mm :T 1 tf HOR NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland Gift of The National Center for Homeopathy A Af: LIBRARY AMERICAN FOUNDATION FOR HOMOEOPATHY LIBRARY AMERICAN FOUNDATION FOR HOMOEOPATHY ON Nasal Catarrh Its Symptoms, Causes, Complications, Pre- vention, Treatment, Etc., WITH ILLUSTRATIVE CASES. BY LUCIUS D. MORSE, M. D. MEMPHIS : A. F. DOT) & COMPANY, PUBLISHERS, TfSRARY AMERICAN FOUNDATION FOR HOMOEOPATHY Printed by "HE SOUTHERN BAPTIST PUBLICATION SOCIETY;, 361 Main Street, Memphis, Term. r*JM PREFACE. This little treatise is offered to the Profession and the general reader, with the hope that it may prove practically useful Nasal Catarrh, in its various forms, afflicts a large num- ber of people, and it cannot be denied that the results of medical treatment are, often, far from satisfactory, both to physician and patient. Anything positive, on the score of its Therapeutics, we feel certain, will not come amiss. While no pretensions are made, as elsewhere stated, to an exhaustive consideration of the subject, the clinical de- partment of this little work will be found tolerably full. The writer has drawn freely from his case book in dicuss- ing the application of remedies. He trusts that the results of his investigations, detailed in the following pages, will not prove valueless to the practitioner, and believes that the information imparted regarding the Causes, Prevention and rational Treatment of a frequent and distressing com- plaint will not be unacceptable to many sufferers. Memphis, 1S7(». CONTENTS. Page Preface..................................................................................................... ^ Introductory........................................................................................... ° PART I. Internal Structure of the Nose............................................................. 9 Symptoms of Catarrh........................................................................... ^ Complications of Catarrh..................................................................... ^ Causes of " ....................•............................................... *5 Prevention of "..................................................................... " Treatment of " .................................................................... a'' PART II. Cases from Practice and Observations os the use of Remedies. Case I -Treatment with Nux Vomica, Hydrastis and Lyco- podium............................................................................. 24 Case II-Treatment with Nux Vomica, Aurum Sepia...................... 27 " III—Treatment with Sepia.......................................................... 29 " iv— " " Calcarea Carb...........................................30 " V— " " Calcarea Carb., observations upon the use of Sulphur, Silicea, Kali Bichromicum and Mer- curius............................................................................. 31 Case VI—Treatment with Calcarea Carb., Mercurius and Arseni- 32 " VII— " " cum Mercurius and Sanguinaria............ 34 " VIII— " " Iodide of Arsenic.....................................3r> " IX— " " Iodide of Arsenic.................................... 3*i " X— '• " Ozsena from Disease of the Antrum........ 37 " XI— " " Nux Vom., Mercurius Jod., Kali Bichro- micum and Sulphur..................................................... 38 " XII—Treatment with Alumina................................................... -11 " XIII— " " Phosphorus and Silicea........................ 42 " XIV— " " Nitric Acid.............................................. 43 " XV— " " Pulsatilla and Sulphur........................... 44 " XVI— " " Graphites.................................................. 40 General Observations............................................................................. 47 PART III. Acute Catarrh—Coryza......................................................................49-53 PART IV. Rioiediks-Alumina—Argentum Nit.,—Arsenicum—Arsenicum Jod ,—Asafo'tida—Auru.n—Calcarea Carb ,—Cliamo- milla—Euphrasia—Gelseminum—Graphites — Hepar Sulph., —Hydrastis —Ipecac —Kali Bichromicuni — Kali lodicum — Lachesis — Lycopodium — Mercurus Jod.,—Mercurius Viv.,—Natrum Carb.—Natru'm Mur , —Nitric Ac.,—Nux Vomica—Phosphorus—Pulsatilla —Sanguinaria—Sepia—Silicea—Sticta—Sulphur...... r,4-72 NASAL CATARRH. INTRODUCTORY. The harrassing and annoying complaint of which we purpose briefly to treat in the succeeding pages, is one of the most common in our changeable cli- mate. In its chronic form it has, too, the reputation of being one of the most obstinate and refractory to medical treatment. This may be ascribed, in part, to the very nature of the trouble itself, often de- pendent upon obscure causes, which are frequently overlooked, even when diligently sought after, and, in part to the prevalence of mistaken notions re- garding topical applications. The still popular sys- tem of local treatment with douche, syringe, ato- mizer, inhaler, etc., is well calculated, by its aggres- vi. NASAL CATARRH: ITS CAUSES, sive character, to excite in the patient's mind hopes of speedy relief—hopes which, it must be confessed, are but too seldom realized. The indiscriminate employment of local medication in these troubles is greatly to be deplored. The Douche. The nasal douche, in particular, is re- sponsible for a great deal of harm. Roosa, Knapp, Pardee and other well-known specialists have clearly indicated the evil effects it is apt to produce. The cleansing of the nasal passages, for which this in- strument was so highly lauded at its first introduc- tion, is accomplished but indifferently by its use, so far as the disease is concerned, and quite too well, so far as the bland mucous covering is con- cerned, which nature provides for the protection of an inflamed or highly irritable tract of membrane ; while the danger of producing serious trouble with the organs of hearing, through irritation of the Eu- stachian tubes, has proven so great that experienced and careful practitioners have mostly abandoned it. The irritating, medicated solutions, which, by its assistance, are forced with such facility into one nostril and out at the other, have a directly perni- cious influence upon the delicate mucous membrane of the nose, coming in contact, as they do, not only with the diseased portions, but