulsatilla are very characteristic. The sleep is restless with frequent waking and troubled dreams ; on waking the patient is dull and listless. In sleep symptoms Pulsatilla and Nux vomica differ very much. While the former is wide awake and full of ideas in the evening, Nux is sleepy in the evening. The Nux patient awakes at three or four o'clock in the morning feeling rested. He then goes to sleep again and awakes at the usual time feeling a great deal worse. Cocculus has sleeplessness from pure mental activity. Sickness fol- lows very slight deprivation of sleep. Sulphur has "slightest noise at night awakens the patient." LECTUEE XXXIV. RUBIACBAB. r Rubia tinctoria. (Madder.) Galium. (Also a red dye). Cinchona. Rubiaceae. \ Ipecacuanha. Coffea. Mitchella. Gambier. To-day, gentlemen, we have before us an order of plants from which we derive three very valuable drugs, Cinchona, Ipecacuanha and Coffea. This order also gives us Gambier (a drug not used in our materia medica) and Mitchella, besides several dyes, as the famous Madder and Galium. From the fact that these dyes are red, the order derives its name. The first one on the board is the Cinchona, frequently, although improperly, called China in our nomenclature. We will now proceed with its consideration : Cinchona Rubra. Ipecac, Arsenic, Ferrum, Veratrum alb., Carbo veg. Phosphoric ac.,Phosphorus,Rhus tox., Bryonia, Pulsatilla. Nux v., Podophyllum, Eupat. perf., Natr. m. Cinchona. { Chinin. sulph., Aranea diadema. Lachesis, Cornus florida, Eucalyptus. > Pulsatilla, Arsenic, Ipecac, Veratr. alb. Tabac, Ars., Nux v. Ipecacuanha cephaelis is a small shrub growing in Brazil. It is bitter, acrid and nauseous, and possesses a peculiar odor which, in some, excites sneezing and even asthma. In many cases the conjunc- tivae are injected, with puffiness under the eyes, profuse coryza and ten- sion over the eyes. Ipecacuanha contains as its active principle a substance called Emetin, which gives to the drug its property of producing vomiting. It also contains an acid called Ipecacuanhic acid, and a small quantity of a foetid volatile oil. This latter constituent probably has something to do with the action of the drug on the pneumogastric nerve and its con- sequent use in the treatment of asthma.' Ipecacuanha is easily studied. It acts upon the nerves (especially- the pneumogastric) and mucous membranes. It has been employed by allopathic physicians as an antispasmodic in asthma and in pulmonary catarrhs. In the latter class of troubles it is used to provoke vomiting, and, of course, gives temporary relief. Of the mucous membranes, it seems to have a special affinity for those lining the bronchial tubes and alimentary canal. One of the most prominent features of this drug is its property of producing nausea and subsequently vomiting. So prominent is this symptom that you will find it present in almost all the cases in which Ipecacuanha is required. Studied more particularly, Ipecacuanha is found suitable for patients 352 A CLINICAL MATERIA MEDICA. who are easily irritated, full of desires, but know not for what. If a child, the patient cries and screams almost continually. A3 an adult, he is irritable and morose, holding everything in contempt. Thus you will find Ipecacuanha indicated in headaches. These are of rheumatic origin. The characteristic sensation is a pain as if the head or bones of the head were bruised or crushed, this feeling seeming to go down into the root of the tongue. This headache is accompanied by nausea and vomiting. Ipecacuanha may also be used in unilateral sick-headaches with deathly nausea. In these cases the face is usually pale, blue rings surround the eyes, and the expression about the mouth betrays the intensity of the nausea. Now, these symptoms are not so necessarily present in the adult as they are in the child. You see the corners of the child's mouth drawn, and a line which extends from the alae of the nose to the corners of the mouth, giving to the child an expression of nausea, and at once suggesting to your mind such remedies as Ipecacuanha, Antimonium tartaricum and ^Ethusa cynapium. In that bursting headache of Ipecacuanha compare Veratrum album, which has that bruised feeling here and there in the brain. There is still another drug which has that symptom, and that is Ptelea. The gastric symptoms of Ipecacuanha, in addition to those already mentioned, are such as would call for the exhibition of this drug after indulgence in rich food, as pastry, pork, fruits, candy, ice-cream, etc. Nausea is constant with all complaints; vomiting of bile; vomits just after eating (like Arsenic); vomits after eating rich or indigestible food; vomiting of mucus; morning sickness. The tongue is usually clean, which latter symptom differentiates it from Nux, Antimony, etc. Dis- tress in the stomach; it feels relaxed as if hanging down (like Staphisa- gria, Theine, Lobelia, Tabacum). • These gastric symptoms which I have just given you for Ipecacuanha should be compared with those of three other remedies, the most im- portant of which is Pulsatilla. You will at once recognize the simi- larities between the two drugs. They are both useful for gastric dis- turbances caused by indulgence in mixed diet, pastry, ice-cream, pork, fatty food, etc. Pulsatilla may be considered the better remedy of the two, when the stomach yet contains the food which disagrees, while Ipecacuanha is better when the stomach is empty and the effects of the indulgence only remain. The best distinction between the two reme- dies, however, lies in the condition of the tongue. In Ipecacuanha, the tongue, as above stated, is clean or only slightly coated, whereas IPECACUANHA. 353 in Pulsatilla the tongue is almost always foul, white or yellow, with a very disagreeable taste in the mouth. Arsenicum must follow or supplant Ipecacuanha when an actual catarrh of the stomach has been produced by indigestible food, espe- cially after sudden chilling of the stomach with ice-cream or ice-water. There are vomiting, burning pains in the stomach, diarrhoea, restless- ness, etc Antimonium crudum, like Ipecacuanha, is suitable for gastric catarrh, following a mixed diet of pastry, etc The tongue is thickly coated white as if it had been whitewashed. Ipecacuanha may be indicated when, in the case of children, in- dulgence in rich food has produced convulsions. It may even be useful in the convulsions of teething children, or convulsions follow- ing suppressed eruptions, cold, etc. The movements are of the rigid tetanic form. Sometimes the rigidity alternates with flexing of arms and jerking of arms towards each other. Colic may occur, and this is of a griping character. Either the pain is situated about the umbilicus, as though a hand were tightly clutch- ing the intestines; or the colic consists of cutting pains which shoot across the abdomen from left to right. The stools are either green, as in diarrhoea of infants, or they are yellow and liquid, and covered with mucus and blood. * Sometimes they have a fermented appearance and look like molasses. That is as good a comparison as I can give you; the stool looks just like molasses when it is frothy. At other times the stools are black from admixture of bile. Some of these diarrhoeas are associated with tenesmus, indicating catarrh of the lining membrane of the bowels. Ipecacuanha you will find frequently indicated in the commencement of cholera infantum. You find present pallor of the face, with the blue rings around the eyes, the fontanelles are still open, showing de- fective nutrition; the child may have nose-bleed with the pale face; it is drowsy, with starting and jerking of the muscles during sleep. The child is subject to frequent attacks of nose-bleed. The condition already simulates that of hydrocephaloid. You must not think be- cause Ipecacuanha is wedded so closely to stomach symptoms, that it cannot be indicated in this reflex cerebral state. You will find nausea and even vomiting usually present. The child eats or drinks and vomits what it has taken almost immediately afterwards. Particularly is Ipecacuanha indicated in these cases as a remedy preceding the ex- 354 A CLINICAL MATERIA MEDICA. hibition of Arsenicum. Arsenicum is complementary to Ipecacuanha in these abdominal affections. In some of these cases of gastro-intestinal troubles in children it will be your misfortune to have Ipecacuanha and the other remedies just mentioned to fail. Then it will be well for you to bear in mind the following remedies, which, though infrequently indicated, may prove themselves to be of inestimable value. Oenothera biennis, the evening primrose, common in fields and waste places, is an invaluable remedy in exhausting/watery diarrhoea. It does not act, as has been suggested, as an astringent, by its tannic acid, but is a genuine homoeopathic remedy, producing and curing diarrhoea. The evacuations are without effort, and are accompanied by nervous exhaustion, and even with incipient hydrocephaloid. Gnaphalium causes a watery, offensive morning diarrhoea, which repeats itself often during the day. The provers were children, and well have they portrayed a very common group of cholera infantum symptoms. They had rumbling in the bowels, colicky pains, and were, at the same time, cross and irritable. The urine was scanty, and the appetite and taste were lost. A writer in the Homeopath used this drug very successfully last summer, and Dr. Hale refers to it in his Therapeutics. Geranium maculatum is also a successful baby's remedy. Dr. Hale devotes eight pages to Geraniurh and other astringents, dividing their action according to his rule of primary and secondary symptoms, and deducing thence two propositions for use in practice. The prov- ings, brief though they are, help us in the choice of the drug: constant desire to go to stool, with inability for some time to pass any faecal matter, then the bowels move without pain or effort. Mouth dry, tip of tongue burning. Allopaths use it as an astringent. Paullinia sorbilis has been suggested for diarrhoea, which is green and profuse, but odorless. Opuntia comes to us recommended by so careful an observer—Dr. Burdick—that, although I have not used it, I do not hesitate to pre- sent it anew. Nausea from stomach to bowels; feels as if the bowels were settled down into the lower abdomen (confirmed in adults). In infants we may, perhaps, look to this drug when the lower part of the abdomen is the seat of disease, as this seems to be its characteristic seat of attack. Nuphar luteum causes a yellow diarrhoea, worse in the morning, either with colic or painless. It has been employed for diarrhoea IPECACUANHA. 355 during typhoid, and indeed seems to cause nervous weakness. Whether it will be of service for infants remains to be seen. We should look to it when Gamboge, Chelidonium, etc., fail, and when exhaustion is a prominent attendant. Kali bromatum has been several times given successfully in cholera infantum when there were great prostration, cool surface and symptoms of hydrocephaloid. Compare Cinchona (incipient hydrocephaloid, fol- lowing prolonged or oft-repeated diarrhceic discharge), Calcarea phos., Carbo veg., Veratrum album, Camphor, etc. Another effect of Ipecacuanha, and one which is just as characteristic as its action on the bowels, is its action on the mucous membrane of the respiratory tract. Thus it may be used in coryza. The nose feels as if stuffed up; often there is epistaxis, loss of smell, nausea and some catarrh of the bronchial mucous membrane. You may compare here Allium cepa, which is an excellent remedy for simple nasal catarrh when the nasal secretion is watery and acrid. Lachrymation is mild. There are rough raw feeling in the throat and cough provoked by tickling in the larynx. I may say in qualifying these symptoms of Allium, that although it quickly stops the nasal catarrh, it seems to drive the trouble to the chest. Phosphorus seems to stop this action of Cepa. Euphrasia is very similar to Cepa in nasal catarrh. Here, however, we have excoriating lachrymation and bland nasal discharge. Arsenicum follows Ipecacuanha, in the catarrhs of fat, chubby chil- dren. Affecting prominently, as Ipecacuanha does, the pneurnogastric nerves, we would expect it to be useful in affections which involve these nerves, as asthma, in which disease it is indicated when there is a sensation as of constriction of the chest worse from the least motion. The patient coughs and you hear the rattling of mucus in the chest, yet none is expectorated. Especially will you find this kind of asthma calling for Ipecacuanha in stout persons of lax fibre, either adult or child, and who are especially sensitive to a warm moist atmos- phere. Very similar to Ipecacuanha in asthma is Arsenicum, which often follows it well either in catarrhal or nervous asthma. Cuprum is also useful in asthma when the spasmodic element pre- dominates. The face gets blue; there is constriction of the throat; the patient almost goes into convulsions. Another drug closely allied to Ipecacuanha is Lobelia inflata. This 356 A CLINICAL MATERIA MEDICA. has, with the asthma, a weak sensation in the epigastrium, spreading up into the chest, nausea, profuse salivation and a feeling as of a lump in the stomach. Ipecacuanha is one of the best remedies we have for capillary bron- chitis of infants, especially if caused by the kind of weather I have described. There is a great accumulation of mucus in the chest. The examining ear hears rales all through the chest, both anteriorly and posteriorly. The cough is spasmodic and usually attended with vomit- ing of phlegm. There may be fever and Ipecacuanha still be indicated. The child may have great difficulty in breathing from the great accu- mulation of mucus in the chest. In such cases, I have used the remedy in all potencies; that is to say, from the third to the twenty thousandth, and I have been well satisfied with its action. When Ipecacuanha is indicated, the stage for giving Aconite has passed, because exudation has begun. If you adhere to the principles of homoeopathy, you will not give Aconite and Ipecacuanha in alternation. After giving Ipecac- uanha, you will notice that the mucus does not adhere so firmly to the walls of the bronchial tubes, but it becomes less tenacious and is raised more readily. Let me warn you that there are two or three changes which will call for concordant remedies. One of these changes calls for Antimo- nium tartaricum, and that is when the cough grows less and less fre- quent, the quantity of mucus in the chest not diminishing in amount. The infrequency of the cough is not a good symptom, although the mother will think so. The chest is so filled with mucus that the child cannot cough. He grows more and more drowsy. In giving Antimonium tartaricum in these cases, give it in frequent doses until the cough increases. Another change calls for Phosphorus, and that is when the inflamma- tory symptoms increase and the substance of the lungs is involved and pneumonia obtains. Then Ipecacuanha ceases to be the remedy. Any one who practices in the colder parts of the country will find these catarrhs frequent, and with Aconite, Ipecacuanha, Antimonium tar- taricum and Phosphorus, he can manage the great majority of his cases. Still other remedies may be needed. In some cases Antimonium tartaricum, though apparently well indicated, fails to control the symp- toms. Then we may have recourse to Sulphur, which produces in the healthy catarrh of the bronchial mucous membrane with loud rales all through the chest, especially in the left lung. Especially is it indi- IPECACUANHA. 357 cated when there is atelectasis. In just such cases I have used Sul- phur with success. Another remedy is Terebinthina, which I have used when the child was drowsy and the lungs seemed to be all clogged up. The urine is apt to be scanty and almost dark from the admixture of blood. Tere- binthina must be given repeatedly. Still another remedy is Lycopodium, which affects more the right lung. Loud rales are heard all through the affected part. Expec- toration is yellowish and thick. We may be called upon to give Ipacacuanha frequently in whoop- ing-cough, this by virtue of the spasmodic character of the cough and the action of the drug on the pneumogastric nerve. You will find in addition to the symptoms already mentioned, that there are spasmodic convulsive symptoms present. During the cough the child stiffens and becomes rigid (from tonic spasm of the extensor muscles), loses its breath and turns pale or blue in the face. Finally it becomes relaxed and vomits phlegm, which of course relieves. While Ipecacuanha is of excellent service here, you are reminded of two other drugs which are similar. One of these is Cina, which I must ask of you to remember as being something more than a mere worm remedy. This remedy is useful in whooping-cough with the same kind of rigidity that I have described for Ipecacuanha, but there is in addition a clucking sound down the oesophagus as the child goes out of the paroxysm. If in addition to this symptom you also have grinding of the teeth, Cina is certainly a better remedy than Ipecacuanha. Cuprum is the complement of Ipecacuanha in spasmodic affections and in whooping-cough. It is especially indicated in convulsions from worms and during the course of whooping-cough. Spasms of the flexors predominate. In fevers we may use Ipecacuanha especially in those of an inter- mittent type. As I said in my lecture on Cinchona, it is one of the best drugs to give when your case is completely mixed up. It is par- ticularly indicated when there is a short chill followed by long fever with nausea and vomiting, especially after the abuse of Quinine. Ipecacuanha is an excellent drug for haematuria, for haemorrhage from the kidneys when the trouble is attended with nausea, oppression of the chest, hard breathing and cutting pains in the abdomen. In some cases' those who work in Ipecacuanha are affected with a violent inflammation of the conjunctiva. Now this fact led Jousset 358 A CLINICAL MATERIA MEDICA. to apply the drug in the treatment of ophthalmia, and he claims many successes from it in the intense conjunctivitis of scrofulous children. There are tearing pains in and about the eyes and copious lachryma- tion. Tears gush forth every time the lids are separated. When, however, there is marked keratitis, he prefers Apis. In closing let me give you the Ipecacuanha temperament. Studied as a homoeopathic remedy, you will find it indicated in patients who are full of desires they know not for what. As a child it cries and screams. Children are continually crying and screaming. Adults are irritable and morose, holding everything in contempt. Bismuth seems to hinder the action of Ipecacuanha. Opium increases its action on the bronchial mucous membrane. Coffea Arabicum. Coffea is extensively used as a beverage. Its active principle is Caffeine, which is identical chemically with several others, as Theine, the active principle of tea, and Guaranine, the active principle of Paullinia sorbilis. This Caffeine has been found to retard waste of tissue, as shown by the diminution of the amount of urea excreted. It is more than likely, then, that Caffeine is useful when there'is an extra drain on the system, particularly after one has been working hard in hot weather, at which time we have two sources of loss of vitality, one the heat and the other the fatigue from labor. Then a cup of coffee is a very good thing. So, too, it may be used after loss of sleep, when waste is greater than it is after labor. Other things being equal,coffee is not so useful for the young as for the old. Take a man in active business life or one who works hard all day, or an elderly man in whom waste is out of proportion to repair, coffee is a remedy to retard the waste. This is the reason, I doubt not, why it is almost instinc- tive on the part of workmen to fall back on coffee as a beverage, be- cause it gives them what their food will not, a certain amount of strength and an antidote to the wear and tear of labor. Wliat are the effects of Caffeine on the system? These bear a certain resemblance to Strychnia, for it seems to excite reflex action, and, if persistently given, tetanus as well. It produces sudden start- ing from the slightest touch of the surface of the body (just like Strychnia), and increased susceptibility to all external impressions. This increased " excito-motor " action explains many of its symptoms Violent emotions, whether of pleasure or of pain, produce symptoms. Patients experience sudden joy, and they are at once sick from the ex- COFFEA. 359 citement. They awaken at night without any desire whatever to return to sleep. Coffea also produces an ecstatic state of mind. Here it finds a con- cordant remedy in Cypripedium. Especially is the latter remedy indi- cated in children who awaken at night from sleep, and are unnaturally bright and playful, and evince no desire to go to sleep again. Such symptoms are often preliminary to some brain affection, which the timely use of Cypripedium may avert. Apoplectic congestion may be cured by Coffea, particularly if an ex- cited state of the mind has been the cause of the excessive fulness of the cerebral bloodvessels. So, too, an animated conversation in which the party interested becomes greatly warmed up and has cerebral congestion will call for Coffea. This remedy is only of value, however, in the beginning of these cases, when it is all-sufficient. But if the trouble goes on to effusion (not inflammatory effusion, but effusion of serum by oozing through the distended capillaries), then you must have re- course to Belladonna, Bryonia or some remedy more adapted to effu- sion than is Coffea. Then, too, we have in Coffea a remedy in eruptive diseases when the eruption keeps the patient awake on account of the excessive itch- ing and burning of the skin ; the patient scratches even until the parts bleed. This symptom is due, in the Coffea case, to the hypersensi- tiveness of the skin. Then, too, we may notice a fear of death allying Coffea with Aconite, this fear of death being usually present with the severe pains. All pain in the Coffea patient is intolerable. He cannot bear even a slight pain, which causes great complaint and crying and whining. Coffea is often indicated in the toothache of children and of nervous people. Sometimes you will be led to give Chamomilla in these cases. You find the mental symptoms indicating that drug, yet it does no good, or it affords but partial relief. You may give Chamomilla when the face is red, when the child cannot bear the least pain and is cross and irritable, and when cold water in the mouth relieves for an instant. But if cold water relieves permanently, Coffea is the remedy. The senses are all too acute under Coffea, not only the sense of touch but that of sight also. Under the stimulating influence of this remedy the patient may see a fine print with a degree of distinctness altogether unnatural. Distant noises seem to be magnified. But there is an opposite to this condition produced by Coffea, and this opposite embraces those symptoms coming from its secondary action 360 A CLINICAL MATERIA MEDICA. or one of depression. We find it acting on the circulation in this way: At first it seems to increase the frequency of the pulse, showing that there is increased action of the heart. Now, it must be remembered that this increased frequency of the pulse is not attended with an in- crease of force, as under Aconite, Bryonia and Baptisia. So you see that the stimulation is not genuine. On the contrary, it weakens the heart muscle. So that after awhile, if this drug be given long enough, or if coffee be indulged in as a beverage to excess, the heart exhibits a ten- dency to dilate. We find Coffea also indicated in diarrhoea, particularly that occurring among housewives; those who have a great deal of care and trouble in the management of the household. Then remember also the use of Coffea for fatigue arising from long journeys, and especially during a heated term. As analogous to Coffea, I would like to mention two or three other drugs that have recently been proved. Piper methysticum, also called Kava-kava and Awa-samoa, is largely used iruPolynesia as a beverage. It has also been proved as a medicine. Its effects seem to be something like those of coffee, as it produces at first a feeling of buoyancy or tension, as though every nerve were "strung-up" to its highest pitch. The prover feels that he can work hard without fatigue. If these effects reach their extremes, there is a feeling of mental tension as though the head were large, almost full to bursting. There is dizziness also; dizziness on closing the eyes or on directing the attention to any object. The vessels of the brain, and particularly those about the base of the brain, feel full, as if ligated (that is the symptom given in the language of the prover). Thus far you see it is something similar to Coffea. But the reverse effects quickly follow the use of Piper, and this reverse is characterized by what we may call brain-fag. The brain feels tired on awakening, as though one had been out late at night and had lost considerable sleep, or as one feels after a hard night's study. There is heavy, dull aching in the head, which is worse from either reading, thinking or any other use of the mind. The mental symp- toms, be they those of excitement or of depression, are relieved by diversion of the mind. Further than this, Piper seems to produce convulsions, and it has cured them. The spasms simulate those of catalepsy. The mind is tired and yields to the least pressure. There is over-sensitiveness to all external impressions. LECTUEE XXXVI. SCROPHULARIACESE. Scrophulariaceae. < Myrica cerifera. Spigelia. Kalmia. Helleborus. < China. Digitalis. Gratiola. Leptandra. Euphrasia. Verbascum. Linaria. From this order of plants we obtain Digitalis, Gratiola, Leptandra virginica, Euphrasia, Verbascum and Linaria. We have not many symptoms for each of these drugs, and those that are known are suffi- ciently distinct to be easily remembered. The most important member of the group is the Digitalis Purpurea. Digitalis contains among other ingredients two substances, one known as Digitaline, the other as Digitoxine. The latter is found in larger quantity than the former. Digitaline has been proved sepa- rately from the Digitalis. Its symptomatology, however, is, like all other alkaloids, very nearly identical with that of the original drug. Digitalis produces among other symptoms very early in the proving or in poisoning cases, the most distressing nausea and vomiting. This emesis is often accompanied by a deathly faint, sinking sensation at the pit of the stomach. The surface of the body is often cold, and sometimes covered more or less with cold sweat. The pulse is irregu- lar. These early symptoms of Digitalis remind you of several other drugs, notably, Antimonium tartaricum, Tabacum and Lobelia. It is quite likely that both the latter drugs and Digitalis cause this nausea and vomiting by affecting the base of the brain, acting there upon the pneumogastric nerves as they leave their origin. Such symptoms as this deathly nausea and vomiting might suggest Digitalis in the vomit- 24 362 A CLINICAL MATERIA MEDICA. ing attendant upon cerebral disease, with meningitis, for instance, whether the meninges of the cerebrum alone, or of the cerebrum and cord combined, are involved in the inflammation. It may even be used in the nausea and vomiting of pregnancy, and in the incipiency of abortion. One of the provers, a pregnant woman, took an overdose of Digitalis, and in consequence was seized with this same deathly nausea and a flow of blood from the vagina. We may also study Digitalis in its action on the heart. Through irritation of the pneumogastric nerves we have inhibition of the heart's action. As a consequence of this effect of the drug, the pulse becomes slow. Arterial tension is greatly increased, probably owing to the action of the drug on the vaso-motor centre, which is supposed to be at the base of the brain ; the pulse is, therefore, primarily strong. In addition to the effect of the drug on nervous structure, we must re- member it also affects muscular tissue, both of the striated and non- striated varieties. Thus it causes weakness of the cardiac tissues. This weakness varies all the way in intensity from a simple weakness to a complete paralysis of the muscular fibre. Consequently, we may very soon have added to these other symptoms, weakness of the pulse. Every little extra exertion, such as that incurred while rising from a sitting to a standing posture, increases the rapidity of the pulse, but the force of the beat is diminished. This quick pulse may become irregular and even intermittent. With this view, then, of the physi- ological action of the drug, you may understand the following symp- toms of the heart and respiration connected therewith. But first let me here give you a word of caution respecting the use of Digitalis in heart affections. The tendency of this drug, like that of Lachesis and Arsenicum, is downwards. You must not use it, therefore, indiscriminately or carelessly, but only when you are guided to its selection by the symptoms of the case, or you will certainly make your patient worse. In organic diseases of the heart, Digitalis must be used with extreme caution, because it may hasten the period when nature is no longer able to compensate for the interference in the circu- lation by hypertrophy of the heart muscle. Nature thus may be com- pelled to give out. Then the heart yields to the pressure of the blood within its cavities and begins to dilate; and then we will have the train of symptoms which I will shortly give you as belonging to Digi- talis. This warning is particularly applicable to the use of the drug in large doses. Given thus it may relieve for a time, but it only DIGITALIS. 363 hastens the fatal end. With this word of warning I now proceed to give you in detail the heart symptoms of Digitalis. The heart feels as though it stood still, and this sensation is attended with great anxiety. There is a sort of indescribable uneasiness in the cardiac region, which may be expressed as a sense of oppression or as tightness about the heart, or only as an uneasy feeling with weakness and numbness in the left arm. There is a feeling of goneness or sink- ing at the epigastrium. This is sometimes relieved by eating, but often comes on worse after eating, particularly after breakfast. There are sharp sticking pains in the region of the heart. Sometimes there is choking when trying to swallow, from reflex spasm of the glottis. The pulse is slow, often slower than the beating of the heart. In these cases the heart beats so imperfectly that some of its pulse waves are not transmitted appreciably to the radial artery at the wrist. Any movement, such as rising from a chair, getting out of bed, or increas- ing the speed in walking, increases the rapidity of the pulse but causes no increase in the force of its beat. The irregular distribution of the blood owing to these alterations in the heart's functions is exhibited in quite a variety of symptoms. In extreme cases, for instance, we find even cyanosis, which suggests Digitalis as a possible remedy for cyanosis neonatorum. The child turns blue and falls into a syncope on the slightest motion, or else it becomes deathly sick, as you see from the expression of the face and from the involuntary gagging. If you can feel the pulse, you will find it irregular both in rhythm and volume; the surface of the body is cool. The borders of the lips are blue or purple. The child is blue around the eyes. The veins wherever they show through the skin are seen to be dark. Other and more common illustrations of the irregular distribution of the blood may be shown in the sleep. The patient's sleep is uncom- fortable and restless. He dreams a great deal; he starts up from sleep dreaming that he is falling from a great height. Sometimes he awakens with an anxious or distressed feeling, which he may be unable to locate, but which proceeds from the cardiac affection. Mentally, the Digitalis patient, besides being anxious, has those gloomy forebod- ings incident to heart disease. He has an apprehensive feeling, ill- defined it is true, yet none the less terrible. He is apt to be sad and depressed, as well as anxious. The respiration is of course changed by this action of the heart. We frequently find breathing deep, sighing and slower than normal. This symptom is almost pathognomonic of heart affection. There is often a desire to take a deep breath, but an 364 A CLINICAL MATERIA MEDICA. attempt to do so only seems to result in half-filling the lungs, which do not expand to their full capacity. Often this is attended with dry cough, which seems to be excited by deep inspiration. The deeper they attempt to breathe, the more likely are they to cough. This is a bronchial symptom altogether, and comes on from over-filling of the bloodvessels there. Suffocative spells with painful constriction of the chest, as if internal parts of the chest were grown together, are not uncommon. Sometimes these force the patient to sit up in order that he may breathe. With these cardiac symptoms you will find Digitalis indicated in several varieties of diseases starting remotely from the heart, and yet depending either directly or indirectly upon the disease of that organ. In almost all the affections in which Digitalis may be used there is present some one of these forms of pulse, either a slow pulse or a feeble pulse becoming irregular or quick. For instance, dropsy may be developed and may call for Digitalis. This dropsy is not of renal origin. You would hardly think of Digi- talis in dropsy resulting primarily from liver or kidney disease, but in that form occurring primarily from cardiac debility, it is at times an invaluable remedy. Digitalis may be used with profit in a number of forms of dropsy. You may give it in anasarca when the surface of the body is bluish, rather than of the alabaster-like appearance characteristic of renal dropsies. Local dropsies, too, are present. Thus you find Digitalis indicated in hydropericardium, and even in hydrothorax and ascites, if they are connected with heart disease. In dropsies of the chest there is a remedy that is often forgotten, and that is the Sulphate of Mercury or Mercurius sulphuricus. Especially is this remedy useful when the chest dropsy occurs from heart or liver disease. When it acts well it produces a profuse watery diarrhoea, with great relief to the patient. A very common form of dropsy calling for Digitalis, is infiltration of the tissues of the scrotum and penis. We may even use Digitalis in hydrocele when the cardiac symptoms calling for that remedy are present. The urine is often suppressed or very scanty. This deficiency in the renal secretion depends upon disordered circula- tion, and not upon primary disease of the kidneys. This urine may be dark red, or it may be albuminous. Then, too, we find Digitalis causing some liver symptoms which are worthy of notice. But here, too, I hardly think that Digitalis has a direct action on the hepatic cells, affecting the secretion of bile; but DIGITALIS. 365 in jaundice, in which the primary trouble is a cardiac disease of the type already mentioned, with ashy white stools, Digitalis certainly acts admirably. The liver is somewhat enlarged and feels sore, as if bruised. Ob- jectively examined, it is found to be somewhat indurated. With this symptom we have jaundice. The taste is bitter, or at other times, sweetish. The tongue may be perfectly clean, or at other times may be whitish-yellow. The pulse is slow, even slower than the beating of the heart. Drowsiness may supervene and even increase to stupor. The stools are of the character above mentioned. The urine is high- colored from admixture of bile pigment. This jaundice calling for Digitalis is not such as follows retention of bile or as that caused by catarrh of the duodenum or by some obstruction of the biliary ducts, but it is due to an actual functional imperfection of the liver, that organ not taking from the blood the elements which go to form the bile. A remedy which here compares favorably with Digitalis is Myrica cerifera, which has the following symptoms: First, despondency, that state of mind depending upon the disordered condition of the liver. The symptoms of Myrica are similar to those of Digitalis, because the origin of the jaundice is somewhat similar; because in each case the jaundice is due to the imperfect formation of bile in the liver, and not to ob- struction in the flow. But the two remedies are very different in their absolute effects on the system. With the Digitalis, the jaundice is traced back to the condition of the heart. With Myrica, the case seems to be functional rather than organic. For some reason the bile is not properly formed, and therefore its elements remain in the blood. The heart is affected secondarily, slowness of the pulse thus being produced. The symptoms calling for Myrica are these: Despondency, dull, heavy headache, worse in the morning; the eyes and sclerotic have a dirty, dingy, yellowish hue, the lids themselves being abnormally red; the tongue is coated a dirty yellow. The patient is weak and drowsy, and complains of muscular soreness and aching in the limbs. The pulse is slow. The urine is dark and turbid. You recognize at once the resemblance to Digitalis; but it is more superficial in its action than is that remedy, and would not be suitable for so violent a case. In heart affections you may compare Digitalis with quite a number of remedies, notably, with Kalmia, Arsenicum, Helleborus and Conium. Kalmia latifolia is a drug which belongs to the order Ericaceae, along with Rhododendron and Ledum palustre and other remedies. It 366 A CLINICAL MATERIA MEDICA. is a valuable remedy in rheumatism when it affects the chest. The pains in the Kalmia affection of the heart are sharp, taking away the breath ; the patient almost suffocates, so severe are the pains. The pains shoot down into the abdomen or stomach ; the pulse being slow, almost as slow as that calling for Digitalis. Kalmia is especially use- ful when gout or rheumatism shifts from the joints to the heart, espe- cially after external applications to the joints. I refer here especially to the applications to the joints, of substances that are not homoeopathic to the case. If you were giving Arnica internally and applying it locally, and if it were the indicated remedy, there would be no danger of metastasis. But if some one apply tincture of Aconite to the affected joint there would be danger of the inflammation travelling to some more vital part. The Kalmia rheumatism, like that of Ledum, almost always travels upwards. Helleborus is similar to Digitalis in the slowness of the pulse. The respiration is also slow and the temperature of the body is greatly diminished, often being as low as 95° or 96° F. There is generally cerebral disease. Spigelia also must be compared with Digitalis. It has the follow- ing symptoms: Sharp pain shooting through the heart to the back, or radiating from the heart and down the arm or over the chest and down the spine; great oppression or anxiety about the heart; palpitation of the heart worse from any movement of the arm or body; thrilling or purring sensation is felt over the cardiac region (this is just such a thrill as you feel when stroking a cat's back when the animal is purr- ing) ; blowing sound over the heart. You will find Spigelia indicated when these heart symptoms accompany other affections, for instance, neuralgia, particularly if it affects the left side of the face, commencing in the occiput and settling over and in the left eye. That is the Spigelia headache. Its aggravation follows the course of the sun. It commences in the morning, reaches its acme at noon, and diminishes towards night. You may also use it in ciliary neuralgia with these accompanying sympathetic symptoms of the heart Sharp pain shoots through the eyeball and radiates in all directions, almost driving the patient mad. At other times there is a sensation as if the eye were being squeezed in a vise or as if it were enormously enlarged and was being pushed out of the head. It is one of the chief remedies to be thought of in iritis with excessive pain. I wish also to mention a symptom for Spigelia that the late Dr. Jacob Jeanes confirmed many times, and that is intermittent pulse. He prescribed this remedy as an DIGITALIS. 367 intercurrent, in many varieties of disease, when the pulse assumed this character. * It will not be unprofitable for us next to study the action of Digitalis on the brain. It causes symptoms which are very much like those of meningitis, even meningitis with effusion, or hydrocephalus, and also in cerebro-spinal meningitis. The symptoms from which you will have to decide are these: There is throbbing headache, which is re- ferred to the forepart of the head ; delirium, which may be so violent as to simulate mania; decided errors in vision ; bright balls of fire appear in the field of vision, or, like Santonine, objects appear of various colors, as blue or green. Still later, as the trouble progresses, mental confusion increases and amaurotic congestion of the retina takes place; the pupils become dilated and fail to respond to light, and finally coma appears. There is great general prostration with cold- ness of the body, which is covered with a cold sweat. Even in these forms of cerebral disease, when Digitalis is to be your remedy, the pulse comes in as your chief guide. If the symptom, buzzing in the ears, which, by the way, I forgot to mention as belonging to Cin- chona, should suggest Cinchona, I entreat you not to give it after Digitalis, for Hahnemann tells us that, although there is a similarity in the cerebral symptoms and in the weakness, yet the drugs are inimical. Lastly we will speak of the action of Digitalis on the urethra and genital organs. Digitalis produces an irritation of the bladder, par- ticularly about its neck, this being catarrhal in origin. The symptoms are strangury and frequent urging to urinate, especially when the patient is standing or sitting; pressure on bladder not relieved by urinating. The patient may also have frequent urging to urinate at night. The urethra is inflamed so that we have burning in the ure- thra with purulent discharge, thick in character and bright yellow in color. Now, if you combine these symptoms with another one, namely, that the glans penis becomes inflamed with copious secretion of thick pus over its surface, you have a perfect picture of Digitalis in gonor- rhoea. This form of the trouble, Digitalis will cure, whether the pulse be slow or fast, soft or weak, or what not. Often, too, when Digitalis is indicated in this trouble, you will find the prepuce puffed up and infiltrated with serum. Let me say, in passing, that if the prepuce becomes indurated, Digitalis will do no good, but Sulphur will. The nearest remedy to Digitalis in gonorrhoea is Mercurius. This 368 A CLINICAL MATERIA MEDICA. is a good remedy for gonorrhoea associated with inflammation of the prepuce, but with less oedema and mo're dark purplish swelling of the parts with phimosis or paraphimosis. Mercurius corrosivus is good in these cases when the glans has a dark red or gangrenous appearance. In the beginning of these cases of paraphimosis, we may give Colo- cynth, which will sometimes relieve the spasm and enable the prepuce to be drawn forwards over the glans. Petroselinum is to be thought of as an intercurrent remedy in gonor- rhceal affections when the neck of the bladder is involved, and there is sudden urgent desire to urinate. It seems as if the patient could hardly retain his urine until he gets to a convenient place. Digitalis also produces violent erections, even chordee. It is one of our best remedies for involuntary seminal emissions during sleep, with- out dreams even. The emissions are followed by great weakness. Linaria Vulgaris. This drug produces fainting. It may be serviceable in fainting of cardiac origin. The " patient faints dead away without apparent cause." Linaria has repeatedly produced that symptom. It is true that there is some difficulty in confirming such a symptom as this, because, in most cases, the patient quickly returns to consciousness without recourse to any remedy. But if a patient who is subject to attacks of fainting of this kind is not only relieved but is cured by taking this drug, you know that this is the result of the remedy. Verbascum. Verbascum is to be thought of as a remedy for catarrhs or colds when they are associated with neuralgia of the face which appears quite periodically, generally twice a day, the same hour in the morning and afternoon of each day. There is considerable coryza and lachryma- tion. Verbascum has a peculiar cough, which is decidedly a cough of the larynx and trachea; a cough that could not occur other than from dis- ease in a hard unyielding tube, as the larynx and trachea. The cough is hard, harsh and barking, and is associated with hoarseness, the voice itself being deep and hard, " a sort of basso prof undo." It bears some resemblance to Drosera, Spongia and Sulphur. LEPTANDRA VIRGINICA—EUPHRASIA. 369 Gratiola. Gratiola is useful in diarrhoea. It produces and cures a profuse yellowish, gushing, watery diarrhoea, as though it were rushing from the hydrant. This diarrhoea is very common in summer, and seems to have as its exciting cause excessive drinking of water, whether it be cold or not. You see that it is concordant with Croton tiglium, Elateriumt Podophyllum and a few other drugs. Leptandra Virginica. Leptandra virginica is a drug which acts prominently upon the liver. Locally, we find dull aching in the right hypochondrium in the region of the gall-bladder, and also posteriorly in the posterior portion of the liver. This aching is often accompanied by soreness. At other times the congestion is great enough to produce burning distress in and about the liver. This often spreads to the stomach and abdomen. As accom- panying symptoms, we find drowsiness and despondency, which belong to liver affections of this character, and also diarrhoea, in which the stools are black, almost as black as pitch. These stools are accompa- nied by burning, distressing, colicky pain at the umbilicus. In other cases we have vomiting of bile with this burning distress, and occa- sionally clay-colored stools. The tongue is coated yellow or more frequently black, or dark brown and black down the middle. With these symptoms present, it may be indicated in bilious and typhoid fevers. The main distinction between Leptandra and Mercurius is this: 3Iercurius almost always has, characteristically, tenesmus continuing after stool. Leptandra has not this symptom, although it may have griping colicky pains after stool. Euphrasia Officinalis. Euphrasia is particularly of use to us as a medicine acting on mucous membranes, especially the conjunctiva and the nasal mucous membrane. It has long been known as a remedy in affections of the eyes. First it produces an inflammation of the eyelids, a blepharitis. The eyelids become reddened and injected, particularly on their inner surface. They become puffed, dark red, or red at least; ulceration takes place, giving us a discharge which is thick and excoriating. The tears them- selves are profuse and excoriate the cheeks. There is marked photo- phobia; the patient cannot bear sunlighi, but even more objectionable 370 A clinical materia medica. to him is artificial light. It has been urged by some physicians that it is "splitting hairs" in attempting to differentiate between aggravation from sunlight and that from artificial light. I cannot see where this objection has any force, for sunlight and artificial light are very different in their compositions. Belladonna has aggravation from artificial light, and Aconite from sunlight. In conjunctivitis, Euphrasia is sometimes indicated in scrofulous cases by these symptoms: Little blisters or phlyctenulae form on or near the cornea; the discharges from the eyes are acrid and purulent and a film of mucus seems to collect over the cornea, causing a diffi- culty in vision. This blurred sight is relieved by wiping the eye or by winking. We find Euphrasia also indicated in conjunctivitis of traumatic origin, and when the above symptoms are present. Arnica, which is more of a remedy for bruises, has no application to this acrid discharge or to the formation of these little blisters; so when these form after an in- jury, Euphrasia is the preferable drug. Although Euphrasia affects the superficial structures of the eye principally, we find it indicated in rheumatic iritis. If you examine the eye, you find that the iris reacts very tardily to light, and the aqueous humor is cloudy from the admixture of the products of in- flammation. The pains are burning, stinging, shooting in character, are worse at night, and are attended with this acrid lachrymation. Now, the coryza of Euphrasia: This drug is indicated in coryza which is perfectly bland with lachrymation which is excoriating. Now let us look at the position which Euphrasia holds with its concordant remedies. First of all, beginning with the eye symptoms, we find it a close ally of Mercurius solubilis. Both remedies have this well-marked blepharitis and conjunctivitis coming from cold. The symptoms of Mercurius, which differentiate it from the other remedy, are these: The discharge under Mercurius is thinner than under Euphrasia; then, too, Mercurius has marked aggravation from the heat of the fire. Next we find Euphrasia similar to Arsenicum. Both have the acrid discharge and the formation of phlyctenulae on the cornea, and both are indicated in scrofulous cases. But Arsenicum has more marked burning—burning like fire, especially after midnight. This symptom is not always relieved by the application of hot water, but frequently EUPHRASIA. 371 so. Nor have we in Euphrasia the marked restlessness we have in Arsenicum. Another similar drug is Rhus toxicodendron, which has profuse gushing tears, excoriating the cheek ; profuse purulent discharge from the eyes. But the pus is thinner under Rhus than it is under Eu- phrasia. Rhus attacks more the right eye, Euphrasia either eye. Rhus has pains in the rheumatic iritis, darting from the eye through to the occiput, with a great deal of restlessness and agony and tossing about at night. Now the coryza: We are accustomed to associate Euphrasia with Cepa. We make this differentiation between the remedies:- Cepa has excoriating coryza and bland lachrymation ; Euphrasia, bland coryza and acrid lachrymation. There is still one other application we may make of Euphrasia, and that is in paralysis of the third pair of nerves, causing ptosis, especially when caused by catching cold, in rheumatic patients. The allies here are Rhus and Causticum, both of which have exactly the same symptom. This gives you very nearly the precise position of Euphrasia in the treatment of catarrh of the eyes and of the nose. The next use we may make of the drug, is its application to the treatment of condylomata. It is useful in broad, flat condylomata of the anus, of course of sycotic origin. Usually there is some oozing of moisture about them. LECTURE XXXVIL BAPTISIA TINCTORIA. Gelsem. Baptisia tinct. < Rhus t., Bry. J Arn., Mur. ac, Lach., Ars. I Ailanthus. I have selected for our study to-day a member of the leguminous plants, Baptisia tinctoria, or the wild indigo. It is a drug which has a short history, but one that is exceedingly interesting. Our journals are replete with glowing accounts of cures of typhoid conditions made with it. Baptisia causes, in general, the changes in the blood, both quantitative and qualitative, which are exhibited in typhoid fever. The offensive exhalations, the mental and nervous phenomena which it develops are characteristic of this disease. Baptisia is suitable to all stages of typhoid, early or late. Its symptoms I will divide into two classes: those which would indicate the remedy early in typhoid affec- tions, and, secondly, those which call for it late. Of course, it is not necessary that all the following symptoms be present in any one case, to make the drug the remedy. I am about to give you the character- istic symptoms of the remedy ; without several of these be present it would not be proper to give Baptisia. These symptoms are as follows: Excitement of the brain, just such as precedes delirium; wild, wan- dering feeling, patient cannot confine his mind to any one subject; restlessness, constant desire to move from place to place, and disturbed sleep. The patient awakens at two or three o'clock in the morning, and then is so restless that he tosses about, unable to sleep any longer. During sleep his dreams are of the most extravagant character. He dreams that he is chained to the bed, or that he is swimming a river, or undergoing some such ordeal as makes a great demand on his strength. He may suffer from nightmare, from which he awakens with a sensation as though the room was insufferably hot, making breathing almost impossible. If he still has strength he goes to the open window to get air. Now this is not a true asthma; it is not due to a spasmodic contraction of the bronchioles or air-cells. There is a 1 BAPTISIA. 373 fulness of the chest, giving this oppressed feeling. One prover de- scribed the symptom, not as a true difficulty of breathing, but as a feeling as though he had not strength to lift his chest. The patient makes frequent errrors as to his own person, supposing at times that he is double or that his body is scattered about, and that he must toss about the bed to collect the pieces. Now these evidences of nervous excitement are accompanied by excessive prostration ; the back and limbs ache; the back feels stiff; the patient feels tired and bruised all over; he complains of the bed feeling too hard; this makes him rest- less, and he tosses about the bed to find a softer spot; weakness pro- gresses so far that he becomes unable to walk; he suffers from an indescribable weak or faint feeling, with or without vertigo; the face is hot and flushed and has a heavy, besotted look, as in the case of one intoxicated. The eyes, also, are heavy and stupid in appearance. The tongue is at first white or slightly yellowish ; frequently, too, the pa- pillae are raised and project through this whitish or yellow coating. The edges of the tongue are of a deep red color; there is a dull, heavy headache, with the sensation as if the head would be pressed in ; some- times the pressure in the forehead seems to go down into the root of the nose. Again, the patient complains of a sensation which he de- scribes "as though the skin of the forehead were being pulled back towards the occiput." This is evidently due to tonic contraction of the occipito-frontalis muscle. At other times the patient simply de- scribes the sensation as though the skin of the forehead were tense, or tight, or drawn. These symptoms of the head are often accompanied with numb, tingling feeling in the forehead or scalp. At other times the h:>ad feels enormously large. The typhoid fever is very character- istic of Baptisia, it being one of the fewr remedies which actually pro- duce this type of fever. There is always an increase of temperature. The pulse is usually accelerated in direct proportion to the intensity of the fever. Even in the early stages of typhoid fever, you may find Baptisia indicated by the abdominal symptoms, slight sensitiveness in the ileo-caecal region, and yellow putrescent stools. These, then, are the symptoms calling for the early exhibition of Baptisia in typhoid fever. I can say confidently that if you select the drug on its homoe- opathic indications as just outlined, you will succeed in aborting a large percentage of typhoid states. I say this despite the assertions of many other physicians who have argued to the contrary. The prop- erly-selected drug will abort typhoid fever. The disease need not run its course, as prominent old-school authorities claim it must necessarily 374 A CLINICAL MATERIA MEDICA. do. You recognize that Baptisia is suited to true typhoid fever, par- ticularly when associated with nervous phenomena. Later in the course of the disease, during the second or third week, you will find Baptisia indicated when the prostration is profound. The patient is in a stupor. He falls asleep while answering questions. His face is now dark-red in color and has, more marked than ever, this heavy, dark, besotted look. The tongue has changed its yellow or white coating to one which has a brown streak down the centre, the edges of the organ still remaining red. All the exhalations and dis- charges from the patient are exceedingly offensive. The teeth, are cov- ered with sordes having an offensive odor. The breath is foetid. The stools are yellowish or dark, and are horribly putrid. The uriue and sweat are both offensive. So you see, Baptisia applies to cases in which there is an evident decomposition of vital fluids and rapid disintegra- tion of tissue. To give Baptisia its legitimate position among other typhoid reme- dies, it will be necessary to compare it with those nearest like it in symptomatology. The first of these remedies to which I shall call your attention is Gelsemium. This usually precedes Baptisia when there are malaise and muscular soreness, and the patient suffers from chills and crawls, which go down the back. This is on the first day, remember. In the afternoon comes the fever with accelerated pulse, this being full and flowing, not tense and not-resisting as under Aconite. The fever is usually associated with drowsiness; the face is uniformly suffused red, and there may even be prostration thus early in the case. Gelsemium causes paralysis of the motor nerves, hence there must be weakness of the muscles. By the next afternoon you may change to Baptisia, if the fever rises in the afternoon, despite Gelsemium, and when the above-mentioned symptoms of Baptisia develop. The reason why I dwell on the relations of the two drugs is because of the great similarity in their symptoms. Both of them have this in- tense muscular soreness and prostration; both have drowsiness and nervous excitement, with prostration ; both of them have this feeling of expansion, as though the head or some part of the body were enormously enlarged; and both of them have the afternoon exacer- bation of the fever. The relation between the two drugs is one of degree, one of intensity. Gelsemium is the milder acting drug of the two. Another remedy which is not unlike Baptisia is Rhus tox. Like Baptisia, Rhus has restlessness, brown tongue and soreness of the mus- BAPTISIA. 375 cles. I must confess that the distinction between the two remedies is not always easy. Formerly, Rhus held undisputed sway in almost all diseases which threaten to assume a typhoid tyye, whether the disease was diphtheria, scarlatina, peritonitis or pneumonia. Now this honor is shared with Baptisia. The main differences between the drugs ? briefly given, are these: Rhus has restlessness, caused more by rheuma- toid pains than by muscular soreness alone. The tongue, under Rhus, has a red, triangular tip, which is not noticed under Baptisia. Delirium is of a muttering character under Rhus, unaccompanied, so far as I know, by these delusions respecting personal identity. Neither are the putrid discharges of Rhus tox. quite so offensive as those of Baptisia. If diarrhoea progresses to a severe type under Rhus, the stools are watery, sometimes bloody and involuntary. The pneumonic symp- toms which often complicate typhoid fever are more prominent under Rhus. Arnica claims a relationship to Baptisia. It is similar to the latter remedy in the stupor, in the intolerance of the bed (the patient com- plaining that it feels too hard), and in the falling asleep while an- swering questions. .Arnica, I think, suits more when there is ten- dency to apoplectic congestion, when the stupor is so profound that both stool and urine are passed involuntarily. The intensity of the involvement of the brain is shown by the loud, snoring respiration. Then, too, in Arnica we find suggillations, sometimes called ecchy- moses. Lachesis also comes forward as similar to Baptisia. You will recog- nize the resemblances between the remedies in the offensiveness of the discharges, in the putridity of the exhalations and in the excessive prostration. I think I have seen apparently hopeless cases react under the benign influence of this remedy. As an animal poison I think it is a deeper penetrating remedy than Baptisia and, in consequence, should be called for in worse cases. It may be distinguished by the following symptoms: Trembling of the tongue when attempting to protrude it, or it catches on the teeth during the act. When he succeeds in getting it out, it hangs there tremblingly, and he may not even have sense enough to take it in again. Haemorrhages are frequent in the Lachesis patient. Blood may escape from almost every orifice of the body. The lips crack and ooze a dark or blackish blood. Dark blood escapes from the bowels. This, after standing awhile, deposits a sediment which looks like charred straw. In severe cases there is marked in- tolerance to light pressure. Even when the sensorium appears to be 376 A CLINICAL MATERIA MEDICA. perfectly benumbed the patient resists the slightest touch about the neck. In still worse cases, you have to separate it from Baptisia when there is approaching cerebral paralysis, dropping of the lower jaw and involuntary discharges. Muriatic acid bears some resemblance to Baptisia in the great pros- tration, in the decomposition of fluids, and in the low form of delirium. But it seems to me that the general character of its symptoms is not sufficiently similar to those of the other remedy to make a distinction difficult. The Muriatic acid weakness is so great that the patient is unable to make the slight exertion required to maintain the head on the pillow; he therefore slides down to the foot of the bed. Now, a word about Baptisia in other diseases than typhoid fevers. In such affections it is indicated by the symptoms already mentioned. In dysentery you will give it when the discharges are offensive and contain blood, and are attended by tenesmus, but with a significant absence of pain, showing an alarming depression of vitality. Baptisia comes into play in the treatment of phthisis. It is espe- cially useful in the later stages of the disease in relieving the fever, particularly when it increases in the afternoon with slight drowsiness, thick speech and bewilderment of mind. Baptisia has proved itself one of our best remedies in diphtheria when it has assumed a typhoid type. Some of the symptoms already mentioned will be present. The mouth is excessively putrid. The membrane is dark and exhibits a gangrenous tendency. Sometimes, early in the disease, you will observe this characteristic: The patient can only swallow liquids. Give him milk and he will drink it. Give him solid food and he rejects it at once. Ailanthus is to be compared with Baptisia in typhoid conditions, scarlatina and diphtheria. It produces an even more profound stupor than the latter remedy. There is a well-marked, excoriating, watery discharge from the nose, making the upper lip sore. The rash, if any exist, is of a livid purplish hue, thus denoting the poisoned state of the blood. I hope now, with this lecture, you may be able to properly place Gelsemium, Baptisia, Rhus tox. and Lachesis in your mind as so many distinct pictures which are to be brought up, in times of necessity, to be used according to their symptoms and their applications. LECTURE XXXVIII. SOLANACE^l. Belladonna. ^ Hyoscyamus. > Mydriatic—Acro-narcotic. Stramonium. J Solanaceae. { Solanum nigrum. Tabacum. Dulcamara. ^ Capsicum—Acrid. The drugs composing this group of remedies present great similari- ties in their respective symptomatologies. The first three remedies on the above list are continually in use, even in an average practice. There is scarcely a symptom of one of them which cannot be found almost the same in one of the others. The resemblances are, in fact, perplexingly similar. I have arranged the remedies on the board, not botanically, but rather according to their medicinal relations. For instance, the first four on the list attack prominently the brain and have narcotic properties; they are, therefore, placed in one group. Then we have Tabacum, which also has narcotic properties, but which acts also on other parts of the body than the brain. Then next comes Dulcamara, which contains a small quantity of Solanine, and is only slightly narcotic A large quantity of this drug would be re- quired to develop the soporific effects which can be obtained from Stra- monium or Hyoscyamus. Then, lastly, we have Capsicum, which is decidedly irritant or acrid. Placed on the skin, it acts as a blister or counter-irritant. It has possibly some narcotic effects, but it differs almost entirely from the other members of the group. The resem- blances between the first three named are so great, and. are so nearly "idem," that it is not well to follow one with the other. There are some symptoms of Belladonna and Hyoscyamus which are opposite, not so much in the phraseology by which they are expressed, for they may read almost exactly alike, but they are results acting in opposite directions; consequently, they sometimes serve to antidote each other. Especially is this true of the skin symptoms. 25 378 A CLINICAL MATERIA MEDICA. Belladonna. Belladonna. { Nerves. Sphincters contract. r Irritates the centres. Irritates, then paralyzes the peri- pheries. Disturbs the circulation; worse in the brain. Disturbs the circulation ; fever. ,., f Violent, sudden. Ailments. •> . . { Usually with brain symptoms. Inflammation. Hyperaemia with tendency upwards. Brain cells. Belladonna or the deadly nightshade was known to the medical world as early as 1500 A.D. The Venetians named the plant "herba bella donna," from the circumstance that the ladies used it in distilled water as a cosmetic. The plant, especially the leaves, yields the well- known Atropine, as well as Asparagine, and also lime and other alka- line substances. The root, too, contains Atropine, although in vari- able proportions. Belladonna is intensely poisonous to man, though herbivorous animals may eat it with impunity. Studied as a poison Belladonna causes the following symptoms: Eyes dry and injected; face red, turgid, and hot; skin scarlet or studded with papillae, all but identical with those in scarlatina; vio- lent congestions, especially to the head ; mouth and throat distress- ingly dry ; this last sensation extends downwards, compelling frequent swallowing, and suffocative spasms of fauces and glottis. Thirst is violent, yet water aggravates; vertigo, confusion, hallucination, and finally stupor. The pupils are so much dilated as to nearly obscure the iris.* Jacitation of the muscles; convulsions. Such poisoning cases are not uncommon in Europe, where the plant is native, and where its berries have been mistaken for cherries. In this country, too, it has been accidentally taken, and employed also in attempts at suicide. To antidote it, use the stomach pump, emetics of hot mustard water, and strong coffee without milk or sugar. * Belladonna dilates the pupil by stimulating the sympathetic; Physoaiigma con- tracts it by stimulating the third cranial nerve; Gelsemium dilates it by paralyzing the third cranial nerves. BELLADONNA. 379 Belladonna as a homoeopathic remedy is almost as old as the art itself. Our symptomatology from provings and poisoning cases enables us to employ the drug with mathematical certainty, so far as its selec- tion is concerned. But like all polychrests, it is abused by hurried and careless practitioners, and so is often given when its resemblances to the cases under treatment are quite superficial and partial. Of all drugs it has most marked the power of producing opposite effects. Belladonna has so often come up in the preceding lectures of this course in comparing it with other drugs that you are already some- what familiar with it. For this reason many of the symptoms of the drug may be passed over in hurried review. But first'of all let me tell you something of the general character of Belladonna. It seems to be best suited to persons of a plethoric habit who are subject to con- gestions, especially to the head more than to any other part of the body, who are rather fleshy and phlegmatic, something akin to Calcarea ostrearum, without the pallor of that remedy. They are pleasant and jolly enough when well, but they become exceedingly irritable and overbearing when sick. This pleasant sociability which seems to make them so companionable, seems to be converted into the opposite con- dition when they are afflicted by illness. It is also suited to pre- cocious children, with big head and small body, who may be scrofu- lous with tendency to swelling of the lips and enlargement of glands. They learn things rapidly; sleep is unnatural; hot head ; red cheeks; screaming during sleep. Belladonna, when it is to be used for chil- dren, demands that there must be some cerebral symptoms present. There must be some irritation of the brain, as shown by jerking of the limbs, irritability making the child fret, or absolute meningeal in- flammation. A peculiarity of Belladonna is the faculty it has of exciting con- striction of the circular fibres of bloodvessels, contraction of sphincters, etc. This universal quality of Belladonna is exemplified in the con- striction of the throat, worse from liquids; constriction of the anus, which, with tenesmic urging and pressing in the rectum, suggests the drug in dysentery; and spasmodic constriction of the os uteri, retard- ing labor; ineffectual or frequent urging to pass water, with scanty discharge. The character of the disease in which Belladonna is indicated is acute, sudden and violent. The very rapidity of the onset of the trouble should at once suggest Belladonna. For example, a child is perfectly well on going to bed. A few hours afterwards it is aroused 380 A CLINICAL MATERIA MEDICA. with violent symptoms, jerking of the limbs, irritation of the brain, and screaming out during sleep. All these symptoms suggest Bella- donna. So, too, in inflammations, if they are violent and come suddenly, and are almost overwhelming in their intensity, Belladonna is again sug- gested. We may think of it in abscess, whether this be an abscess of the tonsil, a boil, or any other kind of abscess when pus develops with lightning-like rapidity. Hence we find it indicated in phlegmonous erysipelas, which quickly goes on to suppuration. The affected parts become greatly swollen. Pus works its way through the tissues be- tween the various muscles. The very suddenness of the attack sug- gests Belladonna. The pains are quite consistent with this character of the drug. They come suddenly and last a greater or less length of time, and then cease as suddenly as they began. So much for the general character of Belladonna. Belladonna acts on muscular tissue and on the joints. It is one of our best remedies in acute and chronic rheumatism. Pains are cutting, tearing, running along the limbs like lightning. Joints swollen, red and shining; streaks of red radiating from the inflamed joint; rheu- matic fever, with pains attacking the nape of the neck, shoulders and upper arms. It is one of the best remedies in rheumatic stiff neck, caused by cutting the hair, getting the head wet, or sitting with the head and neck exposed to a draft. The action of Belladonna on the brain must be understood before we can proceed farther. It does not seem to me, reviewing the symp- toms of the drug, that Belladonna causes so much a positive inflamma- tion of the meninges as it does develop the collateral symptoms of the inflammation. Thus Aconite causes an absolute inflammation of the meninges with an increase of exudation; then again, Bryonia causes an inflammation, with an exudation of leucocytes and blood plasma, constituting complete inflammation. Belladonna seems rather to pro- voke congestion. The surcharged bloodvessels seem to have ruptured, and have produced little reddish spots or ecchymoses in the tissues, exciting thus a congestive irritation of the brain beneath the membrane. What exudation does follow this congestive irritation is that of serum, and is just the kind of exudation that always results from venous con- gestion. It is not the inflammatory exudation, rich in plasma, which is pictured under Bryonia, Apis and Sulphur, but not under Bella- donna. Still, Belladonna produces so many collateral symptoms of cerebral irritation, that we find its use indispensable in this condition. BELLADONNA. 381 What are the particular symptoms which indicate it ? They are these : Congestion of the head. This may, in its milder form, consist of a simple feeling of heat about the head, the feet being cold. At other times and in more violent forms we find the face red and the whites of the eye somewhat injected. The patient complains of a severe throb- bing headache. He may be either drowsy or very wakeful. Fre- quently these latter symptoms alternate, that is, at times the patient is drowsy and falls into a heavy slumber, and is aroused from this startled, crying out, or giving some evidence of cerebral irritation, such as jerk- ing of the limbs and twitching of individual muscles, and, as this form of irritation advances, we find the eyes red, the whites of the eyes looking almost like raw beef. The carotid arteries throb so violently that their pulsations are visible to the unaided eye. This congestion proceeds to an inflammatory irritation. We find intense throbbing in the head, with sharp shooting pains, making the patient scream or cringe, so violent are they. These pains come almost like a flash, and disappear as suddenly as they came. At first the patient cannot sleep. He is in this unfortunate predicament, he is sleepy, yet he cannot sleep. As the symptoms advance, especially in children, there is boring of the head into the pillows, the head is thrown backwards and there is roll- ing of the head from side to side. Some squint is noticed. The pupils are dilated. There is grinding of the teeth. The face is now bright red or else the congestion is so violent as to make it almost purple. If the patient is a child whose fontanelle has not yet closed, you can feel it tense and bulging up above the convexity of the skull, and throb- bing and thumping with each pulsation of the heart. Convulsions often ensue, particularly in children, and these convulsions are very violent, distorting the body in every conceivable manner, opisthotonos predominating. The urine is either scanty or suppressed. Now the various symptoms, subjectice and objective, which belong to this con- dition are these : First, there is jerking in sleep, or even when awake. On closing his eyes the patient is very apt to see abnormal visions. These usually disappear on opening the eyes. At other times he has a sensation as though he was falling. Thus the patient, if a child, suddenly arouses from sleep, clutches at the air, and trembles as if from fear. Sometimes this symptom is owing to dreams, at other times to severe pain in the head, which, by its severity, alarms the child and awakens it, and at still others, to this sensation, as if it were falling. Sometimes we find the patients with this cerebral irritation lying in 382 A CLINICAL MATERIA MEDICA. a stupor. They can scarcely be aroused, and when aroused they are always violent, tossing about, striking those near them, tearing their clothes, all evidences of excitement, which, if not actually due to inflam- mation, approach to that condition. In inflammation of the brain or its membranes, Belladonna must give place to other drugs when exudation takes place, whether there be a simple or a tubercular meningitis present. There is very little rela- tion between Belladonna and tubercular meningitis. Tubercular men- ingitis is slow in its course. Thus we have suggested at once Sulphur, Calcarea, Apis, and deeper and slower-acting remedies than Bella- donna. Then again, when exudation has taken place, as indicated by the persistence of this rolling of the head and sudden shrieking, we know that we must resort to other remedies, principally to Apis. Bryonia, too, often comes in after Belladonna, when the face is flushed red or is alternately red and pale. The slightest attempt to move the child makes it shriek with pain. The pupils do not react readily to light. The child has this chewing motion of the mouth as though it were chewing or sucking. The resemblances between the two remedies are so great as to make a selection often perplexing. Both' remedies have haste in drinking water, both have crying out with pain, both have aggravation from motion, and both have constipa- tion. At times you will find it very difficult to distinguish between the two. To separate Belladonna from Aconite is easier. The fevers caused by the two drugs are distinguished in the following manner: Bella- donna does not produce fever primarily from its action on the sympathetic nervous system ; Aconite does do that. Belladonna acts secondarily on the sympathetic and primarily on the cerebro-spinal nervous system, hence is of use only when that system is involved, which in children occurs very early in the case. In adults, it is apt to commence as a fever, cerebral symptoms ensuing; thus Belladonna becomes the remedy. In the beginning of fever, Aconite is preferable when there is this violent anguish of mind, with restlessness, tossing about, fear of death, dry, hot skin, full, bounding pulse, some hallu- cinations, some crying out in sleep, and some muttering or foolish talk which belongs to the fever. These cerebral symptoms result from the high temperature and not from direct inflammation of the brain. But suppose this case goes on until the brain becomes involved. The skin becomes so hot that it almost burns the examining hand, or, if you raise the bed-clothes, there seems to come forth a hot steam from the pa- BELLADONNA. 383 tient. That is the kind of heat that belongs to Belladonna. At other times, along with this heat there is hot sweat (which is not so charac- teristic of Aconite), particularly about the head and face. Looking at the patient, you see the sweat standing out in beads on the forehead, and it is hot. Then, too, to enable us to distinguish still further, we have, prominently, these cerebral symptoms; jerking in sleep, hallu- cinations, visions, and courting death rather than fearing it. This is often the case in rheumatic fever. The whole system seems to be in- volved, producing general fever with pain in the joints flying about from place to place. This fever is almost always associated with pro- fuse sour sweat, which gives no relief whatever. The patient seems to soak everything about him with the sweat, and the more he sweats the more he does not seem to get any better. Aconite does no good here, but Belladonna does. When the fever has somewhat subsided, and the sweat still continues, Mercurius is the proper remedy to follow. In typhoid types of fever, Belladonna is indicated sometimes in the beginning of the disease. It is indicated in the stage of excitement when the congestion of the brain predominates. We find furious de- lirium, with screaming out and violent efforts to escape from the bed or the house. The face is red, either a bright or deep red, bordering on the purple; the pupils are dilated and the eyes injected. The pa- tient is full of fear, imagining that all sorts of accidents are about to happen to him. The urine is scanty, and when passed it is usually a bright deep-yellow, with or without sediment. The feet are apt to be cold. The patient now falls into a heavy snoring sleep; this sleep is not quiet, for there is apt to be associated with it some evidence of cerebral irritation, as jerking of muscles, twitching of limbs, and cry- ing out. No matter how profound is this sleep, it is never a perfectly quiet stupor; if it is, Belladonna is not the remedy. You will see from this that Belladonna is indicated, not from any changes in the brain caused by the poisoned blood, but from changes resulting from congestion or inflammation. When the disease has gone so far as to cause alterations in the fluids of the body, Belladonna is decreasingly indicated as these changes advance. Then you should have recourse to such remedies as Hyoscyamus, Rhus tox., Lachesis, and many others. Sometimes we have a condition differing from the one already de- scribed, and yet Belladonna may be the remedy. This condition is often perplexing. The face is pale instead of red. Now this indication 384 A CLINICAL MATERIA MEDICA. is just as characteristic of Belladonna as is the red face. It is usually associated with irritation of the brain and starting in sleep. It occurs usually in summer complaint, during dentition, and in colic and simi- lar diseases. The pulse is either full and hard, as under Aconite, or it is slow. It is slow when the cerebral congestion is sufficiently great to cause some pressure on the brain. Here, again, you find an illustration of the alternating effects of Belladonna. The pulse may be rapid for awhile, and then it will become slow, and so it alternates. The headaches of Belladonna are nervous and congestive. The ver- tigo also is congestive; the patient feels as if he would pitch forwards; as suddenly falls unconscious backwards. The nervous headaches are semi-lateral, right sided, worse from 4 p.m. to 3 a.m., worse from lying down ; brain feels as if swashing about; worse from light, noise or any jarring. Vomiting; can't keep quiet; fidgety. The congestive headaches are of a throbbing character, with aggravation from inclin- ing the head toward the part of the brain mostly congested. Pains are often of a stabbing, shooting character, driving patient almost wild. When the whole head is affected, the patient sits up with the head sup- ported so as to keep it from bending; accompanying the headache there is generally a red face, and violent throbbing of the carotid arte- ries. The mind is often affected; the patient delirious, wild and ex- cited, and sees all sorts of hallucinations. We have already seen how Belladonna may be indicated in inflam- mation of the brain. It is also a valuable remedy in inflammation of other parts of the body. For instance, we find it to be the best, though by no means the only remedy we have in otitis media, or inflammation of the middle ear. This disease will perplex you at times. The symp- toms are very severe. The child puts its hands to its head, and you may erroneously presume the trouble to be there. The pains are dig- ging, boring and tearing jn character, and are necessarily so on account of the anatomical relations of the parts affected. They come suddenly, and are very violent. They seem to shoot into the other ear, or into the head, with buzzing and roaring in the ears. Now if you examine the ear, you will find the membrana tympani bulging outwards, its bloodvessels very much injected; in fact, it presents a highly inflamed appearance. There is rapid formation of pus, which seeks to escape either by bursting the membrane, by the Eustachian tube, or through some internal part. In case it takes the latter course, it produces alarming if not fatal symptoms. It is your duty to recognize this disease early, BELLADONNA. 385 at which time you will have a chance of saving the ear. Belladonna is believed to be our best remedy for the disease in its early stages; later, we have other remedies indicated, as Hepar and Tellurium. Tellurium causes inflammation of the -middle ear, with rupture of the membrana tympani, and pouring out of pus, which may, at first, be laudable, but afterwards becomes very offensive, having an odor like that of herring-brine. In inflammations of the eyes, as in conjunctivitis or sclerotitis, we find Belladonna indicated by the suddenness of the pains, by the sud- denness of the attack, and by the violence of the symptoms. There is great intolerance of light. The eye feels as if enormously swollen. The conjunctiva is bright red. These symptoms give you a perfect picture for Belladonna. It seems to attack the right eye more than the left. It is the intense congestion which guides us in the eye-affec- tions of Belladonna; and the same remark applies equally to neuralgias in and about the eye. Spigelia has many eye-pains like those of Belladonna, but they are left-sided, and lack the intense congestion. Amyl nitrite is similar to Belladonna, being indicated when the eyes and face are red. Paris quadrifolia is excellent when there are pains as if the eyes were drawn back by strings; the eyeballs feel' too large (like Spigelia). Prunus has a crushing pain, or sensation as if the eyes were pressed asunder, or sharp piercing pains through and around the eye. The parotid gland is inflamed by Belladonna, especially the right; stitches, extending into the ear; gland swollen, hot and red; the orifice of Stern's duct is painful, as if abraded; saliva thick, gluey, yellowish, tenacious; mucus coats the mouth and throat with a thick tenacious layer; the tongue is white and fissured. Belladonna produces inflammation of the throat. The tongue in such cases is usually bright red, the papillae are enlarged or elevated, giving it a resemblance to the strawberry (and hence it has been called the strawberry tongue). At times you find the tongue coated with a thin white layer on the dorsum, with the enlarged red papillae showing through this layer of white. But, as the case advances, this coating peels off, leaving a bright red, highly-inflamed tongue. The throat is a prominent point of attack in the Belladonna proving. The inflamma- tion which it develops there is of a very common kind. Looking into the throat, you find the fauces inflamed and bright red, the tonsils enlarged, particularly the right, with tendency of the disease to extend 386 A CLINICAL MATERIA MEDICA. towards the left. All these symptoms have the same rapidity of prog- ress that we noticed with the Belladonna symptoms elsewhere. There is great contraction of the fauces and glottis, so that any attempt to swallow is followed by sudden constriction of the throat and ejection of the food through the nose and mouth. The patient makes an attempt to drink, and the moment the water touches the fauces it is ejected, and escapes in any way it can. The patient seems to be worse from swal- lowing fluids, more so, in fact, than from either saliva or solids. The tonsils rapidly suppurate; the glands in the neck, externally, are com- monly involved, and are to be felt as hard but very sensitive kernels in the neck. Sometimes you find a pearly-white exudate on the fauces, which is seen to be mucus and not fibrin. There is, therefore, strictly speaking, no resemblance between the Belladonna inflammation and that characteristic of diphtheria or membranous croup, so that when Belladonna is administered in diphtheria it must be indicated on other symptoms than those belonging to the membrane. The general char- acter of diphtheria is that of blood-poisoning, while Belladonna does not poison the blood. When you give Belladonna in diphtheria, there- fore, be certain that it is the remedy or you will lose valuable time. It may, occasionally, be the remedy in the early stages when the violence of the attack calls for it. Let me here remind you that Lycopodium affects the right tonsil, that it produces high temperature, crying out during sleep, and awaking from sleep cross and irritable. These symptoms we found under Bella- donna also; so be sure when you give the latter remedy that Lycopo- dium is not the one that is indicated. Then, again, you should think of Apis. Apis is a magnificent remedy in diphtheria. The exudate is more on the right tonsil; the throat is bright red and rosy; the tongue is red and the fever is very high; the skin dry and hot, the pulse accelerated, and the patient very restless. But, in tonsillitis or quinsy, Belladonna stands at the head of the list of remedies. Here it far exceeds Apis in therapeutic value, because it attacks the parenchyma of the organ. The inflammation caused by Apis is superficial, only involving the mucous surface. In throat dis- eases Belladonna forms an interesting little group with Hepar, Mer- curius, Silicea and Sulphur. AVhen, after the exhibition of Belladonna, and in spite of that remedy, pus forms, as indicated by the rigors and chills and the sharp, lancinating pains with throbbing, you should change from that remedy to Hepar. Even then you may be able to prevent abscess. BELLADONNA. 387 Change to Mercurius if pus has already formed and the tonsil is enlarged and encroaches on neighboring parts and the breathing is labored. You notice that pus has shown itself; Mercurius, given low and repeatedly, will cause quick breaking of this abscess, and thus will relieve all these symptoms. If you give Mercurius at first you will greatly lengthen the course of your case. Sometimes you must have recourse to Silicea when the abscess has discharged and refuses to heal. Pus keeps on forming and grows less and less laudable, and dark and foetid and disagreeeble to the taste. In some of these cases Silicea fails; then we will have to interpolate a few doses of Sulphur, which generally has the desired effect. There is another remedy that we have used somewhat in this city, and that is the Amygdala persica. This drug causes a dark red injec- tion of the fauces, uvula and tonsils, with sharp pains, causing consid- erable difficulty in swallowing; sometimes they are so severe as to make the patient cry out. With these symptoms it may be used in diphtheria. I have myself cured cases of this disease with Amygdala persica alone when there were present this dark red color of the throat, the sudden sharp pains, and marked general prostration. Amygdala develops the prostrated, tired feeling which is incident to the first days of diphtheria. Belladonna is of use in oesophagitis with sense of constriction ; pain- ful swallowing and breathing. Veratrum viride, Rhus and Arsenic are also remedies sometimes indicated in oesophagitis. In gastric symptoms, Belladonna is called for when there are cramp- like pains in the stomach, worse during a meal; sticking pains; must bend backwards and hold the breath; burning. These gastralgic pains always go through to the spine. Pressure is a prominent gas- tric symptom ; it is worse after eating and comes also at times when walking. (Calcarea ostrearum has pressure as of a shoe, relieved from motion. Chininum arsenicosum has curved pressure in the "solar plexus" with tender spine just back of it.) In inflammations about the abdomen we find Belladonna the remedy; for instance, in peritonitis, whether accompanied by metritis or not, and whether or not it is of puerperal origin. The symptoms which call for it are these; Commencing tympanites; the abdomen is swollen up like a drum, and very sensitive to the touch, so much so, in fact, that the patient wants all the bed-clothing removed. The least jarring in the room makes the patient worse. For instance, if you should unex- pectedly kick your foot against the bed in walking near her, you cause 388 A CLINICAL MATERIA MEDICA. her to complain of pain. You will also notice the pungent heat of which I have already spoken to you. The abdomen feels extremely hot to your hand. On raising the bed-clothes there appears to issue forth the hot steam to which reference has already been made. There is marked cerebral irritation. The lochial discharge is apt to be scanty or suppressed. Ti/ia, Europea is a drug that I feel certain has not received due credit from the profession. It is useful in puerperal metritis when there is intense sore feeling about the uterus; there is also marked bearing-down, with hot sweat which gives no relief. A remedy very commonly used by allopaths is Terebinthina. Now, the symptoms which this drug has actually produced are these: Bear- ing down in the uterine region, burning like fire about the hypogas- trium, burning on urinating, the urine is often cloudy and dark, having a muddy appearance. In these cases, the tongue is apt to be dry and red. For this feeling of soreness in the uterus, Dr. Jeanes used a prepara- tion of honey with salt, Mel cum sale. He used it in the third or sixth attenuation. His key-note for the selection of the drug was feeling of soreness in the hypogastric region extending from ilium to ilium. This is an important indication in uterine displacements and in the com- mencement of metritis. Returning to Belladonna, the urine is yellow and clear; turbid with red sediment, or profuse and involuntary in sleep. This latter sug- gests the use of the drug in children. It will not often disappoint you when the other symptoms concur. There is not a true atony present, but a relaxation of sphincters and overaction from loss of balance of the longitudinal muscular fibres. Feeling in the bladder as of a ball rolling; tenesmus of bladder; strangury; urine dark, turbid and fiery red ; frequent desire with scanty discharge of urine. In enuresis with actual relaxation look to Plantago major, Causticum, etc. Belladonna may have to be followed in these cases by Calcarea ostrearum or Silicea. Kreosote is indicated in enuresis especially when the patient urinates while dreaming of the act. We have next to speak of the action of Belladonna on the skin. It causes at first an erythema, a bright scarlet redness of the skin; the skin becomes exceedingly sensitive to the touch. Sometimes, this erythema consists in a uniform blush over the entire surface of the body such as we have in the Sydenham variety of scarlatina. At other times it has an erysipelatous appearance, coming, as it does, in BELLADONNA. 389 streaks which start from some central point and radiate in all direc- tions from that point, the color usually being quite bright, the swell- ing rapid with very quick involvement of the cellular tissue beneath the skin and, in some cases, rapid formation of pus, which burrows deeply into the cellular tissue. Thus you have a true picture of phlegmonous erysipelas. With these symptoms, you do not often find development of vesicles or pustules. Instead of this, you find the sur- face smooth, shining and tense. Pains are violent and sharp. They are of a lancinating and stinging character and usually associated with a great deal of throbbing, particularly if the deeper parts are involved in the inflammation. If the erysipelas should attack the face, it almost always begins on the right side with tendency towards the left. There is almost always a tendency to cerebral irritation. The younger the patient, the greater is this tendency manifested. Do not confound this cerebral irritation with metastasis of erysipelas to the brain. It is a simple irritation caused either by the amount of fever, by the severity of the pain, or by the poisoning of the blood, or possibly all three; but it is not a true metastasis. If metastasis should take place, Belladonna may still be called for. If, howrever, Belladonna fail in these case*, we have other remedies; for instance, Lachesis, when cerebral metastasis fails to yield to Belladonna, the face is of a purplish or bluish hue rather than of the bright or deep red of Belladonna. The patient is weaker, the pulse more rapid and lacking in force, and there is more drowsiness than we find under Belladonna. Still another concordant remedy is Crotalus, which is quite similar to the Lachesis. So similar, indeed, that I cannot give you any points of distinction between the two. Cuprum is to be thought of for this metastasis if the symptoms are spasmodic and violent. The patient is threatened with convulsions. There are vigorous contractions of the flexor muscles. Returning now to the erythema of Belladonna, we learn that when the condition becomes general, it suggests the employment of the remedy in scarlet fever. In this disease, it is indicated, first of all, by this bright rosy hue of the whole body; secondly, by the irritation of the brain and this of an active kind, the symptoms ranging from a simple starting from sleep or twitchings of individual groups of muscles to the most violent delirium with shrieking and jumping out of bed. The rash itself must be of the smooth kind. Belladonna does not cause a miliary rash. Vomiting is violent. Belladonna produces vomiting just 390 A CLINICAL MATERIA MEDICA. as severely as does Ipecacuanha, particularly is it indicated in cerebral vomiting. Throat symptoms are prominent. There is bright red swelling of the throat, the tonsils are glistening, the tongue has the strawberry appearance, or if it is coated, the coating is thin and the elevated papillae show through. The pulse is full, strong and accele- rated, and there is great restlessness, as you might expect. You may have swelling of the glands, particularly of those about the neck. You may have suppression of urine or copious urination. Either of these conditions is incident to the Belladonna case. The drowsiness or sleep is not that of clearly marked coma. There is not the sleepi- ness or stupor that is developed by poisoned blood, in which condition the brain is so imperfectly supplied with oxygen that it loses its activ- ity. That is not the Belladonna condition. The Belladonna sleep may be profound; the patient may snore; he may sleep "as heavy as a log," but that sleep is not quiet and passive. He cries out in his sleep, the muscles twitch, the mouth is in constant motion as if chew- ing; there is grinding of the teeth. In fact there are almost always present symptoms showing that there is irritation of the brain of an active character. When the patient is aroused from sleep, he is vio- lent, looking around the room wildly, striking at those about him. When, however, the disease from its very onset is of a malignant type, or when it becomes so despite Belladonna, you cannot change too soon from that remedy. You must at once select another, such for example as Lachesis, Rhus tox., or Hyoscyamus. Lachesis has, in these cases, many symptoms similar to those calling for Belladonna. We find in both remedies, crying out during sleep, restlessness, irritability on awaking, strawberry tongue, redness of the whole surface of the body, suppressed urine, sore throat and vomiting. But wherein do they differ? They differ in the very essence of the disease. In the case of Lachesis, the disease is adynamic and the blood poisoning is profound. The cerebral symptoms do not develop to a Belladonna furore, but there is more stupor. The skin has not the bright erythematous hue of Belladonna, but it is either pale, irregular and coming out imper- fectly, or it is purplish and bluish. The throat shows you not only enlarged glands externally, but swelling of the connective tissue all around, in the tissues about the fauces as well as in them. The affected parts are rather of a purplish color. If there is a tendency to the for- mation of pus which is not laudable, all the more is Lachesis indi- cated. Rhus tox. often precedes Lachesis, particularly when cellulitis is a BELLADONNA. 391 complication and before it has assumed that purplish hue. The inflam- mation is of a low type. The rash is of the miliary type (also Hyoscy- amus, Stramonium, Bryonia and Lachesis). Returning again to Belladonna, we find sometimes that it fails, although the symptoms seem to call for it, and the case is one of the Sydenham variety of scarlatina. The remedies to be thought of in this case are two: Sulphur which, just as strongly as Belladonna, pro- duces a smooth erythema of the entire surface of the body. It may sometimes be indicated in the beginning of the case. The other remedy is Calcarea ostrearum, which is complementary to Belladonna, often completing what that remedy only partially cures. So in scarlatina, we find it indicated when the rash comes out under Belladonna but begins to pale off. The face becomes pale and bloated. The urine is scanty or even suppressed, and the brain symptoms sug- gestive of Belladonna may yet be present. Another action of Belladonna on the skin is the production of boils or abscesses. You may give it in mastitis or inflammation of the mammae. It is here indicated by the violence of the symptoms, by the radiating redness, by the throbbing and tendency toward suppura- tion. The same symptoms call for it in abscess of any kind and in any situation. Even a bubo which is specific in its character may call for Belladonna if the symptoms are of the violent character already mentioned, and it will here do good service for the time being. We also find it the remedy for boils that recur in the spring. Belladonna may be used successfully in the summer complaint of very young infants. We find it to be the remedy when there is crying or screaming hour after hour without any assignable cause. We find it also indicated in indigestion of infants, associated with sharp pains, suddenly screaming out and bending backwards, not forwards as under Colocynth. Sometimes the transverse colon is so distended that it pro- trudes like a pad in the umbilical region. This symptom sometimes occurs in lead colic. Then, too, we find Belladonna indicated in diar- rhoea. It is particularly suited to a dysenteric diarrhoea, that is a diarrhoea from cold with enteritis, the discharges being associated with considerable tenesmus (for you must remember that Belladonna has great affinity for sphincter muscles) the discharges being slimy and bloody. In summer complaint the stools are yellowish or green, and contain lumps looking like chalk, consisting no doubt of caseine. You must remember Belladonna as complementary to Chamomilla in this colic and diarrhoea of infants. In neuralgiae, Belladonna is indicated by the pains coming suddenly, 392 A CLINICAL MATERIA MEDICA. lasting a longer or a shorter time, and then as suddenly disappearing; pains are lancinating, burning, tearing and shifting. They are worse from motion, light, noise, or the slightest jar, and from lying down; and better when sitting up. In prosopalgia the right side is mostly attacked, especially the infraorbital nerves, and the face is hot and red. In sciatica the pain is worse in the hip-joint at night, compelling change of position. All these pains, as well as the fevers, are apt to exacer- bate at 2 or 3 p.m., and again at 11 p.m. The power of this drug to excite neuralgic pains in any of the spinal nerves has led to its recom- mendation in the atrocious pains which mark the beginning of loco- motor ataxia. Belladonna is very often called for in the treatment of convulsions. Epilepsy* is readily modified by it, and at times cured. So is that dread disease, puerperal eclampsia. And spasms of children during dentition,f from repelled eruptions, etc., keep the remedy in almost daily demand. In all these cases the cerebral symptoms must be prominently present: Hot head, flushed face, throbbing carotids, start- ing from sleep in terror, etc, foam at the mouth having an odor of rotten eggs. The convulsive movements may be a combination of empros- and opisthotonos; or the patient, usually a child, becomes sud- denly rigid, stiffens out, with fixed, staring eyes. In puerperal cases the woman is unconscious, and each pain re-excites the spasm. Between them she tosses about, moaning and crying, or lies in a deep sleep. In teething children the gums are swollen and the mouth hot and dry. Now we come to speak of the action of Belladonna on the female genital organs. On the female genital organs Belladonna has a decided action. It causes constant and violent bearing down, worse on lying down, and relieved by standing.! The menses are early and copious, * Attention is here called to Absinthium, which causes congestion of the cerebral meninges and the medulla; hallucinations are terrible ; brilliant eyes; epilepsy, fol- lowed by obtuse state of the mind, a dazed condition. Epileptic vertigo or momentary unconsciousness. Artemisia vulgaris is botanically similar to Absinthium, and helps in epilepsy occurring after fright, and when attacks follow one another rapidly. Great restlessness characterizes Absinth, Artemisia, Cina, Chamomilla and others of the order composite. f In ailments during dentition compare: Kreosote, child worries all night; must be patted and tossed all night; teeth decay rapidly. Colchicum, stools changeable; convulsions during teething, reflex from abdominal irritation. Cina, convulsions, face pale, child rests the more, stiffens out; restless. Dolichoses, gums intensely sen- sitive. Seem to itch. Aethusa quickly lessens swollen red gums; vomiting of curdled milk. % Sepia is opposite to this. Kreosote has bearing down, worse from rest and relieved by motion. BELLADONNA. 393 bright red, and attended with cramplike tearing pain in theback,arms, etc.; throbbing headache; most intensely painful congestive dysmen- orrhcea; bearing down ; cutting from behind forwards or vice versa; menstrual flow, which, without any apparent cause, is offensive; lochia offensive without apparent cause. Uterine haemorrhages; blood pours out and feels hot; uterine haemorrhage with bearing down in the back ; leucorrhcea with this bearing down ; spasmodic os uteri, which feels hot and very tender; pain in the back as if it would break. Labor- pains come and go suddenly; pain violent but ineffective. Belladonna may be used during labor when the os does not dilate, when there is a spasmodic condition of the cervix. The labor-pains are violent and cause great distress, and yet the child does not advance. The examin- ing finger finds that the os remain* rigid and spasmodic. A few doses of Belladonna will be found to be sufficient to correct the trouble. On the respiratory tract Belladonna has some action. It causes cough from tickling in the larynx, as from dust; face red, eyes spark- ling; cough dry, hacking, coming in very violent attacks; cough with dryness and tightness in the upper parts of the chest, worse just after lying down in the evenings and at night. Sputum of blood- tinged mucus. Larynx sore and hot internally, worse from pressure. Burning in the chest; sticking pains from coughing and motion, but not affected by breathing. Pains are worse under the right clavicle. Pressing in the chest and between the scapulae, with dyspnoea, walk- ing and sitting. Calcarea also has cough just after lying down. Phosphorus differs from Belladonna in having the irritation lower down in the respiratory tract. It has more rawness, and the larynx is sore, worse from talking or pressure thereon. In Belladonna it is only sore from pressure. Under Causticum the cough is tickling ; the voice is almost gone ; soreness and rawness of the trachea, but not of the chest. Rumex has dry cough from tickling in the suprasternal fossa, aggravated by the least cool air or deep inspiration. With Cepa the cough causes a feeling as if the larynx would split; it makes the patient cringe; coryza. Lachesis has cough from tickling lower down than in the Bella- donna case, and is aggravated by the lightest pressure of the clothing. For rigidity of the os uteri you may also remember Gelsemium. Belladonna is complementary to Calcarea ostrearum. It is anti- doted by Coffea, Nux vom., Opium. Hyoscyamus antidotes its abuse in skin affections and cough. LECTURE XXXIX. STRAMONIUM AND HYOSCYAMUS. Datura Stramonium. Stramonium differs somewhat from Belladonna. The mental symptoms which lead us to the choice of the remedy are these: The mania or delirium is of a wild character, the face being of a bright red; the eyes have a wild and suffused look, although they are not as thoroughly congested as under Belladonna. The hallucinations terrify the patient; he sees objects springing up from every corner; animals of every impossible kind arise and terrify him. The patient, if a child, cries for its mother when perhaps she is by it. The eyes are open and the pupils widely dilated. If an adult, he is decidedly loquacious in his delirium. At times he manifests a merry mood in his loquacity, and at others he has the horrors. One moment he will be laughing, singing and making faces, and at another praying, crying for help, etc He often has photomania or desire for light. He seems to have a perfect fear of the dark. Sometimes he insists upon it that he is conversing with spirits. Sometimes the mania assumes a silly character. He talks in a foolish and nonsensical manner and laughs at his own attempts at wit. This loquacity differs from that of Lachesis. In Stramonium the loquacity consists of a simple garru- lousness, whereas in Lachesis it is a simple jumping from subject to subject. Agaricus seems to stand between Stramonium and Lachesis, having some similarities to both. A condition simulating that of hydrophobia sometimes calls for Stramonium. In this state any bright object causes furious delirium, spasm of the throat and horrible convulsions. The delirium, especi- ally in typhoid conditions, is very excessive and seems to exhaust the patient completely. The spasmodic motions of Stramonium are characterized by grace- fulness rather than angularity; they are more gyratory than jerking. Especially is this condition noted in cases of the exanthemata with non- appearance of the eruption in young children. Stramonium acts better on children and young infants than does Belladonna. Take, for in- stramonium. 395 stance, a case of measles; the rash does not come out properly; the child is hot; it tosses about, crying out in a frightened manner as soon as it falls asleep; it knows no one; you notice that its movements, though convulsive, are not jerking and angular, and the face is bright red. This is a case for Stramonium. Similar to Stramonium in these cases is Cuprum, which has, like the former remedy, aggravation on arousing from sleep and this same terror. It is characterized by the violence of its symptoms. The abnormal movements are decidedly angular. The face is apt to be of a bluish color. It is especially indicated when the rash has been reper- cussed and these violent cerebral symptoms appear. Another remedy similar to Stramonium is Zinc This, too, has crying out in sleep and awaking from sleep terrified. There is con- siderable evidence of debility, the child being so weak that it has not sufficient strength to develop an eruption. Another nervous affection yielding to Stramonium, or at least modi- fied by it, is nervous asthma; can scarcely draw in the breath from the spasm; aggravation from talking. Stramonium is also indicated in locomotor ataxia. The patient can- not walk in the dark or with his eyes closed. If he attempts to do so he reels and staggers. Mental abnormalities as to shape seem to be characteristic of the Stramonium patient. For instance, he imagines that he is very large, or that one arm is very large. Sometimes he feels as if he were double, or that he had three legs instead of two. These errors as to shape and size in the Stramonium patient remind you of other remedies, particularly of Baptisia, which does not, however, resemble Stramonium in other symptoms in the least. It is to be remembered that both of these remedies have these illusions as to shape. The Baptisia patient feels that he is double, or, what is more character- istic, that his body is scattered about, and he must try to get the pieces together. Other remedies have this symptom ; we find it under Petro- leum and Thuja. Under the latter remedy the patient imagines that he is made of glass, and he walks very carefully for fear that he will be broken. During the delirium of the Stramonium patient he frequently attempts to escape, as under all the narcotics. In erysipelas, with involvement of the brain, you may find Stra- monium rather than Belladonna indicated when the disease assumes an adynamic type. The symptoms are very much like those of Rhus tox., but you distinguish it from the latter by the violent cerebral 396 A CLINICAL materia medica. symptoms, the delirium, the restlessness, and the screaming out as if terrified. As in all remedies that irritate the brain, we find grinding of the teeth. We may also find stuttering, which, by the way, has been com- pared to the spasmodic urination of children, when the least excitement will cause them to pass uriue in little jets; in a similar way are the words jerked out. Particularly does the patient find it difficult to com- bine vowels with consonants. Another remedy for stuttering or stammering is Bovista. The tongue of the Stramonium patient is red or whitish, and covered with fine red dots, and is dry and parched. In some cases it is swollen and hangs out of the mouth. Stramonium may excite a decided nymphomania, during which the woman, though very chaste when in her normal condition, becomes exceedingly lewd in her songs and speech. She may become very violent in her manner. Often these symptoms occur in women before menstruation, in which case Stramonium acts most admirably. The menstrual flow is apt to be very profuse, showing that it is the high degree of congestion that produces the nymphomania. There is a strong odor about these women, reminding one of the odor of animals in the rutting season. I would also like to call your attention to the diarrhoea which Stra- monium cures. The stools are very offensive, smelling almost like carrion. They are apt to be yellowish. They may or may not be dark, but the offensiveness is the most important symptom. Absence of pain is characteristic of Stramonium excepting in abscess, particularly when it affects the left hip-joint, in which case it may be so intense as to throw the patient into convulsions. The antidote for Stramonium poisoning is lemon-juice. Hyoscyamus Niger. Botanically and, in a measure, therapeutically, Hyoscyamus is similar to Belladonna. This interesting drug, though innocuous to some animals, is poisonous to fowls, and has received the name of henbane. Hyoscyamus seems to be especially adapted to acute mania, to mania without any evidence of absolute inflammation, to mania which has for its key-note extreme excitation of the sensorium. The patient, under such circumstances, has many flexible notions, all arising from these abnormal impulses. He imagines, for instance, that he is about to be HYOSCYAMUS. 397 poisoned. Possibly he will refuse your medicine, declaring in angry tones that it will poison him. Or he imagines that he is pursued by some demon, or that somebody is trying to take his life. This makes him exceedingly restless. He springs out of bed to getaway from his imaginary foe*. The senses, too, are disturbed. Objects look too large or else are of a blood-red color. Sometimes objects appear as if they were too distinct; that is, they have an unnatural sharpness of outline. The patient talks of subjects connected with everyday life, jumping from one subject to another pretty much as in Lachesis; all this time the face is not remarkably red, possibly it is only slightly flushed. The pupils are usually dilated, sleep is greatly disturbed, the patient lies awake for hours. As the mania advances he seems to lie in a sort of stupor, and yet it is not a real stupor, because the slightest noise rouses him into all these forms of violent mania. Every little im- pression causes excitement of the sensorium. Accompanying these symptoms we find characteristic debility, this debility showing itself in the great prostration on every attempt to move or walk about, and in paralysis of one or more muscles following the maniacal attacks. As the sensorium becomes more and more depressed he answers ques- tions slowly or else gives irrelevant answers. Sometimes he will be in a stupor from which he can be readily aroused and will answer your questions quite correctly, but he will relapse into the stupid state immediately. With this there is a sort of adynamic condition of the brain resulting from this prolonged over-excitement, and in this con- dition we still find delirium, but the patient is greatly prostrated, stool and urine pass involuntarily, the pulse is no longer full and acceler- ated, but is quick, rapid and without volume, and irregular. Stupor is now complete, sordes appear on the tongue and around the teeth, the lungs are engorged, not from a pneumonic process, but because of hypostatic congestion. Associated with this we-have snoring-rattling during breathing. The mouth is opened, the lower jaw dropped, and the patient lies quietly with occasional twitching of groups of muscles. This condition will soon be followed by death unless relief can be ob- tained. At other times we find the delirium returning anew and the symptoms take another form. The patients are silly and laugh in a flippant manner. Sometimes, for hours at a time, they will have a silly, idiotic expression of the face. Again they become exceedingly lascivious, throw the covers off and attempt to uncover the genital region. The abnormal movements accompanying these symptoms are 398 A CLINICAL MATERIA MEDICA. rather angular; they are not at all of the gyratory character signifi- cant of the Stramonium. Still another form in which the cerebral symptoms of Hyoscyamus may appear, particularly in women, is jealousy, and also the effects of powerful emotions, as disappointed love, fright and other emotions that are more or less exciting and at the same time depressing. Coming now to inflammation of the brain or meninges, we find Hyoscyamus sometimes indicated when we have present some of the symptoms already enumerated and in addition to these symptoms, relief from shaking the head or sitting with the head bent forward. Here it is exactly opposite to Belladonna. The patient complains of pulsating waves through the head. We have a cough quite characteristic of Hyoscyamus. This cough comes from elongation of the uvula, the result of relaxation or inflam- mation. The uvula hangs down and rests on the root of the tongue, causing irritation and the consequent cough. This cough is worse when lying down, the patient having almost complete relief when sitting up. It is usually worse at night and also after eating and drinking and from talking. There are two or three remedies to be compared with Hyoscyamus here. One of them is Rumex crispus. This is a splendid remedy for tickling cough from an annoying tickling in the supra-sternal fossa. The patient wants to breathe warm air. Anything which disturbs the temperature of the respired air excites the tickling, and hence the cough. The tickling may extend down into the chest and still Rumex be indicated. There is another remedy which has this same symptom, and one which has been confirmed too. It is Mentha piperita. It is inferior to Rumex, however. I have heard it said that eating apples will relieve this kind of cough. Hyoscyamus is also to be considered as a remedy for sleeplessness. It is useful in the sleeplessness of children when they twitch in sleep, cry out and tremble, and awaken frightened. It is also a valuable drug in convulsions. It is one of the most re- liable remedies we have for epileptic convulsions, that is if there is no other remedy indicated. In the Hyoscyamus convulsion we find the patient twitching and jerking. These angular motions that I have described seem to be provoked by eating. Especially is this to be noted in children; the child will wake up from sleep hungry; the face is apt to be of a deep red color, almost on the purple. There are HYOSCYAMUS. 