■ IT'lili IH DR. SAMUEL C. BUSEY COLLECTION. BOOKSELLERS &. inn »v. „»„, ve four works, bound in one ToIumer $1 00. BECKER. IvI. D., Allopathy, Hahnemannism and Rational Homoeopathy. Compi'ed fioni the German by Dr. Griesselich. Translated from the Ger- man. 1848. 13 eentt. HARTMANN, Dr. F. Practical Observations on some of the chief Ho- mceopa'hic Rt medies. Translated from the German, by A. H. Okie, M. D. First Series. Bound, $1 00. The second and last Series. Bound, $1 0Q. EPPS, Dr J DOMESTIC HOMOEOPATHY; or, Rules for the Domes- tic Treatment « A POPULAR VIEW OF HOMOEOPATHY. By Rev. Thomas R. Ever- est, Rector of W ckwar. With annotations, and a brief survey of the state and progress o( H( moeopathia in Europe. By A. Gerald Hull, M. D. From the second Lor...c:i edition. Bound, price $1. Homoeopathic Books. THE FAMILY GUIDE to the Administration of Homoeopathic Remedies. Third edition, after the second London edition, with additions. Retail price, 25 cents. 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HYDRIATICS, or Manual of the Water Cure.—Especially as practised by Vincent Priessnitz, in Graffenberg; compiled and translated from the Wi kings of Charles Munde, Dr. Oertel, Dr B. Hirschel, and other eye-wit- nesses and practitioners. Fourth edition, by Francis Graeter. Price 50 cents, with one plate or six engravings. 1844. ROKYTANSKY'S PATHOLOGICAL ANATOMY. Translated from the German, with additions on Diagnosis, from ScLonlein, Skoda, and others, by Dr. John C. Peters. 1844. 75 cents. Opinions of the Press.—'■ Dr Rokytansky's book is no more than it pro- fesses to be : it is morbid Anatomy in its densest and most compact form, scarcely ever alleviated by histories, ca e.->. o ' ypotheses. It is just such a work as might be expected from its author, who is said to have written in it the result of his experience gained in the careful examination of over 12,000 bodies, and who is possessed of a truly marvellous power of observing and amassing facts. In the course of our analysis we have said comparatively little of its merits, the best evidence of which is found in the length to which our abstracts have been carried without passing beyond the bounds of what is novel or important. Nor would this fault have been committed though much more had been borrowed, for no modern volume on morbid Anatomy contains half so many genuine facts as this; it is alone sufficient to place its author in the highest rank of European medical observers."—British and Foreign Mediail Review, January, 1843. ENCHIRIDION MEDICUM, or the Practice of Medicine ; the result of fifty years' experience, by C W H .feland, counsellor of state, physician in ordinary of the late King of Prussia, professor in the University of Berlin. From the sixth (Jerman edition: translated by C Bruchhausen, M. D. Re- vised by R. Nelson, M. D Second American Edition. 1844. Bound, #2 50 6 Homoeopathic Books. Opinions.—The following lines from Dr. Manly, formerly President of the Medical Society .1 the State of New York, contain his opinion in a few words of the merits of the book: I am happy to have the opportunity of recommending to the Medical pro- fession the Manual of the Practice of Medicine, by Hufeland. It is not often that books of this character, on perusal, make good the claims which their titles assume, but this is a well-marked exception: its description of diseases though concise, are comprehensive; its reasonings just and philosophical, and it* practice, as a consequence, intelligible and rational. The character of the author and his t xperience of more than half a century, together with the unexampled popularity of the work in its original language, render, in my opinion, all individual recommendation superfluous. I hope that it may soon be found in the hands of every medical man, whether pupil or practitioner. James R. Manly, M. D. New-York, September, 7,1842. Certificate of John F. Gray, M. D., formerly Resident Physician to the New-York Hospital, Lecturer on the Theory and Practice of Physic, Censor of the State and New-York Medical Societies, etc., etc. I am very glad to find the press engaged in diffusing a knowledge of the German medical literature in this country. At the head of the German books of practice stands this book of the good Hufeland. Mr. Bruchhausen and Dr. Nelson have laboured with diligence and good faith in rendering the Enchiridion ; and so far as I have had leisure to compare their work with the original, I find no error of magnitude. Another edition will, no doubt, be called for soon, and then the worthy American curators can dispense with the somewhat meagre characteristic given to it by their too close adherence to the letter of the author. I heartily wish success to the good enterprise. John F. Gray, M. D. New-York, September 8,1842. The reputation of the venerable eclectic of Germany scarcely requires endorsement even on this side of the Atlantic. An independent and original thinker, Hufeland labored for the cause of medical science, and has acquired a universal renown, amply attested to by his "Journal of Practical Medi- cine," " Art of Prolonging Life," " System of Practical Medicine," and nu- merous Essays, besides personal contributions of humane and necessary inno- vations in the treatment of " Inoculation," " Small Pox," and " Signs of Death." His last work, Enchiridion Medicum, concentrates the experience of his entire medical life, and fully maintains in its careful and concise de- scription and diagnosis of diseases all the evidence of the discriminating intel- lect of the Patriarch of German medical literature. A. Gerald Hull, M. D. New-York, September 12, 1842. I have looked over the Enchiridion Medicum of Professor Hufeland. It is an excellent compendium of German Practice, and will be found a valuable vade mecum to the student and practitioner. It can profitably be perused, and ought to be in the hands of all physicians. The justly distinguished reputation of the author will make it a work generally sought for. VALENTINE MOTT, M. D. New-York, September, 1842. r>anxH ARTMANN'S THEORY OP ACUTE DISE A8ES AND THEIR HOMCEOPATHIC TREATMENT. THIRD GERMAN EDITION, REVISED AND CONSIDERABLY 3BNLAHSED BY TEX AUTHOR. TRANSLATED, WITH ADDITIONS, AND ADAPTED TO THE USE OF THE AMERICAN PROFESSION, BY CHARLES J. HEMPEL, M.D. VOL. II. NEW-YORK: WILLIAM RADDE, 322 BROADWAY, PHILADELPHIA:—C. L. RADEMACHER, 339 ARCH-9T, BOSTON :—OTIS CLAPP, 12 SCHOOL-ST. ST. LOUIS:—FRANKSEN & TtfESSELHOEIT. 1848. Entered, according to Act of Congress, iu the year 1848, by WILLIAM RADDE, En the Clerk's Office of the District Court of the United States for the Southern District of New-York. ^' * H. Ludwig & Co., Printers 70 Vesey-street, New-Yoik. v*tU* Public Libraiy. WASHINGTON. D. 0, H9C JAN 14 1902 TABLE OF CONTENTS OF THE SECOND VOLUME. SEVENTH CLASS. FEVERS CHARACTERIZED BY INFLAMMATORY ERUPTIONS HAVING A DEFINITE SHAPE. Page Exanthematic Fevers,........ 1 Short Remarks on Cutaneous Eruptions Generally, ... 1 Classification of Eruptions,....... 1 Cause of Eruptions,.........2 Prognosis in Eruptive Diseases, ...... 2 General Remarks on the Treatment of Aeute Eruptions, . . 3 Special Remarks on the Treatment of Acute Eruptions, . . 4 Variola,...........4 " Stages and Treatment,......5-11 Cow-pox,...........11 Remarks on Vaccination,........12 Varicella, . ..........13 Varioloid,...........14 Urticaria, or Nettle-rash,........15 Measles,...........16 " Stages and Treatment........16-20 Scarlatina...........20 " Stages and Treatment.......20-23 Complication of Scarlatina with other Diseases,.... 23 Secondary Diseases succeeding Scarlatina......24 On the Means of Preventing Scarlet Fever and Scarlatina Compli- cated with Purple-rash,.......26 Purple-rash, Miliaria Purpurea,.......27 Rubeolas............31 Miliaria,...........32 Intertrigo, Soreness of Children, ...... 34 X. CONTENTS. Page Petechia:............35 Aphtha?, Thrush..........36 if} Erysipelas,...........°° Zona. Zoster, Cingulum,......• Perniones, Chilblains.......... EIGHTH CLASS. Fevers with Definite Inflammatory Affections; Local Inflammations, 42 Inflammations iu General, ...-■••• 4^ Causes of Inflammation, ....•••• 4d Character of the Fever in Inflammations,.....44 Terminations of Inflammations, ....••• 4i> Special Treatment of Inflammations, . Pneumonia, Peripneumonia, Pneumonitis......4b « « <« Causes, ... 48 <« » » Prognosis, ... 49 <« « " Treatment, . . 49-55 Pneumonia of Children,........54 of Old People,........55 Typhoid Pneumonia..........56 Asthenic Pneumonia, ......•• •>' Pneumonia Notha, (Occulta,).......58 Pleurisy, Pleuritis,.........°0 Pericarditis, Carditis,........ . 62 " Infantum,........ 63 Diaphragmitis, Paraph renitis,.......64 Rheumatic Affections,........66 Acute Rheumatism, Rheumatalgia,......66 Rheumatism of the Extremities,......68 " of the Heart, (Endocarditis,).....70 « Treatment, . . . 72-76 " of the Thorax,........76 Lumbago Rheumatica,........' • Rheumatismus Cephalicus,.........79 Rheumatic Odontalgia......... 79 ■' " Treatment,.....80-84 Rheumatismus Paralyticus,.......84 Psoitis,............86 Arthritis, Gout, ......... 87 Complication of Gout with other Diseases......91 Gout causing Ophthalmitis Arlhritica, . . . . . 91 " " Gastritis, and other Inflammatory Affections, . 9'J CONTENTS. Xi. Page Gout causing Metastatic Diseases, such as Constipation, Cardialgia, etc..........93 Ischias, Coxalgia, Coxagra,........92 Nervous Ischias, Ischias Nervosa Cotunni, Neuralgia Ischiadica, 93 (a) Ischias Nervosa Postica,........93 (6) " " Antica,.......93 Glossitis, ........... 94 Pharyngitis,..........95 Stomacace, .........: . 99 Angina Maligna, Gangrenosa, Putrida, Diphtherica, . . . 100 " Mercurialis, Stomatitis Mercurialis,.....101 " Pharyngea, Pharyngitis, ...... 102 CEsophagitis, Angina OZsophagea, Dysphagia Inflammatoria, . . 103 Laryngitis, Tracheitis, Bronchitis Acuta, (Angina Pectoris,) . 104 " •« " " Causes, . . . .105 " " " " Duration, ... 105 " " " " Treatment, . . 106-108 Croup, Angina Membranacea, Polyposa, Cynanche strenua, Stridu- la, Exsudatoria, Laryngitis Exsudatoria, .... 109 " Etiology,........110 " Treatment,......111-112 Parotitis, Angina Parotidea, . . .....112 Inflammation of the Nose,.......114 Ozrena Narium,..........114 Ostitis, Inflammation of Bones, . ..... 115 " " " Terminations, . . .115 " " " Treatment.....116 Inflammation of the Lymphatic Glands and Vessels, . . .117 Hepatitis.......... . . 119 " Treatment,........122-125 Icterus, Jaundice, ......... 125 " " Varieties,.......125-126 " " Treatment,......127-130 Splenitis, Lienitis,.....• . . . 130 " " Duration and Treatment, . . . 130-134 Gastritis,........... 134 Enteritis......... . . .137 " Mucoso Infantum,.......140 Incarcerated Hernia, ........142 Nephritis, .... ......142 Cystitis............145 Metritis, Hysteritis, ......... 147 Oophoritis, Inflammation of the Ovary,......150 " " " Terminations, 151 xu. CONTENTS. Page Inflammation of the Labia and Vulva.......153 Puerperal Fever,........ . 153 " " Treatment,......159-163 Endometritis Septica, or Putrefaction of the Uterus, . • 156 Phlegmasia Alba Dolens,........157 Milk-Fever of Lying-in Females,......163 «' « " Treatment, . 163-166 Mastitis, Inflammation of the Mammas,.....166 Orchitis, Inflammation of the Testicles,.....168 " Rheumatic,........165 " Erysipelatous,........169 " Gonnorrhoeal,........169 " Treatment,........169-170 Encephalitis, Cephalitis, Meningitis, Phrenitis, Inflammation of the Meningeal Membranes,.......170 " Causes, ......... 171 " Course and Terminations,.....171 " Treatment........172-174 Delirium Tremens, Phrenesia, Encephalitis Potatorum, . . 174 " Terminations,.......176 " Treatment.......176-178 Acute Hydrocephalus,.........178 « " Stages and Treatment, . . . 178-185 Spinitis, Meningitis Spinosa, Myelitis, Inflammation of the Spinal Marrow, .......... 185 " Course and Terminations,.....186 " Treatment,.......186-187 Otitis,...........187 Ophthalmitis,..........189 Erysipelatous Ophthalmia,.......190 Catarrhal "........191 Rheumatic " ........193 Arthritie " ........194 Scrofulous " ........197 Blepharophthalmitis Glandulosa, Blepharoblennorrhoea, Inflamma- tion of the Meibomian Glands, ...... 199 Ophthalmia Neonatorum,........201 Ceratitis, Inflammation of the Cornea,......202 Iritis, Inflammation of the Iris,..... 203 SEVENTH CLASS. FEVERS CHARACTERIZED BY INFLAMMATORY ERUPTIONS HAV- ING A DEFINITE SHAPE. § 91. Exanthematic Fevers. A few short remarks on cutaneous eruptions gene- rally : An exanthem is an inflammatory process of the va- rious layers of the skin, in consequence of which the colour and form of the skin change. These altera- tions of the skin are quite different from those occa- sioned by mechanical causes, injuries, burns, vesica- tories, sinapisms, etc. An eruption has to be treated differently, according as it is seated in one or the other layer of the skin. This observation applies particu- larly to old eruptions, the successful treatment of which requires that their primitive form should be correctly' ascertained.. Eruptions may be classed under the following heads: (a.) Maculosa, spots without elevation of the epi- dermis, smooth, and only distinguished here and there from the remainder of the skin by an increased red- ness, as in scarlatina, petechiae, lentigines. (b.) Papulosa, pimples, slight elevations on the epidermis, without pustule, as in purpura miliaris, morbili, rubeola, miliaria, essera, verruca. (c.) Pustulosa, elevations of the epidermis which are either empty or filled with a fluid, lymph or pus, as in variola, varicella, pemphigus, scabies. (d.) Crustacea, with dry crusts, as in dry herpes, ti- nea, serpigo, I f ERUPTIVE FEVER. (e.) Ulcerosa, with purulent destruction of the skin as in herpes exedens or ulcerosus, lepra, etc. These different exanthemata may be either acute or chronic. The acute form is distinguished from the chronic by its greater regularity, nnd by the lever which always accompanies the former, and is scarcely ever, and then only slightly, present in the latter. § 92. We are not acquainted with any particular predisposition for acute cutaneous eruptions, unless it be a scrofulous or pituitous disposition, young age, an excessive sensitiveness of the skin from keeping it too warm. Nor are we acquainted with any particular exciting1 causes, causes occasionalcs, except miasmatic and con- tagious causes, or contagious miasms. Cutaneous eruptions generally are secondary affec- tions, which always disappear together with the pri- mary disease. In fevers, eruptions may be occasioned by the intensity of the fever, exposure to excessive heat, diaphoretics, dyscrasia. Acute eruptions differ from each other in form, power of contagion, and the manner in which they originate ; they are likewise distinguished into simple, and compound. Acute eruptions, if not cured, may result in the fol- lowing secondary affections :—Indurations of the lym- phatic glands, leading to atrophy and serofulosis, suppu- ration, ulceration, dropsy, etc. Such secondary affec- tions generally take place in individuals of a sickly constitution, or who are affected by the least change of weather, and are liable to catarrhal fevers, diar- rhoea, rheumatic pains. Other symptoms of a sickly constitution are: sudden alternation of spirits, from elated to low, flaccid state of the muscles, prostration of strength from the least exertion. § 93. In acute eruptions, the prognosis depends, (1.) Upon the age of the patient. The younger the children, the greater the danger. The prognosis is more favourable from the fourth to the twelfth year ; and less favourable again in the age of pubescence] when the disease is disposed to assume a typhoid ERUPTIVE FEVER. g character. At the period of manhood, the eruption may become dangerous, in consequence of the accom- panying fever, which frequently increases to a true synocha, and exposes the patient to the danger of an apoplectic paroxysm. (2.) Upon the constitution of the patient. The exan- them is more dangerous in proportion as the nervous system of the patient is more sensitive and more easily affected. (3.) Upon the accompanying fever. In most cases, the fever is remittent; however, it may assume the character and type which happens to prevail at the time. In the case of robust individuals, the prognosis is favourable if the fever be a synocha of moderate degree. If the fever should become typhoid, the | rog- nosis is not always favourable, owing to the putrid symptoms which are apt to supervene. (4.) Upon the diseases with which the eruption happens to be complicated. A simple eruption is more easily cured than one which is complicated with other diseases. § 94. Acute exanthemata are sometimes so slight, that they disappear again without any treatment. If the exanthem originate in uncleanliness of the skin, the first step towards a cure, is to wash the skin thor- oughly ; at the same time, injurious nourishment and excessive heat, either from too much covering or from a stove, ought to be avoided. The temperature of the room and the quantity of covering are to be regulated agreeably to the desire of the patient, who is the best judge of what is pleasant to him. The notion that the skin, in cases of acute eruption, should be kept very warm, has been abandoned long ago. By keeping the skin too warm, its sensitiveness and consequent liabili- ty to cold, and the danger of a sudden disappearance of the eruption, are unnecessarily increased. If the fever which accompanies the exanthem be very moderate ; if it be a simple and unimportant excitement of the circulation, the patient may do with- out any medicine ; and all that is required in the way of treatment, is to regulate the diet of the patient, the temperature of the sick-room, and to attend to the ne- \ VVRI0LA. cessary ventilation, light, quiet, etc. But if there should be much fever, or if it should threaten to be- come typhoid ; if gastric symptoms should be present, the treatment should be more positive. For the synochal fever and the complete cure of various acute eruptions, Aconite is the well-known remedy. Belladonna is another specific and prophylactic for certain acute eruptions; it shortens their course, di- minishes their intensity, and prevents secondary dis- eases. Mr.rcurius renders essential service in suppurative eruptions, and removes dangerous secondary symp- toms. Ipecacuanha and Bryonia arrest the course of many kinds of eruptions in their commencement, and restore them even upon the skin after they have been sup- pressed by some accidental cause. Pulsatilla promotes suppuration in many kinds of eruption ; this may likewise be said of Hepar sulphu- ris. Arsenic is an excellent remedy for many kinds of malignant eruptions. Dulcamara is useful in many eruptions consequent upon a cold. Rhus t. cures similar eruptions. If, during the course of an acute exanthem, sweat should be suddenly suppressed, it can be restored by a dose of Cocculus or Nux vomica, according as one or the other remedy is indicated by the symptoms. Sulphur and Graphites are indispensable in many cases of chronic eruption. External applications are seldom, if ever, used by homoeopathic physicians for the cure of cutaneous diseases. SPECIAL REMARKS ON THE TREATMENT OF ACUTE ERUPTIONS. § 95. Variola. An eruption consisting of acuminated pustules, which first appear on the third, fourth or fifth day of a contagious fever, in the shap<- of red spots ; these VARIOLA. O spots gradually elevate themselves into pustules dur- ing three days, suppurate for three other days, after which they dry up and form scabs, which, on falling off, leave small, irregular cicatrices. This is the course of a single pock. As the breaking out of fresh pocks continues for three days, the period of desiccation ter- minates about a fortnight after the appearance of the first pock. The first description of small-pox is found in the works of two Arabian physicians. At the end of the ninth century, it was described by Rhazes, another Arabian physician, in his book on the plague. Small- pox seems to have first existed in Africa. In Europe, the disease first invaded Spain, and thence spread through the southern countries. The essential features of the disease have remained the same. It runs a regular course, marked by distinct periods, which are liable to greater or lesser irregulari- ties, in consequence of the disease being complicated with inflammatory, typhoid, gastric and other symp- toms. Such irregularities are,, for instance, unusually rapid, or else irregular, delaying, interrupted breaking out of the pocks; imperfect or arrested formation of the pustules; depressed pustules without areolae; watery pustules (crystallinae, lymphaticae) ; empty pustules (siliquosae) ; discoloured pustules filled with blood (sanguineae) ; sudden falling in of the pustules, or sudden disappearance of the swelling of the face ; too rapid and too general a desiccation of the pocks. Small-pox is one of the most dangerous, painful and disgusting diseases. The more numerous the pocks, particularly in the face, the more complicated the disease ; the older the patient, and the feebler the constitution, the more dangerous is the disease. Epidemic small-pox is more dangerous than sporadic, and more so about the middle of the epidemic than eirher at the commencement or end. Convulsive phenomena previous to the eruption are of no im- portance' ; but they indicate great danger when oc- curring during the period of desiccation. There is 6 VARIOL.4. great danger when the eruption appears very sud- denly, and in clusters, or when the pocks are de- pressed, pale, discolored or sanguineous ; a discharge of blood by the urine or stool during the period of desiccation is particularly dangerous. The course of small-pox is distinguished into four stages. (1.) Tlic febrile stage, which sets in with a slight vascular excitement, and ceases upon the appearance of the first stigmata. The fever is very slight at first, but increases from day to day, and is a continuous re- mittent fever. The fever is accompanied with various secondary ailments, such as headache, ill-humour, low- ness of spirits, weariness, drowsiness, congestion of the head with bleeding of the nose, delirium, nausea, vomiting, a characteristic putrid smell of the breath and urine, epileptic convulsions when the patients arc quite young, colic, drawing in the limbs, stretching, pains in the back, etc. If the fever be violent and accompanied with pains in the limbs, congestion of the head, bleeding of the nose, headache, Aconite is indicated. If there be great sensitiveness to the light, if the headache be aggra- vated by light, and if the nervous system should be greatly irritated, Aconite may not always prove suffi- cient, and it may then be necessary to give a dose of Belladonna, or, in some cases, a dose of Rhus t. Opium is useful when there is a good deal of sopor. Some physicians assert that they have found Arsenic very useful, particularly after the stigmata had commenced to make their appearance. No particular remedy can be recommended for the first stage, on account of the great variety of the symptoms characterizing that stage. Pulsatilla, Ipecacuanha, Antimonium crudum, Arnica, Bryonia, etc., should be thought of when gas- tric symptoms are present; Rhus t., Bryonia, Dul- camara, when the patient experiences rheumatic, drawing-tearing pains in the limbs. Sulphur has been recommended by me and my late colleague, Doctor Franz, as a prophylactic for small-pox ; however, I have not yet had an opportunity of ascertaining by experience whether Sulphur does really possess the VARIOLA. 7 power of arresting the disease at the termination of the first stage, and whether it has any prophylactic virtues whatsoever. § 9G. The second stage is the eruptive stage, which lasts from three to four days. Towards the termina- tion of the third paroxysm of fever the stigmata make their appearance, at first in the shape of small red points which increase in extent and elevation from hour to hour, and are distinguished from measles, petechias and other cutaneous eruptions, by the fact, that upon close examination, a pimple of the size of a millet-seed is discovered in each stigma. The stig- mata first appear on the face, next day on the hands, and on the third day the feet and the rest of the body are covered with them. In many cases the pustules form in the face before the stigmata make their appear- ance on the feet. Thus it is that every patient ex- hibits pocks in the different stages of development. When the last pocks have broken out, the vascular ex- citement ceases. Its continuance, under those circum- stances, would denote an anomalous condition of the disease. Generally the patients complain of nothing but an itching and burning of the skin, sometimes of pains in the eyes and throat. In the eruptive stage, Stramonium has frequently been useful in accelerating the appearance and short- ening the course of the pocks. The remedies men- tioned for the first stage, may likewise be employed if indicated. If gastric symptoms be present, Chamo- milla, Nux c, Antim. cr., Bryo., should be thought of. Aconite is to be continued if the fever be high. If the disease should set in during the period of dentition, it is generally accompanied with the fever incidental to that period, and characterized by various symptoms, and particularly by congestion of blood to the head, or, if there should be great vascular excitement, by congestion of blood to the chest. The congestion of the head is frequently accompanied with delirium, which, when continuing during the waking state, in- dicates an inflammatory condition of the brain, par- R VARIOLA. ticularly when a good deal of thirst, sleeplessness, re- tention of stool, and a burning heat of the skin, with natural warmth or even coolness of the feet and hands are present. The congestion of the chest fre- quently assumes the character of angina pectoris or pneumonia, and is characterized by excessive short- ness of breathing, constant short and sleep-disturbing cough, burning heat, great thirst, quick and strong beating of the heart, extreme restlessness, etc. Neither of these two kinds of congestion in small-pox is apt to yield to Aconite ; Belladonna is much more suitable, and, if there should be great orthopnoe, and the thorax should expand like a cuirass during an inspiration, Phosphorus is the appropriate remedy. If catarrhal symptoms, an affection of the mucous membrane of the lungs, with cough, coryza, hoarseness, etc., should be present, the remedies indicated for catarrhal fevers are to employed; if the throat should be affected, we have to resort to the remedies indicated for angina. During the eruptive as well as the febrile stage, children are frequently attacked with convulsions. These can be speedily arrested by exposing the patient to the influence of a cool, fresh air at the open win- dow ; injections of tepid water are likewise useful. If these means should not be sufficient, if the child should be pale, with cold extremities, frequently emit- ting pale urine, if the symptoms should indicate a purely nervous, spasmodic condition: the patient should be put in a lukewarm bath and should be administered Zincum, third trituration, one dose every hour. If the convulsions should depend upon gastric irritation, the remedies indicated for gastric affections have to be resorted to ; if worms should be the cause, the reme- dies mentioned for worm fever will be found suitable. If the convulsions should be accompanied with sopor, and the patient's face should be bright-red and the forehead hot, Opium is the best remedy. In the eruptive stage more than in any other, the pocks incline to become malignant by combining with typhoid or putrid symptoms, or to disappear suddenly. VARIOLA. 9 h\ either case, Arsenic is best calculated to ward off the danger, provided the vital forces be not too much depressed and the organism too much reduced. After having controlled the eruptive fever, accom- panied with violent congestion of the brain, delirium, burning heat of the skin, dryness of the tongue, great thirst, etc., by Belladonna, I have frequently admin- istered, in this stage, the isopathic variolin, by means of which I have succeeded in shortening the course of the eruption and preventing the suppurative fever. Vaccinin has likewise been found useful in this stage, even more so than variolin.* § 97. The suppurative stage commences on the fifth, seventh or ninth day. In this stage the pustule completes its development and is surrounded with an areola. The lymph with which the pustule is filled, first shows itself in the tip of the pustule where a little blackish depression is seen, which is termed the umbilicus of the pock. The lymph goes through a va- riety of changes in colour and consistence, from water- coloured to white and yellow, and from a fluid to a papescent consistence, until it is gradually transform- ed into a scurf. Isolated pocks are termed variolae discretae. If a number of pocks flow into each other and form one suppurating surface, they are termed confluent small-pox (variolae confluentes). If the pocks be very numerous, the whole body swells, par- ticularly the head and eyes. The mucous mem- brane of the nose and fauces is inflamed. In many cases a real ptyalism sets in. The fever in the suppurative stage may be more or less violent, ac- cording as the pocks are more or less numerous. The higher the fever, the thicker and more turbid the urine, which sometimes exhibits a purulent sediment. In this stage the characteristic small-pox smell is most offensive, and appears intolerable to those who are not constantly with the patient. * It may not be deemed superfluous to recommend Sulphur as an excellent remedy in this and the next stage ; even if it had not the prophylactic vir- tues which Hartmann supposes it possesses, may it not, in a great measure, be capable of preventing the pitting of the skin 1—Himpel. x* 10 VARIOLA. If the fever be very slight and no other untoward symptoms exist, the patient can do without medicine, and all that is required is to observe the hygienic rules previously indicated. But if the fever be violent, if the nose, throat and eyes be affected and ptyalism have set in, Mvrcurius is to be administered in re- peated doses every two or three hours. Nitric acid, Hepar sulphuris c. and Tartarus emetic us are likewise very useful in the suppurative stage. Whatever complication may have existed in the previous stages, becomes much more marked in the third stage, inducing either an inflammatory, typhoid or putrid fever. It may be expedient to open the pustules and to prevent the absorption of the pus. It is likewise use- ful to drink much water in order to act upon the blad- der. The swelling of the face and eyes may be re- lieved by fomentations with tepid milk. The angina faucium is likewise relieved by injections of tepid milk into the throat. A sudden desiccation of the pustules and disap- pearance of the swelling of the face are sure indica- tions of approaching death. In such a case it is some- times possible to rouse the sinking vital force by re- peated doses of Camphor, by washing the body here and there with the spirits of Camphor, applying warm poultices to the hands and feet, and thus establishing an action towards the surface and preventing a metas- tasis to important internal organs. If the pocks should turn black and typhoid symp- toms should set in, Acidum muriaticum will frequently be found sufficient to restore the chances of recovery. Rhus tox. or Arsenic should be given if the pocks should suddenly fade, with livid areolae, blackish color of the inner mouth, dry, shrivelled tongue, burning thirst, meteorism, great exhaustion. § 98. The stage of desiccation and desquamation is the last stage of the disease. It commences with the appearance of a brown point in the centre of the pock. This point is first perceived on the pocks that came out first. The pocks remain longest on the COW-POX. 11 soles of the feet and the hairy scalp. The suppura- tive fever, the swelling and smell diminish gradually and finally disappear. The patient now experiences a violent itching of the skin. The lymph gradually dries up, and a brown, hard, dry scurf forms, which, on falling off, leaves a new, sound skin and cicatrices, corresponding in size and depth to the suppuration which had been going on in the skin. After this pe- riod the skin remains for a long time sensitive to the atmospheric air. All danger ceases as soon as the process of desquamation has terminated in the face. The commencement of the desiccation of the pustules in the face is the most important period of the disease. At this time the greatest number of deaths occur in consequence of putrid decomposition or mortification of the pocks, haemorrhage, inflammation of noble organs, such as the lungs, brain, bowels; or else ner- vous spasms and convulsions set in. If any of these conditions should set in, the phy- sician has to prescribe the remedies indicated in their respective places. Otherwise no further treatment is required, except frequent washing with tepid and lastly with cold water, in order to diminish the sen- sitiveness of the skin. Among the disastrous consequences of small-pox we may notice the following: disfiguration of the face by cicatrices; destruction of the eyes ; chronic ophthal- mia, which is frequently cured by Hepar sulph., Digit- als, Clematis, Baryt. carb., Sulph., Euphrasia, Lycopo- dium, Rhus t., Arsenicum, etc.; frequently recurring boils in various places, which disappear under the use of Euphrasia, Thuja, Belladonna (Sulphur. Nitric acid, Phosphorus, etc., being the best remedies to remove the disposition for their recurrence.) The caries which frequently occurs after small-pox is combatted by Asa, Silicea, Mezereum, Aurum, Nitric ac, etc. For the remaining consumptive affections, the reader is referred to the chapter where these diseases are specially treated of. § 99. Cow-pox (Variolae vaccines, tutoria.) 12 COW-POX. Cow-pox runs a regular course, which is so well known, that it is needless to speak of it more particu- larly. If a morbid disposition which had been latent in the organism previous to vaccination, should be roused into action in consequence of that process, it will have to be met by the remedies indicated by the symptoms. Vaccination does not afford any protection to in- dividuals that are actually infected with the small- pox contagion. However, inasmuch as the infection is not indicated by any perceptible symptoms, it is im- possible to define the period when vaccination will no longer be able to ward off the disease. If the. small- pox should have attacked one member of a family and the other members of that family should never have been vaccinated, vaccination will prove inefficient to protect them from the disease. The remaining inhabi- tants of the place, however, should be vaccinated as speedily as possible, as they may still have a fair chance to be preserved from the infection. If such vaccinated individuals should nevertheless be attacked, the eruption will be somewhat similar to varioloid, but will, according to my experience, never be true small- pox. The true, genuine cow-pox pustule, which is a re- liable proof of the prophylactic virtue of the vaccine, is flat and depressed in the centre, and, on the eighth or ninth day, is surrounded with an inflammatory red- ness, which is the chief sign that the organism has been thoroughly infected with the vaccine ; if the pus- tule be full and convex, and if it begin to rise three or four days after the vaccination had taken place, the prophylactic power of the virus cannot be relied upon ; the vaccine was perhaps too old, or else, if the matter was good, the patient's receptivity was de- ficient. On the seventh day after vaccination I have fre- quently seen a metastasis to glandular organs taking place. Such a metastasis, even if it should take place to the testicles and parotid glands, is not dangerous, and disappears of itself on the ninth or eleventh day, SPURIOUS SMALL-POX. 13 when the nervous and vascular excitement has sub- sided. It has frequently happened in my practice, that morbid symptoras which would not yield to any reme- dy, such as a cnronic inflammation of the Meibomian glands, or a discharge of \>adly-smelling pus from the ears, ceased entirely after vaccination, which, in such a case, ran a regular course, and was accompanied with more fever than usual. The vaccine which is used in vaccination, should never be taken from children that have been affected with eruptions or glandular diseases, etc. The best kind of vaccine, however, may excite a latent dys- crasia in the patient, which should then be met by appropriate remedies. § 100. Spurious small-pox, Varicella. Varicella is very similar to small-pox, from which it is distinguished by its more rapid course, its benign character, and the absence of the characteristic smell. It frequently makes its appearance at a period when small-pox is prevalent. It runs an irregular course, is very mild and without danger, and is never violent except when the patient is very sensitive and the eruption is complicated with other diseases. Vari- cella generally lasts from three to seven days, is ge- nerally first seen on the face, and is accompanied with a moderate remittent fever, or else there is no fever at all. Sometimes the fever is accompanied with catarrhal symptoms. The eruption appears variously modified. Varicella does not require any medical treatment. If fever be present, give a little Aconite. In many cases this disease sets in with symptoms of great ner- vousness, without thirst or general heat of the body, some parts feeling burning hot, others having the na- tural temperature, and others again being rather cool; these symptoms are attended with restlessness, anxious sleep disturbed with dreams and starting; small chil- dren will cry constantly. This group of symptoms is generally relieved by Coffea, or else by Chamomilla, Jalappa, Antim. cr., etc. 14 VARIOLOID. During the period of dentition the foregoing symp- toms, in consequence of the complication with the fever of dentition, frequently increase to spasms. These spasms are sometimes relievedJjy Chamomitla. m but more frequently by Ignatia and Belladonna, by the latter more particularly when the children are unable to keep their heads erect and rest them on some- thing ; when the head and hands feel burning hot, the little patients are very restless, cry a good deal, bend double constantly as if tormented by colic, and when the alvine evacuations intermit. If, under these circumstances, Belladonna be not given in season, en- cephalitis may set in, or else an effusion may take place, which may terminate in serous apoplexy. If the spasmodic symptoms predominate, Ignatia de- serves a preference over Belladonna. The course of simple and uncomplicated varicella is very much shortened by Pulsatilla, which is like- wise an excellent prophylactic against this disease. The varieties from varicella to small-pox are very numerous, and their boundaries cannot well be de- fined. Varicella is sometimes found complicated with other eruptions, where the pocks have a livid colour and bear a close resemblance to black small-pox, with violent fever, the intensity of which is by no means proportionate to the number of the pustules. I have seen two cases where varicella was complicated with pocks that assumed a malignant character on the second day of their appearance, had a livid colour, and where the parts round the pock were inflamed and swollen. The fever which accompanied the eruption, requires the administration of Aconite; but Arsenic is required for the desiccation of the pustule. § 101. Varioloid. This is a modification of small-pox. The eruptive fever is milder than in small-pox, and the suppurative fever is generally wanting; the pustules appear in the same order as in small-pox, are frequently very numerous and confluent, sometimes filled only with lymph or quite empty, the scurfs are not as thick and NETTLE-RASH. 15 hard as those of the real small-pox, and the skin is not disfigured, but exhibits for a time an efflorescent ap- pearance. There are cases, however, where varioloid is as violent and, dangerous as small-pox. The treatment is the same as that of small-pox. § 102. Nettle-rash, Urticaria. This disease is sometimes preceded by catarrhal symptoms for two or three days. Spots or blotches form on the skin, of a palish-red or white colour, ir- regular shape, with bright-red circumference. They itch violently, and excite even a violent burning. Frequently the blotches are elevated, rough to the feel, numb and insensible, and resemble bee-stings. When deep-seated in the skin, they are brought to light by friction and scratching. Sometimes they ap- pear distinctly in a few hours. They are exceedingly evanescent, and frequently appear and disappear on the same day. Both in shape and sensation they re- semble the blotches occasioned by nettles, and are distinguished by the peculiarity of disappearing in warm and coming out in cold weather. They are li- able to constant changes of locality, to such a degree that a blotch frequently does not remain at one spot for an hour. Their retrocession is seldom accom- panied with an alteration of health, but is sometimes accompanied with slight fainting spells, headache and other symptoms, especially when the first appearance of the rash was attended with fever. The disease is apt to be excited by sudden changes of temperature, colds, indigestion, excessive eating and drinking; in some individuals the rash appears after the use of strawberries, crabs and muscles. If the rash should have been occasioned by a cold, or if it should be itching and if scratching should in- duce a burning sensation, or if the eruption should be preceded by a stinging sensation all over the body, Dulcamara is the best remedy. Next to Dulc, Rhus t. is the most suitable remedy, especially when the rash is accompanied by a little fever. Nux and Pul- satilla, and still more frequently Antimonium crudum, 16 MEASLES, MOKRILLl. Bryonia, Arsenic* are indicated when the rash origi- nates in indigestion. Hepar s., and Mcrcurius, are like- wise useful in some cases. Copaiva is an admirable remedy for some kinds of urticaria, particularly chronic, or when arising from a syphilitic or arthritic cause. Ignatia should be administered for a fine- stinging, burning itching without rash, which sets in in the evening, and disappears after scratching. Kali carb. is one of the best remedies for nettle-rash when occurring in females at the period of menstrua- tion, and exciting a troublesome itching over the whole body. A disposition to a frequent recurrence of nettle- lash is to be met by one of the following remedies: Carb. veg., Calc. carb., Sulphur, Magnesia sulph., Nitric ac, Causticum, Lycopodium, Conium, Veratrum, Pe- troleum, Natrum mur., Phosphorus. * 103. Measles, morbilli. The measles are frequently epidemic in spring, and are generally a mild disease, though sometimes fatal. This disease occurs in every climate, attacks princi- pally children, and breaks out ten days or a fortnight after the infection. Diagnosis : spots which are generally more or less raised, one or two lines in diameter and at first resem- bling flea-bites ; they gradually cluster in groups, hav- ing an irregular shape somewhat resembling a half moon. Several days previous to the appearance of the spots the patient is affected with catarrhal symptoms, such as short and dry cough, red eyes with lachryma- tion, frequent sneezing ; the spots remain upon the skin for three or four days, after which they scale off. While the spots are out, the cough and the affection of the eyes continue. The desquamation of the epi- dermis is sometimes the only sign by which we are able to recognise the existence of the eruption. We distinguish the following three stages in this disease: * This kind of rash is apt to appear in persons suffering with nervous irritation. It may be excited by any of the above-mentioned causes, and requires the administration of Aconite aa its most suitable specific-—Hempel. MEASLES, MORBILLI. 17 1. The febrile stage, which lasts three days, and sometimes a little longer; the fever is remittent, and attended with the following catarrhal symptoms : sen- sitiveness and slight inflammation of the eyes, attend- ed with puffiness of the eyelids, lachrymation, photo- phobia ; frequent sneezing and discharge of water from the nose; troublesome, short and dry cough, with hoarseness and difficulty of breathing, frequently ac- companied with moaning, roughness and slight sore- ness of the fauces ; pain in the back or epigastrium ; aching in the forehead, delirium, spasmodic symptoms, diarrhoea ; white-coated tongue, with bright-red edges. During the period of dentition, and in children general- ly, all the symptoms are more violent than in full-grown persons, and the fever increases steadily until the erup- tion appears upon the skin. 2. Eruptive stage. The eruption appears at the end of the third or fourth day, generally on the face and arms first. The spots continue to appear for three or four days, and, if very numerous, are attended with swelling of the face and hands. The fever and un- easiness increase, the eyes are not very sensitive to the light, the cough frequently increases to bronchitis and pneumonia. The symptoms abate on the fourth day, when the eruption grows paler, and if the fever should still continue, there is either a complication, or else it is owing to a violent irritation of the skin in consequence of the extreme violence of the eruption. 3. The stage of desquamation. The scaling off com- mences on the sixth or seventh day, and sometimes even later. If the eruption be slight, the scaling is scarcely perceptible ; in its stead we perceive a healthy sweat, critical urine and diarrhoea, terminating in the disappearance of all the remaining morbid phe- nomena. In this stage the patients are sometimes exposed to real danger. The catarrh increases to pneumonia, which is followed by hectic fever, hydrothorax, haemop- tysis, and, in scrofulous subjects, by real assumption. Measles are likewise followed by other kinds of cach- exia, such as otorrhoea with pain and deafness, obsti- 18 MEASLES, MORBILLt. nate inflammation of the eyes and lids; swelling of lymphatic glands, or diseased condition of the mesen- teric glands leading to consumption. Chronic cutane- ous eruptions arc also consequent on measles, such as ecthyma, rupia. herpes and pustulous porriiro. with swelling of the lips, ulceration behind the ears, and chronic suppuration. The prognosis is doubtful in little children, or in full- grown persons when the disease is complicated with pneumonia, or meningitis; also in pregnant females ; or when the eruption is slow in coming out, or when the breaking out is interrupted, or when the spots look pale, or when, the retrocession of the eruption is ac- companied with nervous spasms, or, finally, when the spots are complicated with petechia1, haemorrhage and colliquative phenomena. § 104. In the first stage a very small dose of Pul- satilla frequently arrests the course of the disease. Pulsatilla is likewise recommended as a prophylactic, giving a small dose every two or three days. Others consider Aconite as the specific for measles. Aconite should undoubtedly be given if the fever be very violent, with dulness of the head, heat in the head, vertigo, redness of the eyes, photophobia, bloatedness of the face, languor and prostration. Aconite is to be continued as long as the symptoms have an inflamma- tory appearance. Aconite has proved a specific in several epidemics, where the organs of degluti- tion and bronchi were principally affected, when the stools were diarrhoeic, fermented, green, some- times frothy and clayish, and when the measle spots were mixed with erythema. Euphrasia is frequent- ly useful in this stage when the eye-balls are in- flamed, with photophobia, profuse secretion of mucus from the eyelids, violent fluent coryza, aching pain in the forehead, violent cough in the day-time. When the patient is disposed to weep, and body and mind are very sensitive; when children are troubled with convulsiv^pymptoms, grating of the teeth ; when the patients are very wakeful and constantly tormented with a dry and short cough : Co (Tea is extremely suit- MEASLES, MORBILLI. 19 able.* After Coffea are sometimes required Pulsatilla, Bryonia, Phosphorus, Sulphur. If, previous to or during the eruptive stage,'the pa- tient should be tormented by violent thirst which they are unable to quench, on account of the stinging in the swollen throat during deglutition ; if the patient should moreover be tormented^ with a dry, rather spasmodic cough ; if the sclerotica should appear injected with lachrymation and a glassy appearance of the eyes; if the patients should be uneasy and should surfer with anxiety, nervousness and sleeplessness : Belladonna corresponds to that state better than Aconite. In very few cases Mercurius is indicated by tho- peculiar an- gina faucium. Bryonia is an excellent remedy to counteract the hurtful effects of the retrocession of the eruption, or to bring it out again upon the skin. It is particularly in- dicated when the eyes are sensitive to the light, and when the patient is constantly tormented by a moist cough, which occasions a raw and sore feeling in the chest. Arsenic is excellent under similar circum- stances, particularly when Bryonia does not relieve the symptoms in a few hours. Pulsatilla is preferable to Bryonia, if a violent diar- rhoea and mucous vomiting should have set in the place of the eruption. Ipecacuanha may be adminis- tered if the vomiting should be very violent, in some cases Cina may be given. Dulcamara will be found more suitable if the diarrhoea should predominate. The bad effects arising from a retrocession of the sweat (in measles as well as in any other acute eruptive dis- ease) are met by Nux v. or Cocculus. Chamomilla is sometimes indicated when the eruption is driven in, in consequence of a cold, when merely bluish spots re- main upon the skin, accompanied with nausea, colic, watery stools, and difficulty of breathing. In epidemic measles, the exanthem is frequently en- tirely wanting, and there are no other symptoms ex- cept a catarrhal inflammation of the eyesr headache, fever and delirium. These symptoms are controlled * Aconite perhaps still more so.