*:•** -£■ '*.-4j T*. '3*. .. mMtiS> ■ "7 • w*> NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland Gift of The National Center for Homeopathy ;aai Jfllaesitnund Ibanninq panes Library c#7T^ 19 HA _ . 174' & A. OaioeO Ml z It ELEMENTS OF HOMEOPATHIC PRACTICE OF PHYSIC. ELEMENTS HOMCEOPATHIC PRACTICE OF PHYSIC. BY J. LAURIE, M.D., LICENTIATE OF THE ROYAL COLLEGE OF SDRGEON8, EDINBURGH ; AND CONSULTING PHYSICIAN TO THE HAHNEMANNIAN MEDICAL INSTITUTION. FIRST AMERICAN, FROM THE SECOND LONDON EDITION. PHILADELPHIA: MATTHEW & HOUARD, 129 SOUTH EIGHTH STREET. 1852. f NOV?) CONTENTS. INTRODUCTION. Regimen, ....... Choice of the remedy. Potencies of the Medicaments, The Choice of the Proper Remedy, The Potency, Attenuation, or Dilution of the Medicament, The Dose and its Repetition, .... Remarks, ...... PAGE xviii xx xx xxi xxiv xxviii NATURE AND FORM OF HOM030PATHIC MEDICINES, Of Vehicles which serve for the Preparation of Homoeopathic Medicines, 1. Of Alcohol, ...... 2. Sugar of Milk, ...... 3. Sugar Globules. ..... 4. Water, ...••• 5. Ether, .....-• Of the Preparation of Medicines in their Primitive State, 1. Observations and General Rules, 2. Particular Rules for the Preparation of Fresh Plants—Tinctures, 3. Preparation of Exotic Vegetable Products, 4. Preparation of Mineral and Animal Substances—Triturations, Of Homoeopathic Attenuations, ..... 1. Of Attenuations in general, . . 2. the Preparation of Attenuations, . . • Of the Dispensation and of the Preservation of Homoeopathic Medicines, 1. Of the Dispensation of Medicines, 2. the Preservation of Medicines, .... List of Medicines adapted to particular temperaments, &c, List of Medicines, . . • • • • ■ • Medicines which act very beneficially when administered after the employment of certain others, ....•••■ Synopsis of the Rules for Diet under Homoeopathic Treatment, . Aliments allowed, . . • • • • Aliments prohibited, ....••• Table of Medicines, with abbreviations, . xxxvm xxxix xxxix xli xliii xliv xlvi xlvi lii lvi lvi lvii lviii lviii lx lxi lxi lxii lxiii PART I. ON THE SYMPTOMS, CHARACTER, DISTINCTION AND TREATMENT OF DISEASES. General consideration of Fever, Causes, . General Treatment in Fever and Diet, 65 65 67 X CONTENTS. Simple or Ephemeral Fever. Febris simplex, ..... Inflammatory Fever, Synochal Fever. Febris inflammatoria simplex. Synocha. Febris synochalis, ........ Nervous Fever. Slow Fever. Febris nervosa. Typhus, . Putrid Fever, Pestilential Fever, or Malignant Typhus. Typhus putridus. Typhus abdominalis, ....... Contagious Typhus, Camp Fever, Jail Fever, Petechial Fever. Typhus contagiosus Accessory Treatment. Prophylaxes, &c, Febris lenta nervosa, ..... Intermittent Fevers. Ague. Febres intermittentes, Raphania. Morbus cerealis, Convulsio cerealis. Eclampsia typhoides The Plague. Pestis. Pestis bubonica. Typhus pestilentialis, Remittent Fever. Yellow Fever. Febris flava. Typhus icterodes, Hectic Fever. Febris hectica, ..... Mucous Fever. Febris pituitosa. Febris mucosa, Gastric Fever. Bilious Fever. Febris gastrica biliosa, Eruptive Fevers, ...... Scarlet Fever, ....... Scarlet Rash. Purpura rubra, s. Miliaris Hahnemanni. Scarlatina miliaris, mili formis, papulosa. Miliaria purpurea, ..... Measles. Rubeola, ....... Small-pox. Variola, ....... Chicken-pock. Variola spuria, Varicella, .... Miliary Fever. Miliaria. Miliaria alba. Miliaris sudatoria. Sudor miliaris, Nettle-rash. Urticaria, ...... PAGE 68 DISEASES OF ORGANS CONNECTED WITH THE DIGESTIVE SYSTEM. Toothache. Odontalgia, ....... Sore Throat, or Quinsy. Aphthous Sore Throat. Angina faucium, Tonsillitis phlegmonoides, Cynanche tonsillaris. Angina aphthosa, &c, Ulcerated Sore Throat. Malignant Quinsy, Malignant, Putrid, or Gangrenous Sore Throat. Angina maligna, Tonsillitis maligna, Cynanche maligna, Inflammation of the OEsophagus. Oesophagitis, Mumps. Parotitis. Angina parotidea, Indigestion, or Dyspepsia, .... Want of Appetite. Apepsia. Anorexia, Derangement of the Stomach, Eructations, &c, Flatulency. Flatulentia. Flatus. Tympanitis intestinalis,. Spasm of the Stomach. Gastrodynia, Cardialgia, Gastralgia, Heartburn. Black-water. Water-brash. Pyrosis, Constipatio, Obstipatio, Obslructio ah Vomiting of Blood. Hcematemesis, Costiveness, Constipation, Obstipation. Piles. Hemorrhoids, Stricture of the Rectum, Abscesses in Ano. Fistula in Ano, Proctalgia, ..... Protrusion of the Intestines. Prolapsus ani, Colic. Enteralgia, .... Determination of Blood to the Abdomen. Congestio viscerum abdominis. Congestio ad abdomen, ........ Looseness of the Bowels. Diarrhcea, ..... Dysentery. Dysenleria. Febris dysenterica, .... Cholera,......... Cholerine, ......... Liver Complaint, ....... Acute Inflammation of the Liver. Hepatitis, .... Liver Complaint, or Chronic Inflammation of the Liver. Hepatitis chronica, Jaundice. Icterus, ........ Inflammation of the Spleen. Splenitis, .... Stomach. Gastritis, ..... Bowels. Enteritis, .... Peritoneum. Peritonitis, .... Invermination. Worms. Helminthiasis. Febris helminthiaca, Blennorrhoea, ........ CONTENTS. XI DISEASES OF THE ORGANS CONNECTED WITH THE RESPIRATORY SYSTEM. PAGE Catarrh, or Common Cold. Catarrhal Fever, ..... 238 Inflammation of the Larynx. Laryngitis, ..... 242 Hoarseness. Raucitas, ........ 243 Cold in the Head. Coryza, ....... 245 Cough. Tussis, ......... 247 Hooping-cough. Tussis convulsiva. Pertussis,..... 255 Croup. Angina membranacea. Angina perniciosa. Cynanche laryngea. Cynanche tracheitis, s. trachealis, #c, fyc, ...... 259 Influenza, .......... 262 Determination of Blood to the Chest. Congestio ad pectus, . . . 264 Inflammation of the Mucous Membrane of the Bronchial Tubes. Cold on the Chest. Pulmonary Catarrh. Bronchitis, .... 266 Inflammation of the Lungs. Pneumonia vera, Peripneumonia, Pneumonitis, Pulmo- nics, ......... 272 Peripneumona Notha, *. Occulta. Catarrhus Bronchiorum. Spurious Peripneu- mony, ......... 290 Typhoid, or Congestive Pneumonia, ...... 291 Inflammation of the Pleura. Pleurisy. Pleuritis, .... 292 Spurious, or Bastard Pleurisy. Pleurodynia, Pseudo-Pleuritis, Pleuritis muscularis, 299 Diaphragmitis, ......... 300 Spitting of Blood. Hemorrhage from the Lungs. Sputum cruentum. Hamorrha- gia pulmonum. Haemoptysis, ...... 301 Pulmonary Consumption. Phthisis Pulmonalis, ..... 305 Asthma, . . . . . . . . 309 DISEASES OF OR CONNECTED WITH THE BRAIN, AND OTHER PARTS OF THE NERVOUS SYSTEM. Determination of Blood to the Head. Congestio ad caput, . . . .314 Inflammation of the Brain and its Tissues. Brain Fever. Phrenitis. Encephalitis, 318 Apoplexy. Apoplexia, ........ 321 Acute Inflammation of the Spinal Cord and its Membranes. Myelitis. Meningitis spinalis, .......... 325 Palsy. Paralysis, ........ 327 Tetanus, . ......... 327 Delirium Tremens Potatorum, ....... 329 Epilepsy. Epilepsia. Morbus sacer. Morbus caducus. Morbus divinus. Morbus herculeus. Morbus comitialis, ...... 332 Nerve Pain. Face-Ache. Face-Ague. Neuralgia. Neuralgia facialis. Tic dou- loureux. Prosopalgia, ....... 335 Headache. Cephalalgia. Cephalcea. Cephalalgia arthritica. Cephalalgia nervosa. Hemicrania (megrim). Clavus hystericus, ..... 338 DISEASES OF THE CIRCULATING SYSTEM. Angina Pectoris, Pericarditis, Endocarditis, Carditis, 344 346 355 374 CUTANEOUS DISEASES. St. Anthony's Fire. Rose. Erysipelas, .... Boil. Furunculus. Abscessus nucleatus, Carbuncle. Anthrax. Furunculus malignans. Pustula nigra, Chilblains. Perniones, ...... Corns. Clavipedis, ... ... Abscess. Lymphatic Tumours. Disease of the Conglobate Glands, Itch. Scabies. Psora, ...... Whitlow. Paronychia. Panaris, .... Irritation, or Itching of the Skin. Prurigo, 376 378 379 380 381 381 383 385 386 Xll CONTENTS. Ringworm. (Herpetic or Vesicular). Herpes circinnatus. Herpes serpigo, . Ringworm of the Scalp. Pustular Ringworm. Porrigo scutulata. Tinea capitis. Tinea annularis. Favus confertus, .■■••• Intertrigo, ...-••" Psoriasis, ..•••• Pemphigus. Febris bullosa, Pompholyx, ■ Shingles. Zona. Herpes zoster. Cingulum. Ignis sacer, $c, . Ulcers. JJlcera, ....-• DISEASES OF THE URINARY AND GENITAL ORGANS. Inflammation of the Kidneys. Nephritis, . Inflammation of the Bladder. Cystitis, . Retention of Urine. Ischuria, Difficulty in Discharging the Urine. Dysuria. Strangut Suppression of Urine, .... Stricture of the Urethra, . . ... Urinary Abscess and Fistula. Fistulce in perinazo, . Incontinence of Urine, ..... Diabetes, ...••■ Hematuria. Mictus cruentus, . . . . • ■ • Discharge of Blood from the Urethra. Urethrorrhagia. Hemorrhagia urethra Stymatosis, ... ..... Inflammation of the Urethra. Clap. Urethrelis. Gonorrhoea. Blennorrhcea, Inflammation of the Glans Penis. Balanitis. Balano-blennorrhoza, Inflammation of the Testis. Swelled Testicle. Orchitis. Hernia humoralis, Sarcocele, ...... Varicocele, . . . Hydrocele, ...... Venereal Disease. Syphilis. Lues Venerea, Phimosis, ...... Paraphimosis, ..... Herpes Preputialis, . . Sycosis, ...... PAGE 387 387 390 391 391 393 395 400 402 403 405 407 409 410 411 412 414 416 416 421 422 422 423 424 426 438 438 439 440 DISEASES OF PARTICULAR ORGANS AND REGIONS, OR OF THE SYSTEM IX GENERAL. Gout. Arthritis, . . . . . ■ . . .454 Rheumatism. Rheumatic Fever. Febris rheumatica. Rheumatismus, . . 456 Lumbago, .......... 462 Inflammation of the Psoas Muscle. Psoitis, ..... 462 Sciatica, .......... 463 Pain in the Hip. Hip-gout. Rheumatism in the Hip. Coxalgia, Coxagra. Ischias, 464 Hip-disease. Morbus coxarius, . . . . . . .466 Determination of Blood to the Abdomen. Congestio viscerum abdominis. Congestio ad abdomen, ...... . 467 Acute inflammation of the Eyes. Ophthalmia, Hordeolum. Stye, ..... Ectropium, ...... Entropium. Trichiasis, ..... Inflammation of the Ears and Earache. Otitis. Otalgia, Bleeding of the Nose. Epistaxis, Swelling of the Nose, Canker of the Mouth. Scurvy in the Mouth. Stomacace, .... Scurvy. Scorbutus, .... Inflammation of the Tongue. Glossitis, Offensive Breath, .... Cramp in the Legs, .... Bronchocele. Goitre. Derbyshire neck, Sweating Feet, .... Sleeplessness. Agrypnia, Nightmare. Incubus. Ephialtes, . Rupture. Hernia, .... Cancrum oris. Gangrena oris 468 473 474 474 475 478 480 482 483 481 486 486 487 487 488 499 499 CONTENTS. xiii Incarcerated Ruptures (Hernia incarceratce), Fainting. Swooning. Syncope, Pains in the Loins. Notalgia, Dropsy. Hydrops, .... Ascites, Dropsy of the Cellular Tissue. Anasarca, Dropsy of the Chest. Hydrothorax. Hydrops pectoris. Scrofula, ..... Ostitis. Caries. Necrosis. Exostosis, Rickets. Rachitis, .... Hydrops thoracis, PAGE 503 508 510 510 511 513 516 518 520 526 CASUALTIES. Concussion, Bruises, Sprains or Strains, Wounds, Dislocations, and Fractures, . 526 Burns and Scalds. Ambustiones, ...... 538 Fatigue, .......... 539 Overheating. Exposure to Heat, ...... 540 Stings of Insects, ......... 540 Sea-sickness, ......... 541 Apparent Death. Asphyxia, ....... 542 Hydrophobia, ......... 545 Mental Emotions, ......... 550 PART II. TREATMENT OF FEMALES, AND OF THEIR PECULIAR AFFECTIONS. Chlorosis. Emansio mensium, ....... 552 Amenorrhoea. Suppressio mensium, ...... 554 Menstruatio Nimia. Menorrhagia, ...... 555 Dysmenorrhoea, ......... 556 Hysterics. Hysteria. Passio hysterica, ..... 556 Inflammation of the Ovaries. Ovaritis, ...... 558 Inflammation of the Labia Majora and Vagina, .... 559 OBSERVATIONS ON PREGNANCY. Air and Exercise, ...... Clothing, ...... Diet, . ..... Employment of the Mind and Habits during Pregnancy, Influence of External Objects upon the unborn Infant, Mental Emotions, . 561 562 563 564 564 564 DERANGEMENTS DURING PREGNANCY. Menstruation, Morning Sickness, Constipation, Diarrhoea during Pregnancy, Fainting and Hysteric Fits, Toothache, Swelled Face, Varices, or Swelled Veins, Pains in the Back during Pregnancy. Miscarriage. Abortus, . Lumbo- sacral Pains, 565 566 566 567 567 568 571 571 572 573 XIV CONTENTS. TREATMENT BEFORE PARTURITION. Preparation of the Breasts, Remedies before Labour, False Pains, .... Parturition, .... Tedious or Complicated Labours, . Spasmodic Pains, Cramps, and Convulsions, 576 577 578 579 579 581 TREATMENT AFTER DELIVERY. After-pains, Duration of Confinement, 583 584 DISEASES FOLLOWING PARTURITION. Suppressed Secretion of Milk, Excessive Secretion of Milk, .... Perspiration after Delivery, Suppression or Excess of, Milk Fever, ...... Irregularities of the Lochial Discharge, Diarrhoea in Lying-in Women, .... Abdominal Deformity, .... Falling off of the Hair, ..... Leucorrhcea after Parturition, Internal or Uterine Swelling and Prolapsus, Inflammation of the Womb. Inflammatio uteri. Metritis, Weakness after Delivery, .... 584 585 585 586 587 588 588 589 589 589 590 591 OBSTACLES TO SUCKLING. Disinclination of the Infant, ..... Excoriation of the Nipples, ..... Inflammation of the Breasts, ..... Mental Emotions affecting the Milk, .... Deficiency in the Secretion of Milk. Suppressed Secretion of Milk, Deterioration and Discoloration of Milk, Mothers not Suckling their Children, .... 592 592 593 594 594 595 595 PART III. TREATMENT OF INFANTS AND CHILDREN. Introductory Remarks, Treatment after Birth, . Asphyxia, Swelling of the Head, . Naval Rupture in Infants, . Meconium, Expulsion of, Suckling of the Infant, The Choice of a Nurse, . Diet during Nursing, Supplementary Diet of Infants, Duration of Suckling. Weaning, Sleep. Sleeplessness, . Exercise, 596 597 597 598 598 599 600 601 601 602 603 604 606 CONTENTS. XV DISEASES OF INFANCY. TAGE Inflammation of the Eyes in New-born Infants, .... 607 Cold in the Head, ....... 608 Crying and Wakefulness of New-born Children, ..... 609 Regurgitation of Milk. Acidity, Flatulence, &c, .... 610 Spasmodic Asthma. Spasms in the Chest, . .611 Milk-Crust. Milk-Scab. Milk-Blotches. Crusta lactea. Porrigo larvalis. Eczema faciei. Tinea faciei, . . . . . .611 Thrush, or Aphthae, ........ 612 Constipation. Obstructio alvi neonatorum, ...... 613 Bowel Complaint of Infants. Diarrhoea neonatorum, .... 614 Excoriations. Excoriationes neonatorum. Intertrigo, .... 620 Jaundice. Icterus neonatorum, ...... 621 Induration of the Cellular Tissue. Infantile Erysipelas. Erysipelas infantum, . 621 Lockjaw of Infants. Trismus nascentium, ..... 622 Heat Spots, ....... ... 022 Derangements during Teething, ...... 623 Convulsions in Children, ........ 625 Water in the Head. Dropsy of the Bain. Dropsy of the Head. Hydrocephalus membranarum et ventricularum, . . . . . . .627 Asthma of Millar. Laryngismus stridulus, ..... 629 Infantile Remittent Fever, ........ 630 Atrophy, Atrophia, ........ 633 Vaccination, ......... 634 Index, 639 PREFACE AND INTRODUCTION. A considerable portion of the contents of this work has already appeared under the title of " Homoeopathic Domestic Medicine, arranged to serve, in some measure, as a Practical Work for Students." But, in consequence of the growing attention which medical men are beginning to bestow upon our science, the Author has been advised to give the result of his labours in a separate form to the professional public. He has accordingly made considerable alterations in those parts of the aforesaid work which must necessarily be retained in the present one, and has added many articles which were purposely omitted in what was chiefly designed to be a treatise on domestic medicine. The Author, therefore, trusts that, notwithstanding its manifold imperfections, this humble effort to furnish the professional inquirer with " an elementary practice of physic according to the homoeopathic principle," may be viewed with that kind indulgence which the occasion calls for, and ar- dently hopes that it may be instrumental in creating a desire for more extensive information, to be gleaned from works of greater pretensions. In compiling the work, the Author has derived much assistance from Hahnemann's Kronischen Kranhheiten, Jahr's Nouveau Manuel de Medecine Homoeopathique, Hartmann's Therapie akuter Kranhheits- formen, Boeninghausen's Manuel de Therapeutique Homoeopathique, Hering's (of Philadelphia) Hausarzt, and Knoack and Trinks's forth- coming Handbuch der Homceopatischen Arzneimittellehre ;l which, to- gether with the Materia Medica Pura, the Organon of Hahnemann, that of Rau, Hamilton's Guide to Homoeopathy, Black's Principles and Practice of Homoeopathy, and the following periodicals—the British Journal of Homoeopathy, the American Homoeopathic Examiner, the American Journal of Homoeopathy, the Archiv fiir Homoeopatische Heilkunst, the Allgemeine Homoeopatische Zeitung, the Hygea, the Oesterreichische Zeitschrift fiir Homoeopathie, the Journal de la Mede- eine Homoeopathique, and the Journal Hahnemannien, the Author 1 English translations of all the above works have already been, or are in the course of being published either in this country or in America. 2 xviii INTRODUCTION. would particularly recommend to the professional student who may be desirous of cultivating an intimate acquaintance with the science of Homoeopathy. It will be found that the Author has introduced into the work a number of diseases which are not ordinarily included in writings on the practice of physic. In deviating thus from the beaten track, he has been led by the conviction that the line of demarcation which has been attempted to be drawn between diseases that are considered to belong to the province of the surgeon, and those which have been allotted to the sphere of the physician, is by far too artificial to admit of its being rigidly adhered to in a practical point of view. Palpably apparent as this must be to the allopathic practitioner, it is still more strikingly so to the experienced homoeopathist who has had repeated opportunities of witnessing the cure of a variety of affections by the instrumentality of medicine, which he had formerly been taught to believe to be removable by the knife alone. The principal points it is now purposed to allude to are the Regimen —the Choice of the Remedy—the Potencies in general use—and the Dose. REGIMEN. The homoeopathic regimen consists merely of the avoidance of medi- cinal and indigestible substances during treatment, both as calculated to interfere with the actions of the medicines and the proper functions of the alimentary system. Consequently, among liquids, the articles generally proscribed, particularly in the different forms of dyspepsia, as also in affections of the liver, in gout, hemorrhoids, and in disorders of the bladder, are, green tea, or strong black tea, coffee, malt liquors, wine,1 spirits, and stimulants of every description, lemonade, or other acid or alkaline drinks, and natural or artificial mineral waters. Cocoa, unspiced chocolate, toast-, rice-, or barley-water, oatmeal gruel sweet- ened with a little sugar, or raspberry or strawberry syrup, if desired; whey, milk and water, or pure milk, not too recent from the cow, boiled milk, and in some instances buttermilk, or in fact any non-medicinal beverage is allowable.2 1 Wine should invariably be forbidden in cases where Nux v. is the remedy pre- scribed; and coffee when Puis., Ignatia, &c, are being taken. 2 The idiosyncrasies in some individuals, in respect of diet, are remarkable; as for example, some cannot take the smallest quantity of milk without serious inconvenience; others throw out a rash after partaking of fish; and again, others loathe the very si^ht of animal food. These peculiarities should not only be attended to in prescribing a suitable course of regimen, but should also be taken into account in the selection of the remedies. INTRODUCTION. XIX In animal food, pork, young meats—such as veal, lamb, &c, and among poultry, ducks and geese, had better be avoided, especially when derangement of the digestive function exists. Beef, mutton, venison, and most descriptions of game, if not too long kept (high), pigeons larks, rabbits, are allowable at discretion.1 (Vide Synopsis, p. 3.) Ham, and neats' tongues, under certain restrictions. Fish is a wholesome article of diet, and may, in most cases, be partaken of without scruple, with the exception of the oleaginous species, such as eels, salmon, &c, or shellfish, as oysters, lobsters, &c. Eggs, raw or soft-boiled; butter, if free from rancid or unusual taste ; cream, plain unseasoned custards, and curds. Stimulating soups and made dishes are so evidently opposed to homoeopathic regimen, as scarcely to require further notice. Beef-tea, veal, or chicken-broth, &c, thickened with rice, macaroni, or sago, and seasoned merely with a little salt, are of course allowable. Among vegetables, all of a pungent, aromatic, medicinal, or indiges- tible description, or greened with copper, are prohibited; such as onions, garlic, eschalots, asparagus, radishes, horseradish, celery, parsley, mint, sage, mushrooms, tomatoes, beets, artichokes, parsnips, &c.; but others free from such qualities, such as potatoes, French beans, green peas or beans, cauliflower, spinach, seakale, &c, may be used with the needful precaution of avoiding any particular article of diet, whether of the animal or vegetable kingdom, that may seem to disagree with the indi- vidual. Lemon or orange-peel, laurel-leaves, bitter almonds, peach- leaves or kernels, fennel, aniseed, marjoram, are objectionable; acids, and the ordinary condiments, such as pepper, mustard, pickles, &c, and salads, ought either to be sparingly partaken of, or entirely ab- stained from, particularly by the dyspeptic. Salt and sugar in mode- ration are admissible. Acid or unripe fruits are clearly objectionable, and even ripe fruits possessing little or no acidity, if fresh or prepared by cooking, such as peaches, raspberries, sweet cherries, grapes, and dried or preserved fruits, as figs, prunes, apples, pears, should be used in moderation, par- ticularly by dyspeptic individuals, and by those subject to colic or diar- rhoea not at all. Cold fruits, such as melons, and raw vegetables, such as cucumbers, &c, are inhibited; nuts of every description are for- bidden. All kinds of light bread2 and biscuit, free from soda or potash and such like, not new-baked; also simple cakes composed of flour or meal, 1 In some forms of dyspepsia meat requires to be prohibited for a short time, or taken only every second or third day. (See Dyspepsia.) The same rule, it may be added, may sometimes be advantageously followed when the patient is under the action of particular remedies, such as Calcarea, Silicea. 2 Unfermented bread is perhaps to be recommended in preference to any other. XX INTRODUCTION. eggs, sugar, and a little good butter ; or light puddings, such as bread, rice, sago, semolina, without wines, spices, or rich sauces, are admis- sible ; but coloured confectionary, pastry, and also honey, are not so. Regularity in the hours of meals should be observed, and too long fast- ing, as well as too great a quantity of food at one time, should be avoided.1 During fevers and inflammatory affections, the patient must of course be kept upon a low regimen; gruel, barley-water, &c.; and at the com- mencement of convalescence a light pudding, with a little weak beef-tea or mutton or chicken-broth, should form the whole of the nourishment given. Nature, however, is our best guide, and when she takes away appetite, thereby intimates the necessity of not taxing the digestive functions. (See also Synopsis of the diet rules.) The use of any medicinal or aromatic substances in the arrangement of the toilet, such as camphorated or otherwise medicated dentifrices, lip-salve, smelling-salts, or cosmetics, is detrimental to the action of the medicines, and had therefore better be avoided. CHOICE OF THE REMEDY—POTENCIES OF THE MEDICAMENTS—DOSE, AND ITS REPETITION. In homoeopathic practice there are three points which merit most par- ticular attention; the first and principal is the Choice of the Proper Remedy ; the second the Potency at which it should be exhibited; and the third the Dose, and its Repetition. THE CHOICE OF THE PROPER REMEDY. To accomplish this; in accordance with the law similia similibus, Hahnemann has directed us to form "a correct image of the disease," by committing to writing every detail of the case ; commencing, in the first place, to note down all those particulars which bear generally on the case, as its history, the previous health of the patient, hereditary predisposition, presumed cause of the disease, the former treatment, the patient's age, temperament, and appearance ; his mode of living, occupation, and disposition, and whether his malady has in any degree altered his normal disposition. There are instances, however, in which bread so made does not agree, and produces symptoms of indigestion. In such cases the use of bread, in the making of which German yeast has been employed, will often prove of easier digestion. ' In almost every instance where it is necessary to make a great alteration in the diet of the patient, it is advisable to do so gradually and cautiously, particularly in the case of those persons who have been long accustomed to the daily use of stimulants of various kinds. INTRODUCTION. XXI In the next place, the questions put must bear minutely upon the disease itself, not only for the purpose of ascertaining those of an im- portant and primary description, but also those which are purely sym- pathetic or secondary, from the circumstance that the latter, in addition to their being frequently very characteristic of the disorder, are more- over the indices to the selection of the individual specific remedy from amongst a class. This part of the examination, as a general rule, is to be commenced at the head, external and internal, proceeding to the senses—sight,- hearing, smell, and touch—thence to the mouth, tongue, throat, and the digestive organs ; from thence to the genital, the urinary, and the thoracic organs; and then the back and the superior and inferior extre- mities. Afterwards the skin, with particulars as to its temperature, secretion, appearance (the anterior or present existence of eruptions), the sleep, dreams, moral symptoms, pulse, &c. The character as well as the seat of the symptoms is of great impor- tance. Thus it is of little use to our purpose when the patient inti- mates that he has a severe pain, but he must describe its nature as accurately as possible, as whether it is gnawing, throbbing, aching, burning, shooting (darting), pricking, cutting, dragging, piercing, &c. Whether the symptoms are increased by movement or by rest (walking, lying, standing, or sitting), at night or during the day, in the house or in the open air, by heat or cold, dampness or dryness; after eating, drinking, or during abstinence. If worse after particular kinds of food; if continuous or periodical; and if increased by mental exertion, emotion, &c. With females, it is essential to pay attention to the following addi- tional particulars: pregnancy, labour, lactation, miscarriage, sterility, and the state of the menses. In reference to the latter, it is requisite to learn whether an irregularity exists, such as too short or too long an interval between the returns; if the discharge exudes uninterruptedly or only at intervals ; if it is copious or scanty; its colour; and if attended with pain ; the state of the body and mind previous to, during, and sub- sequent to the catamenia should also be inquired after; and if the patient is affected with leucorrhoea, its nature, quantity, the periods at which it occurs, or the circumstances under which it manifests itself should be ascertained. The selection of the proper remedy is, farther, materially facilitated by the nature of the cause of the disease; we should never omit, therefore, to elicit that information when practicable. THE POTENCY, ATTENUATION, OR DILUTION OF THE MEDICAMENT. In proceeding to the consideration of this second point, I may make the preliminary remark that it is a subject which is as yet by no means xxii INTRODUCTION. finally determined under what circumstances and conditions the lowest (viz., the 1st, 2d, 3d, and 6th, &c), the highest (the 18th, 24th, 30th), or the recently promulgated so-called highest potencies (the 100th to the 2000th, and even upwards), are to be preferred. The majority, however, especially amongst the more modern homoeopathists, may be said to have decided hitherto in favour of the lower, and particularly the 3d and 6th, in acute, and the higher, especially the 18th, 24th, 30th, &c, in chronic diseases. The main point to be attended to is the correct selection of the remedy; nevertheless, as the Author is of opinion that some importance is to be attached to the dilution, attenuation, or potency in the treatment of the multifarious forms of disease which come under the observation of the medical man in extensive practice, he ventures to throw out the following suggestions, premising at the same time that much depends upon the discrimination of the practitioner, and that it is almost impossible to give any rule to which there are not exceptions. The principal points to be attended to are, the susceptibility of the patient to medicinal influence, how far modified by circumstances, the age, sex, temperament, and habits—the disease itself, and further, the nature of the medicament employed. As regards the first, the susceptibility of the patient, we find four classes: First class.—Those who are comparatively insensible to medicinal influence, particularly at high potencies, upon whom the medicines show neither marked action nor reaction. Such individuals are generally of what is denominated the leucophlegmatic temperament; they require generally low potencies and frequent repetition—such cases are not without their parallel in allopathic practice. Also, in disease, we find some persons who appear to enjoy a peculiar exemption from infectious and even contagious influence. To this rule, however, of giving the low potencies in such cases, there are exceptions; I have found in prac- tice, after a careful study of the individual, and a selection of a remedy suitable to temperament, a marked action and reaction produced by a very high potency, where a lower of the same medicament had failed to elicit any apparent effect, and vice versd. Second class.—A marked susceptibility to medicinal action without a corresponding reflex action; such patients are generally of a highly nervous temperament, exceedingly difficult to treat, and require parti- cular study; here the higher potencies are generally called for, although we frequently find benefit in resorting to the lower. Third class.—Those in whom no marked or a scarcely perceptible medicinal action declares itself, but a well-marked reaction; in such cases we must be guided by other indications in the selection of the potency; watch the effect carefully, and avoid too frequent a repetition. INTRODUCTION. xxiii Fourth class.—Those in whom the medicines show a well-marked action and reaction; here, also, we must be guided by other circum- stances in the selection of the potency, so as to obtain the greatest pos- sible benefit without materially increasing the sufferings of the patient. We generally find a particular susceptibility to medicinal influence, at any potency, in persons dwelling in the country, of robust frame, simple habits, and regular lives, who are not subject to any peculiar dyscrasia. In towns, particularly in large, densely-populated cities, this susceptibility is greatly developed, but the reaction less evident; however, much depending upon the individual's employment, habits, and pursuits, it is difficult to give any fixed rule. Age.—In infancy and early childhood, we find a marked receptivity to medicinal influence, a decided action and speedy reaction, conse- quently the higher potencies are the most applicable in their diseases, and they rarely require so frequent a repetition; however, in acute dis- eases of any of the more noble organs, we may exhibit lower potencies, particularly of some of the less energetic medicines, for example, Sam- bucus, Ferrum, Ipecacuanha, Chamomilla, etc.,'a globule constituting the maximum dose. Some further remarks upon this subject have been made in Diseases of Infancy. Sex.—Females, for the most part, possess a higher degree of sus- ceptibility than males, in which they approach nearer to children ; for them the higher and medium potencies are generally most suitable; to this rule, however, there are many exceptions, particularly in those who are engaged in laborious employments. Temperaments.—In the Sanguine temperament, there is conside- rable susceptibility to all the potencies and a speedy reaction. In the Nervous, we find great susceptibility, sometimes without an equivalent reaction: here we should be cautious in administering, and generally use the higher potencies. In the Bilious, there is generally but little susceptibility, but the reaction, when roused, is powerful, and prolonged; hence a necessity for low potencies, generally given at long intervals. The Lymphatic being the least susceptible of all temperaments, the medicines may be given at low potencies, and frequently repeated till some effect is produced. Since these temperaments often occur in a mixed form, the rules above given must be modified accordingly. We may observe that the remarks above made refer principally to chronic and subacute diseases. • The Disease.—In severe acute diseases, Ave are usually in the habit xxiv introduction. of resorting to the low potencies, and in tinctures, from the circum- stance that we have commonly found them more certain in their effect than the 12th, 18th, or 30th in such affections. In the cases of children, an exception may be made, as already observed. In ordinary cases the best range is from the third to the twelfth potency; this rule should of course be modified according to the remedy itself, the disease, and the individuality of the patient. The seat, character, and the exciting cause of the disease are generally considered of importance in regulating the dose and potency; thus, in inflammation of the brain, or in erysipelas of the head, with implication of the meninges and delirium, Belladonna is not required at so low a potency (2, 3, or 6) as it is called for in ery- sipelas of the extremities. Dulcamara is more efficacious at a low potency (3) in catarrhal affections, or diseases of any kind proceeding from exposure to cold, than at a high one. Aconitum is more suitable at a low attenuation, when given to allay the violence of the accompany- ing fever in inflammations, than when it is prescribed as the specific remedy to the inflammation itself. And, finally, the low dilutions are held to be the best adapted to inflammations of a torpid character; the high to inflammatory affections with increased arterial action. It is undeniable, however, that deviations from the above rules may often be made without disadvantage. The Nature of the Remedy.—Medicaments which, in their crude state, possess little or no appreciable medicinal property, but whose virtues have been developed by trituration and segregation of particles, such as Lycopodium, Natrum muriaticum, Calcarea carbonica, Sepia, Carbo-vegetabilis, Silicea, &c, should generally be used at the higher potencies. Others, also, which have been found from experience to dis- play considerable efficacy, even when greatly attenuated, such as Sulphur, Lachesis, Acidum nitricum, Arsenicum, &c. On the con- trary, some which have a short-lived, but well-marked action, may be used in some cases in the original substance; for example, 3Ioschus, Valerian, and Camphor, but in exceedingly small doses. Others again have been found most useful at the first, second, or third potency, such as Tartarus emeticus, Ferrum, Ipecacuanha, Hepar sulphuris, Stannum, Rhus toxicodendron, Opium, and in many cases Cinchona. Still, all these remedies, in peculiar cases, act well at the higher. the dose and its repetition. Although it is almost impossible to give any general rule that will serve in all cases, much more depending upon the discrimination of the administrator, and a careful observance of the symptoms than routine INTRODUCTION. XXV the following remarks may prove of some service to beginners, for whom indeed, as has already been intimated, the contents of the entire work are almost exclusively intended. From the diversity of opinion which as yet exists as to the " potency of the medicament," it may readily be surmised that various differences prevail as to the mode of prescribing or administering the homoeopathic remedies. Some there are who invariably give one or more drops, or grains ; others, again, adhere as rigidly to globules; whilst a third party give drops in acute, and globules in subacute, and in chronic cases. To the beginner, whose former habits may very naturally incline him to err on the side of excess, by invariably flying to mother tinctures, low dilutions, first triturations, &c, in large and rapidly-repeated doses, we should say, " strive ever to cure by means of the smallest possible dose, and do not imagine that because with a minute dose you have done much, that by increasing it you will do more—more indeed you may do, but that may as likely prove to be to the detriment as to the welfare of your patient." For ourselves, we may state that on most, although by no means on all occasions, we are in the habit of prescribing drops, in the diluted form we have mentioned in certain parts of the work (see Pneumonia, Pleuritis, &c), in the treatment of acute diseases; whereas in subacute and in chronic affections, we very generally, if not exclusively, confine ourselves to the employment of globules, varying the form of prescription according to the age, sex, and temperament of the patient. On ordinary occasions, in the treatment of chronic maladies, we order a couple of globules to be taken every night, in a dessert-spoonful of pure cold water at bedtime, for a week, and then allow the remedy to act for from four to eight days, and even upwards, in particular cases and under particular circumstances, before repeating the remedy, or selecting another. But where the patient is extremely susceptible to the action of the medicines, and, usually, in young sub- jects, we give only one, or at the most two doses (one night and morn- ing), consisting of one or of two globules, either undissolved or in a teaspoonful of water, and allow the remedy to act for the same period as above specified. In many cases of a chronic description, and parti- cularly when the patients are found to be moderately sensitive, we give a dose for four successive days, and then wait for two to six days for a development of improvement. We, as already stated, occasionally vary our mode of prescribing, being guided in doing so by the sex and constitution of the patient, the character of the disease, and the nature- of the remedy (see art. Poten- cies of the Medicaments), but ever prefer the smallest possible dose to a large one, and globules in place of drops of the tincture, even when from no other motive than that of prescribing a medicine free from taste— an advantage of no small importance in the treatment of children— xxvi introduction. whenever we feel convinced that we can do so without fear of allowing the disease to gain head, or of retarding recovery by the insufficiency of the dose. Slight diseases are often removed by a single dose of a well-chosen medicine, but more severe and deeply-seated disorders require a fre- quent repetition. In acute diseases, we must carefully watch the symptoms, and when we feel assured we have chosen the proper remedy, if no perceptible medicinal aggravation or amelioration declare itself, after an interval of from two to four hours at the utmost, but the disease seems to gain ground, repeat the medicine. In cases of high inflammatory action, or the severest forms of acute diseases, as cynanche laryngea, cholera, pneumonia, pleuritis, dysenteria, febres nervosse, phrenitis, cystitis, &c, attended with signs of imminent danger, the dose must be re- peated every quarter, every half, every hour, or every three or four hours. If a medicinal aggravation* take place, followed by amelioration, we must let the medicine continue its action, until the amelioration appears to cease, and the disease again make head; if new symptoms set in, we must then have recourse to the medicine thereby indicated. Should, however, no perceptible medicinal aggravation take place, but an ame- lioration follow, we may safely await its approach to its termination, ere we again administer. If any symptoms remain, from the remedy first selected having afforded only partial relief, we must have recourse to some other medicine which seems best fitted to meet them; but refrain from changing the remedy as long as benefit results from its employment. In chronic, subacute, and indeed almost all cases, when a very strik- ing improvement takes place, it will generally be found advantageous to cease to administer the medicine as long as the improvement conti- nues, and only to repeat as soon as the slightest symptoms of activity in the morbid phenomena reappear. But when a sudden or marked improvement of comparatively short duration follows the first dose of a remedy, and, on repeating the dose, the symptoms of the complaint in- crease instead of subsiding, as they did in the first instance, it may be concluded that the medicine does not answer, and that another must accordingly be had recourse to, in the selection of which it will be necessary to choose one related to the remedy first prescribed. 1 It is necessary to remark that very striking medicinal aggravations are, compara- tively speaking, very rarely met with. • In chronic maladies, occurring in highly sensi- tive persons, and proceeding from or attended with cerebro-spinal irritation, we en- counter them more frequently than in acute diseases. They are, in general, more prone to take place in the instances alluded to, with considerable intensity, after £he employment of the higher than the lower attenuations. So at least the author's expe- rience teaches him to conclude. INTRODUCTION. xxvii When the action of a well-chosen remedy has been disturbed or ar- rested by some incidental cause, such as an error in diet, exposure to cold, &c, some intermediate medicine should be prescribed against the new symptoms thus developed, and on their removal the temedy first employed should again be resorted to. The distinguishing of the medicinal aggravation from that of the disease being a point of material consequence, we shall here endeavour to give the usual characteristics of each. The medicinal aggravation comes on suddenly and without previous amelioration; the aggravation of the disease more gradually, and frequently following an ameliora- tion. Moreover, in the former, several of the medicinal symptoms, some of which we may meet under the indications for the remedy, and not before remarked, declare themselves. Too much stress cannot be laid upon the necessity of carefully watch- ing the effects of each dose, as, in addition to the temporary aggrava- tion of the symptoms which sometimes sets in, a development of colla- teral or pathogenetic signs occasionally takes place, particularly after frequent repetition of different remedies in susceptible patients; by a want of attention to this important point, we may incur confusion, and may be unconsciously treating a medicinal disease of our own creation. Such, unhappily, but too frequently occurs in allopathic practice from ignorance of the real properties of the drugs employed. We must also guard against falling into the opposite extreme, and allowing the disease to gain head unchecked. In severe acute affections we may often repeat the same medicine at the same dose, at regular intervals, as long as it does good ; but this rule has many exceptions, and the directions already given at the commence- ment of this article should be borne in mind. In chronic cases, by a long-continued administration of the same medicine, the patient often becomes less susceptible; in such instances, if the improvement remain stationary, or progress slowly, we may alter the attenuation, or, still better, give at suitable intervals some other remedy or remedies of as nearly analogous medicinal properties to that first administered as possible, and then return to the original remedy, if needful; if, on the other hand, decided amelioration follows each ad- ministration, we should allow a longer interval to elapse before repeat- ing, by which means the system gradually recovers itself, and the sus- ceptibility to the medicinal influence remains unimpaired until the cure is completed. In rare cases, this susceptibility increases; in such instances a higher potency should be selected, or vice versd if that employed has been one of the most minutely subdivided—provided the remedy still appears to be appropriate,—and the intervals between the exhibitions lengthened. This occasionally occurs when the medicine has been frequently re- XXV111 INTRODUCTION. peated, and given in solution. When the beneficial effect of a medicine is interrupted by an attack of cold, diarrhoea, &c, some other medicine must be given for the new affection, on the removal of which, the medi- cine which was previously acting favourably must be recurred to. ' remarks. In the Selection of the Remedy, it is not necessary that all the symp- toms noted should be present; at the same time taking care that there are no symptoms not covered by the medicine, or more strongly indi- cating another. When the symptoms are few in number, not characte- ristic or well-marked, attention to the following points is of material assistance : the period of the day at which they occur, or become most prominent; the side of the body which is affected; the disposition of the patient; his propensities or peculiar habits and likings; the agreeing or disagreeing of different kinds of food ; the longing and craving for, or the unconquerable aversion to certain aliments, &c. When it is requisite to keep a medicine in solution for some days, a few drops of proof spirit may be added to the water, which should be as pure as possible, in order to preserve it from decomposition. Homoeopathists prescribe only one medicine at a time; but in some complicated cases considerable advantage is to be derived from the alternate employment of two remedies, which are equally indicated in the case under treatment. It may be scarcely necessary to explain the Pharmaceutical Signs used in this work, to signify the potency and quantum of the dose; but as the book is intended for beginners, and may fall into hands otherwise wholly unacquainted with the science, we do so as a measure of precau- tion ; it will therefore be sufficient to remark, that Tinct. Aeon. 3 gtt. ij, means two drops of the third attenuation or potency of Aconite; Tinct. Bry. 6 gtt. iij, three drops of the sixth of Bryonia, and the same with any other medicine. The Germans commonly make use of the Roman numerals to denote the attenuation, and as only every third attenuation is very generally used (particularly in northern Germany) the above signs would be written thus: Tinct. Aeon. L, gtt. 00 or 2. Tinct. Bry. II., gtt. 000 or 3. The Roman numeral multiplied by 3, indicating the attenuation meant. When we wish to prescribe globules, the contraction gl. is usually employed. The medicines should be taken fasting, and food or drink, as also INTRODUCTION. xxix excessive bodily or mental exertion, abstained from for half an hour to an hour afterwards. The homoeopathic remedies should be kept in a clean, dry, dark place, free from odours. Every description of allopathic medicine, patent or domestic, is prohibited; likewise bleedings, blisters, medicated fomentations, perfumery, and everything containing camphor. In cases of obstinate constipation, recourse may be had to an enema, or lavement of cold or of tepid water, when the former disagrees, to which may be added, if necessary, a tablespoonful of olive oil. We shall conclude these introductory observations with some extracts from Jahr's New Homoeopathic Pharmacopoeia and Posology,1 for the information of those of our readers who are ignorant of the method in which the homoeopathic medicines are prepared, &c. "NATURE AND FORM OF HOMCEOPATHIC MEDICINES. " 1. We make use of the same simple substances in homoeopathy as in the old school; but, instead of making of them, as in it, compound remedies, we seek, on the contrary, to procure each medicine in all its purity, and to administer it without any admixture which might alter its proper virtues. Without going into detail here on the preference to be given to this mode of administration, we should, nevertheless, observe that it is bound to the prin- ciple of homoeopathy in so firm a manner, that it cannot be sundered without injury to the practice. In consequence of the principle, that no medicine can be employed with success, except so far as it is known in its pure effects, homoeopathy has subjected to examination a number of simple medicines, which it is important now to reproduce, such as they have been experimented on, if we wish to rely on these observations. Even for the medicines which have not yet been experimented on, it is not the less important to submit them to these experiments in all their purity and simplicity; for though each compound remedy forms, after all, also a kind of remedial unity, which may be studied in its effects, still we can never reproduce a second time precisely the same effects as the first, whilst the productions of nature exhibit at all times and in every place the same properties. "2. In thus rejecting all the compound remedies of the old school, as im- proper to be submitted to study and to be employed in practice, homoeopathy claims not, however, the pretension to use only perfectly simple bodies, such as sulphur, for example, metals, and other elementary substances; she derives, on 1 Translated, with additions, by James Kitchen, M.D., Philadelphia. XXX INTRODUCTION. the contrary, her medicines from three kingdoms of nature, the same as the old school, and all the various chemical combinations, which, after invariable laws, are constantly produced in the same manner, can be of use to it as remedial means. " In one word, the simplicity of homoeopathic preparations, of which we speak, has no reference to the primitive substance, which serves for the medicine, but to the medicine itself, which, as such, ought to be composed of only one remedial substance, and prepared in such a manner that the virtues of that substance be as pure and as developed as possible. " 3. If all substances endowed with remedial virtues, presented themselves under a form as convenient as some mineral waters, for example, nothing would be more natural nor more rational than to employ them as nature presented them. But with a great many of these substances, the real virtue is found in a state more or less latent, and could not be put into activity except by the destruction of the primitive matter, and the addition of another substance, which, in quality of simple vehicle, receives the developed virtue, and transmits it to the organism. In other substances, on the contrary, the remedial virtue is found developed, but it is so energetic that, without the addition of a substance which can moderate the effects, we cannot employ them without danger to the health, or even the lives of the sick. In fine, there are yet other substances, which, though their virtues need not to be either developed or moderated, present themselves under a power which opposes as well to their dispensation as preservation, and which, in consequence, equally exacts the addition of foreign substances in order to be conveniently prepared for use. " 4. The preparation and administration of medicines being then impossible under any mixture, it is important to discover substances which, at the same time operating under the form of medicines, are innocent enough in themselves not to alter the virtues of them. This condition, simple as it may appear in theory, is not, however, so easy to fulfil as it appears—for, perhaps, there exists not a substance in the world, which, under such and such circumstances, may not exercise a pathogenetic influence, and, consequently, alter the specific effects of a medicine with which it may be mixed. Even pure water, the sub- stance the most innocent that we know, is not completely exempt from this inconvenience, and even were it so, it would not suffice alone, neither for the preparation nor the preservation of medicines. In consequence, homoeopathy has substituted two other vehicles, viz.: 1. Alcohol, or spirits of wine, for the preparation of liquid or soluble substances; 2. Sugar of milk, for the preparation of dry substances; and though these two substances are not entirely void of medicinal effects, the practical facts are still the same as if these substances were entirely pure, since all the preparations which are made in this manner, are constantly the same among themselves. " 5. By means of these two substances, pure alcohol and sugar of milk homoeopathy makes all its medicinal preparations, without exception, whether under the form of tinctures or powders. The first are obtained, that is, the tinctures, in mingling with alcohol the juice recently expressed from fresh plants, or in infusing in this liquid the dry substances, the active principles of which can be extracted in this way. The powders, on the other hand are INTRODUCTION. XXX1 obtained by the trituration of the insoluble substances with a suitable quantity of sugar of milk. The alcoholic tinctures and the powders are then the only preparations known in homoeopathy. All kinds of essences, syrups, pastes, ptisans, and other inventions of the old school, are entirely foreign to it. " 6. From this, however, it does not follow that homoeopathy always employs the primitive preparations of medicines; on the contrary, in the majority of cases she considers them too energetic to be administered such as they are obtained. But, instead of seeking to diminish their energy by the means which the old school call correctives, homoeopathy endeavours to obtain this end by the simple attenuation of the primitive substance. It is thus that, seeing that a grain or a drop of the primitive preparation of a poisonous substance, for example, would be too active, she attenuates this drop or this grain in mingling it with a new quantity of vehicle, until a preparation is obtained, which is neither too strong nor too weak to operate the cure, nor too energetic to fear any unfortunate consequences. Homoeopathy thus prepares out of each substance a series of attenuations, of which the following one contains ordinarily the 100th or some- times the 10th part of the active principle of the preceding one, and it is generally from one of these attenuations, and rarely from the primitive pre- paration for a medicine, that the homoeopathic physician administers to his patients. " 7. Finally, as to the form under which the homoeopathic physician dis- penses his medicines, it is not less simple than the preparation, and is equally made without any other mixture than that of the least medicinal substances, such as alcohol, pure water, sugar of milk, and globules composed of sugar and starch. The attenuations of each medicine being previously prepared, the patient receives of them the dose prescribed, either in form of solution, with a convenient quantity of pure water, or water mixed with alcohol, or in form of powder, mixed with a small quantity of sugar of milk, or yet again in form of globules, impregnated with the alcoholic attenuation of the medicine. " 8. How simple soever may be the preparation of homoeopathic remedies as to its principle, it nevertheless exacts much precaution and very particular care, if we would be sure to have medicines as active and as sure as possible in their effects. To this end also homoeopathy has prescriptions and positive rules, which it is important to know before all, in order to follow them with exactitude, and to prevent thus the faults, which, diminutive as they may appear in themselves, are, nevertheless, very serious in practice. In the following chapters we shall pass in review all these rules and prescriptions in treating in succession—1. Of vehicles which serve for the preparation of medi- cines. 2. Of the preparations of medicines in their primitive state. 3. Of attenuations. 4. Of the dispensation and preservation of homozopathic medi- cines. These four chapters containing all that has reference to the general pharmacopoeia, we shall occupy ourselves in the second part of this work with the special pharmacopoeia, that is to say, with the rules to be observed in the preparation of each medicine in particular, and with the description of primi- tive substances which homoeopathy has introduced into its pharmacy. xxxii INTRODUCTION. "OF VEHICLES, WHICH SERVE FOR THE PREPARATION OF HOMCEOPATHIC MEDICINES. " 9. The vehicles which homoeopathy uses for the preparation of its medi- cines are, in all, of the number of four, viz. : 1. Alcohol, or spirit of wine. 2. Sugar of milk. 3. Globules, composed of sugar and starch. 