399 also frothing at the mouth and biting of the tongue. These symptoms are almost always followed by profound sleep. In epilepsy compare Cicuta viresa, which has shocks from head down the body; staring; violent convulsions; screaming; red face; limbs greatly distorted ; frothing at the mouth ; face blue; respiration greatly impeded; trembling before and after the spasms; great weak- ness after the attacks. We have Hyoscyamus indicated also in chorea. The patients are very weak with tottering gait. They seem to have abnormal impres- sions of distances. They reach for something that seems to be just within their grasp, when, in reality, it is on the other side of the room. Stramonium is also a remedy to be thought of in chorea, particularly if the brain is affected. The child awakens from sleep with a scream. It sings and laughs without reason. Still another remedy is Veratrum viride, which is particularly indi- cated when there is great congestion in the nervous centres. The pulse is much over-excited. Now let me speak of the fevers of Hyoscyamus. I have already given you the symptoms which would indicate the drug in typhoid fever. We have to see how we may apply it in the treatment of fevers with skin symptoms, as scarlatina. In scarlatina, Hyoscyamus is in- dicated, although not very frequently ; but yet it may be called for in cases that have been spoiled by Belladonna. The rash is of a miliary type and is dark or dark red in color. It is rather scanty, too, from partial repercussion. There are also picking at the bed-clothes, crying out in sleep and stupor, all denoting the alarming progress made by the disease. Stramonium is indicated in scarlatina when we have violent symp- toms present, something like those we have seen in Belladonna. The face is very red, the rash seems to be scattered over the purface, the prostration is excessive, the skin is apt to be very dry and hot without as much of the hot sweat as we have found under Belladonna. If sweat does come, it does not relieve. Now let us compare the three remedies, Belladonna, Stramonium and Hyoscyamus, one with the other, In general, we find that Bella- donna causes more congestion or inflammation of the brain, Stramo- nium congestion with more sensorial excitement, and Hyoscyamus more nervous irritation with less congestion and inflammation than either of the others. 400 A CLINICAL MATERIA MEDICA. The type of the delirium in Belladonna is wild ; there is a desire to escape; the patient bites ad strikes; the face is red and the eyes suffused with violent throbbing of the carotids. He either complains of these hallucinations on closing the eyes or he stares at one point with eyes wide open. Then, too, there is sleepiness with inability to sleep. If there is stupor, it is rather the result of the congestion and inflammation of the brain, and is attended with some symptoms of irritation so that the patient, when aroused, is violent or he alternates between delirium and stupor, there being no evidence of serious blood changes. Hyoscyamus has a similar desire to escape; the patient attempts to bite and strike those about him ; he has the same desire to uncover, but he lacks the violent throbbing of the carotids and intensity of the redness of the face and suffusion of the eyes. The Hyoscyamus pa- tient has a particular aversion to light and has especially marked this fear of being poisoned or of being betrayed. Lying quietly in the bed, he suddenly sits up and looks around as if looking for some one whom he expected to see in the room. At a word from the nurse, he lies down again and goes off into a sleep. He may expose his sexual organs. His wakefulness is very different from that calling for Bella- donna. He is nervous, whining, crying and twitching. Hyoscyamus is used very extensively in insane asylums for acute non-inflammatory mania. These patients you find always weak; the pulse often lacks volume; they either have no appetite whatever or else an enormous appetite. Eating is at once followed by an aggrava- tion of the symptoms. Allopathic physicians use very largely the alkaloid Hyoscyamia. This is very similar to Kali bromatum, having the power of exciting the sensorium without inflaming the brain. Thus we find Kali bromatum indicated in the acute mania of children when they arouse from sleep with screams and imagine that some one is going to hurt them. The patient may also have the insane impres- sion that he is to be murdered or that his honor is at stake, or that those in his house dislike him and intend to hurt him. Hyoscyamus is particularly indicated in these cases if they are puer- peral in their origin. We also find these symptoms of Hyoscyamus in typhoid fevers. The tendency, you will see, is to a low type of dis- ease ; it is a more adynamic remedy than Belladonna. Belladonna may be indicated in the beginning of the disease when there is the wild and furious delirium. Hyoscyamus comes in later when the stupor becomes more marked ; when the patient picks at the HYOSCYAMUS. 401 bed-clothes or at his fingers in a somnolent sort of way and occasionally he will reach out as if grasping for something in the air. You will find the tongue, in such cases, dry and red ; speech, of course, is diffi- cult ; and, as the case progresses, we have the sordes on the teeth with involuntary stool and urine and dropping of the lower jaw. I would like to say here, by way of caution, that although a case for Hyoscya- mus is clearly made out by these symptoms, yet it does not always act. I cannot tell you why. I can see no cause except that the drug does not act deep enough. In such cases, I usually look up Lachesis, Lyco- podium, Muriatic acid and Arsenicum. Stramonium differs from Belladonna and Hyoscyamus. The patient sees objects which seem to rise in every corner of the room and move towards him. He has a mania for light and company, which is just the opposite to Belladonna, is excessively loquacious and laughs, sings, swears and prays almost in the same breath. The desire to escape is present; there is sudden spasmodic lifting of the head from the pillow and then dropping it again ; he awakens from sleep in fright and terror, not knowing those around him; the motions that he makes are quite graceful and easy, although they may be violent. At times, the body is bathed in a hot sweat which does not give any relief to the patient. The desire to uncover is similar to that of Hyoscyamus, but it is more an uncovering of the whole body rather than of the sexual organs. The tongue is often soft, taking the imprint of the teeth; screaming in sleep, often with hiccough ; the face is usually bright red, but not as deeply congested as in Belladonna. LECTUKE XL. TABACUM, DULCAMARA, CAPSICUM AND GLONOIN. Tabacum. Tabacum contains several active ingredients, the most important of which is Nicotine. Ever since smoking was an " art," attempts have been made to get rid of this Nicotine. Every one acknowledges that it has a serious effect on the body. There are three groups of symptoms which may follow the use of tobacco. The primary symptoms are the well-known gastric symptoms, nausea and vomiting, with the most horrible sickness. The patient is deathly pale, does not care whether he lives or dies. Sometimes cold sweat breaks out on the body. The secondary effects are more remote, coming months or even years after using the weed, and these are dyspepsia, and also some symptoms of the heart. These symptoms of the heart I would have you remember. If they are not caused by tobacco, Tabacum will be a very valuable remedy in their cure. I refer especially to dilated heart when these symptoms are present: There are frequent pallor, with lividity of the face; diar- rhoea, alternating with constipation; palpitation when lying on the left side; muscae volitantes, tinnitusaurium and dry cough, which is cardiac in its origin ; paroxysms of suffocation, with tightness across the upper part of the chest; feeble and irregular pulse; pains like those of angina pectoris shoot from the heart down the left arm or up into the neck, and involve different plexuses of nerves; the extremities are cold and covered with a clammy sweat. Another symptom that may come as a secondary symptom of tobacco is neuralgia of the face. Tlys symp- tom, when thus caused, is curable by Sepia, as is also the dyspepsia. Impotence also follows tobacco, and yields often to Lycopodium. The tertiary effects of tobacco include apoplexy. Tobacco, in its effect on the gastric organs, very much resembles Hydrocyanic acid, Veratrum and Camphor. For instance, we find it indicated in cholera, when the nausea and cold sweat persist after Veratrum, Secale or Camphor has stopped the diarrhoea. This nausea is accompanied by burning heat about the abdomen, the rest of the body being cold. The patient persists in uncovering the abdomen. DULCAMARA. 403 I would remark here that this kind of sickness suggests Tabacum in renal colic or in strangulated hernia. There are this deathly nausea and sickness, with slimy stool, from irritation of the bowels. The resemblance to Hydrocyanic acid is in asphyxia. The latter drug acts upon the medulla, and, hence, upon the heart through the pneumogastric nerves. Consequently, the symptoms you would ex- pect it to produce are those of the heart and lungs. We find it pro- ducing convulsions, with drawing at the nape of the neck from irrita- tion at the base of the brain. Along with this, respiration is irregular or gasping, and there is great distress about the heart, with repeated weak "spells" and coldness and blueness of the surface of the body. It is well to remember this fact in nraemic convulsions when the medulla is affected. Hydrocyanic acid is then our only hope. Tabacum is used as an antidote to the bad effects of Cicuta virosa. The primary effects of tobacco are generally relieved by Ipecac. Nux vomica is indicated for the bad taste in the mouth and the head- ache worse in the morning from excessive smoking. It is said that Plantago major produces a distaste for tobacco. I have seen one or two patients who supposed they had a dislike to tobacco after taking it. Dulcamara. Dulcamara, or the " bitter-sweet," contains a small quantity of Sola- nine, a much smaller quantity in fact than any other member of the group. The tender leaves and twigs have been used for the prepara- tion of the tincture. There have been accounts of poisoning from the berries of the Dulcamara. The symptoms thus produced are hard griping pains in the bowels, followed by unconsciousness and spasms. These latter are tetanic, and are accompanied by hot dry skin, trismus, loud rattling breathing, and, in one case, death. The ordinary symptoms produced by the drug are not so severe. We find as the very central point around which all the other symp- toms of the drug group, this one: Aggravation from cold damp weather or from changes from hot to cold weather, especially if these changes are sudden. Thus we find Dulcamara useful in rheumatism made worse by sudden changes in the weather; twitching of the muscles of the eyelids or mouth whenever the weather becomes damp; dry coryza, sore'throat, with stiffness of the neck; colic from cold, especially with diarrhoea at night; earache, when it returns with every such change in weather. 404 A CLINICAL MATERIA MEDICA. Dulcamara has a marked inflcence on the nervous system ; but here again its use in practice is often based on the above aggravation. AVe have the tongue paralyzed in damp weather, with impaired speech; hyperemia of the spinal cord with the paretic state belonging to that disease when caused by lying on damp cold ground, and intensified by every return of damp weather. It is also indicated in paralysis of the bladder aggravated by damp weather. It is also of use in incipient paralysis of the lungs in old people, especially if the symptoms are aggravated by change in the weather. Dulcamara has a specific influence on the lining membrane of the bladder, causing catarrh of that organ. The urine is very offensive, and is loaded with mucus. It also exerts a marked action on the skin. Thus, it develops a bright red eruption on the surface of the body. Here and there there will be large wheals, which may be white or red, and along with these there is usually burning and itching. It is indicated in urticaria traceable to gastric disorder when there is relief from cold air. The complement of Dulcamara is Baryta carb. This has aggrava- tion in cold weather, especially in scrofulous children. Capsicum Annuum. Capsicum possesses few, if any, of the narcotic properties of the Solanaceae, but it has, highly marked, the irritating properties of the group. It takes but little of the drug to produce this irritation. Cap- sicum is eliminated from the body through the kidneys, producing strangury with burning when passing water. This drug acts best in persons of lax fibre, rather stout in build, who do not respond readily to medicine because they are of lax fibre, and also because of impaired digestion. The Capsicum patient has weak digestion or weak stomach, hence the whole man is weak. Such patients are irritable and get angry without any cause. This is true of either adults or children. They are worse from the least draft of air, though this air be warm. They are clumsy in their motions. They are subject to chills and fever. The chill commences in the back. Although the patient is thirsty, yet drinking causes shivering. The Capsicum patient is subject to catarrhal asthma with red face and well-marked sibilant rales. He coughs, and a successful cough raises phlegm, which relieves the asthma. GLONOIN. 405 Capsicum has a symptom of the chest not often met with in practice, and that is very offensive breath during the cough. It also has a well-marked action on the ear, especially on the middle ear. It is of use in rupture of the membrana tympani from disease when there is soreness or inflammation of the mastoid process of the temporal bone. For abscess of the mastoid process the preferable remedies are Aurum and Nitric acid. For chronic suppuration of the middle ear, you may think of Silicea. Capsicum is of importance in diseases of the throat. It is indicated in diphtheria or in gangrene of the throat when there are burning blisters in the roof of the mouth and when there is an odor from the mouth like that of carrion. The throat feels constricted as if spas- modically closed. The patient is worse when not swallowing. In extreme cases the patient becomes greatly prostrated. The most similar remedy here is Cantharis. Capsicum is also indicated in elongation of the uvula. It may be used both externally and internally. In dysentery it is indicated when the stools are frequent but small and attended with violent tenesmus and burning in both rectum and bladder. The stools are bloody and slimy and contain shaggy pieces. There is thirst, and yet drinking causes shuddering. Glonoin** T Blood. Glonoin. < Trauma. (^ Convulsions. Glonoin is nitro-glycerine. It is a very easy drug to study. Its main point of attack is the blood. It does not, however, affect the quality of the fluid so much as it does its circulation. The key-note to the whole symptomatology of the drug is expressed in this one sen- tence : " A tendency to sudden and violent irregularities of the circula- tion." With that for our foundation we can easily work out the other symptoms. Glonoin is a drug which acts very quickly and very vio- lently. The symptoms which are traceable to the irregularities in the circulation are these : Very characteristic, indeed, is a throbbing head- ache. The pain may be in the whole head, or it may be in the fore- * Glonoin was considered in this part of the course of lectures on account of its symptomatic resemblance to Belladonna. 406 A CLINICAL MATERIA MEDICA. head, vertex, occiput or any one part of the head. This throbbing is not a mere sensation ; it is an actual fact. It really seems that the blood- vessels would burst, so violent is the action of the drug. The throb- bing is synchronous with every impulse of the heart. The blood seems to surge in one great current up the spine and into the head. The bloodvessels externally become distended. The external jugulars look like two tortuous cords, the carotids throb violently and are hard, tense and unyielding to pressure. The face is deep red. This throb- bing is either associated with dull, distressing aching or with sharp violent pains. We find Glonoin applicable to sunstroke, indicated either by the symptoms already mentioned, or by symptoms which show that the prolonged congestion has produced depressing effects upon the brain. The face becomes rather pale, the pulse, which was at first full, soft and feeble, and respiration labored. There is not so very much press- ure about the chest as about the medulla oblongata, thus interfering with the nerves of respiration. The eyes are often fixed. The patient may even be unconscious. Glonoin, then, we find to be our best remedy for the effects of heat, whether the trouble arises from the direct rays of the sun, from hot weather or from working in the in- tense heat of a furnace, as in the case of foundrymen and machinists. These effects of the sun or heat are not confined to the head alone, but may involve the whole body. Thus we note oppression of breathing, with palpitation of the heart and nausea and vomiting, the tongue being white. This nausea is not gastric in origin, but cerebral, as under Rhus tox., Belladonna and Apomorphine. The appetite is gone; there is no desire for food; there is a horrible sunken feeling in the epigastrium, and often, too, diarrhoea. All these symptoms may and do call for Glonoin. Still other effects of this congestion are found in the eye. The eyes feel as if too large and protrude as though bursting out of the head. Glonoin is indicated in eye diseases arising from exposure to very bright light, as in the case of one obliged to work at a desk beneath a hot, bright light, as a bright A rgand burner. If you should examine such an eye with the ophthalmoscope, you will find the bloodvessels of the retina distended or, in extreme cases, apoplexy of the retina. Still other effects of the increased blood pressure under Glonoin may be noticed in the symptoms of the mouth. For instance, there is difficulty in conversation from diminished power of the tongue, this GLONOIN. 407 being the result of pressure on the brain. Wine aggravates all these symptoms. Another effect of the cerebral congestion is convulsions. Glonoin is an admirable remedy for the convulsions coming on during labor, puerperal convulsions. The face is bright red and puffed, the pulse full and hard and the urine albuminous. The patient froths at the mouth ; she is unconscious. The hands are clenched, the thumbs being in the palms of the hands. At other times the hands are stretched out as under Secale, and the patient is unconscious. I think that Glonoin is one of the best remedies we have for the congestive form of puerperal convulsions, that form which is announced by rush of blood to the head, especially if there is albuminuria. It is also' in- valuable in congestion to the head from suppressed menses. The mental symptoms traceable to this congestion are syncope or sudden fainting, the face being pale or often livid, black spots before the eyes, sudden onset of unconsciousness, well-known streets seem strange to the patient. -This last symptom is one decidedly dangerous. Suppose a person who is subject to apoplectic congestion, is suddenly seized in the streets with one of these attacks and does not know where he is, then Glonoin is the remedy for him. Another remedy is Petroleum. Sometimes the congestion is so great as to make the patient frantic. He tries to escape, to jump out of the window. Glonoin is also useful for the bad effects of fear. I mentioned that briefly when speaking of Opium. There is horrible apprehension and also sometimes the fear of being poisoned. This last symptom places it alongside of Hyoscya- mus, Rhus tox., Bromide of Potassium and Baptisia. Another use of Glonoin is its application to trauma. It has been found an excellent remedy for pains and other abnormal sensations, following late after local injuries. Long after the reception of an in- jury, the part pains or feels sore, or an old scar breaks out again ; then Glonoin seems to relieve. It is necessary for you to remember the distinctions between Bella- donna and Glonoin, because they meet in the congestions and inflam- mations of the brain with children and old persons. They divide the honors in these diseases, because each has a number of confirmed cures. We have the cri encephalique in Glonoin which is not so marked under Belladonna, so it would seem that Glonoin would suit a worse case than would Belladonna. The symptoms which would help you are these: First, Glonoin; the head symptoms are worse by bending the 408 A CLINICAL MATERIA MEDICA. head backwards; worse in damp weather; worse from the application of cold water, even causing spasms ; better from uncovering; better in the open air; sometimes the patient is obliged to get up and walk about despite the soreness that jarring causes. A very marked symptom which anticipates puerperal convulsions and which is an early symptom in congestion of the brain from suppressed menses and a prominent symptom in the bad effects of the heat of the sun, is a feeling as if the head was enormously large. The head seems as if it was expanding. Although that symptom is found under Belladonna, it is not so char- acteristic of that drug as of Glonoin. Now Belladonna has relief from bending backwards, from sitting up with the head quiet. Belladonna usually has relief from covering the head, while Glonoin has relief from uncovering, although the latter symptom is of less importance than the others. The best antidote to Glonoin that I know of, is Aconite. LECTURE XLI. Lycopodium Clavatum. < LYCOPODIUM CLAVATUM. 1. Constitution. 2. Blood. a. Fevers. b. Ebullitions; pulse. c. Varices. d. Typhoid. e. Scarlatina. /. Diphtheria. 3. Liver. 4. Dropsy. 5. Catarrhs. 6. Kidneys. Lycopodium or club-moss has long been used in legerdemain and also in pyrotechnic displays for the production of artificial lightning. In legerdemain it is used as a coating to the hand, after which that member may be dipped in water and removed from thence perfectly dry. As a medicine, it was considered wholly inert by members of the allopathic school of practice, and was used only as a drying powder by nurses. In the experience of some it was found that quite severe symptoms followed the use of this powder. Others, on the contrary, used it for months and years, and positively declared it to be inert. Now why was this ? The Cryptogamia, unlike other plants, have, instead of seeds, spores, which are sometimes arranged under the leaves, as in the case of Lycopodium. Now these spores have a hard, shell- like covering, within which we find a small quantity of oily sub- stance, which is the active part of the spore. As long as the Lycopo- dium used consisted of unbroken spores it was inert; when, however, these were ruptured, it became active and symptoms followed its local application. In the preparation of Lycopodium, great care should be taken to see that all the spores are broken. When thus prepared, we have in it a truly valuable medicine which Hahnemann proved for us, and one, too, which we need in practice almost every day. I love to extol 27 410 A CLINICAL MATERIA MEDICA. the virtues of this remarkable drug, for Hahnemann with his infallible Law, rescued it from its ignominious use as an infant powder, and elevated it to the highest rank among the antipsorics. In order that you may understand the symptomatology of the drug, I have arranged the schema which you see before you on the board. First of all, we will study the constitution, that is to say, the general character of the drug. We find Lycopodium indicated most frequently in emaciated persons who are muscularly weak; the mind, however, is well developed. Particularly is this noticeable in children. There is a predisposition to liver troubles, and also to affections of the lungs; the face is often pale and sallow ; the eyes being sunken and sur- rounded with dark bluish circles. Often, too, the face is furrowed with creases and wrinkles, indicating deep-seated disease. The face readily flushes, the cheeks become red. This is often so in the even- ing and after eating. As to temperament, the Lycopodium patient is rather impatient and irritable, easily getting angry. At other times, sadness or tearfulness is well marked. When sick, such pa- tients are apt to become domineering and rather imperious in manner; or to consider themselves of great importance and those about them of no importance, so they order others about with an angry vehe- ment manner. As to the intellectual part of the mind, we find the memory always weak. Thus we find the drug often indicated when there are frequent mistakes in speech. The patient forgets words or syllables. The changes made in the blood by Lycopodium are not numerous. In febrile states we sometimes find it indicated by chill coming at three or four o'clock every or every other afternoon; this chill being fol- lowed by sweat without intervening heat; or the case may be charac- terized by chill coming at this hour and sour vomiting. There may or may not be heat. The pulse in Lycopodium is not very characteristic. In the provings the pulse is changed very little, except that it is slightly increased in frequency towards evening. Next, I have to notice varicose veins. Lycopodium, by reason of its action on the liver, tends to produce swelling or enlargement of the veins, particularly those which are more or less imperfectly sup- plied with valves; so we have varices characteristic of Lycopodium; varices in the legs, particularly the right; varices of the genital organs; the labia are swollen by varicose veins; this latter condition LYCOPODIUM. „ 411 occurring during pregnancy, being a symptom which calls for Lyco- podium. So, too, we often find naevi modified by Lycopodium. Now, do not suppose that every naevus is curable by medicine, for such is not the case. It is, however, your duty to cure them by medicine when you can. For this purpose, Lycopodium is one of the remedies. Still another remedy, and one, too, which is better than any other, and has also produced naevi, is Fluoric acid. So, too, carrying out a similar line of symptoms, you will find Lyco- podium indicated in bleeding piles, piles which contain an immense amount of blood, a far greater quantity of blood than the size of the vein involved would warrant; also in piles which do not mature, but which, from partial absorption of their contents, remain as hard bluish lumps. Then, again, in erectile tumors which have now an increase and then a decrease of the amount of blood in them, Lycopodium may be use- ful. Lycopodium must have some effect on the blood or on the nervous system because of its general use in typhoid states. It is not in the beginning of typhoid fevers that it becomes the remedy, but it is when the disease has gone on, despite your treatment, to that state in which the symptoms are very alarming. The symptoms which guide you to the selection of the drug are these: First, in regular typhoid fever it is indicated on or about the fourteenth day of the fully-developed fever, when the rash belonging to the fully-developed disease does not appear and the patient sinks into an unconscious state, with muttering deli- rium, picking at the bed-clothes, distended abdomen, with great rumb- ling of flatus, constipation, sudden jerking of the limbs here and there, involuntary urination or retention of urine; if the urine is passed in bed, it leaves a reddish sandy deposit in the clothing. These are some of the indications for Lycopodium in typhoid fevers. They are very similar to those calling for Calcarea ostrearum. Cal- carea ostrearum has been found to be the remedy in this stage of typhoid fever when the rash does not appear. But Calcarea may have either constipation or diarrhoea. Lycopodium always requires constipation. Calcarea has more hallucinations. The patient sees visions when he closes his eyes; he cannot sleep; although he may be fully conscious, yet he is continually frightened by some imaginary object. In such cases Calcarea develops the rash and brings the patient out of this precarious state. 412 A CLINICAL MATERIA MEDICA. We may have Lycopodium indicated in worse conditions than this • when by reason of the prolonged temperature of the typhoid we have impending paralysis of the brain, it here becomes a leading remedy. The patient lies in a stupor; the eyes do not react to light, and have a fishy look; the lower jaw is dropped and hangs down ; the breathing is snoring and rattling; you can hear mucus rattle as air goes in and out of the lungs; the urine is either passed involuntarily or is sup- pressed. The pulse is intermittent and rapid. In these cases Lyco- podium should be given, and it will save the patient if any remedy can. In these typhoid conditions we have an indication for Lycopodium in the tongue. The tongue seems swollen and the patient cannot pro- trude it, or when the patient does put it out, it rolls from side to side like a pendulum. Almost always, too, the tongue is dry and has blis- ters on it. These are symptoms enough to warrant you in the choice of Lycopodium. In scarlatina, Lycopodium is not indicated by its power to produce an eruption and fever similar to those of scarlatina; it is called for, rather, in those cases which do not take a normal course but which go on to a fatal issue by reason of the constitution. You are guided here by the typhoid symptoms just mentioned, and also by another symp- tom which anticipates these and leads you to Lycopodium long before such serious- symptoms appear. I refer to the condition of the child after sleep. The child wakens cross and irritable, kicking the clothes off and striking every one about it. Although this symptom may seem insignificant, it is not so by any meaus. Here it resembles Cu- prum, Belladonna, Stramonium and Zincum, all of which remedies have arousing from sleep as if frightened. The element of irritability and the absence of symptoms characteristic of the other drugs lead you to Lycopodium. We may make another use of this symptom. Sometimes children have a disease called "gravel," in which lithic acid is passed in suffi- ciently large quantity in the urine as to cause pain on passing water. They awake from sleep screaming out with pain and kicking at all around them. Here Lycopodium is indicated by both the subjective and the objective symptoms. Often, too, when Lycopodium is indicated in scarlatina, you will find that one or the other parotid gland is inflamed and discharging purulent matter. Probably the very best remedy in the materia medica for parotitis LYCOPODIUM. 413 accompanying scarlatina is Rhus tox. The next best is Calcarea ostre- arum, and next to that Lycopodium. Lachesis is only indicated when the swelling is purplish and the pus is not laudable but thin, excori- ating and ichorous. In diphtheria, Lycopodium is to be thought of when the diphtheritic deposit is most copious on the right side of the throat, with a tendency to spread towards the left. There is a constant desire to swallow, amounting almost to spasm of the throat, with violent stinging pains. The patient is worse from swallowing drinks, especially cold drinks. You often find the symptoms aggravated from four to eight p.m. Generally, when Lycopodium is the remedy in either scarlatina or diphtheria, the nose is invaded by the disease. The patient cannot breathe through his nose. The tonsils are very much swollen, as is also the tongue, so that he is obliged to open the mouth and protrude the tongue in order to get breath. Sometimes, after you have given Lachesis, the membrane goes to the right side. Then Lycopodium comes in as a substitute. Next we come to the action of Lycopodium on the liver. Lycopo- dium acts very strongly on this organ, producing quite a number of symptoms. First, beginning with the mouth, we find the tongue coated; sour or, exceptionally, putrid taste in the morning on arising; violent hunger, almost amounting to canine hunger; a few mouthfuls of food seem to produce fulsomeness, as though the patient were "full up to the throat," quickly followed by hunger again ; distress in the stomach immediately after eating, not some little time after, like Nux vomica; cannot bear the pressure of the clothing about the waist, here being somewhat like Lachesis; but it is distinguished from Lachesis in that the latter has the sensitiveness all the time, but Lycopodium only after a meal. The region of the liver is very sensitive to touch. Sometimes there is a feeling of tension there, and this feeling of tension is a subjec- tive symptom which leads you to the choice of Lycopodium in chronic hepatitis when abscesses have formed. The diaphragm is very apt to be affected in this state. There is a feeling as though a cord were tied around the waist. There is marked collection of flatus. Possibly that is the reason why a small quantity of food fills the patient up. This flatulence tends upwards rather than downwards; rumbling of wind in the splenic flexure of the colon, with distension of that portion of the intestinal tract. (Momordica also has this.) There is great fermentation in the intestines, this being followed by discharge of flatus, and even by diarrhoea. The bowels are usually constipated, however, with in- 414 A CLINICAL MATERIA MEDICA. effectual urging to stool. After stool there is a feeling as of a great quantity remaining.unpassed. Now these symptoms, especially if associated with ascites, will lead you to the choice of Lycopodium in that disease known as cirrhosis of the liver. Lycopodium, in these gastric and hepatic symptoms, has many ana- logues, one of which is Nux vomica. Nux may be distinguished from it by the following: Although Nux vomica has sour taste in the mouth, aggravation in the morning and fulness after eating, yet the immediate distress is more prominent under Lycopodium. In the accumulation of flatus, of the two remedies Nux has more pressure downwards, giving frequent urging to stool and pressure on the bladder. Both remedies have prominently constipation, with ineffectual urging to stool. The difference between the two remedies is this: Nux vomica has this in- effectual urging from its fitful action; under Lycopodium it arises from contraction of the* sphincter ani. Sulphur is also similar in the accumulation of flatus and in the sour and bitter taste; but the characteristic place for the accumulation of flatus in Sulphur is in the sigmoid flexure, and is referred by the patient to the left groin. Raphanus is also to be thought of in cases with accumulation and retention of flatus. Dr. James B. Bell, of Maine, one of our most emi- nent surgeons, performed an operation on the abdomen. The patient was decidedly tympanitic, and yet he passed no flatus whatever, although the bowels moved. That symptom is under Raphanus. Dr. Bell gave that remedy, and the patient recovered. Next we come ft) the dropsies curable by Lycopodium. We find the remedy indicated .in dropsies, particularly in the lower half of the body. The upper part of the body is emaciated, the muscles of the arras and chest are shrunken, the abdomen is distended, and the legs swollen and covered with ulcers, from which serum continually oozes. Now, there are three remedies which may be given when ulcers form on the legs in dropsy. They are Rhus tox., Lycopodium and Arsenic. The cause of the dropsy indicating Lycopodium is liver disease. It has also been used successfully for hydropericardium in heart disease after the failure of Arsenic. We next come to the catarrhs of Lycopodium. Lycopodium may be thought of in catarrh affecting the nasal mucous surface, particularly when the nose is " stuffed up " and the child cannot breathe. The child starts up from sleep rubbing its nose. LYCOPODIUM. 415 You may also think of it in bronchial catarrh, whether the larger or smaller tubes are involved, when there is accumulation of mucus, as indicated by rales, rattling breathing, cough and dyspnoea. It may also be given in hectic fever with suppuration of the lungs, particularly when the right lung is worse than the left. It is also useful in pneumonia when the hepatization is so extensive that the patient has great difficulty in breathing, and there is alternate contraction and dilatation of the alae nasi. It may also be employed in typhoid pneumonia, the symptoms agreeing, and also for the bad effects of maltreated pneumonia, particularly if suppuration of the lungs impends. In diseases of the kidneys we find Lycopodium indicated for a trouble to which I have already referred, the presence of lithic acid in the urine, and also in renal colic affecting the right side. There is one symptom for Lycopodium that I would yet like to add, a symptom not uncommon in typhoid fever, pneumonia, and scarlatina, and that is coldness of one foot while the other is warm or even hot. This symptom may appear insignificant on paper, but I can assure you that it is of inestimable value in practice. Lycopodium is complementary to Lachesis. LECTUKE XLII. THE UMBELLIFER^J, THE BERBERIDACEJE AND SPIGELIA. The Umbellifer^e. The Umbelliferae are an order of plants which have a marked action on the nervous system, developing in some cases symptoms akin to hysteria. They also affect the glandular system, producing either engorgement or atrophy of glands. They all act on the mucous mem- branes, producing catarrh, and some of them act upon the skin, de- veloping pustular eruptions. The remedies obtained from this order are as follows: Conium maculatum, Cicuta virosa, (Enanthe crocata, Phellandrium aquaticum, Petroselinum, Asafoetida, Ammoniacum gummi. We will now proceed to consider the one first mentioned on this list. Conium maculatum acts as a depressor on the cerebro-spinal sys- tem. It develops a paretic state which spreads from below upwards, the lower part of the body giving out before the upper. When the drug is taken in poisonous doses we find at first a difficulty in walk- ing, as though the legs could not be moved. As the action of the poison increases, other and more vital organs are involved. The lungs are attacked; there is dyspnoea; the pulse is irregular, showing the fitful condition of the heart muscle. Up to this time the mind of the patient is perfectly clear. Finally unconsciousness ensues, and the patient dies of cerebro-spinal paralysis. We may utilize Conium in those exhausted states of the system re- sulting from old age. It may also be used after severe diseases, as diphtheria and typhoid fever, and for the sequelae of that vice of vices, masturbation. In the paralyses of Conium, sensation is but little THE UMBELLIFER^. 417 involved. Its analogue here is Gelsemium, which produces functional motor paralysis and is a prominent remedy in post-diphtheritic paralysis. In the treatment of the effects of sexual excess, we find Conium of great utility by reason of its mental symptoms. It produces a perfect picture of hypochondriasis. The patient is melancholy. Conium may also be given when this mental condition arises from celibacy. Zinc oxide is here very similar to Conium. The latter is a depress- ing remedy, while the former is irritating as well as weakening. You may use Conium in vertigo, when it is the result of cerebral anaemia and when it is characterized by exacerbations on turning over in bed. It is often associated with a numb feeling in the brain, as if that organ was stupefied. Acting as Conium does upon the glandular system, we would ex- pect it to be a scrofulous remedy. It is indicated in scrofulous oph- thalmia; a characteristic symptom calling for it in this trouble, being intense photophobia disproportionately severe to the degree of inflam- mation present. In addition to this there are ciliary neuralgia and prosopalgia, usually on one side, and worse from cold, under the influ- ence of which the cheek becomes of a dark red color and swells. Conium affects the wax in the ears, increasing it in quantity and making it a dark color, something like chewed-up paper. The proper treatment in these cases is to remove the accumulation of wax by careful syringing, and then give Conium to prevent its for- mation anew. Conium does not act very prominently on the chest. We find it useful in consumptives when they find it impossible to expectorate the sputum; they must swallow it again. It is especially useful for tor- menting day cough. Conium weakens the heart, causing the pulse to be one moment full and regular and the next soft, weak, and irregular. This symp- tom is not an uncommon indication for Conium in aged people. The use of Conium in glandular diseases and in malignant forms of tumors comes from its power of producing enlargement of the glands, adenomata. The glands affected are of a stony hardness. These in- durations are quite common in the mammae, in the testicles, and in the uterus. Usually, there is little or no pain; although, sometimes, there may be darting pains. Conium is indicated, perhaps, in the be- ginning of scirrhus. It is also indicated after contusions or bruises when induration is the result. 418 A CLINICAL MATERIA MEDICA. There is an inflammation of Conium which closely simulates that of malignant disease. In the mouth it gives us a picture of noma; the tongue and mucous surfaces are swollen, with offensive discharge; the parts have an ashy, grayish hue, and may even be gangrenous. There is great difficulty in swallowing, with spasm of the throat. In cancer of the stomach, there is vomiting of blood, and of a gray- ish-black substance which is made up of decomposed blood and broken- down gangrenous tissue. Conium is complementary to Nux vomica in constipation, especially when there is faint feeling after stool. Ammoniacum gummi is a gum obtained from a very large tree growing in Arabia. It has gained quite a reputation as a cure for diseases of the eye. I have used it successfully in asthenopia, when the eyes smart and burn, especially if used at night by artificial light. The eyes become injected, and often throb, especially in the inner can- thus of each eye. It thus stands between Belladonna, which is used for affections of the eyes from overwork when there is great congestion, and Ruta, which is indicated for irritability of every tissue of the eye from overwork or from using the eyes on fine work. Asafoetida is a gum having a decided odor of an alliaceous kind. It is especially useful in two classes of disease: First, in nervous dis- eases developing a perfect type of hysteria; it acts upon the muscular fibres, producing a reverse peristaltic action in the oesophagus and in- testines. Thus, it causes a sensation as though a ball started in the stomach and rose into the throat; this being provoked by over-eating, by motion, or by anything that can excite the nerves. It produces a bursting feeling, upwards, as though everything in the abdomen was coming out at the mouth. This is common in colic from hysteria, after belching of wind of a strong rancid taste, and is associated with an empty gone feeling in the stomach at 11 a.m. The second action of Asafoetida is upon the bones. It produces periosteal inflammations, resulting in ulcers, especially upon the shin bones. A characteristic of these ulcers is an intolerance of all dress- ings. All the parts around it wince under the application of even charpie. We find Asafoetida curing hysteria arising from the sudden suppres- sion of discharges. Asafoetida produces inflammations of the eye. Thus it may be in- dicated in iritis after the abuse of mercury, especially when it is of syphilitic origin, with burning, throbbing pains, and soreness of the THE UMBELLIFER^E. 419 bones around the eyes. The nearest remedy here is Aurum, which has relief by warmth. Asafoetida has relief from pressure on the eye- ball itself, which Aurum has not. Phellandrium aquaticum we find to be indicated in headache which involves the nerves going to the eye. There is a crushing feeling on the top of the head, with burning of the eyes and lachrymation. Phellandrium also causes sharp pains in the course of the lactiferous tubes. Petroselinum comes into use in urethral disease, especially in gonor- rhoea, when the inflammation has travelled back, and the patient com- plains of pain at the root of the penis. There is a sudden irresistible desire to urinate. Conium causes chronic cystitis, with intermittent urination. The urine flows and stops. That symptom of the drug I have utilized in the treatment of enlargement of the prostate in old people. Aethusa cynapium is a frightful poison, having narcotic properties as well as paralyzing effects. The principal use we make of the drug arises from its action on the stomach. It produces a deathly nausea and sickness, with vomiting. In the case of a child the vomit consists of curdled milk, which is often green. After vomiting, the child falls back exhausted and goes to sleep. It awakens hungry, it eats and then vomits. The face is pale, and there are dark rings about the eyes. The analogue here is Antimonium crudum, which differs from ^Ethusa in having a white-coated tongue. Another remedy is Calcarea ostrearum or Calcaria acetica, which has vomiting of curdled milk, and the child is apt to have diarrhoea with sour-smelling stools. Cicuta virosa, another member of the order, when taken in any quan- tity produces congestion at the base of the brain and in the medulla oblongata. At first, the patient is rigid, with fixed staring eyes, bluish face and frothing at the mouth. Next, there passes a shock, or series of shocks, from the head through the body. The patient is often un- conscious, the jaws are locked, the patient bites the tongue. These spas- modic symptoms are followed by profound exhaustion. These symp- toms indicate Cicuta in epilepsy, spasms from worms, and also in some forms of puerperal spasms. We notice, too, that Cicuta, in addition to these symptoms, de- velops phenomena which resemble the remote effects of concussion of the brain. The pupils are dilated; there are also vertigo and head- ache. Cicuta also attacks the skin, producing a pustular eruption, with 420 A CLINICAL MATERIA MEDICA. yellowish honey-colored scabs, particularly about the mouth, and matting the whiskers. It has even cured two cases of epithelioma when the cancerous growth was covered by these honey-colored scabs. Next, .we will study the Berberidace^. Of this order we have time to study but two drugs, namely, Berberis vulgaris and Podophyllum peltalum. Berberis Vulgaris. Berberis vulgaris belongs to the order Berberidacece, along with Caulophyllum and Podophyllum. It contains an alkaloid called Ber- berina, which, by the way, is also found in Hydrastis Canadensis. Some chemists have even asserted that what is sold as Muriate of Hydrastine is not Hydrastine at all, but Muriate of Berberine. This Berberine, when given in large doses to animals, produces restlessness, convulsive trembling, thirst, diarrhoea and, finally, paralysis of the posterior extremities. Man is far less readily poisoned by it than are the lower animals. Berberis vulgaris acts more on the kidneys and bladder than on any other parts of the body ; next to these the liver, and, lastly, on the mucous membranes. It also affects the vital powers and damages nutrition, as shown by the sunken face and excessive prostration. First of all we will consider the kidney symptoms as the most im- portant. Just as I would say that I would recommend Digitalis for several diseases when the heart symptoms decided for it, so would I recommend Berberis in certain affections, peritonitis, metritis, etc., when the Berberis kidney symptoms predominated. We find in the renal regions sticking, digging, tearing pains, worse from deep pressure, for they are evidently in the kidneys themselves. These tearing pains extend down the back and into the pelvis along the course of the ureters. There is a sort of tensive, pressive pain across the small of the back ; the back feels stiff and numb ; pains of a sticking or tearing character radiate from the kidneys down into the small of the back. Another symptom which seems to be peculiar to Berberis is a bubbling feeling as if water were coming up through the skin. It is a peculiar symptom, and one that may point very strongly to Berberis as the remedy. Coming next to the bladder, we find very marked here cutting in the BERBERIS. 421 bladder, extending down the urethra, burning pain even after urinat- ing. The urine itself presents marked characteristics. We find it yellow, turbid and flocculent. Sometimes the sediment is whitish, later becoming red and mealy. With these urinary symptoms are the tearing pains just mentioned. Now, whenever you have these renal and vesical symptoms, you must think of Berberis, whether the trouble be inflammation of the uterus, of the bowels, of the peritoneum, or of any other part of the body. The face is usually expressive of deep- seated disease, being sunken and worn looking. General prostration is great. Sometimes the same condition obtains in liver affections. You find very characteristically sticking pain under the border of the false ribs on the right side. These pains seem to shoot from the hepatic region down through the abdomen. These symptoms may be indica- tive of the presence of gall-stones. The stools of Berberis are accompanied by violent burning in the anus, as if the surrounding parts were sore; frequent or constant de- sire for stool. These symptoms have suggested the use of Berberis in fistula of the anus. You may also use Berberis in complaints of females, when the leu- corrhcea or menstrual difficulty is associated with the peculiar urinary symptoms of the drug. Berberis is to be studied alongside of Pareira brava. The difference between the two drugs is this: In the latter drug the pains go tearing down the thighs, while in the former they seldom go further than the hips. When a fistula in ano has been operated on and other affections follow, Calcarea phos. is the remedy. We may also use Berberis in diseases of the joints, when there are these tearing and burning pains and this bubbling sensation. It is also a very useful drug in rheumatism or gout, when characteristic urinary symptoms are present. This places it by the side of Lithium carb., Benzoic acid, Calcarea ostrearum and Lycopodium. Benzoic acid is useful in gout and in rheumatism with urinary symptoms, when the urine smells very strong, the odor of the urine being compared with that of the horse. Calcarea ostrearum has very offensive urine, with a white instead of a turbid deposit. Lycopodium is useful in rheumatism or gout when the urine con- tains a lithic acid deposit. 422 A CLINICAL MATERIA MEDICA. Podophyllum Peltatum. Podophyllum peltatum is the mandrake or May-apple; it also is a member of the order Berberidaceae. It is a plant that grows to the height of some two or three feet, with leaves spread out like an open hand. It is found mostly on the borders of woods. The parts used in medicine are the roots and the fruit of the plant. When applied externally, Podophyllum produces a rawness of the skin, resembling intertrigo. If the powdered plant gets into the eyes it produces an inflammation of the eyes, and even a perforating ulcer of the cornea. The central point of attack of the drug, however, is in the abdomen. Shortly after it is taken there follow diarrhoea, colicky pains, the well- known morning stool pouring out like water from a hydrant, pre- ceded by retching and vomiting, spasmodic contraction of the stomach making the child scream out; diarrhoea which makes us think of Sul- phur, Dioscorea, Bryonia, Natrum sulph., and a few other remedies. In addition to its intestinal action we find it acting on the liver, and here is the main use that is made of the remedy. In the torpid or chronically congested liver, it is indicated. The liver is swollen and sensitive, and friction over the right hypochondrium relieves this sensation. The face and sclerotica become tinged yellow. There is bad taste in the mouth, evidently arising from the degeneration of food in the intestinal tract. The tongue is coated yellow or white, and takes the imprint of the teeth. The bile may become inspissated in the gall bladder, forming gall-stones; thus we find Podophyllum in- dicated in' that tormenting disease, bilious colic. The stools are as already mentioned; or they are constipated and clay-colored, showing the absence of bile. These symptoms of Podophyllum much resemble those of Mercurius. They have won for the drug the name of vege- table mercury. It is much less injurious, however, than is mercury. Of the remedies producing the symptom, the tongue takes the im- print of the teeth, Mercurius stands at the head of the list. Next to that we have Podophyllum, and then Yucca filamentosa, and, finally, Rhus, Stramonium and Arsenicum metallicum. Podophyllum also produces prolapsus recti with the diarrhoea. The rectum protrudes with each stool, especially in the morning. Podo- phyllum also seems to have the power of producing and curing pro- lapsus of the uterus with the attendant symptoms of bearing down with numbness in the left ovary, extending down the thigh, backache, and often coexisting with these, prolapsus recti. It SPIGELIA. 423 As concordant remedies to Podophyllum in this prolapsus we have Nux vomica and Sepia. Podophyllum is a valuable remedy during dentition. It does not seem to act on the brain, yet it causes reflex cerebral irritation, whether this be from the abdominal symptoms alone or from the teeth. The symptoms which indicate it in addition to the gastric symptoms, are moaning and whining during sleep (not crying out with a sharp, sudden noise, as under Belladonna, but a sick cry); the child grates its teeth ; the head is thrown back and rolled from side to side. Next we find Podophyllum indicated in fevers, usually of a remittent type, particularly in bilious remittent fever. During the chill the drug does not produce many characteristic symptoms; but during the fever the patient is sleepy and sometimes delirious. For the remainder of the hour I will speak of a drug which is not botanically related to either of the drugs I have been speaking of, and that is Spigelia. Spigelia Anthelmintics. Spigelia is a member of the order Loganiaceae. To understand it as a remedy is not a difficult thing to do, if we start with the idea that it acts on the nerves as a neuralgic remedy, having as a grand char- acteristic, neuralgia. Associated with these neuralgic symptoms we almost always find symptoms sympathetic from the head, whether these be neuralgic or not. Mentally, we find the patient exhibiting fear, anxiety, forebodings, as though something was about to happen. This is a very common symptom with nervous neuralgic men and women, especially those whose nerves are very much weakened. Another symptom which sometimes appears is fearfulness of pointed things; for instance, the patient is afraid of pins. . There is often, also, praecordial anguish. The neuralgia itself, if it involve the head, begins in the occiput and comes forward and settles over the left eye. It may also involve the cheeks, especially the left. It also has burning, jerking, tearing pains, worse from any noise or from any jarring of the body. They are usually worse, too, in change of weather, especially in stormy weather. At the acme of the pain there is usually bilious vomiting. The period of exacerbation is quite marked. The pain begins in the morning with the sun, increases during the day, and diminishes toward evening. 424 a clinical materia medica. We often find Spigelia indicated in sick-headache when the patient can bear neither noise nor jarring of the body. Spigelia is our mainstay in ciliary neuralgia. This may be in either eye, more frequently, however, in the left. The eye symptoms are the following: There may be photophobia from slight retinitis; sharp stabbing pains in the eye, or radiating from the eye. The supra- orbital region is tender to touch. The eye-ball feels swollen as if too large for the orbit. Associated with these symptoms are lachrymation and coryza. Three remedies are here to be compared with Spigelia. The first of them is Mezereum. This is useful in ciliary neuralgia. The pains radiate and shoot downward. There is a cold feeling in the eye as though a stream of cold air was blowing on the eye. It is especially indicated when the bones are involved, especially after the abuse of mercury. Another remedy is Thuja. This is useful in ciliary neuralgia. Like Mezereum, it has cold feeling in the eye, but the pains take the oppo- site direction, they go upward and backward. Still another remedy to be thought of is Cedron. Spigelia is a valuable heart remedy. It is to be thought of when there are sharp stitching pains referred to the left chest, and shooting into the arm and neck; when, on placing the hand over the heart, there is a peculiar purring feeling. The patient is worse from the slightest motion of hands or arms. He cannot lie down. The pulse is not synchronous with the heart. Spigelia may be used in worms. It causes the following symptoms: Strabismus from abdominal irritation, jerking over the eyes,.paleness of the face, with blue rings around the eyes. The patient feels faint and nauseated on awaking in the morning when there is hunger, which is relieved by breakfast; colic worse about the navel; stool consisting of mucus, faeces and worms. LECTURE XLIII. MINERAL KINGDOM. I propose now to begin the study of the drugs obtained from the mineral kingdom. I have placed on the board (see next page) for your study the elements, with some of their relations, just as we find them in chemistry. They have not been arranged thus to suit the materia medica. This is not an absolute arrangement which cannot be altered without destroying its correctness. I wish to explain here the general idea of the relation of drugs, and especially of those belonging to the mineral kingdom. If you consult chemistry you will find that the elements hold to each other an electrical relation. They hold to each other a relation of polarity as positive electric and negative electric. Certain of these elements are emphatically negative, and others are just as positively positive. Some of the elements, as gold, silver, etc., hold a middle relation, being rather neutral. These I have placed at the neutral point of the magnet. The advantage of this method of study will be seen as we proceed. The negative electrics are known to be conductors of light, the positive conductors of heat. The ex- treme effects in this respect are noticed at either pole, diminishing as we approach the curve of the magnet. Another fact which is well worth knowing, is this general statement: The electro-negatives act on the bowels in the morning, and the chest in the afternoon ; that is, they act upward on the body during the day. Exactly the opposite holds true with the electro-positive. These act on the chest in the morning, and on the bowels in the latter part of the day. Most of you are acquainted with the morning diarrhoea of Sulphur, which hurries the patient out of bed. You know how the asthma of that remedy increases in the afternoon. Taking the remedies at the other extreme, we have the Kali salts as examples; you know that they have aggra- vation of their chest symptoms in the forenoon, and of their bowel symptoms in the afternoon. This is, of course, a very general state- ment, but it may be of great use to you in enabling you to differentiate between drugs. Let me illustrate. You have a case of scrofula and you are obliged to decide between Sulphur and some salt of lime. You will be astonished to see how similar are many of the symptoms of these two drugs. The very fact of the diarrhoea coming in the morn- 28 426 A CLINICAL MATERIA MEDICA. Electro—. Oxygen. Ozone. Nitric ac. Amyl nitr. Sulphur. Selenium. Sulph. ac. Carboneum sulph. Fluoric ac. Iodine. Spongia. Bromine. Chlorine. Muriatic ac. Cyanogen. Carbo veg. Carbo an. Graphites. Petroleum. Cosmoline. Silicea. Phosphorus. Phosphoric ac. Arsenicum alb. Arsenicum iod. Tellurium. Antimon. crud. Antimon. tart. Aurum. Argentum. Mercury. Thallium. Cuprum. Platina. Palladium. Electro +. Antozone. Hydrogen. Ammonium. Kalium. Natrum. Lithium. Calcarea. Baryta carb. Strontia carb. Zincum. Magnesium. Cadmium. Alumina. Plumbum. Stannum. Ferrum. Manganum. Niccolum. Kobaltum. Iridium. Indium. Rhodium. Osmium. MINERAL KINGDOM. 427 ing or afternoon, insignificant as it may appear under other circum- stances, acts as a symptom of differentiation between these two drugs. Now in making this statement I do not mean that because Sulphur produces a morning diarrhoea, that it must always be the remedy when that symptom is presented; but I do mean that when you are com- pelled to decide between two remedies having opposite directions in action, this relation becomes of great importance. As you approach these remedies or chemicals at the neutral point of the magnet, you find these effects less and less marked, until, finally, they are unnotice- able. There is another fact which we may learn from this arrangement of drugs. You notice that here we have oxygen and sulphur. They are chemical elements, which are placed near together in chemistry, and are similar not only as chemicals but also as medicines. Next on the list we have nitrogen, which is used in medicine in the form of Nitric acid. Below this we have a list of remedies which constitute a group in chemistry known as the halogens; they consist of Fluorine, Fluoric acid, Iodine, Bromine, and Spongia. The latter drug is placed here not as a chemical substance, but as a drug which owes its medi- cinal properties to the iodine and bromine which it contains. It is of practical value to remember these drugs in this connection, because they are not only chemically similar, but they are also similar as medicines. Moreover, this grouping of remedies enables you to keep in mind a group of remedies from which you may choose one to suit your case. I have introduced cyanogen here because it holds impor- tant chemical and medicinal relations to the halogens. Below we have the carbon group, Carbo veg., Carbo animalis, Anthrakokali, the dia- mond, and Graphites. I have also placed in this group Petroleum and Cosmoline, two oily substances, rich in carbon, and having many resemblances to the pure carbons. You will find in a future lecture, that I can show you characteristics which belong to all the carbons. You will say that here is a patient who needs some preparation of carbon, which shall it be? This you determine in the'same way as you selected one of the halogens. Next we have a group composed of Phosphorus and its acid and Arsenicum. Below, we have Tellurium, Antimonium crudum and Antimonium tartaricum, which is similar enough to the sulphide to be placed along side of it. This group of drugs possesses many similarities. Phos- phorus and Arsenic are continually in the physician's mind placed in contrast, and it is often difficult for him to decide which he shall give. 428 A CLINICAL MATERIA MEDICA. The Antimony preparations are similar in form and isomorphous with Sulphur and Selenium. There is another fact which we may borrow from chemistry, and that is that substances of similar crystalline struct- ure have similar medicinal effects. These substances often replace each other in chemistry. I give you these facts so that you may have a rational conception of drugs, not as mere individuals, but as consis- tent with nature and with themselves. Here below we have the noble metals, gold and silver. Then we may go up on this side tracing the drugs through the same relation we did on the other. Every one knows how closely related, chemically and medicinally, are Barium and Strontium. This relation is very much like that of similarity in origin. They are not apt to follow one another well. Here are Sul- phur and Sulphuric acid; suppose you are going to decide between them and suppose it to be a perplexing case. You say "I will give Sulphur, and if he is not better to-morrow I will give Sulphuric acid." That is bad practice. It would be much better to say that I will give Sulphur to-day and Calcarea to-morrow. Why? They are similar drugs but entirely foreign in their family relations. Why do I dwell on these two relations? Because I want you to distinguish between that which is the same and that which is similar. Ignatia and Nux vomica are too much as though they were the same thing. Ignatia and Zinc are concordant remedies which are similar but which are not identical. You note that I have placed hydrogen above all the potash salts. You notice that here is placed antozone. Ozone is negative oxygen, and antozone is positive oxygen. Ozone exists in the sea-air and how many times do you send your patients to the sea-shore for relief. We may derive a hygienic fact from this statement; if I have a patient who is something of a Sulphur patient, I would think that sea-air would do him good because sea-air is rich in ozone, and ozone in a general way suits his condition. On the other hand, if he belongs more to the "salt" class of drugs I would not send him to the sea- shore. I would send him where antozone exists, as in fogs. We will now proceed to study the drugs derived from the mineral kingdom. The remainder of the hour I will devote to the consideration of Sele- nium. To-morrow we will study that king of remedies, Sulphur. Selenium. Arum tri. Selenium. <( Caust., Carbo v., Phos., Spong. I Sulphur. Ign. >Puls. SELENIUM. 429 Selenium is isomorphous with Sulphur and resembles it both chemi- cally and medicinally. We find it producing very little effect on the blood and lymphatic vessels, but it acts on the nervous system. We often find it the remedy in nervous diseases. It seems to produce a weakness or general debility involving all parts of the body. This debility is expressed by easy fatigue from any exertion or labor. If the patient sits up a little late at night, or exerts his mind a little too much, he is exhausted the whole of the next day and is thereby un- fitted for either mental or physical work. Particularly is he weakened from hot weather. It is evident that the hot weather weakens him, for the weakness increases with the heat of the body, and he becomes stronger as the sun sinks and the temperature with it. He is sluggish on account of this debility. He wants to sleep from sheer exhaustion, and yet he is always worse after sleep. He cannot bear any nervous exhaustion, consequently he is made worse by seminal emissions, whether voluntary or involuntary. As a result of the seminal loss, there are the next day irritability, mental confusion, headache, almost paralytic weakness of the spine, involuntary escape of prostatic fluid, dribbling of semen during sleep, and after stool and urination. Now you will notice at once the resemblance of the drug to Sulphur. Both have bad effects of mental exhaustion and loss of sleep, and both have involuntary emissions and prostatorrhcea. The distinction lies in the fact that Selenium is worse in the relaxation. Here you find two sub- stances suitable in similar conditions, and yet that shade of difference is sufficient to enable you to know which one is the more useful for your case. Both have impotence. With Sulphur there is more cold- ness and shrivelling of the genital organs. Writh Selenium there is more of this total giving up or relaxation, so that semen escapes invol- untarily and in dribbles. We may be called upon to use Selenium for the sequelae of typhoid fever. When the patient begins to walk about, there is such great debility of the spine that he fears that he will be paralyzed. Again, you see the great similarity between Sulphur and Selenium. Sulphur is invaluable in the exhaustion consequent upon protracted diseases. This again we have in Selenium. Selenium does not have such char- acteristic Sulphur symptoms as flushes of heat on the least motion. Sulphur has more of that gone weak feeling in the forenoon, which is not marked under Selenium. We find Selenium also indicated in headache of nervous origin. The pain is of a stinging character, and is usually situated over the left eye, 430 A CLINICAL MATERIA MEDICA. and it is worse from the heat of the sun. Notice again how hot weather influences the Selenium patient. The headaches return quite periodi- cally every afternoon, and are increased by any strong odor, as the odor of tube-roses, musk, etc. This headache is evidently nervous because it is associated with profound melancholy and profuse flow of clear limpid urine. You often find this last symptom in hysterical patients. Other remedies, however, have it more marked than Se- lenium. Again, another indication of nervousness of this headache is seen in the fact that the patient is worse from drinking tea and from certain acids, notably lemonade. Even tamarind-water aggravates. Here again we have resemblances to the Sulphur, in the periodical return of the headache. With Sulphur, however, it does not return every afternoon but it returns every week ; nor has this remedy the aggra- vation from tea although it has from coffee. You will find both remedies indicated in the headache of drunkards and of those who have been guilty of debauchery. The Sulphur headache is worse from all forms of alcoholic drinks. The Selenium headache is sometimes improved by brandy, as are also the gastric symptoms. You will find that the patient has a longing for brandy. Now this is not the drunkard's craving. It is the result of a peculiar weakness in the stomach, in which there is a feeling as if the patient wanted something to stimulate him, and brandy is desired, as it has a temporary palliating effect. The same symptom you find under Staphisagria and Hepar sulphur, both of which have that great relax- ation and dragging or want of tone in the walls of the stomach and consequent insufficiency in the secretion of gastric juice. Selenium is indicated in a peculiar form of constipation. It comes to us well-recommended, but it failed me in the one case in which I used it. The constipation for which it is indicated is one purely due to atony of the intestinal tract. Peristaltic action is almost nothing, so that faeces become impacted. The faeces are hard and dry from absorption of their moisture, and require removal by artificial means, yet Selenium is said to tone up the rectum and prevent the recurrence of this symptom. The same symptom is found under Alumina, Opium, Plumbum and Bryonia, but these are probably not indicated so often during convalescence. Another peculiarity of Selenium which qualifies its symptoms is the character of the sleep. The patient sleeps in cat-naps. He awakens often in the night, or is easily aroused by any slight disturbance. He SELENIUM. 431 awakens at precisely the same hour every morning before his usual rising time, at which time all his prevailing complaints are worse. Here again it resembles Sulphur. These " cat-naps " are characteristic of Sulphur. The true Sulphur sleeplessness is this: The patient is aroused from sleep and is then wide awake, and is not ready to fall asleep again. He has not this periodical hour of awakening each morning, which calls for Selenium, Another resemblance between the two drugs, you will find in affec- tions of the skin. Selenium is useful in skin diseases, particularly when there is itching in the folds of the skin as between the fingers, and about the joints, particularly the ankle joint. The itching may also occur in small spots and is associated with tingling, here again showing involvement of the nervous system. The hair falls off, both that of the head, the eyebrows and whiskers and other parts of the body. You will find on the scalp an eczematous eruption which oozes a serous fluid after scratching. Here, again, it bears a striking resem- blance to Sulphur, but is distinguished from that remedy if the patient is old enough to describe his case, by this tingling in spots. We sometimes find, although not often, that Selenium, like Sulphur, is indicated in chronic affections of the liver. Especially is it called for in enlargement of the liver with loss of appetite, particularly in the morning; there is white coating on the tongue, thus separating it at once from Sulphur. Then, too, when Sulphur has, loss of appetite, it has increase of thirst, which is lacking in Selenium. There are sharp stitching pains in the hepatic region, worse on any motion and worse on pressure. Sensitiveness of the liver is found and there is a peculiar fine rash over the hepatic region. If that is present, Selenium is the only remedy you can think of to suit your case. Selenium has a very marked action on the larynx and lungs. Sev- eral animals were poisoned with Selenium. It produced inflammation of the lining membrane of the larynx, congestion of the lungs with ex- udation into the pulmonary substance. Post-mortem examination showed the mucous membrane to be congested, with dark purplish spots here and there through it. Oozing of blood and frothy serum followed the incision of the knife. I have used Selenium successfully in the hoarseness of singers, particularly when the hoarseness appears as soon as they begin to sing. It may also be used when hoarseness appears after long use of the voice. There is frequent necessity to clear the throat by reason of the accumulation of clear starchy mucus. These symptoms are very suspicious of incipient tubercular laryngitis. Here 432 A CLINICAL MATERIA MEDICA. Selenium is grouped with Arum triphyllum, Spongia, Causticum, Carbo veg. and Phosphorus. Arum triphyllum has entirely different effects, but it bears a strong symptomatic resemblance to Selenium. It is also useful for the hoarse- ness of singers and orators, but it is especially indicated when the voice suddenly gives out during use. For example, the patient is talking in a sort of monotone when the voice suddenly breaks and goes up to a higher key. The antidotes to Selenium are Pulsatilla and Ignatia. China and wine are inimical to it. The debility caused by Selenium, so says Hahnemann, is very much increased by the use of Cinchona. Now the emaciation caused by Selenium is very similar to that of Cinchona. We have debility and emaciation from loss of animal fluids. That is also found under Cinchona; yet the two drugs are inimical. LECTURE XLIV. SULPHUR. Sulphur. Calc ostr., Aeon., Aloes. C Psorinum. Merc, Nitric, ac, Lach. Nux., Puis., Bry. { Bapt, Arsenicum. Calc. ostr., Lye, Silic, Sepia. Aconite, Bell., Bry. ^ Phos., Ant. t., Ars. >Nux, Puis., Merc. Sulphur is an element with which you are all familiar. You must be careful, if you prepare the medicine yourself, that you obtain it perfectly pure. The sublimed Sulphur that you buy in the shops is very impure. It contains some of the oxygen acids of Sulphur, some Selenium, and often, too, Arsenic. When chemical substances are associated in this way in nature, it is a fact that they must be re- lated medicinally. There is also a relation between the plant and the soil in which it grows. Thus, Belladonna, which grows in lime earths, is related medicinally to Calcarea. The Agaricus will never grow where there is coal. You will find no relation between Agar- icus and the carbons. Cistus Canadensis grows where there is mica, consequently you may expect some relation between that drug and Magnesium. Sulphur may be said to be the central remedy of our materia medica. It has well-defined relations with nearly every drug we use. The great utility of Sulphur arises from this peculiarity, it is our mainstay in defective reaction. Wlien the system refuses to respond to the well- selected remedy, it matters not what the disease may be, whether it is a disease which corresponds characteristically with the symptomatology of Sulphur or not, it will often be the remedy to clear up the case and bring about reaction, and either itself cure the case or pave the way for another drug which will cure. This quality of Sulphur arises from its relation to what Hahnemann called psora. Hahnemann taught what is practically true, that when a disease is suppressed (and a dis- 434 A CLINICAL MATERIA MEDICA. ease is suppressed when it is driven from the surface to the interior of the body), there is formed a constitution or dyscrasia which will after- wards modify every abnormality from which the patient may suffer. For instance, an eruption on the skin is dried up or is driven in by some external application. Afterwards (it may be some time), another disease may appear. Now, this does not come necessarily as a skin affection. Pathologically, it may be entirely different from it. For instance, as the result of exposure to cold, the patient contracts pneu- monia. This suppressed eruption so modifies the disease that it is not curable until that same eruption is reestablished on the skin. Then you will be amazed to see how promptly the remedy that before refused to act now cures the case. Many times has Sulphur restored such sup- pressed diseases, and in this fact lies its wide application in practice. Particularly is it applicable after the suppression of itch. Sulphur is especially adapted to persons of rather light complexion (although dark-complexioned persons may also yield to its influence) who are easily angered. It is one of our mainstays in the treatment of the negro. Whether this is owing to the rapid growth of scrofula in that race or not, I cannot say. It is also suited to persons who are subject to skin affections, particularly to those who have harsh, rough skin, which very readily breaks out with eruptions of various descrip- tions, varying from a simple erythema to a positive eczema. There is apt to be also an offensive odor from the body. This odor may arise partly from uncleanliness, for the typical Sulphur patient is not very fond of water. Bathing aggravates his complaints. There is, more- over, a positive distaste or dislike for water. This peculiar disa- greeable odor or exhalation from the skin is not removed by wash- ing; hence, you must consider it to be an abnormality arising from impure excretions from the skin. The patient is rather of coarse fibre. His hair is harsh and coarse. There is craving for alcoholic drinks, especially those of the coarser type, as beer, ale, whiskey, etc. The patient walks rather stooped from weakness of the spine. Then, too, as I have already said, he fails to react to the apparently indicated remedy. In defective reaction, Sulphur does not stand alone. I have already spoken of the value of Psorinum in this connection. Cuprum should also be thought of. We also have Lauroeerasus in chest affections, particularly in diseases of the lungs which do not respond to treat- ment ; Valerian and Ambra grisea in nervous diseases; and Carbo SULPHUR. 435 veg., particularly in abdominal affections and in the collapse which is marked by cold breath, cold knees, etc. Now, let me speak of the action of Sulphur on the circulation. In almost every instance in which it is the remedy you will find deranged circulation. It seems to act prominently on the venous circulation, producing a sort of plethora. But this is not a true plethora. It is the result of irregularities in the distribution of the blood, by which certain parts of the body become congested. These congestions, gen- erally speaking, are such as occur particularly from abdominal troubles, especially fulness of the portal system, a very common trouble nowa- days. Especially is Sulphur indicated in plethora that has arisen from sudden cessation of an accustomed discharge, particularly a haemor- rhoidal flow. For example, piles have suddenly stopped bleeding, and fulness of the head, with distended bloodvessels, fulness of the liver, etc., show that congestion of these parts has resulted. Sulphur will, in these instances, ease the congestion and restore the accustomed discharge. Then you may proceed with Sulphur or with some other remedy, accord- ing to the indications of the case, to cure this abnormal discharge in the proper way. The congestion of the head, for which Sulphur is indicated, is accompanied by roaring in the ears (hence there is congestion about the auditory nerves), redness of the face, this symptom being worse in the open air and better in the warm room. The head feels heavy and full almost to bursting. The patient feels worse when he stoops. Sulphur is frequently indicated in congestion of the chest with or without haemoptysis There is great difficulty in breathing. The pa- tient feels oppressed and wants all the doors and windows opened. These symptoms are accompanied with violent palpitation of the heart, that organ trying to compensate for the increased supply of blood to the thoracic cavity. If I may be allowed to use the expression, there is too much blood in the heart. The blood rushes into that organ and is not removed by its contractions rapidly enough. This is a very common symptom indicating Sulphur, and especially calls for it when the patient is dis- turbed at night with sudden rush of blood to the heart, with violent palpitation, gasping for breath, feeling as if the patient would suffocate if fresh air is not obtained. These symptoms may also be experienced during the day from ascending a height or from exercise where the heart is called upon to do extra work. Often the patient feels as if the heart was too large for the thoracic cavity. 436 A CLINICAL MATERIA MEDICA. As further evidence of the irregular distribution of the blood in Sul- phur, we have redness of the various orifices of the body. This symp- tom is very characteristic of the remedy. The lips are of a rich red color. This symptom often indicates Sulphur in pneumonia, scarla- tina, dysentery and anaemia. Redness of the ears may be noticed even when the rest of the body is not abnormal in color. With this last indication, Sulphur has often prevented earache in children. With this indication it has often prevented erysipelas. We also find this redness along the borders of the eyelids, giving them an appearance as if they had been painted. We find redness at the anus, with soreness of the part. That symptom is particularly useful in the diarrhoea of children. The child screams with pain when the bowels are moved. That symptom alone may frequently lead you to decide that Sulphur is the remedy. The same symptom is also true of the vulva, which is found to be red. Another and very common expression of the irregularity in the cir- culation is flushes of heat. It is not particularly the flushes of heat that occur at the climacteric for which Sulphur is indicated, but it is the flushes of heat which may occur in any disease and do occur during convalescence. The "flush" is followed by more or less moisture, which gives relief. To be purely characteristic of Sulphur, this is often associated with other symptoms, such, for instance, as sensation of heat on the top of the head. The feei, in such cases, are apt to be cold and the patient complains of weak feeling in the epigastrium, this being especially worse in the forenoon from ten to twelve. While you often cure flushes of heat with Sulphur when this symptom is absent, you never fail if you have this heat on the top of the head, cold feet and sinking feeling in the epigastrium. In the flushes of heat at climaxis you may also think of Lachesis, Sulphuric acid, Nitrite of Amyl and Kali bichromicum. Another illustration of the action of Sulphur on the circulation is shown in the fever of the remedy. Sulphur is not particularly indi- cated in typhoid or septic conditions. There is no indication that Sul- phur makes changes in the structure of the blood such as belong to scarlatina, typhoid fevers and to septic conditions generally, so that from this fact we could not give Sulphur. There are other reasons than the septic changes that enable us to give Sulphur. It is indicated when the fever is of a remittent or continued type. It may be used after Aconite for the pure synochal fever when, despite the use of that remedy, the dry, hot skin remains and there is no reaction or no critical SULPHUR. 437 sweat, which will give the necessary relief. Hour after hour, day after day, this fever continues; hence its name, continuous. Or it may be what has been termed a " continuous remittent;" that is, there is an exacer- bation each evening and a slight fall towards morning, the fever never going away entirely. You may give Sulphur when this fever ap- proaches the typhoid condition, led by these indications: The patient begins to be drowsy with his fever. His tongue is dry and red at the edges and top, and he responds to your questions very sluggishly and slowly. The patient is literally burning up with the fever. The con- sumption of oxygen of the system is producing these symptoms. Sul- phur acts marvellously in these cases. Sulphur may also be indicated in intermittent types of fever. It is not a specific for intermittent or malarial fever, and yet it has periodi- city in its symptoms. Here you must select it from the well-known symptoms, torpor with slowness in answering questions, chills will not stop despite your well-selected remedy, particularly if the intermittent assumes the remittent type, or, more frequently, if the remittent type commences and runs into the intermittent. It may also be called for in malarial neuralgia occurring mostly in the face and recurring quite periodically and resisting other remedies. Here, too, you must remem- ber Cinchona and Arsenicum. In these fevers I would have you place Sulphur alongside of two other remedies. These usually follow Sulphur. In their symptom- atology they suit a more advanced case than does Sulphur. These two remedies are Baptisia and Arsenicum. Baptisia typifies a fever which is decidedly typhoid in its tendency. The case is a decidedly worse one than that calling for Sulphur. The torpor does not stop with this sluggishness in responding to questions, but it goes on to stupor, so that the patient even falls asleep while answering you. The tongue becomes of a brown or blackish hue down its centre and sordes form on the teeth. The discharges from the mouth and from the bov/els have an offensive odor; the face has a besotted look; the blood is actually decomposed from septic poisoning or from the prolonged high temperature. Arsenicum suits inflammatory fever further advanced than that calling for either Sulphur or Aconite. It has some symptoms which remind you of the latter remedy, notably restlessness; full, bounding pulse; hot, dry skin ; anxiety and fear of death ; yet beneath all these symptoms, there is evidence of profound tissue-changes. The inflam- mation is going on to destruction of the parts involved, whether the 438 A CLINICAL MATERIA MEDICA. disease be typhoid fever or a simple inflammatory affection from cold, as in gastric catarrh. The symptoms are aggravated after midnight; there is burning thirst with tendency to drink little and often, or burnino- thirst with refusal to drink water because it aggravates these symptoms, especially the burning like coals of fire in the part affected. With all these symptoms the brain may remain perfectly clear. Next, we come to the consideration of the action of Sulphur on the lymphatic system, including under this head the glands and the ves- sels themselves. Sulphur is our mainstay in scrofula, which is, as you know, an affection involving this lymphatic system. It is the prince of remedies here. It is especially useful in the very commencement of the disease, when its first evidences are presented, particularly in patients having the temperament which I have already described to you as characteristic of the Sulphur patient. The patient sweats about the head, particularly during sleep. There is a marked tendency to eruptions such as crusta-lactea, boils, and, in older children, acne. In the case of children, the head is large in comparison with the rest of the body. The fontanelles, particularly the anterior, remain open too long from defective osseous growth. There is tendency to bone affec- tions, to caries, and particularly, in early childhood, to rickets and to curvatures of the spine. The child has a voracious appetite. This it expresses by greedily clutching at all that is offered it, whether edible or not, as if it were starved to death. There is defective assimilation. Glands are so diseased that, while sufficient food is taken into the sys- tem, it is not appropriated to the nourishment of the body, so that the child is always hungry and yet emaciated. The child looks shrivelled and dried up, like a little old man ; the skin hangs in folds and is rather yellowish, wrinkled and flabby. All these are precious symp- toms for the exhibition of Sulphur. You may occasionally have to use Sulphur in the beginning in a sort of negative condition. You are certain from a majority of symptoms that you have a case of scrof- ula, and yet no particular remedy appears to be indicated. Then you should give Sulphur, which develops the symptoms and shows you what you have to contend with. In marasmus of children you may give Sulphur when many of the symptoms already mentioned are present. The child is ravenously hungry, especially at 11 a.m. Now, in regard to this eleven-o'clock hunger, I would say that if you want to use Sulphur successfully in these cases, you must also have these symptoms present: Hunger at 11 a.m., heat on top of the head and cold feet. If you have these three SULPHUR. 439 symptoms present, Sulphur never fails you. If there is heat on the top of the head alone, you must think of Calcarea or Phosphorus. Another affection of which I wish to speak under the head of the lymphatic system is tuberculosis, not that I wish to say that scrofula and tuberculosis are identical, but that the lymphatic vessels have con- siderable to do with the spread of tubercle. Sulphur is a valuable drug in tuberculosis, no matter what part of the body it may invade. It is especially useful in tubercular hydrocephalus. Here it has done good work, not in the third stage, when the case is nearly hopeless, but in the commencement of the pathological process, when there are vio- lent convulsions, sudden flushing of the face; the child cannot hold its head up from weakness of the cervical muscles. The child wants to lie with its head low. That symptom expresses a great deal, because, when the head is low, there is less effort of the neck required to hold the head up. The child cries out in its sleep. Often, on fall- ing off to sleep, there is sudden jerking of one or both legs. It cries out in sleep as if frightened. The face is red and the pupils are dilated. This is not a case for Belladonna. Belladonna cannot, never did, and never will cure tubercular meningitis. The symptoms tend to appear more or less periodically. Associated with these few cerebral symp- toms you will have very many general symptoms, some of which I have already mentioned, and some of which will be. When I give you these symptoms in different groups, I do not wish to convey the idea that these symptoms indicate the drug only when they occur in their respective groups. In tuberculosis affecting the lungs, Sulphur is indicated only in the beginning. I would here caution you as to how you use the drug. If carelessly or wrongly given, it may precipitate the disease which it was your desire to cure. You must not repeat your doses too frequently, and you must never give it unless you are certain that it is the remedy, for the tendency of Sulphur is to arouse whatever lies dormant in the system. The particular indications for Sulphur are these: The body feels too hot. The patient wants the windows open, no matter how cold the weather may be. There are frequent flushes of heat, empty feeling in the stomach, heat on top of the head, cold feet, etc., palpita- tion of the heart on ascending, pain through the left chest from the nipple to the back. Now you may, in this condition, give Sulphur as high as you choose, one, two or three doses, and await results. Watch your patient carefully, and in many instances a cure will result, but not in all. 440 A CLINICAL MATERIA MEDICA. In tuberculosis affecting the mesenteric glands, Sulphur is indicated by the symptoms that I have already mentioned under emaciation and scrofula. You may also find Sulphur indicated in hip-joint disease, and in white swelling, both of which are probably of tubercular origin. You will be aided in your selection of the drug by the general symp- toms. In these tubercular troubles you may compare with Sulphur Calcarea ostrearum and Phosphorus. Both of these remedies are suited to scrofu- lous children, generally after Sulphur. They are indicated more by the general character of the patient than by the brain symptoms alone. All three remedies, as you know, have the same imperfect growth of tissue. The Sulphur patient is apt to be thinner than the one of Calcarea ostrearum, but Calcarea especially suits a fat, flabby, apparently well- nourished child; the paleness and the softness of flesh show you that the growth of fat has been obtained at the expense of other tissues. The sweat of the Sulphur patient has an offensive odor; with Calcarea the sweat is on the scalp, and is cool. Calcarea phosphorica gives you these symptoms : There is tendency to emaciation rather than obesity; the abdomen may be large, but is more apt to be flabby; the fontanelles, especially the posterior, remain open too long. Still another remedy is Apis. You know that Apis is one of the best remedies in tubercular meningitis. It is very similar to Sulphur. Both remedies are indicated in cerebral symptoms arising from the repercussion of some.eruption—Sulphur, if it is a chronic eruption, and Apis, if it is an acute one. Even here they collide. The best distinction to make is this: Apis is indicated when there is well- marked effusion on the brain; the patient cries with a piercing shriek. Then, again, the restlessness of the two remedies ought to be com- pared. With Sulphur, the patient does not sleep at all, or it starts up from sleep suddenly, or sleeps in cat-naps. In Apis, we have this picture: The child is sleepy; it suddenly awakes from sleep with a shrill cry; it may be wholly or partly conscious; it is sleepy, but cannot sleep. Sulphur acts as powerfully on the nervous system as it does on the circulation. It affects the brain, producing first some alterations in the functions of that organ. For instance, it may be useful in hysterical states, when the general symptoms of Sulphur are present; when the patient has the insane idea that she is very wealthy; she tears up her SULPHUR. 441 clothes regardless of the consequences; she plays with and examines old soiled rags with pleasure, evidently regarding them as objects of beauty. At other times there is profound melancholy, with disposition to do nothing at all; she is perfectly listless. This is not the indifference of Phosphoric acid, but the listlessness or torpidity that is very com- mon in hypochondriasis. At other times the patient is affected with a religious mania; even this mania is remarkably egotistic; the patient fears that she will not be saved ; there is anxiety about one's own soub with perfect indifference concerning the salvation of others. At other times the patient is intolerably irritable and peevish ; this is particu- larly true with children. Again, Sulphur may be indicated in hydrocephaloid. I have tested it fully in this condition, and know it to be invaluable. The hydro- cephaloid comes in during the course of cholera infantum. The little patient lies almost in a stupor. The face is pale, and bathed in a cold sweat, particularly the forehead. Do not mix the case up with Vera- trum. The eyes are half-open, and you find the pupil reacting very sluggishly to light; the urine is suppressed (a very alarming symp- tom); the child occasionally twitches or jerks one or the other limb, and may now and then start up from sleep with a cry. That is a con- dition in which you will find Sulphur to act like a charm, and that, whether the diarrhoea continues or not. There is no remedy which can take its place. There is not in the case the violent rolling of the head, the suffused face, or the crying out of Belladonna, nor is there the cri encephalique belonging to Apis, but there is a group of symp- toms peculiar to Sulphur. Sulphur acts on the spine, producing several conditions there; first of all, it is useful in spinal irritation. On pressing between the ver- tebra, you notice how the patient winces. Sulphur may also be used in spinal congestion, when the trouble results from suppression of the menses, or, still more particularly, from the suppression of a haemor- rhoidal flow. The back is so sensitive that any sudden jarring of the body causes sharp pains along the spine; there is dry heat, particu- larly in the small of the back, and this is often associated with cold feet. We also find it indicated in paraplegia, or paralysis of both legs. Sulphur has produced this, and it can cure it. I do not think that Sulphur is well indicated in far-advanced cases resulting from either sclerosis or softening of the cord, or from chronic inflammation of its meninges; but it has done good work in paralysis of both legs, with 29 442 A CLINICAL MATERIA MEDICA. total retention of urine, and numbness extending up to the umbilicus. When the urine is drawn by the catheter it is found to be turbid and highly offensive. Now Sulphur must be given persistently in these cases. I must say that it will not always cure, for many cases are in- curable, but it will cure some cases in which the central cause of the trouble is not so chronic, and in which the alterations in the structure of the cord are not so profound but that they can be removed. General weakness of the spine, not classed under any particular name, has been sometimes cured by Sulphur. The patient has the characteristic stooped appearance of Sulphur. The chest feels empty and weak; it tires him to talk ; there is weakness in the epigastrium during the forenoon. We may also use Sulphur when these symptoms occur during convalescence from various acute diseases. We next have to speak of the action of Sulphur on the muscles, ligaments, tendons and joints. Sulphur is indicated in acute and chronic rheumatism, particularly the latter, when the inflammatory swellings seem to ascend; that is, they begin in the feet and extend up the body. The pains are worse in bed, and at night. The patient uncovers on account of burning heat of the feet. Especially do we find Sulphur useful during the course of acute inflammatory rheuma- tism for that annoying symptom, jerking of the limbs on falling off to sleep. We may also use it in synovitis, particularly after exudation has taken place. Sulphur here produces absorption, and very rapidly, too, particularly in the knee. We come next to study the action of Sulphur on the serous mem- branes. I have already spoken of its use in tubercular meningitis, so I now speak of its action on the pleura. We find Sulphur indicated in pleurisy, particularly when you have that sharp stitching pain through the left lung to the back, worse lying on the back, and worse from the least motion. It is also useful in cases that refuse to respond to the well-chosen remedy, particularly when there is well-marked pleuritic effusion. Apis is also to be thought of in this condition. In peritonitis Sulphur is indicated more by the general symptoms than by those directly referable to the affected part itself. We next come to the action of Sulphur on the mucous membranes. Here we will consider its use in catarrhs and pneumonia. AVe find Sulphur indicated first of all in conjunctivitis. It is especially useful when the trouble has resulted from a foreign body in the eye, particu- larly after Aconite fails. It is also useful iu scrofulous inflammations SULPHUR. 443 of the eye, especially with the characteristic tendency of this remedy to congestion. The eyes are red and injected, and there is a feeling as of a splinter of glass in the eye. The inflammation is worse in hot weather. During the winter the child is comparatively free from trouble. This symptom then is due to the relaxing influence of heat. The child is worse when near a hot stove. With the above symptoms to guide us, we may also use Sulphur in keratitis. In nasal catarrh or coryza we find sulphur indicated in those who are subject to catarrhs, especially chronic catarrh, when scabs form in the nasal cavity, the nose bleeds readily, and is swollen, the alae espe- cially are red and scabby, this redness at the outlet of the nose being quite consistent with the Sulphur condition. The nose is " stuffed up " while in doors, but when the patient is out in the open air, breath- ing is unobstructed. Coming next to the throat and lungs, we find Sulphur indicated in laryngitis and also in bronchial catarrh. Hoarseness is present,, and this makes the voice very deep, a sort of basso profundo. In other cases there is aphonia, which is worse in the morning. The more chronic the case the more is Sulphur indicated. In bronchitis, especially chronic bronchitis, Sulphur is indicated when there seems to be an enormous and persistent accumulation of thick muco-pus. The patient suffers from spells of suffocation, with palpitation of the heart. He must have the windows open. The cough is worse when he is lying in a horizontal position, and may then be so violent as to cause nausea and vomiting. Sulphur may sometimes prevent pneumonia by relieving the lungs of that hyperae- mia which necessarily precedes the deposit of plastic matter. If in the very beginning you give Sulphur you will prevent the disease, providing, of course, that remedy is indicated. If you are too late to prevent it you may still use Sulphur when exudation has commenced, that is, in the beginning of the stage of solidification. Even then it may modify the course of the disease. Again, you may give it in torpid cases to bring about a reaction when resolution will not take place rapidly enough, and you fear that there will be formation of tubercles. You may also use it in pneumonia with typhoid tendency, with slow- ness of speech, dry tongue, etc., and also at the later stage of pneu- monia when the lungs refuse to return to their normal condition and you fear the breaking down of lung tissue. You hear all sorts of rales. Expectoration is muco-purulent, the patient has hectic type of fever, loses flesh, etc. Sulphur will save the patient. But you should 444 A CLINICAL MATERIA MEDICA. not give it after tubercles have formed. The proper remedy then is Lachesis. Sulphur is indicated only in the early stages of phthisis. It is seldom indicated in the advanced stages. But in the very incip- iency, when you have an increase of blood in the chest, beginning dul- ness on percussion in the apex of either lung, diminished respiratory movement in the upper portion of the chest, Sulphur will, by equal- izing the circulation, cure the case. In affections of the bowels we find Sulphur a very useful remedy. You may give it in diarrhoea when these characteristic symptoms are present: The stool changes frequently in color; at one time it is yel- low, at another slimy, and at another watery. It may contain undi- gested food, especially in the case of scrofulous children. It is par- ticularly worse in the morning, driving the patient out of bed. You may also use it in dysentery, particularly after the tenesmus has ceased, and mucus and blood are still being discharged. Respecting this early morning diarrhoea of Sulphur, it is necessary that you dis- tinguish several other remedies from it. In the first place, Bryonia, which is useful for early morning diar- rhoea, which comes on as soon as the patient begins to move about. Natrum sulphuricum is similar to Sulphur, and often requires to be used in scrofulous cases. That also has diarrhoea in the morning after getting up and moving about, but the stool is associated with a great deal of flatus. Another remedy is Rumex crispus, which has exactly the same symptom as Sulphur, early morning diarrhoea, hurrying the patient out of bed. But it is indicated after catarrhs, with the characteristic cough of Rumex. Still another remedy that is confused with Sulphur is Podophyllum. This has early morning diarrhoea, hurrying the patient out of bed. Like Sulphur, the stools are of a changeable color. It differs from Sulphur in that the diarrhoea continues through the whole day, although worse at noon. Then, too, with Sulphur, you will almost always find the tendency to soreness and rawness of the anus. Phosphorus has morning diarrhoea, with green, painless stool. Dioscorea also has morning diarrhoea, but it is associated with grip- ing, colicky pains, pretty much of the same character as those calling for Colocynth, but they are apt to fly off to other parts of the body. I wish now to say a few words about the skin symptoms of Sul- phur. I have referred to them already in brief, so that I am only supplementing what has already been given to you. You will remem- SULPHUR. 445 ber that the skin is apt to be harsh, rough, coarse, and measly in the genuine Sulphur patient. There is very little tendency to perspira- tion, or if there is perspiration, it is only partial, and then offensive, sour, or musty. There is tendency to the formation of acne, princi- pally on the face. Pustules form here and there over the body, which heal very slowly, indeed. Freckles are spread plentifully over the face, hands, and arms. There is also a tendency to intertrigo; sore- ness and rawness appear wherever there is a fold of skin, in the groin, mammae, or axillae, or in the folds of the neck. We find Sulphur indicated in that affection known as itch. Now, Hahnemann was the author of the theory that if itch was suppressed by external salves, as by sulphur ointment, that there will appear in consequence many other diseases. He cited hundreds of cases to prove his assertions. Some years after this announcement a Corsican found the little sarcoptis homines burrowing beneath the skin and laying its eggs in these burrows. He showed this to be the cause of the itch, and then thought he had effected the complete destruction of the psora theory. But there is another side of the story. A man who is a victim of the "itch" goes along the street and meets two friends, A. and B., with both of whom he shakes hands, and A. contracts the disease while B. escapes. Now, there must be a difference in the constitutions of these individuals, or they both would have taken the itch or both escaped it, for they were both exposed to the same extraneous influences. A.'s system must have been unsound or he could not have taken it, for the itch insect cannot find a suitable dwelling-place in a healthy organiza- tion. So, after all, the Corsican's discovery did not overthrow Hahne- mann's psoric theory. The term psora is an unfortunate one, but it serves to indicate the constitution which favors the growth of the sarcoptis. Sulphur is a valuable remedy to treat this affection, because the symptoms of this disease belong to it. It has itching in the bends of the joints and between the fingers as soon as the patient gets warm in bed. The skin becomes rough and scaly, and little vesicles form. As the disease progresses, you find occasional pustules appearing here and there over the eruption. Now, in order to rid your patient of this sarcoptis, wash the parts thoroughly in warm water with soap, and then have him rub the skin thoroughly with a common crash towel. Then apply the oil of lavender, which will kill both the eggs and the fully-developed insect without suppressing the disease. Then you may 446 A CLINICAL MATERIA MEDICA. give Sulphur internally. If Sulphur has been used externally and the itch suppressed, you may have other remedies to choose from. Give 3Iercurius when pustulous and eczematous eruptions compli- cate the case. You may give Sepia, particularly when constitutional symptoms appear. There are occasional large and well-formed pustules, which develop into an impetigo. Causticum is especially useful when itch has been suppressed by oint- ments of either mercury or sulphur. I next wish to say a few words about the action of Sulphur on the digestive apparatus. Sulphur is useful in disorders of the stomach, liver and intestinal canal. It may be indicated in dyspepsias of many varieties. The particular indications of the drug may be set down as these: First, in a general way, you find it indicated in patients who suffer from abdominal plethora or passive congestion of the portal system, as indicated by a sensation of tightness or fulness in the abdo- men, with feeling of repletion after partaking of but a small quantity of food. The liver is congested, enlarged and sore on pressure. The bowels are constipated, with frequent ineffectual urging to stool, and with haemorrhoids which are the direct result of this abdominal ple- thora. Constipation frequently alternates with the diarrhoea. In these cases the diarrhoea is not apt to be the early morning diarrhoea of Sulphur. This remedy may also be the remedy for gastric ailments arising from the suppression of an eruption, whether that be erysipelas, eczema, itch or the like. Dyspepsia of drunkards, after excessive use of brandy and beer rather than wines, sometimes calls for Sulphur. Here, too, you often find the enlarged or congested liver. Sulphur is also indicated in dyspepsia from farinaceous food. It seems as if in every case of disease of the liver in which Sulphur is in- dicated, the patient cannot digest farinaceous food, which calls upon the pancreatic juice and bile as well as upon the gastric juice itself. The patient vomits a great deal. He cannot take any milk. If he attempts to do so he vomits it at once. That is a common symptom, you know, in drunkards. The vomited matters are apt to be sour and mixed with undigested food. In addition to these symptoms you find all sorts of abnormalities of appetite. The patient is hungry at ten or eleven o'clock in the forenoon, even after eating a moderate breakfast. He has goneness, faintness or gnawing feeling in the epigastrium, as if he must have food or sink. When he gets the food and relieves his SULPHUR. 447 hunger, he begins to feel puffed up. He feels heavy and sluggish, and so low-spirited that he scarcely cares to live. It will be well to re- member that Sulphur is indicated not so much in the beginning of these affections as after Nux vomica. You find almost exactly the same symptoms under Nux. When that remedy only partially re- lieves, Sulphur comes in to complete the cure. Lachesis should be used in the enlarged liver of drunkards when the case has gone on to a low grade of symptoms, especially if inflamma- tion ensues and abscess forms in the liver. If the liver wastes away, secondarily to the congestion, we must de- pend upon other remedies, the most important of which are Phospho- rus and Lauroeerasus. Next, a word or two in regard to Sulphur in diseases of the sexual organs. There is a trio of medicines, Nux vomica, Sulphur and Cal- carea, which are useful in cases of masturbation and excessive venery. Beginning with Nux you note some improvement in the patient; by and by you will find symptoms of Sulphur presenting themselves. If Sulphur fails after producing partial relief, Calcarea completes the cure. The symptoms calling for Sulphur are these: You will find the patient weak and debilitated, having many of the gastric ailments that I have mentioned, particularly faintness, flushes of heat, cold feet and heat on the top of the head. There is frequent involuntary emission of semen at night, exhausting'him the next morning. The seminal flow is thin and watery, and almost inodorous, and has lost all its characteristic properties, being nothing more than a shadow of the normal seminal secretion. The genital organs are relaxed; the scrotum and testicles hang flabbily ; the penis is cold, and erections are few and far between. If coitus is attempted, semen escapes too soon, almost at the first con- tact. The patient suffers from backache and weakness of the limbs, so that he can scarcely walk. He is, of course, low-spirited and hypo- chondriacal. You may find Sulphur indicated in gonorrhoea, whether the dis- charge be thick and purulent, or thin and watery, when there are burning and smarting during urination, and when there is this bright redness of the lips of the meatus urinarius. Sulphur may also be used when phimosis occurs, especially when there is inflammation and in- duration of the prepuce. Sulphur also acts on the female genital organs. The main symp- toms it produces are those which come from congestion of these organs. They are associated with flushes of heat and abdominal plethora; there 448 A CLINICAL MATERIA MEDICA. are bearing down and weight in the uterine region, a feeling of fulness and heaviness there, standing is a very annoying position to her, and there is burning in the vagina, often in association with pruritus and appearance of papules on the mons veneris. The nearest remedy to Sulphur here is Aloes, which produces pre- cisely the same symptoms, the same bearing down, the same fulness of the abdomen from abdominal plethora. Sulphur has, in addition to the above symptoms, aversion to washing. Aloes acts more on the rectum than on any other portion of the alimentary tract. There is a constant desire for stool. When stool is expelled it is accompanied by a great deal of flatus. The haemorrhoids of Aloes protrude like bunches of grapes, and are always relieved by cold water. In closing my remarks on Sulphur, I want to mention two or three uses you can make of the crude article. Sulphur has in its totality of symptoms a perfect picture of cholera Asiatica. It suits the incip- ient symptoms. It bears a resemblance to the course of the disease, and also to the subsequent symptoms. We have, then, in Sulphur a true prophylactic of that dreaded epidemic. It may be used by plac- ing a little flowers of sulphur inside of the stockings. This sulphur is absorbed, as shown by the exhalation of sulphuretted hydrogen with the sweat. Flowers of sulphur burnt in a closed room may be used as a disin- fectant. LECTURE XLV. THE CARBON GROUP. Carbo animalis (contains phosphate of lime). Carbo vegetabilis (contains carbonate of potash\ Graphites (contains iron). Aniline sulphate. Carboneum (Lampblack). Coal gas. Bisulphide of Carbon. I invite your attention this morning to the medicines obtained from the carbon group. Carbon in its purity is found only in the diamond. We have it comparatively pure, however, in the lampblack, or Carbo- neum. Carbon will necessarily be somewhat different in its action, according to the source from which we obtained it. Hahnemann used principally three carbons, Carbo animalis, Carbo vegetabilis and Graph- ites. The first he derived from the animal kingdom, the second from the vegetable, while the last was an artificial product found principally lining the interior of large iron retorts. Carbo animalis is obtained principally from bones. It contains some phosphate of lime. Carbo veg. contains some carbonate of potash. It is obtained principally from a variety of the beech-tree. Graphites is always contaminated with more or less iron. Hence you see that these are not pure carbons. I have also placed on the board the Sulphate of Aniline, which behaves like a carbon and is a carbonaceous compound. Then, too, we have Carboneum and Carbonic oxide. Carbonic acid gas does not seem to possess active medicinal properties. It is not very poisonous. Its main deleterious effects are due to deprivation of oxygen. Carbonic oxide is much more poisonous, producing death, not only by suffocation, by displacing the needed oxygen, but by another remarkable peculiarity. It has the property or peculiarity of displacing oxygen from the blood and taking its place there. You know that oxygen is carried along in the blood by the red corpuscles. Carbonic oxide has the power of supplanting the oxygen in these structures. For a time, it seems to act like oxygen, but soon its poisonous properties are manifested with 450 A CLINICAL MATERIA MEDICA. all the inevitable results of asphyxia. Coal gas, which we obtain by slow combustion of coal, and the illuminating gas used in our large cities, are of this character. They produce serious effects when taken iu large quantities, especially when the subject is deprived of the ordi- nary atmosphere. It is said that this coal gas is beneficial in the treat- ment of whooping-cough. I have known of but one case thus treated, and that one died. Bisulphide of Carbon, which has also been proved, has some valuable symptoms. Now, all of the carbonaceous substances have some properties in common. For instance, they all have a tendency to relieve putrescence or putrid discharges or putrid exhalations from the body and offensive sores. You all know the mechanical properties of charcoal, what an absorbent it is, and how it can purify the atmosphere or substances that are undergoing decomposition. The animal charcoal, which is more porous, is here more effectual than the vegetable. If you bury a dead rat or mouse in charcoal for several months, you will not find any odor from the animal at the end of that time, but only a clean white skeleton. But this property, I would have you know, is not entirely mechanical. In the potencies, this property may be seen in the human system. Now I do not mean to say that potentized char- coal will prevent the odor from a decomposing animal, but I do say, that in a potentized state it exerts similar effects on the human sys- tem. All the carbons act also on the skin, producing excoriations of the skin and intertrigo. They affect the glands also, causing enlargement and induration of the axillary and other lymphatic glands, even as in the case of Carbo veg. and Carbo animalis, cancerous enlargement and infiltration. They all effect the mucous membranes, producing catarrhs of the nose, throat and lungs, and also of the bowels. They all tend to produce asphyxia. We find this prominently in Carbo veg., less so in the Carbo animalis, and very marked in Aniline and Carboneum. Carboneum may produce asphyxia with convulsions simulating those of epilepsy. Coal gas and Carbonic oxide, too, are calculated to pro- duce dyspnoea from deprivation of oxygen. We find, also, that all the carbons act on the veins, producing varicose veins. We find, too, that all the carbons tend to produce flatulence. This is one of the reasons why I object to toast as an article of diet for the sick. Toast, when the bread is nicely dried through by gentle and continuous heat, is very beneficial, but when it is charred, it tends to produce flatulence. The flatus is offensive and has an odor like that of rotten eggs. CARBO VEGETABILIS. 