with those parts which are still in a normal condition. COMPLICATIONS, PREVENTION, TREATMENT, &C. Vll. loss of smeii. It is not to be wondered at that the olfactory nerve, subjected to the corroding influ- ence of acrid solutions, pungent snuffs and penetrat- ing vapors, which are so constantly recommended in the treatment of Catarrh, should speedily become so benumbed and deadened as to destroy almost entirely the sense of smell. Frequently, patients apply to us, after having submitted to this sort of heroic treatment, unable to distinguish the strong- est odors. In very few of these cases, which have come under our notice, has the extent and severity of the disease itself, justified such a condition. We have been compelled to ascribe it, in no small part, to the mistaken remedial measures to which these patients had been subjected. Apju^uons VeiT rare are tne cases of ^asal Catarrh which can be benefitted by the usual local api»lications, while the harm which such medica- tion has produced, and is liable to produce, furnish- es a warning to both physician and patient against, at least, its routine employment. The theory which pronounced the nose, in all instances, the dire of- fender, over-looking the frequency of remote causes, held such applications to be indispensible, but these erroneous popular ideas are giving place to more in- telligent views. viii. nasal catarrh: its causes, thejwruefr It will be the aim of the writer to present in the succeeding pages some plain, prac- tical observations, regarding the complaint under consifleration, together with brief details of clinical experience and indications for the use of reme- dies. An exhaustive consideration of the subject, under any of its several heads, does not fall within the scope of this little work. If the suggestions, here offered, are found of practical utility, by those under whose notice they may fall, the great object of the writer will be attained. complications, prevention, treatment, AC 9 PART I. INTERNAL STRUCTURE OP THE NOSE. Before proceeding to a consideration of the causes, the symptoms and morbid conditions which arise in Nasal Catarrh, let us glance, for a moment, at the structure or anatomy of the parts involved. As we address ourselves to non-professional, as well as to professional readers, this short digression will tend to a clearer understanding of the subject, on the part of the one class, at least. The anterior nares or nostrils communicate di- rectly with the nasal fossse, which are two irregular cavities, situated in the middle line of the face, ex- tending from the base of the cranium to the roof of the mouth, and separated from each other by a thin vertical septum. They communicate with the pharynx, or upper part of the throat, by two large apertures—the posterior nares. The internal struc- ture of the nose is exceedingly delicate. Each fossa is supplied with three lamella of bone, curved and twisted, known technically as the turbinated bones. These twisted plates, with their two sides free, and s 10 nasal catarrh : its causes, covered with delicate mucous membrane, add vastly to the area of surface contained in each of the two nasal cavities. At the upper part of the nasal fossae the membrane is very thick, soft, spongy and vascular, and is supplied with numerous mucous follicles which exude a secretion by which the sur- face is protected and kept in a moist and sensitive condition. It is only this portion of the mucous membrane which is supplied with filaments of the olfactory nerve, and which is capable of receiving the impressions of smell. It is called the olfactory membrane. Elsewhere the nasal passages are lined with a mucous membrane which is less vascular and spongy in structure, and which is called the Schneiderian membrane. These tissues and the sub-adjacent structures, to a greater or less extent, are involved in Nasal Catarrh. It is well to remember that only a thin plate of bone, pierced by numerous openings for the passage of the olfactory nerve, separates the brain from the upper part of the nasal fossae. This fact of close proximity may have much to do with those distressing mental symptoms which often ex- ist in connection with chronic Nasal Catarrh. The older pathologists erroneously believed that the brain itself was frequently involved in these delug- ing Auctions, and with this conviction they actually gave to a gland-like body, at the base of the brain, the name " pituitary,"—which it still bears—pup- posing it to be the frequent source of catarrhal dis- charge. COMPLICATIONS, PREVENTION, TREATMENT, &C. 11 SYMPTOMS. Catarrh is a term applied to any abnormal dis- charge from a mucous membrane. In a condition of health these membranes are constantly moist. When they become inflamed from cold or any other cause, the character of the secretion is changed. First, the membranes involved become dry, tumi- fied and more sensitive, then follow sensations of in- creased heat, fullness and itching, with perhaps, fre- quent sneezing. The second stage is characterized by the free discharge of a thin, serous, acrid fluid, which irritates the nostrils and lip as it flows over them. In the third stage, the fluid becomes thick- er, less irritating, more viscid, usually opaque and yellowish. Frequently, headache and a general feeling of discomfort accompany these symptoms. If, from any cause, the system fails to re-act from the noxious influence which produced this condi- tion, and the discharge does not cease after a week or two, chronic Catarrh is the result. chrome catarrh. Here the symptoms are as diversi- fied as the different cases. The existing state of af- fairs maybe quite overlooked by the sufferer, under the supposition that he is simply the victim of a "cold in the head," until the increase of the discharge changes in its character and, perhaps, the appear- ance of painful subjective symptoms force the mat- ter upon his attention. The discharge is more or 12 NASAL CATARRH: ITS CAUSES, less copious, and frequently escapes from the nasal cavities through the posterior nares instead of from the nostrils. Sometimes, there is a constant drop- ping back into the throat of a yellowish or grayish opaque matter, which causes frequent hawking and spitting. In other cases, large plugs form in the nose and are expelled with considerable difficulty. The discharge then, be