4. Pure water. Some physicians have wished to add a fifth to the above, viz., ether, and we shall see below (28) to what destination this liquid is suitable. As to the four vehicles which we have just cited, homoeopathy has thus far used them for all its preparations; and it is important to obtain them as pure as possi- ble, in order to be sure to obtain preparations, in every respect, identical with those wifh which Hahnemann and his disciples have made their pure and clini- cal observations. This purity is not, however, always the distinctive quality of the objects which we find in commerce, or that nature furnishes, and that is the reason why it is almost indispensable that homoeopathy should know how to prepare herself vehicles, or at least to render them proper for the use she makes of them. We shall endeavour to give in this chapter the instructions neccesary to this end. "10. Alcohol (spiritus vini, spiritus vini alcoholisatus, spirits of wine, alco- holized spirits of wine) is never found in nature—it is always the product of art —but it is formed every time that sugar is found in contact with a fermentable matter in water, and at a suitable temperature; that is to say, that it is develop- ed in the course of fermentation, to which has been given, after this phenome- non, the name of spirituous or alcoholic. As all liquors which have undergone the spirituous fermentation contain alcohol, and as those which abound in the sac- charine material are by that susceptible of affording it, it results that we may obtain it from a great number of vegetable substances, such as wine, beer, cider malt, grape-dregs, sugar-cane juice, germinating cerealia, pounded cherries, molasses, juice of carrots or beets, potatoes, honey, &c. The Tartars extract it even from the milk of their mares. "11. From whatever substance we obtain it, alcohol is identical; but we must always have recourse to means more or less complicated to obtain it pure. In every case it contains a more or less large quantity of water, and very often it is mixed either with acetic acid, or a small proportion of prussic acid or em- pyreumatic oil, &c, according to the substances from which it has been ex- tracted. The alcohol which seems to be the best for homoeopathic preparations is that obtained from the dregs of grapes (marc de raisin)1 without the addition of other substances, or else the alcohol of rye or wheat. The least suitable kinds are such as come from the laboratories of chemists or pharmaceutists, and which, for the most part, are drawn from the residue of some chemical pre- paration, such as the resin of jalap, &c. Alcohol extracted from potatoes is not more suitable for homoeopathic preparations, since it contains a large quantity of empyreumatic oil, of which even the chemical proceedings, which consist in clearing it by the chloride of lime and powder of charcoal, do not entirely 1 This is the refuse of the grape, after the juice has been pressed out, in the process of making wine. INTRODUCTION. XXX111 purify it. This oil is often found even in the alcohol from rye or wheat; but in this case it is sufficient to mingle this spirit with a suitable quantity of pure olive oil, and to shake it from time to time for several days; in this way the empyreumatic oil combines with the olive oil, and swims on the alcohol, whence it may be easily taken. "12. Alcohol pure and perfectly anhydrous is a colourless liquid, of a re- markable fluidity, of a sweet and penetrating odour, of a hot and burning fla- vour, and whilst it is rubbed between the hands, it should not lather nor emit any foreign odour. Its specific weight is much less than that of water, in which it dissolves perfectly, and in all proportions, with disengagement of heat. Exposed to the air, it evaporates in part, and the part which remains loses its power in becoming saturated with the humidity of the atmosphere, of which it is exceed- ingly greedy. At the approach of a candle, or by the effect of ?he electric spark, alcohol burns rapidly, with a flame white at the centre and blue at the edges, and leaves no residue. Put in contact with other substances, it dissolves a great many, such, among others, as phosphorus and sulphur (both in small quantities), the fixed alkalies, balsams, resins, camphor, sugar, volatile oils, ex- tractive matter, &c. Acids have a marked action on it; some dissolve in it simply, whilst others are transformed into ether. " 13. Alcohol in the state of complete purity, has a specific gravity of 0-791. It then contains not a trace of water, and marks by the alcoholmeter 100 de- grees of force. But it is never employed at this stage of concentration; that which commerce presents, as well as that which we find in medicine, is always more or less weakened. According to the proportions with which water is mixed with it, we may generally distinguish four kinds, viz.: 1st. Spirits of wine of commerce, the weakest quality, having a specific gravity of but 0-910 to 0-920. 2d. Rectified spirits of wine, the quality which is obtained by min- gling 7 parts of water with 17 parts of the best rectified spirits of wine (see 3d); the specific gravity of this spirit is from 0-890 to 0-900, and its degree of con- centration 60°. 3d. The best rectified spirits of wine, superior quality, the specific gravity of which is from 0-830 to 0-840, and its degree of concentration 85°. 4th. Alcoholized spirits of wine, or absolute alcohol, the most concen- trated quality, having a specific gravity of 0-810 to 0-820, and containing from 96° to 100° of alcohol. For the preparation of the mother tinctures of homoeo- pathy, the most suitable quality is the absolute alcohol of 95°; for the attenua- tions, we may, in the majority of cases, be content with a spirit of wine of 60° to 70°. "14. In order to obtain an alcohol as anhydrous as possible, recourse has been had to various chemical measures, which succeed well enough, as regards the concentration, but the majority of these measures (lime, acetate of lime, sulphate of soda, alum, &c.) constantly produce a more or less powerful altera- tion in this liquid. Even chloride of lime is not exempt from this fault, which may easily be recognised, in burning rectified alcohol by this means, after having added to it nitrate of silver, and afterwards examining the residue. This is the reason why the homoeopathist should never make use of alcohol rectified in these chemical ways, but endeavour to obtain the desired quality by more innocent proceedings. That which appears to be the most suitable, 3 xxxiv INTRODUCTION. consists in obtaining the concentration by simple evaporation. For a long time it has been remarked, that alcohol preserved in vessels closed with pre- pared bladder acquires strength, whilst it loses strength if closed by caout- chouc, insomuch that to concentrate it, it is only necessary to put it in beef- or pig-bladders, and suspend them in a warm and dry place. To this effect, after having carefully cleansed the bladder, we paint it with a thin coat of fish- glue ; then we fill it with the alcohol we wish to concentrate, and suspend it, well closed, in a perfectly dry place, and at a temperature of 20° to 25° R. The drier the air that surrounds the bladder, the more prompt is the evapora- tion of the water; and in leaving the bladder in proper conditions until we per- ceive the odour of alcohol, we may be sure of obtaining a quality as anhydrous as possible. " 15. Tn*e most simple and the most sure method of obtaining an alcohol as concentrated and as pure as homoeopathy wants, would then be, to take the first-quality brandies and to concentrate them after the method indicated above. Alcohol obtained in this way is generally in a state of concentration of 95° to 96°, and thus is perfectly suitable for the preparation of alcoholic extracts; only, before employing it, it should be once again rectified by a new distilla- tion. For this, we should be careful to use only glass apparatus, since copper or tin vessels often give out to the product of distillation some of their mate- rial, an adulteration, which is the more to be guarded against, as, often, che- mical means are not capable of revealing it, though it should be strong enough to alter the effects of medicines which might be prepared with a product of that kind. " 16. Respecting the brandies from which we might wish to obtain alcohol, we have said above that the best were those obtained from the dregs of grapes or else from rye. But in taking these liquors such as they are found in com- merce, we should always be well assured that they are pure. Often we find in them lead, which we may detect by treating them with the liver of sulphur, which causes a brownish or blackish precipitate. Should they contain copper, liquid ammonia produces a blue colour. The adulteration of brandies by alum may be discovered by the addition of a solution of potash, and the mineral sul- phates by acetate of barytes. In fine, to be sure that the alcohol we use is really made of the wished-for substance, we mingle 30 parts of it with 0-15 parts of liquid caustic potash, and heating this mixture with spirit of wine, we permit it to evaporate until there remain but four parts. We take this residue, to which we add foiy parts of weak sulphuric acid, in a well-stoppered small flagon, taking care to shake the mixture; in unstoppering the flagon afterwards, we shall perceive a perfect odour of the substance of which the brandy has been made. "Sugar of Milk. " 17. Sugar of milk (saccharum lactis), is a salt of a sweet taste, slightly sugary; it forms masses moderately thick, hard, crystalline, semi-transparent, colourless, and inodorous. By its properties, both physical and chemical, this substance, which is exclusively proper to the milk of different animals, seems INTRODUCTION. XXXV to be intermediate between sugar and gum. Sufficiently purified, sugar of milk contains no azote; it dissolves in 12 times its weight of cold water, and four times its weight of boiling water. Alcohol dissolves it but in a very small pro- portion, and ether not at all; it does not alter by the air, is not susceptible of undergoing the vinous fermentation, melts, puffs up, and is transformed into a kind of gummy matter by the action of fire, decomposes the acetate of copper the same as common sugar; in fine, treated with nitric acid, it forms mucic acid, and by sulphuric acid or muriatic acid diluted, the sugar of grapes. Its pro- portion, as that of the other constituent principles of milk, varies in the different kinds of niammiferae. In general it abounds more in the milk of the ass than in that of the cow, or mare, or goat, &c. According to Berzelius, one thousand parts of skimmed milk give 35, and the same quantity of cream gives 44 parts of sugar of milk, mingled with saline matters. " 18. It is in the mountains of Switzerland that the sugar of milk is pre- pared which we find in commerce. It is prepared from the evaporation of the whey, which they obtain in such large quantities in the preparation of cheese. It presents many varieties, according to its degree of purity. The crystalline sugar in grape form is considered the most pure; the other kinds always con- tain more or less animal matter. We often also find in commerce, under the name of sac. lac. inspissatum, the whey of milk solidified and dried; but this is a kind that in nowise is proper for homoeopathic preparations. The sugar of milk which we find at the druggists is, in the majority of cases, more or less altered by mortars of copper or iron in which it has been pulverized, and still more often impregnated with exhalations of a quantity of aromatic substances, in the midst of which it is preserved. Hence the necessity of the homoeopathic physician to prepare it himself, every time that he has it in his power, or at least to purify it by a new crystallization, if he is obliged to provide himself with it from the druggist. This, however, is not without difficulty, since the sugar of milk does not crystallize, in watery solution, but very slowly, and always in an incomplete manner. It is only by treating it with equal parts of alcohol and water that we can succeed well; the operation, it is true, becomes more costly, but considering the advantages which this procedure offers, we think that the cost is no reason for its rejection. " 19. To purify the sugar of milk in this way, we dissolve about two and a half pounds of the best quality in ten pounds of rain water or distilled water in a boiling state, then filter the solution through filtering paper, in a vessel of porcelain or glass, and mix it with four kilogrammes of absolute alcohol; after which place the vessel containing this mixture in a dry place, and leave it perfectly still. The sugar of milk being insoluble in absolute alcohol, and this being very attractive of water, drawing away a large quantity, the crystallization advances pretty rapidly, and often at the end of three or four days a crust of white and brilliant crystals may be obtained, of the weight nearly of the sugar of milk that was dissolved in the water. When this crust is formed, it is taken away, washed with distilled water, to which has been added a little alcohol, and then dried on blotting paper. That done, we may consider the sugar as alto- gether suitable for all homoeopathic preparations, even the most delicate; it is completely colourless and inodorous—tested by the most active reagents it shows not a trace of foreign salts. XXXVI INTRODUCTION. " 20. Notwithstanding the process we have described above, it would be of little avail, were the sugar of milk not of a good quality in the first instance. In order to be sure of that, it should be separated from all fatty substances and other foreign matters which milk contains, which is recognisable by its per- fectly white colour, by its due degree of resistance to the atmospheric air, and its odour, and pure and natural taste. The adulteration of sugar of milk with common sugar may be known by its sugary taste—with alum, by the aid of acetate of lead or oxydulated nitrate of mercury. To examine sugar of milk that has been boiled in copper vessels, we dissolve a certain quantity in water, and pour it on some caustic ammonia, which colours it blue, should it contain any of that metal. Nitrate of silver detects the presence of kitchen salt, and acetate of lead that of sulphuric acid. When prepared from sour whey, it red- dens the tincture of tournesol. " 21. To reduce the crystallized sugar of milk to powder, we first break the crust in the direction of the crystals, upon a sufficiently thick piece of wood, with a wooden hammer and a strong knife; then we put the pieces in a mortar of porcelain, when we break and triturate them until the powder becomes sufficiently fine for use. That done, we pass the powder through a sieve of crape, which we have fitted above and below with parchment. The finest part, after being sifted, is found below the sieve, whilst the grosser part above should be triturated again. To preserve sugar of milk, it should be placed in a dry place, in order to keep it from the moisture of the air, and prevent it from spoiling. "3. TJie Sugar Globules. "22. The sugar-globules (globuli saccharini) are small nonpareilles destined to be saturated with homoeopathic medicines, in order to be able to dispense these last with more facility. They are generally found at the confectioners, who prepare them from sugar and starch; but as the sugar of the cane or the beet, which enters into this preparation, is not pure enough for the purpose indicated, it is better to have globules made expressly from sugar of milk, or else with the ordinary purified sugar. As to the size of these globules, they should not be too large, so that we may be able to dispense the smallest doses. Hahnemann proposed to give them the size of a poppy-seed, so that about 40 of them would weigh about one and a half grains (one centigramme). This form has been adopted by the majority of homoeopaths; some, however, use them of the size of a millet-seed. "23. To charge these globules with the active principles of the medicine, and to prepare them so that in a large quantity they may not deteriorate, we imbibe them first with those alcoholic attenuations which we desire ; then, after being well assured that all have been well impregnated, we dry them and put them in a well-stoppered bottle. The complete desiccation of the globules before bottling them is absolutely indispensable, since without that precaution they fall into powder in a short time, and afterwards lose, in becoming decom- posed, their medicinal virtue. This is the reason why, after imbibition in a suitable bottle, it is well to turn them out on paper with raised edges, where they may be agitated until they do not adhere one to the other. Should we INTRODUCTION. xxxvii wish afterwards to put them into the same bottle in which we have imbibed them, we should take care to dry it also, before making use of it, or to empty it afresh and dry the globules until they do not adhere to the bottle. All the globules so imbibed have a dry and smooth hue, whilst in their natural state they are white and brilliant. "4. Water. " 24. Among all the vehicles there is not one that is more free from medi- cinal virtue, properly so called, than pure water; but, on the other hand, nothing is more rare than to find in nature this fluid in a perfectly pure condi- tion. Under whatever form water presents itself, it is more or less charged with foreign matters, such as gas, salts, earths, &c. The purest quality of water is rain-water, which, as well as distilled water, has neither odour, nor taste, nor colour; besides atmospheric air, which this water contains, there is but a small portion of fixed matters,—only after a storm, we find, occasionally, a trace of nitric acid combined with ammonia. The water of springs and wells constantly contain many kinds of neutral salts, earths, and muriatic compounds. As to the waters of rivers, lakes, and ponds, in inhabited countries, it is far from the conditions of pure water to merit attention here. " 25. Homoeopathy uses water for three different purposes, viz.—1, for the chemical operations, which require the purification of many primitive sub- stances; 2, for the preparation of some of the attenuations; and 3, for the administration of medicines in the form of watery solution. For the last of these uses we may well enough make use of river or spring-water well filtered; for the chemical operations, rain-water procured during a calm answers in all cases; but for the preparation of the attenuations, we must have the purest water we can possibly obtain. For this, distilled water, which is found in the pharmacies, is not suitable; for even if it has not been distilled in copper or other metallic vessels, it is always to be feared that it is impregnated with foreign matters, derived from substances which, perhaps, but a short time pre- viously had been distilled in the same apparatus, and of which the ordinary care employed in cleansing them is far from discharging the whole. "26. To obtain a perfectly pure water, the homoeopath must himself under- take the distillation in vessels of porcelain or glass, as indicated under the head of alcohol. The most suitable water to distil is rain-water, above all, if we take care, as we have above remarked, not to procure that which falls during a storm, or when the sun shines. We must not, even in an ordinary rain, gather the first rain that falls, since this commonly contains the impurities suspended in the air; it is only after rain has fallen four or six hours that we are able to gather it in its purest possible condition. Still this water contains a certain quantity of carbonic acid, and hence, before submitting it to distillation, we shall do well to boil it in a porcelain vase and let it cool. Respecting the dis- tillation itself, we must be cautious gradually to augment the fire under the apparatus, and to preserve, by wet cloths, the neck of the retort at a moderate temperature, so that the vapour, in passing, may not dissolve from the sides of the vessel even a trace of silex or alkali. The first distillation should be rejected, and when the liquid in the retort is diminished two-thirds, we must xxxvm INTRODUCTION. cease. A good distilled water should leave no residue on evaporation; it should be perfectly limpid, insipid, and inodorous, and neither precipitate by muriate of barytes, nor nitrate of silver, nor hydrosulphuric acid, nor the hydrosul- phates. To preserve it, it should be put into bottles or new jars of yellow glass, that we have been careful to cleanse at first with a part of the same water, and which we put afterwards in a place as cool as possible. "5. Ether. "27. Sulphuric ether, or ether par excellence (sether sulphuricus, spiritus sulphurico-ethereus), is a light, volatile, odorous, and inflammable liquid. Like the other hydratic ethers, as the phosphoric, arsenic ethers, &c, it is composed of two volumes of bicarbonated hydrogen gas and one volume of vapour of water, so that it may be considered either as alcohol deprived of a certain proportion of the elements of water, or as a hydrate of bicarbonated hydrogen. Recently prepared, it is neither alkaline nor acid, and when burnt, it shows no trace of sulphuric acid, an evident proof that the sulphur enters for nothing into its composition. It unites with difficulty with water, which requires ten times its weight to dissolve it, but with alcohol and all the essential oils it unites in all proportions. The fixed oils, also, the strong acids, balsams, several kinds of resins, phosphorus, sulphur, bromine, and many hydrochloric salts, are per- fectly soluble in ether. "28. In homoeopathy, we as yet are not acquainted with any ethereal prepa- ration, except phosphorus, which some have proposed to substitute for the alcoholic preparation of this substance. This substitution of ethereal tinctures for alcoholic tinctures, not only for phosphorus, but also for many other sub- stances, appears to us to be suitable in a great many cases, and we should not hesitate in the least to advise it to all the homoeopathic physicians and pharma- ceutists, were we well assured that the medicines would not undergo any modi- fication in being indifferently treated by the one or the other of these vehicles. The knowledge of the chemical constituents of which ether is composed is not sufficient for us to conclude on its pathogenetic effects, and so long as this doubt is not settled by pure experiments, we think that all those who wish to be guided by the observations contained in the homoeopathic materia medica will do well to procure such preparations as have been employed by the authors of these observations. From this, however, it does not follow that we should not prepare any ethereal tincture, and we are ourselves far from wishing to inter- dict it here, but we only insist on the necessity not to confound them with those of alcohol, and to note at least on the label the vehicle with the aid of which they have been prepared. " 29. Ether, such as it is found in our shops, under the name of rectified ether, is ordinarily pure enough; it only sometimes contains a little alcohol, of which, however, it ought to be freed. To do this, we shake it a short time with double its volume of water, and when it is separated from it we pour it on quicklime, with which it should be shaken at intervals for some days.' In afterwards distilling this mixture, until there remains in the retort about two- thirds, the third which has passed into the recipient is perfectly pure ether. Often, however, we find it adulterated with a quantity of sulphuric acid or INTRODUCTION. xxxix other acids. The adulteration with water is known by the watery residuum evident, whilst at a mean temperature we expose a small portion of ether to evaporation. The presence of sulphuric acid betrays itself by its disagreeable odour, and that of other acids by its reddening tournesol. Finally, to preserve ether free from all deterioration, it should be put into little bottles, the mouths of which terminate in points, so that they may be hermetically sealed by the flame of a lamp. When ether has been deteriorated by the action of the air or the light, it is less volatile, of an acrid and burning taste, and miscible with water in all proportions. "OF THE PREPARATION OF HOMCEOPATHIC MEDICINES IN THEIR PRIMITIVE STATE. " 1. General Observations and Rules. " 30. In order to obtain good homoeopathic preparations, it is necessary, first of all, to procure the primitive substances of the best possible quality, and in the state most suitable for their destination. All the substances which are furnished us by the animal and vegetable kingdoms always lose more or less of their power in drying, and this is the reason why every homoeopathic physician and pharmaceutist should endeavour to procure them himself, as much as pos- sible, in the fresh state, and immediately to submit them for preparation. As to the substances which are only found in far distant lands, and which, in con- sequence, we can only obtain in the tincture, prepared on the spot where they grow, or else the substance itself in a dry state, it is better to accept this last, in this state, than to trust to a preparation, of the purity of which it is impos- sible to be sure. The cunning of our age has carried to such an extent the fal- sification of drugs, that it is impossible, with confidence, to make use, for homoeopathic preparations, of the products of commerce, and among them, the tinctures are those which are the worst, and consequently, the least proper. As to the substances, which are generally sold in powder, we need equal pre- caution ; above all should they be clear, as amber, castor, &c. Should it be impossible to procure them in their natural state, we should never accept them, unless we are perfectly assured of their purity. The same may be said of all the chemical products which are found in commerce; there is not a single one which homoeopathy can make use of without a previous careful examination of its quality. "31. A point, not less important than the good quality of substances, is the exact choice of the particular kind which homoeopathy makes use of, and this is a point upon which we believe ourselves bound to insist so much the more, since not only some pharmaceutists, but also homoeopathic physicians, have often thought to introduce a real advantage, in substituting, for substances used in homoeopathy, others which appeared to them either more energetic or more pure in their chemical qualities. However great these advantages may be in a scientific view, it is not the less certain, that the least essential change intro- duced into the preparation of a medicine may cause the most disastrous conse- quences to the safety of practice. What is most important to the practitioner xl INTRODUCTION. is, not that the preparation should be more or less scientific, but that it should be similar with that which has been employed in the experiments, and the more the conformity in this point of view, so much the more the preparation will be perfect to the end it ought to fulfil. Thus, to obtain the calcarea or subcarbo- nate of lime, for example, such as is employed in homoeopathy, it is absolutely necessary to prepare the oyster-shell just as Hahnemann prescribed, though such preparation is far from containing the pure subcarbonate of lime. It is thus also that cinchona, opium, nux vomica, &c, such as are used to prepare the tinctures of the same names, can never be replaced by the quinine, the morphine, the strychnine, &c, without inconvenience, notwithstanding these last substances are reputed to contain the active principles of the first in a per- fectly pure state. "32. It is absolutely the same as to the measures adopted by homoeopathy in the pharmaceutical preparations of its medicines. Here, as in the gathering and chemical preparation of substances, the strictest observation of prescribed rules is binding. All the substances which homoeopathy transforms into tinc- tures, s"hould be prepared alone with alcohol, and those which are neither solu- ble in this fluid nor in water, by the simple trituration with sugar of milk. The vehicles, such as alcohol, sugar of milk, water, &c, ought to be perfectly pure and good. At the same time, the proportions indicated for the mixtures, as well as the manipulations prescribed for the solution and division of sub- stances, ought to be observed with the utmost possible exactitude. Often, it is true, these indications and prescriptions are of a nature to leave a certain latitude in their execution, according to the use we wish to make of the medi- cines, or the degree of energy which we propose to give to them; but even in this last case, the principles which have dictated the rules ought always to serve as guides in their application; and in every case, where the indications are positive, homoeopathic physicians and pharmaceutists have no business, under any pretext whatsoever, arbitrarily to depart from them. "33. In addition to the precision to be observed in the process of the pre- paration, it is also necessary to prevent, with the greatest care, any foreign influence, so that the virtues of the medicines be not changed, and the action thus rendered uncertain. For this it is requisite, in the first place, to make them in a place where the temperature is not above that of houses in general, and where the substances are not exposed to the direct rays of the sun. At the same time, the atmosphere in which we work should be pure and exempt from every odour or vapour, but, above all, of every medicinal emanation, such as are generally found in the pharmacies in ordinary; for all these exhalations, placed in contact with homoeopathic preparations, are liable to change their virtues. The same may be said respecting vessels or other instruments which have been used for the preparation of substances very odorous or susceptible of adhering tenaciously, as musk, essences, arsenic, corrosive sublimate, &c. We should never make use of such vessels, without having previously cleansed them with the most perfect care. As to small bottles and corks which have already been in use, they should never be employed but for the same sub- stance, no more than the cloth which has been used for filtering or expressing the juice of a plant; for, notwithstanding all the endeavours we may use to INTRODUCTION. xli clean them, we can never be sure that we have entirely purged them of all par- ticles which may adhere to them. " 34. Homoeopathy exacts a much greater cleanliness than is ordinarily given to vessels of pharmacy, notwithstanding the care bestowed on it. Even the wash- ing in large quantities of water, as in rivers, which has been recommended, are far from fulfilling the conditions. No matter how we look on it, a vessel, for example, which has served for the trituration of substances such as sulphur, musk, assafoetida, &c, constantly preserves its odour, even after having been washed and dried several times. As to the cleansing with certain chemical articles, such as acids, chlorine, lime, potash, &c, it cannot be tolerated in any case, since these substances themselves, whilst they have been in a vessel, need to be carefully cleaned out. Some have still imagined to clean the vessels with spirits of wine, but even this is a great error, for either the spirits of wine dis- solves the substance we wish to get rid of, or it does not dissolve it; in this last case, it will clean out nothing, and, in the first, it will form, with the rest of the substance, a medicinal preparation, which, though weak, will always be stronger than one of the last dilutions, and no homoeopath in effect will look upon these preparations as suitable for the end proposed. The best way to obtain the perfect purity of vessels is, at first to clean them with boiling water several times, and then to expose them to the continual action of a strong heat, as for example of an oven, or else to burn, several times, in them absolute alcohol of the greatest purity. As to the stones which have served for the pulverization of a metal, we should cleanse them before employing them again for the preparation of another substance, by scraping their surface with a piece of glass. " 35. Finally, as to the vessels themselves, it is necessary that all which are used in homoeopathic preparations should be of a substance not calculated to alter the effects of substances. Hence, all the mortars, pestles, and spatules, as well as the spoons and other instruments needful, should be of quartz, por- phyry, glass, porcelain, or horn; those of metal, marble, serpentine, or wood are absolutely inadmissible. To close the bottles, stoppers of glass are always to be preferred to those of cork, above all for the substances prepared with sugar of milk, to which the cork stoppers often give a disagreeable odour. For the corrosive substances, such as the acids, iodine, kreasote, &c, glass stoppers are indispensable. If, for the alcoholic preparations, we would, nevertheless, use stoppers of cork, we should procure them of the best quality, never used before. Before making use of them, we should temper them in pure water, after which we should wash them in spirits of wine, and let them dry at a moderate temperature. It has also been advised to boil them, in order to make them larger and softer; but prepared in this way, they become very susceptible of imbibing the humidity of the air and of constantly changing their size. "2. Particular Rules for the Preparation of Plants in the fresh State. Tinctures. " 36. That the plants may be entirely suitable to medical use, we should gather them a little before, or, better still, during their flowering, and we should xlii INTRODUCTION. never take those which grow on a very humid spot and deprived of the sun and of the free air, unless the nature of the plant require those conditions. In the majority of cases, it is important not to gather the flowers and the leaves during a continued cold or damp time, since then the ethereal oils, the corrosive resins, and the alkaline matters do not become developed as they should, and it per- mits the separation of albumen but in a very incomplete manner. The most favourable moment is when, after several warm days, there has been a shower of rain; for it is then that the formation of the active principles and the free development of hydrogen are the most favoured. In every case, where homoeo- pathy indicates nothing particular, we constantly use the entire plant, flowers, body, and root. Before submitting it to preparation, we wash it carefully with fresh water, in order to wash away the dust and other impurities adhering to it. "37. After this, to prepare the plant, in order to bring together all the pro- perties of the different parts, we cut it up as small as possible, we put it into a mortar of stone and reduce it to a fine paste, which is put into a piece of suitable cloth, in order to submit it to the action of a press of wood expressly constructed, thus to obtain the juice of the plant. This juice is at once mixed intimately with an equal quantity of alcohol, and put into well-stoppered bottles. At the end of 24 hours we decant the clear liquor, which swims on the precipi- tate of fibrine and albumen, and we put it apart for medical use. Alcohol prevents fermentation from taking place in the vegetable juice, and the virtue of this is thus preserved completely, without alteration, and for ever, provided we only take care to keep it from the rays of the sun and in well-stoppered bottles. The medicine thus obtained by expression, and by the mixture of the juice with an equal quantity of alcohol, is the m,other tincture of the plant, ob- tained by expression {per expressionem). "38. The preparation of the mother tincture, by expression, is, however, only applicable to plants abounding in juice; for those plants containing much thick mucilage and albumen, it is better to make their preparations by mace- rating them in a double proportion of alcohol. To do this we should at first half dry them in exposing them in the shade, in an airy place, and at a slightly elevated temperature, after which we cut them as fine as possible, and then add ' the necessary quantity of alcohol. As to those plants which have but an ex- cessively small quantity of juice, such as the laurel, rose, thuya, &c, we should begin by pounding them alone; then, after reducing them to a fine and moist paste, we imbibe this paste with the double of alcohol, so that the juice thus mixed with this liquid, may be expressed more easily. The medicine obtained after this method is the mother tincture by maceration (per macerationem). 39. In addition to these two measures for obtaining the mother tinctures there is yet a third, which, though inferior to the two preceding, deserves' nevertheless to be mentioned, as convenient in some particular cases. It is' above all, whist the circumstances do not permit us to express the juice of the fresh plants, immediately after having gathered them; and that, fearing that heir withering, no matter how little, may injure their virtues. Unde/the, ^rts0f eth7nira;T V^8 Tn™in ^^s"?in Bryonia is frequently more efficacious than either Coffea or Ipecacu- anha, in relieving the extreme anxiety, restlessness, deep sighing or moaning, which so generally attend this affection; it should, therefore, be had recourse to in, all cases in which these remedies fail to afford speedy relief. In some rare cases, even Bryonia is not sufficient, and it is then found necessary to administer Cinchona, followed by Phos- phorus. Bryonia is further indicated, when the accompanying fever partakes of a nervous character, attended with delirium and other symp- toms mentioned under Bryonia, in the article on Nervous fever—which see. The excessive and continual urging to urinate, which sometimes sets in, in the course of the disease, is often very readily subdued by Bryonia or by Conium. Belladonna.—When the disorder is met with during the prevalence of Scarlatina pura (as also when symptoms, more or less characteristic of the latter affection, make their appearance in the course of scarlatina miliaris), this remedy is a most efficient auxiliary ; it is moreover a most important remedy, when symptoms of cerebral disturbance exhibit them- selves ; or when the patient complains of his throat, which, on being examined, is found to be in a state of phlegmonous inflammation. Mer- curius may follow Belladonna, when the tonsils become much inflamed and tumefied, or ulceration supervenes ; in the latter instance, however, Arsenicum or Acid, nitricum may become necessary under particular circumstances. (Vide Scarlatina, Sore throat, and Scarlatina maligna.) • . Phosphorus.—This remedy is very useful in cases in which there are symptoms of congestion in the chest, with extreme anxiety and oppres- sion, and also, when there is considerable cerebral irritability, charac- terized by over-excitability of the senses; further, when the patient appears extremely listless and apathetic, and complains of burning sen- sations in isolated parts, rendering a frequent change of posture neces- sary. Phosphorus is often of great utility after Bryonia or Belladonna. Dulcamara.__When severe aching or gnawing (rheumatic) pains are 114 ERUPTIVE FEVERS. complained of in the back or extremities, either in the course of the disease, or at its termination, Dulcamara is useful. Arsenicum may be had recourse to in an advanced stage of the com- plaint, if the vital power seems rapidly sinking, and the organs, which perform the act of deglutition, are, as it were, paralysed, so that the patient is incapacitated from swallowing ; or when, from a metastasis to the throat, the latter has become so rapidly and seriously affected, as to have assumed a gangrenous aspect.1 (See Ulcerated sore throat.) When the disease, in cases of a bad type, puts on a nervous,2 or even a putrid character, with extreme offensiveness of all the excretions, and hemorrhage from the nose, mouth, &c, the medicines, already men- tioned under fevers of the said description (which see, p. 89), must be employed. Cuprum aceticum and Kreosote have been found useful in some of these, almost hopeless, but fortunately somewhat rare cases; the former particularly, when the efflorescence repeatedly appears and disappears suddenly in the course of the disease. To show, however, how very essential jt is to make a careful selection of the remedy, in the strictest possible accordance with the law similia similibus, instead of blindly pursuing the path of routine, and prescrib- ing remedies solely in consequence of their having been found useful in other epidemics of the same name, we add the following account of a severe epidemy Avhich was described by Dr. Elbe, of Dresden, in the " Allg. Horn. Zeitung," No. 15, 21ster Band : " The scarlet-fever epidemy of 1845, which raged not only in Dresden and its environs, but also in many other remote parts of Germany, was unquestionably of a more violent character than has appeared for a long time. There Avere but few families that entirely escaped its ravages, and the number that fell victims to it was very large. It is well known, that in many families as many as from three to four children died of it; in one case, indeed, seven children out of a family of eight; and from this great mortality a conclusion may be drawn of the violence and malignity of the fever." It will, perhaps, not be wholly superfluous to remark, that a rubeo- loid epidemy, but which was not exactly of a malignant character, pre- vailed here in 1844. After it had passed over, the scarlet fever ap- peared in the spring of 1845, sporadic, but of slight character, and continued thus till August; in the said month, however, the epidemy assumed a malignant character, Avhich may perhaps, in a great measure, 1 Compare these symptoms with those described under Calcarea carbonica, at the end of this chapter. 2 Rhus and Sulphur may also be mentioned as having been found useful in this disorder ; the former, when the exanthema had degenerated into a species of vesicular erysipelas' attended with lethargy, great thirst and strangury ; and the latter, in cases where Bella- donna had failed to effect all that could be expected. Antimonium tarlaricum may prove of considerable service in the vesicular or pustular form of the exanthema. Against the convulsions which precede the evolution of scarlet rash, or the efflorescence of scarlet fever, as well as confluent small-pox, Tart. emet. is also indicated. In the event of repercussion of the eruption, Bryonia, Phosphorus, Sulphur, and Cuprum aceticum have been recommended as the most useful. Opium proves very useful when the following symptoms present themselves: burning heat of skin, extreme agitation and anxiety vomiting, diarrhoea, or obstinate constipation, convulsions, and excessive drowsiness. ' SCARLATINA MILIARIS. 115 be ascribed to the excessive heat we had in July (frequently 32° Reaum. in the shade). So much is certain, that a great number of children died from that time forward of scarlet fever, although there were also slight cases which occurred during the course of the epidemy, which were readily cured by Aeon, and Belladonna, or recovered by the unaided efforts of nature. This, however, happens in all epidemies, and as nothing of interest is to be elicited from it, either as regards pathology or therapeutics, I shall pass these over, and confine myself to pointing out the characteristics of the more malignant cases, and to mentioning those remedies which proved specific thereto. The exanthema itself, appeared in many cases very suddenly, with- out any precursors ; in others, a fever preceded the eruption for several days, which possessed, however, in the absence of all local disturbance, no determined character. The only circumstance worthy of notice being, that the skin was usually more dry, and of higher temperature, than it commonly is in fevers, and that Aeon, had no effect. _ hi some cases, headache, hemorrhage from the nose, sore throat, vomiting, and diarrhoea showed themselves as precursors. Neither the nature of the precursory symptoms, nor the character of the exanthema justified the prognostication that the disease would take a malignant course; cases turned out dangerous, with a scanty as well as with an abundant efflor- escence, and vice versd. This alone I observed, that those cases were more dangerous, in which the single patches were confluent and more elevated than usual; frequently also these larger patches had not the proper scarlet red, but more of violet colour. The violence of the angina was, likewise, a certain criterion of a malignant case; on the other hand, the intensity of the fever (although even some cases, where almost no fever existed, suddenly terminated with death), with an asthenic character, which appeared usually with the first eruptions, sometimes also with the following, was an almost infallible prognostic; the skin was at the same time burning hot, partly dry, partly covered with colliquative sweat; the pulse small, weak, and very quick (130 to above 160); the face bloated; the tongue mostly dry, at first furred yellow, afterwards brown; the tip red, and the papillae swollen ;< the lips dry, and brown, as in typhus ; the teeth often covered with a viscid brown mucus; thirst, usually excessive; the difficulty in the perform- ance of the act of deglutition was not always uniformly great; in some cases it proceeded from the swelling of the tonsils in others, the cause appeared to be an inflammation of the throat, and again, in others, it manifested itself only during the febrile exacerbations which mostly took place in the evening ; strangury was not unfrequently an unfavour- able symptom; the urine Avhich was voided, often emitted an ammoma- cal or putrid smell, and was as clear as water. So far, the more malig- nant cases were analogous, but from here they can, as regards the affect- ed organs, the brain or lungs, be divided into two classes. The affec- tion of the brain was, as usual, accompanied by violent delirium periodi- cal or continuous unconsciousness, involuntary evacuations of the urine and faeces, which latter were mostly of a light colour; the skin, which had previously been hot, became cool, the pulse thready, the efflorescence scanty and violet-coloured; death followed from paralysis of the brain. 116 ERUPTIVE fevers. The affection of the chest betrayed itself not only by short, but also by difficult and laborious breathing, by mucous rattling in the bronchi, and sometimes also by an efflux of pus from the nostrils. In this variety, also, involuntary evacuations took place latterly; the excretions Avere in almost all cases clayey, as in icterus in adults, but the urine clear, like water. Delirium was, moreover, not wholly absent, but certainly not so violent as in the affections of the brain; the disease terminated with paralysis of the lungs. I have drawn the distinction between the two forms thus prominently, from the circumstance, that it was of importance in conducting their respective treatment. In most cases, death ensued on the third, but often not before the fifth day, and in rarer instances, already on the first day of the disease. I may transitorily mention that many other symptoms, such as convulsions, &c, made their appearance towards the close of the disease, but all danger was usually over when once the period of desquamation had commenced. The epidemy continued with almost unabated intensity till February, 1846, when it suddenly assumed a milder character, and then gradually disappeared. The sequelae of the disease consisted chiefly in hydrops anasarca, ascites, hydrocephalus, glandular swellings, and abscesses, which ahvays yielded readily to the usual remedies. Before I enter upon the treatment, I must add, that I by no means found the prophylactic poAver of Belladonna so very generally confirmed. I had, it is true, cases, where children, to whom I gave Belladonna as a palliative, escaped the scarlet fever, even when it Avas in the family; but I as often found that others were attacked by the fever although they had taken Belladonna for many weeks, and that notwithstanding the long-continued use of the same, the subsequent disease was not in the least mitigated by it.1 Of the treatment of the milder cases I shall say nothing here, since, as mentioned above, Aconitum and Belladonna perfectly sufficed. That these remedies, however, had no effect, and could have none, in the more malignant cases, may be accounted for by the fact, that in these the fever was not sthenic, or similar to the inflammatory ; that the tendency to paralysis was occasioned by pure nervous weakness, i. e., by prostra- tion of the vital poAver; that Aeon, and Belladonna, on the other hand, can only prove beneficial against erethic and inflammatory fever, and although unquestionably also against paralysis, they are only so when the latter has originated in congestion; consequently, that their curative power in febrile, congestive, and inflammatory states, rests upon their capability of suppressing abnormally-excited vital poAver, but which must, in cases of the description noticed here, by all means be avoided ; on the contrary, we must endeavour to invigorate the already but too much depressed vitality, the lowered condition of which presented so much difficulty in the treatment of the epidemy in question. The remedies employed in typhus, viz., Bryon., Acid, phosph., Phos- 1 Belladonna may only be expected to act as a preservative when it happens to be specific to the prevailing epidemy. Had the remedies (Calcarea and Zincum) which were subsequently employed with such striking success in the treatment of this epidemy, been used as prophylaxes, there is every reason to surmise that these remedies would not have failed to exert a preventive effect.—J. L. SCARLATINA MILIARIS. 117 phor., Carb. veg., Acid, muriat., Arsen., Rhus, and Ammon. carb., ap- peared to correspond to the indication just mentioned, as also to all the other symptoms, and yet none of them had any unequivocal beneficial effect, for although single cases took a favourable course, still, the fatal termination was unfortunately the more frequent: it was therefore much to be doubted Avhether the more rare favourable termination was to be ascribed to these remedies or to nature. Amongst the remedies quoted, Rhus and Ammon. carb. undoubtedly appear the best suited against scarlet fever. Still, Rhus has no specific relation to this disease, for, although we certainly know it to be appro- priate in erysipelatous, phlyctaenous, pustular, scabby, and herpetic forms of eruptions, it is not so in any which are analogous to the efflor- escence of scarlatina. The observation of Dr. Kreussler (Allg. Homoeo- path. Zeitung, 29. 8), that Rhus proved a specific remedy against scar- latina, combined with an intense vascular fever, I did not see confirmed; it is moreover well known that the intense vascular fever abates as soon as the eruption has fully taken place, and before this period it will hardly be possible to mitigate the fever. According to my opinion, a beneficial effect, and that with some certainty, can only be expected from Rhus in scarlet fever, if the latter is complicated with a typhoid state. Ammon. carb., therefore, appeared to hold out the most favourable ex- pectations, especially as it had been already successfully employed by many; this year, however, no advantage followed its employment, and this no doubt arose from the circumstance that every epidemy possesses its peculiarities, as is shown in that described by Schron (Hyg. 21, 1), in which he prescribed Ammon. carb., with great success; for, in the first instance, the frequency of the pulse, in the cases described by Schron, was not above 130, whilst it rose here to 164, consequently, a difference of more than 30 pulsations in the minute ; secondly, in Schrbn's cases, danger Avas indicated by the intensity of the redness and the ex- tent of the efflorescence, whilst in our cases this was not of any prognos- tic moment; and lastly, in Schrbn's cases, paralysis of the brain usually took place after vomiting, and in cases where the eruption was scanty, whilst it was here mostly unpreceded by any perceptible precursory symptoms, and could only be recognised by its consequences, viz., by the diminished temperature of the skin, by the retrocession of the exan- thema, and by involuntary evacuations. Schron makes no mention of cases in which the lungs were implicated. These may be considered as the principal distinguishing characteristics of the two epidemies, and may account for the circumstance, that remedies declared as curative by Schron, were of no avail in the epidemy which occurred in this place. All the remedies mentioned having failed, I was compelled to search for others, and I found Calcarea carbonica, and Zincum to be the most suitable according to the entire morbid picture of the disease. We shall, however, proceed first to attempt to compose, from the pathoge- netic symptoms which can be produced by Calc. carb., a form of disease which presents a strong resemblance to the state described above. We find, as the effects of Calc carb.,1 1 Materia Medica (Homoeop.) 118 ERUPTIVE EEVERS. WITH REGARD TO THE EXANTHEMA. Symptoms.—293, 394, 415. Bed, hot, turgid countenance. 417. Small painless rash on the face. 418. Eruption on the face resembling miliaria. 443. A fine eruption about the neck and chin attended with itching. 1364. Red streaks on the shin-bone, which consist of miliary vesicles, with violent itching and burning after being rubbed. 1403. Burning in the palms of the hands and soles of the feet. WITH REGARD TO FEVER. 1502. Difficulty in falling asleep in consequence of excessive heat, in a cold room. 1555. Restless dozing during the night, with excessive heat and con- fusion in the head, as in fever. 1585. Accelerated pulse. CONCOMITANT SYMPTOMS. a. Affections of the Throat. 512-521. Difficulty of deglutition. 528-29-30. Swelling and inflammation of the palate and tonsils. 525-27. Indicate inflammatory action in the pharynx. b. Trachea and Lungs. 1025. Loud rattling in the windpipe, during the act of expiration, as if from an accumulation of mucus in the chest. 1053. Hot breath, with heat in the mouth. 1069-76. Difficulty of breathing. 1109-10. Praecordial anxiety. 1023. Mucus in the chest, without cough. c. Cavity of the Mouth, and Intestinal Tube. 531-33. Dry tongue. 564-70. Thirst. 517. The faeces perfectly white. d. Urinary System. 871-74, 76, 78. Strangury. 877. Wetting the bed (iiiA'oluntarj emission of urine). 884. Copious emission of Avatery urine. 895. Offensive, acrid smell of the urine, which is very clear and pale. e. Nervous Symptoms. slee505"8' 10' 12' InvoluntarJ exuberance of ideas, with visions during 1544-46. Indications of delirium. 1435-36-79. Weakness, debility. SCARLATINA MILIARIS. 119 If we take the sum of these symptoms, we shall find that it yields as distinct indications of the applicability of Calcarea e to the treatment of scarlet fever,1 as may be gleaned from the pathogeny of Belladonna and Ammon. carb., and more so than can be met with in that of any of the other remedies; the angina, the constant attendant on scarlet fever, is also clearly to be recognised. We certainly find here but a small number of febrile symptoms, only a few times " heat during the night, restlessness, and quick pulse;" experience, however, has long proved that Calc. is of great use in rather violent fevers, e. g., in fever accom- panying dentition,—the usus in morbis is, therefore, in its favour. It is, moreover, known that every febrile state will yield, if the rest of the morbid picture, the source of the fever, corresponds with the remedy employed. Thus far we might already expect a curative effect from Calcarea in scarlet fever; but it is chiefly to be recommended in an epi- demy of the character of that which is at present under our notice, by its so distinctly-marked symptoms of paralysis of the lungs; it possesses also the nervous symptoms, which were never absent in the more malig- nant cases, and even the faeces and the urine, with the peculiar smell of the latter, are of the same nature. There was, therefore, reason to conclude that a beneficial effect might be looked for from the employ- ment of Calcarea; and my expectations were realized in the most strik- ing manner, for, of all those children to whom I gave this remedy, 1 did not lose a single one. At the same time it will be seen from what 1 have stated, that Calc. is only indicated in that form of the disease, where affections of the chest take place, and where paralysis ol the lungs is to be feared. I gave it in the first instance, in these bad cases only, and invariably effected a speedy cure by means of it; afterwards, however, I employed it in all cases without exception, from the com- mencement of the attack, and the disease, under such circumstances, always assumed a mild character, at least symptoms of threatening paralysis of the lungs never appeared after its use; the fever, however violent it might be, diminished so rapidly, that on the third day it was hardly perceptible; the development of cerebral symptoms, indicative of threatening paralysis alone, could not be prevented by it and as soon as these appeared I discontinued the Calc. and proceeded as 1 shall hereafter describe. . f I gave Calc. only once every tAventy-four hours, and usually gr. j. ot the third or fourth trituration. It may probably be asked^ why I re- peated the medicine so seldom in such precarious cases. But 1 must confess, that I have seen a decidedly better effect from these rare doses than from more frequent repetitions. Moreover the curative effect of the Calc developes itself with considerable quickness as I often had occasion to observe; for example, I have even succeeded in arresting incipient paralysis of the lungs (a state which decidedly requires the promptest assistance), by one dose of the third trituration; and inl a case which occurred in a child of one year old where dfa ofd, glutition appeared in the evening, during the febrile exacerbation, to such a degree that suffocation was to be apprehended, relief was so lai afforded in the space of a few minutes by Calc. 4, gr. j., that the child 1 Scarlatina miliaris.—J. L. 120 ERUPTIA'E FEVERS. was enabled to drink with ease, although the symptoms had existed for upwards of an hour before my arrival. The attack returned for several evenings in succession with equal intensity, but as Calc was then im- mediately administered, it never lasted above ten minutes. But great as was the curative power of Calc. in the above-mentioned form of this epidemy, it was inadequate to cope with the other variety, viz.: that with threatening paralysis of the brain ; here Zincum was indicated, its pathogenetic properties bearing not only a similitude to scarlatina^ in general, but with the form in question in particular, as the following catalogue will render manifest. THE ERUPTION IS INDICATED BY : Symptoms.—276. Efflorescence in the face. 297. Violent itching in the knee, and redness of the same. 921. Itching between the shoul- der-blades, with extensive eruptions. 991. Miliaria at the bend of the left elbow. 1035. Red, small, round spots on the hands and fingers. 1231. Pricking itching of the skin with miliary eruption after rubbing. 1232. Itching miliary eruption in the popliteal space and the joint of the elbow. 1234-35. Small red efflorescence with itching, disappearing after scratching. Fever.—157. Sensation of heat in the head, and redness of the face. 158. Heat in the head, during the evening, with increased temperature of the cheeks. 1266. Whilst in a sitting posture, almost burning heat is felt in single small spots. 1358-68. Fever consisting only of heat. 1357. Describes a febrile paroxysm with trembling of the limbs, which was characteristic in this variety of the epidemy. 1371. Quick pulse, some- times with a sensation of increased temperature. ANGINA. 370. Pressive pain in both tonsils during deglutition, in the evening and throughout the night. 373. Feeling of contraction in the throat whilst swallowing. 374. Pain in the throat, as if caused by internal swelling. 376. Pain in the throat whilst swalloAving, with swelling of the external parts, and of the tonsils. Lungs.—807. Tightness of chest, two successive evenings, with small quick pulse. Mouth and intestinal canal.—352. Dryness of the tongue. 390-96. Much thirst. 391. Dry, cracked lips. 613. Viscid, light yelloAV stools. 622. Solid, light-coloured stools. 627. Thinner and easier stools than ordinary. 1288. In the morning, on awaking, involuntary discharge of liquid stools. URINARY SYSTEM. 673. Diminished emission of urine, of a pale colour. 666-68. Strangury. 675. Frequent and somewhat increased emission of urine, varying from the clearness of water to lemon colour. SCARLATINA MILIARIS. 121 677. Frequent but not copious emission of scanty, very light-coloured urine. 679. Involuntary emission of urine whilst blowing the nose. NERVOUS SYMPTOMS. a. Delirium. 11. Fear of thieves, or horrible visions whilst waking, as in febrile delirium. 48. Unconnected ideas. 