451 Carbo veg. * Kali c, Phos. Carbo Vegetabilis. Ars., China, Phos., Phos. ac. In collapse, Camph., Veratr. alb. Caust., Kali c, Sulph. Paralysis of \ ^nt. tart, Amnion, c < Baryt. c, Mosch., Nitr. ac. (^ Lauroc, Lach., Opium. lungs. Bry., Nux v., Puis., etc. As I have already intimated to you, Carbo veg.. contains some car- bonate of potash. It is also a fact worthy of note that Kali carb. is complementary to Carbo veg., especially in lung and throat affections and also in dyspepsia. Carbo veg. is also complementary to Phos- phorus, here, too, in chest affections, in the throat more than anywhere else and, too, in excessive debility, particularly in the threatened paralysis of the whole system as a sequel to severe disease. The drug is antidoted by Arsenicum and by Camphor, and holds an inimical re- lation with Causticum. The inimical relation between Carbo veg. and Causticum is not so marked as that between the latter remedy and Phosphorus. Carbo veg, is especially indicated in patients who are advanced in life, and, consequently, debilitated. It is called for in weak, delicate persons who are old dyspeptics, especially if they have abused their digestive organs by debauchery. In analyzing the drug, we will speak first of its effects on the blood. We find Carbo veg. indicated in affections in which the blood is de- cidedly changed, its composition altered. There is decided sepsis or blood poisoning in many of the diseases in which Carbo ve^. is the remedy. We find the drug indicated in haemorrhages, haemorrhages, too, of a very low type. Thus we give it in epistaxis or nose-bleed when the face is pale and sunken and almost hippocratic The blood flows persistently for hours, perhaps for days. It is dark and rather fluid. It is apt to occur in old and rather debilitated persons and during the course of diphtheria. You find nearly the same symptoms under Camphor and Mercurius cyanatus. We also find Carbo veg. indicated in haemorrhages from the lungs, not only in haemoptysis, but also in bronchorrhagia. In these cases you will find the patient suffering from great anxiety and yet without 452 A CLINICAL MATERIA MEDICA. any particular restlessness. The anxiety is very evident in the face and in the efforts at breathing, but there is no particular restless toss- ing about. The patient complains of burning pain in the chest. Carbo veg. is to be used especially in far advanced cases of lung degenera- tion. The pulse in these cases is apt to be intermittent and thready. The face is pale and often covered with cold sweat. The patient wants to be fanned, because fanning brings more air to the lungs. These same symptoms indicate Carbo veg. in haemorrhages from the uterus, whether metrorrhagia or menorrhagia. Here, however, you find burning pains marked, burning across the sacrum and lower por- tion of the spine. If the haemorrhage continues any length of time you will notice the same trouble in the chest, with the difficulty in breathing above mentioned. Carbo veg., you will find here, will work hand in hand with Cin- chona and Arsenicum. Arsenicum is useful in these persistent haemor- rhages of a low type, depending upon some degeneration in the organ affected. Both it and Carbo veg. have these violent burning pains. With the Arsenicum, however, you have, as a distinction which ap- plies all through, irritability of fibre and mind, too, which is not.the case with Carbo veg. Carbo veg. is a torpid, sluggish remedy, while Arsenicum has irritability, with restless tossing about, anxiety, etc Ipecacuanha should also be remembered in haemorrhages, especially in haemorrhages from the lungs andl uterine haemorrhages, when the patient takes long breaths, as if panting. Unless there is present a cold stage, amounting almost to collapse, you may prefer to begin with it rather than with Carbo veg. or Cinchona. Next we find Carbo veg. useful in varicose veins which occur on either the arms or legs, or even on the female genital organs. These varicose veins tend to ulceration. Now you will find these varices bluish or livid, looking as though the blood had long remained in them. In these varicose ulcers you will find very similar symptoms to those in other ulcers in which Carbo veg. is the remedy; burning pains, mottled appearance of the skin around the ulcer as though the smaller capillaries had become enlarged. Ecchymoses are seen beneath the skin. The ulcers have a decidedly indolent appearance. Carbo veg. is also useful in ulcers other than varicose when they are of a very low type. They are flat ulcers, tending rather to spread on the surface than to dip deeply into the parenchyma of an organ. They discharge not a healthy pus, but instead, that which is ichorous, corrosive, thin, burning and offensive in character. The burning is CARBO VEGETABILIS. 453 worse at night, depriving the patient of sleep and keeping him in tor- ture the whole night. Even in cancerous ulcers, in ulcerating scirrhus, you will find Carbo veg. useful. It may also be administered in carbuncle, particularly when the affected parts are bluish or livid, and when the discharges are offensive and associated with burning pains. In these cases it is not only your duty to give it internally, but also to apply it externally as a plaster. It tends to prevent decomposition of flu'ds, sweetens the sore and so prevents poisoning of the system. The same is true for gangrene. When carbuncles or boils become gangrenous, Carbo veg. may be in- dicated. In these cases it is distinguished from Arsenicum by the absence of this extreme restlessness. In febrile conditions, Carbo veg. is useful for the typhoid and inter- mittent types of fever, for collapse during fever, and for yellow fever. It is a preventive of yellow fever just as Sulphur is of cholera. If all the ejecta of the patient are buried in charcoal, the spread of the dis- ease is sure to be prevented. When the disease is fully established, Carbo veg. would be of no more use than would Sulphur during the course of cholera. The intermittent type of fever in which you may employ Carbo veg. is of a low grade. The case is one of long-standing, and has been abused by quinine. There is thirst during the chill. The feet are icy-cold up to the knees. That is a very characteristic symptom of Carbo veg. (Menyanthes is the remedy in quartan fever when the legs below the knees are icy-cold.) When the heat coraes,*it is in burning flashes. The sweat is either sour or else exceedingly offensive from alterations in the discharges of the skin. During the apyrexia the patient is pale and weak. Memory is weak; the mind seems to be befogged. The patient is decidedly low-spirited and melancholy. In the hectic t}rpe of fever, Carbo veg. is indicated by pretty much the same symptoms as those which I have already mentioned. It is particularly useful for hectic fever dependent upon long-lasting suppu- ration, whether due to abscess in the lungs, or in the hip-joint, or about the vertebrae. You know that abscesses accompanying diseases of the spine may have to be opened. Sometimes surgeons are afraid to do this before they have prepared the system for it, because reaction is so slow that the patient may be made worse by it. The danger from opening these abscesses may be greatly lessened by the use of Carbo veg. or Cinchona. 454 A CLINICAL MATERIA MEDICA. In collapse from various causes you may use Carbo veg. There is decided lack of animal heat. The nose, cheeks and extremities are cold. The breath even may be cold. It is indicated in the late stages of typhoid fever; after protracted loss of vital fluids, as after long-lasting haemorrhages; during cholera Asiatica; during pneumonia; and, in fact, in any form of disease in which these symptoms appear. The body seems to be icy-cold, especially about the extremities; the breath is cool; the pulse is thread-like, scarcely perceptible an 1 intermittent. The lips may be bluish from cyanosis. Breathing is very weak and superficial; the patient may be either conscious or unconscious. Now, Carbo veg. in just such cases comes in as a savior, and rescues many a case that would otherwise die. There are other remedies similar to Carbo veg. in collapse. Camphor, especially, is similar to it in cholera Asiatica, but it is rather indicated in the beginning of cholera without any vomiting or diarrhoea, when the poison seems to have depressed or shocked the nervous system, so that the patient is icy-cold, dry or in a cold sweat; the tongue is cold. If he can speak, it is in a squeaky or in a high-pitched voice,or else it is a husky, toneless voice. Camphor, in such cases, brings about reaction very quickly. Carbo veg. would be indicated in the later stage, when the prostration is the result of the drain on the system by the alvine discharges. Veratrum album is also similar to Carbo veg. in collapse. It has cramps in the calves of the legs, and characteristically cold sweat on the forehead. I wish next to say a word about Carbo veg. for its action on glands. The glands, especially the mammae, become indurated. There are burning pains in the swollen glands, with tendency to suppuration. When they do suppurate, the discharged pus is not of a laudable char- acter. We find Carbo veg. indicated in catarrhal troubles which are pro- voked by warm moist atmosphere, such as we have in this latitude with southwest or southerly winds. The patient is worse in the evening. He has aphonia recurring regularly each evening, associated with raw feeling down the larynx and trachea. There is dry tickling cough, at times quite spasmodic in its character. It is here analogous to Phosphorus, and is often preceded or followed by that remedy. The Phosphorus aphonia is associated with rawness of the larynx, and is worse in the evening. CARBO VEGETABILIS. 455 In the morning aphonia, Carbo veg. is more closely allied to Sulphur, which has loss of voice, particularly in the morning. Still another concordant remedy of Carbo veg. is Causticum, which is suited to laryngeal catarrh in singers with rough hoarse voice, and associated with tracheo-bronchial catarrh, with rawness and burning under the sternum. This is found under both remedies. The main difference is that Causticum has hoarseness worse in the morning, and Carbo veg. in the evening. Causticum has aggravation in dry, cold weather, and Carbo veg. in a damp, warm atmosphere. Another remedy is Eupatorium perfoliatum, which I use for hoarse- ness with soreness in the larynx, trachea and bronchial tubes, too. The hoarseness is worse in the morning, and is apt to be associated with pains all over the body. Carbo veg. may also be used in asthma, particularly in the asthma of old people and of people who are very much debilitated. They look, during the asthmatic attack, as if they would die, so oppressed are they for breath. They are greatly relieved by belching wind. It is espe- cially indicated in asthma which is reflex from accumulation of flatus in the abdomen. It may also be used in threatening paralysis of the lungs in typhoid fever, after pneumonia, and in old people. The " paralytic catarrh " of old people calls for Carbo veg. There are loose rattling rales when the patient coughs or breathes, a marked symptom of emphysema. The bronchial tubes are greatly dilated. In addition to this you will find coldness, symptoms of collapse, etc. The nearest approach to Carbo veg. in emphysema is Ammonium carb., which, like Carbo veg., has blood poisoned by carbonic acid, giving you the coldness, blueness, etc., incident to that condition. In threatening paralysis of the lungs, we have a great many reme- dies to consider, most of which I will reserve until we come to speak of Phosphorus, which stands very close to Carbo veg. Then, too, you should also remember Moschus and Antimonium tartaricum. Antimonium tartaricum applies when there are loud rales heard in the chest. It seems as if there was an immense amount of mucus there. The patient can scarcely raise any phlegni. The extremities are cold and blue from the cyanosis developed by the blood poisoning. The patient soon becomes drowsy and passes into a stupor from which he can be aroused, but into which he readily relapses. You should also remember Antimonium tartaricum when, in the course of lung affections, whether there be bronchiectasia or catarrh on the chest in 456 A CLINICAL MATERIA MEDICA. children (and here it is especially called for), the cough ceases or be- comes more rare and yet there is no diminution in the mucus-pro- duction itself. Your practiced ear placed on the chest detects just as much oppression of the chest, just as copious an exudation, and just as much rattling of phlegm in the lungs, and yet the child does not cough so frequently. The mother thinks the child is better. But in reality the child is worse, for the lungs are losing their power. Carbo veg. is an excellent remedy for the terrible dyspnoea of chronic aortitis, especially when the patient has become very anaemic, dropsical, etc. Here you should compare Arsenicum, Cuprum and Lachesis. Still further, I want to speak of the action of Carbo veg. on the stomach and bowels. We find it here, rivalling other well-known remedies in dyspepsia or indigestion, and those of a rather low type, too. We find it indicated, too, for the bad effects of debauchery, for excessive indulgence in table luxuries, and for bad effects from wines and liquors and all kinds of dissipation. As a result of dissipation, we may have just such symptoms as call for Carbo veg.; headache, par- ticularly in the morning when the patient awakes from sleep, having spent the best part of the night carousing; dull headache referred to the back part of the head, with a great deal of confusion of mind. There is humming or buzzing in the head as though a hornet's nest had taken its place there. The patient feels worse in the warm room. The pain also seems to go from the occiput through the head and into and over the eyes, giving a dull heavy aching in that region. There are nausea and weakness referred to the stomach, usually a burning sort of distress referred to the epigastrium. He is unable to take any fat food, whether meat, gravy or fried food. He cannot drink milk because it produces flatulence. The stomach feels heavy, as if it were dragged down after eating. The abdomen is distended with flatus. Both belchings and borborygmi are offensive. The wind belched has a rancid taste. Sometimes it has a putrid taste and a decidedly offen- sive odor when passed from the bowels. He suffers from constipation with piles. The piles get worse every time he is on a spree; oozing of moisture from anus; perineum, sore, itching.* Sometimes they ,protrude and are bluish, they are so distended with blood. At other * Perineum, moist, raw, oozing, etc.; Ammon. c, Alum, Natr. m., CARBO V., NITR. AC, Gkaph. (or cracked), Sulph., Bhus tox., Arsenic, Ant. cr. (mucous piles), THUJA (offensive oozing), SILICEA (moist), Sulphuric acid, Capsic, Petro- leum (see also Fissures), Borax (slimy, purulent oozing); Sepia (oozing). CAKBO VEGETABILIS. 457 times, he has morning diarrhoea with stool which is watery and thin and accompanied by a great deal of straining. We find Carbo veg. particularly indicated here after the failure of Nux vomica. The pa- tient is peevish, easily angered. Vertigo reflex from the gastric dis- turbance is present. It is especially worse after a debauch and after excessive indulgence in high living. It is often associated with syn- cope, especially at meals or after eating. The nearest concordant remedy here is Arsenicum. Both remedies have bluish protruding piles, both have burning in the epigastrium, both have anxiety, and both have ailments after the excessive use of liquors, and both are suited for the bad effects of ice-cream, and ice- water in hot weather. The difference between the remedies may be expressed in these few words: Carbo veg. is torpid, Arsenicum is always irritable; of the two remedies, Carbo veg. has the burning most marked especially in internal parts, as in the stomach. Nux vomica impinges on Carbo veg. in the bad effects of over-eating and high living. As I have already said, Carbo veg. comes in when Nux has ceased to act. The Nux toper is a thin, spare, yellow, wiry, fellow. That of Carbo veg. is sluggish, stout and lazy. Next we are to distinguish Carbo veg. from Cinchona. That ought to be easily done, because the two drugs meet only in the flatulent dyspepsia and in debility. Cinchona is suited to a peculiar functional debility, when the system is devitalized by loss of animal fluids. Carbo veg. is the better remedy when the debility arises from organic causes, when we have a picture of collapse with hippocratic face and coldness of the body, particularly of the knees. This last is an excellent indi- cating symptom for Carbo veg. It may occur in almost any disease. Both remedies produce great flatulence. Cinchona, however, does not have this rancid belching with burning. Belching temporarily relieves the symptoms. Lycopodium also typifies perfectly this state of tympanites. The abdomen is enormously distended. The distinction to be made between it and Carbo veg. is this : Carbo veg. produces more flatulence of the bowels, Lycopodium more of the stomach. Again, Carbo veg. pro- duces rancid belching or else passage of offensive flatus with bitter taste in the mouth. Lycopodium has more of a sour taste with its belching. Carbo veg. may be indicated in dysentery. Here it is called for in very severe cases. There are burning pains situated deep in the abdomen, usually in one or the other of the bends of the colon. The abdomen is greatly distended and tympanitic The pulse is weak 30 458 A CLINICAL MATERIA MEDICA. and intermittent. The discharges from the bowels are horribly offen- sive and brown, watery and slimy in appearance. You see what a desperate case we have here, one that calls for great skill in prescrib- ing. You must distinguish between two other remedies and Carbo veg. These are Arsenicum and Cinchona. Arsenicum helps when there is, as I have said, that irritability of fibre. The patients are just as sick and just as near death's door as is the Carbo veg. patient, but they are restless, and complain of burning thirst and yet have an intolerance of water. The discharges from the bowels are about the same in character under the two remedies. Ar- senic, however, has not such marked tympanitic distension of the abdomen. Cinchona and Carbo veg. are also similar in these cases. Both have these dark offensive fluid discharges, both have the distension of the abdomen, both have great weakness and hippocratic face. With Cin- chona, however, the movements from the bowels are provoked by every attempt to eat or drink. Belching gives but temporary relief. Again, the flatus is not so offensive as with Carbo veg., nor are the burning pains so marked as under Carbo veg. or Arsenicum. LECTUKE XLVI. CARBO ANIMALIS, GRAPHITES AND PETROLEUM. Carbo Animalis. f Bromine. „ , ... Sepia, Natr. m. Carbo animalis. I *. ' . i Si lie, Fhos. Badiaga. (^ Merc, iod., Nitr. ac. v Calc. phos. Carbo animalis and Carbo veg. do not follow each other well. They are so far inimical that one may not be given with benefit after the other. They are too nearly the same. Carbo animalis* contains some phosphate of lime. Carbo animalis is complementary to Cal- carea phosphorica, especially in affections of the glands. Carbo animalis is suited to old persons and to those who are greatly debilitated by disease, particularly when there is a predominance of what is known as venous plethora. You find such patjents particu- larly inclined to blueness of the skin. The hands and feet readily become blue, with distended veins showing through the skin. They become ill from very slight causes. The cheeks often get bluish. Both it and Carbo veg. are indicated in decomposition in certain parts of the body, as in gangrene and ulcerations of the surface or of in- ternal parts, with putrid discharges. Both, too, are indicated in weak- ness of the digestive organs, both are indicated for the bad effects of loss of animal fluids, particularly during lactation. Now, as a general distinction between the two drugs, you may re- member this: Although both drugs act on the glands, the predomi- nance is in favor of the Carbo anim ilis for glandular affections. For instance, we find it indicated in induration of glands, of the axillary glands and of the glands in the groin, particularly in syphilitic or gonorrhceal patients. These buboes are hard like stone; Carbo ani- malis is especially useful when these have been opened too soon, and 460 A CLINICAL MATERIA MEDICA. when there is a gaping wound which has partly healed, leaving the surrounding tissues of an almost stony hardness. Badiaga rivals Carbo animalis in just these cases, particularly in indurated buboes that have been maltreated. Again, we find Carbo animalis indicated in cancer more frequently than Carbo veg.; particularly is it useful in cancer of the breast or of the uterus. In mammary cancer you have the gland indurated in little nodes; a small circumscribed portion of it is as hard as a stone. Later the skin around the induration becomes bluish and mottled, thus showing you the characteristic effect of Carbo animalis in producing venous stasis. The axillary glands on the affected side become in- durated and there are burning, drawing pains through the mammae. In the case of cancer of the uterus there are induration of the cervix, metrorrhagia, and burning pains extending down the thighs, and thin, offensive vaginal discharge. In affections of the digestive organs, Carbo animalis differs from Carbo veg. in this : We find that under Carbo animalis there is gone- ness and empty feeling in the pit of the stomach, not relieved by eat- ing, and in this respect it is very similar to Sepia. We find these symptoms indicating Carbo animalis preferably to Carbo veg. in the weakness of nursing women; we notice that every particle of food taken distresses the stomach, just as we found under Carbo veg., but with Carbo animalis there is coldness about the stomach, which is relieved by pressing firmly with the hand or by friction over the abdomen, thus showing you the weak debilitated con- dition in which the patient is, who requires this remedy. Carbo veg. has dragging heaviness about the stomach to distinguish it. Both remedies have piles with this weak digestion, but there is oozing of a thin inodorous fluid from the rectum in Carbo animalis which does not exist markedly under Carbo veg. Both drugs meet again in affections of the chest. We find them both indicated in the late stages of pneumonia, bronchitis, or of phthisis pulmonalis, when there is destruction of the lung tissue and decom- position of the fluid which is expectorated. It is just here that you are most liable to make a mistake in selecting one drug for the other. Carbo animalis has this symptom to distinguish it, suffocating hoarse cough producing shaking of the brain as though the brain were loose in the head. There is a cold feeling in the chest. (Bromine has that sensation also.) Expectoration is green, purulent and horribly offen- sive, and comes generally from the right lung, in which, you will find CARBO ANIMALIS. 461 by examination, a cavity. As soon as the patient closes his eyes he feels as if he were smothering. The Carbo veg. cough is spasmodic, with deep, rough voice or else with aphonia. There is decided burning in the chest and expectora- tion is profuse, particularly in the bronchitis of old people. It is yel- low and very foetid, more so than in Carbo animalis. The patient has dyspnoea, worse on turning over in bed and on dropping off to sleep. There is a great deal of rattling in the chest. Carbo animalis is more useful than Carbo veg. in constitutional syphilis, and for this reason : While both may be indicated in consti- tutional or tertiary syphilis, after the abuse of mercury, particularly when the glands are affected, and there is great emaciation, Carbo animalis is indicated more by these symptoms: It has coppery-red blotches on the skin, particularly on the face. That you know to be the characteristic hue of syphilitic eruptions. In this respect it resembles Mercurius bin., Nitric acid and Badiaga more than it does Carbo veg. In debility, we find Carbo veg. always superior to Carbo animalis. We find very few characteristic symptoms indicating the latter as a remedy in the last stages of typhoid fever, pneumonia and scarlatina. The only difficulty you will have in deciding between the two drugs will be in the debility attendant upon lactation. In affections of the ears we find Carbo veg. and Carbo animalis again meeting. Thus, we find both drugs causing otorrhcea. The discharge is thin, ichorous, bloody and excoriating in both remedies. With Carbo animalis there is also associated a swelling of the perios- teum behind the ears over the mastoid process. Here it is similar to Nitric acid, Aurum and Capsicum. With Carbo veg. we find this otorrhcea particularly as a sequel to exanthematous diseases, as measles and scarlatina. There is no swelling of the periosteum back of the ear. Both remedies are indicated in deafness. Carbo animalis has this peculiar symptom : They cannot tell whence sound comes. Carbo veg. is indicated in deafness when the ears are too dry from the absence of the cerumen or wax, or when there is discharge of offensive ceru- men. In eye symptoms we find Carbo animalis indicated when the patient is far-sighted; while walking along the street objects seem to him to be far off. The eyes seem as if they were loose in their sockets. This feeling is due to relaxation in the connective tissue similar to that found 462 A CLINICAL MATERIA MEDICA. Graphites. in the brain. Old people have dimness of sight on attempting to read, but this is relieved by rubbing the eyes. Carbo veg. is indicated when the patient is near-sighted; objects have to be placed near to the eye to be seen. This symptom is worse after exerting the eyes or after using them steadily for any length of time. Graphites. r Sepia, Pulsatilla. Kali carb., Phosphorus, Calcarea ostr. Sulphur, Lycopodium, Silicea, Hepar. Phytolacca. Mezereum, Petroleum, Iris, Rhus. Mercurius, Antimon. crudum. Staphisagria. Ratanhia, Pseonia, Nitric acid. Slight erethism ; then weak, relaxed, anaemic; chlorotic. Fat, chilly, costive; lymphatic glands swollen. Skin : Cracked, rhagades, fissures, herpes, eczema, oozing of scanty gluey humor. Cicatrices are softened. ^ Mucous membranes: Scanty secretion, cracks, fissures, etc. v Arsenicum. v Ferrum. Graphites. < Graphites is not a pure carbon. Even the purest specimens of it contain some iron. You will note that I have placed beneath it two complements, namely, Arsenicum and Ferrum. It has many symp- toms in common with Ferrum, acting complementary to that drug, and many more allying it to Arsenicum. It is a relative of Ferrum, principally in this class of symptoms, particularly in anaemia or chlorosis of females. There are irregulari- ties in the distribution of the blood, and pallor of both skin and mu- cous membranes. It is complementary to Arsenic in many of the skin symptoms, in affections of the glands, burning in internal parts, and other symptoms akin to it. Besides these complementary remedies, Graphites has quite a number of concordant remedies. It is antidoted by A rsenicum, and in some of its gastric symptoms by Nux vomica. Arsenicum, you thus see, holds two relations to Graphites; one of antidote and one of complement. It is complementary in one series of effects, and anti- dotal in another. Arsenicum antidotes especially the mental symptoms of Graphites. GRAPHITES. 463 The Graphites patient is sad and full of grief, particularly if a female. She has an anxious, apprehensive state of mind, which com- pels her to move about from place to place. She has forebodings of some imaginary accident or mishap which is about to take place; it makes her anxious and restless ; she cannot be kept quiet. It is this group of symptoms which Arsenicum antidotes. We find this anxious, apprehensive state of mind in Graphites to be a very important symp- tom. You all know how imporrant in making a homoeopathic pre- scription the mental symptoms are. We find this apprehensiveness, this low-spiritedness, qualifying many of the Graphites conditions. We see it in the chlorosis, in the skin symptoms, in the inflammations of the eye, etc., as you will discover later .on. The circulation is at first excited, followed by loss of energy and consequent venous hyper- semia. Syncope readily occurs, with great anxiety. Motion is im- paired and tissues are relaxed, but paralysis is not complete. We find Graphites acting best in constitutions in which there is a tendency to obesity. This obesity, I would have you remember, is not a healthy, solid flesh, that belongs to a full-blooded, strong, hearty individual, but it is that kind of fat which you find under Calcarea ostrearum, showing improper nutrition. We find the two remedies running close by each other in such fat but not healthy individuals. The Graphites constitution is also one in which there is deficient animal heat, owing to the defective oxygenation of the blood. These patients are always cold, whether they are in or out of doors. In the case of chlorosis, the Graphites patient has these symptoms: There is a ten- dency to rush of blood to the head, with flushing of the face, just exactly similar to that which belongs to Ferrum, The patient feels a sudden shock about the heart, and this is followed by rush of blood to the head. She thinks she has heart disease. On lying down at night, the patient experiences throbbing all through the body. That is not due to true plethora. The blood is decidedly " watery," and, if you were to examine it microscopically you would find an excessive number of white blood corpuscles. The menstrual flow in these cases is too late, too pale and too scanty. The mucous membranes are apt to be pale, just as you find under Ferrum. The lips will be pale. The patient suffers from leucorrhcea, which is watery and quite profuse, sometimes excoriating the parts over which it flows. Now, you may say, how are we going to distinguish this from Pul- satilla f Like Graphites, Pulsatilla has late and scanty menses, with pale or dark flow in chlorotic or anaemic patients; also in patients who 464 A CLINICAL MATERIA MEDICA. are apt to be chilly, and who are low-spirited, crying at every im- aginary trouble. How will you distinguish between these remedies? The main distinction lies in this: The Graphites patient always has some skin symptoms to aid us, Pulsatilla scarcely any. The Graph- ites patient has a rough, harsh, dry skin, with very little tendency to sweat. Little pimples, whether containing pus or not, appear on the body, and are apt to be worse at the menstrual periods. While in Pulsatilla there is strong tendency to diarrhoea, in Graphites there is strong tendency to constipation. These symptoms are sufficient to always enable you to distinguish between these two closely allied remedies. Next, as most important in our study of Graphites, I wish to call your attention to the action of the remedy on the lymphatic glands, and also upon the skin. It produces enlargement of the lymphatic glands of the neck and of the axilla?, and also of the inguinal and of the mesenteric glands. This, together with marked skin symptoms, calls frequently for its use in scrofula. Now, we find it running par- allel with Calcarea ostrearum, Sulphur and Silicea in scrofulosis, par- ticularly of children. We find the abdomen large and hard. The children thus affected suffer from diarrhoea, with stools which are thin, offensive and contain partially digested food. In inflammation of the eyes, of a scrofulous character, we have no remedy, not even Calcarea, Sulphur or Arsenic, that excels Graphites. The cornea is apt to be covered with superficial ulcers, or again, it may be inflamed. There is thickening of the eyelids, particularly along the edges, which are covered with scurf or scales. The lids may be agglutinated or not, but the grand characteristic which makes the choice of Graphites certain is this: The blepharitis is worse in the angles of the eye, in the canthi. There is tendency for the edges of the lids to crack and bleed. If that is present you need not hesitate to use Graphites. The thickening of the cartilages of the lids may be so great as to produce ectropion or entropion. Then, too, the eyelashes become wild, turn in towards the ball of the eye and irritate the conjunctiva. Hardened styes may appear along the edges of the lids. Graphites also affects the vision. Letters appear double and run together. An eczematous eruption appears about the eyes, on the cheeks, on and behind the ears, on the top of the head and down the occiput. It may also be scattered here and there over the surface of the body, particu- larly in the bends of the joints. Behind the ears it assumes the form of intertrigo, being moist and sticky. If the child lies on its ear, the GRAPHITES. 465 ear will be glued fast to the head. Sometimes you find Graphites indicated in phlyctenular ophthalmia. Little vesicles form on the cornea and on other parts of the eye, producing profuse, burning lachrymation. These tears are mixed with pus, which is thin, and excoriates the cheek over which it flows. The discharge from the nose, which is partly from the eye by the way of the puncta lachrymali, is also thin and excoriating, and you find cracks and crusts around the nostrils quite in harmony with the condition of the borders of the eyelids. I would now like to mention briefly a few of the distinctions between Graphites and its allied remedies. Petroleum or coal-oil is similar to Graphites in many of its symptoms. It has an eruption very much like that of Graphites and is particularly indicated when the most marked symptom is an intertrigo behind the ears. If the child is old enough, he will also complain of aching and other painful symptoms in the back of the head. The main distinction between the two reme- dies is that Graphites pictures more of a herpes and Petroleum a pure eczema. In prescribing Calcarea ostrearum the local symptoms, particularly those of the eyes, do not help you much. They are too general. They are just the symptoms of scrofulous ophthalmia. But you would be aided in your selection of the drug by its general symptoms, sweat of the head and cold, damp feet (which are not prominent under Graph- ites). You may also remember that Calcarea ostrearum is the best remedy for the results of scrofulous ophthalmia, rather than the acute symptoms themselves. It is best suited to the opacities of the cornea and the thickening of the lids. Arsenicum has the same burning, excoriating discharge from the eyes, but is distinguished by this: The lids are spasmodically closed. Otherwise the symptoms are provokingly similar. Sulphur will help you when the edges of the lids are redder than natural, while under Graphites the edges of the lids are paler than they ought to be. Euphrasia is useful in phlyctenular ophthalmia with excoriating discharge, etc. But although the discharge is excoriating under Eu- phrasia it is thick and purulent, while it is thin under Graphites. Mercurius is also useful in scrofulous cases, especially when the patient is worse at night and from the heat and glare of the fire. Mer- cury is decidedly preferable if syphilis complicates scrofulosis. Hepar is very similar indeed to Graphites. It is preferable when 466 A CLINICAL MATERIA MEDICA. there is throbbing in and about the eye. Now if the child is not old enough to tell you if there is throbbing in and about the eye, you will notice that there is pain and you will see evidence of the formation of pus; for instance, suppurating styes form on the lids. Hepar suits the suppurative process better than does Graphites. You will also notice that the Hepar child will not allow anything to press on the eye, because the parts are so sensitive. Graphites is said to prevent the return of erysipelas when that dis- ease becomes constitutional. The affected parts feel hard and tough, and if it be the face that is involved, are very much distorted. There are burning, stinging pains, as we found under Apis. It usually com- mences on the right side and goes to the left. It is particularly useful when Iodine has been abused. Still further, you must remember the use of Graphites in the re- moval of cicatrices. This remedy seems to have the property of causing the absorption of cicatricial tissue. It was long ago noticed in workers in graphite, that wounds on the hands healed and the cicatrices disap- peared very rapidly. Dr. Guernsey has made use of this property of the drug for the removal of cicatrices that form after mammary abscess. Professor Korndcerfer greatly relieved a child's eye by the remedy. The child had been operated on, and cicatrices formed which contracted more than the surgeon expected they would. Graphites so far relieved the case that the parts assumed their normal position. We next have to speak of the action of Graphites on the digestive organs, aud here it is allied particularly to the other carbons, Carbo veg. and Carbo animalis. We find the patient complaining of dis- agreable taste in the mouth in the morning, as though he had been eating eggs. This symptom is more marked here than in any other carbon. The patient is worse from all meats. This symptom you find under Pulsatilla, Ferrum, and, in fact, under all chlorotic remedies. Things nauseate and disgust the patient. After eating the stomach becomes distended with wind. There is burning pain in the stomach; also a crampy, colicky pain—a real gastralgia, in fact. The patient wakes up at night gasping for breath; sudden dyspnoea, which is temporarily relieved by eating. The gastralgia is also relieved by eating. In this respect it again resembles Petroleum, which has gas- tralgia relieved by eating. The same symptoms you* will also find under Chelidonium.and Anacardium. The abdomen is greatly dis- tended from flatulence, and with this distended abdomen we have rush of blood to the head. The liver is apt to be hard and enlarged, with GRAPHITES. 467 extreme tenderness to the pressure of the clothing after eating. The bowels are usually constipated. The characteristic stool is this: The stools are covered with mucus or contain shreds of mucus. That is a very characteristic symptom of the Graphites. I think that it is also of Cascarilla. The patient suffers from haemorrhoids, which burn and sting; the anus is so extremely sore that the patient is very much annoyed when sitting. Fissures form in the anus. Graphites is here one of our best remedies. Now we have several similar remedies here. First, Lycopodium. This has this distension after eating, with great accumulation of flatus. but this flatus is not rdncid or putrid, as it is under Graphites. That is a sufficient distinction between the two remedies. Again, we have this list of remedies: Ratanhia, Pceonia, Nitric acid and Silicea. Ratanhia is an excellent remedy for fissure of the anus, and is to be recommended when there is great constriction of the anus. Stools are forced with great effort and the anus aches and burns for hours after stool. Paeonia is also useful for fissures of the anus with a great deal of oozing, thus keeping the anus damp and disagreeable all the time. This is associated with great soreness and smarting. Nitric acid is also a remedy for fissure of the anus, particularly when there is a feeling as if there were splinters or sticks pricking the anus. Now Graphites is distinguished from all these by the fact that they have more or less tenesmus or constriction of the anus, while Graphites has little or none. Silicea is also a remedy for fissure of the anus. The patient tries to force a stool, but it will not come out. The stool partly descends and then slips back again. Now the mucous membranes: Graphites is useful in nasal catarrh when there is extreme dryness of the nose. You often find this in scrofulous cases. This alternates with the discharge of lumps, or clinkers, as they are sometimes called. At other times, the discharge is very offensive and bloody. You notice how the offensive character of the discharge shows itself in these carbons. The borders of the nostrils are sore and scabby, and crack readily. Here you have a resemblance to Antimonium crudum, to Calcarea and to Arum tri* phyllum. The sense of smell is too acute. The patient cannot bear the odor of flowers. There is cracking or roaring in the ears when swal- lowing or chewing. This tells you that there is catarrh of the Eusta- chian tubes. On examining the ear with the speculum, you will find 468 A CLINICAL MATERIA MEDICA. the membrana tympani not perforated, but quite white. The ears are apt to be too dry, and there is a lack of natural secretion (just as you found under Carbo veg.), with hardness of hearing, better from riding in a carriage. It is not the riding that improves the hearing, but the noise made by the carriage. Graphites may also be used in chronic sore throat with sensation as of a lump in the throat. This is worse after empty swallowing. Here it is similar to Sulphur and Calcarea ostrearum. The cough of Graphites is not very characteristic. It is a dry cough with a great deal of strangling, making the face red and the eyes water. It is worse during deep inspiration. On the male genital organs, Graphites acts quite prominently." We find it producing uncontrollable sexual excitement and violent erections. The most important symptom of Graphites is impotence. There is a want of sensation during coition with no discharge of semen. It also acts on the female organs. We find affections of the left ovary with enlargement of that gland, and with scanty delayed menses, chilliness, constipation and coexistent eruptions. The uterus is dis- placed under Graphites. The os is far back and presses against the posterior wall of the vagina, hence the remedy is indicated in ante- flexion and in anteversion. With this, there is bearing down extend- ing into the hypogastrium. The leucorrhcea is watery and profuse, sometimes coming in gushes. Often, with these symptoms, there exists an eczematous eruption about the vulva. Petroleum. This is a highly carbonaceous oil, but it is not a pure carbon. Medi- cinally, it stands somewhat between Sulphur and Phosphorus on one hand, and Graphites and Carbo veg. on the other. We find that those who work in coal-oil are subject to eruptions on the skin. Thus a wheal appears across the face or body looking like a hive, and this itches and burns. Then, again, a vesicular eruption appears there which develops into a perfect picture of eczema, forming thick scabs and oozing pus. The skin soon grows more harsh and dry, and there form deep cracks and fissures which bleed and suppurate. These symp- toms make Petroleum an excellent remedy for eczema wherever it may appear. We find it useful in rhagades, particularly when they occur in winter, when the hands chap, crack and burn and itch intolerably. Sometimes, ulcers develop. petroleum. 469 Again, Petroleum has been used in sprains of joints, especially in old rheumatic patients. It is particularly indicated in rheumatism, when the knees are stiff, this stiffness being associated with sharp sticking pains in them and with stiffness of the neck and cracking sounds when moving the head, owing to roughness of the muscular fibres. Next we find Petroleum to be remembered in diseases of the mucous membranes. It may be used successfully in ozaena. Here the dis- charge is quite in agreement with the character of the eruption. Scabs and purulent mucus are discharged from the nasal cavities. The nose is sore and the nostrils are cracked as in Graphites. The post-nasal space is filled with purulent mucus, causing hawking of phlegm. Then, too, we find the eyes affected under Petroleum. It is espe- cially useful in blepharitis marginalis. It is also indicated in inflam- mation of the lachrymal canal, when suppuration has commenced and a fistula has formed. This tendency to the formation of fistula is also seen in the gums. The cough of Petroleum is also to be remembered. It is a dry teasing cough which comes on when lying down at night. We often find that cough in children. Next we find Petroleum affecting the sweat itself, producing profuse offensive sweat in the axilla and on the soles of the feet. The only chest symptom of Petroleum is cold feeling about the heart. This symptom is strong under Natrum mur., which has it very well-marked, especially when exerting the mind. It is also found under Kali chloricum, Graphites and Kali nitricum. Next we look to Petroleum in its action on the stomach and bowels. It produces nausea and vertigo with vomiting of bile, worse in the morning, worse from riding in a carriage and worse during pregnancy. Then, too, Petroleum is useful in sea-sickness. Petroleum produces a diarrhoea which is somewhat akin to that of Sulphur. The stools are offensive and watery, and often contain un- digested food. They come early in the morning and are associated with emaciation of the body. They differ from Sulphur in coming on also during the day. We have another diarrhoea curable by Petro- leum, and that is a diarrhoea with disordered stomach made worse by the use of cabbage, sauer-kraut and cole-slaw. There is offensive stool with great flatulence, and belching of gas, tasting of cabbage. Petroleum also acts as a nervous remedy. We sometimes find it 470 A CLINICAL MATERIA MEDICA. indicated in typhoid fever, when there is slight delirium. It also pro- duces forgetfulness. The patient loses her way in well-known streets. If this symptom has been produced by exposure to great heat, then you should give Glonoin. Another mental symptom curable by Petroleum is she imagines that she is double, or that somebody is lying beside her. This symp- tom has been utilized in this way: A lady in childbed imagined that she had had two babies, and she was very much concerned as to how she could take care of them both. Petroleum cured her. Petroleum has also been used as an antidote to lead poisoning. LECTURE XLVII. HALOGENS. Highly irritant to the mucous membranes. xx , Spasm of the glottis. Halogen?. { 'r . ,° Pseudo-membranes. Glands, etc. r Bromine. < Halogens. < Phos., Ant. tart. Carbo an. Aeon., Spong., Hep., Kaol. Kali brom. Fluorine. f Merc, Phos., Sulph., Calc. ostr. T ,. J Ars., Calc. Arg. n. Spong., Hep., Kaolin. Ant. tart. Chlorine. >Amon c > Sulph. > Starch. > Hepar. > Arsen. To-day we begin the study of the chemical elements termed halo- gens; Iodine, Bromine, Fluorine and Chlorine are the elements in this group. As a group the halogens may be remembered by this great characteristic symptom, they all act upon the larynx and bron- chial tubes, and in fact upon mucous membranes generally. They are decidedly irritating to the mucous membranes, producing violent in- flammation, rawness and excoriation, as anybody can testify who has once inhaled the fumes of Chlorine, Iodine or Bromine. They all produce spasm of the glottis and this is most marked, has proved most characteristic, in Chlorine, although they all have it. They all tend to produce pseudo-membranous formations on the mucous membranes. All excepting Chlorine tend to produce croupous membranes; Chlorine tends more to diphtheritic membrane than pure croupous. All of the halogens act upon the glandular system, producing enlargement, in- duration and even abscess in glands. Thus we find them all useful 472 A CLINICAL MATERIA MEDICA. in scrofulosis, especially Iodine, which leads the list. Cyanogen also belongs to this group chemically, although it is properly considered as belonging to organic chemistry. It has many similarities to these drugs, and, like Chlorine, is useful in diphtheritic deposits. Thus we use Hydrocyanic acid and Amygdala persica (which contains Hydro- cyanic acid) for diphtheritic sore-throat, and we may use the Cyanide of Mercury for some of the worst forms of diphtheria. The same is true to a less degree of Cyanide of Potassium. These general char- acteristics of the halogens lead you at times to say, " This patient needs one of the halogens, which shall it be?" To answer that question we must study these four elements separately and by comparison. I will first call your attention to Bromine. Bromine produces a rather peculiar effect on the mind, causing a sort of vertigo, which is worse from running water. Moving rapidly by the patient produces this vertigo. It is associated with a peculiar anxious state of the mind. Now this anxiety belongs to all of the halogens. It hardly originates in the mind, probably coming from some defect in the body itself. It is a common symptom in heart and lung affections, and it is probably thence that the symptom springs. This anxiety is expressed in this way: The patients expect to see objects jump around them or they think that, somebody is about them, and they turn around to see if such is the case. This is an effect of Bromine, and those of you who are familiar with Bromide of Potassium will recognize whence it gets its anxiety. The vertigo is relieved by nose-bleed, showing at once that it is congestive in character. Another symptom showing you that there is congestion under Bromine is this: After dinner there is a sensation deep in the brain as though a fit of apoplexy were impend- ing. The patient feels as if he would lose his senses. The Iodine mental condition is more marked than that of Bromine. It is a decided erethism, during which the patient is very excitable, and restless, moving about from place to place, now sitting here, now sitting there; he fears that every little occurrence will end seriously. In his anxiety he shuns every one, even his doctor. He has a great dread of people. At times he becomes quite excited and delirious, with vertigo, red face and anxiety. Next, the lymphatic system. Like all the other members of this group, Bromine attacks the glands, and causes enlargement and indu- ration of the glands. Hence it is called for in scrofulosis. It is par- ticularly suited to scrofulous patients, children usually, when the parotid gland or glands are indurated, when there is a tendency to HALOGENS. 473 suppuration, with excoriating discharge and persistent hardness of the gland around the opening, and undue amount of warmth or heat in the gland. I have merely mentioned the parotid gland for purpose of illustration. Bromine also affects the mammary gland, for cancer of which it has been a very useful remedy. You may perhaps remember that I told you the other day that it was similar to Carbo animalis. Like Carbo animalis, it has induration of the glands in the axilla with burning pains. But Bromine also has cutting pains. The breast is hard and on palpation, a dull subdued sort of throbbing may be felt in it. Sometimes the drawing or cutting is so marked that it feels as if a string were pulling from the gland into the axilla. The testicles are acted upon by Bromine. We find them swollen, hard and perfectly smooth. The pain is worse from jarring. The glands are unduly warm and hot. You will find that glandular affec- tions yield to Bromine, especially in persons of light complexion, with fair skin and light blue eyes. I mention this symptom here to make use of it in a few moments as a symptom of comparative value. I do not mean to say that every scrofulous child with blue eyes must have Bromine, but I do mean that this symptom is of use to enable us to distinguish Bromine from the other halogens. The tonsils, too, are affected in Bromine. Thus we find them deep red and swollen and covered with a network of dilated bloodvessels. They are worse when swallowing, and are accompanied usually with swelling of the glands externally. There is a feeling of rawness in the throat with this tonsillitis. This, too, as you know, is common enough in scrofulous children. There is a strong temptation to excise the tonsils, but this is not good practice, for you can often cure this trouble by internal medication. In some cases, this enlargement of the tonsils may be looked upon as a forerunner of tuberculosis. We find Bromine indicated in enlargement of another gland, namely the thyroid gland, and curing what has been termed bronchocele or goitre. We next have to speak of Bromine in its action on mucous mem- branes. Beginning with the nose, we find that it-is useful in coryza or in nasal catarrh, when the discharge is profuse, watery and excori- ating. The nostrils, alternately, seemed to be stopped up. There is peculiar headache associated with this coryza, a heavy pressure in the forehead which seems to be pushing the brain down and out at the root of the nose. The nose is very sore inside and also around the alse. This is a decidedly smarting soreness, just such as you would expect 31. 474 A CLINICAL MATERIA MEDICA. the fumes of Bromine to make. Later, ulcers form in the nose, with the escape of crusts or scabs, which are blown out and which are always bloody. Every attempt to wipe the nose is followed by a discharge of crusts and blood. This you know is common enough with scrofu- lous children. Coming now to the throat and lungs, we find Bromine indicated in spasm of the glottis, sometimes called laryngismus stridulus. This is a very difficult disease to cure. It is often central in its origin. It com- mences by sudden closure of the glottis. The child turns blue in the face, and its body becomes convulsed. One spell ceases only to be fol- lowed by another. In the second stage, general convulsions appear, followed by emaciation. The trouble may be reflex from dentition, or from indigestion, or from enlargement of the thymus gland. If it can be found to be the result of enlargement of the thymus gland, evi- dently then Iodine would be indicated. AVhen it has been caused by retarded dentition, I think that Calcarea phosphorica promises better than anything else. Dr. Dunham records a case that had been given up by an allopathic physician, but, knowing the symptoms of Chlo- rine, which, above all other remedies, will produce this spasm of the glottis, he generated some Chlorine, and allowed the child to inhale the fumes, with almost instantaneous relief and final cure. All the halogens are useful in this condition, but Chlorine is here the best of them all. Their symptoms differ but little so far as the local symp- toms are concerned. We may also think of Sambucus, Antimonium tartaricum, Belladonna, Lachesis, Arsenicum and, in some cases, Phos- phorus. Lachesis is particularly indicated when the patient awakens from sleep with it. Ignatia, whenever a cross word or correcting the child brings on the spasm. Another remedy is Cuprum, especially when the spasms are general and the child clenches its thumbs. Ipecacuanha may be of some use in some cases, but I have no con- fidence in it. Nor have I in Sambucus, because, under Sambucus, I think the trouble is more in the chest, whereas, with Cuprum, the halogens, Cal- carea phos., Lachesis and Belladonna, the trouble is in the larynx itself. This spasm of the glottis often comes in the course of croup, in which disease Bromine may be the remedy when inspiration seems to be ex- HALOGEN'S. 475 ceedingly difficult; the child is suddenly aroused from sleep as if choking. These symptoms are at least relieved by a drink of water, which seems to quiet the spasmodic condition. In membranous croup Bromine is indicated by the following symptoms in addition to the spasm already referred to: The child has at first a deep, rough voice, which, in the evening, amounts almost to aphonia. The child cries with a hoarse, husky voice. The membrane seems to come up from the larynx into the throat. Every inspiration seems to provoke cough, especially every deep inspiration. Breathing is hoarse, rasping and whistling, as though the child were breathing through a sponge or through some loose metallic substance which is vibrating. This is caused by the vibration of membrane as it is deposited more or less uniformly over the interior of the larynx. Later, there is rattling in the larynx. When the child coughs it seems as if the larynx were full of loose mucus. Antimonium tartaricum is very similar to Bromine in croup. It has rattling and wheezing, extending down the trachea as well as in the larynx. Now, I wish to say a few words about other remedies in connection with croup, especially concerning Aconite, Hepar, Spongia and Kaolin. Kaolin is a kind of porcelain-clay, a combination of lime and silica, and has proved very useful in membranous croup. The relation which these remedies hold is this : Aconite is useful iu the beginning of croup, whether spasmodic, catarrhal or membranous. It is indicated by the child suddenly arous- ing from sleep as if it were smothering. There is great restlessness. The skin is hot. There must be some anxiety present. Breathing is dry. There is no sound of mucus. Pretty soon the child seems better and falls asleep, and then will be aroused again. Aconite is especially indicated in these cases if these symptoms have followed exposure to dry, cold winds. Do not stop your remedy too soon. If you do, while the child will be better in the morning, the symptoms will return with renewed violence the next night, and, before you know it, the mucous membrane of the larynx and trachea will take on fibrinous exudation and you lose your patient. You will need to change to Spongia when you have these symptoms present: Breathing during inspiration is hard and harsh, as though the child was breathing through a sponge. The cough has a decidedly hard, barking, ringing sound. The sputum is scanty as yet. Spongia follows Aconite, especially after exposure to dry, cold winds, and in light-com- 476 A CLINICAL MATERIA MEDICA. plexioned children with blue eyes. The symptoms are usually worse before midnight. Suppose this fails you, then you may have recourse to Hepar sulphur is calcarea. Hepar usually has its symptoms worse after midnight and towards morning. The cough has the same harsh, croupy sound, but there is a great deal of moisture with it. This is the indication for Hepar. It, too is worse from exposure to dry, cold winds. Sometimes all these drugs fail, and we have to resort to the halogens, especially to Bromine and Iodine. I have already given you the symptoms of Bromine; let me tell you how to distinguish it from Iodine. Iodine is particularly indicated after the failure of Hepar, when the membrane has formed ; inspiration is exceedingly difficult, both from spasm of the throat and occlusion of the lumen of the larynx by the membranous formation. Inspiration is wave-like, or in jerks. The cough is moist but harsh, just as you found under Hepar. The voice is almost extinct from the hoarseness. The child grasps its throat to relieve the pressure, throws its head far back so as to straighten the route from the mouth to the lungs and favor the passage of air. It is particularly worse in the morning. Iodine is especially adapted to dark-cotnplexioned children with dark hair and eyes. This in itself is a great distinction between Iodine and Bromine. That is why I spoke of the use of Bromine in light-complexioned chil- dren, because this fact has been proven to be a good distinction between these two drugs, and hence, as a comparative symptom, is one of great value to you. Iodine is particularly adapted to cases that come from damp weather. Long-continued damp cold weather will produce just such a cough as Iodine will cure. Do not change your remedy in these cases too olten. Do not change your remedy on account of alarming symptoms that spring up, unless you are certain that they indicate a change. Kaolin has been used successfully for membranous croup even when the membrane dips down deep into the trachea. There is extreme soreness of the chest. The patient does not want anything to touch him. He will not permit you to use steam or hot cloths, because the chest is so sore. Returning to the study of Bromine, we find it useful in affections of the lungs. It is indicated in asthma, when the patient feels as if he could not get air enough into his lungs, consequently he breathes very deeply. The explanation of this lies not only in the lungs, but also in the constriction of the glottis. Although the patient expands his chest HALOGENS. 477 well, air does not go in on account of the narrowness of the opening in the larynx. It is especially indicated in asthma coming on, at or near the seashore. We also find Bromine useful in pneumonia, particularly when it affects the lower lobe of the right lung, hence lobar pneumonia. We often find nose-bleed as a concomitant symptom when Bromine is indi- cated in these cases. The patient also has the symptom just mentioned under asthma, "seems as if he could not get enough air into the chest;" while there seems to be plenty of mucus, the patient does not appear to be able to expectorate it. We also find Bromine indicated in tuberculosis of the lungs, par- ticularly when the tubercular deposit is more manifest in the right lung. The patient suffers frequently from congestion of the head and chest, which is relieved by nose-bleed. Notice Jiow often that symptom occurs under Bromine. There is also pain in the mam mary region going up into the axilla. The eyes seem to be affected along with the chest symptoms giving rise to a chronic conjunctivitis. Bromine produces a very characteristic picture of uncomplicated hypertrophy of the heart, by which I mean, muscular enlargement without valvular lesion. The patient finds it difficult to exert himself on account of the oppression about the heart. He has palpitation when he begins to move and when he gets up from a sitting to a standing posture. The pulse is full, hard and rather slow, which is just the character that belongs to an over-active enlarged heart. It has cured many cases of this hypertrophy of the heart. I think it was Dr. Thayer, of Boston, who cured many cases of this trouble with Bromine. It may also be used in cardiac asthma, especially when the asthmatic paroxysms are better at sea than on land.* You here find Bromine similar to Aconite, but it lacks the anxiety of that remedy. Both remedies are suited to uncomplicated cardiac hypertrophy, but Aconite has fear and anxiety. The patient fears that he will drop dead in the street. It is also similar to Arnica and Rhus tox., both of which remedies have uncomplicated hypertrophy of the heart from over-exertion. So much for Bromine; now for Iodine; and first let me speak of the symptoms arising from its abuse. Iodine is an absorbent; it has * Professor Farrington refers on the previous page to the asthma of Bromine as coming on at or near the seashore, and here he speaks of cardiac asthma better on sea than on land. Both may be right, for being at sea differs from being at the seashore, where you may have land breezes.—S. L. 478 A CLINICAL MATERIA MEDICA. the property of causing absorption, particularly of glandular struc- tures. Its absorbent properties extend to other tissues, involving, finally, even nervous structures. We find, for instance, in persons who are poisoned with Iodine, great emaciation. With the female, the mammary glands become atrophied and the ovaries, too, no doubt. With the male, the testicles suffer with inevitable progressive loss of sexual power. The skin becomes dark yellow and tawny, dry from deficient action, the sclerotica become yellow, yellow spots appear on the face and also on the body. There is excessive appetite; he is anxious and faint if he does not get his food. He is relieved while eating and yet he emaciates despite the amount of food he eats. Sooner or later the nervous system becomes involved and he is afflicted with tremor. He becomes nervous and excitable; every little annoyance which would be unnoticed in his normal condition causes trembling. He has a longing for the open air, as if the cold fresh air gave him more breath. This gives a fair idea of the condition to which the patient is reduced by the over use of Iodine. One of the best anti- dotes for this state is Hepar. Some cases require Sulphur. The indi- vidual symptoms decide. Now compare Iodine with Bromine in chest affections. Iodine is indicated in pneumonia, more so, perhaps, than Bromine. It is espe- cially useful when the disease localizes itself, that is when the plastic exudation* commences. There is a decided cough with great dyspnoea, difficulty in breathing, as though the chest would not expand (and here the trouble is situated in the chest itself), and blood-streaked sputum. You will find some portions of the lungs beginning to solidify. You may also give it later in the disease, after the stage of hepatization, in the stage of resolution, when instead of absorption and expectoration of the exudate, slow suppuration appears with hectic fever and emaciation ; the patient feels better in the cool open air than he does in the warm room. Phthisis pulmonalis sometimes calls for Iodine. You here find it indicated in young persons who grow too rapidly, who are subject to frequent congestion of the chest, who are rather emaciated, and who suffer from dry cough, which seems to be excited by tickling all over the chest. The patient cannot bear the warm room. Expectoration is tough and blood-streaked. There is a well-marked feeling of weak- * Under Mercurius and Iodine, exudates are plastic; Bryonia, serous and plastic; Hepar, purulent. HALOGENS. 479 ness in the chest, particularly on going up stairs. The patient has a very good appetite, and is relieved by eating. The nearest remedy to Iodine here is Phosphorus, which is also well adapted to phthisis in the rapidly-growing young. Iodine is also indicated in enlargement of the heart, whether or not accompanied by disease of the valvular structures. There is palpita- tion of the heart, particularly after any manual labor. It is suited especially to dark-complexioned persons, with dark hair, etc. The heart feels as if it were being squeezed by a firm hand. At other times there is excessive weakness in the chest, with "goneness" or exhausted feel- ing. The patient can scarcely talk or breathe, so weak does he feel. This shows that Iodine acts on the connective tissue. In valvular affections there is a purring feeling over the heart, just such a sensation as you get when stroking a cat. Spigelia has that same purring, vibrating feeling over the region of the heart. Now let me give you the difference between Iodine and Bromine in scrofulous affections. Iodine causes induration of the glands more marked than does Bromine. They are hard, large and usually pain- less. There is a characteristic of Iodine which is universal, and that characteristic is torpidity and sluggishness. The very indolence of the disease is suggestive of Iodine. It also produces atrophy of the glands. The mammse waste away and the testicles dwindle. We find it indi- cated in scrofulosis of children, when they emaciate rapidly, despite a ravenous appetite. They .are hungry all the time. They cry for their dinner, they feel better while eating, and yet they do not gain any flesh. They are always better in the open air and worse from any confinement in the warm room. The mesenteric glands are enlarged, and you have what is known as tabes mesenterica. This indicates Iodine, particularly when you have these other symptoms present to- gether, with excessive mental irritability. We find Iodine causing a rather singular diarrhoea. In such cases the spleen is enlarged, quite hard, and very sensitive to the touch. The liver, too, must be affected, because the stools are whitish ; some- times they are wheylike. This last symptom you will often find con- nected with obscure disease of the pancreas. Iodine has such an affinity for glandular structures, that it, no doubt, attacks the pancreas as well as other glands. We also find Iodine affecting the ovaries. It is indicated in ovarian dropsy. In such cases as this, the single fact that Iodine has helped 480 A CLINICAL MATERIA MEDICA. in ovarian dropsy, must not lead you to give Iodine in every case of that trouble. Other remedies have proved themselves useful. Apis, Colocynth, and other drugs, have cured cases, and they have sometimes failed. If the whole picture of the patient calls for Iodine, it is your duty to give that drug, but not unless such is the case. It must be given for weeks or months before it will bring about absorption of the tumor. We also find Iodine indicated in cancer of the uterus, particularly with profuse haemorrhages. The leucorrhcea is characteristic, being yellowish and very corrosive. This, in conjunction with the other Iodine symptoms, sallow, tawny skin, ravenous appetite, etc., makes Iodine the remedy which will relieve many cases and cure some. In this connection we have other remedies to remember, and nota- bly among these, Hydrastis, which has cured epithelioma, and may be a remedy for uterine cancer. I have, however, had no personal suc- cess with it. It has been used both externally and internally, when indicated by symptoms which have already been given you in another lecture; especially has it marked goneness at the epigastrium, and palpitation after every motion. There is a substance, or remedy, known as Lapis albus. It is one of Grauvogl's remedies. He, at one time, went to a certain spring, the waters of which, it was claimed, would cure tuberculosis, scrofu- losis, and even cancer. On examining the spring, Grauvogl noticed that the water had gradually worn a crevice in the rocks. He took away a piece of this rock over which the water was falling, and made triturations of it. With this he cured several cases of goitre, and also several cases of scirrhus. This rock has been analyzed, but the analyses differ so that I hardly know which one to recommend. Iodine is sometimes indicated in rheumatic joint affections, with effusion and emaciation. Hydrarthrosis yields, according to Jahr, Jousset and others, to Iodine. In acute cases, compare Apis; in the chronic, Sulphur. Both Iodine and Bromine are of some use in ulcers. Iodine, for instance, is useful in ulcers rather of a scrofulous form, with spongy edges, and discharges of a bloody, ichorous, or even purulent character. Now, Bromine is somewhat similar. It is useful in ulcers which have a carrionlike odor, with threatening gangrene. The surrounding skin has a greenish-yellow hue. That is the form of ulcer to which Bromine is especially adapted. Now, a few words about Chlorine. I do not know much about it as HALOGENS. 481 a medicine. It may be given in a crude form by allowing the gas to be absorbed by ice-cold water, and thus it may be prepared for the cases to be enumerated. Chlorine, and in fact all its combinations, seem to have a special affinity foi* mucous membranes. Hence we find it indicated in catarrhs. Chlorine produces a watery discharge from the nose, with thin, excoriating coryza, making the nose, both inside and about the alse, sore. On examining the mouth, you find it, too, affected with a low grade of inflammation. Chlorine here produces small, putrid-smelling ulcers. These are aphthous in character. You find the mouth filled with yellowish-white aphtha?. Chlorine is indicated in scorbutic states of the blood, and so are all the chlorides. We find under Natrum mur. and Kali chloricum the same kind of stomacace, with excessive fcetor of the breath. We find Chlorine also acting on the nervous system, probably through the blood. It is indicated in typhoid conditions; the patient has a fear of becoming crazy, or that he will lose his senses. He is very forgetful; he cannot remember names, etc. There is a constant fear of some impending disease. There is also, under Chlorine, a peculiar painful sensation in the vertex, this sensation passing down the left side of the body. This is a precursor of typhoid fever. It is worse after eating. In such cases Chlorine will often modify the fever. Chlorine is also indicated in impotence. When this impotence has been produced by inhalations of the fumes of Chlorine, Lycopodium is the proper antidote. Chlorine is a very good antidote to Sulphuretted hydrogen. 482 A CLINICAL MATERIA MEDICA. Spongia. < Spongia. Aeon., Bell., Hep., Iod., Brom. Anacardium. Caust., Selen., Phos. Badiaga. Spongia is not a chemical substance. It is derived from the animal kingdom, but, because its symptoms are closely allied to those of the halogens, it is convenient to study the drug here. Spongia contains iodine, also some bromine and some calcareous matter, and probably other ingredients of minor importance. Spongia has not the same symptoms as Iodine. In the first place, it is adapted to light-com- plexioned persons, and it has not the same property of producing plastic or fibrous exudates that Iodine has. It acts, however, on structures very similar to those influenced by the halogens, especially the glandular system and mucous surfaces. We find it of service in tuberculosis, and we shall find it invaluable in the treatment of heart disease. First, let us study its action on the glands. It is indicated just as are the halogens in indurations and enlargement of the glands. Thus we find it indicated in goitre. The swelling is hard and large, one or both sides are swollen, sometimes even with the chin, and par- ticularly is this associated with suffocating spells at night. This suf- focation does not come alone from the size of the goitre, because some very small goitres give rise to this symptom in a very great degree. I would also call your attention to the fact that goitres will vary in size at different times. They will be larger at one time than another. It is said that they increase and decrease with the moon. It has, therefore, been suggested that you give Spongia, or whatever drug you select, with the waning moon. In this way you hurry its decline. Spongia acts just as powerfully as the halogens on the testicles, producing hardness and swelling of these glands. It is particu- larly useful in cases of maltreated orchitis or inflammation of the testicle after checked gonorrhoeae There is a peculiar sort of squeez- ing pain in the testicle and cord, worse on any motion of the body or clothing. In cases of orchitis, our first remedy is not Spongia. Pulsatilla stands at the head of the list, and next to it we may rank Hamamelis, SPONGIA. 483 or witch-hazel. The latter drug should be used both locally and in- ternally. It relieves the intense soreness and enables the patient to attend to his duties. Still another remedy is Mercurius solubilis, par- ticularly when what little gonorrhceal discharge is present is yellowish- green. Still another remedy in the very beginning is Gelsemium. When, however, you have this peculiar screwing-like, squeezing pain in the cord and testicle, with hardness there, Spongia comes in as one of our best drugs. We find Spongia indicated in acute laryngitis. This is an alarming disease. We find Spongia indicated after Aconite, when there are harsh, barking cough and suffocative spells during sleep, arousing the patient. The larynx is extremely sensitive to the touch. Do not give Lachesis in these cases, for the sensitiveness is not due to hyperesthesia of the cutaneous nerves, but it is the result of the inflamed condition of the laryngeal cartilages. If the patient turns his head, the movement will bring on a suffocative spell. Now there is another remedy that I would have you remember in this connection, and that is Sambucus. This is useful when these spasms of the larynx occur frequently during the course of acute laryngitis. You will find the same symptoms that suggest Spongia in laryngitis also indicate it in laryngeal phthisis. I will not speak of the application of Spongia to croup, because I gave that to you in the early part of this lecture when speaking of Bromine and Iodine. We come next to the lungs. We find Spongia indicated in con- sumption of the lungs, in true tuberculosis. It is especially called for in the beginning of the stage of solidification of the lung tissue. You find the apices of one or both lungs dull on percussion. The cough is of a hard, ringing, metallic character. It is excited by deep breathing or by talking, by dry, cold winds, seldom by damp weather or by any little excitement. It is relieved for awhile by eating or drinking. Anacardium also has this same symptom, eating relieves the cough. There is a great deal of congestion of the chest, especially when the patient is moving about, walking in the street for instance. This is accompanied by sudden weakness as if the patient would fall. In such cases Spongia has cured when given early. It is well followed by Hepar when the same kind of cough con- tinues, but with rather more rattling of mucus, more production of 484 A CLINICAL MATERIA MEDICA. phlegm, whether blood-streaked or not. The symptoms are worse towards morning, while with Spongia they are worse before midnight. You find, too, that the Spongia patient is subject to frequent flashes of heat in these phthisical cases, and these return whenever he thinks about them. He also experiences a chill which usually commences across the back. He shakes even when near a warm stove. The heat which follows is all over the body except the thighs, which remain numb and chilly. Spongia is useful in organic affections of the heart. The patient cannot lie flat on the back with the head low without bringing on a spell of suffocation. He is frequently aroused from sleep as if smother- ing. He sits up in bed with an anxious look and flushed face, and rapid, hard breathing. You will find a loud blowing sound over one or the other valve. Spongia is particularly indicated after Aconite. Here there is the same arousing from sleep with great distress, the face is red and there is probably great congestion of the chest. Aconite suits only the hy- peremia that precedes endocarditis. Spongia comes in when exuda- tion has commenced and the mischief has been already done. While it does not remove the deposit, it prevents the disease from advancing. In treating heart cases do not begin too soon with Lachesis, Hydro- cyanic acid or Arsenicum. Begin rather with Aconite, Spongia, Spigelia, Bryonia or Phosphorus. Arsenic and such remedies come in later. If you give them too soon you weaken the patient. Unless you have a complete picture for the remedy, do not give in the first stages one usually indicated in the last stages of a disease. LECTURE XLVIII. THE ACIDS. Fluoric acid. Phosphoric acid. Muriatic " Hydrocyanic " Nitric " Picric " Sulphuric " Lactic Oxalic " Malic " Citric " Silicic " Arsenious acid. There are many of the acids, many more in fact than have been placed on the board. There are not many of them, however, with which we are thoroughly acquainted, and there are but few facts that need be stated with reference to others. The very idea of acid you will at once understand, implies that they are more or less electro-negative. They all combine very readily with the electro-positive substances, as potassium and sodium. You must rid yourself of the impression that the term "acid " necessarily implies that these substances are sour, for all acids are not sour nor do all acids redden litmus paper. It was formerly supposed that all acids contained oxygen, and that oxygen was one of their necessary ingredients. This has been disproved, for certain acids—as hydrofluoric and muriatic acids—contain no oxygen. These acids are derived from the mineral and vegetable kingdoms. Of those derived from the former, we use in medicine Fluoric and Muriatic acids, which are obtained from the halogens; Nitric acid, a combination of nitrogen and oxygen; Sulphuric acid, Phosphoric acid, Silicea or Silicic acid, which exists as sand in nature and is by no means sour. So, too, the substance which we term Arsenicum is an acid—Arsenious acid. Then we have derived from organic chemistry Hydrocyanic acid, sometimes called Prussic acid. That, we shall find, exists in a great variety of plants. Then here is Oxalic acid. That you are some- 486 A CLINICAL MATERIA MEDICA. what familiar with. Many of you who have tasted the " sorrel grass" know how sour the leaves are. It is Oxalic acid which gives them their acidity. It exists also in the rhubarb. Rhubarb, either the medicinal or the edible variety, may or may not be poisonous. When raised on new ground it is very apt to contain an undue amount of Oxalic acid, and thus may make some persons very sick. Malic and Citric acid are derived from the vegetable kingdom. Malic acid is found more particularly in apples and pears and also in raspberries. Citric acid is found chiefly in oranges and lemons. Acetic acid is an organic acid, and is the principal ingredient of vinegar. Lactic acid is derived from sour milk. In the first place we may say a few words about the acids in general and tell what characterizes them as a class. It has been determined by careful experimentation with the acids as a class that they decrease the acid secretions of the body and increase the alkaline. If, for in- stance, a quantity of acid, such as Citric acid, is taken into the stomach, it will diminish the secretion of the gastric juice. On the other hand, it will increase the secretion of the saliva. The practical value of this hint is hygienic rather than therapeutic, and yet in that degree it is of great use. For instance, we know how intolerable, at times, thirst is in fevers. Now this thirst may be due, at least in part, to lack of secretion from the salivary glands. The mouth is parched and dry; the tongue cleaves to the roof of the mouth. In such cases as this, acidulated drinks, by acting reflexly, increase the flow of saliva, and will give your patient great relief. For instance, you may give lemonade, providing, of course, it is not antagonistic to your indicated remedy, for there are some medicines which Citric acid will anti- dote and some which will disagree with it. Again, if you are giving Belladonna, you would not think of using vinegar, as vinegar retards the action of that drug. But when giving Belladonna you may use lemonade, as that aids the action of the remedy. Antimonium crudum will not tolerate acids, but you may use tamarind water. Now if you find the mouth or throat sore in fever, the " edge " must be taken off the acid by the admixture of some mucilaginous substance to the drink. You might use gum Arabic, but that interferes with digestion somewhat. Irish moss, Iceland moss and slippery-elm are too medic- inal. They all act powerfully on the lungs, and you might induce medicinal symptoms if you employ them. Flaxseed has some medic- inal effect, but not sufficient to make its use inappropriate. Another substance which may be used is gelatin, that is, if you know that it is THE ACIDS. 487 made properly. Some of it is made from the refuse of the tanner; some from fish-bones, and that is quite palatable; but best of all is that made from calves' feet. This last may be used in water to relieve this sharpness. We find that the acids may be useful in dyspepsia, not as remedies (their therapeutic uses we shall see presently), for we are now speak- ing of their hygienic applications. You may give them, for instance, in sour stomach. You then administer the acid before eating. Allow the patient to drink lemonade before meals and you will often find that the usual heartburn and sour risings after eating are thus dimin- ished. Pepsin, which is often used as an adjuvant in the treatment of dyspepsia, is perfectly allowable, as it does not interfere with the action of any medicine and is not itself a medicine, and is often aided in its action by some kind of acid, particularly in the digestion of nitrogen- ous articles of food. Vinegar has been used as an antidote for intoxication. There is a property of the Lactic acid which is well worth noticing. This is a very corrosive acid. It will eat into every tissue of the body. In fact, it will dissolve the enamel of the teeth, so that great care must be used in its administration. When prescribed in material doses, it is usually administered through a tube, which prevents it from touching the teeth. Dr. Hering was in the habit of recommending that the teeth be washed occasionally with cream that had become sour by keeping twenty-four hours. Muriatic and Lactic acids favor digestion. Some persons are greatly relieved by drinking sour milk. Sulphuric acid must be avoided in any form whatever, because it tends to make the food insoluble by combining with its albuminous constituents. Sulphuric acid is not used in dietetics, except by children in the "sour-balls," which are acidulated almost exclusively with this acid. Hydrocyanic acid certainly aids digestion. There are some persons who have been cured of dyspepsia by eating peach-kernels, which con- tain this acid. There is a distinction between the mineral acids on one side and the organic acids on the other. The mineral acids, as a class, all produce an irritability of fibre together with weakness and prostration. I am now speaking of their medicinal effects. You will find them to pro- duce an irritable weakness—the pulse is weak and irritable—whereas the vegetable acids produce weakness without irritability. The acids, 488 A CLINICAL MATERIA MEDICA. too, as a class, check haemorrhages. This is a quality that belongs to nearly all of them. We all know that Acetic acid is useful in check- ing haemorrhage. When I have a patient who is subject to haemor- rhage, I am in the habit of instructing the nurse, in case haemorrhage sets in before I can be called, to dip a cloth in vinegar and place it over the pubes. In many cases, this will be successful. We all know, too, that Citric acid will produce and cure heemorrhage. A child, after eating too freely of lemons, had haemorrhages from every orifice of the body, even from the conjunctiva. We shall see that Phosphoric, Sul- phuric and Arsenious acids all produce and all check haemorrhages. It is said that they all do this by reason of their astringency. But how can this be so when they act favorably even in the two-hundredth potency ? Another quality of the acids is their tendency to produce pseudo- membranes. Thus we find some of them indicated in diphtheria; Muriatic, Phosphoric, Sulphuric and Nitric acids, for instance. Here, again, caution is necessary. As these acids, particularly the vege- table acids, may cause croupous deposits, do not permit a child con- valescing from croup to partake of acid fruits. When the child is susceptible, any one of these acids may tend to produce this disease again. We find that all the acids cause a peculiar debility. This is not a simple functional weakness, such as might result from a rather ex- hausting diarrhoea, such as you find under Cinchona, or such a func- tional weakness of the nerves as will be curable by Zinc, but it is a debility which arises from defective nutrition, particularly from blood disease. Thus we find them called for in very low types of disease, disease in which blood poisoning is a prominent feature, in typhoid states and in scarlatina, particularly when of a low type, in conditions of exhaustion from abuse of various organs of the body. Thus drunk- ards, who have long been indulging in liquors to excess, may be relieved by Sulphuric, Phosphoric and Arsenious acids. We find them indicated, too, in diabetes mellitus. The principal acids for this condition are Phosphoric and Lactic acids. We find, too, that many of the acids are useful in scurvy, particularly when it has arisen from a diet of salty food with deprivation of vege- tables. So much for our general review of the acids. We will now begin to speak of the acids in order, and first of all, of Fluoric acid. FLUORIC ACID. 489 Fluoric acid. Fluoric Acid. r Silicea, Calcarea ostr., Calcarea fluor. Kali carb. Arsenicum, Phosphoric acid. Mercurius. Rhus tox. This is a highly excoriating acid, eating, as you know, even into glass. It is to be particularly remembered from its action on the bones and on the skin. • It acts especially upon the lower tissues of the body. We find it indicated in caries of the bones, particularly when the long bones, as the femur, humerus and radius are affected. The discharges from the affected parts are thin and excoriating. The symptoms are fre- quently relieved by cold applications. Fluoric acid is frequently use- ful for caries of the temporal bones, and especially of the mastoid pro- cess, and that, too, whether it be the result of syphilis, or of scrofulous catarrh of the middle ear. We also find it indicated in dental fistulae. 'The discharge is bloody, and has a saltish, disagreeable taste, rendering the mouth foul, and gradually undermining the whole constitution. Fluoric acid will here relieve. There is another remedy which has not been thoroughly proven, but which seems to act better here than the Fluoric acid, and that is the Fluoride of Calcium or Calcarea fluorica. Calcarea fluorica is especially useful for osseous tumors and for enlargement of bones with or without caries. This summer a lady came to my office with what the dentist had pronounced to be necrosis of the lower jaw on the left side. The teeth had been removed by him, but the patient, instead of getting better, grew worse, and there was a continual discharge from the cavity. The molar just back of the one taken out had been filled with gold, and that I found on ex- amination to be rough at its root; and when she would press her jaws together tightly, there would ooze, apparently from its fangs, a fluid which was offensive, dark and bloody, and mixed with fine pieces of decayed bone. The gum around the bone was purple and offensive in itself. The dentist had said that a surgical operation was necessary. The first remedy given was Silicea, which seemed to have some effect. This was followed by Fluoric acid. These two remedies are comple- mentary, and you will frequently find in bone disease that you will have to give one after the other. Fluoric acid is especially indicated when Silicea has been abused. It is also indicated when Silicea appa- 32 490 A CLINICAL MATERIA MEDICA. rently does some good but fails to complete the cure. Now, in the case I have just related, Fluoric acid also helped for awhile, but im- provement again came to a stand-still, and now I noticed a swelling of the bone on the outer surface. This led me to think that Calcarea fluorica would act better, and I gave it in the sixth trituration. That she has been taking since the first of August. A week ago* the dis- charge had entirely ceased. The tooth, which had been filled with gold, was no longer painful. Pink granulations were springing up all over the gums. The probe can no longer detect bone which is diseased. You will remember, as a distinction between Fluoric acid and Silicea in bone affections and ulcers, that Fluoric acid has relief from cold, whereas Silicea cannot bear anything cold. The slightest draught is intolerable. We next have to speak of the action of Fluoric acid on the skin. It seems to produce a decided roughness and harshness of the skin, de- veloping cutaneous eruptions of various kinds. There is itching. I do not know of any remedy that causes such general and persistent itching as does Fluoric acid. There is itching in small spots here and there over the body. This is worse from warmth and better from a cool place. You will find, under Fluoric acid, that old cicatrices will become redder than natural and itch. By and by, little vesicles will form on or near the cicatrix, thus showing you the affinity of Fluoric acid for this kind of tissue. Then little red blotches appear on the body, and you have well-marked tendency to desquamation. No remedy has this more marked than Fluoric acid. You will find that Fluoric acid also attacks the nails, causing them to grow rapidly. Thuja has the effect of making the nails grow soft. We may use Fluoric acid in felons, particularly in bone felons. Here, as in case of other diseases of the bones, the discharge is offen- sive. Here, also, we may make the same point of distinction between it and other remedies, relief from cold applications. Fluoric acid also acts upon the muscles. Here its effects are rather novel. It causes an increase in muscular endurance. Under its influ- ence a person is able to withstand more muscular exercise than that to which he is accustomed. More than this, he seems to be better able to withstand the heat of summer and the cold of winter. Thus the drug has a general invigorating or tonic effect. The lecturer was speaking on October 17th. FLUORIC AOID. 491 This same effect we find under other drugs. We know how Rhus tox. will enable persons to withstand muscular fatigue. The same is also true of Arsenicum. But the remedy that has this property, more than any other I know, of, is Coca. This interesting plant is used by the people' of South America, particularly by those who climb the Andes. It prevents all the symptoms arising from the fatigue of the journey and from the disproportion between the external and the in- terna,! atmospheric pressures. We may make use of this in persons who are weak, particularly for old people who get out of breath easily when and particularly if they cannot stand a rarefied atmosphere. In that condition Coca relieves. Under the influence of Fluoric acid, a short sleep seems to refresh. This effect may also be produced by low potencies of Mephitis putorius. We find that Fluoric acid has produced, and therefore ought to cure, varicose veins. Little blue collections of veins in small spots were caused in two or three provers by Fluoric acid. It may also be of use in naevus. Other remedies here are Hamamelis, especially in acute cases. It is often used externally and internally in the treatment of enlarged veins, Muriatic Acid. Muriatic acid. < Debility, typhoid fever. Diphtheria. Scarlatina. Muscular weakness from Opium. f Rhus tox., Bry., Phos., Phos. ac. Muriatic acid. { *&' R''US t0X-' ArSe"iCUm- f CamPhor- Opium. > <[ Bryonia. ^ Nitr. ac. I Alkalies. Now that we have obtained an idea of the acids in general, we will find Muriatic acid a very easy drug to study. The continued use of Muriatic acid must give us pathological effects. Now this acid, when abused, produces pathogenetic effects, which present two series of symp- toms for study. We find its mental and nervous disturbances under two stages or classes. Under the first effects of the drug there is con- siderable excitement. The patient is irritable and peevish, and the 492 A CLINICAL MATERIA MEDICA. senses are all too acute. Thus light hurts his eyes, distant noises causes buzzing or roaring in the ears, or aggravating headache. Botli smell and taste are abnormally acute. The patient is restless and changes this position frequently. His mind is actively engaged in visions in reference to the past and present and even to the future. The cheeks are quite bright red, the tongue and mouth are apt to be dry, and the heart-beat is quick and irritable. The heart-stroke, though quick and irritable, lacks energy and force. If he is at all delirious,.it is only slightly so. He is sleepy but unable to sleep, or he tosses about, dreamy and reslless, all through the night. Now these are the tran- sient symptoms of excitement or over-exertion which may occur under the influence of Muriatic acid. You are able to trace under these symptoms, from beginning to end, a certain amount of weakness. There is an appearance of over-strength, but it is in a weakened con- stitution. You know that it is not a true " hyperaction," but only an irritability, that comes under the head of irritable weakness. The next stage, or that of exhaustion, has several grades, of course. Beginning with the mental symptoms, we find that the patient is apt to be sad, and is absorbed in self, so as to be taciturn,,rather introspec- tive, sad and brooding. If you question him, you will learn that he# is anxious about something real or imaginary. Headache may now appear, the feeling being as if the brain were being torn or bruised, or there is heaviness as if the occiput were made of lead. The patient becomes unconscious, with muttering delirium, sighs and groans dur- ing sleep, the tongue grows more dry and seems to have actually shrunken and become narrow and pointed ; so dry is it that when he attempts to talk, it rattles like a piece of wash-leather in his mouth. Still later, the tongue becomes paralyzed, so that he can scarcely move it at all. The heart-beats are inegular and feeble. The pulse inter- mits characteristically at everyr third beat. He now becomes so weak that the muscles refuse their office. He has diarrhoea, which is watery and is accompanied by prolapsus of the rectum. Stool is involuntary when straining to urinate. He slides down in bed. He actually has not sufficient strength to keep his head upon the pillow. There is now threatening paralysis of the brain. This is indicated by vacant, star- ing eyes, dropping of the lower jaw, coldness of the extremities, and this, if not checked, is followed by death. Now these are the symp- toms which call for Muriatic acid, particularly in typhoid fever. The concordant remedies of Muriatic acid here are Rhus, Bryonia, Apis, Phosphoric acid, Nitric acid and Arsenicum. MURIATIC ACID. 493 Bryonia resembles it in the early stages of typhoid fever. Both have that nausea when sitting up in bed, both have dry tongue and soreness through the body, but there are quite a number of other symp- toms which will enable you to distinguish, and which have been men- tioned in the lecture on Bryonia. Rhus tox., like Muriatic acid, has this restlessness in the beginning. The patient is continually moving and tossing about the bed. He can- not sleep at night. There is slight delirium, with muttering. All these symptoms are under both Rhus and Muriatic acid. Rhus has not so much debility as the latter, hence it is followed rather than pre- ceded by the Muriatic acid. Phosphoric acid resembles Muriatic acid, but resembles it in this respect: Phosphoric acid has apathy and indifference; a complete "don't care condition;" indifferent to what may happen to himself, or to others. That is not the condition calling for Muriatic acid, for taciturnity is not indifference. Then again, Phosphoric acid does not cause the same prostration that we find under Muriatic acid. The characteristic stupor of Phosphoric acid is this: The patient is easily aroused from stupor, and is perfectly rational when aroused, no matter how soon he may drop off again to sleep. Apis resembles Muriatic acid. Both remedies have this dry and shrunken tongue, both have sliding down to the foot of the bed, im- pending paralysis of the brain, etc. The Apis tongue is very charac- teristic, and differs from that of Muriatic acid. It is covered with little blisters, especially along the border. The patient cannot put the tongue out; it seems to catch on the teeth, or, if he does get it out, it trembles. Arsenicum you can readily distinguish by the symptoms, which I will give you next week when I lecture on that drug. You should also remember in this connection Baptisia, which has in common with Muriatic acid, this great weakness. Baptisia, however, has a besotted look to the face; the teeth are covered with black sordes, and the tongue is red on the edges and yellowish-brown down the centre. Now, a word of caution. Do not mistake the symptoms of Muri- atic acid for those of Belladonna. The novice is apt to do it. For instance, you notice the flushed face, the over-excitement of the senses, desire to sleep but cannot; these are all symptoms of Belladonna. But try to find the meaning of the Belladonna symptoms and then of those of Muriatic acid, and you will find that they are by no means 494 A CLINICAL MATERIA MEDICA. the same. The Belladonna symptoms apply to hyperaemia, and to the beginning of the disease,.and not to overwhelming of the system by disease, as in Muriatic acid. Next I wish to refer to Muriatic acid in scarlatina. The body is intensely red, looks like a boiled lobster. There is rush of blood to the head, with bright red face and with great drowsiness. Now the rash comes out very sparingly, and is scattered irregularly over the surface of the body, and interspersed with petechiae, with bluish or purplish spots. The child is very restless, throws off the clothes, and will not be covered. As the symptoms progress, the skin becomes purplish and the feet decidedly blue. Then you may have also some of the diphtheritic symptoms already referred to. Catarrhal or even diphtheritic symptoms may complicate the case. There is thin, ex- coriating discharge from the nose, making the upper lip sore. So irritating are the discharges from the mouth that the mucous membrane becomes intensely red, and even denuded of its epithelium. By and by, yellowish-gray deposit forms in the mouth, and particularly in the fauces, and on the tonsils, uvula, and posterior wall of the pharynx. One of the provers had symptoms that made it difficult to decide be- tween those of diphtheria and those produced by Muriatic acid. The breath becomes very foetid, and the uvula, oedematous. Sometimes the latter hangs down as thick as your thumb, and lies on the tongue, and causes the child to gag and choke. These are the diphtheritic and catarrhal symptoms, and they may occur with or without scarlatina. Belladonna is apparently, not truly, a concordant remedy here. These symptoms may cause you to give Belladonna, and incorrectly too. The drowsiness and disturbed sleep, etc., of this remedy are caused by congestion^ of the brain, which is not the case under Muri- atic acid. More closely allied are Apis and Sulphur, which both produce red- ness of the skin to a marked degree. Kali permanganicum resembles Muriatic acid in the throat symp- toms, especially in the oedematous uvula. Other remedies having this symptom are Apis, Natrum arsenicosum, Mercurius cyanatus, Arseni- cum and Hydrocyanic acid. This last remedy resembles Muriatic acid in its throat symptoms, and in the blueness of the surface, and in the presence of petechiae in the rash. Sulphuric acid resembles Muriatic acid in scarlatina in that both remedies have these bluish spots, great weakness and diphtheritic membrane. Sulphuric acid has not relief from uncovering. Then MURIATIC ACID. 495 again, there are appearances on the skin like suggillations. Spots appear that look as though the parts had been bruised. I have also found Muriatic acid useful in the last stages of dropsy from cirrhosed liver. Of course it may be used in any other serious disease of the liver in which the symptoms indicate it. The dropsy progresses as it does ordinarily in cirrhosed liver. The patient finally develops a typhoid condition, and becomes drowsy. Now these are the symptoms for which I have selected Muriatic acid. It does not cure; it will only relieve. The patient is drowsy, and becomes very much emaciated. The mouth is dry, or it is aphthous. The stools are often watery and involuntary. The stomach is so weak and irri- table that no food can be retained. Nitro-muriatic acid is also to be remembered in these cases of weak digestion. Its symptoms you will find recorded in Allen, and are very similar to those of Muriatic acid. The antidotes to Muriatic acid are Camphor and Bryonia for the dynamic effects of the drug, and alkalies for its acute poisonous effects. Muriatic acid may also be used for the muscular debility following the prolonged use of Opium. LECTURE XLIX. PHOSPHORIC AND SULPHURIC ACIDS. f Debility—Aphthae—Typhoid. Phosphoric and Sulphuric acids. •{ Haemorrhages. I Diarrhoea. Phosphoric Acid. Rhus tox. China, Arsenicum, Veratrum. Nux vomica. Ferrum. > Camphor. Baptisia. Phosphoric acid. < Today we have to study Phosphoric acid. This is a combination of oxygen with phosphorus. Phosphoric acid produces weakness or debility. Sometimes it causes a transient excitement, but the main characteristic of the drug is this debility, which is characterized by indifference or apathy, by torpidity of both mind and body, by com- plete sensorial depression. The patient is disinclined to answer your questions. His answers are short, consisting generally of "Yes" or " No," and are made in a way that show that it is annoying to him to speak. The delirium is quiet, not violent, but accompanied with this characteristic depression of the sensorium, and muttering, unintelligible speech. He lies in a stupor, or in a stupid sleep, unconscious of all that is going on about him; but when aroused he is fully conscious. That is characteristic of the Phosphoric acid. You see it is depressing to the sensorium and to the body in general, and yet these changes are in a certain sense superficial. It does not seem to dip deep down into the tissues, so to speak, and effect those serious changes in them that call for some such drug as Lachesis. You will find the quality above mentioned pervading every Phosphoric acid symptom I shall mention. So, you would not expect to give the drug in advanced stages when the stupor is complete. Now the symptoms which indicate Phosphoric acid in typhoid fever are these: Pointed nose; dark blue rings around the eyes. The patient PHOSPHORIC ACID. 497 may suffer from nose-bleed, but this nose-bleed, however, gives no relief to the symptoms in the early stages of typhoid fever. This is a very different symptom from Rhus tox., which is similar to Phosphoric acid. This has epistaxis in the beginning of typhoid fever, the patient being relieved by the haemorrhage. The patient bores his finger into the nose. Now it is not always advisable to remember Cina, and suppose because the patient is picking at the nose that he has worms. He may have itching of the nose. The symptom may also come from abdominal irritation. With Cina, it occurs from worms; with Phosphoric acid, it is on account of the irritation of Peyer's patches, consequently you will find abdominal symptoms plentiful. For instance, the abdomen is apt to be distended and bloated. There is a great deal of gurgling and rumbling in the abdomen. There is often diarrhoea with these symptoms. The stools are watery, sometimes involuntary, and contain undigested food. For instance, the milk which you have given your patient passes more or less undigested, and there is copious escape of flatus with the stool. The tongue is dry, and may have a dark-red streak down its centre; but it is apt to be pale and clammy., and some- times covered over with slimy mucus. Sometimes the patient bites the tongue involuntarily while asleep; this is a spasmodic motion ; while the jaws come together the tongue protrudes. The urine you will find to be highly albuminous; it has a milky appearance, and decomposes very rapidly; you will find it also loaded with earthy phosphates. These are the main symptoms which would suggest the selection of Phosphoric acid in typhoid fever. The nearest remedies here are Rhus and Phosphorus. Phosphoric acid often follows Rhus after the latter has relieved the restlessness and the diarrhoea persists, and the patient goes into this quiet sort of stupor. Phosphorus has more dryness of the tongue, more sensorial excite- ment; all the senses are irritated ; the patient cannot bear any noises or odors. If diarrhoea is present, the stools are blood-streaked and look like " flesh-water." In this sensorial apathy you should also remember the Sweet spirits of nitre. The patient lies in bed, perfectly indifferent to every one. He answers questions readily enough, but is apathetic. That is the condition in which Hahnemann gave Sweet spirits of nitre. I have found it to succeed when Phosphoric acid failed. Arnica is also to be placed by the side of Phosphoric acid. Like the acid, it has apathy or indifference. The patient does not seem to 498 A CLINICAL MATERIA MEDICA. know that he is as sick as he is. But the Arnica condition is a more developed state. The depression and stupor are more profound. He goes to sleep when answering your questions, showing you how over- powering is the stupor. Then, too, you have the petechiae or ecchy- moses common to this remedy, and, still later, involuntary stool and urine. Opium is, more than Phosphoric acid, a remedy for stupor when that stupor is progressive. It is only in the beginning of the Opium state that the patient can be aroused from sleep. The stupor goes on until no amount of shaking can bring the patient to consciousness. Breathing grows more and more labored and stertorous; the face, in- stead of being pale, sunken and hippocratic, as in the acid, is deeper red, almost a brownish-red. The browner the red, the more is Opium indicated. Another series of symptoms in Phosphoric acid are its emotional symptoms. Phosphoric acid is one of the best remedies we have for the bad effects of grief and depressing emotions, particularly for the chronic effects of disappointed love. It is here particularly indicated after Ignatia. Ignatia suits the acute symptoms and Phosphoric acid the chronic. Phosphoric acid is also indicated for homesickness. From the effects of grief the patient is sad ; he often has hectic fever and flushing of the face, especially in the afternoon, evening or toward night. He has sweat towards evening, and complains of crushing weight on the vertex. That last symptom is very characteristic of Phosphoric acid. Now, we may carry these indications further than this. We all know how the emotions affect the body, how bad news affects the digestion, how mother's milk is made poisonous by some terrible emotion. We may find in Phosphoric acid a remedy for uterine and ovarian diseases which arise remotely from emotional causes. Thus you may use it in pro- lapsus uteri which seems to have been precipitated by depressing emo- tions. If you have other symptoms to aid you in its selection, then all the more promptly will you find both local and constitutional symptoms removed by its administration. In homesickness you may'also think of Capsicum. Natrum mur. may be placed alongside of Phosphoric acid for the chronic effects of grief with the " vertex headache," sadness, weeping, emaciation, etc. Next, I would like to say a few words about the diarrhoea caused by Phosphoric acid. It is particularly indicated in diarrhoea which is pre- t , PHOSPHORIC ACID. 499 ceded by rumbling in the bowels. The stools are frequent and per- sistent. Particularly is it indicated in young persons who grow rapidly But the diarrhoea, despite its frequency, does not proportionately weaken the patient. The mother will tell you that her child has had diarrhoea for six weeks, with a great deal of rumbling of flatus, and yet it does not seem to be much weakened thereby. The stool may contain undi- gested food, and it may follow a meal. * The distinction between it and Cinchona lies in the fact that the Cinchona diarrhoea exhausts the patient excessively. Then another symptom of Phosphoric acid is, that the patient, though quite weak, is rested by a very short sleep. I presume that this action of the acid is owing to the stimulating effect of the Phosphorus it con- tains. Phosphoric acid is suited more to the remote effects of the loss of animal fluids rather than to the acute symptoms. Thus we find it indicated for the long-lasting effects of seminal emissions, whether occurring during sleep or when awake, with every effort at stool or urination or from excessive venery. The whole system seems to be weak- ened. The patient is dizzy, feels as if he would fall. There is another peculiar form of dizziness. On lying down he feels that the feet are going higher up than the head. The genitals are relaxed. The scro- tum and testicles hang down flabby and relaxed. The penis has no power of erection, or erections are deficient. Semen escapes too soon during coitus. The patient complains of formication over the scrotum. The back and legs are weak, so that he totters when he walks. He has little or no absolute pain. There is burning in the spine, which is worse at night. Phosphoric acid is very similar to Cinchona, in fact it is superior to it in the chronic effects of loss of seminal fluid. Cinchona is useful for the acute effects. For instance, a man has emissions for three or four consecutive nights, and is thus much weakened ; then Cinchona will relieve him promptly. When you give Phosphoric acid for this relaxed condition of the genitals, give it low. In headache, Phosphoric acid occasionally comes into play, especi- ally when the trouble occurs in school-girls; the headache comes on when they study and continues as long as they study. Phosphoric acid, furthermore, is to be thought of as a remedy for the debility arising from excessive study. Phosphoric acid also affects the mucous surfaces. We have to re- 500 A CLINICAL MATERIA MEDICA. member it particularly in chest affections. The cough arises from tickling in the chest, just about at the ensiform cartilage. It is worse in the evening after the patient lies down. In the morning we find expectoration, which is yellowish or muco-purulent, and usually tast- ing salty. We may think of it, although less frequently than of Phos- phorus, in cases of tuberculosis, when there is great weakness of the chest, so Jhat the patient can hardly talk. This weakness seems to be a cause of dyspnoea. Every draught of air gives him fresh cold. He wraps his chest up warmly; he cannot bear a draught of air to touch his chest. When these symptoms are present, the acid is superior to Phosphorus. Next, the action of Phosphoric acid on the bones. You may give it in scrofulous affections of children ; for example, in hip diseases and in curvature of the spine from caries of the vertebra, when this symp- tom is present: If the child is old enough he will complain of a feel- ing as if the bones were being scraped with a knife. This is from inflammation of the periosteum. It is worse at night. This symptom may occur after the abuse of mercury. Phosphoric acid, like all the mineral acids, affects the kidneys. It produces first what we may call polyuria or copious urination. The symptom, as it was produced in the prover, was this : The urine flowed so rapidly and so frequently that it came out as though the urethra was twice its natural size. You may see in Phosphoric acid a possible remedy for diabetes mellitus. The symptoms which lead you to it are, first of all, this frequent and profuse urination, requiring the pa- tient to rise often at night. The urine is often milky in appearance. Sometimes it deposits jelly-like masses, particularly in catarrh of the bladder. I would also like to call your attention to Lactic acid. As a remedy in diabetes I have used it with great benefit. Phosphoric acid has been recommended for growing pains. Guaiacum is also said to be useful for these. Sulphuric Acid. Arnica, Conium, Ruta. Sulphuric acid. < Pulsatilla, Nux vomica. I Lachesis. ,/ > Pulsatilla. Pulsatilla. sulphuric acid. 501 Sulphuric acid is indicated when the patient is hasty, quick and restless in his actions, sometimes, too, when there is the opposite con- dition, one of great depression, as in typhoid states. He answers ques- tions slowly and with great difficulty, just as does the Phosphoric acid patient. You find that there is a general sensation of trembling in the Sulphuric acid patient. He feels as if he were trembling from head to foot. The face in these conditions is rather peaked and is apt to be pale with blue rings around the eyes. Sometimes there is a feel- ing as though white of egg were dried on the skin. The patient is particularly weak about the digestive organs; thus there is a cold, re- laxed feeling about the stomach, making the patient long for some strong or stimulating drink, as brandy, and this, too, in persons who are not addicted to drink. So weak is the stomach they vomit all food ; the ejected matters are very sour. You will find Sulphuric acid especially indicated for inebriates who are on their "last legs." They have run down completely, and have long since passed the Nux vomica condition. You find them pale, shrivelled-Iooking and cold; their stomachs so relaxed as not to be able to tolerate any food. They cannot even drink water unless it contains whiskey. The liver is enlarged. They have a dry stomach cough, the act of coughing hurting the liver. The diarrhoea is watery and offensive, and is accompanied by excessive irritability of mind. They have a quick, hasty manner of doing everything. Piles annoy them. There is always dampness or oozing of moisture from the rectum. These piles burn, and are so large that they fill up the rectum. These cases are relieved by Sulphuric acid. There is another use we may make of Sulphuric acid, and it is de- rived from its power of modifying the thirst for spirituous liquors. You should take two or three drops of the pure acid and dissolve them in a glass one-half full of water. Give it to the inebriate every two or three hours in teaspoonful rdoses, and it will overcome the physical craving. Give it until he gets well, even if it produces a sore mouth. Should it produce diarrhoea, Pulsatilla is the proper antidote. Another effect of Sulphuric acid is its action in aphthous sore mouth occurring in debility arising from protracted disease, or in children with summer complaint or marasmus. The mouth is filled with yellowish aphthous spots. There is a profuse flow of saliva. With this there is apt to be vomiting of sour milk or sour mucus. The child smells sour despite the most careful washing. The stool is yellowish or slimy. It looks like chopped eggs. The child is very apt to have a cough, 502 A CLINICAL MATERIA MEDICA. which is very likely a stomach-cough, with belching of wind after the cough. You may think of Sulphuric acid also in diphtheria. The tonsils seem to be bright red and quite swollen. So swollen are they that liquids escape through the nose. The child is deathly pale, so pale that it looks like a corpse. It is inclined to drowsiness or somnolence. It can hardly breathe or talk, or make any noise on account of the abundance of membrane. Sulphuric acid is also useful as a traumatic remedy. It may be used for bruises of soft parts after Arnica; in bruises of glands after Conium ; in injuries of bones after Ruta. Particularly may it be used when there are long-lasting black and blue spots with soreness and stiffness. Again, Sulphuric, more than any other acid, is useful in haemor- rhages. It causes haemorrhage from every orifice of the body, the blood being dark and thin. You differentiate Sulphuric acid from Carbo veg., in the dyspepsia of drunkards by the fact that Sulphuric acid is more a " sour remedy " and Carbo veg. a " putrid remedy." LECTURE L. NITRIC, HYDROCYANIC AND PICRIC ACIDS. Nitric Acid. r Calcarea ostrearum, Kali carb, Lycopodium. Arsenicum, Carbo veg., Phosphorus, Moschus, Anti- Nitric acid. { monium tart. Phosphoric acid, Muriatic acid. Hepar, Mercurius. Arum triphyllum. Nitric acid. < Erosion of the mucous membranes, worse where they join the skin. Offensive discharges. Ulcers, irregular, exhibiting exuberant granula- tions ; worse from touch, from which they will bleed. Abuse of mercury. Typhoid.