it remembered, varies wide- ly as to color, consistency and quality. The ele- ments of which it is composed are serum with cor- puscles of epithelium mucus and pus. Pathology. "What is the pathological condition which attends these symptoms? By the hydrostat- ic pressure in the congested parts, the dilated cap- illaries are unable to perform their functions; the serum of the blood transudes through the capillary walls and contributes to the swelling of the sur- rounding parts; the epithelial cells become infil- trated and undergo a series of modifications ; they take on a distended globular form, entangling granulations of mucin ; they are then shed, and con- stitute, with mucous globules and nascent epithe- lium, the semi-transparent, gelatinous, bluish-gray discharge. Corpuscles of pus are usually mixed with this mucus, and give it, according to their number, a more or less opaque, yellowish color. ozsena. When the Catarrhal irritation progresses to ulceration, true ozcena is the result. The discharge becomes of a much more disagreeable character. It usually has a greenish yellow color, a salty taste COMPLICATIONS, PREVENTION, TREATMENT, &C. 13 and is often expelled from the nose and throat in scabs and lumps streaked with blood and having a fetid odor. In the morning the throat and nose are often filled with the filthy secretion, and the ef- forts to expel it frequently result in nausea and vomiting. The patient becomes morbidly sensitive and is tortured with the belief that all who ap- proach him can discover his complaint by the of- fensive odor. There is usually present severe frontal headache and dull, heavy pains, referred to the bridge of the nose. The sense of smell is impaired, occasionally to the point of complete extinction, and the mind of the sufferer is harrassed with gloomy and melancholy forebodings. The general health suffers as the morbid condi- tion of the system, which feeds the Catarrh, inten- sifies. Sometimes a destructive process is set up in the cartilages and bones of the nose, but, happily, this last mentioned condition is comparatively rare, and is usually of a specific origin. COMPLICATIONS. The Ears. rp}ie muc0us membrane lining the Eu- stachian tubes, being continuous with that of the nose and throat, inflammation in the nasal fossae or upper portion of the pharynx readily extends in that direction. Implication of the organs of 14 NASAL CATARRH: ITS CAUSES, hearing is the complication most to be dreaded in Nasal Catarrh. A recent writer, discussing this subject, says: " Chronic pharyngeal and nasal troubles are the starting point for most affections of the ear, which makes throat deafness a common form of defective hearing." It may be remarked, that disease of the external ear is comparatively rare, and much injury has frequently resulted from local treatment directed to that part, when the real fault lay in the passage to the internal ear. A slight amount of irritation at the point where the Eustachian tubes open into the post-nasal cavity will interfere with the free passage of air and cause first, a sense of stoppage, accompanied with crack- ling sounds and ringing in the ears, soon followed by deafness, more or less severe. Curing the ca- tarrh restores the mucous membrane to its normal condition, and the hearing is regained, unless the trouble has existed for so long a time as to produce structural changes, with more or less occlusion of the tubes. The Throat. Maily cases of laryngitis with chronic cough and hoarseness may be traced directly to the extension of a naso-pharyngeal catarrh. Singularly enough, in some instances, when the inflammation has traveled downwards and fastened itself upon the speaking apparatus, the nasal symptoms will sudden- ly and completely disappear. The Eyes. ^0^ infrequently, the inflammation ex- tends from the nose along the lachrymal ducts to the COMPLICATIONS, PREVENTION, TREATMENT, AC. 15 eyes, causing severe irritation of the conjunctiva, with increased secretion, enlargement of the Meibo- mian glands, and general'weakness of sight. CAUSES. The mucous membrane of the nose being more exposed to external influences than any other simi- lar tissue of the body, is correspondingly more liable to disease. Sudden changes of temperature, checking of the perspiration, getting the feet wet, inhalation of dust, soot, acrid vapors, etc., produc- ing mechanical irritation, may be cited as prolific causes of the ordinary acute catarrh. "Where a pre- disposition to this complaint exists, repeated at- tacks so weaken the mucous membrane of the nose that it finally becomes chronically congested, and is seldom free from an abnormal discharge. We have found Catarrh hereditary in some fami- lies, grafted upon a scrofulous or psoric diathesis. Repeiied Eruptions. Chronic itch-like eruptions which have been repelled by external applications, such as salves, washes, etc., not infrequently attack the mucous membranes of the body and sometimes pro- duce very troublesome catarrhal affections. Usual- ly a re-appearance of the former erruption during the progress of treatment is attended with a cessa- tion of the catarrhal symptoms. 16 NASAL CATARRH: ITS CAUSES, Deranfemtmts. Many times, an abnormal discharge from a mucous membrane seems to depend entirely upon waste matter which should have been thrown off by the skin, lungs or kidneys. A restoration of these organs to their healthy functions is followed in these cases by a complete subsidence of the nasal, pharyngeal or laryngeal symptoms. The folly of local treatment, directed to the nose, in these in- stances, and they make up probably the more num- erous class, is sufficiently apparent. A certain proportion of cases is due also to con- stitutional taint of syphilis, the nasal trouble being but a symptom belonging to a general condition. Metastasis, rr^ wrij-er }jas treated a few Cases where metastasis could be clearly traced of a catarrhal con- dition of the mucous membrane in some other por- tion of the body to the nose. Eruptive diseases, such as Scarlet Fever and Measles, by metastasis, often inflame the mucous membranes, and so produce aggravated catarrhal affections in the throat, nose and ear. Malaria. rpnat mySterious an(j peculiar influence known as malaria, is responsible as a powerfully predisposing cause of catarrhal troubles. The pro- found impressions, even