—Hempel. 20 M_ AULA I IN A. by Aconite and Belladonna'; in some cases Hepar .v., Sulphur or Calc. carb. are required besides. If the eruption should be complicated with typhoid or putrid symptoms, the remedies indicated in §§ 75, 76, and 80, have to be employed. Among the morbid conditions remaining after mea- sles, we distinguish mucous diarrhoea, which is remov- ed by Pulsatilla, Dulcamara, Mercurius, Chamomilla, Rheum, Sulphur, Rhus tor., Acidum phosph., China; & raw, dry cough, which yields to Chamomilla, Ignatia, Nux v., Ipec, Coffea, Hyosciamus, Droscro, Hepar s., Cina, and in some places Arnica ;* aspasmodic cough, resembling hooping-cough, yields to Bcllad., Cina, Hy- oscyamus, Conium, Ipcc, Bryon.. Cuprum, and other re- medies. Morbillin is recommended by some physicians as an excellent remedy for measles. I have used it with great benefit in some of the after diseases of measles. § 105. Scarlet-fever, Scarlatina. Scarlatina is a contagious epidemic, and in some cases sporadic disease, of changeable character ; it generally attacks persons only once, is most common among children, and spreads very slowly. The genu- ine, uncomplicated scarlatina occurs very rarely now- a-days, and does not attack any one beyond the age of twelve years. The eruption is of an erysipelatous, fiery, bright scarlet-red, or of the colour of boiled lobster, turning white under the pressure of the finger, but speedily re- suming the original colour. The smooth, shining red- ness gradually loses itself in the surrounding white skin, and is never strictly limited ; frorh time to time the redness either increases or diminishes in intensity, and is constantly seen either spreading or diminishing again in extent. The red skin is perfectly smooth and glossy, by which scarlatina is distinguished from every other kind of rash. The uncovered parts, or those which are but little covered, are generally first attack- * Aconite is frequently more useful than any of the above-named reme- dies.—Hempel. SCARLATINA. 21 ed by the disease, swelling up a little as far as the red- ness extends. The face, neck, chest, hands and feet are first attacked, whence the redness (in violent cases) spreads over the whole body. In every case of genu- ine scarlatina, the appearance of the redness is accom- panied with fever, and in simple cases continues from three to four, in malignant cases about seven days, at the termination of which the eruption gradually grows paler and paler, until it disappears altogether. The redness never disappears suddenly during the fever. As the eruption disappears, the fever abates, and ceases entirely when the desquamation has commenced. The redness remains even after death ; it then assumes a violet tinge. The more intense and general the red- ness, the more malignant the fever. In true scarlatina the red spots are perfectly dry; there is no moisture except on the parts which are not red. Sweat breaks out after the termination of the fever and the disap- pearance of the redness. The sweat is succeeded by the process of desquamation, but the disease may like- wise disappear without sweat. Scarlatina runs the following course, distinguished into three stages. The first stage is characterized by violent fever, sore throat and very quick pulse, which is peculiar to scar- latina, and is not met in any other eruptive disease. Scarlatina is distinguished from measles by the ab- sence of all catarrhal symptoms. The fever and an- gina increase as the exanthem approaches the period of breaking out, and are sometimes attended with de- lirium and spasms. In the second stage of the eruption, the spots first appear on the forearms and hands, afterwards on the rest of the body, but rarely in the face ; they increase in size and redness, and new spots constantly super- vene, the angina and fever continuing all.the time. In this stage internal organs are liable to become in- flamed, which may likewise take place in consequence of the eruption disappearing suddenly. This stage lasts from five to six days. The stage of desquamation commences on the sixth, 22 SCARLATINA. and frequently on the ninth day. sometimes even later ; the epidermis scales off in large patches. This stage lasts several days, and sometimes occurs several times in succession. The fever abates at the commencement of this stage, and terminates with critical phenomena. Many authors speak of a fourth stage, the secondary or metastatic, or dropsical stage, which, in this disease more easily than in any other, is excited by a cold and terminates in acute dropsy, of which the swelling of the eyelids seems to be a precursor. Other metastatic diseases of scarlatina are : dangerous diseases of the eyes, ears, and nose, ulceration of glands, indurations, abscesses. No disease is more insidious and deceitful than scarlatina; in some epidemics the disease is quite mild, without being fatal in a single case ; whereas in other epidemics the disease, though apparently mild with a finely-formed eruption, frequently destroys life by metastasis to the brain. Scarlatina is met in con- junction with any kind of fever; the prevailing char- acter of disease has generally a great influence on the nature of scarlatina. § 106. Belladonna is the specific remedy for the true, genuine scarlatina, whether it is just com- mencing or is already fully developed. Symptoms may however occur which do not correspond to Bel- ladonna, and for which other remedies are required. Ammonium carb. has been employed with great success by some physicians. It is not so much indi- cated by the eruption as by the accompanying symp- toms, fever, state of the mind and sensorium, symp- toms of the head. It does not seem to be suitable when the angina is very considerable. If burning heat, soporous stupefaction, agonizing tossing about with vomiting, diarrhoea or costiveness, or convulsions, should be present, Opium is indicated. Exacerbation of the fever towards evening, sleep- lessness, complete loss of appetite, nausea, whining mood and ill-humour, moaning, indicate Ipec, after which Puis, is sometimes suitable. The cases where the throat is inflamed without the SCARLATINA. 23 skin being affected, are very dangerous. In mild cases the angina is of no great importance, even if it should be somewhat violent. The stinging-burning, the rigidity and dysphagia, the swelling of the tonsils, uvula and fauces, which look red, excoriated and spotted, and are dotted with small, inflamed papillae and covered with tenacious mucus and aphthae; all these symptoms generally yield to one dose of Bella- donna, which, in bad cases, can be followed by a dose of Mercurius on the same day. If such an angina should set in by metastasis, ac- companied with typhoid symptoms and with a number of fetid-smelling little ulcers in the mouth and fauces, great prostration, dryness of the mouth and thirst, neither Belladonna nor Arsenic will prove of much avail, but Nux vomica will help, if help be possible. (See the chapter on angina faucium.) Baryta carb. (sec. or third trit. every three or four hours) is an ex- cellent remedy even in desperate cases, when the parotid glands, tonsils, and submaxillary glands are very much swollen, when the patients are affected with ptyalism, with an aching-stinging pain during deglutition, or when there is a sensation of swelling with dryness. Sulphur and Hepar s. should likewise be thought of, unless Acidum nitri should correspond more exactly to the symptoms. In some cases of epidemic scarlatina neither erup- tion nor angina appear, in the place of which the patient is affected with the following symptoms: quiet lowness of spirits and despondency, faint and staring look, with widely-opened eyelids, obscuration of sight, coldness and paleness of the face, absence of thirst, extremely small and quick pulse, lameness and immobility of the extremities, impeded deglutition with stinging pains in the parotid glands, aching pain in the head, constrictive colic, chilliness and heat of single parts. These symptoms constitute a sort of masked scarlatina, and yield to Belladonna. § 107. Complications of scarlatina, with other diseases. Now-a-days the genuine scarlatina generally occurs in combination with purple-rash. The eruption is 24 SCARLATINA. sometimes attended with gastric symptoms, the fever being either erethic or a real synocha accompanied with vomiting. In this case Aconite should at once be given, particularly if the heat, restlessness and anxiety increase from hour to hour. Although the fever is moderated by Aconite, yet the inflammatory character of the angina increases with the progressive develop- ment of the exanthem, and requires Belladonna, Mer- curius, Dulcamara, Baryta, as its specific remedies. If the fever should set in from the commencement as an erethic fever, without any striking morbid symp- toms, Belladonna is indicated. But if the fever should exacerbate in the evening, with nausea, vomiting, whining mood, moaning, it is proper to give a few doses of Ipecacuanha before Belladonna. The exces- sive pain and the whining mood require sometimes to be controlled by a few doses of Coffea cr., parti- cularly if the patients are very sensitive. This eruption is more or less dangerous even under homoeopathic treatment, inasmuch as it excites many morbid tendencies which had been latent in the or- ganism, and, by so doing, becomes frequently fatal. The symptoms indicate Belladonna, though it is given without effect. The best remedy for that group of symptoms is generally Sulphur; in some cases Am- mon. carb., Sepia, Lycop., Canthar., Arsen., are more suitable. The exanthem is sometimes accompanied with en- cephalitis, which often leads to acute hydrocephalus. In this case Belladonna is the appropriate remedy, par- ticularly when the patient is lying in a state of stupid unconsciousness, as if paralyzed, alternating with wild starting and cries which seem to be occasioned by colicky pains in the abdomen; after the spasms have subsided, Mercurius, Arnica, Digitalis, Arsenic, Hyos- cyam., Sulphur, Rhus t. are frequently useful. § 108. Secondary diseases succeeding scarlatina. In many cases Belladonna will prove useful, particu- larly for the following symptoms: bloatedness of the face, swelling of the hands and feet, lentescent even- ^g-fever with shuddering;, stiffness of the extremities. SCARLATINA. 25 sensation as if the abdomen would become constricted on raising the trunk ; creeping sensation in the dorsal spine asjf gone to sleep, erysipelatous glandular in- flammations, discharge of pus from the ears, ulcera- tion of the corners of the mouth, drowsy appearance alternating with great precipitancy in talking or doing anything; tearing and aching pains in the head, sudden starting with cries, etc. For the dropsical swelling of the body, particularly of the extremities, provided no other characteristic symptoms are present, Rhus t, Heflabor, nig., Digit., Ars., or Dulc, all in repeated doses, deserve a preference over Bell, (likewise in hy- drothorax); Aurum fol. or mar. is the best remedy for the swelling of the Schneiderian membrane or of the nasal bones, or for the discharge of fetid pus from the nose. Mercurius is indicated for ulceration of the face, accompanied with ptyalism and swelling or suppuration of the submaxillary glands. For the subsequent vascular excitement which is apt to recur at various periods, and is accompanied with a disturbed state of the cutaneous secretions, Aconite is the best remedy, which, in some cases, is appropriately followed by Bell, Dig., Chin., Ars., or Sulphur. The subsequent swelling and inflammation of the pa- rotid glands do not always terminate in suppuration, but are sometimes fatal. If attended to in time, this condition can be relieved by Baryta, Hep. s., Calc. carb., Silic, Dulc, Rhus t. The angina sometimes extends to the rima glottidis, occasioning a croupy cough. The treatment for this state of things is the same as for membranous croup, except that the Aconite can frequently be dispensed with. Hepar s. is frequently the most suitable remedy, either alone or in alternation with Spou^ia or lodium. For the remaining tearing in the limbs, I have found Dulc. most suitable ; for the asthmatic complaints, Puis., Nux v., or Arsenic. The cerebral affections set- ting in after scarlatina .require Aconite, Bellad., Mer- cur., Digit., Am., Rhus t. The affections of the scalp, falling off of the hair, etc., are controlled bv Sulphur, 2 26 SCARLET-FEVER AND SCARLATINA. Baryt, Lye., Calc. c, Graph., etc.; the moist eruption on the scalp by Rhus t.. Graph., Oleander, etc. ; the dry eruption by Baryt., Merc., Sulph., Calc. carb. For a morbid state of the skin, disposition to decom- position of the solids, ulceration, Cham., Graph.. Hep. s., Petrol., Sep., will be found suitable. Chamom. is like- wise useful in the subsequent suffocative cough, with flushes in the face which are sometimes accompanied with cold creepings over the extremities and back. For the latter symptom I have frequently given Ipcc andHyoscyam.; but with still greater success Conium. Other means for the cure of scarlatina are: kindly and encouraging persuasion, pleasant little presents, beverages and coverings suitable to the patient's taste ; the feeling of the patient is a much safer guide than all dogmatic rules. The patient should, however, be warned against the too early and copious use of sub- stantial nourishment during his recovery. § 109. On the means of preventing Scarlet-fever, and Scarlatina complicated with Purple-rash. Belladonna is universally admitted to be a prophylac- tic against the genuine uncomplicated scarlatina. It is sufficient to give a small portion of a drop of the 30th attenuation every two or four days, or in robust in- dividuals every day or every other day. In some cases, particularly when the epidemic is very violent, the lower attenuations have to be resorted to. Acids, wine and coffee have to be avoided during the use of Belladonna. By using small doses of Belladonna, the angina and fever, the ulceration of the corners of the mouth, the various eruptions, the affections of mind and body, the paralytic condition of the optic nerves, and all the other symptoms consequent on large doses of Belladonna, are avoided. These bad effects of large doses of Belladonna require, in the first place, a satu- rated solution of camphor, to be given in drop doses every half hour or hour, after which Cojfca, Vinum, Puts., Merc, Hyoscyam., Opium, Aurum, Hepar s., etc., should be administered. If scarlatina and purple-rash should exist combined- ly, both Bellad. and Aconite have to be used as aati- PURPLE-RASH, ETC. 27 dotes, commencing with either medicine according as the symptoms of either disease are more or less pre- dominant. Bellad. should be given 12 or 16 hours af- ter Aconite, and the latter 48 hours after the former. § 110. Purple-rash, Miliaria purpurea, Purpura ru- bra, Scarlatina miliaris Hahnemanni. Purple-rash attacks persons of every age. The eruption consists of purple-red circumscribed spots, which sometimes have a brownish or dark-red tinge, and remain unaltered under the pressure of the finger. The spots are dotted with dark-red miliary pimples, which are not so much raised above as deep-seated in the skin, and distinctly perceptible to the eye and fin- ger. The eruption does not show itself on any par- ticular place, is, however, most frequently perceived on the covered parts and in the bends of the joints. It is least frequent on the face, and is generally without swelling. The eruptive fever does not run a regular course ; the rash is seen now here, then there, and does not disappear after a definite period. The sud- den disappearance of the rash, which takes place at times, becomes frequently fatal in a short time. The danger is not proportionate to the quantity of the erup- tion upon the skin. The disease is sometimes most malignant when the eruption is trifling, whereas there is frequently very little danger when the eruption is fairly out. No sweat appears except on the dark-red spots. Dr. Trinks saw no sweat except on the parts which were free from all eruption : the parts covered by the eruption became turgescent. This rash may occur several times on the same person, even during the same epidemic. There is no angina except when there is no eruption ; it is felt previous to the eruption coming out; there is no angina when the eruption is out fully, and it becomes very violent when the erup- tion recedes from the skin. The angina varies in dif- ferent epidemics and sometimes resembles that of scar- latina. Precursory symptoms are : alternation of chilliness and heat, cloudiness and heaviness of the head, the 28 PURPLE-RASH, ETC. heat soon predominates, is attended with congestion of blood to the head, vertigo, aching-stinging pain in the forehead, catarrhal and gastric symptoms. These precursory symptoms do not last long. The eruption, accompanied with fever, generally first appears in the face, on the neck, back and chest, and lastly on the extremities. The rash-vesicles are sometimes so close together that they fall off in crusts, whereas they generally scale off. The desquamation continues for many days and even weeks, on several parts, two or three times in succession. When the erup- tion is very distinct, the eyes are slightly red, sensitive to the light, with profuse lachrymation, exhibiting a group of symptoms like the measles, from which they are distinguished by the eruption. The uneasiness and anxiety increase with the eruption, and the fever does not abate until the desquamation is nearly over. The alvine evacuations are generally suppressed ; the urine, which is very dark, is passed in very small quantity. The lips, tongue and mouth become dry, and the thirst is excessive. There is tossing about, sleeplessness, starting from sleep, and exacerbation of the fever several times during 24 hours. Purple-rash is just as dangerous and insidious a dis- ease as scarlatina. There is danger of a metastasis to the brain or heart, which cannot be foreseen or pre- vented, and destroys the patient by nervous paralysis. § 3. The specific remedy for purple-rash is Aconite, which should be repeated every two, four or six hours, according as the disease is more or less violent. For the excessive pains and the whining mood, a dose of Coffca cruda is sometimes required. In some cases Cojf'ea cr. and Aconite require to be given in alternation. In some cases the fever is not very violent, and the eruption comes out very slowly, causing anxiety and rest lessness, tossing about, moaning. For these symp- toms a few doses of Ipec. should be interposed, and, when they are accompanied by symptoms of internal inflammation, Bryonia is required. I have seen cases where the eruption remained al- most suppressed, causing by metastasis a dangerous PURPLE-RASH, ETC. 29 angina faucium, which yielded to Mercurius, or some- times to Aconite followed by Belladonna. When the disease is of a malignant nature, the treatment indi- cated for malignant scarlatina has to be pursued. Aconite is the specific when the eruption does not appear upon the skin, and an inflammatory fever with the following symptoms sets in: slight chills through the whole body suddenly alternating with redness and paleness of the face, full and quick pulse, slight dul- ness of the head, with nocturnal loss of consciousness, stupefaction and even delirium ; dryness of the mouth and lips, with thirst; redness of the eyes; oppression of breathing; short cough with reddish expectoration, occasioning a stinging pain under the short ribs. When these symptoms occur, Aconite should be given in repeated doses. Dr. Gross has furnished the following description of epidemic purpura miliaris which prevailed in his dis- trict : " After more or less striking precursory symp- toms, 4h" disease commenced with pains in the head and feet. These symptoms were soon followed by vomiting and delirium. Many patients died in the first days of inflammation of the brain, many died afterwards of angina. At times the palate and fauces were inflamed alone, at times the larynx, in which case the patients were affected with a croupy cough; in other cases two considerable, tight, pad-shaped swellings descended from the parotid gland, which, on being opened, discharged a thin, badly-colored, fetid ichor. In the last epidemic this disorganization was not observed: .the children died before it set in. " In some cases the exanthem resembled the Syden- hamian scarlatina; in most cases, however, it looked like a bright-red rash. Neither Bell, nor Aconite seemed to be of much use in this epidemic. The sub- sequent leucophlegmasia seemed to yield to Rhus t." Dr. Wislicenus employed Dulcamara with great success in the epidemic of 1831. Dr. Gross used it with great benefit for acute cutaneous eruptions, when the angina was not very considerable, and the child- ren complained of violent rheumatic pains in the 30 PURPLE-RASH, ETC. limbs, not allowing them to be moved, and accompa- nied with slight glandular swellings. These symp- toms generally yielded in 21 hours, alter which the skin began to scale off. Purple-rash may co-exist with other diseases, such as variola and measles. When complicated with va- riola, the rash set in at the time when the pus- tules began to inflame, causing an increase of the sy- nochal fever. The pustules remained stationary after the appearance of the rash, and continued their course as soon as the rash had run its course. The treatment was the same as in purple-rash. When measles and purple-rash co-exist in the same patient, it is exceed- ingly difficult to distinguish one from the other. ..ltv;- nite is, in such cases, the chief remedy, although a dose of Bell, or Merc, sometimes requires to be given for the angina, and the supervening typhoid symp- toms require the use of the remedies indicated for ty- phoid fevers. In the scarlatina epidemic of 1842, Dr. Schroen de- rived no benefit whatsoever from the usual remedies, Bell., Aconit., Acid, phosph., Bryon., Merc, sol., Rhi.s /., Sulphur. He employed with the best success Amm. carb., in large doses, from half a scruple to a scruple with two ounces of water, with ordinary white sugar, half a tablespoonful or a whole tablespoonful every two hours ; and if this failed, the patients were wrapt up in sheets soaked with cold water. According to Dr. Schraen, the smell of scarlatina patients resembles that of musty bread. Dr. Hering has furnished the following remarks on epidemic scarlatina. According to him, the smell of such pa- tients is like that of drying funguses, or, in bad cases, like that of funguses in a state of decay. In cases where the vomiting, which is generally the first striking symptom of the disease, is followed by sopor, the Solaneai or Opium, or, at other times, Bryo- nia and Sulphur are useful, according to the symptoms. If the patients should be red all over, even in scrofu- lous subjects, who are generally the worst kinds of scarlatina-patients, the third trituration of Sulphur, RUBEOLA. 31 with intermediate doses of ^icon^e for the dry skin, restlessness, etc., will generally be found sufficient. The remedies may be given every two or six hours, and are to be followed by Puis., Calc. c, Baryt., carb., etc. In doubtful cases, When the eruption was diminish- ing, Senega proved serviceable if indicated by the throat-symptoms. Calc. carb. was indicated by the swelling of the parotid glands, particularly on the right side, and by the desire for boiled eggs, which, however, the child is unable to chew or swallow. Calc. c. was likewise indicated by great ill-humour, occurring in the morning, and by other symptoms. Kali carb. was indicated by swelling of the parotid glands, particularly on the right side, and by restless- ness, moaning, tossing about between two and three o.clock in the morning, the children having been quiet the first part of the night. Several children who were already rattling, with warm sweat on the forehead, cold and bluish limbs, hot breath, were cured by Camphora. In the scarlatina epidemic of 1845, Dr. Elb, of Dres- den, employed principally Calc. carb., particularly when symptoms of paralysis of the lungs and affec- tions of the chest were present; and Zincum when the brain was affected and symptoms of paralysis of the brain were setting in. For the other symptoms, we refer the reader to Hahnemann's Materia Medica. The diseases which generally follow purple-rash, are like those succeeding scarlatina, and require to be treated with the same remedies. § 112. Rubeolce. This exanthem is intermediate between measles an I scarlatina, but more allied to the latter: it is even said that the smell which is generally observed about scarlatina patients has been noticed on patients affect- ed with rubeola?. This exanthem generally occurs in an epidemic, but in various forms. The precursory symptoms are generally of a ca- tarrhal-rheumatic nature, but are rarely as strikingly developed as in measles and scarlatina. The throat- 32 MILIARIA. symptoms, and particularly the atfedtion of the ton- sils, are very violent ; the eyes are sometimes red, with lachrymation, sometimes they are dry and itch a good deal. Pressure in the forehead, nausea and vomiting. are likewise present, and are sometimes accompanied by a violent cough ; until the eruption breaks out, the skin is dry and hot. This exanthem attacks principally children and fe- males; it comes out in from 12 to 24 hours, and remains visible for several days. It appears without regular order, first on the face and then on the other parts of the body, or else on the whole body at once. It con- sists of red spots of one-third of an inch or of a whole inch in circumference, in the centre of which groups of little vesicles become visible, which dry up in five or six days, after which the skin peels off in patches which are larger than in measles and smaller than in scarlatina. The desquamation takes place very rapid- ly. Dropsical effusions are among the secondary af- fections of rubeolae. § 113. The treatment is pretty much the same as 1 hat of scarlatina: Aconite, Bellad., and Bryonia are among the principal remedies. For the violent angina, Mer- curius is sometimes indicated ; and for the excessive thirst and the burning heat of the skin, which make the patients fretful and weak, Arsenic is a real specific. § 114. Miliaria. This eruption consists of small, round millet-sized vesicles (and frequently still smaller than a millet-seed, and perceptible only to the finger) : they appear scat- tered over the body, are surrounded by a slight in- flammation, and appear at irregular periods during a feverish state of the organism. Precursory symptoms are: profuse sour smelling sweats from the commence- ment of the fever, oppressive anxiety on the chest, heavy (not short) moaning, frequently sighing breath- ing, dry, short cough, restlessness, frequent creeping chills, stinging and itching of the skin, sometimes ner- vous attacks, spasms, delirium. These symptoms sometimes abate on the breaking out of the rash. MILIARIA. 33 The eruption is sometimes very slight, sometimes extremely violent, particularly on the neck, chest, and back; in many cases the whole body except the face is covered by it; in other cases the eruption consists of single spots scattered irregularly over the surface of the body, and remains visible for several days. The skin being inflamed, and the fluid contained in the vesicles being quite clear and transparent, the vesicles look red for about thirty hours, after which the fluid becomes opaque and milky. This change has giv- en rise to the denomination of red and white miliaria. Miliaria is generally a symptom of a more deep- seated disorder—fever, etc. It is difficult to say how long such a imtabHOs^Hafftl^yk as new vesicles are constantly bre*AStWtfttP»lkiM&n, however, state, that it disappears l)?HTOerrcSr?'Se^nth and fourteenth day. If the eruptioii^japiild. naakigj its appearance on the seventh, eleve,M^aTla*f*8rTTenth day, accompanied with a general abatement of the symptoms, we ought to look upon it as a favourable critical phenomenon. § 115. There are various kinds of miliaria, which, of course, require different remedies The indolence, anxiety, oppression in the praecordial region, un- easiness, moaning, and other symptoms which gene- rally precede the eruption in puerperal, mucous, and other fevers, are most speedily and certainly relieved by a few doses of Ipecacuanha or Bryonia. If the anguish be excessive, and compel the patient to shift his position all the time, Arsenic deserves a preference over either Ipec. or Bryonia. If the anxiety be attended with a violent orgasm of the blood, great internal and external heat, Aconite is the specific, although Belladon- na is likewise useful when delirium, congestion of the blood to the head, bloatedness of the face, red and glistening eyes, are the characteristic symptoms. If the restlessness proceed from nervous irritation with- out much anxiety, Cojfea is a suitable remedy. Miliaria of lying-in women and their infants are most speedily removed by Bryonia and sometimes by Chamomilla. Chamomilla is particularly indicated in infants,.when the miliaria is occasioned by keeping 2* 34 SORENESS, INTERTRIGO. them too warm, and when it is accompanied with watery, greenish evacuations, looking like stirred eggs, and corroding the anus. Such an eruption in infants may be owing to dietetic transgressions, and may be attended with other symptoms for which Chamomilla is likewise a specific remedy. In eases where Chamo- milla, although indicated, was of no avail, I have fre- quently given with the greatest benefit a very small dose of Sulphur, particularly when the eruption affected the inner surface of the thighs, the abdomen and nape of the neck, when the patients were very restless, and the thighs, sexual organs and anus looked like raw flesh. White miliaria is frequently cured by a single dose of Arsenic, unless the accompanying symptoms should indicate Valeriana. We ought to mention here another kind of eruption, pustules or wheals, with which infants with a flaccid skin are affected in hot weather, particularly when kept too warm. They are not accompanied with dan- gerous symptoms, and do not require the interference of art. Daily bathing and a diminution of the tem- perature are sufficient. If any medicine should be required, Aconite is generally the more suitable ; and if the eruption should be very obstinate, Chamomilla and Bryonia : if the vesicles should be inflamed and suppu- rate, Dulc, Rhus t., Clematis, Ranunculus Sceleratus, etc., are indicated. Chronic miliaria, which disappears in one place and re-appears in another, with much itching and burning, is most certainly removed by Mezereun, Clematis, Sar- saparilla, Staphysagria, Arsenicum, Ammon. carb., Sul- phur, and Carb. veg. § 116. Soreness, Intertrigo. This soreness arises from the friction of two adjoin- ing parts, most frequently under the shoulders, between the thighs, on the neck, at the anus, in the groins. Sometimes a fetid, albuminous matter is secreted from the sore surfaces; at other times the parts are dry, and the disease terminates in a scurfy or scaly exfolia- tion of the skin. In most cases this soreness arises TETECHLE. 35 from a want of cleanliness, the urine, sweat, and dirt, being left on the skin. Frequently, however, the dis- ease originates in some internal cause, particularly when other than the above-mentioned parts are affect- ed, and the whole body resembles amass of raw flesh. To cure this soreness, the patient should be bathed in tepid water every day. If this should not be suffi- cient, Chamomilla should be administered, except when the abuse of that plant in the shape of tea has contrib- uted to occasion the disease, in which case Ignatia or Pulsatilla is preferable. If the whole body should look like a mass of raw flesh, Merc. sol. in repeated do^es is the best remedy. If the disease should not yield entirely to Merc, sol., Lycopodium or Graphite: will complete the cure. When the soreness is occasioned by a mil ry erup- tion, the Tincture of Sulphur or a trituration of Sulphur will remove the disease ; Sarsaparilla, Jacea. S tphysa- gria deserve likewise to be considered. Caisticum, Sepia, Phosphorus and Silicia should like .vise be thought of. § 117. Petechia. Petechias are of a violet, brown, black, and some- times red colour, from one to two lines in diameter, generally round and circumscribed, though sometimes irregular and diffusing into the surrounding skin, with or without fever, (acute petechiae, petechial fever, chronic petechiae). In some cases the spots—some at lea,st—are several inches in circumference ; these are called vibices, ecchymoses, and are, properly speaking, of the class of purpura haemorrhagica. They show themselves at irregular periods, first on the lower ex- tremities, then on the arms and trunk : the face remains free, but not always the hands. At first the spots are of a bright-red, afterwards they assume a livid, and finally a brownish or yellowish aspect: this change can be seen most clearly by the new spots which con- tinue to break out. In some persons, the disease makes its appearance suddenly, at a time when the patients seem to enjoy good health; in others, it is preceded for weeks by 36 APHTHAE. pains in the limbs, which render the patient incapable of makingthe least exertion. Generally the disease is ac- companied with great debility and lowness of spirits; the pulse is either small and feeble, or hard and frequent. Petechiae generally result from debility and from de- composition of the blood, and frequently occur as a symptom in putrid fever; sometimes they arise from keeping the skin too warm, and from getting over- heated, hence they will occur in inflammatory fevers ; they may likewise occur sympathetically in gastric . and worm-fevers. They develop themselves like mi- liaria, and are frequently complicated with the latter disease. If petechiae be a mere symptom of a more general disorder, the remedies prescribed for it have to be em- ployed. The remedies which are most frequently in- dicated for petechiae, are : Belladonna, Arsenic, Rhus t., Bryonia, Chininum, Ledum, Acid, sulph., Phosphor., Sec. corn., Silic, Laches., Aconite, Acid, phosph. § 118. Tlirush, aphthce. This exanthem always affects the inner mucous membrane. It consists of small, white, elevated, lar- daceous, sponge-like little ulcers in the mouth, on the tongue, palate, in the fauces, sometimes covering the whole intestinal canal down to the anus, burning vio- lently, sometimes existing only a few days, sometimes however for weeks and months, new ulceus making their appearance as the older ones disappear. They are accompanied with a number of local and consen- sual symptoms, which are more or less violent and dangerous, such as : angina, painful deglutition, irri- tation in the trachea, nausea, hiccough, cardialgia, vomiting, colic, diarrhoea, dysentery, discharge of de- tached aphthae, enteritis. Precursory symptoms: dryness in the mouth and throat, thirst, sensation as if a foreign body had lodged in the throat, nausea, retching, vomiting, irritation induc- ing cough, roughness, stinging in the throat, hoarse- ness, anguish, pressure in the praecordial region, heart- burn, stupefaction. Aphthae may become dangerous by terminating in APHTHA. 37 angina, gangrene, enteritis. They not only affect in- fants, but may occur in persons of every age as symp- toms of various acute and chronic affections. They are most frequently induced by gastric derangements, suppressed secretion of the skin, rheumatic and ca- tarrhal metastases, and are very rarely a critical symp- tom. Aphthae generally occur in the colliquative stage of phthisis, and in gastric-putrid fevers.* § 119. As a primary disease, Aphthae are less diffi- cult to treat than as a symptom. In the former case, the nipples of the mother are liable to be affected with the disease, for which the most suitable remedy is Bo- rax, particularly when the child is very peevish, cries a good deal, starts up from sleep as if in affright, throws its arms about, looks pale and livid, has a flac- cid skin, does not want to nurse, and when the mucous membrane of the palate and tongue, which exhibits reddish vesicles and aphthae, looks shrivelled. I use with great benefit the strong sulphuric acid, one or a few drops in one ounce or an ounce and a half of water, which the child takes in teaspoonful-doses. The attenuations will do as well if the children enjoy otherwise good health. If there be considerable an- gina, Mercurius sol. is an excellent remedy, which is frequently to be followed by Sulphur, particularly when the child's rest is very much disturbed, starts up from sleep with great cries, when there is ptyalism and the aphthae bleed readily, etc. (The latter symptom furnishes likewise an indication for Borax.) Mercurial aphthae on the tougue or palate are most speedily removed by Sarsaparilla, Borax, Nitr. ac, Thuj., Iodium, Agaricus, etc. Aphthae which are ac- companied with considerable debility in fevers, should be treated with Arsenic, Sulphur, Acid, sulph. Aph- thae accompanied with rhagades in the white-coated tongue, are cured by Cicuta. When the salivary glands are very much affected, secreting a tenacious mucus, Mercury is the best remedy, (provided the dis- ease have not been caused by it). When complicated • They occur very frequently in persons suffering with nervous irritation, and have, in such cases, to be treated with Aconite.—Hempel. 38 ERYSIPELAS. with tuberculosis, lodium and Sulphur will effect a certain cure. § 120. Erysipelas. Tljis is a febrile condition, during which a certain part of the body becomes hot, red and swollen, and is sometimes covered with blisters (erysipelas bullosurr). The redness is superficial and shining, disappears un- der the pressure of the finger, and returns immediately after the pressure ceases. The redness is apt to wan- der from one place to another. The inflammation is seated in the epidermis. When the inflammation is very violent, the more deep-seated tissues are likewis-e affected (erysipelas phlegmonodes). The fever is accompanied with a disposition to sleep, and generally disappears after the breaking out of the erysipelas. If the fever be very violent, it pre- cedes the breaking out of the erysipelas for a few days, accompanied with sopor, and continues even a few days after the appearance of the erysipelas ; in such a case, the fever may last until the seventh or ninth day. Erysipelas is generally accompanied with gastric and bilious symptoms. Erysipelas is generally a mild disease, without dan- ger, except when the face is affected, in which case the inflammation inclines to go to the brain. Erysipelas is likewise dangerous when the fever has a malignant character, or when there is a metastasis to internal noble organs. The terminations are: dispersion, in- duration, suppression, gangrene. § 121. Simple erysipelas affecting the cellular tissue and accompanied with a violent synochal fever, is controlled by Aconite, after which Belladonna may be given, particularly if the erysipelas spreads in rays, and a stinging pain is experienced in the tight swell- ing, increased by contact, and at night. Belladonna is likewise indicated for erysipelas phlegmonodes. In many cases Belladonna is the specific from the com- mencement of the disease ; it shortens the course of the disease very much, which, when left to itself, lasts from nine to twelve days, and occasions a variety of secondary symptoms. ERYSIPELAS. 39 If the joints and the surrounding parts should be affected, and the pain should increase by motion, Bryonia is frequently indicated, still more frequently Belladonna, but least frequently Pulsatilla, which ought to be used when the erysipelas shifts from one part to another; but is never indicated in pure ery- sipelas of the face, except when accompanied with stitches, in which case the disease is apt to go to the brain ; this can be more effectually prevented by Bel- ladonna than by Pulsatilla. I had a case of erysipelas where the disease re-ap- peared frequently, always on one side of the face only, and where every attack was preceded for several days by a violent cardialgia. A single dose of Nux v. 15, effected a permanent, cure, showing that the accom- panying symptoms often indicate a different remedy from what are generally considered specifies for ery- sipelas. In such cases Sulphur might likewise be re- sorted to, particularly when a throbbing-stinging pain is experienced in the swelling. Erysipelas of the face generally runs its course ac- companied with a very violent, generally bilious fever. The affected parts are red, hard and swollen. The vesicles are of different sizes, yellowish, occasion an itching, burning, tension, and incline to flow into each other. If the inflammation extends to the hairy scalp, the cerebral membranes and the brain itself are seized in a similar manner as in scarlatina, though the ce- rebral affection in erysipelas is different from that in scarlatina, inasmuch as it requires a different kind of treatment. The principal remedy for this kind of erysipelas is Rhus t., even if the brain should be affected. I have never used any other remedy but Rhus t., though some physicians have likewise employed Belladonna and Hep. s. beside Rhus. This kind of erysipelas is some- times accompanied with external and internal otitis, which may require Pulsatilla after Rhus. Graphites has been used with great success in erysipelas of the face, if indicated. Carbo animalis and Cantharides have likewise proved useful in single cases of ery- 40 ZONA, ZOSTER, CINCI'LIM. sipelas. Euphorbium is an excellent remedy in ery- sipelas of the head and face, with swelling, and boring, gnawing, digging-up pains, with itching and creeping after the pains cease ; likewise in erysipelas with pea-sized vesicles filled with a yellow fluid, ac- companied with great heat. Solanum mammosum is likewise said to be useful in the last-named erysipelas. Erysipelas neonatorum generally takes place during the first month in the region of the umbilicus, extend- ing to the abdomen and genital organs ; it likewise appears on the upper limbs, chest and back. It gra- dually spreads from one part to another, the fever being very violent and sometimes assuming a typhoid character. It is most frequently epidemic. In all my practice I have only seen two sporadic cases, which I succeeded in curing with Aconite and Belladonna. In dangerous cases, Bryon., Rhus t., Hepar s. or Sulphur, may prove useful. The erysipelatous inflammation of the scrotum, which is most frequently met with in chimney-sweeps and inclines to terminate in gangrene, is most effec- tually controlled by Arsenic, which is likewise the most efficient remedy in the so-called black erysipelas, unless Acid mur., Sec. corn., Sepia, etc., should be more suitable. Camphor, Arnicit, Nilr. ac, Mercur., Lycop., Phosphor., Nux v., are excellent remedies in erysipelas of the feet and knees, or in erysipelas generally ; likewise Lachesis and Crotalus. • § 122. Zona, Zoster, Cingulum. The zona is very similar to erysipelas ; it is gener- ally about a hand's breadth, surrounding the body, or a portion of the body, in the shape of a demi-circle. The eruption is burning, itching and stinging, and con- sists of little pustules upon an inflamed basis. It is frequently acute, attended with fever. The character of zona is intermediate between erysipelas and herpes, frequently arises from the same cause as erysipelas, but more frequently from a more deep-seated and general dyscrasia (Hufeland). The disease is treated like erysipelas. Mercurius CHILBLAINS, PERNIOXES. 4J may prove very efficient after Rhus t. Causticum is principally applicable in zona when there is a pain- ful itching burning. Some propose Graphites, others Sulphur and Arsenic (the latter particularly for the nocturnal burning) ; Acidum nitr. and Euphorbium are likewise recommended. § 123. Chilblains, perniones. Chilblains are a sort of chronic erysipelatous in- flammation, which does not become acute unless ex- cited by some additional cause, change of weather, or some kind of morbid action which becomes concen- trated in the region of the chilblains. This kind of erysipelatous inflammation takes place on the feet, hands and at the tip of the nose. If the inflammation be slight and superficial, with slight, bright-red swell- ing and burning itching in warmth ; if the swelling crack and bleed readily, it is speedily and safely re- moved by a few small doses of Nux vom., especially when the disposition of the patient is suitable to that remedy. Carbo anim. and veg., Arnica, Petroleum, Acidum nitr., Phosphor., Lycop., Crocus, etc., are like- wise useful in this disease.* If the chilblains should be very painful, Nitri ac, Petrol., Phosphor., will be found efficient. Arnica is a certain remedy when the infla'mmation of the chilblain is caused by pressure, friction, etc. If the frozen limbs should be blue-red and swollen, with throbbing pains, Pulsatilla and Belladonna are indicated, the former more particularly by a meek or phlegmatic disposition, the latter by a sad, indifferent and at times vehement temper. For these blue-red and violently itching chilblains. Kali carb. is likewise an excellent remedy, whereas Sulphur is suitable only when the itching occurs during warmth. If blisters should show themselves on the inflamed parts, with a tendency to gangrene, Arsenic should be used ; whereas China deserves a preference, when symptoms of hu- mid gangrene have actually set in. Opium is, in the latter case, sometimes indicated by the accompanying symptoms. * Also Agaricus.—Hempel. 42 INFLAMMATIONS IN GENERAL. Bryonia. Rhus t., Ledum, Merc, and Sulphur, are gen- erally sufficient to cure this kind of erysipelatous inflammation. Acidum nitr. and Petroleum are the best remedies, when the inflammation sets in with very cold weather. EIGHTH CLASS. FEVERS WITH DEFINITE INFLAMMATORY AFFECTIONS.--LOCAL INFLAMMATIONS. § 124. Injlammalions in general. An inflammation, though apparently local, is never- theless a dynamic disease, affecting the vitality of the blood-vessels through a disturbed nervous action. In- flammations are very similar to fevers, and particularly to synochal fevers. These being easily cured by homoeopathic remedies, it follows that inflammations are likewise readily cured by similar means. § 125. An inflammation is an anomaly of the vege- tative process ; it arises from a disturbance of nervous action, which indirectly alfecfsthe vitality of the blood- vessels. The symptoms of inflammation are: quicker and stronger beating of the blood-vessels than in their normal condition. This redness is graduated, and is most intense in the centre of the inflamed organ. Swelling and hardness are generally likewise present in inflammation, but not unless the inflamed organ contains loose cellular tissue. Inflammations are generally attended with pain, arising from the dis- turbed nervous action, though neither pain nor redness or swelling is a necessary pathognomonic symptom of inflammation. The painful sensations vary a good deal, hot, burning pricking, itching, aching and tensive, stinging; they are either continuous or periodical, remittent or exacerbating at distinct periods. In in- flammations of internal organs, the usual characteris- tics of inflammation are wanting : in many cases there is only pain attended with an inflammatory fever. In abdominal inflammations the physician ought to press the abdomen of the patient, by means of which he INFLAMMATIONS IN GENERAL. 43 will discover the inflamed part by the pain which the pressure occasions, and which the patient had not been conscious of before. Although it is Hahnemann's opinion, that the physi- cian needs not to be acquainted with the internal na- ture of the disease, and ought to select his remedy in accordance with the symptoms, yet it is desirable that the physician should possess the clearest possible notion of the disease he is called upon to treat.* It is imporiant, for instance, that inflammations should be distinguished from internal neuralgic or spasmodic affections. If fever be present; if the local affections have set in with a chill; if heat, thirst, and an accele- rated pulse be present, we may safely conclude that there is inflammation. A hard, full, and strong pulse is likewise characteristic of inflammation, although such a pulse is not always present in high degrees of enteritis and pneumonia. One of the chief character- istics of inflammation is the urine : if red, it denotes fever and inflammation; if pale and watery, it denotes spasm. § 120. Inflammation may be excited by either of the following causes: 1. Mechanical causes, wounds, splinters, etc. 2. Chemical agents, acids, ethereal oils, poisons, etc. 3. State of the atmosphere, cold, dry, windy weather, northerly or easterly winds, increased action of cir- cumambient influences upon certain organs at parti- cular periods, for instance, of the atmosphere upon the lungs in winter and spring, and upon the abdominal viscera : increased sensitiveness of particular organs in certain conditions of the organism, of the brain during the period of dentition, of the uterus during menstruation, pregnancy, or confinement, of the breasts during lactation, etc. 4. Emotions, such as anger, chagrin, fright, sudden joy. o. \ arious ailments of the body, such as accumula- * In reference to this subject, see my essay on the present internal con- dition of the homoeopathic school. For a new and, as I believe, true theory of inflammation, the reader is likewise referred to that essay.—Hempel. 