—Debility. Catarrh. Fibrous and osseous tissues. Nitric acid as a chemical substance need scarcely be explained to you, as you know its properties so well. I therefore pass on to con- sider its use as a medicine. You know its effects on the tissues, stain- ing the skin a dark yellowish-brown. It is a highly corrosive acid, eating into the flesh. Hence it has been used for the removal of warts, tumors, ulcers and exuberant granulations. It acts very powerfully on the „mucous membranes, and has a par- ticular affinity for the outlets of mucous surfaces where skin and mucous membrane join. Hence you will find its symptoms about the mouth, lips, nostrils, meatus urinarius and anus; in fact, wherever skin and mucous membrane come together, there has Nitric acid a prominent action. 504 A CLINICAL MATERIA MEDICA. As an illustration, we find it useful in stomacace or ulceration of the mouth. Now, keeping up the character of the drug, this stomacace will present its most violent symptoms about the lips. There will be blisters and vesicles on and around the lips in connection with the sore- mouth. Ptyalism will be present, particularly in cases that have been abused by mercury. So, too, you will find that the diarrhoea is asso- ciated with soreness and rawness of the anus.* Even fissures may be present, as I have already said. The characteristic discharges produced by Nitric acid are offensive, thin and excoriating, and, if purulent, are of a dirty yellowish-green color and not at all laudable. The ulcers calling for Nitric acid are offensive and characteristically irregular in outline, and tend to dip deeply. That is a sufficient dis- tinction from the ordinary preparation of Mercurius, which produces a superficial flat ulcer. These ulcers of Nitric acid are very apt to be filled with profuse exuberant granulations. They bleed readily from the slightest touch. Even the dressing that you apply makes the ulcer bleed. The pains are of a sticking character, as if splinters were sticking into the affected parts. They are often associated with burning pains. The ulcers are worse from the application of cold water. Nitric acid is particularly indicated in syphilitic ulcers after abuse of mercur}7, and also in those of a scrofulous character after Calcarea has failed. Another evidence of the offensiveness of the exhalations and secre- tions in Nitric acid is found in the urine, which has a strong odor, very much like that of the horse. It probably contains an excess of hippuric acid. This symptom is most highly developed in Ben- zoic acid. So characteristic is it in that drug that you will find it curing in a great variety of diseases when that symptom is present. The leucorrhcea is acrid, foetid, thin, brown, watery or stringy. The stools, too, show the putridity of Nitric acid. They are very offensive, and are green in color, and in children contain lumps of casein. They are also slimy from excess of mucus secretion and are associated with much straining; the tenesmus here closely allies it to Mercurius. At other times, particularly in scrofulous children, the stools are pale from deficiency of bile, and pasty and sour as well as offensive. Nitric acid affects the mucous membranes, producing catarrhs. We * Sore excoriated anus: Merc, SULPH., Cham., Arsenic, Puis., Graph., China. NITRIC ACID. 505 find it indicated in coryza, particularly when it is associated with some malignant disease, as scarlatina or diphtheria. Yellow foetid eczema with ulcers; Eustachian tubes obstructed. In nasal diphtheria, Nitric acid is one of the chief remedies. The discharge from the nose is watery and very offensive, excoriating every part which it touches; frequent epistaxis. If you examine the nose, you will find that there is a well-developed white deposit there. Another symptom which is very characteristic as accompanying these conditions, is intermittent pulse. If the membrane is also in the throat, you will have foetid odor from the throat, too. The child will complain of a feeling as though there was a splinter sticking in the throat. This is a general characteristic of Nitric acid, a sensation as of a fish-bone, splinter or piece of glass sticking in the affected part. This runs all through the symptomatology of the remedy. You find it in the ulcers, and you find it in the rectum associated with the fistulae and piles, and you find it here in the throat. Nitric acid is here very similar to its complement, Arum triphyllum, which, like Nitric acid, causes this excoriating discharge from the nose, making the lips sore; the corners of the mouth crack; the child cannot open its mouth on account of the soreness. Another remedy is Muriatic acid, which has thin excoriating dis- charge from the nose, intermittent pulse and loss of appetite. Another effect of Nitric acid, and one, too, in which it has no superior, is its use to remove the bad effects of mercury. The particular symp- toms which call for it in this condition are these: Irritability, restless- ness and mental anxiety. This irritability amounts to cursing and swearing. There are also periosteal pains; ophthalmia; inflammation or ulceration of the cornea, with tendency of the ulcers to perforate; hardness of hearing from catarrh of the middle ear and Eustachian tube; ptyalism; ulcers in the throat; caries of bones, particularly of the mastoid process of the temporal bone; dysentery, etc. It is particularly adapted to secondary more than to primary syphilis, and more especially adapted to secondary syphilis after the abuse of mercury. Chancres have even returned and are phagedenic. There is great soreness in the bones at night, particularly in the bones of the head and along the shins, and this is worse from every change in the weather. On a damp day he will have a boring pain in the bones. Ulcers appear in the throat or on the surface of the body, and these are characteristically irregular in outline. Warts develop, and these are almost always more or less pediculated. There are yellowish-brown 33 506 A CLINICAL MATERIA MEDICA. spots or copper-colored spots all over the body. There is great de- bility, with sweat and exhaustion. When mercury has been abused, Hepar is probably the best antidote we have. Wrhen mercurialization is conjoined with syphilis, Nitric acid is the preferable remedy. Nitric acid may be needed in the treatment of phthisis. There are sudden rush of blood to the chest, and decided hectic fever, which indi- cates ulceration of the lungs from breaking down of tubercles. The chest is extremely sore to the touch. The patient suffers from frequent haemorrhages from the lungs, the blood being bright red and profuse. There is great dyspnoea, so that the patient cannot talk without getting out of breath. There are also morning hoarseness, exhausting phthisi- cal diarrhoea, worse in the morning, and sharp stitches through the right chest to the scapula. The pulse is intermittent. The least attempt at exertion causes palpitation of the heart and dyspnoea. The sweat comes particularly at night and towards morning, and exhausts the patient very much. The skin is apt to be cold towards morning. He is chilly on getting into bed. Heat comes in flashes, or it is only in the hands and feet. The cough is of a tickling character, and seems to annoy him all night. You hear, on examination, loud rales all through the chest, and the expectoration is offensive, bloody and decidedly puru- lent, and of a dirty green color, not being yellowish-green and laud- able, as you find under Lycopodium and Pulsatilla. Sometimes the cough is loose and rattling in character. The patient is usually of thin build, with dark hair and eyes. Nitric acid is very often indicated in phthisis after Calcarea ostre- arum or Kali carb. Calcarea is especially suited to leucopblegmatic patients. The face is pale and sallow. There is soreness of the chest, which is very much aggravated by touch or pressure. The cough is loose and rattling. Diarrhoea, if present, is worse in the evening. Hoarseness, though persistent, is painless. When, however, the Cal- carea condition has run into the acid debility, Nitric acid is one of the very best remedies to follow. It does not often cure, but it relieves and prolongs life for years. Still another application that we may make of Nitric acid is in typhoid fever, particularly in the ulcerative stage; that is, when Peyer's patches have begun to ulcerate. You will find the patient greatly ex- hausted. The characteristic indications for Nitric acid are these: Stools are green, slimy and offensive, and sometimes purulent, the pus coming from these ulcers, and there is profuse bright red haemorrhage from HYDROCYANIC ACID. 507 the bowels, with fainting on the slightest motion. The tongue is either white and studded with vesicles or little sore spots, or it is brownish and dry. We have well-marked pneumonic complications. There seems to be threatening paralysis of the lungs, which you know is by no means an uncommon thing in typhoid fever. This incipient par- alysis of the lungs is expressed by loud rattling of mucus in the chest. The pulse, in such cases, you will find to be intermittent at every third beat. Now, do not forget Moschus, Phosphorus, Antimonium tart., Arseni- cum and Cuprum and other remedies that I have mentioned in this connection. In haemorrhage from the bowels during typhoid, you may also re- member Alumen, which is useful when there are large clots passed. Arsenicum is called for in this haemorrhage from the bowels when the flow consists of dark watery blood, and is associated with anxiety and restlessness. We find Hamamelis indicated when there is a dark venous flow, without anxiety. Sometimes the blood is dark and pitch-like. Still another remedy is Leptandra, which is useful in typhoid fever with symptoms of a bilious character, when the stools consist of black blood, looking like pitch. Hydrocyanic Acid. I Spasms; epilepsy ; tetanus. TT , . ., Cholera. Hydrocyanic acid. < „, . . Scarlatina. Heart; cough. Hydrocyanic acid acts upon the cerebro-spinal nervous system, and particularly upon the medulla and upper portion of the spinal cord. It produces convulsions which are very much like those of the fully- developed epileptic attack. Dr. Hughes, of Brighton, England, re- commends it as a specific for epilepsy. This, of course, it is not. To cure this disease, you will have to take into consideration the symp- toms of each case, and prescribe accordingly. Hydrocyanic acid also produces a tetanus which resembles very much that produced by Nux vomica. The body is stiffened and thrown back, cramp in the nape of the neck like Cicuta; breathing comes in paroxysms, the jaws are set, there is foaming at the mouth, but the face is flushed. 508 A CLINICAL MATERIA MEDICA. It is also useful in convulsions during severe attacks of illness, when the face is blue, and the prostration is very great. There are gasping breathing, clutching at the heart, and livid color of the surface of the body. You may also give Hydrocyanic acid for very severe cases of pros- tration, with approaching paralysis of the brain and lungs, and when there is gurgling from the throat to the stomach when swallowing. In cholera, Hydrocyanic acid is to be placed by the side of Camphor, being indicated in marked collapse with sudden cessation of all dis- charges, as vomiting and purging. In scarlatina it is indicated in almost hopeless cases of a malignant type, in which the rash is livid from the very beginning. The feet are almost always cold. Hydrocyanic acid may be given for the cough of heart disease when it is reflex from organic changes in the heart. It may also be used for the dry tickling cough of consumptives. You may prefer Lauroeerasus, for the dry, teasing cough of con- sumptives, worse at night. You may also give it for cough with ex- pectoration which contains little specks of blood scattered through it. Picric Acid. Picric acid causes at first some congestions. These are soon fol- lowed by weariness and mental inactivity, showing how intensely the remedy attacks the vital forces. This weariness progresses from a slight feeling of fatigue on motion to complete paralysis. It is accom- panied by indifference and want of will-power, and desire to lie down and rest. Animals, poisoned with this acid, were affected with paraly- sis of the hind legs, with slow breathing and great muscular weakness. At the autopsies made on them, the cortex cerebri, the cerebellum, me- dulla oblongata and spinal cord were found reduced to a soft, pulpy mass, that was dark brown in color, and loaded with little shining, greasy particles. The urine was rich in phosphates and uric acid, and poor in sulphates and urates. Albumen and sugar were also found in the urine. The liver was full of fat granules. These symptoms and pathological observations bespeak the use of Picric acid in diseases of the brain and spinal cord. To give it, we need not wait until paralysis has set in. We may find it useful in typhoid conditions and also in conditions of brain fag when the mind has been over-worked. In the latter affection, brain fag, Picric acid is one of our best remedies. PICRIC acid. 509 It is also useful in neurasthenia. You will find dull headache with aggravation from the slightest attempt at using the mind. This may be in the forehead or in a still worse place, in the occiput, and may then extend down the spine. The patient complains of feeling constantly tired and heavy. Any attempt to study brings on anew these symptoms of the brain, and also develops burning along the spine and very great weakness of the legs and back, with soreness of the muscles and joints. Sometimes sleep is restless and disturbed by priapismic erections. With these, of course, there will be frequent seminal emissions. Sometimes you will find severe pains in the neck and occiput going up to the supraorbital notch or foramen, then extending down into the eyes. There are hot feeling in the lower dorsal region, and aching and drag- ging in the lumbar region, which is worse from motion. On awaking from a sleep the patient has a tired aching in the lumbar region. The legs are heavy and, at the same time, weak. With this heaviness of the feet he sometimes complains of dull frontal headache. Sometimes he complains of numbness and crawling in the legs, with trembling and with pricking, as if from needles. He has tingling of the lips, formication about the head, and crawling as of ants over the surface. The least exertion causes prostration. He also has vertigo, worse when he stoops, walks or goes up-stairs. He has headaches, with dull, throb- bing, heavy, sharp pains, worse from study or movement of the eyes, and better from rest, the open air, or binding the head tightly. The pupils are dilated. Sparks appear before the eyes, which may even smart and burn. Thick matter forms in the canthi. The eye symp- toms are worse from artificial light. Accompanying the congestion of the head is nose-bleed. The nose is full of mucus. The patient can breathe only when the mouth is open. The saliva is either frothy or stringy. The taste in the mouth is like that of the acid itself, sour and bitter. The throat feels rough and scraped; better from eating and worse from empty swallowing, and worse after sleep. There is thick, white mucus on the tonsils. On swallowing, the throat feels so sore that it almost seems as if it would split. Sour eructations may accompany the frontal headache. Now, these gastric symptoms may accompany the brain fag. Nausea, which is worse about five o'clock in the morning and worse when attempting to rise. He also complains of pressure and weight about the stomach. He wants to belch, but does not seem to have the power to do it. The irritating effect of the drug is further shown by diarrhoea with stools which are thin, yellow and sometimes oily, with a great deal of burning and smarting at the 510 A CLINICAL MATERIA MEDICA. anus, with prostration and unsuccessful urging to stool. The kidneys are congested. The urine has an abnormally high specific gravity, and contains sugar. It is also albuminous. The conjunctivae are yellow, just as you find in jaundice. Papules appear on the face and turn into small boils. The feet are apt to be cold. These, then, are the main symptoms of Picric acid. Now, let us study those of a few of its re- lated remedies. Phosphorus, like Picric acid, causes fatty changes in the blood, kid- neys, brain and spinal cord. Both remedies meet in sexual excesses and priapism, and both maybe indicated in brain fag; both have con- gestive vertigo and crawling and tingling sensations here and there over the body. The distinction lies principally here: Phosphorus causes more irritability with the weakness, as displayed by over-sensi- tiveness to all external impressions. Hence, the senses are too acute, or, if failing, there are present photopsies; loud noises in the ears; sen- sitiveness to odors; electric changes in the atmosphere; head weak; cannot think, with aggravation from loud noises. Phosphorus also has backache, with feeling as if the back would break on any motion, and with burning spots in the back, better on rubbing. Sexual excitement is very strong, but the erections are not so intense as under Picric acid, although the lasciviousness is more marked. Even when, in extreme cases, all irritability has ceased, the history shows that it once charac- terized the case. Nux vomica resembles Picric acid, somewhat, in the brain fag and in the gastric symptoms, in the sour eructations, in the aggravation towards morning, and in the inability to study. Oxalic acid, more than Phosphorus, resembles Picric acid in the ex- treme picture of spinal softening. There are weakness about the loins and hips, of course, extending down the legs, and numbness in the back. Picric acid has more heaviness and Oxalic acid more numbness. The legs are apt to be bluish and cold. The patient complains of paroxysms of dyspnoea. Another symptom, and one indicative of spinal meningitis, is intense inflammatory pain all through the back. A general symp- tom of Oxalic acid is pains coming in small spots, and greatly aggra- vated on thinking of them. Another remedy closely related to Picric acid is Sulphur. This causes congestion of the lumbar spine. So intense is this congestion that paraplegia, with numbuess and tingling, results. Heat in the spine. There is retention of urine. Phosphoric acid suits cerebro-spinal exhaustion from over-work. PICRIC ACID. 511 The least attempt to study causes heaviness, not only in the head but in the limbs; numbness; vertigo; confusion of thought; tingling; formication, especially in small of back; back and legs weak, yet no pain, except a subjective sense of burning ; emissions even during stool; genitals relaxed. Argentum nitricum has backache, worse when first rising from a seat and better from moving about, with trembling weakness of the limbs; vertigo, with fear of projecting corners, etc.; bones at sacrum give out; limbs tremble; impotency ; organs shrivelled. Alumina is indicated in cases somewhat like those calling for Picric acid, but is distinguished by the pains in the spine as though a hot iron had been thrust into the part. The patient staggers when walking in the dark. He also has painful feeling about the soles of the feet. Silicea is quite similar to Picric acid. It is useful in nervous ex- haustion, where the patient dreads any exertion either of body or mind. When he is warmed up to his work, he can get along pretty well. He also has numbness in the toes, fingers and back, and the constipation peculiar to Silicea. Zinc causes nervous exhaustion. Its backache is worse at the last dorsal vertebra, and is worse while sitting; burning along the spine; formication in the calves; weak limbs; weak back and limbs, with goneness when hungry, especially at 11 A.M. All the nervous symp- toms are worse from wine. ' Of the remedies which cause violent erections you'may compare the following: Cantharis, Phosphorus, Capsicum, Agaricus, Pulsatilla, Platinum, Opium, Ambra grisea, Zincum, Physostigma, Petroselinum and Mygale. LECTURE LI. SILICEA. f Asaf, Phosphorus, Conium, Graphites. Silicea. < Sulphur, Calcarea ostr., Lycopodium. [Gettysburg water. < Mercurius. Silicea in its crude state is inert. It is insoluble, and hence has very little effect on the system. When potentized according to the formula of Hahnemann it becomes one of the most valuable drugs in our ma- teria medica. It is a grand illustration of the efficacy of potentiza- tion. The great and important effect of Silicea lies in the nutritive changes which are made by it. As nutritive changes are more evident in the growing child than in the adult, you will find Silicea symptoms ap- pearing mostly in children from infancy up, not that it is contraindi- cated in the adult, but its use is shown more evidently in the young. The child, then, is imperfectly nourished, not from defective quality of nourishment, but from defective assimilation. The head is dispro- portionately large ; the fontanelles, especially the anterior, are open; the body is small and emaciated, with the exception of the abdomen, which is round and plump, as is often the case in scrofulous children. The head, including the scalp, neck and face, is covered with an offen- sive sweat. The face is pale, waxen, earthy or yellowish. The bones are poorly developed, as are also the muscles, consequently the child is slow in learning to walk. Silicea is especially adapted to rachitic children. The fibrous parts of the joints are inflamed, swollen or ul- cerated. This gives the joints, especially the knees, a knob-like ap- pearance. Silicea is complementary to Thuja, especially in nervous affections and for the bad effects of vaccination. Whatever we may say in favor of the necessity of vaccination, we do know that this operation may be followed by unhappy symptoms, and that, too, when the purest of virus has been used. Hence, at times, you have to counteract the bad effects that may follow the operation. We know that in Paris some 30,000 or 40,000 children were vaccinated after each were given a dose SILICEA. 513 of Sulphur, which prevented the outbreak of any other disease than the vaccinia itself. If such bad effects as erysipelas, convulsions or diarrhoea should follow, then you will give Silicea, which will cure the case. Thuja, itself, is complementary here, and comes in very well for diarrhoea following vaccination, and also when the vaccination fever is high. Pustules, like those of small-pox, together with a rash, ap- pear all over the body. You notice that to the right on the board I have placed Mercurius, prefixed by a "crescendo" mark. That means that Mercurius does not follow well after Silicea. Their symptomatologies are apparently similar, and yet they do not seem to agree, although Silicea will anti- dote some of the effects of mercury, but, as potentized medicines, they do not follow each other well, hence you must be careful in deciding between the two drugs. Fluoric acid antidotes the over-use of Silicea in bone affections. Hepar also antidotes some of the effects of Silicea. We are now ready to take up the effects of the drug. First, on cellular tissue. Silicea has long been known as a valuable drug, be- cause of its affinity for cellular tissue. It produces inflammation of this vast tissue of the body, an inflammation which progresses to sup- puration, and suppuration, too, which is rather indolent or sluggish in type, not necessarily malignant, but tending, rather, to perpetuate itself and become chronic. The case tends rather towards chronicity than towards resolution. The termination of the Silicea cellulitis, then, is in suppuration, which is persistent, in ulceration which is also persistent, or in induration. You may have it indicated in any one of these forms. I have already illustrated this in the application of Silicea to the tonsils when these glands suppurate and refuse to heal. You will see it also in the treatment of boils or furuncles, furuncles which occur in crops and which do not heal readily, but continue to discharge a rather thin, watery and even ichorous pus, usually having a foul odor, or even thick pus. Silicea may frequently be suggested as a remedy to prevent boils, on account of its tendency to produce inflammation of the connective tissue. So, too, it would be suggested in that dread disease, carbuncle, par- ticularly when it is situated between the shoulder and nape of the neck, a common site for carbuncle. Silicea may also be used for induration. For instance, following the treatment of boils and abscesses, or other inflammations of the kind involving the parenchyma of an organ, you may have plastic 514 A CLINICAL MATERIA MEDICA. exudation, giving you inflammation with induration. This induration tends to be absorbed under Silicea. This effect places Silicea alongside of Graphites, Graphites being a drug you will remember which tends to absorb indurated surfaces, even going so far as to effect the obliteration of cicatrices. The same has been said of Phytolacca, but I think that this lacks confirmation. It certainly lacks the confirmation that Graphites has had. Sometimes you will find that Silicea is unsuccessful in these indura- tions. Then a dose of Sulphur, interpolated, makes the Silicea act better. In ulceration we find Silicea useful. In fact it may be given with good result in all forms of ulcers, both benign and malignant. Its distinctive features are ulcers from bone diseases, as caries or necrosis, scrofulous ulcers which appear about joints, ulcers which appear in the back from vertebral caries, and ulcers.which appear about the hip in hip-disease, particularly if connecting with fistulas. The pus is thin and offensive, and often mixed with blood and sometimes with little particles looking like cheese. There is very little tendency to heal spontaneously. These ulcers are relieved by warm and aggravated by cold applications. Silicea acts upon the bones. We find it indicated in scrofulous children where the bones are curved ; where spinal curvature is pres- ent. Not only is it indicated in lateral curvature, but where there is caries of the vertebral column itself. It may also be indicated in disease of the hip- or knee-joint, when the discharges are thin and offensive, and when there are fistulous tracks opening into the joint. The patient is of a scrofulous diathesis, and presents the constitutional characteristics that I have already men- tioned as belonging to the Silicea patient. In addition to the symptoms there enumerated, the Silicea patient may have an offensive foot sweat, and this tends to make the toes sore and even raw. Sometimes there may be an offensive axillary sweat. (I believe that the best remedy for axillary sweat is Petroleum.) The child also has tendency to swelling of the glands, which .suppurate. Now with these symptoms there is marked aggravation from touch, a peculiar susceptibility to touch, in fact. I would here compare it with Lachesis. The patient does not want you to touch him. I dwell on this symptom for two reasons; one is that it helps you to differentiate from the closely allied lime salts, and the other, because it illustrates a property of Silicea which you will see when we come to speak of its action on the nerves. SILICEA. 515 Let us now stop to compare Silicea with its related remedies. Asa- foetida has offensive discharges from the bones. It is distinguished, however, by the intolerable soreness around the ulcer. For instance, in caries of the tibia, with an external outlet and discharging pus, the parts around the ulcer are so sore and tender to the touch that the pa- tient cannot bear the dressing. Phosphorus is very similar to Silicea in bone disease. It resembles it in abscess, particularly in mammary abscess, with fistulous openings. It is similar, too, in the caries of bone, particularly in necrosis. Phos- phorus, like Silicea, has this over excitability of the nervous system. Platinum mur. is also a valuable drug in caries of the bones. Another is Angustura, which is particularly useful in caries of the long bones, as the humerus, tibia, femur, etc. Strontiana carbonica is especially useful in caries of the femur with coexisting watery diarrhoea. Gettysburg salt is rich in carbonate of lithium, and is very useful for symptoms precisely like those of Silicea, namely, carious ulcers, or ulcers about joints, such as occur in hip-disease or in caries of the ver- tebrae. The discharge is acrid and excoriating. Sulphur, Calcarea, and Lycopodium are similar to Silicea in the scrofulous diseases of children. The distinction between Calcarea and Silicea is as follows : The Calcarea head sweat is confined to the scalp, and is sour rather than offensive. The feet also are damp from sweat, but the sweat does not, as in Silicea, make the feet sore or raw. Cal- carea lacks the sensitiveness to touch of Silicea. In this sweating of the head, the body being dry, Silicea is exactly opposite to Rhus tox., which has sweating of the body, the head being dry. The mucous membranes do not escape the action of Silicea. We have otorrhcea, the discharge from the ear being offensive, watery, and curdy; that is, you find whey-like curds in it. Often you find the membrana tympani perforated with discharge of pus thence, containing little pieces of bone, the result of involvement of the mastoid process by the disease. There is keratitis, especially with tendency to the formation of sloughing ulcers. These ulcers slough and perforate the cornea like those of Nitric acid. These in the Silicea child are not vascular, so there is not much infiltration of the surrounding tissues. Hypopyon is present. The lids are swollen and covered with suppurating styes. The nose is affected. Silicea is especially useful in nasal catarrh 516 A CLINICAL MATERIA MEDICA. when ulcers exist on the mucous membranes, and these discharge a thin, bloody excoriating matter; or they may be dry, and then there is annoying dryness of the nose. It is also useful when the catarrhal process extends backwards and involves the outlets of the Eustachian tubes, producing an intolerable itching and tingling in this locality. We also find Silicea indicated in some forms of hay-asthma, espe- cially that which begins with itching and tingling in the nose and vio- lent sneezing and excoriating discharge from the nose. Silicea has also an action on the lungs. It produces hoarseness and roughness and dryness, with a tickling cough which seems to come from the supra-sternal fossa. (Rumex crispus also has this cough.) There is also a feeling as if a hair were lying in the throat, larynx or trachea. The cough is excited by cold drinks, as under Rhus tox., by the very act of speaking, as in Phosphorus, Rumex, Ambra grisea, etc., and worse at night when lying down, just like Rumex, Phosphorus and Lycopodium. Sometimes it ends in the vomiting of mucus. Silicea is useful in the suppurative stage of tuberculosis, when the cough, at first dry, becomes loose, with the expectoration of offensive muco-pus. You will find it of great service in the phthisis mucosa of old people. After great exertion the patient expectorates nasty pus, which is horribly offensive. Silicea will not cure these cases. It can only palliate. Phellandrium aquaticum is an excellent remedy in the last stages of phthisis when the expectoration is terribly offensive. I would advise you to remember Capsicum for bronchial catarrh when the breath is not offensive except during the cough. You know that the Capsicum patient is of lax fibre and cannot get up the expec- toration; so some of it lies there and undergoes decomposition. The air of ordinary expiration is not offensive, but as soon as the patient brings that from the very depths of the lungs, the offensive odor be- comes quite marked. In tonsillitis, Silicea is indicated when the tonsils have suppurated and discharged and refuse to heal. Especially is it indicated when this condition occurs in rachitic children. In the Silicea diarrhoea the stools are offensive and usually painless and lienteric. The child vomits its food. These symptoms are asso- ciated with the characteristic skin lesions and constitutional peculiarities which go to make up the Silicea child. The constipation of Silicea is of this character. Stool partially es- capes from the rectum and then seems to slip back. I think that this SILICEA. 517 symptom is easily explained. There is defective expulsive power on the part of the rectum. With a great deal of straining the stool is partly pushed down. When the bearing down ceases then it slips back. Next you have to remember the action of Silicea on the nervous system. It has here a very peculiar effect, which was pointed out first by Dr. Dunham. It causes a tendency to paralysis and paralytic weakness. Here, too, the trouble seems to be due to defective nutri- tion of the nerves themselves, both in the brain and spinal cord. Then you will have to remember it as a remedy in paralytic weakness ac- companying disease of the spinal column. Often, with this condition, there is the peculiar constipation I have just described. With all these paralytic troubles there is an over-susceptibility to nervous stim- uli. The senses are morbidly keen. The brain and spine cannot bear even an ordinary concussion or vibration. The surface of the body is tender and sensitive to the touch. Cold aggravates the symptoms and heat relieves. Silicea may be given in convulsions of an epileptic character, with well-marked aura, when it starts from the solar plexus, as in Bufo and Nux vomica. The attacks are also said to come in certain phases of the moon. The patients are worse from any overstrain of the mind or emotions. The headache of Silicea is of a nervous character. It is provoked by any excessive mental exertion. Then it is usually supraorbital and is generally worse over the right eye. It is worse from any noise, motion or concussion, and better from wrapping the head up warmly. It is not the pressure, but the warmth, that relieves. Sharp, tearing pains rise from the spine into the head. At the height of the paroxysm there is apt to be nausea and vomiting from sympathetic involvement of the stomach. You should here compare Menyanthes, Paris quadrifolia and Stron- tiana carb. Menyanthes was first confirmed by Dr. Dunham. It has a peculiar headache coming from the nape of the neck, over the lread. There is a bursting pain, as if the membranes of the brain were tense, and were pushing the skull open. This is relieved by pressure rather than by warmth. Paris quadrifolia has headache of spinal origin, which arises from the nape of the neck and produces a feeling as though the head were immensely large. Strontiana carb. produces headache coming up from the nape of the 518 A CLINICAL MATERIA MEDICA. neck and spreading thence over the head. It is just exactly like the headache of Silicea. You will have to distinguish by the collateral symptoms. There are other nervous symptoms produced by Silicea. The pa- tient has vertigo, which, like the pains, seems to rise from the spine into the head. It also causes difficulty in balancing. He has a fear that he will fall, and always to the left. Speech is somewhat confused. He finds it difficult to grasp the exact expression he wishes, and this even in ordinary conversation. Sluggishness is a contraindication of Silicea in nervous conditions. You cannot use it in torpid, flabby, nerveless persons. Remember that exactly the opposite is the case with dieease of the lower tissues. Silicea acts just as powerfully on the spine as it does on the brain, causing general motor weakness. Here, too, it is attended with the same irritability. The neck is stiff, causing headache. This stiffness of the neck is not from cold, not from rheumatism of the various muscles, but from spinal irritation. The small of the back aches as if beaten or pounded. The patient complains of pains about the coc- cyx, and cramps such as one experiences after sitting a long time or after riding a long time over a rough road. The legs tremble. They weary when one moves, particularly in the morning. Loss of animal fluids particularly aggravates the symptoms. For instance, seminal emission or coitus causes, or is followed by, bruised aching all over the body. There may also be symptoms of the spine which indicate loco- motor ataxia. The fingers feel stiff, with loss of power in them. The part of the body on which he lies, goes to sleep. Silicea is useful in chronic rheumatism. It is one of the remedies on which to depend in treating hereditary rheumatism. Particularly are these pains in the shoulders and in the joints, all of which are worse at night and worse when uncovering. A related remedy here is Ledum, which has exactly the opposite aggravation to Silicea. The patient is worse from covering up. The symptoms usually extend from the feet upwards. LECTURE LIT. ARSENICUM ALBUM. Arsenicum. < Phosphorus. Arsenicum. < r Aconite, Sulphur. Phosphorus, Rhus, Lachesis. Ipecac, China, Verat. alb., Colchicum, Ferrum. Baptisia, Muriatic acid, Phosphoric acid, Nitric acid. Antimonium crud., Antimonium tart., Nux v., Pulsa- tilla. Secale, Camphor, Carbo v. Apis. Ailanthus. Anthracinum. > Sesquioxide of iron. > China. > Ipecac. > Ferrum. > Graphites. > Camphor. >Veratr. alb. Irritability. Inflammations: stomach, uterus, etc. Fevers: continued, typhoid, intermittent. Skin: exanthemata, indurations, gangrene, carbuncle, cancer, ulcer. Nerves: neuralgia, convulsions, stupor, exhaustion, fainting. Catarrhs: eyes, nose, throat, lungs, etc. Dropsy: anasarca, hydrothorax. To-day we take up for study the last of the acid remedies. I refer to Arsenious acid, or Arsenicum alburn. It has quite a number of con- cordant remedies and quite a string of antidotes. Its complementary remedies are Phosphorus and Allium sativa. Arsenicum album comes to us quite thoroughly studied, both as a 520 A CLINICAL MATERIA MEDICA. poison and as a remedy. It has long been known as a speedy means of destroying life, hence it has been frequently used for suicidal and homicidal purposes. It has the property of uniting with animal tis- sues, probably with the albuminous portions of the tissues, hardening them and causing them to resist the usual process of decay, so that these tissues are long preserved. This fact is taken advantage of by taxidermists in stuffing birds and animals. Cases of accidental poison- ing with Arsenic are quite common, and this is all the more so because of the use of Arsenic in the arts. In the form of Scheele's green, or arsenite of copper, it enters into the composition of certain paints. It is used frequently in the manufacture of certain green wall-papers, and also in artificial flowers. It is also introduced into pastes to be used in sealing packages, which are to protect goods from insects. All these uses of Arsenic render poisoning, especially chronic poisoning, by it not at all uncommon. In certain districts Arsenicum is indulged in as an article of diet. The women take it for the purpose of beautifying the complexion, and the men indulge in it because it enables them to work hard with little or no fatigue. The drug acts on muscular tissue so as to increase its power of endurance. We may make use of this fact when some dis- ease has resulted, from climbing mountains or a long journey, as a' provoking or modifying cause. The " Arsenic " vice is very objec- tionable, and certainly very injurious. After awhile these persons will suffer from Arsenic poisoning, especially if they move away from the region where they are living. The symptoms of slow arsenical poison- ing are these: (Edematous eyelids ; the patient suffers from slight conjunctivitis; the eyes are always red and injecteJ, and smart and burn. Associated with these symptoms is dim sight. Whether this comes from the inflammation externally, or from any internal ocular trouble, I am unable to say. The mucous membrane of the mouth, nose and throat is unnaturally red and dry. The sufferer complains of almost constant thirst. Digestion is most certainly deranged. The patient will tell you that he is dyspeptic. The skin assumes rather a dry, dirty look; it is only exceptionally clear and transparent. The patient suffers frequently from nettle-rash. Long wheals appear, and these itch and burn intolerably. Still later, eczema makes its appear- ance. The patient also suffers from stubborn neuralgia in different parts of the body. These are the most common, and the most certain symptoms indicating arsenical poisoning. In addition to these there will be some acute symptoms. For instance, there will be times when ARSENICUM. 521 the patient has attacks of vomiting, with deathly nausea. He will vomit everything he drinks. At other times he has symptoms indi- cating cholera morbus, e.g., vomiting and purging, and coldness of the surface of the body. You may frequently be called upon to antidote arsenical poisoning. If it is an acute case you should excite vomiting and administer the sesquioxide of iron as an antidote. Dialyzed iron has also been re- commended. It has the advantage of being more stable than the ses- quioxide. For the nausea occurring during chronic poisoning, Ipecac acts very nicely. In the acute attacks simulating those of cholera morbus, Veratrum album relieves. Cinchona also suits many of the symptoms, particularly the debility, dropsy and neuralgia. Graphites is one of the best remedies to cure the skin symptoms of chronic arsenical poisoning. Now we will consider the symptoms of Arsenicum in their totality. Quite a universal symptom of the drug, and that, too, whether the result of poisoning or of proving, is what I have already mentioned, an irritability of fibre. This is present and prominent in the worst cases in which Arsenicum may be used. Death may be almost certain, and yet there is this irritability of fibre showing the universal charac- teristic of the drug. Even when the patient lies in a stupor, this stu- por is broken by anxious moans and restlessness. Consistently with this quality of the drug, we find Arsenic indicated in patients who are anxious and restless, frequently changing their position, full of fear of death; hence they do not wish to be left alone for fear they will die. Delirium is violent, more violent than in any other of the acids except Nitric acid. It is worse at night, particularly after midnight. The patient has visions of ghosts and other fanciful figures, with trembling of the whole body. You cannot here fail to recognize the similarity to delirium tremens or mania-a-potu. Arsenicum here is of great use, particularly in old offenders who are seriously diseased by the use of alcohol, and who, from some cause or other, cannot get their usual drink. The pains which the Arsenicum patient experiences, whether neu- ralgic or otherwise, make him desperate and angry, almost furious, in fact. When falling asleep, he jerks and starts. During sleep his dreams are frightful and fantastic. Before going any farther, I want to introduce a caution in regard to Arsenic. Arsenic is not a remedy usually called for in the beginning of diseases. The tendency of the 34 522 A CLINICAL MATERIA MEDICA. symptoms is deathward. If you give the drug too soon, in a disease which in itself teuds deathward, you may precipitate the result which you are anxious to avoid. I have myself several times made the mis- take despite great caution. Do not give Arsenicum early in typhoid fever unless the symptoms call for it unmistakably. Here it is espe- cially dangerous to give it too soon. Often Rhus tox. precedes its use. I will say the same thing in regard to tuberculosis. In the Jast stages of this disease this restless tossing about is not an Arsenic symptom, and Arsenicum will not relieve it. That is only a precursor of death. You must be certain that the mental state is indisputably that of Arsenic, or you will do harm instead of good to your patient. There is one exception to this word of caution, and that is in inflammations of the gastro-enteric system. I may say that Arsenicum may here be given quite early in the case without doing any harm, on the contrary, with much benefit. Now for the inflammations and fevers of Arsenicum. Arsenicum alters the blood. It is useful, as we shall learn, in low types of dis- ease, when the blood-changes are serious. The inflammations of this remedy are characterized by their intensity, and by the tendency to t the destruction of the tissue which is inflamed. In these local inflam- mations of Arsenic you will find burning lancinating pains the charac- teristic sensations. This is described by the patient as though hot coals were burning the part. It is often accompanied with throbbing. Now this burning when Arsenicum is the remedy indicates destruction of tissue, hence it calk? for this remedy in gangrene, in sloughing, in car- buncles, and in that dreadful disease, cancer. And it does not call for Arsenic when this burning is a mere sensation. Patients occasionally complain of burning pains, here and there, which arise from nervous causes only. Arsenicum does no good then. I have often seen phy- sicians give Arsenic when women complained of burning pain in the ovaries. There was no evidence whatever of active inflammation, but there was this burning from ovaralgia. Arsenicum could do no good here. If, however, there is ovaritis with this pain, Arsenic becomes an invaluable remedy. All these cases in which Arsenic is called for are relieved by hot applications, and greatly aggravated by cold. The most important sites for the Arsenicum inflammations are the stomach and bowels primarily, and next to these the heart. . This in- flammation in the stomach and bowels may vary from slight irritation to the most destructive gastritis. The mouth is dry, the tongue white as if whitewashed, or, in some other cases of irritable stomach, the ARSENICUM. 523 tongue is red with raised papillae. Thirst is intense, but the patient drinks but little at a time because water hurts the stomach. An or- dinary amount of food causes a feeling of fulness or repletion. In this symptom it is similar to Lycopodium. The least food or drink is vomited as soon as taken. But we may have another group of symp- toms: Weak, sinking sensation at the pit of the stomach, relieved by eating, but so soon as he begins to eat, he has urging to stool with diar- rhoea. Here the drug is similar to Cinchona and Ferrum. There is very distressing heartburn. Sometimes, burning in the stomach like coals of fire is associated with the diarrhoea. The stools are undigested, slimy, and bloody, and are attended with violent ten- esmus and burning in the rectum. If this goes on, the stools become brownish or blackish, and horribly offensive, showing that it is indicated in most serious cases of enteritis and dysentery. The exciting causes for these various sets of symptoms are sudden chilling of the stomach with ice-water or ice-cream, alcoholic drinks in excess, certain poisons, as sausage meat that has spoiled, rancid fat, spoiled butter or fat that has undergone decomposition, and lobster salad at certain seasons of the year. Arsenicum also excites intestinal disease which is almost identical with cholera Asiatica. Even the organic growths of cholera are found in the discharges from the Arsenic proving. Do not conclude from this that Arsenic must be the remedy for cholera Asiatica. It is only the remedy when we have the following symptoms : Intense vomiting and purging, the stools being not so much like rice-water as they are brownish-yellow, profuse, and offensive. The vomited matters are green, yellow, and bilious. There is burning thirst, with the intense agony which belongs to Arsenicum. The surface of the body is as cold as ice, but internally, the patient feels as if full of fire. Arsenicum is also useful in cholera infantum, and in atrophy of in- fants. It is indicated by many of the symptoms that have already been enumerated. The symptoms of the bowels are, undigested stool, diarrhoea which is provoked just as soon as the child begins to eat or drink, aggravation after midnight (particularly the restlessness and the diarrhoea), and rapid emaciation. The child's skin is apt to be harsh and dry, and often yellowish and tawny. The little patient is restless, evidently being in constant distress. Here, too, we often have to give Arsenic quite early in the case, because here the symptoms have been going on before your arrival. It stands in close relation with Nux vomica and Sulphur in atrophy of infants. For instance, early in the 524 A CLINICAL MATERIA MEDICA. case of marasmus, you may give Arsenioum, providing diarrhoea is present in a case which would call for Nux vomica or Sulphur were constipation present. The same dried-up mummy which you find in the Sulphur case, with the peculiar gastric symptoms of Arsenic, would call for the Arsenic. In far-advanced cases, the resemblance is not to these remedies, but to Cinchona, or China, and to Argentum nitricum. Now let us study some of the related remedies of Arsenicum in gastro-intestinal troubles. Argentum nitricum has slimy, greenish stools, with excessive flatu- lence, worse at night. Although both remedies have restlessness, it is not the same in each case. Arsenicum has a restless desire to ohange place, now sitting, now standing. The restlessness of Nitrate of Silver is purely nervous. The patient has difficulty in breathing, with long sighs. Much more frequently will you be called upon to differentiate between Arsenicum and Carbo veg. Carbo veg. is somewhat similar to Arsenicum in abdominal affections arising from chilling the stomach, as with ice-water. It has, perhaps, less of the distinctive restless tossing about, but at the same time it may have a nervous, irritable, anxious state, without tossing about. Carbo veg. is also a similar remedy to Arsenicum when rancid fat has excited gastro-enteric symptoms. Secale cornutum is very similar to Arsenicum in many of its symp- toms. The two drugs are complementary. They agree well one with the other. In the abdominal symptoms both drugs meet in cholera Asiatica. Arsenicum may be distinguished from Secale by these few symptoms: The movements in Secale are copious and come in spurts; Secale has not the same restlessness that belongs to Arsenicum. Now, when there are any spasmodic symptoms present, as is often the case, you will find, under Secale, fingers spread asunder, with tingling in the hands and feet. Veratrum album is somewhat similar to Arsenicum in cholera morbus. The latter has not so copious a stool as the former. Cold sweat on the forehead is more marked in the Veratrum. Do not forget that Cadmium sulphuricum is similar to Arsenicum in black vomit, whether that symptom occur in yellow fever or in any other disease. We find Arsenicum often indicated in intermitting types of fever. We all know how often Arsenic succeeds Cinchona in the treatment ARSENICUM. 525 of chills and fever. It often cures. It is especially indicated after the failure of quinine, or after the abuse of that drug; also when the fever has been contracted in salt marshes along the seashore. The chill is not well defined; in fact, it is rather irregular, but the heat is unmis- takable. It is intense, with burning thirst, especially for hot drinks; cold drinks make the patient feel chilly. Sweat does not always relieve. Sometimes it appears very tardily. Theapyrexia is marked by severe symptoms, dropsy showing itself as the result of enlarged spleen or liver. The patient is scarcely able to sit up. He is often annoyed by neuralgia,* this neuralgia being typical in its appearance. The pain usually affects one side of the face, and seems to be almost maddening, driving the patient from place to place. At the height of the attack there are nausea and vomiting and buzzing in the ears. Arsenicum may be also used in intermittent, semilateral headache of malarial origin, especially after the abuse of quinine. There are several drugs similar to Arsenicum in these malarial neu- ralgias. Cedron has neuralgia, returning at precisely the same hour each day. Chininum sulphuricum is also suited to periodically recurring attacks of neuralgia. Valerian is to be thought of in hysterical patients. Cactus grandiflorus has neuralgic and other forms of pain, which are sure to appear when the patient misses an accustomed meal. Kalmia and Kreosote are useful in neuralgia, especially when there are burning pains. Magnesia phos. is called for in neuralgia which occurs regularly each night. Mezereum has neuralgia in the cheek-bone or over the left eye. The pains leave numbness. They are worse from warmth. It is especially useful when there have been herpetic eruptions after the abuse of mercury. It is one of the remedies we use for the neuralgia of zona. Robinia has: jaw-bone feels as if disarticulated. With this there is intensely sour taste or vomiting. Other remedies to be borne in mind are Cinchona, Spigelia, Plati- num, Stannum and Chelidonium. In typhoid fever Arsenicum is indicated late in the disease, when the blood changes have so far progressed that you have a picture of complete exhaustion. The patient thinks himself still able to move about until 526 A CLINICAL MATERIA MEDICA. he finds out how weak he is. He has fainting attacks, which are very alarming; he faints dead away, with cold sweat on the body. The delirium is worse after twelve p.m., and is attended with great restless- ness. He is sleepless at three a.m. on account of the great heat. The mouth and tongue are covered with sordes, and with a dark brownish coating. Sometimes the tongue is very red. Around the dorsum and tip of the tongue you will find the papillae red and raised, as under Belladonna, but the concomitant symptoms enable you to differentiate it from that remedy at once. The mouth is full of blisters and aphthous ulcers which bleed readily. In other cases, the tongue is bluish with ulcerated edges. Sometimes, in severe cases, water cannot be swallowed because of partial paralysis of the oesophagus. You do not often find much tympany in the Arsenic case. The bowels are very much dis- turbed. Diarrhoea is almost always present, and seems to be provoked by every attempt to eat or drink. Sometimes, stool and urine are in- voluntary. The stool is yellowish and watery in character, horribly offensive and worse after midnight. At other times, the stools contain blood, slime and pus. In some cases, the urine is retained from atony of the muscular fibres of the bladder. The fever is intense, being almost sufficient to consume the patient. Sometimes, you have the haemorrhagic diathesis to deal with, and there is oozing of blood from various parts of the body, from the eyes, nose, etc. This is a dangerous symptom. Colchicum is a remedy which we are very apt to neglect in typhoid fever. It seems to stand in typhoid conditions between Arsenic and Cinchona, having the excessive weakness of the former remedy and the marked tympany of the latter. The chief symptoms of Colchicum are abdominal. They are, this great tympany, involuntary, forcible, watery stools, accompanied with nausea and frequent vomiting of bile. The body is hot and the limbs are cold, just as in Phosphorus. The nose is dry and blackish. The teeth and tongue are both brown. The mind is somewhat cloudy. He answers questions correctly, but otherwise says nothing. He seems not to know the danger he is in. The relations of Arsenic to other remedies in typhoid fever have been described to you elsewhere. I need not, therefore, repeat them here. Arsenicum may also be useful in a continuous fever, which, in its early stages, so closely resembles that of Aconite, that you may not be able to distinguish between the two drugs. There are hot skin, ARSENICUM. 527 full bounding pulse, restlessness and anxiety. Thus far, it is exactly like Aconite. But it does not end here. It goes on to a continuous type of fever without any intermissions, and with only slight re- missions. The heat increases, the patient grows more restless and yet weaker, the tongue becomes brown and typhoid symptoms de- velop. Now, the distinction between Arsenic and Sulphur is easily made. Sulphur is also useful in continuous fever. Arsenic is indicated when the great restlessness and burning show you that the case has gone beyond simple continuous fever. Now, the action of Arsenicum on the mucous membranes. We find it an excellent remedy in winter colds. The nose discharges a thin, watery fluid, which excoriates the upper lip, and yet the nasal passages feel stuffed-up all the time. This is accompanied by dull throbbing frontal headache. Repeated attacks of this kind of catarrh or coryza, result in the discharge of thick, yellowish, muco-purulent matter. Ulcers and scabs form in the nose. Sneezing is a prominent symptom. Now this sneezing in the Arsenic case is no joke. It does not give the relief which one usually gets from a good sneeze. It is a sneeze which starts from irritation in one spot in the nose as from tickling with a feather. After the sneeze, this irritation is just as annoying as it was before. As the cold creeps downwards, you find the case complicated with catarrhal asthma. Dyspnoea appears. The patient cannot lie down, particularly after midnight. He is greatly relieved by cough with expectoration of mucus. You will at once recognize the similarity between the symptoms of Arsenic and those of hay fever. O'ther remedies which you may re- member for this condition are: Ailanthus, Silicea (which has itching or irritation in the posterior nares or at the orifices of the Eustachian tubes), Lobelia inflata, and a remedy introduced by the late Dr. Jeanes, Rosa damascena. This Rosa damascena is useful in the beginning of rose-cold when the Eustachian tube is involved and there is some little hardness of hearing and tinnitus aurium. Sinapis nigra is indicated when the mucous membrane of the nose is dry and hot. There is no discharge. The symptoms are worse in the afternoon and evening. Either nostril may be affected alone or alter- nately with the other. In diphtheria, Arsenicum comes into use as a most valuable drug. It kills the microscopic growths which produce the disease. In its 528 A CLINICAL MATERIA MEDICA. potentized state it is a most valuable assistant. It is particularly indicated when the breath is foetid. There is adynamic fever with a great deal of somnolence." This sleepiness is broken by starts, crying out and by jerking of the limbs. The membrane looks dark and is gangrenous. The pulse is rapid and weak. I would advise you to substitute Arsenicum iodatum, if, in addition to the usual Arsenicum symptoms, there is marked enlargement of the lymphatic glands. I have stated that Arsenic acts on the heart. It gives us a list of cardiac symptoms which are, in brief, these: The heart-beat is too strong, it is visible to the person standing by and is audible to the patient himself. It is worse at night and is particularly aggravated when the patient is lying on his back. There may be palpitation with great irregularity of the heart's action. Or the pulse may be accelerated and weak. In cardiac inflammations, endocarditis or pericarditis, we find Arsenic in- dicated after the suppression of measles or scarlatina. You then find present the characteristic restlessness and agony of the drug, tingling in the fingers especially those of the left hand. (Edema is more or less general, beginning with puffiness of the eyes and swelling of the feet and ending with general anasarca. There is great dyspnoea. Now there are two varieties of dyspnoea which belong to heart dis- ease, one which depends upon the defective carrying of the blood through the lungs and the system generally, and the other which is due to accumulation of water in the chest, hydrothorax and hydroperi- cardium. There are spells of suffocation, worse at night, particularly after midnight and on lying down. The skin is cool and clammy, while internally, the patients are burning hot. Now if this condition calling for Arsenic goes on uncured, Bright's disease of the kidneys develops. The urine is highly albuminous and contains waxy and fatty casts. Dropsy appears. Little blisters appear on the legs and these burst, and serum oozes from the oedematous limbs. The skin itself is rather tense and has a palish-waxen hue. Exhausting diar- rhoea seems to accompany these symptoms. There is very apt to be also a burning thirst with intolerance of water. I wish you now to recall the comparison that I have already given you between Arsenicum and Apocynum, and Acetic acid, which stands midway between Arsenicum and Apis. I would also have you recall the similarity between Arsenicum and Mercurius sulphuricus in hydro- thorax. ARS ENICUM. 529 In kidney affections you may compare Arsenicum with Apis, Helle- borus, Phosphorus, Aurum, Terebinthina, and Digitalis. Now the Digitedis symptoms are these: There is venous hyperaemia of the kidneys. You are to study it, therefore, in renal affections when there are present dropsy, feeble or slow pulse, scanty dark turbid urine, which will, of course, be albuminous. It is exactly like Arsenic, without the restlessness and irritability of that remedy. Again, we find Arsenicum indicated in that dreadful disease, angina pectoris. The patient is obliged to sit upright; he cannot move the muscles of his body without great suffering. He holds his breath, so painful is it for him to breathe. Pain seems to radiate from the heart all over the chest and down the left arm. In extreme cases there is cold sweat on the forehead, the pulse becomes scarcely perceptible, and, with all this, there is apt to be burning around the heart. I would now like to refer to the action of Arsenic on the skin. You have already seen that it tends to produce induration or harden- ing of the skin. This renders it a valuable remedy in eczema, in fact, in every variety of the skin in which there is thickening of that structure, with copious scaling. Arsenicum is also useful in eczema proper, when vesicles appear which turn into pustules and form scabs. Arsenicum is specifically indicated for bran-colored scales on the head, coming down over the forehead. It may also be indicated when there is a thick scabby eruption on the scalp, oozing pusrand very offensive. Arsenicum compares with Sepia, Rhus tox., and Graphites. Like Sepia there is dry scaly desquamation, but in Sepia this "peeling" follows vesicles which were not surrounded by very red skin, or it follows a fine rash, worse about the joints, or a circular eruption like herpes circinatus. Rhus tox. has vesicles on a red erysipelatous surface. Graphites looks very much like Arsenicum, but with oozing of a glutinous fluid. Clematis is similar to Arsenicum, but has more rawness, aggrava- tion from washing and moist, alternating with dry scabs. In the exanthematous diseases we find Arsenicum indicated first of all in urticaria. Here it is a valuable drug when the wheals are at- tended with burning, itching, and restlessness. Particularly may it be indicated for the bad effects of repercussion of hives. Even croup may be cured by Arsenic if it follows the retrocession of nettle-rash. In scarlatina Arsenic is to be used in some of the worst cases when the rash does not come out properly. The child is thrown into con- 530 A CLINICAL MATERIA MEDICA. vulsions, and lies pale and in a sort of stupor. It is very restless, moaning during the stupor. Suddenly it seems to arouse, and imme- diately goes into convulsions, and then relapses again into this stupor. It is also useful when, during the course of scarlatina, the parotid glands swell and suppurate, after the failure of Rhus. Arsenicum is useful in gangrene, particularly in the dry gangrene of old people, with great soreness and burning in the affected part, with relief from warm or hot applications. This modality furnishes you with a sufficient distinction between Arsenic and another great gan- grene remedy, Secale, which is useful in gangrene, with relief from cold applications. We may use Arsenicum in carbuncles or in boils with pepper-box openings in them, and dipping deeply into the cellular tissues. It is indicated by the character of the pains, which you know run all through the Arsenicum symptoms, cutting lancinating pains, with aggravation after midnight, and irritability of mind and body. Arsenicum sometimes fails in carbuncles. Then we have to resort to Anthracinum, chiefly in the thirtieth potency. It has precisely the same symptoms as Arsenicum, but to a more intense degree. Carbo veg. and Lachesis are remedies that we neglect in this disease. If we use Carbo veg. it is well also to use a charcoal poultice over the carbuncle. Arsenicum may be used in cancer. I am not going to propose that this drug will cure cancer. Epithelioma has been cured by Conium, Hydrastis, Arsenic, Clematis and a few other remedies. But in cases of genuine open cancer I have not seen any cases cured; but even if these cases cannot be cured, it is still possible to give them some relief. The pains of cancer you know to be torture. They are of a sharp lancinating character ; a red-hot knife thrust into the part could not be worse. Arsenic sometimes relieves these, sometimes it does not. Sometimes Belladonna brings relief. In some cases Arsenicum iod- relieves when Arsenicum album fails. The ulcers for which Arsenicum may be given are not usually very deep. They are rather superficial. The pains are of the character already described, burning and lancinating. The discharge is apt to be excoriating, dark and sanious. They are apt to bleed very readily. Lastly, we will consider Arsenicum as a remedy in nervous affec- tions. It is indicated in hemicrania when the pains are worse over one ARSENICUM. 531 eye, and are of a severe lancinating character. They often alternate with colic or affections of the liver. They are worse from any motion, and are temporarily relieved by cold applications. It may also be used in epilepsy. The patient falls down uncon- scious, and then writhes in convulsions. Before the attack he has spells of vertigo and intense aching in the occiput. The convulsions are followed by stupor, which, however, is not complete, but is broken by restlessness. LECTUKE LIII. PHOSPHORUS. Phosphorus. Nux vom., Coffea, Ambra. Rhus tox., Muriatic acid, Lachesis. Carbo veg., Arsenicum, Nitric ac, Kali carb. China, Veratr. alb. Sulphur, Calcarea ostr., Silicea, Lycopod., Cal- carea phos. Cepa, Bryonia. Zinc. Terebinthina. Osmium. >Nux vomica, Terebinthina. < Causticum. This hour I wish to say a few words about Phosphorus. It has two complements, Arsenicum and Allium cepa. I have placed Nux vomica and Terebinthina as the antidotes. The use of Terebinthina comes to us from the old school. It seems to antidote Phosphorus by chemical action in rendering it inert. It also has antidotal effects when used in potency. Nux vomica is good when Phosphorus, as a remedy, has produced over-effects, or when it has been incorrectly given. In the study of Phosphorus we have to remember, first of all, as most important and as a quality that permeates every part of the Phos- phorus proving, its action on the nervous system. Its symptoms in no instance point to increase of power or vitality, or to any genuine stimu- lation of function, but rather to that condition which we found under Arsenic, irritable weakness. The patient is exceedingly susceptible to external impressions. He can bear neither light, sounds nor odors. He is very sensitive to the touch. Electric changes, such as occur in sudden changes of weather, but particularly in a thunder-storm, make him anxious and fearful, and aggravate all existing symptoms. His mind too is excitable and impressionable. He is easily angered and becomes vehement. This is not a simple peevishness. He actually gets beside himself with anger, and, just like the Nux patient, he suffers physically PHOSPHORUS. 533 in consequence. At other times he is anxious and restless, especially in the dark or about twilight. He has all sorts of fanciful or imagi- nary notions. He sees faces grinning at him from every corner of the room. His thoughts may be increased so that they fairly rush through his mind; but this effect is only transient, and is followed either by inability to think and remember, or by aggravation of all his symp- toms on mental exertion. He cannot stand mental tax. Here again it impinges on Nux vomica. As further evidence of the irritable weak- ness of Phosphorus, we have the delirium of that remedy. Now this delirium may be associated with typhoid fever, with jaundice, or with sexual erethism. It may be quite violent. It is characterized by a condition of ecstacy. The patient has a notion that his body is all in fragments, and he wonders how he is going to get the pieces together. He imagines that he is a great person surrounded by grand accoutre- ments, the mania of grandeur it is sometimes termed. At other times the mania takes the form of sexual excitement. He uncovers his per- son without any shame and seeks to gratify his sexual appetite, no matter who may be the victim. These delirious attacks pass into a state of coma, or into a stupid condition of mind or state of apathy, during which he answers questions not at all or very reluctantly. Phosphorus is here very similar to Hyoscyamus, and often follows that remedy in erotic mania. It also bears points of resemblance to Stra- monium, Baptisia, Rhus tox. and Muriatic acid. The same quality of the drug is shown in the symptoms throughout the body. Headache, for instance, is attended with increased sensi- tiveness to odors; the sense of smell is very acute, so that the patient faints away from the smell of flowers. There may be pulsating, throb- bing headache, worse from music. The hearing for the human voice is impaired; associated with this is roaring in the ears, as from rush of blood. Sounds reverberate unpleasantly in the ears. There is also sexual excitement with frequent erections, lascivious thoughts entirely beyond the control of the patient, and frequent seminal emissions dur- ing sleep. Symptoms of spinal irritation are very characteristic of Phosphorus These are associated with palpitation of the heart, worse from any emo- tion, whether it be grief, anger or pleasure. The spine, as in all these cases of spinal irritation, is exceedingly sensitive to touch. With all this there is weakness of the spine. The back feels weak, as if it would soon give out. There is weakness of the limbs, with trembling, on beginning to walk. The patient stumbles a great deal, catching his 534 A CLINICAL MATERIA MEDICA. toes in every little projection of the floor or pavement. He totters, and there seems to be imperfect coordination. He is sleepless from excessive heat. When asleep, his dreams are of a horribly exciting character. These are illustrations of the erethism of Phosphorus and also of diminished resistance to external stimulants. Such persons may degenerate into various diseased conditions. The loss of animal fluids, as blood, semen, or milk, or too frequent child-bearing, or too rapid growth in the young, is sufficient to precipitate nervous diseases such as paralysis, chorea and spinal disease, or tuberculosis. You will find Phosphorus indicated in locomotor ataxia, when there is a great deal of burning along the spine. There is also great ting- ling and formication along the spine and in the affected extremities. In the beginning the patients have extreme sexual excitement. That is a sort of sine qua non, either that they are excessively excitable, or else have been so. You seldom find Phosphorus indicated in impotence, unless it has resulted or has been preceded by over-excitation of the sexual organs. This is a valuable hint. I find it especially indicated in young men who are trying to restrain their natural passion, and yet there is locally this erethism. This Phosphorus helps most wonderfully to control. If, by reason of celibacy or of over-indulgence in sexual pleasures, the sexual organs lose their power and the patient becomes impotent, Phos- phorus is the remedy when this has been preceded by over-excitation. It is different from Conium, in which the patient may have been natu- rally excitable, but has gone on to this weakness. Phosphorus is indicated in locomotor ataxiat->also, when it can be traced to excessive loss of animal fluids, as semen. Softening of the brain, is another form of atrophy of the nervous tis- sue in which Phosphorus has won many laurels. The patient has a dull pain in the head, a wearied, tired feeling all the time, and slight difficulty in walking. It is particularly indicated after the use of Nux vomica. The question is sometimes asked, and quite properly, too, how can you put Nux vomica down as the antidote of Phosphorus, and then speak of it as a remedy that can precede or follow it? First, the antidote may follow the drug and may be needed, not to antidote it, but because symptoms which come up have an opposite polarity, and, consequently, require an opposite remedy; and, secondly, a remedy may be antidotal in some of its symptoms and concordant in others. Phosphorus may be used very successfully in chorea when it occurs PHOSPHORUS. 535 in children who are growing too fast. The patient is very weak and walks as if paralyzed. Continuing the nervous symptoms of Phosphorus still further, we find it indicated in low types of nervous fever and in typhoid types of fever. I am induced to use this expression, typhoid types of fever, in order to show that you can consider Phosphorus, not only in typhoid or typhus fever, but in any form of fever which assumes a typhoid form when these symptoms appear. It is indicated when there is great cerebro-spinal exhaustion. It is particularly the brain and spine which seem to have suffered from the typhoid poison. The face is apt to be of an ashy or waxen hue or appearance. The tongue is covered with a viscid, thready sort of slime, which is expectorated with great difficulty. It seems to collect on the teeth and around the gums and on the tongue. It is tenacious and the patient is weak; and these two incompatibles make it difficult for him to cleanse the mouth. The body is hot,—and by the body I mean the trunk,—the head being rather cool and the limbs decidedly cold. There is congestion of both chest and abdomen. The breath is hot, and there is almost always either bronchial catarrh or pneumonia. I refer now more particularly to the pneumonic infiltration which belongs to typhoid fever, in which case Phosphorus is often indicated. The patient has burning thirst, which is relieved by drinking cold water. This thirst is worse from three to six o'clock in the afternoon. The patient is better from cold water until the water becomes warm in the stomach, when it is vio- lently ejected. Phosphorus does not often do any good in vomiting, except in the chronic vomiting of dyspeptics, unless there is this con- dition present. This is different from Arsenic. It is also very different from Bis- muth; this last-named remedy has vomiting immediately after taking food, with burning, cardialgic pains. It is different from Kreosote, which has vomiting of undigested food hours after eating. Let us return to Phosphorus in typhoid types of fever. The bowels are always affected. You will find that the liver is sore to the touch and usually enlarged. This is also true of the spleen. The patient has diarrhoea as soon as he eats. Here it is identical with Arsenic. Now, the stools in the Phosphorus case are flaky, dark, and often bloody, and there is external weakness after stool, that being a decided cerebro-spinal symptom. You find it in the cerebro-spinal remedies, in Conium, in Nux vomica, and especially in Phosphorus. When there 536 A CLINICAL MATERIA MEDICA. is constipation you may have what has been called characteristically " dog stool," i.e., long, slender stool, which is evacuated with consid- erable effort. During this fever, which I say is mostly congestive and affects the chest and abdomen, the patient continually throws off the bed-clothes. He puts the arms out of bed to cool off. There is pro- fuse sweat which does not relieve. Now I would like to caution you here that Mercury is not indicated in typhoid fever unless there be clearly defined icteroid symptoms, consequently you will not often have occasion to give it in this fever, and never should you give it for this symptom, " profuse sweat without relief," unless it is so well defined by the icteroid and bowel symptoms that you are certain that you have the properly indicated remedy. Other remedies than Mercury have this symptom, notably Phosphorus, and also Rhus tox. and Chamomilla the latter particularly in children. Phosphorus is indicated even in extreme cases of typhoid fever when there is threatening paralysis of the lungs. The patient lies in a sort of coma, with hot breath and rat- tling breathing. It seems as if there was a large quantity of phlegm rattling in the lungs.*. The limbs are cold and are covered with a cold sweat. The pulse is scarcely perceptible. I would here remind you of Carbo veg. as also being suitable in collapse. It follows Phosphorus very well. It is distinguished, theo- retically, at least, from the latter remedy by this: Phosphorus acts more upon the cerebro-spinal nervous system and Carbo veg. more upon the sympathetic nerves, particularly on the solar plexus. Next I wish to speak to you of a property of Phosphorus which does not depend upon the action of the drug on the nervous system, and that is the power of the drug to produce fatty degeneration. Phosphorus seems to affect the blood, how is not exactly known. It decomposes the blood, rendering it more fluid, rendering it difficult to coagulate. At the same time it produces hyperaemia of one part or another. Thus you will find tendency to congestion of the head or chest, or of any of the viscera of the body. This hyperaemia is not an active arterial congestion, but rather a stasis of blood. The affected part becomes engorged with blood, and as this is of an impoverished quality, it does not nourish properly and we have setting-in fatty de- generation of the part. This may be in the brain or spine (of this I have already spoken), it may be in the heart or lungs, but it is espe- cially apt to occur in the liver and kidneys. The muscles.even may undergo fatty degeneration. On the liver, Phosphorus acts very prominently. The symptoms PHOSPHORUS. 537 here are directly connected with fatty degeneration. When Phospho- rus is taken for a long time you will find at first this hyperaemia of the liver. That organ is consequently enlarged with the attendant symp- toms, well-marked soreness and jaundice. The stools are apt to be grayish-white, showing the absence of the secretion of bile. The abdo- men becomes decidedly tympanitic. By and by, the jaundice increases to an alarming extent, the pulse becomes weak and thread-like. These symptoms are traceable to two causes: First, the inevitable alterations in the blood which Phosphorus produces; and, secondly, the poison- ing of the blood by the retention within it of the elements which go to make bile. These haVe a depressing effect on the heart, making the pulse slow or else weak and thread-like. If you examine the liver at this stage, you find that it is beginning to atrophy, this atrophy depending upon destruction of the hepatic cells proper and increase of the stroma of the liver. The connective-tissue framework of the liver has undergone inflammatory increase. The pressure which this exerts on the hepatic cells causes their destruction. Thus we have what has been termed cirrhosis of the liver. Then comes ascites, and you find varicose veins coursing all over the abdomen. The icteroid symptoms increase and, finally, death ensues. The blood becomes so poisoned that the patient goes into the delirium which I have already described. The urine may be highly albuminous in these cases. Phosphorus is useful in acute yellow atrophy of the liver, a condition which it also produces. Again, it may be useful in fatty degeneration of the liver as a sequel of heart disease. It may also be indicated in waxy liver dependent upon long-lasting bone disease, as caries of the vertebra or of the hip-joint. Phosphorus is also indicated in hepatitis when suppuration ensues with hectic fever, night sweats, enlargement in the right hypochon- drium, and marked soreness over the liver. The jaundice of Phosphorus is not functional in origin, but is indi- cative of organic disease; it is associated with anaemia, with brain dis- ease, with pregnancy or with malignant diseases of the liver. Phosphorus has a marked action on the alimentary tract. The tongue is coated white, and this, as under Bryonia, is more along the middle of the organ. With bilious affectiqns, the tongue is coated yellow; in typhoid affections, it is brownish or blackish and very dry. Here it is very much like Rhus. The throat may be inflamed, particularly the uvula. White, transparent mucus collects in the throat. The patient 35 538 A CLINICAL MATERIA MEDICA. is very hungry, particularly at night. This symptom may almost amount to bulimy. (That is a symptom which indicates Phosphorus in chills and fever.) He wakes up hungry and lies awake until he gets something to eat. There is longing for cold things, ice-cream, ice-water, etc. Cold food seems to relieve until it gets warm in the stomach, when there appears the characteristic vomiting of the remedy. Phosphorus may cure vomiting in chronic dyspepsia when there seems to be simple exhaustion of the stomach. Perhaps the inner surface of the viscus is coated with mucus, thus preventing the action of the gastric juice on the food. We also find Phophorus useful in spasmodic stricture of the oesoph- agus, especially at its cardiac end. Food seems to go down a certain distance and then is violently ejected. Coming to the stomach itself, we find Phosphorus indicated in that very dangerous disease, perforating ulcer of the stomach. We find it there indicated by the pain, by the vomiting of food as soon as swal- lowed, and by the vomited matters containing a dark, grumous, semi- solid substance looking like coffee-grounds. We also find Phosphorus indicated by these same symptoms in cancer of the stomach, particularly when it is about to pass into the stage of ulceration. Phosphorus is one of the few remedies that act on the pancreas. It is especially useful if there be fatty degeneration of that organ. The symptoms indicating it here are the gastric symptoms just enumerated, and oily stool. Sometimes the stool looks like frogs' spawn, or, to speak more accurately, like cooked sago. It may also be remembered in diabetes mellitus and Bright's disease when these have been preceded or are accompanied by disease of the pancreas. The intestinal tract is attacked by Phosphorus almost as violently as it is by Arsenicum. It produces constipation, the character of which I have already explained to you. It also produces diarrhoea. The stools may be profuse and watery, and worse in the morning. Here it runs against Sulphur and Podophyllum. It also produces green mucous stools, worse in the morning. The stools are apt to contain undigested food and are very debilitating to the patient. We find Phosphorus in- dicated in cholerine, or diarrhoea occurring in time of cholera epidemics. Paralysis of the bowels is also produced and cured by Phosphorus, particularly when the lower portions of the bowels, the colon and rectum are affected. The anus seems to stand wide open and exudes moisture. PHOSPHORUS. 539 In diseases of the urinary organs Phosphorus is a first-class remedy. It is to be thought of in the diseases classed under the general term; Bright's disease. It is useful in fatty or in amyloid degeneration of the kidneys, especially if associated with a similar pathological condi- tion of the liver and of the right or venous heart, with the consequent symptoms of venous stagnation and venous hyperaemia in different organs, with oedema of the lungs and all the symptoms of pulmonary engorgement which indicate pneumonia. The urine contains epithelial, fatty or waxy casts. Phosphorus may cure haemorrhages from any part of the body, par- ticularly from the lungs and stomach when associated with Bright's disease. Phosphorus is a decided irritant to the sexual organs in either sex, producing nymphomania in the female and satyriasis or uncontrollable sexual desire in the male. It does not affect the female organs very prominently. The men- strual discharges seem to be altered. They are often more profuse and long-lasting. There is always a weeping, sad mood at that time. The menstrual blood is pale. It is, however, more when the menses are checked that we find Phosphorus indicated ; amenorrhcea when men- struation becomes vicarious; that is, when blood-spitting, epistaxis or haematuria ensues. In diseases of the mammary gland, Phosphorus is especially useful when abscesses have formed. The inflamed gland has an erysipelatous appearance. Red streaks start from the opening in the abscess. The pus discharged is not laudable, but is of a thin, watery, ichorous char- acter. Here it is complementary to Silicea. Next we take up the action of Phosphorus on the respiratory pas- sages. In nasal catarrh we do not find it often indicated except it be chronic catarrh or ozaena. Then it is indicated by the color of the discharge, which is green mucus and blood-streaked. Green mucus not blood-streaked does not often require Phosphorus. Nasal polypus, when it bleeds much, calls for Phosphorus. It may also be used in polypi of the ears or uterus. Other remedies to be thought of here are Teucrium, Calcarea and Sanguinxiria. On the larynx it acts more prominently than any other remedy we have. It produces inflammation of the larynx. The symptoms indi- cating it here are hoarseness, which is usually worse in the evening, at which time it may amount to aphonia, and extreme sensitiveness of the larynx. The patient is worse from talking or coughing. It hurts 540 A CLINICAL MATERIA MEDICA. the larynx for him to cough or talk, so sensitive is it to the vibrations thus produced. It also causes catarrhal or membranous croup. It is not usually indicated here in the beginning. But it acts as a sort of prophylactic to prevent the return of the disease. It is useful also in advanced cases of croup when the cerebro-spinal system is giving out, just as we found in typhoid states. Thus there are aphonia, rapid sinking of strength, cold, clammy sweat, rattling breathing, sunken, pale face and dropping of the lower jaw. The pulse in such cases is weak, thready and intermittent. In this group of symptoms Phosphorus is very similar to Lycopodium. You find Phosphorus indicated in tracheitis and bronchitis, espe- cially in tall, slender persons of rather tuberculous habit or tendency, rather inclined to stoop and to be hollow-chested. The cough is par- ticularly worse on going from the warm room into the cold air, or in changes from warm to cold. It has dry, tickling cough caused by irritation in the larynx and beneath the sternum. In extreme cases it is associated with tremor of the whole body, so nervously weak is the patient. It is frequently accompanied by almost intolerable pain in the larynx from laryngeal catarrh, by splitting pain in the head just as you found under Bryonia, and by burning rawness down the larynx and trachea. There is tightness across the upper third of the lungs. Now, a word of caution respecting this tightness. It is not a feeling as from a band around the chest, but as though the lungs themselves were constricted. The relation between the fauces, larynx and trachea, as a starting point for cough, has been aptly mapped out by Dr. Dunham and care- fully distributed among three remedies. For instance, Belladonna acts upon the fauces. It causes dry, tickling, teasing cough. The throat is bright red and the tonsils enlarged. Going further down, you find tickling in the suprasternal fossa. Every change in the breathing causes cough. This condition calls for Rumex. When the irritation extends down still further, into the bronchi, then Phosphorus becomes the remedy. We find Phosphorus indicated in a great variety of coughs. Thus it is useful in stomach or hepatic cough coming on after the patient eats, and starting from tickling at the pit of the stomach. It is also indicated in cough made worse by the entrance of a stranger into the room; this being purely a reflex nervous symptom. It is also called PHOSPHORUS. 541 for in cough provoked by strong odors. In fact, perfumes or anything that will disturb the balance of the nervous system will bring on cough under Phosphorus. Phosphorus is indicated in bronchitis or bronchial catarrh, whether the disease involves the bronchial tubes high up or whether it extends down into the bronchioles. The symptoms are as follows: Cough, with tearing pain under the sternum, as if something were being torn loose; suffocative pressure in the upper part of the chest, with constriction of the larynx. You will also find the lungs to be engorged with blood, mucous rales through the lungs, panting and labored respiration and even emphysema. The sputa are of various kind. Thus we may have bloody and mucous sputum. Very characteristic is sputum, consisting of yellowish mucus, with streaks of blood running through it. It may be rust-colored, as in pneumonia, or it may be purulent and have a sweetish or salty taste. In pneumonia, Phosphorus is indicated when the bronchial symp- toms are prominent. Then it is almost certain to be the remedy. It does not cause hepatization of the lungs, so that it would not be indi- cated when the lung or lungs are in a complete state of hepatization. But it may be indicated for typhoid symptoms in the course of pneu- monia (these symptoms I have already given to you), especially in the latter part of the period of deposit and in the early part of absorption, that is just when hepatization is coming on and just when it is going off. There is great dryness of the air-passages, with burning, excoriat- ing, raw feeling in the upper part of the chest. In tuberculosis you find Phosphorus particularly indicated in youths, and by this expression I mean both young men and women who have grown too rapidly, who have delicate skin, long silky eyelashes, and who are of easy, graceful manners. The mental development is excel- lent, yet they have not the physique to support this keenness of mind- Particularly is it indicated if they have an hereditary tendency to con- sumption, or have had bone diseases in early childhood. The early symptoms, you will notice, are these: The patient catches cold easily ; he suffers from rush of blood to the chest; he has the above-mentioned constriction across the chest with every little cold; pains through the apex of the, left lung; patient cannot lie on the leftside; aphonia; dry cough; hectic flush of the cheeks, particularly towards evening; oppres- sion of the chest at night, forcing him to sit up; empty feeling at the pit of the stomach, particularly in the forenoon at ten or eleven o'clock ; he awakens hungry at night, feeling that he must eat, and that he 542 A CLINICAL MATERIA MEDICA. would faint if he did not. Finally, the hectic fever grows more prominent. There is rapid formation of vomicae or cavities in the lungs. These are the indications for Phosphorus in pneumonia, and I must supplement them with a warning. Unless you give the drug cautiously, you precipitate what you would prevent. Be certain that it is the remedy, and do not give it too often, or you will hasten the process you are anxious to avoid. I would not advise you to give Phosphorus in well-marked tuberculous patients. If tubercles have been deposited in the lungs, you should-hesitate before giving it, unless the " picture " calling for it is so strong that you cannot possibly make a mistake. I may say that the same is true also of Sulphur. Sulphur is adapted to the onset of the disease. Then, a dose or two allowed to act will frequently head these symptoms off. But after tubercles have been deposited, you must be careful how you use the drug. I would next say a few words about the action of Phosphorus on the heart. It is particularly indicated in affections of this organ when the right side of the heart is involved more than the left. Its symptoms point more to the bad results that follow disease of the right heart than disease of the left; in a word, venous stagnation. It is suited to all forms of palpitation ; palpitation from emotion, as from the sudden entrance into the room of an unexpected visitor, welcome or un- welcome ; from motion ; and also from rush of blood to the chest. Particularly does this latter occur in the rapidly-growing young. Phosphorus mustalso be remembered in endocarditis, in which disease it is often forgotten. Particularly is it indicated when endocarditis or myocarditis occurs during the course of acute inflammatory rheumatism or during pneumonia. Phosphorus is also useful for fatty degeneration of the heart. You distinguish it from Arsenicum by the involvement of the right heart, by venous stagnation and puffiness of the face, particularly under the eyelids. Arsenicum has more symptoms of the left heart, more oppres- sion of the chest in breathing, more orthopnoea, and more anasarca or general dropsy. Phosphorus acts upon the bones. We find this illustrated in the necrosis of the lower jaw, formerly so common among matchmakers. The fumes of the Phosphorus cause necrosis of the lower and some- times of the upper jaw. You may ask, is this not a local effect pro- duced by inhalation of the fumes? If it is a local effect, why does it affect by preference the lower jaw ? Why not the upper ? Then, too PHOSPHORUS. 543 when persons have been poisoned by eating Phosphorus, if necrosis re- sults, it is the lower jaw that is affected, thus showing you that the drug has a special affinity for this bone. It is to be remembered in caries or necrosis of the lower jaw. This you sometimes meet with from teething or from an inflamed or suppurating gland. Phosphorus affects other bones as well as the lower jaw, however. We find it not infrequently indicated in caries of the vertebra in scrofulous children. The concomitant symptoms have to decide the remedy for you. For instance, the child is of the characteristic Phosphorus build. There is diarrhoea, worse in the morning, much like that of Sulphur, the stool containing undigested food. There is tendency to involvement of the lungs. For instance, the patient catches cold easily, with marked ten- dency to bronchitis. Still further, we may be called upon to use Phos- phorus in caries of the vertebra when the inflammation has extended inwards and involved the spinal cord itself. This you notice to be ex- pressed first by burning in certain portions of the spine. The patient cannot tolerate any heat near the back. A hot sponge on the back causes him to wince. There will be a feeling as of a band around the body. The difficulty in walking increases until finally the child cannot walk at all. There is often partial loss of control over the sphincters. Phosphorus also affects the joints, the hip- and knee-joints in par- ticular. Hence, it may be indicated in morbus coxarius or in white swelling, both common, as you know, in scrofulous children. Here, too, you have to separate it from the other antipsorics by the general symptoms. I would say, for your guidance, that Phosphorus belongs with Silicea and seems to complement it. It is useful when Silicea has been partially successful in these joint-diseases. Fistulae in the glands and about the joints are apt to form with Phosphorus. These fistulous ulcers have high edges from exuberant granulations, the purulent discharge being rather thin and ichorous. Around the ulcer Phosphorus has, probably more than Silicea, an erysipelatous blush, often radiating as in Belladonna. There will fre- quently be burning, stinging pains, well-marked hectic fever with night sweat, diarrhoea, and anxiety towards evening. These same symptoms apply to inflammation of the mammary glands when there are fistulous ulcers, as in Silicea, but distinguished from that remedy by the erysipelatous blush. Burning and stinging pains also suggest Apis, but Apis does not cause deep-seated suppuration, such as that in the parenchyma of an organ. 544 A CLINICAL MATERIA MEDICA. Next, I wish to say a word about the action of Phosphorus on the eyes. While it may not be the best remedy for affections of the ex- ternal parts of the eye, it certainly does lead the list for diseases involv- ing the deeper structures of that organ, as the retina, choroid and vitreous humor. It is particularly in nervous affections of the eye that we find Phosphorus indicated, and by "nervous" I mean belong- ing to the nerves of the eye. Thus it is suited to hyperaemia of the moroid and retina, which may even result in retinitis or choroiditis, and when it does so result, it is apt to be a serious trouble. Vision is greatly lessened. The patient sees all sorts of abnormal colors, black spots in the air and gray veils over things; it seems as if he was con- stantly looking through a mist or fog. Objects look red. Letters appear red when reading. That symptom, I believe, is under no other remedy than Phosphorus. Other remedies have red vision, but under Phosphorus alone is it that in reading the letters look red. This remedy is also indicated in retinitis accompanying kidney affections, retinitis albuminuria. It may also be indicated in retinitis with suppression of menses or some other uterine or ovarian disorder. When you have an eye affec- tion to deal with do not forget that the eyes are not the whole body. Remember that lesion in the eye may have as a starting point disease in some other part of the body. Therefore, in making your prescrip- tion, do not forget to look for any constitutional symptoms that may be present. We also find Phosphorus indicated in either amblyopia or asthe- nopia, particularly when associated with Bright's disease or resulting from loss of fluids. When the patient attempts to read letters blur and run together, and the eyes smart and burn. It is useful in am- blyopia occurring after typhoid fever, sexual excesses or loss of fluids. It is also suited to blindness after lightning-stroke. In these cases the patient almost always sees a green halo around the candle-light. I would like to say that Phosphorus will retard the growth of cata- ract. Other remedies that may suggest themselves in this condition are Silicea, Conium, Secale and Natrum mur. In addition to producing oversensitiveness to sound, as already men- tioned, Phosphorus has the opposite effect, deafness or hardness of hearing, particularly to the human voice. We have exactly the oppo- site symptom under Ignatia. This deafness may be purely nervous, as after typhoid fever. It may also indicate the drug in congested PHOSPHORUS. 545 states when the hardness of hearing is associated with buzzing and roaring in the ears. Phosphorus acts on the blood, destroying its coagulability. Thus it is that small wounds bleed much. I think that these are the words of the symptom as Hahnemann gave it to us. The way that he found that to be characteristic of Phosphorus was this: One prover noticed that when he pricked his finger it did not stop bleeding readily. Hahn- emann put this down as a possible symptom of Phosphorus. Later, a patient came to him, and described the totality of her symptoms. She had this bleeding. He gave her Phosphorus, which cured her. Since then this drug has been used many times for this haemorrhagic diathesis. Lachesis has a similar symptom, but has not been so tho- roughly confirmed as has Phosphorus. Phosphorus is also indicated in haematemesis. This may be vicari- ous as from a suppressed menstrual flow, or it may result from simple congestion of the stomach, or even from organic disease of the stomach, particularly open cancer or round ulcer of the stomach. The vomited matters contain dark grumous substances, looking like coffee-grounds. Phosphorus may also be used in haemoptysis, when indicated by the symptoms already given. LECTURE LIV. THE PREPARATIONS OP ANTIMONY. f Depresses the heart and circulation. I Increases sweat. Antimony. < Mucous membranes: — catarrhs. I Nausea, vomiting, purging, fainting, collapse. I Skin: —rash ; pustules. We take up for study to-day two of the preparations of antimony, Antimonium crudum and Antimonium tartaricum. The term Antimo- nium crudum does not imply that it is the metallic antimony but that it is the ore, the form in which it is most frequently found in nature. Antimonium tartaricum is a compound salt, the tartrate of antimony and potash. There are other Antimony preparations used in medicine, but we shall only consider the above-named as they are the most im- portant. Antimony exerts a depressing influence on the heart and circulation. Respiration too is disturbed by it, and in the majority of cases, perspi- ration is increased. The next important seat of action of antimony is the mucous membranes, particularly that of the alimentary canal. It causes nausea, vomiting and purging, with faintness and relaxation. The vomited matters you'will find at first to consist of mucus and food. Later they contain bile, and finally blood.' It is not because antimony has a special effect on the liver that we have this bilious vomiting, but because it causes a regurgitation of bile. Cramps occur in the limbs. These are accompanied by purging and thus you have a perfect picture of collapse such as you find in cholera or cholera morbus. Now, the emetic properties of antimony are not local. Experiments have been made by which the stomach has been exterminated, a bladder placed in its position, and antimony injected into the blood. Retching will en- sue, and yet there is no stomach. It acts through the pneumogastric nerves. Antimony will cause convulsions. This convulsive action is trace- able to disturbance in the circulation at the base of the brain. The lungs become engorged with blood by any preparation of anti- ANTIMONIUM CRUDUM. 547 mony. It is said that hepatization of a portion of the organ may fol- low poisoning by it, especially by its tartrate. This has been doubted of late. It has been claimed that this so-called hepatization was in reality atalectasis. You also find antimony causing emphysema, particularly of the borders of the lungs. Animals fed on antimonic acid will have fatty degeneration of the liver, heart, etc. The skin is attacked by the antimonies. The irritation they here produce is rather slow and tardy, but the result is very characteristic. There will be, at first, slight redness; this is followed by develop- ment of papules, and these papules become pustules. Pustular erup- tions are very characteristic of antimony, particularly of the tartrate. These pustules resemble the eruption of small-pox, so much so that Antimonium tartaricum has been suggested as a remedy in that dis- ease. Antimony is particularly useful when pustules appear about the genital organs, whether they be syphilitic or not. While the preponderance is in favor of Antimonium tartaricum for pustulation, Antimonium crudum carries off the palm for horny ex- crescences and callosities on the feet and hands. We will now consider Antimonium Crudum. Bryonia, Ipecac, Nux vomica, Pulsatilla. Chamomilla. Sulphur, Arsenicum, Hepar. Ranunculus bulbosus. iEthusa cynapium. Antimonium crudum. In the above schema I have placed no complementary remedy to Antimonium crudum. Scilla has been said to be complementary to it, but I have not satisfied myself that such is the case. When Antimonium crudum is indicated, we find mental symptoms quite prominent. It is frequently used in children when they are cross and peevish. They will not even permit themselves to be looked at. If an adult, the patient is sulky or sad, almost like the Pulsa- tilla patient. In some cases, there is a slightly erotic condition of mind, connected with sexual erethism. The patient becomes ecstatic 548 A CLINICAL MATERIA MEDICA. and fancies that some beautiful female is the object of his sentimental love. In children, this peevish mental state is associated with nausea, hot and red face and irregular pulse. The child is particularly cross when washed in cold water, but not so much in warm water. Now, the symptoms often occur in children in association with gastric symp- toms. The gastric symptoms of antimony are very well marked. It is suited to gastric catarrh, whether it be developed from cold or from improper food. In the first place, the tongue is coated white, and this coating is apt to be spread uniformly over the whole dorsum of the tongue. It has well been compared to a coat of whitewash. The tongue may be dry, and often is so, as in Bryonia. Sometimes, we find this white coating assuming a slightly yellowish tinge, especially on the back part of the tongue. At other times, you will find the borders of the tongue sore and red ; often, there is in the pharynx an accumulation of yellowish mucus. There are nausea and vomiting; the latter is very prominent, and occurs as soon as the child eats or drinks. Antimonium crudum is especially useful in vomiting from overloaded stomach; from eating indigestible substances; after the abuse of fat food, acids, sour wines, vinegar, etc., or from the excessive heat of summer. The vomited mattera contain food; or, in the case of very young children, they consist of curdled milk. The appetite is impaired. There may be colic, in which case, there is almost always a deposit of lithic acid in the urine. The bowels are affected also; there is often diarrhoea; the stool is watery and contains little lumps of faecal matter. This diarrhoea is made worse by vinegar and other acids, by cold bathing and by overheating. If there is constipation, as there may be and often is when vomiting predominates, the stools will consist of white, hard and dry lumps that look like undigested curd. In older persons, par- ticularly in the aged (for Antimonium crudum suits both ends of life), we have an alternation of constipation and diarrhoea: the stool, in con- stipation consisting of hard, dry lumps; that in diarrhoea, of water mixed with faecal lumps. Now let us make some distinctions between Antimonium crudum and its concordant remedies. Aethusa cynapium is our mainstay for vomiting of curdled milk in infants during dentition, or at other times. The vomited matter comes with a " rush," and the vomiting exhausts the little patient. He then falls into a sleep from which he awakens hungry. In Antimonium crudum, the child is hungry as soon as it ANTIMONIUM CRUDUM. 549 rids itself of the milk. JEthusa is suited to severe cases that have been prostrated by a long course of bad diet, by summer complaint or by the irritation of teething. I have known xEthusa to relieve the pain and soreness in the gums of teething children when vomiting is a prominent symptom. Like Antimonium crudum, Ipecacuanha has vomiting after a meal, after coughing and after acids; and hence it is suited to similar cases. But the Ipecacuanha usually has more nausea than has the other. Vomiting and retching predominate in Antimonium crudum, and nausea in Ipecacuanha. Then, too, the latter remedy usually has clean or slightly coated tongue; whereas the former requires a thick white coating of that organ. Bryonia is similar to Antimonium crudum. It has white tongue, dry mouth and constipation. It is suited to gastric catarrh from over- eating in persons of irritable temperament. The Bryonia tongue is a little different from that of Antimonium crudum, in that it is white down the middle, the edges not being coated. Then, too, the Bryonia stool is large, hard, dry and brown. If there is diarrhoea, the stool is offensive and watery, and smells like old cheese. Still another remedy is Pulsatilla. Here we find resemblances in the state of mind. We have both remedies called for in gastric ail- ments from the use of pork. But Pulsatilla has not the characteristic vomiting of Antimony, and the stool of Pulsatilla is usually greenish, or yellowish-green, and slimy. It is especially suited to cases after indulgence in mixed diet, ice-cream, cakes, pastry, etc. Antimonium crudum acts upon the skin, producing thick, horny callosities in this tissue. It is often indicated in eczematous eruptions, when the skin is of this character. It also has a marked action on the nails, causing deficient growth. If, after an accident which has split the nail, the latter does not heal readily, but grows cracked and thick, Antimonium crudum will make it grow as it should. I have also used the drug successfully in the treatment of split hoof, in the case of my own horse. Children in Antimonium crudum often have a crusty sort of erup- tion, in which the crusts are of a honey-yellow color. They are thick, just as we have seen with the callosities. The affected portions of the skin crack readily. This is particularly well-marked about the nos- trils and corners of the mouth. Now, I know of one case of diphthe- ria cured by Antimonium crudum when the symptoms were these: The child was very cross; whining and crying simply because it was 550 A CLINICAL MATERIA MEDICA. looked at; this was especially so on awaking from sleep; there were, also, these crusts around the nostrils and in the corners of the mouth. Antimonium crudum not only removed these but cured the diphtheria. The eyes are inflamed. They are worse from any bright glare, as the sunshine, or the glare of a bright fire, here reminding you of Mer- curius. It is distinguished from Graphites by the fact that the raw- ness is confined to the canthi, whereas under Graphites the inflamma- tion involves the whole border of the lids. On the female genital organs Antimonium crudum has some action. It is useful in prolapsus uteri when there is constant bearing-down feeling, as if something were pushing out of the vagina, and tenderness over the ovarian region, particularly when the menses have been sup- pressed by cold bathing. The leucorrhcea is watery and contains little lumps. There is one more use of Antimonium crudum to mention and we are done with it, and that is in adults who are tormented with gout. It is especially useful when gout has become constitutional. There will be gouty nodes in many of the joints. It here helps, provided there are the gastric symptoms characteristic of the remedy present, but not otherwise. Antimonium Tartaricum. Baryta c, Lachesis. hroat and IPecac' Kali M- t < Phosphorus, Sulphur, Carbo v. I Lauroeerasus, Ammonium carb. ^ Bromine, Iodine, Spongia. 2. Skin.—Conium, Mercurius, Kali hi., Kali hyd. 3. Bowels.—Yeratr. alb., Merc. Antimonium tartaricum or Tartar emetic, as it is also called, is a com- pound salt of antimony and potash, both of which substances depress the circulation. Hence you will expect to see symptoms due to this cause intensified under Antimonium tartaricum. It causes more weak- ness of the heart and lungs than does Antimony itself. Under Antimonium tartaricum we find the head confused, with warmth of the forehead and confused feeling, as if the patient ought to sleep. This drowsiness is worse in the forenoon. Often there is a headache, with sensation as if a band were tied around the forehead. This is a common headache in passive congestion of the brain. You Antimonium tartaricum. antimonium tartaricum. 