to organic changes, which it is capable of producing secondarily in some of the great organs of the body, lead, not infrequently, to sympathetic disturbance in remote parts. The mu- cous membranes are often involved, and hence arise multitudinous catarrhal affections, confined by no means to the nose. COMPLICATIONS, PREVENTION, TREATMENT, &C 17 poisomng. Strong medication with Mercury, Ar- senic, Potassium, and other powerful drugs, fre- quently gives rise to serious and long lasting throat and nasal symptoms. Many a catarrhal discharge dates back its origin to an illness, during which the system was saturated with Mercury in some of its many forms. Fortunately for this class of sufferers, such cases are amenable to an enlightened treat- ment, which antidotes the effects arising from drug poisoning, and brings back the tissues to a normal condition. PREVENTION. A deep interest attaches to this branch of the subject, from the fact that the belief is gaining ground, among those best able to judge, that per- sistent Catarrh of the nasal passages is but too often the forerunner of more serious disturbances in the respiratory organs. It is certain that persons who are predisposed to this complaint, by attention to hygienic rules, may greatly lessen the liability, and perhaps overcome it entirely. The writer ventures the following brief suggestions : clothing. Dress warmly in cold weather and wear woolen under-clothing, but do not sleep in flannel ; such a habit is highly objectionable. Keep the extremities warm to obviate congestion to the 18 NASAL CATARRH: ITS CAUSES, head and chest. Do not muffle up the throat; this practice is very pernicious, as it induces per- spiration in the parts, and the least exposure results in cold. Bathing, a moraing sponge bath of the entire body in tepid or cold water, three or four times a week, aids greatly to maintain a vigorous cutane- ous circulation and to toughen the cuticle, prevent- ing the tendency to excessive perspiration, so fre- quently a prominent symptom with catarrhal suf- ferers. After the bath, the body should be rubbed briskly with a coarse towel or flesh brush until re- action is produced. A little salt may be added to the water occasionally, with benefit. Where bathing the entire body is found to be too trying upon the powers of reaction, a cold sponge half-bath, with vigorous dry rubbing from the face down to the waist, is a ready, and gener- ally effective mode of putting the body in a condi- tion to resist the chilling influence of the cold air throughout the day. Bathing the throat and neck in cold water, once or twice a day, is also efficacious in warding off cold. It is well, however, to abstain from wetting the hair on these occasions. Exemse. Take pienty of out_aoor exercise. Walk- ing, horse-back riding, use of dumb-bells, clubs, cross-bar and similar appliances, may all be recom- mended in moderation. Persons of sedentary hab- COMPLICATIONS, PREVENTION, TREATMENT, &C. 19 its, especially those living in cities, cannot pay too much attention to this branch of hygiene. Diet, Etc. rn respect to diet, all stimulating food should be carefully avoided. Under this head are included all those dishes which are prepared with strong peppers and spices. Rich pastry of all kinds should be abstained from. Good, nourishing, well- cooked food, of any sort which the patient's diges- tion will tolerate, can be eaten in moderate quan- tity. Fresh vegetables and fruits may be recommend- ed. Strong coffee is not allowable. Regularity in respect to meals is important, and between meals nothing should be eaten. Sleep in a well-ventilat- ed and cool room. Finally, live temperately in all things. As a comment upon the above, we may remark that catarrhal affections involving the organs of speech, as in the case of clergymen and literary men, often arise from, or are greatly aggravated by a dyspep- tic state of the stomach. Such may be prevented and sometimes remedied by proper exercise and diet. There is no complaint which requires closer at- tention to hygienic means to insure its complete eradication, when it is thoroughly established, than chronic Catarrh. Its prevention, in those predis- posed, demands equal vigilance. Immunity, how- ever, purchased at the expense of the slight trouble involved in adhering to a few simple, hygienic rules, is cheap, indeed. 20 NASAL CATARRH: ITS CAUSES, TREATMENT. We have no panacea or cure-all to recommend. Each case must be individualized. As there are no two faces exactly alike, so there are no two cases of disease precisely similar. A remedy, which would afford relief in one instance, might have no per- ceptible curative effect in another. It should be borne in mind, as already intimated, that " Catarrh " itself is, in many cases, merely a symptom of a morbid condition of the system, more or less pro- nounced, dependant, perhaps, upon the derange- ment of some remote organ or organs; that de- rangement removed and the Catarrh ceases. Remedies. The ]\{ater[a Mediea is rich in drugs which have a specific influence upon the mucous mem- branes of the nose and throat, either directly or by reflex action. Such are the remedies upon which reliance must be placed in the treatment of the complaint under consideration. When administer- ed according to the law, similia sim'dibus curantur, they may be made to meet all the varied curative indications, and by removing the causes which pro- duce deranged action, secure permanent relief. It must be distinctly understood, however, that neglect of hygienic measures can hardly be atoned for by medical treatment, no matter how skilfully applied. Right living is, at last, the basis of good health. The physician, as well as patient, must not be- COMPLICATIONS, PREVENTION, TREATMENT. iC. 21 discouraged, while using the properly indicated remedies, if the progress be slow and often inter- rupted, as every cold taken, however slight, is sure to be felt early, if not at first, in the nasal fossae and neighboring parts. indicates. Improvement in the general health is often, noticeable under proper treatment, for some time, before there is any marked abatement in the nasal symptoms proper. When the patient says he feels better every way, except as to the nose, the physician may be confident that he is upon the right course, and should hesitate and carefully con- sider before