1310-29. Restless sleep with anxious dreams, and delirium. b. Indications of Paralysis of the Brain. 49. Diminished faculty of comprehension, and difficulty of collecting the thoughts. 50. Absence of thoughts, and mental torpor. 51. Oblivion of what has transpired during the day. 52. Great forgetfulness. 55. Sensation of weakness in the head. 217. Transfixed, motionless eyes, with absence of mind. Further, with regard to the symptoms combined with suppressed activity of the brain :— 263-64. Pale countenance ; and 1029. Cold hands. Rademacher also mentions, as the primary effect of zinc, '^great dis- position to sleep, and a state between dreaming and sleeping," and em- ploys it for this reason in delirium; he, at the same time, admits its usefulness against sleeplessness in acute diseases of the brain, and con- siders its principal effect to be on the brain. When we come to com- pare the ensemble of these symptoms with the first variety of scarlet fever above described, we find a reflection of the whole picture of the disease; we see an eruption not dissimilar to that of scarlet fever, a febrile state, which consists only of dry heat, with a quick pulse and excessive thirst, as also the symptoms of difficult deglutition (not merely those which are spasmodic, but likewise those which arise from swelling of the tonsils). These are the reasons in general that are calculated to determine us to employ Zincum in scarlet fever ; but that which chiefly points out the sphere of its operation is its influence upon the brain, with incipient signs of paralysis of that organ, giving rise to the follow- ing concomitant phenomena: involuntary evacuations of faeces and urine, diminished temperature of the skin, accelerated pulse, trembling or paralytic state of the extremities. On the other hand, with the exception of the single symptom of oppression, we do not meet with any indications of a paralytic affection of the lungs. From what has been stated, it is sufficiently obvious that Zincum can only be beneficial m those cases which are complicated with affections of the brain; the effi- cacy of Zinc in analogous states, e. g., in paralytic states of the me- dulla spinalis, has been long known. I found it necessary to prescribe Zincum in large and frequently-repeated doses (gr. /3—gr. j. of the first trituration,—at the commencement every hour, afterwards every two to three hours), from the circumstance that, in consequence of the 122 ERUPTIVE FEVERS. prostration of activity in the central organ of the nervous system, the organism is neither readily nor lastingly acted upon by external agency. As we have just seen, both forms of the disease possess exactly those symptoms in common, in which Calc. and Zinc, resemble one another, and both differ in those in which Calc and Zinc do not coincide. But in order to substantiate theory by practical evidence, may I be allowed to communicate at least two cases of cure by means of these remedies. Oskar Graf, 3 years old, scrofulous, but strong, formerly afflicted for a long time with hydrocephalus chronicus, had, on the 31st of Decem- ber, been affected with general dry burning heat during the whole day. January 1st he complained, after a sleepless night, of headache and colic, and vomited once; in the course of the morning the scarlet efflo- rescence began to appear, and spread over the whole body before the close of the day ; the skin was burning hot, the pulse small, weak, and could not be counted ; there was also profuse sweat. The child, usually so cheerful, lay still and quiet, with closed eyes, and answered only reluctantly if spoken to; the face was bloated, the thirst excessive, and the patient drank often, but little at a time; in addition to these symptoms, grinding of the teeth and convulsions of the face took place almost every half hour (both symptoms in this case probably arising from the presence of ascarides); delirium subsequently supervened. I prescribed, in the forenoon, Calc 3, gr. j. The child remained in much the same state throughout the day, only, in the afternoon, the heat became diminished, and the gnashing of the teeth less frequent; in the evening, however, both returned, with increased restlessness and delirium. In the night, between January 1st and 2d, the patient slept little, and was very rest- less, particularly between 12-1, and in the morning he passed the faeces and urine involuntarily; the paroxysms of teeth-gnashing had not returned so frequently, and the child appeared to be in a less sopo- rous state, but was boring rather more Avith his head into the pillow; the heat was no longer so excessive ; the pulse, towards evening, could at least be counted 152, and was consequently also no longer so small; the efflorescence looked well (another dose of Calc. had been given that morning). On January 3d the child Avas no better, and had passed a rather sleepless and restless night; the gnashing of the teeth was more violent and more frequent; the patient went on boring with the occiput into the pillows; and there was great anxiety, with oppressed respira- tion, and mucous rattling; the pulse as it was the day preceding. Calc was repeated, whereupon the attacks ceased entirely during the day, the restlessness subsided, the respiration was no longer so difficult, and in the afternoon the child slept for a short time; in the evening the fever had not increased. During the following night the restlessness was not great, and the sleep continued for half an hour at a time ; in the morning, an involuntary alvine evacuation occurred, but there was perfect consciousness, no sopor, no delirium, no difficult respiration, and no mucous rhonchus ; the exanthema still looked well. Calc. repeated. In the evening the fever did not increase, the temperature of the skin moderate, and the pulse no longer small, 142. January 5th, the child had passed a quiet night, sitting cheerfully on the bed; no dangerous symptoms were present, the eruption was receding, the temperature of SCARLATINA MILIARIS. 123 the skin little increased, the pulse 115, no involuntary evacuations, and the child responded perfectly sensibly to all inquiries; no febrile ex£- cerbation ensued in the evening. I accordingly discontinued the medi- cine, and the disease proceeded on its course, as free from danger as usual under the employment of Calcarea. Oskar Wagner, 4 years old, an uncommonly tall, stout, ^ over-ted, flaccid, scrofulous boy, was attacked with several fits of vomiting in the night, between December 20-21. On the following morning the vomiting had ceased, the child was very restless, the surface of the body cool, and the exanthema made its appearance. Calc. carb. 3, gr. j. During the evening much heat, in the night delirium, and two involuntary, but liquid alvine evacuations. On the morning of the 22d very violent fever, the exanthema fully developed and very much raised, the single points or elevations standing together in groups; Calc. repeated. During the day, delirium, great thirst, dry brown lips; the state of the tongue could not be discovered, as the child could not be induced, during its whole illness, to show it; periodical unconsciousness and delirium, the latter continuing during the night with restlessness. Calc repeated. On the 23d, early in the morning, intense fever with delirium. Calc repeated. In the evening the child was in a state of complete sopor, pulse collapsed, small, 152; extremities cool,—Zincum 1, gr. j> eve|7 2 hours ; the night very restless, much delirium. After^ midnight the child appearing quiet, the parents discontinued the medicine. This supposed quietude was, hoAvever, a bad symptom, for on the morning of the 24th I found the child lying perfectly motionless ; the pulse very small, and could not be counted; utter unconsciousness ; the extremities icy cold, the rest of the body cool, and the whole cutaneous surface bluish-red, except about the eyes, forehead, and chin, these parts being white; the eruption remaining was but scanty. Zinc^ 1, gr. j., every two hours. After the first dose, symptoms of returning consciousness were already perceptible; in the evening the skin was warm, and its bluish-red colour had disappeared; the pulse was some- what strengthened, 150, and there was some degree of sweat; the night passed over pretty favourably, now and then delirium, but also several hours' sleep. On the 25th, the child appeared to have recovered more consciousness, he recognised his parents and asked for something to drink. The temperature of the skin was somewhat higher, the pulse no longer weak, 140, and, for the first time, the urine was not emitted in- voluntarily. Zinc continued every three hours. The following night he slept perfectly quiet, without delirium; in the morning he was in full possession of his faculties, and wished to play; the temperature of the skin was natural, the pulse strong, 128, and the skin had commenced to exfoliate. Zinc, three times a day. On the 27th, the child was well, as far as circumstances could admit, and recovered perfectly without taking any more medicine. . , . • j The difference between the effects of Calc. and Zinc in this epidemy, not only as elucidated by the symptoms enumerated in the Materia Medica, but also as established by experience, consists accordingly in the following: Calc. operates more upon the organs of the chest, Zinc. more upon the brain; Calc diminishes the immoderate febrile heat and 124 ERUPTIVE FEVERS. the frequency of the pulse ; Zinc, does not affect the frequency of the pulse, which is associated with febrile heat, but removes the icy coldness of the skin (the result of depressed vitality), strengthens the small, quick pulse, and reduces it to a normal state of frequency ; Calc is only useful in slight delirium, but very effective in violent angina; Zinc is as beneficial in violent delirium alternating with sopor, as in paralysis of the brain; Calc is, on the other hand, preferable in incipient para- lysis of the lungs. I must guard myself here against the imputation of any intention to hold Zinc, and Calc. curative in all malignant cases of scarlet fever, by stating, that it was only in this epidemy that I found them of such great efficacy, and it is only in similar instances that their beneficial effects may be looked for. I was induced to make these com- munications, chiefly from the circumstance that I consider it would be attended with great advantage if the different epidemies were carefully described and compared, their distinguishing characteristics pointed out, and the remedies mentioned which had proved most serviceable in each,—as it is mainly by such means that the selection of the specific remedy, at the first outbreak of the disorder, can in future be facilitated, and a number of sacrifices thereby avoided. The remedies required for the occasional sequelae of scarlatina miliaris are the same as those enumerated at the conclusion of the chapter on Scarlatina. MEASLES. Rubeola. This disease generally reigns as an infectious epidemic, and, for the most part, confines its attack to children, in which cases it is seldom, when properly treated, either severe or dangerous; when it occurs in adults, it generally assumes a more critical character* It rarely attacks an individual a second time. Measles is not to be so much dreaded for itself, as for the delete- rious consequences it, under an improper mode of treatment, frequently entails, or to use the technical term, the dreg it leaves after it, which, in many constitutions, develope an inherent disposition to consumption. Diagnosis.—Catarrhal symptoms, such as short, dry cough, lachry- mation, with redness of the eyes, and a degree of fever, more or less marked, preceding the eruption from three to five days, and generally continuing as long after, or all through the disease. Eruption of a number of small red spots (frequently papular), the skin, in the intervals between them, generally preserving its natural colour, and sometimes exhibiting a faint reddish hue. We often find them in the shape of small irregular arcs. They, for the most part, make their first appearance on the face and neck, become confluent, and extend themselves gradually downwards over the rest of the frame. About the sixth or seventh day from the time of sickening, the eruption begins to turn pale on the face, and afterwards on the rest of the body, and, generally, entirely disappears about the ninth day, with a bran-like desquamation of the epidermis, a distinguishing sign of this disease. MEASLES. 125 Therapeutics.—Aconite has been regarded, in some instances, as almost specific against measles, and in its mild form, will frequently be found sufficient, in a few doses, to conquer the disease, or at least mate- rially to shorten its duration. This remedy is particularly indicated, when the fever assumes an inflammatory form, attended with dry heat of the skin, heat in the head, with confusion and giddiness, redness of the eyes, intolerance of light, general weakness or prostration; and is more or less useful, throughout the course of the malady, either alone or in alternation with Pulsatilla, or any of the other remedies which may be better indicated, whenever marked febrile or inflammatory action becomes prominent. (Coffea or Hepar are frequently useful after Aco- nite, when there is a distressing, dry cough.) Pulsatilla is also very efficacious, and even specific in this disease, and is frequently indicated at the commencement, from the strong re- semblance which some of its pathogenetic properties bear to the catarrh attendant upon measles, together with the characteristic exacerbation of the symptoms towards evening, &C.1 This remedy is, moreover, of great utility in bringing out the eruption, when it is longer than usual in making its appearance ; but, whilst the fever is high, Aconitum must be administered, and, if the febrile irritation does not diminish after a dose or two of Aconitum, Sulphur may be given, after which, if the fever return with increased force, Aconitum will rarely fail to answer our expectations. When there is great oppression at the chest, before the eruption is evolved, a dose or two of Ipecacuanha is very useful. Pulsatilla is also valuable when any gastric derangement is present, or when the cough, which so generally accompanies the disease, is worse towards evening, or in the night, and is attended with considerable mucous rhonchus, or copious, thick, yellowish or whitish expectoration, sometimes followed by vomiting, or symptoms of approaching suffoca- tion ; further, when there is coryza with a thick, yellowish or greenish nasal discharge. (Sulphur is frequently of considerable service after Pulsatilla, particularly in strumous subjects. Where there is dry noc- turnal cough, Nux v. will be found useful, especially in dark-complex- ioned subjects.) Belladonna.—When the inflammation attacks the throat, presenting many of the throat symptoms we have given for this medicine under Scarlet fever, attended with great thirst, which the patient is often pre- vented from indulging by the acute shooting or pricking pain in the throat produced by swallowing; and further, when there is a hoarse, dry, barking, and somewhat spasmodic cough, worse at night, with mucous rhonchus, great restlessness, and high nervous excitement; also, in those cases of measles, where no eruption declares itself, but simply headache and catarrh, with severe inflammation of the eyes, which pre- sent a glassy appearance, are bloodshot, or streaked, and watery; finally, Avhen evident signs of cerebral irritation set in. (Against ulce- rations on the cornea, Mere, followed by Calc. or Hepar s.) _ Bryonia is an excellent remedy, when the eruption is faint, or im- 1 Pulsatilla and Bryonia are two of the most important remedies, when there is pro- minent bronchitic complication. (See also Bronchitis.) 126 eruptive fevers. perfectly developed, and the respiration much oppressed and laborious, attended with aching in the limbs: also, when there is dry cough, and the patient complains of shooting pains in the chest, increased by a full inspiration. This disease has frequently terminated fatally, from the eruption being driven in by sudden exposure to cold or change of temperature; in such cases, Bryonia, administered as above, is generally found effica- cious in re-evolving the eruption, and preventing this disaster ; if diar- rhoea, with mucous discharge, follow the suppression, Pulsatilla is in- dicated ; if the vomiting, with great oppression at the chest, be the more prominent symptom, Ipecacuanha should be substituted, and followed in turn by Arsenicum, if symptoms of improvement do not speedily show themselves. In the case of children, Chamomilla is to be preferred to Ipecacuanha, when there is dyspnoea and diarrhoea with colic and vomit- ing. When symptoms of cerebral disturbance supervene, Cuprum ace- ticum,1 Belladonna, and Stramonium, or Helleborus niger, Arsenicum, and Sulphur, have proved of the greatest utility;—and in the case of pulmonic inflammation, Phosphorus, Bryonia, or Sulphur, should Aco- nitum and Pulsatilla not suffice. In those comparatively rare cases in which typhoid symptoms manifest themselves, either during the course of the disease, or at its termination, Bryonia, Arsenicum, and Phos- phorus will be found useful, where any chance of recovery remains. (Vide Typhus.) For the treatment of coughs, which sometimes remain after measles, Sulphur, Sepia, Carbo. v., Conium, Chamomilla, Drosera, Dulcamara, Hyoscyamus, Ignatia, Nux v., Belladonna, &c, are very serviceable. (See Coughs.) Against Laryngitis, Aconitum, Hepar s., Spongia, Belladonna, Lachesis, Arsenicum, Mercurius, &c. (See Laryngitis.) For the diarrhoea, which the disease sometimes leaves behind it, Cin- chona, Pulsatilla, Mercurius, and Sulphur are in general the most ap- propriate remedies ; for their several indications, see Diarrhcea. For otitis or otorrhoea, Pulsatilla, Carbo v., Sulph., Mere, and Hepar sul- phuris (chiefly); for parotitis, Arnica, and Phos. ; for tenderness of the skin, Mercurius ; for miliaria alba (chiefly), Nux v.; and for burning, itching rash, which bleeds after scratching, Arsenicum and Sulphur are severally indicated. As a precautionary measure against the attacks of this disease, when epidemic, we may prescribe a few globules of the third or sixth potency of Pulsatilla, in a little water, followed by Aconitum, at the same potency, three days after; allow the latter medicine to act for twenty- four hours, and continue the alternation for a fortnight, renewing it, when necessary, at the termination of a week or ten days. This treatment will, frequently, be found sufficient to ward off this disease, or if it be taken, will generally reduce it to an extremely mild form. Diet.—In this respect we may follow the rules given under Scarlet Fever. 1 Vide Scarlatina, p. 111. small-pox. 127 SMALL-POX. Variola. This disease is, by pathologists of the present day, divided into two varieties—the distinct, when the pustules on the face are clearly defined, and do not run into one another; and the confluent, when they coalesce and form one continuous whole. When the symptoms are less severe than those properly characteristic of the disease, and the eruption on the face slight, it is called the modi- fied small-pox. We generally find this description in such persons as have been properly vaccinated, a precaution which, although not always a preservative from the attacks of variola, greatly lessens its virulence, and gives a milder character to the complaint, when taken. Diagnosis.—The disease is frequently very sudden in its attacks, commencing with chilliness and shivering, followed by febrile symptoms, headache, severe pains in the small of the back and loins, languor, Aveari- ness, and faintness; the patient also complains of oppression of the chest, and acute pain in the pit of the stomach, increased by pressure. The eruption makes its appearance at the close of the third day, first on the face and hairy scalp, then on the neck, and afterwards spreads over the whole body. Catarrhal symptoms, as sneezing, coughing, wheezing, and frequently difficulty of breathing, often accompany this disease. The eruption first displays itself in the shape of small, hard-pointed, red elevations, which, in about three days, present a vesicular appear- ance, surrounded by an inflamed circular margin, and become depressed in the centre as they enlarge. About the sixth or eighth day, the lymph in the pustule becomes converted into pus, and the depression in the centre disappears. When the pustules are very numerous on the face, it generally be- comes much swollen, and the eyelids are frequently closed up. On the first day, a small lump, like a millet-seed, may be felt in each of the elevations above noticed, distinguishing this eruption from all other exanthemata. The pocks continue coming on during the first three eruptive days, and each pock runs its regular course ; thus, those Avhich first appeared, are forming into scabs, or dying off, while the others are suppurating. The general desiccation commonly takes place on or about the eighth or fourteenth day, according as the pustules may hap- pen to be distinct or confluent. When the pustules have attained their full development, they gene- rally burst, in mild cases emitting an opaque lymph, which dries into a crust and falls off, whilst in severe ones, we find a discharge of puriform matter, forming scabs and sores, which leave, on their healing, perma- nent marks or pits. Red stains, caused by increased vascular action, always remain for a while after the eruption ; but if no ulceration has taken place, they disappear in process of time. In Confluent Small-pox, all the precursory symptoms are more severe, the fever runs high, and frequently continues so throughout the course of the disease • the pain in the pit of the stomach, and difficulty of breathing, are more complained of, and, in children, the eruption is fre- 128 ERUPTIVE FEVERS. quently preceded by convulsions and delirium; the latter symptom, indeed, is frequently present with adults, during the suppurative or secondary fever, which frequently assumes a typhoid character, and sometimes carries off the patient on the eleventh day. ^ All cases, in which we have generally a deep-rooted morbid constitutional taint to contend against, require the utmost skill of the experienced practitioner to ward off a fatal result. An extensive erythematous efflorescence of the face or trunk almost invariably precedes the confluent variety of small-pox. Salivation, Avith soreness of the throat and aphthae, or pustules on the tongue and pharynx, frequently declares itself in both forms of this disease, but more particularly in the confluent. Before we come to the medicines to be administered in the different stages of the disease, we may say a few words upon the general treat- ment of the patient. Cool and fresh air are our best auxiliaries, the variolous virus being of a nature to react upon the organism, and warmth being calculated to increase its activity. So beneficial is cool air found in this malady, that taking a child to an open AA'indow when attacked with convulsions, will generally be found to afford immediate relief. Great cleanliness must also be observed, and the linen frequently changed. When the vesicles declare themselves, and begin to form into pus- tules, the room ought to be kept as dark as possible, to aid in prevent- ing the risk of disfigurement, a precaution deducible from common experience, since we find that the parts of the frame exposed to the action of light are always those most strongly marked by the ravages of the disease. Therapeutics.—In the first or febrile stage of the disorder, Coffea is valuable in allaying the nervous excitability generally present. Aconite may either folloAv or precede this medicine when the fever runs high, and visceral congestion threatens. Chamomilla is often of great service at this period, or during the course of the disease in children, when there are dyspnoea and diarrhoea, with colic and vomiting; or when startings or convulsions set in, prior to the appearance of the eruption, and again, during the maturative stage, Avhen the nights of the little patient are much disturbed by a troublesome cough. Should Chamomilla afford but slight relief, Bella- donna may be administered. When considerable tightness and oppression at the chest, sometimes attended with nausea and vomiting, are experienced before the appear- ance of the eruption, the alternate use of Ipecacuanha and Antimonium tartarieum affords speedy relief. The latter remedy is, moreover, well indicated when convulsions precede the evolution of variola; and, from the close analogy which the eruption it is capable of producing bears to that of small-pox, may be administered with advantage during the eruptive and maturative stages also, unless some other remedies should be more urgently called for by the nature of the symptoms; the existence of a hollow-sounding cough, with loud mucous rhonchus, is an additional index for the employment of Antimonium tartarieum. SMALL-POX. 129 Bryonia is sometimes useful in assisting the natural course of the eruption ; it is also indicated when symptoms of considerable gastric derangement are present, such as bitter taste in the mouth, foulness of the tongue, headache, rheumatic pain in the limbs, increased by motion, constipation, and irritability of disposition; also, when there are occa- sional shooting pains in the chest, especially during inspiration. Rhus is equally serviceable at this stage of the disease, and particu- larly, when the acute pains in the head, back, and loins are aggravated during a state of rest, and temporarily relieved by movement. Belladonna.—This remedy may follow Aconite', when the latter has been indicated, should symptoms of cerebral disturbance have set in, characterized by flushed countenance, intolerance of the eyes to light, headache, and delirium, great thirst, nausea, and vomiting; or, Avhen there is redness of the tongue at the tip and margins; abdomen tumid and painful, particularly at the epigastrium, Avith sensibility on pres- sure ; prostration of strength, stupor, &c. For additional indications for the employment of this remedy, see Inflammation of the Brain and its tissues. Opium is useful Avhen there are symptoms of stupor or strong incli- nation to somnolence. If Antimonium tartarieum and Ipecacuanha do not succeed in allay- ing the nausea and vomiting, and the patient complains of excessive thirst and dryness of the mouth, the tongue being at the same time very foul and dark, and the prostration of strength excessive, we may pre- scribe Arsenicum—(the dose to be repeated every two or three hours, if required, but the remedy must be discontinued as soon as decided benefit has resulted from its action). The last symptom generally oc- curs after the maturation of the eruption and secondary fever.1 Pulsatilla is occasionally of considerable utility in confluent small- pox, when an efflorescence, similar to that of measles, precedes or ac- companies the eruption, attended with nausea or vomiting, and aggra- vation of all the symptoms towards evening. An occasional dose of Stramonium, two globules, is sometimes useful, when some pustules are already formed, in forwarding the eruption, and shortening its duration. During the filling up of the pocks, a secondary or suppurative fever frequently sets in, particularly when the pustules are thick, and evince a disposition to run into the confluent form; when, moreover, the™ is swelling of the head, inflammation of the eyes, throat, and nose, with salivation, hoarseness, and impeded deglutition; tenderness of the sto- mach; diarrhoea, with tenesmus, and sometimes sanguineous stools. Having, if this remedy be called for, first attacked the more prominent febrile symptoms, with Aconite, we should have recourse to Mercurius, 3-6, a few hours afterwards, in repeated doses, until amelioration de- i In some cases, and especially those of a bad type, livid spots, or diffused ecchy- moses are observed on the skin, prior to the evolution of the eruption (variola nigra) Arsenicum is here also of considerable service, particularly when great weakness and languor, thirst, nausea, or vomiting, with pain in the epigastrium, are present. Acidum muriaticum, in repeated doses, has been found of important service m cases of a similarly bad type, wifh typhoid fever, and constant tendency of the patient to sink downwards in the bed. 130 ERUPTIVE fevers. clares itself. When the fever runs high, in confluent small-pox, and threatens to continue so, as it often does throughout this form of the disease, Aconite must repeatedly be had recourse to, and given in alter- nation with Sulphur, when not sufficient of itself to mitigate the exces- sive febrile action. While the disease is running its course, particularly during the dis- tension of the pustules (should no other remedies be imperatively called for), and also towards the period of their bursting, we may safely admi- nister an occasional dose of Mercurius as above, and in the latter case, follow this medicine with a dose or two of Sulphur, to assist in the desiccation. When rheumatic pains, in the back and extremities, which become worse at night, and are somewhat relieved by movement, are complained of at this period, Rhus may be advantageously alternated with Sulphur. Rhus is moreover extremely serviceable in confluent small-pox, when the fever assumes a typhoid type, attended with the signs denominated putrescent; Mercurius and Arsenicum are also occasionally useful in the latter case, when indicated by the character of the symptoms. (Vide Typhus.)1 During the period of desiccation, frequent laving of the pustules with tepid water and bran, and gently drying them afterwards, will be suffi- cient ; cleanliness being then the great requisite, combined with a careful attention to diet. Repercussion of the Eruption.—When this has taken place, and symptoms of cerebral disturbance have set in, Ave may haAre immediate recourse to Cuprum aceticum, provided Belladonna, Sulphur, Bryonia, or some other remedy be not better indicated. Some physicians, in their treatment of the affection, divide it into two distinct stages ; we have, however, contented ourselves, when necessary, with slightly re- ferring to them. Should Laryngitis supervene during the course of small-pox, we must have immediate recourse to Aconite, Hepar s., Spongia, Belladonna, Lachesis, Arsenicum, or Mercurius, &c. (See Laryngitis.) Against the cough, which sometimes results from an attack of small-pox, Belladonna, Mercurius, and Arsenicum, are three of the most appropriate remedies in most cases (the particular indica- tions for Avhich will be found in the article on Coughs, which see); and against asthmatic symptoms, attended with mucous rattling in the chest, Tartarus emeticus should be employed, and followed by Senega, if in- sufficient to effect a cure. When, in the suppurative stage of confluent small-pox, the pus becomes sanious, and sphacelus is apprehended, Ar- senicum and Carbo v., may exert a beneficial effect. Cinchona and Phosphorus have repeatedly been found specific against the Diarrhoea, Avhich occasionally results:—and against the Ophthalmia, Conium, Belladonna, Hepar sulphuris, Euphrasia, Sulphur, Calcarea, Arsenicum, Pulsatilla, Mercurius, Nux vomica, and Rhus toxicoden- dron, have been found the most useful remedies. 1 When Pleuritis or Pneumonia intervene during the progress of the disorder, the re- medies mentioned under these different heads must be had recourse to. The invasion and progress of the latter disorder are sometimes so insidious, that, unless the aggre- gate signs of pneumonic inflammation be narrowly looked for, disorganization of the lung may take place before the existence of such a complication is detected. chicken-pox. 131 Modified Small-pox is merely a mild description of the above, and, as we have before said, is the form the disease generally assumes, when it attacks those who have been properly vaccinated. We must regulate our treatment according to the symptoms, being guided in the selection of the remedies by the indications before given.1 Diet should be regulated by the virulence of the attack; but, in all instances, the beverages should be cold, as a warm regimen, and neglect of the precautions before mentioned, may convert the mild into the malignant form. After recovery, it is necessary that the patient abstain, for a considerable time, from animal food. It may be remarked that, after an attack of malignant small-pox, the patient's constitution generally requires a thorough renovation,—he should, therefore, be put under a course of medicine best calculated to attain that result. CHICKEN-POCK. Variola spuria, Varicella. Diagnosis.—A disease, bearing a considerable resemblance, in its external character, to small-pox, but differing in its duration, and symp- tomatically, being considerably milder, generally requiring no medical assistance, but merely attention to diet, and but rarely becoming dan- gerous, except when the lungs or brain become involved. The fever, however, occasionally runs high. When this affection attacks an individual during the prevalence of small-pox, which is not unfrequently the case, it is often mistaken for that disorder, but it soon discovers its real character, by the rapidity with Avhich the eruption declares itself; the pustules (in many instances closely resembling those of the small-pox), being generally fully matured by the third day, and the whole eruption disappearing at the end of the fourth or fifth, without leaving any mark. Therapeutics.—When much fever is present, we should check it by the administration of Aconite, repeated from time to time as required, or Coffea, also occasionally repeated, if there be simply extreme rest- lessness and anxiety. When cerebral symptoms threaten, Belladonna must be given; for the employment of this medicine, see Inflammation of the Brain. When the complaint is attended with convulsions in children, particularly during dentition (see Convulsions), Antimonium tartarieum may be given to accelerate the eruption. Mercurius, may be employed when the lymph of the pustules be- comes converted into pus, as in the small-pox, and is also beneficial if strangury be present. For the course of treatment to be adopted when the eruption has been driven in, see Repercussion of the eruption in Small-pox. In anomalous cases, where other symptoms supervene, more closely resembling small-pox, we may refer to the remedies men- tioned under that disease. 1 I have given in detail the treatment which has been generally adopted by Ho- moeopathists, and with great success. But it may here be added, that Vaccinine, given internally, has obtained much repute, as an important and eminently successful remedy, in the treatment of variola, the most virulent cases having been reported to have yielded to it with a promptness and certainty, that would afford another great illustration, if such were needed, of the truth of the homoeopathic law. 132 ERUPTIVE FEVERS. MILIARY FEVER. Miliaria. Miliaria alba. Miliaris sudatoria. Sudor miliaris. Diagnosis.—The primary feature of the disease consists of a great number of exceedingly small, round, red pimples, Avhich are soon con- verted into white vesicles, afterwards become opaque, and end in scurf; they are irregularly scattered, of the size of millet-seeds (hence the name of the complaint), and when the hand is passed over the cutaneous surface, a sensation is experienced as if caused by the presence of small grains of sand beneath the cuticle. This affection is sometimes idiopathic, but more frequently associated with fever, and even occasionally accompanies various chronic diseases, in which latter instance, it may generally be considered as an evidence of some internal constitutional taint; it is most frequently met with in women, particularly at the turn of life, and at the period of confinement (arising from the room being kept at too high a temperature—a frequent cause of this malady). This, like other cutaneous affections of the same nature, is generally preceded by febrile symptoms, the eruption appear- ing on the fifth or sixth day; from the commencement of the fever we frequently find profuse perspiration, with a putrid, sour odour; previous to the vesicles evolving themselves, there is a tingling or itching of the skin, occasionally attended with a sensation of burning, together with a numbness of the extremities; the patient complains of dyspnoea or a sense of oppression at the chest, sometimes with short dry cough, and stitches in the side, and not unfrequently, of creeping, tingling, numb- ness, weight and stiffness in the extremities, or severe or fugitive rheu- matic pains in the limbs and teeth. Low spirits, excessive anxiety, extreme restlessness, sighing, tinnitus aurium, violent palpitation of the heart, irregular pulse, and the emission of clear, colourless urine, are also frequent premonitory indications of approaching Miliaria. Prognosis.—This must be regulated by the severity of the accom- panying symptoms. Death often takes place suddenly, particularly on the shrinking of the vesicles. When the morbid signs decline after the appearance of the eruption, the termination of the disease will commonly be favourable. In malignant forms of the complaint, a fatal issue some- times takes place Avithin twenty-four or forty-eight hours. The general course of the disease varies from four or five days, to three weeks. Convalescence, in severe cases, rarely sets in before the fourth week. Therapeutics.—In consequence of the numerous diseases with which miliary fever is complicated, it requires a variety of medicaments. When it appears in a simple and apparently idiopathic form, and is attended with anxiety and restlessness, which seems to depend upon an accelerated circulation of the blood, Avith great internal and external heat, Aconite is a specific remedy. When the above symptoms seem more particularly to arise from high nervous excitability, Coffea is indicated. Belladonna should be administered Avhen the accelerated circulation is attended with considerable determination of blood to the head, and delirium; but Arsenicum is the most appropriate remedy Avhen the MILIARY FEVER. 133 eruption is accompanied by excessive anxiety and oppression at the chest. (Veratrum is sometimes useful after, or in alternation with, Arsenicum). When the disease is found conjoined with puerperal or other fevers, and is preceded by oppression, lassitude, anxiety, and a sense of weight about the chest, restlessness, sighing, &c, it is generally speedily sub- dued by Ipecacuanha ; when, however, the symptoms, which precede the eruption, are accompanied by constipation, or shooting pains in the chest, Bryonia should be selected. Nux vomica is useful when aching, gnawing pains are experienced in the epigastric region, attended with eructations, constipation, and other signs of gastric derangement. Calcarea carbonica is a most valuable medicament in critical miliary fever, especially against the extreme anxiety which is so fre- quently manifested, or against the convulsions which sometimes take place in the case of children, and finally as a general remedy to hasten the development of the eruption when it is tardy in making its ap- pearance. Chamomilla (followed, if no alteration takes place, by Tincture of Sulphur) is also useful when the disease occurs in children, brought about by excessive warmth, or even errors in diet, attended with a watery, greenish or yellowish diarrhoea. Puis., Tart, stibiat., Stram., Acid, phosph., Led., Cocc, or Carb. v., may be required in certain cases. When this disease is benign.and appears in an idiopathic form, it is rarely so severe as to require a very frequent repetition of the medicines if the accessory treatment, about to be pointed out, be carefully attended to—in most cases, a globule or two, repeated in from four to twelve hours, according to the intensity of the disease, will be found sufficient, and, in some instances, a single dose will dissipate all the symptoms, or at least so modify them that we may safely trust to Nature to perfect the cure—but it is otherwise in the severer or more complicated forms of the malady. (See also Scarlatina miliaris.) Remarks.—When it exhibits itself in complication with other affec- tions, Miliaria may be either symptomatic or critical, and the physician should always bear in mind that an improper treatment of other affec- tions may develope it. When symptomatic, it may be recognised by ap- pearing either very early or late in the original affection, which, so far from being relieved by the eruption, is frequently exacerbated by the excitement of the nervous system consequent on its appearance. Even Avhen critical—\n which case, after the eruption has been fully developed, amelioration takes place,—it is still dangerous from its liability to retro- cede. When the disease is very prevalent, its outbreak amongst lying- in women may generally be prevented, if proper attention be paid to keeping the patient cool by light covering and the removal of feather bed*, and allowing a free supply of pure air. When, however, it appears critical, we must be most careful not to check it, and a moderately warm temperature must be kept up. Repercussion of the Eruption.—When this has taken place we must carefully watch the result, as sometimes Nature herself provides for it by an increase of some other secretion, but Avhen symptoms of 134 eruptive fevers. cerebral disturbance, &c, present themselves, Cuprum aceticum, Cal- carea c, or Belladonna, &c, must be had recourse to, according to cir- cumstances. (See articles Scarlet Fever, and Scarlatina miliaris.) Diet.—Same as already given for Fever, modifying it according to the violence of the symptoms ; when repercussion threatens to take place, the patient's beverages should be given moderately warm. nettle-rash. Urticaria. Diagnosis.—Spots or wheals, flat or prominent, and of a dull white colour, like the sting of a nettle, or redder than the surrounding skin, generally encircled with a rosy areola, disappearing in warmth, and reappearing when exposed to cold, evolved suddenly, and continually changing their situation. This eruption is brought to the surface by various causes, not unfre- quently arising from indigestion, caused by the use of improper articles of food. Before the eruption discloses itself, the patient is affected with restlessness, languor, oppression, and want of appetite, derangement of the digestive functions, and fever. When the eruption breaks out, the above symptoms become relieved, but considerable suffering arises from heat and itching, sometimes accompanied with swelling of the parts affected. This disease, in almost all cases arising from a constitutional cause, requires for its total eradication a regular course of treatment. Therapeutics.—In acute cases, the remedies found most useful are Dulcamara, Aconite, Nux vomica, Pulsatilla, Antimonium crudum, Bel- ladonna, Hepar sulphuris, Rhus toxicodendron, and Bryonia. Dulcamara, when the exciting cause has been cold or damp, when the affection occurs in wet weather, or when we find considerable fever with bitter taste in the mouth, foul tongue, diarrhoea, pains in the limbs, and extreme itching, with a burning sensation after scratching. Aconite, when the febrile symptoms are more intense, the pulse high, the skin hot and dry, and great restlessness and anxiety are present. Nux vomica, when there is considerable gastric derangement, with constipation, more especially when arising from wine, stimulants, or indigestible substances ; it may, if necessary, follow Aconite in eight or twelve hours after the febrile symptoms are somewhat modified. Pulsatilla deserves a preference, under similar circumstances, Avhen the bowels are relaxed, and the patient is of a quiet disposition and lymphatic temperament, and the attack has apparently been excited by indigestible food. Antimonium crudum may follow Pulsatilla, should the latter have failed to relieve the affection. Belladonna is indicated when the affection is attended with a severe throbbing headache, with redness of the face. Hepar sulphuris has frequently been found useful in urticaria accompanied by cold in the head, and particularly when the coryza was confined to one nostril. Rhus Toxicodendron is one of the most useful remedies in a great majority of cases of this eruption, and especially when the affection has toothache. 135 apparently arisen from some idiosyncrasy of constitution, in which the eruption has been thrown out by the use of some particular article of food. (See Article on Diet, in Introduction.) Prescription.—In ordinary cases, we may prescribe 6-12 globules of the sixth dilution in six dessert-spoonfuls of water, and order one to be taken morning and evening, except in the case of Aconite, which may be more frequently repeated, when the febrile symptoms seem to demand it.1 In this, as in every other cutaneous eruption, great care ought to be taken against driving it inward, by external applications or lotions; a sudden retropulsion, as before noted under Scarlatina and Small-pox, being frequently attended with fatal consequences. When, however, from improper treatment, we have reason to dread this having taken place, we may generally succeed in re-establishing the eruption, and thereby averting any dangerous consequences, by the employment of Bryonia in repeated doses. Should, however, marked cerebral symp- toms declare themselves, the complaint should be treated as before described under Scarlatina, ko.,—Repercussion of the eruption, which Urtica urens has been found useful in some cases ; and in those of a chronic or extremely obstinate character, Calcarea, Lycopodium, Sul- phur, Carb. veg., Causticum, Acid, nitric, Conium, Natr. mur., &c.; the last two, particularly, when the eruption is liable to reappear after violent exercise or exertion of any kind; Calcarea, when exposure to cold fresh air produces it; and Acid, nitricum when it arises from the patient going into the open air, after having kept within doors for a day or two. DISEASES OF ORGANS CONNECTED WITH THE DIGESTIVE SYSTEM. toothache. Odontalgia. When we find a constant disposition to this distressing malady, on the slightest exposure to cold, without any presumable cause, or what is ffenerallv called rheumatic toothache, we are warranted in concluding that some taint lurks in the constitution, and until proper measures are adopted for its eradication, even the remedies most clearly indicated » See the directions for the,repetition of the dose, in the Introduction. 136 digestive system. under other circumstances, fail to relieve the patient, or at most but temporarily alleviate his sufferings. Another obstacle to the selection of the proper remedy is the difficulty we find in obtaining from the patient a perfectly clear description of his sensations. We shall, never- theless, mention a few of the remedies Avhich have proved most effica- cious in the relief of toothache, and when the symptoms of the sufferer approximate closely to the indications given for the several medicines, they will, in very many cases, afford a prompt relief. Therapeutics.—Among these, Belladonna, Chamomilla, Mercurius, Nux vomica, Pulsatilla, Sulphur, Carbo vegetabilis, Hepar sulphuris, and Arsenicum, hold a high rank. Administration.—The medicine selected may be taken dry, or dis- solved in a little water; and if an aggravation of pain is experienced soon after taking the medicine, the dose must not be repeated, as this is generally succeeded by considerable relief; but when the pain threatens to get Avorse again, the same remedy may be repeated, pro- vided the symptoms are of a similar description to what they were before taking the remedy; if they have altered, select another medicine. Belladonna is particularly indicated when the pains are very severe, of a drawing, tearing, or shooting nature, extending to the face and ears ; becoming aggravated in the evening, and especially at night, with gnaw- ing or boring pain in the carious teeth, SAvelling of the gums and cheeks, dryness of the mouth with excessive thirst, with or without salivation: renewal of the pains from intellectual labour, or after eating ; aggrava- tion of suffering when masticating ; also in the open air; congestion to the head, with heat and redness of the face, also pulsation in the head and cheeks. Chamomilla, when there are severe drawing, jerking, pulsative or shooting pains; heat and redness, especially of one of the cheeks; the pain becomes almost insufferable, especially at night in the warmth of the bed; shooting and pulsative pains in the ear of the affected side; the pains are aggravated by eating or drinking a7iything hot or cold, but especially the former ; great agitation and loss of self-control from pain, or excessive weakness, sometimes amounting to fainting; great irasci- bility, and disposition to shed tears during the paroxysms. Chamomilla is useful when the toothache has arisen from an abuse of Coffee,1 in which case Nux vomica and Pulsatilla are also valuable, when indicated by the symptoms. Rhus and Dulcamara frequently answer best after Chamomilla in toothache from cold, when the last-mentioned remedy has not removed the attack. And Avhen the toothache returns after every exposure to cold, Sulphur is, generally, the best remedy, but in some cases, Cinchona. Mercurius is particularly indicated when the pains affect carious teeth, or exist in the roots of the teeth, and consist of tearing, shooting, pains, occupying the whole side of the head and face of the part affected, 1 Those who are subject to toothache ought to abstain from coffee altogether; as also from very hot or cold drinks, stimulants of every description, sweetmeats and acids ; they ought farther to refrain from using medicated tooth-powders, particularly if they wish to derive any benefit from homoeopathic treatment; the toothpick ought to be cautiously used if required, and the mouth well rinsed with tepid water (or about the same tem- perature as that of the mouth), night and morning, and after each meal. toothache. 137 and extending to the ears; loosening of the teeth, and a feeling as if they were too long; the pain becomes almost insupportable towards evening, and especially at night in the warmth of the bed, and is also aggravated by eating or drinking, particularly after anything^ cold has been partaken of, and likewise by exposure to cold or damp air ; swell- ing and inflammation of the gums ; nocturnal perspiration, peevishness, and inclination to tears; this medicine is especially useful in persons who are subject to glandular swellings. Nux vomica is useful for persons who are habituated to wine, coffee, or other stimulants, or addicted to a sedentary life, or to severe study ; of lively or irritable temperament, dark or florid complexion; or whose Bufferings are increased by intellectual labour. The pains generally occur in carious teeth, and are of a drawing and jerking or gnawing description, occasionally diffusing themselves to the head and ears, some- times attended with painful enlargement of the submaxillary glands: gums swollen and painful, accompanied with throbbing and pulsation. The toothache is more liable to come at night or on awaking in the morning, sometimes also after dinner or in the open air. Pulsatilla is peculiarly adapted to persons of a mild or phlegmatic disposition. The pains are digging and gnawing, attended with prick- ing in the gums, and extending to the face, head, eye, and ear of the side affected; this remedy is particularly efficacious in toothache, when accompanied with earache, or with paleness of the face, when the affec- tion has been excited by taking cold, and when Ave find shortness and difficulty of breathing ; the pains are sometimes of a drawing, tearing, shooting, or jerking description, and occasionally produce a sensation as if the nerve Avere drawn tight, and then suddenly relaxed ; the pain is much aggravated in the evening or after midnight, generally increased by warmth and when the patient is at rest, and mitigated by cold air or cold applications to the mouth. Spirit, sulphuris.—This remedy is particularly valuable in stru- mous habits, with a tendency to constipation. It is indicated by pain, sometimes attended with swelling of the cheek, and shooting pains.in the ears, congestion of the blood to the head, and pulsative headache ; the pain is of a tearing, jerking, pulsative description, affecting both carious and sound teeth; aggravated in the evening and at night, or by expo- sure to the open air, also by the application of cold water or by mastica- tion ; sensation as if the teeth were loosened, elongated, and set on edge; the gums are swollen, affected with pulsative pains, and bleed easily. Bryonia is also a useful remedy in this affection, particularly with persons of a lively, choleric, and obstinate disposition. Its indications are loosening and sensation of elongation of the teeth, especially during or after eating; shooting in the ears, with inclination to lie down, pains aggravated by taking anything hot in the mouth, mitigated by lying on the affected side, or exacerbated by the contrary position. Carbo vegetabilis is indicated by toothache, with dragging, tear- ing, or constrictive and throbbing pains, excited by anything hot, cold, or salt; chronic looseness of the teeth; receding, ulcerated, and suppu- rating gums (particularly after the abuse of mercurial preparations, such as calomel, &c), bleeding of the teeth and gums, with tendency of the teeth to decay rapidly. 138 digestive system. Hepar sulphuris is indicated by dragging, jerking toothache, in- creased by approximating the teeth (clenching), by masticating, or from sitting in a warm room ; swelling of the gums, with tenderness on pres- sure, or abscess in the gums. This medicine is especially useful in cases where hurtful doses of Mercury have previously been taken under allopathic treatment. Arsenicum, when there is nocturnal pain, which extends into the ear, cheek, bones of the face, and temple ; aggravation of the pain by lying on the affected side ; amelioration from the warmth of the fire ; aching in the teeth so excessive as almost to drive the patient to madness or distraction ; sensation of elongation and looseness of the teeth ; grinding of the teeth, and bleeding of the gums. Aconite, Belladonna, Chamomilla, Coffea, and Ignatia, are the most useful in affections of this nature with children. Aconite, when the pains are difficult of description, or are described as being of a pulsative nature, attended with great agitation, feverish sensation, blood to the head, heat and redness of the face, and when the pains are described as of a pulsative, throbbing nature. Coffea, against violent pains Avith great excitability and almost dis- traction in adults; also Avhen the patient is conscious that the excite- ment is disproportionate to the pain suffered. For Chamomilla we have already given indications; if it prove in- sufficient, and the toothache has been caused by a chill, and is attended with diarrhoea, we may substitute Dulcamara. Ignatia is suitable for such cases as present similar indications to those of Nux vomica or Pulsatilla, but more particularly applicable to mild or sensitive dispositions, with alternation of high and low spirits. Tartarus emeticus will often be found beneficial in toothache occurring during cold, wet weather,—particularly in women,—with nocturnal exacerbation, or aggravation of the pain when drinking any cold liquid.1 Assafgstida may generally be prescribed with advantage when the pain is chiefly of a subdued description, and is intermittent; also when it partakes of a burning or shooting character, and seems to proceed from within outwards. sore throat, or quinsy, aphthous sore throat. Angina faucium, Tonsillitis phlegmonoides, Cynanche tonsillaris.—Angina aphthosa, etc. Quinsy.—Diagnosis.—Inflammation of the throat, denoted by swell- ing and red colour of the back part of the throat, accompanied with difficulty of swallowing, impeded respiration, alteration of the voice, and fever. 1 In rheumatic or arthritic toothache with nocturnal aggravations, or increase of pain on partaking of cold or warm drinks, but with temporary relief on the external applica- tion of heat; also in toothache which returns every spring or autumn during the preva- lence of easterly winds (and then continues sometimes for several weeks), the pain being occasionally confined to one tooth, which is extremely sensitive to the slightest touch, and often accompanied with acute shootings into the ear, Rhododendron Chrysan- thum is a useful remedy in repeated doses. SORE THROAT, OR QUINSY. 139 In the incipient stage of this affection, there is a sense of constric- tion about the throat, with a feeling of soreness, and sometimes of obstruction in the act of swallowing the saliva ; if it runs its course, the difficulty of swallowing and breathing increases, the tongue swells and becomes foul, the tonsils assume a redder hue, occasionally a number of small yellow eminences appear at the back of the throat, particularly on the tonsils; the patient complains of thirst, and the pulse is high, strong, and frequent; sometimes the cheeks swell and become florid, and the eyes inflamed, and in severe cases delirium is not an unfrequent occurrence. As the local affection progresses the majority of the fore- going symptoms become aggravated, and the tonsils tumefied, and sup- puration ensues if resolution be not speedily effected. When suppuration takes place, the pain is instantly relieved on the bursting of the abscess ; it sometimes happens, however, that scarcely has the patient been relieved from suffering by the latter event, before the state of the other tonsil gives indications that a similar train of symptoms are about to be encountered there. This affection, occa- sionally dangerous, if not properly treated, even in its simple form, becomes particularly critical when it puts on the putrid type. In such instances, the attendant fever generally assumes a typhoid character ; when this takes place, we may always infer a peculiar constitutional tendency. Therapeutics.