44 INFLAMMATIONS IN GENERAL. tion of gastric and bilious matter in the intestines ; suppression of the lochia, menses, or piles ; suppres- sion of chronic cutaneous eruptions, such as itch, herpes, tinea capitis, etc. Secondary diseases, induration, adhesions, suppura- tion, may occur under homoeopathic the same as under allopathic treatment, though the)' are much less fre- quent : in such a case the pain never ceases entirely. They occur most frequently in consequence of violent bleeding, latent psora, and in feeble, scrofulous sub- jects. § 127. The fever which accompanies inflammations is either a synocha, or an erethic or typhoid fever. The prognosis depends 1. Upon the character of the inflammation. In- flammations with a synochal or erethic fever are less dangerous than those with a typhoid fever. 2. Inflammations of noble organs, such as the brain and lungs, are more dangerous than inflainniations of less important organs and tissues. 3. Simple inflammations are more easily cured than compound or inflammations arising from other diseases. 4. The prognosis depends likewise upon the consti- tution of the patient; the more lymphatic the consti- tution of the patient, the greater the danger. § 128. In the treatment of inflammations, the homoe- opathic physician proceeds in the same way as in all other forms of disease; he notes the totality of the symptoms, and selects his remedy in accordance with them. It is, of course, of importance to study as much as possible the cause of the inflammation, with a view of removing it by appropriate dynamic, surgical, or chemical means. The chief remedy with which homoeopathic physi- cians combat inflammation is Aconite. It should be employed in every inflammation accompanied with synochal fever, continual great heat, quick, full, and tight pulse, burning thirst, scanty and saturated urine. It may be used with children, as well as full-grown persons. It is an excellent remedy for rheumatic dis- eases, and acts as a prophylactic against angina pecto- INFLAMMATION IN GENERAL. 45 ris occasioned by exposure to east wind.* Aconite supersedes the necessity of bleeding, even in those who were in the habit of resorting to it. After Aconite are principally indicated, Bellad., Mercur., Bryon., Cantharides, Hepar s., Rhus t., Puis., Nux v., Ignat., Sulphur, Spong., Dig., Cann., Acid, hy- droc, Am., Dros., Squill., Seneg., Ars., Kali c, Phosph., Lye Asa, Cina, China, Mangan., Dulc, Chamom., Mag- nes arct., and a number of other remedies. Mercurius is an excellent remedy when debilitating sweats, and particularly night sweats, great nervous- ness, and debility, are present; when internal inflam- mations threaten to terminate in effusions and suppu- ration ; in catarrhal, rheumatic, arthritic, erysipela- tous inflammations, and inflammation of the perioste- um. Belladonna is suitable to plethoric persons dis- posed to phlegmonous inflammations, particularly in the case of children, and delicate, sensitive individuals. Bryonia corresponds to inflammations of serous mem- branes, congestive inflammations attended with vio- lent fever and great vascular and nervous excitement. After the inflammation has been allayed, the pain can be speedily relieved by applying one or more dry cups in the neighborhood of the inflamed organs, or, if exudation should have taken place, by resorting to Tartar emet., Seneg., Dig., Am., etc. If, in spite of the abatement of the inflammatory symptoms, the local irritation should still continue, or should point to an increased nervousness, Ipec, Hyoscyam., Laurocer., Pul- sat., Sulph., Nitrum, etc., should be employed. § 129. As was said above, the homoeopathic physi- cian does not always succeed in dispersing an inflam- mation. In such a case the inflammation terminates : 1. Iu suppuration. This occurs particularly in in- flammations of glandular organs, in boils and wounds, and in inflammations that have reached a high degree of intensity. The best remedies for this condition are, Merc, Bell., Puis., Asa, Mczereum, Sulphur, Hepar sulp., Tart, emet., Phosph., Iod., Silicea, every remedy * The East wind in Germany is a very dry wind. 46 PNEUMONIA, ETC. to be, of course, selected with reference to the totality of the symptoms. * 2. In induration. The remedies indicated for this state of things are, Sulphur, Carbo amm. and veg., Iod., Baryt., Conium, Kali carb., Si/icra, Calc carb., and several others. Sometimes Rhus t., Nux v., Bryon., Dulc, Ranunculus, Spongia. and other remedies, may have to be used previous to the above mentioned an- tipsorics. 3. In adhesion. This does not interfere with the enjoyment of perfect health, and cannot be removed. I ought to state, however, that a cure of an adhesion is reported in the third volume of the All. horn. Zeitung. p. 7. § 130. In regard to diet, I refer the reader to my pre- vious remarks on that subject, which are likewise ap- plicable to patients suffering with inflammations. Such patients should content themselves with very light food, and should not satisfy their thirst to excess. SPECIAL TREATMENT OF INFLAMMATIONS. § 131. Pneumonia, peripneumonia, pneumonitis. An inflammation of the lungs generally commences with chilliness, which frequently increases to a shak- ing chill followed by heat. During the heat the pa- tients generally first experience a pressure deep in the chest, which soon increases to an intense seated pain. The pain may be various, acute, burning, cutting, sticking, aching, dull, oppressive, constrictive, and is generally accompanied with anxiety. The pain is felt in the region where the inflammation is seated. If both lungs should be inflamed, the pain extends over both sides of the chest; if but one lung should be af- fected, the pain is felt on one side of the chest only, but extends farther in proportion as the inflammation continues to spread. The breathing is impeded, fre- quent, painful, anxious, superficial, and is carried on only with the uninflamed portions of the lungs ; or, if both lungs should be inflamed, with the abdominal * In phlegmonous inflammations accompanying a remittent fever, Aconite is the specific remedy, even in the suppurative stage: see my Essay on the present internal condition of the Homoeopathic School.—Hempel PNEUMONIA, ETC. 47 muscles and the diaphragm, but not by raising the thorax. There are cases of pneumonia where the pain is entirely wanting, and where the existence of pneu- monia can only be inferred from the breathing, but not always with certainty. Pneumonia is almost always attended with a deep cough, which is at times dry, at times accompanied by expectoration ; at times it is spontaneous, at times excited by deep breathing, talk- ing or even swallowing. The expectoration is tena- cious, sticky, at first semi-transparent, slimy, after- wards bloody, saffron or rust-coloured. The patients generally lie upon their backs. The fever, which is very acute, and scarcely ever leaves the patient at the commencement of the disease, sometimes assumes an intermittent type, disappearing in the morning, together with a great many trouble- some symptoms, until the heat and other symptoms of inflammation return in the evening. The pulse, which was soft in the morning, again becomes hard and bounding, the cough becomes again violent, and denotes danger. These paroxysms indicate the synochal or erethic character of the fever. The fever may, how- ever, assume a typhoid form after the inflammation has reached its climax, or in compound pneumonia, or when the meningeal membranes are affected, in which case the patients are delirious. The face of the patient is intensely red, the head is dull and painful. The patient craves cooling drinks, and emits a small quantity of dark-red urine. It would be unsafe, without resorting to percussion and auscultation, to infer the existence of pneumonia from the above-mentioned symptoms ; nor is it possi- ble to determine, without percussion, whether the in- flammation is still confined to the stage of inflamma- tory engorgement, or has passed to the stage of hepati- zation. § 132. At the commencement of pneumonia, when the organic tension of the pulmonary cells is diminish- ed in consequence of the exudation of bloody serum, percussion yields a tympanitic sound, which is at first clear and full, but becomes much less so as the con- 48 PNEUMONIA, ETC. densation of the pulmonarv tissue in consequence of the congestion increases. As soon as the process of hepatization commences, the percussion-sound becomes dull, insonorous and hollow. When exudation has set in, the so-called crepitant rattle is heard during an in- spiration, and during cough. When a portion of the lungs, into which one of the larger bronchial tubes opens, hepatizes, the communication between the air in the lungs and the column of air in the trachea and larynx is interrupted ; this gives rise to peculiar sounds termed bronchial respiration, bronchophony and ^con- sonant rattle. These three sounds are not heard when the bronchus is stopped up, or when the voice and respiration of the patient are very feeble. Over the hepatized portion we always hear a peculiar whiffing, bronchial respiration, but never the vesicular murmur. § 133. Anybody may be attacked with pneumonia, though it occurs more rarely in childhood, and most frequently between the 17th and 50th years of age. Females are less liable to pneumonia than males, for the very reason that the lungs of the former are much less developed than those of the latter. Predisposing causes are : a tuberculous diathesis, previous pneu- moniae, suppressed discharges of blood. Exciting causes are : atmospheric influences, north- east winds. Hence it isthat inflammations of the lungs occur most frequently at the end of winter and the commencement of spring, or also in summer, when the air suddenly becomes cool after sultry heat; they oc- cur likewise on taking cold after having got heated by dancing or running, or by sounding musical instru- ments ; they may be occasioned by mechanical and chemical irritants, sharp, sour, oxydizing vapours, va- pours of muriatic or nitric acid, arsenious vapours, by inhaling plaster, lime, pebble, coal, flour, or wool-dust, in consequence of fracturing a rib, or penetrating stab or shot wounds. Patients can recover from pneumonia in every stage. The general and local symptoms disappear gradually ; the fever, pain and cough abate, the sputa again be- comes normal, and the respiration easy and regular. PNEUMONIA, ETC. 49 In spite of these favourable changes, we know from auscultation and percussion that there are still some morbid phenomena remaining, inviting the patient to be on his guard lest he should have a relapse. Unfa- vorable terminations are, 1, when the plastic exuda- tion changes to tubercles ; 2, when an abscess forms ; and 3, when the hepatization has lasted too long to admit of resolution. Death takes place by excessive congestion, or by complication with an affection of the heart, or in consequence of some secondary disease. The prognosis is more favourable in young and vigor- ous subjects, and in persons who are attacked for the first time, than in old people. It is likewise more fa- vourable in simple than in compound pneumonia, or when the inflamed Jung was already partially hepa- tized, or otherwise morbidly affected. A good deal, however, depends upon the treatment, even in unfa- vourable cases. § 134. The chief remedies in pneumonia are: Aconite, Bryon., Puis., Lauroc, Mercur., Canthar., Phosphor., Rhus t., Tart, stib., Bellad., Am., Lye, Seneg., Cann., Nux v., etc. If the fever should have a synochal character, if the pulse should be hard, quick and full, the face red, the chilliness or heat excessive, the pains in the chest vio- lent, and the respiration oppressed and accompanied with anxiety, Aconite should be given in repeated doses. Bryonia is an excellent remedy when the inflamma- tion was occasioned by exposure to dry and cold wea- ther, by straining, or other violent muscular exertions ; when it is not entirely developed or not violent. This remedy is principally indicated when the fever and pains are moderate, the sputa white, slimy and streaked with blood, the cough loose and the oppression not ex- cessive, attended with constant desire to draw breath. Rheumatic or bruising pains in the muscles of the chest or extremities are an additional indication for Bryonia. Next to Bryonia we mention Pulsatilla, which is particularly indicated when the pneumonia has a rheu- matic-catarrhal character, when the expectoration is 3 50 PNEUMONIA, ETC. copious and not bloody, when the pain is more external and is increased by pressure on the thorax, and when the breathing is rattling. Rheumatic pains in different parts of the body are an additional indication for Pul- satilla. It is particularly suitable when the above- mentioned, symptoms occur in a female patient with pale face, blue eyes, blond hair, when they occur in consequence of fright or chagrin, and are accompanied with gastric symptoms. Belladonna will be found suitable when there is great congestion of blood to the brain, when the face is bloated and very red, the lips and tongue are cracked and dry, when there is de- lirium, and the disease threatens to assume a typhoid character. Belladonna is frequently useful after Acon- ite ; it corresponds to the synochal as well as the erethic fever, to a strong, full and quick, as well as to a small and quick pulse, to stitches in the chest as well as to pressure attended with heavy, short, anxious and quick breathing. It should always be used if Aconite should prove unavailing to moderate the fever. Tartarus emet. is recommended as the principal re- medy in the second stage of pneumonia, and is, ac- cording to Dr. CI. Midler indicated by the following t symptoms : little or no stinging pain, great oppression and difficulty of breathing ; loose cough with mucous rattling and alleviation of the oppression by the ex- pectora'ion, which is very profuse ; the sputa con- tains little or no blood, but a quantity of mucus ; a portion of the lungs is hepatized (stage of spleniza- tion as well as red hepatization). The percussion- sound over a larger or smaller portion of the thorax is dull, with increased resistance ; the portion of the thoracic walls adjoining the afore-mentioned region has either a tympanitic or the normal sound. Auscul- tation reveals bronchophony, bronchial respiration and consonant rattle. In bilious pneumonia, Tartar, emet. is indicated by the following symptoms : slight bilious tinge of the skin, of the albuginea, alae nasi and cor- ners of the mouth, yellow-brownish coating of the tongue, bitter taste, disposition to vomit or actual vom- iting, brown saffron-coloured urine ; stinging pain un- PNEUMONIA, ETC. 51 der the right false ribs, or pain in the pit of the stom- ach with distention of the pit, frequent eructations and hiccough ; violent aching, boring pain in the frontal region, sometimes increasing to furious delirium to- wards evening ; the cough is frequently attended with vomiting, with scanty expectoration of a somewhat blood-streaked, frothy, saffron-coloured mucus. Nux v., Mercur., Senega, Digit., China, Sulph., are likewise suitable in that kind of pneumonia. Nux vom. is indicated in pneumonia by a difficult, tenacious, sanguineous expectoration with much cough : the expectoration affords momentary relief: the patient complains of pressure and a feeling of anxiety in the chest; the pulse is not very strong, the patient is uneasy and restless. In pneumonia, with bilious symptoms, Nux v. deserves great attention. In violent pneumonia, when the sticking pains in the chest are excited or aggravated by coughing or breathing (also in pleuro-pneumonia), when they are very violent and extend over a large surface, when a large portion of the lungs is inflamed with dyspnoea, when the cough is dry and the sputa rust-coloured (a characteristic symptom), Phosphorus is then in many cases the only remedy, affording relief in 8 or 12 hours. We should give two or three drops of the third or fourth attenuation every two or three hours. Some- times, when the attack is very violent from the com- mencement. Phosphorus has to be given in alternation with Aconite or Belladonna, agreeably to the symptoms. This alternation may be necessary in the second stage of pneumonia, when the percussion-sound over the af- fected portion of the lungs is dull, and bronchophony or bronchial respiration or perhaps consonant rattle is heard. Phosphorus is likewise indicated when the inflammation threatens to assume a typhoid charac- ter, the physical symptoms remaining nearly unalter- ed, or when symptoms of approaching paralysis of the lungs denote the passage of the inflammation into the stage of gray hepatization or purulent infiltration of the pulmonary parenchyma, attended with remarkable depression of the mental faculties, bland delirium and 02 PNEUMONIA, ETC. grasping at flocks, subsultus tendinum, rapid prostra- tion, cold, viscid sweats, small, frequent, feeble pulse, dim eyes, sunken countenance, dry lips and tongue, short and difficult breathing, oppression and anguish, diffi- cult cough and respiration, etc." Mercurius is indicated by a crampy-tensive pain in the left side of the chest, with violent oppression of breathing, which is sometimes increased by a burning, lancinating pain ; this is attended with a cough which is at first dry, and afterwards accompanied with bloody expectoration; the pulse is hurried, full ; much thirst; the fever is attended with a general nervous irritation, great heat, profuse, fetid sweats, nightly delirium, vio- lent pains in the limbs, violent vertigo, dry mouth and throat, and particularly with great sensitiveness and painfulness of the region of the liver and epigastrium and of the pit of the stomach. Cannabis sat. is a useful remedy when the inflam- mation affects the lower portion of the lungs or princi- pally the left lung, with palpitation of the heart, op- pression behind the sternum, with dull shocks in the region of the heart, frequent hiccough, when the whole body is rather cold than warm, and the heat of the face increases constantly. Cannabis deserves at- tention in asthenic pneumonia. Crocus is a distinguished remedy in pneumonia when there is much orgasm of the blood, palpitation of the heart, anxiety in the region of the heart, violent dry cough, particularly at night, obliging one to sit still, with stitches in the left breast near the heart; short, oppressed breathing, general, burning heat, full, hur- ried pulse, violent thirst, hot urine, dry skin. Zincum is useful when the following symptoms oc- cur : Constant, short, generally nocturnal cough* caus- ing the most violent 'stitches in the left chest, which are likewise caused by deep breathing; after cough- ing, a bloody mucus is hawked up ; the breathing \f very much oppressed; with burning heat of the whole body, great anxiety the w*hole night, quick, hard and * Sep the "Essay on Pneumonia," in the Homoeopathic Examiner, vol. I PNEUMONIA, ETC. 53 full pulse, vivid redness of the cheeks and glistening eyes. Kali carb. is likewise said to be useful in pneumo- nia, but more in pleuritic affections. Kali nitricum is recommended for violent stitches in the left side of the chest, shortening the breathing, worse towards even- ing, and being aggravated by the cough, which is ac- companied with expectoration of pure blood. The fever is a synocha, with full, hard and quick pulse, ac- companied with heat, heaviness and dulness of the head. The stool is sluggish and hard; the urine red and turbid ; the thirst violent and constant. § 135. If the inflammatory symptoms should be moderated, but not completely subdued, and the fever should show a tendency to assume a lentescent char- acter, Bryon., Bellud., Rhus t., Mercur., Hyoscyam., Acid, phosph., Lycop., China, are to be resorted to. Bryonia is suitable when the fever is assuming a torpid character, the pains are still violent, the pa- tient's speech is becoming heavy, slight delirium and comatose symptoms are setting in. Belladonna is indicated when the typhoid symptoms are more marked. The pains in the chest are still sticking, but have partly become dull and aching, the * breathing is painful, the cough dry and fatiguing, the skin hot and dry, the head dull, the eyes are staring and red, there is delirium or sopor. If the typhoid symptoms should be still further developed, if the pa- tient should cease to complain of pain although the objective symptoms (impeded or hurried breathing, and the abnormal physical symptoms) should be un- changed ; if the face should be red, the patient sopor- ous, and in a state of great debility and anorexia, Rhus t. should be exhibited. Merc, and Acid, phosph. are principally indicated by great debility and profuse sweats. Mercurius es- pecially by congestion of blood to the brain, slight delirium, and quick and strong beating of the arteries; when cough is still present, with difficult, blood-tinged expectoration. Acid phosph. more particularly by ex- cessive debility and diarrhoea, loss of consciousness, 51 PNEUMONIA, RTC. strong, irregular, frequently intermittent pulse, disten- tion of the temporal arteries and the arteries of the hand ; the symptoms of the chest should, of course, correspond to the pathogenetic effects of this remedy. Lycopodium is indicated by the following symp- toms : nervous irritability without heat of the head or redness of the face, circumscribed redness of the cheeks, great debility, sweats which do not afford any relief, red and dry tongue, frequent irritation with desire to cough, and difficult, scanty gray expectora- tion, after which the rattling in the chest does not at all abate, and the difficulty of breathing becomes evi- dent. Hyoscyamus is indicated by typhoid symptoms, small, feeble pulse, oppressed breathing, expression of anguish in the face, etc. CAina may be given when the patient has become exhausted by excessive loss of blood, giving rise to a typhoid state. Sometimes we only obtain partial relief by the above-named remedies, even when fully indicated. This may be owing to the impoverished vitality of the patient, in which case a few magnetic passes will re- store the susceptibility of the organism to the proper action of the remedy. At other times, the acute dis- ease may have excited some latent dyscrasia, which can be effectually controlled by Sulphur, after which the treatment will proceed successfully. § 136. It may not be superfluous to add a few re- marks in reference to the distinctive characteristics of pneumonia in the different ages of man. In children, the disease frequently commences quite mildly, so that it is scarcely noticed; it is generally mistaken for catarrh. The disease generally sets in after a cold in winter or spring, is frequently epidemic, commences sometimes with convulsions, but always with loss of appetite, and some fever which is particu- larly perceived in the evening. The symptoms gra- dually get worse, the cough is particularly trouble- some, especially while the fever is on the increase, during which period the cough frequently intermits ; PNEUMONIA, ETC. 55 it is generally dry and comes on in short turns, be- cause the child is unable to take deep breath. Dur- ing the cough the child's countenance is expressive of anguish, the features are distorted and denote suffer- ing ; immediately after the cough the children cry and moan. The cough is excited by motion, breathing, or by taking the child out of the cradle. There is no expectoration, even when the cough is loose. These are the symptoms of pneumonia in infants, but older persons likewise do not always complain of violent stitches in the chest, but of a mere general soreness. The breathing, which takes place by means of the diaphragm and the abdominal muscles rather than by expanding the chest, is quick, intermittent and short; the cough frequently terminates in yawning and vomiting, which affords some relief. The inspirations are short, and the expirations are very quick. If the disease be far advanced, the alae nasi dilate during an inspiration, and the cervical muscles co-operate in the act of breathing. The respiration is the principal phenomenon to which the physician should draw his attention, since it reveals distinctly the local affection. The fever is frequently very violent, the pulse is frequent and quick, small and hard, the heat burning, thirst excessive, particularly during the exacerbation of the fever, towards night. The face and skin are not always red, but sometimes pale although very hot, or else there is a frequent alternation of paleness and redness ; the mouth is hot, the tongue generally coated white and moist, the lips are dry and hot. Nursing infants occasion a feeling of disagreeable heat about the nipples. The breathing has frequently a disa- greeable smell. The urine is dark-coloured, hot, has sometimes a sharp smell, and finally becomes thick and milky. The stool is irregular ; at times undigest- ed, light-green, accompanied with pinching, slimy, diarrhoeic; at other times there is constipation. Dur- ing the course of the disease there is no general sweat, mostly only about «the head and chest; if a general sweat should break out, the disease is broken. 56 PNEUMONIA. F.'IC.. Little children always lose their appetite ; larger chil- dren want to drink all the time. Infants nurse with more greediness, sleep a good deal, though not quietly, start frequently up on account of the pain, and on hearing the least noise; are impatient when laid down, and want to be carried all the time. The duration of such an inflammation depends upon the treatment; if properly treated, it can sometimes be removed in a few hours. § 137. The principal remedy is Aconite in repeated doses. If the vascular excitement should not entirely yield to Aconite, Bryonia may be given after it; if catarrhal irritation should remain, Chamomilla and Nux com. are indicated. If the cough be loose, and the rattling should indicate the existence of a quan- tity of mucus in the chest, which, however, may like- wise arise from internal spasms, Ipecac, Puis., Chamom., Dulc, Senega or Tart. emet. are to be re- sorted to. In inflammation of the chest the brain is sometimes sympathetically inflamed. This inflammatory irrita- tion of the brain is sometimes perceived only after the inflammation of the lungs has subsided. Be this as it may, the treatment ought invariably to be commenced with Aconite, after which Belladonna may be given for the other symptoms. I have seen cases of pneumonia in infants, where it was necessary to commence the treatment with Rhus t., and then to give Aconite, which was of no avail previous to the other remedy. There are cases where Bryonia is required after Aconite, although that remedy is very seldom indicat- ed in the affections of children. In cases where paralysis of the lungs and suffoca- tive catarrh, with accumulation of mucus, threaten to set in, Ipfc, Tart. stib. and Arsenic, and sometimes Sambucus and Moschus are excellent remedies. § 138. In persons of middle age, pneumonia frequent- ly assumes a typhoid character. The typhoid symp- toms develop themselves gradually and the pains in the chest increase in violence during the course of the PNEUMONIA, ETC. 57 disease. The pulse is frequent, small, easily compres- sible ; the pains which the patient never defines or complains about very positively, are constant, without intermission. In robust persons, typhoid pneumonia frequently appears like true pneumonia, with a full, strong pulse, and without any of the characteristic ty- phoid symptoms ; nevertheless, the sensitive system is principally affected, the patient lies in a state of half stupefaction, is more or less delirious, complains too little although the disease is very violent, he is in a state of sopor, with stertorous breathing and his eyes half open, he is roused with difficulty, and is scarcely conscious of himself even after waking, etc. In such a case Rhus t. is indicated, although Acidum phosph. may likewise be of service, particularly when the ex- pectoration is purulent, and when the patient is trou- bled with profuse night-sweats, etc.; Belladonna should also be thought of. When, in this kind of masked ty- phoid pneumonia, the fever has a synochal character, it is perfectly proper to give first a little Aconite before we administer the principal remedies, viz.: Bryon., Phosphor., Tart. emet. If the inflammatory character should not be subdued after the administration of Aconite, and a good deal of mucous expectoration with loose cough, sticking, rather superficial pains im- peding deep breathing, should be present, Squilla is to be used. If, however, the typhoid character should predominate, Rhus t., Bellad., Hyoscyam., Stramon. or Verat., have to be resorted to; the latter remedy par-^ ticularly when a small, easily compressible pulse, prostration of strength, involuntary evacuations, mel- ancholy delirium, vomiting, complete sleeplessness, etc., are present. When the patient is half stupefied, slum- bers with stertorous breathing, with his eyes half open, and is roused with difficulty, Opium soon affords relief. Conium mac. is an excellent remedy when the exacerbation takes place at night and the patient is exceedingly low-spirited, debilitated and cold in his lucid moments. § 139. In people of a more advanced age, pneu- monia frequently has an asthenic character. The re- 3* 5S PNEUMONIA, ETC. medies indicated for that species of pneumonia are principally those which we employ in typhoid affec- tions, and which at the same time correspond to in- flammatory diseases of the chest, such as, Bryon., Bellad., Rhus t., Nux vom.. Mercur.. Arnica, Puis., Baryta, Conium. An excellent remedy is Tartar emet., which is, perhaps more than any other remedy, capable of preventing paralysis of the lungs, and is a specific re- medy for the sopor generally attending that kind of pneumonia. It is scarcely necessary to state, that all the other remedies which have been proposed for ty- phoid affections in preceding chapters, may likewise prove useful in the treatment of asthenic pneumonia. I have lately treated a case of pneumonia with or- thopnoea, in a patient of advanced age, where Bryon., Rhus t., Bellad., Phosph., were of no avail: the cure was effected by repeated doses of the third attenua- tion of Cannabis. § 140. Pneumonia is sometimes complicated with gastric, bilious and mucous fevers, in which case the remedies indicated for pneumonia and the accom- panying affections have to be used. The treatment of the secondar}r affections arising from pneumonia will be discussed hereafter. We may here state, however, that Lycopodium has proved cura- tive in several cases of pneumonia where the disease threatened to run into phthisis, and that Nitric acid, Tart, emet., Kali carb., etc., have been found useful in the treatment of empyema. We ought to observe that auscultation and percus- sion should be instituted every day until the patient is entirely restored. The abnormal physical symptoms disappear in an opposite order to that of their develop- ment : bronchophony gives place to the rattle, the whiffing or crepitant rattle to the mucous rattle, this to the normal vesicular breathing ; the percussion- sound from dull again becomes clear. § 141. There is another species of pneumonia which goes by the name of false or occult pneumonia (pneu- monia notha, occulta). It frequently sets in so clan- destinely that the patient is not aware of it. It is PNEUMONIA, ETC. 59 sometimes preceded by lassitude and heaviness of the limbs, or it sets in in the shape of an ordinary catarrh of the lungs, with alternate chilliness and heat, with- out cough. The cough is generally moist, even from the commencement of the disease ; the expectoration is white, yellow, slimy, sometimes it consists of a little froth only, but is never thick and compact;'there are cases where the cough is dry, and the patient coughs constantly and violently, as if his chest and head would fly to pieces from pain. The breathing is impeded, with slight pressure or stinging and burning sensa- tions here and there in the chest, which go and come and always appear at the same narrow spot. These paroxysms of anxiety and fleeting pains increase on going up stairs, sitting erect or turning to either side, so that the patient is frequently compelled to lie on his back all the time. The disease is frequently accompanied with all sorts of catarrhal and rheumatic symptoms. Fever is almost always wanting, or, when present, it is very slight and scarcely ever violent. The pulse is some- what increased, feeble, the cheeks are but slightly red- dened, the thirst is very little, and the appetite and general health continue good. The disease generally appears in old people, and inclines to terminate jn com- plete paralysis of the lungs, suffocative catarrh (ca- tarrhus suffocativus). § 142. A most excellent remedy for this kind of pneumonia is Arnica, particularly when the fever is slight; the internal chest feels as if bruised, the cough is not too frequent, and accompanied with scanty, somewhat blood-streaked, slimy, expectoration. In some cases Bryonia is preferable, particularly when the pains and suffocative symptoms increase at night, with great heat in the chest, violent cough, as if the head and chest would fly to pieces, with scanty expec- toration of dingy-reddish mucus. Pulsatilla is indicated by profuse white-yellowish expectoration, loose cough, which does not fatigue the chest. If these symptoms should have become chron- ic, with predominant inflammatory character, Dulca- mara sometimes renders essential service. 60 PLEURISY, PLFI RITIS. If the cough be dry, with much tenacious mucus in the larynx and trachea, and a good deal of rat- tling, causing aching pains in the chest, and as if it would fly to pieces. Senega is an excellent remedy; whereas Nux. vom. is more indicated by a dry, spas- modic cough, accompanied with oppression of the chest, or difficult respiration. Sulphur, Lycop., Calc, etc., and the remedies indi- cated for pneumonia generally, may prove useful un- der certain circumstances. § 143. Pleurisy, Pleuritis. Pathognomonic symptoms: Rather superficial vio- lent stitch, emanating from a certain part of the chest, generally below or sideways from the nipple, extend- ing over a large portion of the chest, and increased or excited by deep breathing ; if the pleura costalis should be affected, the pain will likewise be increased by pressure on the intercostal muscles. The breathing is short, hurried, incomplete; sometimesthe patients do not experience any pain on raising the thorax partially, but if a large portion of the pleura should be affected, respi- ration has to be carried on with the abdominal mus- cles ; nevertheless, there is not as much anxiety as in pneumonia. The cough is short, generally dry or at- tended with mucous expectoration: if the inflamma- tion should communicate itself to the lungs, the sputa becomes frothy, or like saliva, tenacious, and blood- streaked. The cough occurs either spontaneously or in consequence of talking, or deep breathing. Lying on the affected side increases the pain very much. If the mediastinum posticum be the seat of the in- flammation, there is less difficulty of breathing, but the pains along the whole vertebral column are gnaw- ing and dull, and increase on moving the dorsal ver- tebras. The pain frequently extends up to the throat, preventing deglutition ; disposition to vomit and real vomiting are likewise frequently present. The fever is generally moderate, and frequently pre- cedes the local symptoms ; the pulse is tight, and fre- quently small, in consequence of the imperfect breathing. PLEURISY, PLEURIT1S. HI All these symptoms, however, are more or less de- ceitful, without the physical symptoms; they very often characterize an affection of the pulmonary tissue itself. The physical symptoms depend upon the exu- dation which accompanies every case of pleurisy. If the exudation be not too inconsiderable, the affected side of the thorax is raised very little, or not at all, during an inspiration, and seems to have increased in size in consequence of the extension of the intercostal muscles : the wall of the thorax does not vibrate when talking ; the vesicular murmur from below upwards is entirely wanting, and the apex of the heart is pushed somewhat out of its place, and does not strike the tho- rax at the normal point; the diapragh'm and the liver are somewhat crowded out of their normal positions. The percussion-sound is always dull and hollow, and if the exudation should be of a fluid consistence, the sound changes according to the position of the patient. Auscultation does not yield constant symptoms. Previous to the introduction of auscultation and per- cussion, the empyema was diagnosed from the follow- ing facts: previously existing pleuritis, rupture of a vomica, dull pressure on the chest, with violent dys- pnoea, immobility of the affected side of the thorax, oedema of that side and of the back, position of the pa- tient on the affected side and on the batjk, increase of the dyspnoea when lying on the sound side of the chest, swelling of the arm of the affected side, feeling of fluctuation in the chest on changing" one's position, hectic fever, sedimentous and fetidly-smelling urine. The exudation continues and develops itself togeth- er with the local inflammation. § 144. If the fever be a synocha, and the sticking pains very acute, Aconite sometimes cures the whole disease; if any pain should be left, Bryonia will re- move it. If the exudation should be considerable, (see physical signs,) Arnica, Sulphur, or Scilla will pro- mote the absorption, and soon remove the disease. Characteristic indications for Arnica is the uneasiness in the affected side of the chest, inducing constant changes of position; accompanied with a feeling in 62 PERICARDITIS, CARDITIS. the chest as if bruised, which constantly invites the patient to lie down, accompanied with general inter- nal heat and cold feet and hands, or else the patient complains of a stinging pain in one side of the chest, with dyspnoea, and a frequent, short, and dry cough, which increases the pain very much. Scilla is suitable, when there is a dry, burning heat, with chills on uncovering any portion of the body ever so little, attended with violent stitches in the side striking from the ribs to the shoulder, and in- creased by the cough, which is generally accompanied with profuse expectoration of mucus. Sulphur, Rims t., Nux v., Kali carb., and Bell., are useful when the*infiammation has communicated itself to the lungs. In some kinds of muscular pleuritis, particularly when there is no inflammatory fever, no thirst, when the patient complains of coldness, and at times only of flushes of heat, which are generally oc- casioned by the increased pain and the subsequent anguish, Sabadilla will prove useful. § 145. Pericarditis, carditis. It is difficult to distinguish these two kinds of in- flammation from each other ; a post-mortem examina- tion is the only safe means to obtain certainty in re- gard to either.* These inflammations generally run a rapid course, which renders them very dangerous. They are likewise dangerous in this respect, that the symptoms are not always sufficiently violent to denote imminent danger. In most cases, these inflammations are characterized by the following symptoms : violent, more burning than cutting, pain behind the lower half of the sternum, near the xyphoid process, rather to- wards the left side, in the praecordial region, whence the pain spreads in different directions; considerable dyspnoea, which may be inferred from the expression of the features, and does not depend upon an affection of the lungs, or pleura, since no such affection is re- vealed, either by percussion or auscultation. The res- piration is quick and short, panting, without mucous rat- tle. Cough is frequently present,though not in every in- stance, frequently without expectoration, or with slimy, CARDITIS AND PERICARDITIS INFANTUM. 63 purulent sputa. The beats of the heart are violent, frequently irregular, and increase to the most violent cardiogmus ; the pulse is small, frequent, vibrating, frequently intermittent. The patient prefers lying on his back and with his head raised; lying on his side increases the pain. The distress is likewise aggra- vated by motion. The disease is accompanied with all sorts of sympathetic affections: delirium, frightful an- guish, starting from sleep as if in affright, hiccough, difficulty of swallowing, vomiting, swelling of the joints, frequent fainting, want of agreement between the pulse and beats of the heart, etc. The praecordial region, particularly in young sub- jects, is fuller, and the costal cartilages in the region of the heart are more prominent. When considerable exudation is present, the percussion-sound over the whole region of the heart is dull; the stethoscope re- veals friction-sounds, together with the abnormal beats of the heart. § 146. Exciting causes are : cold drinking when the body is heated, etc. ; inflammation of the pleura by metastasis to the pericardium. Females at the age of pubescence are most liable to that disease. Other causes, are : penetrating wounds in the chest, blows on the region of the heart. It is most generally a se- quel of acute rheumatism, particularly of the knees. It likewise occurs by metastasis in the course of acute exanthemata, small-pox, scarlatina, measles, erysipe- las, miliaria, etc. Emotions, such as anguish, fright, fear, may likewise lead to inflammation of the heart. § 147. Carditis and pericarditis infantum. These inflammations are not very unfrequent in children, but the symptoms are so deceitful that there is great danger of mistaking the true seat of the dis- ease. It is likewise frequently impossible in these lit- tle children, when so restless and tormented by anguish, to ascertain the physical symptoms. Frequently we only notice great dyspnoea, which sometimes occurs in paroxysms, excessive anguish, constant moaning and tossing to and .fro ; the painful sensations are frequently described as being in the ab- 64 I)IAPIIRA(.M1TIS. domen, or in the region of the heart. Palpitation of the heart is sometimes present, at other times absent. There is generally violent fever, hot skin, dryness of the lips and tongue, frequent, small and irregular pulse; finally, convulsions and generally collapse, which leads to the suspicion of the brain being affect- ed. Sometimes, however, the symptoms of pericardi- tis are more distinct. Auscultation should never be neglected (Canstatt). § 148. The treatment will be more fully indicated in the chapter on Rhewnatism of the heart, or endocarditis. We shall here content ourselves with briefly indicating the remedies referring to that disease. The first remedy is Aconite, every half hour, after which Nux vom. is sometimes indicated. If the fever and the local distress should have been moderated by the Aconite, and if oppression, palpita- tion of the heart, anxiety, apprehension, sadness should remain, Pulsatilla would be most suitable. If some inflammatory symptoms should still remain, attended with violent anguish, distorted countenance, great prostration of strength and debility, Cocculus will be found most suitable, particularly when accom- panied with inflammatory swelling of the knee. If the symptoms mentioned under Cocculus should be excessively violent, and a little inflammation should still remain, Arsenic should be resorted to. Cannabis, first, second or third attenuation, is an ex- cellent remedy, after the diminution of the fever by means of Aconite, when the patient complains of a tensive aching pain in the middle of the sternum, with oppression of breathing, frequent shocks in both sides of the chest, and most painful in the region of the heart, accompanied with orgasm and a sensation of fulness about the heart. Distinguished remedies are: Spigelia, Oleander, Tart, emet, Phosphor., Sulphur, Belladonna, Nitrum, Digit, etc. As we said above, we shall hereafter recur to the treatment of this affection. § 149. Diaphragmitis, paraphrenias. This kind of inflammation is generally complicated DIAPHRAGMITIS. 65 with pneumonia, pleurisy, hepatitis or nephritis. It is known by a very violent pain in the lower portion of the thoracic cavity, which is more or less superficial or deep-seated, limited or extended, being felt lower down during a deep inspiration, with sensation of contrac- tion in the whole region of the diaphragm, from the sternum to the back and loins. If the whole dia- phragm be inflamed, the pain is exceedingly distress- ing, extending from the lowest ribs to the dorsal verte- brae. The epigastric region, and particularly the pit of the stomach, is very hot, sensitive, drawn in, some- times swollen, tight, beating, and burning internally. The inflammation is accompanied with a violent fever, with small, quick, sometimes intermittent pulse, vio- lent and constant delirium soon sets in, with restless- ness and excessive anguish, which the patient express- es by his looks and features ; in many cases risus sardo- nicus, trembling, singultus, dry and distressing cough, vomiting, convulsions, attacks of paleness as if the pa- tient would faint. The pain increases to a frightful extent from the least pressure or motion of the dia- phragm. In higher degrees of inflammation, degluti- tion is impossible. Respiration is hurried, short, suffo- cative, anxious, or sighing and moaning. The pain is the same in any position of the body, and is somewhat relieved only by erect posture, with a slight inclination forwards. § 150. Diaphragmitis may be occasioned by inflam- mation of adjoining organs ; by cooling the heated body suddenly, by uncovering it or by taking a cooling drink ; by all sorts of organic injuries and atmospheric influences. The prognosis depends greatly upon the violence and complication of the symptoms. § 151. If the fever have a true synochal character, Aconite is to be given first; but if the fever should have the erethic form, Bryonia is more specifically in- dicated. I consider Bryonia the most important reme- dy for diaphragmitis. Chamomilla relieves the following symptoms : swell- ing of the pit of the stomach and subcostal region, with aggravation of the beating, burning pain extend- 66 R1IEUMATALG1A. ing from that region to the spine, by every pressure which moreover shortens the already oppressed breath- ing ; the breathing is anxious and short, or intermit- tent in consequence of the pain ; frequent, dry, harass- ing cough; vomiting, convulsions, great restlessness, tossing about, complaining, and the like. When these symptoms occur in liver-grown children. Chamomilla is likewise the best remedy. If the lower part of the chest should feel constrict- ed, as if surrounded with a band, with short, drv, dis- tressing cough, amruish, retention of stool, great thirst, Nux vom. is a specific remedy, which gives place to j\ux mosch., when the chest feels as if oppressed with a load, and when this feeling of oppression seems to come from the pit of the stomach, attended with a dry cough and arrest of breathing. The symptoms come on af- ter taking cold by being in the water. Colchicum is likewise useful when the symptoms are occasioned by the same cause, and when the pain resembles a ten- sive pressure and is periodically worse. ^ Ctnnuhis is suitable for anguish and oppression, C>c ulus for a constrictive sensation, Pulsatilla for both conditions, provided they exhibit an inflammatory character. Ambra. deserves a preference over any other remedy, when the painful oppression is accom- panied with flushes of heat and anxiety in the region of the heart. Other remedies are, Arsenic, Phosphor., Drosera, Sepia, Veratr. Spigel, Lauroc, etc. § 152. Rheumatic affections. These affections are described under two principal heads, rheumatism and catarrh. By rheumatism we understand the rheumatic irritation of the muscles, li- gaments and aponeuroses ; by catarrh, a similar irri- tation of the mucous membranes, particularlv those of the bronchi, trachea, frontal sinuses and nose Both classes arise from the same cause, have the same char- 9 acter, and can pass the one into the other. § 153. Acute rheumatism, rheumatalgia. A joint of an upper or lower extremity, or all the RHEUMATISM. 67 joints of the extremities, suddenly swell and become painful, generally without any precursory symptoms ; in a few cases of violent rheumatism the vertebral ar- ticulations from the head to the pelvis are likewise affected, or the muscles of the trunk, the heart, pleura. etc. The pain is violent, sticking or tearing, aggra- vated by pressure or motion ; the swelling is at times great, at times inconsiderable, generally soft and not very red. The affection is generally seated in the joints, tendons and ligaments ; the muscular and simi- lar tissues are likewise liable to rheumatism. It is pe- culiar to this species of rheumatism, to wander from one joint to another. Simultaneously with or shortly after the appearance of the local affection, the patients are seized with chills followed by intense heat, which is permanent; the skin is hot and dry, or covered with viscid sweats which do not afford any relief; the pulse is at first full, 100 or 120, tight, hard, and, after the disease has lasted for a time, becomes fleeting, small, contracted ; the thirst is violent; the urine dark-red and fiery, burning while passing through the urethra, saturated with free uric acid ; the appetite has disap- peared, the tongue is generally coated whitish or yel- lowish, with slimy, bitter taste and obstinate consti- pation. § 154. Young and vigorous individuals are most liable to acute rheumatism. It may be occasioned by keep- ing the body too warm, increasing the sensitiveness of the skin to an undue extent, sedentary life in closed rooms, want of exercise, etc. Exposure to a draught of keen air while sweating, is a sure means of having acute rheumatism. It lasts from 7 to 21 days, and longer; it is liable to become chronic. Recovery takes place with profuse sour sweats, and copious se- dimentous urine. Relapses are very frequent. Death takes place by the suppression of miliaria, which had made its appearance, or by metastatis to some internal organ, brain, heart, lungs. Rheumatism may lead to exudations in the ad- joining cellular tissue, induration, anchylosis, sup- puration, paralysis, etc. I'H RHEUMATISM. The prognosis depends upon the permanency of the local affection, upon metastasis to some internal or- gan, the setting in of miliaria and anasarca, the com- plication with nervous symptoms. § 155. As regards the treatment of rheumatism, I refer the reader to § 36. In regard to the treatment of the local affection, the following remarks will be found useful. § 156. A. Rheumatism of the extremities. This is the most frequent form of acute rheumatism. The pain is violent, tearing, following the course of the muscles, generally limited to one extremity or only a portion of it; not continuous, but generally character- ized by paroxysms of violence, aggravated by pressure and motion ; the affected limb is stiff and sometimes swollen and red. The rheumatism is scarcely ever seated, wanders from the forearm to the upper arm, or from the upper to the lower limbs, or vice versa. The fever is generally mild, with profuse sweat and thirst. § 157. Aconite should be resorted to for this rheuma- tism, when the usual Aconite symptoms are present; violent orgasm of the circulation, congestion of blood to the head and chest, sympathetic affection of the heart, pleura or brain, etc. In most cases, how- ever, Bryonia will be found indicated from the com- mencement, particularly by tearing or tensive-stick- ing pains in the muscles and joints, generally striking from above downwards, excited or aggravated by mo- tion and pressure, and worse in the evening and at night, attended with stiffness and shining-red swelling ; by tearing or sticking pains in the whole body, parti- cularly in the wrist, elbow, knee and tarsal joints, with swelling and heat and radiating redness of the skin, violent headache, beating in the forepart of the head and vertex, profuse sour sweats and great thirst. Bella- donna may likewise be of service for those symptoms.