deciding to change the treatment. A good rule is to administer the remedy at longer and still longer intervals, after improvement has set in. ofl'um&te. ^e must not omit to mention the fact that, in the treatment of some cases, a change of air and scenery is productive of the most beneficial results. Numerous illustrative instances might be cited, were it necessary, to prove the influence of climate in modifying the symptoms of catarrhal af- fections. Those who reside in low, malarial regions will experience the most benefit from a sojourn among the hills and mountains in a dry, bracing atmosphere; while those who already inhabit ele- vated sections of country, might try, with fair pros- pect of betterment, a visit to the low-lands or sea- shore. In obstinate cases, where circumstances permit, such aids to treatment as are offered by brief change of residence should not be neglected. NASAL CATARRH: ITS CAUSES, 1 Dffi£te.of ^° one who is not expert in diagnosis, in the widest signification of that term, can treat chronic Nasal Catarrh successfully. The common acute attacks, arising from cold, will usually run a course and the symptoms disappear, even if medical treatment is entirely neglected. But the chronic forms of this complaint arise from such a variety of causes, being often kept up by functional or struc- tural derangement of some remote organ, and again frequently depending upon hidden constitutional taint or hereditary bias, that the keen faculties of the practiced and experienced observer are demand- ed for their proper understanding and treatment. This is an important fact, and one well worthy of careful consideration, for it shows how utterly un- suited bad cases of " catarrh " are to self or empiri- cal treatment. The physician who is applied to for relief in these often obscure and deeply-seated troubles, should spare no time nor pains in his efforts to elicit a clear picture of the general and special conditions in each individual case. Treatment based upon a hasty and superficial examination will result in little good to the patient and less satisfaction to the prescriber. The problem presented for solution, in many in- stances, is a profound one—how to restore to their normal action the long perverted vital forces. The task which the physician sets out to accomplish is not the work of a day or a week, but must often be prolonged through months, and sometimes, even COMPLICATIONS, PREVENTION, TREATMENT, &C. 23 through years. What care, what patience, what judgement, what discrimination must he not exer- cise. PART II. OASES FROM PRACTICE AND OBSERVATIONS ON THE USE OF REMEDIES. The writer believes there is no more ready or effective method of conveying information re- garding the treatment of any complaint than the citation of characteristic cases, with detail of symp- toms and application of remedies. There is, it seems to him, a positiveness and reality about the knowledge thus attained, which can be imparted in no other way. Acting upon this conviction, he presents here a number of carefully selected cases, taken from his record book, and trusts that the ac- companying therapeutic observations and compari- 2i NASAL CATARRH: ITS CAUSES, son of symptoms and remedies may not prove valueless to the inquirer. They are, at all events, the fruit of the writer's practical experience. TREATMENT WITH NUX VOMICA, HYDRASTIS AND LYCOPODIOI. Case I.—Mr. C, book-keeper, aet. 29; Nasal Catarrh for two years. Had used, in that time, a great many domestic cure-alls and patent nostrums, as well as gone through the cauterizing and disin- fecting treatment with douche and syringe. Symp- toms were as follows: Frequent, severe, frontal headaphe, affecting the eyes, the conjunctiva be- ing reddened and irritated ; worse from cold ; fre- quent stoppage of the nose, with dropping of mu- cus into the throat, from the posterior nares: pa- tient not able to sleep on his back, on account of the choking produced by the discharge; large lumps of yellowish and whitish mucus blown from the nostrils every morning, four or five minutes being required to clean out the nose; bowels con- stipated. Prescrip.—Nux vomica 3, gtt. iii, inmorning,Nux 30, gtt. iii, at night, for one week. As expected, the severe frontal headache almost ceased, after a few days, but the other symptoms remained about the same. Prescrip.—Hydrastis 3, trit. gr. ii, morning and night for two weeks, then, only at night for another week. COMPLICATIONS, PREVENTION, TREATMENT, &C. 25 At the end of the three weeks, the dropping of mucus into the throat, from the posterior nares,—a prominent symptom of the drug administered, which, together with the condition of the bowels, led to its selection,—had ceased, and the patient could sleep on the back undisturbed. There re- mained, however, an obstruction of the nose high up, with frequent forcing out of plugs of partially dried mucus; the patient's urine was dark and scanty, and, though there was good appetite, a small quantity of food seemed to fill him up. Prescrip.—Lycopodium 200th. dose at bed time for three nights—no more medicine. The cure was complete, at the end of three months, when the patient had gained in flesh to the extent of ten pounds, and expressed himself as never having felt better. Hydrastis. The Hydrastis is a remedy which the writer has found, very frequently, of striking bene- fit in the treatment of catarrhal troubles. Not with- out good reason have the Eclectics pronounced it to be one of the very Lest of the so-called tonics. In cases where the stomach lacks vigor, where the bowels are inactive and the nose dripping, as if from simple hydrostatic pressure, its administration in two or three grain doses, of the 1st. or 2d. dec. trit, three or four times a day, will produce strik- ingly beneficial results. It is useful in those cases where ulceration exists with fVee muco-purulent dis- charge, but its range of action stops far short of 26 NASAL CATARRH: ITS CAUSES, those virulent cases which call for Aurum, Nitric Acid and Mercurius. It is the rival of Kali bichromi- cum in those cases where the discharge is tenacious and stringy, but has not the same intensity or per- sistence of action manifested by the latter remedy. It acts vigorously upon the posterior nares and post- nasal cavity, and should be considered in those cases, where the catarrhal