—The following are the principal remedies used in the treatment of quinsy: Aconitum, Belladonna, Mercurius, Carbo v., Acidum nitricum, Lachesis, Pulsatilla, Nux v., Arsenicum, Chamo- milla, Ignatia, Dulcamara, Hepar sulphuris, Silicea, Sulphur. When this disorder is, at the commencement, attended with consider- able fever, thirst, and dry heat, deep redness of the parts affected, painful and difficult deglutition, pricking sensation in the throat, with aggravation of the symptoms when speaking, we should have recourse to Aconitum. , The next medicament we shall mention, Belladonna, as may have been observed in the treatment of Scarlatina, Measles, &c.,is one ol the best remedies we possess against phlegmonous inflammation ol the throat, more especially when it occurs in plethoric or lymphatic sub- jects. The following are the symptoms by which it is particularly in- 'paL'in the throat as if from excoriation, attended with scraping, and a sensation of enlargement, and burning or shooting pams^ principally experienced during the act of swallowing; these pains sometimes extend to the ears. Other characteristic indications for this remedy are-a sense of spasmodic constriction or contraction of the throat, with con, stantand almost uncontrollable desire to swaUow the saliva ; occasional y there is violent thirst, with dryness of the throat, but a dread of d ink from the suffering it occasions. Sometimes a complete inability to drink exists, and the liquid returns by the nostrils On examina ion, the throat presents a bright red colour, with swelling of the palate uvula, and tonsils; there is also an accumulation of slimy whitish mucus in the throat and on the tongue, obliging the patient to spit fre- quently • swelling of the muscles and glands of the neck, severe head- 140 digestive system. ache, chiefly confined to the forehead, sometimes determination of blood to the head, and delirium. (After Belladonna,—Mercurius, Lachesis, or Pulsatilla are often suitable.) This remedy frequently succeeds in speedily removing the whole of the above group of symptoms, or, at least, so far subdues them as to enable Mercurius to complete the cure. Mercurius is frequently valuable at the commencement of the disease, and forms one of our best remedial agents; in some cases advantage accrues from the employment of Belladonna in alternation with it. The indications for its selection are: violent shooting in the throat and tonsils, especially when swallowing,—these pains extend to the ears, and glands before the ears, and under the jaw; inflammatory redness and swelling of the affected parts of the throat, burning in the throat, desire to swallow, attended with a sensation of an obstruction existing in the passage; accumulation of thick and tenacious mucus in the throat, difficult deglutition, especially of liquids, which sometimes escape through the nostrils ; swelling of the glands, and muscles of the neck, and of the posterior part of the tongue; occasional swelling of the gums; unpleasant taste in the mouth, which is filled with saliva more or less inspissated ; throbbing, and formation of matter in the tonsils (con- fluent, or small, isolated, round, white specks or vesicles on the tonsils; indolent ulcers in the throat—Angina aphthosd); offensive odour from the mouth; aggravation of the symptoms at night, from the act of speaking, and in the evening; chills, and shivering, sometimes alter- nated with heat; nocturnal sweating. (Lachesis, Hepar sulphuris, Carb. v., or Ac. nit., are often suitable after Mere.) Lachesis.—One of the characteristic indications for this remedy is, aggravation of all the symptoms on awaking from sleep, or an increase of the pain in the throat from the slightest external pressure; it is, moreover, an excellent remedy in cases of tonsillitis in which Bella- donna or Mercurius have afforded relief, but seem incapable of effecting resolution; and also in aphthous sore throat with considerable ulcera- tion, when Mercurius has afforded only partial relief. Carbo vegetabilis.—This remedy may either folloAv, or be selected in preference to, Mercurius,—after a previous dose or tAvo of Aconite when necessary,—in Aphthous sore throat characterized by the appear- ance of small white specks or pimples (which, if not checked, become confluent and spread beyond the throat) on the enlarged and protube- rant tonsils, when the patient complains of severe burning and pricking pain, with great thirst. Acidum nitricum is indicated when Aconite and Mercurius have been administered in Aphthous sore throat, characterized by superficial ulcerations in the throat, and the small white or gray ulcers refuse to put on a healing appearance a few hours after the use of the latter re- medy. Nux vomica.—This remedy is especially useful when the sore throat appears to arise from, or to be accompanied by, symptoms of deranged digestion, and when a sense of scraping or excoriation exists in the throat, and also when a feeling of contraction is experienced in the upper part of the throat during empty deglutition ; secretion of viscid SORE THROAT, OR QUINSY. 141 mucus, which can be expectorated only with great difficulty, and some- times accumulates in such a quantity as to threaten suffocation ; or there is swelling and elongation of the uvula, producing a constant desireto swallow; at times only a sensation of swelling, with aching pressive pains; or when cold has been the exciting cause, and the affection is attended with dry cough and headache, chiefly in the morning, and pains under the lower ribs during the cough. This remedy is likewise indicated when there are small offensive ulcers of the throat, or when considerable debility is present. (Vide Ulcerated Sore Throat. Sulphur is frequently useful after Nux vomica.) Pulsatilla is frequently serviceable after Belladonna when there is an undue secretion of viscid mucus in the fauces ;—but it is more par- ticularly when the following symptoms are met with that this remedy is called for : gastric derangement, with dark livid redness of the throat and tonsils ; a sensation as if the parts affected were much swollen, or a feeling of enlargement in the upper part of the throat, as also of exco- riation and scraping, Avith dryness of the throat without thirst; shooting pains in the throat when not swallowing; aggravation of the symptoms towards evening, attended with shivering; also accumulation of adhe- sive mucus in the throat. This remedy is more particularly suitable for females, or for individuals of a mild and phlegmatic temperament. Chamomilla is a remedy particularly useful in sore throat when it occurs in children, or in nervous or sensitive females who suffer much from trivial ailments, and especially when the disease has been brought about by checked perspiration,—when there are shooting or burning pains, with a sensation of swelling in the throat, deep redness of the parts' affected, inability to swallow solid food, especially when lying down; thirst, with dryness and heat of the mouth and throat, or secre- tion of frothy saliva with burning heat in the throat and gullet; swelling of the tonsils and glands before the ear and under the jaw; cough ex- cited by constant tickling in the throat, attended with hoarseness ; fever towards evening; alternate heat and shivering, redness of the face, but especially of one cheek, great excitability and tossing about. > Ignatia is indicated when there is a sensation as oj a plugm the throat when not performing the act of deglutition, with red and inflam- matory swelling of the tonsils or palate; burning pains during the act of deglutition, as if the substance being swallowed were passing over an excoriated surface, or partially obstructed by some foreign body in the throat Liquids are more difficult to swallow than solids ; there are also shooting pains in the cheeks, thence extending to the ears, when not performing the act of deglutition ; induration of the tonsils or evolution of small pustules upon them. Dulcamara is generally a most useful remedy when sore throat par- ticularly in the form of tonsillitis, has arisen from exposure to wet It may be followed by Belladonna or Mercurius, should it not wholly re- move the affection, and should any of the symptoms given under these medicines present themselves. Coffea cruda.—Sometimes useful as an intermediate remedy when manv of the symptoms enumerated under Belladonna, with the excep- tion of the external swelling of the throat, are present; and also when 142 digestive system. there is a sensation as if the uvula were elongated or loaded with mucus, causing a constant inclination to swallow. One of the best indications for its employment in this, as in other diseases, is an over-excitability of the nervous system, characterized by sleeplessness, great restlessness, sensitiveness, disposition to weep, and peculiar impressionability to ex- ternal agents. When the disease occurs in an aggravated form, or Avhen it has been neglected, and all the parts have become so excessively tumefied that the mouth can scarcely be opened, the breath being at the same time ex- tremely offensive, the tongue foul, and the strength much exhausted, Arsenicum may be given with advantage. (See also the indications for the employment of this remedy in sore throat, which have been already given under Scarlet Fever, and will also be found under Malignant Sore Throat.) Hepar sulphuris is valuable in bringing the matter to a head, when resolution cannot be effected, and the quinsy has attained to such a height that its bursting is desirable from the painful sense of suffocation, arising from the tumefied condition of the tonsils. Silicea.—This remedy is, in some instances, of greater efficacy than Hepar in rapidly forwarding the suppurative process, and causing the ripened abscess to burst. It generally promotes incarnation more effec- tual than Hepar. Mercurius may follow either of the last-mentioned medicines, after an interval of a few hours, to facilitate the healing. Silicea and, in some cases, Sulphur may be called for after Mercurius. Bryonia and Rhus have been found useful in some forms of sore throat, the former especially when attended with considerable gastric disturbance, and Avhere there was great dryness of the throat, with redness of the soft palate and tonsils, but no swelling;—the latter Avhere there was con- siderable fever towards evening, hot dry skin, aching and pricking pain during deglutition, lowness of spirits, and excessive anxiety. Bryonia is indicated by sore throat, with difficult deglutition and hoarseness; pain in the throat as from excoriation; excessive dryness of the throat, and pressure in the throat as if caused by a hard angular body; pain and pricking in the throat, which is also experienced on external pressure or on moving the head; accumulation of adhesive mucus in the trachea, temporarily removed by coughing. It is further called for when there is marked gastric disturbance, the tongue covered with a dirty yellow fur, the taste insipid, and the bowels confined ; when there is severe frontal head- ache and very disturbed sleep, with dryness of the throat, redness of the tonsils and palate (velum palati), Avithout swelling. Rhus toxico- dendron, when the pains seem situated lower in the gullet, the disposi- tion of the patient anxious, depressed, or disposed to tears ; and when Bryonia has not been sufficient to remove the complaint. Where there is difficulty of swallowing, and, at the same time, a sensation as if a plug or some kind of foreign substance were in the throat,—Lachesis, Nux v., and Arsenicum are useful when otherwise indicated. Sulph., Bella., Baryta, Merc, Sep., Ign., G-raph., Am. c, and Cocculus are also indicated by this latter symptom. In obstinate cases, such as are occasionally met with in bad constitutions, the healing of the cavity, sore throat, or quinsy. 143 after the matter has been discharged, goes on very unfavourably, and even fresh abscesses form in succession: Sulphur, Hepar s., and Psori- cum, repeated every eight or twelve hours, have chiefly been recom- mended to subdue these fortunately rare symptoms ;—Sulphur in ordinary cases, Hepar, when the patient has been previously subjected to an abuse of Mercury under allopathic treatment, and Psoricum when Sulphur has been taken in excess.1 Sepia is a useful remedy in obstinate cases of angina, with pain in the fauces as if the parts were excoriated, and prickings during the act of deglutition. Relaxed sore throats generally require Nux, Puis., Capsie, Cf-en- tiana cruciana, or Sulph., &c. (See also the other remedies mentioned in the article on dyspepsia, as such sore throats are commonly connected with deranged digestion.) The following remedies may also be mentioned as being useful in angina when the symptoms are as described:— Veratrum album is indicated by constrictive and suffocating pain in the throat, particularly during deglutition ; sensation of contraction in the gullet; sense of roughness and scraping, or of extreme dryness in the throat; intumescence and burning in the gullet, sometimes at- tended with danger of suffocation. Cocculus, indicated by great dryness and sensibility of the gullet, causing everything partaken of to seem pungent, acid, or too salt; by constriction or sensation of paralysis in the gullet, and noisy or clucking deglutition. Capsicum is often useful in sore throat from cold, when Puis., Cham., Ign., Bry., or Nux v., afford little relief, particularly when a degree of fever continues, with shiverings and thirst, followed by heat; pressive aching pains, accompanied by a sensation of spasmodic con- striction in the throat; distressing cough; constant desire for the recumbent posture and for sleep, with dread of the slightest breath of cold air. In gangrenous sore throat, or sphacelated quinsy:—Ars., Lach., Carbo v., Am. e, China, Conium, Rhus, or Baryta m., are the reme- dies which are chiefly to be relied on where there is any chance of reco- very. (See Ulcerated Sore Throat.) The diet of the patient must be regulated according to the degree of inflammation present. If required, the throat may be gargled with a little warm water, and when much pain is present, inhalation of the vapour from boiling water will often afford considerable relief, but at the same time it may be ob- served that all medicinal gargles, blisters, leeches, or other topical applications are rendered unnecessary by proper homoeopathic treat- ment. While we thus free the patient from a considerable degree of annoyance and needless suffering, we, at the same time, by a careful attention to the symptoms, and the exhibition of the proper remedy, effect a speedy cure. In overcoming the predisposition to sore throat, Mercurius, Sepia, Baryta m., and Graphytes, have been found useful. 1 Brit. Jour, of Homoeopathy, No. VII. 144 DIGESTIVE SYSTEM. The latter two particularly, Avhen sore throat results after every expo- sure to cold, and is always prone to terminate in suppuration. ULCERATED SORE THROAT. Malignant Quinsy. Malignant, putrid, or gangrenous Sore Throat.—Angina Maligna, Tonsillitis Maligna, Cynanche Maligna. This serious disease is also known by the name of Scarlatina Maligna, from the eruption with which it is frequently attended. It is usually epidemic, of a highly contagious nature, and generally occurs in damp and sultry autumnal seasons. It sets in with coldness and shivering, succeeded by heat and accom- panied with great languor and oppression at the chest; nausea, or vomiting, and sometimes purging; eyes inflamed and watery ; deep-red colour of the cheeks; the nostrils are also more or less inflamed, and secrete a thin acrid discharge, frequently causing soreness or excoria- tion of the nose and lips; pulse indistinct, or very weak, small, and irregular ; tongue white and moist. The deglutition is painful and difficult, and the throat, on being exa- mined early in the disease, is observed to be of a bright red colour, and much tumefied; but this state is very soon altered, and numerous ulcers of various sizes will then show themselves interspersed over the parts, which become covered with a white, grayish brown, or livid coat. In some cases, these ulcerations spread so widely as to extend over the whole fauces into the nostrils, or downwards even to the glottis and gullet, &c, and assume a sloughing appearance as they increase in magnitude. The prostration of strength, considerable from the first, is noAv excessive; the tongue, lips, and teeth are covered with brown or blackish incrustations, and there is more or less delirium ; the breath is extremely fetid, and the patient himself complains of a disagreeable odour. The neck appears swollen and of a livid colour, and an efflores- cence of a faint scarlet hue, or blotches of a dark or livid red, sometimes intermixed with petechiae, break out on various parts of the body, and usually, though not necessarily, add to the danger,—as many are carried off, particularly children or persons of an advanced age, without any eruption, when the local symptoms are severe and the fever high, —but the appearance of livid spots or petechiae, and other indications of so-called putrescency, Avith frequent shivering, weak, fluttering, or intermittent pulse, sunken countenance, severe purging, extreme pros- tration, and bleedings from the nose, mouth, &c, must decidedly be regarded as symptoms of imminent danger. When the local symptoms are mild, the danger is rarely great; and even in the severe forms of the disease, when a gentle sweat breaks out about the third or fifth day, when the sloughs throw off in a favourable manner, leaving a clean, florid, healthy-looking bottom, and the respi- ration becomes more gentle and free, the expression of the face more lively, and the pulse stronger and more equal, a salutary result may be held in expectation. Therapeutics.—The subjoined remedies will frequently be found adequate to subdue the various forms which the malady assumes, where ULCERATED SORE THROAT. 145 any prospect of a cure may reasonably be entertained from the com- mencement : Aconitum, Belladonna, Mercurius, Acidum nitricum, Pul- satilla, Arsenicum, Lachesis, Nux v., Carbo vegetabilis, Sulphur, &c. The accompanying fever being generally of a low typhoid character, Aconite is rarely necessary in this complaint; however, there are cases, particularly when the fever runs high from the commencement, in which advantage is found to result from a dose or two of this remedy, followed by Belladonna as soon as the patient complains of dryness, Avith impeded deglutition and a sense of constriction or choking in the throat, which, on examination, is observed to be swollen and to present a florid red appearance. Belladonna is additionally indicated when the fever continues to run high; when the face is bloated and the eyes much inflamed; when the patient is affected with considerable delirium, and is, occasionally, with difficulty to be restrained from leaving the bed, or committing acts of violence; or, further, when the rash, which sometimes breaks out in this disorder, about the third day, presents a scarlet hue, and is smooth and glossy. In cases in which the symptoms are mild, or in which the above- mentioned symptoms have been reduced by means of the remedies quoted, and an increased secretion of mucus supplies the place of the previous dryness, while the patient is at the same time afflicted with nausea and bilious vomiting,—a dose or two of Pulsatilla may be administered with good effect. The progress of matters in the throat must, however, be carefully watched, and as soon as the presence of small ulcers, or still better, their incipient formation, can be detected, a dose of Mercurius should be prescribed, followed by Acidum nitricum when, from the increasing size and painfulness of the ulcers, Mercurius does not promise to arrest their progress or cause them to assume a healthy aspect. In the milder forms of this disease, the two last-named remedies will frequently be found sufficient to conduct it to a speedy and successful termination ; but in those much more dangerous forms, which the com- plaint so readily assumes when it rages as an epidemy, and when the patient, at the commencement, is seized with vomiting and purging, at- tended with such prostration of strength as to render it impossible for him to leave the recumbent posture without feeling faint, and compelled to fall back exhausted by his efforts ; when, moreover, the ulcerations spread with alarming rapidity, and early take on a sloughing character. In such cases, the conducting of the disease to a happy issue becomes obviously a much more serious and difficult task.. Here the symptoms must generally at once be attacked by administering Arsenicum,— sometimes, however, benefit will be found to result from a dose of Pulsa- tilla beforehand, when there is an excessive degree of bilious vomiting,— but Arsenicum must unhesitatingly be had recourse to when there is that marked prostration of strength so characteristic of this disease, ac- companied with nausea or vomiting; or when the ulcers present a livid hue. This important remedy is also indicated in a more advanced stage of the disease when the ulcerations are covered with dark sloughs, sur- rounded by a livid margin; the teeth and lips incrusted Avith sordes; 146 DIGESTIVE SYSTEM. the tongue parched, cracked, blackish, and tremulous; the pulse small and irregular; and there is delirium or constant muttering ; Avith fre- quent hanging of the lower jaw; laborious respiration ; acrid discharge from the nostrils, causing excoriations; the eyes dull and glassy; the skin hot and dry, and the thirst excessive, yet the patient drinks but little at a time, and appears to perform the act of deglutition with great pain and difficulty; finally, when the prostration of strength is so extreme that the patient seems rapidly sinking, and a rash of a livid colour breaks out in blotches, here and there intermingled with petechiae. Lachesis will frequently be found very useful a.fter, and in some cases alternately with, Arsenicum, should the patient complain of great pain in the throat, Avhich is aggravated by the slightest external pres- sure ; or should the sloughs seem indisposed to cast off, and the neck become much swollen and discoloured. Conium has been recommended when the diseased parts assume an ash-gray colour and a dark brown or blackish aspect, paleness and puffmess of the face, swelling of the tongue, inarticulate speech, loose, sanguineous, involuntary stools, depression of strength and spirits, evolution of a whitish eruption on various parts of the body. When the tendency to gangrene continues, and the patient is still affected with considerable prostration of strength, accompanied with debilitating sweats, Cinchona will often be found of service. Nux vomica is frequently serviceable after Arsenicum, when the diarrhoea has been checked, but numerous, small, foul, offensive ulcers are seen in the mouth and throat,—and may be succeeded by Carb. v., should a copious fetid ichor be discharged from the ulcers, attended with extreme exhaustion, and small, indistinct, or scarcely perceptible pulse. Secale comutum may sometimes be administered with advantage in alternation Avith Carb., when the latter appears to afford but temporary benefit. Rhus is occasionally useful in extreme cases, particularly if there be great muscular weakness, with trembling of the extremities, especially on movement; sopor, and other symptoms described under this remedy in the chapter on Typhus. When, from the beneficial effects of Arsenicum, or any of the other remedies above mentioned, the strength of the patient becomes invi- gorated, the countenance more animated, and the sloughs are thrown off in a satisfactory manner, yet the ulcers threaten to become indo- lent; these will, generally, very speedily acquire a clean and florid bottom, and begin to cicatrize, on the administration of Acid, nitricum. In other cases the aid of Sulphur and Silicea will be found necessary. For further particulars in the treatment of malignant sore throat, the reader is referred to page 112 of this work.1 In conducting the cure, the utmost cleanliness, combined with free ventilation, ought to be strictly observed, for the double purpose of removing all malignant ex- cretions and effluvia,—and thereby putting a check to the ready exten- sion of the contagion,—and providing for the comfort and Avell-being of the patient. The diet should consist of semolina, sago, gruel, and similar articles of food. 1 See also Sore Throat. inflammation of the cesophagus. 147 Angina Pharyngca. Pharyngitis. Cynanche Pharyngea. Inflammation of the membrane which lines the pharynx is generally an attendant on tonsillitis ; and, in like manner, when phlegmonous in- flammation commences in the pharynx, it for the most part, extends to the tonsils. In pharyngitis simplex, although there is usually some de- gree of inflammatory fever, it rarely attains a considerable height, and is, together with the local affection, with facility subdued by means of a dose or two of Aconite. When the inflammation spreads to the tonsils and neighbouring parts, the same remedies must be employed which have been enumerated under Tonsillitis, which see. When the velum palati is particularly implicated, Coffea, Belladonna, Mercurius, or Nux vomica answer best, after Aconitum, where the lat- ter has been called for, but found inadequate to complete the cure. If, on the other hand, the uvula participates chiefly in the pharyngeal in- flammation, Nux v., Coffea, Bella., Merc, Sulphur, or Calcarea are, in addition to Aconitum, the more important remedies. When a spasmodic, almost suffocating, constriction of the gullet takes place in pharyngitis, and Belladonna, Mercurius, or Lachesis fail, Cal- carea c often affords rapid relief. inflammation of the oesophagus, oesophagitis. Inflammation of the gullet is more frequently met with as a sympto- matic disease. It is, accordingly, sometimes encountered in strictures, measles, small-pox, and in the case of tumours in the neighbourhood of the oesophagus. It does, however, occasionally occur in an idiopathic form, either in consequence of mechanical or chemical irritants, or otherwise. The disease is indicated by the following symptoms : a sense of burning heat is experienced in the oesophagus, either high or low in the tube, accord- ing to the seat of the disease, with painful and difficult deglutition. The patient can almost always point out the locality of these, generally cir- cumscribed, sensations ; and consequently refers them either to the neck or to the back, between the shoulders, and under the sternum. In the treatment of symptomatic oesophagitis, our attention must be directed to the removal of the exciting cause, when this is practicable. In the idiopathic form again, we must be guided, in the selection of our remedies, by the law similia similibus. Amongst the medicines which are capable of producing symptoms, analogous to those which charac- terize the disease, Belladonna, Hyoscyamus, Cantharis, Arsenicum, Mercurius, Arnica, Carbo v., etc., are the most important. In some instances it may be found requisite to commence with Aconitum, but generally speaking, the attendant fever, of the phlogistic character, will find a sufficient antidote in Belladonna, which remedy is, moreover, better adapted to the collective features of the complaint. Hyoscyamus frequently succeeds in removing any signs of spasmodic contraction in the gullet when Belladonna is insufficient to remove them; but when the burning heat continues unabated, and deglutition is still performed with great pain, Cantharis should be resorted to. Mercurius is 148 DIGESTIVE system. especially useful when symptoms of incipient suppuration make • their appearance; Arsenicum, when great prostration of strength sets in, either in the course of the complaint, or at the commencement of the attack, accompanied by intense thirst and sleeplessness. Should only partial relief result from Arsenicum, Carbo v. may be had recourse to. In other instances Veratrum may be required. In cases arising from mechanical lesion, the early employment of Arnica has been favourably spoken of. The remedy selected in any case will rarely require to be repeated earlier than six to eight hours after the first dose; and subse- quently at longer intervals, if the symptoms are found to yield. When the symptoms become more unfavourable after an interval of twenty- four hours from the taking of the first dose, another medicament must be prescribed. mumps. Parotitis, Angina Parotidea. Diagnosis.—Inflammation with swelling of the parotid and submax- illary glands, sometimes running high, and extending to the throat and tonsils, with danger of suffocation. This complaint generally affects individuals under the age of puberty, and frequently declares itself as an epidemy, during the prevalence of cold damp weather. When properly treated, it is rarely dangerous, but particularly apt, if not carefully attended to, to attack some more im- portant organs by metastasis,—for example, suddenly disappearing in the glands mentioned, and painfully affecting those of the breast, &c.; these metastases may occur either from fresh exposure to cold, or from the application of saturnine, camphorated or other repellent lotions. This complaint is generally ushered in by the ordinary symptoms of mild catarrhal fever, after which the swelling declares itself, sometimes interfering with the motion of the jaw, and, by the extension of inflam- mation to the tonsils, affecting the hearing and impeding inspiration. Therapeutics.—Mercurius may almost be termed the specific remedy in the idiopathic form of this disease. When Mercurius does not promise to produce much benefit, after a dose or two (which is frequently the case in those who have been for- merly salivated by Mercury under allopathic treatment), Carbo vegeta- bilis should be administered, particularly if the affection be accompanied by a considerable degree of hoarseness. When, through any neglect in taking proper precautions against cold, a metastasis to the brain has taken place, characterized by a sudden disappearance of the swelling of the glands, followed by a loss of consciousness, delirium, or other symptoms of Inflammation of the Brain (which see), we should have immediate recourse to Belladonna, Hyoscyamus, or Cuprum aceticum, etc. Belladonna is moreover indicated when the swelling is red and pre- sents an erysipelatous appearance. If the inflammatory symptoms do not readily yield to Belladonna, Hyoscyamus may be given; and after the latter Rhus, Bryonia, Sulph., Arsenicum, Lachesis, or Silicea, according to circumstances. indigestion, or dyspepsia. 149 Should, however, the disease in the same manner be transferred to the stomach, Carbo Vegetabilis is usually a most useful remedy; when it fails to afford all the desired relief, Cocculus may be had re- course to. When the glandular enlargement occurs as a sequela of any of the following disorders, the remedies thereafter mentioned will generally be found the best adapted to effect resolution when practicable: of Typhus, Bella., Sulph., Calc. c ; of Measles, Arnica, Bryonia, Rhus; of Scarlatina, Hepar s., Dulc, Baryta, Bella., Rhus, and Arsenicum. —Carb. v., Silicea, Lycopodium, Hepar, Conium, Chamomilla, Aurum, Sulph., and Calc, in general cases, according to circumstances. During the treatment of this affection, every care should be taken that the patient be kept moderately warm, exposed neither to damp, cold draughts, nor vicissitudes of temperature. indigestion, or dyspepsia. This disease appears in so many different phases, that we shall simply content ourselves with an enumeration of some of the principal exciting causes, and refer to the symptoms given under the different medica- ments for its Diagnosis. The following may be considered the chief of these:— Irregularities in diet—such as an over-indulgence in the pleasures ot the table, partaking of rich and indigestible food and stimulating soups, excessive use of wine, malt and spirituous liquors, strong tea, coffee, and other stimulants ; imperfect mastication of food ; irregularity of, or too long fasting between meals ; indolent or sedentary habits ; exhaus- tion from intense study ; keeping late hours ; mental emotions, &c. The foundation of this disorder is frequently laid in early life, by the baneful practice of administering large doses of calomel and other dele- terious drugs, for the most trivial as well as the more serious derange- ments of the chylopoietic viscera ; and the evil is perpetuated in more mature age, by a continuance of the same absurd and injurious system. Therapeutics.—The principal homoeopathic remedies for the treat- ment of this affection are : Nux vomica, Sulphur, Pulsatilla, Bryonia, Chamomilla, Ipecacuanha, Ignatia, Carbo vegetabilis, Cinchona, and Hepar sulphuris. Nux vomica covers the following symptoms, either when they have arisen in consequence of sedentary habits, excessive mental exer- tion, or long watching, or from the abuse of wine or ardent spirits: the head confused, with occasionally a, feeling as if resulting from intoxica- tion, and giddiness with sensation of turning and wavering of the brain; headache, unfitting for, and increased by, mental exertion ; tearing, drawing, or jerking pains in the head or cheeks, and pulsative pains, and a sensation as if a nail were driven into the brain ; congestion of blood to the head, with humming in the ears. The headaches are often deeply seated in the brain, or in the back part of the head, frequently confined to one side, or over the eyes, and at the root of the nose, coming on chiefly in the morning, after a meal, or in the open air. Yellowness of the lower part of the white of the eyes, with a mist 150 digestive system. before them; a sensation as if one were about to fall; sparks, or small gray or black spots before the eyes ; short-sightedness ; pale or yellowish colour, or redness of the face, especially about the mouth and nose ; frequent headache, and impaired powers of digestion, with insipidity of food; foul, dry, white or yellowish tongue ; thirst, with water-brash, particularly after acids or rich food ; accumulation of slimy mucus, or water in the mouth; metallic, salt, sulphurous, herbaceous, mucous, bitter, sour, sweetish, or putrid taste, chiefly in the morning, or after meals; bitter eructations, or continued nausea, especially after meals, or even after drinking cold water or milk,—or on going into the open air after a meal, or after partaking of acids; heartburn, hiccough, acidity, flatulence, frequent and violent vomiting of food, mucus, or bile, or ineffectual efforts to vomit; distension and fulness in the epigastrium, with excessive tenderness to the touch ; a feeling of tightness of the clothes round the upper part of the waist; cramps in the stomach; con- stipation ; reddish urine, with brickdust-coloured sediment; sleep unrefreshing and restless, either from suffering or otherwise, with disa- greeable dreams, and drowsiness in the morning. One of the most distinctive indications for the employment of this remedy in preference to the next mentioned, is the temperament, which is restless, irritable, lively, and choleric. A disposition to Hemorrhoids is also a good indication. For Pulsatilla we have nearly the same range of dyspeptic symp- toms, with the distinction of its being particularly adapted for females, children, individuals with light hair, and a marked predisposition to purulent exudations at the edge of the eyelids, or to styes, and for mild or phlegmatic dispositions. Amongst its characteristic indications, we more frequently find a want of thirst than thirst; a repugnance to fat and rich meat, and suffering, after taking pork or pastry; general chilliness, or great difficulty in keeping the hands and feet sufficiently warm; deficient sense of smell, sometimes accompanied by increased secretion from the nostrils; frequent and loose, or difficult and loose, or sluggish evacuations ; hypochondriasis, hysteria. Bryonia : Headache, burning or expansive, particularly after drink- ing, attended with bewilderment of the head and vertigo ; tongue dry and red, or covered with a coated, Avhitish-yellow fur; sometimes the aversion to food is so strong, that the patient cannot bear the smell of it; loss of appetite, alternately with unnatural hunger; craving for acid drinks; great thirst; insipid, clammy, putrid, sweetish, or bitter taste in the mouth; acidity and flatulence, or bitter risings after every meal, or after partaking of milk. Hiccough, nausea, water-brash, vomiting of food or bile, particularly at night; tenderness of epigastrium to the touch, sensation of swelling in the pit of the stomach ; especially after a meal, or on walking; sensation of burning in the pit of the stomach, especially when moving. Constipation ; temper restless, iras- cible, and obstinate ; also when want of exercise or anger are frequently the exciting causes of the derangement, or the means of aggravating the symptoms. The dyspepsia is more apt to manifest itself in summer, or in damp Aveather, is frequently accompanied with chilliness. (Rhus is often of service when Bryonia produces little or no improvement.) indigestion, or dyspepsia. 151 Chamomilla: Headache, with sometimes semi-lateral pulling, shoot- ing, and beating in the head; fulness, giddiness, and staggering in the morning when getting up, oppressive heaviness, vertigo, and sensation of a bruise ; headache, felt sometimes during sleep, with obscuration ot the eyes ; and yellow colour of the white; tongue dry and cracked, with a thick and yellowish coating ; mouth dry, with the occasional presence of frothy mucus; excessive thirst and desire for cold drink ; bitter taste in the mouth and of food; want of appetite and dislike to food. Acidity or sour risings, regurgitation of food, nausea, vomiting of food, mucus, and bile; acute, oppressive pain in the region of the heart, distension at the epigastrium, pit of the stomach, and upper part of the waist, chiefly after eating, and at night attended with inquietude and terror ; burning pain in the pit of the stomach, uneasiness and feel- ing of sinking in the stomach ; cramps in the stomach, especially when traceable to coffee; sometimes constipation, but generally relaxation of the bowels. This remedy is valuable in indigestion, brought on by a fit of passion, or suppressed perspiration. . An abuse of coffee and tea is a frequent cause of many descriptions of sick and nervous headache, attended with excitement and dyspeptic symptoms, which will frequently disappear of themselves on the disuse of these beverages. If, however, this result should not speedily ensue, for the effects of coffee we may have recourse to Nux vomica, Pulsatilla, Chamomilla, or Ignatia, according to the character of the symptoms. Against the effects of tea, Cinchona will generally be found an antidote, followed by Ferrum, if necessary; in other cases, Ipecacuanha, Itiuja, or Selinum will be found useful. Ipecacuanha:—Face pale and yellowish; tongue sometimes clean, at others coated white or yellow; aversion to food, and particularly to fat, or to rich indigestible food, such as pork, pastry, &c, or dyspeptic^ suffering on partaking of such; vomiting of food, drink, mucus, or bile sometimes after a meal; retching or easy vomiting, generally attended with coldness of the face and extremities, and sometimes alternating with watery diarrhoea; feeling of emptiness, and flaccidity, and sensa- tion of sinking at the stomach. Headaches, attended with nausea and vomiting; shooting pains, with heaviness and painful pressure on the forehead Both this medicine and Pulsatilla are valuable remedies for indigestion in children, arising from imperfect mastication or improper ^Ignatia may sometimes follow Pulsatilla to complete a cure, or even sunersede it, when there is a tendency to constipation and particularly n persons who are subject to sudden alternations from high to low l^rTeversd; it is especially indicated when grief has been the inducing cause of dyspepsia, hysteria, and hypochondriasis. . In chronic cases, these remedies, as indicated, are chiefly valuable in the commencement of treatment, and may require to be followed by other Jeme^to complete the cure. Sulphur or Tincture of Sulphur, wm be found especially useful after Pulsatilla and lux vomica, in re- moving any symptoms that may remain. Hepar sulphuris is a valuable remedy m some cases of dyspepsia, but particularly when the patient 152 digestive system. has previously been taking blue-pill, or any other mercurial preparation, for a considerable time. Acidum sulphuricum :—Dyspepsia arising from excessive study, drinking, or other excesses, with the following symptoms: great Aveak- ness of digestion; acrid, foul, putrid taste in the mouth, dry tongue, burning and smarting sensation in the throat, sometimes attended Avith pricking, especially at night, and so troublesome as to prevent sleep (Pyrosis); offensive breath, especially in the morning (aphthae); renewal or aggravation of the symptoms from drinking cold water; all cold drinks appear to disagree, unless a little brandy or some other ardent spirit is added to them; accumulation of Avater ; saliva in the mouth; flatulence; bitter risings; vomiting of a limpid fluid, or of food. It may be here remarked that, in cases where Nux vomica seems indicated, but the disposition is of a morose or hypochondriacal turn, Cocculus may be substituted with effect; when, however, the indications for tem- perament are not sufficiently distinctive, Cocculus, Nux vomica, and Pulsatilla may be advantageously alternated. Finally, Carbo vegeta- bilis will frequently remove any symptoms that may remain after Nux vomica. Cinchona is a valuable auxiliary in the treatment of this derange- ment, when there is impaired appetite with great weakness of digestion, which is more liable to be experienced on partaking of supper; flatu- lence ; bitter taste; languor ; hypochondriacal disposition; and particu- larly when we can trace the affection to debilitating losses of fluids, such as the abstraction or loss of blood, too great a drain upon the resources during lactation, prolonged use of aperient medicines, &c.; also in disor- ders arising from the abuse of tea, or from a residence in impure atmo- spheres, especially such as are overloaded with the exhalations of de- cayed vegetable matter. Natrum c. may follow Nux v., Bryonia, or Cinchona, with advan- tage, when a degree of weakness of digestion remains. In chronic cases this disorder sometimes takes a critical turn, when vomiting becomes excessive, everything taken is returned from the stomach, the skin is hot and dry, the patient becomes emaciated, and the countenance cadaverous. In serious cases of this description, Ar- senicum and Lachesis will tend much to invigorate the sinking energies, and even—with the occasional aid of Lycopodium, Veratrum, Baryta, Phosphorus, Conium, or some one or other of the above-mentioned remedies, where necessary,—eventually effect a cure, provided the in- roads of organic lesions have not already placed the unfortunate sufferer beyond the reach of art. (See also Chronic inflammation of the stomach. Cardialgia. Want of appetite. Flatulency, and Derangement of the stomach.) The following are frequent additional pathognomonic signs of deranged digestion, and may, when taken in conjunction with others already described, facilitate the selection of the remedies placed in juxtaposi- tion : Tongue, swollen: Lach., Merc., Ars., Bella., Kali, Hell.; Calc, China, Silic, Dig., Plumb., Anac, Elect., Con., Thuj., Stram., Sec. indigestion, OR dyspepsia. 153 Tongue, with a vhite fur: Puis., Sulph., Merc, Tart., Am. ;—Nux v., Bry., Ant. c, Calc, Sep., Bism., Ign., Ipecac, Dig., Raph., &c. Tongue, with a yellow fur: Nux, Puis., China, Ipecac, Plumb. ;—C nam., Bry., Cocc, Veratr., Bella., Alum., Coloc, China, Sulph., Elect., &c. Tongue, with a slimy fur: Puis., SulpK, Merc, Bella., Acid, phosph.;— Lach., Chin., Sulph., Verb., Nux mosch., Cupr. Tongue, with a brownish fur: Sulph., Bella., Phosph., Sil, Verb., Hyos.j Sabin., &c. Tongue, with a grayish fur : Tart., Amb., Cupr. acet., Puis. Tongue, with a grayish-brown fur (whity-brown) : Ambra, Puis., Nux, Bryon., Ipecac, &c. Tongue, with a greenish fur : Plumbum. with a blackish fur: Merc, Chin., Phosph., Lach. with a dirty fur: B%y., Lye, Olean., Anthraps. with a thick fur: Pids., Merc, Bella.;—Nux v., Cham., Sulph. vivid red at the margins: Bella., Nux v. with vivid redness of the papillae: Bella., Ammon. red at the tip : Elect. vivid redness of the whole tongue : Bella., Bry., Lach., Hyos., JSux v., Cham., Ran. sc, Rhus, Ars., Sulph., Veratr., &c. Tongue, dry: Nux v., Sulph., Veratr., Bella., Merc, Nux mosch., Cham. ; Lach., Bry., Rhus, Sep., Carb. a., Baryt. m., Plumb., &c. Tongue, glazed, shining: Lachesis ;—Bella., Sulph., Bry., Ars., Veratr., &c. with elevated Papillce: Elect, Crocus, Oleand., Bella., &c. cracked, defied, or split into furrows: Nux, Puis., Lach., Bella., China. Plumb., Cham., Veratr., Ars., Baryt., Cic, Ran. sc, Sulph Tongue, tremulous: Bella., Ars., Bry., Merc, Dig., Dulc, Nux, Cocc, Ign., Veratr., Lach., Rhus. Saliva, acrid: Merc, Dulc, Veratr. alkaline: Galv. bitter: Ars., Sulph., Thuja. brownish: Bism. cool: Asar. . „ 7 frothy: Bry., Plumb., Ran, sc, Sulph., Spig., Eng., Berb., Canth., Phell., Sab. sIliva, of amSsh, insipid taste : Bry., Puis., Ipec, Ign., Nux v., Cham., ^^S^d^^Bton., Ran, b., Zinc, Cocc, Hepar, Agn., Cl^ToT^en^e, fetid smell: Merc, Dig., Hydrary. subm. of a reddish colour : Sabm. of a saline taste: Sulph., Sep., Veratr., Euph., Merc, sol, Hyose, ^Tliva'o? a^rtaste: Ign., Sulph., Calc. ;- Calc phosph., Galv., Alum., Lact., Natr. s., &c. , Sattva of a sourish-sweet taste : Ainc. oxya. sluivl; of a sweetish taste : Puis., Plumb., Dig., Sabad. ;-Alum, Gran., o qattva thick- Nux mosch., Bism., Bella., &c. IIliva, th^ serous: Pub,] Magn. m, Kreos., Mags, an,, Galv., Lobel, ^11'Llv!"enCaeCious: Puis., Nux Lach., Pho^h Staph., Ar,, Zinc, &e. Saliva of white colour: Ran. b., 01 an,, Sabm., Spy., &c. IumJ, bleeding of the: Nux v., Carbo v., Sulph., Natr. m. Acid, nitr., 154 DIGESTIVE system. Merc, Phosph., Sil, Staph., Calc, Graph., Baryt. c, Am. c, Alum., Magn. m., Acid, sulph., Sep., Kali c, &c. Gums, redness of the : Carb. v.. Kreos., Nux v., Merc, Kali, Natr. m., Phell, Ran. sc, Hep., Aur. Gums, spongy: Nux v., Caps., Natr. m., Carb. a. et v., Bry., Ars., Merc, Staph., Sidph., Kreos., China. Gums, swollen: Nux v., Natr. m., Sulph., Merc, Caps., Staph., Sep., Baryt., Am. m. et c, China, Ac. nitr., Lach., Lye, &c. Gums, tender: Nux v., Lach., Natr. m., Caps.;—Staph., Calc, Agar., Amb., Acid, nitr., Carbo v., Hepar. Gums, fetid: Carb. a. et v.; Acid, n., Staph., Hepar, China, Natr. m., Merc, Graph. Gums, shrinking, or separation of the gums from the teeth : Carb. v., Merc, Sulph., Par., Cist. t Gums, paleness of the: Staph., Plumb., Acid, nitr., Zinc, Oleand., Merc Teeth, discoloration, aching, decay of the: Nux v., Puis., Bryon., Cham., Merc, Staph., Lach., China, Sulph., Calc, Plumb., Ars., Natr., Veratr., &c. Lips, vivid redness and spongy state of the : Nux v., Bry., Carbo v. et a., Baryt. c, Bella., Hep., Lach., Caps., Merc, Sil, Staph., Sulph., Alum., China, Spig., &c. Lips, blanched, yellowish, and somewhat indurated : Nux v., Sulph., Calc, Lycop., Ars., Lach., Can., Clem., Silic, Aur., Natr., Alum., Spig. Throat, sensation of excoriation, roughness, and dryness : Nux v., Lach., Carb. v. et a., Sulph., Puis., Calc, Merc, Cham., Ign., Bryon., Hep., Teuc, Scilla, Staph., &c. Throat, redness of the, with swelling of the uvula, &c. : Nux v., Bryon., Ign., Cham., Caps., Puis., Lach., Sulph., Calc, Baryt., China, Sep., Veratr., Cocc. Eyes, bleared and suffused: Nux v., Puis., Natr. m., Staph., Graph., Cham., Calc, Lye, Bism., Ant., Agar., &c. Eyes, muscse volitantes : Nux v., Puis., China, Lye, Sulph., Sep., Agar., Merc, Cocc, &c. Eyes, appearance of vapour or mist before the : Puis., Plumb., Sulph., Calc, Merc, Bell, Cyc, Dig., Alum., Ign., Enon., Am. m., Ambr., &c. Eyes, sparks, flashes of flame: Nux v., Lach., Lycop., Dig., Staph., Calc. c, Merc, Natr. m., &c. Eyelids, thickened, gorged, and inflamed at the margins: Nux v., Puis., Cham., Merc, Hep., Bry., Sulph., Euph., Veratr., Lye, Ars., Baryt. c, Staph., Sep., Natr. in., &c. Nose, dryness of the nostrils: Sulph., Calc, Sep., Graph.; Bryon., Bella., Ign,, Mag. m., Phosph., Rhus, Kali, Sil, &c. Nose, excessive secretion from the : Ars., Lach., Ign,, Lye, Puis., Ipecac, Hep., Bry., Nux v., Sulph. ; Cocc, Carbo v., Alum., Ammon. c, Calc, Merc, &c. Nose, itching in the nostrils: Nux v., Puis., Carb. v., Ign,, Am. c, Agar., Spig., Teuc, Cin., Sabad., Sulph., Calc, &c. Nose, imaginary smells : Nux v., Puis., Sulph., Calc, Ars., Graph., Alum., &c. Nose, deficient sense of smell: Puis., Sep., Sulph., Calc, Alum., Ipecac, Natr. m. Nose, great acuteness of smell: Sulph., Lye, Hep., Colch., Nux v., Cham., Calc, Kali e, &c. Ears, dryness of the (eustachian tube) : Graph., Lach., Ac. nitr., Petr., Carb. v., Ars., &c. INDIGESTION, OR DYSPEPSIA. 155 Ears, acuteness of hearing: Lach., Ars., Lye, Bry., Cham., Veratr., Sep., Plumb., Magn,, Chin., .Sil, &c. Ears, dulness of hearing : Nux, Puis., Sulph., Calc, Carb. v., Lach., Bell, Ars., Veratr., Ant, Anae, Asar., Kal, Hep., Staph., Bry., Lye, &c. Head, frontal headache : Nux v., Puis., Bry., Ign., Natr. m., Chin., Plumb., Sep., Natr. m., Ant., Staph., Plat, Sulph., &c. (See also Art. Cephalalgia.) Face, flushes of heat in the : Lye, Graph., Cocc, Kali c, Alum., Ambr., Kali m., &c. Face, pimples on the: Nux v., Carb. v. et a., Lach., Sulph., Sep., Acid. nitr., Acid, m., Ambr., Alum., Hepar., &c. Face, eruptions various, on the : Nux v., Rhus, Sulph., Lach., Lye, Graph., Mere, Sep., Calc, Am. e, Dig., &c, &c. Face (earthy colour of the, and of the skin in general) : Nux v., Ars., Lach., Lye, Ign., Ipecac, China, Natr. m., Mere, Bry., Silie Face, pale: Nux v., Puis., Carb. v., Lye, Sidph., Veratr., Magn. m., Plumb., China, Sep., Calc, Anae, Dig., Graph., Ign., Am. c.,Ambr., Olean,, Merc, &c. Face, red: Bry., Nux, Cocc, Lye, Puis., Plat., Hep., Ign., Sulph., Calc, Lach., &c. Face, yellowish: Nux v., Puis., Lye, Natr. m., Magn. m., Carb. v., Graph., Calc, Mere, Bry., Sulph., Sep., &c. Skin, like parchment: Arsenicum ; Lye, Graph., China, Sep., Ambr., Am. c, Calc, Kali, Natr. e Giddiness : Nux, Pals., Plumb., Matr. m., Op., Bry., Calc, Kali, Natr. m., Lach., &c. (See also Art. Vertigo.) Head, confusion in the: Bry., Nux, Puis., Calc, Sepia, Plumb., Op., Rhod,, Zinc, Natr., Plat., Staph., Caps., Graph., Magn. m., Calc, ph., Nux mosch., Rhus, Ambr., Am., &c. Upper Extremities, tremidousness of the : Bry., Rhus, Veratr., Phosph., Silie, &c. Upper Extremities, numbness (torpor) : Nux v., Lye, Cham., Croc, Graph., Kali, Sep., Sulph., Verat., Silie, Magn. m., Ambr., Baryta, &c. Upper Extremities, jerkings or spasmodic movements of the: Puis., China, Ign., Lye, Bry., Cham., Plumb., Cie, Sabad., Bella., Op., &c. Hands, tremulousness of the : Lach., Sulph., Calc ; Phosph., Zinc, Agar., Cocc, Kali, Tart, Rhus, Sabad,, Bis., &c. Hands, numbness of the hands and fingers: Nux v., Lye, Puis., Croc, Carb. a., Cocc, Phosph., Lye, Veratr., Zinc, Calc, Am. e, Baryta e, Sep., Sil, Matr. m., Kali, Zinc, Cham., Sidph., &c. Hands, jerkings or spasmodic movements : Ign., Lye, Bry., Cham,, Kali, Cie, Merc, Phosph., Sulph., &c. Upper Extremities, tingling, crawling, or creeping sensations in the : Nux v., Puis., Ign., Caps., Rhod., Sulph., Am., Magn., Bella., Sabad,, Mgs., Mags, ans., &c. Hands or Fingers, tingling, &c, of the : Veratr., Sulph., Rhod., Nat. m., Magn., Colch., Lam., Cole, Sil, Baryta c, Nux, Bry., Bella., Cocc, &c. Fingers, paleness and torpor of the, as if dead: Sulph., Calc, Thuja, Chel. ; Am. mr, Lye, Hep., Phosph., Acid, phosph., Mere, Acid, m., Acid, n,, Hep., Cie, &c. Hands or Fingers, coldness of the: Nux v., Sulph., Puis., Cocc, Ambr., Baryta c, Cham., Natr. m., Phosph., Petr., Kali, Ac. nit., Ran. b., Scilla, Tart, Thuja, &c. Hands or Fingers, burning heat in : Nux, Lach., Lye, Carbo, Staph., Phosph., &c. 156 DIGESTIVE SYSTEM. Lower Extremities, tremulousness of the: Nux, Cocc, Puis., Bry., Lye, Calc, Carb. v., Cliam., Natr., &c. Lower Extremities, numbness of the (torpor): Nux v., Graph., Petr., Ant., Carb. v., Calc, Lye, Alum., Ambr., Cham., Platina, Plumb., Kali, Olean., Sulph., Sep., Silie, Verat., Led., Thuja, &c. Lower Extremities, jerkings or spasmodic movements of the : Ign., Puis., Carb. v., Op., Lye, Kali, Ipecac, Scilla, Natr. m., Plat, Sep., Am. c, Ba- ryta e, Silie, Sulph., Cie, &c. Lower Extremities, torpor and paleness (deadness) : Graph, chiefly. Lower Extremities, creeping, crawling or tingling in the: Plat, Rhod., Sulph., Caps., Bor., Sabad., Guai., Raph., &c. Feet, creeping, &c, in the : Caps., Sulph., Sep., Am., Par., Zinc, ox., Croc, Ammonium, Cole, See, Am. m. Feet, torpor and paleness (deadness) of the : Calc, Nux v., Rhus, Lye, Chel, See Feet, feeling of numbness or torpor in the : Nux, Cocc, Lach., Plumb., Sep., Kal, Sil, Oland., &c. Feet, feeling of heat in the: Puis., Staph., Phosph., Elect, Petr., Led., &c. Feet, coldness of the : Sulph., Sep., Sil, Cocc, Carbo a., Graph., Kalic, Rhod., Colch., Con., Dig., Lach., Lye, Plat, Plumb., Acid, nitr., Natr. m., &c. Lower Extremities, tottering, staggering, (trembling) or giving way of the legs or knees : Nux v., Puis., Bry., Plat., Lach., China, Ruta, Sulph., &c. Lower Extremities, cramps in the : Nux v., Sulph., Calc, Lye, Bry., Cham., Acid, nitr., Lach., Carb. v. et. a., Baryt c, Am. c, An., Colocy., Can., Magn. m., &c. Lower Extremities, cramps in the feet: Nux v., Sulph., Lye Carb., Plumb., Staph., Silie Rhus, Natr., Ran., Graph., Am. e, Petr., &c. Drowsiness, tendency to: Puis., Nux v., Bry., Ant, Cocc, Carb. v., Plumb., Staph., Ign., Am., Cham., Coloe, Ars., Veratr., Zinc, &c. Emaciation : Nux v., Puis., Sulph., Calc, Ars., Veratr., Lye, China, Natr. m., Cham., Ant, Am. e;—Cocc, Carb. v., Fer., Plumb., Graph., Hep., Lach., Mere, &c. Obesity : Cole, Sulph., Baryt. c, Ant. c, Ars., chiefly. Asthma : Nux v., Carb. v., Caps., Cham., China, Sulph., Zinc, Ars., Veratr., chiefly. Moral Symptoms. Hypochondriasis : Nux, Ptds., Sidph., Calc, China, Bella.;—Cham., Cocc, Natr. m., Staph., Rhus, Zinc, Anae, Ars., Aur., &c. Ill-humour, irascibility: Nux v., Bryon,, Cham., Carb. v., Ars., Natr. m., Graph., Veratr., Kali, Sulph., Sep., Sil, Ac. nitr., Lye, &c. Sadness, depression, dejection, gloominess: Ign., Puis., Cocc, Lach., Lye, Natr. m., Sulph., Calc, Plat., Nux v., Veratr., Ars., Graph., Silie, Sep., Ac. sulph., Plumb., Am. m., Anae, &c. Suspicion, mistrust: Puis., Nux v., Lach., Baryt. c, Merc, Ac sulph., Cie, Bella., &c. Anxiety, inquietude : Nux v., Puis., Bryon., Lach., Cham., China, Carb. v., Sulph., Calc, Lye, Mere, Plumb., Acid, nitr., Ars., Veratr., Am., Aur., Sabad., Cie ;—Alum., Amb., Am. m., Anae, Graph., Plat., Natr. m., Rhus, Sep., Staph., Acid, sulph., Cocc, Baryt c, &c. Fickleness : Ign., Plat, Natr. m., Zinc, Cin., Caps., Puis., Sulph., Val, Carb. a., Kali, Ars., Nux mosch., &c. Hysteria, tendency to : Ign., Puis., Plat, Sep., Nux, Sulph., Calc, &c. want of appetite. 157 Accessory Treatment and Diet.—In no class of disorders is it more requisite to adhere strictly to dietetic regulations, than in those which consist of derangement in the digestive system, whether so called functional or organic : the patient should therefore, in such cases, regu- late his regimen, as closely as possible, by the rules1 laid down at the commencement of this treatise, carefully avoiding, moreover, all such articles as he may find disagree with him even if they appertain to the aliments allowed. He should generally abstain from soups, and every- thing that has a tendency to distend the stomach, such as taking large quantities of warm liquids ; he should not indulge his appetite to its full extent, and carefully avoid late hours, unnecessary exposure, and severe mental exertion or anxiety; he should also take sufficient exercise in the open air, and, as much as possible, keep his mind from dwelling upon his complaint, or on gloomy subjects. WANT OF APPETITE. Apepsia. Anorexia. Want of appetite, being a concomitant symptom of many diseases, is treated accordingly in other parts of this work; but we now propose to look upon it as one of the leading symptoms of indigestion, and in this character deserving a particular notice. In a great variety of cases, amongst others that of dyspepsia, it is usually attributable to an ill-re- gulated regimen, imperfect mastication of food, the abuse of tonics and other medicines in large doses, sedentary habits, and the neglect of sufficient exercise in the open air. In many instances the removal of the exciting cause will cure this disorder. Sufferers from this inconvenience should carefully avoid creating an artificial appetite, and also partaking of the smallest quan- tity of food, until the previous meal has been assimilated; the habit of taking tea, and even, as the expression is, "making a meal of it," within a couple of hours after removing from the dinner-table, is a fre- quent cause of apepsia and dyspepsia. Another source is the habit of drinking frequently, or very copiously during meals—thereby attenuating the saliva and gastric juice, and rendering them less fitted for the purpose of digestion. Other causes are the custom of sleeping after dinner, partaking of heavy suppers, before retiring to rest, and the indulgence in fermented vinous or spirituous liquors, or in tea or coffee, particularly the latter. An alteration in the hours of meals, and avoiding too long fasts between them, will frequently remove this affection. 1 As we have already observed at the conclusion of the said " Rules," there are par- ticular cases in which the regulations given are subject to considerable modifications. Thus, in some severe forms of dyspepsia, it is necessary to allow meat only every other, or every third day, or to prohibit it entirely for a time, and to substitute farinaceous food or fish, or meat which is of a less stimulating quality, such as chicken. In other forms particularly where the patient suffers much from flatulence, vegetables must be disallowed. A<*ain, there are cases, but especially those with symptoms of biliousness, or rather excessive secretion of bile, in which milk, eggs, butter, and fat rich food are inapplicable. The use of unfermented bread will frequently be found of more easy di- gestion than that which is made by the ordinary process. There are instances, how- ever in which the former does not agree with dyspeptics. In such cases, bread made by means of the German yeast will often prove of easier digestion. 