551 find it under Gelsemium, Mercurius, Carbolic acid, Sulphur, and sev- eral other remedies. Cool air and moving about seem to brighten the patient up. Bathing the head relieves; this is rather contrary to Antimonium crudum. There is sometimes throbbing, particularly in the right side of the head. Still another form of headache is drawing in the right temple, extending down and into the jaw-bone. This is a sort of rheumatic tearing pain in the periosteum. If the patient is a child we note an unwillingness to be looked at or touched. If you persist in your unwelcome attention it will have convulsions. On awaking from sleep the child seems stupid, and is so excessively irri- table that he howls if one simply looks at him. Vertigo is often an accompaniment of the Antimonium tartaricum ailment; this vertigo seems to alternate with drowsiness. We often find Antimonium tartaricum indicated in cases of sup- pressed eruptions when there result these symptoms of the head. Par- ticularly is it called for when the eruption of scarlatina, measles or variola does not come out properly, or has been repelled ; then we have, in addition to the symptoms I have already mentioned, great difficulty in breathing. The face is bluish or purple, the child becomes more and more drowsy and twitches. There is rattling breathing. All of these symptoms indicate a desperate case. Antimonium tartaricum will frequently restore the eruption and save the child. Now, these symp- toms that I have mentioned accompany two grand sets of phenomena for which Antimonium tartaricum may be useful, namely, pulmonary and gastro-enteric affections. For children it is an invaluable drug in diseases of the chest. You find it, for instance, indicated in whooping-cough, and, in fact, in any cough, whether from dentition or other causes, when the cough is pro- voked whenever the child gets angry, which is very often. Eating brings on the cough, which culminates in the vomiting of mucus and food. Again, there is another form of chest trouble in which it is indicated. A nursing infant suddenly lets go of the nipple, and cries as if out of breath, and seems to be better when held upright and carried about. Now, this is the beginning of capillary bronchitis. There are finesub- crepitant rales all through the chest. Antimonium tartaricum here nips the whole disease in the bud and saves the child much suffering. Again, there is another form of cough in which it may be used. There is marked wheezing when the child breathes. The cough sounds loose, and yet the child raises no phlegm. This symptom increases until the 552 A CLINICAL MATERIA MEDICA. child grows drowsy. Its head is hot and bathed in sweat. The cough then grows less and less frequent. The pulse is weak. Symptoms of cyanosis appear. The quicker, in these cases, you give Antimonium tartaricum, the better for your patient. Now for a few of the concordant remedies in these cases. I will first say, in addition to what I have already said, that Antimonium tar- taricum is also indicated in affections of old people, and particularly in orthopnoea, or threatening paralysis of the lungs in the aged. You hear loud rattling of phlegm in the chest, and yet the patient cannot get up the phlegm. Here Baryta carb. is complementary to Antimo- nium tart., and often succeeds when the latter remedy only partially relieves. Ipecacuanha often precedes Antimonium tartaricum in catarrh of the chest in children. Loud rales are heard through the chest. When they cough they gag, but raise but little phlegm. In this threatening paralysis of the lungs you must compare Anti- monium tartaricum with several other drugs: with Lachesis, which has aggravation when arousing from sleep; with Kali hydriodicum, especially when there is oedema pulmonum and a great deal of rattling of mucus in the chest. What little sputum is raised is frothy and greenish, looking like soap-suds. Carbo veg. also suits these cases, but here the rattling is accompanied by cold breath and by coldness of the lower extremities from the feet to the knees. Moschus in paralysis of the lungs, when there is loud rattling of mucus and the patient is restless. It is especially indicated after typhoid fever. The pulse grows less and less strong, and finally the patient goes into a syncope. Also, do not forget Ammonium carb. in this condition. Antimonium tart, is indicated in the asphyxia at the beginning of life, asphyxia neonatorum, when there is rattling of mucus in the throat. Lauroeerasus is useful in the asphyxia of new-born children when there is great blueness of the face, with twitching of the muscles of the face, and gasping without really breathing. Antimonium tartaricum produces a perfect picture of pleuro-pneu- monia. Certain portions of the lungs are paralyzed. Fine rides are heard, even over the hepatized portions. There is great oppression of breathing, particularly towards morning. The patient must sit up in order to breathe. It may also be indicated in bilious pneumonia, that is, pneumonia with hepatic congestion and with well-marked icterus. ANTIMONIUM TARTARICUM. 553 The pit of the stomach is very sensitive to touch or pressure. There are meteorism, nausea and vomiting. It may be used in the pneumonia of drunkards with these complications. Antimonium tartaricum produces pustules very nearly identical with those of small-pox; hence, it may be a very useful remedy in that dis- ease. It is very useful in the beginning before the eruption appears, and the patient has a dry teasing cough, which, under other circum- stances, might suggest Bryonia. Here, however, you should give Anti- monium tart., because it covers all the symptoms. It suits the cough and also the reason for the cough. It also suits the eye symptoms which occur during eruptive diseases, as small-pox, scarlatina, measles, etc. In diseases of the intestinal tract we find it indicated by the follow- ing symptoms: Nausea with great anxiety, eructations tasting like rotten eggs, and drowsiness. The vomited matters are green and watery, and sometimes frothy, and contain food. The vomiting itself is associated with trembling of the hands, and is followed by drowsi- ness. Vomiting and purging may take place, with every symptom of collapse, coldness of the surface, the hands and feet are like ice, and the stools are profuse and watery. Here you have an almost perfect picture of Veratrum. The distinction between the two remedies is that Veratrum has more cold sweat on the forehead, and Antimonium tart, more drowsiness. When Antimonium tart, has produced pustules, the antidote is Cb- nium. . 36 LECTURE LV. THE PREPARATIONS OP MERCURY. ^ r Hepar. Mercurius vivus and soli dulcis. ibilis. Cinch. Nitr. ac. a corrosivus. Dulc. u aceticus. Kali hyd u protoiodatus. biniodatus. '>• Aurum. Asafoet. u cyanatus. Staph. Cinnabaris. Lach. Mercurius sulph. Iodine. u praecip. rub. > Mezer. , Stilling. We begin this morning with the study of Mercury and its combi- nations. Mercury has long been known and used as a medicine in the old school of practice. Its abuse, when given in excess or inappropri- ately, has rendered it a very unpopular remedy among the laity. There are many physicians in the so-called old-school practice who have en- deavored to obtain for Mercury a substitute which would answer the same purpose without deleterious results. They have been more or less successful, but they have never really obtained anything equivalent to that remedy in its genuine usefulness. Of late days, there are not so many allopathic physicians who give the great doses of Mercury that used to be so common. This caution in its administration is no evi- dence of improvement of the medical world, scientifically speaking, but only that they have been driven to this course by their unfortunate results and by popular clamor. There are many physicians who are afraid to let their patients know that they are taking mercurials. The eclectics have substituted such plants as Podophyllum and Leptandra for Mercury, especially in liver affections. We, of the homoeopathic school, are not afraid to use mercurials, because we do so according to a fixed law, guided by their effects on the human system; therefore, we are not in any danger of the bad THE PREPARATIONS OF MERCURY. 555 results which follow overdosing or misapplication of the drug. You notice that I have placed on the board a number of mercurial prepa- rations. All of these have some medicinal properties, but we have not the time, nor will it be proper, to dwell on them all. Our main object is to treat of the principal actions of Mercury in general, and then to teach you the principal characteristics which will enable you to prefer one of these preparations rather than others. From the gen- eral character of the patient, you know that he needs some mercurial preparation, and you want to know which one. We have here two preparations, Mercurius vivus and solubilis, that I have placed on the same line. I do not know enough to separate them symptomatically. The provings have been separately placed in Allen's Encyclopaedia, but I have not been able to separate them. These preparations are the quicksilver, or metallic Mercury, and the Soluble Mercury of Hahne- mann. Mercurius solubilis is not a pure mercurial preparation. It contains some ammonia and some nitric acid. There are only traces of nitric acid, however, and yet these traces must modify its symp- tomatology somewhat, but to what degree I do not know. The prov- ings of " the solubilis " are excellent. They are complete, much more so than those of quicksilver. These latter are collected more from poisoning cases and from clinical cases than from actual provings. If, then, the symptoms are clearly placed in the Encyclopaedia under Solu- ble Mercury, I would advise you to use that preparation. Below the Mercurius vivus and solubililis on the board we have two preparations of Mercury with chlorine. Next comes Mercurius aceticus, of which we have but few symptoms. Next we have the two Iodides of Mer- cury, which are very important. The Biniodide is red, the Protoiodide, yellow. Then we have the Cyanide of Mercury. Next we have Cin- nabaris, which is the Sulphide of Mercury. Beneath this we have the Sulphate of Mercury, and then the Mercurius preecipitatus ruber. Of these we have but few symptoms. Cinnabaris, the two iodides, the corrosivus, the solubilis and the vivus are the most frequently used. You see here on your right a list of antidotes to Mercury. That is in itself evidence of the numerous ill-effects which may result from its abuse. They are not all equally well indicated. As I mentioned the other day, Hepar is the most important antidote for Mercury, and also for many of the other metals. It is useful for the mental symp- toms that may follow a course of Mercury, the anxiety, distress, and even the suicidal mood; also for the bone pains, sore mouth, ulcers and the gastric symptoms. 556 A CLINICAL MATERIA MEDICA. Nitric acid is particularly to be remembered when the lower tissues are attacked, as the periosteum, the bones and the fibrous tissues. The patient has bone-pains worse at night, aching in the shins in damp weather, ulcers in the throat; particularly if secondary syphilis is complicated by mercurial poisoning. Cinchona is said to antidote the chronic ptyalism produced by Mer- cury. Dulcamara has been successfully used for the salivation of Mercury, particularly when it is aggravated with every damp change in the weather. Kali hydriodicum, or the Iodide of Potassium, is a well known anti- dote for Mercury, and has come into practice of late years, and is given by both schools of medicine very extensively, whether the case be syphilitic or not. Like Nitric acid, it is particularly indicated when syphilis and Mercury combine to make the patient sick, particularly when the lower order of tissues are involved, as the bones, the perios- teum and the glands; when there is the well-known syphilitic ozaena, thin watery discharge from the nose, making the upper lip sore and raw. You will find it the best drug we have for the repeated catarrhs which may follow the abuse of Mercury. Every little exposure to a damp atmosphere, or even to cool air, causes coryza. This, remember, is a case of mercurial poisoning which the Iodide of Potassium is to antidote. The eyes are hot, and watery, and swollen. There are neu- ralgic pains in one or both cheeks, the nose feels stuffed up and is swol- len, and discharges at the same time a profuse watery scalding coryza. With these symptoms there is more or less sore throat. These symp- toms recur at every fresh exposure. There is scarcely any drug which will cure these cases quicker than will Iodide of Potassium. There is another salt of potash that has an antidotal relation to Mercury, and that is Kali chloricum. This is just as efficient an anti- dote when the poison has developed a sort of scorbutus, and the gums are spongy, soft, and bleed easily; there are ulcers of an aphthous character in the mouth and throat, and foetor of the breath. Aurum has next mention. This we find particularly called for in the suicidal mania which may develop after a course of Mercury, and also for the caries of the bones, particularly of the bones of the palate, nose, etc. Asafoetida also comes in as a drug to be thought of in the bone affections developed by Mercury. Here you have, as a characteristic distinguishing it from the others, extreme sensitiveness around the dis- THE PREPARATIONS OF MERCURY. 557 eased portion of bone. For instance, in the case of an ulcer communi- cating with a carious tibia, the parts are so sensitive that the patient can scarcely bear the dressing that you apply. You will find that the tissues are firmly adherent to the bone for some little distance around the inflamed portion. Then, too, you find Asafoetida sometimes indi- cated for iritis following mercurialization. Here, to distinguish it from other remedies, you have the same characteristic, extreme soreness of the bones around the eye. Staphisagria is an antidote for Mercury, and in rather bad cases, too, when the system is very much depreciated by the mercurial poison. We find the patient wasting away and sallow, dark rings around the eyes, well-marked mercurial mouth and throat, with spongy gums, tongue flabby, ulcers on the tongue and in the throat and well-marked bone pains. Lachesis is an occasional antidote for some of the symptoms, but there are no special characteristics. Iodine comes in as an antidote when the glands are affected. Mezereum is an excellent antidote when the mercurial poisoning has invaded the nervous system and neuralgia has developed. This neuralgia may appear in the face, in the eyes or in any part of the body. Lastly, we have Stillingea. Mercury, it is well known, enters into loose combination with the tissues of the body. It has been found in every tissue and may be excreted by almost every channel. It has been found in the perspira- tion, urine, bile, faeces and saliva. It has even been found in the child in utero and, again, in the nursing infant, when the drug has been taken by the mother. I said that the combination of Mercury with the tissues is a loose one, by which I mean it is easily displaced. If a person is poisoned with Mercury, it will be readily displaced by one of the above remedies. It is only the chronic cases that need alarm you, and the cure of which, you may despair of. When mercurializa- tion is combined with other poisons, as with syphilis and scrofula, then you will have greater difficulty. The symptoms of poisoning by Mercury may be stated as these: After exposure to the poison, the patient has a rather disagreeable odor to the breath; that is, a sickening sort of odor hard to describe but easy to remember. There is also a sort of metallic taste complained of. These are very early symptoms and assert themselves long before the well- known characteristics of the drug appear. The patient feels languid and is frequently sick at his stomach. He vomits his food without any 558 A CLINICAL MATERIA MEDICA. apparent cause. His face becomes rather pale, with dark rings around the eyes; the lips are rather livid and purplish. He complains of heat, particularly in the forehead and down the root of the nose. He cannot bear the warmth of the bed. As soon as begets warm in bed, his aches and pains return. Then his mouth begins to feel sore. The mucous membrane becomes puffed, swollen and redder than natural. The sali- vary glands begin to secrete more rapidly and the mouth is filled with saliva, which is, however, normal in its composition. In a more ad- vanced case, the saliva becomes vitiated. It is no longer the pure secretion, for the glands are overworked. The breath becomes more and more offensive, the gums swell and are tender to touch and the teeth become loose. A dark red line sometimes appears on the gums below the teeth. Later, the gums grow spongy and yellowish-white and ulcerate and discharge an offensive matter. The tongue swells and readily takes the imprint of the teeth. The glands then become in- volved and you find more or less tumefaction of the parotid and cer- vical glands. If you were to look into the mouth at this stage, you would find the opening of Steno's duct red and inflamed and, in some cases, even ulcerated. Other glands, too, are affected. We find the pan- creas attacked by Mercury. The liver also comes in for a share of the poison. You are probably aware that the liver has been said to be affected by Mercury, and that allopathic physicians have been accus- tomed to give blue mass or calomel iu almost every attack of "liver- complaint.''' Quite recently, several eminent physicians in the old school have declared that Mercury does not increase the flow of bile and hence is not useful for torpid liver; but, however that may be, it is certain that Mercury does affect the liver in one way or another. It has caused catarrh of the duodenum, and this catarrh has extended along the bile-duct into the liver. This is a form of trouble which frequently causes jaundice, and a form, too, for which Mercury is useful. It has also produced and cured hepatitis, particularly when one or more abscesses have formed in the liver. Individual suscepti- bility varies these symptoms considerably. You will find that it is more difficult to salivate children than adults. Some persons are salivated by very small quantities, while it is difficult to affect others. The scrofulous are very seriously affected by Mercury, as you all know. The more remote symptoms of mercurial poisoning are these: You will find that the blood becomes impoverished. The albumen and fibrin of that fluid are affected. They are diminished, and you find in their THE PREPARATIONS OF MERCURY. 559 place, a certain fatty substance, the composition of which I do not ex- actly know. Consequently, as a prominent symptom, the body wastes and emaciates. The patient suffers from fever which is rather hectic in its character. The periosteum becomes affected and you then have a characteristic group of mercurial pains, bone pains worse in changes of the weather, worse in the warmth of the bed, and chilliness with or after stool. The skin becomes rather of a brownish hue; ulcers form, particularly on the legs; they are stubborn and will not heal. The patient is troubled with sleeplessness and ebullitions of blood at night; he is hot and cannot sleep; he is thrown quickly into a perspiration, which perspiration gives him no relief. The entire system suffers also, and you have here two series of symptoms. At first, the patient be- comes anxious and restless and cannot remain quiet; he changes his position; he moves about from place to place; he seems to have a great deal of anxiety about the heart, prsecordial anguish, as it is termed, par- ticularly at night. Then, in another series of symptoms, there are jerk- ings of the limbs, making the patient appear as though he were attacked by St. Vitus's dance. Or, you may notice what is more common yet, trembling of the hands, this tremor being altogether beyond the control of the patient and gradually spreading over the entire body, giving you a resemblance to paralysis agitans or shaking palsy. Finally, the pa- tient becomes paralyzed, cannot move his limbs, his mind becomes lost, and he presents a perfect picture of imbecility. He does all sorts of queer things. He sits in the corner with an idiotic smile on his face, playing with straws; he is forgetful, he cannot remember even the most ordinary events. He becomes disgustingly filthy, and eats his own ex- crement. In fact, he is a perfect idiot. Be careful how you give Mer- cury; it is a treacherous medicine. It seems often indicated. You give it and relieve; but your patient is worse again in a few weeks and then you give it again with relief. By and by, it fails you. Now, if I want to make a permanent cure, for instance, in a scrofulous child, I will very seldom give him Mercury; should 1 do so, it will be at least only as an intercurrent remedy. I have placed on the board in tabular form, a list of the mercurial salts together with the parts of the body on which they act. Wherever you notice the cross, you know that the preparation acts on the part of the body placed on that line under the heading of Mercurius vivus. This table is only a convenient form. There is nothing practical or scientific in it. 560 A CLINICAL MATERIA MEDICA. Corros. Cinn. Sulph. Rub. Acet. + + ' — — — + + — — — + + — — — + — — — + + — + + — + + + — — + + — + - + + + + + + + — + - + + + — — Taking Mercurius vivus as a type of the whole, as an individual remedy in fact, we find that it is indicated in persons who are of a scrofulous habit, whether of syphilitic constitution or not, in whom the glandular system is active. This glandular activity shows itself in two ways. In the first place, we may have a condition simulating plethora. In more advanced stages, we may find Mercurius indicated in enlarged glands with emaciation and deficiency of blood. We find Mercurius, too, indicated in scrofulous children who have unusually large heads with open fontanelles, particularly the anterior fontanelles. They are slow in learning to walk, the teeth form imperfectly or slowly, the limbs are apt to be cold and damp, and there is a damp clammy feel- ing to the limbs. You may distinguish it from Calcarea, Silicea and Sulphur by these characteristics : The head is inclined to perspire in the Mercurius case, but the perspiration is offensive and oily. It is not as often indicated as Calcarea, Silicea or Sulphur, nor is it as certain or as permanent in its effects. But it may come in as a remedy to par- tially relieve, and it may be indicated as an intercurrent remedy in a course of treatment with Sulphur, when the latter remedy seems to fail. You will find the Mercurius patient illustrating plethora with anxiety and restlessness, tossing about, moving from place to place. It is one of the remedies useful for nostalgia or home-sickness. The patient becomes anxious and irritable. This anxiety seems as if it Mercurius Vivus. Eyes................ Nose............... Mouth and \ Throat, J Kidneys and \ Bladder, / Heart.............. Lungs.............. Genitals........... Glands and > Bones, J Skin................ Stomach and "1 Liver, J Bin. Prot. Cyan. — + — + + + + + +' -f- — + + + + — + + + ■ + + + + + + + + — THE PREPARATIONS OF MERCURY. 561 were in the blood, that is, it is always attended with ebullitions of blood. That distinguishes it from other remedies. The congestions of Mercurius indicate it after Belladonna. There are resemblances between the two remedies, which have been well con> firmed clinically. It often follows Belladonna in inflammations, even in inflammation of the meninges of the brain when, as under Bella- donna, there are the same hasty speech and the quick, nervous talking; the child talks so rapidly that one word runs into another. Its man- ner is just as quick and nervous as its speech. You will find the face flushed very much as in Belladonna, but you have, in addition, to dis- tinguish it from that remedy, glandular swellings, and tendency to sore mouth. You find Mercurius often indicated in catarrhal or gastric fevers when the face is puffed, when the throat is swollen, both internally and externally, from involvement of both glands and cellular tissue; when there are aching pains in the joints, which are rendered worse by the warmth of the'bed, and are not relieved by sweat. In addition to this you almost always find that there is a tendency to catarrh of the bowels. This is characterized by slimy, bloody stool, accompanied by great tenesmus, this tenesmus not ceasing after stool. Here, too, you find Mercurius to follow Belladonna. We find Mercurius indicated in haemorrhages. It is often called for in nose-bleed or epistaxis, particularly when the blood coagulates and hangs from the nostrils like icicles. This is a useful hint. Sup- pose that in a full-blooded patient, a boy at the age of fifteen or six- teen, when congestions are so frequently noticed, or that in a scrofulous child, nose-bleed appears. You have given Belladonna, Hamamelis, and Erigeron, and have failed to check it. The blood is quite bright, and runs in streams. Medicines do not stop it. Then comes this Mercurius condition. You give that remedy and cure, not only that attack, but you prevent the return of others. The same indications apply to uterine haemorrhage or menorrhagia when the flow is profuse, dark and clotted. Then, if the other symptoms agree, glandular swell- ing, sore mouth, etc., Mercurius is certain to be the remedy. We find Mercurius often indicated in pneumonia. Here it requires that the right lung be affected, and that there are also icteroid symp- toms. The skin is yellow. .There is sharp stitching pain through the lower portion of the right lung. There will be other symptoms pecu- liar to pneumonia present, but these need not be specified separately. We find it indicated in peritonitis, and here it follows Belladonna 562 A CLINICAL MATERIA MEDICA. when suppuration has commenced and you have tympanitic abdomen, some evidence of effusion, which will be partly serous and partly pur- ulent, sweat, rigors, etc. Here Mercurius comes in and prevents the further spread of the suppurative process. Another condition in which we may use Mercurius is one of inflam- mation in which suppuration has occurred, whether the disease be a boil, a tonsillitis, or any other form of inflammation. We here find Mercurius connected with an interesting little group of medicines which you will use very often; they are Belladonna, Hepar, Mercu- rius and Lachesis. To these we may also add Silicea. and Sulphur. We prefer Belladonna in the beginning of inflammation as in tonsil- litis. The throat is bright red and swollen, and there is difficulty in swallowing fluids, and sharp pains through the tonsils. You should change to Hepar when the sharp sticking pains and chills indicate the beginning of suppuration. It may prevent suppu- ration when given in the incipiency of that process. Mercurius is suited to a still more advanced state when pus has formed and you wish it evacuated. If you give it too soon you will spoil the case. Mercurius does not prevent the formation of pus, but rather favors it. In felons, if it is given low, it will generally favor the rapid formation of pus. Silicea follows Hepar better than does Mercury when pus continues to discharge and the wound refuses to heal. In some of these cases, the benefit under Silicea will cease. Then a dose or two of Sulphur will excite reaction and the Silicea can effect a cure. Lachesis is indicated when the pus degenerates and becomes of a dark, thin, offensive character. Mercurius vivus we find indicated in inflammations in and about the eyes, usually of scrofulous or syphilitic origin. We find that the patient suffers from the glare and heat of the fire, consequently he avoids the fire and warm rooms. You sometimes find it indicated in blepharitis of men who work in and about fires, as foundrymen. The pains are usually worse at night. The lids are thickened, especially at their tar- sal edges, and the eyes discharge a thin acrid muco-pus. This makes the cheeks sore, and you find little pimples scattered over the cheeks. Ulcers may form on the cornea. These ulcers are usually superficial, and have an opaque look as though pus were between the corneal layers. In syphilitic iritis, Mercurius solubilis will be sometimes in- dicated when there is hypopyon. Now let us distinguish between this and other preparations of Mercury. THE PREPARATIONS OF SiERCURY. 563 The Biniodide of Mercury is indicated in inflammations of the eye. The symptoms are very similar to those of" vivus," but there is more glandular swelling under the Biniodide. The Protoiodide is more frequently indicated in eye diseases than is the Biniodide. It is called for in corneal ulcers which look as if they had been chipped out with the finger nail. There is usually, when it is the remedy, a thick yellow coating on the base of the tongue, the anterior portion being clean and red. Mercurius dulcis, or calomel, is selected more by its general symp- toms, which are these: It is indicated in scrofulous children who are pale, and who have swelling of the cervical and other glands. The skin is rather flabby and ill nourished. The flabby bloatedness and pallor are the indications for calomel. Next to this we have Bichloride of Mercury or Mercurius corrosivus. This is indicated in inflammatory symptoms of the most violent char-, acter. There is no mercurial that produces such intense symptoms as does the Bichloride. It produces burning, agonizing pains, with most excessive photophobia and profuse excoriating lachrymation, making the cheeks sore, almost taking the skin off so excoriating is it. There are tearing pains in the bones around the eye. There is ulceration of the cornea, with tendency to perforation. In such cases you will, as a matter of course, have hypopyon. Mercurius corrosivus is almost a specific for syphilitic iritis. If the symptoms of the case do not point to some other drug as the remedy, you should give it in this disease. If you choose to use atropia locally, do so in order to prevent the adhesions which will otherwise almost inevitably take place in these cases. You will also find Mercurius corrosivus indicated in retinitis albuminurica. Cinnabaris is next. That is a remedy for a variety of inflamma- tions of the eye. I will only give you one symptom for it, and that is pain which shoots across the eye from canthus to cauthus, or seems to go around the eye. Next, the action of Mercury on the nose. We find Mercurius vivus indicated in catarrhs of the nose and throat, which are provoked by damp, chilly weather and by the damp, cool evening air. The nose itches and burns and feels stuffed-up ; with this there is thin coryza. The throat feels raw and sore. There is aching in the various joints. These are the symptoms which will indicate Mercurius both as to their exciting cause and as to the symptoms present. You may have with these a hot feeling. The face flushes up and gets red, perspiration 564 A CLINICAL MATERIA MEDICA. breaks out but it gives no relief. There is another form of coryza in which you may give Mercurius, and that is when the cold is " ripe," when the discharge from the nose is yellowish-green, thick and muco- purulent. Here it rivals Pulsatilla, which is also useful for these thick, yel- lowish-green nasal discharges. Pulsatilla, independently of its other symptoms, is distinguished by the fact that the discharge is never irritating, but is perfectly bland. You are also to distinguish Mercurius from Nux vomica, which is suited to coryza caused by exposure to dry cold, and when there are soreness, roughness and a harsh, scraped feeling in the throat. Mer- curius always has a smarting, raw or sore feeling. Now, the throat symptoms of Mercurius vivus may lead you at times to think of it in diphtheria. Think of it as much as you choose, but think of it only to reject it. It is not indicated in diphtheria. I do not believe it indicated even in diphtheritis. But there are prepara- tions which may be used here. We first notice the Mercurius bin- iodatus. Both the Biniodide and the Protoiodide of Mercury are indi- cated in diphtheritic sore throat, or even in true diphtheria. The Biniodide is of use when the membrane is on the left side, when the left tonsil is inflamed and there is a yellowish-gray membrane forming there. The glands of the neck are swollen. There is also some in- volvement of the cellular tissue around the throat. The patient may have an accumulation of slimy or sticky mucus in the mouth and throat. The symptoms are worse from empty swallowing. The simple attempt to swallow saliva excites more pain than does the swal- lowing of food. The Protoiodide of Mercury is more to be thought of when the deposit begins on the right side of the throat, with swelling of the glands in the neck and with the accumulation of this tenacious mucus in the throat. Here there is almost always present that thick, yellow, dirty coating on the base and posterior part of the tongue, the tip and sides of that organ being red. These two remedies are often indicated in diphtheria and diphtheritic sore throat. Next you will notice the Cyanide of Mercury, which is a combina- tion of hydrocyanic acid and mercury. We have in this drug one of the very best remedies in diphtheria, especially when it is of a true adynamic or malignant type. By reason of the presence of the prussic acid you will find it indicated in cases in which the patient is very much prostrated from the beginning.- The pulse is quick. It may be THE PREPARATIONS OF MERCURY. 565 as high as 130 or 140, and it has no volume to it at all. The mem- brane at first is white, covering the velum palati and tonsils. The glands soon begin to swell, however, and then the membrane becomes dark, threatening even to grow gangrenous. Weakness is extreme. The breath is foetid. There is loss of appetite. The tongue is coated brown, or, in severe cases, even black. Nose-bleed sets in, and this you know is a dangerous symptom. It may also be used in diphtheria of the larynx. The expectoration is thick and ropy. There is harsh, barking, croupy cough, with dyspnoea. Here, too, the Cyanide of Mer- cury has saved life, but it will not always do so. You will notice its resemblance to Kali bichromicum in diphtheritic croup. The resemblance lies in the position of the disease, that is, in the larynx and in the thick, tough, tenacious expectoration. The dis- tinction lies in this: The Cyanide of Mercury has great weakness. Now this weakness is not a simple prostration which should come from the efforts of the child at breathing. It is due to poisoning of the blood, which is represented by the blueness of the surface, coldness of the extremities, and quick, weak pulse. If you have not these, Kali bichromicum is to be preferred. Cinnabaris is a remedy not often thought of in catarrhal troubles. It is indicated in nasal catarrh when there is great pressure at the root of the nose, a feeling as though something weighty was pressing on the nose, a heavy pair of spectacles for instance. We also frequently find throat symptoms with this form of catarrh. The throat is swollen and the tonsils are enlarged and redder than normal. There is great dry- ness in the throat, and this is more annoying at night, waking the patient from sleep. Remember this sensation across the bridge of the nose and the character of the throat symptoms in connection with it. These symptoms may occur in the syphilitic, in the scrofulous, or in persons in whom there is tendency to catarrh. We have found Cin- nabaris of use in the sore throat of scarlatina, which is often diphthe- ritic in its character, when there is quite an accumulation of stringy mucus in the posterior nares. That symptom being prominent, Cin- nabaris will be the remedy for the emergency. I have used Mercurius corrosivus successfully when the accumula- tion of mucus in the nose is quite thick ; in fact, almost like glue. In some cases of syphilitic disease of the nose, you find Mercurius corro- sivus indicated from the fact that the ulcers perforate the septum of the nose. In these cases there are burning pains, the discharges are acrid, corroding the tissues over which they flow. 566 A CLINICAL MATERIA MEDICA. The throat symptoms of Mercurius corrosivus are very violent. I can conceive of cases where it would be required in diphtheria, and yet I have never o-iven it in that disease. The uvula is swollen, elongated and very dark red. There is intense burning in the throat, just as in- tense in fact as that of Arsenicum album, Arsenicum iodatum or Cap- sicum. This burning pain is rendered intolerable by any external pressure. It is accompanied by violent constriction of the throat. Any attempt to swallow, be the matters swallowed solid or liquid, causes violent spasm of the throat, with the immediate ejection of the solid or liquid. You here recognize a resemblance to Belladonna in the spasmodic character of the symptoms. Mercurius corrosivus is at once distin- guished from Belladonna by the inflammatory tendency of the symp- toms as indicated by these extreme burning pains. Thus it has the constrictive quality of the Belladonna plus the most intense, destruc- tive inflammation of the throat. You may further distinguish be- tween the two remedies by the pulse. In Mercurius corrosivus the pulse is quick, weak, and irregular, and not full and strong as under Belladonna. Next, a word or two about the Mercuries in their action on the genitals and the glands. The Mercuries have long been used in the treatment of syphilis. Mercurius solubilis or vivus is indicated in primary syphilis for the so-called soft chancre or chancroid. The ulceration is superficial rather than deep, and the base of the sore has a dirty, lardaceous appearance. Mercurius sol. has produced such an ulcer as this, and, therefore, it ought to cure it. The sore throat which often ushers in the syphilitic fever six or seven weeks after the appearance of the primary lesion, is also found under Mercurius solubilis. The Iodides of Mercury are the preferable remedies for the Hunte- rian or hard chancre. That is a form of ulcer which the Protoiodide and Biniodide have both produced, therefore they will cure it. There is no necessity whatever for such external applications as caustics, for the proper internal remedy if it does not entirely prevent the onset of secondary symptoms will at least lessen their intensity. Mercurius corrosivus is to be preferred to any of the drugs men- tioned for syphilitic symptoms when the ulceration is very destructive. The ulcer is serpiginous ; it has a ragged edge, eating out and destroy- ing in a few days nearly half the penis. Secondary syphilis may be treated with one or the other of these preparations, if the drug has not been abused in the primary stages THE PREPARATIONS OF MERCURY. 567 Mercurius solubilis very quickly helps those syphiloderms on the palms of the hands. They are red, itch slightly, and scale off. Returning to Mercurius vivus, I want to say a few words concern- ing its use in diseases of the liver. The tongue is coated a dirty yel- lowish-white and takes the imprint of the teeth. There are scorbutic symptoms frequently present. The gums ulcerate and become spongy. There is a foetid or disagreeable odor from the mouth. The skin and conjunctiva have a well-marked jaundiced or icteroid hue. There is tendency to rush of blood to the head. The region of the liver is sore to the touch. The abdomen is rather tympanitic and swollen, particularly across the epigastrium and in either hypochondrium. The patient cannot lie on the right side. You will find the liver enlarged and often indurated. The stools are either clay-colored, from absence of bile, or there are yellowish-green bilious stools, passed with a great deal of tenesmus and followed by a " never-get-done " feeling. Mercury is indicated in dysentery, especially when it occurs in a season when warm days are followed by cold nights. Nux vomica has many resemblances to Mercurius, but it differs in that the pains and tenesmus usually cease after stool; whereas, with Mercurius, they continue after stool. Aconite often precedes the exhibition of Mercury in the weather I have spoken of, hot days followed by cold nights. In the incipient stages, such troubles may be checked by Aconite. If Aconite fails, then JNIercurius will be indicated. Often, after the tenesmus and blood have ceased, and the mucus still persists, Sulphur will be the remedy. There is another remedy to be remembered in connection with Mer- cury in bilious troubles, and that is Leptandra. Both of them have these yellowish-green stools, and stools black like pitch, and horribly offensive stools. The distinction lies here: Leptandra has urging to stool, griping continuing after stool, but not the tenesmus. Leptandra frequently has dull, aching, burning pains in the posterior portion of the liver. LECTURE LVI. THE NOBLE METALS—AURUM. In this group we have Aurum metallicum, Aurum muriaticum, Ar- gentum metallicum, Argentum nitricum, Platinum and Palladium. There are also two or three others of which we know but little. Auritm and Argentum have many symptoms in common, and yet their distinctive characteristics are sufficient to enable you to separate them readily in practice. I will give you the general distinctions between the two drugs before I consider them individually. Gold affects more the circulation of the blood. It also acts on the mind, producing emotional symptoms. Now, by this I mean that if you find symptoms of the nervous system in Aurum, they will be followed by symptoms of the circulation as the primary or most important quality. Argentum has more symptoms of the respiratory organs and intellec- tual part of the mind. With Aurum, we have tendency to hyperaemia; in Argentum, more nervous phenomena; only, Aurum seems to attack the bones. We find very few symptoms of Argentum indicating it in bone affections. The latter, however, causes an arthralgia or neuralgic pains in the joints. It also attacks the cartilages of joints.. For in- stance, you find Argentum metallicum useful in the arthralgic pains of women who suffer from prolapsus uteri. They can scarcely move their joints, and yet a most careful investigation shows no rheumatic inflammation. Aurum suits in scrofula with redness of the face, thus keeping up the tendency to hyperaemia or fulness of the bloodvessels. In these scrofulous cases, you will find that the opacities and ulcers on the cor- nea are surrounded by well-filled bloodvessels; here, again, the hyper- aemic quality of the drug is well brought out. Argentum suits in chlorosis. It affects the oxidizing power of the blood; it shrivels the body. Aurum affects the distribution of the blood, giving us fulness or hyperaemia, whereas Argentum affects its quality, rendering it incapable of fully carrying oxygen. Hence, all parts of the body become dwindled from malnutrition. Silver, and especially its nitrate, coagulates albumen, and this is the reason why the latter has been used locally for so many years as a caustic. When applied with moisture to animal tissues, it imme- AURUM. 569 diately coagulates the albuminous portions, and so tends to destroy whatever process is going on. Its action does not extend deeply, however, on account of the formation of this layer of coagulated albumen. Argentum Nitricum more than the metal itself, causes gastro-enteric inflammation, very much like Arsenic. In poisoning cases it also seems to affect the epithelial layers. For instance, when animals that have been fed on it for quite a while die, the epithelial layers in all parts of the body seem to be more or less destroyed. That is the rea- son why you find it of use in cancer and in haemorrhages, in both of which conditions the epithelial structures are diseased. Aurum Metallicum. r \. Mind. 2. Hyperaemia. Aurum met. Hepar. [_ Natrum mur. >Bell. > Merc. Aurum is a remedy of not very extensive application, but still it is well marked in its limited sphere. Its antidotes are principally He- par, Belladonna, and Mercurius. I am not positive that there is a com- plement to Aurum. Now, in studying the action of this remedy, we are to keep in mind, first, this one prominent quality, its power of producing hyperaemia; and, secondly, its action on the emotional mind more than on the intellectual. First, let us study the hyperaemia of Aurum. We find this in every part of the body on which it may act. It affects the heart, causing increased activity of that viscus. This increased activity of the heart is indicated by increased force of the heart-stroke^ just as you find in pure cardiac hypertrophy without dilatation. As a result of this in- creased action, the heart enlarges, and you have, secondarily, hyper- 37 570 A CLINICAL MATERIA MEDICA. trophy of the heart. Consecutive to this trouble, you have a list of symptoms that are very characteristic. The lungs are too full of blood, or liyperaemic. The condition is exhibited in this manner: The patient on attempting to walk up hill, or use any little exertion, fools as though there were a crushing weight under the sternum. He feels that if he did not stop walking the blood would burst through the chest. Aurum relieves this kind of a case very nicely. According to Kafka, Aurum muriaticum is here preferable.to the metallicum. It is here'very similar to Ammonium carb., which has this crushing weight on the sternum ; but this remedy has more tendency to somno- lence, and is better suited to venous fulness than is Aurum. This condition of the heart necessarily causes hyperaemia in other organs. We find, for instance, this tendency to rush of blood to the head aggravated by mental labor, because study always increases the amount of blood in the brain, if there is any tendency to cerebral con- gestion. There is a feeling of fulness in the head, accompanied by roaring in the ears. The head feels sore and bruised, and the mind is confused. Sparks or flashes of light before the eyes show pressure on the retinal vessels. The face, in extreme cases of congestion, is rather bloated, and has a glassy look. Still further evidence of the hyperemia in the eye is displayed by the ophthalmoscope. You find a sensation in the eye as though it were being pushed out, with a certain amount of tension there. Two errors of vision may be associated with these symptoms; either he sees double, or he suffers from what is known as half-sight. Now, these symptoms are suggestive of hyperaemia of the brain, which may occur from various causes, among the most promi- nent being overwork with the eyes, and persistent use of the eyes, or working in hot places. Glaucoma may suggest Aurum. In scrofulous ophthalmia we frequently find Aurum indicated, if there are present those symptoms of congestion. The bloodvessels are very much injected ; pannus is present; great vascularity is a characteristic in these cases calling for Aurum. In addition, you will find profuse scalding lachrymation. The eyes are very sensitive to the touch. Aurum may be used in cases of syphilitic iritis when the eye is de- cidedly worse from touch. There is a very characteristic soreness around the eye, as if in the bones. Especially is it indicated in syph- ilitic cases after the abuse of mercury. In retinal congestion, you should compare with Aurum, Belladonna, Glonoin and Sulphur. AURUM. 571 In syphilitic iritis, with that sore bruised sensation around the eyes, compare Asafoetida. This remedy, however, has less of that sensitive- ness around the eyes. You may also compare here, Mercurius corro- sivus and Nitric acid. The nose, too, is congested and has a red knobby tip, greatly dis- figuring the face. This may exist as a sequel to the long indulgence in alcohol, or it may be found in children as a symptom of scrofula. If the latter is the case, it is often accompanied by the characteristic catarrh for which Aurum is the remedy. In nasal catarrh or ozaena it is indicated when the nostrils are sore and cracked. There is foetid nasal discharge, often accompanied by caries of the nasal bones. There is ulceration of the soft parts with perforation of the nasal septum. It is especially indicated in cases of scrofulous or mercurio-syphilitic origin. The Aurum symptoms of the ears are not very numerous but are suggestive. The ears are congested, and you find roaring in the ears, as I suggested a few moments ago. Further than this, you find great sensitiveness to noises. Now, it is sometimes indicated in catarrh of the middle ear. In these cases you note a foetid otorrhcea. In addi- tion to this you will very likely find the membrana tympani seriously damaged. The external auditory meatus and the mastoid process of the temporal bone become affected by direct spread of the disease. There are boring pains in the mastoid process. The trouble may pro- gress to caries. I have already shown you illustrations of the effect of Aurum on the bones. You noticed that it was indicated in iritis with pains in the bones around the orbits ; and you know also that it affects the nasal bones, producing caries there. In this affection of the mastoid process, Nitric acid is the nearest ally to the Aurum metallicum. For simple soreness or inflammation, beginning in the mastoid cells, Capsicum has won some laurels, but for caries of this process, Aurum, Silicea and Nitric acid are the best remedies. Aurum has some throat symptoms. The tonsils are apt to be red and swollen, and the parotid gland on the affected side feels sore, as if contused. The hard palate may be carious. .With all this, there is a mercurial or syphilitic history. I have dwelt on these symptoms be- cause they are those which Aurum has most frequently removed. Returning to the circulatory disturbances of Aurum, we find a hyper- aemia of the kidneys. This is shown in the beginning by simple in- crease in the amount of urine passed. By and by the kidneys begin 572 A CLINICAL MATERIA MEDICA. to undergo fatty degeneration. The urine then grows scanty and al- buminous, or there maybe granular or cirrhosed kidney. Aurum will not do any good in these cases, unless the renal trouble is secondary to some heart affection. The nearest remedy, pathologically, to Aurum in granular kidney is Plumbum. We find, too, that the genital organs are affected by this hyperaemia and there is strong tendency to erections. The testicles become inflamed, particularly the right. Aurum is especially suited to chronic orchitis, particularly when the right testicle is affected. As another sequel to this effect of Aurum, we find hepatic congestion. The liver is swollen consecutive to cardiac disease. This hyperaemia is associated with burning and cutting in the right hypochondrium. As the hyperaemia continues, the liver becomes cirrhosed or else undergoes fatty degeneration. Ascites appears. The stools are of a grayish or ashy- white color from defective amount of bile, and we have here, as in almost all ailments in which Aurum is the remedy, a peculiar state of the emotional mind, a melancholy or a low-spiritedness, which I shall describe to you presently. The lungs are also liyperaemic. There is great oppression of ihe chest, which is worse at night, particularly in the first part of the night; it is worse from prolonged exercise, from prolonged walking. The face may be purple. In extreme cases, syncope may take place. On the female organs we find Aurum acting powerfully, causing congestion of the uterus. The uterus becomes prolapsed from its great weight. It is enlarged from chronic congestion. This is the form of prolapsus which Aurum will cure, and no other. The ordinary rem- edies for prolapsus, such as Lilium or Nux vomica, cannot relieve this case, because the prolapsus is not the main characteristic. The cause of the prolapsus is the weight of the organ and not the relaxation of the ligaments or weakness of the general system. There is another salt of gold which has been successfully substituted for Aurum metallicum in these cases, and that is Aurum muriaticum natronatum. This has been used in the second and third potencies for prolapsed and indurated uterus. Aurum has some very characteristic mental symptoms. In almost all cases in which it is the similimum, there is present a melancholy, with disposition to weep, or with a feeling of self-condemnation, as if he was not fit to live. This feeling of self-condemnation or worthlessness may amount to despair, sometimes even taking the form of religious mania. AURUM. 573 He prays all the time. He is sure that he is going to be condemned. He has suicidal thoughts, if he" does not make actual attempts at suicide. With all this there is a great deal of mental anguish, which mental anguish is associated with praecordial distress, by which I mean dis- tressed feeling referred to the cardiac region. In addition to the melan- choly, Aurum also produces weakness of the memory. Decided anger may also be characteristic of the remedy. Any contradiction or dispute excites the patient furiously. He becomes red in the face and his pugnacity is aroused. - Mental labor becomes irksome to the patient. He is very apt to suffer from headaches which are of a congestive char- acter, as has already been described. Next, we have to study the action of Aurum on the bones. This I will dismiss in a very few words. It is useful in caries of the cranial bones, and of the bones about the nose and palate, particularly after the abuse of mercury, whether the case be syphilitic or not. 4 LECTURE LVII. THE PREPARATIONS OP SILVER. Argentum Nitricum. C Arsenicum, Nitric acid. Argentum nitr. 1 Plumbum, Cuprum. ^ Zinc. > Natrum mur. Argentum nitricum, or the Nitrate of Silver, in its action on the brain and spine furnishes us with a list of symptoms that lead to the use of the remedy in many forms of nervous disease, from simple ner- vous debility to full-fledged locomotor ataxia, or paralysis. Among the anomalous sensations which it causes are the following, which are characteristic of the drug: A very common general symptom which may be present in the headache, ovarian affections and in many other diseases, is this, a feeling as if the body or some part of the body were expanding. In the case of headache, the patient has a sensation as if the head were enormously large. Sometimes, with the ovarian pains, the patient says that she feels as if there were an immense swelling in the side affected ; and yet an examination shows no enlargement of the painful organ. We find this symptom under several other drugs, very prominently under Argentum ni'ricum, however. Again, vertigo is almost always present when it is the remedy. This vertigo is asso- ciated with general debility and trembling from nervous weakness. The patient staggers and reels as if he were intoxicated. The vertigo is so severe at times that he becomes momentarily blind in association with mental confusion, buzzing in the ears, nausea and trembling. The patient suffers from mental anxiety. He is very impulsive. He must be always busy and yet he accomplishes nothing. He makes frequent errors of perception. He hurries restlessly about to fulfill an engagement, thinking that he will be too late, when, in reality, he has an hour or so more than is necessary. In some cases, there is pro- found melancholy. He imagines if left alone he will die; full of appre- hension that he has some incurable disease of the brain. He constantly makes mistakes as to his estimation of distances. For instance, when walking the street, he dreads to pass a street corner, because the corner argentum nitricum. 575 of the house seems to project and he is afraid that he will run against it. All these errors are traceable to imperfect coordination of muscle. This last is no imaginary symptom ; it has been met with a number of times and it has been cured by the Argentum nitricum. This defective coordination of muscles is a prominent symptom in the disease known as locomotor ataxia, for the treatment of which allo- paths have long employed Argentum nitricum as a most valuable remedy. We also may use it when the following symptoms are present: The patient staggers in the dark or when his eyes are closed. The legs are weak and the calves feel bruised as after a long journey. There is a feeling of soreness in the lumbo-sacral region; also pain in the small of the back, very severe when rising from a sitting posture, but rather relieved by walking. Zincum is also better from walking and worse from sitting. The difference between the two remedies is that Argentum nitricum has pain when rising. Sometimes there is pain in the sacro- iliac symphyses, a feeling as if the bones were loose there. Here it i? similar to A^sculus hippocastanum. Another symptom which I would like to specialize is trembling of the hands, which causes the patient tc drop things. He is very nervous at night. When he does sleep, he has all sorts of horrible dreams. These nervous symptoms are especially worse at eleven a.m. So you see that Sulphur is not the only remedy that has this eleven a.m. aggravation. You will at once see the resemblances between Argentum nitricum and Kali bromatum and Natrummur. That trembling weakness, with palpitation, is the exact counterpart of the Natrum mur. condition. This fearful and apprehensive mood, this imagining that he cannot pass a certain point, reminds you of Kali bromatum. But there are less severe symptoms that will call for Argentum nit- ricum, and one of them is what we may call functional paralysis, such as follows exhausting diseases, post-diphtheritic paralysis, for example. Gelsemium is here a concordant remedy of Argentum nitricum. Other nervous affections, for which we may use Argentum nitricum, are the following: It is one of the best remedies we have for hemi- crania. This is not a simple neuralgia. It is a deep-seated neurotic disease, and by some is supposed to be of epileptic nature. It comes periodically; for its relief the remedy under consideration is one of the best. There is frequently boring pain in the head, which is worse in the left frontal eminence. This boring is relieved by tight bandag- ing of the head, hence the wearing of a tight-fitting silk hat relieves. It is excited by any mental emotion of an unpleasant kind, or by any- 576 A CLINICAL MATERIA MEDICA. thing that depreciates the nervous system, as loss of fluids, loss of sleep or mental strain. Sometimes the pains become so severe that the patient loses his senses. The paroxysms frequently culminate in vomiting of bile or sour fluid. There is another form of headache which is mostly neuralgic, and for which Argentum nitricum is the remedy. The bones of the head feel as if they were separating, or the head feels as if it were enormously large. The pains about the head increase to such a degree that the patient almost loses her senses. These attacks end in vomiting, prob- ably to recur once more within a few minutes or an hour. We also find Argentum nitricum indicated in prosopalgia, particu- larly when the infraorbital branches of the fifth pair and the nerves going to the teeth are affected. The pain is very intense, and at its height is accompanied by unphasant sour taste in the mouth. The pains are of the same character as those already described for the hemi- crania. I do not believe that this sour taste in the mouth is of gastric origin, but I think that it is due to some abnormality or disturbance in the gustatory nerves. The face, in almost all these cases, is pale and sunken, rather sallow than pure pale, and in extreme cases, when the blood is very much affected, the surface of the body is of a dark, muddy, leaden hue. We also find Argentum nitricum indicated in that troublesome dis- ease, gastralgia, a neurosis of the stomach. It is especially indicated in delicate nervous women. The gastralgia is excited by any emotion, by loss of sleep, and frequently at the catamenial period. There is a feel- ing in the stomach as though there was a lump there. This is some- times accompanied by gnawing ulcerative pain referred to the pit of the stomach. From this spot, pains radiate in every direction. These pains seem to increase and decrease gradually, just as under Stannum. With this there is apt to be intense spasm of the muscles of the chest. The patient cannot bear to have a handkerchief approach the mouth, as it would cause dyspnoea. The patient cannot bear the least food because it makes this pain worse. Sometimes the pain is relieved by bending double and pressing the hand firmly into the stomach. The paroxysms end with vomiting of glairy mucus which can be drawn into strings, or what is more common, the? are accompanied with enor- mous accumulation of wind. The patient for a long time cannot belch, but when he does succeed in so doing, the flatus comes in an enormous volume. Tnis is often accompanied with general tremor, and a ner- vous feeling, or by a sensation as if he was being squeezed in a vice. ARGENTUM nitricum. 577 The nearest ally to Argentum nitricum here, is Bismuth, which is indicated in pure nervous gastralgia. The main distinction between it and Argentum nitricum is in the vomiting. Just as soon as food touches the stomach it is ejected. Another nervous disease in which Argentum nitricum is indicated is epilepsy. The strong indicating syniptom for Silver nitrate is this : For days or hours before an attack the pupils are dilated. After the attack, the patient is very restless and has trembling of the hands. It is especially indicated in epilepsy caused by fright or in that which comes on during menstruation. It may also be used for puerperal convulsions, when between the attacks, the patient is very restless, and tossing about, now on one side and now on the other. Nitrate of Silver is also indicated in angina pectoris. The patient complains of intense pain in the chest and about the heart. He can hardly breathe. We also find it indicated in pure nervous asthma. There are present spasms of the respiratory muscles. The dyspnoea is great. A crowded room produces or aggravates this dyspnoea. Leaving now the action of Argentum nitricum on the nervous sys- tem, we come to its use in inflammations and ulcerations. First of all, under this head, we will consider it in diseases of the eye. Nitrate of Silver cures purulent ophthalmia, and by this term I mean any inflam- mation of the lids or eyes which develops ulceration or pus. This pus is thick, yellowish and bland. It is .useful in ophthalmia neonatorum when the pulse is of the character just mentioned and is profuse. Es- pecially is it called for after the failure of Pulsatilla or one of the mer- curies. You may also use it for the purulent ophthalmia of adults with pus of this character. Like Pulsatilla, the symptoms are relieved in the open air and become intolerable in the warm room. In purulent ophthalmia, Pulsatilla stands very closely allied to Ar- gentum nitricum. You will notice that both have profuse, thick, bland purulent discharge, and both have relief from the cool open air. It has been determined clinically that when Argentum nitricum ceases to act, a dose of Pulsatilla interpolated, helps. You may also use Argentum nitricum in blepharitis when there are thick crusts on the lids, suppuration and induration of tissue. Even the cornea has become affected by the continued inflammation. The 578 A CLINICAL MATERIA MEDICA. heat of the fire makes the patient a great deal worse. This symptom you also find under Mercurius. Granular conjunctivitis also calls for Argentum nitricum. The conjunctiva is almost scarlet, so red is it, and there is profuse muco- purulent discharge. Rhus tox. is very similar to Argentum nitricum, but it has more spasmodic symptoms. There is spasmodic closure of the eyelids, and when you force them open, hot, scalding tears gush forth, and these cause pimples around the inflamed eyes. Euphrasia is similar in granular lids; it differs from Argentum nitricum in this: The purulent discharge is excoriating, and there is, in addition, excoriating lachrymation. Kreosote may be used in inflammation of the eyelids, whether in the infant or the adult. There is a discharge of hot, scalding tears from the eyes, occurring early in the morning. Argentum nitricum may be useful in asthenopia from want of ac- commodation. Even the coarsest kind of work strains the eyes. Coming now to the mucous membrane of the mouth and throat, we find Argentum nitricum producing a dark red appearance of the fauces. Thick mucus collects in the throat and the patient complains of a sen- sation as of a splinter there. With all this, there may be ulceration. The cause may be mercury, syphilis or scrofula. The papillae of the tongue are elevated. The gums are tender and bleed readily, but are very seldom swollen, thus giving you a distinction between it and Mercurius. The larynx suffers from the action of Argentum nitricum. There is muco-purulent sputum, seeming to come from the posterior wall of the larynx. There is also marked hoarseness and sometimes even loss of voice. Singers frequently complain of a feeling as if there were some- thing clogging the vocal organs. * Manganum is similar to Nitrate of Silver, causing laryngeal symp- toms, particularly in pneumonic or tubercular patients. The hoarse- ness is usually worse in the morning and grows better as they succeed in hawking up lumps of mucus. The Manganum patient has cough from loud reading, with painful dryness and roughness of the larynx. The cough is usually relieved by lying down. Selenium is also similar to Argentum nitricum. Paris quadrifolia is a neglected drug in laryngeal affections. We find it indicated when expectoration is mostly noticed in the morning and when it is green and tenacious. ARGENTUM METALLICUM. 579 Nitrate of Silver may be used in ulceration of the cervix of the uterus when it is enlarged and indurated, with copious yellow, corroding leu- corrhcea and frequent bleeding from the points of ulceration. Next, I would refer you to the action of Argentum nitricum on the kidneys, because attention is not paid to this action of the drug. I think that it was Dr. Preston, of Norristown, who used the drug mostly in such cases. He gave it very frequently in nephralgia from congestion of the kidneys or from passage of calculi. The face is of a rather dark hue and has a dried-up look; there is dull aching across the small of the back and also over the region of the bladder. The urine burns while passing and the urethra feels as if swollen. There is sudden urging to urinate. The urine is dark and contains blood, or else renal epithelium and uric acid deposit. It is especially useful when Can- tharis, which it resembles, fails. Nitric acid is to be thought of for urinary calculi when the urine contains oxalic acid and when that substance is the principal ingredient of the stone. Lastly, I have to speak of the action of Argentum nitricum on the bowels. Here it is very similar to Arsenic. The stools are green and shreddy and consist of blood, slime and epithelium. This is often associated with the discharge of a great deal of flatus and is often provoked by the use of sugar. Especially is it indicated when diar- rhoea follows any excitement or when the imagination has been played upon. The bowels are apt to move as soon as the least food or drink is taken. In cholera infantum it is indicated in children who are thin, dried-up looking, almost like mummies. The legs are apparently nothing but skin and bones. The stools are green and slimy, with noisy flatus, and are worse at night. Natrum mur. is the proper remedy to antidote the abuse of Argen- tum nitricum. Argentum Metallicum. Argentum metallicum produces spasms which simulate those of epilepsy. The attack3 are followed by delirious rage. The patient jumps about and tries to strike those near him. It produces spasmodic pain in various parts of the body; thus it gives rise to pain in the head, which gradually increases and, after reaching its acme, suddenly ceases. This pain is usually on the left side and is often associated with vertigo. The patient is extremely 580 A clinical materia medica. forgetful. • The heart muscle sympathizes in these neuralgic pains. Thus, there will be spasmodic twitching of the heart muscle, particu- larly when the patient is lying on his back. Now, the debility which naturally follows is very easily understood if you remember one quality of the Argentum metallicum, and that is its action upon joints. It has a particular affinity for the cartilages of joints. Thus, we find general debility, with bruised feeling in the small of the back from the weakness of the spine, general weariness forcing the patient to lie down to obtain rest. The knees are particu- larly weak. There will be, not a true articular rheumatism, but an arthralgia, with pains of the same character as those of the head. All these symptoms are common enough. We find them in nervous, hysterical women and in men after loss of fluids, particularly semen. Argentum metallicum acts upon the mucous membrane of the throat and larynx. It produces a copious exudation of mucus in the larynx. This exudation is of pure mucus, not purulent or not serous, but look- ing just like boiled starch. It is associated with burning and rawness in the larynx, which rawness and burning Cham. >Bry. Alumina is a form of pure clay and is known as argilla. Accord- ing to Hering, the symptoms which Hartlaub obtained are not pure, because he simply washed his preparation of clay, while Hahnemann subjected his to a red heat. You notice by the table on the board that I have placed Bryonia as the complement of Alumina. This is particularly true of the gas- tric symptoms. These drugs follow each other well in gastro-enteric affections. Bryonia, also, acts as an antidote to Alumina, as does also Chamomilla. I have placed several of the concordant remedies with a few words in parentheses to indicate the points of resemblance. Thus Pulsatilla is marked with chlorosis and ozaena, showing that in these 586 A CLINICAL materia medica. two affections particularly, Pulsatilla is concordant with Alumina. Then you notice that Plumbum is similar to it in colic, and Nux and Sulphur in spinal affections, etc. Alumina acts best in aged persons of spare habits, who are rather wrinkled and dried-up looking, or in girls at puberty, especially if they are chlorotic, and also in delicate or scrofulous children, particu- larly children who have been artificially fed, that is, nourished by the many varieties of baby foods with which the market is glutted. Such children are weak and wrinkled; nutrition is decidedly defective. The bowels are inactive. This constipation is characteristic. There is a great deal of urging to stool even though the faeces be soft, show- ing you at once that the inactivity of the bowels is the main influence at work in its causation. Here, we have it exactly like Bryonia. The child suffers from ozaena or chronic nasal catarrh, with a great deal of dryness of the nose. This you know by the dry sniffling sound which the child makes in breathing through its nose. The child, too, when teething, may suffer from strabismus. This comes from weakness of the internal rectus muscle of the affected eye. This symptom is sometimes curable by medicine, and when it is so, this method is preferable to any surgical procedure. Sometimes, it follows worms. Then Cina is the remedy; when it comes from brain irrita- tion, Belladonna; and Cyclamen when from menstrual or gastric irregularities. The Alumina patient is very low-spirited and inclined to weep, like Pulsatilla, and this low-spiritedness is worse on awaking, here resem- bling Lachesis, Pulsatilla, Sepia, etc. At other times, you find the patient troubled with an apprehensive Ptate of mind, a fear that he will go crazy, and this is ant exact counterpart of Calcarea ostrearum, Iodine, etc. This shows you the irritable state of brain fibre. Another peculiarity that may be present, particularly in hysteria, is suicidal tendency when the patient sees blood, or a knife, or something of that kind. ■Men in whom Alumina is useful are hypochondriacal. There is a great deal of lassitude and indifference to labor or work. An hour seems to them half a day. They are exceedingly peevish aud fretful; and here you find Alumina rivalling Nux vomica and also Bryonia. Now, on the right of the board, you will notice several headings under which I propose to consider Alumina. First, what changes are made in the blood by Alumina? I cannot tell you how it alters the blood, but there are diseases of the blood to which it is applicable, and it is ALUMINA. 587 convenient here to bring these to your notice. We find it indicated in anaemia, and also in chlorosis, especially in young girls at puberty, when the menses are pale and scanty, and there is an abnormal craving for certain indigestible articles, such as slate pencils, chalk, whitewash, etc. The leucorrhcea to which they are subject is usually transparent, or else is composed of yellowish mucus, which is profuse, sometimes running down the limbs to the feet, and quite ropy and tenacious. This exhausts them very much, because it is rich in albumen. With these symptoms, you will almost always find the mental states that I have given you. Now in nervous affections. Alumina has been ueed in nervous affec- tions of a very grave character. Bcenninghausen used the metal Alu- minium for the following symptoms in that dreaded disease, locomotor ataxia: Frequent dizziness; objects turn in a circle. There maybe ptosis, diplopia or strabismus present. The patient cannot walk in the dark or with his eyes closed without staggering. He feels as if he were walking on cushions. There is formication, or sensation as from creeping of ants in the back and legs. The nates go to sleep when sitting. The heels become numb when walking. He has a feeling in the face as though it was covered with cobwebs, or as though the white of an egg had dried on it. He may also complain of pain in the back, lis though a hot iron were thruit into the spine. These are the symptoms indicating Alumina, and these are the symptoms which led Bcenninghausen to Aluminium, and enabled him to cure four cases of the disease. Next, the mucous membranes. Alumina is a unique drug here. It acts in a limited but very well described class of cases. It causes un- mistakable dryness of the mucous surfaces. If you ke^p that fact in mind you can explain all the symptoms which it causes. You have at once the key to its dyspepsia, nasal catarrh, sore throat and constipation. There is dryness of the mucous membranes. After a while, there is formation of mucus, which is thick, yellow, and very difficult of de- tachment. Let me show you a few illustrations of this. In the eyes, for instance, we will have it indicated in blepharitis particularly, with great dryness of the conjunctiva. The lids feel stiff; the lids crack, so dry are they. The nearest analogue here is Graphites, which has the same symptoms, only it has more bleeding than has Alumina. Alumina is useful in asthenopia from irritated conjunctiva; also in granular lids and chronic blepharitis. 588 A CLINICAL MATERIA MEDICA. For dry eyes, Allen recommends, also, Berberis, Natrum carb., and Natrum sulph. Eyes dry on reading, Crocus, Argentum nitricum. Drooping eyelids, Nux moschata, Sepia, Rhus. Alumina also has loss of power over the internal rectus. Here it is like Conium, Ruta, and Natrum mur. The latter, according to Wood- yatt, is the best. In nasal catarrh you will find Alumina indicated in children with great dryness of the nose, formation of scabs and remotely, thick, tena- cious yellow phlegm or mucus, which is difficult of removal. The cough indicating Alumina is dry and spasmodic. It is worse in the morning when the patient coughs until he detaches a small amount of tightly adherent mucus, when it is better for a while. You find it indicated in disease of the throat, in a relaxed condition of the mucous membrane, just that condition you meet with in cler- gymen's sore-throat. The throat is dark red, the uvula elongated. Hoarseness appears worse in the morning, with a feeling as of a splin- ter in the throat when swallowing. This last symptom you find also under Hepar, Argentum nitricum and Nitric acid. The mucous membrane of the stomach is dry, and therefore, there is defective secretion of gastric juice. Here you have the same dyspepsia as is curable with Bryonia. The distinctive symptoms for Alumina are these: There is a feeling of constriction along the oesophagus when swallowing food. The patient is always worse from eating potatoes; that is a good symptom for Alumina. There is aversion to meat and a craving for indigestible substances. The liver is sensitive to touch, and there are stitching pains in that organ, as under Bryonia. You find the already described constipation with urging to stool, even though the stool be not dry and hard. Piles itch and burn, and are moist. Next, we consider the action of Alumina on glands. Here I have only one symptom for you, and that is the use of the drug in treating buboes. You may give it in gonorrhceal bubo when there exists with it a yellowish gonorrhceal discharge, with burning and itching along the urethra, particularly at the meatus. Lastly, the skin. Alumina acts on the skin just as it does on the mucous membranes, producing dryness and harshness of the skin; as a consequence, we find it indicated in rough, dry eruptions, which crack and may bleed, although not often, and which itch and burn intolerably, and are worse in the warmth of the bed. ALUMINA. 589 You will recall here that Argentum nitricum, Nux vomica, and Sul- phur, are similar to Alumina in spinal affections. You will find Mercurius the most similar remedy to Alumina in the treatment of bubo. Alumina has been used as an antidote to the colic caused by Plum- bum. LECTURE LIX. PLUMBUM AND STANNUM. Plumbum Metallicum. |" Belladonna, Platina, Nux vomica, Cuprum, Opium. Plumbum. J j China. J Opium. I Alumina. The symptoms of Plumbum, or lead, maybe studied from its main property, that is, its tendency to cause contraction of muscular fibre, both voluntary and involuntary. It will cause this Contraction of muscles, and it will also cause contraction of the bloodvessels, because it affects the involuntary or non-striated muscular fibres. The first symptom thafusually follows poisoning by lead, whether taken by the stomach in slow doses, as in case of drinking water impregnated with it, or whether by inhalation, as in the case of painters, is lead colic, and this consists of horrible griping cramp-pains, with retraction of the abdominal walls, making the abdomen concave rather than convex. There is understood to be spasm of the recti muscles ; as these are con- tracted, of course they draw the abdominal walls in. Pain radiates in all directions, generally following the course of the nerves, sometimes causing delirium when extending to the brain, dyspnoea when involv- ing the chest, retraction of the testicles when extending in that direc- tion, and violent cramps in the legs when reaching the nerves there. With this colic there is obstinate constipation, and in some cases, even stercoraceous vomiting. The colic is antidoted by Alumina, Alum, Platina, Opium, Nux vomica, or Belladonna, and is prevented by alcohol. Next the symptoms of Plumbum that are of a paralytic character. The first characteristic symptom here is wrist-drop from paralysis of the extensor muscles of the wrist. This Plumbum has cured when it has arisen from other causes than lead-poisoning. This paralysis ex- tends to other parts of the body, always involving extensor muscles in preference to flexors. There appears on the border of the gums a blue line, known as the gingival line. It is caused by the sulphur that PLUMBUM. 591 exists in the tartar on the teeth combining with the lead in the blood- vessels, and forming a deposit of insoluble sulphide of lead. As I have said, the paralysis extends and involves other parts of the body, and then you have this to characterize it: Paralysis, with atrophy of the affected parts, hence due to true organic changes. Thus you find Plumbum indicated in paralysis of organic origin; in paralysis from disease of the spinal cord when that nervous structure has undergone fatty degeneration or sclerosis. Plumbum suits very nicely that disease known as multiple cerebro- spinal sclerosis. It is indicated by this symptom: Tremor, followed by paralysis. We often find Plumbum indicated in paralysis with contracture. Progressive muscular atrophy may also call for Plumbum. Lead tends to produce non-development of the uterus. We may, therefore, find it indicated in cases of tendency to abortion. The foetus in utero grows, but the muscular fibres of the uterus do not develop in proportion, hence the uterus is no longer able to accommodate the growing foetus and abortion ensues. Sometimes we find Plumbum indicated in delirium, this delirium alternating with the colic. It is very much like that of Belladonna ; the patient bites and strikes at those near him, but it differs from that of Belladonna in this: There is tremor of the head and hands, and yellow mucus collects about the mouth and teeth. The delirium, moreover, alternates with colic, which is not the case in Belladonna. Other cerebral disturbances from lead-poisoning are not common, but still the following may be met with : Insomnia, severe headache, either occipital or frontal, with or without vertigo; noises in ears; dis- ordered vision ; diplopia; amaurosis; contraction of pharynx, though liquids are swallowed in gulps and greedily; mind weak, morose,and sad; preceded by albuminous urine. Plumbum has frequently caused epilepsy. The characteristic symp- toms which indicate it are these: Almost paralytic heaviness of the legs before the attack, and paralysis and prolonged snoring sleep after- wards. It is especially indicated in convulsions from cerebral sclerosis or tumor. In constipation you may use Plumbum when there ie present the retraction *of the abdomen already mentioned, and when there is marked spasm or contraction of the sphincter ani. There is urging to stool, and the patient complains of a sensation as though a string were drawing the anus up into the rectum. 592 A CLINICAL MATERIA MEDICA. In its action on the kidneys Plumbum produces granular degenera- tion or cirrhosis of those organs. There is very little dropsy or albu- minuria, but a marked tendency to uraemic convulsions. Stannum. [ Causticum. Stannum. < Phosphorus, Sulphur. Sepia, Pulsatilla, etc. Pulsatilla. [ Exhaustion. XT Paralysis. ^Nerves. < 0 J opasms. Neuralgia. Mucous membranes. Fevers. Organs. Stannum is a drug that has not many symptoms, hence it can be disposed of very quickly. Its complement is Pulsatilla. The Stannum patient is usually sad and lachrymose, just like Pul- satilla. Crying usually makes the patient worse. This low-spirited- ness is found in the lung troubles for which Stannum is your remedy. This is rather different from the usual mental state of consumptives, who, you all know, are generally hopeful, almost to the last hour of life. Stannum is particularly indicated when they are low-spirited, hence it is rarely indicated in true tuberculosis. The woman for whom Stannum is indicated is also nervous and weak; so nervous, irritable, and weak is she, that she becomes anxious and has palpita- tion of the heart, even from so little exertion as giving directions con- cerning her household affairs. This nervous exhaustion is exhibited in various ways; it is particularly induced when the patient goes down stairs, more than when ascending. She feels as if she could not walk down stairs, or as if she had not sufficient strength in her limbs. You may see this exhaustion in another way: The patient does not com- plain much about walking, but on trying to sit down she fairly drops into the chair. This is not an imaginary symptom. You will meet it in uterine affections. In the mental symptoms you may compare Stannum with Natrum mur., Pulsatilla, and Sepia. Natrum mur. has a melanoholy, sad, weeping mood. Consolation seems to aggravate. On trying to com- fort him, he becomes enraged. The Pulsatilla patient is of a mild, tearful, yielding disposition. STANNUM. 593 She rather likes consolation. She has'scanty, delayed menses, while Stannum has the opposite. The Sepia patient has sadness concerning her own health, while she exhibits great indifference to her family. She is easily offended and is inclined to be vehement. In this relaxation of tissue, producing goneness or weakness, we have several remedies. First of all, when you find patients are weak from talking, compare the following remedies: Cocculus, Veratrum alb., Sulphur and Calcarea ostrearum. For the functional paralysis that may come from fatigue or from mental emotions, compare with Stannum, Cocculus, Ignatia, Phospho- rus, Natrum mur. and Collinsonia. The Stannum patient is troubled with disordered digestion, other- wise called dyspepsia. There are nausea and vomiting in the morning, or the odor of cooking causes vomiting. This last symptom is a par- ticularly strong indication for Stannum, especially in women. There is weak, gone feeling in the stomach, as in Sepia; also bitter taste in the mouth. The rectum is inactive. Much urging is required to evacuate even a soft stool. The face is apt to be pale and sunken, with dark rings around the eyes. These symptoms indicate debility, with which women suffer, and they are the symptoms of worms. They may call for the exhibition of Stannum when worms are present. It may be indicated even when convulsions result from the irritation of these parasites, thus placing it alongside of Cina, Artemisia, etc. Men may require Stannum when they are hypochondriacal. They have gastralgic pains, which compel them to walk about for relief, and they are so weak that this exercise is very fatiguing to them. The tongue is coated yellowish. The Stannum patient suffers from prolapsus uteri. This prolapsus so often calls for Stannum, that Dr. Richard Hughes generally finds it useful for simple prolapsus uteri. You will find, too, that under Stannum the vagina is prolapsed. These prolapsus symptoms are worse during stool. The menses are always profuse. The leucorrhcea corresponds with the prevailing character of the drug. It is yellow- ish or else it is clear mucus, and is always associated with unbearable weakness. The patient is so weak that she can scarcely move about. The prostration is so great that, on dressing in the morning, she has to sit down several times to rest. There is trembling of the arms and legs. The limbs feel as heavy as lead. This weakness is always worse when descending, as when going down stairs or assuming a sitting 594 A CLINICAL MATERIA MEDICA. posture. These uterine symptoms may be associated with weak or gone feeling in the chest. The patient feels so weak she can scarcely talk. As somewhat similar to Stannum in prolapsus uteri, with aggrava- tion of symptoms during stool, you may remember Podophyllum, which has prolapsus uteri with diarrhoea. The stool is usually green, and comes with a rush. As you might expect, a patient, so thoroughly weakened as to the ner- vous system as is the Stannum patient, must suffer from neuralgia. The general characteristic guiding you to its use is, the pains increase and decrease slowly. They are especially liable to occur in the course of the supra-orbital nerve. With this character to the pain, we find Stannum useful in prosopalgia following intermittent fever and abuse of quinine. In these pains that increase and decrease slowly, the nearest remedies are Platina and Strontiana carb. Epilepsy has been treated with Stannum, particularly when reflex from abdominal irritation, as from the presence of worms in the intes- tinal canal. The patient has a pale face and dark rings around the eyes, and colic, which is relieved by pressing firmly on the abdomen. If the child is old enough to describe his sensations, he will complain of a sweetish taste in the mouth. It is also useful in epilepsy with sexual complications; opisthotonos; clenching of the thumbs. Hysterical spasms may also call for Stannum, especially when asso- ciated with pain in the abdomen and diaphragm. Next, the action of Stannum on mucous membranes. When it is the remedy, you find that there is copious secretion from the mucous membranes. This is bland and unirritating, and is yellowish or yellowish-green; hence it is a muco-purulent secretion. Sometimes, although not so often, this mucus is tenacious, viscid and intermixed with blood. The mucus collects very rapidly in the chest and is quite easily expectorated, with great relief to the patient. The oppression, the weakness, and the tightness of the chest are all relieved when this sputum is raised. The voice, which is husky and hoarse, seems to be raised in pitch by this expectoration. Dyspnoea, too, is decidedly better after expectoration. The cough is very annoying and teasing. It is worse at night, and is excited by talking and walking rapidly. The patient, in addition, complains of that weakness of the chest. It seems as if he had no strength there whatever. Dyspnoea comes on, worse towards evening. STANNUM. 595 Now these are the symptoms which indicate Stannum in cases of neglected cold. They also suggest the drug in what has been very properly termed catarrhal phthisis. There is marked hectic fever. The chills come characteristically at ten o'clock in the morning. Towards evening the patient becomes flushed and hot, with aggrava- tion of his symptoms on any exertion. At night he has profuse sweat, which is particularly worse towards four or five o'clock in the morning. Let me say here that in this hectic fever, with chill at ten o'clock in the morning, I have several times tried Natrum mur., but without obtaining any benefit from it. Stannum is a remedy which you must select with great care, or it will surely disappoint you. You must have the weakness present. When you find Stannum insufficient in catarrhal phthisis, you may think of the following remedies : Silicea is indicated in catarrhal as well as in true tubercular phthisis when there is cough, which is increased by rapid motion. There is copious rattling of phlegm in the chest. The expectoration is more purulent than that of Stannum. There are usually vomicae in the lungs. You will find Silicea frequently indicated in the catarrhal phthisis of old people. Phosphorus must often be carefully compared with Stannum, as the two remedies are frequently misused for each other. Both have hoarse- ness, evening aggravation, weak chest, cough, copious sputum, hectic, etc. Phosphorus has more blood or blood-streaks, tightness across the chest, etc. Senega is a drug which produces great soreness in the walls of the chest and great accumulation of clear albuminous mucus, which is difficult of expectoration. These symptoms are often accompanied by pressure on the chest as though the lungs were pushed back to the spine. It is especially indicated in fat persons of lax fibre. This Senega contains Senegin or Polygalic acid, which is identical in com- position with Saponin, the active principle of the Quillaya saponaria. This also produces the same kind of relaxed cold as the Senega does. Coccus cacti is useful in whooping cough, with vomiting of great ropes of clear albuminous mucus. It may be useful in catarrhal phthisis when, with this ropy phlegm, there are sharp stitching pains under the clavicles. Balsam of Peru is indicated in catarrhal phthisis by copious puru- lent expectoration. We know but little concerning this drug. We 596 A CLINICAL MATERIA MEDICA. must, therefore, adopt the expedient of selecting it by a process of ex- clusion. Yerba santa or the Eryodiction Californicum is indicated when there is asthmatic breathing from accumulation of mucus. There are con- siderable emaciation and fever. Among other remedies with much phlegm on the chest are, Anti- monium crudum and tartaricum, Chamomilla, Belladonna, Calcarea ostrearum, Calcarea Phosphorica and Ipecacuanha (in children), Lyco- podium Sulphur, Phosphorus, Balsam of Peru (purulent sputum) He- par, Scilla, Yerba, santa (fever, emaciation, asthma from mucus, Co- paiva (profuse greenish-gray, disgusting-smelling sputa); Illicium anisatum (pus, with pain at third cartilage, right or left); Pix liq. (purulent sputum ; pain at left third costal cartilage); Myosotis (copi- ous sputa, emaciation, night sweat). In pleurisy you find Stannum indicated by sharp, knife-like stitches, beginning in the left axilla, and extending up into the left clavicle. Sometimes they extend from the left side down into the abdomen. They are worse from bending forward, from pressure and on inspira- tion. Stannum is sometimes used in functional paralysis arising from onanism or from emotions. Sometimes persons of the weak, nervous temperament I have described are so affected by emotions as to lose the power of motion. Here Stannum compares with Staphisagria and Natrum mur. LECTUEE LX. CUPRUM AND ZINCUM. Cuprum Metallicum. 1. Blood.— " Sulphur. a. Chlorosis. Argentum nitricum, Arseni- b. Fever. cum, Veratr. alb. c. Heart. Cuprum. < Colocynth, Plumbum, Cho- 2. Nerves.— los terrapinae. a. Spasms. Stramonium, Belladonna, 6. Cramps. V „ Hyos. c. Neuralgia. Calc. ostr. j Sugar. d. Lack of reaction \ Albumen. e. Paralysis. 3. Collapse.— Cuprum metallicum and Cuprum aceticum are used interchange- ably by many physicians as having the same symptomatology. The original idea of those who proposed the substitution of the latter for the former was based on the supposition that the acetate of copper is soluble, while the metallic copper is not. This applies, of course, to the crude drug, but not to the potentized preparations. Copper has for its complement Calcarea ostrearum. It is antidoted by sugar and albumen. Hepar, as a general antidote to the metals, comes into play as a dynamic antidote, as do also Belladonna and Stramonium. Copper possesses considerable interest as a prophylactic in disease. Workers in copper seldom contract Asiatic cholera. Here it resembles Sulphur. Unlike Sulphur, however, it is a remedy for the symptoms of cholera. It is indicated for the following symptoms: Intense coldness of the surface of the body, blueness of the skin, cramps of the muscles, the muscles of the calves and thighs are drawn up into knots. There is considerable distress, referred by the patient to the epigastrium, and this is associated with most intense dyspnoea. So intense is the dyspnoea.that the patient cannot bear his handkerchief approached to his face; it takes away his breath. Now, this picture of Cuprum seems to place it between Camphor and Argentum nitricum. Camphor has symptoms of collapse, like Cuprum; and Argentum nitri- cum has terrible distress in the epigastrium with dyspnoea. It differs 598 A CLINICAL MATERIA MEDICA. from Camphor in this: Camphor lacks the prominence of the cramps which are ever present in the collapse of Cuprum. There is another condition in which Cuprum maybe used, and that is in the uraemia or uraemic convulsions following cholera. The char- acter of these convulsions will appear in a few minutes when I speak of the nervous symptoms of the remedy. We find Cuprum indicated in chlorosis, after the abuse of iron. The symptoms are worse in hot weather. We also find it indicated in fever with marked tendency to frequent relapses ; hence, in a sort of relapsing fever. It is not the specific re- lapsing fever, but rather a fever in which the relapses are the result of defective reaction. Cuprum, when taken in large doses, produces an inflammatory colic, presenting a combination of neurotic with inflammatory symptoms; these are gastro-enteric. We find the abdomen as hard as a stone; the bowels are, at first, obstinately constipated, the constipation being suc- ceeded at times by bloody, greenish, watery stools. The vomiting is terrific and is spasmodic in its character. It seems to be relieved by a drink of cold water. Here it is very different from Arsenicum, Veratrum and other remedies. Now, what takes place in this group of symptoms? In the first place, Cuprum not only acts upon the bowels, inflaming them, but it acts upon the nerves, causing constriction of fibre, particu- larly of the involuntary muscular fibres, as in the bloodvessels, and with this we have direct irritation producing inflammation. Now, to clearly understand the character of Cuprum, you must remember the other side to this picture. This condition is soon followed by collapse with great prostration, from which it is exceedingly difficult for the patient to rally. Thus, we have as a remote symptom of Cuprum, and one, too, which has been greatly neglected, lack of reaction. We have seen that quite a number of remedies are useful in this condi- tion. We all know that Sulphur may often be used; we have learned under what circumstances Carbo veg. is called for; that Lauroeerasus, Valerian and Ambra grisea are suited in some nervous temperaments; Capsicum in flabby, lazy individuals of lax fibre, and Psorinum in well-marked psoric cases. But here we have, when Cuprum is the remedy, a tendency of all the symptoms to relapse. Especially is it an indication when this lack of reaction occurs in persons who are thoroughly " run down" by overtaxing both body and mind. I know of a case in which Cuprum prevented paralysis of both legs, and this was the indication, overtaxing of both brain and body. ZINCUM. 599 So, too, in pneumonia, we may have to use Cuprum to bring about reaction before the appropriate remedy will cure. It is indicated by sudden suffocative attacks, with coldness of the surface of the body, with great prostration and dyspnoea disproportionate to the amount of solidification. The body is covered with a cold viscid sweat. The main action of Cuprum and that which will call for its most frequent use in practice, is on the nervous system. We find it indi- cated, for instance, in spasms with affections of the brain, as in menin- gitis. No remedy in the materia medica excels it, and very few equal it, in this direction. We find it indicated when there has been an eruption suppressed, whether that be scarlatina, measles or erysipelas. The symptoms which call for it are these: Delirium of a violent char- acter very much like that of Belladonna, the patient bites the offered tumbler, loquacious delirium on awaking from sleep, or on becoming conscious he appears frightened. Here it is the exact counterpart of Stramonium. But it is a far deeper acting remedy than Stramonium. The convulsions usually start from the brain with blueness of the face and lips, the eyeballs are rotated and there are frothing at the mouth and violent convulsive symptoms, especially of the flexor muscles. The convulsion is followed by deep sleep. Now this spasm, especially if epileptic, may be ushered in by a violent shriek or cry. There is grinding of the teeth. Cuprum is indicated not very frequently in neuralgia, but it may sometimes be used in sudden attacks of neuralgia with active conges- tion affecting the nervous supply of the involuntary muscles. Cuprum arsenicosum I have used in the third potency, on the recom- mendation of Dr. J. H. Marsden, for neuralgia of the abdominal viscera. I have prescribed it in cases in which no other remedy seemed to be indicated, and I believe with excellent success. Zincum. Nervous depression. Undeveloped diseases from enervation. ( Hemispheres. Brain. < Sensorium, Zinc. ■{ ( Pons, medulla. Spine. Anaemia. Organs. Skin. 600 A CLINICAL MATERIA MEDICA. Belladonna, Cuprum, Stramonium. Hyoscyamus. Zinc. -{ -Calcarea ostrearum. > Ign. Camphor. < Nux von'i. Plumbum. > Hep. Zincum metallicum is the zinc preparation we most frequently use. You will notice the very peculiar fact that two preparations containing strychnia, Nux vomica and Ignatia, hold opposite relations to Zinc. Ignatia follows Zinc well, and may even act as an antidote to its effects on the nervous system. Nux vomica tends rather to increase the effects of Zinc, in fact is inimical to it. Hepar also antidotes Zinc, as it does every other metal. It is a safe remedy to fall back on in cases of me- tallic poisoning when the symptoms point to no special antidote. Zinc often precedes Apis when there are sharp cutting pains all over, coming quickly, jerks of tendons in sleep, head hot, feet cold ; kidneys still act. I have had mapped out on the board some of the sphere of ac- tion of Zinc. I wish to impress on you all that this is not placed here as an exhaustive analysis of the remedy, nor is it intended to teach you that you are to use Zinc only in the diseases here named. This table is only for convenience sake, to give a sort of starting point around which you may group the symptoms of the remedy. In poisonous doses the salts of zinc cause formication, that is, a sen- sation as of ants creeping over the body. This creeping or tingling is relieved by rubbing or by pressure. There is even a tremulous vibra- tion all through the body. This is experienced by the patient, and is noticed, too, by the observer. Later, there appear fainting spells, with a great deal of numbness and deathly nausea. As soon as water touches the stomach, it is vomited. This is increased by acids, so, if any one should give the patient vinegar or lemon-juice, it only adds to his tor- ment by increasing the nausea. With all this, there is vertigo. The head reels, the eyes feel as if they were being drawn together, and there is hard heavy pressure at the root of the nose. These symptoms are followed by convulsions and stupor, and finally, if the poison cannot be antidoted, by death. I would warn you, too, if you meet with such a case of poisoning, do not give wine or other stimulants, for every symptom of Zinc, from head to foot, is made worse by wine. Other remedies having aggravation from drinking wine are Rhodo- ZINCUM. 601 dendron, Glonoin, Nux vomica, Selenium, Ledum, Fluoric acid, Anti- monium crudum and Pulsatilla. Glonoin has congestive headache, made worse by wine. Ledum is indicated in drawing pains in the joints, made worse by drinking wine. Fluoric acid has aggravation from red wines. Pulsatilla from sulphurated wines. Antimonium crudum is suited to the bad effects of Rhenish sour wines. Bovista, easily intoxicated. Silicea, ebullition of blood, with aggravation from wine. Workers in zinc, after ten or twelve years' exposure, suffer from the following symptoms : Pains in the back ; sensitiveness of the soles of the feet; formication, numbness and coldness of the legs; sensation as of a band around the abdomen ; cramps and twitching of the muscles. Reflex excitability is increased so that irritation in one part of the body will produce violent jerking in another. Muscular sensibility is lessened, hence the patient staggers when his eyes are closed, or when he is in the dark. There are muscular tremors which almost simulate those of shaking palsy. Still later, the gait becomes stiff, motions are spasmodic with the step on the full sole. From involvement of the sympathetic nervous system there are anaemia and progressive and general emaciation. In studying Zinc as a remedy we are to remember, then, that it is a medicine which acts prominently^ on the nervous system. This influ- ence which it has on the nervous tissue, is one rather of depression than stimulation. It weakens the cerebro-spinal nerves, and also those of the sympathetic, or ganglionic nerves more accurately called. It is, therefore, to be used in those diseases in which there is weakness of the nervous system. One very useful condition in which we may em- ploy this drug comes under the second heading, undeveloped disease from enervation. By that I mean that Zinc is an invaluable drug when the patient is nervously too weak to develop a disease, and hence he suffers all the consequences of hidden disease, or disease spending its force on the internal organs. To give you an illustration of this in exanthematous diseases, we find Zinc called for in scarlatina, or in measles when the eruption remains undeveloped. As a result of the non-development of the disease, the brain suffers, as we shall see presently. Now, as another evidence of this nervous condition of non-reaction, 39 602 A CLINICAL MATERIA MEDICA. we find pains in the ovaries which are relieved during the menstrual flow. Another illustration of this action of Zinc will be found in the catarrhal asthma in-which it is indicated. This asthma is accom- panied by great constriction of the chest (Cadmium sulph., Kali chlor. and Cactus g.), and is relieved as soon as the patient can expectorate. So, too, in the male organs there is a local irritation which may be the result of spinal irritation, or self-abuse. This irritation is relieved by a seminal discharge. Again, during dentition, from failure to develop the teeth, the child has slow pulse, seeming to come in long waves; it is drowsy, and lies with the back of the head pressed deeply into the pillow, with the eyes half-closed and squinting, the face pale and rather cool, or alter- nately red and pale. The child gives forth loud cries, not exactly the cri encephalique, but something akin to it, with trembling all over, boring the fingers into the nose (as you find under Cina, Arum tri- phyllum, Veratrum and a few other remedies), or pulling nervously at the dry, parched lips. That will remind you of Arum triphyllum, too. There will be automatic motion of different parts of the body, usually the arms and hands, and, particularly, restless, fidgety move- ments of the feet. That last is a very strong indication for Zincum. If still conscious enough to take water, he drinks it hastily. In extreme cases the abdomen is hot and sunken, and the stools and urine invol- untary. In milder brain symptoms we find the child delirious, as if frightened on awaking. It seems to know no one. It rolls the head from side to side. It may have convulsions, with anxious screams and springing up out of bed, gnashing the teeth and rolling the eyes. The child is exceedingly cross and irritable before the attack, with hot body and great restlessness, particularly at night. Zincum may be indicated in chorea or St. Vitus's dance, when caused by fright or suppressed eruptions, especially when the general health suffers very much. There are great depression of spirits, and irritability. Still another form of cerebral trouble calling for Zinc is meningitis. Here it is indicated when, in the beginning either of a case of rheu- matism, or in fact from any cause, you find these sharp, lancinating pains through the head ; they are worse from wine,* or from anything * In headache worse from wine, compare: Rhododendron, Glonoin, Nux vomica, Oxalic acid and Selenium. Both Conium and Zinc have aggravation from small sips of wine; Conium is easily intoxicated thereby. Zinc ha* nearly all symptoms by taking small quantities. ZINCUM. 603 that stimulates. There are, also, pressing, tearing pains in the occi- put, particularly about the base of the brain; and these pains seem to shoot through the eyes, and, sympathetically, into the teeth. There is a very distressing, cramplike pain at the root of the nose, just as we found in the poisoning symptoms. Now these symptoms will suggest Zinc to you in quite a variety of ailments, but especially in meningitis arising from the non-development of an eruption. So you find Zincum indicated in scarlatina with the brain symptoms that I have mentioned, and with the following additional symptoms: The eruption is imperfectly developed; the skin is rather livid; the child is restless and delirious, or else quiet and unconscious; even in the smooth or Sydenham scarlatina, Zinc may supplant Belladonna by reason of this enervation of the child. A still worse case than this may occur, and still Zincum be indicated, and that is, when the skin is bluish and cold, the body is heavy, and the pulse is almost thread- like, it is so weak and volumeless. Let us now compare Zincum with other remedies. Cuprum has cerebral symptoms, convulsions with screaming out, clenching of the thumb into the palm of the hand, boring of the head into the pillow, and predominant spasm of the flexor muscles; the face is usually red, or even purple; the teeth are clenched ; the child foams at the mouth ; it awakens from its sleep frightened, and does not know anybody about it, just as in Zincumand Stramonium. All these symp- toms in Cuprum are the result of a suppressed eruption. In the Zinc they are due to an undeveloped eruption. The symptoms are more violent under Cuprum; they are more like those of active inflamma- tion. In the Belladonna scarlatina the case is different. Belladonna is indicated in the smooth variety of scarlatina, in the early stages. The vomiting is violent, and the cerebral symptoms prominent. There are screaming out, wild look about the eyes, and redness of the face. The throat is bright red and swollen, and the tongue covered with elevated papillae; the patient springs up from sleep screaming, and clings to those about it. Suppose, however, this case goes on, and the rash does not come out; the child becomes pale and livid; it rolls its head in the pillow, grinds its teeth, and screams out whenever you move it, and the feet are restless; then Belladonna, Cuprum or Lachesis will do no good; no remedy but Zinc will. If the case goes on in spite of Zinc, and the skin becomes livid and 604 A CLINICAL MATERIA MEDICA. cold, the pulse filiform, Camphor may still bring about reaction, espe- cially if there is cold sweat. In some cases Veratrum album will come in. In still others I would have you remember Hydrocyanic acid. Calcarea ostrearum is often forgotten in scarlatina. It is to be placed alongside of Zinc, particularly in scrofulous children, when the rash is either undeveloped, or else recedes, leaving the face unnaturally pale and bloated. Zincum is indicated in several forms of headache. One of them is a stinging, tearing headache, worse in the side of the head, greatly in- creased by wine; this headache is also worse after dinner. Sometimes you will find Zinc indicated in obstinate pain in the head, obstinate in its persistence, yet intermittent in its quality, now very severe, and now fading away, but continually returning. It is also indicated for hypochondriasis and pressure on the top of the head, increased after dinner. You will also find Zincum indicated in hydrocephaloid, following cholera infantum. The child rolls its head ; it awakens from sleep as if frightened, and looks around the room terrified ; the occiput is apt to be hot and the forehead rather cool ; there is grinding of the teeth ; the eyes are sensitive to the light, and are fixed and staring; the face is sunken and pale, or alternately red and pale; the nose is dry; there is jerking of the muscles during sleep ; and last, but not least, there is constant fidgety motion of the feet. In hydrocephaloid, Zincum is closely allied to Calcarea phos. Next, I would like to speak of the action of Zincum on the spine. Zinc is a good remedy in diseases of the spine of a functional character, especially in spinal irritation. The symptoms which call for it are these : First and foremost, dull, aching pain about the last dorsal or first lumbar vertebra, and this is worse when the patient is sitting than it is when he walks. That symptom, I can assure you, isagood indi- cation for Zinc. I think that very nearly the same symptom is found under Sepia. It is not situated in the same locality, however, but has the same aggravation. It is also found characteristically under Kobalt. This backache under Zincum is associated with burning along the spine, which burning I believe to be purely subjective and not conges- tive in character. We also find under Zinc, trembling of the limbs, with a feeling as if they were about to be paralyzed; sudden spasmodic bursting sensation about the heart; the heart seems to be beating reg- ularly, when it suddenly seems as if it would burst through the chest; ZINCUM. 605 constriction of the chest causing shortness of breath ; the pulse is slow, or weak and irregular; weakness or goneness in the stomach at 11 a.m. This last symptom you will also find under Phosphorus, Natrum carb, Sulphur and Indium. Zincum is also indicated in paralysis from softening of the brain, following suppressed foot-sweat, with vertigo, trembling, numbness and formication. These symptoms are relieved by friction, and greatly aggravated by wi e. There may be marked ptosis with this paralysis. In these paralytic affections, Zincum is similar to Phosphorus and Plumbum. It is similar to Phosphorus, in that both remedies suit cases of enervation and of softening of the brain with the accompanying trembling. Phosphorus has not the aggravation from wine nor the ptosis. Plumbum has nearly the same symptoms as Zinc, but there is added to these, impaired nutrition, or atrophy of the paralyzed part. There will be pains in the atrophied limbs, alternating with colic. Now a word or two as to some local effects of Zinc, and we will have done with the remedy. First of all, we find it indicated in some affec- tions of the eyes; for instance, in amblyopia, accompanied by severe headache, which is probably dependent upon some organic change in the brain or its meninges, and with severe pain at the root of the nose. The pains are particularly worse at the inner canthus of each eye. The pupils are contracted. We may also use Zinc for opacities of the cornea following repeated and long-lasting attacks of inflammation of that membrane. The best preparation here is Zincum sulphuricum. Pterygium may be removed by Zinc, particularly if there are smart- ing and stinging pains at the inner canthus. Zincum is also useful for granular lids. Zincum sulphuricum is here preferable to the metallicum. It is also indicated in prosopalgia when the pains are severe and are accompanied by blueness of the eyelids. Zincum has marked gastric and hepatic symptoms. It produces bitter taste, which is referred by the patient to the fauces. As soon as a spoonful of water reaches the stomach it is ejected. Heartburn is present, and this is increased by wine and also during pregnancy. When occurring during pregnancy it is apt to be accompanied by vari- cose veins of the legs. Hunger is particularly manifested towards noon. Zincum also affects the liver. You will find recorded in the original provings a symptom, the exact language of which I have for- 606 A CLINICAL MATERIA MEDICA. gotten, but which is in substance this: There is a feeling as of a hard tumor in the neighborhood of the umbilicus, and this is accompanied- by griping pains. This symptom has led to the use of the drug in enlargement of the liver. Zincum affects the abdomen something like Plumbum, producing griping pains about the navel, with most obstinate constipation. This is accompanied by a great deal of pressure backwards, as though the abdomen was being drawn back toward the spine. Now, in almost all cases in which Zincum is useful you will find that the predominant pressure is on the sides of the abdomen; so it must affect principally the ascending and the descending colon. The urine often contains blood; it is sometimes turbid and loam-colored, and has a yellowish sediment. The patient cannot pass urine unless he sits cross-legged, and that, too, though the bladder be full. The cough of Zinc is spasmodic, as if it would draw the chest in pieces. The sputum maybe bloody. This is particularly noticed just before or during a menstrual period. It is also aggravated by eating sweet things. You will sometimes find Zincum helping in children, who, every-time they cough, put their hands on the genital organs. In its action on the male genital organs Zincum is similar to Conium. It is indicated in spermatorrhoea following long-lasting abuse of the genital organs, with great hypochondriasis. The face is pale and sunken, with blue rings around the eyes. There is great local irrita- tion. The testes are drawn firmly up against the external ring. It differs from .Conium in that the latter remedy lacks the excessive irritability. Zincum is also useful in diseases of the female organs, especially for irregularity in the menstrual function, particularly when it is associated with ulceration of the cervix uteri and boring pain in the left ovarian region. All the symptoms improve a*t the onset of the menstrual flow. LECTURE LXI. Ferrum. FERRUM AND THE MAGNESIA SALTS. Ferrum Metallicum. r Ipecacuanha, Arsenicum, China, Veratrum alb. Pulsatilla. Iodine. f Arsen. > I Puis. Cuprum. v v China. Alumina. Ferrum has two complements, Cinchona, or China, and Alumina. Ferrum and Alumina are complementary in chlorosis; and Ferrum and Cinchona in anaemia from loss of animal fluids. Now, the best antidote to Iron I know of is Pulsatilla. And, as good fortune will have it, Pulsatilla also antidotes Cinchona, which is so frequently given in combination with Iron by old-school physi- cians. Ferrum acts best in young persons, male or female, who are subject to irregular distributions of blood. The cheeks are flushed a bright red, giving them an appearance of blooming health ; and yet this is only a masked plethora. When they are unexcited and quiet they are apt to be pale and the face has an earthy color. Among the evidences of this irregular distribution of blood we have the following symptoms: Vio- lent hammering headache, which is usually periodical in its return and worse after twelve o'clock at night; nose-bleed, with bright red flush- ing of the cheeks ; the nose is filled with dark, clotted blood during an attack of catarrh; asthma, associated with an orgasm of blood to the chest, and which is worse after 12 p.m., at which time the patient must sit up and uncover the chest. He uncovers the chest to get cool, and sits up in order to breathe, Ferrum is also suited to haemoptysis, espe- cially in young boys or girls who are subject to consumption and who are just in the incipient stages of phthisis florida. Almost all these symptoms are excited by any emotion and are accompanied by great fatigue, despite the appearance of health. Even the neuralgia which Ferrum may cure has fulness of the bloodvessels as a concomitant con- 608 A CLINICAL MATERIA MEDICA. dition. This neuralgia is excited by washing in cold water, especially after being overheated. The pains are of a throbbing character, and' are worse at night. Almost all of these symptoms, both the congestions and the pains, are relieved by slowly walking about. Now, you may understand the action of Ferrum if you remember this one quality of the drug. It has the power of dilating the bloodvessels, probably by diminishing the action of the vaso-motor nerves; hence, you do not find a full bounding pulse, as under Aconite, but a full, yielding pulse. You will find, when Ferrum is indicated, that the walls of the abdomen are sore, as if bruised. This is iue, not to inflammation, but to dilata- tion of the bloodvessels. This places Ferrum alongside of Gelsemium and separates it from Aconite. We have next to study Ferrum as a chlorotic remedy. We do not use Ferrum or, at least, we should not, as allopathic physicians do in chlorosis, because in this disease there is a defective amount of iron in the blood. That is not the homoeopathic principle for giving the drug. The homoeopathic principle is to correct the defective supply of haema- tin which lies back of the want of iron in the blood. This deficiency is due, not to want of iron in the food taken, but to want of power on the part of the system to assimilate it. Therefore, Ferrum is not the remedy in chlorosis. It may, however, be indicated in that disease when the following symptoms are present: In the first place, in a gen- eral way, it is called for in erethistic chlorosis; that is, chlorosis with erethism of blood. It is usually aggravated during the cold weather, less so, however, than it is during warm weather. The face is ordi- narily of a pale, waxen or earthy hue, and subject, at every little emo- tion, to flush up red. The slightest emotion of pleasure or distress, the sudden entrance of any one into the room, the meeting of a stranger and, in fact, anything that is calculated to disturb the mind, causes flushing up of the face. The cheeks become bright red. Now, this is not a true plethora; it is a masked case. The face is really of an earthy hue, but flushes up on any little emotion. The stomach is always out of order, the patient being subject to gastralgia and heavy pressure in the region of the stomach. With this there is a feeling as if something rolled into the throat and closed it like a valve. There is great aver- sion to meat, and, in fact, to anything that is really nourishing. Food has little or no taste. The patient has frequent spells of nausea, which come as soon as he eats, or periodically at 12 p.m. Here it reminds one of Arsenicum. Mucous membranes are abnormally pale. For instance, the vermilion of the lips is exchanged for a simple pale pink. In the FERRUM. 