inflammation has in- volved the Eustachian tubes, and even affected the middle ear. Where there is induration or chronic enlargement of the glands, the Hydrastis will sel- dom claim attention ; here, recourse must be had to the various preparations of Mercury, Calcarea, Iodine and Sulphur. In many cases where Nasal Catarrh in the female is attended with uterine trou- bles, notably leucorrhceal discharges, it ranks with Sepia and Pulsatilla. It should not be forgotten, where the eyes are involved in a general catarrhal condition of the mucous rjiembranes of the head. In acute attacks it is valueless, during the first stages and so long as febrile symptoms are mani- fested, but, when the active inflammation subsides, it comes in splendidly. In chronic catarrhal cases, where torpidity of the liver and a general atonic condition of the digestive organs obtains, this remedy may be administered with great confidence. For that exceedingly characteristic symptom : "Dropping down of mucus from the posterior nares into the throat," I am indebted to Dr. H. Noah Martin, of Philadelphia. COMPLICATIONS, PREVENTION, TREATMENT, &C. 27 NUX VOMICA, AURUM AND SEPIA. Case II.—Mrs. D., set, 29, dark hair, light com- plexion, angular form, illy nourished, applied to me for treatment of a chronic Catarrh, of the ozsena variety, which had existed for six years. She had tried every method of treatment of which she could hear; had visited different cities, and consulted practitioners of every kind; had submitted to the douche for months at a stretch, and taken large quantities of Iron, Cinchona and other tonics Ap- petite and digestion were impaired; bowels severely constipated; terrible frontal headache. The mind was in a constant state of the most horrible gloom and depression, and altogether, the patient present- ed a forlorn appearance. The nasal discharge was copious, green and yellow as to color, terribly fetid and often streaked with blood. There were severe constrictive pains in the bones of the nose. The sense of smell had been apparently obliterated and there was partial deafness. An inspection of the throat made it apparent that the morbid process after spreading from the posterior nares to the post-nasal cavity, had traveled downward, so as to involve the entire pharynx, the mucous membrane of which was of a dull purplish color, and highly congested. This patient came to me from a distance, and could only remain for a day or two. I prescribed Nux vom. 3, gtt. vi, in half a tumbler of water, a teaspoonful to be taken every two hours 23 NASAL CATARRH : ITS CAUSES, during the paroxysms of headache. Also Aurum metalicum 3d, trit. gr. ii, morning and night for two weeks. At the expiration of that time my patient wrote me that she was much better. Appetite had improved, bowels were regular, frontal headache had almost vanished, and the discharge was much less troublesome. I continued the Aurum, one dose a day, for another fortnight, when my patient called to see me again. I found the hearing improved, sense of smell returning, while the nasal discharge had greatly decreased. The mind was cheerful and free from the former gloom and melancholy. I told her to return home and write me again in a fortnight, meanwhile, taking a dose of the same medicine (Aurum) every other day. Improvement still continuing, I suspended the mediciue for a month, when the patient reporting that there was an occasional discharge of greenish scabs, I pre- scribed Sepia 6, gtt. vi, in half a tumbler of water, a teaspoonful of the mixture night and morning for one week. Three months elapsed before I saw this patient again. She had fully recovered, save an obtuseness of smell. The writer has found Nux vomica to be almost a specific, as an intercurrent remedy, in those severe frontal headaches, accompanied by constipation and derangement of the digestive organs, with which catarrhal patients so frequently suffer. If the patient feels worse when out in the wind, and is subject to neuralgic pains about the head COMPLICATIONS, PREVENTION. TREATMENT, &C. 29 and face, Phosphorus or Arsenic will usually afford relief, if the Nux fails ; the two former, however, seem to possess none of the antidotal powers which render the latter so useful in beginning treatment after strong medication has been employed. Aurum. rpne q^qyq case, very strikingly, illustrates the happy effects of the Aurum in those deeply seated symptoms, where the mind has become notice- ably affected. The settled, melancholy, hopeless- ness, and loathing of life, are very characteristic indications for the use of this remedy. The mental symptoms of Nitric acid are somewhat similar to those of Aurum, but fall short of the intensity pos- sessed by the latter. In syphilitic ozaena, these two remedies are oftener indicated than any others save Mercurius, and are especially useful where this latter remedy has been excessively employed. Sepia, the last remedy used in the foregoing case, is one of the most prominent to be thought of in case of greenish discharge from the nose, especially in women, though it is sometimes indicated in the other sex. What is said of Sepia may be applied equally to Asaf employment of a number of the more prominent remedies useful in the treatment of Nasal Catarrh. Alumina. This remedy ranks with those which have proven efficacious in combatting scrofulous taint, coupled with chronic na^al or aural discharges. It also coun- teracts the tendency to Catarrh in those who are predisposed, and may be classed with those drugs which are first to be considered in cases of ozsena. COMPLICATIONS, PREVENTION, TREATMENT, &C 55 Its prominent symptoms are ulceration of the Sch- neiderian membrane, with discharge of thick yellow- ish mucus or expulsion of yellowish-green scabs, stoppage of the nose, snapping in the ears, when chewing or swallowing, caused by partial occlusion of the Eustachian tubes. Pain in the root of the nose, chronic inflammation of the fauces with accitmula- lion of tenacious mucus in the throat. Alumina is a prominent remedy for old people and to be thought of in all cases of Catarrh when there is obstinate constipation from atony of the bowels, so that even soft stools are passed with dif- ficulty ; useful in Catarrhal affections occurring among painters and workers in lead. Alumnia pa- tients are generally better in the open air, but