158 DIGESTIVE SYSTEM. In other cases, early rising, great attention to diet, abstinence from rich or highly-seasoned food, together with the daily use of pure, cold water —drinking a tumblerful an hour or so before breakfast, tAVO to four hours after dinner, and again about the hour of retiring to rest,— will suffice to restore the weakened digestive functions to a normal condition. When, however, we cannot trace this disorder to some of the above, or any other probable cause, when every attention to regimen, and even an alteration of diet, according to individual peculiarities or idiosyncrasy, has failed to produce any good effect, Ave generally find the want of ap- petite accompanied with other symptoms of derangement in the digestive functions, Avhich may prove useful in aiding us to select a proper remedy to restore the natural tone of the stomach;—this Avill be found among the medicines most useful in Dyspepsia and Cardialgia : namely, Nux vomica, Chamomilla, Pulsatilla, Cinchona, Ipecacuanha, Antimo- nium crudum, Bryonia, Arnica, Hepar sulphuris, Lachesis, Sulphur, and Calcarea, &c. Nux vomica is the principal remedy when the want of appetite can be traced to late hours, the habitual use of wine and coffee, or to seden- tary and studious habits, also Avhen the folloAving symptoms are present: dryness of mouth, tongue coated Avhite, with cracks or slimy mucus in the mouth, agustia, pyrosis, or insipidity of aliments (particularly meat), accumulation of water in the mouth, aversion to food, costiveness or con- stipation, confusion in the head or giddiness (as if the results of intoxi- cation), amnesia, and difficulty of fixing the mind to a train of applica- tion, weight in the occiput, tinnitus aurium, heaviness and aching in the limbs, uneasiness and a feeling of working or dragging of the tendons in the lower extremities, or cramps, restlessness, and irritability of temper, —symptoms aggravated in the morning. Chamomilla is frequently found useful after Nux vomica, when, although considerable benefit has been derived, the whole train of symp- toms are not removed. The following are its particular indications: restless sleep, sensation of fulness and aching in the head, heat and red- ness of the face, a degree of fever, tongue thickly coated, yellowish, rough and cracked (anorexia and greenish diarrhoea), and general sen- sibility of the nervous system. This remedy is especially called for, when a bitter taste in the mouth (or vomiting of bile, or of greenish mucus) ensues after eating. Pulsatilla.—This remedy is specific in the affections arising from partaking of over-rich or greasy food, for instance, pork or pastry ; or of aliments causing flatulence, such as vegetables; or of food, in the preparation of Avhich rancid butter or lard has been used. The more immediate indications are, Avhitish, cleft or fissured tongue, with bitter, salt, or foul taste in the mouth, sliminess of the mouth, scraping, rough- ness or acidity at the pharynx, bitter eructations, aversion to warm food or to meat, as Avell as butter, and all rich food ; loss of taste ; distension of the abdomen, and particularly a feeling of tension under the false ribs, borborygmus, retarded or difficult defecation, or diarrhoea, draAying- in of the limbs (resembling that presentment in ague), exacerbation of symptoms in the evening, in contradistinction to Nux vomica, which is WANT OF APPETITE. 159 generally indicated by this occurrence in the morning. This remedy is well adapted to the mild lymphatic temperament, and also when there is a peculiar sensibility, with a dislike to conversation; it is likewise valuable when imperfect mastication is the cause of the affection, as well as in cases, where there is a marked aversion to tobacco, even Avhen the patient is accustomed to its use. Moreover, this remedy will be fre- quently found of benefit in some cases where Chamomilla has only tem- porarily relieved; but should a considerable degree of nervousness, or even irritability, remain after Pulsatilla, Nux vomica may be had recourse to. Cinchona is highly efficacious in anorexia occurring during foggy Aveather, Avhen the air is charged Avith unwholesome vapours, or in the vicinity of marshy lands. The following are its indications : a sensation of constant satiety, with general indifference'to food, and adypsia; tongue cracked, or loaded with yellow or white coating: sensation of sinking and fluttering in the epigastrium (particularly when this symp- tom can be traced to the effects of tea); eructation after eating; desire for highly-seasoned food, acids, pepper, and other condiments ; general weakness, with inclination to assume the recumbent posture, and inability to remain long in one position; uncomfortable feeling of dry heat, or shivering and sensitiveness in the open air; retarded or interrupted sleep; general feeling of uneasiness, Avith moroseness and peevishness. Ipecacuanha is indicated by the following symptoms: Nausea or vomiting, without foulness of the tongue, with dislike to food. _ Tobacco —even to smokers—has a nauseous taste, and causes vomiting. This remedy is also useful when the impaired appetite has arisen from bolting the food, particularly in children, and may be followed by Pulsatilla, when only partial relief has been obtained. Antimonium crudum will prove a good remedy in cases where a great disposition to nausea and vomiting with foul tongue exists; ano- rexia, dryness of the mouth with great thirst, particularly during the night; accumulation of phlegm in the throat, Avith continual attempts to clear the throat; frequent rising, soon after meals, of the food last partaken of; pain or disagreeable fulness at the epigastrium, frequently with sensibility to external pressure. In cases of recent standing with the above symptoms it is very speedily efficacious ; and when relief does not quickly follow, the next mentioned remedy should be had recourse to. Bryonia in recent derangement of the stomach with anorexia ; when we find thirst more during the day than through the night; with a sen- sation of dryness in the throat, extending down the oesophagus ; chilli- ness ; yellow, dark brown, or Avhite-coated, cracked tongue, with consti- ^Arnica —This remedy is valuable when the loss of appetite has arisen from sitting up at night; watching at a sick bed; from not having devoted a sufficient number of hours to the period of rest; from intense mental exertion ; or from provocation or excitement. When from these causes the nervous system is powerfully affected ; tongue coated yellow; taste foul, bitter, or sour, or nauseous, or chalybeate, with offensive smell from the mouth; rising of the food, or eructations of the taste or 160 digestive system. smell of rotten eggs ;* aversion to smoking and desire for acids ; sensa- tion of fulness in the scrobiculus after meals, with inclination to vomit; distension of the abdomen, Avith pinching colic, relieved by doubling up the body, and renewed by drinking the smallest quantity of wine, or passing off and then coming on with inclination to evacuate the bowels; general irritability and impossibility of fixing the mind upon any subject; inclination to remain lying down, as this position relieves a heavy stupe- fying headache, which the least motion or even conversation increases. Hepar sulphuris is useful in chronic cases of want of appetite, with indigestion from the slightest cause, notwithstanding the most careful observance of diet. It is indicated by desire for high-seasoned dishes, acids, and wine; nausea, even inclination to vomit, particularly in the morning; and constipation, frequently with colic. This remedy is one of our chief antidotes to Mercurius, and consequently one best adapted to those affections of the stomach which have arisen from the long-con- tinued use of calomel, or other mercurial preparations. Lachesis is a valuable remedy to follow Hepar sulphuris in obstinate cases, particularly when long-continued constipation is complained of, and the symptoms have ahvays been aggravated by acid drinks, &c.; in the latter case Arsenicum is also useful, and may sometimes precede or follow Lachesis with advantage. In addition to the two last-mentioned remedies, we may observe, that in the same class of cases, Belladonna, Mercurius, Sulphur, and Cal- carea, may be used with considerable advantage, when the former reme- dies have afforded only partial relief. Acidum sulphuricum is a useful remedy in cases of impaired appe- tite, with weakness of digestion, arising from habitual excess in the use of ardent spirits, or from debilitating loss of fluids, such as blood, or in consequence of excessive study,—with the following symptoms: acrid or putrid taste, dry tongue, burning and smarting sensation in the gullet resembling heartburn ; offensive breath, especially in the morning; aphthge; disagreeable sensation of pricking in the throat, frequently occurring during the night, and disturbing sleep. In other cases the practitioner or student may consult the subjoined remedies in the Materia Medica with advantage, either as applicable to the treatment of this affection, or to that of dyspepsia and cardialgia: Sepia, Col- ehicum, Ferrum, Silicea, Buta, Ammon c, Rhus, Aurum, Baryta c, Acid, nitr., Kali c, Natr. m. and c, Graphites, Hyoscyamus, Ignatia, Staphysagria, Kreosotum, Petroleum, Anacardium, Drosera, JST. mosch., Capsicum. (See also Dyspepsia and Cardialgia.) derangement of the stomach, eructations, etc. Under this head we intend treating of a disorder which may arise in individuals of a generally unimpaired digestion—the characteristics of eructations will assist to indicate the remedy for persons subject to this unpleasant affection. The ordinary causes of this derangement are: hurried, imperfect 1 [Tartarus emet., Sulphur, Valerian, Sepia, Stannum, also cover the latter symptom): the practitioner will therefore do well to bear the said remedies in mind, when this particular symptom is a prominent one, and does not yield to Arnica. derangement of the stomach. 161 mastication; overloading the stomach; fat, greasy, indigestible, or tainted food, flatulent vegetables, ices, stimulants, &c Therapeutics. — When the symptoms of approaching stomachic derangement declare themselves immediately, or a few hours after a repast, a little strong black coffee is frequently a sufficient resto- rative. Should, however, this fail to relieve, and sick headache and inclina- tion to vomit be present, we should assist Nature by tickling the fauces with a feather, and giving tepid Avater to drink until the stomach has completely evacuated its contents. If, nevertheless, on the folloAving morning, symptoms of deranged digestion continue, such as nausea, inclination to vomit, or vomiting, and disagreeable or offensive eructa- tions, we should administer Antimonium crudum,—one of our most useful remedies in this affection, and which rarely fails to afford at least some relief. It is also peculiarly indicated when the affection has arisen from drinking sour or impure wine; or when, in addition to the symptoms of disordered stomach, a degree of fever returns every second day. Ipecacuanha.—When a rash has been thrown out, from the effects of a disordered stomach, attended with anxiety, oppressed breathing, and sickness, this remedy will, in most cases, effect speedy relief;—but should the difficulty of breathing, or a degree of nausea, or other un- easiness continue, Bryonia should be employed. {Tartarus emeticus is sometimes more efficacious than either Ipecac, or Bryonia, Avhen there is great drowsiness, with constant nausea and frequent vomiting: re- laxed, brownish, yellow motions.) Bryonia.—In addition to the usefulness of this remedy in the fore- going instance, it is also very serviceable when the following symptoms are present: bitter eructations; fever, alternately with coldness and shivering; or redness of the face, heat in the head, and thirst with coldness and shivering; also Avhere diarrhoea or constipation and peevishness, or excessive irritability are present. (In derangement of the stomach, arising from succulent vegetables, and attended Avith excessive flatulence, this remedy is frequently productive of speedy relief.) Arsenicum is appropriate when there are acrid and bitter eructa- tions with nausea and vomiting; also dry tongue, excessive thirst, salt taste in the mouth, and burning or violent pressure in the stomach, with diarrhoea or colic, and griping in the hypogastrium, and particularly when these derangements have arisen from the effects of an ice which had been partaken of when warm, or from fruit, stale vegetables, or acids. It may, in many cases, be advantageously followed by Carbo vegetabilis, Avhich see. Nux vomica is indicated by offensive or acrid eructations, constipa- tion, and confused headache, particularly when arising from preA'ious intoxication, or even slight over-indulgence in wine or other stimulants; when possible, it should be taken the same night, as, taken in the morning, although eventually relieving, it frequently causes an aggra- vation for a few hours. (In derangement of the stomach, Avith heart- burn, flatulence, more or less nausea and headache, &c, in conse- 162 DIGESTIVE SYSTEM. quence of a chill or of indulging in mental or corporeal exertion immediately after a meal, this remedy commonly affords speedy amelioration.) Arnica, deranged stomach, accompanied by eructations resembling rotten eggs.1 Pulsatilla is next to Antimonium crudum, the most important remedy in recent cases of deranged digestion, with eructations of ingesta, tongue foul and covered with mucus ; chilliness and lowness of spirits; and also when a rash has been thrown out in consequence of the derangement. This remedy is, moreover, almost specific when the disturbance has arisen from the effects of rich food, such as pork or pastry, or even tainted meat, or from the effects of ices, cold fruits, or crude vegetables, acid wine, &c. [Arsenicum may follow Pulsatilla, if the latter do not effectually relieve.) Aconite.—When the affection owes its origin to partaking of sour beer, vinegar, or other acids, particularly when we find oppressive pain in the stomach, great heat in the head, nausea, or actual vomiting of mucus, or even of blood. Hepar sulphuris.—When the digestion is naturally weak, and sour vomiting, attended with burning in the throat, colic, and diarrhoea, is liable to ensue from the slightest error of diet, and particularly when anything of an acid quality has been partaken of. {Lachesis is often of great service here in alternation with Hepar sulphuris, at intervals of a week or so.) When a fit of passion has produced an attack of indigestion, Chamo- milla rarely fails to relieve. Bryonia is, however, to be preferred when chilliness and shivering accompany the symptoms of gastric derange- ment. (See Mental Emotions.) Carbo vegetabilis, although last mentioned, is not one of the least valuable remedies in this affection, and is often found particularly useful after Pulsatilla, Arsenicum, or Nux vomica, in removing any symptoms that may remain; it is, moreover, particularly useful Avhere great sus- ceptibility to the influence of the atmosphere, particularly to cold, exists at the same time; or in sufferings arising from abuse of wine, ices, or salt; further, in derangement of the stomach, arising from having par- taken of game or fish which has been too long kept, or meat that has been recooked whilst in a state of fermentation, Avhich is liable to occur in warm weather ; in the latter instances Carbo v. is to be preferred to any other medicine, and will rarely fail to afford relief; but if any dis- agreeable symptoms remain, Cinchona may be administered in a little water; and followed, if required, by Pulsatilla in the same manner. Finally, this remedy {Carbo v.) is peculiarly valuable in obstinate and chronic cases of deranged digestion, when annoyance or inconvenience is felt after every meal, even amounting to nausea and vomiting, at- tended with excessive flatulency, and where the pit of the stomach is tender on pressure.2 1 See also the following note. 2 A small quantity of finely-powdered charcoal, in a little good French brandy, will be found an equally efficacious mode of administering this remedy as a corrective against derangement of the stomach, produced by having partaken of tainted meat or fish. FLATULENCY. 163 FLATULENCY. Flatidcntia. Flatus. Tympanitis intestinalis. This affection, together with the sufferings it entails, is generally found in individuals of Aveak digestion, and many also suffer from it im- mediately on taking cold in the abdomen or feet; it is also, as well known, a common result of errors in diet, and the too frequent indul- gence in vegetables and fruits. In corpulent individuals the sufferings arising from this complaint, such as difficulty of breathing, palpitation of the heart, trembling of the limbs, confusion of the head, and swelling of the face, especially in hypochondriacal subjects, are most distressing. However, with proper attention to regimen, and suitable medical treat- ment, it is rarely very difficult to remove. As an accompaniment of deranged digestion, it has already been noticed under Dyspepsia. The most useful preservatives against the complaint are avoiding cold, exposure in cold damp Aveather, very cold drinks, or distending the stomach Avith a large quantity of warm fluid, particularly strong tea or coffee; each patient should also study his own digestion, and carefully refrain from partaking of any species of aliment which experience has proved to produce flatulency. Sedentary habits also should be avoided, and a proper portion of the day devoted to exercise in the open air. Therapeutics.—In the treatment of this affection the following me- dicines are most frequently called for: Cinchona, Arsenicum, Nux vomica, Pulsatilla, Carbo vegetabilis, Colchicum, Belladonna, Colocynth, and Spirit, sulphuris. Of these, Nux vomica and Pulsatilla are per- haps the most frequently required. Cinchona.—When the affection can be traced to the effects of ha- bitual indulgence in tea or warm drinks, an hour or two after a hearty . meal, by which the process of digestion has been interrupted; or to de- bility, loss of humours from venesection, or the continued use of purga- tives ; or to deranged digestion arising from flatulent food, with painful tension and distension of the abdomen; or when, on the occasional ex- pulsion of flatus, a sensation of tension is felt in the umbilical region; or, finally, where coldness or shuddering is experienced after drinking. Arsenicum, where the last-mentioned symptom has not been relieved by the foregoing medicine. Nux ArOMiCA.—In cases where the flatulence is attended with sensa- tion of pressure at the pit. of the stomach, causing dyspnoea and a feel- ing as if the clothing were too tight, or a sensation of pressure as from a stone, and particularly when the affection arises from an habitual use of coffee, or from sedentary habits. Pulsatilla, Avhen the affection has arisen from having eaten of rich or greasy food, after which a copious draught of water has been par- taken of, and the abdomen is tumid and accompanied by a pain as from a bruise, Avith borborygmus. Carbo vegetabilis is one of the most impor- tant remedies after the foregoing, in chronic cases, especially when the inconvenience arises after partaking of the smallest morsel of food. Colchicum, when from a considerable accumulation of flatus the ab- domen is extremely distended, or, as it might be expressed, inflated, and 164 DIGESTIVE SYSTEM. sounds like a drum on being struck with the hand {Tympanitis intesti- nalis)—without any marked pain, but with heat and difficulty of respi- ration. This remedy is generally peculiarly efficacious when the de- rangement is attributable to vegetable food ; or to the effects of exposure to a cold, damp atmosphere. Belladonna.—In cases of flatulent obstruction, in which the trans- verse section of the colon is the particular seat of the accumulated flatus, and becomes protruded like a pad, this remedy should be employed; it may be followed by Colocynth when the relief obtained is only tempo- rary, or when, from the manner in which the patient traces the course of his uncomfortable feelings, there is every reason to conclude that the flatulent distension and obstruction occupy the entire extent of the colon. When the flatulence occurs very frequently, in fact, where a marked predisposition to it exists, we must have recourse to Spirit, sulphuris. Although we have pointed out the remedies best suited to the cases of this affection most ordinarily met with, and have also treated of the same subject under Dyspepsia and Colic, to which the reader is referred, we still think it advisable to add a few medicines which bear particularly upon this disorder, and are deserving of attention. They are: Lycopo- dium, Cocculus, Natrum, Natrum muriaticum, Zincum foliatum, Mag- netis Polus Arctus, Agnus castus, Ferrum, Graphites. spasm of the stomach. Gastrodynia, Cardialgia, Gastralgia. Diagnosis.—Contractive and spasmodic or gnawing pains at the epi- gastrium, extending to the chest and back, attended with anxiety, nau- sea, eructation or vomiting, with faintness, and coldness of the extremi- ties : the patient is sometimes relieved by emission of ascending flatus, and when complicated with pyrosis, by a discharge of a quantity of lim- pid fluid; occasionally headache and constipation are present. In some cases the pain is very slight, but there is always more or less, and a degree of anxiety, with nausea, often increased by taking food. The disease originates in an abnormal state of the nerves of the stomach, and is frequently accompanied by a disease of the liver, spleen, or pan- creas, or even by scirrhus of the stomach or duodenum, in its advanced stages. It is a frequent attendant on gout; and very rarely occurs be- fore the age of puberty. The paroxysms last for a longer or shorter time, according to the violence of the affection, and return in many instances periodically, and may be brought on by partaking of improper articles of diet, or in severe cases by any solid food whatever. The chief articles to be avoided by an individual suffering from this malady are—crude, uncooked vegetable substances (such as salads), also cheese, new bread, sweetmeats, cherries, nuts, olives, and roasted chest- nuts ; and stimulants of all kinds, whether strong tea, coffee, alcoholic or fermented drinks. The exciting causes are: long fasting between meals, very hot or cold drinks, an habitual use of ardent spirits, or of indigestible food, worms, and in some instances, perhaps, exposure to cold or damp weather. SPASM OF THE STOMACH. 165 It is a more frequent affection in the female than the male sex, often occurring after the cessation of the usual monthly discharge, or from any interruption of its usual course ; in such instances it is frequently accompanied with hysteria, syncope, and may pass on to vomiting of blood. Notwithstanding the general intractable nature of this affection, it has been treated with marked success by the method about to be pointed out. Therapeutics.—Nux vomica is one of the principal, and, in a large number of cases, the most appropriate remedy against spasms of the stomach, and particularly in cases where this affection can be attributed to the long-continued use of strong coffee, or an excessive indulgence in spirituous liquors; it is, moreover, of essential service in many cases which have arisen after the suppression of chronic or hemorrhoidal dis- charges, or when the party affected is liable to fits of hysteria or hypo- chondriasis ; the following are the immediate symptoms which call for the administration of this medicine : Constipation, pressure, squeezing, or spasm in the stomach, accompanied with a sensation as if the clothes were too tight at the waist, or as if flatus were pent up in the hypo- chondria. This sensation, as well as the pains before mentioned, become generally increased after a meal, or after partaking of coffee ; in addition to which, a feeling of depression or constriction is expe- rienced at the chest, which, in many cases, extends to between the shoulders and the lower part of the back. Frequently, also, we find nausea, accumulation of clear water in the mouth, or risings of sour, bitter fluids, attended with a sensation of burning in the throat and gullet (pyrosis); sour or putrid taste in the mouth, vomiting of ingesta, flatulent distension of the bowels, constipation, aching in the forehead, palpitation of the heart, and anxiety. When these symptoms are liable to be excited by a fit of passion, or become aggravated in the morning, or when the patient is occasionally awakened out of his sleep by the spasmodic attack, this remedy is still more certainly indicated. Should Nux vomica merely afford temporary benefit, followed by re- newed aggravation, and in cases where the disorder returns again after it has been for a time suppressed by Nux, we should first repeat that remedy; and if it then fail to afford relief, Carbo vegetabilis will generally be found to answer our purpose; if not, Spirit, sulphuris may then be had recourse to, particularly where the affection is trace- able to the suppression of some chronic eruption. This last-named medicine, as well as Pulsatilla and Sepia, the value of which in such cases we shall notice under their several heads, is particularly useful in gastrodynia in females, arising from derangements of the menstrual functions. In other cases, where no improvement results from the exhibition of Nux vomica, the following should be consulted: Chamomilla, Bella- donna, Cocculus, Lpecacuanha, Pulsatilla, Sepia, Ignatia amara, Cin- chona, Staphysagria, St annum, Bryonia, Platina, Senega, Matanhia, and Arnica montana. Should any one of these seem strongly indicated from the first, we must not hesitate to employ it in preference to those we have already noticed above. 166 digestive system. Chamomilla.—For the employment of this remedy the principal indications are: pressure as if from a stone in the pit of the stomach ; or painful pressure at the prcecordial region, as if the heart would be crushed, flatulent distension at the same part, as also of the hypochon- dria and abdomen, with shortness of breath, anxiety, and throbbing headache ; mitigation of the above symptoms on partaking of coffee,—a distinguishing mark between the indications of this remedy and those of Nux vomica;—on the other hand (as in the case of the latter), it is also indicated when the symptoms, as described, are liable to be brought on by a fit of passion. Colocynth is sometimes more efficacious than Cham, in the latter case, and especially when the fit of passion is accompanied by indignation. In obstinate cases, where Chamomilla fails, notwithstanding the appa- rent similarity of the symptoms, Belladonna ought to be substituted for it; also Avhen we meet with gnawing pressure, or spasmodic tension in the pit of the stomach, relieved on bending backwards and holding in the breath ; or, further, spasm of the stomach, which recurs daily during dinner, or else pain of so violent a nature as to deprive the patient of consciousness. Carbo v. may, however, be preferred to Belladonna, when the most prominent symptom remaining consists of a sense of aching and pressure at the pit of the stomach and the prsecordial region, causing a feeling as if the heart were about to be crushed. (See Chamomilla.) Cocculus, in many cases of this complaint, is particularly indicated, when, in addition to the usual symptoms, there are constipation and constrictive pains over the entire abdomen, with flatulency, and accumu- lation of water in the mouth, and alleviation of the sufferings on the recurrence of the latter symptoms. Ipecacuanha is useful in cases of this affection, when the paroxysms are accompanied by nausea, vomiting, dull darting pains in the pit of the stomach, and sensation of excessive uneasiness in the same region. Pulsatilla.—In cases with shooting pains in the stomach, which are aggravated by movement, and particularly by making a false step. Pul- satilla is also one of the most appropriate remedies when the attacks are followed by vomiting, or accompanied by violent tension and squeez- ing, or throbbing and sensation of anxiety about the pit of the stomach, increase of pain after eating, or more particularly a feeling of pressure and pinching after dinner, Avith a relaxed state of the bowels, or a dis- position thereto. Tendency to hysteria or hypochondriasis. This remedy, as well as Sulphur and Sepia, is called for in cases of this affection, arising from suppressed menstruation. When Pulsatilla does not afford much relief, the desired result is often attainable through the agency of Lgnatia. Sepia is an efficacious medicine in gastrodynia arising from sup- pressed or difficult menstruation, and may in general cases advan- tageously follow Pulsatilla; it is indicated when, as in the cases of Nux v. and Pulsatilla, most of the sufferings arise after a meal, Avhen there is pressure in the stomach as from a stone, and a burning pain is experienced in the epigastrium and scrobiculus. By restoring singly, or in conjunction with Pulsatilla and Sulphur, the menstrual flux, it SPASM OF THE STOMACH. 167 frequently removes the cardialgia and hysteria consequent upon this derangement, or, at least, places the affection in such a position that it is easily cured by some other medicine, closely corresponding to the remaining symptoms. Ignatia amara is indicated under nearly the same circumstances as Pulsatilla, with the exception of the state of the bowels, Lgnatia being more appropriate to cases attended with costiveness, and where the inclination to vomit is absent, or when the affection has been caused by grief, anxiety, exhaustion by long abstinence, &c, or occurs in very hysterical or hypochondriacal individuals. (See also the remedies men- tioned at the end of the chapter.) Cinchona is of great service in most cases of spasms of the stomach with general weakness arising from loss of humours, the result of blood- letting, or repeated hemorrhages, abuse of emetics or aperients, too long- continued suckling, &c.; and is further indicated by great Aveakness of digestion, distension and uncomfortable weight, pressure, or pains in the stomach after eating, so that the patient feels much easier when fast- ing ; these latter symptoms are the more immediate indications for the employment of this medicine. {Nux v. and Carbo v. may follow Cin- chona, should the latter not remove all the symptoms.) Staphysagria.—This is useful in some cases of this complaint, and is particularly applicable when there is acute pressive tension and] squeezing about the pit of the stomach, which sometimes obstructs the breathing, but which is relieved by bending the body forward. When, however, the pain partakes of a marked tensive character, and extends to the region of the navel, accompanied by sensibility of the region of the stomach on external pressure, shortness of breath, anxiety, and nausea, Stannum will be found more appropriate. Bryonia.—This medicine is more particularly adapted to the milder cases of cardialgia, Avith painful pressure, or a feeling of disagreeable fulness in the stomach after a meal, which occasionally becomes con- verted into a feeling of constriction, cutting, or pinching, and is relieved by eructation and external pressure. This remedy is, moreover, still more clearly indicated when the symptoms are generally accompanied by severe headache or painful compression in various parts of the head, and particularly at the temples, Avhich is liable to be excited whenever any article of diet disagrees in the slightest degree; increase of the sufferings by movement; habitual costiveness. Platina.—Spasms of the stomach in females, occurring particularly at the monthly period {Chamomilla, Pulsatilla, Nux v., and Cocculus are equally efficacious at such periods when the symptoms are as indi- cated under these remedies), and especially when the menses are, at the same time, generally very copious, and of too long duration. Senega will be found efficacious in cases characterized by painful pressure and burning in the stomach, especially at night. Ratanhia.—Spasm of the stomach, or painful constrictive pain, relieved by eructation, Avith loss of appetite, hiccough, distension of the abdomen, costiveness, and frequent micturitions. Arnica Montana, in spasm or pains in the stomach, which have originated in the effects of a strain, or from a blow, etc., will be found 168 DIGESTIVE system. specific. It is, however, also an excellent remedy when there is a sense of pressure as from a stone, or of fulness in the stomach and scrobiculus, constrictive pain in the stomach and in the prcecordial region, shooting pain in the pit of the stomach, Avith painful pressure or aching, extend- ing to the back, and tightness of the chest, increased by eating, drink- ing, and external pressure. Bismuth,—Cardialgia, with tenderness on pressure at the pit of the stomach in hysterical females. This remedy is, further, often of great service in some of the most obstinate cases, particularly when there is a sensation of great weight on pressure, with indescribable pain and uneasiness in the stomach. Arsenicum.—Periodic pains in the stomach, chiefly consisting of a burning character, and attended Avith acrid, sour eructations, vomiting of ingesta, or of mucus, sometimes even of blood; anorexia, extreme debility, emaciation. Lycopodium.—Squeezing or compressive pains proceeding from each extremity of the stomach, with flatulent distension ; want of appetite, pains in the back and loins (constipation); exacerbation of the symptoms in the open air, after a meal, or in the morning ; cardialgia in lymphatic females, with too copious catamenia. Lachesis.—Spasms of the stomach, particularly in persons addicted to excessive indulgence in wine or ardent spirits, relieved by partaking of food; tongue covered with dark brown fur, or glazed, red, and cracked, or swollen; flatulence, constipation; tremulousness, numbness, and paralytic weakness of the extremities. Sulphur is frequently an indispensable remedy in chronic cases, attended with heartburn; aggravation of the pains after a meal; con- stipation, hemorrhoids. Calcarea.— In obstinate cases, occurring in individuals Avho are habitually addicted to the abuse of wine or ardent spirits, Calcarea will generally be found of great service, especially after the previous employ- ment of Nux. v., Lachesis, and Sulphur. It is further a valuable remedy in the cases of plethoric females subject to nasal hemorrhage, or to ex- cessively copious menstruation; and is generally indicated when the paroxysms of pain come on usually at night, or after a meal; in which latter instance, vomiting sometimes results, or nausea and acidity, with painful sensibility on pressure at the epigastric region. Constipation, hemorrhoids, or chronic looseness of the bowels, are additional general indications for the employment of this remedy. These are the principal remedies to be employed in ordinary cases of Cardialgia; but, in some cases, one or more of the following medi- cines may be called for: Sanguinaria canadensis, Bismuth, Carbo v., Graph., Gratiola, Magn., Nitr. spir., Sil., Stann., Staph., Stront., Am. c, Cup., Baph., Kali, Euphorb., Kreos., Natr., Natr. m., Nux m., Assafoetida, Digitalis. In Cardialgia occurring in hysterical or hypo- chondrial subjects, Lgn., Nux v., Calc, Grat., Cocc, Stann., Bism., Bigitalis, etc., form the more important medicaments. The diet ought to be extremely simple, and easy of digestion; and everything which is knoAvn by experience to bring an attack should be eschewed. Fat, oil, butter, cheese, etc., are often hurtful, and should therefore be avoided. See also Dyspepsia, of which this malady is but a modification. vomiting of blood. 169 HEARTBURN. Black water. Water-brash. Pyrosis. This is not an affection of that organ which its name would imply, but a painful or uneasy sensation of heat or acrimony about the pit of the stomach, sometimes extending upwards. It is frequently accom- panied with anxiety, nausea, and vomiting; or a violent gnawing spas- modic pain in the region of the stomach, from which the patient expe- riences no relief, until he succeeds in ejecting a quantity of limpid fluid. The remedies required for the treatment of the disorder are the same as those mentioned under Dyspepsia, Flatulence, and Spasm of the Stomach, according to the symptoms ; of which Nux v., Puis., Sulphur, Acid. sulphuricum, Carbo v., Cinchona, or Calcarea, will be found the most appropriate in ordinary cases. (See the aforesaid derangements for particular indications.) VOMITING OF BLOOD. Hcematemesis. Diagnosis.—Blood evacuated by vomiting, sometimes pure (generally venous), of a dark colour, but sometimes of a bright red; it is occa- sionally mixed with bile, food, &c.; the quantity varies ; blood is also not unfrequently discharged in coagula by stool. Premonitory Symptoms.—Weight, pressure, fulness or tensive pain or spasm in the hypogastric or hypochondriacal regions; griping and colic; burning heat in the region of the stomach; anxiety, particularly on partaking of food or drink, or on pressure at the stomach; saltish taste in the mouth; impaired appetite and nausea; giddiness ; syncope, cold perspiration ; sometimes also, an intermittent pulsation is percepti- ble at the scrobiculus. Some only of the preceding symptoms may be present previous to the attack, and others, during its course when very severe, or frequently renewed. We often find wild delirium or wandering accompanied with spasms, and a gradually increasing weakness and remission of pulse Avith frequent syncope. The most frequent causes of this affection are the sudden suppression of any sanguineous discharge, and the consequent determination of blood to the stomach; it is, therefore, apt to declare itself after a stoppage of the hemorrhoidal flux, and is a very common affection in females, from the suppression or cessation of the catamenia; in which case (as before remarked under that affection), it is frequently preceded by Cardialgia. Other causes are scirrhus of the stomach, internal lesions or injury of that organ from swallowing sharp substances, or from worms; poisons, drastic purgatives, or emetic drugs, external contusion, obstruction of important viscera, or a change in the constituent principles of the blood itself; the direct cause is the bursting of some of the vessels of the stomach. The dangers arising from the use of powerful astringents are, inflam- mation or subsequent induration of the stomach, or putrid gastric fever. When this affection occurs in females from non-appearance or sup- 170 DIGESTIVE SYSTEM. pression of the monthly discharge, or from its final cessation, see articles Chlorosis, Amenorrhea, Cessatio mensium ; Avhen it arises from worms, see Helminthiasis ; from poisonous substances, see Poisons ; and when it originates in disease of the spleen, consult Sple- nitis. We may now proceed to the consideration of the remedies above alluded to. Aconitum.—When the premonitory symptoms, above given, declare themselves, and particularly when a considerable degree of fever precedes the attack. Nux vomica.—In a decidedly plethoric constitution with a marked (venous) stomachic or abdominal congestion, and tendency to constipa- tion, particularly when arising from suppression of hemorrhoids, or of the menstrual flux, or from indulgence in vinous, spirituous, or fer- mented liquors; this remedy is still further indicated by irritability of temper. Pulsatilla.—The value of this remedy is noticed in the disease of females above mentioned; it is also, in many cases, found more suitable than Nux vomica for males, when of lymphatic temperament and mild disposition. Some of the best indications for this medicine will be found under Dyspepsia, Cardialgia, and Derangement of the Stomach. Cinchona.—When a quantity of blood has been already vomited, this remedy, from its power of restoring the energy of the system after debilitating losses, is clearly indicated; it should also be chosen Avhen the patient has had a severe attack of hsematemesis, which has ceased of itself, but still left great weakness. Arnica.—One of our most important remedies in severe cases, and especially when occurring in individuals of a robust constitution, of a sanguine temperament, and choleric disposition. It is further indicated, when the patient complains of pains resembling the results of a contu- sion, in all the extremities. Spirit, sulphuris is useful in strumous habits, or when the affection has arisen from suppressed hemorrhoids ; its value also in cases of ab- normal menstruation will be pointed out in the proper place. The following remedies also deserve a careful study: Phosphorus, Belladonna, Arsenicum, Lycopodium (which may be ranked next to Nux v., in cases arising from abdominal congestion), Hyoscyamus, (which, with Belladonna, is particularly useful in cases attended Avith Spasmodic action), Lycopodium, Arsenicum, Phosphorus, and Secale cornutum (in Schirrus), together with Carbo vegetabilis, Millefolium, Cantharides, Calcarea carbonica, Natrum muriaticum, and Zincum, under peculiar circumstances, and as tending to eradicate the predisposi- tion to such affections. The application of dry cupping-glasses to the abdomen and under the ribs, or of a cloth which has been dipped in cold water, to the lower region of the abdomen, sometimes forms a useful auxiliary in arresting the hemorrhage. See also Hemorrhage from the Lungs, under Haemo- ptysis. Diet.—The rules already given under Cardialgia should be observed, constipation. 171 but with still greater strictness ; no solid food must be partaken of; all drinks should be cold; animal jellies, preparations of milk, light pud- dings, and broths, merely tepid, may be allowed in cases where the patient may require such nourishment, but nothing more must be taken than is absolutely necessary for that purpose ; immediately after an at- tack, no food should be given for some hours, and then very cautiously, and in small quantity. It is evident that, in such cases, absolute rest, both mental and bodily, is essentially requisite. costiveness, constipation, obstipation. Constipatio, Obstipatio, Obstructio Alvi. We have now to treat of an affection which so frequently baffles the skill of the practitioners of the old school; their leading cause of failure being their ignorance of, or inattention to, the great curative principle, and consequent proceeding upon a system opposed to the operations of Nature. This complaint is generally sympathetic with some other derangement of the organism, and consequently, in our treatment of different diseases, we have had frequent occasion to allude to it. One of the leading causes of aggravation and excessive obstinacy in the Con- stipation, most closely approaching to an idiopathic form, is the practice of flying to aperient medicines on the slightest appearance of costive- ness, under the absurd idea that keeping the bowels open is a species of panacea against disease of every description. Many mothers are so possessed with this idea, that they continally administer physic to their children, without the slightest apparent call for it, and thus lay the foundation of dyspepsia and other visceral derangements in after-life. Many a slight case of costiveness which, if left to nature, Avould have disappeared of itself, leaving no ill consequences, has, by an ill-judged administration of aperients, been converted into obstinate and habitual constipation, embittering existence, and predisposing the constitution to a variety of diseases in after-life. To prevent misconception upon this point, it should be clearly understood, that we by no means undervalue a regular state of the bowels, but, that when costiveness shows itself, we happily possess remedies calculated to restore the general balance of the system ; and in obstinate cases, do not content ourselves with simply alleviating the symptoms, but mainly direct our attention to the perma- nent removal of the affection. Many of the principal causes of this disorder, besides that mentioned, are the same as those particularised under Indigestion or Dyspepsia. Therapeutics.—In trivial cases it will be found sufficient to pay proper attention to diet, to avoid too dry or indigestible food, to masti- cate properly, to partake of meat only once a day, and to take sufficient exercise in the open air.1 Should this course not have the desired effect, we must choose one or more of the folloAving remedies: namely, Opium, Alumina, Bryonia, Nux vomica, Pulsatilla, Platina, Natrum muriati- cum Plumbum metallicum, et carbonicum, Sulphur, Calcarea c, Lache- sis Veratrum, Lycopodium, Sepia, Veratrum, Silicea, Zincum, etc. ' See also the concluding remarks of this chapter. 172 DIGESTIVE SYSTEM. Opium is chiefly to be selected in recent cases, when constipation is not habitual; but is also, like Nux v., and other remedies, serviceable in cases of a more chronic character, occurring in vigorous, plethoric, well-nourished subjects, and arising from inactivity in the intestinal canal, or from sedentary habits. In old people, it is generally more useful than Bryonia and Lachesis, when diarrhoea alternates with the constipation, although these and other remedies, such as Antim., Phosph., and Buta, must be borne in mind and administered when called for by the nature of the symptoms. The more immediate indications for Opium are: want of power to relieve the bowels, with a feeling of con- striction in ano ; pulsation and sense of weight in the abdomen, dull, heavy pain in the stomach, parched mouth, and want of appetite, deter- mination of blood to the head, Avith redness of the face, and headache.1 Alumina.—Constipation from an apparent absence of peristaltic motion; faeces hard, dry, broken, evacuated with considerable exertion of the abdominal muscles and forcing, and sometimes streaked with blood ; constipation from travelling. Bryonia is especially useful in constipation occurring in warm weather, and in persons of dark complexion and an irritable or obsti- nate disposition, with a tendency to be easily chilled, and subject to rheumatism; it is further indicated when constipation arises from dis- ordered stomach, and is attended with determination of blood to the head, and headache. Nux vomica.—This remedy is particularly useful when constipation results from too heavy a meal, indigestible food, and stimulating liquids ; or Avhen the confined state of the bowels has resulted from prolonged diarrhoea or frequent purgings. In the latter instances Opium may often be advantageously alternated with Nux v. In chronic cases aris- ing from long-continued indulgence in vinous, fermented, or spirituous drinks, or coffee, or from sedentary habits or excessive study, Nux is one of the most effectual medicaments. It is peculiarly adapted to persons of irascible and lively temper, with determination of blood to the head, and headache, unfitness for exercise, disturbed sleep, and a 1 Opium is strongly recommended by Dr. Perry, as the best palliative remedy in con- stipation arising from pressure on the rectum, such as that which is occasioned by the gravid uterus, abdominal tumours, swelling of the ovarium, fibrous swelling of the uterus, and, in consequence of which, the faecal matter frequently accumulates in excessive quantities in the rectum, and can only be expelled after great effort, accompanied by severe pain. In weak, nervous, emaciated females, in whom the monthly discharge is always too copious, or in cases where the constipation has arisen from affections of the stomach or liver, Opium is contraindicated. M. Perry recommends the administration of Opium by olfaction, in preference to the ordinary method, and that as follows. At the period of the day at which the patient used formerly to have the bowels relieved, or, otherwise, as soon as a slight ineffectual inclination for stool is experienced, he desires the patient to smell a solution of Opium (a few globules dissolved in a small phial con- taining a mixture of spiritus and aqu. destill.) several times, and to repeat the process, after an interval of half an hour, and again, as before, on the day following, if no satis- factory action result from the first trial. He frequently found, that on the first occasion, only a more decided inclination to go to stool was the sequel, whereupon, after a repeti- tion of the olfactus, the desired effect took place. In some very obstinate cases, he ordered a simple enema to be employed, after several previous trials of Opium, in the foregoing method, and succeeded in this manner in instances where neither Opium, nor the enema alone, was capable of affording the desired relief.—Journal de la Mid. Homoeop., torn. i. chap. 1. CONSTIPATION. 173 feeling of general oppression or heaviness; frequent and ineffectual efforts to relieve the bowels, attended with a sensation of stricture, and sometimes frequent, painful, and difficult emission of urine. It is further, as remarked under Dyspepsia, particularly indicated for individuals subject to hemorrhoids. Pulsatilla has nearly the same indications as Nux vomica, with the characteristic distinction of temperament before noted under Dyspepsia. In recent cases, it is particularly indicated when the obstruction has arisen from indigestion brought about by rich or greasy food, and when it is accompanied by moroseness and shivering. Platina is a useful remedy when constipation has been brought about by travelling, when Opium has failed, or especially when the act of expulsion is attended with great straining. Plumbum metallicum, or Carbonicum.—Obstinate constipation, with ineffectual efforts ; painful retraction and constipation of the anus ; or eAracuation of tenacious, hard, bullet-shaped faeces. (See Obsti- pation.) Natrum muriaticum.—This remedy will sometimes be found effica- cious when many others have failed to relieve, particularly in chronic and extremely obstinate cases. Sulphur is one of the best remedies in the relief of habitual costive- ness, constipation, particularly when hemorrhoids are present, or a dis- position to them exists; or frequent inclination to go to stool, but with- out the desired result. Veratrum.—Constipation, chiefly from inactivity of the rectum, with heat and dryness of skin, determination of blood to the head, and lateral headache. {Alumina is also of great efficacy in constipation from torpidity of the rectum—see Constipation from inertia recti.) Lachesis.—In obstinate constipation, this medicine may be given with effect after Nux v. to those who habitually take wine rather freely, or who experience flatulent distension after meals, and ineffectual efforts to eructate. Sepia may frequently be taken with advantage in chronic constipa- tion after Nux and Sulphur; and is, moreover, particularly well adapted for females in whom there is an irregularity or obstruction of the menstrual flux; it is also indicated by constipation in individuals subject to rheumatism, as well as by hard, conglomerate, bullet-shaped faeces. (See Obstipation.) Silicea is often useful when constipation is accompanied with colic, impaired appetite and thirst; the stools hard, knotty, and passed with great difficulty; and the patient troubled with tenesmus. {Conium is occasionally useful in completing the cure after Silicea.) Lycopodium.—Chronic constipation with ebullition and determination of blood to the head: colic, flatulence, sense of weight in the lower part of the bowels. In Obstipation Avith indurated faeces, formed into hard balls {scybala), Plumb., Magn. m., Sep., Ruta, Verb., and sometimes Nux v., Op., Veratr., Sulph., &c, are useful; but in obstinate and complicated forms of this affection, the treatment requires considerable experience, in addition to a thorough knowledge of the Materia Medica. In all cases 174 digestive system. of constipation of an obstinate or chronic nature, recourse may occa- sionally be had to an enema of tepid water, as a temporary mode of relief until the medicine has effected the desired result. The drinking of a tumblerful or more of cold water, thrice a day, fasting, dashing cold water against the abdomen, and then applying brisk friction by means of a coarse towel, combined with early rising and daily exercise (not violent or beyond the strength of the patient, so as to cause suf- fering, or defeat the object we have in view, by exhausting instead of giving tone to the energies of the patient), will be found useful auxi- liaries in promoting a regular action of the bowels. The diet ought to be regulated according to the state of the primary digestive organs,1 and highly-seasoned food, or that which contains much fibrous or lig- neous matter, such as radishes, cabbages, turnips, green fruits, &c, avoided. When constipation occurs in alternation with diarrhoea, Nux v., Lachesis, Rhus, Antimonium, Ruta, Bryonia, Opium, and Phosphorus have been found useful. In constipation from inertia recti, or from atony of the intestinal canal, Sepia, Veratrum, Aurum muria- ticum, Alumina, Natrum m., and Padus avium have been recom- mended as the best general remedies; but when the indications for the selection of any of the remedies we have given in the preceding part of this article manifest themselves, we must not hesitate to prescribe accordingly. For constipation in aged persons, the following medicaments are generally the most efficacious: Opium, Aurum m., Natrum m., and Padus avium {Padus prudus), or Veratrum, Bryonia, Lachesis, Baryta c, Ruta, &c. In that which is prone to occur when travelling: Platina, Opium or Alumina, Calcarea, Cocculus, Conium, Graphites, Cfratiola, Arsenicum, Kali, Baryta c, Agaricus m., or Amnion., &c, may also be called for in particular cases. When frequent purgings or protracted diarrhoea have given rise to constipation, Nux v. and Opium sometimes in alter- nation, or China, Aurum m., Natr. m., Pad. prud., Lachesis, Antim-., Ruta, usually answer best. Against constipation from exposure to the Vapour of Lead ; Opium, Alumina, Platina, are, in general cases, the most important remedies. That from congestion or fulness of the vessels of the head ; Aconit., Belladonna, and, still better, Opium, Nux v., Pulsatilla, Sulphur, Calcarea, Lycopodium, &c. (See Determination to the head.) And against that from Duodenitis {chronic); Nux v., Pulsatilla, Sul- phur, Lachesis, Veratrum, and sometimes, Mercurius, Digitalis, Kali, Sepia, Ars., Silicea, Ammon. c. (See also Hepatitis, Dyspepsia, and Spasmodic stricture of the rectum.) piles, hemorrhoids. Diagnosis.—Varices, or effusion of blood in the cellular tissue of the rectum, either within or without the anus (internal or external piles); or protrusion and filling of one or more of the inner folds of the same intestine, and with or without bleeding (open or blind piles), preceded or accompanied by pains in the back, sacrum, and abdomen; sensation 1 See Dyspepsia, rules for diet in. hemorrhoids. 175 of itching, pricking, tickling, burning, or pressing at the rectum, some- times extending to the adjacent parts, with, in general, constipation, and not unfrequently derangements of the urinary functions. The predisposing cause of the disease is a constitutional taint; whilst among the exciting causes are habitual costiveness, severe exertion on horseback, prolapsus, use of drastic medicines, stimulating diet, the use of vinous, alcoholic, and fermented drinks, or coffee, the suppression of long-continued discharges, sedentary habits, &c. During the treatment of this affection it is of the utmost importance to attend strictly to the homoeopathic rules for diet. Strong or heating drinks, such as wines, coffee, strong tea, and stimulating or highly-seasoned food of all kinds are particularly to be avoided. Sedentary habits and the use of soft cushions or chairs materially tend to aggravate the affec- tion. The painful practice among surgeons of removing the hemorrhoi- dal excrescences by means of the knife or ligature is much to be depre- cated ; for, independent of the danger not unfrequently attending the operation, it may occasion serious consequences by metastasis of the congestion to some of the noble viscera; in a great number of cases, moreover, it Avholly fails, and the disease returns, sometimes even in an aggravated form. Therapeutics. — The medicines most used in this affection are Aconitum, Nux vomica, Sulphur, Lycopodium,^ Arsenicum, Belladonna, Hepar sulphuris, Pulsatilla, Platina, Ignatia, Antimonium crudum, Colocynth, also Ipecacuanha, Calcarea, and Cinchona. Aconite, although not specific in its curative action, is useful in allaying pain, when considerable and distressing inflammation exists, and may in such cases precede the administration of each of the follow- ing medicines, which are among the principal remedial agents in this disease. Nux vomica, as we have before had occasion to remark, is a most valuable remedy in this affection, and is equally efficacious against both descriptions of piles, particularly for individuals who lead a sedentary life, or who indulge in the use of coffee or stimulating liquids, and also for females during pregnancy; when the hemorrhoids are attended with shooting, burning or itching pains ; colic; shooting and jerking pain, as if from bruises in the loins, rendering it difficult to rise or walk in an erect position; and when they are accompanied by constipation and sometimes painful and difficult urination, and the other symptoms de- scribed under Indigestion or Dyspepsia. Sulphur may follow the administration of Nux vomica ; and an alter- nation, at intervals of a week or ten days, of these remedies, frequently effects a cure in cases of long standing. Arsenicum.—Hemorrhoids accompanied by burning and shooting pains, heat, and agitation, sometimes with prostration of strength. Belladonna, moist hemorrhoids, with an insufferable pain in the sacral region, as if the back Avould break or be rent asunder; difficulty in voiding urine. . Hepar sulphuris may follow Belladonna, should that medicine fail to, or only partially, relieve these symptoms. Rhus toxicodendron : when the violent pain, mentioned under Bel- 176 DIGESTIVE system. ladonna still continues severe, this medicament may be selected in pre- ference to Hepar, particularly if the pain be relieved by motion. Capsicum, when a burning sensation exists, attended with considerable itching and diarrhoea. Pulsatilla, discharge of blood and mucus during stool, sometimes accompanied by painful smarting, and sensation of excoriation in the hemorrhoids, pains in the back, pallid countenance, and disposition to fainting; difficulty in passing water. Platina, Avhen there is frequent inclination to go to stool, followed by a very scanty and difficult evacuation, succeeded by general shud- dering and a feeling of weakness in the abdomen; frequent creeping, itching, and piercing at the anus, particularly in the evening; griping in the lower intestine, discharge of blood during stool, and at other times. Lycopodium is a most important remedy in chronic hemorrhoidal affections, particularly when there is congestion to the head, with giddi- ness and headache, flatulent distension of the abdomen, constipation, severe burning, itching, and pricking pains in ano, with painful protru- sion of the hemorrhoids, and sometimes prolapsus ani after a motion ; acrid discharge from the hemorrhoids; and prurient eruption round the anus. Ignatia, is indicated by itching and creeping, and also sensation of constriction and excoriation in the anus, and pricking or darting pain extending deep into the lower intestine ; discharge of blood or of bloody mucus, rumbling noise in the abdomen, and protrusion of the loAver in- testine accompanied by acute pain. Antimonium crudum, discharge of mucus and of blood at every stool, followed by severe colic and pain in the hemorrhoids, with throb- bing, itching, and burning at the anus, and discharge of viscous acrid moisture particularly at night; frequent determination of blood to the head, with bleeding at the nose; stiffness in the back, shooting pains in the loins, burning and rheumatic pains in the limbs, flatulence, and constipation. Colocynth.