609 case of a male patient the glans penis is shrivelled and white, almost as pale as the prepuce. So, too, the cavity of the mouth and the gums are almost white, showing this bloodlessness. The menses are pro- fuse and consist of watery and lumpy blood, and are attended with labor-like pains in the abdomen. The patient is very inactive; it is with great effort that she can move about. She is relieved bj exercise. She is chilly during most of the day, with bright red flushing of the cheeks in the evening. There is palpitation of the heart, with well-marked bellows murmur. The bloodvessels all over the body throb violently. Sometimes, the anaemia progresses so far that the patient becomes affected with oedema of the feet. The Ferrum patient is subject to frequent congestive headaches, with pulsating pain in the head, worse usually after midnight. The face is fiery red during the attack, and the feet arc cold. It is here very much like llclladonna, but is indicated in a very different class of cases from those calling for that remedy. Such patients always complain of ver- tigo or dizziness, which is worse when they rise suddenly from a lying to a sitting posture. Walking over a bridge or by some running water or riding in a car or carriage also causes this vertigo. These are the cases in which you will find Ferrum to succeed. An English physi- cian has advised that Ferrum be administered after a meal instead of before. He thinks it acts better then. I do not know whether this is so or not. Another use that we may make of Ferrum, arising from its tendency to produce ebullitions of blood, is in phthisis florida. It is indicated in young people who are subject to tuberculosis, here rival- ling the well-known Phosphorus. It is indicated more than Phos- phorus when there is this apparent plethora, with great oppression of the chest from any little exertion. The nostrils dilate and work hard with the efforts to breathe. There is frequent epistaxis or nose-bleed, and also haemoptysis, the blood being bright red and coagulated. The cough is of a dry, teasing character, and is made worse after drinking anything warm. It is usually associated with bruised, sore feeling in the chest, and with dull, aching pain in the occiput. In addition to this erethistic phthisis, we may have Ferrum indicated later in the case when expectoration is purulent and greenish and has a very bad odor, and is mixed with blood streaks. This reminds me of a salt of Ferrum, Ferrum phosphoricum. This is a remedy which was suggested by Schussier in all cases of inflamma- tion before exudation has taken place. He bases his prescription on the combined effects of Ferrum and Phosphorus. Ferrum phos. stands 610 A CLINICAL MATERIA MEDICA. midway between Aconite and Gelsemium. In fact it develops that stage of inflammation which the pathologists describe as indicated by enlargement of the bloodvessels, with paresis of the vaso-motor nerves. Schiissler proposed Ferrum phos. as a substitute for Aconite. It has been given so many times that I now offer it to you with these qualifications. The indications for Ferrum phos. are these: The pulse is full, round and soft; the inflammation has not yet gone on to ex- udation ; the discharge, if it is a mucous surface that is affected, is blood-streaked. In other words, the condition calling for it, is sur- charging of the bloodvessels. If a patient with phthisis should take cold, and so become greatly prostrated, and have this blood-streaked expectoration, Ferrum phos. even in the two hundredth potency will quickly quiet the pulmonary congestion. So, too, in the secondary congestion following pneumonia. The right lung, for instance, is in- flamed, when suddenly the left becomes congested. Here Ferrum phos. again acts. Or, again, on a warm summer's day, a child is ex- posed while perspiring, and the perspiration is checked. In conse- quence of this, inflammation of the bowels sets in. The stools are watery and bloody. Here, again, is a case for Ferrum phos. In the beginning of dysentery, Ferrum phos. never does any good if there is tenesmus. Then you will have to give Mercurius or some other remedy. We may use Ferrum metallicum itself in diarrhoea. The stools contain undigested food, and come as soon as the patient attempts to eat.. In summer complaint of children or cholera infantum, we find these symptoms recurring quite regularly or periodically just after midnight, when the lienteric stools may be accompanied by periodical vomiting. These symptoms of Ferrum place it with Cinchona and Arsenic in a little group of diarrhoea remedies, and rather in advance of Oleander, this last-named drug being indicated when the lienteric stools occur hours after eating. For instance, the child passes one day that which he had eaten the day before. With Cinchona and Arsenic, the stool appears more after than during eating. Argentum nitricum may also be thought of in these cases of diar- rhoea. It seems as if the child had but one bowel, and that extended from mouth to anus. In uterine haemorrhages, Ferrum is useful when there is a flow of bright red blood, often mixed with coagula, and this is associated with a great deal of flushing. The face, which is ordinarily earthy and sallow, becomes bright red and flushed, breathing becomes rapid and a MAGNESIA CARBONICA. 611 little labored, just as it is in Ipecac The pulse itself is very much increased in frequency and in strength. Ferrum in haemorrhages seems to stand between Cinchona and Ipecac. Like Cinchona, it is suited to very much prostrated cases in persons naturally anaemic. It is allied to Ipecac, in the bright red gushing flow of blood and the difficulty of breathing. Ipecac, suits haemorrhage that comes with a gush. It maybe asso- ciated with nausea and it may not, but there is very apt to be loud, hurried breathing. Lastly, Ferrum is indicated in intermitting types of fever, particu- larly after the abuse of quinine. You find during the heat distension of the bloodvessels, particularly about the temples and face, throbbing headache, enlargement of the spleen, and even dropsy. Magnesia Carbonica. f Arsenicum, Phosphorus. Magnesia carb.-/ Belladonna, Camphor, Pulsatilla, Merc, Colocynth. (^ Ratanhia, Sepia, Cocculus. > Pulsatilla. >R,heum. > Chamomilla. > Belladonna. Magnesia is much used in one form or another by allopaths as a purgative medicine. When thus abused several results may follow. It may become injurious from its tendency to accumulate in the intes- tines as an incrustation of ammonio-magnesian phosphate, and also from its remoter effects on the nervous system. Its action on the latter is not unlike that of Zinc, and it may be used for similar forms of neuralgia. The constipation for which it has been prescribed may be made worse, when Nux vomica will have to be prescribed. Rheum is also to be given for the abuse of Magnesia when diarrhoea, with sour, slimy stool and tenesmus, results. Pulsatilla may be useful in some symptoms. Colocynth is called for in case griping pains result from abuse of Magnesia. Chamomilla is indicated when Magnesia causes neuralgia. Almost all the symptoms of Magnesia carb. seem to centre around the action of the drug on the gastro-intestinal organs. All other symptoms depend upon this action more or less, or else are secondary 612 A CLINICAL MATERIA MEDICA. in importance. To describe the Magnesia carb. patient to you, I must say that the drug acts on both adult and child. If the patient is a child, you will find it puny and sickly from defective nutrition, milk is refused, or, if taken, causes pain in the stomach, or is passed undi- gested. The child is subject to frequent griping, colicky pains, which are very much like those of Colocynth. The child draws its limbs up to relieve these abdominal pains. The stools are characteristically sour, green and slimy (reminding us here of Rheum and Chamomilla), and are preceded by much griping and rumbling in the bowels, and have been very aptly compared iu appearance to the scum on a frog- pond. Sometimes, when the stool is not exactly diarrhceic, it looks as though there were lumps of jelly in it. In severe cases you will find the child poorly nourished, and its mouth full of aphthous ulcers, which are simply indications of the impoverished state of-the system from defective nutrition. With these symptoms you can see how Magnesia carb. may be used for marasmus in children. There are several drugs which are here very similar to Magnesia carb., and it will be well for us to consider them. In the first place, Magnesia carb. is similar to Colocynth, in that it has griping, colicky pains, doubling the child up, but it is distinguished from that remedy by the green, slimy stool. Still greater is the resemblance between Magnesia carb. and Rheum. Here the resemblance lies in the sour, slimy stool. The former is the deeper acting remedy of the two, and if you are in doubt as to which to give, Rheum should precede. I must say that Rheum is a rather treacherous remedy. With the sour, slimy, frothy stools it has griping colic and twitching of the muscles of the face and fingers during sleep. Chamomilla resembles Magnesia carb. in many cases, particularly in diseases of children. In both remedies anxiety and restlessness are prominent. But in Chamomilla there is a yellowish-green stool, look- ing like chopped eggs. Both remedies have relief from moving about, and both have griping pains before stool, and both have irregularity in feeding as a cause of the illness. Magnesia carb. is also similar to Calcarea ostrearum. Both have sour stool, rejection of milk, and imperfect nourishment of the body. Calcarea, however, may readily be distinguished from the other by the sweat on the head, face, and scalp, by the damp and cold feet, and by the enlargement of the abdomen. In marasmus compare Magnesia carb. also with Antimonium crudum, Sulphur, Podophyllum, Sepia and Natrum carb. MAGNESIA CARBONICA. 613 If the Magnesia carb. patient is an adult, we may have some of the following symptoms to guide us: The gastric and hepatic symptoms predominate. The patient suffers from what has been tewned acid dyspepsia. Food, such as cabbage and potatoes, and starchy food generally, are indigestible in such cases. He becomes anxious and warm while eating; so hot can't sleep; yet dreads exposure. Pregnant women may require Magnesia carb. when they suffer from toothache, and when the pains are worse at night and force the patient to get up and walk about. There is another remedy which I shall mention in this connection, one which you would hardly think of. Some years ago, it may be twenty, a physician of this city was treating a lady in the first months of pregnancy, who suffered terribly from toothache. He gave her Magnesia carb. and other remedies. Still the pain continued. Dr. Lippe was called in consultation, and he thought of Ratanhia, which has toothache at night, compelling the patient to get up and walk about. You can remember these two remedies then, and you may place them with Chamomilla, which is complementary to Magnesia carb. The menses are usually late and scanty, and they have this pecu- liarity : They flow more at night or on first rising in the morning, even ceasing in the afternoon. The flow is also more profuse between the pains. This is true, whether they be profuse or scanty. In all the Magnesia salts the menstrual flow is dark or black, almost like pitch. Magnesia carb. also has some relation to rheumatism, to affections of the muscles and joints. It is suitable for rheumatism in the right shoulder. It also has rheumatic pains in the limbs, which are worse after a long walk, better from warmth, and worse in bed. Sanguinaria is similar to Magnesia carb., in that it has rheumatism affecting the right deltoid muscle. Several years ago I used Sangui- naria quite a number of times without any effect, and I became so dis- gusted with it that I announced to the class that I did not believe in it. Within a week after that I had two cases promptly cured by it. Nux moschata is indicated in rheumatism affecting the left deltoid. There are two cases of cataract on" record as having been cured by Magnesia carb. In one of these the patient was predisposed to head- ache and boils. 614 A CLINICAL MATERIA MEDICA. Magnesia Muriatica. Caulophyllum, Actea racemosa. __ . Chamomilla, Pulsatilla, Mercurius. Magnesia mur. < 0 , , T -,. 0 . Sulphur, Lycopodium, Sepia. Phosphorus, Ignatia. > Chamomilla. The next remedy of which I shall speak is the Chloride of Magnesia or Magnesia mur. This remedy acts particularly on women and children, especially in hysterical women and in scrofulous children. It is indicated in women who suffer from hysterical paroxysms, with the following symptoms: After dinner the patient is seized with nausea, eructations, trembling and fainting spells. These occur after dinner, because that is the principal meal, and more is eaten then than at other times. The patient is anxious and restless, and is always made worse from mental exertion. The headaches are described as congestive, with sensation as of boiling water in the cranium, or as a frontal numb- ness. The pains are referred to the temples, and seem to be relieved by firm pressure with the hands. They are also better from wrapping the head up warmly. The patient also complains of a sensation as of a ball rising from the stomach into the throat. This is relieved by eructation. This shows that the accumulation of gas in the stomach is the cause of this reflex symptom. She also has bearing down in the uterine region and uterine spasms. The menses are black and pitch- like, and are accompanied by pain in the back when walking, and in the thighs when sitting. She also has leucorrhcea after every stool, or following the uterine spasms. In nearly all these cases in which Mag- nesia mur. is indicated, you will find characteristic constipation, in which the stools are passed with great difficulty, being composed of hard lumps, or they are so dry that they crumble as they pass the anus. If you find that symptom present with the uterine symptoms, you may be sure that Magnesia mur. will help the patient. .In other cases we find the liver affected. Magnesia mur. is one of our best remedies for liver disease. The liver is enlarged and the abdomen bloated. There are pains in the liver, which are worse from touch or from lying on the right side. The tongue is large, coated yellow, and takes the imprint of the teeth. You will see at once how this resembles Mercurius, but it is differentiated from that remedy by the characteristic crumbling stool. The feet are often oedematous from interference with the portal circulation, and there are palpitation of the heart and dyspnoea, both of these last-named symptoms being MAGNESIA MURIATICA. 615 reflex symptoms from the hepatic disorder. You will also find this crumbling stool. Frequently we find Magnesia mur. indicated in the enlarged liver of children who are puny in their growth and rachitic. They suffer, too, from skin affections. They have what is known as tinea ciliaris, an eruption which occurs at.the roots of the hairs, particularly of the eyelids. The hairs drop out. A scaly eruption appears around the hairs, the skin ulcerates, and the hairs drop out. With this tinea there are pimples on the face, and acrid ozaena, with redness and swelling and scali- ness of the nose. With these symptoms there is sweat of the feet. Here we are reminded of Silicea. But the sweat under Silicea is offensive. A general characteristic of Magnesia mur., belonging to either men or women, is palpitation of the heart, which is worse when the patient is quiet, and better from moving about. That symptom has been confirmed many times. Then there is another symptom which occurs frequently in women, and that is inability to pass urine without press- ing on the abdominal walls. The analogues of Magnesia mur. must be studied here, or else you will not be able to separate it from similarly acting drugs. We find that in uterine spasms, Caulophyllum and Actea racemosa act like Magnesia mur. I must say that I believe Caulophyllum leads the list. I know of no other drug which produces such continued spas- modic condition of the uterus unless it be Secale. Silicea ought to be mentioned as similar to Magnesia mur. in the treatment of scrofulous children. Both remedies have sweating of the feet, enlarged liver, rachitis, and ozaena. The difference lies in this: The Silicea patient has offensive smelling sweat, both of the feet and of the head. That is one good distinction. There are many others. There is a resemblance between the headaches of the two remedies. Silicea and Magnesia mur, both have headache, relieved by wrapping the head up warmly. ' Mercurius is similar to Magnesia mur. in liver affections. It is dis- tinguished from the latter by its diarrhoea, with tenesmus, or, more exceptionally, with gray or ashy stool. Also similar to Magnesia mur. is Ptelea, which is useful in conges- tion of the liver when there is a feeling as of weight and pressure in the right hypochondrium. The liver is found to be enlarged. The patient finds relief by lying on the right side. I may say that the Magnesia salts have been placed with Zinc as remedies acting on the nervous system. This fact led Schiissler to Magnesia phos. as a nerve tonic LECTUKE LXIL BARYTA CARB., STRONTIANA CARB., AND LITHIUM CARB. Baryta Carbonica. Barium and strontium are very closely related to each other chemi- cally. Of the elements themselves we have no provings. The carbo- nates of these have, however, been proved, as have also the Muriate and the Sulphate of Baryta. Baryta is somewhat of a poison. There are not many cases of poisoning by it on record, because it is rarely used in domestic practice. Baryta carb. has Antimonium tartaricum as its complement, particu- larly in the complaints of old people. Animals poisoned with Baryta carb. exhibit some irritation of the abdominal organs, resembling great inflammation there, with increased peristaltic action of the bowels. The heart, too, is affected by it, the animal apparently dying from paralysis of the cardiac muscle. This paralysis happens in systole. Its action is here very much like that of Digitalis. So much for the toxic action of Baryta. In all its symptomatology, we find Baryta adapted to ailments occurring at the extremes of life, age and childhood; to old age, when there are mental symptoms and bodily weakness, and to children, when there is in addition, scrofula. The child to whom we may give Baryta effectively is almost an imbecile. He, very unnaturally, shows no desire to play; he sits in a corner doing nothing. He cannot re- member well, and is slow in learning to talk, to read, and to under- stand. This slowness in learning to talk does not come from defect in the apparatus of speech, the tongue, for instance, but it is the result of mental weakness. The child is rather emaciated, with the excep- tion of the abdomen, which is large. The face, also, is bloated. He may have a voracious appetite, but food is not appropriated by the system, because of the diseased condition of the mesenteric glands. A case of chronic hydrocephalus in a child improved after the exhibition of Baryta selected by these symptoms. Adults, especially old people, have a rather peculiar aversion to strangers, and shun the approach of any unfamiliar face. They seem to have a fear of the presence of baryta carbonica. 617 others. They imagine that they are being laughed at. They are easily angered and suffer from cowardice. You all have seen similar symptoms to these in persons of a half-imbecile state of mind from disease, whether in old age or in early life. A peculiar mental symptom of Baryta which I give you on the authority of Dr. Talcott, of Middletown, N. Y., is this: The patient thinks his legs are cut off and that he is walking on his knees. You may use Baryta carb. for old people when they suffer from paralysis, particularly paralysis following apoplexy. Very frequently in old people, the brain shrinks and, as the skull does not yield, there would be a vacuum formed, were it not that an effusion of serum takes place. This is followed by a more or less severe paralysis. You will find, in such cases, that the patient is childish and has loss of memory, trembling of the limbs and well-marked paralysis of the tongue- Baryta carb. is one of the few remedies that cause positive paralysis of the tongue. (Colchicum has loss of sensibility of the tongue.) You will see these paretic symptoms also in children of this half-imbecile char- acter of which I have spoken. The mouth is kept partly open and the saliva runs out freely. The child has a silly, vacant look, showing at once that it is non compos mentis. Baryta is one of the remedies for the apoplexy of drunkards. (Vide Opium.) Baryta also seems to induce paralysis by causing degeneration of the coats of the bloodvessels, even to the production of aneurisms. Causticum acts similarly to Baryta in paralysis, but the paralysis of this remedy has more contractures or spasms. Secale acts on the bloodvessels; but its symptoms are apt to be associated with burning and numbness; gangrene. Both the Muriate • and the Carbonate of Baryta may be used in multiple sclerosis of the brain and spinal cord. This is not an un- common disease in infants and children in whom it may give rise to the idiotic symptoms mentioned above. These same symptoms indi- cate it in disseminated sclerosis occurring in old people. For the trembling associated with this disease, Hyoscyamus should be thought of. When associated with the symptoms just enumerated, you may use Baryta for non-development of the brain in early childhood. The Chloride of Baryta has been used by old-school physicians for this sclerosis, and with more or less success. The remedy which most resembles Baryta here is Causticum. 40 618 A CLINICAL MATERIA MEDICA. The use of Baryta in catarrhs demands attention. It is one of the best remedies we have for the tendency to tonsillitis, particularly in scrofulous children with dry scurf on the head. Baryta mur. and Baryta carb. cause induration of connective tissue. They control pro- liferation of connective tissue, hence their use in tonsillitis, indurated glands, etc, general symptoms agreeing. Every little exposure to damp or cold weather awakens anew the inflammation of the tonsils. This is not a simple sore throat, a swelling up of the mucous lining of the fauces with trouble in swallowing, but it is an actual inflammation of the tonsils with formation of pus. In these cases, you will find enlargement of the glands in the neck, under the jaw and behind the ear. It is one of our remedies to prevent the return of this catastrophe. It changes the constitutional tendencies of the patient. It is thus more the remedy for the effects of the trouble than for the acute symptoms. The local symptoms for the throat are principally these: The right side of the throat is worse than the left, just as you find under Bella- donna ; the throat feels worse from empty swallowing. In the treat- ment of tonsillitis, I frequently use the same prescription that I employ in diphtheria, namely, a gargle of alcohol and water. This seems to remove the accumulation of phlegm from the throat. In tonsillar affections, you may compare the following remedies with Baryta : Calcarea ostrearum, in fat, leuco-phlegraatic children. Calcarea phos., in chronic cases ; bones diseased. Ignatia, large tonsils, with small, flat ulcers on them. Hepar, large tonsils, hearing poor, sensation as of a fish-bone in throat. Lycopodium, large tonsils, studded with small indurated ulcers. Calcarea iod. is similar to Baryta in some cases with enlarged glands, particularly when there are enlarged tonsils which are filled with little crypts or pockets. Conium is suited to enlarged tonsils without any tendency to suppu- ration. Baryta may also be used in children who, in addition to this tonsil- litis, have post-nasal catarrh. Scabs form in the posterior nares and at the base of the uvula. The upper lip and nose are swollen, just as you find in Calcarea, but the mental symptoms are different. Baryta is also called for, for a chronic cough occurring in strumous or scrofulous children with swollen glands and enlarged tonsils. Every little exposure to cold or damp causes headache, backache and diar- BARYTA CARBONICA. 619 rhoea. Here Baryta is similar to Dulcamara. The ears may be in- volved in the catarrhal process; crackling in the ears on swallowing, reverberations in the ear on blowing the nose, sneezing, etc. In catarrh of the middle ear after scarlatina, the late Dr. McClatchey used Baryta. Baryta is sometimes indicated in scrofulous ophthalmia; the pains are relieved by looking downwards. The general symptoms are like those of Calcarea ostrearum. We find Baryta also indicated in old people who have what is known as suffocative catarrh, with orthopnoea. I think you can understand this when you remember the influence of Baryta on the voluntary and involuntary muscular fibres. It paralyzes them. In old people, the chest is very much weakened. They get a catarrh, which is not so severe, but appears suddenly in the night. There is difficulty of breathing and blueness of the face, etc. Baryta carb. is one of the remedies that come in after the failure of Antimonium tartaricum. The patient complains of a sensation as of smoke or pitch in the lungs. Baryta should not be given in catarrhal asthma or asthma with em- physema; but when the disease is of the purely nervous variety, in the aged, when aggravation occurs in wet, warm air. You will see that its aggravations are much like those of Aurum. Amblyopia, in the aged, sometimes calls for Baryta; the patient cannot look long at any object; sparks before the eyes when in the dark. It is also indicated in the headaches of the aged, with aggravation after waking, after meals and near a warm stove; the patient has a stupefied feeling. We also find Baryta carb. of use for the fatty tumors which occasion- ally appear here and there over the body. It is very easy to remove these with the knife. But it is much better to cure them by medicine, if you can do so. In tabes mesenterica, Baryta is indicated when there are present, in addition to the foregoing symptoms, the following: Food, when swallowed, seems to pass over sore spots in the oesophagus. There is always pain in the stomach after the child eats. The stool is sometimes undigested. AVith this, you find the abdomen hard and swollen, and an offensive sweat on the feet, just as you find in Silicea. Now, there are remedies which may be compared with Baryta in this form of disease. Iodine is similar to Baryta in that it is suitable in torpid cases. The complexions of the patient in the two remedies are 620 A CLINICAL MATERIA MEDICA. different. The Iodine patient has a dark complexion, dark hair and eyes and sallow skin. There is, too, extreme hunger. If you observe the child carefully, you will find it anxious and fretful, until he eats which relieves him for the time being; and yet he grows thin despite the quantity of food consumed. Then, there is a mental symptom which is almost always present when you find Iodine indicated in tabes mesenterica, and that is intolerable crossness, which is even worse than that belonging to Antimonium crudum. Calcarea phosphorica is indicated in children who are weak-minded, who cannot walk, although they are old enough to do so, who are anxious and restless in their manner and who suffer from defective osseous growth. The bones are thin and brittle.. Like Baryta, the Silicea patient suffers from damp changes in the weather. He also has offensive sweat and general emaciation with the exception of the abdomen. The difference between the two remedies lies principally in the mental symptoms. The Silicea child is obstinate and self-willed, and, too, his head is disproportionately large to the size of the body. Lactic acid has copious sweating of the feet, but it is not offensive. For the offensive foot sweat, compare Silicea, Thuja, Nitric acid, Kali carb., Graphites and Carbo veg. Strontiana Carbonica. Strontiana carbonica has a few symptoms that 'are of importance. It has more effect on the circulation than has its relative, Baryta. We have, as characteristic, flushes in the face and violent pulsation of the arteries. It may be useful in case of threatening apoplexy with vio- lent congestion of the head, with hot and red face every time the patient walks. Mere exertion increases the circulation upwards towards the head. Some erethism is shown in the chest in some patients. There is a smothering feeling about the heart; they cannot rest; there is a feeling as of a load on the chest. These are the congestive symptoms of the heart, lungs and head which suggest Strontiana carb. The pecu- liarity which will distinguish these symptoms from those of any other remedy is, that with these symptoms, which may occur at the climaxis when flashes of heat are so common, you will find that the head symp- toms are relieved by wrapping the head up warmly, just as you find under Silicea and under Magnesiamur. The patients cannot bear the least draught of air ; therefore, despite this congestive tendency, they wrap the head up warmly, though it may cause perspiration. It cer- LITHIUM carbonicum. 621 tainly does resemble Silicea, in that both remedies have congestion of the head relieved by wrapping the head up warmly. The Silicea con- gestion seems to come up the spine and go into the head. That is not characteristic of Strontiana carb. Another effect that we find caused by Strontiana carb., and one, too, for which it is not often used, is diarrhoea, which is worse at night, and which has this peculiar urgent character: The patient is scarcely off the vessel before he has to return. It is better towards morning at three or four o'clock. Strontiana carb. has a marked action on the bones. It has a particular affinity for the femur, causing swelling and caries of that bone; usually in scrofulous children. This trouble is often associated with the diar- rhoea just described. Strontiana carb. causes an eruption which very much resembles that of sycosis. Hence, it has been given for a sycotic eruption on the face or other parts of the body, and which is moist, and itches and burns. Another peculiarity of the drug, and the last one I care to mention, is its effects in chronic sprains, particularly of the ankle-joint, when both Arnica and Ruta have failed. The long interference with the circulation has produced some oedema about the joint. Lithium Carbonicum. Lithium carb. has not a very extensive range of action. It is par- ticularly useful in affections of the joints. It does have very much depreciating effect on the vital forces. It is efficacious in rheumatism and, above all, in some forms of gout. In its provings, debility is noticed only in connection with or as a sort of sequel of the joint affection. Of the various organs attacked by Lithium carb., the most important in the order of their importance are the heart, stomach, kidneys and bladder. The mucous membranes are also affected by the drug. At first they are unduly dry, and this dryness is followed later by thick mucous secretion. The skin does not escape. There appears an erythema, with itching of the skin, which occurs par- ticularly about the joints, and is very annoying. It is particularly noticed along with rheumatism. Further than this, Lithium carb. may produce roughness of the skin and an eruption about the face resembling barbers' itch. Studying now the symptoms of the drug with this general action before us, we find confusion of the head; headache on the vertex and 622 A CLINICAL MATERIA MEDICA. on the temples, worse on awaking; the eyes pain as if sore, and diffi- culty in keeping the eyelids open. This vertex headache and soreness of the eyes follow suppression of the menses. The patient has pain from the left temple into the orbit of that side; relieved while eating and worse after eating. A very characteristic symptom of the retina, or rather of vision, is, the right half of objects vanishes. In keeping with its effect on mucous membranes, we find the drug causing conjunctival asthenopia, just as does Alumina. The conjunc- tiva of both lids and eyeball is painfully dry and the eyes feel sore when the patient reads. The nose is affected, too, in the Lithium proving, being swollen and red. Sometimes there is dryness of the nose when in the house, and mucus dropping from it when in the open air; or mucus seems to hang in strings from the posterior nares. Another symptom of Lithium is sensitiveness of the mucous membrane when the inspired air is unduly cold. Lithium cures a cough which seems to come from a certain spot in the throat. There is a form of gastralgia which Lithium will cure. It is accom- panied by pain in the left temple and orbit, which is better by eating. Lithium has some effect on the bowels. Drinking chocolate or cocoa will cause diarrhoea. Lithium irritates the neck of the bladder. This, you know, is often a symptom of rheumatic patients. The urine is turbid and flocculent. The pains extend down either ureter and into the spermatic cords or testicles, and are followed by red urine with mucous deposit. In the female, you find Lithium carb. indicated when the menses are late and scanty. The provers found that all the symptoms accompany- ing the irregularity in menstruation were on the left side. Now, we will consider the rheumatic symptoms of Lithium carb., including under this head those of the heart also. I have succeeded, in several instances, in relieving chronic rheumatic patients by this remedy. The symptoms which indicate the drug are these: Rheu- matic soreness about the heart; valvular deposits will be found in many instances; mental agitation causes fluttering of the heart; very marked is the pain in the heart when the patient bends forwards; the cardiac muscle is evidently irritated, for we find shocks or jerks about the heart; the cardiac pains are relieved when the patient urinates. LITHIUM CARBONICUM. 623 Now, the symptoms of the body, joints and limbs; Tenderness, with swelling and occasional redness of the last joints of the fingers; clumsi- ness in walking from unwieldiness of the muscles; intense itching on the sides of the feet and hands without any apparent cause. The pains in the joints are usually worse in the knee-, ankle- and finger-joints. The whole body feels stiff and sore as if beaten. Pains go down the limbs. The whole body increases in weight and becomes puffy. I may say that this puffiness is not due to a healthy fat, but is a flabby con- dition which belongs to all the alkalies. Gettysburg spring water, which contains carbonate of lithia, is very efficacious in scrofulous children when there are ulcers about the joints, as in Pott's disease and hip-joint disease, when there are offensive pus and diarrhoea. This character of the catarrh of Lithium carb. in which the inspired air feels cold is also found under Kali bich. and Corallium rubrum. Kali bichromicum, Sepia and Teucrium have catarrh, with expecto- ration of solid chunks from the posterior nares. In valvular deposits in the heart you may compare Lithium carb. with Ledum, Kalmia and Benzoic acid, the latter remedy being selected by the offensive character of the urine. Zincum, Conium and Aurum have sudden jerks or shocks about the heart. In rheumatism and gout you may compare Kalmia and Calcarea ostrearum, which resemble Lithium in the rheumatism of the finger- joints. When there are nodular swellings in the joints, compare Calcarea ostrearum, Benzoic acid, Lycopodium and Ammonium phos. LECTURE LXIII. THE AMMONIUM PREPARATIONS. Ammonium caust. Ammonium carb. Ammonium phos. Ammonium mur. Blood.— Scorbutus. Uraemia. Carbonized blood. Heart. Mucous membranes.— Nose. Throat and larynx. Lungs. Skin.— Erythema. Scarlatina. Organs. We have on the board to-day several of the salts of ammonia, the Carbonate of Ammonia or Ammonium carb., Caustic Ammonia or Ammonium causticum, Muriate of Ammonia or Ammonium muriaticum and Phosphate of Ammonia or Ammonium phosphoricum. The am- monium salts taken as a class, we find best suited to rather fat and bloated persons. Ammonium carb. is particularly indicated in fat flabby individuals of indolent disposition who lead a sedentary life. This is very different from Nux vomica and Sulphur both of which are indicated in complaints arising from sedentary habits. But Am- monium carb. is especially indicated in fat lazy individuals. Ammonium mur. is best indicated for fat sluggish individuals par- ticularly when the adipose tissue is mostly distributed over the trunk, the legs being disproportionately thin. That is the distinction that may be made between the Carbonate and the Muriate. The salts of ammonium exert a considerable influence over the blood. Thus if Ammonium carb. is taken for awhile there will be produced symptoms simulating those of scurvy. There will be haem- orrhages from the mouth, nose and bowels, showing you that there is a disintegration of the blood. The muscles become soft and flabby and there is well-marked tendency to emaciation. AMMONIUM CARBONICUM. 625 We find that all the salts of ammonium act powerfully on the mu- cous membranes, of which tissue every one of them produces inflam- mation. This inflammation is of a violent character, starting with a simple feeling of burning and rawness, progressing to a complete in- flammation of the mucous membrane and ending in the destruction of the epithelium, which peels off in layers and leaves a raw, burning ul- cerated surface. It is, then, not to be wondered at, that the salts of Ammonia have won considerable praise in affections of the nose, throat and larynx and somewhat of the lungs. The ammonium salts also have an impression on the skin. When applied locally, there is produced a simple erythema followed by der- matitis and some little swelling. Soon, however, an eruption appears and this varies with the different ammonium salts. It is at first pap- ular, then vesicular and finally advancing to ulceration. These condi- tions are common to all the ammonium preparations of which we have any knowledge. Therapeutically, the salts of ammonia are antagonized by Veratrum viride, Digitalis, Aconite, and other cardiac sedatives. Their action is favored by heat, Opium, Iodine, Valerian, Asafoe- tida, Alcohol, etc. Ammonium Carbonicum. f Arnica, Antimonium tart. . . , Belladonna, Apis, Lachesis, Ammonium carb. < . . . ~ , ~ Arsenicum, Aurum, Carbo veg., Curare. Conium, Senega, Kali bi., Calcarea ostr. J Camphor. 1 Arnica. < Lachesis. We will first study Ammonium carb. Let me call your attention to the fact that the Carbonate of Ammonia may be antidoted by Cam- phor; and some of its symptoms by Arnica. Despite the apparent resemblance between Carbonate of Ammonia and Lachesis, these two drugs have been found to be inimical. Ammonium carb. may be studied from its action on the blood. As I have already said, its prolonged use produces a scorbutic condition. The vital powers are weakened. Haemorrhages of dark fluid blood appear. There is degeneration of blood tissue. The' muscles become soft and flabby. The teeth loosen and the gums ulcerate. With these scorbutic symptoms, there is developed also a hectic form of fever. 626 A CLINICAL MATERIA MEDICA. I now take up the indications for Ammonium carb. in uraemia. These symptoms which I am about to give you are very important. They are not only characteristic of Ammonium carb. in uraemia, but also in any other disease in which this remedy may be indicated. We may find them present in scarlatina with decomposition of the blood, and also in heart disease. Now for the symptoms: You will find Ammonium carb. indicated for somnolence or drowsiness with rattling of large bubbles in the lungs, grasping at flocks, bluish or purplish hue of the lips from lack of oxygen in the blood, and brownish color to the tongue. You recognize in these symptoms some condition of blood-poisoning from the presence of carbonic acid. This may be in uraemia, or it may be in catarrh of the lungs, or in any other disease in which there is deficient oxygenation. The nearest analogue here is Antimonium tartaricum. A similar condition obtains in Arnica in typhoid states when the patients are drowsy and heavy, and fall asleep while answering ques- tions. With the symptoms just enumerated you can remember Ammonium carb. for oedema of the lungs or emphysema. Ammonium carb. is also of use in poisoning by charcoal fumes. Arnica is sometimes of use in these cases, as is also Bovista. Still another use we may make of Ammonium carb., and one, too, that would hardly suggest itself to you, is in the beginning of cerebro- spinal meningitis. Sometimes, in the beginning of this disease, the patient is stricken down by the violence of the poison and falls into a stupid non-reactive state. He is cold, and the surface of the body is cyanotic. The pulse is very weak. In just such cases you should give Ammonium carb., which will bring about reaction. Then you may select some more specific remedy which will cure the trouble. I would now like to mention the action of Ammonium carb. on the heart. This drug is useful in dilatation of that organ. The patient suffers when ascending a height, as when going up stairs or up a hill. He also suffers intolerably in a warm room. He frequently has cough which is accompanied by bloody sputum. There is palpitation of the heart with dyspnoea and retraction of the epigastrium. You may also find cyanotic symptoms present. Ammonium carb. is also indicated in pneumonia when there is great debility, together with symptoms pointing to the formation of heart clot. It is also indicated in chronic bronchitis with atony of the bronchial AMMONIUM CARBONICUM. 627 tubes, this atony favoring emphysema. There are copious accumula- tion of mucus in the lungs, dilatation of the bronchial tubes, and oedema pulmonum. The patient in these cases is weak and sluggish in his movements, coughs continually, but raises either not at all or with great difficulty. Drowsiness, or even some delirium with mut- tering, may be present. Another use we may make of ammonium carb. is in scarlatina. It is undoubtedly a useful remedy.in the treatment of this disease, even when of a rather malignant type. We find that it produces a rash resembling that of scarlatina, but which is, however, of a miliary character. The throat is swollen internally and externally with en- largement of the glands externally, and with bluish or dark red swell- ing of the tonsils. The neck externally is engorged, that is, there is, in addition to the swelling cf the cervical lymphatics, inflammation of the cellular tissue. The nose is often obstructed, particularly at night, causing the child to start from its sleep as if smothering. Frequently it has to lie with its mouth wide open in order to breathe. The child is drowsy, and may even go into a stupid sleep. We frequently find, too, an enlargement of the right parotid gland. Let us now study some of the concordant remedies of Ammonium carb. in this disease. First of all Belladonna. Between this remedy and Ammonium carb. the resemblance is only apparent. Both reme- dies have right side of the throat affected, bright red rash, scarlatina and drowsiness. But the distinction between the two lies in this: There is in Ammonium carb. a miliary eruption on the skin, which Belladonna has not. The throat in Ammonium carb. is of a darker red than in Belladonna, and the drowsiness is more complete. The drowsiness of the latter remedy alternates with either wildness or starting from sleep, or-restless delirium or crying out in sleep. In Ammonium carb. the patient is in a state of simple somnolence. The starting from sleep is not from irritation of the brain, but from stop- page of the child's breathing. There is some resemblance between Ammonium carb. and Apis, in that both remedies have miliary rash, and both are indicated in low types of scarlatina with somnolence. Apis has, however, more drop- sical symptoms present. Whenever it is the remedy, you will find puffiness of the throat and oedema of the uvula. But you will also find inflammation or irritation of the meninges of the brain in Apis, as indicated by the sudden shrill crying of the child. This is a sudden 628 A CLINICAL MATERIA MEDICA. shriek, and not a mere start as if frightened. There is rolling of the head in the pillow. Lachesis, though apparently similar to Ammonium carb. in scarl?- tina, is really inimical to that remedy. It resembles Ammonium carb. in the blueness of the surface, in the somnolence, in the engorgement of the neck and in the dark red or bluish Swelling of the throat. Lachesis has almost always, if not always, that extreme sensitiveness of the surface, so that the patient caimot bear to have anything touch the neck. Then, too, Lachesis affects more the left side and Ammo- nium carb. the right. This sensitiveness of Lachesis is not the same kind of soreness that you find iu other remedies, as in Apis. This symptom is here due to a hyperaesthetic condition of the spinal nerves ramifying through the affected part. Firm pressure does not aggra- vate, although a light touch will. Rhus tox. is similar to Ammonium carb., in that both remedies have dark throat and both have drowsiness. It is the left parotid gland that is most likely to be affected under Rhus; with Ammonium carb., it is the right. There is more restlessness under Rhus. Next, the action of Ammonium carb. on the mucous membranes. This remedy is useful in nasal catarrh. The nose is stopped up at night; the patient wakens gasping for breath. He is worse at three or four o'clock a.m. The cough is dry and tickling, associated with hoarseness, and with a great deal of oppression from mucus in the chest. The nostrils are sore and raw, and sometimes, in children, there is a discharge of bluish-colored mucus. This symptom is also found under Kali bichromicum and Ambra grisea. At times the coryza is scalding, excoriating the upper lip, with burning in the throat and along the trachea. There is a feeling as of a lump in the throat. Dry night cough comes, which seems to threaten suffocation; copious flow of saliva, with consequent expectoration ; beating like a pulse in the chest. Ammonium carb. is particularly suited to winter catarrhs. The sputum is slimy and contains specks of blood. In the 3 a.m. aggravation of Ammonium carb., you may compare the Kali salts. In this catarrh, with stoppage of the nose, excoriating discharge and rawness down the sternum, there are a few drugs which I would have you compare. One of these is the Ammonium causticum, which is one of the best remedies in the whole materia medica for aphonia, especially if there be present the burning rawness in the throat. AMMONIUM MURIATICUM. 629 Causticum and Carbo veg. are very similar to Ammonium carb. in this rawness and burning down the sternum. Lauroeerasus has that expectoration containing little specks of blood. Ammonium carb. has also been used for sprains when the injured joint is hot and painful. Here you may compare Arnica, Sulphuric acid and Ammonium mur. • Ammonium Muriaticum. Apis, Arnica, Natrum mur. Ammonium mur. < Kali bichromicum. I Sepia, Sulphur. As I have already explained to you, Ammonium mur. is suited to sluggish persons, who are rather corpulent as to the body, but dispro- portionately thin as to the limbs. Like the Carbonate, it produces violent inflammation of the mucous membranes. It also disturbs the circulation of the blood. The face reddens during a short, animated conversation, especially so, as you might expect, in a warm room. There are ebullitions of blood, violent throbbing in all the arteries, ac- companied by anxiety and weakness, as if "paralyzed. The nervous system suffers, too, from the action of Ammonium mur. There is a cer- tain periodicity of symptoms, as shown in the chills and fever. The paroxysms return every seven days. There are many other symptoms of the nervous system ; especially do we find this characteristic: Pain in the left hip, as if the tendons were too short; this makes the patient limp when walking. While sitting there is gnawing referred to the bones. Sciatica is very readily cured by Ammonium mur. when the symp- toms call for it. The pains are worse while the patient is sitting, some- what relieved while he is walking and entirely relieved when he lies down. Ammonium mur. has also been used for the neuralgic pains which may occur in the stumps of amputated limbs. Ammonium mur. is also useful for tearing, stitching pains from ulceration in the heels, worse at night in bed and better from rubbing. Other remedies attacking the heels are, Pulsatilla, Causticum, Man- ganum, Antimonium crudum, Ledum, Graphites, Natrum carb., and Allium cejyq. Sabina is particularly suitable in plethoric women who suffer from what they call rheumatic inflammation. 630 A CLINICAL MATERIA MEDICA. Manganum is an excellent remedy in rheumatic patients when the heels are affected and the patient cannot bear any weight on the heels. In addition to thisyou will find that Manganum is indicated when the rheumatic symptoms come in dark, almost bluish, spots. Antimonium crudum is useful in soreness of the heels. Ledum palustre, Graphites and Natrum carb. cause blisters on the heels. Allium cepa cures ulcers on the heel when developed by friction of the shoe or stocking. Ammonium mur. has some influence on the joints. It causes a feel- ing of constriction in these parts. It is one of the remedies that have been used in the treatment of chronic sprains. It also affects the fibrous tissues about the joints. Thus, it is one of the remedies when there is contraction of the hamstring tendons. When the patient walks these seem to be drawn tight. This symptom is relieved on continued motion. On the female organs, Ammonium mur. acts more powerfully than does Ammonium carb. It has a great many symptoms referred to the inguinal and hypogastric regions which would suggest the use of the drug in uterine and ovarian diseases. For instance, the patient com- plains of tensive pain in one or the other groin. Sometimes this symp- tom is described as a feeling as if she had sprained herself. There are stitches, cutting and soreness, or, what is more characteristic than all, a strained feeling in the groin, which forces the patient to walk bent, That is an indication which leads to Ammonium mur. in the treatment of deviations of the uterus, and also in ovarian diseases. You will find in almost all these cases the characteristic muriate stool, crumbling as it passes the anus. We have, too, a characteristic leucorrhcea attending the symptoms, a brown a'nd lumpy or else clear and albuminous leucor- rhcea, which follows every urination. Ammonium mur., in that feeling as if sprained in the groin in women, finds its counterpart iu several other remedies: in Arnica, which has that same strained feeling in the groin; in Apis, which has it all the way across the hypogastrium, with a sensation as if the skin were tight or stretched. Next, we have to consider the action of Ammonium mur. on the mucous membranes. Beginning with the nose, we find that it causes coryza. The nose is "stopped-up" more at night than in the day- time. One nostril is usually stopped-up at a time; there is an ex- coriating, watery discharge from the nose, which makes the inside of AMMONIUM PHOSPHORICUM. 631 the nostrils and upper lip sore. The throat is swollen so that the patient cannot open his mouth. The mouth and throat are filled with a viscid phlegm, which the patient expels with great difficulty. There is throbbing in the tonsils. This is characteristic of Ammonium mur. It is a symptom which may suggest it in tonsillitis or in scarlatina when the faucial symptoms are so severe as to produce almost complete strangling. The chest symptoms are by no means unimportant in Ammonium mur. We find a cough which may accompany the foregoing symptoms or which may be separated from them. The cough is very violent, and seems to excite the salivary glands, for during it the mouth fills with saliva. Hoarseness, with burning and rawness in the larynx, neces- sarily belong to such an acrid remedy as Ammonium mur. Coldness between the shoulder-blades accompanies the chest affections, as in bron- chitis and phthisis. The patient also complains of heaviness in the chest. This is also noticed in the Ammonium carb. where it is asso- ciated with burning. Sometimes the patient will describe his sensation to you as a feeling as of a lump in the chest. Again, he will complain of certain spots in the chest which burn, throb and beat with the pulse. Ammonium mur. may be used in chronic congestion of the liver. Depression of spirits accompanies the disease, and the stools are coated with mucus. Ammonium Phosphoricum. I have one or two symptoms of Ammonium phosphoricum to give you. It has been successfully used in the treatment of constitutional gout when there are" nodes or concretions in the joints. It is not to be used for the acute symptoms, not for the twinges of pain, but when the disease has become systemic, and when concretions of urate of soda appear in the joints. The worst case of this kind I ever saw was that of a man who had been bedridden fifteen years. He showed me a box which was filled with these concretions, which he had picked out of his joints. They varied in size and looked like lumps of chalk. Some of these same concretions could be seen under the skin and along the ten- dons. His hands were twisted out of shape. His feet also were affected. He had a cough, which finally killed him, and he expecto- rated from the lungs these lumps of urate of soda. Ammonium phos.' relieved him for awhile. LECTURE LXIV. SALTS OF LIME.—CALCAREA OSTREARUM. Calcarea ostrearum. Calcarea caustica. Calcarea fluorica. Calcarea phosphorica. There are quite a number of the salts of lime which have been more or less proven. The first one on the list is Calcarea ostrearum, or the lime of oysters. This preparation, which was given to us by Hahnemann, was proven as Carbonate of Lime or Calcarea carbonica. It was obtained from the middle stratum of the oyster-shell, where Hahnemann supposed he could secure a perfectly pure specimen of the carbonate of lime. Chemically speaking, this is not a pure carbonate of lime, for it must contain some .of the animal matter belonging to the oyster. Moreover, it always contains a trace of Calcarea phos. You will thus see the reason why Dr. Hering proposed to call it Cal- carea ostrearum instead of Calcarea carbonica. Calcarea, caustica is the ordinary caustic lime. Calcarea fluorica was proven by Dr. Bell of Maine. Of it we have a few symptoms. It is one of Schiissler's twelve tissue remedies. This combination of fluoric acid with lime gives us a very powerful drug in the treatment ofMiseases of the osse- ous system. I have already related to you a case in which Calcarea fluorica acted well in necrosis of the jaw. We shall also find it a useful drug in bone tumors. Calcarea phosphorica is also a valuable drug. It should be your duty and your pleasure to know the distinctions between these various salts of lime, and especially between Calcarea ostrearum and Calcarea phosphorica. They are not indicated in pre- cisely the same cases. When one is indicated, the other cannot be. They are not difficult to distinguish, so I think we will be able to make the necessary distinctions. One chapter in the history of Calcarea phosphorica is of some little interest. Some years ago a preparation for the cure of a certain dis- Nutntion. -r,, , f Anaemia. Blood. < . I Leucocythaenna. Glands. Bones. CALCAREA OSTREARUM. 633 ease was put on the market in Europe. It soon gained quite a repu- tation. After awhile, cures effected by it became less and less frequent. Finally, a wealthy man who failed to be cured by the preparation, sued the company for deceiving him. Analysis of the preparation became necessary. The main ingredient was found to be phosphate of lime. In the beginning the manufacturers used the phosphate of lime from bones; but later they found a cheaper way of making it in the labora- tory, and without using bones at all. The company claimed that phosphate of lime is phosphate of lime, no matter how made or where found. That there is a difference between the phosphate of lime as obtained from the chemist's laboratory, and from the bones of animals, is shown by the difference in therapeutical efficacy of the two prepara- tions, as illustrated in the above case and many others. Calcarea sulphurica, or the Sulphate of Lime, is another one of Schiissler's remedies. It was proven by one of the students of the New York College. Schiissler claims that Calcarea sulphurica acts energetically in curing suppuration and in removing the tumefaction of boils. The proving, while not positive, rather favors "this idea. The Hypophosphite of Lime given in the second decimal, has pro- duced the following: Dull heavy pain on top of the head, causing de- pressed feelings, fulness and oppression around the heart, fulness of head and chest; veins on hands, arms, neck and head, stand out like cords; difficult breathing, must have window open ; profuse sweat all over; limbs powerless from weakness of the muscles. All the salts of lime act prominently in the direction mentioned on the board. They all affect the nutrition of the body, hence they are of great use in infancy and childhood, when growth must be accomplished. They favor the development of bones and other tissues. You will find that some of them, the ostrearum and phosphorica, cause anaemia when pushed to the extreme. They all affect the glands and they all act on the bones. Calcarea Ostrearum. Calcarea ostrearum is a drug that may come into use in almost every form of disease, and is second in importance only to Sulphur. You will recall that it is not a perfectly pure carbonate of lime, but contains some phosphate of lime and some organic matter from the body of the oyster. Chemically it differs but slightly from the car- bonate of lime made in the laboratory. Calcarea ostrearum is suited to cases in which there is defective 41 634 A CLINICAL MATERIA MEDICA. growth, hence it is a very necessary remedy in childhood and in in- fancy. It affects chiefly the vegetative system, altering materially the nutrition of the body. Under its influence secretion and absorption progress rapidly, and so it becomes a favorite remedy in cases in which the " constitution " is to be changed. The glands are readily affected by Lime; they swell, inflame and even become the seat of pathologi- cal deposits. This is especially true of the cervical and mesenteric lymphatics. The nervous system, that is the animal nerves, is not primarily affected, but becomes eventually influenced by general nu- tritive failure, causing thus spasms, excitement, etc. The Calcarea ostrearum patient is fat and plump, rather of a bloated than of a solid, hard fat. The face is rather pale, occasionally, however, flushing up red. Usually the color is of a watery or chalky paleness. The child is slow in its movements. It is not active, nervous, or quick, as we find in the case of the Sulphur child. Growth is irregular, so that the head is disproportionately large to the rest of the body. This defect is one of osseous growth ; thus you find the fontanelles remain- ing open, particularly the anterior fontanelle. The abdomen is large and has been compared to an inverted saucer or basin. The features are rather large, and the lips, particularly the upper, are swollen. Dentition is slow. The scalp sweats profusely, particularly during sleep. This is not usually a warm sweat, nor is it a cold sweat; but it is cool from natural evaporation. When the child awakes, you no- tice the pillow damp or wet for some little space around the head. The feet are often cold and clammy. (Do not, however, be deceived by this symptom, for there are some children who, by wearing too heavy a stocking, will have sweaty feet.) Such patients suffer from partial sweating of still other parts of the body. That is in itself an almost certain symptom for Calcarea ostrearum. Thus it may affect the chest or knees when all other parts of the body may be perfectly dry. Now, from this extreme picture we may have the opposite con- dition, one of great emaciation. The skin hangs flabby and in folds. Despite this emaciation, the abdomen remains abnormally large. Such children are scrofulous, and it is genuine scrofula, for which Calcarea ostrearum is indicated. There is another form, which is tubercular in its character, and in this form we have Phosphorus indicated. We find the same swelling of the glands, the same indolent ulceration, and the same difficulty in learning to talk and walk, but the patient has a delicate, refined skin, and the features are sharp and rather handsome. The eyelashes are CALCAREA OSTREARUM. 635 long and silky, and the hair dark and glossy. This is the kind of scrofula which will, if not neutralized, ultimately end in consumption of the lungs. As the Calcarea child grows older it is slow in teething. It may even have fever or convulsions attending the tardy eruption of the teeth. In cases in which the convulsions persist, Calcarea is far supe- rior to Belladonna. Scrofulous inflammation of the eyes is almost always present. There are pustules on the cornea, and these threaten to destroy that membrane. The parts about the ulcer are very vascular. The child dreads artificial light in particular, although it complains bitterly of the daylight hurting its eyes on awaking in the morning. The discharges from the eyes are apt to be bland. The cornea is left more or less opaque by the ulceration. Calcarea has often been used after the subsidence of the acute symptoms, to remove the corneal opacity and the chronic thickening of the eyelids. No remedy excels Calcarea in corneal opacities; but compare Apis, Saccharum officinale, Cuprum, Alumen, Kali bi. and Natrum sulph. Saccharum officinale in particular is to be remembered as similar to Calcarea ostrearum. This drug has been proved on several persons, and has many confirmations. It is iudicated in children who are large- limbed, fat and bloated, with a tendency to dropsy. It has produced opacity of the cornea, and it ought to cure it. The mental states which lead me to the use of Cane-sugar are these : The child is dainty and capricious; he cares nothing for substantial food, but wants little " nick-nacks;" he is always cross and whining, and if old enough he is indolent, and does not care to occupy himself iu any way. Everything seems to be too much trouble to him. You will find that in the eye-symptoms Calcarea acts better after Sulphur than before. It is suited to advanced cases that are sluggish and refuse to react to Sulphur. Hahnemann noticed that Calcarea particularly followed by Sulphur when there was tendency to dilatation of the pupils. Another remedy which holds a relation to Calcarea ostrearum in scrofulous and tubercular ailments is Nitric acid. This must be sub- stituted for the Calcarea if the ulcers on the cornea progress and threaten to perforate or destroy the cornea. The Calcarea children are subject to eruptions on the skin, particu- larly eczema. This eczema is quite characteristic, too. It appears on the scalp, with a tendency to spread downwards and over the face. Frequently it appears in patches on the face or scalp, forming thick 636 A CLINICAL MATERIA MEDICA. crusts, which are often white like chalk deposits. Another symptom which may suggest Calcarea is this: The child scratches its head on awakening from sleep. The change from sleep to activity seems to produce itching of the existing eruption. We find in these scrofulous children calling for Calcarea, inflamma- tion of the external ear or auditory canal, aid also of the middle ear or cavity of the tympanum. First, Calcarea produces thickening of the membrana tympani, with all the symptoms of defective hearing. There are humming, roaring and buzzing in the ears, all dependent upon the abnormal pressure on the chain of bones. The otorrhoea has a sort of pappy or fatty appearance. It is purulent, but it also has a pappy appearance, looking just like chewed-up paper. Now, on cleans- ing the external ear of this pus and looking at the membrana tympani, you find it perforated from previous inflammation. You will find the edge of the rupture thickened and granular, and you may even notice a tendency to the formation of polypi. The pains are of a sudden, jerking, pulsating character. Here Calcarea is, according to the best authorities, to be followed by Silicea, if the ulceration becomes very indolent and will not heal despite the exhibition of lime. The Silicea patient has a head dispro- portionately large to the rest of the body. The sweat appears on the whole head and face rather than on the scalp alone, and the foot-sweat causes soreness of the feet. These symptoms you will recall from our lecture on Silicea. Besides Silicea, you should here compare Calcarea with Hepar and Mercurius. Attending these inflammations of the eyes and ears with Calcarea we may have scrofulous enlargement of the lymphatic glands of the neck, axilla, etc. These are hard and firm, and yield very slowly to medicine. We have also in these cases a coryza or chronic nasal catarrh. The wings of the nose are thickened and ulcerated. There is apt to be a moist scurvy eruption about the nostrils. There is an offensive odor, as of rotten eggs, gunpowder or manure from the nose. The nose is stopped up, with thick yellow pus. The patient often has nose-bleed in the morning. Here you may compare Belladonna which follows Calcarea well. Now, if the Calcarea children are attacked with summer complaint or a genuine cholera infantum, you will find these symptoms of the digestive organs: There will be an unusual craving for eggs. Why this is I do not know; it rtiay be because of the sulphur in the egg*. CALCAREA OSTREARUM. 637 This is a very common symptom. Milk disagrees. As soon as they take it they vomit it in sour cakes or curds. That is a strong symp- tom for Calcarea. Or the milk may pass by the bowels in white curdled lumps. There are ravenous appetite and thirst, the latter being worse towards evening. The diarrhoea, too, is worse toward evening, thus being distinguished from Sulphur. The stools are greenish, and may contain undigested food. They are more or less watery and sour. In these symptoms Calcarea ostrearum is similar to two or three other drugs. One is the Aethusa cynapium, or fool's parsley. This is indicated in vomiting of children, when they vomit everything they drink, particularly milk, which is ejected in white or yellowish or greenish curds. This vomiting exhausts the child, so that it goes to sleep at once. Still another remedy is Antimonium crudum, which has this condi- tion : After nursing, the child vomits its milk in little white curds, but refuses to nurse afterwards ; the iEthusa patient, on the contrary, wants to nurse again. There is also the characteristic diarrhoea of Antimonium crudum, which will help you to distinguish it from cases that call for Kreosote. If the latter remedy had no other symptom than the following it would still be invaluable, and could not be re- placed : The stomach is so weak that it cannot retain or digest food, so that food is vomited either immediately or hours after eating. Phosphorus and Arsenicum should also be compared in this vomit- ing. Again, we may find Calcarea ostrearum indicated in acute hydro- cephalus in the early stages. Here, as in many other cases, it acts particularly well after Sulphur. It may even do good when symp- toms of effusion are present. It is indicated mainly by the general constitutional symptoms present in the case. In these cases you frequently find that it follows the previous use of Belladonna. You are called to attend one of these cases. You find the patient with hot head, flushed face, starting in sleep, and you give him Belladonna, which relieves. In a few days a relapse occurs, again you give Belladonna, and this time it fails. This intermittency of the disease shows that it is not a Belladonna case. Then you have to select another drug, which is sometimes Sulphur and very frequently Calcarea, the latter especially if the patient be the characteristic Cal- carea child. Belladonna and Calcarea are complementary, particu- larly in affections of children, in brain troubles and in dentition. 638 A CLINICAL MATERIA MEDICA. Again, we may find Calcarea ostrearum indicated later in life, at puberty. Here it is more frequently indicated with girls than with boys. We find it called for at the time for the onset of the menses, when they are delayed. The girl is apparently plethoric, and suffers from congestions of the head and chest. She i^ fat and apparently robust, but if you were to examine the blood of such a patient you would find it disproportionately full of white blood-corpuscles" or leu- cocytes. She complains of palpitation of the heart, dyspnoea and headache, worse when ascending. Calcarea will bring on the men- strual flow, and will relieve all these symptoms. Again, you may find it useful at puberty for similar symptoms when tuberculosis of the lungs threatens. The patient has this dyspnoea, palpitation and rush of blood to the chest on ascending, and even haemorrhages from the lungs. There is dry cough at night, which becomes loose in the morning. The patient has fever, which is worse in the evening, with partial sweat and soreness of the chest to touch, thss soreness being worse beneath the clavicles. Digestion is greatly disturbed. The patient cannot eat any fat food without becoming sick. There is chronic tendency to diarrhoea, and with it prolapsus ani. So you see Calcarea is a companion to Phosphorus, but there is a difference between the two remedies. The difference is expressed in these few symptoms. In Calcarea, you find the patient scrofulous and fat, and his or her past history shows the well-marked symptoms of Calcarea. As children they have been slow in teething, have had slowly-closing fontanelles, and often there is yet remaining dispropor- tionate swelling of the upper lip. On the other hand, the Phosphorus patient is slender and over- grown, tall for her years, and narrow-chested. She has a fine grain of tissue, rather than fat and coarse as in Calcarea. Calcarea is indicated late in phthisis when large cavities are forming. It acts particularly upon the right lung about its middle third. There will be pain in the middle of the right side of the chest; loud mucus rales are heard all over the chest, of course worse on the right side. Expectoration is purulent, yellowish-green and bloody. The patient has great repugnance to animal food, as meat, which passes undigested. Emaciation progresses, sweat increases, and the menses, if it is a female, become checked. These are the symptoms calling for Calcarea in tuberculosis. Still later in life we find Calcarea indicated for the ailments of women, particularly for irregularities in menstruation. It is especially CALCAREA OSTREARUM. 639 indicated when the menstrual flow is too frequent, coming every two or three weeks, and is profuse, amounting almost to a menorrhagia. The flow is provoked by over-exertion or by emotions. The patient complains of sweating of the head and coldness of the feet. One of the best remedies I know of for ordinary profuse menstrual flow, coming frequently and yet without any decided constitutional character by which to judge the case, is Trillium pendulum, especially if the flow exhausts the patient very much. I have never given it w any potency but the sixth. That has been sufficient in all my cases, In suppression of the menses Calcarea has several concordant reme dies. Belladonna is suitable when there are hyperaemia, rush of blooa to the head, subjective feeling of coldness, wakefulness, and throbbing about the temples. Gelsemium is indicated in menstrual suppression when there is a drowsy, apathetic state. Glonoin is an admirable remedy when there is violent throbbing about the head, and particularly if the urine is albuminous, as it may be, from congestion of the kidneys. Aconite is indicated for suppression of menses from violent emotions, as fright. Still other drugs called for under these last-named circumstances are Actea spicata and Lycopodium. The leucorrhcea of Calcarea ostrearum is rather profuse, with con- siderable itching and burning, and is generally milky, purulent and yellow or thick in appearance. It is especially indicated for leucor- rhcea occurring before puberty, even in infants. Another remedy that I have found very valuable in the leucorrhcea of little girls is Caulophyllum, when the discharge is profuse and weakens the child very much. Calcarea ostrearum is useful in diseases of the male sexual organs. It is one of that little group of remedies, Nux, Sulphur and Calcarea, first suggested by Jahr for sexual weakness arising from masturbation or other excesses in sexual indulgence. Calcarea is indicated when there is excessive sexual desire, but this sexual desire is more mental than physical—that is, there is more passion than the objective con- comitants of passion. Erections are diminished or imperfect during coitus, emission is imperfect or premature. Calcarea is also indicated when, after abuses of this kind, a man settles down to a moral and quiet life. His sexual power is of the character just described, and 640 A CLINICAL MATERIA MEDICA. its gratification is followed by these symptoms: Vertigo, headache and weakness in the knees. In milder cases, which have not been traced to so deep an origin as defective nutrition, you will find Dioscorea all-sufficient for the exces- sive loss of semen with weakness of the legs, particularly about the knees. In old men, who, having spent their youth and early manhood in the practice of excessive venery, are just as excitable in their sexual passion at sixty as at eighteen or twenty, and yet they are physically impotent, Agnus castus is a good remedy. We may use Calcarea ostrearum from its action on the nervous sys- tem. It is indicated in nervous fevers, even in typhoid fevers, in the beginning of the disease, with these symptoms : The patient falls into a troubled sort of sleep and dreams of some perplexing subject which awakens him. He again goes to sleep and dreams of the same thing. As soon as he closes his eyes, he sees persons, objects, etc., which dis- appear as soon as he opens them. Later, in the course of typhoid fever, about the second week, you will find Calcarea ostrearum indicated when, for instance, the rash will not appear, and the patient goes into a sort of stupor. The abdomen swells and becomes more tympanitic. The patient becomes very restless and anxious and distressed, although he may be unconscious. He cries out, twitches and grasps at flocks. The body may be too hot and the limbs cold and clammy. There may be diarrhoea or constipation present. He starts up from sleep and looks about him as if frightened. A drug which is complementary to Calcarea here is Lycopodium, the symptoms of which have been already mentioned. Another use that we may make of Calcarea ostrearum in nervous affections is one which would not appear from a superficial study of the drug, and that is its application in insomnia. The sleeplessness that calls for this remedy does not consist simply in lying awake an hour or two, but it is that long wakefulness which is the precursor to some dis- eases and the accompaniment of others. For instance, during child- bed a woman cannot sleep. In such cases you have this class of symptoms: She has visions on closing the eyes; she starts and twitches at every little noise, and is beside herself with anguish. The tongue gets dry. She borders on the state of acute mania. Calcarea ©strearum, particularly in the thirtieth potency, given every three hours during the day, almost invariably produces a desire to sleep the next night. How does Calcarea produce it? Like opium, caffeine or CALCAREA OSTREARUM. 641 chloral ? No; but by bringing about a healthy sleep. Still another use of Calcarea ostrearum is in that unhappy affection, delirium tre- mens. It is indicated when there are pretty much the same symptoms as I have mentioned for the insomnia, particularly with visions of rats and mice, and of horrible objects which terrify the patient. He talks deliriously about fire and murder. He has a constant fear that he is going crazy. Calcarea ostrearum seems to be able to cure epilepsy, not so much the paroxysms themselves, as to aid in the change of constitution by which this dreadful disease may be cured. The aura which precedes the attack in some cases begins in the solar plexus and moves upwards* and the patient is at once thrown into convulsions (that being charac- teristic of Nux vomica, Bufo and Silicea). In some cases it feels as if a mouse were running up the arm. In still others the aura may go from the epigastrium down into the uterus or into the limbs. The causes for the Calcarea ostrearum epilepsy are fright, suppression of some chronic eruption, and also excesses in venery. It follows Sulphur very well. You are apt to think first of Sulphur for this sensation as of a mouse creeping up the arm; the symptom is just the same in Sulphur and Calcarea; the causes, also, are the same, viz., excessive venery and suppression of an eruption. Calcarea is particularly indicated if Sul- phur does not cure, or if the pupils do not dilate after the use of Sulphur. For the paroxysms, Hydrocyanic acid is a useful drug. Artemisia vulgaris is indicated in cases which have arisen from fright, and in which the attacks are duplicated. If indigestion starts the trouble, Nux vomica is the first remedy to be thought of, especially if the aura starts in the epigastrium and spreads upwards. Calcarea ostrearum is useful in diseases of the bones and in curva- tures of the spine, especially for curvatures in the dorsal region in chil- dren who are slow in learning to talk and walk, who are weak at the ankles, and turn their feet in or out according to the muscles that are weakened. There is a remedy which has been suggested for this weakness of the legs which I have never been able to confirm, and that is Pinus sylvestris. This is said to have cured emaciation of the lower extremities, with tardiness in learning to walk, in scrofu- lous children. Calcarea ostrearum is also indicated in affections of the joints; for instance, in white swelling and in hip-joint disease. It 642 A CLINICAL MATERIA MEDICA. is indicated in the second stage of these diseases, when abscesses have formed. Now, you must learn to distinguish between Calcarea and Silicea. To the superficial observer the cases are very similar, but there are some differences which you may note. In the first place, the Silicea patient has sweat about the whole head, and this sweat has a sour or offensive odor; the head is unduly grown, the rest of the body being rather emaciated; the sweat of the feet in Silicea is apt to be offensive, and produces soreness between the toes and on the soles of the feet; the face is rather of an earthy or ye'lowish-waxen hue. The Silicea child is nervous and excitable rather than sluggish, as is the case with the Calcarea ostrearum patient. Silicea has the same imperfect nutrition from defective assimilation that Calcarea has. There seems to be, in the Silicea child, a decided weakness of the cerebro-spinal nervous system; and yet, with this weakness, there is a certain amount of irritability, so that it is made worse by any external impression. Thus, if there is any tendency to epilepsy, any little emotion will tend to throw it into convulsions. There is more tendency to ulcer- ation in Silicea than you find in Calcarea. The discharge from these ulcers is not a healthy, laudable pus, but it is rather thin and excori- ating. Calcarea ostrearum is of service in rheumatism. The symptoms indicating it are these: Rheumatic affections, caused by working in water; rheumatism of the muscles of the back and shoulders after failure of Rhus. It is also indicated for gouty nodosities about the fingers. It may also be useful in constitutional gout and in arthritis deformans. Rhus tox. seems to be the best remedy we have for lumbago, whether the pains are better from motion or not. It seems to have a special affinity for the deep muscles of the back. Calcarea fluorica is a good remedy to follow Rhus in chronic cases; for lumbago, worse on beginning to move but improving on continued motion. Secale cornutum is indicated for sudden " catch " or " kink " in the back. Nux vomica is called for in rheumatism of the back, when the patient is unable to turn over in bed without first sitting up. LECTURE LXV. CALCAREA PHOSPHORICA AND HEPAR. Calcarea Phosphorica. r Cinchona, Zinc, Phosphorus (hydrocephaloid). Dulcamara, Silicea, Sulphur. Calcarea phos. ^ Rhus, Causticum. I Sulphur, Calcarea ostr., Silicea, Phosphorus. I Baryta c. (mental weakness). The complementary drugs of Calcarea phos. are, Zinc, Ruta gra- veolens, and Sulphur. Zinc you will find complementary to Calcarea phosphorica in hydrocephaloid; Ruta in affections of the joints and periosteum; and Sulphur pretty much as we found under Calcarea ostrearum. Now there are many symptoms that are common to both Calcarea ostrearum and phosphorica. It is not a little perplexing at times, in a case which seems to call for lime, to decide which one of these prep- arations we should give. Perhaps I can give you distinctions enough to enable you to judge. To determine the efficacy of Calcarea phos- phorica you must remember its ingredients, lime and phosphorus, and you will see how they are modified in their chemical combination, so that while we have some resemblances to Calcarea and others to Phos- phorus, we have still other symptoms which belong to the combina- tion, Calcarea phosphorica and which are found neither in Calcarea nor in Phosphorus alone. Calcarea phos. seems especially called for in defective nutrition, hence it is often useful in childhood as well as at puberty and in ex- treme old age. Beginning with the infant, we shall find it of in- estimable service when the child is thin and emaciated, with sunken, rather flabby abdomen, and predisposed to glandular and osseous disease. The head is large, and both fontanelles are open. The cranial bones are unnaturally thin and brittle. The teeth develop tardily. It has curvature of the spine. The child is slow in learning to walk, and the spine is so weak that it cannot support the body. The neck is so thin and weak that it cannot support the head, which falls 644 A CLINICAL materia medica. whichever way it happens to be inclined. The child vomits milk per- sistently, whether it be the breast milk or that artificially prepared from the cow. It suffers from colic after every feeding. The stools are often green, slimy and lienteric, and are accompanied by the passage of a great deal of foetid flatus. Sometimes, the stool is very profuse, watery and hot. In cholera infantum, the stools may be of the character men- tioned, or they may present a flaky appearance from the admixture of a small portion of pus. There is, in this cholera infantum, great ema- ciation of the whole body. The little face is pale, and the prominent parts of the body are cold. There is craving for bacon or ham. Mentally, these children are very much depressed, so that they are slow of comprehension. They seem to be stupid. Even cretinism may be developed by the continued use of Calcarea phosphorica. This will place it in your mind, alongside of Baryta carb., in mental symptoms. As the child grows in years, if not in stature, any exposure to dampness or wet causes a feeling of general aching or soreness, particularly when the child is moved. The least motion is unbearable. Do not give Bryonia in such a case as this, because the patient is worse from motion. Do not be misled by this aggravation from motion. It is not here a symptom for Bryonia, for it indicates the incipient symptoms of rachitis. Every little exposure produces a feeling of heat all over the body. The periosteum and the articulations are irritated and inflamed, and cause this aggravation from motion. You will find Calcarea phosphorica an excellent remedy to prevent rachitis. If it fails you, you may still fall back on Silicea. This sensitiveness to dampness enables us to use Calcarea phos. in diseases of adults. This I consider an important qualification of the drug. Thus, it is indicated in women with a feeling of weakness and distress referred to the hypogastrium with uterine displacements, and worse by passage of either stool or urine. Especially is it indicated in women whose joints ache in every change of the weather. This quality separates it from other similarly-acting drugs. The uterine symptoms are aggravated by this change in weather. That symptom is promi- nent in Calcarea phosphorica, more so, in fact, than in either Calcarea or Phosphorus. Phosphorus has the gone, weak feeling in the hypo- gastrium, just like Calcarea phos., but the modality just mentioned is absent. So, too, we may use Calcarea phos. in rheumatism appearing in any change of weather. On exposure to dampness, we find stiffness of the neck, aching and soreness in the limbs and wandering pains through CALCAREA phosphorica. 645 the limbs, particularly around the sacral region and down the legs. All these symptoms appear with every change of weather. If the patient contracts a cold, it is associated with dryness and soreness in the throat, stitches in the chest, heat on the lower parts of the chest and upper arms, and a yellow sputum. Another use of Calcarea phos. arises from its action on joints. I refer to its use in the treatment of fractures. Wherever bones form a suture or joint, there Calcarea phos. has an action. We find it, for instance, causing pains along the sagittal suture. Again, where the sacrum unites with the iliac bones, forming the sacro-iliac symphyses, there Calcarea phosphorica produces pain. If, during pregnancy, a woman complains of pain in this locality, Calcarea phosphorica ought to help her. Now, when there is a sort of artificial suture, as there is at the point of coaptation of broken bones, there, also, Calcarea phos. has an action. In some cases, the fractured ends may fail to unite; you give Calcarea phosphorica, which stimulates the formation of callus. It is better to use a low potency of the drug in this case. In this respect, Calcarea phos. compares favorably with Symphytum, which is also used for non-union of fracture, particularly when the trouble is of nervous origin. Conchiolin may here be mentioned. It is useful in osteitis at the ends of the diaphyses. This " mother of pearl " causes such a disease among workmen. We have yet another use for Calcarea phosphorica, and that is for schoolgirls, particularly when they get near the age of puberty and they are exceedingly nervous and restless. They want to go away from home, and when away, they want to come back again. They suffer from headache when at school. They develop very slowly and are often chlorotic We may use Calcarea phosphorica in children who are suffering from marasmus. They have the peculiar craving and the diarrhoea that I have already described. The face is white and pale, or else sallow. The circulation is so imperfect that the ears and nose are cold. These cases, too, have that inability of the neck to support the head, of which I have already spoken. There is a resemblance between Calcarea phosphorica and Cinchona. The latter may prevent this extreme picture if you give it for the fol- lowing symptoms: When, from the frequency of the discharges, the child becomes drowsy and exhausted and has cold face. In these cases, 646 A CLINICAL MATERIA MEDICA. the administration of Cinchona will bring the child up and prevent the condition calling for Calcarea phos. On the other hand, you will find Calcarea phos. to give place to Zinc when you have the Zinc symptoms that I have already given you, roll- ing of the head, grinding of the teeth, cold pale face, hot occiput, fidgety motion of the feet, etc. In aggravation from exposure to wet we may compare Dulcamara, Silicea, Sulphur, and Causticum. It is highly important to be able to distinguish between Calcarea ostrearum and Calcarea phosphorica. This you can do by comparing the descriptions I have given you to-day and yesterday. Calcarea ostrearum has an enlarged abdomen; Calcarea phos. has flabby abdo- men, from the admixture of phosphorus with the lime. In cholera infantum Calcarea ostrearum has craving for eggs; Calcarea phos. for salt or smoked meats. The calcarea ostrearum stools are sometimes green, but generally watery, white and mixed with curds. The Cal- carea phos. diarrhoea has green, slimy or hot watery stools accom- panied by foetid flatus. Calcarea ostrearum has particularly the ante- rior fontanelle remaining open ; Calcarea phos. has both anterior and posterior fontanelles open. Hepar Sulphuris Calcarea. Hepar f Belladonna, Lachesis, Merc. Nitri sp. dulc > Arsenicum. > Phosphorus. To-day we begin our study of Natrum muriaticum or common table-salt. This has always been held up to us as an opprobrium against medicine, and as a confirmation of the fallacies of homoeo- pathy. A physician once said to me : " What! will you use a sub- stance which is used in almost every food and call it a medicine, and say that you obtain good effects from it?" I can assure you, gentle- men, as 1 assured him, that Natrum mur. is a medicine, and I can assure you, too, that that very man afterwards became a warm advo- cate of the medicinal virtues of Natrum muriaticum. I tell you that when you potentize a drug you will find that you no longer have to depend upon the ordinary laws of dietetics, hygiene or chemistry, but you step into a realm which is distinct from the laws of chemistry and of physics. Medicines are then no longer subject to the coarser laws. Natrum mur. was re-proved by the Austrian provers, a company of physicians who made heroic provings of some drugs, some of them dying from the effects of their provings, so large and powerful were the doses of the medicines they took. One of the provers, whose name I have forgotten, said, when he published his provings of Natrum mur., that the higher potencies of the drug produced the most symp- toms, and these symptoms, moreover, were more valuable than those produced by the low. It is true of Natrum mur. as of most other drugs, that the high potencies act best. You will notice on the board that I have placed Argentum nitricum and Apis as complementary to Natrum mur. Argentum nitricum 660 A CLINICAL MATERIA MEDICA. holds a complementary relation to Natrum mur. It also, at times, antidotes. It acts as a chemical or as a dynamic antidote according to the quantity of the drug taken. The relation between Apis and Natrum mur. is particularly evident in the treatment of chills and fever, and skin affections. Salt is one of the substances used to antidote the poisonous effects of bee-stings. When natrum mur. has been abused as a condiment, Sweet spirits of nitre may be used as a successful antidote. Some other effects of Natrum mur. are antidoted by Arsenicum, and still others by Phos- phorus. I do not now recall any remedy inimical to Natrum mur. Natrum muriaticum or Chloride of Sodium may be considered first in its physiological relations, so that we may learn something of its value as a medicine. It enters into every tissue of the body, even into the enamel of the teeth. Speaking now physiologically, it is regarded as a stimulant to the various tissues into which it enters. It exists in quite considerable quantities in the various humors of the eye, par- ticularly in the aqueous humor and crystalline lens, and also in the vitreous humor. It has been said that its function here is to preserve the transparency of the respective tissues. Virchow, in his Pathology, quotes an authority who gave Chloride of Sodium to dogs until he produced opacity of the crystalline lens. Hence, cataract may be produced by Natrum mur. Chloride of Sodium in the stomach stimulates digestion and this, too, within the bounds of physiology. It stimulates digestion in various ways. First, it promotes the flavor of food. We all know how insipid certain articles of diet are unless salted. We know from physiology that if a substance has its taste enhanced, its digestibility is also increased. That which is agreeable, digests more readily than that which is unsavory. Salt also acts on the stomach itself by favor- ing the secretion of gastric juice. Salt acts on the glands producing an increase in the glandular secretions. Thus we find it acting on the sudorific glands and also on the mucous glands. Schiissler argues that salt is excreted through the mucus. That is true. Therefore he says that as salt has a function here, it must be the remedy for all catarrhs. That is too sweeping a conclusion for so limited a premise. It is true that if you examine healthy mucus you will find that it contains considerable salt. It is true also that Chloride of Sodium produces an excessive flow of normally consti- tuted mucus. From this you may take a useful hint. Wherever you find a catarrh with a copious secretion of clear normal mucus, there NATRUM MURIATICUM. 661 Natrum mur. can come in as a remedy. We find it acting also on the sebaceous glands. These little glands are quite numerous in cer- tain parts of the body, particularly around the wings of the nose and the cheeks. Their function is to lubricate the skin. Natrum mur. stimulates these. The skin becomes oily in appearance. We notice this particularly in the face, in the scalp, and more than likely, in other parts of the body. Salt also has a stimulating effect on the nervous system, keeping up its tone. Muscular tone is also favored by the presence of salt within the tissues of the muscles. This brings me to hint to you that common salt may be used as an external application in weaknesses of the muscles and nerves that favor deformities of the limbs. When you first notice that a child is ^valking on the side of its feet, or when you meet with a case of post-diphtheritic paralysis, you may use friction with salt to great advantage. I do not mean to say that it will cure all deformities, for some arise from inflammation of the anterior gray cornua of the cord. Chloride of Sodium cannot cure then, for this trouble is due to organic disease. Again, we may frequently use salt in the form of the sitz-bath for obstinate amenorrhcea. We shall frequently find Natrum mur. indicated when the blood is impoverished. The nutrition of the whole system, therefore, suffers. We find it indicated in anaemia, particularly in anaemia provoked by loss of fluids, hence often with women who suffer from menstrual dis- ease and with men who suffer from loss of semen. We shall often find it indicated in scorbutic states of the system when the patient suffers more or less from scurvy. It is quite likely that the prolonged use of salt meat is a common cause of scurvy. In these cases the mouth becomes sore, ulcers form on the tongue and on the gums, and the breath has a foetid odor. The tongue presents a mapped appear- ance. This symptom we find in other remedies, as Arsenicum, Rhus tox., Kali bichromicum and Taraxacum. Again, as a result of this impoverishment of the blood, we find the nervous system suffering secondarily. Natrum mur. may be given for the following symptomatic indica- tions: The patient is emaciated, and this emaciation is very marked The skin is rather harsh and dry and of a yellowish hue. The patient feels greatly exhausted from any little exertion of mind or body. On account of the anaemia we have the circulation readily excited, so that every little exertion produces throbbing all over the body. The pa- 662 A CLINICAL MATERIA MEDICA. tient suffers frequently from palpitation of the heart, and this, too, is excited by every emotion. It is often described by the patient as a sensation as though a bird's wing were fluttering in the left chest. Mentally, we find these patients sad and tearful. You will seldom find Natrum mur. indicated in chronic affections unless there is this low-spirited condition of the mind. The patient seems to be made worse by any attempt at condolence. Consolation may even make her angry. This tearful condition is accompanied by palpitation of the heart and intermittent pulse. Now, this intermittent pulse does not necessarily imply organic disease of the heart, but simply a nervously weak heart. At other times you will find the patient decidly hypochondriacal, just as we have already found with Natrum carb. This hypochondri- asis is directly associated with indigestion, as in Natrum carb. But there is this difference: With Natrum mur., the remedy under consid- eration, this hypochondriasis keeps step with the degree of constipation, not alone with the indigestion, as in the other. In addition to this melancholy mood we also have irritability devel- oped by Natrum mur. The patient becomes angry at every little trifle. He stores up in his mind every little real or imaginary offence. He wakes up at night with palpitation of the heart and cannot go to sleep again, because past unpleasant events occupy his mind. Intellectual ability is impaired. He becomes disinclined for mental work; makes mistakes, as if confused; loss of memory; study aggra- vates. Frequently school girls suffer from headache, as if little ham- mers were pounding the head, whenever they study. Excitable, laughs immoderately at something not ludicrous; fingers move involuntarily, as in chorea; trembling of the limbs; muscular jerks; awkward; she drops things. Now add to these chronic symptoms the following, and you have a complete picture of Natrum mur. Excitement is always followed by melancholy, anxiety, fluttering at the heart, limbs go to sleep, with " crawling " even in the lips and tongue; limbs heavy, espe- cially in anaemic girls, whose faces are yellow, skin dry and shriveled, and menses scanty or checked. Mental emotions cause such weakness that one or more limbs are useless. While on this subject of the nerves we may as well add the remain- ing symptoms: Spinal irritation ; backache relieved by lying on some- thing hard; small of back pains, as if broken; paralyzed feeling in lumbar region, worse in the morning after rising; tongue stiff, clumsy speech; joints weak, especially the ankles, worse in the mornings. NATRUM MURIATICUM. 663 This last symptom accompanied by imperfect nutrition, grows thin in spite of good appetite, has led to the successful topical and and inter- nal use of salt in children with weak ankles; the feet turn under while walking. Now, in mental symptoms, Natrum mur. runs against several drugs. One of these is Pulsatilla, which is the most lachrymose remedy of our materia medica. But Pulsatilla has rather a tender, yielding dis- position, that likes consolation. The more you console her the better she likes it. Sepia is more similar to Natrum mur. than is Pulsatilla, in that both remedies have this low-spiritedness and vehement angry disposition combined. Both have Indian-like hatred of those who have injured them. In fact, these remedies are complementary to each other. The Sepia patient, however, has marked indifference to her household affairs. The patients who suffer from these mental symptoms calling for Natrum mur. are generally chlorotic. They suffer from leucocythaemia. The menses are often late and scanty, or else cease altogether. Wrhen the menses have not entirely ceased and are scanty they are accompa- nied by such marked symptoms as these: Decided increase of the sad- ness before menses; palpitation of heart, which, too, is apt to be of this fluttering variety, and throbbing headache, which headache continues persistently after the menstrual period. The Natrum mur. patient fre- quently suffers too from uterine displacements. She has quite charac- teristically prolapsus uteri, which is particularly induced when she gets up in the morning. The symptom reads, "When she gets up in the morning, she must sit down to prevent prolapsus." This is a func- tional disease altogether. There is no organic change in the uterus, but there is great relaxation in the ligaments which support that organ. As she arises in the morning, relaxed instead of refreshed after her night's sleep, the uterus falls and she has to sit down to pre- vent this dragging. You will find these uterine symptoms accompa- nied by backache and decided spinal irritation, which is greatly relieved by lying flat on the back or by pressing a pillow firmly against the back. That I have confirmed over and over again for Natrum mur. In addition, jou will have a characteristic symptom of the bladder that is just as often present as is thf prolapsus itself, and that is, cutting in the urethra after urination. That symptom, I have seen successfully applied many times. Backache and morning aggravation are symptoms which will aid you in the selection of Na- trum mur. 664 A CLINICAL MATERIA MEDICA. Natrum mur. produces a headache, worse from any use of the mind. In the morning on awaking, there is throbbing, mostly in the fore- head, as if from many little hammers beating in the head. This, too, is worse from any use of the mind. The pain is so severe at times as to make the patient almost maniacal. With this kind of headache, the tongue is dry and almost clings to the roof of the mouth, although it may look moist when put out. There is great thirst. The pulse is almost always intermittent. This helps you to distinguish it from its complement, Sepia, which has a similar symptom. I do not want you to forget that sharp headache of Sepia, that sharp pain in the lower part of the brain, apparently in the meninges, shooting upwards. The patient can bear neither light nor noise. The pain is usually attended with nausea and vomiting as a secondary symptom. Natrum mur. also produces a headache simulating that of Bryonia; sharp stitching about the head and sore bruised feeling about the eye- balls, especially when the eyes are moved. I may say that these head- aches of Natrum mur. are particularly common in school children at the age of ten or eleven. Calcarea ostrearum is also a good remedy here. You may have occasion to use Natrum mur. in ciliary neuralgia, especially when the pains are periodical, returning from sunrise to sunset, being worse at mid-day. Spigelia is a drug which also has headache or ciliary neuralgia, coming and going with the sun and worse at mid-day. Gelsemium and Glonoin have not so much neuralgia as throbbing in the head, which grows worse and worse with the sun. Natrum mur. also causes headache with partial blindness; here it resembles Kali bichromicum, Iris and Causticum. Natrum mur. has a very powerful influence on the various portions of the eyes. Now, all over the body, the drug produces weakness of the muscles. This is especially manifest in the muscles of the eyes. The muscles of the lids feel stiff when moving them. Letters blur and run together when looking steadily at them, as in reading. You see that there is marked asthenopia. Natrum mur. is especially indi- cated when the internal recti muscles are affected. These asthenopic symptoms depend upon a general break-down. The spine is weak and irritated, digestion is slow and imperfect, and nutrition is not as rapid or as complete as it should be. Another form of eye disease in which Natrum mur. is indicated, is scrofulous ophthalmia. You will be called upon to use the drug in NATRUM MURIATICUM. 665 such cases when nitrate of silver has been abused. There are smart- ing and burning pains and a feeling as of sand beneath the lids. The tears are acrid and there is very marked spasmodic closure of the eye- lids. You can hardly force the lids apart. Ulcers form on the cornea. The eyelids themselves are inflamed and agglutinated in the morning. In addition to these eye symptoms, these scrofulous children suffer from eruptions particularly marked at the border of the hair. Scabs form on the scalp and from these there oozes a corrosive matter. There are moist scabs in the angles of the lips and wings of the nose, and with these, emaciation. In scrofulous ophthalmia you should compare with Natrum mur., Argentum nitricum, Arsenicum and Graphites. For scabs in the corners of the mouth and wings of the nose, com- pare Antimonium crudum, Graphites and Causticum. Natrum mur. also causes half-sight. Here you should compare Aurum, Lithium carb., Lycopodium and Titanium. Natrum mur. acts on the mucous membranes. We find it indicated in catarrhs with mucous secretion abnormal in quantity rather than in quality. This hypersecretion of mucus is accompanied by paroxysms of sneezing. Fluent alternates with dry coryza. Every exposure to fresh air gives the patient cold. The wings of the nose are apt to be sore and sensitive. There is almost always in the Natrum mur. catarrh, loss of smell. Natrum mur. is one of the best remedies for hawking of mucus from the throat in the morning, when the symp- toms call for no other remedy. The tonsils are often very red. The uvula is elongated, probably from relaxation of its muscles. There is a constant feeling as of a plug in the throat. The patient chokes easily when swallowing. The tongue is coated in insular patches. The cough arises from the accumulation of clear mucus in the poste- rior nares, pharynx and larynx. Of course, there is hoarseness. Another form of cough calling for Natrum mur., is cough arising from tickling in the throat or at the pit of the stomach. This kind of cough is accompanied by bursting headache, here reminding one of Bryonia, and sometimes, by involuntary spurting of urine, as we find under Scilla and Causticum, and often, too, by stitches in the liver. Natrum mur. has marked action on the male genital organs. It causes great weakness of these, giving rise to seminal emissions during sleep. These are followed by debility and great weakness. The geni- tal organs are greatly relaxed. Wet dreams may even occur after 43 6Q6 A CLINICAL MATERIA MEDICA. coitus. That may seem to you an anomalous symptom, but it is not. During the act of coitus, erections are not strong and the ejaculation of semen is weak or even absent. The consequence is, there is not an entire emptying of the seminal vesicles. There is still irritation re- maining there. When the man goes to sleep, this irritation, by reflex action, excites lascivious dreams. As consequences of the excessive seminal loss, we find backache, night-sweat, weakness of the legs and the melancholy which is characteristic of the remedy. Natrum mur. is not alone among the soda salts in this class of ailments. Natrum phos. was proved by gentlemen in this college. They had seminal emissions every night. At first, there seemed to be erethism with lascivious dreams, but later, emissions took place, one or two in a night, without any sensation whatever. These were followed by weakness of the back and by trembling of the knees, which felt as though they would give way. You will find, too, that gonorrhoea is curable by Natrum mur., espe- cially when chronic. The discharge is usually clear (it may be some- times yellowish). There is well-marked cutting iu the urethra after urination. It is especially indicated in cases that have been abused by the Nitrate of silver. Nutrition is greatly impaired under Natrum mur. as I have already told you. Emaciation is marked in almost every case in which it is the similimum. We may make use of this fact in children who suffer from marasmus from defective nourishment. They are thin, particu- larly about the neck.* They have a ravenous appetite and, despite this, they grow thin, at least they do not grow fat. Here you find it comparable with Iodine, but the peculiar emaciation of the neck, dis- proportionate to that of the body, is sufficient to distinguish it from that drug. In addition to this, you may have, at times, well-marked thirst. The child craves water all the time. This is what the laity term inward fever. There is constant heat and dryness of the mouth and throat, which the water relieves. If there is constipation when Natrum mur. is the remedy, there is a very characteristic stool, hard, difficult to expel, Assuring the anus and, as a consequence, there is bleeding with the stool. Of course, smarting and soreness is the result of this laceration of the anus. Natrum mur., like the other salts of soda, is a first-class remedy in the treatment of dyspepsia. We find it indicated when farinaceous * Veratrum album has emaciation about the neck, especially in whooping-cough. NATRUM MURIATICUM. 667 food, particularly bread, disagrees. The symptom reads, " He is averse to bread of which he was once fond." On the other hand, there is crav- ing for oysters, fish and salty food or for bitter things. After eating, the patient is very thirsty. There is a distressed indescribable feeling at the pit of the stomach. This is relieved by tightening the clothing, just the opposite to Lachesis and Hepar, and precisely the same as Fluoric acid. The constipation, which I have described, causes hypo- chondriasis. The patient is low-spirited and ill-humored, and this mental condition seems to keep pace with the degree of constipation. When the bowels are moved, the mind is relieved. You must use this symptom rationally. Those who have been accustomed to taking purga- tive medicines will almost always feel badly if their bowels remain costive longer than the usual time. They have dull headache, nasty taste in the mouth, etc., and when the bowels move, they feel better. Here, Nux vomica is the remedy. It is not often that undisturbed con- stipation produces this condition of mind, but when it does, Natrum mur. is the remedy. The rectum suffers from tenesmus with slimy discharge as in chronic proctitis. Prolapsus ani with discharge of bloody mucus and water, and burning preventing sleep; dryness and smarting of rectum and anus, with tendency to erosions of the mucous membrane. Sensation of a rough substance in the rectum and yet bowels are loose.* Constric- tion of the anus, faeces hard and evacuated with such exertion as to tear the anus. Chronic watery diarrhoea with dry mouth, secondary to dry stool.f We find Natrum mur. indicated in affections of the coarser tissues, for instance, of the skin. I have already told you how it affects the sebaceous glands. We find that it produces urticaria. The itching is very annoying. It occurs about the joints, particularly about the ankles. Wheals form on different parts of the body and these itch, smart and burn. Especially do we find Natrum mur. indicated when these symptoms accompany intermittent fever, or occur after exposure to damp cold, especially at the seaside. Exercise makes this nettle-rash intolerably worse. Just here, we find Natrum mur. complementary to Apis. * Compare Sepia, which has lump in rectum ; JEsculus and Collinsonia, that have sensations as of splinters or sticks in the rectum. f This dry state resembles Alumina, Graphites, Magnesia mur., Ratanhia, JEsculus, etc. Oraphites has mucus-coated stools; Alum has smarting soreness. Magnesia mur., crumbling stools; Ratanhia, feeling of splinters of glass ; fissures. 668 A CLINICAL MATERIA MEDICA. Apis is an excellent remedy in the treatment of urticaria, but it is not so good, I have found, in the treatment of the chronic form of the disease. Here we have to use other drugs, as Natrum mur., and above all, Calcarea ostrearum. There is another form of eruption yet to be thought of for Natrum mur., and that is herpetic eruptions. Thus, we find particularly char- acteristic of Natrum mur., what are called hydroa-labialis. They are little blisters which form on the borders of the lips and which accom- pany every marked case of chills and fever indicating Natrum mur. They are akin to what are commonly known as fever blisters. Hepar, Natrum mur. and Rhus tox. are the remedies which have this symp- tom most marked. Arsenicum also has it. In the very beginning of these cold sores, the application of camphor will stop the trouble. If however, they are well advanced, Hepar relieves them and prevents their return. Camphor is not a curative remedy, but Hepar is. Herpes circinatus, a variety of ring-worm, calls for Natrum mur. Other remedies for this trouble are Sepia, Baryta carb. and Tellurium. Another form of eruption calling for Natrum mur. is eczema, which appears in thick scabs, oozing pus, and matting the hair together, a crusta lactea in fact. Lastly, I come to speak of the well-known application of Natrum mur. to intermittent fever. There it shares the honors long accorded to Cinchona and Arsenic. Natrum mur. is to be considered when the chill comes characteristically between ten and eleven a.m. The chill begins in the small of the back or in the feet. It is accompanied sometimes by thirst, and by aching pains all over the body. Some- times urticaria complicates the case. Fever is usually violent. Thirst increases with the heat. The headache becomes more and more throb- bing. So severe is this cerebral congestion at times that the patient becomes delirious. By and by, sweat breaks out quite copiously and it relieves the headache and also the other symptoms. This is the chill curable by Natrum mur. When chill occurs at 10 a.m., as a result of hectic fever or phthisis, Stannum is to be used and not Natrum mur. LECTURE XLVIII. BORAX VBNBTA. f Staphisagria, Mercurius. Borax. < Sepia, Pulsatilla. (^ Bryonia. > Chamomilla, Coffea. \Vinegar. /Wrine. Borax is the biborate of soda. As a medicine, it won its first laurels in the nursery, where it has long been used in the treatment of sore nipples and children's sore mouth. Like all popular remedies, it has been greatly abused. Homoeopathy has rescued it from the nursery and now offers it to the profession as a medicine of great value, telling when it may and when it may not be used. Underlying this sore mouth, which seems to be the keynote for the use of Borax, is a system or constitution which will permit of the sore mouth, that is, an illy- nourished system. Thus the infant becomes pale or of an earthy hue, its flesh grows soft and flabby; it cries a great deal when it nurses, screams out during sleep and awakens clinging to its mother as if frightened by a dream. The child is excessively nervous, so much so, that the slightest noise, the mere rustling of paper, or a distant heavy noise, will arouse and frighten it. This nervous excitability qualifies the pains. For instance, in the earache, you will find that each paroxysm of pain causes the child to start nervously. This earache is accompanied by soreness, swelling and heat of the ear, just as you find in Belladonna, Pulsatilla and Chamomilla. There is a mucous or muco-purulent otorrhcea. Borax is distinguished from these similar remedies by this character of the nervousness, this starting with the pain or with slight noises, by the paleness of the face and above all by another well-proved symptom, the child dreads a downward motion. Thus if the little one is soundly asleep in its mother's arms and she makes the attempt to lay it down in its crib, it gives a start and awakens. If she attempts'to carry it down stairs, it will cling to her as if afraid of falling. This must not be confounded with the excita- 670 A CLINICAL MATERIA MEDICA. bility of other medicines, as Chamomilla and Belladonna. It is not the motion that awakens the child. The child will not awaken if it is moved without any downward motion. It must, then, be the down- ward motion that arouses it. The reason for this is, that the child is suffering from cerebral ansemia and this downward motion causes a feeling as though it were going to fall. This symptom may also be utilized in adults, as, for example, in the case of invalids who have been ordered to take horseback rides, but who cannot do so, because when the horse lets them down, they feel as if they were in torture. You will also find that ladies, after some exhausting disease, cannot use a rocking-chair, because when they rock backwards, they feel as if they would tumble. The digestion in the Borax case is impaired, as you might infer from the defective nutrition. Colic precedes the diarrhoea in the child I am describing. The stools are usually green, or they may be soft and yellow, but they always contain mucus. Here you have another illus- tration of the affinity of Borax for mucous membranes. Aphthous inflammation of the mouth appears as a concomitant of the diarrhoea. Aphthae form in the pouches on the inside of the cheeks, on the tongue and in the fauces. The mouth is hot, which the mother notices when the child takes hold of the nipple. The mucous membrane around these aphtha? bleeds easily. The child lets go of the nipple and cries with pain and vexation, or else refuses the breast altogether. Similar to Borax are the following remedies: First, Bryonia; this remedy has caused and has cured infants' sore-mouth. But the char- acteristic symptom in Bryonia is this: The child refuses to nurse or makes a great fuss about it, but so soon as its mouth is moistened, it takes hold of the nipple and nurses energetically. Is not this in keep- ing with the character of Bryonia ? Those of you who know anything of that drug will remember how dry the mouth is, and how devoid of secretion is the mucous tract. Hence, when the mucous membrane of the mouth is moistened the child nurses at once. Mercurius comes in as a substitute for the Borax when, with the sore mouth, there is very often salivation. Water dribbles from the child's mouth. The diarrhoea is accompanied by well-marked tenes- mus. These are sufficient distinctions between Mercury and Borax. Again, you must remember a forgotten remedy, and that is Aethusa cynapium, or the fool's parsley. This is to be preferred when the colic and cryiug are accompanied by the violent vomiting characteristic of this drug. BORAX. 