take cold from the slightest exposure. Argentum Nitricum. Violent itching in the nose—ulcers in the nose which become covered with yellow crusts. Scurfs in the nose which excite pain and are followed by slight bleeding when detached. Stoppage of the nose at night with much itching. Bloody and puru- lent mucus discharged from the nose. Dullness of the sense of smell. Coryza with constant chilliness, lachrymation, sneezing and violent stupefying head- ache. Argentum is a good remedy in both acute and chronic Catarrh of the nasal passages. The phar- vnx larvnx and eyes will nearly always be found 56 nasal catarrh: ITS CAUSES, more or less affected by catarrhal inflammation when this remedy is indicated. When Catarrh is compli- cated with Ophthalmia, this is among the foremost remedies. Arsenicum. The discharge for which this remedy is indicated is of a burning, acrid character, occasioning a biting and soreness in the nose. There is frequent stop- page of the nasal passages, accompanied by a sting- ing, burning sensatron and succeeded by fluent coryza. There is usually great restlessness and chilliness even, in the chronic cases; the sufferer clings close to the fire, and is better in a warm room and worse in the opeu air and at night. Sleeplessness with beating in the forehead and sometimes nausea; no thirst or desire to drink often but little at a time; the ears are sometimes affected, and one or both become closed during deglutition. The catarrhal symptoms often affect the eyes, pro- ducing a discharge of excoriating tears. This drug is to be thought of prominently in cases of thin and illy nourished subjects and in those who have been long subjected to malarial influences. Arsenicum Jodatum„ The Iodide of Arsenic is applicable in persons with pale, delicate skin, enlarged tonsils, defective assimilation; tendency to passive oedema, shown by pufriness of the eyelids. It is also strongly indica- COMPLICATIONS, PREVENTION, TREATMENT, &.C. ted in the tuberculous diathesis, upon which has been grafted a Nasal or laryngeal Catarrh. The dis- charge in these cases is generally copious and thin, but sometimes scanty and thick, now and then ten- acious and frothy. Discharge of very irritating and corrosive, watery mucus, which burns the nostrils and lips, attended, often, with alternate chills and heat. Epidemic influenza; otorrhcea, complicated with Catarrh, where the discharge is fetid and cor- rossive. Summer Catarrh or Hay Fever. A burning sensation in the nose and throat is quite characteristic. Like the simple Arsenic, this combination is often useful in cases complicated by effects of malaria. Asafcetida. This drug has proven useful in offensive nasal discharges in nervous, hysterical females. The writer has, however, seldom found it of advantage save as an intercurrent remedy. Aurum. This remedy affects the nose as prominently, per- haps, as any other known to the 3Iateria Mediae. It is indicated in caries of the bones of the nose; fetid discharge of greenish or vellow dus. Saltv tasting, watery discharge through the posterior nares. Nos- trils closed with ulcers. Loss of smell and frequent discharge of blood from the nose. Swelling of the nose after walking in the open air; nasal bones 58 nasal catarrh: its causes, painful to the touch; fetid otorrhoea with Catarrh; coryza, sometimes violent and profuse; habitual na- sal tone of voice; drinks flow back again through the nose. It is one of the first remedies to be thought of af- ter abuse of Mercury; in syphilitic ozeena, and in Catarrhs which appear only in winter. The mental symptoms are characteristic. There is great depression of mind ; patient constantly be- moans his condition and thinks everybody knows his complaint—shuns society on account of the dis- agreeable odor from the nose. When the scrofulous diathesis is marked, the Au- rum muriaticurn is preferable to the Aurum metal- ieum. Calcarea Carbonica. This is among the most prominent of the reme- dies which are useful in combatting profoundly seated constitutional taints. It should always be carefully considered in cases of children of scrofulous diathesis and phlegmatic temperament, with affec- tions of the'glands, and having a chronic discharge either from the ears or the nose. The symptoms in such subjects are usually of a sub-acute character. Dampness, coldness of the feet and a feeling as though the stockings were always wet are promi- nent symptoms under this drug. The nasal dis- charge for which the Calcarea is applicable is usu- ally thick and pus-like, but sometimes thin and wa- tery. There is frequently dryness of the nose at COMPLICATIONS, PREVENTION, TREATMENT, &C 59 night, with moisture during the day. Often,the ca- tarrhal symptoms are not confined to the nose, but the pharnyx and larnyx are also involved and there is present, sometimes, a peculiar raw feeling in the vocal organs, accompanied, not infrequently by chronic hoarseness. Inflammation, swelling and redness of the anterior portion of the nose; erup- tion on the nose; sore ulcerated nostrils; very bad smell in the nose; itching of the eyes with lachry- mation. Calcarea is exceedingly useful in females of leuco- phlegniatic temperament where Catarrh existsin con- nection with leucorrhooa or menstrual irregularities. The constitutional symptoms and characteristic temperament are most reliable indications for the employment of this remedy. Chamomilla. Adapted to children, where there is great irrita- bility, with feverishness; one cheek red, the other pale; acrid mucus from the nostrils, which are fre- quently ulcerated; obstruction of the nose with flu- ent coryza: chills with thirst. Euphrasia. Very profuse, fluent coryza, with inflammation and redness of the eyes and discharge of excoria- ting tears; photophobia with dimness of sight; pain- fulness of the nasal passages, with sneezing and discharge of watery mucus. This remedy will be found frequently adapted to acute cases, but seldom useful in those of a chronic character. 