* Colchicum is nearly related to Bryonia, particularly *Bell. cures --heumatism of the upper limbs, particularly the right, when the sympto-m are violent ard distressing, with creeping and tingling in the bones, ex ruciating, cutt>' or tearing pain, striking from the shoul- der U, the elb.w-joini on raisl.., the arm ; see the pathog. sympt.—Hempel. RHEUMATISM. 69 in affections of the joints without swelling or inflam- matory redness, with general painfulness of the whole body, and great irritability during the pain which is frequently felt on one side of the body only, is most violent and frequent in the evening and at night, and is aggravated by motion and contact, particularly in individuals with great disposition to sweat and liable to be troubled with acidity, with a white and delicate skin, deficient and irregular action of the skin and in- creased irritability. Colchicum is moreover indicated when the rheumatism was occasioned in wet and cold weather, in the fall and spring. Other remedies for this kind of rheumatism are : Pulsatilla, Nux vomica, Chamomilla, Rhus t., Rhodo- dendron, Dulc, Tinctura acris, Thuja, etc. Pulsatilla* corresponds particularly to rheumatic pains, shifting rapidly from one limb to another, causing a swelling and redness, with evening exacerbations, violent tear- ing, drawing or jerking pains with numbness, lame- ness or swelling of the affected parts. Excessively acute rheumatisms and disposition to sthenic inflam- mations are not curable by Pulsatilla. Nux vom. is suit- able for drawing pains with sensation as if the affected parts had gone to sleep and were lame, particularly in the afternoon hours ; the pains appear periodical- ly, and seem to point to an affection of the spinal marrow, the large muscles of the back, loins, chest and small of the back, with bruised pain and im- mobility of the small of the back and nape of the neck. Chamomilla is suitable to drawing or tear- ing pains, with sensation of lameness or numbness, particularly in the parts where the pain has abated ; the tendons and the ligaments seem to be affected more than the muscles ; there is no swelling; the pains are aggravated excessively at night, and by the warmth of the bed. Belladonna is useful for rheumatism with red, erysipelatous swelling, the least motion causing a most violent pain: the pains are wandering, with stiff- t Pulsatilla corresponds to rheumatic redness and swelling of the upper portion of the foot from the toes to the middle of the leg ; the cure is effect- ed very speedily. See the pathogenetic symptoms.—Hempel. 70 RHEUMATISM. ness and swelling of the posterior cervical muscles. headache, aching-tearing pains deep on the bones, striking to the adjoining articulation like an electric shock, and terminating in the articulation in the shape of a dull pressure which is relieved by counter-pres- sure, aggravated by motion and exacerbating at night. Rhus tox. is indicated by tearing, tensive? and drawing pains when worse during rest and at night by the warmth of the bed, relieved by motion, brought on by cold and by getting wet when perspiring ; or it is in- dicated by rheumatic pains with pale-reddish swelling, intolerable creeping and throbbing, or lame feeling in the affected part. Rhododendron is excellent for draw- ing and tearing pains in the joints and limbs, most vio- lent at night and during rest, leaving a feeding of stiff- ness and lameness in the joints, attended with periodi- cal tearing pains in the lower limbs, with sensation of formication, swelling or redness of single joints, aggra- vated by stormy weather and rest, and not allowing the patient to sleep at night. Dulcamara cures the following symptoms : sticking, drawing and tearing pains in the limbs, as are frequently observed after the disappearance of acute cutaneous eruptions, or after a cold, generally exacerbating at night or in the even- ing, also during rest ; the accompanying fever is char- acterized by great heat, dryness, and burning of the skin, thirst, and exacerbates at the above-mentioned periods. The tearing, sticking pains in the joints in consequence of a cold, with numbness and deadness of other non-affected parts, and aggravation of the pains towards evening or in a cooler temperature, are cured by Causticum. Thuja removes a beating sticking in the joints and limbs, with painful cracking on stretch- ing the affected parts, swelling of the cutaneous veins in the affected parts, and aggravation of the symptoms in a warm temperature. § 158. B. Rheumatismus cordis. Endocarditis. Either during an already existing rheumatism of the joints, or without any previous disease, the patients experience a sensation of heaviness in the left side of the chest, sometimes with fleeting stinging pains ; in RHEUMATISM. 71 case a fever was present, it now grows worse. Dis- tress of breathing, anguish, restlessness, palpitation of the heart, set in. The oppression sometimes increases to the most violent anguish and fainting fits; cough, with or without expectoration, sets in, the head and sensorium become affected, the features distorted, etc. Frequently nothing is seen except the exacerbation of the fever, and slight uneasiness. If a joint was swollen and painful, these local symptoms disappear sometimes suddenly, though this is not generally the case. The subjective symptoms being so uncertain and slight, the physical symptoms should be studied so much more carefully. At first, the percussion-sound is normal; not till hypertrophy and dilatation have set in, is the percussion-sound dull over a larger surface ; the motions of the heart are more violent and hurried, sometimes irregular; hence the heart strikes the wall of the thorax with more force, and the palpitation is distinctly visible externally. The pulse of the extrem- ities is frequently small, feeble, contracted, and not synchronous with the beats of the heart. The two sounds of the heart continue normal, but are more fre- quent and louder, or a murmur is heard with the first sound, which is generally more distinct in the left ven- tricle. The inner membrane of the left ventricle is most frequently the seat of the disease; the endocardium becomes red, injected, or it exhibits opacities, thicken- ings, roughnesses, or actual exudations set in on the fibrous valvular tissue, leading to adhesions, diminu- tion, ossification, and final insufficiency of the valves, from which result hypertrophy and dilatation of the right or left ventricle. Sometimes, but much more rarely, the pericardium is inflamed. In this case the beats of the heart are at first distinct and violent; but if exudation in the peri- cardium take place, they grow feeble, and are scarcely perceptible, and the sounds are less clear and strong; as the exudation becomes more consistent on the sur- face of the heart, we distinguish a friction-sound, oc- casioned by the motion of the heart; the percussion- 72 RHEUMATISM. sound remains normal, as long as the quantity of ex- uded matter in the pericardium is slight, but if it in-^ creases, the percussion-sound from the apex to the upper portion of the heart is constantly dull. § 159. The disease is met with most frequently in persons at the age of pubescence ; organic defects of the heart, or former inflammations of that organ, are among the causes which, in articular rheumatism, in- cline to occasion a metastasis of the inflammation to the heart. The disease runs a very rapid course, if we exclude the secondary affections resulting from it. The dis- ease may terminate in dispersion, with the usual crit- ical discharges by the skin and urine, or in metastasis to a joint, or to some other organ, the eye, for exam- ple, (which sometimes occurs with extreme rapidity,) or in hypertrophy and dilatation of the heart. Death scarcely ever takes place as a primary termination of the disease, except when pericarditis supervenes. Re- lapses occur easily, which fact alone renders the prog- nosis somewhat doubtful. § 160. The chief remedy, at first, is Aconite, when the restlessness, anxiety, and apnoea are accompanied with increased action of the heart and blood vessels; when the motion of the heart is hurried and violent, the beats of the heart and pulse are not synchronous, and the patient complains of slight pressure in the left side of the chest, between the fourth and sixth ribs. The bold and frequent use of Aconite will frequently be sufficient to disperse the inflammation and prevent exudation and organic malformations. The physical signs indicating Aconite are : dulness of percussion- sound over a normal space, the motion of the heart is hurried, violent, (without raising that portion of the wall of the thorax corresponding to the heart,) the beats of the heart are not synchronous with the ra- dial pulse ; both sounds of the heart are still audible, without any murmur, except that they are more vio- lent and louder, particularly in the region of the left ventricle. Belladonna is suitable for general congestions of the RTIEUMATTSM. 73 chest and vascular excitement, with pressure in the • region of the heart, arresting the breathing and occa- sioning anxiety; for unequal, irregular contractions of the heart, for "violent constant palpitations of the heart, and occasional intermission of the beats of the heart. Belladonna quiets the most violent vascu- lar excitement, vomiting, with fainting fits, and cold sweat over the whole body, fleeting stitches in the re- gion of the heart, constant panting for drink, involun- tary stools, and excessive anguish, with dilatation of the pupils. The lower attenuations should be used, and frequently repeated. Cannabis is frequently useful after Aconite, when the violence of the vascular excitement has abated, when the patient complains of tensive aching pains in the middle of the sternum, with oppression of breath- ing, when the patient is tormented by nocturnal par- oxysms of anguish, driving the patient from one place to another, and when he complains of violent shocks in the region of the heart on moving the body, with hammering from within outwards, below the costal cartilages, near the sternum, with violent palpitation of the heart, and sensation as if the heart were beat- ing lower down. Cannabis may moreover act with benefit when the pericardium is involved, when morbid formations on the endocardium and valvular defects have taken place, when the percussion-sound is normal or else dull over a larger surface, when the sounds of the heart are strong, violent, or mixed with murmurs. The most constant symptom of Digitalis is to limit the action of the heart, and to render its beats slow and feeble ; it is indicated by palpitation of the heart, orgasm of the blood, with great anguish, congestion of blood to the head, with loud noise and buzzing in the ears, dyspnoea, distress of breathing, suffocative par- oxysms, irregular, intermittent, slow beating of the heart. This last paroxysm is eminently characteristic of Digitalis, and occurs very seldom in endocarditis. Hence it is that Digitalis will be of little use in acute rheumatism of the heart, but will be found an invalu- *able remedy in organic malformations of the heart. I 74 RHEUMATISM. particularly when symptoms of hydrothorax and urine with brick-dust sediment are present. Arsenic is indicated by excessive palpitation of the heart, particularly at night.' with great oppression and anguish, irritated and frequent beating of the heart, small, scarcely perceptible or entirely collapsed pulse ; the contractility of the heart is diminished or appar- ently destroyed, with frightful paroxysms of nightly anguish and danger of suffocation, which does not al- low the patient to rest on his back. Arsenic is less useful in acute endocarditis than in pericarditis, or, particularly, in chronic affections of the heart, and in the asthma which depends upon organic diseases of that organ, and is accompanied with serous exudations. Colchicum is a remedy of great importance ; it cor- responds to the cases where a joint was still affected shortly previous to the affection of the heart setting in, or where the joint remains inflamed during such an affection, with hot, painful swelling of the knee or some other joint, not admitting of the least contact, with general painfullness of the whole; body and exces- sive debility, distressed and hurried respiration, panting and moaning, unequal, intermitting breathing, anxiety and oppression, stitches and tearing in the chest and region of the heart during an inspiration, with strong and fluttering beating of the heart, contracted, quick, very frequent pulse, tormenting thirst, profuse, sour- smelling sweats which do not afford any relief, scanty emission of bright-red, turbid, acid urine. Nitrum is, like Aconite, indicated by a general vas- cular excitement, congestions of various organs, in- flammatory and febrile symptoms. Violent palpita- tion of the heart, particularly when lying on the back, at night, with oppression and anxiety, obliging one to sit up in bed, full, hard and quick pulse, pressure on the chest, spasmodic constriction of the chest, with op- pressive shortness of breathing and painful contrac- tive sensation in the pit of the stomach, dry and hack- ing cough, with audible beating of the heart, violent * A characteristic indication for Arsenic is, when the palpitation sets in while the patient is lying on his back, and ceases on rising.—Hempel. RHEUMATISM. 75 stitch in the region of the heart, are symptoms char- , acteristic of Nitrum. Spigelia is a chief remedy in affections of the heart, and is generally to be preceded by Aconite. It corre- sponds to endocarditis, with or without articular rheu- matism, to pericarditis, and to chronic affections of the heart arising from inflammation. It is particularly useful in endocarditis rheumatica. It is indicated by the following symptoms: undulating motions of the heart, indistinct, continuous beating of the heart, tumul- tuous beating of the heart when lying or sitting, which is perceived by laying the hand flat over the heart, and is not synchronous with the beating of the pulse ; spasms of the chest, suffocative complaints, tremulous sensation in the chest and temples, which is aggravated by motion, sensation as if the inside of the chest would be torn on raising the arms above the head or touching the pit of the stomach (Horn. Gaz., III.) ; purring noise dur- ing the beating of the heart, stitches in the region of the heart, tremulous pulsations of the carotids, great dyspnoea on changing the position of the body, bright- red lips and cheeks, which turn pale at every motion, elevation of the four last true ribs, of the sternum and xiphoid cartilage, displacement of the dorsal vertebrae, (Arch. X.) audible beating of the heart, which causes a pain extending to the back, cutting pains from the heart to the shoulders, extending even up to the head and down the arms, dyspnoea increasing to actual suf- focation, cutting, aching pain in the abdomen, in the region where the ribs commence, arthritic pains and stiffness of the joints (Arch. XVI. and Hygea XIX.); dull stitches recurring with pulse-like regularity in the region where the beats of the heart are felt, violent, audible beating of the heart, with anxious oppression of the chest, scraping in the throat, affection of the tracheal and bronchial mucous membrane, the beats of the heart are not synchronous with the pulse, purr- ing in the region of the heart. The physical indica- tions for Spigelia are: percussion-sound normal, or dull over a larger surface ; increased shock of the heart; that portion of the wall of the thorax which 76 RHEUMATISM. corresponds to the heart, is visibly raised by the heart striking against it; the beats of the heart are not syn- chronous with the pulse; the sounds of the heart are increased, very loud, or accompanied with murmurs in different parts of the heart, or the murmurs are heard in the place of the sounds, both during the systole and diastole of the heart. Spigelia requires to be given in frequently repeated doses. Aurum metallicum is an excellent remedy when rheumatic affections recur frequently, and finally shift to the region of the heart, in consequence of a cold, with distressing anxious pains hindering a recumbent posture, and obliging the patient to sit up ; the pulse is irregular, frequently sluggish, intermittent; slight fever ; oppression of the chest. After repeated doses, the rheumatism returns to the originally affect- ed parts (Hygea XVIII.). Asparagus is useful in chronic organic affections of the heart. It is indicated by indistinct stinging in the region of the heart, throbbing of the heart, perceptible to the hand and ear, and setting in after slight motion, irregular, quick, double beats of the heart, with anx- iety, etc. It diminishes the violence of the occasionally recurring paroxysms. Bismuthum causes strong beating of the heart, visi- ble from a distance, frequency of the pulse, and con- gestion of blood to various organs. It is suitable for diseases of the heart arising from inflammation of that organ. Other remedies, such as Nux vom. and Mosch., Mer- cur., Nitri. ac, Phosphor., Staphysag., Coccul. Tabac, Coff., Asa feet., act likewise upon the heart, but only sympathetically. These remedies do not cure inflam- matory affections of the heart, but will be found use- ful in removing the anguish and palpitation of the heart of hysteric, chlorotic, etc. individuals. China, Ferrum or Arnica are likewise without avail in acute rheumatism of the heart. § 161. C. Rheumatism of the thorax. The affection is generally sealed in the pect.orales, less frequently in the intereostales muscles. The pain LUMBAGO RHEUMATICA. 77 is generally sticking or tearing in one part of the chest, generally only on one side, rarely on both sides at the same time ; it is aggravated by deep breathing when the intercostal muscles, and by stooping and pressure when the pectoral muscles are affected. Cough, and the physical symptoms of pleuritis and pneumonia are entirely wanting, except when the rheumatism seizes the pleura, which is sometimes the case. There is generally very little fever, and scarce- ly ever critical sweat or urine. § 162. Bryonia and Arnica are generally indicated, seldom Aconite. Arnica should be given when the ex- ternal muscles are alone affected, sensitive to pressure and sore, particularly when the affection arises from some mechanical cause and the body feels bruised and languid. Bryonia is useful when both the external and intercostal muscles are affected. Bellad., Nux vom., Rhus t, Squilla, Sabad., may likewise be useful. For rheumatic pleuritis or pleuro-pneumonia, use the remedies indicated for those diseases. § 163. D. Lumbago rheumatica. This is a rheumatic affection of the lumbales mus- cles, from the posterior portion of the vertebral column to the crest of the ilium, generally on one side only. The pain is generally tearing, drawing, seldom stick- ing, appearing periodically and frequently shifting to some other place. The pain is very much aggravated by motion, so that the patients keep their backs quite stiff. There is no swelling or rednesss, but a darting pain is experienced along the muscle on touching it. There is very little fever. The disease is liable to be confounded with psoitis, nephritis or an affection of the lumbar nerves. In the latter affection, however, violent pains are present, which set in like electric shocks; they follow the track of the nerves, and are not aggravated by motion or contact. In nephritis, the pain is rather deep-seated, dull, aching, and fol- lowing the course of the ureter ; the urine is dark, bloody, purulent, attended with strangury, dysury and disturbance' of the digestive functions. In psoitis, the pain is located in the region of the insertion of the 7!S LUMBAGO RHEUMATICA. psoas-muscles, the transverse processes and bodies of the lumbar vertebra? : it follows the course of the muscle beyond Poupart's ligament towards the thighs, swelling soon sets in under Poupart's ligament, and the characteristic pain in the knee and pain on moving the thigh is felt. § 164. Aconite is seldom required in this affection. The chief remedies are: Bryonia, Colchicum. China, Pulsat., Am.. Rhodod., Nux com., Sulph.. Ledum. China corresponds particularly to violent tearing, sticking, drawing pains, which are increaseel by the least motion, or to bruised pains in the small of the back, with occasional painful jerks in the region of the os sacrum ; it corresponds likewise to the dragging pains in the small of the back as from a load or as from long stooping, with nervousness and general debility. Nux vom. is useful in violent, painful jerks, and jerk- like, dull sticking; in pains in the small of the back, which appear periodically and extend to the shoulder and down to the sexual organs, occasioning even a lameness and stiffness of the lower limbs. Rhodod. has been frequently found useful in violent pains in the small of the back preceded by a tearing pain in the arm and nape of the neck ; the pain was worse during rest and in bed, and, in the evening, it some- times extended as far as the abdominal ring, accom- panied with drawing, pressing pains In the testicles. § 165. Sometimes, on stooping, a most excruciating pain is suddenly felt in the small of the back, so that the trunk can only be raised with the greatest difficulty, and the least motion in the small of the back is im- possible. The pain lasts from two to eight days, and is unaccompanied by fever, or any other morbid symp- toms. The pain arises probably from the stretching or tearing of a few muscular fibres, or a muscular sheath. Arnica, Nux v., Rhus t., Bryon., Sulphur, Ledum, are the principal remedies. I have frequently cured this pain with Nux and Sulphur alternatelv, in one or two days. Rheumatic lumbago sometimes affects the cervical or abdominal muscles. There is tearing pain in one RHEUMATISMUS CEPHALICUS, ETC. 79 or both sides of the neck, which can scarcely be turned or moved ; sometimes the inner parts are affected, oc- casioning a morbid condition like angina. Belladonna and Lycop. are the best remedies. If the abdominal muscles be the seat of the disease, the tearing pain follows the course of the muscular fibres, in either the recti or oblique muscles, and is aggravated by motion. There is no distention, no sensitiveness, no nausea or vomiting, no fever, as in peritonitis and enteritis, al- though this former disease may develop itself out of lumbago, by the rheumatism invading the peritoneum. Arnica is generally a specific for this kind of pain. If the rheumatism should affect the articulations of the vertebral column, rendering motion impossible; or if symptoms of tetanus or trismus should set in in consequence of the articulation of the temporal bone and maxilla being affected by the rheumatism, Bellad., Nux vom., Causticum, Cocculus, Cokhicum, should be used. § 166. E. Rheumatismus cephalicus and rheumatic odontalgia. The pain is chiefly seated in the temporal, occipital or facial muscles, or in the aponeurosis, generally on one side of the head only; it is tearing, and follows the course of the muscle. The disease sometimes in- vades the nose (as a catarrhal affection), the con- junctiva (frequently increasing to rheumatic ophthal- mia), and the ear. The fever is slight, and is some- times wanting. Of itself, the disease is not dangerous ; but it may become complicated with otitis, leading to permanent otorrhoea and hardness of hearing, or with rheumatic ophthalmia, terminating in disorganization of the eye, or with meningitis. Sometimes the pain increases to a real neuralgia, particularly in females, and feeble, irritable individuals, who had formerly been liable to megrim. Some'times the pain invades the teeth and jaws, enther a few teeth or both rows, and extends even to the ear and eye, or shifts from one place to another. It is generally tearing, sticking, gnawing, boring. HO RHELMAJ IS.MI S CEPHALIC'La sometimes continuing for a long time, is most violent at night, and particularly in bed. After some time, the cheek and the gums of the affected side swell up, after which the pain generally disappears, and the swelling disperses again. § 167. Among the many remedies which correspond to the various symptoms of rheumatic toothache, we notice Chamomilla. Nux vom,, Bellad., Mercur., Pul- satilla, Staphysagria. Chamomilla is suitable for pains which are most violent at night, come on in paroxysms, and do not affect any tooth in particular ; when slight, the pains are creeping,jerking; when violent, they are tearing, or even darting,#striking into the ear, aggravated by warmth, eating or drinking, or by cold water, and ac- companied by swelling of the cheeks, excessive secre- tion of saliva, heat and redness of one cheek, exces- sive irritability, sometimes by swelling of the gums, looseness of the teeth, and sensation as if they were elongated. Nux vom. is a chief remedy for rheumatic pains of the head and face, teeth and jaws; the pain is prin- cipally drawing, tearing, less frequently jerking and sticking; it invades the soft and hard parts of the face, with or without swelling of the cheeks, is fre- quently attended with vertigo, dulness of the head, nausea, heat of the face, buzzing and pains in the ear. The toothache is principally aggravated by open air, cold, wine and coffee, sometimes relieved by warmth ; it frequently affects only a decayed tooth, as a boring pain, or as if the tooth would be wrenched out of its socket, accompanied with single stitches which con- cuss the whole body, and with painful swelling of the gums; sometimes the pain shifts from the decayed to sound teeth, or to adjoining parts ; it appears rather periodically, generally at night and in the morning, is less during rest and warmth, but is made a good deal worse by mental exertions, chewing, or opening the mouth in the open air. Belladonna removes a pain in the forehead, and one side of the head which appears periodically, is ag- VND RHEUMATIC ODONTALGIA. 81 gravated by moving the eyes, by concussion, warmth of the bed at night and in the evening, with bright- red swelling of one side of the face, sticking and boring in the ear, inflammation of the inner and outer ear, otorrhcea, inflammatory swelling of the parotid gland, violent digging and sometimes boring tooth- ache, which is rendered intolerable by contact, air and eating, relieved by cold water, attended with swelling and sensitiveness of the gums, and swelling of the submaxillary glands. Mercurius is a specific remedy for rheumatic sticking and tearing pains in the ear, for inflammation of the inner ear, with violent boring and gnawing pains, which are most violent at night, with otorrhcea, or even if caries of the ossicula should have already set in ; for tearing, boring pains in the eye and the surrounding parts, with evening and night-exacerba- tions, inflammation of the sclerotica and conjunctiva, ulcers on the cornea, with broad, whitish-gray, opaque edges. It is particularly suitable for sticking, jerking, darting, tearing-gnawing and boring toothache, ge- nerally in decayed teeth, particularly in the roots, ag- gravated by the warmth of the bed, in the evening, and at night, also by eating and drinking, momen- tarily relieved by the application of cold water; the pain extends to the temples, ears, over the whole side of the head, with swelling of the cheek and gums, swelling of the submaxillary and parotid glands, co- pious secretion of a fetid, tenacious mucus, fetid smell from the mouth, thick-coated tongue, flat taste, febrile sensations, profuse sweat, which does not afford any relief; the gums are frequently inflamed, interstitially distended, standing off from the teeth, ulcerated, readily bleeding, with looseness and elongation of the teeth. Pulsatilla is suitable for periodical hemicrania of a tearing, sticking and throbbing character, aggravated by warmth, and in the evening, generally extending as far as the ear, where a tearing, darting pain is ex- perienced, with hardness of hearing, buzzing and painfulness of the region of the ear to contact. Pul- N2 RHEUMATISMUS IUTHALICUS satilla does not seem to be of any avail in internal otitis, with,discharge of pus. The Pulsatilla tooth- ache is drawing-gnawing, tearing in the' upper and lower molares. both sound and decayed, most violent at night, extending to the eye. temple and e^ar. aggrava- ted by warmth, and particularly affecting individuals with a mild and gentle disposition, great patience and equanimity, delaying catamenia, etc. It corresponds to toothache, which abates in the open air, and returns in the warm room, with stinging in the gums, and drawing-jerking in the nerve, (as if the nerve were vi- olently pulled, and then suddenly let loose again.) with chilliness and paleness of the face ; the- toothache usually appears in the eveming, much less frequently in the morning, is aggravated by the warmth of the room and bed, relieved by the contact of cool air, not increased by chewing, but excited by picking the tooth. Pulsatilla is seldom ever useful when the gums and chee'ks are swollen. Staphysagria removes toothache affecting both sound and carious teeth, which is aggravated by food and drink, with tearing which commences in a decayed tooth and extends over the whole side of the face as far as the pes anserinus, where the most violent pains are experienced, aggravated by slight contact, and re- lieved by strong pressure. It is useful for gnawing pain in a decayed tooth, with drawing in other teeth, aggravated early in the morning, after chewing, in the open air and by cold drinks, relieved by warmth, with readily bleeding gums, or with painful swelling of the gums. There are many other remedies for rheumatic tooth- ache, such as Hyoscyamus for violent tearing tooth- ache, which generally comes on in the morning and is excited by cold, with congestion of blood to the head, and heat which is sometimes felt over the whole body ; or for tearing, beating pains in the upper anterior and molar teeth of the right side, both sound and decayed, ex- tending over the upper jaw and right half of the nose as far as the root of the nose and right eye, also to the lower jaw and teeth, with swelling of the gums, rush AND RHEUMATIC ODONTALGIA. 83 of blood to the head, burning heat of the face and whole body, dulness of the head and dull headache, the teeth feel elongated, loose, and are covered with mucus. Bryonia is useful for flashing-darting pain, which shifts to another tooth on touching the affected tooth ; it is aggravated by warm drinks and warmth of the room, also by mastication. It frequently relieves the toothache of pregnant females. Rhus tox. for tear- ing pains with soreness, aggravated by warmth and at night, less when sitting than when lying; if the teeth be sound, Rhus t frequently helps in cases where Nux v. has failed. Sabina for beating, tearing pains, with sensation as if the tooth would be shattered, with beating in all the blood-vessels. Colchicum for sticking jerking pain, attended by a feeling of lameness and cramp pain in the articulation of the jaw, and by a peculiar sensi- tiveness of the teeth on pressing them together, with nightly exacerbations. China for throbbing toothache, the pain being felt even externally, aggravated by the least contact, relieved by pressing the teeth firmly toge- ther; warm drinks are more easily borne, but the pains are aggravated by external warmth and a horizontal po- sition. Causticum is useful for pains which are caused by cold air penetrating into the mouth, particularly violent at night, at times affecting the teeth on one side of the face only, at others affecting all the teeth, and extend- ing even to the forehead, with sensation of elongation and looseness, painful, readily-bleeding gums, and ina- bility to lie on the affected side, or to take any thing warm or cold into the mouth. Ignatia removes vio- lent, clawing, digging pain which is felt quite sudden- ly, particularly after eating, when drinking coffee, or when touching the sound teeth with the tongue; it likewise removes a pain as if the teeth and their nerves would be crushed. Spigelia for constant drawing and tearing in all the teeth, particularly of the upper jaw and in the front teeth; or for a pain flashing through the crown and roots of single teeth, and which is some- times beating, most frequent in the day-time, less at night, relieved by tepid applications, aggravated and excited by heat or cold; for beating toothache with si RHEUMATISMUS PARALYTICUS. pain in the face, bloatedness of the face' and great sensitiveness of the teeth to cold air, particularly when carious. Rhododendron for toothache^ which general- ly returns in the spring and fall during an east wind, with boring in one tooth which feels as if in a vice, with sticking penetrating as far as the ear ; the pain is aggravated by contact, cold drink, cold air, or at night, and is somewhat relieved by warmth. Coffea is useful for darting pains, or paroxysms of pressure, for pain when biting, or for pains which seem intoler- * able, the patients are beside themselves, weep, trem- ble. Sulphur for sticking jerks in decayed teeth, ex- tending to the upper and lower jaws and to the ear, with swelling of the gums, beating pains, bleeding of the gums, swelling of the gums around an old stump, with pain in the evening or in the open air, or in a draught of air, aggravated by cold water. /Sepia for tearing or beating pains, (particularly in pregnant fe- males) ; the pains are aggravated by warmth and by currents of air, with dulness of the teeth and soreness of the gums ; generally at night, and when the pains are chronic. Aconite for toothache which is accom- panied by violent vascular excitement, and is relieved by cold drinks. The north pole of the magnet cures a toothache which affects all the decayed teeth at once, when the gums are swollen and painful to the touch ; slight dartings, with pressure, or a digging, tearing, or burn- ing sticking is experienced in the periosteum of the jaw, and the incisors are frequently painful on inhaling air. For nocturnal toothache: Nux v., Chamom., Pulsat., China, Bellad., Magnes. carb., Acid nitr. For toothache which is aggravated by cold things in the mouth: Nux v., Merc, Rhus t., Staphysag. For toothache which is relieved by cold things in the mouth : Bryo., Puis., Aeon., Bell. § 168. F. Rheumatismus paralyticus. This rheumatism affects the motor nerves only, and is without pain or swelling. It affects principally the muscles of the face, and those 6f the extremities, and sets in suddenly, without any precursory symptoms. RHEUMATISMUS PARALYTICUS. 85 The facial muscles are strikingly distorted ; the mouth and frequently the eyelid on the affected side droop, and inasmuch as the muscles of this side do not counter- balance those of the opposite side of the face, the mouth is constantly drawn to this side, in laughing, talking, etc. Mastication is more or less impeded, the saliva flows from the half-opened mouth, the tongue is fre- quently involved, and can only be put out of the mouth on the sound side, the eyelids are generally open, and cannot be closed except with the finger, and then they remain so. The affected parts feel cold and more or less insensible to the patients, although they have the usual temperature to others. If the extremities should be affected, it is generally the lower, and usually both together, they become stiff, immoveable, more or less insensible, without change of shape or temperature. Sometimes a painful creeping and formication is ex- perienced for some hours before the attack sets in. If the upper limbs should be affected, the breathing is generally impeded. There is scarcely ever any fever. The disease cannot well be confounded with apo- plexy, inasmuch as the functions of the brain and senses remain undisturbed, and the patient feels other- wise well. This rheumatism is generally caused by exposure to cold water or a current of air. The rheumatic lameness of the facial muscles is generally without danger ; that of the extremities may change to actual paralysis, or, by invading the cen- tral portions of the nervous system, may terminate in nervous apoplexy. When the upper extremities are affected, the pectoral muscles may become paralyzed, in consequence of which the respiration may stop. § 169. This affection is principally cured by Nux vom., Bellad., Rhus t., Caust, Graph., Secale com. Nux vom. has cured many cases of paralysis, partic- ularly of the facial muscles, when a painless drawing, jerking, and formication were experienced in the af- « fected part. Motion is restored very gradually. Nux v. is likewise useful in paralysis of the lower extrem- ities, with or without pain in the vertebral column. 86 PSOITIS. Belladonna corresponds to paralysis of the facial mus- cles, when the tongue is involved and the speech im- peded in consequence. Rhus t. is eminently useful in catarrhal affections with perspiring skin, and partic- ularly in rheumatic paralysis of the extremities. S,>- calc cornutum deserves great attention in this affection, and Plumbum likewise, particularly in paralysis of the eyelids. For further details we refer the reader to the article " Paralysis." § 170. Inflammation of the psoas muscle.—Psoitis. This kind of inflammation is not very rare, but it is easily misapprehended when gradually developing itself out of a rheumatic affection of the lumbar re- gion. It is known by the violent drawing, tearing, tensive, inflammatory, seated pain in the* region of the kidneys, sometimes extending along the1 spine' up to the shoulders, or down to the bladder and feet, without following exactly the course of the nerves. It is fur- thermore known by the sensation of debility and numb- ness of the thigh of the affected side, and by the pain being aggravated when the thigh is extended or drawn up. The pain is likewise aggravated in a re'cumbent posture, or by turning from side to side-. The patient limps, and has to bend forward in attempting to walk. Swelling is rarely visible. The absence of urinary difficulties and of constipation distinguishes psoitis from nephritis. If suppuration should set in, the' pus may discharge into the cavity of the abdomen, and thus lead to death, or it may- burrow downwards, causing phthisis lumbalis, and suppuration in distant parts. The fever is generally a synocha. In chronic psoitis the pain is less intense, more er- ratic, remitting, or felt only when drawing the thigh up or turning it, or when turning from side to side, or bending backwards ; there is a feeling of numbness, of debility, or a peculiar kind of sensitiveness, without • much fever at first. The pain becomes more and more seated, until at last, in the absence of proper treat- ment, perhaps after years, symptoms of suppuration show themselves. Psoitis is sometimes occasioned by a mechanical cause, violent straining, a blow, fall on GOUT, ARTHRITIS. 87 the back, nates ; rheumatism and piles are among the general causes. § 171. If the accompanying fever should be a syno- cha, Aconite has to be used until the fever and the other inflammatory symptoms abate. If typhoid symp- toms should be present from the commencement, proper remedies have to be selected. Bryonia, Nux voin., and Bellad. have to be used when the pains in- crease during motion; Rhus t. and Puis, when the pains are worse during rest, or are aggravated by cool air blowing on the affected part; Cantharides, when the inflammatory affection is accompanied by ischuria, dysuria, or strangury; Mercurius and Chamomilla when the pains are most intolerable at night; Staph- ysagria when the pain is beating and points to incip- ient suppuration, in which case Arnica, Chamomilla, China, Mercurius. Hep. s., Stannum, Sulphur, Eupion, Kali carb., Aurum, Asa, are likewise useful. Bella- donna, when the pains are drawing, tearing, and have a still somewhat inflammatory character. Belladonna is suitable for both acute and chronic psoitis; so are Rhus t. and Nux v., whereas Digit., Colocynth, Arg. fol., Plumb., Sil., are more adapted to the chronic form. § 172. Gout Arthritis. Gout is supposed to originate in some peculiar dys- crasia, affecting the joints and synovial capsules. An attack of gout is almost always preceded by loss of appetite, flatulence, pressure in the region of the stomach, heaviness and tension in the abdomen, rum- bling in the bowels, turbid and slimy urine, slimy coat- ing on the tongue, sluggish alvine evacuations or slimy stools, discharges of mucus from various parts of the body, lungs, bladder, rectum, etc. A sensation of coldness, drawing numbness, stiffness, creeping heavi- ness and heat is generally experienced in the parts some time previous to the attacks setting in. Malaise, lowness oLspirits, hypochondriac symptoms generally co-exist with the other precursory symptoms. These precursory symptoms seldom exist all together, and are frequently designated by the term " atonic gout." It is not always easy to designate the precursory symp- N8 GOUT, ARTHRITIS. toms of gout, inasmuch as similar symptoms may arise from other sources. We are somewhat sure of the- arthritic character of those symptoms if the patients are bornof arthritic parents, ifthey are visited now and then by arthritic pains, if the pains are relieved by sweat, if a calcareous sediment is deposited in the1 urine, if sea- son, weather and temperature of the atmosphere have a great influence on the disease. A characteristic symptom of latent gout is numbness at a certain spot on the skin, or the sensation as if wool or fur were ly- ing on the skin. Symptoms of fully-developed acute arthritis are : pain now in one, then in another joint of the' extremi- ties ; it comes on suddenly, is gnawing, boring, cutting, and then changes to a violent tearing and burning, with great sensitiveness of the affected parts, so that they bear neither covering nor contact. This pain ex- acerbates and remits regularly with the fever, is most violent at night, makes the patient wakeful and uneasy. The joint cannot be bent or moved on ac- count of the pain, which is relieved by warmth, and is disposed to shift to other joints or internal organs, with more or less danger. The affected part does not be- come red till the pain has lasted several hours ; the redness is attended with heat and a tight hard swelling, of the colour and consistence of erysipelas, and readily transformed into arthritic nodosities with calcareous concretions. The accompanying fever has generally an erethic character. It Sets in at the same time as the looal inflammation, and is generally attended with flatulence, acidity, accumulation of mucus, apepsia, constipation, scanty, turbid, cloudy urine and dry skin. § 173. Genuine acute gout is distinguished by regular paroxysms which are accompanied with fever, and ter- minate critically ; they occur generally at the equinoc- tial periods, and are succeeded by perfect relief, lasting more or less time. These paroxysms have the char- acter and run the course of an inflammatory fever. They last from three to four weeks, with disposition to relapses, each paroxysm being characterized by in- crease, acme of development, decrease, and terminate GOUT, ARTHRITIS. 89 with critical sweat which generally smells sour, and a thick, white, calcareous and sometimes reddish sedi- ment in the urine. Gout may affect various parts of the body, and is apt to shift to internal organs. Chronic gout arises most frequently from the frequent recur- rence of an acute attack, and results in the formation of arthritic nodes, calcareous concretions, which form around the joints, impeding motion or rendering it im- possible, and sometimes in actual exostosis. Gout affects principally males, with strong, plethoric constitutions, fond of rich food, excesses in venery, spirituous drinks, and leading a sedentary life. This disease is hereditary, and may moreover arise from exposure to a damp, cold atmosphere, damp habita- tions, suppression of habitual discharges of blood, such as piles and menses, suppressed or mismanaged cuta- neous eruptions, particularly from suppression of itch and syphilis. § 174. Gout is more easily cured in the precursory stage than when fully developed. When arising from rich living, abuse of coffee, wine and spirits, mental exertions, watching and sedentary mode of life, Nux v. is the best remedy. When caused by venereal ex- cesses, onanism, China, Acid Phosph., Phosphor., Coni- um, Sepia and Staphysagria should be used. In other cases, Bryonia, Pulsat., lgnat, Chamom., Bellad., or some one of the remedies mentioned for gastric affec- tions, will prove useful. (See § 44, etc.) If the local affection should be accompanied with synochal fever, Aconite should be used first. FWrum proves curative when several parts are affected at once, when the violent stinging and tearing obliges the patient to move the parts constantly, and when the patient has a pale, consumptive complexion. If there should be evening exacerbations, or if the pains should be diminished by uncovering the part and exposing it to a current of cool air, Pulsatilla is the best remedy. It is a specific remedy when the symptoms shift sud- denly from one place to another, or when the knee is inflamed, with fleeting drawing, darting pains. Cocculus is sometimes useful in arthritis inflamma- 90 i GOUT, ARTHRITIS. tion of the knee, or in hot swelling of the hands; likewise for a tearing, sticking pain in the shoulder and elbow-joints, as if broken, with sensation of heavi- ness, aggravation during rest, and diminution when moving the affected parts. Sabina is likewise an ex- cellent remedy for wandering gout, with tearing, stick- ing pains in the distended joints, with feeding of lame- ness, general malaise, and disappearance of the pains by exposure of the a fleet eel parts to cool air. If the exacerbation should set in in the morning hours, Nux r. is indicated. Bryonia corresponds to attacks of gout which are1 excited by motion. If the local affec- tion should be accompanied with erysipelatous swell- ing. Bellad. is frequently the most suitable remedy. Beside these remedies we have Arnica, Rhus t., China, Dulc, Dig., Conium mac. An rum. >yw//g., Tiuct. arris, jfcrcur.. Atifim. cr.. Sfnj)hus., Staiin... Strom., Guajac, Arsen., Sarsap., Rhodod., CIn lid., Sulph. Calc acet. is useful for little n lapses, which are apt to set in at every change of we'ather. Autim. cr. will prove use- ful when nause'a, vomiting, coated tongue, flatulence, diarrhoea, etc., continue in spite of the local affection. I know from experience that China and Arnica are two of the principal remedies for gout; China for swelling of the knee and foot and aggravation of the pain by contact; and Arnica for inflammatory, or rathe-r erysipelatous swelling of the joints, with sensation of great uneasiness in the parts, obliging one to move therryxonstantly, and sensation as if they were lying too hard : the patient looks pale and livid. Arnica is likewise useful in erratic gout. In arthritic panaritia and swelling of the joints of the fingers, Mercurius and the south pole of the magnet deserve particular attention. For nodous gout, when another acute paroxysm sets in, Stnphusagria is very useful. Bryonia is excellent in arthritic swelling of the foot, with redness and heat of the> affected parts. Le- dum, Arnica, Sabina and Vera'rum are particularly suitable for podagra, when the big toe is affected. Ar- nica is the best remedy for an arthritic, numb pain in the joint of the big toe, as if sprained, and attended GOUT, ARTHRITIS. 