671 Another remedy is Arum triphyllum. This is readily distinguished from Borax by the violence of the symptoms. The inflammation of the mouth is exceedingly violent and is accompanied by soreness and scabs around the mouth and nostrils. Another common baby symptom in the Borax case is that the infant screams before urinating. The urine when passed is hot and has a peculiar pungent foetid odor. Now this is not to be confounded with gravel, which is not uncommon in little children, and which will call for Sarsaparilla, Lycopodium, Benzoic acid, etc.; but it is the equiva- lent of the inflammations of other mucous membranes, so that it com- pares with Aconite, Cantharis and another excellent baby medicine, Petroselinum. Do not forget this last-named drug. It is not generally mentioned in our materia medicas, yet it is an excellent remedy. You should give Petroselinum for conditions very similar to those calling for Borax when there is sudden violent urging to urinate. It may be indicated even in gonorrhoea when this sudden urging is present. Passing from child to adult, we find that although the aphthous condition is still master, we still have many of the other symptoms of Borax, the same difficulty in digesting food, the same weakness, and the mucous membranes still the point of attack. We find, for instance, the conjunctiva, particularly the palpebral portion affected by Borax, giving you soreness especially marked along the borders of the lids. The eyelashes grow inwards instead of outwards and irritate the eye- ball. You should remember it as a remedy which will sometimes help 'in trichiasis or " wild hairs," and here you should compare it with Graphites. The nostrils ulcerate in the Borax case, causing a great deal of sore- ness, pain and swelling of the tip of the nose. On the mucous membrane of the throat we find Borax having an action, being indicated, like all the soda salts, for accumulation of mucus there. But under Borax, this mucus is tough and difficult of detachment. The leucorrhcea of Borax is clear, copious and albuminous. Like all the other secretions of Borax, this, too, has an unnatural warmth or heat to it. The action of Borax on the lungs must not be forgotten. We fiud it indicated when there is cough which is accompanied by sharp stick- ing pain, worse through the upper part of the right chest. So sharp are these pains that they make the patient catch his breath. The ex- pectoration has a sort of musty, mouldy odor. You can often use 672 A CLINICAL MATERIA MEDICA. Borax in lung troubles and even in phthisis when these symptoms are present. Lastly, we have to mention a few symptoms of the skin. The skin is unhealthy; every little cut or scratch suppurates readily. There is itching of the skin, particularly on the backs of the fingers, here being something akin to the dorsal eczema of Natrum carb. Little ulcers form about the joints of the fingers. The best remedy we have for these small ulcers about the joints is Sepia. Lastly, Borax has been used in erysipelas of the face, particularly of the cheeks. The distinctive character of the drug is a feeling as though there were cobwebs on the face. I would advise you to caution your nurses, if you can do so, not to use powdered borax every time the child has a sore mouth. It may do harm if it is not indicated. I think that I have noticed after this use of the drug that the bowels suffer and the child grows paler and dwindles rapidly, which it did not do before the meddlesomeness of the nurse. LECTUKE LXIX. SALTS OF POTASH. Toxicologically, potash may be of some interest to you when, by accident, caustic potash is swallowed. Its great affinity for water makes it attack the tissues with great avidity, producing very deep escharotic effects. It has more power to penetrate the tissues than have some of the other caustics, nitrate of silver for instance; hence, it has been selected as the caustic for use when it is desired to reach far into the parenchyma of a part, as in the treatment of carbuncle; when a large portion of tissue has become gangrenous and a slough must be pro- duced, caustic potash is used. The tissues thus acted upon have a greasy appearance, which is due to the formation of a soap made from the combination of the fats with the potash. Thus it differs materially in its action from the mineral acids, which make the tissues dry and dark, almost like a mass of tinder. When swallowed by accident, for it is seldom used for suicidal pur- poses, the effects of caustic potash are violent. It causes such violent contraction of the stomach that what little of it gets that far is imme- diately ejected by violent vomiting. If the amount of caustic taken is sufficient, it causes a brownish film over the mucous membrane, or there may be spots here and therein the mouth and throat which are denuded of their epithelium. The inflammatory process may increase to such an extent that these spots ulcerate, and as they heal they form cicatricial tissue with the subsequent unfortunate contraction and stricture of the part. The antidotal treatment to such accidents is both chemical and mechanical; chemical, to relieve the effect of the drug, and mechanical, to relieve the trouble that remains. Vinegar, lemon-juice and large draughts of mucilaginous drinks are mostly relied upon to relieve the acute symptoms of this poisoning. But there are many cases of slow poisoning with the potash salts, particularly when our allopathic friends use bromide of potassium so extensively. We, therefore, have the chronic effects of this to treat. These may require to antidote them : Hepar, which is an antidote to 674 A CLINICAL MATERIA MEDICA. the metals in general; Sulphur, and other remedies may be called for according to the symptoms present. It has been determined by experiments on mammals, that potash, particularly the carbonate, acts paralyzingly on the muscles. This accounts for the general weakness which belongs to all potash pre- parations. This paralyzing effect is very manifest in the case of the heart muscle, which becomes early affected in poisoning with potash, the animal eventually dying with the heart in diastole, that is, the heart is widely dilated at the moment it ceases to beat. With this hint, you would expect to find potash salts of use iu great muscular weakness, in what has been termed paresis, such exhaustion as accom- panies convalescence from protracted disease as typhoid fever. We have it on the authority of Dr. Hering, that mushrooms contain a large percentage of potash, and are therefore to be recommended as au article of diet in cases of exhaustion. Kali Bromatum. The first potash preparation we will consider is Kali bromatum or Bromide of Potassium. We find that this drug is antidoted by Hepar mainly. It has some few analogous or concordant remedies, Ambra grisea, Hyoscyamus, Stramonium, Tarentula and Mygale. Bromide of Potassium acts mainly upon the nervous system and acts, too, in two opposite directions. Primarily, it decreases reflex action; secondarily, it depresses the mind. This property of the drug to modify reflex action has led to its extravagant use in the treatment of epilepsy. It is given in progressively increasing doses until the system is affected by what is -known as bromism. When the system has be- come saturated with the drug, then it is discontinued for awhile. The first effect of the drug seems to be to increase reflex action, particularly reflex motor action, and it is on this quality of the Bromide of Potassium that the allopath bases his prescription. Every little disturbance in the periphery of the nerves, every little alteration in the function of an organ, is at once reflected to the nervous centres, and produces some other disturbance, either an uncomfortable sensation, twitching of muscles, anxiety, headache or even absolute convulsions. This is the first condition of the Bromide of Potassium. You know that this is the starting point of almost all convulsions. Witness for instance, a case of eclampsia, where the pressure of the child on some of the nerves in the pelvis or against an undilating os, causes spasms; or still another case, where some indigestible substance in the stomach produces con- KALI BROMATUM. 675 vulsions. This reminds you at once of Stramonium, in which a bright light, by affecting the retina, reflects the irritation to the brain and causes convulsions. As a result of this oversensitiveness to external impressions, we have quite a number of characteristics of the Bromide of Potassium. Many of these are symptoms of the drug calling for its exhibition in acute mania', when there are sleeplessness and strange imaginations. The patient imagines that he will be poisoned; that he is pursued by some demon; that he is hated by everybody, or that his honor is at stake. Some such impression acts on the mind irresistibly, and causes him to resort to violent procedures; thus, he will try to commit suicide in order to avoid the supposed danger. All this time, the pupils are dilated, and the face bright red and expressive of anguish and fear. The body trembles, and the muscles twitch in various parts of the body- You see how this resembles Hyoscyamus, both being parallel remedies in this form of disease. Kali bromatum has also acted very well in the night-terrors of chil- dren, when from over excitement of the brain, whether it be reflex from dentition or worms, or even from affection of the brain itself, the child shrieks out in its sleep, and if old enough, will complain of seeing hob- goblins, ghosts or something of that kind. Even when that symptom occurs in impending dropsy of the brain, Bromide of Potassium may be the remedy. We have another condition calling for Kali bromatum, and this seems to be an irritability of the nerves, not only of the brain, but of the whole body. This irritability is expressed by the following symp- tom : The patient is nervous aud cannot sleep, and feels better when engaged at some work. He is either busy playing with his fingers or he is walking about, or in someway occupying his mind or body in some exertion ; then he feels better. Simple sleeplessness will not be relieved by Kali bromatum unless there is this relief from activity or motion. In this respect, I find it similar to Tarentula, which also has this irritation of the periphery of the nerves relieved by exercise and by rubbing. The patient plays with her dress, or with her watch-chain? as if to work off this over-irritation of the peripheral nerves. Even in the case of the headache of this remedy, the patient rubs the head against the pillow for relief. Another remedy which is similar to Kali bromatum in this over- excitability, is Ambra grisea, which has this same sensitiveness to 676 A CLINICAL MATERIA MEDICA. external impressions, the slightest influence causing excitement and difficulty in breathing. Ambra grisea, however, almost always has some sort of vertigo associated with its other symptoms. It is a very quick-acting drug. Conversely to this primary action of Kali bromatum, we have an- other, one of great depression of the cerebro-spinal nervous system, Thus we find it producing absolute loss of memory. The patient can- not remember words particularly. Associated with this symptom we find a distressing melancholy; everything looks dark and gloomy. He cares nothing for anybody or for his occupation. This condition of things often follows excesses in venery, in which case Kali bro- matum is an excellent remedy. There is also a sort of ataxia developed. The patient seems to be unable to manage his legs as he should. There are numbness and tingling in the legs and in the spine; this symptom being accom- panied, in the first stages, by an increase in the sexual appetite, but as the case advances it is associated with absence of erection and, too, frequent nightly emission of semen, thus increasing the melancholy. You will find Bromide of Potassium indicated for business men who have worked long and hard, who have pored over difficult pro- blems until they have this dizziness, this staggering when they walk, and this benumbed feeling in the brain. It was only yesterday that I prescribed it for a business man on Third street, who has been work- ing himself almost to death. I expect that it will relieve him promptly and effectually. He said that when he had been working at his books he would get a numbness in the back of the head, and a certain indescribable terrified feeling, as though he was going to lose his senses. Good results might also be obtained in this case by the galvanic current, the positive electrode being applied to the cervical region and the negative on the vertex. But Kali bromatum will give a more permanent relief. Now, a word about Kali bromatum as an anti-epileptic remedy. I do not believe that it ever cured epilepsy. In almost all cases in which it has been given, it has not cured but simply suppressed the disease, and thus has produced a worse condition than the one pre- viously existing, namely, imbecility. Kali bromatum produces lesions of the skin. Its long-continued use gives rise to little, hard, dark red papules on the face, surrounded by little vesicles and ending in suppuration. We may, therefore, use the drug in acne, particularly that resulting from masturbation. KALI HYDRIODICUM. 677 Another form of eruption which the Kali bromatum produces is a livid blotch as large as one's thumbnail, covered with scales, and hav- ing in its centre a yellowish appearance as if it were suppurating. After a while it does suppurate and discharge, leaving a central de- pression, something like that of the small-pox pustule. Still a third form of eruption, is an eczema which evidently arises from the action of Kali bromatum on the sebaceous or sudoriferous glands, causing an abscess in each of these and developing a scaly eruption. Kali Hydriodicum. The Iodide of Potassium, or Kali hydriodicum, does not, like the Bromide of Potassium, act on the higher tissues of the body. It seems to affect more the lowest tissues, as the fibrous, acting particularly on the periosteum and the connective tissue wherever they may be found. It attacks the nervous tissues ultimately, probably by involving the neuroglia. The tendency of. the drug is to produce infiltration, so that when it is thoroughly indicated you will almost always find an oedematous or infiltrated state of the part affected. Some of the symptoms produced by Iodide of Potassium are due directly to the Iodine which it contains. For instance, what is known as iodine intoxication may be developed by the drug. The patient exhibits a great deal of anxiety about the heart, the face is flushed, the head is hot, and the patient very talkative ; in fact, he acts pretty much the same as would a man under the partial influence of liquor. The headache which Kali hydriodicum causes is one of external head, probably from the action of the drug on the aponeurosis of the occipito-frontalis muscle, because there appear hard lumps like nodes on the scalp and these pain excessively. This may be a remote symp- tom of syphilis or of mercurialization, or it may appear in a patient with the rheumatic diathesis. In affections of the eyes Kali hydriodicum is called for principally by the violence of the symptoms, especially in syphilitic iritis after the abuse of mercury. Now, if mercury has not been abused, I do not consider the Iodide of Potassium to be the best remedy. If there is any best remedy for iritis it is Mercurius corrosivus. We may also use Kali hydriodicum for inflammation involving both choroid and iris, the result of syphilis. More externally we find pustular keratitis, with chemosis, especially after the abuse of mercury. Coming next to the nose, we have the following indications for the Iodide of Potassium: Coryza or catarrh, occurring repeatedly in 678 A clinical materia medica. patients who have been mercurialized; every little cold or exposure or every damp day causes the nose to become red and swollen ; an acrid watery discharge flows from it, and the eyes smart and lachry- mate, and become puffed. The patient is alternately chilly and hot, the urine is high colored (as the patient expresses it) and scanty, and there is usually some sore throat. Every exposure provokes a return of these symptoms. Kali hydriodicum also cures this thin excoriating nasal discharge when it appears as an inheritance from syphilitic parents. The ozajna which it cures is either scrofulous, syphilitic or mercurial, or a combi- nation of all these. The discharge may be either thin and acrid, or else thick, green and offensive, and attended with burning sensation in the nose and even perforation of the nasal bones. Next,the action of Iodide of Potassium on the lungs and heart: It is not a little singular that all the preparations of Mercurius pro- duce sharp, stitching pains through the lungs (through either the right or left lung, and shooting in different directions), and that the very best antidote to mercury also produces stitching pains through the lungs, particularly through the sternum to the back; worse from any motion. Now, there are two very different conditions in which Iodide of Potassium is to be here thought of. One of these is in pneumonia, in which disease it is an excellent remedy when hepatiza- tion has commenced, when the disease localizes itself, and infiltration begins. In such cases, in the absence of other symptoms calling dis- tinctively for Bryonia, Phosphorus or Sulphur, I would advise you to select either Iodine or Iodide of Potassium. It is also called for when the hepatization is so extensive that we have cerebral congestion or even an effusion into the brain as the result of this congestion. Now, the symptoms in these cases are as follows: First, they begin with very red face, the pupils are more or less dilated, and the patient is drowsy; in fact, showing a picture very much like that of Bella- donna. You will, in all probability, give that remedy, but it does no good. The patient grows worse, the breathing becomes more heavy, and the pupils inactive to light, and you know then that you have a serious serous effusion into the brain, which must be checked in a short time or the patient dies. Why did not Belladonna cure? He who would prescribe by the symptoms alone in this case would fail, because he has not taken the totality of the case. The trouble did not start in the brain. The cerebral symptoms are secondary to others. What, then, is the primary trouble? You put your ear to the patient's chest, KALI HYDRIODICUM. 079 and you find one or both lungs consolidated; hence the blood cannot circulate through the lungs as it should, and the different organs in the body become congested. So, until you have proved Belladonna has produced such a condition, you cannot expect it to do any good. Another condition in which we may use Iodide of Potassium is in pulmonary oedema, thus again showing you the infiltration producible by the drug. This is almost always, as you know, a secondary trouble. The expectoration looks just like soapsuds, only it is apt to be a little greenish. We may also have Kali hydriodicum indicated in phthisis pulmo- nalis, particularly if there is present this same sort of frothy expecto- ration, night-sweats, and loose stools in the morning. The cough is of a violent racking, tearing character, and is worse in the morning, thus keeping up the character of the potash salts, to have aggravation of chest symptoms from two to five o'clock in the morning. I may say that these symptoms of the lungs are often consecutive to Bright's disease, in which disease Kali hydriodicum may be the remedy. Yerba santa is used by eclectics for phthisis of catarrhal origin. It is used empirically. There is a gentleman who has a tendency to catarrhal asthma, with thickening of the bronchial tubes and constant oppression of breathing. I treated him for a year. Sulphur seemed to be indicated, but was given with only partial relief. Finally, I gave him Yerba santa in the tincture. It so far relieved him that every morning he coughed up a quantity of sputum, and there then followed a freedom of breathing he had not had for years. The action of Kali hydriodicum on the heart is also characteristic. It produces a horrible smothering feeling about the heart, awakening the patient from sleep and compelling him to get out of bed. This symptom is also found under Lachesis. Kali bichromicum, Lactuca, Euphrasia, Graphites, and some others. It is also useful for repeated attacks of endocarditis or pericarditis of rheumatic origin. There are sharp, darting pains in the heart, worse from any motion, and particularly bad from walking. In diseases of the spine you will find Kali hydriodicum indicated by these symptoms: Feeling as if the small of the back were being squeezed in a vise; bruised pain in the lumbar region and difficulty in walking; spinal meningitis with oedema or exudation, particularly when of syphilitic origin. When gummatous tumors involve the nervous tissues Iodide of Potassium is your only hope. 680 A CLINICAL MATERIA MEDICA. • It may also be of use when rheumatism involves the spine and para- plegia results. In these cases I think that it is the neuroglia that is attacked. It may still further be used in rheumatism of the joints, particularly of the knee. The knee-joint is swollen and has a doughy feel; here again, you see the tendency of the remedy to produce infiltration of tissue. There is no fluctuation to be detected. The skin about the inflamed joint is apt to be spotted, and the pains are of a gnawing boring character, and are worse at night. In sciatica you may give Kali hydriodicum when the pains are worse at night, and'from lying on the affected side, and when the trouble is of mercurial or syphilitic origin. You will find that the Iodide of Potassium will help you in the treatment of the so-called contracted kidney, especially when of mercu- rial origin. Iodide of Potassium, like all the potash preparations, produces an eruption of a papular or of a pustular character. Especially do these appear on the scalp and down the back; when they heal they leave a cicatrix. You may also remember Iodide of Potassium as a remedy for tertiary syphilis, particularly rupia. The best antidote to Iodide of Potassium is Hepar. LECTUEE LXX. KALI BICHROMICUM. To-day, I shall lecture on Kali bichromicum, or the Bichromate of Potash. You would expect, in a drug having the combination of this one, to obtain not only the results of potash, which forms the base of the salt, but also the modifying influence of the chromic acid. You will find, therefore, that while there are evident general resemblances to the other Kalis, there are decided differences arising from the acid combined with it. Chromic acid, as you probably well know, is a highly irritating acid. It is a powerful escharotic, destroying animal tissue very rapidly, and penetrating quickly into the part, and so pro- ducing a deep ulcer or sore. Kali bichromicum is a drug which acts generally, although not ex- clusively, on fat persons, especially on fat, chubby children more than on adults. We find that it possesses great virtues in inflammation of mucous surfaces, with tendency to plastic exudation and pseudo-mem- brane. It attacks mucous membranes, causing at first inflammation of these, violent in character and associated with a great deal of redness and swelling, and at first a.production of an excessive amount of mucus, from over-action of the muciparous glands. This excessive mucous secretion is very rapidly turned into a fibrinous exudate; hence there is a tendency to the formation of false membranes. This character of the exudation on mucous surfaces gives us the well-known characteristic of the Bichromate of Potash, discharges are ropy and stringy. This symptom is true of the coryza, it is true of the discharges in pharyngitis and laryngitis, and it is true of the vomited matters in gastric catarrh. It also applies to the leucorrhcea and also to the gleety discharge from the urethra, which may sometimes call for Kali bichromicum. Illustrations, then, of this general characteristic of the drug are not wanting in any part of the body. We find even in scrofulous children, for whose diseases Kali bichromicum is often an excellent drug, this same quality to the mucous discharges. For in- stance, it is indicated in inflammation of the middle ear, particularly when it affects the membrana tympani. There is ulceration not only of the membrana tympani, but also of the mucous surface of the middle 44 682 A CLINICAL MATERIA MEDICA. ear. The distinction between Kali bichromicum and other remedies in these cases is that the discharge is tenacious, stringy and purulent. With this there will be earache, with pains of a sharp stitching character which shoot up into the head and down into the neck. You will find the glands of the neck swollen and also the parotid gland on the affected side. This becomes large and indurated, and pains shoot from the ear down and into the swollen parotid. In diseases of the mucous membrane of the throat we find this same character to the exudation. Thus, in diphtheria, we find Bichromate of Potash indicated under two or three contingencies. It may be a remedy when diphtheria assumes the croupous form. The membrane is quite thick, and is decidedly yellow-looking, like wash-leather. The dis- charges, whether coming from the nose or throat, or both, are decidedly stringy. This has been, in my mind, a sufficient distinction between Kali bichromicum and the Iodides of Mercury. When I am giving Iodide of Mercury in diphtheria, so soon as I find that the expectora- tion becomes stringy I change to Kali bichromicum if it suits that condition, and also because it may prevent the extension of the disease to the larynx. Although, in general, Kali bichromicum is suited to rather sthenic types of inflammation, yet we have indications enough to prove that it may be suited to the adynamic cases also. The Iodide of Mercury is to be thought of in diphtheria when the membranous deposit is more or less profuse, involving the tonsils and posterior nares. The glands in the neck are swollen. The tongue is coated dirty yellow. There is excessive production of mucus in the throat, causing a great deal of " hawking." We find Kali bichromicum indicated in still other forms of inflam. mation of the throat than diphtheritic. Thus, it is called for in fol- licular pharyngitis. The follicles of the throat become hypertrophied and look like little tubercles on the pharyngeal walls. These discharge a white cheesy-like mass, which, when crushed between the fingers, gives forth a foetid, disagreeable odor. These are attended by a feeling of roughness and dryness in the throat, and at times by an accumula- tion of tenacious mucus. You will find this disease a stubborn one to treat. In addition to Kali bichromicum, it will be well enough to remember Hepar, Kali chloricum (especially when there is a great deal of fcetor of the breath) and Msculus hippocastanum, or the horse- chestnut. .ZEsculus resembles Kali bichromicum very closely, but lacks the tenacious stringy mucus. There is dry, rough, burning feeling in the throat and pharynx and yet no swelling. The face is sallow and KALI BICHROMICUM. 683 digestion is slow. There is tendency to portal congestion, as shown by deep throbbing in the hypochondrium, and constipation and haemor- rhoids. In other.cases you will have Nux vomica indicated by well-known symptoms, which I need not here repeat. Still other cases call for Secale cornutum, which has hawking up of these little follicular exudates. We have Kali bichromicum indicated in yet another form of throat disease which is neither scrofulous nor croupous nor diphtheritic, but syphilitic. Ulcers form on the fauces and tend to perforate. The sur- rounding mucous surface is of a coppery-red color. It is also indicated in nasal catarrh. It produces, at first, dryness of the nasal mucous membrane, with tickling in the nose and sneezing, these being especially marked in the open air. The secretion from the nose is ropy and stringy, and often collects in the posterior nares. It may or may not be offensive. At other times, as in ozsena, there are discharges from the nostrils or posterior nares consisting of plugs, or clinkers, as they are sometimes called. Lumps of hard green mucus are hawked from the posterior nares, particularly in the morning. At other times (often in syphilitic cases) you will find ulcers which carry out the perforating character of Chromic acid, and tend to perforate the parts on which they are located. Kali bichromicum is indicated in true membranous croup. It suits best, although not exclusively, light-haired, fair-complexioned children who are rather fat and chubby. The cough has a decidedly metallic sound. It has more than the mere bark of catarrhal croup. The fauces you will generally find quite red; the tonsils, perhaps, are some- what red and a little swollen. The cough seems to descend ; that is, the rattling goes down lower and lower until it apparently reaches the upper part of the epigastrium, or rather the lower third of the sternum, the irritation of the cough seeming to start from there. In this posi- tion, as well as in the throat, there seems to be a smothering, oppressive sensation; breathing becomes very labored. The child has smother- ing spells, arousing it from sleep, choking. The whole chest heaves with the efforts at respiration. The membrane forms quite thickly in the larynx, narrowing its lumen. The expectoration is tough and stringy, and, perhaps, mucous, and contains pieces looking like boiled maccaroni. The patient is worse in the morning from three to five o'clock. Sometimes there is a tendency in these cases of croup to ex- 684 A CLINICAL MATERIA MEDICA. tend downwards and involve the trachea, and even the bronchi, giving rise to what has been termed croupous bronchitis. This is not a very common disease, but it is an exceedingly dangerous one. I remember treating a patient who, after taking Kali bichromicum, expectorated pieces looking like vermicelli and having numerous little branches, probably casts of the ramifications of the bronchial tubes. One of the remedies following Kali bichromicum well in throat and croupous diseases is Lachesis. It suits particularly when the spasmodic cough becomes so violent as to cause choking spells, and when the patient drops off to sleep, he awakens as if smothering. Kali bichromicum has modified the inflammation, but has not suc- ceeded in preventing spasm of the throat. Then Lachesis comes in and relieves the remaining symptoms. Then should the croupous symptoms increase, you may return to Kali bichromicum. There is also a resemblance between Mercurius cyanatus and Kali bichromicum in diphtheritic croup. Kaolin is very useful for membranous croup when it extends down- wards, and when one of the characteristic symptoms is intense soreness along the trachea and upper part of the chest. The mucous membrane of the stomach, too, fails under the influ- ence of Kali bichromicum. The drug is so irritating that it causes gastritis. Thus it produces gastric symptoms varying in severity all the way from those of simple indigestion to those of malignant disease of the stomach. In the milder forms of dyspepsia we find it indi- cated when there is headache, the pain usually being supra-orbital. This may be periodical in its return, but is particularly excited by gastric irritation. Although it is neuralgic in its character, it is reflex from gastric irritation. Another form of headache which is associated with these gastric symptoms is one of a peculiar kind. The patient is affected with blindness more or less marked, objects become ob- scured and less distinct, the headache then begins. It is violent, and is attended by aversion to light and to noise, and the sight returns as the headache grows worse. I have met with that symptom in my practice four or five times. I have found the same symptoms pre- cisely given under Gelsemium, but I have never used that drug under these circumstances, so I have not confirmed it. There are quite a number of remedies having blinding headache, but Kali bichromicum is the best of them. We have Causticum sometimes indicated for blindness with the headache, but not diminishing as the headache increases. We also find it under Natrum mur., Iris versicolor, Psor- KALI BICHROMICUM. 685 inum and Silicea. In the latter remedy the blindness comes after the headache. With this headache of Kali bichromicum the face is apt to be blotched and bloated, and covered with pimples or acne. It is also sallow and yellowish, as if the patient were bilious. The whites of the eyes are yellow and a little puffed. The tongue is thick and broad and scalloped on its edges, as though it had taken the imprint of the teeth. The stomach seems to swell up immediately after a full meal, just like Lycopodium. The bowels are constipated, or else there is early morning diarrhoea, as you find under Sulphur, Rumex, Bryonia and Natrum sulph. The stools are watery, and are followed by tenesmus. These are some of the gastric symptoms which will yield to Kali bichromicum. They are particularly apt to occur after excessive beer drinking. Kali bichromicum is one of the best remedies for the chronic effects of excessive indulgence in beer and ale. We also find Kali bichromicum producing gastritis, herein very much resembling Arsenicum. The vomited matter is sour, and is mixed with clear mucus. You see how Kali bichromicum everywhere excites an over-production of mucus. The vomit may be bitter from admixture of bile. It is renewed by every attempt at eating or drink- ing, and is associated with a great deal of distress and burning raw- ness about the stomach. With this kind of vomit you may give Kali bichromicum in the vomiting of drunkards and in the round, perforating ulcer of the stomach. In dysentery, Kali bichromicum is sometimes indicatsd. The dis- ease occurs periodically in the spring or in the early part of the sum- mer. The stools are brownish and watery, and mixed with blood and attended with great tenesmus. The distinctive symptom is the appear- ance of the tongue, which is dry, smooth, red and cracked. In its action on the skin, Kali bichromicum causes first of all, a rash which very much resembles that of measles. Kali bichromicum has been given in measles with these symptoms: It is particularly indicated after Pulsatilla. The latter remedy is suited for the milder symptoms, the former for the more severe. The inflammation of the eyes grows worse with the formation of vesicles or pustules on or about the cornea. The meibomian glands or other structures of the lids ulcerate, so that the lids agglutinate, and there is more or less purulent discharge from the eyes. The ears, too, become involved, and there is a discharge from the ears of quite offensive pus. There are also violent, stitching pains which extend from the ear to the roof 686 A CLINICAL MATERIA MEDICA. of the mouth and to the parotid gland on the affected side. The ex- ternal auditory meatus is greatly swollen. Kali bichromicum is one of the best remedies we have, when measles is associated with these ear symptoms and swelling of the glands, with sharp pains shooting from the ears into the glands. There is also diarrhoea which resembles that of Pulsatilla, but differs from the latter in the presence of slight tenesmus. The rash is the same as we find in nearly every case of measles. In a general way, we may say that it resembles Pulsatilla, only it is Pulsatilla much worse. It has the simple catarrh of Pul- satilla, watery or more commonly yellowish green secretions, made worse and even advancing to ulceration. We next find Kali bichromicum, like all the potash salts, producing papules. These papules are hard and tend to enlarge and develop into pustules. In extreme cases, these pustules may even develop into ulcers. We have also developed by Kali bichromicum symptoms resembling those of sycosis. This places the drug alongside of Thuja, Pulsatilla and Sarsaparilla. We find scabs on the fingers, often about the nails, and also on the corona of the glans penis. There is a gleety discharge from the urethra, which is very often stringy, thus keeping up the general action of Kali bichromicum on mucous membranes. Ulcers looking like chancres, and tending to eat deeply rather than spread superficially, form about the glans penis and prepuce. In addition to these symptoms you must have the inflammation of the nose and throat of the character already described, with perforating ulcers affecting even the bones. Kali bichromicum is also called for in inflammations of the eyes ; this inflammation being rather indolent in character. There is lack of reactive power, so that ulcers form which progress slowly and show but little tendency to heal of their own accord. The same is true of the conjunctivitis, which may be of scrofulous or of sycotic origin. The lids are swollen and agglutinated, especially in the morning, with thick yellow matter, and, to keep up the indolent character of the remedy, you find very little photophobia. Sometimes, we find chemosis with these cases. You will find that iritis, whether syphilitic or not, may call for Kali bichromicum. It is indicated, not in the beginning but late, when there has been exudation posteriorly between the iris and crystal- line lens, causing adhesions of these structures to each other. These exudations, if not too great, will be absorbed under the action of Kali KALI BICHROMICUM. 687 bichromicum. Characteristic of this iritis is indolence. There is little or no photophobia and not a very decided redness attending the in- flammation. This is a general hint which will guide you to Kali bichromicum, and will save you the memorizing of less characteristic symptoms. Do not, therefore, forget the indolence of the ulceration, the absence or deficiency of inflammatory redness and the dispropor- tionate absence of photophobia. We next come to the action of Kali bichromicum on the chest. It is indicated in bronchitis, particularly if the glands are involved. Pos- teriorly, on either side of the spinal column, you find dulness on per- cussion. The cough is of a hard, barking character, almost as in croup. It seems to start from the epigastrium. The expectoration is generally of a stringy character. Sometimes it consists of bluish lumps, and is attended with a great deal of difficulty of breathing, arising mechani- cally from thickening of the lining membrane of the bronchial tubes. This cough is almost always made worse after eating, and is better when warmly wrapped up in bed. There is a great deal of feeling of tightness in the epigastrium. You must also remember Kali bichromicum as a remedy indicated in asthma dependent upon bronchiectasia. The bronchial tubes are filled up with this tough tenacious exudation. But we find Kali bi- chromicum indicated in another form of asthma, which is worse from three to four o'clock in the morning, and is especially liable to return in the winter weather or in summer time, when chilly. The patient is compelled to sit up in bed in order to breathe. Relief comes when the patient raises stringy mucus. This kind of asthma calls for Kali bi- chromicum, whether the patient be stout or thin. If you have this after midnight aggravation and relief from sitting up and bending forward, and from the expectoration of stringy mucus, you have a certain remedy in Kali bichromicum. Here is it a perfect complement to Arsenicum, which has nearly the same symptoms, but lacks the tenacious sputum. The low potencies have been most successful in the treatment of asthma. The high potencies have not failed, but in all of the literature that I have been able to see, the low potencies have seemed to be the most successful. Whether this is true or not, I do not know. I only give you the facts as I find them, that you may judge for yourselves. Lastly, I have to speak of the use of Kali bichromicum in rheu- matism, particularly in rheumatism which occurs in spring or summer weather, when there are cool days or nights. The smaller joints seem 688 A CLINICAL MATERIA MEDICA. to suffer. Thus we have pains about the fingers and wri3ts more than in any other part of the body. Pains wander from one part of the body to another. Gastric and rheumatic symptoms alternate. I have had several instances in which I have been able to confirm this char- acteristic of the drug. LECTURE LXXI. CAUSTICUM. Causticum is evidently a potash preparation, but its exact compo- sition I do not know. Hahnemann was not able to define it, and chemists since his time have not been able to tell of what it is com- posed. Nevertheless it is a unique remedy, and is one that we cannot do without in practice. The drug is conveniently studied under the heads placed on the board. Causticum. < Carbo veg. Lachesis. Coloc. Rhus, Dulc, Aconite, Colch. Guaiacum. < Phosphorus. Paralysis. Spasms. Rheumatism. Mucous membranes. Skin. Organs. It has a tendency to cause paralysis and spasmodic symptoms, rheu- matism, affections of the mucous membranes, and diseases of the skin and organs generally. You will recall the fact that there is an inimi- cal relation between Phosphorus and Causticum. These remedies do not follow each other well, although indicated in the same class of diseases. This is to be remembered particularly by those who use the higher and medium potencies. The main power of Causticum is the first one on the list, the para- lytic weakness which the drug exhibits. This paralytic tendency is a genuine potash weakness. Causticum is especially suited to patients who are timid, nervous and anxious, and full of fearful fancies, par- ticularly in the evening at twilight, when shadows grow longer and fancy more rife. The child, for instance, is afraid to go to bed in the dark. This applies not to the unfortunate child who entertains these fears by reason of faulty education, but to the child who is afraid as the result of nervous disease. As an adult, the patient is apprehensive that something is about to happen, or he feels conscience stricken, as if he had committed some crime. When closing his eyes, he sees fright- ful images. This is no new symptom to you, as you will recall it for 690 A CLINICAL MATERIA MEDICA. several remedies. The patient, especially if a woman, is apt to be tear- ful and melancholy. The face is a correct picture of the mental con- dition, and is expressive of this low-spirited state. The face is apt to be sallow and sickly looking. The patient is either taciturn and dis- trustful, or is inclined to fits of anger, with scolding. This is, as you know, by no means dissimilar to the Phosphorus, and yet you must not make the mistake of giving one, when the other is indicated. Memory fails. Any attempt at mental labor is followed by untoward symptoms, such as stitches in the temples when reading or writing, feeling of tension in the head and scalp, particularly in the forehead and about the temples. This is'worse in the evening, and also on awakening from sleep. Here again it is very similar to Phosphorus, which also has that feeling of tension. The patient also has a rather odd sensation, and one that is not frequently met with, and that is a feeling as though there were an empty space between the brain and the cranial bones. This is relieved by warmth. As odd as this symptom may seem to you, it is not too uncommon for you to make note of. Our materia medica is not over rich in this direction, and so we ought to utilize every such symptom that we can get. The vertigo of Causticum is that which belongs to an excited brain and spine, such as we find in the incipiency of paralysis, and even of locomotor ataxia. There is a tendency to fall either forwards or side- ways. There is with this vertigo a constant feeling of anxiety and weakness of the head. The sight is bedimmed as though the patient were looking through a fog. Now, concomitant with these brain symp- toms you have the following symptoms, one or two of which ought to be present in order to make the picture complete. < The skin in these cases is apt to be dry and hot, and there is almost always constipation, which constipation is quite characteristic. It is attended with a great deal of urging, probably from defective expulsive effort in the rectal muscular fibres, with redness of the face and fulness of the bloodvessels. This symptom is very common in weak persons and in children when they are nervously debilitated. Very characteristic of the drug is paralysis of single parts or of single nerves. Thus you may have to use it in paralysis of the facial nerve, particularly when it is the result of exposure to dry cold winds. It may also be called for in ptosis, when the result of the same cause. Causticum is still further called for in paralysis of the tongue, when deglutition and speech are more or less destroyed, paralysis of the lips, and in glosso-pharyngeal paralysis. In this last-named disease, you CAUSTICUM. 691 cannot expect much improvement from any remedy. The larynx and the bladder may be attacked. These are illustrations of the local pal- sies which come within the range of Causticum. These paralyses may be caused either by deep-seated nervous disease, or, very characteris- tically, by exposure to cold, particularly to the intense cold of winter, when the patient is of the rheumatic diathesis. Aconite, like Causticum, is useful in paralyses which are traceable to exposure to cold, especially to dry cold winds. Aconite suits well in the beginning, and Causticum more when the paralysis has become chronic and refuses to yield to the Aconite. Rhus tox. and Dulcamara compare favorably with Causticum for paralysis of rheumatic origin, provoked by exposure to a.damp and cold atmosphere, particularly when there have been changes from tol- erably warm to cold and wet days. Dulcamara is suited to the begin- ning of such cases, and not when the trouble becomes chronic. Rhus tox. is suited to chronic cases. You may also find Causticum indicated in paralysis which arises from apoplexy; it is not called for, for the immediate results of the stroke, not for the congestion, nor for the exudation, but for the remote symptoms, when, after absorption of the effused blood has taken place, there yet remains paralysis of the opposite side of the body. Causticum may be applied in diseases of children. It is suited to children of a scrofulous habit in whom, though emaciated generally and particularly about the feet, the abdomen is large and tumefied. They are slow in learning to talk. There is a tendency to scrofulous inflammation of the eyes, scabs form about the tarsi, the conjunctivae become injected, and the cornea inflamed. There is a constant feeling as of sand beneath the eyelids. An eruption appears about the scalp, especially behind the ears, making this portion of the skin raw and excoriated. The discharge is slight in quantity and sticky in character. Often there is otorrhcea, purulent in its character. The child stumbles when it attempts to walk. The cause of this symptom will be found in disease of the brain or spine. These cases do not recover rapidly. There is defective nutrition in the whole nervous system. You must instruct your patients that hygienic measures must be observed in con- junction with medicinal, and that you can promise a cure if they will but be patient with you. Other remedies which may be thought of here are, first, Sulphuric. acid, which is a good remedy for this weakness or giving way of the ankles; another is Sulphur, and still another, Silicea. 692 A CLINICAL MATERIA MEDICA. Still further, as illustrating the paralytic effect of Causticum, we find it causing aphonia or failure of the voice. This may or may not be catarrhal. It is associated with great weakness of the laryngeal mus- cles, which seem to refuse their office. This is often the case in phthisis and in laryngeal troubles, whether of a tubercular nature or not. The paralytic tendency is further illustrated in the cough. The patient is unable to expectorate. Just as under Sepia,, Drosera, Kali carb., Arnica and a few other remedies, the patient succeeds in raising the sputum so far, when it slips back into the pharynx. The remedy also has this as characteristic: The patient cannot cough deep enough for relief. In addition to these paretic symptoms in catarrhs, you may also add the following: Rawness and burning down the throat and trachea, feeling as if these parts were denuded, and hoarseness with aggravation in the morning. At this time, also (consistent with the action of the potash salts" generally), there is accumulation of mucus in the fauces and larynx. The sputum often tastes greasy and soapy. Drinking cold water seems to relieve the cough. Accompanying the cough, you find pain over the hips, and this is very characteristic, and, too, the cough is often associated with involuntary spurting of urine. This last symptom is very characteristic of Causticum. It is also found under Natrum mur. and Scilla. In the laryngeal symptoms, it is necessary to make a distinction be- tween Causticum and Phosphorus. One point of difference is that Phosphorus often has evening aggravation of the hoarseness; Causti- cum has aggravation in the morning. Both have this nervous weak- ness. One symptom I have often found indicating Phosphorus, and that is, extreme sensitiveness of the box of the larynx. The patient dreads to cough, because it aggravates the laryngeal soreness. He dreads to talk for the same reason. Relief from cold drinks is found only under Causticum. More similar to Causticum yet, is Carbo veg. Here you can make no serious mistake, because both drugs follow each other well. If you do make the mistake of giving one of these when the other is indicated, you will not injure your patient any more than from the delay caused by your imperfect selection. Both remedies have this rawness and soreness down the throat; both have hoarseness, Carbo veg. having aggravation in the evening and Causticum in the morning. The former is indicated after exposure to damp evening'air; the latter, after dry, cold, severe winter weather. Eupatorium perfoliatum is very similar to Causticum in that it causes CAUSTICUM. 693 hoarseness worse in the morning. Both remedies are indicated in in- fluenza with aching all over the body, but Eupatorium has more sore- ness in the chest than it has burning and rawness. In the hoarseness of singers or those who exert their voices a great deal, Causticum resembles Graphites and Selenium. In some cases, when Causticum fails in chronic hoarseness worse in the morning or evening, Sulphur is an all-sufficient remedy. Still another kind of cough for which you may give Causticum is one which improves up to a certain point and then remains stationary, getting neither better nor worse. Causticum is a good remedy for buzzing and roaring in the ears, or tinnitus aurium, when sounds reecho unpleasantly in the ears. A voice which is of an ordinary tone, sounds loud and reechoes in the ear with unpleasant confusion. When Causticum is the remedy, these symptoms may be concomitant with catarrh of the throat in- volving the Eustachian tube. They may also be symptoms of Me- niere's disease, of which affection I once cured a case with Causticum. There is a drug which you may compare here, and that is Salicylic acid, which has caused and cured Meniere's disease. You may also compare Carbon bisulphide and the well-known Cin- chona. We find Causticum indicated in involuntary urination or enuresis, especially in children. It is especially called for when the accident occurs during the first sleep. The trouble is aggravated in the winter and ceases or becomes more moderate in summer. The urine is espe- cially liable to escape involuntarily during the day in winter, as the result of any excitement. For nursing women we may use Causticum when over-exertion or loss of sleep threatens their supply of milk. This makes them very low-spirited, and they are apt to have this sallow, sickly complexion which is characteristic of Causticum. Causticum may be used in spasmodic diseases, even in convulsions. Thus it may be used in epilepsy, particularly in la petit mal. When walking in the open air, the patient falls, but soon recovers. During the unconscious stage, the patient passes urine. It may even be used when the attacks are of a convulsive nature, especially when they recur at the new moon. Now you are not to consider that the moon has any- thing to do with these epileptic attacks. It is only the laws which govern the relation of the planets, which regulate the tides and have to do with the periodicity of nature generally that also apply to the moon 694 A CLINICAL MATERIA MEDICA. and to the disturbances within the human body; so it is that some symptoms are worse at new moon, others at full moon; some at the rise and others at the fall of the tide. It does not, therefore, follow, because the patient is worse every time at new moon, that the moon causes the aggravation. Causticum is, moreover, indicated in epilepsy when it is connected with menstrual irregularities, and also when it occurs at the age of puberty. In these symptoms, Causticum is closely allied to Calcarea ostrearum. Causticum is indicated in chorea when the right side of the body is affected more than the left. The muscles of the face, tongue, arm and leg are all involved in the disorderly movements. When the patient attempts to speak, words seem to be jerked out of the mouth. The patient is anxious and restless in bed at night. He must sit up and change his position. He involuntarily throws the head about, and finally he falls asleep exhausted. During sleep the legs and arms are constantly "on the go." Lastly, we may be called upon to use Causticum in rheumatism, especially when the joints are stiff and the tendons shortened, drawing the limbs out of shape. It is frequently indicated in what has been termed rheumatoid arthritis. Rheumatic pains attack particularly the articulation of the jaw. They are worse from cold and are relieved by warmth. Now,you will have to distinguish Causticum herefrom several other remedies. Rhus tox. also has rheumatism from exposure to cold. Some of the distinctions between it and Causticum I have already given you, There is yet another good one. Rhus tox. has restlessness and relief from motion all the time. In Causticum the restlessness only occurs at night. Guaiacum is to be preferred to Causticum, and follows that remedy well when, in either gout or rheumatism, there are contractions of the tendons, drawing the limbs out of shape, aggravated by any attempt at motion, particularly if there are well-developed gouty nodosities in the joints. Colocynth is to be remembered for articular rheumatism when the joints remain stiff and unwieldy. The pains in the affected parts are of a boring character. Causticum also acts on the skin, one of its most characteristic symp- toms being warts. It is useful in the cure of these hypertrophies of the papillae when they occur on the hands or face. I remember once giving Causticum to a child who had two warts on the under eyelid. CAUSTICUM. 695 At the end of the third week after taking the remedy, there was a string of warts over the inner canthus of the other eye. I believed that these resulted from the Causticum. Of course, I stopped the medicine. At the end of several weeks more, all the warts had disap- peared, and the child has had none since. This shows you that Caus- ticum really produces and cures warts. Causticum may be called for in colic after the failure of Colocynth. The pains are of a griping, cutting character, and are relieved by bend- ing double. Particularly do you find pains of this character suggest- ing the drug in menstrual colic. Previous to the menses, these colicky pains appear, and are associated with tearing pains in the back and limbs. All the sufferings cease entirely at night. LECTURE LXXII. Kali carb. < Carbo veg. KALI CARBONICUM. r Phos., Carbo veg., Arsen. Ant. tart. Hypophosphite of Lime, Psorinum. Caust, Senna. Natr. m. Lachesis. To-day I will study with you Carbonate of Potash, known in our nomenclature as Kali carb. This is complementary to Carbo veg. and similar to it in many forms of disease, particularly in lung inflamma- tions. Sometimes when one fails the other completes the cure; hence the origin of the complemental relation. We have quite a number of analogues to Kali carb., some of which have been placed on the board. We will have occasion to refer to some of these as we go on. There is also somewhat of a complemental relation between Kali carb. and Phosphorus. Kali carb. exerts an influence over the manufacture of the blood, quantitatively as well as qualitatively. This is shown in the anaemia which the remedy causes. This is illustrated by the following symp- toms : Frequent chilliness ; every time the patient goes out of doors, he becomes chilly if the air is in the least cool, not having the nor- mal resistance to temperature; quite consistent with this anaemia, there is throbbing in the bloodvessels all through the body. This is not plethora, but only an appearance of plethora. It is associated with local congestions which are really anaemic in origin ; the blood being normal volumetrically, but is not as rich in red corpuscles as it should be. The congestion to the head is associated with humming in the ears. The patient suffers from vertigo when he turns his head rapidly, or from riding in a carriage, or from anything that dimin- ishes the supply of blood to the brain. The patient suffers from weakness of sight, especially following excessive sexual indulgence. Again, we find Kali carb., by reason of this anaemia, indicated after KALI CARBONICUM. 697 severe or protracted diseases. It thus becomes useful for the weakness following labor or abortion when we have the following symptoms : There is a very troublesome backache, a weak, lame feeling in the small of the back, which makes walking very difficult to the patient; the patient suffers from cough and frequent sweating at night. You find persistent discharge of blood from the uterus. The urine is loaded with urates. This latter symptom, this excess of urates, shows great waste of tissue, and is evidence of the exhaustion which Kali carb. causes and cures. You will recall that I mentioned Kali carb. as a drug which causes great exhaustion in the muscular system, and it is frequently in this kind of exhaustion that the urates are excessive in the urine. Kali carb. acts not only on the voluntary muscles, but on the heart also. The heart becomes weakened when it is indicated, and you thus have a pulse which is irregular or intermittent, or, being rapid, is very weak. Now, this character of the pulse ill Kali carb. will qualify every disease in which you may use the drug. It is a chacrateristic of the drug which lies at the very root of its symptoms ; therefore, you will seldom find Kali carb. indicated when there is a full round pulse. This condition of the urine, in which it is loaded with urates as evi- dence of exhaustion from disease, is also found under other remedies. Perhaps the best remedy in the materia medica for this symptom, other things being equal, is Causticum. Remember that this assertion is to be qualified. A symptom of this character has not the same value as a symptom of the mind would have. It is characteristic in its place, and yet, if symptoms more characteristic of the case indi- cate another drug, then you should not think of using Causticum. Suppose you have a patient whose other symptoms are those of Kali carb., for example, a woman after confinement with backache, sweat, and other symptoms of importance, then you may give Kali carb. with satisfaction. But if you have a patient with no prominent symptoms, and with this excessive deposit of urates in the urine, Caus- ticum will help you out. Still another remedy for this symptom is Senna, which is one of the best remedies in the materia medica for simple exhaustion with excessive nitrogenous waste. The particular combination of symptoms that we have under Kali carb., the sweat, the backache and the weakness, are found in no other remedy. It acts as well with the high as the low potencies. You may also remember the Hypophosphite of Lime, which comes 45 698 A CLINICAL MATERIA MEDICA. near to the Kali carb. in the excessive sweating, weakness and pallor of the ekin. You may also remember, as akin to Kali carb., Psorinum, which, as you have already learned, is eminently useful in convalescence from disease when there is great weakness, profuse sweat and, in addition, a mental state, a perfect hopelessness. The patient despairs of perfect recovery. Next, let us look at the action of Kali carb. on the nervous system. Viewed mentally, the patient is excessively peevish and nervous, and is very easily startled. You often find this in women. They are startled by imaginary hallucinations; they imagine that some one is in the room or some figure comes before the mind and tantalizes them. Especially is this anxiety manifested on any noise, as the mere shutting of a door or window, particularly if the noise be unexpected. They are not only startled as many healthy persons would be under similar circumstances, but they are frightened, are driven into a fit of trembling. You will sometimes find the intellect seriously impaired when Kali carb. is indi- cated. The patient does not seem to care for anything. This indiffer- ence is associated with great bodily exhaustion. When questioned, the patient, usually a female, does not seem to know exactly what to say or what she wants. The condition borders somewhat on that of Phos- phoric acid, but still the apathy of the two remedies is not exactly the same. Kali carb. has not a sensorial apathy, but it has exhaustion too great to frame their answers to your questions. You will frequently find these symptoms of the mind calling for Kali carb. in puerperal mania and in puerperal fever. Again, we find that spasms may occur as a symptom of the nervous system under Kali carb. The patient does not lose consciousness during the convulsions, hence the remedy is not indicated in true epi- lepsy; but it may be indicated in puerperal eclampsia, the spasms seeming to pass off with eructations of wind. The spine suffers severely in the Kali carb. patient. In addition to the backache, already mentioned as the result of anaemia or of abortion, we have spinal irritation, which, by the way, is just as vague a symptom as is any other of a general character, as headache. You must always know what causes this spinal irritation. Does it come from loss of fluids, from brain troubles, from emotional causes, or what? In the Kali carb. patient you will find it frequently occurring with the uterine symp- toms. Thus, you will have pressure in the small of the back as though there were a heavy weight pushing down there. There are also bear- KALI CARBONICUM. 699 ing down in the uterine region during the menses, burning along the spine, especially along the right side of the spine. This is not a real congestion. It is merely a subjective sensation caused by irritation of the posterior spinal nerves. The backache is worse while the patient is walking. She feels so exhausted that she must drop into a chair or support herself in some way. Sometimes you find, in the morning, a pulsating in the small of the back, quite akin to the pulsations occur- ring in other parts of the body. Here the drug is quite analogous to Sepia and the well-known Cimicifuga. This pulsating and drawing backache is particularly relieved when the patient lies down. This suggests a comparison between Kali carb. andNatrummur. You will recognize at once the resemblance in the spinal symptoms, the spinal irritation, the backache and the relief from lying down. Natrum mur. has, particularly, relief by lying flat on the back with firm pressure. Further than this, you will find these two drugs playing into each other's hands in the treatment of amenorrhcea. Hahnemann says that Kali carb. will bring on the menstrual flow when Natrum mur., though indicated, fails. I once cured a singular backache with Kali carb. A very nervous patient came under my treatment for dyspepsia. She said to me: " There is something very strange about my case. Every time I eat a meal I suffer for half an hour or more with most intense pain in the back." This was certainly an odd symptom. I did not know where in the materia medica to find it. I hunted, and I found under Kali carb. this symptom : Pain in the spine while eating. I gave her Kali carb., which cured her completely. On the mucous membranes, Kali carb. acts, causing quite a series of catarrhal symptoms. We may give it in coryza with hoarseness or loss of voice. The patient catches cold at every little exposure to the fresh air. This is a very strong symptom of Kali carb. The Kali carb. patient has a tendency to obesity, and is rather weak in muscular de- velopment. With the catarrhal symptoms of this remedy there often occurs a sensation in the throat as though there were a lump there which must be swallowed. The neck is stiff and the uvula elongated. There are stinging pains in the throat when swallowing just as marked as under Apis. Sometimes we have a more chronic form of catarrh in the nose; the nasal passages fire obstructed, and the patient can only breathe with the mouth open. This obstruction is relieved in the open'air, but returns so soon as the patient enters a warm room. There is either a dis- 700 A CLINICAL MATERIA MEDICA. charge of foetid green mucus or, in the morning, the nose is swollen and red, and there is a bloody discharge. There is a sticking sensa- tion in the pharynx, as from a fish-bone lodged there, whenever the patient catches cold. This is a good symptom for Kali carb. You will find it in Allen's Encyclopaedia in large type. Now, in addition to these symptoms, there is almost always accumu- lation of mucus in the pharynx. The patient " hawks and hems" in the morning. This hawking is found under every alkali, but this one peculiarity, sensation as of a fish-bone in the throat as soon as he "catches cold," with the hawking, is found under no other remedy. Hepar, Niti'ic acid, Alumen, Carbo veg., and Argentum nitricum all have this sensation as of a splinter or fish-bone in the throat. In coughs, we sometimes find Kali carb. of use. The cough is of a paroxysmal character, and is accompanied by gagging and by vomiting of sour phlegm and of food. This suggests the use of Kali carb. in whooping cough, in which disease it has been very successful. Boen- ninghausen has given us a characteristic symptom for Kali carb., namely, a little sac filled with water between the upper lids and eye- brows. You will often meet with that symptom. I would warn you not to confound it with a similar condition which is in no particular pathological at all, and that is a certain looseness of the tissues in this locality occurring in persons advanced in years. Now for the action of Kali carb. on the lungs. We find it indicated in bronchitis, pneumonia and phthisis pulmonalis. I will give you the symptoms calling for it in these separate states as we go on. The most characteristic symptom of all, and one which runs through the symptomatology of the drug, is stitching pains which are prominently located in the walls of the chest. They are made worse by any motion, but unlike Bryonia, they come at all times independently of this ag- gravation. They occur characteristically in the lower third of the right lung, going through the chest to the back. They may occur all over the chest, but that above mentioned is their most frequent site. Then, too, they are erratic and wander all over the body. Here it reminds you of Kali bichromicum, Pulsatilla and Sulphur. Kali carb. is indicated in infantile pneumonia or capillary bronchitis when the following symptoms are present: Intense dyspnoea; although there is a great deal of mucus in the chest, it is raised with difficulty. The child is so oppressed that it can neither sleep nor drink. Breath- ing is wheezing and whistling in character, and the child has a choking cough. You should here compare Kali carb. carefully with Antimo- KALI CARBONICUM. 701 nium tartaricum and thus determine which suits the case best. One cannot be the remedy when the other is indicated. In phthisis, Kali carb. is indicated when the constitution favors it. The patient has a bloated alkaline look to the face. There are also present these well-defined stitching pains through the chest and over the body, with the puffiness of the upper eyelids. Cough is difficult. The patient cannot get up the sputum. He raises it partly, when it slips backwards into the pharynx. Now, if you examine this expec- toration, you will find that it is often bloody, and that there are little globules of pus scattered through it. There is an aggravation of all the symptoms from three to five o'clock in the morning. This hour of aggravation belongs to all the potash salts. There is also a very stubborn sensation, namely, chilliness at noon. Kali carb. is indicated in cardiac inflammations, in endo- and peri- carditis when these sharp stitching pains are characteristic. Do not give it too soon in the case. If is not an early remedy in cardiac dis- ease. It is indicated rather late when there is a deposit on the cardiac valves. We fine] these same stitching pains under Kali carb. in backache, a very stubborn form of rheumatism. The same symptom applies in case of impending miscarriage and during labor; sharp stitching pains in the lumbar region shooting down from the buttocks into the thighs. The same kind of pain suggests this remedy in nephritis. Lastly, in connection with the stitching pains, I want to refer you to its application in puerperal fever of the metritic form, that is, when metritis is a prominent condition. There are sharp, stabbing, cutting pains in the abdomen, the abdomen is bloated and distended, and the urine is dark and scanty, the pulse is rapid but feeble, and you have present the state of mind described in the early part of the lecture. One more symptom and we are done with the drug, and that is its use in dyspepsia. You will find it called for in indigestion, particu- larly in old persons, in those who have lost a great deal of vital fluids, when there is an empty, weak feeling in the stomach before eating and bloatedness after eating, especially after soup or coffee. There are sour eructations, heart-burn, and uneasy, nervous feeling when hungry. You see then that Kali carb. is a remedy indicated in a great variety of diseases. It is a drug much neglected in practice, for much the same reason that many other remedies are, because the hurried and careless physician falls into routinism. INDEX OF REMEDIES. ABIES CANADENSIS prolapsus uteri, 139 ABIES NIGRA dyspepsia, 285, 327. 345 ABSINTHIUM, 2:27 epilepsy, 392 delirium ebriosorum, 2:27 tvphoid fever, 227 ACALYPHA INDICA hemoptysis, 344 hemorrhages, 344 ACETIC ACID dropsv, 99 ACIDS remarks on the, 485 ACONITIC ACID, 295, 313 ACONITINE, 294 ACONITUM NAPELLUS, 294 abortion, 304, 307 amenorrhcea, 639 • cerebral congestion, 300 cholera infantum, 303 colic, 268, 303 conjunctivitis, 300, 370 continued fever, 526 coryza, 304 croiip, 302, 475, 649 diarrhoea, 303 dysmenorrhcea, 303. 304 dysentery, 303 episcleritis, 300 eyes, 300, 370 fever, 272, 295, 382. 526 gastric catarrh, 303 gastric fever, 272 gastritis, 303 glaucoma, 300 haemoptysis, 303 haemorrhages, 227 headache, 188 heart, 210, 301, 484 hernia, 303 hypertrophy of the heart, 301, 477 inflammations, 36, 94 labor, 304 measles, 165, 338 meningitis, 300, 380 mental symptoms, 300, 359, 581 milk fever, 304 nephritis, 304 neuralgia, 301 paralysis, 295, 301, 691 pleurisy, 274 ACONITUM NAPELLUS (Continued) pleurodynia, 310 pneumonia, 275, 302 poisoning from, 295 pregnancy, 304 puerperal fever, 301, 304 scarlatina, 304 serous membranes, 274 skin, 304 sunstroke, 300 tetanus, 171 typhoid fever, 296 urine, 671 worms, 229 ACTEA EACEMOSA, 306 abortion, 307 after-pains, 307 angina pectoris, 308 chorea, 71 cough, 308 dysmenorrhcea, 167, 191, 615 eyes, 306 female genital organs, 136, 307, 334 headache, 167, 307 heart, 210 hysteria, 73 labor, 307 loquacity, 39 myalgia, 136, 306 nervous system, 73, 136, 306 neuralgia,* 306, 334 phthisis, 308 pleurodynia, 308 puerperal mania, 277, 307 spinal irritation, 308, 699 uterine diseases, 306, 331 ACTEA SPICATA amenorrhcea, 639 rheumatism, 278, 306 ^ESCULUS HIPPOCASTANU.M follicular pharyngitis, 6.82 hemorrhoids, 177 locomotor ataxia, 575 .ETHUSA CYNAPIUM colic, 670 dentition, 392 mental symptoms, 97 vomiting, 419, 548, (>37 AGARICUS MUSCARIUS blepharospasmus, 179 chorea, 71, 76 delirium, 394 loquacity, 39 704 INDEX OF REMEDIES. AGARICUS MUSCARIUS {Continued) spinal irritation, 308 AGNUS CASTUS agalactia, 333 sexual excesses, 640 spermatorrhoea, 166 AILANTHUS diphtheria, 197, 376 hay fever, 527 scarlatina, 197, 217 ALCOHOL diphtheria, 197 ALETRIS FARINOSA prolapsus uteri, 139 uterine diseases, 336 ALOE SOCOTRINA alimentary canal, 448 diarrhoea, 156, 158 dysentery, 179 female genital organs, 443 hemorrhoids, 131, 178 headache, 178 liver, 130 prolapsus uteri, 131 ALSTONIA SCHOLARIS, 160 diarrhoea, 160 intermittent fever, 160 ALUMEN corneal opacities, 635 tvphoid fever, 507 ALUMINA, 585 anemia, 587 antidotes to, 585 asthenopia, 527, 622 blepharitis, 587 blood, 586 buboes, 588 chlorosis, 586, 587 complementarv relations, 585, 607 constipation, 176, 253, 430, 587 constitution, 586 cough, 588 dyspepsia, 588 eves, 124, 587 glands, 588 granular lids, 587 hypochondriasis, 586 lead colic, 589, 590 leucorrhcea, 587 locomotor ataxia, 511, 587 mental symptoms, 586 mucous membranes, 587 nasal catarrh, 587, 583 ozena, 587 ptosis, 124 skin, 588 strabismus, 586, 587 throat, 588, 650, 700 ALUMINIUM MET. locomotor ataxia, 587 AMBRA GRISEA, 143 asthma, 144 cough, 144, 516, 628 defective reaction, 133, 144, 434, 5 female genital organs, 144 insomnia, 144 leucorrhcea, 145 lyiug-in, 145 menses, 145 AMBRA GRISEA (Continued) nervous system, 144, is 1, i;75 softening of brain and spine, 144 AMMONIACUM GUMMI asthenopia, 418 AMMONIUM preparations of, 624 AMMONIUM BENZOICUM urine, 64 AMMONIUM CARB., 625 antidotal relation, 207, 625 asphyxia, 626 blood, 625 bronchitis, 626 cerebro-spinal-meningitis, 626 constitution, 624 coryza, 628 cough.628 emphysema, 455, 626 heart,* 570, 726 inimical relation, 625 menses, 63 mucous membranes, 62^ paralysis of the luugs, 552, 626 pneumonia, 626 poisoning by charcoal fumes, 626 scarlatina, 626, 627 sprains, 629 uremia, 626 AMMONIUM CAUST. aphonia, 628 diphtheria, 197 AMMONIUM MUR., 629 bronchitis, 631 circulation, 629 constitution, 62-1, 629 corvza, 630 cough, 631 female genital organs, 630 heels, 629 intermittent fever, 629 joints, 630 leucorrhcea, 630 liver, 631 nervous system, 629 neuralgia, 629 phthisis, 631 scarlatina, 631 sciatica, 629 sprains, 630 tonsillitis, 631 AMMONIUM PHOS. gout, 631 joints, 623 AMYGDALA AMARA diphtheria, 199 tonsillitis, 387 AMYL NITRITE (Flee Nitrite of Amyl) ANACARDIACE.E, 202 ANACARDIUM OCCIDENTALE erysipelas, 206 rheumatism, 215 skiu, 206 ANACARDIUM ORIENTALE, 202, 203 antidotal relation. 206 constipation, 201 cough,433 gastralgia, 466 INDEX OF REMEDIES. 705 ANACARDIUM ORIENTALE (Continued) gastric symptoms, 204 hemorrhoids, 205 headache, 204 heart, 206 hypochondriasis, 204 joints, 206 mental fatigue, 204 mental symptoms, 203 pericarditis, 206 pregnancy, 205 profanity, 204 rheumatism, 206 skin, si, 205 spiual cord, 206 suicide, 204 variola, 203 vomiting of pregnancy, 205 ANGUSTURA caries of boues, 515 injuries, 171 necrosis of lower jaw, 171 scapular pain, 263 trismus. 170 ANISUM STELLATUM chest paius, 286 phthisis florida, 79 ANTHRACINUM carbuncle, 77, 217, 530 ANTIMONIUM CRUDUM, 547 complementary relations, 547 diarrhea, 548 diphtheria, 549 eczema, 311, 549 eyes, 550 female genital organs, 550 gastric catarrh, 328, 353, 543 gout, 550 heels, 630 lungs, 596 mental symptoms, 267, 547 nails, 549 nasal catarrh, 467 prolapsus uteri, 550 skin, 82, 549, 665 teeth, 319 tongue, 548 vomiting, 548, 637 wine, aggravation from, 601 ANTIMONIUM TART., 550 asphyxia neonatorum, 552 capillary bronchitis, 356, 551, 650 complementary relation, 616 cough, 252, 551 croup, 475 headache, 550 intestinal symptoms, 553 laryngismus stridulus, 474 lungs, 596, 626 measles, 551 paralysis of the lungs, 455, 552, 619 pneumonia, 260, 276, 542, 552 scarlatina, 551 skin, 551 suppressed eruptious, 283, 551 variola, 551, 553 vomiting, 361 whooping cough, 551 ANTIMONY remarks on preparations of, 546 APIS MELLIFICA, 93 albuminuria, 64 amenorrhea, 106 antidotal relations, 108 aphthous sore mouth, 46 apoplexy, 95, 251 asthenopia, 107 asthma, 105 conjunctivitis, 107 corneal opacities, 635 cough,106 cystitis, 89 diarrhea, 108, 158 diphtheria, 50, 95, 104, 199, 386 dropsy, 64, 97 dysuria, 138 erysipelas, 41, 100, 217 eyes, 107 female genital organs, 106, 534, 630 fever, 297 heart, 105 hydrocephaloid, 108 hydrocephalus, 98 hydropericardium, 105 hydrothorax, 97, 105 hysteria, 94, 106 inflammation, 94 inimical relation, 108 intermittent fever, 67, 102 kidneys, 529 larynx, 105 mammary abscess, 543 meningitis, 95, 275 mental symptoms, 94 mode of preparing Apis, 93 edema glottidis, 105 edema pulmonum, 105 ovarian tumor, 107 ovaries, 62, 106 ovaritis, 107 paniritium, 108 paralysis, 102 pleurisy, 98, 442 poisoning by Apis, 93 post-scarlatinal dropsy, 64 rheumatism, 102 scarlatina, 64, 94. 95, 103, 494, 627 scrofulous ophthalmia, 108 soreness, 36 stapWloma, 107 synovitis, 98, 277, 331 tubercular meningitis, 98, 316, 440 typhoid fever, 95, 103, 250, 493 urticaria, 101, 668 uterus, 106 variola, 102 APIUM VIRUS, 93 APOCYNACE.E, 154 APOCYNUM CANNABINUM, 155 diarrhea, 156 dropsy, 99, 155 hemorrhoids, 157 heart, 105 hydrocephalus, 156 hydrothorax, 99 joints, 156 rheumatism, 156 706 INDEX OF REMEDIES. APOCYNUM CANNABINUM (Continued urine, 155 APOMORPHIA sea-sickness, 243 vomiting, 406 ARACESE, 194 ARACHNIDA, 70 ARANEA DIADEMA bones, 78 constitution, 77 diarrhea. 77 intermittent fever, 77, 348 toothache, 78 ARCTIUM LAPPA crusta lactea, 159 rheumatism, 178 ARGEMONE MEXICAN A tape worm, 255 ARGENTUM METALLICUM, 579 arthralgia, 581 debility, 580 epilepsy, 579 larynx, 580 neuralgia. 579 ovaries, 580, 585 prolapsus uteri, 580, 585 ARGENTUM NITRICUM, 574 angina pectoris, 577 antidotal relations, 253, 579 asthenopia, 578 asthma, 577 blepharitis. 577, 578 brain, 574 cholera infantum, 579 conjunctivitis, 325 diarrhea, 158, 167, 579, 610 epilepsy, 577 eyes, 577 female genitals, 584 gastralgia, 576 gastro-enteric symptoms, 524, 597 gonorrhea, 87 granular conjunctivitis, 573 headache, 574, 576 heart, 580 hemicrania, 575 kidneys, 579 larynx, 578 locomotor ataxia, 573 marasmus, 253 mental symptoms, 574 nephralgia, 579 nervous system, 574 neurasthenia, 510 ophthalmia neonatorum, 325, 577 ovaries, 574 paralysis, 575 prosopalgia, 576 puerperal convulsions, 577 purulent ophthalmia, 577 renal calculi, 579 scrofulous ophthalmia, 665 spinal cord, 574, 589 throat, 578, 588,650, 700 urinary organs, 87 uterus, 579 vertigo, 574 ARNICA MONTANA, 221 antidotal relations, 625 apoplexy, 226, 251 asphyxia from charcoal fumes, 151, 254 bloodvessels, 222 boils, 225 cholera infantum, 22 conjunctivitis, 370 cough, 692 diarrhea, 226 dysentery, 226 dyspepsia, 226 ecchymoses of the sclerotic, 180 enteritis, 58 female genital organs, 630 hypertrophy of the heart, 208. 223, 302, 477 hemiplegia, 226 injuries, 222, 502 lying-in, 225 muscular exertion, 214, 223 myalgia,' 224 pleurodynia, 276 pyemia, 225 retinal apoplexy, 40 skin,225 sprains, 214, 620, 629 soreness, 36 testicles, 330 typhoid fever, 39, 213, 223, 315, 375, 497 urine, 64 whooping cough. 226 ARNICIN, 222 ARSENICUM ALBUM, 519 albuminuria, 528 angina pectoris, 529 antidotal relations, 207, 451, 462, 521 aortitis, 456 aphthous sore mouth, 46 asthma, 355, 527, 687 bladder, 253 blood, 522 boils, 530 Bright's disease, 523 burns, 92 cancer, 522, 530 carbuncle, 217, 522, 530 catarrhs, 355 cholera Asiatica, 150, 523 cholera infantum, 523 cholera morbus, 150, 523 chorea, 76 complementary relations, 462, 519, 532 conjunctivitis, 107 I continued fever, 526 convulsions, 43 coryza, 527 cough, 106 croup, 529 debility, 343 delirium tremens, 251, 521 diarrhea, 158, 346, 523, 610 diphtheria, 104, 199, 527 dropsy, 65, 99, 156, 414, 523 dysentery, 458, 523 dyspepsia, 53,145,176, 457 INDEX OF REMEDIES. 707 ARSENICUM ALBUM (Continued) eczema, 529 endocarditis, 528 enteritis, 523 epilepsy, 531 eyes, 370 face, 42, 43 fatty degeneration of the heart, 5 fever, 299, 437, 526 . fever blisters, 668 gangrena oris, 46 gangrene, 149, 522, 530 gastric catarrh, 353 gastric symptoms, 328, 352, 457 gastritis,'53, 522, 685 hemorrhages, 452 hemorrhoids, 457 hay fever, 311, 527 heart, 105, 223. 365, 484, 528 hectic fever, 349 hemicrania, 122, 530 herpes zoster, 311 hiccough, 191 hydrocephaloid, 97 hydropericardium, 528 hydrothorax, 528 hypertrophy of the heart, 223 hysteria, 583 inflammation of the brain, 90 inflammations, 90, 94, 522 intermittent fever, 66, 524 kidneys, 528 laryngismus stridulus, 474 lungs, 349 marasmus, 523 meningitis, 97 menorrhagia, 452 mental symptoms, 56, 521, 581 metrorrhagia, 452 mucous membranes, 527 muscular exertion, 214, 491 nervous system, 76 neuralgia, 437, 525 esophagitis, 387 ovaries, 62 ovaritis, 522 pericarditis, 528 phlyctenular ophthalmia, 370 poisoning by, 520 prosopalgia, 583 puerperal mania, 307 retention of urine, 253 scarlatina, 494, 529 scrofulous ophthalmia, 370, 464, 665 skin, 529 throat, 90, 566 tongue, 312, 662 tuberculosis, 522 typhoid fever, 212, 234, 437, 493, 522, 525 ulcers, 60, 61, 530 uremia, 90 urticaria, 101, 529 vertigo, 31 vomiting, 638 ARSENICUM IODATUM cancer, 530 crusta lactea, 159 ARSENICUM IODATUM (Continued) diphtheria, 527 psoriasis, 119 throat, 566 ARSENICUM MET. tongue, 422 ARTEMISIA ABROTANUM mvelitis, 228 ARTEMISIA VULGARIS, 226 asthenopia, 227 convulsions, 593 epilepsy, 30, 226, 392, 641 eyes, 227 worms, 593 ARTICULATA, 31 ARUM TRIPHYLLUM, 194 aphonia, 432 diphtheria, 218, 505 follicular pharyngitis, 196 inflammation of the brain, 195 larynx, 196 nasal catarrh, 467 scarlatina, 194,218, 505 sore mouth, 671 throat, 89 uremia, 195 ASAFOETIDA antidotal relations, 556 bones, 515 eyes, 418 hysteria, 113,187 iritis, 418, 571 nervous system, 76, 113, 115, 418 periostitis, 418 syphilis, 571 ulcers, 60, 418, 515, 571 ASARUM EUROPIUM nervous symptoms, 76, 184 ASPARAGUS heart, 105 AURUM METALLICUM, 569 albuminuria, 572 antidotal relations, 556, 569 bones, 573 cervix uteri, 132 cirrhoses, 133 cirrhosis of the liver, 36 congestions, 569 congestion of the head, 570 congestion of the liver, 572 diplopia, 570 ears, 42, 461, 571 eyes, 570 fatty degeneration of the liver, 572 female genital organs, 572, 584 glaucoma, 570 heart, 569,623 hemiopia, 570, 623, 665 hyperemia, 569 hvpertrophv of the heart, 302, 569 " iritis, 418, 570 kidneys, 529,571 lungs, 570 mastoid process, abscess of, 405, 571 mental symptoms, 133, 572 nasal catarrh, 571 orchitis, 572 otorrhea, 571 ozena, 571 708 INDEX OF REMEDIES. AURUM METALLICUM (Continued) pannus, 570 prolapsus uteri, 133, 572, 582 retinal congestion, 570 scrofulous ophthalmia, 570 syphilis, 570, 571 testicles, 330 throat, 571 uterus, 132 AURUM MURIATICUM cervix uteri, 132 AURUM MURIATICUM NATRONATUM cervix uteri, 132 prolapsus uteri, 572 BAD1AGA buboes, 460 enlarged lymphatics, 31 heart, 31 svphilis, 461 BALSAM OF PERU bronchitis, 201 lungs, 596 phthisis, 595 BAPTISIA TINCTORIA, 372 aphthe, 45 diphtheria, 198, 376 dysentery, 376 enteritis, 57 face, 43 mental symptoms, 395, 407 peritonitis, 57 phthisis, 376 typhoid fever, 213, 223, 372, 437, 493 BARYTA CARBONICA, 616 amblyopia, 619 aneurism, 617 apoplexy, 250, 617 brain, 617 capillary bronchitis, 552 complementary relations, 404, 616 constitution, 616 cough, 618 cretinism, 644 ears, 618 enlarged tonsils, 618 fatty tumors, 619 glossoplegia, 617 headache, 619 herpes circinatus, 119,668 mental symptoms, 617 multiple sclerosis of brain and spinal cord, 617 ophthalmia, scrofulous, 619 paralysis, 617 paralysis of the lungs, 619 poisoning by, 616 post-nasal catarrh, 618 scrofulosis, 616 sweat, 620 tabes mesenterica, 619 throat, 618 tonsillitis, 618 BARYTA MURIATICA brain, 617 multiple sclerosis of brain and spinal cord, 617 BELLADONNA, 378 abscess, 380, 562 BELLADONNA (Continued) amenorrhea, 639 antidotal relations, 569, 597 apoplexy, 41, 250, 251 asthenopia, 418 biliary calculi, 181 boils, 391 brain, 219, 300, 380 cancer, 530 cholera infantum, 391 chorea, 74 colic, 590 complementary relations, 391 congestions, 561 conjunctivitis, 385 convulsions, 188, 392 coryza, 305 cough, 106, 393, 540 delirium. 237 dentition, 231 diarrhea, 391 diphtheria, 200, 386 enteritis, 57, 391 enuresis, 388 epilepsy, 392 episcleritis, 385 erysipelas, 44, 101, 380, 388 erythema, 388 eyes, 370, 385 face, 42,43,383 female genital organs, 392, 584 fever, 273, 299,382 gastralgia, 387 gastric symptoms, 328 general character of, 379 glands, 218 hemorrhage, 344 headache, 258, 384, 609 heart, 105 hemicrania, 122 hydrophobia, 89 hysteria, 188 inflammations, 94, 380, 561 inflammation of the brain, 89,381,407 labor, 391 laryngismus stridulus, 474 lead colic, 590 lungs, 596 mammary abscess, 282, 391, 543 meningitis, 41,95,100,274, 300, 359,561 mental symptoms, 203, 274, 642 menses, 582 metritis, 387 metrorrhagia, 254 neuralgia, 391, 582, 647 esophagitis, 387 otalgia, 648, 669 otitis media, 326,384 parotitis, 385 peritonitis, 57,387 poisoning by, 378 puerperal convulsions, 392 puerperal metritis, 387 puerperal peritonitis, 387 pulse, 384 retinal congestion, 570 rectum and anus, 58 rheumatism, 380 INDEX OF REMEDIES. 709 BELLADONNA (Continued) scarlatina, 68, 95, 103, 217, 389, 494, 604, 627 skin, 388 sleep, 103, 412 soreness, 36 sphincters, 379 strabismus, 586 sunstroke, 38 temperament, 379 tetanus, 171 throat, 89, 165, 385, 566 tousillitis, 386, 562 torticollis, 184 typhlitis, 59, 562 tvphoid fever, 273, 383 urine, 388 vomiting, 248 BENZOIC ACID gout, 421 heart, 623 joints, 623 rheumatism, 421 urine, 64, 504, 671 BERBERIDACEAE, 420 BERBERINE, 420 BERBERIS VULGARIS, 420 alkaloids of, 420 biliary calculi, 181, 421 eyes, 588 female genitals, 421 fistula in ano, 421 gout, 421 joints, 421 kidneys, 88. 420 leucorrhea, 421 liver, 279, 421 menses, 121 metritis, 420, 421 peritonitis. 420, 421 renal colic, 181 rheumatism, 421 stools, 421 urinary organs, 88 urine, 420 BISMUTH gastralgia, 175, 577 vomiting, 535 BLATTA, 32 BOMBUS, 93 BORAX VENETA, 669 aphthe, 670 colic, 670 constitution, 669 cough, 671 diarrhea, 670 erysipelas, 672 eyes, 671 ~~leucorrhea, 671 lungs, 671 mucous membranes, 671 nervous system, 669 nose, 671 otalgia, 669 otorrhea, 669 skin, 672 throat, 671 trichiasis, 671 ulcers, 119, 672 BOTHROPS LANCIOLATUS !, aphasia, 33 BOVISTA asphyxia from charcoal fumes, 151.254, 626 colic, 268 epistaxis, 150 mental symptoms, 97 edema, 151 speech,396 urticaria, 101 uterine hemorrhage, 150 BROMINE, 472 asthma, 476 cancer, 473 conjunctivitis, 477 coryza, 473 croup, 474, 649 glands, 472 goitre, 473 headache, 473 hypertrophy of the heart, 208, 223, 477 laryngismus stridulus, 474 mental symptoms, 472 mucous membranes, 473 nasal catarrh, 473 pneumonia, 477 scrofulosis, 472 testicles, 473 tonsillitis, 473 tuberculosis, 473, 477 ulcers, 480 vertigo, 472 BRUCIA, 168 BRYONIA ALBA, 270 alimentary canal, 279 antidotal relations, 585 blood, 270 bronchitis, 277, 540 complementary relations, 585 constipation, 176, 253, 430, 586, 651 coryza, 275 cough, 106, 276, 657, 665 dyspepsia, 279 diarrhea, 108, 280, 422. 444, 685 eyes, 280 face, 229 female genital organs, 281 fever, 270, 297 gastric catarrh, 328, 549 gastric symptoms, 231 gastric fever, 270 glaucoma, 281 headache, 40, 280 heart, 484 hypochondriasis, 586 jaundice, 177 joints, 421 liver, 263, 279 mammary abscess, 281 measles, 282 meningitis, 96, 100, 274, 359, 380, 385 menses, 231, 281 mental symptoms, 280 milk fever, 281 nasal catarrh, 275 peritonitis, 274 pleurisy, 274 pleurodynia, 276, 540 710 INDEX OF REMEDIES. BRYONIA ALBA (Continued) pneumonia, 275, 302 rheumatism, 277, 330 scarlatina, 382, 391 serous membranes, 274 sore mouth, 281, 670 suppressed eruptions, 282 sweat, 280 synovitis, 98, 274, 277 tongue, 537, 548 toothache, 281 typhlitis, 59 typhoid fever, 243, 271, 493 urine, 281 BUFO face 42 epilepsy, 30, 517, 641 peritonitis, 30 skin, 30 ulcers, 30 CACTUS GRANDIFLORUS asthma, 602 diaphragmitis, 310 hemoptysis, 303 heart, 2.23 hypertrophy of the heart, 302 neuralgia, 525 CADMIUM SULPH. asthma, 602 indigestion, 53 yellow fever, 524 CALADIUM SEGUINUM asthma, 200 nymphomania, 582 seminal emissions, 166 sexual excesses, 317 spermatorrhea, 200 worms, 230 CALCAREA ACETICA vomiting, 419 CALCAREA FLUORICA bones, 489 lumbago, 642 CALCAREA IOD. enlarged tonsils, 618 CALCAREA OSTREARUM, 633 amenorrhea, 638 bones, 641 cholera infantum, 636 complementary relations, 597 conjunctivitis, 219 constitution, 463, 633 corneal ulcers, 635 convulsions, 635 cough, 393 delirium, 251 delirium tremens, 641 dentition, 635 diarrhea, 651 eczema, 635 enuresis, 388 epilepsy, 641, 694 female genital organs, 138 gastralgia, 387 glands. 636 gout, 421 headache, 664 herpes circioatus, 119 CALCAREA OSTREARUM {Continued) hip-joint disease, 641 hydrocephalus, 637 hysteria, 583 insomnia, 640 joints, 623, 641 leucorrhea, 639 lumbago, 642 lungs, 596 marasmus, 439, 612 menorrhagia, 639 menses, 638 mental symptoms, 274, 586 nasal catarrh, 467, 636 nervous system, 640 neurasthenia, 583 opacities of the cornea, 635 otitis externa, 636 otitis media, 636 otorrhea, 636 parotitis, 413 phthisis, 506, 638 polypi, 539 post-nasal catarrh, 618 puerperal mania, 307 rheumatism, 421, 623, 642 scarlatina, 218, 391, 604 scrofulosis, 464, 515, 560. 634, 641 scrofulous ophthalmia, 464, 465, 635 seminal emissions, 166, 182 sexual excesses, 182, 318, 447, 639 stomach, 125 temperament, 379 throat, 468 tonsillitis, 618 tuberculosis, 440, 638 typhoid fever, 411, 640 ulcers, 504 ulcers of cornea, 635 urine, 421 urticaria, 101, 668 vomiting, 419, 637 CALCAREA PHOSPHORICA, 643 bones, 225, 645 chlorosis, 645 cholera infantum, 644 complementary relations, 459, 643 constitution, 643 cretinism, 644 female genital organs, 138, 644 fistula in ano, 421 hydrocephaloid, 342, 604, 645 joints, 645 laryngismus stridulus, 474 lungs, 596 marasmus, 545 prolapsus uteri, 139 rachitis, 644 rheumatism, 644 tabes mesenterica, 620 tonsillitis, 618 tuberculosis, 440 ununited fracture, 225, 645 CALCAREA SULPHURICA boils, 633 CALENDULA injuries, 225 CALTHA pemphigus, 83 * INDEX OF REMEDIES. 711 . CALTHA (Continued) skin,83 CAMPHOR antidotal relations, 110, 451, 625 cholera Asiatica, 149, 238, 454, 597 cholera morbus, 149 epistaxis, 451 erysipelas, 82 collapse, 454 diphtheria, 451 face, 43 facial convulsions, 44 inflammation, 90 inflammation of the brain, 90 intermittent fever, 66 scarlatina, 604 seminal emissions, 166 skin,82 stomach, 90 strangury, 89 sunstroke, 38 syncope, 37 tetanus, 173 urinary organs, 89 CANCHALAGUA intermittent fever, 346 CANNABIS INDICA backache, 338 chordee, 85 delirium tremens, 251 gonorrhea, 85 kidneys, 85 mental symptoms, 85 paralysis, 301 uremia, 85 urinary organs, 85 CANNABIS SATIVA chordee, 85 gonorrhea, 85 nephritis, 85 CANTHARIS, 80 alimentary canal, 90 antidotal relations, 89 bladder, 83 brain, 89 burns, 92 chordee, 91 cystitis, 85, 329 diphtheria, 90, 405 dysentery, 90, 235 erysipelas, 92 female genital organs, 92 gastritis, 89 genital organs, 91 gravel, 85 hematuria, 85 hydrophobia, 89 inflammation of the brain, 89 labor, 92 mucous membranes, 90 nephritis, 84 nymphomania, 91 priapism, 91 renal calculi, 84, 181 retained placenta, 92, 333 skin, 80 throat, 90 urethritis, 84 urinary^organs, 83 CANTHARIS (Continued) urine, 671 CAPSICUM, 404 asthma, 404 bronchitis, 349, 516 defective reaction, 143, 598 diphtheria, 405 dyspepsia, 404 dysentery, 91, 405 ears, 42, 405, 461 elongation of the uvula, 405 general action of, 404 gonorrhea, 87 home sickness, 405, 498 inflammation of the mastoid cells, 405, 571 intermittent fever, 66, 190, 346, 405 neuralgia, 582 skin, 82 throat, 90, 405, 566 CARBO ANIMALIS, 459 acne, 134 brain, 219 bronchitis, 460 buboes, 31, 459 cancer, 460 cervix uteri, 134 constitution, 459 cough, 460 deafness, 461 debility, 459, 460 ears, 461 eyes, 461 female genital organs, 134 gastric symptoms, 430, 460 glands, 459 gonorrhea, 459 hemorrhoids 460 headache, 331 lactation, 157 otorrhea, 461 phthisis, 460 pneumonia, 460 stomach, 125 syphilis, 459, 461 uterus, 460 CARBO VEG., 451 abscess, 453 antidotal relations, 451 , aortitis, 456 aphonia, 432, 454, 692 aphthous sore mouth, 46 asthma, 181, 455 blood, 451 bronchorrhagia, 451 cancer, 453 carbuncle, 217, 330, 452,453 catarrhs, 454, 629 cholera, 149, 454 collapse, 454 complementary relations, 451, 696 constipation, 176, 456 cough, 106, 461 debility, 451,461 defective reaction, 143, 434, 598 diphtheria, 451 dysentery, 457 dyspepsia, 54, 176, 456, 502 ears, 461, 468 712 INDEX OF RExMEDIES. CARBO VEG, (Continued) emphysema, 455 epistaxis, 149, 451 eyes, 462 face, 42, 43 female genital organs, 134 fever, 453 gangrene, 453 gastric symptoms, 328, 456, 524 gastro-enteric symptoms, 524 glands, 454 hemoptysis, 451 hemorrhages, 344, 451 hemorrhoids, 456 headache, 280, 456 hectic fever, 349, 453 hip-joint disease, 453 inimical relations, 451 intermittent fever, 348 menorrhagia, 452 metrorrhagia, 452 otorrhea, 461 paralysis of the lungs, 455, 552 syphilis, 461 throat, 700 tympanites, 243, 253, 457 typhoid fever, 2^.3, 235, 453, 536 ulcers, 452 urine, 64 varicose veins, 452 'vertebral caries, 453 yellow fever, 453 CARBOLIC ACID burns, 92 headache, 551 urine, 64 CARBON BISULPHIDE Meniere's disease, 693 CARBONEUM OXYGENISATUM herpes zoster, 63 skin, 83 CARBONS general characteristics of, 449 CARDUUS MARIANUS jaundice, 177 CASCARILLA abdominal symptoms, 292 constipation, 467 CASTOR EQUI sore nipples, 28 CASTOREUM amenorrhea, 111 colic, 111 nervous system, 115, 184 typhoid fever, 27, 111 CAULOPHYLLUM dysmenorrhea, 167, 615 labor, 334 leucorrhea, 639 pregnancy, 334 prolapsus uteri, 139 rheumatism, 278 CAUSTICUM, 689 agalactia, 333, 693 anger, effects of, 267 ankle-joint, 656 aphonia, 432, 455, 692 apoplexy, 691 bladder,'253 CAUSTICUM (Continued) brain, 617 catarrh, 629 chorea, 694 colic, 694 constitution, 689 cough, 393, 665, 692 dysmenorrhea, 694 ears, 693 enuresis, 388, 693 epilepsy, 693 gout, 269 heels, 630 headache, 664, 684 inimical relations, 451, 689 locomotor ataxia, 690 Meniere's disease. 693 mental symptoms, 120, 267 nature of, 689 nervous system, 73 paralysis, 301, 617, 689, 690 paralysis of tongue, 690 ptosis, 162, 219, 371 rectum and anus, 58 retention of urine, 253, 694 rheumatism, 269, 694 scabies, 446 scrofulosis, 691 skin, 83, 665, 694 tongue, 690 urine, 697 vertigo, 690 warts, 694 CEDRON ciliary neuralgia, 424 intermittent fever, 77 neuralgia. 269, 307, 350, 525 CEPA complementary relations, 532 coryza, 355, 371 cough, 393 ulceration of heel, 630 CHAMOMILLA, 230 abortion, 232 after-pains, 333 anger, effects of, 207 antidotal relations. 535, 611 biliousness, 279 colic, 318 convulsions, 190 coryza. 231 cough,106 dentition, 231 diarrhea, 232, 320, 612 dysmenorrhea, 191, 244, 245 gastric symptoms, 232 insomnia, 231 jaundice, 177, 231 labor, 232 lungs, 596 mental symptoms, 231, 267, 322 menses, 245 nervous system, 230 neuralgia. 269, 611 otalgia, 326, 618, 6 J-9 rheumatism, 231 skin,652 sweat, 536 teeth, 319, 613 INDEX OF CHELIDONIUM, 261 capillary bronchitis, 263 gastralgia, 466 liver, 193, 262, 279 neuralgia, 263 pneumonia, 263, 276 scapular pains, 262 CHENOPODIUM scapular pains, 263 CII1MAPHILA gonorrhea, 87 CHININUM ARSENICOSUM gastralgia, 387 CHININUM SULPH. blood, 341 enlarged spleen, 77, 341 infusoria, 341 intermittent fever. 77, 346 pemphigus, 83 reflex action, 341 skin, 83 tissue waste, 341 CHLORAL skin, 83 CHLORIDE OF GOLD AND PLATINUM caries and necrosis, 320 CHLORINE, 480 antidotal relations, 481 aphthous sore mouth, 481 catarrh, 481 coryza, 481 impotence. 481 laryngismus stridulus, 474 nervous system, 481 scurvy, 481 typhoid fever, 481 CHOLOS TERRAPINS cramps in muscles, 269 CICUTA VIROSA cancer, 419 convulsions, 44, 419 epilepsy, 173, 419 face, 43 nervous system, 76 puerperal convulsions, 419 skin, 419 tetanus, 171, 172, 507 worms, 419 CICUTINA, 172 CICUTOXINE, 172 CIMEX LECTULARIUS intermittent fever, 32 CINA, 229 bladder, 230 convulsions, 593 dentition, 392 eyes, 230 face, 229 intermittent fever, 230 strabismus, 586 temperament, 229 whooping cough, 230, 357 worms, 229, 593 CINCHONA, 339 abdominal symptoms, 458 alkaloids of, 340 anemia, 342 antidotal relations, 348, 351, 522 asthenopia, 345 REMEDIES. 713 CINCHONA (Continued) biliary calculi, 182 bowels, 346 brain, 219 cholera infantum, 342 complementary relations, 607 coryza, 305 debility, 457 defective reaction, 143 diarrhea, 158, 346, 499, 610 dyspepsia, 51, 345, 457 enlarged spleen, 77 face, 42 gastric symptoms, 328, 523, 524 hemorrhages, 274, 343, 452, 611 headache, 40, 345 hectic fever, 348 hydrocephaloid, 342 intemperance, 340 intermittent fever, 77, 214, 346 jaundice, 350 lungs, 349 malarial neuralgia, 437 marasmus, 645 Meniere's disease, 693 mental symptoms, 274 nervous symptoms, 345 neuralgia, 349 poisoning from, 341 retained placenta, 343 rheumatism, 349 seminal emissions, 342, 499 tympanites, 243, 346, 458 typhoid fever, 234 ulcers, 61 CINNABARIS condylomata, 291 eyes, 563 nasal catarrh. 565 scarlatina, 565 sycosis, 291 syphilis, 291, 565 throat, 565 CINNAMON hemorrhage, 344 CITRULLUS, 266 CLEMATIS CRISPA, 82 CLEMATIS ERECTA cancer, 530 gonorrhea, 86 orchitis, 330 skin, 82, 529 urethra, 82, 86 COCA muscular fatigue, 491 COCCULUS INDICUS, 241 cerebro-spinal meningitis, 244 convulsions, 243 debility, 242 dysmenorrhea, 190, 244 genera] action of, 241 headache, 244, 331 hernia, 179 menses, 244 nervous system, 242 neurasthenia, 593 paralysis, 295, 593 rectum and anus, 59 sleeplessness, 338 46 714 INDEX OF REMEDIES. COCCULUS INDICUS (Continued) spinal cord, 242 spinal irritation, 309 stomach, 125 tympanites, 243. typhoid fever, 242 COCCUS CACTI phthisis, 595 whooping cough, 31 CODEIN muscular twitchings, 247 phthisis, 247 COFFEA ARABICUM, 358 alkaloids of, 358 apoplectic congestion, 359 circulation, 360 diarrhea, 360 fatigue, 360 general action of, 358 heart, 31 mental symptoms, 300, 359 . skin, 359 special senses,. 359 teeth, 319 toothache, 281,359 COLCHICUM AUTUMNALE, 233. abdominal symptoms, 235 antidotal relations, 236 Bright's disease, 236 cholera, 57, 236 convulsions, 57 debility,. 233 dentition, 392 dropsy, 65, 236 dysentery, 91, 235 gastric symptoms, 328 glossoplegia, 617 gout, 235 heart, 236 indigestion, 57 pericarditis, 236b. prosopalgia, 301 rheumatism, 278 tympanites, 235, 243, 253,. 346 typhoid fever. 234, 526 COLEOPTERA, 32 COLLINSONIA constipation, 178' hemorrhoids, 178 neurasthenia, 593 paralysis, 593 prolapsus uteri, 17& COLOCYNTH, 266 abdomen, 267 antidotal relation, 611 arthritic ophthalmia, 269, 32ft ciliary neuralgia, 269 colic, 267, 303, 318, 391, 611 cramps of muscles, 269 diarrhea, 612 dysentery, 90, 267 dysmenorrhea, 267 enteritis, 266 epididymis, 267 glaucoma, 269 gout, 269 headache, 269 hip disease,, 269-. iritis,.269 COLOCYNTH (Continued) mental symptoms, 26.S ovarian tumor, 266 paraphimosis, 269, 368 rheumatism, 269, 694 sciatica, 269 COMOCLADIA DENTATA erysipelas, 202 eyes, 202 skin, 202 COMPOSITE, 221 CONCHIOLIN osteitis, 645 CONIFERS, 284 CONIUM MACULATUM, 416 bladder, 86 cancer,. 417, 530 cancer of the stomach, 418 cataract, 544 complementary relations, 418 constipation, 418 cough,417 cystitis, 419 debility, 416 ears, 417 eyes, 588 glands, 417 heart, 365, 417, 623 hypochondriasis, 417, 606 impotence, 534 injuries, 417. 502 muscular exhaustion, 315 noma, 417 edema, 417 paralysis, 295, 416 post-diphtheritic paralysis, 416 prosopalgia, 417 rheumatism, 215 scrofulosis, 417 scrofulous ophthalmia, 417 seminal emissions, 166 sexual excesses, 417, 534 testicles, 330 tonsils, enlargement of the, 618 urethra, 86 urethritis, 86 vertigo, 417 COPAIVA lungs, 596 pemphigus, 83 skin, 83 CORALLIUM RUBRUM chancre, 290 nasal catarrh, 623 psora, 30 syphilis, 30 whooping cough, 27, 31 CORNUS FLORIDA intermittent fever, 347 CRABRO, 93 CROCUS chorea, 71 eyes, 588 hysteria, 73r 76 menses, 582 muscular twitchings, 247 CROTALUS HORRIDUS cough, 106 diphtheria, 49 INDEX OF REMEDIES. 715 CROTALUS HORRIDUS (Continued) ears, 42 erysipelas, 44, 389 hematuria, 63 keratitis, 42 retinal apoplexy, 41 CROTON TIGLIUM antidotal relations, 207 cholera infantum, 266 colic, 268 diarrhea, 238. 268, 291, 369 gonorrhea, 86 mammary abscess, 282 skin, 81, 292 CUBEBS gonorrhea, 87 CUCURBITA .tape-worm, 266 CUCURBITACEAE, 265 CUPRUM ARSENICOSUM visceral neuralgia, 599 CUPRUM METALLICUM, 597 after-pains, 333 antidotal relations, 597 aortitis, 456 asthma, 355 chlorosis, 598 cholera Asiatica, 597 colic, 598 complementary relations, 597 convulsions, 189 defective reaction, 434, 598 epilepsy, 599 erysipelas, 389 exanthemata, 395 face, 42, 43 fever, 598 intermittent fever, 68 laryngismus stridulus, 474 meningitis, 96, 599 neuralgia, 599 pneumonia, 599 scarlatina, 412, 603 sleep, 412 suppressed eruptions, 96, 232, 599 uremia, 598 whooping cough, 357 CURARE, 192 catalepsy, 170 emphysema, 192 liver spots, 119, 170 muscular exhaustion, 315 nervous system, 192 tetanus, 170 CYCLAMEN asthenopia, 123 chlorosis, 336 dysmenorrhea, 245 gastric symptoms, 328 hemorrhages, 344 headache, 124 nasal catarrh, 326 neurasthenia, 336 strabismus, 586 CYPRIPEDIUM sleep, 359 DIFFENBACHIA throat, 89 DIGITALIS PURPUREA, 361 abortion, 362 alkaloids of, 361 balanorrhea, 367 cerebro-spinal meningitis, 367 chill, 67 chordee, 368 cyanosis neonatorum, 363 cvstitis, 367 dropsy, 64,156, 364 gonorrhea, 367 heart, 105, 162, 362 hydrocele, 364 hydrocephalus, 316, 367 hydrothorax, 364 jaundice, 364 kidneys, 529 liver, 364 meningitis, 316, 362 paraphimosis, 368 seminal emissions, 166,368 sleep, 363 syncope, 37 urinary organs, 86 vesical irritation, 89 vomiting, 361 vomiting of pregnancy, 362 DIOSCOREA diarrhea, 422, 444 seminal emissions, 166 sexual excesses, 318, 640 visceral neuralgia, 266 DOLICHOS dentition, 392 DORYPHORA urethritis, 86 DRACONTIUM bronchitis, 201 DROSERA asthma, 27 cough, 254, 368, 692 phthisis, 27 whooping cough, 27 DULCAMARA, 403 antidotal relations, 556 bladder, 404 colic, 403 complementary relations, 404 coryza, 403 cough,618 cystitis, 329, 404 diarrhea, 403 lungs, 404 mental symptoms, 647 myelitis, 220 nervous system, 404 otalgia, 403 paralysis, 404, 691 paralysis of the lungs, 404 poisoning by, 403 rheumatism, 403 skin, 404 speech, 404 spinal cord, 404 throat, 403 tongue, 404 twitching of muscles, 403 716 INDEX OF REMEDIES. DULCAMARA (Continued) urticaria, 404 ELAPS ears, 42 gastro-intestinal symptoms, 57 lungs, 50 phthisis, 50 pneumonia, 50 stomach, 57 ELATERIUM cholera infantum, 266 diarrhea, 34, 237, 238,265, 268, 369 EQUISETUM HYEMALE albuminuria, 86 cystitis, 86, 329 enuresis, 86 hematuria, 86 ERIGERON CANADENSIS uterine hemorrhage, 151, 344 vesical irritation, 87 ERYODICTION CAL. (See Yerba Santa) EUCALYPTUS intermittent fever, 347 EUPATORIUM PERFOLIATUM, 228 aphonia, 455, 692 intermittent fever, 213, 228, 347 EUPATORIUM PURPUREUM intermittent fever, 228 vesical irritation, 86 EUPHORBIA COROLLATA cholera morbus, 292 ulcers, 61 EUPHORBIA CYPARISSIAS skin, 82 EUPHORBIA PEPLUS skin, 82 EUPHORBIACEAE, 291 EUPHORBIUM erysipelas, 45, 82 skin, 82, 293 ulcers, 61 EUPHRASIA, 369 blepharitis, 369 condylomata, 291, 371 conjunctivitis, 369 coryza, 370 eyes, 369, 648 granular lids, 578 heart, 679 iritis, 370 nasal catarrh, 355 ptosis, 371 scrofulous ophthalmia, 465 FEL TAURI constipation, 29 FEL VULPI constipation, 29 FERRUM IOD female genital organs. 136 FERRUM METALLICUM. 607 anemia, 343, 462 antidotal relations, 348, 607 circulation, 607 chlorosis, 463, 608 cholera infantum, 610 complementary relations, 462, 607 constitution, 607 FERRUM METALLICUM (Continued) cough,609 diarrhea, 157, 346, 523, 610 female genital organs, 584 gastralgia, 608 gastric symptoms, 523 hemoptysis, 607, 609 hemorrhages, 610 headache, 609 intermittent fever, 611 menses, 609 neuralgia, 607 phthisis florida, 607, 609 rheumatism, 216, 231, 261 tuberculosis, 609 uterine hemorrhage, 610 vertigo, 609 FERRUM PHOS. bladder, 87 cholera infantum, 152, 251, 610 diarrhea, 610 dvsentery, 610 fever, 299 inflammation, 152, 609 lungs, 152 phthisis, 610 pneumonia, 610 pulmonary congestion, 610 urinary organs. 87 FLUORIC ACID, 489 antidotal relations, 513 bones, 489 caries, 489 cicatrices, 490 dental fistula, 489 felons. 490 gastric symptoms, 667 muscular fatigue, 490 nevi, 411, 491 nails, 490 skin, 490 sleep, 491 syphilis, 489 varicose veins, 491 wine, aggravation from, 600, 601 FORMICA, 93 albuminuria, 82 skin, 82 GAMBIER, 339 GAMBOGE diarrhea, 156 GAULTHERIA pleurodynia, 276 GELSEMIUM, 161 abortion, 167 amenorrhea, 639 antidotal^elations, 167 aphonia, 162 bilious fever, 164 catarrhs, 165 cerebro-spinal meningitis, 163 diarrhea, 167, 237, 254 diplopia, 161 dysmenorrhea, 167 dyphagia, 162 emotions, 167, 254, 257 epididymitis, 166 female genital organs, 166 INDEX OF REMEDIES. GELSEMIUM (Continued) fever, 164, 297 genital organs, 166 gonorrhea, 166 headache, 40, 163, 188, 244, 280, 664 heart. 162, 257 hemicrania, 122 intermittent fever, 66, 164, 214 labor, 166, 393 measles, 165, 338 muscular fatigue, 315 nervous system, 161 paralysis,'l58, 163, 417 passive congestion, 163 pneumogastric nerves, 207 poisoning by, 161 post-diphtheritic paralysis, 162, 575 prosopalgia, 165 ptosis, 161, 219 puerperal convulsions, 167, 239 remittent fever, 164 rheumatism, 166 seminal emissions, 166 sexual excesses, 318 skin, 165 throat, 165 typhoid fever. 164, 374 uterus, 167 GERANIUM MACULATUM diarrhea, 354 GETTYSBURG SPRING WATER] bones, 515 hip-joint disease, 320, 623 vertebral caries, 320, 623 GLONOIN, 405 albuminuria, 407 amenorrhea, 639 apoplexy of the retina, 406 brain, 300 circulation, 259, 405 congestion of the retina, 406, 570 convulsions, 189, 407 eyes, 406 headache, 405, 664 inflammation of the brain, 407 injuries, 407 meningitis, 96, 300 mental symptoms, 407, 470 metrorrhagia, 259 puerperal convulsions, 407 retinal congestion, 570 speech, 406 sun, ill effects of the, 38, 406 wine, aggravation from, 601 GNAPHALIUM diarrhea, 354 sciatica. 269 GRAPHITES, 462 antidotal relations, 207, 462, 521 aphonia, 196, 683 blepharitis, 124, 464, 587 chlorosis, 463 cicatrices, 466, 514 complementary relations, 462 constipation, 467 constitution, 463 cough, 468 551, 417. GRAPHITES (Continued) crusta lactea, 159 ears, 167 eczema, 464 erysipelas, 92, 466 eyes, 124, 464, 550, 671 female genital organs, 134, 468 fissure in ano, 467 flatulence, 466 gastralgia, 466 gastric symptoms, 466 glands, 464 hemorrhoids, 467 heart, 469, 679 heels, 630 impotence, 468 indigestion, 55 leucorrhea, 463 liver, 466 m le genital organs, 468 menses, 463 mental symptoms, 463 nasal catarrh, 467 obesity, 463 ovaries, 63, 468 prolapsus uteri, 135 scrofulosis, 464 scrofulous ophthalmia, 464, 665 skin, 463, 464, 529, 665 sweat, 620 tarsal cysts, 319 throat, 468 trichiasis, 671 GRATIOLA diarrhea, 369 GRINDELIA ROBUSTA antidotal relations, 207 heart, 162 pneumogastric nerves, 207 GUAIACUM chest pains, 286 gout, 269 growing pains, 500 phthisis, 201 pleurodynia, 308 rheumatism, 269, 278, 694 HALOGENS, 471 HAMAMELIS abortion, 307 ecchymoses of the sclerotic, 180 hematemesis, 281 hemorrhage, 151, 344 hemorrhoids, 178 milk leg, 333 orchitis, 329 pregnancy. 324 typhoid fever, 507 varicocele, 324 varicose veins, 324, 491 vicarious menstruation, 281 HEDEOMA female genitals, 139 HELLEBORUS, 313 alkaloids of, 313 aphthe, 47 apoplexy, 251 convulsions, 44 dropsy, 64, 99, 156, 316 718 INDEX OF REMEDIES. HELLEBORUS (Continued) heart, 366 hydrocephalus, 99, 316 intermittent fever, 67 kidneys, 529 meningitis, 96, 315 nephritis, 316 scarlatina, 64 sensorium, 313 shock,316 tubercular meningitis, 315 typhoid fever, 39, 314 HELONIAS DIOICA albuminuria, 335 female genital organs, 128, 335, 584, 585 leucorrhea, 336 lying-in, 335 neurasthenia, 335 prolapsus uteri, 139 uterine disease, 128 uterine displacements, 335 vaginitis, 335 HEPAR SULPHURIS CALC, 646 abscess, 562, 648 antidotal relations, 506, 513, 555, 569, 597, 652 bladder, 652 Bright's disease, 649 buboes, 650 capillary bronchitis, 650 catarrhs, 649 constipation, 651 corvza, 648 cough, 483, 649 croup, 303, 476, 648 dental abscess, 45 diarrhea, 651 dyspepsia, 51, 650 ears, 42, 384, 648 eczema, 652 enuresis, 652 eyes, 465, 648 faceache, 648 fever blisters, 668 follicular tonsillitis, 682 gastric symptoms, 430, 667 glands, 650 inflammation, 647 liver, 651 lungs, 596, 650 marasmus, 651 mental symptoms, 121, 647 mercury, abuse of, 506 nervous system, 230, 647 neuralgia, 647 ophthalmia, 648 otalgia, 648 otitis externa, 648 otitis media, 385, 648 periodontitis, 45 pneumonia, 650 scrofulous ophthalmia, 465 skin, 652 styes, 648 throat, 588, 650, 700 tonsillitis, 386, 562, 648 tonsils, 618 tuberculosis, 484, 650 HEPAR SULPHURIS CALC. (Continued) ulcers, 60, 61, 652 HIPPOMANE MANC. scarlatina, 292 HURA BRAS. skin, 81 HYDRASTIS CANADENSIS cancer, 530 cancer of the uterus, 480 mucous membranes, 337 post-nasal catarrh, 326 stomach, 126 uterus, 337 HYDROCOTYLE vesical irritation, 138 HYDROCYANIC ACID, 507 asphyxia, 403 cholera, 508 convulsions, 44, 403, 508 cough.508 epilepsy, 507, 641 face, 43 heart, 484, 508 intermittent fever, 66 nervous system, 507 paralysis of brain and lungs, 315, 508 phthisis, 508 scarlatina, 494, 508, 604 syncope, 37 tetanus, 172, 507 uremia, 403 HYMENOPTERA, 32, 93 HYOSCYAMUS, 396 apoplexy, 251 bladder, 253 brain, 397 chorea, 399 convulsions, 43, 189, 398 cough, 106, 398 delirium, 399 elongated uvula, 398 epilepsy, 398 face, 42, 43 fever, 399 hiccough, 191 hysteria, 187 inflammation of the brain, 397 intermittent fever, 67 mania, 396, 400 meningitis, 397 mental symptoms, 97,211,396,397,407, 581 metrorrhagia, 254 multiple sclerosis of the brain and spinal cord, 617 nervous system, 73, 76 nymphomania, 533 paralysis, 397 puerperal mania, 400 retention of urine, 253 scarlatina, 390, 397 sleep, 398 typhoid fever, 39, 250, 383 urethritis, 87 HYPERICUM injuries, 225 tetanus, 171 INDEX OF REMEDIES. IGNATIA AMARA, 186 antidotal relations. 192, 600 chorea, 71 convulsions, 188 cough, 106, 190 deafnesss, 544 dysmenorrhea, 190, 245 dyspepsia, 191 eyes. 191 gastralgia, 191 grief, effects of, 186, 498 headache, 74, 188 hiccough. 191 hysteria, 74, 187, 257 intermittent fever, 190 joints, 220 laryngismus stridulus. 474 mental symptoms, 97, 322, 498 neurasthenia, 583 nose, 257 paralysis, 593 phlyctenular ophthalmia, 192 proctalgia, 58 prolapsus ani, 191 rectum and anus, 53 stomach, 125 temperament, 186 throat, 190 tonsils, 618 toothache, 192 worms, 191, 229 ILLICIUM ANISATUM lungs, 596 INDIGO epilepsy, 30 worms, 191, 229 INDIUM gastric symptoms, 605 INULA female genital organs, 139 IODINE, 477 abuse of, 477 antidotal relations, 478, 557 cancer, 480 croup, 476 diarrhea, 479 diphtheria, 205 glands, 479 heart, 479 joints, 98 laryngismus stridulus, 474 marasmus, 664 mental symptoms, 472, 586 ovarian tumor, 480 ovaries, 479 pancreas, 479 phthisis, 47S pneumonia, 478 rheumatism, 480 scrofulosis, 479 synovitis, 98 tabes mesenjerica, 479, 619 ulcers, 480 IPECACUANHA, 351 alkaloids of, 351 antidotal relations, 403, 521 asthma, 355 capillary bronchitis, 356, 552 cholera infantum, 353 IPECACUANHA (Continued) colic, 353 conjunctivitis, 357 convulsions, 353 coryza, 355 diarrhea, 353 gastric symptoms, 328, 352 general action of, 351 hematuria, 357 hemorrhage, 343, 452, 611 headache, 352 intermittent fever, 348, 357 laryngismus stridulus, 474 lungs, 596 stomach, 320 suppressed eruption, 283 temperament, 351, 358 vomiting, 549 whooping-cough, 357 IRIS VERSICOLOR cholera morbus, 238,329 diarrhea, 329, 346 headache, 258, 664, 685 hemicrania, 122 JABORANDI asthenopia, 123 bronchitis, 650 JACARANDA chancroid, 290 condylomata, 290 JATROPHA CURCAS cholera Asiatica, 238, 292 JUGLANDACE.E, 192 JUGLANS CATIIARTICA (Flee Juglans Cinerea.) JUGLANS CINEREA headache, 192, 244, 280 hydrothorax, 193 jaundice, 193 JUGLANS REGIA menses, 192 KALI BICHROMICUM, 681 asthma, 687 I bronchitis, 687 constitution, 681 corneal opacities, 635 corneal ulcers, 686 cough. 628, 687 croup, 565, 683 diarrhea, 685 diphtheria, 200, 565, 682 dysentery, 59, 91, 685 eyes, 686 flushes of heat, 436 follicular pharyngitis, 681 gastric catarrh, 681 gastric symptoms, 684 gastritis, 684 gonorrhea, 681 headache, 664, 684 heart, 679 iritis, 686 laryngitis, 681 leucorrhea, 681 measles, 338, 685 mucous membranes, 681 nasal catarrh, 623, 683 720 INDEX OF REMEDIES. KALI BICHROMICUM (Continued) otalgia, 682 otitis media, 681 otorrhea, 681 ozena, 48, 290, 683 pharyngitis, 681 rectum and anus, 58 rheumatism, 331, 687 scrofulous ophthalmia, 108 skin, 83, 685 sycosis, 686 syphilis, 683 throat, 700 tongue, 662 ulcers, 61 whooping-cough, 32 KALI BROMATUM, 674 brain-fag, 676 cholera infantum, 355 diarrhoea, 355 eczema. 677 epilepsy, 676 locomotor ataxia, 676 mental symptoms, 407, 581, 676 nervous system, 73, 575, 674 night terrors, 675 sexual excesses, 318 skin, 83, 676 urticaria, 101 KALI CARB., 696 anemia, 696 asthenopia, 123 blood, 696 chest pains, 286 complementary relations, 696 coryza, 699 cough, 692, 700 debility, 697 face, 42, 43 heart, 105, 697, 701 liver, 279 lumbago, 215 mental symptoms, 69» muscular fatigue, 315 nasal catarrh, 699 nervous system, 698 phthisis, 506 pneumonia, 264 puerperal convulsions, 698 spinal irritation, 698 stomach, 125 sweat, 620 throat, 699 urine, 697 KALI CHLORICUM asthma, 602 antidotal relations, 556 follicular pharyngitis, 682 heart, 469 KALI FERROCYANICUM female genital organs, 137 KALI HYDRIODICUM, 677 antidotal relations, 556, 680 bones, 319 catarrh, 677 coryza, 677 endocarditis, 679 eyes, 677 general symptoms of, 677 KALI HYDRIODICUM (Continued) gummatous tumors, 679 headache,677 heart, 679 iritis, 677 joints, 98 keratitis, 677 kidneys, 680 lungs, 677 ozena, 61, 677 paralysis of the lungs, 552 pericarditis, 679 phthisis, 679 pneumonia, 678 pulmonary oedema, 679 rheumatism, 680 sciatica, 680 skin, 83, 680 spinal cord, 679 synovitis, 98 syphilis, 61, 680 KALI NITRICUM heart, 469 kidneys, 88 skin, 83 KALI PERMANGAN diphtheria, 105, 200 scarlatina, 494 KALI SULPHIDE skin, 83 KALMIA heart, 210, 302, 365, 623 hypertrophy of the heart, 302 neuralgia, 307, 525 ptosis, 162, 219 rheumatism, 216, 365, 623 KAOLIN croup, 476, 684 KOBALT backache, 338 | sexual excesses, 182 spinal irritation, 309, 604 KREOSOTUM blepharitis, 578 cancer, 130 enuresis, 388 female genital organs, 129, 584 gastric symptoms, 176, 328 neuralgia, 281, 525 teeth, 47, 319 urinary symptoms, 129 vomiting, 535, 637 LAC CANINUM diphtheria, 28, 49 ozena, 48 LAC DEFLORATUM diabetes, 28 headache, 28 prolapsus uteri, 139 LACHESIS, 35 abscess, 562 albuminuria, 63 antidotal relations, 556 aortitis, 456 aphthe, 45 apoplexy, 250, 251 asthma, 50 Bright's disease, 63 INDEX OF REMEDIES. LACHESIS (Continued) bronchitis, 48 cancer, 68 carbuncle. 