60 NASAL CATARRH: ITS CAUSES, Gelseminum. Bland, watery discharge from the nose, with fre- quent tingling in the nasal passages; great chilliness with dread of leaving the fire; fever without thirst or restlessness; soreness in the throat and chest. This remedy affects prominently the mucous membranes of the nose, ears and eyes, and is fre- quently applicable in those severe epidemic influ- enzas which prevail at certain seasons of the year. It is often useful in suppressed Catarrh, but is rarely applicable in chronic cases. Graphites. Catarrh, accompauied with inflammation of the fauces and stoppage of the Eustachian tubes, pro- ducing constant desire to clear the nose and throat. Roaring in the ears and crackling when swallowing. Catarrh of the middle ear. Bloody mucus from the nose, alternating with expulsion of dry scurfs, also discharge of thick fetid mucus. The aural symptoms are quite characteristic in this remedy and are nearly always produced by stoppage of the Eustachian tubes. There is fre- quently present in some part of the body, a tetter- like or humid eruption in cases where it is appli- cable. It often follows admirably after Mercurius and should be carefully considered in cases of women with tendency to unhealthy corpulance, and in those suffering with menstrual troubles. COMPLICATIONS, PREVENTION, TREATMENT, &C. 61 Hepar Sulphur. Swelling of the nose, which is painful like a boil, accompanied by Catarrh and smarting roughness iu the fauces. The bones of the nose are painful to the touch. Nasal discharge thick and pus-like; some- times tinged with blood. Headache worse from mo- tion; Catarrh confined to one nostril; every exposure to cold causes a new attack; cases of ordinary Catarrh where Mercurius has afforded partial relief and im- provement has ceased. Especially useful where the patient has, at some period in life, had the itch, or other cutaneous disease which was repelled by external applications, such as ointments and washes. Also applicable where there is great sensitiveness; patient is chilled by the slightest draft of air; the least injury causes ulceration; swollen, indurated tonsils and hard, glandular swellings about the neck. Useful antidote to abuse of mercury where charac- teristic symptoms are present. Hydrastis Canadensis. Dropping down of mucus from the posterior nares into the throat. Raw, excoriating feeling in both nares. Constant inclination to blow the nose. The fauces feel raw and inflamed. Hawking up of touerh vellow or whitish mucus. Tenacious stringv discharge. Ulceration of the membranes of the nose/ Scrofulous ozrena; aphthous sore mouth; excessive secretion of tenacious mucus from the mouth; profuse lachrymation. The dropping down of mucus from the posterior 62 nasal catarrh: its causes, nares into the throat is exceedingly characteristic of this remedy, If constipation of the bowels and general atony of the system accompany the above symptoms, it will seldom fail to effect a cure, or, at least, produce a favorable change and pave the way for the successful employment of some other remedy. Ipecac Coryza, with obstruction of the nose; loss of smell, and bleeding from the nose; Catarrh with asthmatic dyspnoea; debility and loss of appetite, with nausea and vomiting; frequently useful in acute cases where Arsenic and Nux Vom. fail to relieve; rarely appli- cable in chronic Catarrh. Kali Bichromicum. This, in the writer's experience, is one of the most frequently indicated remedies in Nasal Catarrh. It exercises a very marked influence upon the nose, pharynx and larynx and is exceedingly useful in cases where all these parts seem involved. It is one of the few drugs beneficial in caries of the bones of the nose, and useful in combatting the constitutional effects of Syphilis, when complicated with Catarrhal affections of the nose and throat. It is especially suitable for fat, light haired people. The symptoms calling for its administration are: yellow discharge from the nose: internal ulcera- tion; severe pain across the bridge of the nose; periodical discharge of tough plugs from the nose, tinged sometimes with blood; discharge of tough. complications, prevention, treatment, &c. 63 stringy mucus; destruction of nasal septum; chronic "cold in the head," and Catarrhal inflammation of the fauces, with chronic hoarseness; loss of smell; fetid smell before the nose; headache from sup- pressed ozsena; Catarrh which is worse in warm weather; or which involves the mucous membrane of the stomach; loss of appetite, with nausea on moving about, relieved by lying down. Kali IIydriodicum. The Iodide of Potassium is applicable in fluent coryza, with copious discharge from the nose, at first very thin, watery, scalding, then thicker; frontal pressure and headache, with lachrymation, more or less profuse, and sometimes irritation of the throat. It resembles Arsenicum, in its nasal symptoms, more closely, perhaps, than any other remedy and is exceedingly useful in acute cases,"cold in the head" —where the characteristic symptoms are present. It will be found applicable, in some instances, in chronic Catarrhal troubles where the discharge is very copious and watery. Lachksis. Extremely copious discharge of watery mucus; swelling of and soreness of the nares and lips; scurfs in the nose; vesicular eruption in the nostrils; discharge of pus and blood from the nose, with violent headache. Fluent coryza, with profuse se- 64 nasal catarrh: its causes. cretion of mucus, running of the eves, and cough; or when the coryza does not fully form itself, with stoppage of the nose. This remedy is especially useful in acute cases, where Nux Vom., Mercurius or Hepar seem indica- ted, but do no good. In chronic cases, where the nose is very sore and greatly inflamed, the patient irritable, mind con- fused, with inability to think, this remedy is espe- pecially useful. Lycopodium. This remedy is useful in cases where there is a persistent dryness of the nose, high up, with peri- odical expulsion of elastic plugs. The writer has seldom found it indicated in the commencement of treatment, but frequently indispensible towards the close. The symptom—"Patient feels hungry, but a little food fills him up," the writer has frequently veri- fied in treatment of Catarrhal troubles, as also a feeling of excessive accumulation of flatus in stomach and bowels; and stoppage of the nose only at night, with burning or dull heavy feeling in the forehead. This remedy will be found useful in some cases where there is great aptness to take cold. Each attack being attended at the out-start by fluent coryza—corroding the upper lip. Mercurius Jodatus. This drug is frequently called for in Catarrhal complications, prevention, treatment.