—In cases of hemorrhoids, attended with excessive almost insupportable colic, this is a most efficient remedy. When the discharge of blood from piles amounts to hemorrhage, a dose or two of Aconitum may be given in the first place, followed by Ipecacuanha, if improvement do not speedily follow; again, if Ipeca- cuanha does not arrest or diminish the discharge in a feAV minutes, Sulphur should be prescribed, and folloAved in turn by Aconitum: but if, notwithstanding the employment of these remedies, the hemorrhage does not cease, Belladonna should be given, and then Calcarea.1 Cinchona is valuable either as an immediate remedy to support the patient, when there has been much loss of blood, or afterwards against prolonged debility. These are the principal medicaments to be employed in the treatment of ordinary cases of hemorrhoids ; and Avhen judiciously selected, will be certain to afford the desired relief, provided the patient is careful to 1 C. Hering's Hausartz. stricture of the rectum. 177 adhere strictly to the rules laid down in the introductory remarks upon this affection. In severe cases of long standing, much patience and perseverance are required before the disease can be permanently re- moved. Against hemorrhoids with mucus discharge {blennorrhoea intestini recti), Mercurius, Helleborus niger, Colchicum, and Spigelia are valua- ble medicines. STRICTURE OF THE RECTUM. Stricture of the rectum is divided, by some authors, into two kinds, viz., the spasmodic and permanent. The first appellation being given to that form of the complaint which sometimes arises in consequence of the existence of hemorrhoids, or from constipation, the prolonged use of drastic purges, &c, and in which the patient is affected with the fol- lowing symptoms: costiveness, with considerable pain in the anus, par- ticularly after a stool; the faeces are small in diameter, and present a twisted appearance. On passing the finger into the rectum, the lower sphincter is felt spasmodically constricted. The disease is, moreover, often complicated with a small but painfully sensitive ulcer of the mucous membrane, or with rhagades, or irregular fissures or cracks. The second variety, the permanent stricture, or stricture proper, con- sists in a thickening and induration of the mucous and muscular tex- tures, and probably also of the interposing cellular tissue. In this form of the disease, the faeces are flattened and diminished in volume, and the patient encounters much difficulty in expelling them ; the pain about the anus is distressingly severe, and does not remit, as in spasmodic stricture. When the finger is introduced into the rectum, the gut will, in most cases, be found contracted two or three inches from the anus ; but in some cases the seat of the stricture is considerably higher. As permanent stricture of the anus is by far the most serious and obstinate form of the complaint, we shall offer the following additional particulars connected with it. The disease comes on very insidiously, and occurs in both sexes and at all ages, but in adults more frequently than in children. The patient, at the commencement, meets with some difficulty in evacuating the contents of the rectum, and is under the necessity of exerting considerable expulsive force. These symptoms gradually increase in severity, and are sometimes accompanied by others, which resemble those of ileus; the pain becomes extremely violent, and the faeces are not only accompanied by a discharge of mucus, but also of blood and purulent matter, from the accession of inflammation in the contracted portion of the intestine. If the disease be not^checked, the cellular tissue around the rectum becomes implicated in the inflammatory process, and putrid abscesses form which burst in various spots in the vicinity of the anus, and the patient sinks. In some cases, the patient is carried off Avith symptoms resembling those of strangulated hernia, from the blocking up of the stricture by indurated faeces. In the advanced stage of the disease, most patients become hectic, but frequently linger on for several years. Therapeutics.—In spasmodic stricture, or preternatural contraction of the sphincter ani, the homoeopathic treatment is, in recent cases, at 178 digestive system. once gentle, simple, and peculiarly efficacious ; and even in long-stand- ing, inveterate cases, their employment is generally attended with suc- cessful results, when the patient can be prevailed upon to pursue the treatment long enough. The following are amongst the more frequently applicable remedies in ordinary cases of the disorder. Nux v., Opium, Lachesis, Plumb. c, Sepia, Natrum m., Mang., Mags., Staph., Calc, Coloc, Aug., Thuja. Where the patient is habitually of a costive habit, or the faeces are dry and hard, as is commonly the case in this affection, these remedies will prove equally opportune. And where hemorrhoids appear to have given rise to, or at all events accompany and aggravate the disorder, the same medicines, together with Sulphur, Colocynth, Calcarea, &c, form the principal remedial agents. In hysterical females, Ignatia, Sepia, Nux v., Lachesis, and Natr. m., Calc, Staph., N. mosch., deserve a preference. The indications which are given for the choosing the above-mentioned remedies under the chapters of Constipation, and Hemorrhoids, as also under that of Dyspepsia, when deranged digestion accompanies the complaint, will assist us in making a selection of the remedy or remedies best adapted to particular cases. Although we are opposed to the employment of a bougie for the purpose of dilating the anus in spasmodic stricture, still we are willing to allow that there are some cases in which the introduc- tion of a suppository of tallow, at night (a portion of a mould candle for instance), may prove serviceable. Cases that are complicated with rhagades require the employment of such remedies as Graphites, Agnus, Sulphur, Calcarea, Rhus, or Hepar, Mezereon, Alumina, Mercurius, Lycopodium, Sarsaparilla; but one or more of the medicaments enume- rated, at the commencement of this article, will commonly be called for in the course of treatment. When the complication of a small, and excessively painful ulcer exists: Lachesis, Arsenicum, Lycopod. And, sometimes, Sulphur, Silicea, and Calcarea are chiefly requisite. The homoeopathic treat- ment of permanent stricture likewise possesses many advantages over that of the ordinary method, particularly when, in the latter, the em- ployment of bougies is rendered unsafe or inapplicable by the distance of the obstruction from the anus, or by an insuperable degree of irrita- bility of the bowel. At the commencement of the disease, when the patient experiences much difficulty in expelling the faeces, and almost constantly complains of more or less pain about the anus, the same remedies are required as those we have mentioned as appropriate in recent cases of spasmodic stricture. In the majority of instances, and especially in the male sub- ject, Nux v. answers best to begin with, the more so, if the patient has been addicted to a rather free mode of living, or been given to sedentary habits and suffers from constipation, hemorrhoids, &c, in consequence. After the employment of Nux v., we shall generally find it requisite to have recourse to Sepia, Sulphur, and Calcarea at proper intervals.1 At a more advanced stage of the complaint, where inflammation has taken 1 See rules for the repetition of the dose, &c, in the Introduction. ABSCESS in ano. 179 place in the constricted portion of the bowel, and the pain has become intense, and is attended with a discharge of blood and even of purulent- looking matter, we have often obtained very satisfactory results from the use of a dose or two of Aconitum, followed by Sulphur in repeated doses. After deriving all the apparent benefit from Sulph. which it seemed capable of accomplishing, we have prescribed Nux v., Ignatia, or Lachesis, according to circumstances, with decided benefit; the former was selected in preference where the indications or peculiarities were present which we have already given above,—Ignatia where the patient was affected with shuddering after each evacuation, and the last-named remedy, where the pain in the anus Avas accompanied by throbbing. Pulsatilla we have substituted with advantage for Nux v., as an inter- mediate remedy, in individuals of phlegmatic temperament; but have always found it necessary to folloAV up the administration of this, or any of the three preceding remedies, with Sep., Sulph., Calc, Silex, &c. There are a variety of other medicines which may be required in pre- ference, or subsequent to any of the foregoing, in particular cases, and in different stages of the disease. Amongst these, we may quote the following, as deserving of especial attention: Staphys., Graph., Lycop., Clem., Magn. n., Natr. m., Plumb, c, Alum., Merc, Mez., Dulc, Coloc, Plat., Rhod., Hep. s., Phosph., Thuj., &c. In cases where the bougie may be thought necessary, but where great pain is produced by its in- troduction, the alternate use of Aconitum and Arnica may remove the irritation. When the faeces accumulate above the obstruction and give rise to additional irritation by over-distending the rectum, Opium should be prescribed, and succeeded by Nux v., if no effect take place after an interval of a few hours.1 But when symptoms resembling strangulated hernia have made their appearance, in consequence of a blocking up of the stricture by a collection of hardened faeces, it may be advisable to attempt to introduce an elastic gum catheter through the stricture, for the purpose of throwing up an injection of tepid soap and Avater, and then tepid water and a couple or so of tablespoonfuls of SAveet oil, pre- viously to having recourse to aforesaid medicines ; and if the enema fail to empty the bowel of its contents, we must avail ourselves of the re- medies mentioned, or any of the others for which we have given special indications in the article on Hernia. In advanced cases of stricture, with ulceration of the mucous mem- brane, and the formation of abscesses, a cure may yet be attainable through the instrumentality of Silicea, Phosphorus, Sulph., Calc, Lycop., Merc, or Hepar s., &c. ABSCESSES IN ANO. FISTULA IN ANO. The formation of matter in the vicinity of the anus is often preceded by a shivering fit. In some cases, the first marked symptom of derange- ment consists in a swelling of a part of the buttocks in the vicinity of the anus, which presents a somewhat extensive circumscribed hardness, and soon becomes very red in the centre, or assumes the form of phleg- monous inflammation, accompanied by a quick, full pulse, with great 1 Plumbum c. may, perhaps, be better indicated than Nux v. in certain cases. 180 DIGESTIVE SYSTEM. dryness and heat of skin. In other instances, the suppurative process is ushered in by an attack of widely ramified erysipelatous inflammation, unattended by any circumscribed hardness, and exhibiting the disease in a more superficial character ; the quantity of matter secreted being at the same time small, but the cellular tissue sloughy to a greater or less degree. On some occasions, the affection commences somewhat in the appearance of a carbuncle ; the skin displays a livid or dusky red aspect, the matter is unhealthy and small in quantity, and the cellular membrane is in a gangrenous state. Finally, it may be observed, that the abscess sometimes begins as a hardening of the cutaneous surface, near the anus, exempt from pain and discoloration ; the induration softening and suppurating very gradually. The pulse is, incipiently, full, and hard; but as the disease progresses, it speedily becomes low, or feeble, unequal and irregular ; the strength sinks rapidly; and the spirits are excessively dejected. The abscess may point in the buttock, either remote from the anus or in its immediate vicinity; or in the perineum. The matter may make its exit from one orifice or from several. Most frequently there is either only an external opening, or both an external and an internal one, which communicates with the exterior of the rectum ; but in other instances there is merely an internal aperture. Hence, abscess, or rather fistula in ano, has been divided into three kinds: viz., the blind external; the complete; and the blind internal. When a fistula in ano, or sinus by the side of the rectum, is fairly established, the folloAv- ing symptoms present themselves : The patient experiences pain in ex- pelling the faeces, and is not unfrequently affected with strangury, prolapsus ani, tenesmus, hemorrhoids, diarrhoea, or obstinate costive- ness ; there is a discharge of thin sanies from the anus, or from a small fistulous opening in its immediate vicinity, according to the variety of the fistula; and the surrounding integuments are generally red and indurated. Therapeutics.—The homoeopathic treatment of fistula in ano is, in many instances, eminently preferable to the surgical. It is the duty of a surgeon, however expert he may be as an operator, to spare the knife on every occasion, and in every disease, when he can do so without de- triment to the case, and especially when there are other, and equally efficacious means either of terminating or of materially alleviating the sufferings of his patient. The disease in question, in addition to being frequently capable of a cure through the instrumentality of medicine, is, moreover, in some cases, so complicated, that the performance of the surgical operation for laying open the fistula, will fail in effecting a cure, or if it succeed, the affection will either return again at some future period, or its healing up will be followed by a more rapid advance and unequivocal development of the existing collateral disease. We par- ticularly allude to complications with disorders of the liver, lungs, or with stricture of the rectum, scirrhus, &c, or to cases where the com- plaint occurs in persons of a very bad habit of body, and whose organism is in a greater or less degree of general derangement. In the early stage of abscess about the anus, if the patient be of a full, plethoric habit, the pain violent, and the inflammation of a phleg- abscess in ano. 181 monous character, a few doses of Aconitum are requisite. A simple emollient poultice may then be applied to the part, and the suppura- tive process forwarded by repeated doses of the third trituration of Silicea, or of Hepar s. and Silicea in alternation. Should the abscess not burst during the employment of one or both of these remedies, which will rarely be the case, however, it may be opened mechanically, when the skin has become much attenuated. When the inflammation is erysipelatous, and spreads extensively, Bella, and Rhus may be pre- scribed alternately in the first instance, but as soon as a degree of fluc- tuation, however trivial, can be felt, or*when shivering sets in, Silicea, which is one of the most important remedies in established fistula in ano, must be given in repeated doses. Should an opening not form, soon after the exhibition of Silicea, and the cellular membrane be found in a sloughy state, an aperture should be made for the discharge of the mat- ter. If the skin presents a livid appearance, and the fistula commences with the features of a carbuncle, Lachesis and Silicea must be exhibited in alternation at the commencement; but if a healthy action do not early display itself, a free incision may be made in the part, and Arse- nicum and Cinchona had recourse to, in alternation, if the patient's strength and spirits become much depressed. A little wine may also be allowed, Avhere required, as is sometimes the case, even under the invi- gorating or tonic action of the homoeopathic remedies, and that particu- larly in elderly subjects, or in those who have been long habituated to the use of stimulants, or have had their constitutions impaired by intem- perance. After the bursting of the abscess and discharge of its contents, the approximation and union of the sides of the cavity may be left to Nature ; but when incarnation appears to proceed slowly or imperfectly, her efforts must be assisted by the internal exhibition of Mercurius, Sulphur, and Silex, or of Merc, Hepar, and Calc When the rectum has become involved or a true fistula has resulted, either through neglect or otherwise, our first object ought to be to at- tempt to heal it by the employment of medicine. Even in cases of long standing, and particularly, as already stated, where any other disease is found to exist, or where the general health is in a much impaired state, the employment of appropriate homoeopathic medicines must be resorted to before the surgical operation is thought of. In recent cases where the fistula has not been under homoeopathic treatment from the begin- ning of the attack, a dose or two of Mercurius may be given, and then Silicea and Sulphur to forward granulation. Should these not be suffi- cient to effect a cure, or should the case have been under homoeopathic treatment from the commencement, and Silicea have been employed to promote the ripening and bursting of the abscess, we may have recourse to Pulsatilla, Sulphur, and Calcarea, in alternation, if the employment of only one of these be found inadequate to effect a cure or surmount the complicated features of the case. Hepar may sometimes be required after Mercurius where the fistula is extensive, and Phosphorus after Silicea where there is considerable constitutional disturbance, or where there is complication with disease of the lungs. In cases which have been maltreated, or which have been long in existence and utterly neglected, the medicines with which the cure may be attempted are the 182 DIGESTIVE SYSTEM. same as we have already mentioned; but Silex, Sulphur, and Calcarea may be named as those on which we may chiefly rely, where any chance of success remains. It may be added that, when the liver is implicated, or the digestion much impaired, either through habits of intemperance or otherwise, Nux v., Pulsatilla, Mercurius, and Lachesis will form valuable intermediate remedies, provided Sulphur, Silicea, and Calcarea prove insufficient to overcome that additional derangement. (See Hepa- titis and Dyspepsia.) Where hemorrhoids exist, Sulphur is almost indispensable (see also art. Hemorrhoids) ; and where the disease is associated with scirrhus or carcinoma, Silicea, Sulphur, or Merc, Lach., Con., Arsenicum, and Lycopodium, are the remedies that are most likely to afford any chance of a cure. In complications Avith stricture Nux, Sulph., Calc, &c, claim attention. (See Stricture.) PROCTALGIA. Proctalgia, or severe pain in the anus, is liable to attack certain indi- viduals after every exposure to cold; but it more commonly occurs as symptomatic of some other affection, such as piles, prurigo, scirrhus, or the existence of a small ulcer, which often forms on the posterior wall of the rectum, opposite to the extremity of the os coccygis. The suffer- ing in the latter, or symptomatic forms of the complaint, is solely expe- . rienced, or is at all events materially aggravated during and after the expulsion of faeces; and the act of defecation is frequently attended with copious hemorrhage. Therapeutics.—When the disorder takes place in consequence of exposure to cold, or occurs apparently as a purely idiopathic affection, it will often yield to the employment of Kali c In other cases, espe- cially when the pain is excessively acute, a dose of Aconitum will be found useful, folloAved, if required, by the continuation of the pain in an undiminished ratio, after an interval of a feAV hours, by Nux v., or by Ignatia if the pain is increased after a stool, or is attended with shiver- ing or shuddering. The following medicaments may be named as likely to prove efficacious in some instances : Conium, Natrum m., Sulph., Sepia, or Carb v., &c. In the symptomatic forms of the disease, the remedies must be selected according to the nature of the primary com- plaint. Thus, in the case of hemorrhoids, Aconitum, Belladonna, Nux v., Puis., Sulph., &c, are principally required. (See Hemorrhoids.) In that of prurigo, Sulph., Sep., Ac. nitr., Merc, Thuja, Calc, &c. In scirrhus or cancer, Con., Arsenic, Lachesis, Merc, Sulph., Silicea. And in that arising from the formation of a small, excessively sensitive ulcer in the lower and posterior part of the rectum, Lachesis, Lycopod., Sulphur, especially when there is obstinate constipation; and Arsenicum, Silicea, or Calcarea, when the bowels are in a normal state, or the for- mer remedies are insufficient to effect a cure. PROTRUSION OF THE INTESTINE. Prolapsus Ani. By this term is understood the protrusion of a portion of the mucous membrane of the lower intestine; it is of much more frequent occur- COLIC. 183 rence in children than adults, and takes place during straining when at stool, or when urinating. The reduction of the protruded portion of intestine is easily effected by gentle pressure with the thumb, or thumb and fore-finger, which have previously been dipped in oil. Therapeutics.—The principal remedies for removing the tendency to this affection are, Ignatia, Nux vomica, Mercurius, and Sulphur. Ignatia is particularly efficacious when the disorder occurs in persons of mild and sensitive temperament, and is attended with constipation. Nux vomica is indicated for persons of irritable or lively disposition, and addicted to high and stimulating diet, with a tendency to hemor- rhoids and constipation. Mercurius is particularly suited for children, in Avhom the disease is attended with hardness and swelling of the abdomen, and great tenesmus. Sulphur is one of the best remedies for the permanent removal of the disease. Calcarea, Lycopodium, and Sepia, may be found neces- sary in some obstinate cases, after Sulph. In other cases : Plumbum, Arsenicum, Mezereum, Natrum to., Colchicum, Ruta, Theridion, and Magnes. artificialis, have been found efficacious. colic. Enter algia. Diagnosis.—Griping, tearing, gnawing, or shooting pain in the bowels, chiefly confined to the region of the navel, generally attended with painful distension of the abdomen, spasmodic contraction, and sometimes vomiting and costiveness, or diarrhoea. The general exciting causes of this complaint are, acid fruits and indigestible substances; cold from wet feet, drinking cold beverages when heated, constipation, worms, &c. It is frequently also a concomi- tant symptom of some other derangement, but occurs equally often as a primary disease. We shall here content ourselves with giving the symptoms under the medicines, without entering upon the different varieties of this affection. One of the distinctive characteristics betAveen this malady and internal inflammation, is the pain being somewhat relieved by pressure. Therapeutics.—In general cases the selection of the remedy is con- siderably facilitated by directing our attention to the cause of the affec- tion. Thus, Avhen the pain is evidently induced by a morbid accumula- tion of flatus {flatulent colic), one or more of the following remedies will be required: Nux v., Puis., Chin., Cocc, Carb. v., Cham., Bella., Sulphur; or Lycop., Colch., Natr. m., Coloc, Graph., Fer., Veratr., Acid, nitr., Mags, arct., N. mosch., Agn., Phosph., Zincum. When the attack proceeds from a spasmodic contraction in a portion of the intestinal tube (Ileus): Opium, Plumbum ; or, when inflammation has supervened, or given rise to this form of the complaint: Nux v., Bella., Lachesis, Merc. (See Enteritis.) For colic resulting from hemorrhoids {Hemorrhoidal colic); Nux v., Puis., Lach., Coloc, Carb. v., Sulphur. (See Hemorrhoids.) For that arising from the presence of Avorms in the alimentary canal: 184 digestive system. Cina, Cicuta, Spigelia, Merc.; or Fer., Ruta, Sabad., Nux mosch, &c. (See Invermination.) For spasmodic colic: Bella., Hyose, Cham., Coloc, Cocc, Nux v., Puis., Cupr., Lach., Sulph., &c. For that which has been occasioned by indigestible food: Puis., Antim. c, Nux v., Bella. : or Bryon., Carbo v., Arsenic, China, Coffea, Hepar Sulph. For colic which has been excited by a moral cause, such as a fit of passion, or indignation: Chamomilla, Colocynth, and, sometimes, Sulphur. When external violence, such as a blow, strain in the abdomen, or in the loins, has given rise to the attack: Rhus, Bryonia, Am., or Carbo v., Calc, Lach. Against Lead colic, Devonshire colic, Dry bellyache {colica pictonum), Opium, Belladonna, and secondly, Alumina or Platina, are the most efficacious remedies. (See also Lead paralysis, Art. Palsy.) For colic arising from a chill, Nux v., Cham., Merc, Coloc, China, are the most serviceable. For that from exposure to cold, damp weather, Pulsatilla ; and that from a thorough wetting, Rhus. In hysterical colic: Ignatia, Cocculus, Mosch., Magn. to., Nux v., Puis., Ipecac, Bella., Bryon., Stramon., are the most useful. And in that Avhich occurs in females during the catamenia {menstrual colic): Cocculus, Nux vomica, Belladonna, Pulsatilla, Coffea; and Carbo v., Secale, Sulphur, Zincum, &c. (See Dysmenorrhea.) Nux vomica is especially indicated, either in flatulent or hemorrhoidal colic, or colic arising from a chill, when there is a sensation of fulness and tightness at the upper part of the abdomen ; deep-seated or cutting pains in the abdomen, with acute, pressive, and forcing-down sensation, compelling the sufferer to bend double; violent cutting pains in the hypogastrium ; confused headache, with occasional loss of consciousness ; short and difficult respiration; flatulence, aggravation of the pains on the slightest motion, generally disappearing Avhen at rest; violent pains in the loins, and sensation of internal heat and obstruction ; constipa- tion, coldness and numbness in the hands and feet during the paroxysm. It is a very useful remedy at the monthly period in females, when we find weight or violent, deep-seated, aching pain in the abdomen, and aching in the sacral region ; dragging pains extending to the thigh ; aching and creeping sensation in the same part Avhen sitting ; painful pressure towards the rectum. Pulsatilla is often of peculiar efficacy in colic occurring in females, either during the catamenia or at other times, Avhen coming on periodi- cally in the evening during cold, damp Aveather, and accompanied by tightness and distension of the abdomen and epigastrium; pulsation in the pit of the stomach, aggravation of the suffering ivhen at rest or in the evening, attended with shivering, which increases with the pains, and is mitigated by motion; severe bruising pains in the loins, espe- cially when rising up; also Avhen the affection has arisen from overload- ing the stomach, or from rich greasy food, with inclination to vomit, flatulence, diarrhoea, paleness of the face, livid circle round the eyes, and headache; or in hemorrhoidal colic, Ayith fulness of the veins of the hands and forehead, restlessness, anxiety, and sleeplessness. colic. 185 Chamomilla,—bilious colic; colic in females during the menstrual flux. The following are the principal indications: sensation as if the intestines were gathered into a ball, and as if the abdomen were empty, with tearing and drawing pains, attended with excessive anxiety and restlessness; distension under the lower ribs and in the pit of the sto- mach ; incarcerated flatus, sometimes nausea, or vomiting of a bitter or bilious fluid, bitter vomiting, followed by desire to relieve the bowels, and bilious diarrhoea ; livid circles round the eyes, alternate paleness and redness of the face; the pains come on particularly at night, at other times early in the morning, or after a meal. This remedy, as before stated, is particularly adapted for children of irritable tempera- ments, and is extremely serviceable in all cases, in which a fit of pas- sion has been the exciting cause of the sufferings. It is also useful Avhen colic has arisen from cold in the feet or checked perspiration. Although in instances quoted, Chamomilla is of itself generally suffi- cient, it has been sometimes found useful to precede it by a dose of Aconite. {Colocynth is often useful after Chamomilla, when the latter has produced only partial relief.) Belladonna,—flatulent colic, when there is distension of the trans- verse section of the great intestine, attended with colic-like pain which is relieved by pressure on the part; also severe dragging pains, from above downwards, as if the whole of the intestines would be forced dowmvards from their containing cavity; menstrual colic, with spas- modic constriction in the abdomen, and a burning pain lower down or in the small of the back; violent griping in the hypogastrium. The symptoms are frequently attended with a liquid or puriform species of diarrhoea, and swelling of the veins of the head; and the pains are ag- gravated by movement, or are sometimes so violent as almost to deprive the patient of reason. Cocculus is indicated (especially in menstrual or flatulent colic) when there are severe constrictive or spasmodic pains in the lower part of the abdomen ; great flatulence, fulness, and distension of the entire abdomen, with nausea and difficulty of breathing; also when there are a sensation of emptiness, tearing and burning pains in the intestines, sometimes with squeezing, tearing and dragging pains, excessive anguish and nervous excitement, and constipation. Colocynth.—In the majority of violent and obstinate cases, we find this a valuable remedy; it is indicated when the pains are excessively violent, and of a constrictive or spasmodic character, or resemble stab- bing and cutting, as if from knives ; sometimes there is a sensation of clawing and pinching, and tenderness of the abdomen; with a pain as from a Woav ; or distension of the abdomen; at other times a sense of emptiness is experienced, with cramps and shivering, or tearing pains in the legs; during the continuance of the attack, we find excessive restlessness, agitation, and tossing about from the violence of the pain : Avhen the pains come on, they continue without any apparent intermission; after their disappearance, a bruised sensation remains, and the sufferer feels as if the intestines were held together by thin threads, likely to break from the slightest motion. Both this remedy and Chamomilla are particularly efficacious in the so-called bilious colic, 186 digestive system. being indicated by the diarrhoea and bilious vomiting attending it, and also in cases where passion has been the exciting cause. Colocynth is more particularly useful in the case of adults, or where the fit of anger is attended with indignation. Sulphur may follow either Chamomilla or Colocynth in cases of bilious colic, where only partial relief has been obtained ; or, in flatulent colic, may be taken after Nux v., Carbo v., Cocculus, or Chamomilla; and in hemorrhoidal colic after Nux v., or Carbo v. Arsenicum in colic, arising from disordered stomach, with nausea, vomiting; diarrhoea, with green or yellow evacuations, violent gripings, headache, paleness of the face, and blue marks round the eyes ; acces- sion of the pains particularly during the night, or after eating or drinking. Coffea is valuable when we have to prescribe for colic with excessive pains, attended with great agitation, anxiety, and tossing about, grind- ing of the teeth, convulsions, threatening suffocation, oppressive despair, acidity, and coldness of the body and extremities. It is also useful in some kinds of menstrual colic, denoted by a sensation as if the abdomen were being rent asunder; or by fulness and pressure in the abdomen, and violent spasms, which extend to the chest. It is also indicated by cutting pains in the intestines as if divided by a knife, and when the pains are so violent as almost to drive the patient to distraction, causing him to bend double, and draw up his limbs. Bryonia, colic with constipation, tension in the abdomen, and Aoav of saliva like salivation. In cases of colic, arising suddenly from indi- gestible food, a cup of black coffee, without milk or sugar, will fre- quently afford relief, by causing the stomach to free itself from the cause of annoyance; i. e. in patients, who have not used that article as an ordinary beverage. When the complaint arises from Constipation, Silicea is sometimes called for, at others Conium. See Constipation. (See also articles Dyspepsia, Gastrodynia, Flatulency, Hepatitis, Ne- phritis.) determination of blood to the abdomen. Congestio viscerum abdominis. Congestio ad abdomen. This derangement is characterized by a disagreeable or painful sensa- tion of weight, heat, and burning, with hardness and tension in the lower portion of the abdomen. Nux vomica is one of the most frequent sources of relief in those who lead a sedentary life, or are much addicted to over-indulgence in the pleasures of the table, and particularly when the following symptoms are complained of: hardness, tension, and fixed pain in the abdomen, sense of great weakness or prostration, rendering it difficult or almost impossible to walk about; constipation, with pain in the loins, spirits oppressed and irritable. Sulphur will frequently be found serviceable in completing the cure after the above, or it may be selected in preference in cases of long standing, when we meet with the following indications : dull pains, and disagreeable sensation of distension in the abdomen, constipation, ten- dency to obstinate hemorrhoidal attacks, extreme dejection. looseness of the bowels. 187 Carbo vegetabilis, may be selected when the symptoms are ac- companied with excessive flatulency, and will frequently be found of great service in some obstinate cases when alternated with the two pre- ceding remedies. Arsenicum will also be found useful, especially when there is a dis- position to diarrhoea with extreme weakness: or— Capsicum, when these symptoms occur in individuals of a lymphatic temperament. Sepia is often of much utility in the case of females, particularly when the symptoms are analogous to those described under Sulphur. In particular cases the following will also be found useful: Pulsatilla, Belladonna, Mercurius, Bryonia, Lycopodium, Chamomilla, Rhus, Ve- ratrum, Toxicodendron. (See also Dyspepsia and Hemorrhoids.) Daily exercise in the open air, together with a careful attention to regimen, must be observed by those who are afflicted with this affection. looseness of the bowels. Diarrhoea. Diagnosis.—Fluid discharge from the intestines in increased quan- tity- This affection is simply an increase of the peristaltic action of the in- testinal canal, and is so well known under its different forms, that I shall simply allude to the principal exciting causes, and then proceed to the treatment. The exciting causes are acid indigestible food, a check of perspiration, sudden changes of temperature, the prolonged use of poAverful purga- tives, which, although still more frequently the cause of constipation, nevertheless, by producing irritation of the intestinal canal, also pre- dispose to attacks of this derangement, worms, &c. Sometimes diarrhoea is a salutary crisis, as remarked under Fevers; here again the homoeopathic treatment assists Nature, and, while it abridges the duration of the affection,—and thereby obviates future de- bility,—does not rashly check its course. Therapeutics.—We shall, in the first place, give a synopsis of the medicaments, and the different forms of diarrhoea in which they are especially applicable, and then proceed to describe the leading indica- tions for those remedies which are most frequently required in general cases. In Diarrhoea biliosa,—Pulsatilla, Nux v., Bryon., Cham., Ipecac, Antim. c, chiefly ; or, Arsenic, Coloc, China, Veratr., Aeon., Bella., Digitalis, Tarax., Asar., Colch., Ign., Acid, phosph. In Diar- rhea mucosa s. pituitosa : Puis., Coloc, Merc, chiefly; and Petrol., Acid, phosph., or Phosph., in inveterate cases. Or again, Nux v., Secale c, Dulc, Ammon. to., Ignat., Staph., Senega, Bry., Rheum, Cham., Digit, Cina, Bella., Acid, sulph., Arsenic, Sep., China, Rhus, Spig., Mez. In Diarrhea stercoralis : Puis., Ipecac, Ant. c, Nux, Bry., Cham., Tart., Arsenic, Ac. phosph., Sulph., chiefly; or Coloc, Coccul., China, Merc, Dig., Bella., Veratr., &c Diarrhea serosa: Arsenic, Cham., China, Puis., Nux, Rhus, Lach., Calc, Sec, Fer., Hyose, chiefly; or Phosph., Petr., Sulph., &c. Lienteria : Cinchona, Fer- rum ; or Arsenic, Bry., Nux v., Phosph., Acid, phosph., Lach., &c 188 digestive system. When an attack of diarrhoea has been occasioned by a Chill : Cham., Dulc, Bry., Bella., Merc, Veratr., or Nux mosch.; in some cases, Puis., China, Natr., Nux, Sulph., are the most appropriate remedies. When arising from a chill during spring, summer or autumn: Ars., Dulc, Bry., or Merc. When from cold drinks : Ars., Bry., Puis., Carb. v., Nux mosch. If a sudden mental emotion has given rise to the attack, —Coffea, Opium, Veratr., Antim., Aeon., or Puis., are the most useful when it has consisted of a sudden fright or an unexpected joy,—Ignatia or Acid, phosph. when of a depressing character, such as grief; and Cham., Coloc, or Bry., when a fit of passion, or the effects of contra- diction, have brought on the complaint. For diarrhoea arising from excessive indulgence in intoxicating liquors, Nux v. and Carbo v. are commonly the most useful. That which is liable to ensue after partaking of milk, Bry., Sulph., Lycop., Sep., Natr. And that which takes place after eating fruit, or after the use of acids, Ars., Lach., or Puis., chiefly. Against the diarrhoea which sometimes occurs as a sequela of Measles, Scarlatina, Small-pox, &c, Arsenic, Puis., Merc, Ac. phosph., or Sulph., are commonly of the greatest efficacy. That which is encoun- tered in strumous habits, Calc, Sulph., Silie, Lye, Sep., Dulc.; or Arsenic, China, and Baryta c That in Phthisical persons : Fer., China, Phosph., Calc. That in individuals of Debilitated or exhausted constitutions: Secale c, China, Fer., Acid, phosph., Phosph., Nux mosch. And that in the aged, Antim., Secale, Bry., Phosph. When diarrhoea is unattended with pain, Ferrum is the most useful remedy in general cases, but China and Secale c. are often useful; the latter especially when the tongue is coated with mucus, the taste clam- my or pap-like, and there is much borborygmus. When accompanied by colic (Diarrhea torminosa): Calc, Ars., Merc, Cham., Puis., Bry., Rhus., Rheum, Sulph., Acid, nitr., Hepar s., &c. When attended with tenesmus, Merc, Lach., Hepar, Rhus., Nux v.; or Arsenic, Rheum, Caps., Sulph., &c. With vomiting : Ars., Ipecac, Veratr. ; or Cham., Coloc, Dulc, Fer. (See also Cholera.) With prostration OF strength {colliquative diarrhoea); Arsenic, Veratr., Cin., Ipecac.; or Secale c, Phosph., Acid, phosph., Nux v., Sep. In chronic or inveterate diarrhoea, Phosph., Acid, phosph., Petrol., Sulph., Calc, China, Fer., Acid, nitr., Graph., Hepar, Rhus, Lach., Acid, sulph., are the most important medicaments. And in cases in which there is constantly a relaxed state of the bowels or tendency to have several stools daily, Phosph., Sulph., Calc, Acid, nitr., Sep., Kreos., Graph., or Natr. m. The principal remedies in ordinary cases are, Dulcamara, Bryonia, Cinchona, Ferrum aceticum, Chamomilla, Rheum, Mercurius, Pulsatilla, Nux vomica, Ipecacuanha, Arsenicum, Antimonium crudum, Rhus toxi- codendron, Opium, Sulphur, Calcarea, Acidum phosphoricum, Phos- phorus, &c. Dulcamara is often the most appropriate remedy in diarrhoea, occur- ring in summer from cold, especially from wet feet or exposure to rain. Particular indications for its exhibition are, the diarrhoea being attended looseness of the bowels. 189 with colic, or cutting pain, chiefly in the region of the navel; the evacuations being liquid, slimy and yellow, or greenish, generally com- ing on at night, and sometimes attended with nausea, or even vomiting; want of appetite and great thirst, paleness of the countenance, and lassitude. Bryonia should be given in cases of diarrhoea arising from the before- mentioned causes, and attended with many of the symptoms noted under Dulcamara, when that medicine has failed to afford the required relief in six or eight hours, particularly if the looseness is liable to be aggra- vated after a meal, or after drinking, and the stools are passed almost involuntarily, and certain portions undigested ; also when looseness is experienced after partaking of milk.1 In diarrhoea occurring during hot weather, when we cannot trace the causes to any errors of diet, requiring other remedies, this medicine is further indicated, and parti- cularly so in the following instances : diarrhoea from checked perspira- tion, or being over-heated— cold drinks—a, chill from remaining in any cold exposed situation, or in draughts—or from biting, easterly winds. When this affection has been produced by passion, particularly in indi- viduals of a bilious temperament, Bryonia is again a most useful remedy. {Chamomilla is equally efficacious here, and deserves a preference in the case of children.) It may also be remarked, that the diarrhoea, arising from drinking impure water when heated, has frequently found relief in this medicine. When the water is strongly impregnated with vegetable substances, it may be advantageously followed by Cinchona, Pidsatilla, or by Arsenicum, according to the symptoms (see these remedies). {Antimonium is sometimes required to complete the cure after the pre- vious employment of Bryonia.) Cinchona :—Looseness, in consequence of indigestion, particularly if occasioned by partaking of fruit or flatulent food, such as vegetables; stools very profuse, sometimes attended with but little pain, frequently occurring immediately after partaking of food, or especially during the night, watery, and brownish, and sometimes containing portions of undi- gested food. Cinchona is, in some instances, further indicated when considerable spasmodic or griping pain is present, accompanied by flatu- lence, want of appetite, thirst, and great weakness ; and is also valuable after improper treatment or protracted cases of this affection, when con- siderable debility remains. Ferrum aceticum may be advantageously given in alternation with Cinchona at intervals of twelve hours, when the evacuations are partly composed of undigested food,1 and pass without pain; or this remedy may be administered alone, when the diarrhoea is unattended with pain, and there are paleness of the face, weakness of the eyes, pains in the back and anus, with great weakness of digestion. Chamomilla is a remedy, as already stated elsewhere, particularly useful in children, either at the time of teething, or at a more advanced period, Avhen the affection has been excited by checked perspiration ; it is further particularly indicated when the evacuations are watery, bilious, green, yellow, or slimy, or of a fetor resembling rotten eggs, and accom- 1 See also Arsen., Merc, Bryonia, Phosph., Lachesis. 190 digestive system. panied by fulness at the pit of the stomach, severe colic or spasm, pain in the abdomen, distension and hardness of the abdomen, bitter taste in the mouth, foul tongue, thirst, want of appetite, bilious vomiting, and flatulence (in infants), with restlessness, screaming, and drawing up of the limbs towards the stomach. Sulphur is frequently useful in com- pleting the cure when the pains have been removed by Chamomilla. Rheum, AArhen the symptoms, in a great measure, resemble those of Chamomilla, but the pain is not so violent, and the evacuations have a very sour smell; paleness of the face is also an indication for this medicine. (See Diarrhea in Children.) Mercurius, when the diarrhoea arises from a chill, and the motions are copious, watery, slimy, frothy, bilious, or greenish, or streaked with blood, and cause a smarting or burning sensation on being evacuated; also when there is painful tenesmus before, during, and after stool, frequently followed by protrusion of the lower intestine ; severe cutting pains; moreover, nausea and eructation, cold perspiration, trembling or shivering, shuddering, great lassitude, and disposition to syncope; sour smelling stools ; diarrhoea with ingesta. Pulsatilla, is one of the best remedies in simple looseness, or diar- rhoea, arising from errors of diet, such as indulgence in acids, fruits, or rich indigestible food, attended with foul tongue and other dyspeptic symptoms. (See Indigestion.) Another remarkable indication for this remedy is one evacuation differing from another in colour. Ipecacuanha :—Looseness arising from indigestion, particularly if caused by imperfect mastication, attended with nausea and vomiting; paleness of the face (see also Arsen.), weakness, and desire to retain the recumbent posture (in the case of children). When Ipecacuanha does not appear to afford much relief, Pulsatilla ought to be had recourse to, in the space of from twelve to twenty-four hours, after the last dose of Ipecacuanha. Nux vomica : Scanty stools, consisting of slime and blood, attended with straining and great weakness, flatulency, and violent cutting pains in the region of the navel. For some of the occasional accompanying symptoms the reader is referred to the indications given under this remedy, in Indigestion. Arsenicum :—Autumnal diarrhoea, or looseness arising from errors in diet, acids, fruits, cold drinks, ices, or from a chill, &c, the charac- teristic symptoms for its employment are watery, slimy, greenish, or brownish, corrosive, burning evacuations, with violent colic, excessive thirst, emaciation, and great weakness ; and when the affection is more liable to come on at night, or after eating or drinking. {Vide the further indications for this important remedy in Part III., under Bowel Complaints in Children.)1 Antimonium crudum is a good remedy in cases arising from disor- dered stomach, with white tongue, loss of appetite, eructations, and nausea; also when the symptoms given under Bryonia (which see) con- tinue after the administration of that medicine. 1 When Arsenicum does not answer our expectations, Veratrum should be substituted; the latter remedy is, moreover, for the most part to be preferred, when the disease ap- pears to have arisen from atmospheric causes., dysentery. 191 Rhus toxicodendron:—Lumpy or pap-like diarrhoea, coming on only at night, and preceded by colic, which disappears after each evacua- tion. Opium is efficacious in diarrhoea arising from fright, or from cold, and may be followed, if required, by Dulcamara, in the latter case. For other indications, vide Mental Emotions. Lachesis :—Diarrhoea from acid drinks, or sour unripe fruits, with severe griping ; diarrhoea Avith ingesta ; diarrhoea during damp weather. Sulphur is a most valuable remedy in diarrhoea, particularly when the affection is worst during the night, or when it occurs in strumous habits. In adults predisposed to hemorrhoids, or in children, when the diarrhoea is attended with excoriation and papular eruptions, it is par- ticularly efficacious ; also in very obstinate cases, and where the slightest cold brings on a relapse or an attack; or when milk disagrees and causes a looseness. Calcarea may be had recourse to after Sulphur. Acidum phosphoricum:—In obstinate cases, with portions of undi- gested food in the evacuations ; or occasional involuntary evacuations. Phosphorus :—In chronic, painless diarrhoea, Avith gradual prostra- tion of strength ; diarrhoea with ingesta. When diarrhoea occurs only or chiefly during the night, Arsenicum, Cham., China, Puis., Merc, Rhus, Sulph., Dulc, or Bryonia, are the most appropriate remedies; and when it occurs alternately with con- stipation, Nux v., Lach., Antim. c, Rhus, Ruta, or Tartarus. Lastly, when diarrhoea has been produced by the abuse of medicinal agents in allopathic practice, the following are the most serviceable: Hepar s., or Acid, nitr., China, or Carbo, when from the abuse of Mercurial preparations. Puis., or Rheum, when from the employ- ment of Magnesia. And Puis., Cham., Merc. ; or Coloc, and Nux v., when from Rhus. Diet.—Acids or acidulous wines, beer, coffee, strong tea, and fruits, whether raAV or cooked, should be carefully avoided. Solid food should likewise be proscribed, as tending to keep up the intestinal irritation; and gruel, fresh milk, broths, and light mucilaginous food substituted. In protracted cases, attended with debility, but no symptoms of in- flammation or ulceration, generous, easily-digestible food, and sometimes a little wine, or wine and water, must not be withheld. DYSENTERY. Dysentcria. Febris Dysenterica. Diagnosis.—Constant urgency to evacuate the bowels, tenesmus, violent pains in the abdomen, a greater or less degree of fever, particu- larly towards evening, and stools of mucus or blood, or both. It may appear suddenly, but is frequently preceded some time by loss of appetite, costiveness, flatulency, nausea or slight vomiting, with chills followed by heat of skin and accelerated pulse, then dull abdomi- nal pains and increased evacuations; after a time no faeces are dis- charged, but white mucus {dysenteria alba) which may afterwards chano-e to blood {dysenteria rubra); stools, particularly when fever is 192 digestive system. present, very frequent and fetid. If not checked in time, the disease may terminate in ulceration or gangrene, or the patient may sink from exhaustion. The prognosis becomes very unfavourable when the pains, which have previously been extremely severe, suddenly cease, the extremities become cold, the pulse small and intermittent, the stools putrid and in- voluntary. This affection is very frequently complicated with pains resembling those of rheumatism {Dysenteria rheumatico-catarrhalis), which will be noticed under the different remedies, as an additional indication for their employment. The exciting causes are, checked perspiration, particularly in warm weather, or an exposure to the cool atmosphere of an autumnal evening after the pores have been opened by active exercise, or exertion during the day; low or marshy situations, local irritations, such as worms, scybala, &c, and suppression of hemorrhoids, metastases, and sometimes, in infants, difficult dentition. Therapeutics.—The principal remedies in dysentery are Aconitum, Belladonna, Chamomilla, Pulsatilla, Ipecacuanha, Colocynth, Mercurius corrosivus, Merc, vivus, Arsenicum album, Carbo vegetabilis, Nux vomica, Capsicum, Cinchona, Kreos., Aloe., Rhus, Sulphur, Staph., Tart., Sep., &c. Of these Aeon., Bella., and Nux or Merc, are the most appropriate in Dysenteria inflammatoria. Aeon., Cham., Rhus or Puis., in Dysenteria rheumatico-catarrhalis. Aconitum, Merc, corros., Colocynth, Colch., Puis., or Veratrum, in Dysenteria biliosa. Puis., Ipecac, Merc, Dulc, but more especially Colchicum and Merc, corros.; and, in some cases, Acid, sulph., Hepar s., Aloe, Canth., Caps., Carbo v., Rhus, Staphys., Acid, nitr., Plumb., in Dysenteria pituitosa s. alba. Arsenic, Nux, Carbo v., Petrol., Kreosot., Acid, sulph. et nitr., in Dysenteria putrid a. On consulting the chapters on Enteritis, Febris gastrica, biliosa, et mucosa, Diarrhoea, Cholera, and Dyspepsia, many of the general indications for the most of these remedies will be found detailed, and considerable assistance in the selection of the reme- dies thereby afforded. The following are, however, some of the charac- teristic indications for some of those medicaments which are most fre- quently called for in dysentery: Aconitum.—This remedy is peculiarly adapted to cases attended with synochal fever, and in young and plethoric patients is generally required at the commencement or in the course of the disease. It is indicated by full and hard pulse ; severe pains, generally in one spot; abdomen tense and painful Avhen touched, denoting the commencement of inflammation {dysenteria inflammatoria); and is also valuable when we find pains resembling rheumatism in different parts of the body, with shivering, or excessive heat and thirst. Prescription as in Inflammatory Fever, which see. Chamomilla should be prescribed if, after the administration of Aconite, we still find violent heat and thirst, rheumatic pains in the head, and constant agitation and tossing. This remedy is also useful when the disease seems to have taken for its proximate cause the for- mation of gastric impurities in the primae viae; or when it has arisen from exposure to a cool atmosphere when in a state of perspiration. dysentery. 193 "When we find foul tongue, with clammy, bitter taste in the mouth, and bilious stools, before tenesmus declare itself. This remedy is evidently indicated as most useful in the first or diarrhoeal stage of the complaint; it may be followed by Pulsatilla, when the symptoms given under that remedy present themselves. R Tinct. Cham. vulg. 3, gtt. iij. Aq. pur. 3ij. M. Dose. 3ss every six hours, until improvement takes place, or indications for some other remedy present themselves. Pulsatilla, Avhen the gastric symptoms noted under Chamomilla are present, but the stools consist entirely of mucus, striated with blood. {Dysenteria pituitosa.) R Tinct. Puis. 6, gtt. iij. Aq. pur. gij. M. Dose. 3ss every six hours.1 The three remedies, above mentioned, are also valuable in dysentery, arising from cold, or A\rhat is commonly denominated rheumatic catar- rhal dysentery. Ipecacuanha.—This remedy is serviceable, when the dysenteric affection seems fairly established; when the stools consist of slimy matter containing white flocks, followed by evacuations of sanguinolent mucus. R Ipecac. 3, gtt. iij. Aq. pur. 3ij. M. Dose. As above. Colocynth.—In cases attended with violent colic and excessive dis- tension of the abdomen ; shivering with chills, apparently extending from the abdomen over the whole body; excessive agitation and restless- ness ; tongue coated white ; slimy, and sometimes bloody evacuations ; it is sometimes found useful after Ipecacuanha or Mercurius. R Tinct. Coloc. 6, gtt. viij. Aq. pur. 3iv. M. Dose.- gss every hour, or every three to six hours, according to the severity of the symptoms, until amendment supervenes, when the intervals between the doses may be lengthened. Mercurius 'corrosivus, may be considered to be one of the most important of all the homoeopathic remedies in dysentery; but it is more especially in cases with the following train of symptoms that it is cha- racteristically indicated: in the red dysentery or bloody flux, Avhen Ave find severe tenesmus or straining, with evacuation merely of a little mucus, sometimes succeeded or accompanied by the protrusion of a por- tion of the intestine, and increased discharge of pure blood, or of putrid, corrosive, greenish, yellowish, or frothy mucus, intermixed with blood, and sometimes folloAved by the evacuation of small hard substances (scybala) after much straining; burning in ano; severe griping and Iancinatino- pain before, during, and even after the motions; increased desire to go to stool after each evacuation. 1 See "Rules for the repetition of the dose."—Introduction. 13 194 DIGESTIVE system. R Merc, corros. 3, gr. ij. Pulv. sacch. lact. gr. viij. Misce intime, et in chart, sequales viij distribue, quarum sumat unam tertiis vel quartis horis, p. r. n.1 In cases with the above symptoms, Mercurius corrosivus may be con- sidered a specific : it will, at all events, prove so efficacious a remedy, that any remaining symptoms can, in general, be removed with facility, either by means of Colocynth, Acidum phosphoricum, or Acidum nitri- cum (the two latter especially, in the event of a continuance 'of the san- guineous stools), or any of the other remedies, which may seem more appropriate, according to the indications for their employment, as given in this chapter. (The directions for the dose are already given above.) Bryonia is frequently called for in those cases in which it has been found necessary to administer Aconite, at the commencement of the disease; but is more particularly indicated, when the attack has occur- red, during the heat of summer, from the effects of a chill, and is at- tended with typhoid fever of the inflammatory form ; with loose evacua- tions of a brownish colour and putrid odour, occasionally containing lumps of coagulated mucus, resembling undigested substances, or small hard lumps or balls (scybalous faecal matter), with griping during, and burning in ano after, the act of evacuating, and aching pains in the limbs, aggravated by movement. When the disease has attained an ad- vanced stage, and the accompanying fever is of a low typhoid type, the patient being much exhausted and distressed with severe rheumatic or aching pains in the loins and extremities, when reclining or sitting still, and the stools of a slimy, frothy, white, gelatinous, or sanguineous nature, passed involuntarily at night in bed, Rhus not unfrequently gives a favourable turn to the disorder. Dose of Bryonia or Rhus. Three drops of the third dilution to two ounces of water, a dessert-spoonful every two to four hours, until a favourable alteration is effected. Arsenicum.—Dysentery of epidemic or contagious origin, with fever of a typhoid or putrid type {Dysenteria putrida); dysentery arising from exposure to noxious exhalations in marshy situations, &c This remedy may, however, be selected in all cases, from whatever cause arising, when great weakness and even prostration exists from the commencement, with burning pain in relieving the bowels, thirst and aggravations of the sufferings after drinking, or, on the contrary, adipsia; —also when the disease threatens to assume the ulcerative or gan- grenous form — characterized by previous severe pains, particularly burning, which suddenly cease; Hippocratic expression of countenance ; rapid sinking of the vital energies; pulse small and intermittent; cold- ness of the extremities ; highly offensive, putrid, and cadaverous-smell- ing evacuations, both of faeces and urine ; unconscious passing of stools; offensive breath, and petechiae in different parts of the body. R Tinct. Arsen. alb. 6, gtt. iv. Aq. pur. 3iij. Dose.—A dessert-spoonful every two, three, or six hours, according to the urgency of the case, carefully watching the effects, and shortening or lengthening the intervals accordingly. 1 See "Rules for the repetition of the dose."—Introduction. DYSENTERY. 195 Carbo vegetabilis is a most useful remedy in those desperate capes, Avhere the breath is cold, the pulse almost imperceptible, and the patient complains of severe burning pains. Its indications closely resemble those of Arsenicum, with the exception of the thirst, and the aggrava- tion caused by drinking. It may be given with benefit when that remedy has failed, or only partially relieved, and in this, as in other affections, many instances might be cited, where a judicious alternation of these two remedies has effected benefit—neither of them having been, singly, adequate to the exigency of the case. Form of prescription, same as Arsenicum. Nux vomica.