91 with redness ; also for an indescribable pain in the af- fected foot, as if from internal uneasiness, as if the part were lying too hard, obliging one to move the part to and fro. Sulphur, second, third, or fourth trituration, is excel- lent for swelling, redness, heat, pain of the affected part, particularly violent in bed. In podagra, Sulphur sometimes relieves the most acute pain in a few hours. When the pain in the ball of the big toe had been ex- cited by friction or pressure of the boot, Arnica is the best remedy. Some propose" to use a very high dilu- tion of Arnica for that kind of pain, and if some rigid- ity of the knee-joint should remain, to remove it with Colocynth and Graphites. Rhododendron is frequently useful after the inflam- matory symptoms have been removed by Aconite, Ar- nica, Sulphur, etc. Causticum has been employed for -nodous gout, or gouty concretions, with apparent anchylosis. The affected part should be wrapt in flannel, oil- silk, or new wool, to promote perspiration. § 175. Gout is sometimes complicated with various symptoms indicating a disturbance of the reproductive functions. Sometimes the arthritic affection shifts to other organs, causing, (1.) Ophthalmitis arthritica, which is recognised by the fact that it appears simultaneously with or after the sudden disappearance of arthritic pains. Its symp- toms are, a dark redness of the opthalmic arteries, .stinging, pressure, photophobia, and lachrymation. It generally affects the cornea, which is dim and exquis- itely painful. This kind of ophthalmitis is disposed to terminate in internal exudations and suppuration, causing perforations in the cornea, and resulting in staphyloma, leucoma, prolapsus iridis, etc. The remedies for this disease are various : they are, Aeon., Bellad., Nux v., Puis., Antim. cr., Chamom., Dig., Conn., Rhus t., Mcrcur., Veratr., Euphras., Crocus, Colocynth, Spiare here likewise present: redness, heat, dryness, swelling and pain of the affect- ed parts; difficulty of swallowing, the pain is in- creased by swallowing, and yet there is a constant desire to swallow; on swallowing food, it sometimes 96 INFLAMMATION OF THE FAUCES, ETC. returns by the mouth; solid food is sometimes swal- lowed with more ease than liquid. There is a con- stant accumulation of tenacious mucus in the pos- terior part of the mouth, with constant desire to hawk it up. The patient finds it difficult to talk or breathe, he breathes with his mouth open. In a high degree of angina the jugular veins swell, the face becomes purple-coloured and livid, there is headache and de>- lirium. The inflammation is generally attended with bad taste, and fetid breath, even with desire to vomit and ptyalism. The organism is generally disturbed in most cases ; the general symptoms preceding the local affection for some days. The patients complain of weariness, pain in the limbs, chilliness, heat, headache, fever. This is a synocha, when the inflammation has a phleg- monous character, and depends greatly upon the con- stitution of the patient, the exciting cause, etc. In tonsilitis, the mucous membrane exhibits a more or less vivid redness, or red spots, is swollen, dry, or covered w^th a pappy, gray, white, yellow mucus, which extends to the tongue. One tonsil is generally inflamed first, the left sooner, and more violently than the right. If the uvula be inflamed, it is likewise more or less swollen, red, elongated, the point generally resting on the root of the tongue. We have no particular remarks to make on pharyn- gitis mucosa. § 184. Such an angina generally disperses in from five to fourteen days, with decrease of all the general and local symptoms. If the cellular tissue of the ton- sils should be the seat of the inflammation, it readily terminates in suppuration ; in this case the swelling, and the difficulty of breathing and swallowing in- crease, and it is frequently impossible to open the jaws ; in many cases the pus discharges suddenly in hawking, coughing, etc., with immediate relief. Ul- ceration and gangrenous degeneration, only take place in individuals with syphilitic, scorbutic, scroph- nlous, etc.. dyscrasias. Induration and hypertrophy INFLAMMATION OF THE FAUCES, ETC. 97 result from chronic angina, which had developed itself in consequence of frequent relapses. A predisposition for such inflammations exists in young people, in persons who had been attacked with angina, in scrofulous subjects, and in individuals of feeble and sickly constitutions. Exciting causes are : a cold, getting wet, exposure to wind, cold drink- ing when the body is heated, unfavourable state of the weather, cold north and east winds. Angina may result from wounding the throat by mechanical or chemical substances, from inhaling acrid sub- stances, from aphthae, syphilitic ulcers, and abuse of Mercury. § 185. The principal remedies for angina faucium are : Aeon., Bellad., Merc, sol., Merc, subl., Hep. sulp., Rhus t, Bryon., Ignat., Chamom., Puis., Cocc, Arg., Caps, an., Nux vom., Ars., Sulph., Acid, nit., Acid. phosph., Baryt, etc. Angina faucium most frequently involves the root of the tongue, the soft palate and the pillars, the uvula, tonsils, and the mucous membrajie of the fauces, either singly or all together. The most fre- quent kind of angina, is an angina tonsillaris and uvularis. The patient is troubled with a constant ac- cumulation of saliva, inducing constant and painful efforts to swallow or hawk. When this inflammation is accompanied with synochal fever, and congestion of the blood to the head, Aconite is the suitable specific. Chamomilla will prove useful in some mild cases of angina tonsillaris and pharyngea characterized by a burning, stinging pain in the region of the larynx, and attended with roughness of the voice, some tightness of the chest, titillation and hacking cough ; the tonsils and submaxillary glands are sometimes involved. Belladonna is indicated by the following symptoms : bright, phlegmonous redness of the soft palate, velum pendulum palati, root of the tongue, uvula and tonsils, without much swelling ; dryness of the fauces, sting- ing pain during deglutition, which is difficult and fre- quently attended with a sensation as if the fauces were spasmodically constricted : between the acts of 5 98 1NFLAMMATKJN OF THE FALC'ES, ETC. deglutition a tearing pain is frequently experienced, expending to the temple and jaw. and particularly the submaxillary gland, which is frequently swollen. Aco- rite should be given first if there be synochal fever. Kummel states that Bellad. and Dulc. act most ra- pidly in angina if a dose of Merc is given previous to or in alternation with those remedies. Dulc is more suitable to the pituitous stage. Belladonna is likewise suitable for angina, which is r be quite well, and even go to sleep quietly. The continuance of the feverish pulse, howeve'r, shows that this rest is only apparent. The breathing is anxious, hurried, by fits and starts ; when the paroxysms of cough are very violent, the child is sometimes on the point of suffo- cating. The patient expediences more or less pain in the larynx or trachea, which is aggravated by contact. On looking into the mouth, the tonsils and fauces ap- pear red, the epiglottis looks cedematous and swollen. Little by little the paroxysms of cough increase in vi- olence ; the breathing becomes more and more diffi- cult, hissing, rattling, as if from a fluid in the trachea, the sawing respiration being heard even at a distance. The patients lie with thedr necks stretched, and some- times grasp at them during the attack. The orthop- noea becomes excessive ;" at every inspiration the la- rynx descends towards the sternum, during an expira- tion it is raised towards the jaw. Under these cir- cumstances, vomiting frequently sets in, with discharge of membranous, tubular masses. If the pulse be- come quick, small, thready, if the rattling breathing increase, and the breathing be effected by means of the abdominal muscles, if the face become bloated and blue, and the children bend their necks backwards, or sink into a sopor from which they are only roused by the paroxysms of cough, the danger of apoplexy is very near. Croup is generally seated in the larynx; the tra- cheal croup is much less frequent, and the bronchial croup is distinguished from the other kinds by a rather stertorous than wheezing respiration, by an absence of distinct remissions, by constant dyspnrea, and by the rattling noise which is perceived all through the chest by means of the stethoscope. §200. Etiology: Croup is more'frequent in the north than south. In some families croup seems to be hereditary. It is sometimes occasioned by sudden exposure to cold, when the thoracic organs are CROUP, ETC. HI heated by running, crying, etc. According to Schcen- lein, croup may likewise arise by metastasis from whooping-cough, from a simple catarrhal affection, or it may be occasioned by the measle-contagium. which will lead, in some individuals, to the formation of croup, instead of developing the measle-eruption. Croup appears most frequently in the first part of spring and in the latter part of the fall. As an epi- demic disease, it may occur in every season. The prognosis depends upon the nature of the epi- demic, upon the age and individuality of the patient, and particularly upon the periods when the physician is called to the patient. The prognosis is more unfa- vorable when there is considerable exudation with lit- tle expectoration ; when symptoms of suffocation, ner- vous paroxysms, convulsions, coma, etc., have set in, there is scarcely any hope. § 201. When the disease is preceded by a catarrhal stage, the remedies indicated for a catarrhal fever, (see § 29, etc., and § 196,) may be employed. A keen ob- server will however perceive that this apparently simple catarrh is of a peculiar kind, that the cough is spasmodic, hollow, hoarse, attended with wheezing or rattling. In this case, the following remedies should be thought of: Hyoscyam., Bellad., Cina, Chamom., China., Ipec, Nux vom., Puis., Drosera. If the cough should have the croup-sound, without inflammation or swelling being present, Hepar sulph. c will prove very serviceable. In one case I have removed a me- tastatic cough with the croup-sound, by a few doses of Cupr. met., second trituration ; (the patient was a full-grown girl.) If the disease should set in suddenly, with synochal fexer and evident symptoms of inflammation of .the larynx, Aconite should be employed in repeated doses, until the nervous and vascular irritation, the burning heat, thirst, the hurried breathing, are removed. Aco- nite is sometimes sufficient to cure the disease. If the wheezing, quick, anxious, difficult breathing, and a hollow, hissing cough, with pain in the region of the larvnx. etc., should set in from the- commencement, 112 PAROTITIS, ETC. Spongia should be used immediately ; in 24 hours the danger is generally over. If after this lapse of time, the cough should still have the peculiar croup-sound, the breathing should still be hissing, or if there should still be danger of suffocation, Hepar s. c is then to be employed. I have frequently cured croup with Hepar sulph. c, without first giving Aconite or Spongia. The disease was then epidemic, and attacked, for the most part, scrofulous subjects. In some sporadic cases, where the membrane was already formed, a solution of Io- dine, third attenuation, in alternation with the second attenuation of Aconite, giving three drops every half hour, the patients were cured slowly but certainly. Iodine always deserves consieh ration when scrofulous or leucophlegmatic individuals are attacked by the disease. If the disease should not yield to the aforesaid rem- edies, or if the height of the paroxysm should be char- acterized by spasmodic symptoms, Sambucus, but more frequently Moschus, is of great use, and sometimes al- ters the character of the disease so as to render one of the\)ther remedies available. In some cases of croup, an obstinate hoarseness with slight catarrhal croup remains after the disease is cured. This hoarseness seems to arise from a lameness of ex- ternal laryngeal, and its branch, the recurrens, and yields most frequently to Phosphorus. Merc, Hep. sulph., Rhus t., Drosera, Mang-an., are sometimes of use for the last mentioned difficulty, but they scarcely ever do more than palliate the trouble. Arnica and Belladonna are much more available, or frequently and rapidly repeated doses of Hepar s. Now-a-days most physicians treat croup with alter- nate doses of Hepar s. and Spongia. § 202. Parotitis, Angina parotidea. Parotitis is generally preceded by a precursory stage ; the patient feels languid, low-spirited, com- plains of pains in the limbs, sleeplessness, restlessness, loss of appetite, chills alternating with heat, drawing PAROTITIS, ETC. 113 in the cervical muscles, headache, coryza, etc. In a few days the parotid glands begin to swell, after which the submaxillary and sublingual glands become involved. If the lymphatic glands of the neck should become involved, the neck grows as large as the head, and becomes quite stiff. The affected parts are hard and painful, but the pain is, generally speaking, slight, tensive, itching, aching. The motion of the jaws, mas- tication and deglutition, are impeded. The fever gen- erally abates when the parotis commences to swell. The precursory symptoms vary in violence ; the fe- ver may be slight or violent, attended with delirium, convulsions, vomiting, etc.; it has distinct intermis- sions and exacerbations. The swelling generally ap- pears on one side first, and then shifts to the other; it is not very tight, the skin over it is not very red ; there is not much heat in the swelling ; sometimes it is at- tended with pain about the neck and scapulae, or with pain in the ears. There are cases where the swelling disappears suddenly, and shifts to the testes, breasts, labia pudendi, ovaria, or to the meningeal membranes. Suppuration occurs very seldom, and then only when the inflammation had a phlegmonous character, or in parotitis typhosa or scarlatinosa. The termination in induration is likewise very rare. If the physician be called in time, and adopt proper measures, the disease generally ends favorably, except in very scrofulous subjects and in persons who have been frequently at- tacked with the disease. § 203. The disease appears both epidemically and endemically. Persons of either sex are liable to it, particularly at the age of pubescence. § 204. The principal remedies are Rhus t and Merc. sol. H. The latter may be used in any stage of the disease, even when suppuration has already set in. When the disease is characterized by erysipela- tous redness and swelling, Bellad. should be given. When typhoid symptoms set in, Bellad. and Rhus, t, are indicated, (see § 75, etc.) Some physicians recom- mend Kali carb.. when chilliness and heat alternate. the glands are highly inflamed, hard, painful to con- 114 INFLAMMATION OF THE NOSE. tact, and the hearing is diminished. If parotitis should set in, in conjunction with angina faucium, the reme- dies which have been indicated for the latter disease should be used. If lock-jaw should take places Rhus. t, Hyoscyam.. Bryon., and electricity will remove it, "particnlarlv when the closing of the jaws arises from the swelling or the subsequent, induration of the glands. Conium, Dulc. Chini, Bellid.. Cocc, Ferr., Baryt. aeet. or carb., Silicca, are likewise suitable for that con- dition. § 205. Inflammation of the nose. For erysipelatous inflammation of the external nose with swelling and burning pains. Arnica, Belladonna, Rhus t. Sulphur, or Silicca, are the most suitable rem- edies. In ozaena narium, which does not always depend upon syphilis, but sometimes arises from scrofula, a violent cold, or some general dyscrasia, the frontal sinuses and the antrum highmorianum are involved, first the mucous membrane and afterwards the perios- teum and the bones (caries.) The nose becomes red and*big, even the periosteum becomes thickened, and frequently induces such a swelling of the nose as makes it impossible to breathe through that organ. Aurum, Bryon, Rhus (., Cocculus, Veratr., Urcur., Sunn., Calc. carb., and the magnet, relieve that condition. For ex- ternal and internal swelling of the hard and soft parts, with great sensitiveness, loss of smell, dryness of the nose, (dry coryza,) Zincumis one of the principal rem- edies, although B.iryt, Graphit., Nat rum mur., and other remedies, are sometimes indicated. If the in- flammation should be attended with titillation, or a burning, smarting pain, discharge of fetid, purulent, yellow-greenish matter, the following remedies are in- dicated: Rhus L, Nux v., Conium, Mezereum, Cina, Merc, Aurum, Ranunculus bulbos., Asa., Thuja, An- tim. cr., Canthar.. Phosphorus. Rhus, t, Nux c, Can- thar. and Bellad. desen-ve a preference when the dis- ease broke out without any definite cause. Merc, Thuj., and Aurum, when it arose from gonorrhoea, or OSTITIS. 115 some other syphilitic affection. If the disease should be attended with mercurial symptoms, or caries, Hep. Sulp., Aur., Mez., Asa., Con., Phosp., Calc. c, and Sit, should be used. § 200'. Ostitis, inflammation of bones. The vessels of bones and the periosteum are fre- quently found inflamed. The pain is most violent when the marrow is inflamed, less in periostitis, and still less in ostitis. It is sometimes easy and at other times difficult to diagnose ostitis ; in diagnosing that disease, we have to consider the scrofulous and syphilitic diathesis. Some bones are more liable to inflammation than oth- ers. The symptoms of ostitis are : heat, which is even felt externally ; redness, not only of the bones but also of the periosteum and the external integuments; swell- ing and softening of the inflamed bone, most distinct in the epiphyses of bones. This swelling develops itself slowly, the bone becomes spongy, porous, ex- tremely sensitive, and loses its specific gravity. The pain is rather dull, boring, more violent at night than in the day time, particularly when the inflammatioYi is of a syphilitic nature, or arises from mercurial poison- ing. The bone becomes curved, the muscular action preponderates, whence deformities ensue. The fever is not very violent, but exacerbates in the evening and at night. § 207. The course, duration, and classification of os- titis vary considerably, according as the disease arises from one or the other cause. The fever is generally erethic, except in the case of young subjects, where the fever is frequently a synocha. Ostitis is generally cured under homoeopathic treat- ment ; it may, however, terminate unfavourably : (1.) In suppuration of the bone. The pus is a red- dish, fetid fluid. The suppuration generally takes place superficially, the periosteum is destroyed, the bone becomes rough and porous. If the suppuration should be more deep-seated, the pus is more coloured and fetid. The inflammatory symptoms disappear 116 OSTITIS. gradually, the bone swells up more and more, parts become detached, causing external suppuration. If the suppuration should continue for a time, it some- times terminates in humid caries. (2.) In induration. This termination is more frequent in chronic than in acute inflammations, particularly when the patient is weakly and has a torpid, scrofu- lous constitution. The bone becomes unusually hard, raised, (tophus,) changes to a porous, spongy mass, which is liable to renewed inflammations. (3.) In softening, (osteosarcoma,) terminating sooner or later in induration. (4.) Anchylosis; this occurs most frequently in the joints, elbow, knee, carpal and tarsal joints. (5.) Osteonecrosis; when this condition sets in, the acute pains cease, the inflammatory symptoms abate, the diseased portion of bone gradually separates from the sound bone, in which suppuration gradually sets in, by means of which the last portion is sometimes re- stored. This termination is most frequent in the long bones, particularly on their surface. Children and adults are more liable to ostitis than old people, particularly when born of scrofulous or syphilitic parents. Bones which have been once in- flamed are exposed to a renewed attack of inflamma- tion. Simple ostitis is not incurable. Ostitis complicated with some general dvscrasia, or with a mercurial or psoric diathesis, is much more difficult to cure. § 208. Aconite will be found necessary in a few cases only, particularly when the inflammation was caused by fracture, contusion, etc. In most cases, the inflammation is a mere symptom of some more general disease, and will yield to the remedies indicated for the latter. In slight cases, when the inflammation is not yet far advanced, and the skin is simply red, with slight swell- ing of the bone, and sensitiveness to contact, Bryon. and Puis, will be found suitable A much more use- ful remedy in ostitis is Mercurius, except when the inflammation was caused by the excessive use of that INFLAMMATION OF LVMPHATIC GLANDS. 117 poison, in which case Puis., China, Hep. sulp., Sulph., Electricity; or, when the inflammation has an erysipe- latous character, Bellad. will prove beneficial. Spe- cific remedies for ostitis, including mercurial and sy- philitic, are : Daphne Mez., Asa fceiida, Staphysag., Aurum, Mangan. acet, Acid, phosphor., Sulph., Silic,' Calc. carb., Lycop., Nitr. ac, Sepia, Baryta, etc. Man- gan. acet. is less useful in inflammation of the bone itself, than in periostitis and inflammation of the joints with intolerable pains. In inflammation of the facial bones, Mercur., Staphys., and Aurum are particularly useful. Merc, and Staphys. are likewise useful in in- flammation of the iliac bones. Asa and Mezer. are more especially indicated in inflammation of the super- ficial bones. Mezer. is particularly useful in periosti- tis, which maybe discovered from the fact that the adjoining soft parts are likewise more or less inflamed. Acid, phosph., Asa, Mez., Merc, Sil., and the other above-named remedies, are excellent for caries and ul- cers of bones, even when caused by the excessive use of Mercury. All these remedies may likewise be em- ployed with advantage for the chronic disorganiza- tions resulting from ostitis. Carb. veg. should be mentioned for a burning pain in the bones; Phosphorus is likewise excellent. § 209. Inflammation of the lymphatic glands and ves- SSlSm This condition occurs very frequently among chil- dren, and involves the adjoining cellular tissue. Such inflammations frequently recur periodically, excited by the least cause, and continue until the age of pubes- cence, or even a more advanced age, in case nothing is done to eradicate the constitutional disposition. This disease is likewise a symptom of a more general af- fection, and disappears under the use of proper rem- edies administered for the latter. An inflammation of the superficial lymphatic glands and vessels is easily seen. The inflamed vessels form shining-red radiating strings or cords, which frequently extend to some larger or conglomerate gland, some- 118 INFLAMMATION OF LYMPHATIC GLANDS. times involving smaller glands, which likewise become inflamed and swollen, thereby giving the vessel a knotty appearance. The affected parts feel hot, occa- sion a tensive, exceedingly stinging pain, the tension being even perceptible externally; the pains are ag- gravated by motion, generally exacerbate simultane- ously with the fever, which is most frequently erethic, and accompanied with gastric symptoms. § 210. One of the principal remedies for inflamma- tion of lymphatic vessels and glands is Belladonna, which is likewise indicated when the' lymphatic in- flammation is accompanied with erysipelatous inflam- mation of the adjoining parts. Belladonna is likewise frequently suitable for the so-called cold swellings of the lymphatic vessels, with little or no inflammation, such as is frequently seen on the lips and external gen- ital organs, accompanied with tension, fluctuation, and violent periodically-appearing pains. An inflamma- tory condition very similar to the one above described, with swelling of the face, of one cheek, and of the up- per lip, containing hard places, which are painful to the least touch, do not bear tne least covering, with throbbing pain, and attended with confusion of the head, is likewise safely and permanently removed by Belladonna. If the pain in such a swelling should be burning, Carbo veg. is preferable to Belladonna ; in some few cases Arsenic Next to Belladonna, Mercurius is one of the best rem- edies for lymphatic inflammations, even when it has become impossible to prevent suppuration; though Silicea will always hold the first rank as a specific for suppurating lymphatic swellings. Cocculus is suitable for sub-inflammatory lymphatic swellings, when contact excites stinging, tearing pains and heat in those swellings. Bryonia should be exhibited when violent pains are excited in the affected part by motion. Puis., Dulc, and Conium have more specific rela- tions to the lymphatic system than Bryonia, and are, therefore, more suitable than this latter remedy, for inflammatory conditions of the lymphatic vessels and HEPATITIS. 119 glands. Conium is known as a specific for inflamma- tion of the mammae, occasioned by contusion or a shock. ' Rhus t, Sulph., Hep. s., Antim. cr., Dig., Spong., Cicuta, are sometimes suitable for lymphatic inflammations attended with gastric derangement. § 211. Hepatitis, inflammation of the liver. Most physicians distinguish an acute and chronic inflammation of the liver. The inflammatory process does not involve the whole liver; it is limited to one lobe, or to only a portion of a lobe. We know from post-mortem examinations, that at the end of the first stage the liver is filled with black blood, and en- larged ; this condition of the liver is soon followed by the stage of red softening, which terminates in suppuration; hence the frequency of abscesses of the liver in hepatitis. Such an abscess corresponds to the extent of the previous inflammation ; in recent abscesses the pus is white, creamy; in old ones it is greenish, yellowish, chocolate-coloured, and has a fetid ammoniacal odour. According as the abscess is situa- ted, the pus burrows in various directions, towards the umbilicus, region of the hip, along the dorsal vertebrae, or into some adjoining organ, stomach, duodenum, transverse colon, or even into the right lung, in conse- quence of adhesions with the diaphragm. Recovery may take place in all those cases, except in the latter, where the patient generally dies of hectic fever. It is difficult to diagnose hepatitis, inasmuch as the pathognomonic symptoms of hepatitis may likewise be supposed to point to some other morbid condition of the liver or of some adjoining organ. The difficulty of a correct diagnosis is increased by the fact, that in most cases only a portion of the liver is inflamed, and that the seat of the inflammation varies a good deal. The following may be considered essential symptoms of hepatitis: Seated pain in the right hypochondrium, below and around the false ribs, frequently extending to the epigastric region or sternum, and afterwards even to the thorax. The pain is stinging, burning. 120 HEPATITIS. cutting, tensive, sometimes very violent, al other times only dull, aching or felt only during a deep inspiration, cough, external pressure, or when lying on the right side. The region of the liver is extremely sensitive, tight, sometimes swollen, hot, dotted with red spots, and a strong throbbing being frequently experie-nced in that region. The percussion-sound is dull over a large surface. Consensual symptoms are: pain in the top of the right shoulder, in the clavicle, arm, with sensation of paralysis or as if the part would go to sleep; these sensations are sometimes experienced in the whole right half of the body. Breathing is very difficult, anxious, interrupted, sighing; sometimes a dry, deep, and hollow cough is present. Pleuritic stitches, dyspnoea, cough, and other symptoms, resem- bling those of pleurisy, increase by turning to the left side, so that, in some cases, the patient has to lie on his back, or sit stooping. The patient is unable to sneeze. All these symptoms point to inflammation of the convex portion of the liver. The inflammation is generally attended with a violent fever, which is fre- quently remittent or sometimes intermittent, the pulse is more or less hard and frequent. Other gastric or bilious symptoms are : hiccough, loathing, eructations, attended with anguish, occasional retching and mode- rate vomiting, without relief, or rather with aggrava- tion of the morbid symptoms ; a peculiar sensation of fulness, nausea, burning, and anguish in the pit of the stomach, bitter taste, yellow tongue, more or less jaundiced appearance, retention of stool, or else hard, gray, clayey stool, particularly when the concave por- tion of the liver is affected. The precursory stage is like that of gastric fevers. It generally sets in with a violent chill, followed by burning heat, which generally abates in the morning hours. The symptoms of hepatitis differ according to the seat of the inflammation ; they will be described more particularly hereafter. § 212. The bilious secretion is more or less dis- turbed by the inflammation, which occurs more fre- HEPATITIS. 121 quently in summer. It is occasioned by colds in tne abdomen, particularly at a time when great heat alter- nates with damp and cold weather; it may likewise be caused immediately by a cold drink. Violent emo- tions, anger, grief, chagrin, may likewise occasion it; or it may be brought on by emetics, drastics, worms, or by the paroxysms of violent colic attendant on gall-stones; or by direct or indirect concussion of the liver, by means of blows on the right hypochondrium, or of a fall from a height on the feet, knees, buttocks, or head; or finally by injuries, wounds, etc.; hepatitis may likewise be occasioned by metastasis in conse- quence of suppression of piles, of inflammation of joints, chronie exanthemata, erysipelas, diarrhoea, dys- entery, etc. The prognosis under homoeopathic treatment is not unfavourable. It depends upon the extent and degree of inflammation, upon the constitution of the patient, and the morbid conditions with which it may happen to be complicated. An inflammation of the paren- chyma, or the concave portion of the liver, is more dangerous than an inflammation of the surface of the liver or of its convex portion. Dangerous symptoms are : great anguish in the praecordial region, obstinate vomiting of a leek-coloured substance; pain which cannot be relieved : frequent, small, irregular pulse, delirium. Hepatitis is distinguished from gastritis by the fol- lowing symptoms: In gastritis there is no enlarge- ment of the volume of the liver which exists in hepa- titis, and can be diagnosed by percussion and palpita- tion ; jaundice is wanting, and the secretions have their natural colour. Pneumonia, pleuritis, and em- pyema, cannot be confounded with hepatitis, provided we do not overlook the above-mentioned characteris- tic symptoms of those diseases. In diaphragmitis the pain extends along the insertion of the diaphragm, the breathing is more painful, panting, sighing; there is occasionally singultus, risus sardonius, anguish, del. r- ium. A colic induced by biliari calculi is recognisa- ble by the paroxysmal recurrence of the pains, la 122 HEPATITIS. hepatitis the secretion of urine, which is interrupted ,• in nephritis, is undisturbed. The division of hepatitis into acute and chronic, fa- cilitates the treatment, It is likewise useful to distin- guish a svnochal, erethic and typhoid form, and not to overlook the sporadic, endemic or epidemic character of the disease. This inflammation terminates as all other inflamma- tions. I ought to observe, however, that no disease, after the use of leeches, is more liable to metastasis than an inflammation of the liver, and that these me- tatastic diseases are more difficult to cure than the primary affection. § 213. I know from experience that it is best to com- mence the treatment with Aconite. If the inflamma- tion should have been occasioned by violent chagrin, with gastric and icteric symptoms, Chamomilla is a specific remedy, and frequently relieves the disease in a few hours. Chamomilla is likewise indicated when there is more anguish than pain, or when the pain is dull-aching, and is not aggravated by pressure, turn- ing from side to side, or drawing breath; when the pain is accompanied by oppression of the stomach, tightness and feeling of heaviness in the precordial region, occasioning oppression of breathing; when bilious symptoms, jaundice, etc., are present, showing that the concave surface of the liver is more particu- larly inflamed. If the paroxysms of anguish should occur more frequently or at night, if there should be green, slimy, diarrhoeic stools, and a disposition to vomit, Pulsatilla may prove useful. If the inflammation be attended with retention of stool, and spasmodic symptoms of the chest, Bryonia will generally be found a specific for that condition Bryonia is, in fact, suitable for all congestive inflam- mations with violent fever and great vascular and ner- vous excitement; or for inflammations which had been occasioned by a cold or chagrin, or which are charac- terized by exacerbations occurring at night, or on wa- king, or during motion, etc. Bryonia deserves con- sideration when the fever has an erethic character, HEPATITIS. 123 and is attended with bilious symptoms ; but particu- larly when the right hypochondrium is swollen and tight, with burning or stinging pain during contact, cough, or breathing. Belladonna, in alternation with one of the above- mentioned remedies, will prove curative in chronic hepatitis, characterized by chronic sensitiveness in the region of the liver, by a yellowish complexion, altered stool, sensation of pressure or tightness in the epigastric region, irregular appetite, increased thirst, restless nights. An inveterate chronic hepatitis re- quires to be treated with the antipsorics, principally with Natrum, Muriate of Magnesia, Natrum mur., Antim. cr., Sal. ammon., Lycop., Kali carb., Sulph., Sep., Carb. an., Asa, etc. An acute inflammation of the liver can sometimes be cured by Belladonna alone, particularly when the convex surface towards the diaphragm is inflamed, in which case the pain is superficial, stinging, aggravated by pressure, inspiration, cough, or by lying on the af- fected side, when the pain resembles pleurisy, and ex- tends to the shoulder and neck. Accompanying symp- toms are : dry cough, dyspnoea, hiccough, congestion of blood to the head, dulness of the head, obscuration of sight, vertigo, as if one would faint. Sometimes these symptoms are accompanied with distention of the pit of the stomach, and an intolerable tightness across the abdomen above the umbilicus, occasioning difficulty of breathing and anxiety. If considerable thirst, agonizing tossing about, sleeplessness, etc., should be present, Belladonna is more suitable than any other remedy. Nux vomica is particularly suitable when gastric symptoms are present, and the patient has a lively, sanguine, or choleric temperament. It is more suita- ble to males than females. Nux is indicated by a stinging pain in the region of the liver, which is ex- ceedingly painful to contact, with occasional beating or throbbing in the right hypochondrium ; by consti- pation, sour and bitter taste", loss of appetite, inclina- tion to vomit or vomiting, tightness, pressure, short- 124 HEPATITIS. ness of breathing, with sensation as if the clothes were too tight, although the oppression of the chest increases on removing them, great thirst, frequent and hard pulse, bright-red, scanty urine, pressing headache, ex- acerbation of the fever, and pains early in the morn- ing. I ought to add in this place, that Aconite is much more useful in hepatitis when the pulse is accelerated, soft, full, or even irregular, than when it is frequent and hard. Mercurius solubilis is a valuable remedy when the patient complains of bitterness in the mouth, with more thirst than hunger, constant chilliness, aching pain in the right epigastric and the praecordial region, (which is likewise very sensitive to contact,) when the patient is unable to lie on the right side, has a jaundiced appearance, and complains of frequent par- oxysms of anguish. Antim. cr., China, Puis., are like- wise suitable for the above group of symptoms. I have used Cocculus with benefit for stinging and violent aching pains in the right hypochondrium, get- ting worse on stooping, coughing, or breathing; the pain extends to the pit of the stomach and stomach, and does not admit of the least contact; the abdomen is distended, with frequent vomiting of water and mu- cus, which increases the pain extremely; attended with burning heat and redness of the face, great thirst, and small, rather hard pulse. Cantharis seems to be indicated by a full and hard pulse, by violent, vague (perhaps stinging) pains in the right hypochondrium, attended with constipation. I have found China an admirable remedy for a sticking pain in the region of the liver, with sensation of subcutaneous ulceration on touching it, swelling of the right hypochondrium, diarrhoea, quick and hard pulse, redness of the cheeks, swelling of the veins of the head, etc. Lycopodium and Sulphur are excellent remedies for chronic hepatitis. Sepia is indicated by an aching- sticking tightness in the right hypochondrium, aggra- vated by contact, deep breathing, or turning to one side : it is particularly indicated by a bland and gen- JAUNDICE. 125 tie disposition, when chagrin is the exciting cause, by restless night-sleep, with paroxysms of anguish, arrest of breathing, anxiety, and palpitation of the heart. § 214. Icterus, jaundice. Idiopathic icterus consists in a limited or suppressed secretion of bile in the liver, inducing a derangement of the digestive functions, and a deposition of bilious pigment in other secretory organs, particularly the skin, kidneys, and lastly, in the mucous and serous membranes. Suddenly or gradually the albuginea assumes a yellow tinge, which spreads rapidly over all the other parts of the body ; at first it is a pale-yellow, after- wards the yellow becomes darker, reddish, saffron-col- oured ; in the highest degree of jaundice, the skin is brown, or even black-yellow. Bilious pigment like- wise makes its appearance in the urine, which be- comes yellow, brown, or even black, and, like the sweat, tinges the linen yellow. The tongue is some- what whitish, coated with mucus, the taste is flat, fre- quently bitter, attended with inclination to vomit, or vomiting of mucus and a bilious substance, the abdo- men is distended, sometimes there is pain in the re- gion of the liver, the stool is scanty or suppressed, white, gray, clayey, without bilious pigment, and fre- quently accompanied with colicky pains around the um- bilicus. If fever be present, the chilliness is of short duration, not very violent, the heat is somewhat con- siderable, the pulse is accelerated but soft, the thirst increased, and the fever has distinct remissions in the morning. Sometimes the humours of the eye even look yellow, and everything then appears to the patient in a yellow or faint-red light. § 215. We distinguish the following varieties of ic- terus : (1.) Icterus neonatorum. This comes on between the third and fourth day after the birth of the infant, very rarely on, but never after, the seventh day. Within 12 or 24 hours the skin becomes yellow, rather of an orange-colour, except the albuginea, which re- 126 JAUNDICE. mains unchanged ; the abdomen is not distended, but soft, painless ; there is little or no bilious pigment in the urine, the stool is either retained or thin, but green- ish and mixed with bilious pigment. Afterwards, between the second and tenth month, another malignant form of jaundice sometimes devel- ops itself, distinguished from the other form by the dark, brass-coloured appearance of the skin, (even of the albuginea,) by the presence of a quantity of bil- ious pigment in the urine, and by the supervention of fever, spasms, and sopor. (2.) Icterus acutus, febrilis, spasticus. This form sets in suddenly, without precursory symptoms, and is always attended with fever. (3.) Icterus vulgaris, chronicus, afebrilis. The col- our is light-yellow, the urine becomes dark-red, gradu- ally black, the tongue is clean, although the taste is bitter and even foul; there is no appetite, but rather an aversion to certain kinds of food, particularly to meat. Striking symptoms are the increasing slowness of the pulse, which sometimes falls to 40, and the irri- table mood of the patients ; their anger is excited by the least circumstance, they feel feeble, and get tired from the least exercise. (4.) Icterus senilis. This being occasioned by bili- ary calculi and an arthritic diathesis, we shall treat of this subject hereafter. Idiopathic jaundice cannot well be confounded with a similar symptomatic affection accompanying hepati- tis, organic aflections of the liver or bilious fever, on account of the absence of all symptoms denoting an in- flammatory affection of the liver or characterizing bilious fever. § 216. Acute jaundice generally occurs in individu- als at the age of pubescence, with a delicate skin, in midsummer; and is occasioned by taking fold when the skin is covered with sweat. It may even become an epidemic disease when the hot atmosphere is sud- denly cooled by a thunder storm. Jaundice may like- wise be caused by overloading the stomach, or by eat- ing hurtful food, by cooling the stomach or liver bv JAUNDICE. 127 means of cold water or ice while the body is heated, by an impeded circulation of the blood in the liver, (hence in pregnant females,) by abuse of China, rhu- barb, Mercury, (particularly calomel,) mercurial and sulphur ointments, in conjunction with improper diet; and lastly, it may arise from intermittent fevers, by a sort of metaschematismus. Icterus neonatorum is probably always occasioned by a cold, or may perhaps arise from the retention of the meconium, or from the immoderate use of chamomile tea, during the latter part of pregnancy, by the mother, or, afterwards, by the infant. The. different varieties of jaundice run a different course. The icterus neonatorum runs its course in from 6 to 10 days, and almost always terminates in complete recovery, with copious discharges of black and afterwards bilious matter ; it very rarely assumes a malignant character, in which case it may last weeks and months, frequently terminating in atrophy, scrofula mesenterica, softening of the stomach, eclamp- sia, acute hydrocephalus, and death. The icterus febrilis runs its course in from 7 to 14 days, and re- covery generally takes place by means of critical sweats, sedimentous urine, and bilious evacuations ; it is only in consequence of great mismanagement that this form of jaundice sometimes passes in hepatitis or bilious fever. The icterus afebrilis frequently con- tinues for weeks and months; but if it should have been caused by hurtful food, the disease may termi- nate in two or three days, the white stools again be- coming bilious, and the dark urine clearer; it is very sel- dom that dyspeptic symptoms or hepatitis supervene. The prognosis is generally favourable, particularly in icterus neonatorum and icterus febrilis ; in icterus afeb- rilis recovery is likewise generally certain, except if it should have arisen from abuse of mercury, in which case the prognosis is somewhat doubtful. In icterus neona- torum malignus the prognosis is unfavourable, if the disease have lasted some time, if the skin be of a dark brass color, the abdomen distended, if the children utter a squeaking noise, with spasms or sopor, if the 128 JAUNDICE. region of the stomach be hot and painful to the tone?/, and if putrid vomiting set in. § 217. The following remedies deserve particular attention in the treatment of jaundice : Aconite, Arse- nic, Bryon., Calcar., Canthar., Carb. veg., China, Con.r Cupr., Dig., Iod., Mercur., Acid nitr., Nux torn., Plumb., Puis., Ran., Rhus t.. Sec, Sulph., Acid, sulph. China is indicated by pressure at the stomach, vom- iting, diarrhoea, fainting, great debility, bitter mouth, anorexia, hard distention of the abdomen, and when the symptoms can be traced to abuse of mercury. Mercurius is indicated after abuse of China, in scro- fulous individuals, when asthmatic symptoms, painful- ness of the liver, rheumatic pains in the pectoral mus- cles are present, both in icterus neonatorum and afeb- rilis. Sulphur, in scrofulous, psoric individuals, after abuse of Mercury, or when the disease was occasioned by the suppression of a cutaneous eruption. lodium, by a dingy, yellow skin, excessive emacia- tion, lowness of spirits, or irritable spirits, yellow or brown, dark colour of the face, thick coating of the tongue, much thirst, turns of nausea, white diarrhoeic stools alternating with constipation, dark, yellow- green, corrosive urine, etc., after abuse of mercury. Even jaundice accompanied with organic changes in the liver, hectic fever, dyscratic conditions, etc., comes within the curative action of iodium. Chamomilla is suitable for jaundice occasioned by a cold, by chagrin, anger, or when the body is exces- sively sensitive to the open air, accompanied with sleeplessness, cries and starting during sleep, dryness of mouth, heat of the face after dinner, distention of the abdomen, discharges of white mucus, particularly at night, discharge of undigested food, &c. Digitalis is particularly suitable when the whole body and particularly the albuginea and the more delicate portions of the skin exhibit a yellow tinge, when there is loathing, frequent empty retching, sen- sitiveness, and pressure in the pit of the stomach and region of the liver, distention of the abdomen, slug- J A I. N DICE. 129 gish stool, gray, clayey faeces, scanty, turbid, thick, saturated, yellow-brown urine, alternate shuddering and heat^ it is likewise useful in icterus spasticus, with constant inclination to vomit, and chalky stools, with full, slow pulse ; these symptoms constitute a particular indication for digitalis in icterus afebrilis. Pulsatilla is principally indicated after abuse of China, Chamomilla, and Sulphur, when an overloaded stomach is a principal cause of the disease, and the following symptoms are present: sleep disturbed by frightful and anxious dreams, violent nocturnal an- guish, sad, whining mood, yellow or slimy tongue, bit- ter, foul, or earthy taste, bitter eructations, slimy, bil- ious, or bitter-sour vomiting, perceptible throbbings in the pit of the stomach, difficult stool, with painful straining, white stools, scanty discharge of red, brown urine, or else retention of urine. Carbo. veg. is suitable for chronic jaundice, attended with scorbutic symptoms, vehement, vexed mood, aversion to meat, butter, grease, constipation, or else pale, white stool, discharge of dark-red urine. Arsenicum, as well as lodium, may still prove use- ful in jaundice, attended with degenerations of the liver, China, lodium, Mercury-cachexia, scorbutic or scrofulous dyscrasia, and hypochondriac mood. Nux vomica corresponds to jaundice in persons who have made an excessive use of spirits, coffee, tobac- co, opium, chamomile tea, or to jaundice occasioned by violent chagrin or anger ; or by a sudden change of temperature, in individuals with irritable, hypochon- driac, melancholy, hysteric dispositions, or who are exceedingly sensitive to open air, and are apt to take cold when exposed to the least draught. Icterus occasioned by chagrin and anger, is princi- pally cured by Aconite, Bryon., Chamom., China, Ig- nat, Nux vom., Natrum mur., Sulphur. When occa- sioned by a cold or a sudden change of temperature : Dulc, Nux com., Chamom. When arising from an overloaded stomach and dietetic transgressions : Puis., Antim., Bryon., Carb. veg., Chamom., Natrum m., Nux v. When caused by abuse of spirituous drinks: Nuj 6-' 130 BPLENITIS, LlENITlS. v., Dig., Ars. When caused by abuse of Chamomile : Ignat., Nux v.. Puis., China. By abuse of Mercury : China, Hepar s., Sulph., Acid, nitr., Asa fat., Iod., Ars. By abuse of China: Puis., Ars.. Merc, Ipec. Jaundice occurring during pregnancy, which is proba- bly caused by mechanical pressure on the liver, is most speedily relieved by Nux v., Ipec, and Natr. mur. The dyspeptic symptoms which sometimes remain, such as loss of appetite, loathing of food, nausea, op- pression of the stomach after eating, obstinate consti- pation, etc., generally yield to Bryonia. Icterus neonatorum, if of a benign nature, generally gets well with little or no treatment. If it should have arisen from cold, from the use of damp and cold bandages, or from too long an exposure after birth, it will be sufficient to bathe the infant in tepid water, and to keep it warm ; a dose of Dulc. or Chamom. may likewise be of service. If the excessive use of Cham- omile-tea, during or after pregnancy, should have oc- sioned the disease, Ignat., Puis., Nux vom., China, Cof- fca, will be found the most suitable remedies, in con- junction with proper diet. The malignant form of icterus neonatorum is more difficult to cure. If it should have been caused by bad milk, the infant has to be nursed by some other person, and any kind of food which is disposed to ferment should be avoided. Nux v., Puis., Aeon., and Chamom. are the remedies to be used. If the disease should have been caused by the desiccation, by means of lead-ointments, of sore places on the genitals, buttocks, in the axillae, etc., the obnoxious application should at once be removed, and Chamom., Sulph., Hep. sulph.. Alum., Opium., should be exhibited. For convulsions, spasms, sopor, violent fever, Belladonna will be found most suitable. When these latter symptoms occur, it is to be feared that acute hydrocephalus, gastromalacia, or atrophy, will supervene. § 218. Inflammation of the spleen, splenitis, lienilis. Affections of the spleen, even when amounting to BPLENITI8, L1EMITIS. 