68, 77, 530 chancre, 60 cholera, 57 circulation, 63 climaxis, 36, 63 coryza, 275 cough, 106, 393 croup, 684 cystitis, 63 delirium, 394 delirium tremens, 251 diarrhea, 51 diphtheria, 49, 200, 413 dysentery, 59 dyspepsia, 651 ears, 42 enteritis, 57 erysipelas, 44, 101, 389 eyes, 41 face, 42 female genital organs, 60 flushes of heat, 436 gastric symptoms, 667 hematuria, 63 hemophilia, 545 headache, 40 heart, 63, 105, 486, 679 inimical relation,628 intermittent fever, 65, 190, 347 laryngismus stridulus, 474 liver, 51, 413, 447 loquacity, 39, 394 lungs, 349 male genital organs, 60 malignant pustule, 68 meningitis, 41 menses, 61 mental symptoms, 36,38,97,203,586,' metrorrhagia, 259 modalities, 68 nasal catarrh, 48, 275 nose, 48 ovaralgia, 60 ovarian tumors, 60 ovaries, 60 ovaritis, 60 ozena, 48 paralysis of the lungs, 552 parotitis, 413 peritonitis, 59 pneumogastric nerves, 207 pneumonia, 50, 444 post-scarlatinal dropsy, 64 prosopalgia, 45 puerperal mania, 307 rectum and anus, 58 retinal apoplexy, 41 scarlatina, 68, 217, 383, 390, 628 scrofulous ophthalmia, 41 skin, 82 sleep, 36 sore mouth, 45 stomach, 51 syphilis, 60 teeth, 45 tetanus, 172 LACHESIS (Continued) throat, 48 tonsillitis, 48, 562 tuberculosis, 50 typhlitis, 52, 59 typhoid fever, 38,103, 250, 375 ulcers, 60 universal symptoms, 35 urine, 64 vertigo, 36 vellow fever, 53 LACHNANTHES intermittent fever, 67 LACTIC ACID diabetes mellitus, 500 sweat, 620 LACTUCA heart, 679 LAC VACCINUM, 28 LAMIUM ALBUM hemorrhoids, 205 LAPIS ALBUS cancer, 480 catarrh, 480 tuberculosis, 480 LATHYRUS, 154 LAUROCERASUS aphonia, 629 asphyxia neonatorum, 552 catarrhs, 629 cough,508 defective reaction, 143, 434, 598 liver, 447 phthisis, 508 vertigo, 37 LEDUM antidotal relations, 108 ecchymoses of the sclerotic, 180 gout, 216 hemorrhages, 344 hemoptysis, 303 heart, 623 heels, 630 injuries, 225 lumbago, 215 rheumatism, 216, 278, 518 wine, aggravation from, 601 LEPTANDRA VIRGINICA diarrhea, 369 liver, 369, 567 tvphoid fever, 507 LILIUM TIGRINUM asthenopia, 123 chest, 128 circulation, 324 female genital organs, 127, 585 leucorrhea, 128 mental symptoms, 120 prolapsus uteri, 127 retroversion, 128 subinvolution of the uterus, 127 uterine symptoms, 128, 337 LIME preparations of, 632 LINARIA enuresis, 86 fainting, 368 LITHIUM CARB., 621 asthenopia, 622 722 INDEX OF REMEDIES. LITHIUM CARB. (Continued) bladder, 622 cough,622 diarrhea, 622 eyes, 622 gastralgia, 622 gout, 421,621 headache, 621 heart, 622 hemiopia, 622, 665 joints, 621 menses, 622 mucous membranes, 621 nasal catarrh, 622 rheumatism, 421, 622 skin, 621 LOBELIA INFLATA asthma, 355 hay fever, 527 gastric symptoms, 352 vomiting, 247 LOBELIA SYPHILITICA scapular pain, 263 LYCOPODIUM, 409 amenorrhea, 639 aphthous sore mouth, 46 asthma, 181 blood,410 bronchial catarrh, 414 capillary bronchitis, 357 cirrhosis of the-liver, 413 complementary relations, 415 constipation, 176 constitution, 410 convulsions, 43 cough, 506. 516 diphtheria, 49, 197, 386, 413 dropsy, 414 dyspepsia, 125. 457 erectile tumors, 411 face, 42, 43 feet, 656 fever, 410 flatulence, 467 gastric symptoms, 413, 523, 685 gout, 421 gravel, 412 hemorrhoids, 411 hectic fever, 415 hemiopia. 665 hernia, 179 hydropericardium, 414 intermittent fever, 67 joints, 623 kidneys, 415 labor, 307 liver, 263, 413 lungs, 414, 596 mental symptoms, 37, 410, 581 mucous membranes, 414 nevi, 410 nasal catarrh, 414 ovaries, 63 paralysis of the brain, 411 parotitis, 412 pneumonia, 414, 415 preparation of, 410 pulse, 410 renal colic, 181 LYCOPODIUM (Continued) rheumatism, 216, 421 scarlatina, 197, 412, 415 scrofulosis, 515 seminal emissions, 166, 182 sensitiveness, 36 sexual excesses, 182, 318 skin, 652 sleep, 412 stomach, 125 syphilis, 61 temperament, 410 tinea circinatus, 119 tongue, 412 tonsillitis, 386, 618 tympanites, 243, 253, 457 typhoid fever, 39. 411, 415, 640 ulcers, 60, 61 urine, 253, 412, 671 varicose veins, 410 MAGNESIA CARBONICA, 611 abuse of, 611 antidotal relations, 611 cataract, 613 colic, 612 constitution, 612 diarrhea, 612, 651 dyspepsia, 613 marasmus, 612 menses, 613 pregnancy, 613 rheumatism, 613 teeth, 613 MAGNESIA MURIATICA, 614 constipation, 614 constitution, 614 dysmenorrhea, 191, 614 headache, 614, 620 heart, 614 hysteria, 614 liver, 177, 614 menses, 614 nervous system, 114, 115, 615 ozena, 615 rachitis, 615 scrofulosis, 615 skin, 615 sweat, 615 urine, 615 uterus, 614 MAGNESIA PHOSPHORICA nervous system, 615 neuralgia, 525 MAMMALIA, 27 MANCINELLA scarlatina, 82, 292 skin, 82. 292 MANGANUM cough, 578 heels, 630 larynx, 578 rheumatism, 630 MEDUSA urticaria, 31 MELANTHACEJE, 233 MEL CUM SALE metritis, 388 uterus and ovaries, 107 INDEX OF REMEDIES. MELILOTUS headache, 258 MENISPERMAOEJE, 241 MENTHA PIPERITA cough, 398 MENYANTHES headache. 331, 517 intermittent fever, 66, 347, 453 MEPHITIS asthma, 27 loquacity, 39 nervous system, 27, 76 sleep, 491 whooping cough, 27 MERCURIUS BINIOD. diphtheria, 200, 564 eyes, 563 syphilis, 461, 566 MERCURIUS CORROS. balanorrhea, 368 corneal ulcers, 563 diphtheria, 566 eyes, 563 . gonorrhea, 87, 368 iritis, 563, 571, 677 ophthalmia neonatorum, 325 retinitis albuminuria, 563 , syphilis, 563, 571 syphilitic nasal disease, 565 throat, 89, 566 typhlitis, 59 urinary organs, 87 MERCURIUS CYANATUS croup, 684 ■ diphtheria, 200, 451, 564 epistaxis, 451 scarlatina, 494 MERCURIUS DULCIS eyes, 563 scrofulous ophthalmia, 563 MERCURIUS PROTOIOD. diphtheria, 564 eyes, 563 syphilis, 566 ulcers of the cornea, 563 MERCURIUS SULPHURICUS hydrothorax, 364, 528 MERCURIUS VIVUS abscess, 562 abscess of teeth, 45 antidotal relation, 569 aphthous sore mouth, 46, 670 balanorrhea, 290 blepharitis, 370, 562, 578 bones, 319 buboes, 589 catarrhal fever, 561 catarrh of the bowels, 561 congestions, 561 conjunctivitis, 370 corneal ulcers, 562 coryza, 180 diarrhea, 232, 268, 561 diphtheria, 564 dysentery, 179, 235, 268, 303/610 dyspepsia, 52 epistaxis, 561 eves, 370, 465, 562 fever, 383 MERCURIUS VIVUS (Continue gastric fever, 561 glands, 560 gonorrhea, 87, 290, 330, 367 hemorrhages, 561 headache, 561 inimical relations, 513 iritis, 284, 562 liver, 369, 567, 615 male genital organs, 84 meningitis, 561 monorrhagia, 561 nasal catarrh. 563 nostalgia, 560 otitis media, 326 ozena, 48 periodontitis, 45 peritonitis, 561 pneumonia 263, 561 rheumatism, 290 scabies, 446 scrofulosis, 560 scrofulous ophthalmia, 465 skin, 652 syphilis, 566 throat, 564, 650 tongue, 422 tonsillitis, 387, 562 toothache, 45, 78 typhlitis, 52 typhoid fever, 211 ulcers, 60, 504 urinarv organs, 87 MERCURY antidotes to, 505, 506, 555 preparations of, 554 MEZEREUM antidotal relation, 557 ciliary neuralgia, 424 cougli, 218 crusta lactea, 158 eczema, 218 herpes zoster, 311 neuralgia. 525 rectum and anus, 59 skin, 82,158 ulcers, 119 MILLEFOLIUM, 227 hematemesis, 281 hemoptysis, 303 hemorrhages, 227, 344 menstruation, 281, 582 MINERAL KINGDOM, 425 MITCHELLA cervix uteri, 138 uterine hemorrhage, 151 vesical irritability, 138 MOMORDICA BALSAMUM flatulence, 40, 266, 413 MORPHIA cancer, 247 tympanites, 247 MOSCHUS, 27, 109 antidotal relation, 79 hysteria, 75, 110, 187, 583 menses, 63 mental symptoms, 75 nervous system, 109 paralysis of the luugs, 552 724 INDEX OF REMEDIES. MOSCHUS (Continued) vertigo, 37 MUREX PURPUREA menses, 129 uterus, 129 MURIATIC ACID, 491 antidotal relations, 253, 495 aphthous sore mouth, 46 cirrhosis of the liver, 495 diphtheria, 197, 494, 505 dropsy, 495 gastric symptoms, 495 general symptoms, 491 mental symptoms, 491 muscular exhaustion, 315, 495 nervous system, 491 scarlatina, 197, 494 typhoid fever, 103, 212, 376, 492 ulcers, 61 MYGALE, 70 chordee, 72 chorea, 70 nervous system, 71 MYLABIS CICHORII ET PHALATERII, 80 MYOSOTIS lungs, 596 MYRICA CERIFERA jaundice, 365 MYRTUS COMMUNIS phthisis, 79 NAJA diphtheria. 49, 199 NATRUM ARSENICOSUM diphtheria, 105, 199 face, 43 scarlatina, 494 NATRUM CARBONICUM, 653 ankle-joint, 656 burns, 653 catarrhs, 656 constipation, 654 corneal ulcers, 656 cough,657 debility, 656 diarrhea, 654 dyspepsia, 654 eczema, 657, 672 eyes, 588 feet, 656 female genital organs, 135, 657 gastric symptoms, 605 heat, ill effects of, 655 heels, 630 hypochondriasis, 653 labor, 657 mucous membranes, 656 nasal catarrh, 656 ozena, 656 nervous system, 655 pregnancy, 657 phlyctenular ophthalmia, 656 seminal emissions, 666 skin, 657 sunstroke, 655 NATRUM HYPOCHLOROSUM aphthous sore mouth, 46 female genital organs, 136 NATRUM HYPOCHLOROSUM (Con- tinued) prolapsus uteri, 139 NATRUM MURIATICUM, 659 anemia, 661 antidotal relation, 103 asthenopia, 124, 664 cataract, 514 catarrhs, 665 chlorosis, 662 ciliary neuralgia, 664 conjunctivitis. 124 constipation, 666 coryza, 665 . cough, 665, 692 dyspepsia, 666 eczema, 668 eyes, 124, 588, 664 female genital organs, 135, 581, 663 fever blisters, 668 fright, ill effects of, 254 gonorrhea, 666 grief, chronic effects of, 498 headache, 280, 664, 684 heart, 128, 469 hemiopia, 665 herpes, 668 hypochondriasis, 662, 667 intermittent fever, 102, 213, 668 marasmus, 666 mental symptoms, 97,120, 322, 592, 662 mucous membranes, 665 nervous system, 76, 575, 662 nutrition, 666 paralysis, 162, 593, 596 prolapsus ani, 667 prolapsus uteri, 135, 139, 663 ptosis, 124 rectum and anus, 58. 667 scrofulous ophthalmia, 664 scurvy, 661 seminal emissions, 665 skin,667 spinal irritation, 308, 663, 699 sunstroke, 38 sweat, 283 throat, 665 tongue, 312 urticaria, 667 NATRUM PHOSPHORICUM seminal emissions, 666 NATRUM SULPHURICUM, 657 constitution, 657 corneal opacities. 635 diarrhea, 422, 444, 658, 685 eyes, 588 flatulence, 658 hip-joint disease, 658 phthisis, 658 svcosis, 658 NICCOLUM stomach, 125 NICOTINUM tetanus, 173 NITRI SPIRITUS DULCIS (See Sweet Spirits of Nitre.) NITRIC ACID, 503 abscess of the mastoid process, 405 antidotal relations, 505, 556 INDEX OF REMEDIES. 725 NITRIC ACID (Continued) aphthous sore mouth, 46 caries of the mastoid process, 571 catarrhs, 504 chancre, 61 condylomata, 290 corneal ulcers, 515, 635 cough,506 diarrhea, 504 diphtheria, 196, 505 ears, 42, 405, 461 fissure in ano, 467 iritis, 571 leucorrhea, 504 local effects of, 503 mastoid abscess, 405 mental symptoms, 204 mercury, abuse of, 505 mucous membranes, 503, 504 pemphigus, 83 phthisis, 506 ptyalism, 504 rectum and anus, 58 renal colic, 579 scarlatina, 196, 505 scrofulosis, 635 stomacace, 504 syphilis. 61, 461, 504, 505, 571 sweat, 620 throat, 588, 650 tuberculosis, 635 typhoid fever, 492, 506 ulcers, 61, 504 urine, 504 NITRITE OF AMYL eyes, 385 flushes of heat, 436 heart, 31 metrorrhagia, 259 prosopalgia, 301 NITRO-MURIATIC ACID gastric symptoms, 495 NOBLE METALS, 568 NOSODES, 140 NUPHAR LUTEUM diarrhea, 354 NUX JUGLANS crusta lactea, 159 tinea favosa, 218 NUX MOSCHATA eyes, 588 face, 43 hysteria, 111, 188 nervous system, 111 rheumatism, 613 NUX VOMICA, 168 abdominal symptoms, 130 antidotal relations, 248, 462, 532, 6 apoplexy, 251 arthritic headache, 121 asthma, 180 atrophy of the retina, 179 backache, 183 bladder, 182 blepharospasmus, 179 brain-fag, 510 brain, softening of the, 184, 534 colic, 177, 590 NUX VOMICA (Continued) complementary relations, 174 composition of, 168 conjunctivitis, 179 constipation, 175, 205, 414, 651, 667 coryza, 180, 231, 305 cough, 106, 180 cramps in muscles, 269 debility, 234 diarrhea, 178 dysentery, 91, 178, 567 dysmenorrhea, 245 dyspepsia, 175, 447, 457, 655 ears, 180 ecchymoses of the sclerotic, 179 epilepsy, 517, 641 epistaxis, 180 Eustachian catarrh, 180 eyes, 124, 179 face, 43 female genitals, 130, 183 follicular tonsillitis, 683 gastric catarrh, 328 gastric irritability, 175 gastric symptoms, 328, 414 gonorrhea, 182 hematuria, 182 hemoptysis, 181 hemorrhoids, 177 headache, 121,174, 280 hemicrania, 122 hernia, 179 hypochondriasis, 586, 667 hysteria, 257 inimical relation, 600 intermittent fever, 185, 190 jaundice, 177 kidneys, 181 labor, 183, 333 lead colic, 590 liver, 124, 176 liver spots, 119 locomotor ataxia, 184 lumbago, 184, 642 marasmus, 523 menses, 183 mental symptoms, 97, 322 nasal catarrh, 564 nose, 257 paralysis, 295 pregnancy, 183 prolapsus uteri, 183, 422 renal colic, 181 rheumatism, 184 scrofulous ophthalmia, 179 seminal emissions, 166 sensitiveness. 36 sexual excesses, 182, 318, 447 sleep, 174, 338 spinal cord, 183, 589 spinal irritation, 183, 309 stomacace, 180 stomach, 57, 125 temperament, 174 torticollis, 183 typhoid fever, 185 uterus, 130 vomiting of pregnancy, 183, 205 wine, aggravation from, 601 726 INDEX OF REMEDIES. CENANTHE CROCATA, 416 OENOTHERA BIENNIS diarrhea, 354 OLEANDER, 157 abdominal organs, 157 antidotal relations, 158 crusta lactea, 158 diarrhea, 157, 346, 610 headache, 157 lactation, 157 mental symptoms, 157 paralysis, 157, 158 skin, 158 stomach, 125 vertigo, 157 OLEUM ANIMALE, 28 OLEUM JECORIS ASELLI general symptoms of, 29 OLEUM RICINI COMMUNIS [See Ricinus Communis J OPHIDIA. 33 OPIUM, 246 alkaloids of, 246 antidotal relations, 250, 253 apoplexy, 95, 250 asphyxia from charcoal vapors, 254 bladder, 253 cholera infantum, 251 colic, 254, 590 constipation, 176, 252, 430 convulsions, 189 cough,252 defective reaction, 143 delirium tremens, 251 diarrhea, 167 face, 43 fever, 254 fright, ill effects of, 254 general action of, 248 hemoptysis, 252 lead colic, 590 marasmus, 253 mental symptoms, 254 metrorrhagia, 254 muscular exertion, 315 poisoning by, 249 puerperal fever, 254 rectum and anus, 58, 59 retention of urine, 253 suppression of urine, 253 suppuration of the lungs, 252 tympanites, 253 typhoid fever, 39, 250, 315, 498 OPUNTIA VULGARIS diarrhea, 354 ORTHOPTERA, 32 OXALIC ACID spinal softening, 510 testicles, 330 P.EONIA fissure in ano, 467 PALLADIUM, 584 female genital organs, 584' headache, 584 hysteria, 75 mental symptoms, 75, 121, 584 ovaritis, 62 PAPAVERACE.E, 246 PAREIRA BRAVA urinary symptoms, 88,421 PARIS QUADRIFOLIA eyes, 385 headache, 517 larynx, 578 loquacity, 39 PASSIFLORA 1NCARNATA tetanus, 170 PAULLINIA SORBILIS diarrhea, 354 headache, 258 PENTHORUM SEDOIDES corvza, 326 PETROLEUM, 468 antidotal relations, 470 blepharitis, 469 cough,469 dacryo cystitis, 469 diarrhea, 469 eczema, 468 eyes, 469 dislocation of joints, 220 gastralgia, 466 gastric symptoms, 469 headache, 280 heart, 128, 469 lumbago, 215 mental symptoms, 407,470 nervous system, 469, 655 ozena, 469 rheumatism, 469 sea-sickness, 469 skin, 465, 468 sprains, 469 sweat, 469, 514 sycosis, 291 typhoid fever, 470 vomiting in pregnancy, 469 PETROSELINUM gonorrhea, 86, 368, 419 urine, 671 PHELLANDRIUM headache, 331, 418 mammary glands, 282, 419 phthisis, 516 PHOSPHORIC ACID, 496 bones, 500 cough,500 debility, 313, 490 diabetes, 500 diarrhea, 346, 49s face, 42 fright, ill effects of, 2.54 grief, ill effects of, 186, 498 growing pains, 500 headache, 499 hip-joint disease, 500 home-sickness, 498 kidneys, 500 mental symptoms, 186, 441, 496 mucous membranes, 499 neurasthenia, 343, 510 ovaries, 498 seminal emissions, 499 sensorial depression, 314, 496 sleep, 499 tuberculosis, 500 typhoid fever, 213, 314, 493, 496 INDEX OF REMEDIES. 727 PHOSPHORIC ACID (Continued) ulcers, 60 uterus, 498 vertebra] caries, 500 PHOSPHORUS, 532 alimentary tracts, 537 amblyopia, 544 amenorrhea, 539 antidotal relations, 532 aphonia, 432, 454, 539 asthenopia, 544 - blood, 536 bones, 515, 542 brain fag, 510 Bright's disease, 536 bronchitis, 540, 541 cancer of the stomach, 538 capillary bronchitis, 356 cataract, 544 cerebral softening, 185, 534 chest pains, 286 chorea, 534 choroiditis, 544 colds, 180 complementary relations, 355,451, 532, 696 constipation, 538 cough, 144, 516, 540 croup, 540 deafness, 544 debility, 343 delirium, 533 diabetes, 538 diarrhea, 158,444, 538 dyspepsia, 538 endocarditis, 542 eyes, 544, 648 face, 42 fatty degeneration, 536 fatty degeneration of the heart, 542 fatty degeneration of the liver. 537 fistule, 543 gastric symptoms, 605 hematemesis, 545 hemophilia, 545 hemoptysis, 281, 545 hemorrhages, 344, 539 headache, 533 heart, 542 hip-joint disease, 543 impotence, 534 inimical relation, 689 jaundice, 537 kidneys, 529 laryngismus stridulus, 474 larynx,539 liver, 447, 536, 692 locomotor ataxia, 534 lungs, 596 mammary abscess, 539 marasmus, 439 menses, 281, 539 mental symptoms, 532 myocarditis, 542 nasal catarrh, 539 necrosis of the lower jaw, 542 nervous system, 532, 655 neurasthenia, 510, 343 nose, 257 PHOSPHORUS (Continued) nymphomania, 533, 539 ozena, 539 pancreas, 538 paralysis, 544, 593, 605 phthisis, 479 pneumonia, 260, 541 polypi, 539 retinal apoplexy, 41 retinitis, 544 retinitis albuminurica. 544 rose-cold, 257 scrofulosis, 634 seminal emissions, 166, 510 sexual excesses, 544 softening of the brain, 185 spasmodic esophageal stricture, 538 spinal cord, 534 spinal irritation, 533 sweat, 536 throat, 537 tongue, 537 tracheitis, 540 tuberculosis, 440, 534, 541, 638 typhoid fever, 212, 497, 535 ulcer of the stomach, 538 ulcers, 60, 538 vertebral caries, 543 vicarious menstruation, 281 vomiting, 638 waxy degeneration of the liver, 537 white swelling, 543 yellow atrophy of the liver, 537 PHYSOSTIGMA spinal irritation, 184, 308 tetanus, 169 PHYTOLACCA aphthous sore mouth, 46 cicatrices, 514 convulsions, 170 diphtheria, 199 heart, 210 mammary abscess, 282 tetanus, 170, 173 PICRIC ACID, 508 back, 128, 338 brain-fag, 508 brain, softening of the, 185 general symptoms of, 508 locomotor ataxia, 92 meningitis, 92 myelitis, 92 neurasthenia, 509 poisoning by, 508 priapism, 92, 509 seminal emissions, 509 PICROTOXINE tetanus, 169 PINUS SYLVESTRIS joints, 641, 656 PIPER METHYSTICUM nervous system, 360 PIPER NIGRUM skin, 82 PISCES, 29 PIX LIQUIDA bronchial catarrh, 201 lungs, 596 728 INDEX OF REMEDIES. PIX LIQUIDA (Continued) phthisis, 79, 286 skin, 82, 286 PL ANT AGO MAJOR enuresis, 388 otalgia, 326 relation to tobacco, 403 PLANTAIN antidotal relation, 108 PLATINA, 581 convulsions, 317, 583 female genital organs, 62, 133, 582, 583 headache, 75 hysteria, 75,187, 583 lead colic, 583, 590 masturbation, 317, 583 menses, 63, 582 mental symptoms, 121, 133, 581 neuralgia, 532, 594 nymphomania, 62, 133, 581 ovaritis, 62, 582 prolapsus uteri, 582, 583 puerperal convulsions, 583 sexual excesses, 317, 583 PLATINUM MUR. bones, 515, 583 PLUMBUM, 590 abortion, 591 antidotal relations, 590 cerebral disturbance, 591 colic, 590 constipation, 253, 430, 591 delirium, 591 epilepsy, 591 granular kidney, 572 kidney, 592 multiple cerebro-spinal sclerosis, 591 muscles, 590 paralysis, 590, 591, 605 progressive muscular atrophy, 591 rectum and anus, 59 ulcers, 61 PODOPHYLLUM PELTATUM, 422 abdominal symptoms, 422 bilious remittent fever, 423 cholera infantum, 266 cholera morbus, 238 convulsions, 57 dentition, 57, 423 diarrhea, 178, 232, 346, 369, 422, 444 fever, 423 marasmus, 612 prolapsus recti, 131, 422, 594 prolapsus uteri, 131, 178, 422, 594 tongue, 422 POTASH SALTS remarks on the, 673 POTHOS FOETIDA, 201 asthma, 201 PRUNUS eyes, 385 neuralgia, 269 PSORINUM, 141 cholera infantum, 142 constitution, 141 debility, 698 defective reaction, 141, 143, 434, 598 headache, 685 herpes, 142 PSORINUM (Continued) night sweats, 349 scabies, 143 sebaceous glands, 142 skin, 142 ulcers, 142 PTELEA headache, 352 liver, 615 PULMO VULPIS PULSATILLA NUTTALLIANA, 321 chest-pains, 286 PULSATILLA PRATENSIS, 321 after-pains, 333 amenorrhea, 332 anemia, 322 antidotal relations, 321, 607, 611 backache, 338 chest, 128 chlorosis, 322, 463 circulation, 323 complementary relations. 321 conjunctivitis, 124, 325 constipation, 329 corneal ulcers, 325 coryza, 180, 325 cough,506 cystitis, 329 dacryo-cystitis, 325 diarrhea, 167, 238, 329 dysmenorrhea, 190, 244, 245, 332 dyspepsia, 176, 345 ears, 326, 669 epistaxis, 324 eyes, 124, 325 face, 42, 43 female genital organs, 13.2, 332 fever, 337 fright, ill effects of, 254 gastric catarrh, 327, 549 gastric symptoms, 352 general character of, 321 gonorrhea, 290, 329 gout, 331 headache, 40, 331 heart, 210 hemoptysis, 281, 324 heels, 630 hemicrania, 122 hiccough, 191 hydrocele, 330 intermittent fever, 337 joints, 206 labor, 183, 333 lungs, 700 mammary glands, 333 measles, 165, 338 menses, 245, 281, 332 mental symptoms, 120,186, 322,586,592 milk leg, 333 mucous membranes, 325 nasal catarrh, 326, 564 neuralgia, 338 ophthalmia neonatorum, 325, 577 orchitis, 290, 329 otalgia, 326, 648, 669 otitis externa, 326, 332 otitis media, 326 INDEX OF REMEDIES. 729 PULSATILLA PRATENSIS (Continued) ozena, 290 pregnancy, 329, 332 prostate gland, enlargement of the, 330 prostatitis, 290 purulent ophthalmia, 577 retained placenta, 333, 343 rheumatism, 216, 290, 330 sleep, 338 spinal irritation, 338 sycosis, 290, 686 synovial membranes, 330 synovitis, 330 temperament, 322 testicles, 330 throat, 327 tuberculosis, 323 urine, 253 urticaria, 101 uterus, 132 varicocele, 324 varicose veins, 323 vesical irritation, 87 vicarious menstruation, 281 wine, aggravation from, 601 QUASSIA worms, 230 QUININE (See Chinin. Sulph).. RHUS GLABRA, 202 RHUS RADICANS headache, 207 pleurodynia, 276 rheumatism, 216 RHUS TOXICODENDRON, 208 antidotal relations, 207 apoplexy, 258 brain, 218 carbuncles, 216 cellulitis, 216, 219 colic, 219 conjunctivitis, 107, 219, 371 coryza, 218 cough, 218, 516 diarrhea, 218 diphtheria, 198, 210 dislocation of the jaw, 220 dropsy, 414 dysentery, 210, 218 eczema, 217 enteritis, 57, 218 erysipelas, 45, 101, 217 eyes, 107, 219, 371, 578, 588 face, 42, 44 fever blisters, 668 glaucoma, 219 granular lids, 578 heart, 208 herpes zoster, 311 hypertrophy of the heart, 208, 223, 302, 477 influenza, 218 inimical relation, 208 intermittent fever, 213 iritis, 219 lumbago, 214, 642 meningitis, 97 mental symptoms, 407 metritis, 218 muscular exertion, bad effects of, 214, 491 esophagitis, 387 otalgia, 219 palpitation of the heart, 210 paralysis, 220, 301 parotitis, 413 periproctitis, 58 peritonitis, 57, 210, 218 perityphlitis, 218 phlyctenular ophthalmia, 219 pneumonia, 210 ptosis, 162, 219, 371 pulse, 210 rheumatism, 215, 231, 278, 642,694 scarlatina, 97, 103,210, 217, 390, 628 scrofulous ophthalmia, 219 skin, 81, 217, 529 sprains, 214, 224 sweat, 515, 536 tongue, 312, 422, 537 toothache, 220 typhlitis, 59, 218 typhoid fever, 210, 273, 374, 383, 493, 497, 522 ulcers, 414 urticaria, 101 variola, 218 vertigo, 219 RADIATA, 30 RANUNCULACEiE, 294 RANUNCULUS BULBOSUS, 309 alcoholism, 311 diaphragmitis, 310 epilepsy, 311 eczema, 311 hay fever, 311 headache, 331 herpes zoster, 311 pemphigus, 311 peritonitis, 309 pleurisy, 309 pleurodynia, 263, 276, 310 pneumonia, 310 rheumatism, 310 serous membranes, 309 skin, 82, 311 ulcers, 311 RANUNCULUS SCELERATUS, 311 diphtheria, 312 headache, 331 skin, 82, 311 stomacace, 312 tongue, 312 typhoid fever, 312 RAPHANUS flatulence, 253, 414 RATANHIA fissure in ano, 467 toothache, 613 RHEUM antidotal relation, 611 diarrhea, 611, 612, 651 RHODODENDRON nervous system, 655 orchitis, 330 rheumatism, 216 wine, aggravation from, 601 730 INDEX OF REMEDIES. RHUS TOXICODENDRON (Continued) vomiting, 248, 406 RHUS VENENATA, 202 RICINUS COMMUNIS agalactia, 293, 333 antidote to, 293 ROBINIA neuralgia, 525 ROSA DAMASCENA hay fever, 527 RUBIACE^E, 339 RUMEX CRISPUS asthma, 27 cough, 106, 393, 516, 540 diarrhea, 444, 685 pleurodynia, 276 urticaria, 101 RUTA asthenopia, 418 complementary relations, 643 eyes, 588 injuries, 502, 620 lumbago, 215 sprains, 620 SABADILLA, 239 influenza, 240 mental symptoms, 239 worms, 240 SABINA, 285 abortion, 285 condylomata, 291 gastric symptoms, 328 menses, 582 post-partum hemorrhage, 285, 344 rheumatism, 629 SACCHARUM OFFICINALE corneal opacity, 635 mental symptoms, 635 SALICYLIC ACID aphthe, 46 Meniere's disease, 693 SAMBUCUS coryza, 231 croup, 303 laryngismus stridulus, 474 laryngitis, 483 SANGUINARIA CANADENSIS, 255 acne, 261 aphonia, 261 bronchitis, 349 circulation, 257 conjunctivitis, 260 coryza, 260 cough, 259, 260, 349 croup, 261 ears, 256 general action of, 256 hemorrhages, 259 headache, 257 hemicrania, 122 hysteria, 257 larynx, 261 mental symptoms, 256 metrorrhagia, 259 nose, 257 phthisis, 259 pneumonia, 259, 276 polypi, 261, 539 SANGUINARIA CANADENSIS (Con- tinued) rheumatism, 261, 613 rose-cold, 257 skin, 261 vertigo, 257 SANTONINE, 229 eyes, 230 SARSAPARILLA antidotal relations, 253 chest pains, 286 marasmus, 253 stomach, 125 sycosis, 291, 686 urine, 672 SCILLA MARITIMA cough, 665, 692 lungs, 596 SCROPHULARIACESE, 361 SECALE CORNUTUM, 146 abortion, 148 blood, 147 bloodvessels, 147 cataract, 544 cholera Asiatica, 148, 524 cholera infantum, 148 cholera morbus, 148 circulation, 146 convulsions, 146, 159, 407 face, 42 female genital organs, 138 gangrene, 147, 530 gastro-enteric symptoms, 524 follicular pharyngitis, 683 hemorrhages, 147, 344 intermittent fever, 67 labor, 147 lumbago, 642 lungs, 349 paralysis, 617 poisoning by, 146 retained placenta, 147 ulcers, 61 uterus, 147 SELENIUM, 428 aphonia, 196, 431, 693 constipation, 430 debility, 429 gastric symptoms, 430 headache, 429 heat, ill effects of, 38, 429 impotence, 429 inimical relation, 432 larynx and lungs, 431, 578 liver, 431 nervous system, 429 prostatorrhea, 429 seminal emissions, 166, 429 skin, 431 sleep, 430 typhoid fever, 429 wine, aggravation from, 601 SENECIO AUREUS catarrh, 336 cough, 336 hemoptysis, 281 menses, 281, 336 uterus, 336 INDEX OF REMEDIES. 731 SENEGA pleurodynia, 276 phthisis, 595 whooping cough, 32 SENNA debility, 697 urine, 697 SEPIA, 116 abortion, 139 anemia, 324 antidotal relation, 402 arthritic headache, 121 asthenopia, 123 backache, 338, 604 blood, 118 cataract, 123 chlorosis, 323 « circulation, 117 complexion, 117 conjunctivitis, 123 connective tissue, 119 constipation, 208 constitution, 117, 118 cough,692 discovery of medicinal virtues of, 116 dyspepsia, 124, 402 eczema, 657 epistaxis, 118 eyes, 123, 588 female genital organs, 127, 584 gastric symptoms, 328, 460, 593 general action of, 117 gonorrhea, 367 hemorrhoids, 124 headache, 121, 664 hemicrania, 121 herpes, 119 herpes circinatus, 119, 668 hypochondriasis, 654 joints, 119 liver, 177 liver spots, 119 marasmus, 612 mental symptoms, 119,322,586,593,663 motion, 117 neuralgia, 402 post-nasal catarrh, 613 prolapsus uteri, 182. 423 ptosis, 162, 219 scabies, 119 seminal emissions, 166, 446 skin, 117, 119, 529, 657 sphincters, 117 spinal irritation, 604, 701 stomach, 124 time, 118 trachoma, 123 ulcers, 119, 657, 672 urticaria, 101 uterus, 119 venous congestions, 117 SILICEA, 512 abscesses, 513, 562 ankle-joint, 691 antidotal relation, 513 boils, 513 bones, 490, 514 carbuncle, 77, 513 cataract. 544 SILICEA (Continued) cellulitis, 513 chest pains, 286 cicatrices, 513 complementary relation, 489, 513 constipation, 516 constitution, 512 corneal ulcers, 515 cough, 516 diarrhea, 516 ears, 42, 405, 515 enuresis, 388 epilepsy, 517, 641 fissure in ano, 467, 543 fright, ill effects of, 254J glands, 514 hay fever, 311, 516, 527 headache, 188, 517, 620, 685 hemicrania, 122 hip-joint disease, 514 inimical relation, 513 keratitis, 515 knee-joint disease, 514 lungs, 516 mammary abscess, 539 mastoid process, caries of the, 571 mental symptoms, 254 mucous membranes, 515 nasal catarrh, 515 nervous system, 517, 655 neuralgia, 647 neurasthenia, 511 otitis media, 405 otorrhea, 326, 515, 636 ozena, 615 paralysis, 517 periodontitis, 45 phthisis, 516, 595 rachitis, 512, 615 rheumatism, 518 scrofulosis, 464, 514, 560, 615 skin, 652 spinal cord, 518 sweat, 514, 615, 620 tabes mesenterica, 620 tetanus, 171 tonsillitis, 387, 516, 562 tuberculosis, 516 ulcers, 60, 61, 514 vaccination, ill effects from, 287, 512 vertebral caries, 514 vertigo, 518 SINAPIS NIGRA hay fever, 527 SODA salts of, 653 SOLANACE^E, 377 SPIGELIA, 423 brain, 219 ciliary neuralgia, 424, 664 eyes, 300, 306, 385, 424 headache, 78, 331, 423, 664 heart, 105, 236, 366, 424, 479 mental symptoms, 424 neuralgia, 269, 288, 306, 423 post-nasal catarrh, 326 prosopalgia, 301 retinitis, 424 worms, 424 732 INDEX OF REMEDIES. SPONGIA, 482 constitution, 482 cough„368, 483 croup, 302, 475, 483, 649 glands, 482 goitre, 482 heart, 484 hoarseness, 432 laryngeal phthisis, 483 laryngitis, 483 orchitis, 482 testicles, 330, 482 tuberculosis, 483, 650 SQUILLA MARITIMA (See Scilla.) STANNUM METALLICUM, 592 complementary relation, 592 dyspepsia, 593 epilepsy, 594 hypochondriasis, 593 hysteria, 594 mental symptoms, 322, 592 mucous membranes, 594 neuralgia, 576, 582, 594 neurasthenia, 592 paralysis, 596 phthisis, 592, 595 pleurisy, 596 prolapsus uteri, 130, 593 stomach, 125 worms, 593 STAPHISAGRIA, 317 anger, ill effects of, 268 antidotal relation, 557 aphthous sore mouth, 46 arthritic ophthalmia, 320 bones, 319 colic, 318, 320 condylomata, 290, 319 crusta lactea, 159, 318 diarrhea, 320 eczema, 319 eyes, 319 gastric symptoms, 352, 430 gout, 320 hypochondriasis, 317 injuries, 225 lumbago, 215 mental symptoms, 231, 317, 318 mouth, 45, 319 ovaries, 318 paralysis, 301, 596 pediculi, 318 prolapsus uteri, 320 sexual excesses, 182, 317 skin, 318 stomach, 125, 320 styes, 319 sycosis, 318 syphilis, 318 teeth, 318 temperament, 317 testicles, 330 STICTA PULMONARIA asthma, 27 coryza, 231 nervous system, 76 STILLINGIA' antidotal relations, 557 STILLINGIA (Continued) bones, 319 hip-joint disease, 658 STRAMONIUM, 394 antidotal relation, 597 brain, 395 chorea, 71, 399 convulsions, 189, 394, 685 delirium, 237, 394, 401 delirium tremens, 251 diarrhea, 396 erysipelas, 395 exanthemata, 395 face, 42 hiccough, 191 hip-joint disease, 396] hydrophobia, 394 locomotor ataxia, 395 , loquacity, 39 mania, 401 mental symptoms, 203, 237, 282, 394, 396 nervous system, 76 nymphomania, 396 scarlatina, 391, 395, 412 sleep, 412 speech, 406 tetanus, 173 tongue, 396, 422 typhoid fever, 250 urine, 253 STRONTIANA. CARBONICA, 620 apoplexy, 620 bones, 621 caries of the femur, 515 circulation, 620 climacteric. 620 diarrhea, 621 headache, 517 neuralgia, 594 ostitis, 319 skin, 621 sprains, 621 STRYCHNIA, 168 tetanus, 168 SULPHUR, 433 abscess, 562 acne, 438, 445 ankle-joints, 656, 691 antidotal relations, 253 aphonia, 443, 455 asthma, 425 boils, 438, 443 bronchitis, 443 capillary bronchitis, 356 cholera Asiatica, 448 cholera infantum, 441, 637 cicatrices, 514 circulation, 435 complementary relation, 174 congestion of the chest, 435 congestion of the head, 435 congestion of the spinal cord, 510 conjunctivitis, 300, 442 constipation, 446 constitution, 434 continued fever, 527 coryza, 443 cough,368 INDEX OF REMEDIES. SULPHUR (Continued) crusta lactea, 158, 438 debility, 429 defective reaction, 433, 598 diarrhea, 232, 422, 444, 469, 658, 685 dropsv, 99 dysentery, 90, 436, 444, 567 dyspepsia, 125, 446 epilepsy, 641 erysipelas, 436 eyes, 443, 635 female genital organs, 447 fever, 299, 436, 527 flatulence, 414 flushes of heat, 436 gastric symptoms, 414, 605 glands, 43# gonorrhea, 447 hemorrhoids, 435, 446 headache, 551 heart, 105, 435 hip-joint disease, 440 hydrocephaloid, 441 hydrocephalus, 99, 439 hysteria, 440 intermittent fever, 214, 437 keratitis, 443 laryngitis, 443 liver, 177, 431, 446 liver spots, 119 lumbago, 215 lungs, 439. 596, 700 marasmus, 253, 438, 523 meningitis, 96, 275 mental symptoms, 37, 441, 647 mucous membranes, 442 nasal catarrh, 443 nervous system, 440 neuralgia, 437, 647 neurasthenia, 593 panaritium, 108 paralysis, 102, 220, 301, 441 peritonitis, 442 pleurisy, 98, 442 pneumonia, 50, 260, 436, 442, 443 prostatorrhea, 429 psora, 429, 434 rachitis, 438 , retinal congestion, 570 rheumatism, 331, 442 scabies, 119, 434, 445 scarlatina, 391, 436, 494 scrofula, 438, 464, 515, 560 scrofulous ophthalmia, 443, 464, 465 seminal emissions, 166, 429 sexual excesses, 182, 318, 447 skin, 158, 431, 444 sleep, 338, 431 spinal congestion, 441 spinal cord, 5^9 spinal irritation, 441 spinal weakness, 441 stomach, 125 suppressed eruptions, 96,433 synovitis, 277, 442 * tabes mesenterica, 440 throat, 468 tonsillitis, 387, 562 tubercular meningitis, 99, 439 SULPHUR (Continued) tuberculosis, 439, 440, 542 tympanites, 243 typhoid fever, 437 ulcers, 60 uterine diseases, 128 vertebral caries, 543 white swelling, 440 SULPHURIC ACID, 500 alcoholism, 501 ankle-joint, 656 aphthous sore mouth, 46. 501 brain, 219 cough, 144, 501 diarrhea, 501 diphtheria, 502 dyspepsia, 502 flushes of heat. 436 general symptoms of, 501 hemorrhages, 502 hemorrhoids, 501 indigestion, 56 injuries, 502 marasmus, 501 pemphigus, 83 scarlatina, 494 skin, 83 sprains, 629 stomach and bowels, 56 tvphoid fever, 501 SWEET SPIRITS OF NITRE sensorial depression, 314, 497 typhoid fever, 314, 497 SYMPHYTUM fractures, 645 injuries, 225 TABACUM, 402 antidotal relation, 403 apoplexy, 402 asphyxia, 402 cholera, 402 dyspepsia, 402 gastric symptoms, 352 general symptoms of, 402 heart, 402 neuralgia, 402 relation to Gelsemium, 167 renal colic, 403 strangulated hernia, 403 tetanus, 173 vomiting, 361 TARAXACUM, 227 liver, 227 tongue, 312 typhoid fever, 213 TARENTULA, 72 chorea, 71 nervous system, 72, 675 poisoning by, 72 uterus and ovaries, 72 TARENTULA CUBENSIS, 76 TELLURIUM herpes circinatus, 119, 668 otitis media, 326, 385 TEREBINTHINA, 285 albuminuria, 64 'antidotal relations, 534 Bright's disease, 236, 286 734 INDEX OF REMEDIES. TEBEBINTHINA (Continued) bronchitis, 286 capillary bronchitis, 357 dropsy, 64, 316 hematuria, 64 kidneys and bladder, 285, 529 metritis, 285 peritonitis, 2S5 post-scarlatinal dropsy, 64 puerperal metritis, 388 scarlatina, 285 skin, 82 tympanites, 253, 346 typhoid fever, 64, 285 urticaria, 101 TEUCRIUM MARUM VERUM hiccough, 191 polypi, 539 post-nasal catarrh, 623 THAPSIA GARGANICA skin, 82 THEA stomach, 126, 352 THEBAINE tetanus, 169 THERIDION, 78 antidotal relations, 79 bones, 79 headache, 78 head symptoms, 73 hemicrania, 123 hysteria, 78 ozena, 79 phthisis, 79 sea-sickness, 79 spinal irritation, 79 sun, ill effects of the, 38 vertigo, 37, 78 THUJA OCCIDENTALIS, 286 balanorrhea, 289 blepharitis, 124 ciliary neuralgia, 424 complementary relations, 512 condylomata, 288 eyes, 124 female genital organs, 289, 677 gastric symtoms, 328 gonorrhea, 87, 288 headache, 288 history of, 286 iritis, 289 marasmus, 290 mental symptoms, 239, 287, 395 nails, 289, 490 nervous system. 287 neuralgia, 288 orchitis, 289 ozena, 289 prostatitis, 289 pseudo-cyesis, 288 rheumatism, 289 sclerotitis. 289 scrofula, 290 sweat, 620 sycosis, 287, 288, 686 teeth, 47, 289 urinary organs, 87 vaccination, bad effects of, 287, 512 TILIA EUROPEA puerperal metritis, 388 TITANIUM ■ hemiopia, 665 TRIFOLIUM PRATENSE cough, 277 TRILLIUM PENDULUM menorrhagia, 639 hemorrhages, 344 UMBELLIFER^, 416 URTICA URENS agalactia, 293, 333 urticaria, 31, 101 USTILAGO crusta lactea, 159 female genital organs, 138 hemoptysis, 281 hemorrhages, 139, 150 menses, 281 VALERIANA defective reaction, 143, 434, 598 hysteria, 112, 187, 257 lumbago, 215 nervous system, 112, 115, 230 nose, 257 VALERIANATE OF ZINC hysteria, 188 VEGETABLE KINGDOM, 153 VERATRIA, 169 VERATRUM ALBUM, 236 abdominal organs, 236 antidotal relation, 521 eardiac debility, 238 cholera Asiatica, 237 cholera infantum, 237, 266 cholera morbus, 237, 329, 524 colic, 268 collapse, 454 convulsions, 189 cough,144 cramp, 268 delirium, 237 diarrhea, 167, 237, 329 fright, ill effects of, 254 headache, 188, 331, 352 hemicrania, 122 hiccough, 191 intermittent fever, 66 intestinal symptoms, 553_ mental symptoms, 237, 254 nervous system. 230 neurasthenia, 593 nymphomania, 237 rheumatism, 231 scarlatina, 604 syncope, 37 tetanus, 173 VERATRUM VIRIDE, 239 chorea, 239, 399 fever, 299 heart, 239 lungs, 239 esophagitis. 239, 387 pneumonia, 239, 260, 302 puerperal convulsions, 239 tetanus, 171 VERBASCUM THAPSUS cough, 368 INDEX OF REMEDIES. VERBASCUM THAPSUS (Continued) neuralgia, 368 prosopalgia, 583 VESPA, 93 os uteri, 138 VIBURNUM OPULUS abortion, 232 female genital organs, 139 VINCA MINOR, 158 crusta lactea, 159 hemorrhages, 159, 344 menorrhagia, 159 plica polonica, 159 VIOLA ODORATA rheumatism, 278 VIOLA TRICOLOR crusta lactea, 158, 159 XANTHOXYLUM FRAXINEUM after-pains, 333 YERBA SANTA lungs, 596 phthisis, 201, 596 YUCCA FILAMENTOSA biliousness, 279, 292 skin, 292 tongue, 422 ZINCUM METALLICUM, 599 amblyopia, 605 antidotal relations, 600 asthma, 602 backache,338 brain, 343, 602 brain, softening of the, 605 cholera infantum, 604 chorea, 602 colic, 606 complementary relations, 643 corneal opacity, 605 cough, 606 debility, 429 ZINCUM METALLICUM (Continued) dentition, 602 exanthemata, 395 eyes, 605 female genital organs, 606 gastric system, 604, 605 granular lids, 605 headache, 602, 604 heart, 623 hydrocephaloid, 604 hypochondriasis, 606 inimical relation, 600 liver, 605 locomotor ataxia, 575 measles, 601 meningitis, 96, 316, 602 menses, 606 nervous symptoms, 76, 601 neurasthenia, 511 ovaries, 63, 602 paralysis, 605 poisoning by, 600 prosopalgia, 605 pterygium, 605 rheumatism, 602 scarlatina, 395, 601, 603 sexual excesses, 602 sleep, 412 spermatorrhea, 606 spinal cord, 601, 604 spinal irritation, 308, 602, 604 suppressed eruptions, 96, 282 urine, 606 wine, aggravation from, 601 ZINCUM OXIDATUM hypochondriasis, 417 ZINCUM SULPHURICUM corneal opacities, 605 granular lids, 605 ZINGIBER asthma, 181 urine, 253 ZIZIA chorea, 71 THERAPEUTIC INDEX. ABDOMINAL SYMPTOMS arsenicum, 458 cascarilla, 292 cinchona, 458 colchicum, 235 nux vomica, 130 oleander, 157 podophyllum, 422 veratrum album, 236 ABORTION aconite, 304, 307 actea racemosa, 307 chamomilla, 232 digitalis, 362 gelsemium, 167 hamamelis, 307 plumbum, 591 sabina, 285 secale, 148 sepia, 139 viburnum, 232 ABSCESSES belladonna, 380, 562 carbo veg., 453 hepar, 562, 643 lachesis, 562 mercurius, 562 silicea, 513, 562 sulphur, 562 ABSCESS OF LUNGS lachesis, 50 sulphur, 50 ABSCESS OF TEETH hepar, 45 lachesis, 45 mercurius, 45 silicea, 45 ACNE carbo animalis, 134 sanguinaria, 261 sulphur, 438, 445 ADENOMATA conium, 417 AFTER-PAINS actea racemosa, 307 chamomilla, 333 cuprum, 333 Pulsatilla, 333 xanthoxylum, 333 AGALACTIA agnus castus, 333 causticum, 333, 693 Pulsatilla, 333 ricinus communis, 293, 333 urtica urens, 293, 333 ALBUMINURIA apis, 64 arsenicum, 528 aurum, 572 equisetum, 86 formica, 82 glonoin, 407 helonias, 335 lachesis, 63 terebinthina, 64 ALCOHOLISM ranunculus bulbosus, 311 sulphuric acid, 501 ALIMENTARY CANAL aloes, 448 bryouia, 279 cantharis, 89 lachesis, 50 phosphorus, 537 AMBLYOPIA baryta carb., 619 phosphorus, 544 zincum, 605 AMENORRHEA aconite, 639 actea spicata, 639 apis, 106 belladonna, 639 calcarea ostr., 638 castoreum, 111 gelsemium. 639 glonoin, 639 lycopodium, 639 phosphorus, 539 Pulsatilla, 332 salt. 643 ANAEMIA (See also Chlorosis.) alumina, 570 cinchona, 342 ferrum. 343. 450 kali carb., 677 natrum mur., 661 Pulsatilla, 322 sepia, 324 ANALYSIS OF DRUGS, 18 ANASARCA (See Dropsy.) ANEURISM baryta carb., 617 ANGER, ILL EFFECTS OF causticum, 267 chamomilla, 267 colocynth, 267 staphisagria, 267 THERAPEUTIC INDEX. ANGINA PECTORIS actea racemosa, 308 argentum nitricum, 577 arsenicum, 529j ANKLE-JOINT . causticum, 691 natrum carb., 656 pinus sylvestris, 656 silicea, 691 sulphur, 656, 672 sulphuric acid, 656, 691 ANTIDOTAL RELATIONS, 24 ANTIDOTES aconite, 305 alumina, 585, 589 ammonium carb., 625 anacardium, 206 argentum nitricum, 579 arsenicum, 521 aurum, 569 bryonia, 283 carbo veg.. 451 castor oil, 293 chlorine, 481 cicuta, 403 cinchona, 350, 652 colchicum, 236 cuprum, 597 ferrum, 607 gelsemium, 167 glonoin, 408 graphites, 462 hepar, 600, 680 ignatia, 192 iodine, 478, 652 kali hyd., 680 magnesia carb., 611 mercury, 556 muriatic acid, 495 natrum mur., 660 oleander, 158 ophidia, 35 opium, 248, 253, 495 phosphorus, 516 plumbum, 470, 589, 590 Pulsatilla, 321 rhus tox., 207 selenium, 432 silicea, 513 stramonium, 396 tabacum, 403 zinc, 600 ANUS belladonna, 58 causticum, r>H cocculus, 58, 59 ignatia, 58 • kali bi., 58 mezereum, 58, 59 natrum mur., 58 nitric acid. 58 opium, 58, 59 plumbum, 58, 59 AORTITIS arsenicum, 456 carbo veg., 456 cuprum, 456 lachesis, 456 APHASIA bothrops lanciolatus, 33 APHONIA ammonium caust., 611 arum triphyl., 432 carbo veg., 432, 454, 692 causticum, 432, 454, 692 eupatorium perf., 455, 693 gelsemium, 162 graphites, 196, 693 phosphorus, 432, 454, 539 sanguinaria, 261 selenium, 196, 431 spongia, 432 sulphur, 443. 455 APHTHOUS SORE MOUTH apis, 46 arsenicum, 46 arum triphyllum, 671 baptisia, 45 borax, 670 bryonia', 281, 670 carbo veg., 46 chlorine, 481 helleborus, 47 lachesis, 45 lycopodium, 46 mercurius, 46, 670 natrum hypochlor., 46 nitric acid, 46 Phytolacca, 46 salicylic acid, 46 staphisagria, 46 sulphuric acid, 46, 501 APOPLECTIC CONGESTION coffea, 359 APOPLEXY apis, 95, 251 arnica, 226, 251 baryta carb., 250, 617 belladonna, 41. 250, 251 causticum, 691 helleborus, 251 hyoscyamus, 251 lachesis, 250, 251 nux vomica, 251 opium, 95, 250 rhus tox., 251 strontiana carb., 620 tabacum, 412 APOPLEXY OF THE RETINA arnica, 41 crotalus, 41 glonoin, 406 lachesis, 41 phosphorus, 41 ARTHRALGIA argentum met., 580 ARTHRITIC HEADACHE nux vomica, 121 sepia, 121 ASCITES acetic acid, 99 apocynum canuab., 99 lycopodium, 414 ASPHYXIA ammonium carb., 626 arnica, 151, 254 bovista, 151, 254 738 THERAPEUTIC INDEX. ASPHYXIA (Continued) hydrocyanic acid, 403 tabacum, 402 ASPHYXIA NEONATORUM antimon. tart., 552 lauroeerasus, 552 ASTHENOPIA alumina, 587, 622 ammoniacum gummi, 418 apis, 107 argentum nitricum, 578 artemisia vulgaris, 227 belladonna, 418 cinchona, 345 jaborandi, 123 kali carb., 123 lilium tigrinum, 123 lithium carb., 622 natrum mur., 124, 664 phosphorus, 534 ruta, 418 sepia, 123 ASTHMA ambra grisea, 144 apis, 105 argentum nitricum, 577 arsenicum, 355,527, 687 bromine, 476 cactus, 602 cadmium sulph., 602 caladium seguin., 200 capsicum, 404 carbo veg., 181, 455 cuprum, 355 drosera, 27 ipecacuanha, 355 kali bich., 687 kali chlor., 602 lachesis, 50 lobelia, 355 lycopodium, 181 mephitis, 27 nux vomica, 180 pothos fetida, 201 pulmo vulpis, 29 rumex crispus, 27 sticta, 28 sulphur, 425 zincum, 602 zingiber, 181 ATROPHY OF THE RETINA nux vomica, 179 BACKACHE cannabis indica. 338 kobalt, 338 nux vomica, 183 picric acid, 128 i Pulsatilla, 338 sepia, 338 . zincum, 338 BALANORRHOEA digitalis, 367 mercurius corrosivus, 368 mercurius vivus, 290 thuja. 289 BILIARY CALCULI belladonna, 181 berberis, 181, 421 BILIARY CALCULI (Continued) cinchona, 182 podophyllum, 422 BILIOUSNESS chamomilla, 279 yucca fllamentosa.279,292 BILIOUS REMITTENT FEVER gelsemium, 164 podophyllum, 423 BLADDER arsenicum, 253 berberis, 420 cantharis, 83 cina, 230 causticum, 253 colocynth, 268 dulcamara, 404 erigeron, 87 ferrum phos., 87 hepar, 652 hyoscyamus, 253 lithium carb., 622 nux vomica, 182 opium, 253 Pulsatilla, 87 senecio, 336 BLADDER, PARALYSIS OF THE dulcamara, 404 hepar, 652 BLEPHARITIS alumina, 587 argentum nitr., 577, 578 euphrasia, 369 graphites, 124,464, 587 kreosote, 578 mercurius, 370, 562, 578 petroleum, 469 sepia, 123 thuja, 124 BLEPHAROSPASMUS agaricus, 179 nux vomica, 179 BLOOD alumina, 586 ammonium carb., 625 arsenicum, 522 bryonia, 270 carbo veg., 451 kali carb., 696 lycopodium, 410 phosphorus, 536 quiuine, 341 rhus, 210 secale, 147 sepia, 118 BLOODVESSELS arnica, 222 secale, 147 BOILS arnica, 225 arsenicum, 530 belladonna, 391 calcarea sulph., 633 silicea, 513 sulphur, 438 BONES angustura, 515 aranea diadema, 78 asafetida, 515 THERAPEUTIC INDEX. BONES (Continued) aurum, 573 calcarea fluorica, 489 calcarea ostrearum, 641 calcarea phosphorica, 225, 645 chloride of gold and platinum, 320 fluoric acid, 489 Gettysburg spring water, 320, 515 kali hydriodicum, 319 mercurius, 319 phosphoric acid, 500 phosphorus, 515, 542 platinum mur., 515, 583 silicea, 490, 514 staphisagria, 319 stillingia, 319 strontiana carb., 319, 515, 620 Symphytum, 225 theridion, 79 BOWELS berberis, 421 cinchona, 346 colchicum, 346 sulphur, 444 terebinthina, 346 BOWELS, OBSTRUCTION OF opium, 253 BRAIN aconite, 300 argentum nitricum, 574 arsenicum, 92 baryta carb., 617 baryta mur., 617 belladonna, 219, 300, 380 cantharis, 88 carbo animalis, 219 causticum, 617 cinchona, 219 glonoin, 300 hyoscyamus, 397 plumbum, 591 rhus tox, 219 spigelia, 219 stramonium, 395 sulphur, 441 sulphuric acid, 218 zincum, 343, 602 BRAIN, CONGESTION OF THE belladonna, 300, 380 glonoin, 300, 406 BRAIN-FAG kali bromatum, 676 nux vomica, 510 phosphoric acid, 510 phosphorus, 510 picric acid, 509 BRAIN, INFLAMMATION OF THE arsenicum, 90 arum triphyllum, 195 belladonna, 88, 381, 407 camphor, 90 cantharis, 88 glonoin, 407 hyoscyamus, 397 BRAIN, PARALYSIS OF THE hydrocyanic acid, 315, 508 lycopodium, 411 BRAIN, SOFTENING OF THE ambra grisea, 144 BRAIN, SOFTENING OF tinned) nux vomica, 184, 534 phosphorus, 185, 534 picric acid, 185 zincum, 605 BRIGHT'S DISEASE arsenicum, 528 colchicum, 236 hepar, 649 lachesis, 63 phosphorus, 538 terebinthina, 236 BRONCHIAL CATARRH ammonium carb., 626 ammonium mur., 631 balsam of Peru, 201 bryonia, 277, 540 capsicum, 349, 516 carbo animalis, 460 carbo veg., 460 • dracontium, 201 ipecacuanha, 356 kali bichromicum, 687 lachesis, 48 lycopodium, 415 phosphorus, 538, 539 pix liquida, 201 sanguinaria, 349 sulphur, 443 terebinthina, 286 yerba santa, 201 bro'nchorrhagia carbo veg., 451 BUBOES alumina, 588 badiaga, 31, 460 belladonna, 391 carbo animalis, 31, 459 hepar, 650 mercurius, 589 BURNS arsenicum, 92 cantharis, 92 carbolic acid, 92 sapo soda, 92 soda bicarbonate, 92,653 €ANCER arsenicum alb., 522, 530 arsenicum iod., 530 belladonna, 530 bromine, 473 carbo animalis, 460 carbo veg., 452 cicuta virosa, 420 clematis, 530 conium, 417, 530 hydrastis, 480, 530 iodine, 480 kreosote, 130 lachesis, 68 lapis albus, 480 morphine, 247 CAPILLARY BRONCHITIS antimonium tart., 356, 551 baryta carb., 552 chelidonium, 263 ipecacuanha, 356, 552 740 THERAPEUTIC INDEX. CAPILLARY BRONCHITIS (Continue kali carb., 700 lycopodium, 357 phosphorus, 356 sulphur, 356 terebinthina, 357 CARBUNCLE anthracinum, 77, 217, 5130 arsenicum, 217, 522, 530 carbo veg., 217, 452. 530 lachesis, 68, 77, 530 rhus tox., 216 silicea, 77, 513 tarentula Cubensis, 76 CARDIAC DEBILITY veratrum album. 238 CARIES OF BONES angustura, 515 aranea diadema, 78 calcarea fluorica, 489" fluoric acid, 489- sulphur, 438 CATALEPSY curare, 170 CATARACT conium, 544 magnesia carb., 613 ■ natrum mur., 544 phosphorus, 544 secale, 544 sepia, 123 silicea, 544 CATARRHAL FEVER mercurius, 561 CATARRHS (See also Mucous Membranes.) arsenicum, 355 carbo veg., 454, 629 causticum, 629 s chlorine, 481 gelsemium, 165 hepar, 649 kali hydriodicum, 677 lapis albus, 480 lauroeerasus, 629" natrum carb., 656 natrum mur, 665 nitric acid, 504 rauunculus sceleratus, 312 senecio, 336 CELLULITIS apis, 216 rhus tox., 216, 21& silicea, 513 CEREBRO-SPINAL MENINGITIS ammonium carb., 626 cocculus, 244 digitalis, 367 gelsemium, 163 CERVIX UTERI aurum metallicum, 132 aurum muriaticum,. 132 aurum muriaticum natron., 132 carbo animalis, 134 kreosote, 130 mitchella, 138 murex, 129 natrum carb., 135 CHANCRE corallium rubrum, 290 kali hydriodicum, 61 lachesis, 60' lycopodium, 61 nitric acid, 61 CHANCROID jacaranda, 290 mercurius solubilis, 566 CHANGE OF LIFE lachesis, 36, 63 nitrite of amyl, 31 strontiana carb., 620 CHARCOAL FUMES, ASPHYXIA FROM ammonium carb., 626 arnica, 151, 254 bovista, 151, 254, 626 opium, 254 CHEST PAINS angustura, 263 anisum stellatum, 286 chenopodium, 263 fluoric acid, 286 guaiacum, 286 kali carb., 286 lilium tigrinum, 128 lobelia syphilitica, 263 oxalic acid, 286 phosphorus, 286 pix liquida, 286 Pulsatilla nut., 286 ranunculus bulbosus^ 263 sarsaparilla, 286 silicea, 286 sumbul, 286 theridion, 286 CHLOROSIS (See also Anemia.) alumina, 587 calcarea phosphorica, 645 cyclamen, 336 cuprum, 598 ferrum, 463, 608 graphites, 463 natrum mur., 661 Pulsatilla, 463, 322 sepia, 118, 324 CHOLERA ASIATICA arsenicum, 149, 523 camphor, 149, 238, 454, 597 carbo veg., 149; 454 colchicum, 57, 235 cuprum, 597 hydrocyanic acid, 508 jatropha curcas, 238, 292 lachesis^ 57 secale, 148, 524 sulphur, 148 tabacum, 402 veratrum album. 149. 237 CHOLERA INFANTUM aconite, 303 argentum nitr., 304, 579 arnica, 226 arsenicum, 523 belladonna, 391 calcarea ostr., 636 calcarea phos., 644 THERAPEUTIC INDEX. 741 CHOLERA INFANTUM (Continued) cinchona, 342 croton tiglium, 266 elaterium, 266 ferrum, 610 ferrum phos , 152, 252, 610 ipecacuanha, 353 kali bromatum, 355 opium, 251 podophyllum, 266 psorinum, 142 secale, 148 sulphur, 441, 637 veratrum alb.. 237, 266 CHOLERA MORBUS arsenicum, 149, 523 camphor, 149 euphorbia corrallata, 292 iris versicolor, 238, 329 podophyllum, 238 sgc&Ig 148 veratrum alb., 149, 237, 329, 524 CHORDEE cannabis indica, 85 cannabis sativa, 85 cantharis, 85, 91 digitalis, 368 mygale, 72 CHOREA actea rac. 71 agaricus muscarius, 71, 76 arsenicum, 76 belladonna, 74 causticum, 694 crocus, 71 hyoscyamus, 399 ignatia, 71 mygale, 70 phosphorus, 534 sepia, 139 stramonium, 71, 399 tarentula, 71 veratrum viride, 239, 399 zincum, 602 zizia, 71, 139 CHOROIDITIS phosphorus, 544 CHOROIDO-RETINITIS nux vomica, 179 CICATRICES fluoric acid, 490 graphites, 466, 514 Phytolacca, 514 silicea, 513 sulphur, 514 CINCHONISM, 341 CIRCULATION ammonium mur., 629 coffea, 360 ferrum, 607 glonoin, 259, 405 lachesis, 63 lilium tigrinum, 324 Pulsatilla, 323 rhus tox., 208 sanguinaria, 257 secale, 146 sepia, 117 strontiana carb., 620 CIRCULATION (Continued) sulphur, 435 CIRRHOSES aurum, 133 CIRRHOSIS OF THE LIVER aurum, 572 lycopodium, 414 muriatic acid, 495 CLERGYMEN'S SORE THROAT arum triphyllum, 196 CLIMAXIS (See Change of Life.) COLIC aconite, 268, 303 ethusa cynapium, 670 alum,' 590 alumina, 589, 590 belladonna, 391, 590 borax, 670 bovista, 268 castoreum, 111 causticum, 695 chamomilla, 318 colocynth, 218, 267, 3Q3, 318, 391, 612 croton tiglium, 268 cuprum, 598 dulcamara, 403 ipecacuanha, 353 magnesia carb., 612 nux vomica, 177, 590 opium, 254, 590 platina, 590 plumbum, 590 rhus tox., 218 staphisagria, 318, 320 veratrum album, 268 zincum, 606 COLLAPSE aconite, 295 camphor, 454 carbo veg., 454 veratrum album, 295, 454 COMPLEXION sepia, 117 CONCORDANT REMEDIES, 24 CONDYLOMATA cinnabaris, 291 euphrasia, 291, 371 jacaranda, 290 lycopodium, 61 nitric acid, 290 sabina, 291 staphisagria, 291, 319 thuja, 288 CONGESTION OF THE BRAIN (See Brain) CONGESTION OF THE CHEST sulphur, 435 CONGESTION OF THE HEAD aurum, 570 sulphur, 435 CONGESTIONS aurum, 569 belladonna, 561 mercurius, 561 CONJUNCTIVITIS aconite, 300, 370 apis, 107 argentum nitricum, 325 742 THERAPEUTIC INDEX. CONJUNCTIVITIS (Continued) arnica, 370 arsenicum, 107, 370 belladonna, 385 calcarea ostrearum, 219 euphrasia, 370 ipecacuanha, 357 mercurius cor., 325 mercurius viv., 370 natrum mur., 124 nux vomica, 179 Pulsatilla, 124, 325 rhus tox., 107, 219, 371 sanguinaria, 260 sepia, 123 sulphur, 300, 442 CONNECTIVE TISSUE sepia, 119 CONSTIPATION alumina, 176, 253, 430, 587 anacardium, 204 bryonia, 176, 253, 430, 586,651 carbo veg., 176, 456 cascarilla, 467 collinsonia, 178 conium, 418 fel tauri, 29 fel vulpi, 29 graphites, 467 hepar, 651 lycopodium, 414 magnesia mur., 614 natrum carb., 654 natrum mur., 666 nux vomica, 175, 205, 414, 651, 667 opium, 176, 252, 430 phosphorus, 538 plumbum, 253, 430, 591 Pulsatilla, 329 selenium, 430 sepia, 205 silicea, 516 sulphur, 446 CONSTITUTION alumina, 586 ammonium carb., 624 ammonium mur., 629 aranea diadema, 77 baryta carb., 616 borax, 669 calcarea ostrearum, 463, 633 calcarea phos., 643 carbo animalis, 459 causticum, 689 ferrum, 607 graphites, 463 kali bichromicum, 681 lycopodium, 410 magnesia carb., 612 natrum sulph., 657 nux vomica, 174 psorinum, 141 secale. 147 sepia, 117, 118 silicea, 512 spongia, 482 sulphur, 434 CONTINUED FEVER (See also Fever.) CONTINUED FEVER {Continued) aconite, 526 arsenicum, 526 sulphur, 526 CONVULSIONS arsenicum, 43 artemisia vulg., 593 belladonna, 189, 392 calcarea ostr., 635 chamomilla, 190 cina, 593 cocculus, 243 colchicum, 57 cuprum, 189 glonoin, 189, 407 helleborus, 44 . hydrocyanic acid, 43, 403, 508 hyoscyamus, 43, 189, 398 ignatia, 188 ipecacuanha, 353 kali bromatum, 674 opium, 189, 254 Phytolacca, 170 platina, 317, 583 podophyllum, 57 secale, 146, 189, 407 stannum, 593 stramonium, 43, 189, 394, 675 veratrum album, 189 CORNEA, OPACITY OF THE alumen, 635 apis, 635 calcarea ostrearum, 635 cuprum, 635 kali bi, 635 natrum,sulph., 658 saccharum offic, 635 zincum, 605 zincum sulph., 605 CORNEA, ULCERS OF THE calcarea ostrearum, 635 kali bichromicum, 686 mercurius corrosivus, 563 mercurius protoiod, 563 mercurius vivus, 562 natrum carb., 656 nitric acid, 515, 635 Pulsatilla, 325 silicea, 515 CORYZA aconite, 304 ammonium carb., 628 ammonium mur., 630 arsenicum, 527 belladonna, 305 bromine, 473 bryonia, 275 cepa, 355, 371 chamomilla, 231 chlorine, 481 cinchona, 305 dulcamara, 403 euphrasia, 370 hepar, 648 ipecacuanha, 355 kali bichromicum, 681 kali carb., 699 kali hydriodicum, 677 lachesis, 275 THERAPEUTIC INDEX. 743 CORYZA (Continued) mercurius, 180 natrum carb., 656 natrum mur., 665 nitric acid, 504 nux vomica, 180, 232, 305 penthorum sedoides, 326 Pulsatilla, 180, 325 rhus tox., 218 sambucus, 232 sanguinaria, 260 sticta pulmonaria, 232 sulphur, 443 COUGH actea racemosa, 308 alumina, 588 ambra grisea, 144, 516, 628 ammonium carb., 628 ammonium mur., 631 anacardium, 483 antimonium tart., 252,551 apis, 106 arnica, 692 arsenicum, 106 baryta carb., 618 belladonna, 106. 540 borax, 671 bryonia, 106, 276, 657, 665 calcarea ostr., 393 capsicum, 349 carbo animalis, 460 carbo veg., 106 causticum, 393, 461, 665, 692 cepa, 393 • chamomilla, 106 conium, 417 crotalus horridus, 106 drosera, 254, 368, 692 dulcamara, 618 ferrum, 609 graphites, 468 hepar, 483, 649 hydrocyanic acid, 508 hyoscyamus, 106, 398 ignatia, 106,190 kali bichromicum, 628, 687 kali carb., 692, 700 lachesis, 106, 393 lauroeerasus, 508,629 lithium carb., 622 lycopodium, 506, 516 manganum, 578 mentha piperita, 398 mezereum, 218 natrum carb., 657 natrum mur., 665, 692 nitric acid, 506 nux vomica, 106, 180 opium, 252 petroleum, 469 phosphorus, 144, 393, 516, 540 Pulsatilla, 506 rhus tox., 218, 516 rumex, 106, 393, 516, 540 sanguinaria, 259, 260, 349 scilla, 665, 692 senecio, 336 sepia, 692 silicea, 516 COUGH (Continued) spongia, 368 sulphur, 368 sulphuric acid, 144, 501 trifolium pratense, 276 verbascum, 368 zinc, 606 CRAMPS cholos terrapine, 269 colocynth, 269 nux vomica, 269 veratrum album, 269 CRETINISM baryta carb., 644 calcarea phos., 644 CROUP aconite, 302, 475, 649 antimonium tart., 475 arsenicum, 529 bromine, 474, 649 hepar, 303, 476, 648 iodine, 476 kali bichromicum, 565, 683 kaolin, 476, 684 lachesis, 684 mercurius cyanatus, 684 phosphorus, 540 sambucus, 303 sanguinaria, 261 spongia, 303, 475, 483, 649 CRUSTA LACTEA arctium lappa, 159 arsenicum iod., 159 graphites, 159 mezereum, 158 nux juglans. 159 oleander, 158 staphisagria, 159. 318 sulphur, 158, 438 ustilago, 159 vinca minor, 159 viola tricolor, 158, 159 CYANOSIS NEONATORUM digitalis, 363 CYSTITIS apis, 88 cantharis, 85, 329 conium, 419 digitalis, 367 dulcamara, 329,404 equisetum, 86, 329 lachesis, 63 Pulsatilla, 329 DACRYOCYSTITIS petroleum, 469 Pulsatilla, 325 DEAFNESS carbo animalis, 461 carbo veg., 461 ignatia, 544 phosphorus, 544 DEBILITY (See also Defective Reaction. ) argentum metallicum, 580 arsenicum, 343 carbo unimalis, 460 carbo veg., 451, 461 cinchona, 343, 457 744 THERAPEUTIC INDEX. DEBILITY (Continued) cocculus, 242 colchium, 233 conium, 416 bypophosphite of lime, 697 kali carb., 697 natrum carb., 656 nux vomica, 234 phosphoric acid, 343, 496 phosphorus, 343 psorinum, 698 selenium, 429 senna, 697 sulphur, 429 zincum, 429 DEFECTIVE REACTION ambra grisea, 143, 144, 434. 598 capsicum, 143, 598 carbo veg., 143, 434, 598 cinchona, 143 cuprum, 434, 598 lauroeerasus, 143, 434, 598 opium, 143 psorinum, 141, 143, 434, 598 sulphur, 433, 598 valerian, 143, 434, 598 DELIRIUM absinthium, 227 agaricus, 394 belladonna, 237, 400 hyoscyamus, 399 lachesis, 394 phosphorus, 533 plumbum, 591 stramonium, 237, 394, 400 veratrum alb., 237 DELIRIUM TREMENS arsenicum, 251, 521 calcarea ostrearum, 251, 611 cannabis indica, 251 lachesis, 251 opium, 251 ranunculus bulb., 311 stramonium, 251 DENTAL FISTULA calcarea fluorica, 489 fluoric acid, 489 DENTITION aethusa, 392 belladonna, 231 calcarea ostrearum, 635 cina, 392 chamomilla, 231 colchicum, 57, 392 dolichos, 392 kreosotum, 392 podophyllum, 57, 423 zincum, 602 DIABETES lac defloratum, 28 lactic acid, 500 phosphoric acid, 500 phosphorus, 538 DIAPHRAGMITIS cactus grandiflorus, 310 ranunculus bulb., 310 DIARRHOEA aconite, 303 aloes, 156, 158 I DIARRHOEA (Continued) alstonia schol., 160 apis, 108, 158 apocynum, 156 aranea diadema, 77 argentum nitricum, 15S, 167, 524, 610 arnica, 226 arsenicum, 158, 345, 523, 610 belladonna, 391 borax,670 bryonia, 108, 280,422, 441, 685 calcarea ostrearum, 651 chamomilla, 232, 320 cinchona, 158, 346, 499, 523, 610 coffea, 360 colocynth, 267 croton tiglium, 238, 268, 291, 369 dioscorea, 422, 444 dulcamara, 403 elaterium, 237, 238, 265 euphorbia coronata, 290 ferrum met., 346, 157, 523, 610 ferrum phos., 610 gamboge, 156 gelsemium, 167, 237 geranium, 354 gnaphalium, 354 gratiola, 369 hepar, 651 iodine, 479 ipecacuanha, 353 iris versicolor, 329, 346 kali bichromicum, 685 kali bromatum, 355 lachesis, 51 leptandra, 369 lithium carb., 622 magnesia carb., 612, 651 mercurius, 232, 268, 561 natrum carb., 654 natrum sulph.. 280, 422, 444, 658, 685 nitric acid, 504 nuphar luteum, 354 nux vomica, 178 enothera, 354 oleander, 157, 346, 610 opium, 167 opuntia, 355 paullinia sorbilis, 355 petroleum, 469 phosphoric acid, 346, 498 phosphorus, 158, 444, 538 podophyllum, 178, 232, 346, 369, 422, 444 Pulsatilla, 167,238, 329 rheum, 611, 612, 651 rhus tox, 218 rumex crispus, 444, 685 silicea, 516 staphisagria, 320 stramonium, 396 strontiana carb., 621 sulphur, 232, 422, 444, 469, 658. 685 sulphuric acid, 501 veratrum album., 167, 237. 329 DIPHTHERIA ailanthus, 197, 376 alcohol, 197 THERAPEUTIC INDEX. 745 DIPHTHERIA (Continued) ammonium caust., 197 amygdala annua., 199 apis, 50, 95, 104, 199, 386 arsenicum, 104, 199, 527 arsenicum iod., 528 arum triphyllum, 218, 505 baptisia, 198, 376 belladonna, 200, 386 bromine, 200 camphor, 451 cantharis, 89, 405 capsicum, 405 carbo veg., 451 crotalus, 49 iodine, 200 kali bichromicum, 200, 565, 682 kali permangan., 105, 200 lac caninum,28, 49 lachesis, 49,200, 413 lycopodium, 49, 197, 386, 413 mercurius biniod., 200, 564 mercurius cor., 566 mercurius cyanatus, 200, 451, 564 mercurius protoiod., 565 mercurius vivus., 564 muriatic acid, 197, 494, 505 naja, 49, 199 natrum arsenicosum, 105,199 nitric acid, 196, 505 Phytolacca, 199 ranunculus seel., 312 rhus tox., 198, 210 sulphuric acid, 502 DIPHTHERIA, LARYNGEAL lachesis, 49 DIPLOPIA arum, 570 gelsemium, 161 DISLOCATION OF JOINTS ignatia, 220 petroleum, 220 rhus tox., 220 DROPSY acetic acid, 99 apis, 64, 97 apocynum can., 99, 155 arsenicum, 65, 99, 156, 414, 523 colchicum, 65, 236 digitalis, 64, 156, 364 helleborus, 64, 99, 156, 316 lachesis, 63 lycopodium, 414 muriatic acid, 495 rhus tox., 414 sulphur, 99 terebinthina. 64, 316 DRUNKARDS, COMPLAINTS OF arsenicum, 53 baryta carb., 617 carbo veg., 56 lachesis, 51, 447 opium, 617 selenium, 430 sulphur, 446 sulphuric acid, 56 DYSENTERY aconite, 303 aloes, 178 DYSENTERY (Continued) arnica, 226 arsenicum, 458, 523 baptisia, 376 cantharis, 91, 235 capsicum, 91,405 carbo veg., 457 cinchona, 458 colchicum, 91, 235 colocynth, 91, 267 ferrum phos., 610 kali bichrom., 59, 91, 685 lachesis, 59 mercurius, 178, 235,268, 303, 610 nux vomica, 91,178, 268, 567 rhus tox., 210, 218 sulphur, 91, 436, 444, 567 zincum sulph., 91 DYSMENORRHCEA aconite, 303 actea racemosa, 167,191, 615 caulophyllum, 167, 615 causticum, 695 chamomilla, 191, 244, 245 cocculus, 190, 244 colocynth, 267 cylamen, 245 gelsemium, 167 ignatia, 190, 245 magnesia mur., 191, 614 nux vomica, 245 Pulsatilla, 190, 244, 245, 332 DYSPEPSIA abies nigra, 285, 327, 345 alumina, 588 arnica, 226 arsenicum, 53, 176, 45.7 bryonia, 279 cadmium sulph., 53 capsicum, 404 carbo veg., 54, 176, 456, 502 cinchona, 51, 345, 457 graphites, 55 hepar, 51, 650 ignatia, 191 kali bichromicum, 684 kali carb., 701 kreosote, 176 lachesis, 51, 651 lycopodium, 125, 457 magnesia carb., 613 mercurius, 52 natrum carb., 654 natrum mur., 666 nux vomica, 175, 447, 457, 655 phosphorus, 538 Pulsatilla, 176, 345 sepia, 124, 402 stannum, 593 sulphur, 125, 446 sulphuric acid, 56, 502 tabacum, 402 DYSPHAGIA gelsemium, 162 DYSURIA apis, 138 EARS aurum, 42, 405, 461, 571 48 746 THERAPEUTIC INDEX. EARS (Continued) baryta carb., 618 belladonna, 384, 669 borax, 669 capsicum, 42, 405, 461 carbo animalis, 461 carbo veg., 461, 468 causticum, 693 chamomilla, 669 conium, 417 crotalus, 42 dulcamara, 403 elaps, 42 graphites, 467 hepar, 42, 384, 648 lachesis, 42 nitric acid, 42, 405, 461 nux vomica, 180 Pulsatilla, 325, 669 sanguinaria, 256 silicea, 42, 405, 515 ECCHYMOSES OF THE SCLEROTIC arnica, 179 hamamelis, 179 ledum, 179 nux vomica, 179 ECZEMA antimonium crudum, 311, 549 arsenicum, 529 calcarea ostrearum, 635 hepar, 652 kali bromatum, 677 mezereum, 218 natrum carb., 657 natrum mur., 668 nux juglans, 218 petroleum, 468 ranunculus bulb., 311 rhus tox., 217 selenium, 431 sepia, 657 staphisagria, 319 EMPHYSEMA ammonium carb., 455, 626 carbo veg., 455 curare, 192 ENDOCARDITIS arsenicum, 528 . kali carb., 701 kali hydriodicum, 679> phosphorus, 542 ENTERITIS arnica, 58 arsenicum, 523 baptisia,, 57 belladonna, 57, 391 colocynth, 266 colchicum, 58 lachesis, 57 rhus tox, 57, 218 ENURESIS belladonna, 388 causticum, 388, 693 calcarea ostrear., 388 equisetum, 86 hepar, 652 kreosote, 388 • linaria, 86 plautago major, 388 ENURESIS (Continued) silicea, 388 EPIDIDYMITIS gelsemium, 166 EPILEPSY (See also Convulsions.) absinthium, 392 argentum metallicum, 579 argentum nitricum, 577 arsenicum, 517, 531 artemisia vulgaris, 30, 226, 392, 641 belladonna, 392 bufo, 30, 641 calcarea ostrearum, 641, 694 causticum, 693 cicuta virosa, 173, 419 cuprum, 599 hydrocyanic acid, 507, 641 hyoscyamus, 398 indigo, 30 kali bromatum, 676 nux vomica, 517, 641 plumbum, 591 ranunculus bulb., 311 silicea, 517, 641 sulphur, 641 stannum, 594 EPISCLERITIS aconite, 300 belladonna, 385 thuja, 289 EPISTAXIS camphor, 451 carbo veg., 149, 451 mercurius, 561 mercurius cyanatus, 451 nux vomica, 180 Pulsatilla, 324 sepia, 118 ERECTILE TUMORS lycopodium, 411 ERGOTISM, 146 ERYSIPELAS anacardium occ, 206 apis, 44, 100, 217 belladonna, 41, 44, 101, 380, 388 borax, 672 cantharis, 92 comocladia, 202 crotalus, 44, 389 cuprum, 389 euphorbium, 45, 82 graphites, 92, 466 lachesis, 44, 101, 389 rhus tox., 45,101,217 stramonium, 395 sulphur, 436 EUSTACHIAN CATARRH nux vomica, 180 EYES aconite, 300, 370 actea racemosa, 306 agaricus, 191 alumina, 124, 587 amyl nitrite, 385 antimonium crudum, 550 apis, 107 argentum nitricum, 568, 577 arnica, 41 THERAPEUTIC INDEX. 747 EYES (Continued) arsenicum, 107, 370, 465 artemisia vulgaris, 227 asafetida, 418 aurum, 419, 570 belladonna, 370, 378. 385 berberis, 588 borax, 671 bryonia, 280 calcarea ostrearum, 465, 635 carbo animalis, 461 carbo veg., 462 cedron, 424 cina, 230 cinnabaris, 563 comocladia, 202 conium, 588 crocus, 588 crotalus horridus, 41 cyclamen, 123 euphrasia, 369, 465,- 578, 648 glonoin, 406 graphites, 124. 464, 550, 587, 671 hepar, 465, 648 ignatia, 191 jaborandi, 123 kali bichromicum, 686 kali carb., 123 kali hydriodicum, 677 kreosote, 578 lachesis, 41 lithium carb., 622 mercurius, 370, 465, 562 mercurius biuiod., 563 mercurius cor., 563 mercurius dulcis, 563 mercurius protoiod., 563 mezereum, 424 natrum carb., 588 natrum mur., 124, 588, 664 natrum sulph., 588 nux moschata, 588 nux vomica, 124, 179 Paris quadrifolia, 385 petroleum, 469 phosphorus, 544, 648 prunus spinosa, 385 Pulsatilla, 124, 325 rhus tox., 107, 219, 371, 578, 588 ruta, 583 saccharum offic, 635 santonine, 230 sepia, 123, 588 spigelia, 300, 306, 385, 424 staphisagria, 319 sulphur, 300, 443, 465, 635 thuja, 124, 424 zincum, 605 zincum sulph., 605 FACE apis, 42, 44 arsenicum, 42, 43 baptisia, 43 belladonna, 42, 43, 44, 383 bryonia, 229 bufo, 42 camphor, 43 carbo veg., 42, 43 FACE (Continued) cicuta, 43 cina, 229 cinchona, 42 cuprum, 43 euphorbium, 45 hydrocyanic acid, 43 hyoscyamus, 42, 43 ipecacuanha, 229 kali carb., 42,43 lachesis, 42, 44 lycopodium, 42, 43 natrum arsenicosum, 43 nux moschata, 43 nux vomica, 43 opium, 43 phosphoric acid, 42 phosphorus, 42 Phytolacca, 43 Pulsatilla, 42 rhus tox., 42, 44 secale, 42 stramonium, 42 sulphur, 43 veratrum album, 42 FACE-ACHE hepar, 648 FAINTING linaria, 368 FAMILY RELATION OF DRUGS, 23 FATIGUE coca, 491 coffea, 360 fluoric acid, 491 FATTY DEGENERATIONS aurum, 572 phosphorus, 536 FATTY TUMORS baryta carb., 619 FEET lycopodium, 656 natrum carb., 656 FELONS fluoric acid, 490 FEMALE GENITAL ORGANS actea racemosa, 136, 307, 334 aletris farinosa, 336 aloes, 130, 448 ambra grisea, 144 ammonium mur., 630 antimonium crud., 550 apis mellifica, 106, 138, 584, 630 argentum metallicum, 585 argentum nitricum, 584 arnica, 630 aurum, 132, 572, 584 belladonna, 392, 584 berberis, 421 bryonia, 281 calcarea ostrearum, 138 calcarea phos., 138, 644 cantharis, 92 carbo animalis, 134 carbo veg., 134 caulophyllum, 334 cyclamen, 336 ferrum, 584 gelsemium, 166 graphites, 135, 468 748 THERAPEUTIC INDEX. FEMALE GENITAL ORGANS (Continued) hedeoma, 139 helonias, 128, 335, 584, 585 hydrocotyle, 138 inula, 139 kali ferrocyan., 137 kreosote, 129, 392, 584 lachesis, 60 lilium tigrinum, 127, 585 mitchella, 138 murex, 129 natrum carb., 135, 657 natrum hypochlorosum, 136 natrum mur., 135, 584, 663 nux vomica, 130, 183 palladium, 584 phosphorus, 643 platina, 62, 133, 582, 583 podophyllum, 131 Pulsatilla, 132, 332 secale, 138 senecio, 336 sepia, 127, 392, 584 stanuum, 130 sulphur, 128, 447 thuja, 289, 584 ustilago, 138 vespa, 138 viburnum opulus, 144 zincum, 606 FEVER aconite, 272, 295, 382, 526 apis, 297 arsenicum, 299, 437, 522, 526 baptisia, 437 belladonna, 273, 299, 382 bryonia, 270, 297 carbo veg., 453 cuprum, 598 ferrum phos., 299 gelsemium, 164, 297 hyoscyamus, 399 lycopodium, 410 mercurius, 383 opium, 254 podophyllum, 423 Pulsatilla, 337 sulphur, 299, 437, 527 veratrum viride, 299 FEVER BLISTERS arsenicum, 668 hepar, 668 natrum carb., 668 rhus tox., 668 FIBROUS TISSUES rhus tox., 214 ITSTUL.F phosphorus, 543 silicea, 543 FISTULA IN ANO berberis, 421 calcarea phos., 421 graphites, 467 nitric acid, 467 peonia, 467 ratanhia, 467 silicea, 467 FLATULENCE fel tauri, 29 FLATULENCE (Continued) fel vulpi, 29 graphites, 466 lycopodium, 413, 467 momordica balsamum, 40, 266, 413 natrum sulph., 658 raphanus, 253, 414 sulphur, 414 FLUSHES OF HEAT amyl nitrite, 436 kali bichromicum, 436 lachesis, 436 sulphur, 436 sulphuric acid, 436 FRACTURES calcarea phos., 645 Symphytum off., 645 FRIGHT—ILL EFFECTS OF gelsemium, 254 natrum mur., 254 phosphoric acid, 254 Pulsatilla, 254 silicea, 254 veratrum, 254 GALL-STONES (See Biliary Colic.) GANGRENE arsenicum, 149, 453, 522, 530 carbo veg., 453 secale, 147, 530 GASTRALGIA anacardium, 466 argentum nitricum, 576 belladonna, 387 bismuth, 175, 577 calcarea ostrear., 337 chamomilla, 232 chelidonium, 466 chininum ars., 387 graphites, 466 ignatia, 191 lithium carb., 622 nux vomica, 175 petroleum, 466 GASTRIC CATARRH aconite, 303 antimonium crud., 328, 353, 548 arsenicum, 328, 353 bryonia, 328, 549 ipecacuanha, 328 kali bichromicum, 681 nux vomica, 328 Pulsatilla, 327, 549 GASTRIC FEVER bryonia, 270 mercurius, 561 GASTRIC SYMPTOMS ■ aconite, 303 anacardium, 204, 466 antimonium crudum, 352 arsenicum, 328, 352, 522 belladonna, 328 bryonia, 231 carbo animalis, 430, 460 carbo veg., 328, 466, 524 chamomilla, 232 chelidonium, 466 cinchona, 328, 523 colchicum, 328 THERAPEUTIC INDEX. 749 GASTRIC SYMPTOMS (Continued) cyclamen, 328 graphites, 466 hepar, 430, 667 indium, 605 ipecacuanha, 328, 352 kali bichromicum, 685 kreosote, 176, 328 lachesis, 667 lobelia, 352 lycopodium, 413, 523, 685 muriatic acid, 495 natrum mur., 667 nitro-muriatic acid, 495 nux vomica, 328, 414 petroleum, 469 phosphorus, 605 Pulsatilla, 352 raphanus. 414 sabina, 328 selenium, 430 sepia, 328, 460, 593 staphisagria, 352, 430 sulphur, 414, 605 tabacum, 352 thein, 352 thuja, 328 zincum, 604, 605 GASTRITIS aconite, 303 arsenicum, 53,-173, 175, 522, 685 cantharis, 89 kali bichromicum, 684 GASTRO-ENTERIC SYMPTOMS argentum nitricum, 524, 597 cadmium sulph., 524 carbo veg., 524 magnesia carb., 611 secale cornutum, 524 veratrum album, 524 GENITAL ORGANS (See Female Genital Organs Male Genital Organs; apis, 106 cantharis, 91 croton tiglium, 81 gelsemium, 166 graphites, 468 picric acid, 92 GLANDS alumina, 588 badiaga, 31 belladonna, 218 bromine, 472 calcarea ostr., 636 carbo animalis, 31, 459 carbo veg., 454 conium, 417 graphites, 464 hepar, 650 iodine, 479 mercurius, 560 phosphorus, 541 silicea, 514 spongia, 482 sulphur, 438 GLAUCOMA aconite, 300 aurum, 570 GLAUCOMA (Continued) bryonia, 281 rhus tox., 219 GLOSSOPLEGIA baryta carb., 617 colchicum, 617 GOITRE bromine, 473 spongia, 482 GONORRHOEA argentum nitricum, 87 cannabis indica, 85 cannabis sativa, 85 cantharis, 84, 85 capsicum, 87 carbo animalis, 459 chimaphila, 87 clematis, 86 copaiva, 87 cubeba, 87 digitalis, 367 gelsemium, 166 kali bichromicum, 681 mercurius corrosivus. 87, 367 mercurius solubilis, 87, 290, 330, 367 natrum mur., 666 nux vomica, 182 petroselinum, 86, 368, 419 Pulsatilla, 290, 329 sulphur. 367, 447 thuja, 87,288 GOUT ammonium phos., 631 antimonium crudum, 550 benzoic acid, 421 berberis vulgaris, 421 calcarea ostrearum, 421 colchicum, 235 colocynth, 269 guaiacum, 269 ledum, 216 lithium carb., 421, 621 lycopodium, 421 Pulsatilla, 331 staphisagria, 320 GRANULAR LIDS argentum nitricum, 578 euphrasia, 578 rhus tox., 578 zincum, 605 zincum sulph., 605 GRAVEL cantharis, 85 lycopodium, 412 GRIEF, BAD EFFECTS OF ignatia, 186, 498 natrum mur., 498 phosphoric acid, 186, 498 GROWING PAINS guaiacum, 500 phosphoric acid, 500 GUMMATA kali hydriodicum, 679 HiEMATEMESIS hamamelis, 281 millefolium, 281 phosphorus, 545 ustilago, 281 750 THERAPEUTIC INDEX. HEMATURIA cantharis, 84 crotalus, 63 equisetum, 86 ipecacuanha, 357 lachesis, 63 nux vomica, 182 terebinthina, 64 HEMAPHILIA lachesis, 545 phosphorus, 545 HEMOPTYSIS acalypha indica, 344 aconite, 303 cactus, 303 carbo veg., 451 ferrum, 607, 609 ledum, 303, 344 millefolium, 303 nux vomica, 181 opium, 252 phosphorus, 281, 545 Pulsatilla, 281, 324 rhus tox., 214 senecio, 281 sulphur, 435 HEMORRHAGES acalypha indica, 344 aconite, 227 aranea diadema, 77 arsenicum, 452 belladonna, 344 bovista, 150 carbo veg., 344, 451 cinchona, 343, 452, 611 cinnamomum, 344 erigeron, 151, 344 ferrum, 610 ferrum phos., 151 hamamelis, 151, 344 ipecacuanha, 344, 452, 611 ledum, 344 mercurius, 561 millefolium, 227, 344 mitchella, 151 phosphorus, 344, 539 sabina, 285, 344 sanguinaria, 259 secale, 147, 344 sulphuric acid, 502 vinca minor, 159, 344 HEMORRHOIDS esculus.hip., 177 aloes, 131, 178 anacardium, 205 apocynum, 157 arsenicum, 457, 458 carbo animalis, 460 carbo veg., 456 collinsonia, 178 graphites, 467 hamamelis, 178 lamium album, 205 lycopodium, 411 nux vomica, 177 sepia, 124 sulphur, 435, 446 hemorrhoids, 501 HAY-FEVER ailanthus, 527 arsenicum, 311, 527 lobelia inflata, 527 rosa damascena, 527 ranunculus bulbosus, 311 silicea, 311, 516, 527 sinapis nigra, 527 HEADACHE aconite, 188 actea racemosa, 167, 307 aloes, 178 anacai-dium, 204 antimonium tart, 550 argentum nitricum, 574,576 baryta carb., 617 belladonna. 258, 384, 609 bovista, 151 bryonia, 280 calcarea ostrearum, 664 carbo animalis, 329 carbo veg., 280, 456 carbolic acid, 551 causticum, 664, 684 chamomilla, 269 cinchona, 345 cocculus, 244, 329 colocynth, 269 cyclamen, 124 ferrum, 610 gelsemium, 40, 163/ 188, 244, 230, 551, 664 glonoin, 405, 664 ignatia, 74, 188 ipecacuanha, 352 iris versicolor, 258, 664, 685 juglans cinerea, 192, 244, 280 kali bichromicum, 664, 684 kali hydriodicum, 677 lac defloratum, 28 lachesis, 40 lithium carb., 621 magnesia mur., 614 melilotus, 258 menyanthes, 331, 517 mercurius, 551 natrum carb., 655 natrum mur., 280, 664, 684 nux vomica, 12\, 174, 280 oleander, 158 palladium, 584 paris quadrifolia, 517 paullinia, 258 petroleum. 280 phellandrium, 332, 418 phosphoric acid, 499 phosphorus, 533 platina, 75 psorinum, 685 ptelea, 352 Pulsatilla, 40, 331 ranunculus bulb., 331 ranunculus seel., 331 rhus radicans, 207 sanguinaria, 257 selenium, 429 sepia, 121, 664 silicea, 188, 517, 685 spigelia, 78, 331, 423, 664 THERAPEUTIC INDEX. 751 HEADACHE (Continued) strontiana carb., 517 sulphur, 551 theridion, 78 thuja, 289 veratrum alb., 188, 331, 352 zincum, 602, 604 HEART aconite, 210, 301, 484 actea racemosa, 210 ammonium carb., 570, 626 anacardium, 206 apis, 105 apocynum, 105 argentum metallicum, 580 arnica, 208, 223, 302 arsenicum, 105, 223, 365, 484, 528 asparagus, 105 aurum, 302, 569, 623 belladonna, 105 benzoic acid, 623 bovista, 151 bromine, 208, 223, 477 bryonia, 484 cactus, 223, 302 colchicum, 236 conium, 365, 417, 623 digitalis, 105,162, 362 euphrasia, 679 gelsemium, 162, 257 graphites, 469, 679 grindelia, 162 helleborus, 366 hydrocyanic acid, 484, 508 iodine, 479 kali bichromicum, 679 kali carb., 105, 697, 701 kali chloricum, 469 kali hydriodicum, 679 kali nitricum, 469 kalmia, 210, 365, 623 lachesis, 63, 105, 484, 679 lactuca, 679 ledum, 623 lithium carb., 622 magnesia mur., 614 natrum mur., 128, 469 petroleum, 469 phosphorus, 484, 542 Phytolacca, 210 Pulsatilla, 210 quinine, 341 rhus tox, 208,223 spigelia, 105,236, 366, 424, 484 spongia, 484 sulphur, 105, 435 tabacum, 402 veratrum alb., 238 veratrum viride, 239 zincum, 623 HEART, FATTY DEGENERATION THE arsenicum, 542 phosphorus, 542 HEART, HYPERTROPHY OF THE aconite, 301, 477 arnica, 208, 223, 302, 477 arsenicum, 223 aurum, 302, 570 HEART, HYPERTROPHY OF THE (Con- tinued) bromine, 208, 223, 477 cactus, 223, 302 kalmia, 302 rhus tox, 208, 223,302,477 HEART, PALPITATION OF THE badiaga, 31 coffea, 31 nitrite of amyl, 31 phosphorus, 31 HEAT, ILL-EFFECTS OF natrum carb., 655 selenium, 38, 429 HECTIC FEVER arsenicum, 349 carbo veg., 349, 453 cinchona, 348 lycopodium, 415 stannum, 668 HEELS ammonium mur., 629 antimonium crudum, 630 causticum, 630 cepa, 630 graphites. 630 ledum, 630 manganum, 630 natrum carb., 630 Pulsatilla, 630 HEMICRANIA argentum nitricum, 575 arsenicum, 122, 530 belladonna, 122 gelsemium, 122 iris versicolor, 122 nux vomica, 122 oleum animate, 163 Pulsatilla, 122 sanguinaria, 122 sepia, 121 silicea, 122 theridion, 123 veratrum album, 122 HEMIOPIA aurum, 570, 622, 665 lithium carb., 622, 665 lycopodium, 665 natrum mur., 665 titanium. 665 HEMIPLEGIA arnica, 226 HEPATITIS phosphorus, 537 HERNIA aconite, 303 carbo veg., 55 cocculus. 179 » lachesis, 55 lycopodium, 179 nux vomica, 179 tabacum, 403 HERPES psorinum, 142 natrum mur., 668 sepia, 119 HERPES CIRCINATUS baryta carb., 119, 668 calcarea ostrearum, 119 752 THERAPEUTIC INDEX. HERPES CIRCINATUS (Continued): natrum mur., 668- sepia, 119, 668 tellurium, 663 HERPES ZOSTER arsenicum, 311 carboneum oxygen., 8& mezereum, 311 ranunculus bulb., 311 rhus tox., 311 HICCOUGH arsenicum, 191 hyoscyamus, 191 ignatia, 191 Pulsatilla, 191 stramonium, 191 teucrium marum verum, 191 veratrum album, 191 HIP-JOINT DISEASE calcarea ostrearum, 641 carbo veg., 453 colocynth, 269 Gettysburg spring water, 320, 515, 623 natrum sulph., 658 phosphoric acid, 500s phosphorus, 543 silicea, 514 stillingia, 658 stramonium, 396 sulphur, 440 HOARSENESS (See Aphonia.) HOMESICKNESS' capsicum, 498 mercurius, 560 phosphoric acid, 498 HYDROCELE digitalis, 364 Pulsatilla, 330 HYDROCEPHALOID apis, 108 arsenicum, 97 calcarea phos., 342; 604, 645' cinchona, 342, 645 ferrum phos., 152 sulphur. 441 HYDROCEPHALUS' apis, 98, 440 apocynum^ 156 calcarea ostr., 637 digitalis, 156. 316, 367 helleborus, 99. 156, 316 sulphur, 99,439 HYDROGENOID CONSTITUTION, 77 HYDROPERICARDIUM apis, 105 arsenicum, 528 lachesis, 63 lycopodium, 414' HYDROPHOBIA belladonna, 88 cantharis, 88 stramonium, 394 HYDROTHORAX apis, 97, 105 apocynum cannabinum, 99* arsenicum, 528 colchicum, 236 digitalis, 364 HYDROTHORAX (Continued) juglans cinerea, 193 lachesis, 63 mercurius sulph., 364, 523 HYPOCHONDRIASIS alumina, 536 anacardium, 203 bryonia, 586 conium, 417, 606 natrum carb., 653 natrum mur., 662, 667 nux vomica, 586, 667 sepia. 654 stannum, 593 zincum, 606 zincum' ox., 417 1 HYSTERIA actea racemosa, 73 . apis, 94, 106 arsenicum, 583 asafetida, 113, 187, 418 belladonna, 188 calcarea ostrearum, 583 hyoscyamus, 137 ignatia. 74, 186 magnesia mur., 614 moschus, 75,110,187,583 nux moschata, 111, 188 nux vomica, 257 platina, 75, 187, 582, 583 sanguinaria, 257 sepia, 118 stannum, 594 sulphur, 440 Valeriana, 112, 187, 257 valerianate of zinc, 188 IMPOTENCE chlorine, 481 conium, 534 graphites, 468 phosphorus, 534 selenium, 429 INFLAMMATIONS aconite, 36, 94 apis, 94 arsenicum, 90, 94,522 belladonna, 94, 330, 561 camphor, 90 cantharis, 90 ferrum phos., 152, 609 hepar, 647 mercurius, 561 INFLAMMATORY FEVER arsenicum, 437 INFLUENZA rhus tox., 218 sabadilla, 239 INIMICAL DRUGS ammonium carb. and lachesis, 625 apis and rhus, 108 cinch, and seleu., 432 carbo v. and caust., 451 nux and zinc, 185, 600 phos. and caust., 689 psorin. and lach., 143 ranunculus bulb, and sulph., 311 rhus tox. and apis, 203 selenium and cinchoua, 432 THERAPEUTIC INDEX. 753 INIMICAL DRUGS (Continued) silicea and mercurius, 513 INIMICAL RELATION OF DRUGS, 24 INJURIES angustura, 171 arnica, 222, 502 calcarea phos., 225 calendula, 225 - conium, 417, 502 glonoin, 407 hypericum, 225 ledum, 225 rhus tox , 224 ruta, 502, 620 staphisagria, 225 sulphuric acid, 502 Symphytum, '225 INSOMNIA (See also Sleep.) ambra grisea, 144 calcarea ostrearum, 640 chamomilla, 231 INTEMPERANCE cinchona, 340 INTERMITTENT FEVER alstonia schol., 160 . ammonium mur., 629 apis mellifica, 67, 102 aranea diadema, 77, 348 arsenicum, 66, 525 camphor, 66 canchalagua, 347 capsicum, 66, 190, 346, 405 carbo veg., 66, 348, 453 chininum sulph., 77, 346 cina, 230 cinchona, 77, 214, 346 cornus florida, 346 cuprum, 68 digitalis, 67 eucalyptus, 347 eupatorium perf., 213, 228, 346 eupatorium pnrp., 228 ferrum, 348, 611 gelsemium, 66,164, 214 helleborus, 67 hydrocyanic acid, 66 hyoscyamus, 67 ignatia, 190 ipecacuanha, 318, 357 lachesis, 65, 190, 347 lachnanthes, 67 lycopodium, 67 menyanthes, 66, 346, 453 natrum mur., 102, 213, 668 nux vomica, 185, 190 Pulsatilla, 337 rhus tox., 213. secale, 67 sulphur, 214, 437 veratrum album, 66 IRITIS asafetida, 418, 571 aurum, 418, 570 euphrasia, 370 kali bichromicum, 686 kali hydriodicum, 677 mercurius, 289, 562 mercurius corros., 563, 571, 677 IRITIS (Continued) nitric acid, 571 rhus tox., 219 thuja, 289 JAUNDICE bryonia, 177, 193, 279 carduus marianus, 177 chamomilla. 177, 231 chelidonium. 193 cinchona, 350 digitalis, 364 juglans cinerea, 193 nux vomica, 177 phosphorus, 537 JOINTS ammonium mur., 630 ammonium phos., 623 anacardium. 206 apocynum, 156 benzoic acid, 421, 623 berberis, 421 bryonia, 421 calcarea ostr., 421,623, 641 calcarea phos., 615 Gettysburg spring water, 623 ignatia, 220 kali hydriodicum, 98 lithium carb., 622 lycopodium, 623 petroleum, 220 pinus sylvestris, 641 Pulsatilla, 206 rhus tox., 214, 220 sepia, 119 KERATITIS crotalus, 42 kali hydriodicum, 677 silicea, 515 sulphur, 443 KIDNEYS ammonium benz., 64 apis, 64, 529 argentum nitricum, 579 arsenicum, 65, 528 aurum, 529, 571 berberis, 88, 420 cantharis, 83 carbolic acid, 64 colchicum, 65 digitalis, 64,529 helleborus, 64, 529 kali carb., 64 kali hydriodicum, 680 lachesis, 64 lycopodium, 415 natrum mur., 64 nux vomica, 181 phosphoric acid, 500 phosphorus, 529, 539 plumbum, 572, 592 terebinthina, 64, 285, 529 KNEE-JOINT DISEASE silicea, 514 LABOR aconite, 304 actea racemosa. 307 334 754 THERAPEUTIC INDEX. LABOR (Continued) belladonna, 167,391 cantharis, 92 caulophyllum, 334 chamomilla, 232 gelsemium, 166, 392 ipecacuanha, 307 lycopodium, 307 natrum carb., 657 nux vomica, 183 Pulsatilla, 183, 333 secale, 147 LACTATION (See also Agalactia.) carbo animalis, 157 oleander, 157 LARYNGEAL PHTHISIS spongia, 483 LARYNGISMUS STRIDULUS antimonium tart., 474 arsenicum, 474 belladonna, 474 bromine, 474 calcarea phos., 474 chlorine, 474 cuprum, 474 ignatia, 474 iodine, 474 ipecacuanha, 474 lachesis, 474 phosphorus, 474 sambucus, 474 LARYNGITIS apis, 105 kali bichromicum, 681 sambucus, 483 spongia, 483 sulphur, 443 LARYNX (See also Laryngeal Phthisis.) apis, 105 argentum metallicum, 580 argentum nitricum, 578 arum triphyllum, 196 causticum, 692 eupatorium perf., 455 manganum, 578 phosphorus, 536, 692 paris quadrifolia, 578 sanguinaria, 261 selenium, 431, 578 LEAD-COLIC alum, 590 alumina, 589, 590 belladonna, 391, 590 nux vomica, 590 opium, 590 platina, 583,590 LEUCORRHCEA alumina, 587 ambra grisea, 145 ammonium mur., 630 berberis, 421 borax, 671 calcarea ostrearum, 639 carbo veg., 134 caulophyllum, 639 graphites, 463 helonias, 336 LEUCORRHCEA (Continued) kali bichromicum, 681 kreosote, 130 lilium tigrinum, 128 murex purpurea, 129 natrum mur., 136 sepia, 127 LIVER (See also Hepatitis and Gall Stoxes.) ammonium mur., 631 aurum, 572 berberis, 279, 421 bryonia, 263, 279 chelidonium, 262, 279 chenopodium, 263 digitalis, 364 graphites, 466 hepar, 651 kali carb., 279 lachesis, 51, 413, 447 lauroeerasus, 447 leptandra, 369, 567 lycopodium, 263, 413 magnesia mur., 177, 614 mercuriu=, 369, 567, 615 myrica cerifera, 365 nux vomica, 124, 176 phosphorus, 447, 536 podophyllum, 422 ptelea, 615 selenium, 431 sepia, 177 sulphur, 177, 431, 447 taraxacum, 227 zincum, 605 LIVER SPOTS curare. 119, 170 lycopodium, 119 nux vomica, 119 sepia, 119 sulphur, 119 LOCOMOTOR ATAXIA alumina, 511, 587 argentum nitricum, 575 esculus hippocastanum, 575 causticum, 690 kali bromatum, 676 nux vomica, 184 phosphorus, 534 picric acid, 92 stramonium, 395 zincum, 575 LUMBAGO calcarea fluorica, 642 calcarea ostrearum, 642 kali carb., 215 ledum, 215 nux vomica, 184, 642 petroleum, 215 rhus tox., 214, 642 ruta, 215 secale, 642 staphisagria, 215 sulphur, 215 Valeriana, 215 LUNGS ammonium carb., 626 arsenicum, 349 aurum, 570 THERAPEUTIC INDEX. 755 LUNGS (Continued) balsam of Peru, 596 borax, 671 calcarea ostr., 596 calcarea phos., 596 chamomilla, 596 cinchona, 349 copaiva, 596 dulcamara, 404 ferrum phos., 152, 610 hepar, 483, 596, 650 illicium anisatum, 596 ipecacuanha, 596 kali bichromicum, 700 kali carb., 700 kali hyd., 677 lachesis, 349 lycopodium, 415, 596 myosotis, 596 opium, 252 phosphorus, 596 pix liquida, 596 Pulsatilla, 700 scilla, 596 secale, 349 selenium, 431 silicea, 516 spongia, 483 sulphur, 439, 596, 700 veratrum viride, 239 yerba santa, 596 LUNGS, ABSCESS OF THE lachesis, 50 LUNGS, PARALYSIS OF THE ammonium carb., 552, 626 ammonium mur., 631 antimonium crudum, 596 antimonium tart., 455, 552, 596, 619 baryta carb., 619 borax, 671 carbo veg., 455, 552 dulcamara, 404 hydrocyanic acid, 508 lachesis, 552 moschus, 455, 552 LYING-IN aconite, 304 ambra grisea, 145 arnica, 225 arsenicum, 253 bryonia, 281 causticum, 253 chamomilla, 232 croton tiglium, 282 helonias, 335 hyoscyamus, 253 opium, 253 phellandrium, 252 Phytolacca, 282 Pulsatilla, 333 LYMPHATIC GLANDS (See Glands.) MALIGNANT PUSTULE lachesis, 68 MAMMARY GLAND, AFFECTIONS OF THE apis, 543 belladonna, 282, 391, 543 MAMMARY GLAND, AFFECTIONS OF THE (Continued) bryonia, 281 carbo veg., 454 croton tiglium, 282 phellandrium aq., 282, 419 phosphorus, 515, 539, 543 Phytolacca, 282 Pulsatilla, 333 silicea, 539, 543 MANIA hyoscyamus, 396, 400 kali bromatum, 400 stramonium, 401 MARASMUS antimonium crud., 612 argentum nitricum, 253 arsenicum, 523 calcarea ostrearum, 439, 612 calcarea phosphorica, 645 cinchona, 645 hepar, 651 iodine, 666 magnesia carb., 612 natrum carb., 612 natrum mur., 666 nux vomica, 523 opium, 253 phosphorus, 439 podophyllum, 612 rheum, 612 sarsaparilla, 253 sepia, 612 sulphur, 252, 438, 523, 612 sulphuric acid, 501 MASTOID PROCESS, DISEASES OF aurum, 405,571 capsicum, 571 nitric acid, 405, 571 silicea. 571 MASTURBATION (See Sexual Excesses.) MEASLES aconite, 165, 305 antimonium tart., 551 belladonna, 165 byronia, 275, 282 cuprum, 395 gelsemium, 165, 338 kali bichromicum, 338, 685 Pulsatilla, 165, 338, 685 stramonium, 394 zincum, 395, 601 MENIERE'S DISEASE carbon bisulphide, 693 causticum, 693 cinchona, 693 salicylic acid, 693 MENINGITIS aconite, 300, 380 apis, 95, 275 arsenicum, 97 belladonna, 41, 95, 100, 274, 300, 359, 561 bryonia, 96,100, 274, 359, 380 cuprum, 96, 599 digitalis, 316, 362 glonoin, 96, 300 helleborus, 96, 315 756 THERAPEUTIC INDEX. MENINGITIS (Continued) hyoscyamus, 397 lachesis, 41 mercurius, 561 picric acid, 92 rhus tox., 97 sulphur, 96, 275 zinc, 96, 316, 602 MENINGITIS, TUBERCULAR (See Meningitis.) MENORRHAGIA arsenicum, 452 calcarea ostrearum, 639 carbo veg., 452 cinchona, 452 ipecacuanha, 452 mercurius, 561 trillium pendulum, 639 vinca minor, 159 MENSES ambra grisea, 145 ammonium carb., 63 belladonna, 582 berberis, 421 bovista, 150 bryonia, 281 calcarea ostrearum, 638 chamomilla, 245 cocculus, 244 crocus, 566 graphites, 463 hamamelis, 281 juglans regia, 192 lachesis, 63 lithium carb., 622 magnesia carb., 613 millefolium, 281, 582 moschus, 63 murex, 129 nux vomica, 183 phosphorus, 281, 539 platina, 63, 582 Pulsatilla, 245,281, 332 sabina, 582 senecio, 281, 336 sepia, 127 ustilago, 281 zincum, 127, 606 MENTAL FATIGUE anacardium, 204 MENTAL SYMPTOMS aconite, 300, 581 ethusa cynapium, 97 agaricus, 394 alumina, 586 anacardium, 203, 282 antimonium crudum, 201, 287, 547 apis, 94 argentum nitricum, 574 arsenicum, 521, 581 aurum, 133, 569, 572 baptisia, 407 baryta carb., 617 belladonna, 203,237, 274, 647 bovista, 97 bromine, 472 bryonia, 231, 280 calcarea ostrearum, 274, 586 cannabis indica, 85 MENTAL SYMPTOMS (Continued) causticum, 120, 267, 689 chamomilla, 231, 267, 322 cinchona, 274 coffea, 300, 359 colocynth, 267 cypripedium, 359 dulcamara, 647 gelsemium, 254, 257 glonoin, 395, 470 graphites, 463 hepar, 121, 647 hyoscyamus, 97, 211, 396, 397, 407, 581 ignatia, 97, 186, 322, 397v iodine. 472, 586 kali bromatum, 407, 581, 675 kali carb., 698 ! lachesis, 37, 38, 97, 203, 394, 586, 647 lilium tigrinum, 120 lycopodium, 37, 410, 581 mercurius, 560 moschus, 75 muriatic acid, 491 natrum mur., 97,120, 135,254, 322,592, 662 nitric acid, 204 nux moschata, 111 nux vomica, 97, 322 oleander, 157 opium, 254 palladium, 75, 121, 133, 584 petroleum, 395, 407, 470 phosphoric acid, 186, 441, 496, 493 phosphorus, 532 platina, 75, 121, 133, 581 Pulsatilla, 186, 322, 586, 592 rhus tox., 211, 407 sabadilla, 239 • sanguinaria, 256 sepia, 119, 322, 586, 593, 662 silicea, 254 spigelia, 423 stannum, 322, 592 staphisagria, 231, 267, 317, 318 stramomium, 203, 237, 394, 395 sulphur, 37, 441, 647 ' thuja, 239, 287, 395 valerian, 112 veratrum album., 237, 254 METRITIS belladonna, 387 berberis, 420, 421 mel cum sale, 101, 388 rhus tox.,218 terebinthina, 285 METRITIS, PUERPERAL lachesis. 60 METRORRHAGIA arsenicum,'452 belladonna, 254 carbo an., 460 carbo veg., 452 cinchona, 452 glonoin, 259 hyoscyamus, 254 ipecacuanha, 452 lachesis, 259 mercurius, 561 [ nitrite of amyl, 259 THERAPEUTIC INDEX. 757 METRORRHAGIA (Continued) opium, 254 sanguinaria, 259 MILK FEVER aconite, 304 bryonia, 281 MILK LEG hamamelis, 333 Pulsatilla, 333 MISCARRIAGE (See Abortion.) MORBUS BRIGHTII (See Bright's Dis- ease.) MOUTH apis, 45 arsenicum, 45 arum triphyllum, 671 baptisia, 45 borax, 670 bryonia. 670 carbo veg., 45 iodine, 45 kali chloricum, 45 lachesis, 45 mercurius, 670 muriatic acid, 45 nitric acid, 45 staphisagria, 45, 319 sulphuric acid, 45 MUCOUS MEMBRANES (See also Catarrhs.) alumina, 587 ammonium carb., 628 borax, 671 bromine, 473 cantharis, 89 graphites, 467 hydrastis, 337 ipecacuanha, 351 kali bichromicum, 681 lithium carb., 621 lycopodium, 414 natrum carb., 656 natrum mur., 665 nitric acid, 503, 504 petroleum, 469 phosphoric acid, 499 Pulsatilla, 325 senecio, 336 silicea, 515 stannum, 594 sulphur, 442 MULTIPLE CEREBRO-SPINAL SCLE- ROSIS baryta carb., 617 baryta mur., 617 hyoscyamus, 617 plumbum, 591 MUSCULAR EXERTION, ILL-EFFECTS OF arnica, 214, 223 arsenicum, 214, 491 coca, 491 fluoric acid, 490 rhus tox., 214, 491 MUSCULAR EXHAUSTION conium, 315 curare, 315 gelsemium, 315 kali carb., 315 MUSCULAR EXHAUSTION (Continued) muriatic acid, 315, 495 opium, 315 MYALGIA actea rac, 136, 306 arnica, 224 MYELITIS artemisia abrotanum, 228 dulcamara, 220 nux vomica, 183 picric acid, 92 rhus tox., 220 MYOCARDITIS phosphorus, 542 NEVI fluoric acid, 411, 491 lycopodium, 411 NAILS antimonium crudum, 549 fluoric acid, 490 thuja, 289, 490 NASAL CATARRH alumina, 587, 588 ammonium carb., 628 antimonium crudum. 467 arum triphyllum, 467 aurum, 571 bromine, 473 bryonia, 275 calcarea ostrearum, 467, 636 cinnabaris, 565 corallium rubrum, 623 cyclamen, 326 euphrasia, 355 graphites, 467 hydrastis, 337 kali bichromicum, 623, 683 kali carb., 699 lachesis, 48, 275 lithium carb., 622 lycopodium, 414 mercurius, 563 natrum carb., 656 nux vomica, 564 phosphorus, 539 Pulsatilla, 326, 564 sepia, 623 silicea, 515 sulphur, 443 teucrium, 623 NECROSIS OF THE LOWER JAW angustura, 171 phosphorus. 542 NEPHRALGIA argentum nitr., 579 NEPHRITIS aconite, 304 cannabis sativa, 85 cantharis, 84 helleborus, 316 NERVOUS SYSTEM actea racemosa, 73, 136, 306 agaricus muse, 76 ambra grisea, 144, 184, 675 ammonium mur., 629 argentum nitricum, 574 arnica, 345 arsenicum, 76 758 THERAPEUTIC INDEX. NERVOUS SYSTEM (Continued) asafetida, 76, 113, 115, 418 asarum, 76, 184 belladonna, 74 borax, 669 calcarea ostrearum, 640 castoreum, 111, 115, 184 causticum, 73 chamomilla, 230 cicuta, 76 cinchona, 345 cocculus, 242 colocynth, 268 crocus, 73 curare, 192 dulcamara, 400 gelsemium, 161 hepar, 647 hydrocyanic acid, 507 hyoscyamus, 73, 76 ignatia, 74 kali bromatum, 73, 575, 674 kali carb., 698 magnesia mur., 114,115, 615 magnesia phos., 615 mephitis, 27, 76 moschus, 75,109 muriatic acid, 491 mygale, 71 natrum carb., 655 natrum mur., 76, 575, 662 nux moschata, 111 opium, 249 palladium, 75 petroleum, 469, 655 phosphorus, 532, 655 piper methysticum, 360 platina, 75 rhododendron, 655 selenium, 429 sepia, 117 silicea, 517, 655 spigelia, 345 sticta, 76 stramonium, 76 sulphur, 440 tarentula, 72, 675 thuja, 287 Valeriana, 112,115, 230 veratrum alb., 230 zincum, 76, 601 NEURALGIA (See also Prosopalgia.) aconite, 301 actea racemosa, 306, 334 ammonium mur., 629 amyl nitrite, 301 argentum met, 579 arsenicum, 437, 525 belladonna, 391, 582, 647 cactus, 525 capsicum. 582 cedron, 269, 307,350, 525 chamomilla, 269, 595 chelidonium, 263 cinchoua, 349.437 colchicum, 301 colocynth, 266 cuprum, 599 NEURALGIA (Continued) cuprum arsenicosum, 599 cyclamen, 336 dioscorea, 266 ferrum, 607 hepar, 647 kalmia, 307, 525 kreosote, 281, 525 magnesia phos., 525 mezereum, 525 platina, 582. 594 prunus spinosa, 269 Pulsatilla, 338 robinia, 525 sepia, 402 silicea, 647 spigelia, 269, 288, 301, 307, 423 stannum, 582, 594 strontiana carb., 594 sulphur, 437, 647 tabacum, 402 thuja, 288 verbascum, 368 NEURALGIA, CILIARY actea racemosa, 137 cedron, 424 mezereum, 424 natrum mur., 664 spigelia, 424, 664 thuja, 424 NEURASTHENIA aletris farinosa, 336 alumina, 511 argentum nitricum, 511 calcarea ostrearum, 593 cocculus indicus, 593 collinsonia, 593 cyclamen, 337 helonias, 335 ignatia, 593 natrum mur., 593 phosphoric acid, 343, 510 phosphorus, 343, 510, 593 picric acid, 509 silicea, 511 stannum, 592 sulphur, 593 veratrum alb., 593 zincum, 511 NIGHT TERRORS kali bromatum, 675 NIPPLES, SORE castor equi, 28 graphites, 135 sepia, 135 NOMA conium, 417 NOSE aurum, 571 borax, 671 ignatia, 257 lithium carb., 622 nux vomica, 257 phosphorus, 257 sanguinaria, 257 Valeriana, 257 NOSTALGIA mercurius, 560 THERAPEUTIC INDEX. 759 NYMPHOMANIA caladium, 582 hyoscyamus, 533 phosphorus, 533, 539 platina, 62, 133, 581 stramonium, 396 veratrum alb., 237 OBESITY graphites, 463 OBJECTIVE SYMPTOMS, 19 (EDEMA bovista, 151 conium, 417 (EDEMA GLOTTID1S apis, 105 CEDEMA PULMONUM apis, 105 'OESOPHAGITIS arsenic, 387 belladonna, 387 rhus tox., 387 veratrum viride, 239, 387 OESOPHAGUS, SPASMODIC STRICTURE OF THE phosphorus, 538 OPHTHALMIA, ARTHRITIC cplocynth, 269, 320 staphisagria, 320 OPHTHALMIA NEONATORUM argentum nitricum, 325, 577 mercurius corrosivus, 325 Pulsatilla, 325, 577 OPHTHALMIA, PURULENT argentum nitricum, 577 Pulsatilla, 577 OPHTHALMIA, SCROFULOUS apis, 108 argentum nitricum,665 arsenicum, 464, 465,665 aurum, 570 calcarea ostrearum, 464, 465, 635 conium, 417 euphrasia, 465 graphites, 464, 665 hepar, 465 kali bichromicum, 108 lachesis, 41 mercurius, 370, 465 mercurius dulcis, 563 natrum mur., 664 nux vomica, 179 rhus tox., 219 sulphur, 443,464, 465 ORCHITIS aurum, 572 clematis, 330 gelsemium, 483 hamamelis, 330 mercurius, 483 Pulsatilla, 290, 329 rhododendron, 330 spongia, 482 thuja, 289 OSTITIS conchiolin, 645 stillingia, 319 strontiana carb., 319 OTALGIA belladonna, 648, 669 borax, 669 chamomilla, 326,648,669 dulcamara, 403 hepar, 648 kali bichromicum, 682 plantago major, 326 Pulsatilla, 326, 648, 669 rhus tox., 219 OTITIS EXTERNA calcarea ostrearum, 636 hepar, 648 Pulsatilla, 326, 332 OTITIS MEDIA belladonna, 326, 384 calcarea ostrearum, 636 hepar, 384,648 kali bichromicum, 681 mercurius, 326 Pulsatilla, 326, 332 tellurium, 326, 385 OTORRHCEA aurum, 42,571 borax, 669 calcarea ostrearum, 636 capsicum, 42 carbo animalis, 461 carbo veg., 461 elaps, 42 hepar, 42, 636 kali bichromicum, 681 lachesis, 42 mercurius, 636 nitric acid, 42 Pulsatilla, 326 silicea, 42, 326, 515, 636 tellurium, 326 OVARALGIA colocynth, 267 lachesis, 60 OVARIAN TUMORS apis, 62,107, 480 colocynth, 267, 480 hepar, 60 iodine, 479 lachesis, 60 mercurius, 60 OVARIES apis, 62,106 argentum metallicum, 580, 585 argentum nitricum, 574 arsenicum, 62 graphites, 63,468 iodine, 479 lachesis, 60 lycopodium, 63 palladium, 62 phosphoric acid, 498 platina, 62 staphisagria, 318 tarentula, 72 zincum, 63, 602 OVARITIS apis, 107 arsenicum, 522 lachesis, 60 palladium, 62 platina, 62, 582 760 THERAPEUTIC INDEX. OZENA alumina, 587 aurum, 571 kali bi., 290 kali hyd., 677 natrum carb., 656 petroleum, 469 phosphorus, 539 Pulsatilla, 290 thuja, 2*9 PANARITIUM ' apis, 108 sulphur, 108 PANCREAS iodine, 479 phosphorus, 538 PANNUS aurum, 570 PARALYSIS aconite, 295, 301, 691 apis, 102 baryta carb., 617) cannabis indica, 301 causticum, 301, 617, 689, 690 cocculus ind., 295, 593 collinsonia, 593 conium, 295, 416 J dulcamara, 404 gelsemium, 158, 163, 295, 417, 691 hyoscyamus, 397 ignatia, 593 natrum mur., 162, 593, 596 nux vomica, 295 oleander, 157,158 phosphorus, 544, 593, 605 plumbum, 590, 591, 605 rhus tox, 220, 301, 691 secale, 617 silicea, 517 stannum, 596 staphisagria, 301, 596 sulphur, 102, 220, 301, 441 zincum, 605 PARALYSIS, POST-DIPHTHERITIC argentum nitricum, 575 conium, 416 gelsemium, 162, 416, 575 rhus tox., 214, 220 sulphur, 220 PARAPHIMOSIS colocynth, 269, 368 digitalis, 368 PAROTITIS belladonna, 385 calcarea ostr., 413 lachesis, 413 lycopodium, 412 rhus tox., 413 PEDICULI . staphisagria, 318 PEMPHIGUS caltha, 83 cantharis, 83 carboneum oxygenisatum, 83 causticum, 83 chininum sulph., 83 copaiva, 83 nitric acid, 83 PEMPHIGUS (Continued) ranunculus bulDosus, 311 ranunculus sceleratus, 83 rhus tox., 83 sulphuric acid, 83 PERICARDITIS anacardium, 206 arsenicum, 528 colchicum, 236 kali carb., 701 kali hyd., 679 PERIODONTITIS hepar, 45 lachesis, 45 mercurius, 45 silicea, 45 PERIOSTEUM, INJURIES TO THE angustura, 171 ruta, 171 PERIOSTITIS aranea diadema, 78 asafoetida, 418 stillingia, 319 PERIPROCTITIS lachesis, 58 rhus tox., 58 PERITONITIS baptisia, 57 belladonna, 57, 387 berberis, 420, 421 bryonia, 274 carbo veg., 55 lachesis, 55, 59 mercurius, 561 ranunculus bulb., 309 rhus tox., 57, 210, 218 sulphur, 442 terebinthina, 235 PERITYPHLITIS rhus tox., 218 PHARYNGITIS kali bichromicum, 681 PHARYNGITIS. FOLLICULAR esculus hippocastanum, 682 hepar, 682 kali bichromicum, 682 kali chloricum, 682 nux vomica, 683 secale, 683 PHLEBITIS PHLYCTENULAR OPHTHALMIA arsenicum, 370 euphrasia, 465 graphites, 464 ignatia, 191 natrum carb., 656 rhus tox., 218 PHTHISIS actea racemosa, 308 ammonium mur., 631 anisum stellatum, 79, 286 balsam of Peru, 595 baptisia, 376 calcarea ostrearum, 506, 638 carbo animalis, 460 carbo veg., 460 coccus cacti, 595 codein, 247 THERAPEUTIC INDEX. 761 PHTHISIS (Continued) conium, 417 drosera, 27, 284 elaps, 50 eryodiction, 201 ferrum, 607, 609 ferrum phos., 610 guaiacum, 201 hydrocyanic acid, 508 iodine, 478 kali carb., 506, 700, 701 kali hydriodicum, 679 lauroeerasus, 508 myrtus communis, 79, 286 natrum sulph., 658 nitric acid, 506 phellandrium, 516 phosphorus, 479. 595 pix liquida, 79, 286 sanguinaria, 259 senega, 595 silicea, 516, 595 spongia, 483 stannum, 592, 595 sulphur, 444 theridion, 79 yerba santa, 201, 596, 679 PLEURISY aconite, 274 302 apis, 97, 442 bryonia, 274 ranunculus bulbosus, 309 stannum, 596 sulphur, 98, 442 PLEURODYNIA aconite, 310 actea racemosa, 277, 308 arnica, 276 bryonia, 276, 540 gaultheria, 276 guaiacum, 308 ranunculus bulb., 263, 276, 310 rhus radicans, 276 rumex crispus, 276 senega, 276 PLICA POLONICA vinca minor, 159 PNEUMONIA aconite, 275, 302 ammonium carb., 626 antimonium tart., 260, 264, 276, 552 bromine, 477 bryonia, 275, 302 carbo animalis, 460 carbo veg., 455 chelidonium, 262, 287 cuprum, 599 elaps, 50 ferrum phos., 610 hepar, 650 iodine, 478 kali carb., 264, 700 kali hydriodicum, 678 lachesis, 50, 444 lycopodium, 415 mercurius, 263. 561 phosphorus, 260, 541 ranunculus bulb., 310 PNEUMONIA (Continued) rhus tox., 210 sanguinaria, 259, 276 sulphur, 50, 260, 436, 442, 443 veratrum viride, 239, 260, 302 POLIOMYELITIS rhus tox., 218 POLYPI calcarea ostrearum, 539 phosphorus, 539 sanguinaria, 261. 539 teucrium marum verum, 539 POLYURIA phosphoric acid, 500 POST-NASAL CATARRH baryta carb., 618 calcarea ostrearum, 618 hydrastis, 326 kali bichromicum, 623 sepia, 623 spigelia, 326 teucrium marum verum, 623 POTT'S DISEASE (See Vertebral Caries.) PREGNANCY aconite, 304 anacardium, 205 apis, 106 caulophyllum, 334 digitalis, 362 hamamelis, 324.332 lycopodium, 411 magnesia carb., 613 natrum carb., 657 nux vomica, 183, 205 Pulsatilla, 329, 332 PRIAPISM agaricus, 511 ambra grisea, 511 cantharis, 91, 511 capsicum, 511 mygale, 511 opium, 511 petroselinum, 511 phosphorus, 511 physostigma, 511 picric acid, 92 platina, 511 Pulsatilla, 511 PROCTALGIA !, ignatia, 58 PROFANITY anacardium, 204 nitric acid, 204 PROGRESSIVE MUSCULAR ATROPHY plumbum, 591 PROLAPSUS ANI ignatia, 191 natrum mur., 667 podophyllum. 422, 594 PROLAPSUS UTERI abies Canadensis, 139 aletris fariuosa, 139 aloes, 131 antimonium crudum, 550 apis, 62 argentum met., 58,580 aurum, 133, 572, 582 aurum muriat. natr., 572 762 THERAPEUTIC INDEX. PROLAPSUS UTERI (Continued) calcarea phos., 139 caulophyllum, 139 collinsonia, 178 graphites, 135 helonias, 139 lac defloratum, 139 lilium tigrinum, 127 mel cum sale, 107 natrum hypochlorosum, 139 natrum mur., 135, 139, 663 nux vomica, 182, 423 platina, 582, 583 podophyllum, 131, 178, 422, 594 sepia, 182, 423 stannum, 130, 593 staphisagria, 320 PROSOPALGIA (See also Neuralgia.) aconite, 301 amyl nitrite, 301 argentum nitricum, 556 arsenicum, 583 capsicum, 582 colchicum, 301 conium, 417 gelsemium, 165 lachesis, 45 spigelia, 301 verbascum, 583 zinc, 605 PROSTATE GLAND, ENLARGEMENT OF THE Pulsatilla, 330 PROSTATITIS Pulsatilla, 290 thuja, 289 PROSTATORRHCEA selenium, 429 sulphur, 429 PSEUDO-CYESIS thuja, 288 PSORA corallium rubrum, 30 psorinum, 141 sulphur, 434 PSORIASIS arsenicum iod., 119 sepia, 119 PTERYGIUM zincum, 605 PTOSIS . alumina, 124 causticum, 162, 219, 371 euphrasia, 371 gelsemium, 161, 219 kalmia, 162,219 natrum mur., 124 rhus tox., 162, 219, 371 sepia, 162, 219 PTYALISM nitric acid, 504 PUERPERAL CONVULSIONS argentum nitricum, 577 belladonna, 392 cantharis, 88 cicuta, 419 gelsemium, 167, 239 glonoin, 407 PUERPERAL CONVULSIONS (Continued) kali bromatum, 674 kali carb., 698 platina, 583 secale, 407 veratrum viride, 239 PUERPERAL FEVER aconite, 304 opium, 254 PUERPERAL MANIA actea racemosa, 277, 307 arsenicum, 307 calcarea ostrearum, 307 hyoscyamus, 400 kali carb., 698 lachesis, 307 PUERPERAL METRITIS belladonna, 387 kali carb., 701 lachesis, 60 mel cum sale, 388 tilia Europea, 383 terebinthina, 338 PUERPERAL PERITONITIS belladonna, 387 PULSE aconite, 384 belladonna, 384 lycopodium, 410 PYEMIA arnica, 225 RACHITIS calcarea phos., 645 magnesia mur., 615 phosphorus, 645 silicea, 512, 615, 645 sulphur, 438 RECTUM belladonna, 58 causticum, 58 cocculus, 59 ignatia, 58 kali bichromicum, 58 lachesis, 58 mezereum, 59 natrum mur,, 58, 667 nitric acid, 58 opium, 58, 59 plumbum, 59 REMITTENT FEVER gelsemium, 164 sulphur, 436 RENAL CALCULI argentum nitricum, 579 berberis, 88,181 cantharis, 84, lsl lycopodium, 181, 415 nitric acid, 579 nux vomica, 181 tabacum, 403 RETAINED PLACENTA cantharis, 92, 333 cinchona, 343 Pulsatilla, 333, 343 sgcrIg 147 RETENTION OF URINE arsenicum, 253 causticum, 253, 694 THERAPEUTIC INDEX. 763 RETENTION OF URINE (Continued) hyoscyamus, 253 opium, 253 RETINA, ATPOPHY OF THE (See Atrophy of the Retina) RETINAL APOPLEXY (See Apoplexy of the Retina) RETINAL CONGESTION aurum, 570 belladonna, 570 glonoin, 406, 570 sulphur, 570 RETINAL HYPERESTHESIA actea racemosa, 137 nux vomica, 179 RETINITIS mercurius cor., 563 phosphorus, 544 spigelia, 423 RETINITIS ALBUMINURIC^ mercurius cor., 563 phosphorus, 544 RHEUMATISM actea spicata, 278, 306 anacardium, 206, 215 apis, 102 apocynum, 156 arctium lappa, 278 arnica, 224 belladonna, 380 benzoic acid, 421 berberis, 421 bryonia, 277, 331 calcarea fluorica, 642 calcarea ostrearum, 421, 623, 642 calcarea phos., 645 caulophyllum, 278 causticum, 269, 694 chamomilla, 231 cinchona, 349 colchicum, 216, 278 colocynth, 269, 694 conium, 215 dulcamara, 403 ferrum, 216, 231, 261 gelsemium, 166 guaiacum, 269,278, 694 iodine, 480 kali bichromicum, 331, 687 kali carb., 701 kali hydriodicum, 680 kalmia, 216, 365 ledum, 216, 278, 518, 623 lithium carb, 421, 622 lycopodium, 216, 421 magnesia carb., 613 manganum, 630 mercurius, 290 nux moschata, 613 nux vomica, 184, 642 petroleum, 469 Pulsatilla, 216, 290, 330 ranunculus bulb., 310 rhododendron, 216 rhus radicans, 216 rhus tox., 215, 231, 278, 642, 694 sabina, 629 sanguinaria, 261, 613 secale, 642 RHEUMATISM (Continued) silicea, 518 sulphur, 330, 442 thuja, 289 valerian, 215 veratrum album, 231 viola odorata, 278 RIGIDITY OF THE OS UTERI gelsemium, 165 ROSE-COLD phosphorus, 257 sanguinaria, 257 SCABIES causticum, 446 mercurius, 446 oil of lavender, 143, 446 psorinum, 143 sepia, 119, 446 sulphur, 119, 445 SCARLATINA aconite, 304 ailanthus, 197, 217 ammonium carb., 626, 629 ammonium mur., 631 antimonium tart., 551 apis, 64, 94, 95, 102, 494, 627 arsenicum, 494, 529 arum triphyllum, 194, 218, 505 belladonna, 41, 68, 95, 103, 218, 389, 412, 494, 603, 627 bryonia, 275, 282, 391 calcarea ostrearum, 218, 391, 604 camphor, 604 causticum, 691 cinnabaris, 565 cuprum, 412, 603 helleborus, 64 hydrocyanic acid, 494, 503, 604 hyoscyamus, 390, 397 kaliperman., 494 lachesis, 68, 217, 390, 628 lycopodium, 197, 412, 415 mancinella, 82, 292 mercurius cyan., 494 muriatic acid, 144. 494 natrum ars., 494 nitric acid, 196, 505 rhus tox., 97,103, 210, 217, 390, 628 stramonium, 391, 395, 398, 412 sulphur, 391, 436, 494 sulphuric acid, 494 terebinthina, 64 veratrum alb., 604 zincum, 395, 432, 603 SCIATICA ammonium mur., 629 colocynth, 269 gnaphalium,269 kali hydriodicum, 680 SCLEROTITIS (See Episcleritis.) SCROFULOSIS baryta carb., 616 bromine, 472 calcarea ostrearum, 464, 515, 560, 634 641 causticum, 691 conium, 417 fluoric acid, 489 764 THERAPEUTIC INDEX. SCROFULOSIS (Continued) graphites, 464 iodine, 479 lycopodium, 515 magnesia mur., 615 mercurius, 560 nitric acid, 635 phosphorus, 634 silicea, 464, 514, 560, 615 sulphur, 438, 515, 560 theridion, 79 SCROFULOUS OPHTHALMIA Ophthalmia, Scrofulous.) SCURVY chlorine, 431 natrum mur., 661 SEA-SICKNESS apomorphia, 243 petroleum, 459 theridion, 79 SEBACEOUS GLANDS psorinum, 142 SEMINAL EMISSIONS agnus castus, 166 caladium seg., 166, 200 calcarea ostr., 166,182 camphor, 166 cinchona, 499 conium, 166 digitalis, 166, 368 dioscorea, 166 gelsemium, 166 kobalt, 182 lycopodium, 166,182 natrum mur., 666 natrum phos., 666 nux vomica, 166, 182 phosphoric acid, 499 phosphorus, 166, 510 picric acid, 509 selenium, 166,429 sepia, 166 sulphur, 166 SEROUS MEMBRANES aconite, 273 bryonia, 273 ranunculus bulb., 309 SEXUAL EXCESSES agnus castus. 640 caladium, 317 calcarea ostr., 182, 317, 447, 639 cinchona, 342 conium, 417, 534 dioscorea, 318, 640 gelsemium, 318 kali bromatum, 318 kobalt, 182 lycopodium, 182, 318 nux vomica, 182, 318, 447 phosphorus, 534 platina, 317, 583 staphisagria, 182, 317 sulphur, 182, 318, 447 SHOCK helleborus, 316 SKIN aconite, 305 alumina, 588 (See SKIN (Continued) anacardium occid., 206 auacardium orientale, 81, 205 antimonium crudum, 82, 549, 665 antimonium tart., 551 arnica, 225 arsenicum, 529 belladonna, 388 borax, 672 bufo, 30 camphor, 82 cantharis, 80 capsicum, 82 carboneum oxyg., 83 causticum, 83, 665, 694 chamomilla, 652 chininum sulph, 83 chloral, 83 cicuta, 419 clematis erecta, 82, 529 coffea, 359 comocladia, 202 copaiva, 83 croton tiglium, 81, 292 dulcamara, 404 euphorbia cyparissias, 82 euphorbia peplus, 82 euphorbium off, 82, 293 fluoric acid, 490 formica, 82 gelsemium, 165 graphites, 463, 464, 529, 665 hepar, 652 hura Brasiliensis, 81 juglans cinerea, 192 kali bichromicum, 83, 685 kali bromatum, 83. 676 kali hydriodicum, 83 ,680 kali nitricum, 83 kali sulph., 83 lachesis, 82 lithium carb., 621 lycopodium, 652 magnesia mur., 615 mancinella, 82. 292 mercurius, 652 mezereum, 82, 158 natrum carb., 657 natrum mur., 667 oleander, 158 petroleum, 465, 468 piper nigrum, 82 pix liquida, 82, 286 psorinum, 142 ranunculus bulb., 82, 312 ranunculus sceleratus. 82, 83, 312 rhus tox., 81, 217, 529 sanguinaria, 261 selenium, 431 sepia, 117, 119, 529 silicea, 652 staphisagria, 318 strontiana carb., 621 sulphur, 158, 431, 441 sulphuric acid, 83 terebinthina, 82 thapsia garganica, 82 viola tricolor, 153 yucca filamentosa, 292 THERAPEUTIC INDEX. 765 SLEEP belladonna, 103, 412 cocculus, 338 cuprum, 412 cypripedium, 359 digitalis, 363 fluoric acid, 491 hyoscyamus, 398 kali bromatum, 675 lachesis, 36 lycopodium, 412 mephitis, 491 nux vomica, 174, 333 phosphoric acid, 499 Pulsatilla, 338 selenium, 430 stramonium, 412 sulphur, 338, 431 zincum, 412 SPEECH bovista, 396 glonoin, 406 stramonium, 396 SPERMATORRHOEA agnus castus, 166 caladium, 200 conium, 606 zincum, 606 SPINAL CONGESTION sulphur, 429, 510 SPINAL CORD anacardium, 206 argentum nitricum, 574, 589 cocculus, 242 dulcamara, 404 kali hydriodicum, 679 nux vomica, 183, 589 phosphorus, 534 picric acid, 508 silicea, 515 sulphur, 441, 589 zincum, 601, 604 SPINAL CORD, SOFTENING OF THE ambra grisea, 144 oxalic acid, 510 • SPINAL IRRITATION actea racemosa, 308, 699 agaricus, 308 cocculus, 309 kali carb., 693 kobalt, 309, 604 natrum mur., 308, 663, 699 nux vomica, 183, 309 phosphorus, 533 physostigma, 184, 308 Pulsatilla, 338 sepia, 604, 699 sulphur, 441 theridion, 79 zincum, 308, 604 SPINAL WEAKNESS sulphur, 441 SPLEEN aranea diadema, 77 chininum sulph., 77, 341 cinchona, 77 SPOTTED FEVER (See Cerebro-Spinal Meningitis.) I SPRAINS , ammonium carb., 629 ammonium mur., 629 arnica, 621, 629 petroleum, 469 rhus tox., 214 ruta, 621 strontiana carb., 621 sulphuric acid, 629 STAPHYLOMA apis, 107 STOMACACE nitric acid, 504 nux vomica, 180 ranunculus sceleratus. 312 STOMACH actea racemosa, 126 calcarea ostrearum, 125 camphor, 89 cantharis, 89 carbo animalis, 125 cocculus, 125 colchicum, 57 elaps, 57 hydrastis, 126 ignatia, 125 ipecacuanha, 320 kali carb., 125 lachesis, 50 lycopodium, 125 niccolum, 125 nux vomica, 57,125 oleander, 125 sarsaparilla, 125 sepia, 124 stannum, 125 staphisagria, 125, 320 sulphur, 125 thea, 126 veratrum alb., 57 STOMACH, CANCER OF THE conium, 418 phosphorus, 538 STOMACH, ULCER OF THE phosphorus, 538 STRABISMUS alumina, 586 belladonna, 586 cina, 586 cyclamen, 586 STYES hepar, 648 staphisagria, 319 SUBINVOLUTION OF THE UTERUS lilium tigrinum, 127 mel cum sale, 107 SUICIDAL TENDENCY anacardium, 204 antimonium crudum, 204 SUN, ILL EFFECTS OF THE aconite, 300 belladonna, 33 glonoin, 38, 394 natrum carb.r 38, 655 natrum mur., 38 theridion, 38 SUPPRESSED ERUPTIONS antimonium tart., 283, 551 apis, 95 766 THERAPEUTIC INDEX. SUPPRESSED ERUPTIONS (Continued) bryonia, 96, 282 cuprum, 96, 282, 599 helleborus. 96 ipecacuanha, 283 sulphur, 96, 433 zinc, 96, 282 SWEAT baryta carb., 620 bryonia, 280 carbo veg., 620 chamomilla, 536 graphites, 620 kali carb., 620 lactic acid, 620 magnesia mur., 615 natrum mur., 280 nitric acid, 620 petroleum, 469, 514 phosphorus, 536 psorinum, 349 rhus tox., 515, 536 silicea, 514,615,620 thuja, 620 SWEAT GLANDS, PARALYSIS OF THE opium, 250 stramonium, 250 SYCOSIS cinnabaris, 291 euphrasia, 291 kali bichromicum, 290, 686 natrum sulph., 291, 658 nitric acid, 290 petroleum, 291 Pulsatilla, 686 sabina, 291 sarsaparilla, 291, 686 staphisagria, 318 thuja, 287,288,658,686 SYNCOPE camphor, 37 digitalis, 37 hydrocyanic acid, 37 lauroeerasus, 37 veratrum album., 37 , SYNOVITIS apis, 98, 277,336 bryonia, 98, 273, 277 iodine, 98 kali hyd., 98 Pulsatilla, 330 sulphur, 277,442 SYPHILIS asafetida, 571 aurum, 570,571 badiaga, 461 carbo animalis, 459,461 carbo veg., 461 cinnabaris, 291, 565 corallium rubrum, 30 fluoric acid, 489 kali bichromicum, 683 kali hydriodicum, 61, 680 lachesis, 60 lycopodium, 61 mercurius biniod, 461, 566 mercurius cor., 565,566, 571 mercurius prot., 566 mercurius vivus, 566 SYPHILIS (Continual) nitric acid, 61, 161, 504, 505,571 staphisagria, 318 TABES MESENTERICA baryta carb., 619 calcarea phos., 620 iodine, 479, 619 silicea, 620 sulphur, 440 TAPE WORM argemone Mexicana, 255 cucurbita, 266 pumpkin seeds, 266 TARSAL CYSTS graphites, 319 TEETH antimonium crudum, 319 chamomilla, 319, 613 coffea, 319 kreosote, 47, 319 lachesis, 45 staphisagria, 318 thuja, 290 TEMPERAMENT belladonna, 379 calcarea ostrearum, 379 capsicum, 404 chamomilla, 322 cina, 230 ignatia, 186 ipecacuanha, 358 lycopodium, 410 nux vomica, 174 Pulsatilla, 322 staphisagria, 317 TESTICLES arnica, 330 aurum, 330 bromine, 473 conium, 330 oxalic acid, 330 phosphorus, 330 Pulsatilla, 330 spongia, 330, 482 staphisagria, 330 TETANUS aconite, 171 angustura, 170 belladonna, 171 camphor, 173 cicuta, 171,172, 507 curare, 170 hydrocyanic acid, 172, 507 hypericum, 171 lachesis, 172 nicotinum, 173 passiflora, 170 physostigma, 169 Phytolacca, 173 picrotoxiu, 169 silicea, 171 stramonium, 173 strychnia, 168 tabacum, 173 thebaine, 169 veratrum album, 173 veratrum viride, 166,171 THERAPEUTIC INDEX. 767 THROAT alumina, 588, 650, 700 apis, 699 argentum nitricum, 57&, 588, 650, 700 arsenicum album, 90, 566 arsenicum iod., 566 arum triphyllum, 90 aurum, 571 barvta carb., 618 belladonna, 90, 165, 385, 566 borax, 671 calcarea ostrearum, 468 cantharis, 90 capsicum, 90, 566, 405 carbo veg., 700 cinnabaris, 565 diffenbachia, 90 dulcamara, 404 gelsemium, 165 graphites, 468 hepar, 588, 650, 700 ignatia, 190 kali bichrom., 700 kali carb., 699 lachesis, 48 mercurius, 564 mercurius cor., 89, 566 natrum mur., 665 nitric acid, 583, 650, 700 phosphorus, 537 Pulsatilla, 327 sulphur, 468 TINEA FAVOSA nux juglans, 218 TONGUE antimonium crudum, 548 arsenicum album, 312 arsenicum metallicum, 422 baryta carb., 617 bryonia, 537, 548 causticum, 690 colchicum, 617 dulcamara, 404 kali bichromicum, 50, 662 lycopodium, 412 mercurius, 211, 422 natrum mur., 312 phosphorus, 537 podophyllum, 422 ranunculus sceleratus, 312 rhus tox., 211, 312, 422, 537 stramonium, 396, 422 taraxacum, 312 yucca fllamentosa, 422 TONSILLITIS ammonium carb., 631 amygdala persica, 387 baryta carb., 618 belladonna, 386, 562 bromine, 473 calcarea ostr., 618 calcarea phos., 618 hepar, 386, 563, 648 lachesis, 48, 562 lycopodium, 386 mercurius, 387, 562 silicea, 387, 516. 562 sulphur, 387, 562 TONSILS, ENLARGEMENT OF THE baryta carb., 618 calcarea iod., 618 conium, 618 hepar, 618 ignatia, 618 lycopodium, 618 TOOTHACHE • aranea diadema, 78 bryonia, 281 chamomilla, 613 coffea, 281, 359 ignatia, 192 magnesia carb., 613 mercurius, 45, 78 ratanhia, 613 rhus tox., 220 TORTICOLLIS belladonna, 184 nux vomica, 183 TRACHEA apis, 105 TRACHEITIS phosphorus, 540 TRACHOMA sepia, 123 TRICHIASIS borax, 671 graphites, 671 TUBERCULAR MENINGITIS apis, 95, 98, 316, 440 helleborus, 315 sulphur, 99, 439 TUBERCULOSIS arsenicum, 522 bromine, 473, 477 calcarea ostrearum, 440, 638 calcarea phos., 440 ferrum, 609 guaiacum, 201 hepar, 650 lachesis, 50 lapis albus, 480 nitric acid, 635 phosphoric acid, 500 phosphorus, 440, 534, 541, 638 Pulsatilla, 322 silicea, 516 spongia, 680 sulphur, 439, 440, 542 TYMPANITES carbo veg., 243, 253, 457 cinchona, 243, 346 cocculus, 243 colchicum, 235, 243, 253, 346 lycopodium, 243, 253, 457 morphine, 247 opium, 253 raphanus, 253 sulphur, 243 terebinthina, 253, 346 TYPHLITIS belladonna, 59, 562 bryonia, 59 lachesis, 52, 59 mercurius, 52 mercurius cor., 59 rhus tox., 59, 218 768 THERAPEUTIC INDEX. TYPHOID FEVER and Typhoid Con DITIOXS. absinthium, 227 aconite, 296 ailanthus, 376 alum en, 507 apis, 95, 103, 250, 493 arnica, 39, 213, 223, 315, 375, 497 arsenicum, 212, 234, 437, 493, 507, 525 baptisia. 213, 224, 372, 437, 493 belladonna, 273, 383 bryonia, 243, 271, 493 calcarea ostr., 411, 640 carbo veg., 213, 235, 452, 536 castoreum, 27, 111 chlorine, 481 cinchona, 234 cocculus, 242 colchicum, 234, 526 gelsemium, 164, 374 hamamelis, 507 helleborus, 39, 314 hydrocyanic acid, 315 hyoscyamus, 39, 250, 383 laches'is, 38, 103, 250, 375, 383 leptandra, 507 lycopodium, 39, 411, 415, 640 mercurius, 211 muriatic acid, 103, 212, 376, 492 nitric acid, 492, 506 nux vomica, 185 opium, 39, 250, 315, 498 petroleum, 470 phosphoric acid, 213, 314, 493, 496 phosphorus, 212, 497, 535 ranunculus sceleratus, 312 rhus tox., 210, 273, 374, 383, 493, 497, 523 selenium, 429 stramonium, 250 sulphur, 437 sweet spirits of nitre, 314, 497 taraxacum, 213 terebinthina, 64, 285 ULCERS arseuicum, 60,61, 414,530 asafetida, 60, 418, 515, 571 borax, 119, 672 bromine, 480 bufo, 61 calcarea ostrearum, 504 carbo veg., 452 cinchona, 61 euphorbia corrollata, 61 euphorbium, 61 hepar, 60, 61, 652 iodine, 480 kali bichromicum, 61 lachesis, 60 lycopodium, 60, 61, 414 mercurius, 60, 504 mezereum, 119 muriatic acid, 61 nitric acid, 61, 504 phosphoric acid, 60 phosphorus, 60, 537 plumbum, 61 psorinum, 142 ULCERS (Continued) ranunculus bulb., 311 rhus tox., 414 secale, 61 sepia, 119, 672 silicea, 60,61.514 sulphur, 60 UREMIA ammonium carb., 626 arsenicum, 90 arum triphyllum, 195 cannabis indica, 85 cuprum, 598 hydrocyanic acid, 403 URETHRA cantharis, 84 capsicum, 87 clematis erecta, 82, 86 conium, 86 doryphora, 86 URETHRITIS cannabis sativa, 85 cantharis, 84 conium, 86 doryphora, 86 hyoscvamus, 87 URINARY ORGANS aconite, 88 apis, 88 argentum nitricum, 87 berberis, 88 camphor, 88 cannabis indica, 85 cannabis sativa, 85 cantharis, 84 capsicum, 87 chiniaphila, 87 clematis, 86, conium, 86 copaiva, 87 cubebs, 87 digitalis, 88 doryphora, H(i equisetum, 86 erigeron, 87 eupatorium purp., 86 ferrum phos., 87 hydrocotyle, 133 hyoscyamus, 87 kali nitricum, 88 kreosotum, 129 linaria, 86 mercurius, 87 mercurius cor., 87 J pareira brava, 88, 421 petroselinum, 86 thuja, 87 URINE aconite, 671 ammonium benz., 64 apis, 64 apocynum can., 155 aruica, 64 arsenicum, 64, 65, 253 belladonna, 388 benzoic acid, 64, 504, 671 berberis, 420 borax, 671 bryonia, 281 THERAPEUTIC INDEX. 769 URINE .((Winner?) calcarea ostrearum, 421 ■ •antharis, 671 carbolic acid, 64 carbo veg., 64 causticum, 253, 687 colchicum, 64, 65 digitalis, 64 helleborus, 64 hyoscyamus, 253 kali carb., 64, 697 lachesis, 64 lycopodium, 253, 412, 671 magnesia mur., 615 natrum mur., 64 nitric acid, 504 opium, 64, 253 petroselinum, 671 Pulsatilla, 253 sarsaparilla, 671 senna, 697 stramonium. 253 terebinthina, 64 zincum, 606 zingiber, 253 URINE, RETENTION OF arsenicum, 253 cantharis, 85 causticum, 253 hyoscyamus, 253 opium, 253 URTICARIA apis, 101, 668 arsenicum, 101, 529 bovista, 101 calcarea ostrearum, 101, 668 dulcamara, 404 kali bromatum, 101 medusa, 31 natrum mur, 667 Pulsatilla, 101 rhus tox., 101 rumex, 101 sepia, 101 terebinthina, 101 urtica urens. 31, 101 UTERINE HEMORRHAGE bovista, 150 erigeron, 151 ferrum, 610 mitchella, 151 ustilago, 150 UTERUS actea rac, 73, 136, 306, 334 aletris, 336 aloe, 130 apis, 106 argentum nitr., 579 aurum, 132 aurum mur., 132 aurum mur. natr., 132 bovista, 150 carbo an., 460 caulophyllum, 334 gelsemium, 167 helonias, 128, 335' hydrastis, 337 krosote, 129 lilium tigrinum, 127, 337 UTERUS (Continued) magnesia mur., 615 mel cum sale, 107 murex, 129 nux vomica. 130 palladium, 75 podophyllum, 131 Pulsatilla. 132 secale, 147 senecio, 336 sepia, 119, 127 stannum, 130 sulphur, 128 tarentula, 72 ustilago, 150 VACCINATION, ILL EFFECTS OF silicea, 287, 512 thuia, 287,512 VAGINITIS helonias, 335 VARICOCELE hamamelis, 324 Pulsatilla, 324 VARICOSE VEINS carbo veg., 131, 452 fluoric acid, 491 hamamelis, 324, 491 lycopodium, 410 Pulsatilla, 323 VARIOLA anacardium, 203 antimon. tart., 551, 553 apis, 102 rhus tox., 218 VERTEBRAL CARIES carbo veg., 453 Gettysburg water, 320, 515, 623 phosphoric acid, 500 phosphorus, 543 silicea, 514 sulphur, 543 VERTIGO ambra grisea, 144 argentum nitr., 574 arsenicum, 37 bromine, 472 camphor, 37 causticum, 690 conium, 417 digitalis, 37 ferrum, 609 hydrocyanic acid, 37 lachesis, 36 lauroeerasus, 37 moschus, 37 oleander, 157 rhus tox., 219 sanguinaria, 25,7 silicea, 518 theridion. 37, 78 veratrum alb., 37 VOMITING ethusa cynap., 419, 548, 637 antimonium crud., 419, 548, 637 antimonium tart., 247, 361 apomorphia, 247, 406 arsenicum, 637 belladonna, 218, 406 770 THERAPEUTIC INDEX. VOMITING (Continued) bismuth, 535 cadmium sulph., 53, 524 calcarea acetica, 419 calcarea ostr., 419, 637 colchicum, 57 digitalis, 361 glonoin, 248, 406 ipecacuanha, 247, 549 kreosote, 535,637 lachesis, 53 lobelia, 247 nux vomica, 175 phosphorus, 637 rhus tox., 248, 406 tabacum, 361 veratrum alb., 57 VOMITING OF PREGNANCY anacardium, 205 . digitalis, 362 nux vomica, 183, 205 petroleum, 469 WARTS causticum, 694 WAXY LIVER phosphorus, 537 WHITE-SWELLING phosphorus, 543 sulphur, 440 WINE, AGGRAVATION FROM antimonium crud., 601 fluoric acid, 601 glonoin, 601 ledum, 601 nux vomica, 601 Pulsatilla, 601 rhododendron, 601 WINE, AGGRAVATION FROM [Con- tinued) selenium, 601 zincum, 600 WHOOPING-COUGH ambra grisea, 144 antimonium tart., 551 arnica, 226 cina, 230, 315, 357 coccus cacti, 31, 595 corallium rubrum, 27, 31 cuprum, 357 drosera, 27 ipecacuanha, 357 kali bichromicum, 32 kali carb., 700 mephitis, 27 senega, 32 WORMS aconite, 229 artemisia, 593 caladium seguinum, 230 cicuta, 419 cina, 229, 593 ignatia, 191, 229 indigo, 191, 229 quassia, 230 sabadilla, 240 spigelia, 424 stannum, 593 YELLOW ATROPHY OF THE LIVER phosphorus, 537 YELLOW FEVER cadmium sulph., 524 carbo veg., 453 lachesis, 53 N ■! • ** T NATIONAL LIBRARY Of MEOII NLM 001373Tb 5 Sl-^P Jki m NLM001373962