—When Arsenicum has diminished the severity of the symptoms and warded off the impending danger, but we find that the faeces still retain a highly putrid odour ; also at any period during the course of the disease, when the following symptoms are present:—Fre- quent and scanty evacuations of mucus or sanguineous mucus, and occa- sionally small, compact, hard faeces (scybala), attended with violent cut- ting or griping pains in the region of the navel, borborygmus, pains in the loins, tenesmus, burning or sensation of excoriation in the anus, and sometimes protrusion of the intestine ; great heat and excessive thirst. Cinchona is a good medicine when the disease has an endemic cha- racter, occurring in marshy countries, and in many cases where a state of putridity remains in the faeces, after the administration of the reme- dies above mentioned. Form of. prescription for Nux and China, same as that given for Pulsatilla. Cantharides.—Sanguineous stools, mixed with whitish mucus or solid substances like false membranes ; strangury.1 R Tinct. Canth. 6, gtt. iv. Aq. pur. 3iij. M. Dose. 3ss every four or six hours. Sulphur.—When the more marked symptoms are ameliorated by the use of the foregoing remedies, but the dysentery still continues obstinate, and especially Avhen the disease occurs in subjects, who have previously been long affected with hemorrhoids; or when it has from time to time been subdued, and afterwards returned with greater or less violence; or even when the apparently best-selected remedial agents have failed to check its course. It will frequently be found most efficacious in all these cases, since, Avheneyer they occur, we may suspect some latent constitutional cause is baffling our efforts. In the first instance, denoted by the removal of the more prominent symptoms, the affection is terminated ; in the second, the predisposition to a return of the attack is obviated; and in the third, the constitutional taint alluded to being controlled, the organism becomes susceptible to the specific action of the other medicaments. ' Colchicum auiumnale is preferable to Cantharides when the symptoms are as de- scribed, but more particularly when the stools consist almost exclusively of mucus, unmixed with blood {dysenteria alba, pituitosa), and when pain is experienced in the sigmoid flexure of the colon, and the disorder rages as an epidemy during the autumnal season. 196 DIGESTIVE SYSTEM. R Tinct. Sulph., 6, gtt. iij. Aq. pur. 3ij. M. Dose. 3ss at first every twelve hours, until an effect is produced, then discon- tinued for a time and allowed to act. In conclusion, we must not omit to add that, when the disease is of long standing, and has become (so to speak) habitual, a cure is often effected by means of Phosphorus. Rules of Conduct and Diet.—In this affection, it is of great impor- tance to keep up a moderate degree of warmth around the abdomen, which is best obtained by flannel, worn outside the linen. During the course of treatment barely sufficient nutriment to keep up the strength of the patient should be alloAved; and the more severe the inflammatory symptoms, the more strict must be the abstinence. No solids should on any account be given; but the diet should consist principally of mucilaginous or demulcent fluids, such as thin barley- water and gruel; in comparatively mild cases, white of egg in sugar and water, weak chicken-broth or beef-tea, may be allowed. Even after convalescence, this course of diet should be for a short time observed, fruit and vegetables escheAved (especially when the disease is raging in an epidemic form), and a return to the usual diet gradually brought about. Wine and alcohol are absolute poisons in this affection. Having thus given the general mode of treatment for this disease, which is ordinarily so fatal, Ave may remark that, in a great majority of cases, the homoeopathic method checks it at its commencement, without allowing it to assume the more serious forms portrayed in the instruc- tions for its treatment, but, on the contrary, causing it to pass off, leaving the patient in sound health; whilst in the most violent cases, where it has already made head, and seems approaching a fatal termi- nation, this may almost be said to be the only system which offers a chance of salvation to the sufferer; and in strumous constitutions (where, under the old mode of procedure, the results were commonly so unfortunate), it gently mitigates the violence of the symptoms, and safely conducts the patient through his perils. Suppressed Dysentery.—When the dysenteric evacuations have been suddenly checked by allopathic means, and a violent inflammatory or spasmodic action declares itself, distinguished by severe pains, anxiety, dyspnoea, nausea, and empty retchings, or distension and tenderness of the abdomen; suppression both of faeces and urine; coldness of the face, tongue, and extremities; breath also cold; with spasms of various kinds in different parts of the body, which are renewed by any exertion, either of speech or movement,—the following remedies will be found useful. Aconitum.—Against any inflammatory symptoms that may present themselves. Cuprum aceticum, when spasms or cold sweats predominate. Belladonna, against inflammatory colic, or if symptoms of abdo- minal inflammation set in (see article Enteritis, and also Colic), and administer accordingly. Colocynth, violent colic and distension of the abdomen (see Colic). Veratrum album, coldness of the body and extremities, and retching. cholera. 197 Carbo vegetabilis, in extreme cases, with scarcely perceptible pulse, and cold breath. The use of clysters of Avarm water has, in many instances, been found serviceable, in promoting an evacuation of the bowels, and bringing back the suppressed discharge. When the patient has escaped the serious consequences above noticed, chronic complaints are often the result of Suppressed Dysentery: the most frequent being Dropsy, Paralysis, and Rheumatism. CHOLERA. By the term Cholera Morbus was formerly understood a disease attended Avith nausea, griping, purging, and vomiting, generally preva- lent towards our summer months, and at the season when fruit abounds. But it has now become a generic term, under which are included two varieties,—the Cholera Morbus, properly so called, and the Asiatic Cholera. Diagnosis.—The first-named, sometimes called the Sporadic Cholera, generally commences with a sudden feeling of nausea and griping, fol- lowed by purging and vomiting ; in severe cases, accompanied with coldness of the body, particularly the extremities, anxious and hurried breathings, excessive thirst, a feeling of cramp in the legs, sometimes in the arms, with spasmodic contractions of the abdominal muscles, shrinking of the features, and a hollow expression about the eyes; pulse weak, sometimes scarcely perceptible ; thin, watery, and fetid, or bilious evacuations, sometimes with dark bilious vomiting, anxiety, and tenesmus. Causes.—The most frequent are worms, gall-stones, unwholesome indigestible food; fruits, or crude vegetables, alterations in tempera- ture, moist or marshy situations, damp weather, wet feet, suppressed perspiration from sudden exposure to cold, cold drinks Avhen over- » heated, dentition, or parturition. Therapeutics.—In the treatment of Cholera, in its sporadic form, (i. e. when the disease arises from occasional causes, such as cold, fatigue, &c), the following remedies will be found the most efficacious: Chamomilla, Ipecacuanha, Veratrum album, Arsenicum album, Cin- chona, and Pulsatilla. Chamomilla is almost specific in the premonitory stage, particu- larly when the complaint has been excited by a chill, or a Jit of passion, or great dread of being attacked during the prevalence of the disease. The following are the symptoms which particularly indicate its em- ployment : acute colic-like pains, or heavy pressure in the region of the navel, sometimes extending to the heart, with excessive anguish; bilious diarrhoea, cramps in the calves of the legs ; yellow furred tongue, and sometimes vomiting of acid matter. {Pulsatilla is preferable to Cha- momilla, when the attack has been brought on by partaking of rich, in- digestible food, and Avhen the stools are more of a mucous character. Colocynth, again, is more appropriate in some cases arising from a moral cause, more especially a fit of anger or mortification, attended with in- dignation.) Chamomilla, &c, may be prescribed as follows: 198 digestive system. R Tinct. Cham. vulg. 3, gtt. iij. Aq. pur. 3ij. M. Dosis. Coch. maj. j, tertia vel sexta quaq. hor. pro re nata. Ipecacuanha may be administered after the above, should the attacks of vomiting become more prominent; or it may be selected from the commencement, should vomiting predominate, or at least assume as marked a character in the complaint as the diarrhoea. Other indica- tions are—sensation of weakness, or softness (flaccidity) in the epigas- trium, coldness in the face and limbs, sense of shivering in the abdomen; slight cramps in the calves of the legs, and in the fingers and toes. {Nux v. has been found of great value after Ipecac, when the vomiting yielded to the employment of that remedy, but symptoms of Cardialgia remained, such as weight in the epigastric region, anxiety, pain in the abdominal viscera, frequent small evacuations, and tenesmus, frontal headaches, horripilation with predominating internal chills.) Form of prescription, same as Chamomilla. Veratrum album, should the disease increase notwithstanding the employment of the preceding remedy, and assume the following cha- racteristics : violent vomiting with severe diarrhwa, excessive weakness, and cramps in the calves of the legs ; eyes holloAV or sunken, counte- nance pale, and expressive of acute suffering and intense anguish ; cold- ness of the breath and tongue ; excruciating pain in the region of the navel, tenderness of the abdomen when touched; dragging pains and cramps in the fingers, shrivelled appearance of the skin on the palms of the hands. (This is one of the best remedies in both varieties of this disease.) R Tinct. Veratr. 6, gtt. iij. Aq. pur. giij. Dosis. Coch. medioc. j. omni bihorio, omni hor., omn. quadr. hor., vel ssepius p. r. n.' Arsenicum is useful, when this malady assumes a severe character from the beginning, but is more particularly indicated when the disease is attended with rapid prostration of strength, insatiable thirst, excessive anxiety, loss of articulation, with fear of approaching death, burning sensation in the region of the stomach, almost constant discharge from the bowels, or renewal of the discharge, as often as the desire for drink is gratified; suppression of urine or scanty micturition, followed by a burning sensation ; violent and painful vomiting, tongue and lips dry, cracked, bluish or black; hollow cheeks, pointed nose; pulse almost imperceptible, or small, weak, intermittent, and trembling; severe spasms in the fingers and toes; clammy perspiration. Form of prescription the same as that given for Veratr. The dose to be repeated every half hour, every hour or every two hours, accord- ing to the severity of the symptoms ; the intervals to be lengthened as soon as signs of amendment set in. Cinchona is chiefly most useful against the Aveakness which remains after cholera, but is also serviceable, occasionally, during the course of the disease, particularly when there are vomiting of ingesta, and fre- quent watery and brownish evacuations, containing particles of undi- 1 See Rules for the repetition of the dose, in the Introduction. cholera. 199 gested food; also when there is oppression at the chest, with eructations, which afford temporary relief; severe pressure in the abdomen, espe- cially after partaking of the smallest portion of food; great exhaustion, sometimes amounting to fainting. This remedy is, moreover, indicated when the disease has been excited by indigestible substances, such as unripe fruit, &c, or by inhabiting a marshy situation: R Tinct. Cinch. 3, gtt. giij. Aq. pur. 3ij. M. Dose. 3ss every six or twelve hours, according to circumstances, until ameliora- tion results. Pulsatilla, in mild cases, with mucous diarrhoea and dyspeptic symptoms. It is also useful when the disease has been excited by the use of indigestible articles of diet. (Vide Diarrhea and Indigestion.) R Tinct. Puis. 6, gtt. ij. Aq. pur. 3ij. M. Dose. A dessert-spoonful every six or eight hours, until amendment takes place. Asiatic Cholera. Malignant Cholera. {Cholera asiatica, epide- mic^ spasmodica.) This disease generally commences with vertigo, headache, and singing in the ears, a sensation of flatulence m the stomach, or griping pains, and a feeling of weight and oppression in the region of the heart. In some, though not all cases of Asiatic Cholera, we findthe lips, nails, and sometimes the whole skin, of a blue colour, but, in almost every instance, the frame loses its power of generating heat, the pulse and pulsation of the heart are almost unfelt, and the circulation of the blood becomes stagnant. Patients, who have escaped through the second stage, are frequently carried off by a typhoid fever in the third. We quote the following accounts of malignant cholera, as it has ap- peared in India, in the north of Europe,1 and in this country,2 as giving a sufficiently full and vivid description of the symptoms of the malady in its different stages. . " The attack of the disease in extreme cases is so sudden, that, froni a state of apparent good health, or with the feeling only of trifling ail- ment, an individual sustains as rapid a loss of bodily power as if he Avere suddenly struck down, or placed under the immediate effects of some poison; the countenance assuming a death-like appearance, the skin becoming cold, and giving to the hand (as expressed by some observers) the sensation of coldness and moisture which is perceived on touching a frog; by others represented as the coldness of the skin of a person already dead. The pulse is either feeble, intermitting, fluttering, or lost; a livid circle is observed round the eyelids ; the eyes are sunk m their sockets; the tongue is cold, and either clean or covered with a slight white fur; and, in many instances, even the breath is cold. In cases of this severity, the vomiting and purging characteristic of the disease do not commonly take place so early as in milder attacks, but seem to be delayed until the almost overpowered functions of the body » Hooper's Med. Diet., page 380. 2 Mackintosh's Practice of Physic, p. 337. 200 digestive system. make a slight effort at reaction. It is worthy of remark, that, unless death takes place in these extreme cases within a few hours, some effort of the animal power is made to rally the constitution ; and this point is insisted upon here, because it will direct the mind of practitioners to the particular moment when bleeding, and certain other parts of practice, recommended in the Indian Reports, can be enforced in this country with probable success. Vomiting soon succeeds; first of some of the usual contents of the stomach, next of a turbid fluid, like whey, white of egg, water-gruel, or rice-water ; described, perhaps, more accurately as a serous fluid, containing flocculi of coagulated albumen. The lower bowels seem to let go their contents; what happens to be lodged in the rectum is passed more or less in its natural state ; the next discharges are similar to those thrown up from the stomach, and are passed with violence, as if squirted with a syringe. The same similitude may be applied to the vomiting. Spasms, beginning at the toes and fingers, soon follow, and extend, by degrees, to the larger muscles of the legs and arms, and to those of the abdomen. These vary in intensity, but are sometimes so violent as to put on the appearance of tetanus. " In some severe cases the vomiting is slight, in others considerable; and the purging and vomiting precede each other without any known rule; but whichever may be the precursor, a severe burning heat is early felt at the praecordia; there is an invincible desire for cold liquids, particularly water; and, although the skin and tongue are cold to the touch, and the pulse nearly lost, or altogether imperceptible, the patient complains of intense heat, and has an almost insuperable aversion to any application of it to the skin. The spasms increase, sometimes spread- ing gradually, sometimes suddenly, to the abdomen, as high as the scrobiculus cordis. The next severe symptoms are, an intolerable sense of Aveight and constriction felt upon the chest, accompanied Avith anxious breathing, the spasms continuing at the same time; a leaden or bluish appearance of the countenance, the tongue, fingers, and toes assuming the same colour; the palms of the hands and soles of the feet becoming shriA'elled; the fingers and toes giAdng the appearance of having been corrugated by long immersion in hot water. There is, throughout a suppression of the secretion of urine, of the secretions of the mouth and nose: no bile is seen in the evacuations; and it may be generally ob- served, that all the functions employed in carrying on life are suspended, or alarmingly weakened, except that of the brain,—Avhich appears, in these extreme cases, to suffer little, the intellectual powers usually remaining perfect to the last moment of existence. At length a calm succeeds,—and death. The last period is commonly marked by a sub- sidence of the severe symptoms, Avithout improvement of the pulse or return of natural heat; but, occasionally, it terminates in convulsive spasm. Within an hour or two from the commencement of such a seizure, and sometimes sooner, the pulse may be imperceptible at the wrist, or in the temporal arteries. If it be discoverable, it will usually be found beating from eighty to a hundred strokes in a minute ; this, however, is not invariable, the pulse being not unfrequently quicker. The powers of the constitution often yield to such an attack at the end of four hours ; and seldom sustain it longer than eight. cholera. 201 " In the less rapid and more ordinary form, sickness at the stomach, slight vomiting, or perhaps two or three loose evacuations of the bowels, which do not attract much attention, mark the commencement ot the attack; a sense of burning heat soon felt at the praecordia excites sus- picion of the disease; an increased purging and vomiting of the peculiar liquid gives certain indication of its presence if this has not been pre- viously declared by the prostration of strength, and an expression ot the countenance not often exhibited, except when death is to be expected within a few hours. The symptoms before described follow each other in similar but slower succession; the spasms of the extremities increase with the vomiting and purging, and particularly in proportion to the constriction of the thorax; and this form of the disease, which creeps on at first insidiously, and is in its progress more slow, by giving a greater opportunity for assistance, is, if treated early, more tractable; but if neglected, equally fatal with the more sudden seizures. Such cases last from tAvelve to thirty-six hours. " The principal difference consists in the diffusion of the symptoms through a greater space of time ; a misfortune, it is true, to the patient, if the disease prove ultimately fatal, but advantageous, by affording an interval for the natural powers of the constitution to rally themselves, and for the employment of the resources of medical art. But there is another remarkable distinction well worthy of attention. It has been observed before, that in the more rapid cases, the intellectual faculties suffer but little ; and it may be added here, that the disturbance of them is not delirium, but rather a confusion and hesitation of mind resembling slight intoxication. In those of longer duration, if the individuals, either by the natural vigour of their constitution or medical assistance, sustain the shock beyond the period of twenty-four hours, suffusion of the tunica conjunctiva often takes place, not unfrequently delirium, and even coma. " It is remarked, that those who survive seventy-two hours, generally rec0ver—but there are exceptions to this; for although, according to the Reports of the Medical Practitioners in the Presidencies of Bombay and Madras, the recovery from this seizure commonly terminates the disease ; or, as is stated in the latter, the sequelae are those dependent upon some previous ailment of the individual; yet the Bengal Report details a series of subsequent symptoms resembling those of low nervous fever, which, when they proved fatal, usually terminated within eleven days 'from the commencement of the seizure called Cholera. To com- plete the outline, an account of these symptoms, extracted from the Beno-al Reports, will be presently given ; and we may observe, that they correspond accurately with the description given by Dr. Keir of the second stage of the disease, as it appeared at Moscow from the begin- ning of the month of October to the earlier part of the month of March. But we will previously point out the manner in which the recovery from this seizure commonly takes place. The first symptoms are, the abate- ment of the spasms and difficulty of breathing, a return of heat to the surface of the body, and a restoration of the pulse; these, however, are equivocal, from being often only temporary; and the prognostic from them is very uncertain unless they follow a progressive march of amend- 202 digestive system. ment: sleep and Avarm perspiration attending it are of more importance and more certain signs of recovery. The return of the secretion and evacuation of urine is reckoned one of the most favourable signs ; the next is, the passage of bile by the bowels; and if this be freely esta- blished, and accompanied Avith an improvement of the pulse and of the temperature of the skin, the patient is soon placed in a state of security from the attack: but it will appear, from the following extract from the Bengal Report, that upon this recovery he has often a serious stage of disease to encounter; the description of which, is given in the words of the author. Before, however, we proceed to this, we must remark, that the seizure, when not fatal, has three modes of termination: one in immediate convalescence, accompanied only with great weakness;—a second, in which large evacuations of vitiated bile are passed for several days, sometimes attended with blood, and with peculiar pains in the boAvels, particularly in the rectum. The third is of a febrile nature, of which the folloAving account is supplied from the information given in the Bengal Report, viz. :— " ' The fever, which almost invariably attended this second stage of the disease, . . . partook much of the nature of the common bilious attacks of these latitudes. There was a hot, dry skin, a foul, deeply- furred tongue, parched mouth, thirst, sick stomach, restlessness, Avatch- fulness, and quick variable pulse, sometimes with delirium and stupor, and other marked affections of the brain. Generally, when the disorder proved fatal in this stage, the tongue, from being cream-coloured, became brown, and sometimes black, hard, and more deeply furred; the teeth and lips were covered with sordes, the state of the skin varied, chills alternating with heats, the pulse became extremely quick, weak, and tremulous, hiccough, catching of the breath, great restlessness and deep moaning succeeded, and the patient soon sunk incoherent and insensible under the debilitating effects of Ioav nervous fever, and fre- quent dark, tarry alvine discharges.' It is to be observed, that the able author of the Bengal Report doubts Avhether these symptoms can be considered as ' forming any integrant or necessary part of the disorder itself,' or whether they belonged to the bilious seizures of the climate. Subsequent experience of the disease has removed this doubt by show- ing that the febrile stage of cholera has been much more frequent in other climates than in India. " The cholera morbus of the north of Europe, to which the Russian peasants have given the name of ' chornaia bolezn,' or black illness, like most other diseases, is accompanied by a set of symptoms which may be termed preliminary; by another set which strongly mark the disease in its first, cold, or collapsed stage; and by a third set, which characterize the second stage, that of reaction, heat, and fever. " Preliminary Symptoms.—We have had but few opportunities of witnessing the presence of all these symptoms, some of which precede the complete seizure by so short an interval, that the utmost diligence is scarcely sufficient to bring the patient and the physician together, after their occurrence, before the disease is fully formed. Diarrhoea, at first feculent, with slight cramps in the legs, nausea, pain or heat about the pit of the stomach, malaise, give the longest warning. Indeed, purging, CHOLERA. 203 or ordinary diarrhoea, has been frequently known to continue for one, tAvo, or more days, unaccompanied by any other remarkable symptom, until the patient is suddenly struck blue, and nearly lifeless. Often the symptoms just mentioned. are arrested by timely judicious treatment, and the disease completely averted. When violent vertigo, sick stomach, nervous agitation, intermittent, slow, or small pulse, cramps beginning at the tips of the fingers and toes, and rapidly approaching the trunk, give the first warning, then there is scarcely an interval. " First stage.—Vomiting or purging, or both these evacuations, of a liquid like rice-water, or whey, or barley-water, come on; the features become sharp and contracted ; the eye sinks ; the look is expressive of terror, wildness, and, as it were, a consciousness on the part of the suf- ferer, that the hand of death is upon him. The lips, the face, the neck, the hands, feet, and even the thighs, arms, and whole surface assume a leaden, blue, purple, black, or deep brown tint, according to the com- plexion of the individual, varying in shade with the intensity of the attack. The fingers and toes are reduced at least a third in thickness ; the skin and soft parts covering them are wrinkled, shrivelled, and folded; the nails put on a bluish pearl-white. The larger superficial veins are marked by flat lines of a deeper black; the pulse is either small as a thread, and scarcely vibrating, or else totally extinct. The skin is deadly cold, and often damp, the tongue always moist, often white and loaded, but flabby and chilled like a bit of dead flesh. The voice is gone; the respiration quick, irregular, and imperfectly per- formed. Inspiration appears to be effected by an immense effort of the chest, whilst the alee nasi (in the most hopeless cases and toAvards the close), instead of expanding, collapse, and stop the ingress of the air. Expiration is quick and convulsive. The patient asks only for water, speaks in a plaintiA'e Avhisper (the ' vox cholerica,') and only by a word at a time, from not being able to retain air enough in his lungs for a sentence. He tosses incessantly from side to side, and complains of intolerable weight and anguish around his heart. He struggles for breath; and often lays his hand on his stomach and chest, to point out the seat of his agony. The integuments of the belly are sometimes raised into high irregular folds, Avhilst the belly itself is violently drawn in, the diaphragm upwards, and inwards towards the chest. Sometimes there are tetanic spasms of the legs, thighs, and loins; but we have not seen general tetanus, nor even trismus. There is occasionally a Ioav suffering whine. The secretion of urine is always totally suspended; nor have we observed tears shed under these circumstances. Vomiting and purging, which are far from being the most important or dangerous symptoms, arid which in a very great number of cases of the present epidemic have not been profuse, generally cease, or are arrested by medicine early in the attack. Frictions remove the blue colour for a time from the part rubbed, but in other parts, particularly the face, the livor becomes every moment more intense and more general. The lips and cheeks sometimes puff out and flap in expiration, with white froth between them, as in apoplexy. If blood be obtained in this state, it is black, floAvs by drops, is thick, and feels to the finger colder than natural. Towards' the close of this scene the respiration becomes very slow; there 204 digestive system. is a quivering among the tendons of the wrist. The mind remains entire. The patient is first unable to swallow, then becomes insensible; there never is, hoAvever, any rattle in the throat, and he dies quietly, after a long convulsive sob or two. " The above is a faint description of the very worst kind of case dying in the cold stage, in from six to twenty-four hours after the setting in of the bad symptoms. We have seen many such cases just carried to the hospital from their homes or their barracks. In by far the greater number vomiting had ceased ; in some, hoAvever, it was still going on, and invariably of the true, serous kind. Many confessed that they had concealed a diarrhoea for a day or two. Others had been suddenly seized, generally very early in the morning. " From the aggravated state which we have just described, but very few indeed recover; particularly if that state have been present even for four hours before treatment has commenced. A thread of pulse, however small, is almost always felt at the wrist, where recovery from the blue or cold stage is to be expected. Singular enough to say, hic- cough, coming on in the intermediate moments between the threatening of death and the beginning of reaction, is a favourable sign; and gene- rally announces the return of the circulation. " In less severe cases, the pulse is not wholly extinguished, though much reduced in volume; the respiration is less embarrassed; the op- pression and anguish at the chest are not so overwhelming, although the vomiting, the purging, and the cramps, may have been more intense. The coldness and change of colour of the surface; the peculiar altera- tion of the voice ; a greater or less degree of coldness of the tongue; the character of the liquids evacuated, have been invariably well marked in all the degrees of violence of attack which we have hitherto witnessed, in this epidemic. In no case or stage of this disease have we observed shivering, nor have we heard after inquiry, of more than one case in which this febrile symptom took place. "Fever, or hot stage.—After the blue, cold period has lasted from twelve to twenty-four, seldom to forty-eight hours or upwards, the pulse and external heat begin gradually to return ; headache is complained of, with noise in the ears ; the tongue becomes more loaded, redder at the top and edges, and also dryer. High-coloured urine is passed with pain, and in small quantities; the pupil is often dilated; soreness is felt on pressure over the liver, stomach, and belly; bleeding by the lancet or leeches is required ; ice to the head gives great relief. In short, the patient is now labouring under a continued fever, not to be distinguished from ordinary fever. A profuse, critical perspiration may come on, from the second or third day, and leave the sufferer convalescent, but much more frequently the quickness of pulse and heat of skin continue; the tongue becomes brown and parched; the eyes are suffused and drowsy ; there is a dull flush, with stupor and heaviness, about the countenance, much resembling typhus; dark sordes collect about the lips and teeth; sometimes the patient is pale, squalid, and low, Avith the pulse and heat below natural: but with the typhus stupor, delirium su- pervenes ; and death takes place from the fourth to the eighth day, or even later, in the very individual, too, whom the most assiduous atten- CHOLERA. 205 tion had barely saved in the first or cold stage. To give a notion of the importance and danger of the cholera fever, a most intelligent physician, Dr. Reimer, of the Merchants' Hospital, informs us, that of twenty cases treated under his own eye, who fell victims to the disease, seven died in the cold stage, and thirteen in the consecutive fever. " This singular malady is only cognizable, with certainty, during its blue or cold period. After reaction has been established, it cannot be distinguished from an ordinary continued fever, except by the shortness and fatality of its course. The greenish, or dark, and highly bilious discharges, produced in the hot stage, by calomel, are not sufficiently diagnostic; and it is curious, that the persons employed about these typhoid cases, Avhen they are attacked, are never seized with ordinary fever, but with the genuine, cold, blue, cholera. Nothing, therefore, is more certain, than that persons may come to the coast of England, ap- parently labouring under common, feverish indisposition, who really and truly are cases of cholera in the second stage. "Phenomena of Asiatic Cholera as it appeared in this country. " The disease consists of three stages. The first stage may be called premonitory ; the second, the stage of collapse ; the third, that of con- secutive fever. " The first stage is characterized by symptoms of indigestion, flatulent disturbance in the abdomen, praecordial weight or oppression, slight nausea, acidity, griping pains, diarrhoea, vertigo, some degree of head- ache, or tinnitus. These symptoms, even when accompanied by spasms, are too often either disregarded or concealed, till the second stage is far advanced. It is most unfortunate, that this reluctance to confess the early part of the indisposition should so frequently exist in all classes of society, but particularly among the poor, because few of the more severe maladies, to which flesh is heir, are so remediable as cholera in the first stage, and not one more hopeless after the lapse of a few short hours. "It is stated by the Russian physicians, that at Orenberg, Moscow, and other places, scarcely a person escaped, during the season when cholera prevailed, without some disorder of the stomach and bowels,— indicated by nausea, vomiting, and oppression at praecordia, indigestion, pain in the belly, and looseness of bowels. Many instances of disorder of the stomach and bowels prevailed during the epidemic season, and for some weeks before there Avas a well-marked case of cholera in Edinburgh. " Second stage.—The duration of the premonitory or first stage is various; sometimes the unpleasant symptoms suddenly cease, and the patients recover quickly; but this happy issue is comparatively rare, Avhen proper remedies are not used; and in some few cases, from the peculiarity of constitution of the patient, remedies seem to have little effect in arresting the progress of the disease, even when applied in this early stage. The stools, which were at first feculent and bilious, now become characteristic of the true Asiatic cholera. They have the ap- pearance of very thin gruel, or rice-water ; sometimes they are watery. 206 DIGESTIVE SYSTEM. limpid, with small flakes of curdy-looking matter intermixed ; at other times, they present an appearance of water in which fresh beef had been macerated. The usual feculent smell has vanished, instead of which the stools have a peculiar odour, Avhich struck me to resemble that produced by macerating fish in Avater; a similar odour is generally observed from the surface of the body. More rarely, the stools look like the lees of port-wine; and it was remarked, that almost none recovered who passed ' port-wine stools ;' I recollect at present one recovery only in which there was this appearance. The desire to go to stool is irresisti- ble and instantaneous; tenesmus is great in some cases, sometimes pre- ceded or accompanied by a sense of heat or griping. The stools are generally very copious,—sometimes, however, scanty; often accom- panied by loud discharges of flatus from the bowels. Along with the bowel-complaint, there are burning heat in the region of the stomach, and vomiting of large quantities of a similar fluid from the stomach. The abdomen feels doughy. The thirst is intense, and there exists an urgent desire to drink cold water. The mind, for the most part, remains comparatively entire, but the vertigo and tinnitus increase. Cramps are general attendants,—sometimes confined to the fingers and toes ; at other times they affect the muscles of the extremities, and often those of the trunk of the body, more particularly of the abdomen. The urine is generally suppressed early in the disease. The Aroice is whispering, the person being unable to speak in any other tone. The respiration, although weak, is often nearly natural in other respects, even at times when the pulse is scarcely perceptible at the wrist; occa- sionally, however, the breathing is hurried and oppressed, sometimes laborious. The pulse becomes weak and rapid early in the disease, even when the action of the heart is comparatively strong and tumultu- ous ; but frequently both the pulse and action of the heart are feeble. As the disease goes on, both become more and more weak; the pulse is only now and then felt like a 'flutter,' and often ceases to be per- ceptible at the wrist for some hours before death. The tongue is cold and shrunk. It is quite painful to a bystander to watch the restless- ness and impatience of the sufferers, who are constantly in a state of jactitation, more particularly when restrained, and when heat is applied. Indeed, they seem to have a horror at, and to suffer pain from, warm applications. The temperature of the body, but more particularly of the extremities, diminishes early in the disease, and goes on sinking. It is often impossible to raise the temperature of the body during life, but the moment death takes place, and for two or three hours aftenvards, the body becomes warm,—even the icy coldness of the ex- tremities gives place to a genial warmth. The colour of the hands and feet become changed, more particularly the nails assume a blue appear- ance ; the face often is similarly affected; occasionally the whole sur- face presents a blue colour, and, consequently, the second stage has sometimes been termed «the blue stage;' but it is an error to suppose that the blueness is invariable, or that it is an attendant only on the worst forms of the complaint,—the patient who had this appearance more strongly marked than any other, was the one who made the most rapid and the most complete recovery. Blood, drawn from an CHOLERA. 207 artery or vein during this stage, flows with difficulty, is of a dark colour, does not coagulate, or separate any serum. It remains in a semi-fluid state, and has the appearance which the ancients called ' dissolved blood.' The surface of the body is covered, for the most part, with a cold exudation, the features and eyeballs shrink, and death closes the scene,—sometimes very unexpectedly, at others the body seems to be long dead, while the functions of the brain are still going on and com- paratively entire. " Sometimes the prostration of strength is extreme ; but it is my belief, that muscular debility is no part of the disease, till far advanced in the second, or collapsed stage. I have been surprised at the efforts made by patients when they were thought to be near death. . . . The appearance of muscular debility is occasioned by the vertigo, which renders the gait unsteady and tottering, as well as by the dread of motion producing cramps. " Many exceptions might be made to this account of the symptoms in these two stages. Sometimes no premonitory symptoms can be traced. I know of one case where the person appeared to have died under the effects of the first attack of cramps; he Avas known to have laboured under slight boAvel complaint for several days, but he did not confine himself, and was lying without any complaint on a sofa; he was dressed and engaged reading. A noise was heard, and he was soon after found on the floor on his face, dead, with the book clenched in his hand, and his muscles rigid. I have seen several cases where the urine was not entirely suppressed, and others in which the stools were feculent and bilious up to the moment of death. But those cases are to be regarded as exceptions to the rule, which they do not contravene. The symp- toms in this disease, as in all others, must suffer modifications from pecu- liarity of constitution, previous condition of health, and habits of the patient affected. " The symptoms Avhich present the most unerring characteristics of Asiatic cholera are diarrhoea, and other symptoms of disordered stomach and bowels, in the first or premonitory stage. I believe previous diarrhoea may be discovered in at least four out of six cases, and proba- bly exists in all, if the history of each were perfect. Thus, in the city of Albany, U. S., diarrhoea occurred in 282 out of 336 cases; in the remaining 54, it could not be ascertained whether this symptom had or had not existed. In the stage of collapse, there are the whispering voice, great restlessness, characteristic discharge upwards and down- wards, cramps, suppression of urine, excessive thirst, weak faltering pulse, weak respiration, coldness of extremities, shrivelled hands and feet, bedewed with a cold exudation. The general blueness, when it exists, is also quite peculiar to cholera. It is remarkable how quickly an extremely collapsed state of the features takes place. The patients appear to dread hot applications. The blood-vessels, on such parts of the body as the temples, where they are comparatively superficial and easily seen, are observed to be full of blood of a very dark colour; even the serpentine branches of the temporal artery can be traced in this manner, and the motion of the blood is very slow. " Third stage.—A large proportion of patients died in the second 208 DIGESTIVE SYSTEM. stage; there were few immediate recoveries from collapse, without under- going the danger and miseries of a consecutive fever, which is noAV to be described. I shall never forget the joy expressed by all who were watching the first case of cholera in Avhich death did not take place in the stage of collapse. This feeling was increased as the Avatery diarrhoea, vomiting, and cramps diminished, and at last ceased, and as reaction became more evident and permanent. Nor shall I attempt to describe the subsequent disappointment, as bad symptoms arose one after another, to convince us that the patient, although he had made an escape from 'one set of dangers, was still surrounded by another, which experi- ence speedily proved to us Avere extremely formidable. " The symptoms that denoted an escape from the horrors of the second stage, were, diminution in the number and quantity of the evacuations, both from the bowels and stomach; cessation of restlessness, thirst, and cramps; increase of the temperature of the body, and strength of the pulse ; an expression of animation in the countenance ; and a disposition to sleep. Sometimes the stools speedily lost the characteristic watery appearance, and became feculent; but this change was generally gradual. Sometimes the secretion of urine took place early after the reaction was established, but this favourable circumstance rarely occurred so soon. In some cases, after everything appeared to be going on Avell, the vomiting and purging suddenly returned, the pulse became weak and quick, and the patient rapidly died. " The phenomena of the third stage presented every appearance of fever ; sometimes of that form denominated in this country ' Typhus,' and in several cases a similitude was easily traced to the last stage of Yellow Fever. In fact, the general opinion that was, and still is main- tained, that cholera is nothing but a fever, with violent irritability of stomach and bowels, suppression of the secretions of bile and urine, with a cold stage, appeared to derive support from the resemblance to the phenomena of intermittent fever. But it will soon be in my power to show how erroneous this opinion really is, when the pathology of cholera falls to be considered. "After the complete development of reaction, patients for a time appear to be doing very well, not teased with violent tenesmus and vomiting, nor disturbed with intense thirst and violent cramps. The restlessness has ceased, and they seem to be enjoying tranquillity. But this state is generally to be regarded as a calm which is too soon to be followed by a storm. The subsequent symptoms vary very much in dif- ferent cases, depending on the previous state of health and habits of the patient, and his peculiarities of constitution, as well as on the pheno- mena of the previous stage, and the treatment pursued. " These symptoms Avere, lethargy or coma, which were frequent; de- lirium ; convulsions ; paralysis ; rigidity of the flexor muscles of the extre- mities ; distressing nausea; bilious vomiting and thirst; dyspnoea, or hurried respiration; cough, expectoration; palpitation and irregular action of the heart, and more or less heat of skin; bilious diarrhoea; port-wine stools; tenesmus; and pain or tenderness, increased on pressure, in some part of the abdomen. Of all these symptoms, convulsions were the most rare. The others existed variously combined and modified. CHOLERA. 209 "Causes of Cholera.—The undivided opinion of medical men who saw the disease in India is, that in the East it is not contagious. After the appearance of cholera in Russia and Poland, however, a belief became prevalent that the disease had been modified by climate, and the habits of the people in Europe ; that it had more resemblance to a fever, and Avas highly contagious. There are few medical men Avho were not influenced by this specious statement; and I confess that my mind was at one time so strongly impressed with the belief in the contagious nature of the disease, that for the first five or six weeks after its appear- ance in Edinburgh, when I retired to bed at night I scarcely expected to find myself alive in the morning. But my fears were at last dis- pelled, and my opinion is, that if it be contagious, it is not so in any very great degree. The following are the grounds on which this opinion is formed. It Avas intimated to me, by authority, that as the disease Avas so contagious, every possible precaution must be taken to prevent its extension, and that few bodies could be allowed to be opened, as the contagion was more virulent and searching after than before death. But from the moment my mind was made up to accept the appointment, I resolved that fear should not be allowed either to interfere with my attendance on the sick, or to hinder my investigations after death. Accordingly, in attending the first case of cholera in the hospital, I remained in the ward all night, and became so much exhausted, that I fell fast asleep in the bed next the dying person, and slept for above an hour, at a time when my animal spirits Avere low and my physical strength diminished by the fatigues of the previous day. Subsequently, I have more than once accidentally fallen asleep on a bed on which some unfortunate had died, and in a ward in which there were several dying persons at the time. None of the house surgeons, the number being between 20 and 30, who Avere seldom out of the wards, had the disease, although their bodies must have been ready to receive the con- tagion, if fatigue of body, anxiety of mind, and want of sleep ever pre- disposed any person to take a disease. Two male nurses had cholera. One was a sober man, and although he had the Avarning diarrhoea, he neglected himself, but had the disease slightly. The other was a com- plete tippler ; he had a slight bowel complaint, Avhich he concealed, and by Avay of curing, obtained leave to go home to see his family; he got drunk, and Avas brought to the hospital with cholera, but never became collapsed. Several female nurses Avere also attacked; but that is no wonder, for, independent of the fatigue they underwent, they were drunkards, and bad characters in other respects ; and were actually in the habit of drinking the spirits and wine served out to their patients. Tavo of these characters, after much fatigue and a hard course of drink- ing, went to bed one night quite drunk ; they were both speedily seized with cholera—one died. But there is no proof of the influence of con- tagion in these cases. In truth, no case has ever been advanced in proof of the contagious nature of cholera, that cannot be explained on other and more satisfactory principles. Is it because four children, with father and mother, in one family, have had cholera, and because communication can be proved between them and an infected house, by means of a bundle of dirty clothes, or a Aveb of linen, or actual personal 14 210 DIGESTIVE SYSTEM. contact, that we are rashly to attribute the whole to contagion ? The same story may perhaps be told in a different way. The father is a dissipated, good-for-nothing man, Avho spends almost all his wages on whiskey ; he deprives his family of the means of procuring suitable nourishment; the poor mother has pawned her last blanket, to purchase a few potatoes for her starving children, who have all had loose bowels for several days or weeks. The explanation is easy to show the strong predisposing cause—insufficient clothing, deficiency of food, &c. What ansAver can be made to this fact, that I have seen several mothers suckle their children when they themselves were dying of cholera, and in one instance I found an infant sucking its dead mother's breast,—and yet not one of them had a symptom of cholera, at least for months after- wards ? . . . From the economical arrangement of the Board of Health, and the difficulty of procuring a proper apartment, the dead-room, where these examinations Avere conducted, was a miserable place about eight feet square ; generally six or eight persons were present, sometimes more; and in an inner apartment, about ten feet square, there some- times lay six dead bodies. Not one of those who frequented this den of death, and who had their hands imbrued in the secretions of the dead for six hours out of the twenty-four, were affected with cholera, although their hands were irritated and punctured daily! " It cannot be denied that some mysterious influence was operating at the period cholera prevailed, by whatever name it may be called,— that it selected its own victims—exercised its poisonous qualities in one district, town, or hamlet, more than in another—changed the scene of its ravages suddenly and capriciously, and made its progress from place to place, by strange detours, avoiding many populous situations, in the direct tract of human intercourse. . . . " Were any persons more prone to contract cholera than others ? This is an important question, and it is rare that a point in medical investigation can be so satisfactorily answered. All who had any im- portant visceral disease, or tendency to bowel complaint from slight causes, and drunkards, were the persons generally attacked. It is no doubt certain, that in each locality where cholera prevailed, some in- stances may be quoted to the contrary ; but these are very few indeed, and are to be regarded as exceptions to the general rule. Nothing could be more unsatisfactory than the accounts we received of the previous health and habits of patients ; very frequently we found them to be quite the opposite of Avhat had been stated; but when we opened the bodies, in the careful and minute manner in Avhich the dissections were conducted, we had the best evidence that few subjects were even tole- rably sound. " Persons advanced in age had, in the epidemic that I saw, a bad chance of recovery. Females seemed to be more liable to the disease than males. Almost every Avoman we opened, under a certain age, had the catamenia; and Ave found a great number of diseases, of various kinds, of the uterus, ovaries, tubes, and broad ligaments." Therapeutics.—We now proceed to mention the remedies, which have been successfully prescribed by those homoeopathists who have treated the disease in all its forms. CHOLERA. 211 When the premonitory symptoms of this disease, as above noted, exhibit themselves, its complete development is frequently prevented, by the administration of the saturated solution of camphor. Dose.—One or two drops of the above, every five minutes, in a tea- spoonful of cold water, until a cessation or amelioration of the symptoms takes place, when the intervals between the doses may be lengthened at first to every two, and then to every four or six hours. In many cases also, we may succeed in checking the disease at its commencement, by the remedies already mentioned under Sporadic Cholera. But when Cholera sets in in all its frightful forms, we should have immediate recourse to Veratrum, a remedy which all who have had an opportunity of trying have eulogized. R Tinct. Veratr. 3, gtt. viij. Aq. pur. giv. Dose. A dessert-spoonful every hour, every half hour, or even every quarter of an hour, according to the severity of the symptoms. But should no improvement set in after several doses, and the cramps change to spasms and convulsions, with spasmodic constriction of the chest, which obstructs respiration,—Cuprum (third trituration, or sixth dilution) must be had recourse to, in the manner as prescribed for Ve- ratrum : and if Cuprum be productive of only partial melioration, Veratrum may be administered in alternation with it. When symptoms of trismus and tetanus supervene, Camphora has been recommended as preferable to Cuprum. Arsenicum should be selected in preference to, or given alternately with, Veratrum, when an intense burning sen- sation is experienced in the stomach and bowels, with extreme prostra- tion of strength, great thirst, &c (Vide the indications for both these remedies, page 198.) Carbo vegetabilis (sixth dilution), may often be given with advan- tage when the patient is reduced to a state of almost complete asphyxia, with scarcely perceptible pulse ; or Avhen, on the cessation of vomiting, diarrhoea, and cramps or convulsions, congestion to the head and chest ensues, with oppressed breathing, coldness of the breath, redness or lividity of the face (which is covered with clammy sweat), and lethargy. It has been found useful in some instances to exhibit a dose or two of Acid hydrocyanicum, about an hour before the employment of Carbo v. Should the pulse become stronger under the action of Carbo v., but the pain, vomiting, cramps, &c, return, Veratrum must again be had recourse to. {Carbo v., like Cicuta, and perhaps Stramon., is, properly speak- ing, not so appropriate during the disease itself, as against the sequelae, especially those of a nervous type.) Ipecacuanha and Nux v. have been found efficacious before or after Veratrum, or any of the other medicaments, when the symptoms assumed the character mentioned at page 197. (The Russian homoeopathic practitioners found Ipecac, of peculiar efficacy.) Phosphorus (folloAved by Acidum phosphoricum, should great clam- miness of the tongue supervene) is particularly useful in cases of diar- rhoea, Avhich are so liable to occur during the prevalence of cholera, and which, if neglected, are but too prone to pass on rapidly to confirmed cholera. {Camphora, Secale corn., and Mercurius may also be required 212 DIGESTIVE system. in chlorine. The Russian practitioners found Mercurius often useful in cholera proper. See also art. Diarrhea, as any of the remedies men- tioned there may be resorted to in preference to the medicaments just named, if better indicated.) Dosis. Tinct. Phosph. 3 gtt. j, quarta vel sexta quaque hora.1 Phosphorus is also useful in the event of congestion in the chest during the course of the disease; and is, moreover, one of the most serviceable remedies against the obstinate diarrhoea, which sometimes remains after an attack. Tartarus emeticus.—Amongst the physiological effects of this medi- cament we find, those spasmodic movements, or jerking and twitching of the muscles; the trembling of the limbs, prostration of strength, or weakness to fainting; tremulous or imperceptible pulse ; peculiar pale- ness of the face ; hoarseness ; cramps in the calves of the legs; and especially the symptoms of gastric derangement that are so frequently met with in some forms of the disease. When the stools still consist of feculent matter, as is the case in cholera biliosa, or at the commence- ment of cholera indica, or also at the termination of the same, where the functions of the abdominal viscera are not yet restored to a normal state, Tartarus is, at all events, well deserving of attention.2 Cicuta virosa is considered an appropriate remedy, when there are spasms in the pectoral muscles, continuous vomiting, and little diarrhoea ; when the eyes are turned upwards, and the patient is in a soporific state. It is particularly in neglected cases, and consequently more in the sequelae of cholera, than in the disease itself, that this remedy is more generally indicated. Stramonium may likewise be useful in similar cases. In conclusion it may be added, that a few doses of Cantharis will be found useful, when there is great irritation and pain in the bladder; Rhus, Bryonia, Acid, phosphor., Bella., Hyoscy., Stram., Carb. v., Op., &c, when Typhus Fever results (vide Typhus); Belladonna (fol- lowed, if required, by Opium and Lachesis), when there is Congestion of the brain; Aconite, Phosphorus, Bryonia, Belladonna, &c, in addition to Phosphorus, should Congestion in the Chest supervene ; and Aconite,, followed by Nux v., Bryonia, or Mercurius, &c, when the stomach and intestines become the seat of congestion. (Vide Con- gestion to the abdomen). Secale cornutum is very useful in cases of colourless diarrhoea, Avith pains in the extremities remaining on the ces- sation of the vomiting, but is also valuable after Veratrum and Cuprum, when the cramps or convulsions do not yield to these remedies. Cinchona is useful against the general debility, and Sulphur and Phosphorus are two of the most important remedies against irritation or weakness in the alimentary canal, characterized by frequent attacks of or nearly con- tinual looseness occurring after cholera. The foregoing, then, are the principal remedies employed by homoeopathists in cholera, and when the treatment is had recourse to from the commencement, the disease gene- rally yields without difficulty, rarely passing even into the second stage, 1 Vide Rules for the repetition of the dose, in the Introduction. 2 Hartmann's Therapie, 3te Auflage, p. 188. CHOLERA. 213 and scarcely ever into the third. When patients affected with cholera sought the aid of a homoeopathic practitioner, after haying been pre- viously treated allopathically, it was found essential to give Camphora in repeated doses, in the first place, partly for the purpose of rousing the reactive power, and partly to neutralize the effects of the allopathic medicines. The best preservatives against infection are Veratrum, Cuprum, and Camphor; an occasional dose of the preparation mentioned under the latter medicine, at page 211, has frequently been found sufficient to ward off an attack: it is, however, more particularly during the first stage of the disease itself, under whatever form it sets in, that the greatest reliance is to be placed on this remedy. Veratrum and Cu- prum are the prophylaxes Avhich have been employed with the greatest success. Many homoeopathic practitioners recommend Veratrum alone, but the alternate prescription has perhaps been more generally preferred. They may be prescribed as follows: R Veratr. alb. 30, glob. xxiv. (red. in pulv.) Pulv. sacch. lact. q. s. Misce intime, et divide in partes sequales quatuor. Sign 1, 3, 5, 7. R Cupr. 30, glob. xxiv. (red. in pulv.) Pulv. sacch. lact. q. s. Misce intime, et divide ut supra. Sign 2, 4, 6, 8. N. B.