131 disorganizations, do not affect the general organism in any great degree, and are not easily diagnosed. An acute inflammation of the parenchyma of the spleen is characterized by the following symptoms: Violent sticking, boring, tensive, throbbing pains in the region of the spleen, extending to the shoulder, clavi- cle, nipple, or towards the stomach, back, kidneys, with oppression of breath, constriction of the epigas- trium, with aggravation of the pain on turning to the left side, on pressing on the left hypochondrium, or during motion, exertion, cough, sneezing, etc. This painfulness is constant; sometimes there is an increase of heat in the region of the spleen ; and if the lower and anterior portion of the spleen be affected, a hard, round, not very moveable swelling, is felt in the region of the ninth and tenth ribs, anteriorly, which is extremely painful when touched. Accompa- nying symptoms are: Oppression, anguish, cough, dyspeptic symptoms, vomiting, burning in the region of the stomach, bitter, or sometimes sour taste, with burning eructations, retching, vomiting without relief, singultus. Vomiting of blood is always present, even at the commencement; the blood, particularly at the commencement, is scarcely ever pure blood, but is mixed with bilious, slimy matter, looks like serum, but assumes a blackish venous colour; afterwards the blood becomes thick, blackish, and is vomited in larger quantity. Obscuration of sight, vertigo, disposition to fainting, are frequently present, particularly in an erect posture. The fever is a synocha, with intense thirst and changing pulse, which is sometimes sup- pressed and intermittent at the left wrist; the -urine is burning, of a dark brown-red, less frequently of a dingy saffron colour. The fever is remittent, and has sometimes a quartan or tertian type. § 219. Splenitis runs a course of from 5 to 14 days, and terminates with critical sweats, urine, phlyctaenas around the mouth and nose, and sometimes bleeding from the nose or other orifices. It may leave adhe- sions, induration, or permanent enlargement. Spleni- tis is seldom directly fatal; death generally ensues by 132 SPLENITIS, LIEMT1?. softening or suppuration : the former termination being much more frequent than the latter ; hence the frequent tearing of the spleen. The distinction between inflammation of the cap- sule and parenchyma of the spleen is of no practical value. Splenitis is frequently epidemic in hot sum- mers, and is sometimes confounded with melaena, hep- atitis, peritonitis, pleuritis, nephritis, gastritis, or car- ditis. Gastrodynia likewise frequently depends upon or co-exists with an affection of the spleen. In such a case the spleen is probably more or less inflamed, which we may infer from a previously existing ab- dominal plethora, or from' one actually present and oc- casioned by the suppression of an habitual discharge of blood from the bowels. Among the numerous violent symptoms which come under our observation in such a complicated case, those pointing to an in- flammation of the spleen are frequently overlooked. Splenitis is most frequent among persons of middle age or among old people. It occurs more frequently among men than women. It may be caused by me- chanical injuries, coneussion of the trunk, long run- ning, dancing, colds, sudden suppression of habitual discharges of blood, suppression of ulcers on the feet, or the inflammation may reach the spleen by spread- ing from adjoining organs. § 220. In acute splenitis, with violent synochal fe- ver, Aconite is the first remedy. If, under the influence- of Aconite, the pain does not subside simultaneously with the fever, other remedies should be resorted to. Nux vom. is indicated by a sensation of swelling, increase of the stinging pain by contact or motion, spasmodic pains in the left hypochondrium, with qualmishness in the pit of the stomach, aversion to food, with fainting spells, vomiting of blood or gulp- ing up of dark blood from the stomach, pains in the sfomach, retention of stool, dyspeptic symptoms, etc. The constitution and disposition of the patient should likewise be considered. Arnica deserves attention when the blood is coagu- ated, between light and dark-red, with constant ach- SPLENITIS, L1ENITIS. 133 ing-sticking pain in the left hypochondrium, and con- sequent arrest of breathing. Cantharides is indicated when the kidneys are like- wise inflamed, with constant retching and some dis- charge of blood by the mouth, sticking pressure and feeling of fulness in the left hypochondrium, extend- ing to the dorsal vertebrae, tossing about in despair and agony. Belladonna is likewise suitable for splenitis. Chamomilla corresponds to a tensive and burning pain in the left hypochondrium, pressure in the pit of the stomach, frequent hiccough, etc. China, although not generally indicated in inflam- matory diseases, will be found useful in splenitis, after the fever has been subdued by Aconite, when the fre- quent vomiting of blood induces great debility, and the pinching and pressure change to lancinations, with swelling and hardness of the spleen ; frequent diarrhoeic stools, with discharge of dark, coagulated blood, do not counter-indicate China, although in such a case Arse- nic deserves a preference, particularly if the patients complain of a burning pain in the spleen, with swell- ing, attended with constant anguish and pulsations in the pit of the stomach. China is likewise indicated by painful swelling of the spleen, and tearing stitches in that organ, preventing the patient from lying on the affected side. The fever is characterized by dry burning heat, great thirst, restlessness, anguish about the heart, yellow, livid countenance, dry and parched lips, white-coated tongue, bitter taste in the mouth, nausea, aversion to food, etc. Bryonia is counter-indicated by haematemesis and diarrhoea ; it corresponds to constipation and sticking pains in the spleen. I think Bryonia and Pulsatilla particularly adapted to an inflammation of the capsule of the spleen, with sticking, aching pains, aggravated by motion, and when the affected part is visibly swollen. Laurocerasus, Mezercum, Drosera, Stannum, Plum- hum, Spigelia, Lycopodium, Carbo veg., and other reme- dies, may sometimes prove useful in splenitis. 1^4 GASTRITIS- § 221. Gastritis, inflammation of the stomach. Acute gastritis, as is occasioned by corrosive poi- sons, is characterized by the following symptoms: Excessively burning, gnawing, constrictive, tearing, sticking pain in the epigastrium, increasing rapidly and without intermission, extending over the chest, and occasioning dyspnoea ; the pain is aggravated by breathing, contact, the least pressure. There is a constant and intense desire for cold drinks, although every drop is vomited up again. The region of the stomach is hot to the touch, the patient wants cooling things to be applied to that region constantly ; the epigastrium is distended, and the patient can neither swallow solid nor liquid things. The pulse, in such violent cases, is suppressed, small, wiry, frequently in- termitting ; face and extremities are covered with a cold sweat; the face is pale, spasmodically distorted, expressive of much pain ; the patient is uneasy, anx- ious ; stool and urine suppressed, or the secretion of urine is at any rate very scanty; death takes place very rapidly, from paratysis, preceded by singultus, dysphagia, aphonia, delirium, subsultus tendinum, and other nervous symptoms. There are milder forms of gastritis, characterized by a feeling of pressure, heaviness, gnawing, tension in the umbilical region, which is not so sensitive to pressure. The patient is able to eat and drink, but afterwards he experiences pain, frequent eructations, attended with red face, accelerated pulse, hot hands, disposition to vomit, etc. The region of the stomach is distended by gas, tight, percussion yields a tympa- nitic sound over a large surface. The fever is not al- ways present; when present, it is either synochal or erethic. The skin is dry, and its temperature raised. Sympathetic symptoms are : headache, pain in the limbs, paroxysms of cough, palpitation of the heart, nervousness, etc. A mild form of acute gastritis may lead to a chronic one, which is frequently so deceitful that death takes place suddenly, in consequence of perforation: or in- GASTRITIS. [35 nervation and marasmus develop themselves. The physician is frequently misled by the difficult diges- tion, eructations, flatulence, pyrosis, pain in the sto- mach, and is induced to treat the patient for dyspepsia, cardialgia, etc. § 222. An acute gastritis runs a rapid course; its phenomena are of short duration, but intense in their nature. The disease frequently terminates in death in a few hours, by exhaustion and paralysis of the nervous system. This likewise takes place when a chronic gastritis becomes acute, or else a slowly-pro- gressing ulceration leads to perforation of the stomach. An acute gastritis lasts from 10 to 25 days ; a chronic for months and even years. Gastritis is frequently confounded with cardialgia, colic, cholera, etc. Gastritis may be occasioned by the following causes : the use of cold drinks or of ice when the stomach is heated ; cold bathing when the body is very hot ;* in- troduction into the stomach of mineral acids, arsenic, mercury, corrosive sublimate, saltpetre ; inflammation of adjoining organs, mechanical injuries of the sto- mach, metastasis of inflammations of other organs to the stomach, suppression of herpetic eruptions, locali- zation of dyscratic action, etc. The prognosis depends upon the course and origin of the disease. When occasioned by cold drinks, poisons, metastasis, or d}'scrasia, it is very danger- ous. Children and old people are exposed to great danger. § 223. The treatment of gastritis differs according to the cause of the disease. A gastritis from gastric impurities or acrid bile is not very difficult to cure. Among these kinds of gastritis belongs the one arising from the use of too heavy food in the case of infants. The milk of the nurse ought to be changed for more adequate nourishment, after which, Ipec, Nux v., Bry- on., Antim., Pulsat, or Veratr., should be exhibited. Traumatic gastritis is, properly speaking, a surgical * These causes may likewise cause a sort of cholera, which at first bears a great resemblance to gastritis. 136 GASTRITIS. disease, which requires to be treated, among other remedies, with Arnica, externally and internally. In gastritis toxica, the poison has first to be removed ; the vomiting should be promoted by warm drinks, except when it is excessive, in which case it has to be moderated. This result can most easily be obtained by means of mild oleaginous and mucilaginous sub- stances, which are likewise the most suitable to neu- tralize the poison. Such substances are : linseed oil, milk, warm water, sugar-water, slimy drinks, etc.; milk and sugar-water may be continued together with the specific medicine. Gastritis potatorum is to be treated with one of the remedies which we shall point out hereafter. After the removal of the local causes of the disease, a few doses of Aconite require to be given, in rapid succession, to moderate the synocha, if there should be any. The best remedy for the above-described most acute form of gastritis, is Arsenic. Next to this comes Phosphorus, if the patient com- plain of a cutting burning, with pressure, burning heat in the stomach, as if hot gas were rushing out of the mouth, etc., accompanied with violent thirst, burn- ing in the pit of the stomach, anguish, convulsions of the face, violent shuddering, cold extremities, clear eyes, with lachrymation, pale lips, hurried, small, feeble pulse, and prostration of strength. Camphora corresponds to burning with pressure in the stomach, with coolness in the pit of the stomach, great painfulness of the pit of the stomach to contact, violent vomiting of bile and blood, gulping up of the ingesta, cold sweat in the face, general coldness of the body, hurried breathing, bruised feeling in the back, and feeble, scarcely perceptible, pulse. Cantharides correspond particularly to stinging, burning, and cutting, particularly in the region of the orifice of the stomach, feeling of fulness, sensation of screwing together, extending to the dorsal vertebrae, vomiting of the ingesta, vomiting of blood, with con- stant retching, agonizing uneasiness, small and inter- ENTERITIS, COLICA INFLAMMATORY, ETC. 137 mittent pulse, with burning thirst. This kind of gas- tritis is always accompanied with pains in the abdo- men, kidneys, and bladder, the pains of the latter or- gan descending from the ureters, and being attended with ischuria. Bryonia is one of the remedies for the less violent forms of gastritis. It corresponds to an aching, sting- ing, burning pain in the stomach and pit of the stomach, to a sensation as if the pit of the stomach were distend- ed, to gulping up of the ingesta, vomiting, even vomit- ing of blood, sore pain in the pit of the stomach, when touching it or coughing, anxiety and oppression. It corresponds particularly to a phlegmonous inflamma- tion of the stomach, with violent synochal fever, great nervous and vascular excitement, burning and dry heat, with thirst. Nitrum is indicated by a violent aching pain in the stomach, with cooling burning in that organ. Among the accompanying symptoms we distinguish : canine hunger, slight thirst, hiccough, gulping up of bitter fluid with some relief, vomiting of blood, as the dis- ease increases; the pulse is very quick, full, and hard. Nux vomica may prove useful in some cases of gas- tritis", it is indicated by burning in the region of the orifice of the stomach, violent vomiting, etc. Veratrum is likewise an important remedy in gas- tritis. We would likewise name : Puis., Euphorb., Sec, Ipec, Antim. cr., Mezer., Helleb., Calc, Ranuncul. seel., lod., etc. If hydrophobic symptoms should su- pervene, Hyoscyam., Stram., Canthar., and Bellad., should be employed. • § 224. Enteritis, colica infammatoria, inflammation of the bowels. Such an inflammation generally commences in the mucous coat, whence it spreads to the other tissues. We distinguish an erythematous, (mucous,) phlegmo- nous, viscous, follicular, serous inflammation of the bowels. It is principally the follicular inflammation 13S ENTERITIS, COLIC A INFLAMMATORY, ETC. which occasions ulcers in the intestines, such as we observe in abdominal typhus. The most frequent kind of enteritis is ileocolitis, which occurs both as a mucous and phlegmonous in- flammation. The latter is characterized by excessive- ly violent, piercing, burning, and tearing pains, which are frequently most intense at a circumscribed spot in the umbilical region or the right iliac fossa ; here the pains are seated, constant, aggravated by the least contact, efforts to vomit, breathing, cough, etc.; the patient is lying on his back, without stirring, with his lower limbs drawn up, moaning, not daring to move lest the pain should get worse. The pain comes on in paroxysms, like colic. The abdomen, feels hot, dis- tended, hard, frequently tympanitic ; obstinate consti- pation, which continues during the whole period of the inflammation: troublesome, painful flatulence, passing upwards; vomiting, first of mucus, bile, and food, afterwards of green masses, resembling faeces, and even vomiting of faecal matter. An inflammation of the bowels, like all other violent inflammations, sets in with a violent chill, or else fever and inflammation develop themselves at the same time. The pulse is very frequent, (100 to 120,) small, spasmodically contracted, hard, and intermittent. There is internal heat, and unquenchable thirst, al- though the extremities are cool; the features express pain and anguish; the respiration is anxious, hurried, and is generally performed by means of the intercos- tal muscles. The tongue is generally dry, red, or coated white ; skin dry ; urine scanty and red. Some- times nervous paroxysms, singultus, speechlessness, fainting spells, and delirium, are present. A mucous inflammation is distinguished from the other one by being less violent; the pain is more re- mittent, as in colic, even intermittent, dull, tensive, cutting, with feeling of fulness in the umbilical region and in the right iliac fossa. There is no vomiting, unless the inflammation should reach the stomach. This form of inflammation is more frequently attended with diarrhoea than constipation, generally occurring ENTERITIS, COLICA INFLAMMATORY, ETC. 139 at night, characterized by discharge of flocks. The fever is erethic, sometimes even inclining to torpor', the pulse is soft and frequent. Evening exacerba- tions, and remissions in the morning. § 225. A very acute enteritis runs a course of from 24 to 48 hours, or at most from 3 to 6 days ; a mucous enteritis runs from 4 to 14 or even 30 days, in which case the inflammation becomes chronic. Recovery from the phlegmonous inflammation takes place by alvine evacuations, and from the mucous enteritis by critical fevers and abatement of the symptoms. Death ensues by gangrene and paralysis of the abdomen; in the second form, by the passage of the disease into en- terophthisis. The disease may be caused by irritating, bad, de- cayed food, unripe fruit, melons, cucumbers ; overbad- ing the bowels ; abuse of spirituous drinks ; irritating drugs; acrid bile ; mechanical irritants ; suppression of cutaneous secretions, in consequence of cold ; sup- pression of habitual discharges of blood, of sweat on the feet; or the disease may set in as a sequel of gastritis, hepatitis, peritonitis, or may be occasioned by dys- crasia. The prognosis depends upon the nature of the course of the disease, upon the extent and intensity of the inflammation, and upon the general character of the symptoms. § 226. The treatment should commence with Aco- nite, which is to be continued at longer or shorter in- tervals, according as the inflammation is more or less violent; for the symptoms which remain, after the in- flammation has been subdued, Nux. v., Bryon., Cha- mom., Bellad., Rhus t., Puis., or Merc, Arsen., or Can- thar., are appropriate remedies. In some cases these remedies are indicated from the commencement. If some other adjoining organ should be inflamed at the same time as the bowels, the "Specific remedy should be administered in alternation with Aconite. For sub-inflammatory symptoms, when the inflam- mation is not distinctly developed, Belladonna and Hyoscyamus are excellent remedies. 140 ENTERITIS, MUCOSA INFANTUM. The so-called stagnationes sanguinis, (physconia sanguinis,) in the abdomen, have frequently the ap- pearance of an inflammation of the bowels, particu- larly when they are accompanied with fever and pain. The symptoms are less intense, with remission and even perfectly free intervals. The pain is less seated, more changeable, goes and comes ; sometimes there is only a disagreeable sensation of pressure, tension; burning, or beating, accompanied with other various symptoms according as one or the other portion of the abdomen is the seat of the affection. This condition frequently arises from irregular piles or catamenia. and occurs in hypochondriac or hysteric persons, or in those who are fond of spirituous drinks. Indigestible, stimulating food aggravates the disease. The patient complains of troublesome thirst, dryness of the lips and mouth, flatulence, borborygmi. The stool is lumpy, dry, and dark, or slimy, thin, fetid. Diarrhoea some- times alternates with constipation. At first, there is no fever, afterwards only in the evening, with morn- ing remissions and slight sweat. Emaciation, prostra- tion of strength, cachectic appearance, cough, night- sweats, dropsical symptoms. The cure is generally effected by Nux v., Bryon., Puis., Bellad., Digit., Phosphor., Calc. acet., Sep., Ve- ratr., Sulphur, and other remedies.* § 227. Enteritis, mucosa infantum. This disease is of frequent occurrence among chil- dren. It is both acute and chronic. It commences with increased stool, frequently without fever. The evacuations gradually increase in frequency, and are sometimes preceded by restlessness, starting, on ac- count of the pain and convulsions ; during the evacu- ation the children moan and cry. The stools are of a brown-reddish colour, sometimes mixed with bloody, flocculent, slimy, and purulent substances, or they look green and stirred, or they are watery and of a dark * These symptoms frequently set in in persons suffering with nervous irri- tation, and then yield to Aconite, as their most certain specific.—Hempel. ENTERITIS, MUCOSA INFANTUM. 141 colour, or undigested. The anus becomes sore and erythematous; sometimes tenesmus is present, and diarrhoea alternates with constipation. These symp- toms are accompanied with burning heat, frequent pulse, bright-red tongue, which afterwards becomes dry and crusty; there is vomiting and constant drink- ing ; tympanitic distention of the abdomen, which is sensitive to pressure, and hot, with decline of strength and loss of flesh ; the face is sunken, looks old, with dim and faint eyes, sallow skin. The phenomena of this disease are frequently rendered obscure by symp- toms pointing to a cerebral or pulmonary affection. The disease frequently terminates fatally, particu- larly among new-born infants ; but even among larger children it is sometimes very dangerous. In regard to treatment, I would observe that it should invariably be commenced with Aconite. We know, from thousands of cases of post-mortem exami- nation, that a vast majority of the aflections of chil- dren are characterized by inflammatory conditions, and that the little beings might have been saved if physicians were more willing to heed all the indica- tions of suffering in the infantile organism. It is true that Hahnemann teaches that the homoeopathic phy- sician need not trouble himself about anything but the symptoms of the disease ; but we ought not to forget that both the external and internal phenomena consti- tute the true and complete character of the disease, and that it is, therefore, the physician's duty to under- stand this character fully. Although I am an old practitioner, yet I keep up with all the improvements in medicine which lead to a safer and more correct diagnosis, and it is owing to this progressive initia- tion into the internal conditions of disease that I have accustomed myself to commence the treatment of most of the affections which befal children, with Aconite. This remedy moderates the violence of the symptoms, and frequently removes them altogether. Next to Aconite, Chamomilla deserves to be recom- mended, when the thin and fluid discharges from the bowels, or the corrosive discharges of white or green 142 INCARCERATED HERNIA. NEPHRITIS. mucus are attended with violent pains, when they oc- cur most frequently at night, and the night's rest is frequently interrupted by cries and starting. Pulsatilla is indicated by sudden alternation of heat and chilliness, with sleeplessness, except a little slum- ber towards morning, constant moaning, and frequent discharges of corrosive mucus, with vomiting. Nux v. and Bryonia are indicated when constipa- tion is present, the latter particularly when the abdo- men is sensitive to pressure. Belladonna and Hyoscyamus may prove useful when the inflammation is sub-acute, or when the inflamma- tory symptoms are accompanied with periodically-re- curring spasmodic phenomena. ■ Cojfea requires to be used as an intermediate rem- edy, to allay the nervous irritation, which sometimes exceeds the vascular excitement. For the other remedies, we refer the reader to pre- ceding paragraphs. § 228. Incarcerated hernia. Hernia, unless it should have been occasioned by mechanical causes, in which case it requires surgical treatment, is a dynamic disease, and can be removed by internal treatment. The incarceration arises from a spasmodic contraction of the bowel, which soon leads to inflammation. Nux vomica is the most suit- able specific for that condition. Shortly after its ad- ministration, the spasmodic phenomena disappear, and the hernia can be replaced. If relief should not set in two hours after the exhibition of Nux, it is not the proper remedy. Some physicians recommend large doses of Opium instead of Nux. In some cases of vi- olent spasms, Belladonna will prove curative, even in volvulus. § 229. Nephritis, inflammation of the Jddneys. We distinguish nephritis, or inflammation of the parenchyma ; pyelitis, or inflammation of the mucous membrane of the tubes and pelvis of the kidneys ; and perinephritis, or inflammation of the capsule. These NEPHRITIS. 143 different varieties bear a close resemblance to each other; we shall therefore condense their symptoms in one group. One or both kidneys may be inflamed at the same time. The patient complains of an acute or dull pain in one or both loins, frequently extending over the whole lumbar region; it is aggravated by pressure, motion, bending forward, deep breathing, coughing, sneezing, urging to stool, lying on the affected side, and warmth of the bed. The pain extends along the ureters down to the bladder, and the testicle of the affected side is spasmodically drawn up ; in females the pain strikes into the round ligaments. Sometimes the inflammation is attended with vomiting, nausea, retching, cardialgia, colicky pains; the region of the kidneys is hot, painful, bloated, and the patient is una- ble to lie on the affected side ; if both kidneys should be affected, the patient has to lie on his back. In some cases the secretion of urine is either diminished or suppressed, or the emission of urine is attended with pain and burning ; the urine has a fiery-red appear- ance, and is sometimes sanguineous or mixed with pus. In most eases the thigh of the affected side is numb, there is great anguish and restlessness, consti- pation, and other secondary affections supervene. The disease generally sets in with a hard chill, which frequently occurs simultaneously with the pain in the kidneys: the skin then becomes hot and dry; the pulse is full, hard, and tight, sometimes contracted. The fever sometimes becomes typhoid, in which case sopor sets in, the patient lies immovable on his back, his answers are incomplete, the tongue becomes dry and black, the pulse small and frequent. § 230. Nephritis principally befalls full-grown peo- ple. In young, plethoric subjects, it is disposed to ter- minate in suppuration. In this case, the pains become dull and aching, and the patient complains more and more of heaviness in the region of the kidneys ; in the most fortunate event, the pus is discharged with the prine. Complete suppression of the urine, typhoid ana pu- 144 NEPHRITIS. trid symptoms, delirium, sopor, violent vomiting, hic- cough, great anguish and restlessness, coldness of the extremities, repeated chills, are unfavourable symp- toms. The simultaneous presence of inflammation of other organs, renders the prognosis still more doubt- ful. §231. The best remedies for nephritis are: Can- tharides, Cannabis, Nux vom., Belladonna, Aconite, Pul- sat., Hepar. sulph., Merc, Sulphur, Thuja, Cocculus, Colchicum. The treatment depends a good deal upon the cause of the disease. If the disease should have been caused by suppressed hemorrhage, or by abuse of spirituous drinks, Nux vom. will be found the best remedy, when the disease is characterized by tension, distention, pressure, heat, burning in the lumbar and renal re- gion. Nux is likewise suitable for nephritis gene- rally, provided the symptoms correspond ; or for ne- phritis occasioned by gravel or suppression of the piles. The causes just named, particularly suppressed, scanty, or delayed catamenia, point likewise to Pul- satilla, especially in patients with slender forms and irritable dispositions. Belladonna, and in some cases, Hepar sulphuris, is indicated by the following symptoms: Stinging-burn- ing pain in the region of the lumbar vertebra;, close to the spine, extending along the ureters down to the bladder, and recurring periodically with increased vi- olence ; it sometimes involves the abdomen below the umbilicus, and is aggravated by contact; colicky pains and cardialgia, heat and bloatedness in the region of the kidneys, a fiery urine, which is passed in small quantities ; anguish and restlessness, constipation, etc., are likewise present. One of the principal remedies for nephritis is Can- tharides, particularly when sticking, tearing, and cut- ting pains in the lumbar and renal regions are present, the pains being aggravated by the least motion, setting in in paroxysms, and thereby suddenly interrupting the breathing: the emission of urine is very painful, CYSTITIS, INFLAMMATION OF THE BLADDER. 145 and frequently impossible, or the urine is passed in drops with intolerable burning pains, mixed with blood. The fever is violent, the pulse frequent, full, rather hard ; the thirst is great, the cheeks hot and red ; loss of appetite ; constipation : sleep is impeded by the violent pains and the urging to urinate, which is always greater at night; the patient always feels worse in the morning. Cannabis is indicated by a drawing, ulcerative pain from the renal region to the groin, attended with anx- iety and a qualmish sensation. Cocculus, Mercur., Plumbum, Thuja and Colocynth, are likewise useful in affections of the kidneys. § 232. Cystitis, inflammation of the bladder. Inflammations of the bladder, are, generally speak- ing, rare and dangerous. They are generally accom- panied with inflammation of the urethra, kidneys, and are sometimes occasioned by stones in the bladder. The pains are seated, continuous, burning, cutting, sticking, and are felt in the region of the bladder and perineum; they frequently extend over the whole abdomen towards the kidneys, frequently striking into the penis accompanied with painful erections, or into the rectum. The pain is aggravated by contact, mo- tion, concussion ; every effort to urinate is very pain- ful, although the patient is tormented by a constant desire, with tenesmus of the sphincter vesicae and ani. The urine is discharged in drops ; it is thick, dark-red, turbid, frequently mixed with mucus, blood, or pus; in some cases the secretion of urine is totally suppressed. Gradually the bladder swells up into a tight, pear- shaped, extremely painful ball; the introduction of the catheter is either impossible or attended with horrible pain. Alvine evacuations are likewise painful. The 1'ever is generally a synocha, the pulse is tight, full, the skin burning-hot, thirst violent, tongue whitish. afterwards red and dry. Accompanying symptoms are : great re'stlessness and anguish, prostration of strength, cerebral and typhoid symptoms, singultus, fainting spells, convulsions. 146 CYSTITIS, INFLAMMATION OF THE BLADDER. § 233. Cystitis runs a course of from five to fourteen days. Recovery takes place by means of critical secre- tions by the skin, critical urine or discharge of blood from the pelvic organs. Death ensues by paralysis. Suppuration and gangrene occur very randy, and are extremely dangerous. Exciting causes: cold ; diuretics ; frequent use of heating drinks ; acrid injections in gonorrhoea : me- chanical injuries, contusion, pressure, retroversion of the womb. The prognosis is alway doubtful, particularly when the inflammation is very acute and involves a large portion of the bladder, with complete suppression of urine. It is more favourable when the inflammation was occasioned by a cold or by diuretics. § 231. For the synochal fever. Aconite should be ex- hibited and the treatment should otherwise- be con- ducted with reference to the cause of the disease. If the inflammation should have been caused by can- tharides, frequent small doses of a saturated solution of Camphor have to be administered, after which the remaining symptoms are controlled by other appro- priate remedies. If the inflammation be caused by a retroversion of the womb, this organ has to be replaced before other medicines can be used. If heating spirituous drinks be the cause of the disease, Nux vom. will be found the best remedy. If the disease should have arisen from suppression of the piles, arthritis, etc., the treat- ment does not require any particular reference to those conditions. I have cured two cases of cystitis, arising from suppressed gonorrhoea, with Can'harides; \\\e inflam- mation extended as far as the neck of the bladder, and was accompanied with distressing pain ; the urine was discharged drop by drop, mixed with blood, t he emission being accompanied with frightful burning; the patient could not find any relief in any situation. In the course of two days, all these; dangerous symptoms had disappeared, and the gonorrhoeal discharge was restored. The remaining pains in the urethra during METRITIS, HYSTER1TIS, ETC. 147 micturition, the painful drawing in the testes and spermatic cords, the feeling of fulness in the region of the bladder, yielded to Nux com. Mezereum may like- wise prove' useful for a similar condition. Digitalis will be found useful in Ischuria with con- tractive pain in the bladder, the disease being more spasmodic than inflammatory. Hyoscyam. and Puis., although not adapted to a completely developed cysti- tis, are likewise deserving of consideration. In inflammation of the fundus of the bladder, with constant urging to urinate, induced by the slightest accumulation of urine, with pain at every contraction of the bladder, Squilla maritima will prove of great service. Calc. carb., Sepia, Lycop., Caust., Graph., Kali carb., etc., should not be lost sight of in cystitis. § 235. Metritis, hysteritis, inflammation of the uterus. Metritis is either acute or chronic. We distinguish metritis parenchymatosa, or inflammation of the pa- renchyma of the uterus ; metritis micosa, or endome- tritis, inflammation of the internal mucous membrane of the uterus ; and metrophlebitis, or inflammation of the veins and lymphatic vessels of the uterus. Metritis parenchymatosa is characterized by the fol- lowing symptoms : More or less violent aching, press- ing, boring, throbbing, or sticking pains deep in the pelvis, towards the small of the back, extending into the round ligaments or to the labia, sometimes even down to the knees along the ischiadic nerve, and gen- erally accompanied with a troublesome sensation of heaviness in the womb. The pains are aggravated by pressure, motion, concussion of the abdomen, efforts to urinate or expel the faeces, internal examination ; they frequently exacerbate like labour-pains ; the patient is most comfortable in a recumbent posture, with her limbs drawn up. When the pain extends over a large surface, the peritoneum is generally involved. The uterus can be felt as a round body, sensitive to pres- sure. The examination by the vagina and anus is generally very painful; the vagina and the vaginal 148 METRITIS. IIVSTERIT1S. ETC portion of the womb feel hot, swollen, dry ; the latte-r is higher up in the pelvis. According as the anterior or posterior wall of the uterus is affected, the rectum or bladder is sympatheti- cally involved ; the evacuations and the emission of urine are painful ; there is tenesmus, strangury, ischury: sometimes stinging pains in the mamma'. headache, vertigo, buzzing in the ears, delirium, con- vulsions. The fever sets in simultaneously with the local symptoms, transitory chilliness followed by heat, with full, irritated, tight pulse, whitish coating of the tongue, violent thirst, red urine. When a considerable portion of the peritoneum is involved, the pains extend over the larger portion of the abdomen, with meteorism, nausea, vomiting, small and intermittent pulse', disfigured features; "in this case the disease runs a rapid course, and frequently terminates fatally. When the vaginal portion is alone inflamed, there is a deep-seated pain in the pelvis. All these symptoms are less violent when the uterus of an unmarried female is the seat of the disease ; they are more violent and lead to miscarriage in the im- pregnated uterus, or shortly after parturition. § 236. The disease runs its course in from seven to fourteen days ; chronic metritis has an indefinite dura- tion. Recovery takes place with the critical phenom- ena which usually occur in fevers, and abatement of the topical phenomena, particularly with critical dis- charges of blood or purulent mucus. Metritis may like- wise terminate in partial recovery, exudation, suppura- tion, gangrene ; both the latter terminations are fatal. Causes : The uterus is most disposed to inflamma- tion at the time of the menses, during pregnancy, child- bed, at the critical age. The disease may be occasioned by either of the fol- lowing causes: Rude management during e-onfine- ment; pressure and contusion during parturition ; irri- tation of the uterus by drugs, such as turpentine, crocus, sabina; retentiem of the; placenta, of coagula, suppressed menses ; taking cold by exposure of the METRITIS, HYSTERITIS, ETC. 149 feet or abdomen ; inflammations of adjoining organs ; injuries and retroversion of the uterus ; emotions at a peniod when the action of the uterus is intensely ex- cited, etc. The prognosis depends upon the state of the uterus, upon the extent of the inflammation, and upon the more or less complicated nature of the disease. The danger is very great when the impregnated uterus is inflamed and when the peritoneum is involved, when there is great prostration, recurrence of chills, distortion of the features, small, intermittent pulse, fetid discharge from the vagina. § 237. Nux vom. has, in my hands, proved a most efficient remedy in metritis, whether the fundus, neck of the uterus, the anterior or posterior surface of the uterus was the seat of the inflammation. In some cases, where the fever commenced with a violent chill followed by great heat, with frequent and tight pulse and violent thirst, I have given Aconite previous to Nux vom. This remedy is indicated by the following symptoms : Aching pain over the ossa pubis, aggra- vated by pressure and an internal examination, violent pains in the small of the back and loins, constipation, or hard stools accompanied by burning-stinging pains, painful micturition or retention of urine, stinging and bruising pain of the abdomen during motion, cough and sneezing ; increased temperature and swelling of the os uteri, attended with pain in the vagina ; exacer- bation in the morning-hours. Belladonna is indispensable when the sensation of heaviness and dragging in the abdomen, which fre- quently increases to a painful pressing downwards, is excessive, accompanied with a stinging-burning pain over the ossa pubis, with pains in the small of the back as if it would break, stinging pains in the hip- joints which bear neither motion nor contact. (Aconite and China may likewise prove serviceable for those symptoms.) If the inflammation should set in after parturition, and the lochia should be suppressed, with retention or attachment of the placenta, or if an ichor- ous, fetid fluid should be discharged from the uterus, 150 OOPHORITIS, OPHORITES. ETC. with violent burning and feeling of fulness in the vagina, Belladonna is specifically indicated. Next to Belladonna we ought to mention Mercurius solubilis, which is indicated by a sticking, aching, or boring pain. Rhits t. and Bryonia may likewise some- times be useful. An inflammation occasioned by violent chagrin, after parturition, yields most speedily to Chamom lla. In such a case the lochia are generally more profuse, or, if white, change again to bloody, and even increase to metrorrhagia, with coagulated dark and black blood. For metritis occasioned by the abuse of Chamomile tea, Nux c, Ignat. and Puis, are the best remedies. China is a distinguished remedy after heavy labor, if the patient should have lost much blood, or if an ex- cessive quantity of milk should be secreted, occasion- ing great debility, and developing a metritis in con- sequence. A characteristic indication for China is the discharge of fetid, sanguineous, purulent matter, which corrodes the parts and debilitates the patient. An unexpected joy, during confinement, sometimes develops a condition of things bordering on metritis ; this is most easily relieved by Coffea. If metritis be attended with metrorrhagia, one of the remedies indicated for metrorrhagia will be found useful; if puerperal fever should supervene, one of the remedies indicated for that affection will be found suitable. § 238. Oophoritis, Ophorites, inflammation of the ovary. We distinguish acute and chronic oophoritis. Acute oophoritis is characterized by the following symptoms : The patient complains of a dull, more or less intense, sometimes rather burning, but more fre- quently stinging, pain in the groin. If the patient be examined on her back, with the limbs drawn up, a deep-seated swelling, of variable size, is felt through the abdominal wall, directly over the horizontal ra- mus of the pubes, on one side of the median line of the abdomen. The pain sometimes extends to the ad- OOPHORITIS, ETC. 151 joining parts, even to the thigh of the aflected side, which feels numb and rigid; it is aggravated by the patient suddenly raising herself, and by straining at stool. The swelling is sometimes more distinctly felt by means of an examination per amim. If the swell- ing be large, the uterus is pushed to one side. There is generally a discharge of serum from the vagina, particularly during the fever paroxysm. The fever is either erethic or synochal, and is accompanied by a variety of nervous symptoms, such as, hysteric symp- toms, spreading of the pain towards the stomach, nau- sea, spitting of water, vomiting, hysteric megrim, cla- rus, which is sometimes attended with convulsions, delirium, which generally bears the character of nym- phomania, etc. Chronic oophoritis is easily confounded with hys- teria. The pain is duller, and is only felt at the time of the menses, during an embrace, and after bodily exertions. There is a bearing-down sensation in the pubic region and perineum ; at times, metrorrhagia ; at others, suppression of the menses, leucorrhea. The swelling is not distinctly perceived at first. § 239. Oophoritis rarely occurs on both sides at the same time ; generally only on one side, and most fre- quently on the left. The disease occurs between the age of pubescence and the critical age. It may be occasioned by mechanical causes, rough handling du- ring delivery or an embrace, abortion, onanism, sup- pression of'the menses; or the inflammation may spread to the ovaries from adjoining parts. Terminations: (1.) Dispersion, after eight days or a fortnight, with abatement of the painful sensations, and restoration of the menses or lochia. (2.) Suppu- ration, with increase of the throbbing pains, swelling, numbness in the thigh, with frequent recurrence of the chills, and suppurative fever. (3.) Hypertrophy, induration, or some other degeneration. (4.) Death, by extension of the inflammation to the peritoneum, by exudation, etc. The prognosis depends upon the extent and charac- ter of the inflammation, and upon the diseases with 152 OOPHORITIS, ETC. which the inflammation happens to be complicated- According to Schoenlein, the prognosis is unfavoura- ble, because ihe disease generally arises from moral causes which it is difficult for a physician to remove. § 240. For the synochal fever a few doses of ^lco- nite are required in the first place, after which the proper specific remedy should be exhibited. If the disease had been caused by a sedentary life. or the abuse of spirituous drinks, Nnx vom. will be found efficacious. If excessive veneryor onanism was the cause of the inflammation, China is the best remedy; those prac- tices should, of course, be discontinued. Other reme- dies, such as Acidum phosjriior. and Staphysugria ought not to be overlooked. If the pain should get worse during motion, Bryonia will prove most suitable ; and if during rest, Rhus tox. ■ Arsenic is indicated when the pain is relieved by constantly moving the feet. Colocynthis may likewise prove serviceable for this symptom, particularly when the patient complains of boring, tensive pains in the region of the ovary. If the disease should have been caused by disap- pointed love, and constant dwelling of the fancy on sexual things, the alternate use of Ignatia, Staphys., and Acidum phosphor., will accomplish a good deal. The best course in regard to the use of those reme- dies is, to select each according to the symptoms. Platina is indicated by the following symptoms : Constant titillation in the internal sexual organs, obli- ging the patient to rub herself, and atlended with complete nymphomania ; when the characteristic pain in the region of the ovaries is, by pressure, changed to a contusive or bruised pain ; when anxiety and op- pression, palpitation of the heart, stitche's in the fore) part of the head, alternate sadness and excessive mirthfulness are present. Belladonna is related to Platina, except that the nymphomania and the above-mentioned itching are; not present. INFLAMMATION OF THE LABIA AND VULVA. 153 Ambra, Mercurius, Cantharides, Ignatia, Pulsatilla, and Antim. cr., will likewise be found useful. If the disease should be complicated with psora, the anti-psorics will have to be resorted to. § 241. Inflammation of the labia and vulva. The labia are painful, burning, red, hard, dry, swol- len. This inflammation runs the same course as all other inflammations. It arises particularly in recently married females, from rupture of the hymen, and nar- rowness of the vulva. The vagina is likewise swol- len. Walking and sitting are very troublesome, on account of the painful burning. The disease may likewise be caused by difficult la- bour. The disease is easily cured by washing the parts with a solution of the tincture of Arnica. If wound- fever should be present, it will be found more expedi- ent to give Arnica internally ; or if the fever should have an inflammatory character, Aconite. For erysipelatous swelling, and inflammation of the labia, with burning pain, and a sensation of fulness, tightness, and pressing down, Belladonna is the best remedy, no matter what the cause may be. Mercurius is the best remedy for a lymphatic in- flammation, swelling, and hardness. An internal swelling of the vagina, resembling pro- lapsus, with burning, stinging pains, which are aggra- vated by contact, yield to Nux vom. Sulphur, Carbo veg., and Calc. c, deserve likewise to be mentioned. § 242. Puerperal fever. This is an acute fever, to which lying-in women are exclusively liable, and which is generally accom- panied with disturbance of one or more of the func- tions peculiar to those persons. No disease has caused more lively discussion among physicians than puerperal fever; for no disease is more obscure than that malady. The fever generally develops itself a few days after 7* 154 PUERPERAL FEVER. parturition. Its symptoms seem to constitute an acute peritonitis, where the fever frequently makes its ap- pearance before the pain is felt, although there are cases where fever and pain appear simultaneously. The burning or cutting colicky pains are most frequently ex- perienced in the umbilical region, whence they spread rapidly oven- the whole abdomen, and frequently be- come so violent that the least pressure or even touch is intolerable. Sometimes the fever exists without any pain. Meteorism sets in. Vomiting is frequently one of the first and most troublesome symptoms ; the sub- stances which the patient vomits up being at times like verdigris, dirty, bitter, .and even Itrcal matter; at others, a discoloured, blackish fluid, resembling coffee- dregs. This is a bad symptom, for it points to a gan- grenous softening of the mucous membrane of the stomach. At times, obstinate constipation, at others profuse diarrhoea, with bilious, purulent, fetid, gray- ish, blackish, bloody discharges, is present. The face is extremely pale, with circumscribe'd redness and sunken appe-arance of the cheeks ; it exhibits an ex- pression of consternation and despair. If the fever should occur at a time when epidemic or endemic diseases prevail, it is disposed to assume the character of these diseases. Generally the fever has an erethic character, but it may likewise be a synocha, or a fever with typhoid or putrid symptoms. The erethic fever sets in with chills, followed by heat which alternates with the chills for the first twenty- four hours, after which the heat becomes permanent, with irritated, hurried pulse, hot and dry skin, reddish urine, and abatement of the symptoms in the morn- ing. These phenomena are more distinct when the fever is a synocha. If the fever have' an adynamic character, the symptoms are : Sunken, disfigured coun- tenance, prostration of strength, decreased painfulness of the abdomen, increased meteorism, vomiting, which cannot be allayed, diarrhoea, dry tongue and lips, which look as if coated over with soot, apathy, suppressed or discoloured, fetid lochia, small, very frequent pulse, dry or clammy, cool skin, miliaria, etc. PU2RifEiiAL FEVER. 155 § 243. According to the symptoms, the fever ought to be classed as follows : Peritonitis erethica; perito- nitis inflammatoria ; peritonitis erysipelatosa or gas- trico-biliosa; peritonitis typhosa, septica. The dis- ease generally lasts from 5 to 15 days, but it may be- come fatal in from 2 to 3 days, or it may become a protracted disease. Terminations : Recovery, or else death by exudation, paralysis, etc. The disease may be occasioned by colds, emotions, such as fright, fear, chagrin; injuries of the womb. predisposing causes are: inflammation of adjoining parts, heavy labour, abuse of Chamomile-tea during and after parturition, and particularly the abomi- nable practice of applying cold water to the pubic region to arrest metrorrhagia which set in soon after birth. The prognosis is frequently unfavourable. If the patient be constitutionally feeble and cachectic, the prognosis is more unfavourable than if the patient should be robust and should generally enjoy good health. The prognosis depends likewise upon the character of the epidemic ; upon the diseases with which the fever happens to be complicated ; upon the period when the fever set in ; for the sooner after par- turition, the more acute the disease. The prognosis is unfavourable when the fever is attended with inflam- mation of the uterine veins and putrefaction of the- uterus. § 244. The remedies corresponding to puerperal fever, are : Aconite, Chamom., Bellad., Puis., Rhus t., Ipec, Bryon., Colocynthis, Coff., Hyoscyam., Stramon., Am., Ars., Nux v., Mercur., Platin., Verat, and sev- eral others. The treatment has always to be commenced with Aconite, if the symptoms correspond to an inflamma- tion of the bowels, or if pleuritic symptoms should be present. Even in fevers which are attended with fre- quent paroxysms of anguish, repeated doses of Aconite are of great service, although Ipec, Ars., Bryon., and other remedies are likewise indicated. M<.'lore continuing our remarks on the treatment of 156 PUTREFACTION OF THE UTERI.*. ETC. puerperal fever, it seems expedient to speak of a dis- ease which frequently co-exists with puerperal fever : we mean § 245. Putrefaction of the uterus, or endometritis septica. This disease never occurs except in lying-in females, both after miscarriage and natural delivery. Precur- sory symptoms exist even during pregnancy, but they are so slight that no very dangerous disease is appre- hended. Anomalies occur likewise during parturi- tion, such as spasmodic pains, slow labor, exhaustion, symptoms which do not indicate the approach of any very dangerous disease. Local symptoms are : Burn- ing pain over the symphysis pubis ; on examination, the uterus is found contracted and hard; in other cases there is no pain, the uterus is distended, raised, the substance is soft, flaccid, insensible, the lochia are ichorous, and have a fetid smell. The labia are swol- len, and gangrenous streaks are discovered in the va- gina. The neck of the uterus is soft, burning-hoi. not very painful, discharging a bloody ichor on pres- sure. The mammae become flaccid, the flow of milk either stops suddenly or gradually. The patient experiences chills, followed by heat; dry, hot skin, particularly in the palms of the hands. She does not complain of pain, but a feeling of inde- scribable weakness and languor of the extremities. The respiration is oppressed, the pulse frequent, small, feeble, wiry. There is a peculiar distortion of the features, great restlessness, anguish, unquenchable thirst, though the tongue is at first moist. The mind dwells upon thoughts of death. Little by little the skin becomes dead, like paper; there is a sensation as if a cool air were blowing on the parts, although the body is otherwise hot to the touch; delirium, grasping at flocks, irregular, laboured breathing, and even lock-jaw, supervene. These symptoms indicate putrefaction of the uterus, which is generally a fatal disease, inasmuch as death is near at hand when the PHLEGMASIA ALBA DOLENS. 157 symptoms are sufficiently developed to diagnose the disease. § 246. The disease lasts from 10 days to a fortnight. Women who lead a sedentary life, have much care and anxiety, live in damp dwellings, are most liable to it. The disease occurs either spontaneously or epidemically (in lying-in hospitals.) Terminations: Recovery, by separation of the gan- grenous parts, and abatement of the fever; suppura- tion, leading to phthisis of the uterus ; death. The prognosis is highly unfavourable. The more fetid the lochia, the more dangerous the disease ; putrefaction occurring during pregnancy, or sponta- neously, is likewise very dangerous. Livid complex- ion, and supervention of convulsions, are very dan- gerous symptoms. § 247. During a practice of 28 years, I have met with only three cases of putrefaction of the womb, attended with an eruption of rash on the trunk, and, during the last two days, with miliaria alba ; all those cases proved fatal. Aconite, Ipec, Bryon., China, Ars., Am., Puis., seem to correspond to the disease, but are given without avail. The disease might perhaps be arrested if attacked during pregnancy, but the symp- toms are so little developed that neither the patient nor the physician is aware of the approaching change. Carbo animalis or veget. might perhaps prove useful if the disease be fully developed. Kreasot, Sec com., Phosphorus, and Nitr. ac, in large doses, correspond perhaps more than any other remedies to uterine af- fections and gangrenous symptoms of other organs. Before resuming our remarks on the treatment of puerperal fever, we will first indicate the treatment of § 248. Phlegmasia alba dolens. This is a species of phlebitis, with the following symptoms : In some the labia swell, in others the crural or the obturator vein. The swelling is tight, painful, of a strikingly white colour. The pain is tensive-tear- ing, increasing periodically, the part becoming rigid and immovable. Sometimes the pain commences in 158 PHLEGMASIA AI.15A DOLENS. the bend of the knee1, or in the calf, but never near the foot; the swelling never extends to tlmse parts. Gen- erally only one side is affected. In a few days a swelling and tension are perceived in the groin, ex- tending as far as the labia, where the swelling termi- nates very sharply, and afterwards follows the inner border of the lower limb, as far as the bend of the knee and foot. As soon as the tension is e'xperienced in the leg and foot, the thigh and afterwards the leg swell, after which the pain abates. The s wed ling now becomes general, and the limb frequently acquires double the natural size. It cannot be moved without great pain, is hot and very painful; the swelling is smooth, shining, pale, or of a milky white, opaque, ho- mogeneous, and continuous all over ; frequently, how- ever, glandular indurations are felt in the groin, bend of the knee, or calf; at first, the swelling is elastic and unyielding, but afterwards pressure leaves pits. The fever commences with a violent chill, followed by heat, with a full, irritated, at first hard, and afterwards soft pulse. The disease is attended with bilious phe- nomena, such as jaundiced colour of the eye-ball, bit- ter taste in the mouth, loathing, sometimes vomiting, and affection of the liver. The character of the disease is sub-acute. The dis- ease terminates in recovery, suppuration, death, in consequence of pus getting into the circulation, and inducing a suppurative fever. The prognosis is not very favourable, particularly when the treatment commences late. The last case which occurred in my practice was attended with a tertian fever, and a debilitating di- arrhoea, and was completely cured in six days, by means of Arsenic. Arnica is said "to have been em- ployed by some with success, upon the supposition that the disease arose from the pressure; of the foetus upon the lymphatic vessels, as it passed through the pelvis. Rhus tox. and Nux vom. are likewise to be recommended. Bryon., Merc, China, Bellad., Veratr., Puis., Chamom., Sulphur, Calc. carb., Lycop., may like- wise prove useful. PUERPERAL FEVER. 159 § 249. We shall now return to the treatment of pu- erperal fever. Chamomilla is very suitable, provided it had not bee-n abused during or after parturition, if a greater or lesser number of the following symptoms are pres- ent : Great restlessness, nervous excitement, dulness of the head, beating headache, particularly in the forehead, oppression of the chest, with shortness of breathing; flaccidity of the breasts, in consequence of the secretion of the milk being arrested; slimy, greenish, watery, or milky diarrhoeic stools, which are frequently accompanied with cutting colic ; excessive lochial discharge, with labour-like pains extending from the small of the back towards the front part of the abdomen, and regularly followed by a greater or lesser discharge of coagulated blood; pale yellowish complexion, occasionally and for a short time only yielding to flushes on the cheeks, with general fever- heat, and constant restlessness, anxious, agonizing tossing about, and delirium. If these symptoms should not entirely yield to the action of Chamomilla, the remaining group of symp- toms is sometimes easily controlled by Rhus tox. This remedy is sometimes indicated from the commence- ment, if the patient's nerves should be very much irri- tated, and the symptoms should be aggravated by the least chagrin, or if the white lochia should suddenly change to a bloody, coagulated discharge. Chamo- milla is always indicated in puerperal fevers, when metrorrhagia is present, with discharge of dark, black- ish, coagulated blood, which takes place in paroxysms, or when the hemorrhage is accompanied with violent labour-like pains in the uterus, with much thirst and coldness of the extremities. Pulsatilla is suitable when the symptoms are oppo- site to the former ; it is indicated when the features of the patient are expressive of her suffering, and a gentle disposition and great nervousness are present; when the lochial discharge had been suddenly sup- pressed, with a burning sensation of fulness in the internal sexual organs ; it is furthermore indicated by 160 PUERPERAL FEVER. paroxysms of nocturnal heat and anguish, palpitation of the heart, sleeplessness : the violent thirst is no counter-indication; jt is indicated by diarrhoeic stools rather than costiveness. Pulsatilla is an excellent remedy when the fever has been induced by the abuse of chamomile. It is an excellent remedy when the lochial discharge stopped prematurely or had been ar- rested by some sudden and violent emotion, such as fright, fear, chagrin, or by a cold : the timely exhibi- tion of Puis, is apt to prevent the occurrence of puer- peral fever consequent upon such causes. Nux vom. is frequently suitable, particularly when the abuse of coffee or chamomile had been one of the exciting causes, provided the symptoms correspond. It is indicated by the following symptoms: Intense pains in the sacral and lumbar region ; pricking and bruising pain of the abdomen during motion, contact, cough, or sneezing; bitter taste, and eructations, loathing, nausea, even vomiting, dry lips and tongue, slimy or dingy yellowish coating of the tongue, sen- sation of heaviness in the sexual parts, with burning heat; suppression of the lochia ; constipation, or hard stools, with burning-stinging pains in the rectum ; painful micturition, or else retention of urine ; dry, parchment-like, burning-hot skin, with great thirst, particularly a desire for cold drinks, full, hard pulse, and sometimes expression of anxiety in the features, and constant restlessness; the secretion of milk is rather increased than otherwise, inducing turgescence of the breast, with pressure and tension. Nux v. is generally more suitable when the excitement of the circulation has an erethic character. When Nux is indicated, Coffea should likewise be- thought of, particularly when coffee is not the habit- ual beverage of the patient. But even if this should be the case, Coffea, if indicated, will pmve useful. It is required by the following symptoms : Excessive painfulness of the affected parts, excessive bodily and mental excitement, wakefulness, chill, with fever- ish warmth of the body, delirium, with open eyes, violent colic, with great irritability, which sometimes PUERPERAL FEVER. 161 increases even to despair. Bryonia is indicated by similar symptoms, particularly when the breasts feel empty, (according to others whey they feel full and turgid,) when the urine is secreted in larger quantity, the lochia are not suppressed, (or when bloody lochia again make their appearance.) and no pain is felt in the rectum during stool ; the exciting causes which have been mentioned for Nux vom. should likewise be absent. Bryonia is more particularly indicated by depression of spirits, painful sticking in the region of one or the other ovary, aggravated by contact, and in- dicating an inflammatory condition of those parts, with painfulness of the thigh of the affected side, par- ticularly during motion. Belladonna 30, is indicated by the following symp- toms : Disappearance of the milk from the mammae, or else partial accumulation of milk with cord-shaped hardnesse's, redness, radiating toward one point, (ery- sipedatous inflammation,) with stinging and tearing pains m the breast; short, oppressed breathing, anxi- ety ; drawing, stinging, labour-like pains deep in the abdomen, with painful dragging towards the sexual parts and anus, and constant urging to stool, without ability to satisfy the desire, on account of a spasmodic constriction of the' rectum, (for which Belladonna is a specific ;) discharge of coagulated, fetid, black blood, or suppression of the lochial discharge ; meteorism of the whole abdomen, without eructations or emission of flatulence, stinging-digging pains in the abdomen, which are aggravated by contact, and attended by constant irritation in the chest, and short cough ; burn- ing heat of the whole body, particularly of the fore- head and palms of the hands, sweat on the rest of the body, and violent or moderate thirst, sometimes at- tended with impeded deglutition ; excessive headache, a sort of pressing and pushing, particularly in the forehead, distention of the vesels of the head, and tur- gescence of the vessels of the scleratica, with con- traction or dilatation of the pupils, imparting to the eye's a glassy appearance; these symptoms are some- times accompanied with illusions of sight, scintilla- 162 PUERPERAL FEVER. tions. luminous vibrations and colours before the eyes, or even with amaurotic blindness; headache, which is increased by motion or noise, or even by the men; motion of the eyeballs, and is frequently so excessive that the patient loses her. senses and is attacked with furious delirium; the sleep is disturbed, and not re- freshing, the patient being constantly tossing about. Belladonna always deserves consideration when a puerperal fever has a typhoid character, or ine lines te> typhus, when symptoms of an inflammatory irritation of the meningeal membranes or brain is present, and when it was caused by violent e-motums. Arsenic is a distinguished remedy in puerperal fe- ver. It is indicated by the following symptoms : Burn- ing, or burning-gnawing pains in the' interior of the offended parts, with inability to lie on the affected side, and diminution of the pains during motion. Ex- cessive anguish, with sudden pre>stration of strength, sunken, extinct eyes, yellow, livid complexion, nightly sleeplessness, restlessness, tossing about, and sensation as if burning-hot water were running through the blood-vessels : sleep disturbed by Rightful and anxious dreams. The Arsenic-fever is always very violent; the heat is burning and dry with great thirst, frequent drinking, though little at a time, dry and parched lips, phlyctfenae about the mouth, nausea, and aversion to food, bilious vomiting, violent aching-burning pains in the abdominal organs, mete'e>rism, oppressive- pains in the chest, dizziness and headache-, restlessness, deliri- um, small, feeble, intermittent pulse, etc. Colicynthis is indispensable in puerperal fevers oc- casioned by indignation, chagrin, on account of un- worthy treatment; they commence with fainting fits and sleeplessness, and are characterized by feverish heat, hot, dry skin, hard, full, and quick pulse*alternate sopor and d ii* urn, with the eyes open, disposition to escape, heat about, the heael, stinging in the eyes and forehead, dark-red face, yellowish-coated tongue, bit- ter taste in the mouth, and of everything the patient eats, colic and diarrhoea after taking 1 he least nourish- ment, with pain in the pit of the stomach on touch- MILK-FEVER. FEBRIS LACTEA. 163 ing it; perceptible beating of the heart and all the arteries Arnica deserves a preference over all other reme- dies, if a condition resembling puerperal fever should have been developed by injuries occurring during par- turition. Ili/oscyamus is a principal remedy'in such fevers, particularly when typhoid symptoms predominate, with frequent discharge of coagula and spasmodic symptoms of the whole body or of single parts, tris- mus, starting of the whole body or extremities ; and when these symptoms owe their origin to emotions of various kinds, Stramonium is related to Hyoscyamus. Platina is indicated by irritation of the sexual or- gans, which frequently increases to nymphomania, and is accompanied with copious discharge of thick blood ; the patient complains of a painful pressing down in the sexual organs, and distressing pain in the small of the back, with almost constant internal chills ; violent pressing pain in the forehead, which is aggravated by every motion, and is attended with anguish, an anx- ious burning heat in the face, great thirst, and appre- hensions of death. Sepia, Bell 'donna, Crocus, are likewise more or less indicated by those symptoms. The diet should consist of light soups or broth, with a little bread, gruel, sago, vermicelli; after the fever has abated, a more substantial but easily digestible kind of nourishment may be substituted. Toast- water, sweetened with sugar, cherry or raspberry- juice, are the best kinds of beverage for the patient. § 250. Milk-fever of lying-in females. Febris lactea. Utero-gestation and lactation are natural states, which are not characterized by any morbid symptoms, unless some pre-existing cause in the female organ- ism should develop them. The same may be said of milk-fever, on the third, fourth, or sixth day after parturition. The appearance of the milk in the breast is a purely physiological act, which is not ne- cessarily accompanied by any morbid phenomena. Nevertheless, we discover in some lying-in females a 164 MILK-FEVER. FEBRIS LACTEA. group of morbid symptoms, such as chills, heat, thirst, and sweat ; the pulse, which is at first small, gradu- ally becomes fuller, and is sometimes even quite full, and is generally moderately quick, soft, and regular: the exacerbation usually sets in in the evening : to- wards morning perspiration sets in with relief. Some- times this kind of fever is attended with drawing pains from the back to the breasts, headache, loss of appe- tite, flat taste, etc. The paroxysm of fever freemently comes on again on the day following ; upon the whole, however, the symptoms are very light, and the general health is but slightly disturbed. After parturition, the irritability of the nervous sys- tem is, of course, increased, so that even a slight cold, emotions, slight dietetic transgressions, and particularly a morbid irritation of the organs which are of partic- ular importance after parturition, the breasts, nipples, sexual parts, may occasion such a fever as has been spoken of above. This kind of morbid irritation may be induced by weaning, after-pains, tumors, injuries, etc. Inasmuch as the most important diseases somelimes arise from trifling causes in lying-in females, the at- tending physician should always ascertain whether such fevers are accompanied with disturbance of any of the more important functions of a lying-in female. § 251. If the milk-fever should be very slight, it can easily be controlled by diet, and a moderate ex- ercise of the function of nursing. For the more violent degrees of ibis levin-, the fol- lowing remedies are indicated: Puis., Am., Aconite, Bellad., Bryon., Coff., Ignat., Chamom., Mercur., Opium. If the fever should have been caused by a cold, and should have the characler of a rheumatie: fever, Pul- satilla, sometimes removes it. If the fever should be a synocha, Aconite is the well known remedy. If there should be less synochal fever, and the rheumatic pains in the chest and mammae more striking, Bruonia is the most useful remedy, and removes the morbid condition in a few hours. If the fever should be more acute, with inflammatory symptoms in the mamma'. MILK-FEVER. FEBRIS LACTEA. 165 (erysipelatous inflammation,) Belladonna is the most important remedy. If the fever should be occasioned by too sudden and too copious a secretion of milk, li/iu\ tox. will easily remove it. Such fevers are frequently occasioned by emotions. Sudden joy, for instance, frequently increases the natural irritability of the nervous system in lying-in females to a dangerous extent. Coffea is the best remedy for morbid conditions induced by such causes. If the fever should have been induced by violent cha- grin, Chamomilla is the well-known specific, which, if the fever should be violent, may be preceded by a few doses of Aconite. If fright should have been the exciting cause, Opium will generally be found to cor- respond to the symptoms. Milk-fever caused by fright and chagrin, is most easily removed by Aconite. Fevers arising from internal mortification and grief, yield to Ignatia. If fear should have been the ex- citing cause, Puis, or Belladonna will be found suf- ficient. Fevers induced by a sudden ebullition of temper are most easily removed by Nux vom.; if caused by well-founded chagrin, Siaphysagria is the best remedy. Gastric derangements, with fever, induced by diet- etic trangressions during the period of confinement, are treated like gastric affections generally. If such derangements should have been induced by morbid irritations of any of the organs which are of particular importance during the period of confine- ment, the treatment has to be conducted with refer- ence to that cause. If mechanical injuries of the sex- ual organs should be the cause, Arnica is to be given internally ; and if the wound should be considerable, the external use of Arnica should not be omitted. If the derangements should have been occasioned by after-pains, Coffea, Chamomilla, Nux vom., Puis., or Arnica, are indicated. Coffea. is indicated by an excessive spasmodic pain, as if all the bowels would be torn. Convulsions frequently supervene ; the body bends double, hands and feet start, the patients lament in the most piteous manner, grate their teeth, become 166 MASTITIS. cold and stiff. Pulsatilla may be suitable to patients with gentle dispositions, if the fever should have been caused by violent after-pains: if the patient should be very irritable, and start at the least surprise. Puis. would be so much more indicated. Crocus will be found suitable when the lever is accompanied with lancinations in the sexual organs, groin, anel from both sides to the small of the back, and when a black, dark, viscid blood is secreted, beyond the normal pe- riod. An additional indication for Chamomilla in milk-fever is the passage of coagula, attended with the most violent after-pains. Sometimes these kinds , of fever are successfully treated with Nux vom.. par- ticularly when violent after-pains are present, which occasion an urging to stool during a recumbent pos- ture, which disappears as soon as the patient sits down to relieve the bowels, and is then followed by spasmodic pains in the uterus and bladder. Arnica is the principal remedy when these levers arise from pressure and contusion of the uterus, or from injuries received during parturition. Females who wean their infa* ;s, should keep their breasts covered with cotton or matting, and should moreover take Bryonia, Belladonna, or Mercurius. § 252. Mastitis, Inflammation of the mamma?. Mastitis occurs most frequently after parturition. At such periods the breasts require particular care and attention. Affections of the breast do not always arise from bad management after parturition; they frequently occur in consequence of the increased func- tions which those organs are called upon to perform at such periods. § 253. Soreness of the nipples is one of the most fre- quent occurrences during lactation, and induces many mothers to wean their infants at an early period. The nipples become painful, particularly while the infant is engaged in the act of nursing; upon close examina- tion, it will be found that the epidermis has become detached, and that the parts where this has taken place are inflamed. If this inconvenience should not MASTITIS. 167 soon be removed, the nipples crack, and blood is apt to be drawn from such rhagades by the infant. An excellent remedy for this affection is the tincture of Arnica, fixe, ten, fifteen or more drops to one hun- dred drops of water applied externally. The nipples require to be moistened with this solution every time the infant has been nursing, and before putting it again to the breast, the nipples have to be washed with tepid water. If the soreness should not be com- pletely removed under the use of Arnica within two days, Sulphur should be exhibited, inasmuch as the affection, in such a case, evidently depends upon psora. In some cases Chamomilla, Calcarea, Lycopo- „ dium, Phosphorus, Silicca, Sepia, Graphites, are indi- cated from the commencement. The last-named rem- edy has been found particularly suitable when the in- flammation around the nipple was of an erysipelatous nature. Graphites is likewise indicated when the mother had been formerly affected with scrofulous cutaneous eruptions, particularly tinea capitis, and continues to complain of a corrosive itching of the scalp, with a quantity of bran-like scales. § 254. Mastitis generally arises from stagnation of the milk in the breasts, from violent emotions, etc. When the breasts are inflamed, they are generally hard ; the lactiferous tubes feel like knotty cords af- fected with tension and pressure, and which after- wards become inflamed. The surface of the breasts either wholly or here and there only, becomes red ; a violent stinging pain is experienced, with burning, swelling, hardness, heat, and general febrile symptoms. When the inflammation is very violent, the secretion of milk ceases. A similar condition frequently sets in after weaning. If the inflammation be not fully developed, Bryonia is the principal remedy ; but if it should be very acute, Belladonna has to be exhibited. These two reme- dies, even if they should not remove the difficulty en- tirely, yet meliorate the condition of the breasts, leav- ing slight hardnesses here and there, without much pain. 168 ORCHITIS. In females tainted with dvscrasia of one kind or another, these remedies will prove insufficient, and Sulphur. Conium, Carbo anim. or veg., Graphites, Phos- phor., Silic, will have to be resorted to. Phosphorus is an excellent remedy in erysipelatous inflammation of the breasts, when inflammation is on the point ot setting in or has actuallv commenced. In suppuration of the breasts, which is exceedingly apt to set in after inflammation, Silic, Krcasot, Mer- cur., Carbo anim., Phosphorus, are excellent remedies. Siiicea is particularly useful when portions of the breast have been destroved by the suppurative pro- cess. § 255. Orchitis, inflammation of the testicles. Not only the testicles, but the whole spermatic cord up to the abdominal ring, is involved in the swelling ; the pains are stinging, tearing, although permanent, yet at times more violent than at others, as in rheumatism. The skin of the scrotum is not very tight, nor is it red or shining ; it does not ex- hibit any great alterations of any kind. If the dis- ease should have been occasioned by a cold, muscu- lar parts are likewise affected with tearing and draw- ing pains. The fever is either synochal or erethic. In traumatic orchitis, occasioned by external inju- ries, the' swelling is generally more considerable than in the former kind, and the sensitiveness to contact is likewise greater. The testicle is drawn up to the abdominal ring. The swelling is most violent in orchitis gonorrhoica, which generally comes on in consequence of cold, and is accompanied with suppression of the gonorrheoal discharge. § 256. We have already stated, in other parts of this work, that Arnica is a specific remedy for affections aris- ing from external injurie-s, contusions, bruises, strains, or tearin0- of solids. It is likewise an excellent remedy for orchitis arising from mechanical causes. If the; inflammation and fever should be very acute', the ex- hibition of Arnica may be preceded by a few doses of ORCHITIS. 169 Aconite. Contusions of glandular organs, and their consequences, are sometimes removed by Conium, to which we will add Calendula officinalis. Chronic indurations of the glands and testes frequently yield permanently to a few doses of Rhododendron chrysan- thum. In rheumatic and erysipelatous orchitis, the follow- ing remedies are the most suitable: Bryonia, Bella- donna, Rhus tox., Puis., Mercurius, etc. Clematis is an excellent remedy when the swollen and indurated testicle is painful and sensitive, and a drawing is felt from the testicle along the spermatic cord; a crampy and bruised feeling when touched, with drawing and stretching in the lumbar region, thigh, and scrotum,* is frequently present. In erysipelatous orchitis, Arse- nic should not be left out of consideration. In gonorrhoeal orchitis, Mercurius is frequently the most suitable remedy. Pulsatilla may prove useful for a painful drawing and stretching along the sper- matic cord to the inflamed testicle, both those organs feeling bruised when touched. In other cases, Clema- tis erecta may be indicated ; in others again, Acidum nitricum; if inflammatory fever should be present, a few doses of Aconite should be exhibited, previous to resorting to the more specific remedies. I have found the second and third trituration of Mercurius solubilis the best remedy for induration of the testicles, though, in some cases, Aurum may deserve a preference over Mercury. If the pain in the swollen testicle should be a crampy, contusive, choking pain, with dull stitches striking suddenly through the part, and reaching into the swollen spermatic cord, Spongia is the most suitable remedy. Spongia, lodium, positive electricity, and Mezcreum, are likewise excellent remedies for indura- tion of the testes. Pulsatilla and Staphysagria, especially the latter, are' excellent remedies for an aching pain and draw- ing-burning stitches in the testes and spermatic cords. Carbo should not be overlooked. There is a species of orchitis where the affected 8 170 ENCEPHALITIS, ETC. testicle swells up to the size of a child's head, partic- ularly under the alloeopathic use of Mercury, and where, according to the doctrines of the old school, the sick testicle cannot be cured without an opera! ion. This affection frequently yields to a single remedy, particularly China, Aurum, Sulphur. § 257. Encephalitis, cephalitis, meningitis, phrenitis, inflammation of the meningeal membranes. The nature of the brain and its surrounding mem- branes gives rise to a variety of inflammations of that organ. Inflammations of the dura mater are very rare; the arachnoid membrane is more frequently in- flamed, and the pia mater, which is exceedingly vas- cular, most frequently. An inflammation of the latter membrane frequently borders on synocha. If the cor- tical substance should be the seat of the inflammation, it is still more intense. In inflammation of the me- dullary substance, the inflammatory phenomena are less marked, but the nervous symptoms are so much more prominent. We know all this from post-mor- tem examination. We shall include the symptoms of the different va- rieties of encephalitis in one group, for the reason that it is scarcely possible to separate them from each other, and that such a separation, even if it were possible, would have no practical value. En- cephalitis is either acute or chronic, at times furri- bond, of various degrees of intensity, with delirium, convulsions; at others, with pressure on the brain, depression of the cerebral functions, coma, paralysis ; at times, the symptoms resemble apoplexy. The precursory symptoms of encephalitis, attended with congestion of the brain, are: Dull pain through the whole head, sensation of fulness, confusion of the head, red and bloated face ; throbbing of the carotids ; Sensation of rushing of blood in the head ; increased irritability,vertigo, sleeplessness, restless sleep, which is disturbed by dreams, and starting, as if in affright; or sopor, inability to think ; cloudiness of sight, photo- phobia, diplopia, buzzing in the ears, hardness of ENCEPHALITIS, ETC. 171 hearing, unsteady gait; formication in the limbs, stammering speech. The pulse is full, sometimes suppresseel, and generally accelerated ; the heart beats, and the nose bleeds. These are the most ordinary symptoms of encephalitis, which, when increasing, change to a dull, aching pain throughout the brain. After a shorter or longer precursory stage, and sometimes suddenly, a digging-up, beating, boring, or frequently a dull headache, sets in, extending from the occiput over the whole head, and increasing con- siderably on moving and shaking the head. The pa- tient's head feels hot and burning. He frecpiently grasps at it, while in a state of unconsciousness. The countenance has a wild and threatening expression, with redness and turgescence, shining and injected eyes, photophobia, contraction of the pupils, disturb- ance of the sensual functions, stupefaction, sopor, and bland delirium, or else excessive sensitiveness, the patient being painfully affected by the least noise ; the eye is wild and staring, with furious delirium, increas- ing unto rage, attended with a desire to commit acts of violence, and with unusual muscular power, particu- larly towards evening. Spasmodic or tetanic con- tractions of the muscles, strabismus, distortion of the eyes, grating of the teeth, are frequently present; likewise sympathetic vomiting, in many cases. The fever is generally a synocha ; the heat is great, tongue dry, thirst intense, urine saturated, but sometimes clear, spastic. The pulse is generally small, frequent, anel tremulous. § 258. Causes : Keeping the head too warm ; ac- tion of the sun on the bare head, nightly mental exer- tions, violent emotions, metastasis, abuse of spirituous drinks, onanism, mechanical injuries, worms, sup- pression of cutaneous eruptions, of bloody discharges, etc. Course and terminations of the disease : It may be- come fatal in 24 hours ; in full-grown persons it runs a course' of from three to four days, but may last from sevem days to a fortnight. It terminates in : (1.) Re- covery. (2.) Softening, suppuration, with increased 172 ENCEPHALITIS, ETC. delirium, convulsions, etc., coma, paralysis set in; suppuration is attended with chills alternating with heat, etc.; sometimes the pus discharges by the ears. (3.) Exudation, which is not very rare among in- fants, inasmuch as the serous coat is very frequently the seat of the inflammation ; this termination is al- ways fatal. Death, however, may likewise take1 place by apoplexy, or paralysis of the brain. Encephalitis sometimes leaves vertigo, chronic headache, weak- ness of memory, strabismus, mental derangement, etc.; acute encephalitis may likewise pass into a chronic form. Under the homoeopathic treatment, the prognosis is much more favourable than under the alloeopathic treatment, which, even now, though much more con- formable to nature than formerly, is still very uncer- tain and dangerous. Sopor, grating of the teeth. strabismus, paralysis, singultus, masticating motion of the jaws, vomiting of black or grass-green substances, rumbling noise during deglutition, etc., are bad symp- toms. If spasms alternate' with delirium and coma, the prognosis is bad. Favourable symptoms are: bleeding at the nose, discharge from the ears, reap- pearance of suppressed secretions, etc. § 259. It has already been stated above, that there is a great variety of cerebral inflammations which are more or less violent. The fever is either syno- chal or typhoid. Encephalitis may likewise develop gastric symptoms. It occurs most frequently in chil- dren, particularly in those with prominent foreheads, and is apt to increase to acute hydrocephalus. Con- gestions of the brain, resembling encephalitis, are likewise frequent among children. A cerebral irrita- tion is likewise apt to occur in infanls, after weaning, and is characterized by a good deal of screaming, tossing about, redness and bloatedness of the face' and eyes, and complete sleeplessness. It also exists in in- fants when they cease to vomit up the milk, which takes place during the first weeks after parturition, and is very conducive to the health of the infants ; they refuse to nurse when the vomiting stops. ENCEPHALITIS, ETC. 173 Belladonna is the principal remedy for encephalitis, particularly in the above-mentioned cases of infants, and is more especially indicated by the following symptoms: Constant boring with the head into the pillow, excessive sensitiveness .to noise and light, so- por, great heat in the head, red and bloated face, with visible throbbing of the carotid and temporal arterie's, swelling of the veins, and the other symp- toms mentioned in the preceding paragraph; some- times hydrophobia phenomena are present. If there should be a true synochal fever, it is ad- visable to give a few doses of Aconite, previous to the exhibition of Belladonna, even in acute hydrocepha- lus. Encephalitis occasioned by insolution, is probably most easily cured by Camphor. In a case of stupor, with sopor, occasioned by a stroke of the sun, Opium afforded speedy relief. Encephalitis erysipelatosa is a species of inflamma- tion accompanying external injuries of the head, or occasioned by the sudden suppression of an acute cu- taneous eruption or erysipelatous inflammation, par- ticularly of the face ; the meningeal membranes are the seat of the inflammation, which manifests itself by sudden, violent headache, delirium, etc. This spe- cies of encephalitis frequently leads to hydrocephalus. For this affection, Belladonna is likewise one of the most suitable remedies, which only yields to Rhus tox., when the inflammation was occasioned by the sudden suppression of erysipelas of the face. Ence- phalitis consequent upon the sudden disappearance of otitis, sometimes requires Pulsatilla. Belladonna, however, is the specific remedy when the cerebral inflammation is occasioned by suppression of scarlati- na or purple-rush, or when it exists simultaneously with either of these aflections. If such an inflamma- tion should threaten to pass into hydrocephalus, Merc. sol. will free]uently be able to prevent this. If effusion should actually have set in, Belladonna and Mercurius may still prove useful, but Arnica or Digitalis, or per- haps some other remedy as yet unknown to me, will 174 DELIRIUM TREMENS, ETC. be more suitable. The symptoms of incipient acute hydrocephalus, without previous inflammation, are fre- quently rapidly and permanently removed by a dose of Aconite followed by Belladonna. In typhoid meningitis, the remedies which have been mentioned for typhus require to be' resorted to, especially Bryonia, Cantharides, Hellcborus, Hyoscya- muSf and Stramonium. § 260. Delirium tremens, phrenesia, or encephalitis potatorum. This disease is partly of a physical, partly of a psy- chical nature. It is generally preceded by pressure in the region of the stomach or liver, loss of appe- tite, vomiting of water, tre'mor when not in a state of intoxication, languor, confusion of the head, rest- less sleep or else sleeplessness, anguish, unsteadiness and vehemence, quarrelsomeness, and lowness of spir- its. These symptoms precede the attack for days and weeks, after which the paroxysm sets in suddenly, in consequence of an intoxication. Although -the disease may be brought on by the abuse of any kind of spirituous drink, yet it is prin- cipally occasioned by brandy, and more particularly in individuals of an ardent disposition, lively fancy, sanguine and choleric temperament, and general ner- vous irritability, and who have been sullering with gastric derangement, nocturnal restlessness, and men- tal derangement. §261. We have already stated above-, that the' at- tack is preceded by derangements of the abdominal organs, loss of appetite, vomiting, constipation, which sometimes alternates with diarrhoea, increasing, in some instances, to a perfect cholera morbus. Symptoms of mental derangement are likewise present; ill-hu- mour, weakness of memory, anxiety, confusion of ideas. The patient stutters, the movements of the body be- come unsteady,the sleep is unrefreshing and disturbed, with unpleasant drCams ; there is great disposition to sweat, and the patient is troubled with illusions of sight and hearing. The more the dise-ase progresses, DELIRIUM TREMENS, ETC. 175 the more sleep becomes disturbed, and the fancies with which the patient was haunted during sleep, continue even in the waking state, and are supposed by him to be realities. Little by little sleep ceases entirely, the looks and manners of the patient betray great internal uneasiness and anxiety ; he talks a good deal, see:ms very busy, and finally becomes delirious, the dedirium being sometimes of a merry, at others of a vehenient character, the latter particularly when the patient's desires are opposed ; at times the patient is tormented with anguish, and apprehension of im- aginary dangers. The strange and peculiar expres- sion of the eye and features is characterized by an awkward desire to conceal the internal state; if, however, the patient should be troubled with one fixed idea only, those attempts at concealment do not exist. The patient is, as it were, in a waking dream, from which.he can be roused for a short time, by speaking to him, or by other impressions: when roused, he talks rationally, considers himself sick, which is not the case otherwise, asks for aid, after which he re- lapses into his dreams. When the paroxysms are at their height, he is apt to confound persons well known to him with others. He expresses his fancies Ijy his gestures, which are sometimes very comical on that account. The patient is exceedingly jealous. He does not like to be left alone, because his anxiety in- creases in solitude and when in bed. It is difficult to keep him in bed, particularly towards the termination of the malady, and any attempt to oppose his leaving the bed and walking about the room, frequently in- duces a fit of rage. The disease generally exacer- bates towards evening. On account of the violent starting and trembling of all the limbs, it is difficult to determine the pulse with any degree of accuracy. The upper limbs tremble more than the lower, even before the attack has set in ; the trembling is worse after the attack has set in, and diminishes or increases with the disease. The more feeble the patient, the more' profuse the sweat, which generally smells sour and is cool; sometimes the sweat is entirely wanting. 1*76 DELIRIUM TREMENS, ETC. The tongue is generally coated whitish, the thirst is not very great, the appetite scanty, stool sluggish, or even suppressed, the secretion of urine is likewise diminished. In consequence of the congestions of the head, which are always present, the face is red, though it has sometimes a jaundiced appearance. At the commencement of the disease, when the patient has not yet lost his senses, he frequently complains of heat in the head, headache, and buzzing in the ears ; afterwards the eyes and eyelids turn red. The disease sometimes runs its course in a few hours, or in a few days, or even in some days or weeks ; hence we distinguish acute and chronic delir- ium tremens. Terminations: (1.) In recovery, by sleep, which sometimes lasts 24 hours, the trembling ceases, the face brightens up, bilious discharges from the bowels take place. Relapses are apt to set in after the least excesses. (2.) In death, by paralysis of the brain, or apoplexy. The prognosis is rather favourable ; it depends upon the mode of treatment. § 262. I am unable to say, for want of sufficient ex- perience, whether the last stage of this disease can be cured by homoeopathic remedies. As regards the first stages of this disease, it is certain that they can be cured, and that the development of the disease can be arrested. One of the best specifics for delirium tremens aris- ing from abuse of brandy, even if the disease should be considerably advanced, is Nux vomica. To pro- mote the cure, the patient should be given small por- tions of brandy, in water, one portion of brandy to three portions of water; this will bring on sleep, without interfering with the suitable specific. Coffea Cruda is an excellent remedy to regulate the excessive irritability of the nervous system, to quiet the fancy and excessive muscular mobility. Every homoeopath knows that our mode of changing crude drugs to remedial agents, alters the original sub- stance to such an extent that the homoeopathic pre- DELIRIUM TREMENS, ETC. 177 paration, as, in this instance, Coffea, will be found sufficient, even if the same substance should have been constantly used by the patient in irs crude state. Arsenic is an excellent remedy for trembling of the limbs, pale, jaundiced complexion, bloated face, cold and blue skin, fainting fits, particularly during vomit- ing, anxious heat, starting, anguish, melancholy, sad- ness, despondency, vehemence, or derangement of the will-faculty generally, etc.* Opium is likewise a very useful remedy in delirium tremens, inasmuch as it-increases the irritability and action of the voluntary, and diminishes those of the in- voluntary muscles; hence the slower pulse, the sup- pression of stool, etc.; on its secondary action, it ex- alts the fancy and courage, and stupefies, at the same time, the sentient power and the consciousness. As Nux v. is a specific remedy for 'this disease in the first stage, so is Opium in the second, and should at once be substituted for the former remedy if the dis- ease progresses uncontrollably towards the second stage. Camphor seems to me a suitable remedy when the nervous excitement, the mobility and tremor of the limbs, do not yield to any of the above-named reme- dies. As opium corresponds to Nux, so does Cam- phor to Coffea, and will be exhibited with advantage if the latter remedy, though indicated, should prove of no avail. According to some, Stramonium, one or two doses, is frequently indicated. Hyoscyamus, in alternation with Belladonna, is said to have cured a case very much like delirium tremens, though not entirely the same. Some maintain likewise that Nux vom. is only useful in the stage of convalescence. For the remaining mental derangement, mania, * A characteristic indication for Arsenic is this : Vermin crawling about the bed, ugly animals staring at the patient, strange faces, etc At the same time the patient seems to talk rationally. One of ihem asked me repeatedly to remove the vermin from the bed-clothes; it seemed to be his honest be- lief that the vermin was there He likewise saw money, dice, etc., and be£rKed me to pick them up for him. He was cured with Arsenic, in a week. I had cured him of delirium tremens four times.—Hempel. S* 1 7!S ACUTE HYDROCEPHALUS. craziness, idiocy, (which is more frequent in females.) paralysis, habitual sweats, dyspepsia, cachexia, eir- ganic diseases of the liver, e>tc. Nux vom. is likewise' the most suitable remedy, though I vratrum. Acid. phosphor., Aurum, etc., are likewise very valuable in some cases. For the inclination which some men possess to drink from morning to night, in order to keep themselves in a constant state of intoxication, I have administered the tincture of sulphur with great success. § 263. Acute hydrocephalus. Acute hydrocephalus runs a regular course, like all other acute diseases, particularly encephalitis; it is, in fact, nothing else than an inflammation of the brain with effusion. Formerly, the phenomena and course of the dis- ease were very little understood. Thanks to the dis- coveries of Formey and Goelis, it is much easier now to diagnose this disease, and to trace it through its various stages. Among children, those- from two to six years old are most liable to it. It attacks even children of the best constitution. In some families there prevails a natural disposition for that disease. A dangerous symptom is, if death by hydrocephalus did occur in a family. Other dangerous indications for the probable development of hydrocephalus are : Globular shape of the head, prominence of the ante- rior and posterior portions of the head, with sunken eyes, and the fontanels remaining open, much viva- city, premature mental development, disposition to nose-bleed; the new-born infant looks feeble, sickly. without strength or intellectual expression, sleeps a good deal, has a vacant and staring look on waking; want of sensibility ; retarded and imperfect develop- ment of body and mind. (1.) The precursory stage. This is not always pre- sent, or at any rate, not distinctly perceptible : in in- fants, particularly, it is sometimes overlooked, or is supposed to indicate a different disease. This stage sometimes lasts only a few hours, at other times a ACUTE HYDROCEPHALUS. H9 few days, and does not offer any of the characteristic symptoms of acute hydrocephalus. It is recognised by the following symptoms: The child which was pre- viously able to run about with ease, has an unsteady, vacillating gait; he raises his feet high from the floor, and is liable to fall on a level floor, even in the room This unsteadiness communicates itselt to tne whole body. We observe, moreover, a sudden change of disposition ; in the place of the former cheerfulness and lightness of heart, the children become morose, peevish. On moving the head suddenly, for instance, or raising it in a recumbent posture, vertigo, or a sudden stupefaction is experienced. In some cases, the secretion of urine is scanty, in others the urine is turbid, flocculent, opalescent. Some authors number a fine. dry. colourless eruption on the outer side of the upper arm, on the cheeks and lips, among the precur- sory symptoms of hydrocephalus. Beside these characteristic symptoms, there are some that are less characteristic, such as loss of the blooming, appearance, sudden change of complexion, diminished appetite, restless sleep, during which the children moan, groan, start up as in affright, alterna- tion of creeping chills and flushes of heat; a pulse of the ordinary rapidity, but intermitting at times, or beating more feebly. If these less characteristic symptoms should co-exist with the above-mentioned characteristic ones, the physician will be led to suspect the approach of hydrocephalus, and will watch the de- velopment of the symptoms with redoubled attention. & 26t The most suitable remedy for the above-de- scribed symptoms of the precursory stage is Pulsatil- la. It corresponds more especially to the tottering gait, the vertigo, and the deranged secretion of urine. The moral condition of the patient in this stage of hydrocephalus is likewise one of the best indications for Pulsatilla. Belladonna is preferable to Pulsatilla, when the gait of the patient is not so much unsteady and tottering as vacillating, when the urine is scanty but of a natural colour, and when the above-mentioned eruption is distinctly perceptible. Cases may like- 180 ACUTE HYDROCEPHALUS. wise occur where Ipec, Chamom., Ignat.. and..i?r»/o«., are indicated. In some cases, the above-mentioned precursory symptoms exist without any further devel- opment ; the children are very backward in learning to walk, and the continuance of the' aforementioneel symptoms points to the existence of a more deep-se;at- ed affection. No other symptoms are seen except a want of power to walk. For this difficulty, I have frequently administered Causticum with benefit. § 265. First stage, irritative stage. This stage is characterized by the following symptoms : Violent headache, particularly in the forehead and temporal region, with pressure in the eyes. Infants express this pain by moaning and grasping at the forehead; disposi- tion to vomit, and actual vomiting, which is less apt to occur in a quiet position, and is excited by raising the child, carrying it about, moving it to and fro, or by any other motion ; liquids are more readily vom- ited up than solid food. The more the' disease develops itself towards the following stage, the less vomiting there is. A characteristic symptom is the increaseel sensibility of the eye to the light; the patients do not open their eyes except in the dark, or by a feeble light. The little patients are likewise very sensitive to noise, and are tormented by internal anguish and restlessness in consequence of it. The alvine evacu- ations are generally suppressed, and when they occur theyare viscid, tenacious, brown. The face is gen- erally pale, the features are altered, distorted, the nose is always dry, the lips are pale or of a faint dark-red, cracked in consequence of the heat. According to Goelis, a pathognomonic symptom is the collapsed state of the bowels, without any increase of the alvine evacuations. There is scarcely ever any characteris- tic fever present. The pulse is small, irregular, very changeable, frequent, now and then intermitting, or beating more feebly. There is a disposition to sleep, but the sleep is restless, attended with grating of teeth, fancies, starting as if in affright. § 266. This stage is characterized by a number of definite symptoms, and it Mould seem as though it ACUTE HYDROCEPHALUS. 181 were possible to adopt a definite course of treatment in regard to it. *But this is not so. Different consti- tutions require a different treatment, and the other morbid phenomena are frequently present, which com- plicate the original disease. Be that, however, as it may, it is absolutely necessary to commence the treat- ment with Aconite, which frequently changes the dis- ease to a milder form. If the physician should be in doubt respecting the propriety of exhibiting Aconite, he will have to re- sort to Belladonna, which is the next most suitable remedy after Aconite. If Belladonna should prove useless, I give Zincum, second or third trituration, every two hours. In every case where Zincum was administered, the disease yielded in from 12 to 24 hours, except some languor, for which I continue the Zincum until every vestige of the disease has disappeared. Beside those remedies, Hyoscyamus and Stramonium may prbve useful in some cases.' The former is indi- cated by a bright-red face, throbbing of the carotids, glistening, staring eyes, wild looks, convulsive mo- tions of the eyes, unquenchable thirst, etc.; the latter is indicated by similar symptoms attended with wild delirium and violent congestion of the head. If this stage should have been occasioned by erup- tions, scarlatina, whooping-cough, etc., the treatment is the same, as those causes do not affect the charac- ter of the disease, and cannot be removed. If abdom- inal difficulties, derangement of the digestive func- tions, dentition, scrofula, etc., should be present, the treatment has to be combatted accordingly. Pulsa- tilla, Bryonia, Calcarea, Chamomilla, etc., will fre- quently prove of service. § 267. The second stage, the stage of exudation, ef- fusion of serous and lymphatic fluid, sets in in conse- quence' of bad treatment in the former stage, or in individuals endowed with excessive sensibility and feeble constitutions, persons who have been suffer- ing from their infancy, and are deficient in reactive power. 182 ACUTE HYDROCEPHALUS. This stage is characterized by a sort of insensibili- ty, which is probably owing to the pressure on the brain. The child which was restless in the former stage, now becomes dull and stupid; the- child lies quiet, is unable to be on his feet, or to keep his head erect. The eye, which was extremely sensitive to the light in the former stage, becomes insensible ; the pupil dilates; the visual power is leeble; diplopia takes place ; optical illusions set in; the child stares, and frequently squints. The pulse becomes slower, feebler, but remains irregular. The urine is frequently passed involuntarily, and without the patient being conscious of it; the bowels are closed. The patients sink into a state of sopor, with their eyes half' open ; they moan and groan on awakening, or grasp at thedr heads and stomachs. On raising the patient, we ob- serve in him anguish, restlessness, a spasmodic cough, and still more frequently, vomiting, are apt to set in ; the grasping at the head continues, but there are situ- ations where the head feels relieved. All these symp- toms, which denote a diminution of cerebral reaction, generally increase towards the end of this stage. In this stage the children take some nourishment, partic- ularly in a recumbent posture. If the disease should not be arrested in this stage, it passes into the third stage in three or four days. § 268. Goelis proposes to exhibit Digitalis in the second stage. This does not seem to be irrational treatment, though, in our judgment, Arnica is a more powerful agent in the second stage than Digitalis. If Arnica be the most powerful remedy to absorb the extravasated fluid consequent upon contusions, swellings, and mechanical injuries, why should it not likewise prove a powerful agent in absorbing extra- vasated fluids occasioned by internal causes ? We know now, from experience, that repeated doses of Arnica, as well as Digitalis, are eminently useful in the second stage of hydrocephalus. Beside these remedies, the following may likewise prove useful: Belladonna, provided it has not been employed without effect in any of the former ACUTE HYDROCEPHALUS. 183 stages ; Stramonium, which is particularly useful when strabismus and other spasmodic symptoms, par- ticularly spasms of the chest, are present; and lastly, Rhus fox., which is considered an important remedy by some. Other distinguished remedies in this stage are Artemisia and Cina. This remedy is particularly useful when the sphincter muscles are partially pa- ralyzed, when the child bores with the finger in his nose until blood makes its appearance. Hyoscyamus may likewise prove useful when paralytic symptoms have set in. Mercurius vivus should not be over- looked. § 269. In the last stage, that of paralysis, we ob- serve phenomena denoting an excessive derangement of the cerebral functions and paralysis of the nervous system. Stupor and sopor increase more and more the paralytic attacks in number and intensity, the pu- pil is paralyzed, complete deafness and blindness, and paralysis of the extremities, set in. The tongue be- comes dirty-looking, black, the breath is fetid, respira- tion is short, anxious, spasmodic. Symptoms of a fe- brile condition make their appearance ; the pulse is excessively irregular, hurried, small, spasmodic, inter- mittent ; the skin is burning-hot, and dripping with sweat, hands and feet feel alternately cold; hectic, circumscribed redness alternates with great paleness in the face. All sorts of spasms of the facial mus- cles, oesophagus and extremities, singultus, epileptic and tetanic spasms, make their appearance. Miliaria frequently breaks out before death. § 270. If the disease should have progressed so far without having been in the least influenced by the treatment, medicine will prove totally useless in this stage. Slight relief, however, may be afforded by Aconite, if the febrile svmptoms should be very vio- lent ; even the spasms may be somewhat diminished ; and by Ipecacuanha or Ignatia, if the spasmodic symp- toms should be the more marked. Opium is an excel- h-nt remedy if the sopor should be very obstinate, and the child, with his eyes half open, should nr rec >ver his senses. In general spasms with the head drawn 184 ACUTE 11VDROC KPH ALU S. backwards, the patient should smell, every five min- utes, of a solution of Camphor. If the symptoms should have abated, it would be proper to put a few globules moistened with the sweet spirits of nitre on the child's tongue, or, in case* of lock-jaw, to hold the open vial containing the spirits of nitre for a few sec- onds under the child's nose. In some cases, Moschus may prove of great service. Inasmuch as we do not know of any remedy which might be used with anything like certainty in the last stage of hydrocephalus, I may be permitted to suggest Indigo among the physiological effects, of which we remark the following: Sensation as if the head were enlarged and more prominent; undulating motions; warmth and sensation as of boiling water in the occiput, etc. § 271. I shall conclude with a few remarks which seem to me of some importance. It is frequently difficult, even for experienced phy- sicians, to diagnose the disease in its first stages, more especially for this reason, that the disease seldom exists among children as an idiopathic disease, char- acterized by peculiar symptoms, and that it generally comes on slowly, in consequence of dentition, acute cutaneous eruptions, or diseased condition of the re- productive organs. It is easily confounded with worm- fever, though such symptoms of the latter affection as resemble hydrocephalus never last with anything like permanence, but exhibit long intermissions. The most dangerous kinds of hydrocephalus are those which arise from acute diseases, particularly eruptive diseases by metastasis. Gcelis terms such cases of hydrocephalus " hydrocephalic apoplexy." In chronic hydrocephalus the interference of art is most available, especially in the first stages, which last longer and exhibit even, at times, a decrease, of the symptoms. If the physician be sent for in time, he will generally be able to save' the patient. This variety of hydrocephalus arises most frequently from external injuries, blows, or a fall on the head. The treatment differs from the course which has been de- SPINITIS, ETC. J 8.3 scribed in the preceding chapter, even from the com- mencement. The specific remedy for such cases is Arnica, internally and externally. For the external application, I use one portion of the tincture of Ar- nica to one, two, or three portions of pure water, and continue the application as long as any pain or other morbid symptoms remain. § 272. Spinitis, meningitis spinosa, myelitis, inflam- mation of the spinal marrow. In myelitis, as well as -in encephalitis, the mem- branes and substance of the marrow generally suf- fer simultaneously, and we therefore prefer describ- ing the symptoms in one group, as we did in ence- phalitis. The disease is characterized by a more or less violent burning-stinging, tearing pain, along the course of the spinal marrow, frequently resembling a rheumatic pain. The patient feels the pain deep- seated, not in the muscles or bones, which can be pressed upon without increasing the pain ; it is most violent on bending or moving the spinal marrow, and is sometimes intolerable in a recumbent posture, particularly in bed. The patient is able to lie on either side, but on turning has to keep the spinal mar- row straight and rigid, on account of the pain. In some cases the pain remits at first, but soon becomes permanent. The pain not only extends over a large portion of the spinal marrow, but spreads also to the chest, shoulders, abdomen, thighs, according as one or the other portion of the spinal marrow is inflamed, and frequently occasions a troublesome drawing in those parts. In the later stages of the disease, clonic spasms are experienced in the extremities which are nearest the seat of the inflammation, not in the face ; these spasms are apt to come on or to get worse in consequence' of pressing on the spinal marrow, or of quie'kly moving the trunk. The same remark applies to painful paraplegia. The patient complains, moreover, of chilliness, an- guish, unnatural, unpleasant warmth, or, in the more violent cases, of excessive heat in the spinal marrow, 186 SPINITIS, ETC. particularly in the most painful part of it ; the pulse is accelerated, the skin hot, profuse swe'ats se-t in. The head is free, without pain or heaviness, (e'\e«e'pt when the inflammation extends to the brain, in which case delirium, dysphagia, etc.. set in.) the eye1 is bright, open, moves freely, consciousness is undisturbed, even during the convulsions. The nearer the inflammation reaches the head, the more difficult it is to move the latter, or to swallow. The nearer the chest, the more the chest, shoulders, and hypochondria are affected. In myelitis lumbalis, the pain extends to the bowels, thighs, and pelvis. § 273. Myelitis occurs meVst frequently among young subjects and persons of robust constitutions. It fre- quently arises from mechanical causes, blows on the back, contusion of the back, concussion by a fall, dis- location and fractures of the' vertebra?; from cold, ex- posure- to wet, rheumatism, etc. Myelitis generally runs a rapid course, particularly when the disease arose by metastasis from exanthe- matic diseases, or from dysmenorrhea. The disease? terminates: (1.) In recovery, with gradual disappear- ance of the symptoms, and the development of the critical phenomena generally attendant on fevers. (2.) In exudation, suppuration, and softening, with in- crease of the paralytic symptoms. (3.) In death, which generally ensues in consequence of the last- named conditions. Paralytic conditions frequently remain, which disappear either gradually or not at all. The prognosis is generally unfavourable-; it is most favourable when the disease arises from some me- chanical cause. Copious sweat, hardness of the pulse, and delirium, are said to be fatal symptoms. § 274. The treatment should generally commence with Aconite, even if the fever were not a true syno- cha; but if the pulse be quick and bounding, Aconite is the first remedy to be administered, no matter where the inflammatiem may be' seated. Although Bryonia is supposed to be indicated in all affections which get worse, by motion, yet it is only OTITIS EXTERNA ET INTERNA. 187 indicated in myelitis when the disease is seated in the lumbar and sacral regions, when the adjoining abdomi- nal organs are likewise affected, and the alvine evac- uations are difficult. Nux vomica is more suitable in chronic myelitis without scarcely any fever. The inflammation in this case holds a middle rank between- acute and chronic rheumatism, the interior of the vertebral col- umn being principally affected, and the abdomen re- maining more or less free. I have seen some cases of myelitis arise from im- perfectly developed acute exanthems, particularly scar- latina and measles, the symptoms setting in with so much violence that every motion occasioned the most horrid pains. The joints of the extremities were like- wise affected, their motion being impeded in conse- quence. There was considerable fever, but not acute, and there seemed to be a tendency to exudation. Dul- camara proved the best remedy, even if exudation had threatened to set in, or had actually taken place. Belladonna is a principal remedy in this disease, particularly when arising by metastasis from the above-named acute eruptions, or when the disease is seated in the upper part of the spinal marrow. I am unable, for want of experience, to point out more specifically the symptoms to which the above- mentioned remedies correspond. There are other rem- edies, which may likewise prove available, such as Pulsatilla, Arsenic, Digitalis, etc., when the chest is involved, with paroxysms of anguish, palpitations of the heart, etc.; or Veratrum, Ignatia, Cocculus, etc., when spasmodic conditions of the abdomen, a feeling of coldness, etc., are present. § 275. Otitis externa ct interna, inflammation^ of the out9f and inner ear. These two kinds of inflammation, if arising from an internal cause, are generally found united. They are generally accompanied with cerebral suffering, particularly if the inflammation of the inner ear be very prominent. 188 OTITIS EXTERNA ET INTERNA. These inflammations are characterized by the fol- lowing symptoms : Heat, redness, and swelling, which frequently closes the meatus auditorius externus, par- ticularly when the outer ear is inflamed, and spreads even over the adjoining parts. In internal otitis the pain in the inner ear is extremely violent, burning, stinging, tearing, boring, throbbing ; it is aggravates! by the least motion, extends frequently over the whole head, and affects even the brain ; this is the cause why otitis is apt to be accompanied with symptoms of ce- rebral inflammation. The meatus is exceedingly sen- sitive, a humming and roaring are perceived in the ears. There is violent fever, with furious delirium, vomiting, coldness of the extremities, great anguish, convulsions, fainting turns, throbbing of the carotids and temporal arteries, etc. Under alloeopathic treatment, this kind of otitis is very apt to terminate in suppuration. Such a result has never occurred to me in my practice. The disease generally sets in in consequence of a cold ; but it may likewise occur in consequence of inflammation of some adjoining organ extending to the ear, or in consequence of the suppression of acute and chronic cutaneous eruptions, particularly the itch. I have likewise observed otitis in conjunction with secondary syphilis. § 276. The treatment of otitis is pretty much the same in all cases, no matter by what cause the disease may have been originated. If the symptoms of cere- bral disturbance should be most prominent, the rem- edies will have to be chosen with especial reference to that state of things. Experience has induced me to consider Pulsatilla as the true specific for otitis with delirium, horrid pain, swelling of the internal meatus, e>ar, anel ad- joining parts. According to Hahnemann's provfhgs, Pulsatilla should not be given when there is much thirst and costiveness ; although these symptoms are constantly present in otitis, yet I have always given Puis, with success. Although Puis, is the specific remeely for otitis when OPHTHALAMITIS, OPHTHALMIA. 189 the inflammation attacks simultaneously the inner and outer ear, and is equally violent in either part, yet there are cases where Belladonna is the best specific, especially when symptoms of cerebral inflammation, a painful tightness in the head, delirium and rage, convulsions and fainting turns, aphony, and the like, are prominent symptoms. For the latter symptom, Rhus tox. might likewise be used with success. Other remedies are: Bryonia, Aconite, Mercurius, Hepar sulphuris, Cantharides, Calcar., etc.* § 277. Ophthalmitis, ophthalmia, inflammation of the eye. It is impossible to furnish a correct description of - the various inflammatory conditions to which the eyes and eyelids are subject, inasmuch as not only the mor- bid condition of the eye, but also the general patho- logical state of the patient, mode of life, age, sex, constitution, and particularly the exciting cause, have to be considered in the treatment. There is much which remains yet to be observed in these affections, and for which the physician has to rely upon his own judgment. This must enable him to determine the true character of the morbid symptoms, and thus to supply the deficiencies of our Materia Medica. It is a misfortune that the eye symptoms should have been ob- served by pro vers who did not possess a correct knowl- edge of the diseases of the eye. It is not my intention to give a minute description of all the various inflammations of the eye; I shall content myself with indicating some of the remedies that are most suitable in inflammation of the eyelids or eyeball. These scanty indications will be sufficient to guide the homoeopathic physician in the treatment of all other cases of ophthalmia. * Belladonna is chiefly indicated when the ear looks like a mass of raw flesh, with bloody, fetid discharge, and agonizing pain extending deep into the head, swelling of the mastoid process, and parotid glands, etc. Mercurius is indicated by ronfused noises in the head, with sensation as if water were rolling through the head, excessive pain in the inner ear, ex- tending along the ascending plate of the jaw, yellowish discharge from the ear. The pain is worse at night, etc. 190 ERYSIPELATOUS OPHTHALMIA. By inflammation of the eye, we generally under- stand an inflammation of the conjunctiva, which is generally more or less involved. From the conjunc- tiva the inflammation may spread to the adjoining parts, the sclerotica and cornea, or even the' iris and retina. Let us first treat of inflammation of the con- junctiva and of the remedies which correspond more particularly to that state. § 278. Erysipelatous ophthalmia. Sometimes only one eye is affected, but the inflam- mation frequently passes to the other eye after a short time. The whole conjunctiva exhibits a pale- red tinge, with yellowish-red, moveable, vesicular formations, arising from a serous infiltration of the con-. junctiva, and sometimes increasing to such a size that they protrude between the eyelids and impart a very strange appearance to the patient. The eye is very sensitive to the light, the pain is tensive and burn- ing, but not very intense. There is much lachryma- tion, and an increased secretion of mucus. Some- times there' is fever. In the second stage of the dis- ease the inflammation is more intense, and the vesicu- lar formations increase in size. The conjunctiva is very much injected and even ecchymosed here and there. Pain, photophobia, and secretion of mucus, ex- ist to a much greater degree in this stage-. Erysipelatous ophthalmia is most frequently occa- sioned by cold, sojourn in damp and cold air, by wash- ing, scrubbing, etc. The symptoms of the first stage are principally re- lieved by Aconite. If the fever and the inflammato- ry symptoms should have subsided, and an aching or burning pain should still remain behind, Hepar sulph. is then the most suitable remedy. Belladonna is in- dicated if the inflammation arise from a true erysipe- las of the face ; but if the inflammation she u'd be very violent, Hepar s. will be preferable to Belladon- na. In the second stage, however, if the inflamma- tion should be so intense, the ulceration of the con- junctiva so extensive, and the secretion of purulent CATARRHAL OPHTHALMIA. 191 mucus so profuse, that the eye can only be opened with difficulty, then Sulphur is required after Aconite. It is particularly indicated when the inflammatory vesicles, redness and swelling of the conjunctiva are characterized by an itching, burning, and a feeling of painful dryness. Sulphur acts best in this case, after the previous exhibition of Belladonna. Causticum, Lycopodium, and Arsenic, are likewise useful in this disease; the latter particularly, when the inflamma- tion of the eyelids is so violent that it is impossible to open them. Traumatic ophthalmia, as may arise from the pres- sure of a hard object on the eye, is very similar to the second stage of erysipelatous ophthalmia. In such a .case, Arnica should be used internally and externally, and if the inflammation should nevertheless continue, Aconite should be given, after which Sulphur or Calc. are indicated. However, it is not always possible, in such a case, to prevent the atrophy of the organ, which sometimes follows the hypertrophy. § 279. Catarrhal ophthalmia. This inflammation generally affects both eyes, at- tended with catarrh, cough, and catarrhal fever. The inflammation and redness of the eye generally pro- ceed from the canthi ; soon, however, this redness, which has a yellowish, dingy tinge, extends over the whole conjunctiva; the cornea sometimes becomes a little dim, though it generally remains clear. If the inflammation be not arrested, phlyctaenae form around the cornea, which sometimes break and induce ulcer- ation. The patients have a sensation of burning and pressure in the eyes, as if sand had lodged between the eyelids. Lachrymation, and subsequently, secre- tion of mucus, are very considerable. Evening exa- cerbations are generally present. The disease is brought on by exposure to damp, cold, rough weather. Contagion takes place by trans- ferring the secretions of the affected eye to a sound one. Chamomilla is an excellent remedv for such an in- ibX CATARRHAL OPHTHALMIA. flammation, when the scleratica is not very much in- flamed, when there is no lachrymation, when a sensa- tion of pressure is experienced on opening or closing the lids, with agglutination of the lids and slight ca- tarrhal fever. Nux vom. will be found of very little use in this kind of ophthalmia, except when the symptoms corre- *spond exactly. Belladonna, Euphrasia, and Arsenic, are principal remedies in this kind of inflammation. Belladonna deserves a preference when there are violent congestions of the head, when the conjunctiva and sometimes even the scleratica are very much in- jected, when a painful photophobia, very little secre- tion, and even a painful dryness of the eyes, are pres- ent. It is more particularly indicated by profuse co- ryza, making the nose sore, by paroxysms of a short, spasmodic, dry, hacking cough, and similar catarrhal symptoms. Euphrasia is indicated by similar symptoms as Bel- ladonna, except the profuse secretion of tears and mucus, which is not characteristic of Belladonna. Euphrasia is more particularly indicated when the inflammation is rather extensive, when the conjunc- tiva and sclerotica are very much injected, and phlyc- taenae or little ulcers have formed around the border of the cornea. Profuse coryza, with violent headache, and evening exacerbations, are other indications for the use of Euphrasia. Ignatia is indicated when the perceptible symptoms of the inflammation are less marked; when there is little redness, but a violent aching pain in the eyes, profuse lachrymation, and violent photophobia, at- tended with fluent coryza. We would refer the reader to the remedies for ca- tarrh and catarrhal fever contained in § 34, etc. A constitutional disposition for catarrhal ophthal- mia, exposing one to catarrhal affections at every little change of the weather, requires the use of the antipsorics. However, the remaining sensitiveness of the eyelids, which induces a redness of the mar- RHEUMcATlC OPHTHALMIA. 193 gins of the lids whenever the least change takes place in the weather, sometimes yields to a single dose of Nux vom., particularly when the patient complains of congestion about the head, brought on by the abuse of spirituous drinks. If the eyes and eyelids should be very sensitive, with diminution of sight, scintillations, luminous ap- pearances before the eyes, obscuration of sight, and even paralysis of the optic nerves, Belladonna will still prove useful, though Digitalis, Aurum, Dulca- mara, Phosphorus, Sepia, China, Causticum, Sulphur, etc., may likewise be indicated.* § 280. Rheumatic ophthalmia. In rheumatic ophthalmia, the pains are sticking and tearing, and aggravated in warmth. It is gener- ally attended with other rheumatic pains, a tearing headache on the affected side, toothache, etc. The whole eye is red, with intense photophobia and pro- fuse secretion of tears. This kind of inflammation is more dangerous than any other, in this respect, that it is disposed to spread from the conjunctiva to the other membranes of the eye, giving rise to corneitis and iritis. If the cornea should be invaded, ulcers and their products, to which they give rise, soon make their appearance. In the commencement of the disease, and if the in- flammation should be slight, Pulsatilla will relieve the pain, Bryonia remove the inflammation. Rhus tox., particularly after Aconite, may likewise suffice to control the pain and inflammation. If the pressure in the eyes, the photophobia, lacrn^- mation should be increased in the open air ; if the eyelids should be agglutinated in the morning, with a feeling of heat in the eyes ; if the iris should likewise be inflamed, Clematis erecta is the most suitable remedy. * One of the mojst important remedies for catarrhal ophthalmia is ^cont/e, particularly in nervous individuals. Even in mismanaged cases of this kind, with extensive ulceration of the conjunctiva, deep-seated aching, and sore nain in the eveball, baring or sharp-aching pain in the frontal sinuses, Aconite fs the specific remedy, even ff there^nould be little or apparently no {»rer.*~Hempel. 9 194 ARTHRITIC ^OPHTHALMIA. If the tearing pains should have become intoler- able, if the inflammation should have extended to the cornea, with decrease of the photophobia, but increas- ed intensity of the hemicrania, Euphrasia will be found eminently serviceable. The remaining symp- toms will then yield to Sulph., Calcarea, or Causticum. § 281. Arthritic ophthalmia. This kind of inflammation is principally seated in the sclerotica, iris and conjunctiva, and lastly reaches the cornea. • The pain is violently boring, digging, either in rhe eyeball or bones of the skull ; it is chang- ing, subject to the influence of the weather, aggra- vated I-y feather-bids. The eye is of a rose colour, less in the canthi th;in towards the cornea, which is surrounded by ihe injected and varicose vessels as by a wreath. Th;s wreath of varicose vessels furnishes a charac:eristic distinction between arthritic and syphilitic iritis. In the latter affection the wreath is close around the iris, from which it is separated in ar- thritic ophthalmia by a narrow, whitish band. There is much photophobia, and sometimes even scintilla- tions. If the intlammation be not speedily arrested, the iris changes its colour, and the pupil contracts ; it becomes dim, extravasations are seen through the pupil, and the cornea becomes dim and opaque. Pan- nus may set in, or else an ulcer with a varicose ulcer- ated border is observed on the cornea. A misman- aged inflammation of this kind may, beside pannus, lead to bypopion, chronic corneitis, atrophy of the eyeball. % some cases the inflammation commences from within, and extends towards the front part of the eye. The sclerotica and iris are violently inflamed. The pains are less intense than in the former variety, there is less redness, only single vessels appearing injected. The pupil however is dilated and distorted, the margin of the pupil is indented, with a greenish-white colour behind, showing that the capsule is invaded (cata- racta glancomatosa.) In this case the visual power disappears entirely, the periodical pains become ARTHRITIC OPHTHALMIA. 195 violently tearing, and spread over the whole side of the head; profuse lachrymation is present. An abscess is apt to form behind the lens, with in- crease of pain, and breaking anteriorly sooner or later. In ordinary and not too violent cases, the disease ter- minates in atrophy of the eyeball. Arthritic ophthal- mia runs a chronic course. This inflammation arises from anomalous gout, whether it have shown itself already or make its ap- pearance afterwards. Sometimes, however, the dis- ease, particularly the internal inflammation, sets in, without any symptoms of arthritis being present. In regard to treatment, we can only furnish a few indications on account of the great variety of the symptoms, and invite the practitioner to obtain as comprehensive a knowledge of the Mat. Med. as pos- sible, in order to be prepared to meet every case of such inflammations by an appropriate remedy. The treatment should be commenced with Aconite, if the usual inflammatory phenomena, fever, bounding pulse, etc,, be present. If Aconite should not be clear- ly indicated, if there should be much lachrymation and photophobia, with arthritic pains around the eyes, and symptoms of violent congestion about the brain, Belladonna would be the most appropriate remedy. Spigelia is more particularly suitable when the in- flammation has reached the more deep-seated tissues of the eye. It is indicated when the above-mentioned wreath of vessels around the cornea is distinctly per- ceptible, when the eyeball exhibits a number of vari- cose vessels, the patient complains of a sensation as if the eyeballs were swollen, the power of vision is un- diminished ; the pain is a violent sticking, boring, dig- ging pain, proceeding from the interior of the eye to- wards the inner canthus ; the pain obliges one to keep one's eyes closed, and, on opening them, objects seem to be floating in fire. Colocynthis is an excellent remedy when the pains are seated in the eyeball i'.self, not in the surrounding bones, and of a burning-cutting character. Par.icular indications for Colocynthis, are: Congestion of the 196 ARTHRITIC OPHTHALMIA. head, photophobia, lachrymation, pressing and tearing pain in the whole brain, which is most violent in the forehead on moving the eyes ever so little ; anguish, which drives the patient from one place to another. Chamomilla is of not much use, except in very mild cases; and Nux vom. helps when the inflammation arises in the first place from excessive living. If ulcers should have formed on the cornea, if the pupil should have become contracted, and should ex- hibit the above-mentioned whitish-green colour in the back-ground, Euphrasia is the appropriate remedy, especially when a rash has broken out around the eyes. In internal arthritic inflammation. Belladonna is the principal remedy. The inflammation of the retina which frequently attends this disease, likewise yield most readily to Belladonna, when, beside the symp- toms'which have already been mentioned, the patient complains of a distressing, aching pain over the eyes, with pain in the eyeballs as if they would be torn out of their sockets or pressed into the head ; the patient sees flashes and sparks-before his eyes, particularly whein congestions of the head are present, with more or less amblyopia; muscse volitantes make their ap- pearance, surrounded with a bright, fiery border, and gradually disappearing as the amblyopia increases. If these phenomena should be accompanied with in- flammation of the choroidea, iris and sclerotica, if the pupil should be indented and dilated, the physician should not consider those symptoms as a counter-in- dication to Belladonna, and employ Euphrasia, Pulsa- tilla, Sepia or Calcarea in its stead. If the inflamma- tion threaten to terminate in amaurosis, Belladonna sometimes averts the danger. Phosphorus, Caustic, Hepar sulph., Aurum, Rhus tox., St lie, Natrum mur., Sulphur, etc., are very efficient agents in this inflam- mation. Beside the cases which have been mention- ed as indicating Bellad., this remedy is likewise useful when this kind of inflammation set in suddenly, or after simple ophthalmia, or after taking cold in the eyes when they were heated. In the latter case-, Dulc. and Tartar emet. are likewise useful. Under SCROFULOUS OPHTHALMIA. 197 such circumstances amaurosis sets in gradually, the patients see things as if covered with a black gauze, black points or flocks or spots with various colours hover before the eyes, which go and come; the pa- tient is frequently seized with violent vertigo, which generally terminates with considerable diminution of the visual power and violent headache. When amau- rosis thus threatens to set in, the following remedies should be thought of in conjunction with those men- tioned above: Puis., Dig., Sepia, China, Capsic, Ruta, Secale, Zincum, etc. Sulphur, which is an admirable remedy in all kinds of arthritic affections, is likewise eminently useful in arthritic ophthalmia, and frequently requires to be given immediately after Aconite. § 282. Scrofulous Ophthalmia. Scrofulous ophthalmia occurs more frequently than any other variety of inflammations of the eye. It generally attacks children, scarcely ever persons who have past the age of pubescence. The inflammation is principally seated in the conjunctiva, but sometimes in the cornea. The conjunctiva of the eyeball is very red, bundles of varicose vessels run towards the cornea, and the sclerotica exhibits a rosy tinge. Pho- tophobia, which sometimes increases to spasm of the eyelids, profuse discharge of corrosive tears, increased secretion of mucus, are almost always present. These symptoms are worst towards morning, and decrease towards night. The eyelids are likewise reddened, and continue so, even after the real inflammation has been relieved. If the cornea be affected, it becomes dim, in consequence of extravasation of lymph, or phlyctaenae form, which sometimes pass into ulcers. Patients affected with this disease are liable to re- lapses. Scrofulous ophthalmia has been divided into erethic and torpid, according as the disease runs a more or less rapid course; the former is found.in children of a sanguine disposition, the latter in chil- dren of a phlegmatic disposition and bloated appear- ance. 198 SCROFULOUS OPHTHALMIA. Pulsatilla is particularly indicated at the com- mencement of the disease, when the following symp- toms are present: redness of the lids and conjunctiva, aching-stinging pain in the eye, photophobia and dis- charge of corroding tears, profuse secretion of mucus, "nocturnal agglutination of the eyelids. Euphrasia, Nux, Ignatia, or Ferrum are sometimes indicated by the symptoms. In some cases, where1 the disease' was distinctly worse ■ in the morning, Nux v. has proved very useful. Hepar s. is one of the best remedies in this disease; I have given it-with the best result at the commencement or acme of the disease, and even when the cornea had become completely dim. I gave two or three grains of the 2d or 3d trituration at a dose, two or three times a day. Belladonna is a suitable remedy when the disease has somewhat progressed, and the above-mentioned bundles of varicose vessels have made ihcir appear- ance, extending into the cornea; when the sclerotica looks red and phylyctamse have* formed at the termi- nation of the vascular bundles, changing to ulcers ; when the patient complains of painful pressure in the eyes, which increases by turning them up when pho- tophobia is occasioned by the inflammation ; and when the symptoms which have been enumerated under catarrhal ophthalmia are present, and the disease is aggravated by the least cold, or by a sudden spell of Cold and damp weather during the fine season. Some- timteSj however, this remedy is not sufficient, and we have to give Sulphur, Calcarea, Sepia or Causticum. The alternate use of Sulphur and Calcarea in this 'disease is frequently attended with the most brilliant results; I give Sulphur one day and Calcarea the next, using the 2d or 3d trituration. By this means I have frequently cured scrofulous ophthalmia of Years' standing in a week or a fortnight. Conium macul. is likewise indicated by the above symptoms, except that the photophobia results from the morbid action of the Optic nerve, and not from the inflammation of itself. J For the pustules and ulcers which sometimes form on the sclerotica or cornea, and leave herpes and BLEPHAROPTHALMITIS GLANDULOSA, ETC. 199 scars, the following remedies are used with benefit: Nux v., Dig., Euphrasia, Hepar s., Cannab., Sulphur, Calc, Silic, Sepia. Rhus tox. is an excellent remedy in scrofulous ophthalmia, when accompanied with scrofulous or herpetic eruptions in the face. Staphy- sagria has likewise been used with benefit. If the inflammation should resist any of the above remedies, in that case a few doses of Arsenic, either alone or in alternation with Euphrasia, will cure the disease in a short time. We refer the reader to the second part of this work, where he will find a detailed description of the treat- ment to be pursued for scrophulosis; for, in most cases, a scrofulous inflammation of the eyes will not yield till the source from which the disease springs has been eradicated. § 283. Blepharophthalmitis glandulosa, bhpharohlen- norrhcea, inflammation of the Meibomian glands. This disease is in many cases a sequel of other in- flammations, such as catarrhal ophthalmia. The lightest degree of this disease is a mere blennorrhoea of the canthi (lippitudo.) The higher forms of the disease are accompanied with burning and itching of the eyelids and a feeling of dryness in the eye which is particularly violent towards evening. The secre- tion of mucus is likewise worse towards evening, causing an agglutination of the eyelids over night. On looking at candle-light, the patient experiences a sensation of heaviness in the eyelids, obliging him to close them. The inner surface of the lids is red, and has a velvety, puffed-up appearance. Sometimes, in the highest forms of the disease, the eyelids become excoriated. This kind of inflammation is frequently very obstinate, or is excited again by the least exer- tion. The disease may be caused by the action of dele- terious substances, or by catarrhal causes ; it may likewise spring from dyscrasia, gout, scrofula, syphilis, (see the paragraphs where this disease is treated,) or from old age (ophthalmia senilis.) 200 BLEPHAROPHTHALM1TI3 GLANDULOSA, ETC. For the milder form of the disease. Euphrasia is an excellent remedy, particularly when it arises from cold, and photophobia is present. If the inflam- mation should be very acute, with profuse secretion of mucus. Clematis erecta or Spigelia is to be exhibited. Digitalispurp. has been found very efficient in many cases, particularly in chronic blear-eyedness; the pa- tients complain particularly at candle-light of a sensa- tion of burning dryness about the margins of thceye- lids, with swelling of the lower lid. If the inflamma- tion should terminate in suppuration or ectropium, whether it be painless or attended with stinging, burning and itching, a few doses of Mercurius follow- ed by Hepar. snip, should be given. Belladonna will prove useful after Mercurius, when the e version of the eyelid is accompanied with twitching, trembling, and blinking of the lids, or when the lids are paralyzed and droop (blepharoptosis.) Next to Belad., Sepia deserves to be recommended for the latter affection. In most cases, however, Digitalis diminishes the in- flammatory symptoms, and changes the disease to a form which requires Sulphur for its complete removal. Heaviness of the eyelids, which frequently increases to a spasmodic closing of those parts, (blepharo- spasmus,) yields most readily to Hyoscyamus, Chamom., or Crocus. If these remedies should not prove suffi- cient, Veratrum, Stramonium, Hepar sulph., or Tinctura aeris or Causticum are indicated. § 284. If the inflammation should be confined to a single Meibomian gland, or a circumscribed portion of cellular tissue, the disease is termed hordeolum or stye. It sets in with a sensation of pressure or itch- ing, a narrow spot on the eyelid becoming gradually raised and red. This small tumour either disperses or suppurates. In the former case the trouble does not last long. The swelling may likewise become hard, (chalazion.) The disease is seldom accompanied with conjunctivitis, photophobia, or acute pain. It is apt to recur when patients are constitutionally disposed to it. The disease either arises from dyscrasia, or in con- OPHTHALMIA NEONATORUM. 201 sequence of blepharoblennorrhcea. To remove it, the patient should be kept under a strict diet, and should take Pulsatilla, which prevents the suppuration. If it should set in frequently, particularly in scrofulous subjects, with obstinate stoppage and ulcerated crusts in the nose, redness and swelling of the eyelids, Au- rum is said to be a specific remedy. Staphysagria will be found an excellent remedy when the stye be- comes indurated, and the indurated stye shows a dis- position to torpid inflammation, with agglutination of the lids over night. If Staphys. should prove unavail- able, Silic. will be found the best remedy. In some scrofulous children I have removed a disposition to styes, together with the scrofulous disease, by a few doses of Sulphur and Calc. carb. Graphites, Lycop., Rhus t, Con., etc., deserve likewise our attention. § 285. Ophthalmia neonatorum. This disease generally affects the eyelids only ; if the inflammation should be violent, the conjunctiva and even the whole eye are sometimes invaded. At first one or both lids swell and close the eye. A few hours after the swelling commenced, a profuse secre- tion of mucus sets in from the Meibomian glands, which should not be confounded with pus. The cor- nea is sometimes attacked and remains dim for some time. I have seen blood discharged from the eyes previous to the secretion of mucus taking place. This may lead to important defects of the eye afterwards, and generally results from a constitutional dyscrasia. (See my cases, Arch. VI. 2, p. 30.) Feeble infants which were not born at full term, are predisposed to such affections. Other predispos- ing causes are: bad diet, washing infants in unclean water, exposure to glaring light immediately after birth, infection during parturition with fluor albus, exposure to cold or draughts of air. Slight cases are cured by frequently washing the eyes with a clean sponge dipped in tepid water. If this should not be sufficient, a little Aconite, and, if the disease should not entirely yield, Euphrasia have 202 CERATITIJC to be exhibited. Ignatia is likewise recommended by many. If the disease should be attended with diarrhoea, soreness of the genitals, flaccidity of the muscles, miliary eruptions, restless sleep, etc.. Chamomilla will prove useful in many cases, which sometimes re- quires to be followed by Belladonna. If the infant be at the breast, it is important to attend to the diet of the nurse or mother, and it will be found that Nux v., Pals, or Bryon. are indicated; these remedies should then be given to the nursing female. The principal remedy, particularly when constitutional symptoms are present, is Sulphur, which only yields to Mercurius when the disease arises from contact with syphilitic fluor albus. § 286. Ceratitis, inflammation of the cornea. Inflammations of this kind have been spoken of in preceding chapters, to which we therefore refer the reader. We shall here mention some of the most characteristic symptoms of ceratitis, including the treatment. In most cases this inflammation is chronic. The symptoms are not very striking, on account of the cornea being an organ of inferior organization ; there is little redness and pain, but photophobia and lach- rymation are always present. The cornea becomes faint, dim, dingy ; the power of vision is diminished, and even entirely suppressed, if the dimness should continue. If the inner membrane of the cornea should be seized, the inflammation soon spreads to the iris, but the cornea does not alter its shape. If, however, the substance of the cornea should be affected, this organ assumes a conical shape. This disease is very apt to remain unaltered for a long time. The termi- nations are : dispersion with exudation of lymph, or suppuia ion. Pannus, staphyloma, synizesis, etc., sometimes result from ceratitis. The inflammation is generally caused by injuries of the cornea. Many pathologists are, however, of opinion, that the inflammation would never attain a IRITIS. 203 high degree if it were not for some dyscrasia which had been slumbering in the organism, or if it were not complicated with scrofula or rheumatism. In regard to the treatment, we refer the reader to the previous chapters. In idiopathic ceratitis, Eu- phrasia, Hepar sulp.. lod., Baryt, and Spig., deserve a preference. Hepar s. acts best when given morning and night, second or third trituration. It is of particu- lar service when pannus has commenced setting in. If the inflammation should have been caused by me- chanical injuries, Arnica is probably the best remedy, externally and internally. Calendula off., which has been found of great use in wounds, may likewise be of great service. lod., Baryt., and the hvdriodate of potash, are particularly indicated when the inflamma- tion has become chronic, and is complicated with scrofula. § 287. Iritis, inflammation of the iris. This inflammation is generally accompanied with inflammation of adjoining parts. The pain is princi- pally seated in the eyeball, but is often felt in the fore- heaei and occiput, particularly at night. Photophobia is very considerable. The pupil contracts, becomes immoveable, and, if the inflammation should progress, and exudations should set in, the pupil becomes in- dented, elongated, and the visual power is lost. The iris changes its colour ; if brown, it changes to a red- dish, and if gray, to a blue-greenish colour. The thickening of the iris is distinctly perceptible. The eye is excessively sensitive, and there is considerable lachrymation. If the inflammation be not speedily controlled, exudations set in, which appear like white specks or bands in the pupil, and impair vision. In the worst case the pupil closes (synizesis). The ter- mination in suppuration, and the formation of hypo- pion. is less frequent. The disease is always accom- panied with fever, which exacerbates in the evening. It runs a rapid course. It is caused by previous inflammations, traumatic 204 IRITIS. ophthalmia, injuries during operations, dyscrasia, gout, syphilis, etc. In the first stage of the disease, when the inflamma- tion is yet in an incipient state of development, Aconite is sufficient to control it; but if pain in the forehead or occiput should already have set in, Belladonna will have to be given in the place of Aconite. The alter- nate use of Aconite and Bella lonna is sometimes com- mendable. Even if the pupil should have contracted, and have become less dilatable, Belladonna will still prove useful. Cina is admirable when the contrac- tion and immobility of the pupil is attended with fre- quent scintillations, great dryness and consequent pressure in the eyes, and when the patient complains of aching, rather than tearing, pain in the head. If the disease should have considerably progressed, the power of vision should be much diminished ; or, if exudation should have set in, Merc corros. is most suitable. Plumbum is likewise a powerful absorbent of the exuded lymph. Sulphur, Clematis erecfa, and Zincum, are likewise of service in this affection, and have to be chosen with reference to the constitutional state of the patient. We therefore refer the reader to the various chronic affections and dyscrasias, which will be treated of in the second division of this work. THE END. NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland § The National Center for Homeopathy m w -y. i- I!-