—A powder to be taken in numerical order, every fourth day. Some practitioners, again, would prefer prescribing as follows: R Veratr. alb. 6, gtt. iij. Spirit, vin. rectif. 3j. Aq. distil, giij. R Cupr. 6, gtt. iij. Spirit, v. rectif. 3j. Aq. destil. 3iij. N. B.—The mixture to be taken alternately; the dose to consist of a table-spoonful night and morning, every third day. Or thus : R Veratr. alb. 3, gtt. j. Pulv. sacch. lact. q. s. F. pulv. tales sex. Sign 1, 3, 5, 7. R Cupr. 3, gr. vj. Divide in chart, sequales sex. Sign 2, 4, 6, 8. N. B.—A powder to be taken in the order numbered every third day. The same rules should be observed, whilst these preservatives are being taken, as those we have notified in the article on Scarlatina. The patient at the same time avoiding excesses of all kinds, late hours, exposure to night air, melancholy thoughts, or fear, which are all strongly predisposing causes to attacks of this malady. When the disease hap- pens to break out, notwithstanding these precautions, it is almost inva- riably in a mild form. During the prevalence of cholera the clothing should be sufficient to preserve the body at an equable temperature, and care should be taken to avoid chills or checked perspiration, or cold and wet feet: those Avho have habitually considerable perspiration in the feet, should change their stockings at least once daily ; a flannel bandage worn round the abdomen, is also a useful precaution, and should not be hastily laid 214 DIGESTIVE SYSTEM. aside, even when the danger seems to have passed away; constant exer- cise should likewise be taken, during the day, in the open air. Adhe- rence to the homoeopathic rules is a sufficient dietetic guide, but too sudden a change of diet is not advisable; raw vegetables and cold fruits, for example melons, should be carefully abstained from, and even the more wholesome varieties and all cooked vegetables, should be used in extreme moderation; pure beer and non-acid Avines are unobjectionable for individuals not attacked, and accustomed to their daily use, with the same limitation. It may appear almost supererogatory to observe that purity of air and thorough ventilation are highly necessary. Accessory Treatment.—The patient should be kept in a room of a warm temperature, the bed should be heated by artificial means, and bottles of hot water applied to the feet, if necessary. The observance of this rule greatly facilitates the action of the medicine employed: anything which might disturb the equanimity of the sufferer, such as noise or contradiction, should be carefully avoided, and his spirits should be sustained as much as possible. Cold water is the best drink, but the patient should not be allowed to take too much at a time; the occa- sional administration of a small piece of ice, if possible, or of iced water in teaspoonfuls, is often attended with benefit; and injections of iced water are sometimes serviceable in relieving the colic cramps in the intestines. During the convalescence following this disease, we must be careful not to indulge the patient to the full extent of his appetite. But if the appetite remain for a long time afterwards, in an impaired state, the employment of such remedies as Arsenic, Nux v., Puis., Rhus, Veratr., Cyclamen, or Acid, nitr., will, according to the pecu- liarities of the individual cases, prove of considerable service. Remarks.—When this disease is raging as an epidemy, we not unfrequently find individuals suffering under many symptoms bearing a marked resemblance to those of cholera, but with constipation instead of diarrhoea, and retching in place of vomiting; this affection being closely analogous to Suppressed Dysentery, the reader will find its appropriate treatment under that head, article Dysentery. CHOLERINE. This affection being merely diarrhoea, occurring during the preva- lence of Cholera, without any of the more severe symptoms of that dis- ease, the reader is referred to that article for its treatment. LIVER COMPLAINT. This disease is divided into the Acute and Chronic : the latter gene- rally goes by the name of Liver Complaint, although a careful diagnosis will often discover, that the real disease is in the stomach and intestines; however, in many cases the liver itself becomes materially implicated, and in itself deserves considerable attention. When the disease has been for a long time unchecked, and the in- flammation becomes deeply seated in the substance of the liver, an abscess frequently forms, bursting either externally or internally; in the latter case often proving critical, or bringing on hectic fever. HEPATITIS. 215 ACUTE INFLAMMATION OF THE LIVER. Hepatitis. This disease is much more common in tropical climes than with us. There, a high mode of living, exposure to heavy dews or damps in the evening, and the poAverful rays of the sun by day, are among its princi- pal exciting causes; but it may also arise from violent mental emotions, the use of stimulating or alcoholic drinks, suddenly suppressed evacua- tions, strong emetics or purgatives, the abuse of mercury, gall-stones, external lesions, or injury of the brain. Diagnosis.—This differs according to the seat of the inflammation. When it occurs on the outer surface or convex side, the symptoms closely resemble those of pleuritis; there is generally a violent pain in the right hypochondrium, sometimes resembling stitches, at others burning—shooting to the sternum, the right scapula and point of the shoulder, and even affecting the right foot,—sensation of numbness or tingling in the arm of the same side, the pain increased by inspiration; a short dry cough, and the symptoms of inflammatory fever; bowels irregular, generally constipated, and stools, in the majority of cases, of an unnatural colour. In this form the patient can only lie on the left side. When the seat of inflammation is on the inner or concave side of the liver, the pain is much less, and the patient complains rather of a sensa- tion of pressure than actual pain, but the Avhole biliary system is much more affected. The eyes and countenance become yelloAv, and some- times complete jaundice declares itself; the urine is orange-coloured, the evacuations mostly hard, and generally of a whitish or gray colour. We also find bitter taste in the mouth, vomiting, and considerable dis- tress. The patient can only lie on the right side. Inflammatory fever is met with in this variety likewise. In both forms, the right hypochondrium, on examination, will usually be found hot, tumefied, and painful on pressure. Inflammation of the liver, unless properly treated, is apt to assume the chronic form ; it may also end in suppuration externally, or inter- nally by a communication either with the lungs or intestinal canal, or by a vomica in the substance of the organ itself, or it may terminate in indurations or other alterations of structure, in gangrene, or in the formation of adhesions. The disease may terminate by resolution, critical metastases, hemor- rhoids, diarrhoea, epistaxis, or cutaneous, particularly erysipelatous, eruptions. Therapeutics.—The following remedies are those Avhich are most frequently required in the generality of cases :— Aconitum, Belladonna, Mercurius, Lachesis, Bryonia alba, Chamo- milla, Nux vomica,- Pulsatilla, and Sulphur. Aconite is especially indicated in the commencement of the attack, and may always precede the other remedies, when there is violent inflammatory fever, attended with insupportable shooting pains in the 216 digestive system. region of the liver, with tossing, restlessness, and great anxiety and anguish. Belladonna1 may be advantageously employed after Aconite has subdued the preceding symptoms, or from the commencement, when the following indications present themselves : oppressive pains in the region of the liver, which extend to the chest and shoulders, distension of the pit of the stomach, sometimes extending across the epigastrium, producing a sensation of tension, Avith difficult and anxious respiration; determination of blood to the head, with cloudiness and giddiness, some- times causing faintness ; great thirst, tossing about at night and sleep- lessness. (Temperament, sanguine lymphatic.) When Belladonna fails to remove the whole of these symptoms, Ave frequently find that Mercurius will have the desired effect; this me- dicament is too well known as an allopathic remedy in the cure of this disease, and the consequences produced by its abuse are frequently so great, as to render the disease almost incurable. It is generally ad- ministered by allopathic practitioners, even when not indicated, until its marked pathogenetic symptoms declare themselves, and consequently the patient, in addition to the original malady, has frequently to contend with a medicinal disease. The following are some of the principal indi- cations for its employment. Considerable fulness or tumefaction in the region of the liver, with pricking, burning, or oppressive pains, not allowing the patient to lie long on the right side, and sometimes augmented by movement of the body or part affected; pains in the shoulders; bitter taste in the mouth, want of appetite, thirst, and protracted shivering, sometimes followed by sweating, but Avithout relief, with pale yellow colour of the skin and eyes ; also in more advanced stages of the complaint when there is in- duration of the liver, or when we have reason to suspect the formation of matter. {Arsenicum, Hepar s., or Silicea, are equally, if not more, deserving of attention in the latter case.) If the patient is of a lym- phatic temperament, or is distinguished by softness of the muscular sys- tem, there will be additional reason for selecting Mercurius. Lachesis.—In subacute cases, or in those in which Belladonna or Mercurius have merely afforded partial relief, Lachesis is often of great service. It may also be administered with advantage, alternately with the said remedies, in obstinate cases occurring in drunkards. Bryonia, when the pains in the region of the liver are mostly shoot- ing, or consist of an obtuse pressure, with tension and burning, increased by touch, coughing or respiration, and especially during inspiration; or much exacerbated by movement; also when the symptoms are attended with violent spasmodic oppression of the chest; rapid and anxious respi- ration ; bitter taste in the mouth, tongue coated yellow; and constipation. Bryonia, like Chamomilla, is particularly useful in cases which have 1 Dr. Bosch found the alternate employment of Belladonna and Bryonia very effica- cious in acute inflammation of the liver; when the liver remained tumid and painful after the removal of the fever, Phosphorus and Bryonia: and when fulness, weight, dull pain, with dyspepsia and icterus, Carbo v. and Bryon.: or, when the said fulness and weight were unaccompanied by pain, but the patient complained of a feeling of weight in the scrobiculus, with frequent eructation, constipation, clayey stools, extreme languor, and jaundice, Carbo v. andiVwx in alternation.—Hygea, XX Bd, 5 Heft. hepatitis chronica. 217 been excited by mental emotion, such as a violent paroxysm of anger, and is Avell adapted to persons of nervous or bilious temperament, and of choleric disposition. Chamomilla, in slight cases, or simple irritability of the liver with pressiAre, aching pains, pressure in the stomach, oppression of the chest, and a sensation of tightness under the ribs; yellow colour of the skin, pains not aggravated by motion, &c.; tongue foul and yellow, bitter taste in the mouth ; paroxysms of great anxiety. Chamomilla is almost a specific, when the above symptoms have been brought on by a fit of passion. Nux vomica is particularly indicated, when the pains are shooting and pulsative, and attended with excessive tenderness, at the region of the liArer, to the touch, pressure in the epigastrium and under the ribs, Avith shortness of breath, and constipation : also when enlargement and induration occur ; and, in the chronic form, when there are marked symptoms of gastric derangement. (Temperament sanguine or bilious ; disposition choleric.) (Vide Nux vomica, art. Indigestion.) Arsenicum :—Distension of the right hypochondrium, with severe burning pains and sensibility to the touch, burning heat of skin, accele- rated pulse, intense thirst, anxiety, vomiting of a dark-coloured, grumous fluid. Pulsatilla.—Sensation of tension in the region of the liver, and pressure or dull pain in the epigastric region; oppression at the chest, bitter taste, yellow tongue, nausea; loose, greenish, and slimy stools ; excessive anxiety, especially towards evening or during the night. (Temperament lymphatic ; disposition mild.) Sulphur is valuable to follow Nux v. or Pulsatilla when either the one or the other, although apparently indicated, does not speedily de- clare a decided action, or when the disease continues, although in a diminished degree ; it is particularly efficacious after Nux vomica, to combat the sequelae of the disease. Rhus, Lycopodium, and Kali c, may be required in some forms of Hepatitis. The two latter have, together Avith Sulphur, Silicea, and Hepar, been especially recommended in abscess of the liver. Diet.—The same as under Fevers, modified according to the violence of the disease. LIVER COMPLAINT, OR CHRONIC INFLAMMATION OF THE LIVER. Hepatitis Chronica. In this form of the disease we find many of the symptoms which attend the acute variety, but in a modified degree; and in addition, a continued pain or uneasiness in the right side seldom leaves the patient, who gradually falls off in flesh, and loses strength ; and there is, not unfrequently, an occasional cough with expectoration ; sometimes con- siderable perceptible enlargement of the liver, either continuous or returning periodically, with a number of dyspeptic symptoms; high- coloured or red urine, yelloAv tinge of the skin and eyes, occasional febrile symptoms; the pulse, except during these attacks, generally quick but regular. 218 DIGESTIVE SYSTEM. Nux vomica, Bryonia, Arsenicum, and Sulphur are remedies of great value in this as well as the acute form of liver complaint. It fre- quently, however, requires a careful discriminative treatment, and all the acumen of the experienced practitioner to conduct the affection to a happy issue. For the indications for the above medicaments, see Acute inflam- mation OF THE LIVER. Carduus marianus.—This remedy is indicated by most of the symp- toms Avhich have been described under Bryonia and Nux v. in the pre- ceding chapter, but it is more particularly called for, when there is bitter taste, with dull pain or occasional shooting or pricking in the right hypo- chondrium, increased by inspiration ; yellow hue of the skin ; short dry cough, or cough, with expectoration of mucus streaked with blood; and slight feverishness. Aurum, Hepar s., Lycopodium, Magn. m., Natrum, Silex, Cinchona, Alumina, Calcarea, Digitalis, Laurocerasus, Berberis vulgaris, Sepia, Carbo v., Natrum m., Kali c, Plumbum c, Acid, nitr., Magnesia, Cuprum m., &c, have also been found useful in chronic disease of the liver. JAUNDICE. Icterus. Diagnosis.—Yellow colour, varying in shade from a pale saffron to a dark brown yellow, appearing first in the eyes, then extending over the surface of the whole body; hard whitish faeces ; orange-coloured urine ; symptoms of deranged digestion, and sometimes, tensive pain or pressure in the region of the liver. In severe cases, even the perspiration will impart a yellow hue to the patient's linen. The disease frequently declares itself without being plainly referable to any exciting cause; the principal causes, however, are affections of the liver, indigestion, poisonous substances, taking cold, powerful mental emotions, emetics, or drastic purgatives, or internal obstructions, such as gall-stones, or even worms obstructing the biliary duct. Among the predisposing causes may be enumerated a too sedentary or irregular mode of life, indulgence in spirituous liquors, and the fre- quent use of aperients. It may be remarked that the malady frequently assumes the inter- mittent type. Jaundice is not, of itself, to be considered as a dangerous disorder, but rather as an indication of some internal derangement, which, if neglected, may entail serious consequences, for example, dropsy, hectic fever, or general atrophy. Therapeutics.—Mercurius and Cinchona are two of the best remedies in the treatment of the disorder, particularly the former; but, in cases where the patient has suffered from the abuse of that mineral, a preference may, in most cases, be given to Cinchona, especially when the disease appears to have arisen from partaking of indigestible sub- stances, or where it assumes an intermittent form. inflammation of the spleen. 219 In cases which have been excited by a fit of passion,—as we have before noted, no unfrequent cause—we should have recourse to Chamo- milla ; but Nux vomica is to be preferred, when, in addition to this, the bowels are confined, or alternately confined and relaxed. Nux vomica is also indicated, when sedentary habits, over-study, or indul- gence in spirituous liquors, appear to be the predisposing, or partly the exciting causes. Pulsatilla : Lassitude, great weakness and anxiety, especially towards evening ; obtuse pressure, but sometimes also pricking or shoot- ing pain, in the region of the liver, extending occasionally upwards, towards the right shoulder ; whitish stools. Digitalis, is a most important remedy in many cases of this disease ; the following are the principal indications for its employment: nausea, retching, or vomiting, tongue clean or coated white; pressure at the pit of the stomach and region of the liver ; sluggish state of the bowels, with white, gray, or clay-coloured evacuations; alternate heats and chills. (Icterus Spasmod. s. Spast.) Aurum is frequently an excellent remedy in obstinate cases, after Pulsatilla, when the disorder occurs in young females. Should the Jaundice be accompanied with symptoms of inflammation, and pain and pressure in the hepatic region, see Acute inflammation of the liver ; it may, however, be again observed in this place, that in the majority of such cases, Aconite, followed if needful, by Bella- donna, Mercurius, or Chamomilla, as best indicated, will be found of essential service. In inveterate icterus, the alternation of Sulphur, Hepar sulphuris, Lachesis, and Acid, nitricum has been found successful; but as these cases frequently arise from obstructions, atony, or a spasmodic or irri- table state of the liver and duodenum, they require considerable skill and discrimination in their treatment. The diet should be light and unstimulating; veal or chicken broth, with bread (unfermented); roast apples, also mild vegetables, such as vegetable marrow, stewed lettuce, and French beans. Bacon, butter, eggs, milk, wine, spirits, and malt liquors in general must be strictly avoided. The drink should chiefly be confined to water. INFLAMMATION OF THE SPLEEN. Splenitis. Diagnosis.—Sharp pressing or shooting pains in the region of the spleen, with, in most cases, a high degree of fever, general derangement, and sometimes enlargement and tumefaction ; and, when very severe, hematemesis. It is a rare disease in this country, but sometimes declares itself in hot seasons, when it is not unfrequently mistaken for other affections. It may, however, arise in individuals of delicate constitutions, or in children, Avhen exposed to the influence of margh miasms, particularly Avhen to that cause has been added insufficient clothing, want of exercise or proper nutriment, and long-continued mental disquietude. The value of Cinchona in this malady, and the power it displays of 220 DIGESTIVE SYSTEM. developing an affection closely similar to it, affords one of many exempli- fications of the truth of the homoeopathic law. From our very imperfect knoAvledge of the physiology of this viscus and its relation to the other organs, this disease, except when it presents itself in the tangible form above mentioned, is extremely difficult to diagnose. Its best characteristics are tenderness or sensibility on pres- sure in the splenic region, with general debility, paleness of the com- plexion, bloodless appearance of the conjunctiva, languid circulation, and tendency of the extremities to become cold. Therapeutics.—The chief remedies in this affection are Cinchona and Arsenicum which are useful not only in its treatment, but against the tendency to dropsy, which not unfrequently develops itself in connexion with this complaint; an aggravation, however, Avhich can but rarely oc- cur Avhere the proceedings of the practitioner are guided by the homoeo- pathic laAv, inasmuch as the very remedies employed to combat the dis- ease itself are the surest preventives against such a result. The other medicines most frequently required are Aconitum, Arnica montana, Nux vomica, and Bryonia alba. Aconitum.—Against the fever generally present, if the disease be severe. Cinchona, when the inflammatory symptoms have abated, or if no fever of any moment exists at the commencement, particularly if the disease OAves its origin to marsh miasm, or if the accompanying fever presents an intermittent type, in which case it should be administered during the Apyrexia ; moreover, if impaired appetite and general de- rangement be present;—see this medicine under Apepsia. Also, if the patient have been weakened by hematemesis or diarrhoea ;—see these articles. When the abuse of this medicine has given rise to disease of the spleen, benefit will often be derived from the employment of Arse- nic, Carbo v., Puis., Veratr., and Sulph. Arsenicum is useful where the disease resembles or is complicated with ague (see Cinchona and this remedy under art. Intermittent Fever) ; and further, when the patient complains of a violent burning pain in the region of the spleen, and a constant pulsation at the scrobi- culus, attended with great anxiety ; also vomiting of a dark grumous, fluid, watery, or sanguineous diarrhoea, and burning at the anus ; exces- sive weakness, and oedema of the feet. In some cases it has been found advantageous to alternate these tAvo remedies, by giving a dose of Cin- chona morning and evening, allowing an action of one, two, or three days, according to circumstances, and then exhibiting the other in the same manner. Arnica is indicated by pressive pain in the left hypochondrium, caus- ing dyspnoea, and when the vomiting of blood is excessive. (When exter- nal violence has given rise to the disorder, Arnica is especially called for. Rhus may also be useful under similar circumstances, particularly when severe corporal exertion has produced the disease.) Nux vomica is chiefly indicated by the symptoms of deranged diges- tion, constipation, &c, which remain after the more threatening symp- toms are removed. Bryonia is found useful in milder cases, where an aching shooting inflammation of the stomach. 221 pain is felt in the region of the spleen, which is much aggravated by the slightest movement ; or when the patient complains of a constant stitch in the side, or the left hypochondriac region, and general gastric de- rangement, with constipation. The preceding are the remedies, which have been found most useful in the treatment of the disease, in the acute form. Chronic enlarge- ment and indurations of the spleen require a long and judicious course of treatment for removal, or even amelioration. We shall, therefore, simply direct the attention of the reader to those remedies, which have proved most successful in these instances —namely, Sulphur, Calcarea carbonica, and Baryta carbonica (particularly when the mesenteric glands have become affected), and further, Lycopodium, Carbo vegeta- bilis, Plumbum, Ferrum, Mezereum, Platina, and Stannum. inflammation of the stomach. Gastritis. As some difference of opinion exists among medical authors, as to the application of this term, it may be as well to state clearly the disease intended to be treated of in this place. By gastritis is here meant, inflammation of the mucous membrane of the stomach, which frequently involves the submucous tissue, and some- times the muscular coat. Diagnosis.—Burning, pricking, or shooting pain in the gastric region, increased by pressure, inspiration, or the passage of food;_ swelling, considerable heat, and tension over the Avhole stomachic region, some- times with pulsation; great thirst, nausea, and vomiting, increased or brought on by the smallest quantity of food or drink; sometimes with hydrophobic symptoms {hydrophobia symptomatica); soreness of the throat, with inflammation of the fauces; hiccough, sobbing, great rest- lessness, anxiety, and prostration of strength; coldness of the extremi- ties ; tongue generally red at the tip and round the edges, foul, rough at the centre and round the root; frequently also syncope, violent spasms, convulsions, even tetanus; small, sometimes scarcely perceptible, and remittent pulse ; sunken features, Avith expression of anxiety ; and, generally, constipation, but frequently diarrhoea, or alternations of these two states. Death may ensue—either from gangrene, in which case the pains suddenly cease, the coldness of the extremities increases, and the pulse becomes scarcely perceptible, and remittent; or from paralysis of the nervous system, during the attacks, of the spasms or syncope. When this disease has been neglected or improperly treated, and the patient has the good fortune to escape with life, it may pass into chronic inflam- mation, scirrhus, or ulceration of the stomach. Causes.—The most frequent are the partaking of cold drinks or iced water Avhen heated or during hot weather; the admission of acid or poisonous substances into the stomach; lesion from having swallowed any rough-pointed body, external injury, ardent spirits, suddenly-checked secretions or evacuations, abuse of emetics, and, finally, metastases. Therapeutics.__The remedies which have been found the most useful 222 DIGESTIVE SYSTEM. in the homoeopathic treatment of Gastritis, are Aconitum napellus, Belladonna, Ipecacuanha, Nux vomica, Antimonium crudum, Pulsatilla, Bryonia, Ranunculus bulbosus, Euphorbium, Cantharis, Hyoscyamus, Arsenicum. Aconite is requisite in those cases, in which synochal fever is developed, and must be repeated until relief is obtained, or an alteration in the symptoms calls for the selection of another remedy. Belladonna may follow Aconite, if the active febrile symptoms become relieved, but do not wholly subside under the employment of Aconite, and when there is vivid redness of the tongue at the tip and margins, inflammation of the fauces, and hydrophobia symptomatica. Ipecacuanha is useful when the vomiting is excessive, the epigastric region considerably distended, and the patient affected with great anxiety, restlessness, and difficulty of breathing. Antimonium crudum may follow this remedy, or be given in preference thereto, if the tongue be much loaded. Bryonia may be administered after any of the fore- going remedies, should they have afforded only partial relief, and particularly, if the disorder has been excited by a chill from having partaken of cold drinks when over-heated. Nux vomica is one of the most important remedies in the gastritis mucosa of drunkards, with low fever, nausea, and vomiting in the morn- ing or after the simplest food; weight, fulness, and pain in the epigastric region, and tremulousness of the hands. It is, moreover, one of the most useful medicaments, when this disease occurs, as a metastasis from suppressed hemorrhoids, and has also been found efficacious after the previous administration of Aconitum, Bryonia, Ipecacuanha, and Arse- nicum, when the disorder has been caused by a chill from drinking iced water when over-heated. Lachesis and Arsenicum may, in some instances, be advantageously administered in alternation with Nux v., in the idiopathic gastritis mucosa of drunkards.1 Pulsatilla has been recommended in the subacute form of gastritis, arising from the sudden suppression of some secretion, such as the menstrual flux, &c; and also in cases proceeding from a chill in the stomach from ice, particularly after the previous employment of Ipe- cacuanha or Arsenicum. Ranunculus bulbosus, Euphorbium, and Cantharis have been recommended in the more violent forms of the disease, especially when the burning pain, so commonly attendant on this disease, is well marked. When, however, in addition to the last- mentioned symptom, there is excessive prostration of strength; thirst, with violent vomiting immediately after drinking; small, quick, and occasionally intermittent pulse; anxiety, restlessness, and apparent sinking of the vital energies—Arsenicum must at once be had recourse to, whether the disease has arisen from a chill in the stomach or any other cause,—excepting, of course, poisoning by that mineral, in which case the treatment to be followed will be found under the head of Poisons. The alternate administration of Aconitum with Arsenicum has been found useful in some cases,—in others, Veratrum and Arse- nicum : the former, at an earlier stage of the disorder, with accom- 1 Opium may also be included with advantage here. inflammation of the bowels. 223 panying inflammatory fever; and the latter, where the extremities have become cold, the pulse small, features sunk and expressive of great anxiety; with hiccough, thirst, vomiting on partaking of the smallest morsel of food, solid or liquid, extreme debility, and other symptoms mentioned in the diagnosis. When the pain suddenly ceases, or Avhen the burning pain continues, and the tongue becomes covered with a thick yellow coating, the pulse weak, irregular, or intermitting, and purulent matter is occasionally ejected,—Arsenicum is again one of the few remedies by means of which we may yet hope to arrest the progress of the disease. Sulphur, Cocculus, and Carb. v. have also been recom- mended in the last stage of gastritis. In certain cases the attention of the practitioner may be directed to the following remedies. Hyoscya- mus,—Stupor, or confusion of ideas with incoherent speech; convul- sions, hydrophobia symptomatica. Lachesis, Stramonium, and Cantharis may likewise prove useful in cases in which the latter symptom is present,—see Hydrophobia. Finally, Colocynth, Mercurius vivus, Sulphur, and Chamomilla may be mentioned, as likely to prove ser- viceable auxiliary remedies in some instances; and Arnica should be resorted to, if the attack can be traced to lesion of the stomach from any rough or pointed substance having been SAvallowed, or if it has arisen from external injury. When the disease has passed into the chronic form, Natrum m., Lachesis, and Nux v. may be administered in alternation with great ad- vantage ; and followed, if required, by Lycopodium, Colchicum, Sulphur, and Phosphorus, &c. Arsenic, Sep., Plumb., Platina, Kali c, Natrum m., Calc. c, Magn. c, and Rhus may also be named as likely to be required in some old-standing cases.1 Vide also Cardialgia (which chronic gastritis nearly resembles), and Dyspepsia. INFLAMMATION OF THE BOWELS. Enteritis. Diagnosis.—This disease is comparatively of rare occurrence in the idiopathic form, and appears much more frequently as a symptomatic affection, particularly in the course of certain fevers—such as low Nervous or Typhoid Fever, Scarlet Fever, Measles, &c. ; and also in all diseases attended with hectic fever. It much more frequently occurs in the subacute or chronic, than in the acute form. In the acute form of the disease, involving the sub- mucous tissue and peritoneal coat, as Avell as the mucous membrane, the symptoms are usually as follows: intense burning or pungent pain, 1 The alternate employment of Sulphur and Carbo v., has been recommended in chronic inflammation of the stomach with the following symptoms: Burning constrictive pains* with sensibility to the touch, fulness and tension of the epigastric region, acidity, and frequent vomiting of watery fluid, or even of ingesta, great debility and sensation of paralysis in the extremities; should indurations (not scirrhous) have formed (symp- toms—periodic, pressive aching pains, extending from the stomach to the spine, com- monly increased after partaking of the most simple food, and accompanied by anxiety, oppressed breathing and obstinate constipation, and sometimes vomiting of mucus), which are often to be felt at the region of the pylorus, Sepia and Aurum should be given in alternation.—Hygea, Zeitschrift besonders fiir rationell-specifische Heilkunst, XX Band, 1 Heft. 224 DIGESTIVE SYSTEM. generally in one spot of the abdomen, especially in the region of the navel, increased by the slightest pressure and by movement, Avith tight- ness, heat, and tympanitic distension of the abdomen; sobbing, anxiety, and violent thirst, with aggravation of suffering from cold drinks ; obstinate constipation ; violent vomiting, first of slime and bile, and sometimes even of excrements {Ileus miserere); small and contracted pulse, inflammatory fever, flatulence, and frequently obstruction of urine. In the subacute form of the disease, or in simple enteritis mucosa, the pain is often very slightly felt, in comparison with that which accompanies inflammation of the peritoneal coat, and generally consists of a diffused soreness over the abdomen, Avhich is commonly, though not always, increased on pressure ; but indigestible food or cold drinks almost invariably cause an aggravation of pain. The tongue is often very red, smooth, and glossy; and, generally speaking, there is more or less redness at the tip and margins, however foul the centre may be. We also find loss of appetite, and indigestion with nausea and vomiting, more or less prominent, according to the portion of the intestinal tube affected; being greater the nearer the seat of the inflammation is to the stomach. When the inferior parts are implicated (indicated by pain or soreness in the iliac regions and in the course of the colon), there is usually diarrhoea, the stools being frequently slimy and mixed Avith blood, in severe cases consisting of pure blood, particularly when the rectum is involved, in which case there is, moreover, considerable strain- ing. The pulse is quick, the thirst sometimes excessive, Avith a greater or less degree of fever and extreme languor. Unless resolution take place, it may terminate in induration of the intestines—laying the foundation of chronic constipation, hydrops, suppuration, or gangrene. The signs of approaching gangrene, or of its having set in, are the same as in gastritis, with the difference of situation. Among its exciting causes are, cold in the feet and abdomen, sup- pressed discharges, cathartics, Avorms, metastases, parturition, indigesti- ble or highly stimulating food, prolonged use of acids, sour wine or beer, &c. The state of the atmosphere appears to have some share in pro- ducing it, from the circumstance that the disorder sometimes prevails almost as an epidemy. Therapeutics.—Arsenicum and, where required, Veratrum are the principal remedies in the first-described variety of this disease, as well as in the severest forms of gastritis, to Avhich, indeed, it bears a strong resemblance; but the treatment must necessarily be commenced Avith Aconite Avhen the accompanying fever is intense, and the skin hot and parched. For the selection and administration of the tAvo former reme- dies, see Gastritis. Opium and Plumbum are the principal remedies against Ileus miserere, when that derangement arises from spasmodic congestion or strangulation of the intestines ; but when it is connected with inflammatory action, or has resulted therefrom, Aconitum and Sulphur are more appropriate. Lachesis, Merc, Bella., &c, may, however, be better indicated, by the existing symptoms, in some cases. (See also Hernia.) inflammation of the bowels. 225 In the subacute form of the complaint, a few doses of Aconite are often serviceable;—but as soon as the marked inflammatory symptoms have been subdued, one or more of the following remedies must be se- lected to complete the cure: Belladonna, Mercurius, Acid, nitricum, Bryonia, Colocynth, Chamomilla, Nux v., Pulsatilla, China, Opium, Cantharis, Colchicum, Rhus, Phosphorus, Sulph., Silex. Belladonna :—Tongue red and smooth, or coated white, or yellowish brown in the centre Avith intense redness of the tip and margins, and inflammatory redness of the papillae; skin hot and dry, intense thirst, hot, flushed face, giddiness with occasional delirium, especially at night; sensation of soreness or of excoriation either in the umbilical and csecal regions or over the entire abdomen, with tenderness on pressure, and sometimes considerable distension, particularly in the region of the arch or transverse section of the colon. {Lachesis is sometimes of great ser- vice after Belladonna.) Lachesis is a most important remedy in enteritis, with burning, ach- ing, cutting pain, oppressed respiration, tense, distended abdomen, with sensibility on pressure over the affected part, and obstinate constipation. {Belladonna may sometimes be returned to with advantage after La- chesis; but if any of the other remedies, such as Bryonia, Nux, or Sulphur, &c, seem better indicated, they should unhesitatingly be had recourse to.) Nux vomica :—Redness of the margins of the tongue, with yellow or whitish coating in the centre; sensation of soreness, with burning heat in the abdomen; loss of appetite; indigestion, with vomiting after par- taking of food, and aggravation of the abdominal pain after drinking; flatulence, constipation, or constipation and looseness alternately; scanty watery stools, or stools consisting of a small quantity of mucus, some- times tinged with blood, and attended Avith straining. This remedy is especially useful when the above symptoms have been caused by the sudden suppression of a hemorrhoidal flux, or from indigestible food, &c. Sulphur is frequently of great service after the previous employment of Nux. Mercurius is a most important remedy in this disease, even in the most serious cases, and especially after Aconite, and Belladonna, or even Arsenicum, should that remedy have been called for. The follow- ing are its principal indications : tongue very foul, coated white or dark brown, sometimes dry, but more frequently covered with thick mucus; excessive thirst; abdomen hard, tense, distended, and very tender to the touch; copious, watery, bilious, and highly offensive stools, but more frequently there is constant urging to stool, folloAved, after severe strain- ing, by the evacuation of a small quantity of mucus tinged with blood; or at other times, of pure blood in considerable quantity; extreme prostration of strength, chilliness and shivering, with tendency to sweat- ing at night, Avhich, however, brings little or no relief. {Mercurius may sometimes be beneficially alternated with Belladonna, or with Lachesis in more advanced cases.) Acidum nitricum.—The indications for this remedy are much the same as those described under the foregoing ; it is, therefore, sometimes of great service in completing the cure, when Mercurius has effected 226 digestive system. considerable improvement, but seems inadequate to give further relief. It is an invaluable medicine in chronic cases, attended Avith abdominal tenderness and tenesmus, and especially when the disorder occurs in individuals who have been previously subjected to an abuse of Mercury under allopathic treatment. Bryonia.—After the previous employment of Aconite, Bryonia is occasionally a very useful remedy here, particularly when the patient complains of severe headache, with constipation and acute pain in the abdomen, aggravated by movement, and after meals ; it is also indicated when, after Aconite, there remain dark redness of the tongue, or Avhitish or yellow coated tongue, with parched mouth, and considerable thirst; loose, offensive evacuations, particularly after partaking of food or drink ; nausea and vomiting after eating. Pulsatilla.—When the acute inflammatory symptoms of enteritis, arising from the sudden suppression of some habitual discharge, such as the catamenia, or the hemorrhoidal flux, or occurring as a sequela of measles, have been subdued by Aconite, and the following symptoms remain : tongue loaded with a thick, white, grayish, or yellow coating; adipsia, or, on the contrary, excessive thirst, deranged digestion, loss of appetite, with nausea and vomiting after partaking of a little nutriment; sensibility of the abdomen on pressure, or on every movement; flatulence. Colocynth.—In cases where the large intestines are the seat of inflammation, attended with tympanitic distension of the abdomen, and soreness and sensibility to the touch; tormina and diarrhoea, with in- crease of pain, followed by urgent desire to go to stool, after eating or drinking; nausea, or vomiting of bilious matter; frequent discharge of flatus. Chamomilla is peculiarly well adapted to the treatment of the dis- order in the form it is sometimes met with in children, or in highly nervous and excitable females, Avho are extremely sensitive to pain and complain loudly from trivial suffering; it is indicated, moreover, by a sensation of soreness in the abdomen, as if arising from internal excoria- tion or ulceration, accompanied with painful tenderness on slight pres- sure, and slimy, whitish, watery, or greenish, or yellowish diarrhoea, of an offensive odour. Cinchona is frequently used after Aconite or any of the foregoing remedies, when there is a tympanitic distension of the abdomen ; diar- rhoea, aggravated after a meal, with portions of undigested food in the evacuations ; thirst, extreme weakness of digestion, and great debility. Cantharis.—In very serious cases, with discharge of pure blood at stool, and strangury; or in an advanced stage of the disorder, with evacuations of mucus and solid substances, like shreds of membrane, this remedy will frequently be found of considerable service. Colchicum Avill also be found useful, occasionally, in advanced stages of the disorder, with tympanitic distension of the abdomen, diarrhoea, the stools consisting of white or transparent gelatinous mucus, or of blood mixed with substances resembling false membrane. Rhus.—When eruptions break out about the mouth, and there is redness of the tongue, Avith pain as if from soreness or ulceration in the abdomen, and tenderness on pressure; watery, slimy, frothy, or sangui- inflammation of the bowels. 227 neous stools ; low fever, with nocturnal delirium. Rhus is chiefly use- ful in symptomatic enteritis, such as frequently occurs in Ioav Nervous Fever, which see. When ulceration, with purulent evacuations and nocturnal SAveats, sets in, Arsenicum, Nux v., Sulph., Phosph., Acid. nitr., or Carb. v., rarely fail to relieve, and may even effect a cure when the mischief is not too extensive. The chronic stage of the complaint, which is chiefly characterized by fixed pain, fulness, or uneasiness and oppression in the lower part of the abdomen, increased after meals or after cold drinks; appetite im- paired or capricious ; thirst, particularly after dinner or at night; bowels constantly relaxed, or affected by constipation alternately with diar- rhoea ; fetid and discoloured evacuations : skin hot, harsh, and of an unhealthy hue ; pulse rather quick; tongue loaded, but red at the tip and margins,—or redness of the entire tongue, with large and elevated papilla?, especially at the root; emaciation, weakness, and languor. Here the foregoing remedies required the acute and subacute varieties, but more particularly Belladonna, Nux v., Bryonia, and Rhus, together with Acidum nitricum, Phosphorus, Sulphur, Silicea, Arsenicum, &c, will in most instances be found the most serviceable. Acidum nitricum is particularly indicated Avhen there is thirst, attended with pains in the bowels or other uneasiness after drinking; impaired appetite, tenderness of the abdomen, fetid diarrhoea and tenes- mus ; greenish stools, Avith ingesta, skin dry and harsh during the day, sometimes Avith nocturnal sweats. Phosphorus.—Soreness in the abdomen, with tenderness on pressure, and distressing distension after meals; obstinate diarrhoea, or constipa- tion and diarrhoea alternately; stools containing ingesta ; pulse rather quick and hard; weakness and emaciation. Sulphur.—This remedy is one of the most useful in enteritis, arising from the suppression of some accustomed discharge, such as the hemor- rhoidal, &c. ; as also in cases arising from the driving inward of a tetter, or sudden healing up of an ulcer. It is also indicated when we find the tongue red or loaded; thirst; pain, as from excoriation, in the abdomen, with tenderness on pressure; or fulness and uneasiness in the abdomen, increased by cold drinks or after meals ; diminished or fastidious appe- tite, Avith aversion to meat; fetid diarrhoea, frequently containing ingesta ; constipation, or constipation alternately with diarrhoea, flatu- lence ; skin yelloAv, or otherwise unhealthy looking, or dry and peeling, but often covered Avith perspiration at night, or toAvards morning; pulse quick and hard; emaciation, Avith considerable debility. Silicea.—When the disorder has been excited by the sudden sup- pression of the perspiration of the feet, or the sudden healing up of a chronic ulcer, Silicea is one of the most important remedies. The fol- loAving symptoms are some of the more immediate indications for its selection : dryness of the mouth, loaded tongue, great thirst, with di- minished appetite, and sometimes disgust at meat, or cooked and hot food, with desire for cold food and drinks ; abdomen hard, hot and tense, and painful to the touch ; constipation, or extremely fetid watery stools; borborygmus, especially on movement; skin dry and parched 228 DIGESTIVE SYSTEM. during the day, and covered with sweat towards morning; pulse quick and hard. Arsenicum, has already been noticed as the principal remedy in acute cases of a violent character; it is, moreover, a remedy of con- siderable service in some of the chronic varieties of enteritis, charac- terized by a feeling of soreness or of burning heat in the abdomen, at- tended with nausea, want of appetite, and great thirst; increase of pain after cold drink; borborygmus; diarrhoea, sometimes with ingesta; fetid, discoloured stools ; skin parched, hard, and of a yellowish, un- healthy-looking hue ; emaciation, with extreme debility. Lachesis, Lycopodium, Kali nitricum, Natrum muriaticum, Secale cornutum, Hepar sulphuris, Sepia, Calcarea, Graphites, and Carbo vege- tabilis, may also be of considerable service in some cases. When we have reason to suspect worms as the cause of this affection, the patient must be treated accordingly. See INvermination. Diet.—In acute cases of inflammation, either of the stomach or bowels, the regimen must be placed under the same restrictions as described at page 67 {Fever); and in sub-acute and chronic cases the food should be very light, and given in small quantities ; raw fruit, green vegetables, and sometimes potatoes, must be strictly prohibited; and the drink should consist solely of toast-water, barley-water, or the like. INFLAMMATION OF THE PERITONEUM. Peritonitis. Diagnosis.—Painful tension and tumefaction of the abdomen, with a sensibility to the touch even more acute than in Enteritis, so much so, that the patient cannot bear the pressure even of a sheet upon the abdomen; frequently constipation or ischuria, and the symptoms of enteritis. Causes.—General causes of inflammation, and, moreover, external injury, parturition, chill of the abdomen, and metastases. Therapeutics.—In the first place it will generally be found benefi- cial to administer three or four doses of Aconitum, exhibited at inter- vals of time varying according to the exigency of the case, until the fever and inflammation lower: this remedy has been found, in many cases, sufficient of itself to remove the affection, and in all it materially modifies its violence. When the cause is external lesion, we should prescribe Arnica, and ' at the same time apply bandages wetted with a diluted tincture of the medicine, as recommended under External injuries in cases of con- tusion. {Aeon, followed, if requisite, by Belladonna, is, nevertheless, indispensable, as soon as inflammatory fever, with excessive local ten- derness, supervenes.) Sometimes vomiting and other symptoms, closely resembling those of enteritis, are present; at other times, merely the marked sensibility of the abdomen and tumefaction with gastric derangement; but as, phy- siologically considered, these symptoms arise from the intensity and extent of the inflammation, and the sympathy of the other organs, our INVERMINATION. 229 chief care must be to lower the inflammation, which having been in a great measure effected by the first-mentioned remedy, we shall find con- siderable benefit from the employment of Nux vomica and Mercurius in combatting any remaining symptoms :— Nux vomica, where there is painful sensibility, and distension of the abdomen, Avith a tendency to the predominance of gastric symptoms and ischuria. Mercurius is more particularly suited to the advanced stages of the disease, with weak, quick pulse, nocturnal sweats, and great weak- ness. When the inflammation extends to the pleura, and the breathing becomes affected, Avith acute shooting pain, we should have recourse to Bryonia, in the same manner as directed for Aconite. (See also Pleuritis.) When the peritoneal coat of the upper portion of the alimentary tube or of the stomach itself becomes affected, evinced by an increase in the intensity of the disease, the pain extending higher—vomiting, gene- rally a rare symptom, becoming severe and continual—collapse of the features, small pulse, and a rapid sinking of the vital energies, we should have recourse to Arsenicum. In cases Avhere there are evidences of the brain being affected, Bella- donna may be had recourse to. (See Phrenitis.) In other instances Cantharides, Lach., Chamomilla, Bryonia, Rhus, Lycopodium, Colo- cynth, &c, may be found necessary.1 (See also Gastritis and Ente- ritis, as the indications for many of the remedies mentioned under that head will, in many instances, prove useful in the selection of the appro- priate medicament in inflammation of the peritoneal coat.) INVERMINATION. WORMS. Helminthiasis. Febris helminthiaca. The existence of worms in the intestinal canal, in the majority of cases, evidently arises from a peculiar constitutional taint, inducing a certain diseased state of the mucus or lining membrane, and thereby giving rise to the formation of these parasites ; and, although no period of life is wholly exempt from their presence, infants and children appear to be much more subject to the affection than adults, on account of the predominance of nutrition in early youth. Weakness of the digestive functions, accumulation of mucus in the intestines, an ill-regulated diet, and a degree of moisture in the atmosphere, favour their generation. The three species most generally met with in the human subject are, the thread, or maw-worm {Ascaris vermicularis, Oxyuris), the long round worm {Lumbricus, Ascaris lumbricoides), and the taenia or tape- worm ; of the latter there are two varieties,—the solitary tape-Avorm (Tamia solium, Taenia osculis marginalibus), composed of long and slen- der articulations, which has been known to exceed the length of thirty 1 In Peritonitis puerpcralis: Aconitum, Ipecacuanha, Bryonia, Arsenicum, Veratrum, Chamomilla, and Pulsatilla, are the remedies which have chiefly been used; but some of the others which have been mentioned in the treatment of Enteritis may be found ser- viceable in particular cases. 230 DIGESTIVE SYSTEM. feet- and the broad tape-worm {Taenia osculis superficialibus, Bothrio- cephalus latus), which varies from three to ten feet, seldom comes away entire, but in joints, which are considerably broader and thicker than those 'of the variety first mentioned. The presence of Avorms, unless when passed, is not always easy ot detection, since subacute inflammation of the mucous membrane from other causes will frequently present nearly the same range of symptoms; but here (as in the treatment of most diseases) Homoeopathy presents two manifest advantages over the old system. In the first place, if act- ing upon the certainty of the existence of worms, Ave administer a remedy specific to the affection; in the next, when we are uncertain as to the true character of the complaint, and select a medicament distinctly indi- cated by the united symptoms, this medicament will be found applicable to the affection, from whatever cause it arises; Avhilst a careful obser- vance of the known pathogenetic powers of the remedies selected, will materially assist us in tracing the disease to its proper source. _ Diagnosis.—Worms, and especially ascarides, frequently exist in the intestines without occasioning any disturbance, and their presence is only known by their being observed in the evacuated faeces; but when the alimentary tube becomes irritated by them, a number of symptoms are developed* of Avhich the following are the principal: Pallor and sickly appearance of the countenance, and sometimes flushing; livid circles round the eyes, dilated pupils; headache or vertigo; irregularity of appetite, or great voracity ; fetidity of breath ; acrid eructations ; occa- sional nausea and vomiting ; foul tongue; tensive fulness of abdomen, with a sensation of gnawing and burning at particular parts of the intes- tines ; hard and tumid belly; great thirst; discharge of mucus from the rectum, bladder (and vagina); heat and itching at the anus ; slight febrile symptoms, or remittent fever, and nocturnal Avakefulness, with low spirits or irritability of temper, and gradual emaciation; we also usually notice an inflammatory redness of the nostrils, Avith great dispo- sition to picking or boring at the nose, especially in children, with sud- den screaming Avhen waking, and grinding of teeth. In addition to the above general symptoms of this affection, we frequently meet Avith severe colic-like pains, with tenesmus and slimy and bloody evacuations; dy- sury; strangury; involuntary flow of saliva, especially when asleep; convulsions in children, and epileptic attacks, combined with cerebral affections, in adults; inflammation of the bowels. The pain is periodic, and occurs particularly in the morning, and Avhilst fasting ; melioration generally after eating. The quality of the food exercises considerable influence over the pains ; milk, sugar, and other sweets, pungent, salted food, ham, cheese, raAV fruit, &c, often produce aggravation. In tamia, in addition to the above, Ave find a crawling, scraping or groping, and twisting sensation, extending from the left side of the ab- domen towards the epigastrium, and even as far up as the oesophagus; or a sensation as of something rising into the left side of the throat, and then falling back; the feeling of a cold ball on either side, Avith an un- dulatory motion; a sense of sugillation in the abdomen ; creeping torpor and numbness in the fingers and toes. The principal exciting causes of Avorms are, insufficient and unwhole- INVERMINATION. 231 some food, (excess of vegetable, and deficiency of animal diet,) un- cleanliness, impure air, with residence in a damp, dark, ill-ventilated dwelling. The leuco-phlegmatic habit appears to engender a predisposition to their formation ; and females are oftener affected than males. As already observed, the alimentary tube may be infested with Avorms, without any other indication of their existence being developed beyond. But the reverse is more frequently the case, and in addition to the anxiety and alarm which are so often created in the minds of parents by the distressing nature of many of the symptoms, in severe cases a further and more serious cause for apprehension is given rise to, when other diseases above noticed, such as chronic inflammation of the mucous membrane (sometimes folloAved by perforation), mucous fever, epilepsy, or hectic fever, become associated with invermination. The progress of the disease is generally sIoav, and there is a constant proneness to relapses. The prognosis is generally favourable, particu- larly in the case of ascarides. It is less so in that of tape-worm, chiefly on account of the greater duration of the disease, and its more uncertain cure. When the colon and rectum are the seat of the disorder, the cure is more easily accomplished than when the stomach and small in- testines are affected. When the nervous symptoms so-called, such as sopor, spasms, dilated pupils, vomiting, are present, the case is liable to be confounded Avith hydrocephalus; but in the latter the abdomen is flat or retracted, whereas in helminthiasis it is soft and distended; the head in hydrocephalus is hot, and the symptoms succeed each other in a regular course, whereas here they are very changeable, periodic, and inconstant.1 Therapeutics.—Aconitum, Ignatia amara, Sulphur, Calcarea car- bonica, China, Ferrum metallicum, Marum ver., Cina, Nux vomica, Mercurius, Valeriana, Spigelia, Belladonna, Sabadilla, Silicea, Cicuta virosa, Filix mas, &c. Of these, Aconitum, Ferrum, Ignatia, Merc, Nux v., Valer., Marum ver., Cina, and Sulph. tinct., are generally the most appropriate against Ascarides. Cina, Nux v., China, Bella., Merc, Spigelia, &c, against Lumbrici. And Graph., Calc, Sabad., and Fragaria vesca (Dr. Gross); or Sulph., Merc, and Calc. (Dr. C. Hering); as also Carbo a. et v., Kali c, Magn. m., Natr., Phosph., Petrol., Plat., Tefeb., Filix mas, Punica granat., Stannum, against tape-worm. Aconitum :—When considerable febrile irritation exists, with rest- lessness at night, fever and irritability of temper, continual itching and burning at the anus, and at times a sense of crawling in the throat. In many cases Ignatia amara will be found the most appropriate medicine after Aconite, particularly if spasmodic tAvitchings take place in one of the extremities or in individual muscles, intolerable itching, and pain as from excoriation in the anus and rectum. (See Cina.) Valeriana may be substituted when the insupportable nocturnal itching causes spasmodic muscular tAvitching, and sleeplessness. 1 Hartmann's Therapie, p. 163. 232 digestive system. Ferrum metallicum is of much service when there is frequent vomiting and accumulation of watery fluid in the mouth. Mercurius.—When, in addition to many of the ordinary symptoms of worms there is especially a constant inclination to go to stool, and diarrhoea with tenesmus; distension and hardness of the abdomen (um- bilical region); increased secretion of saliva. Sulphur, in case the annoyance still continues after the lapse of two or three days. This remedy is, however, sometimes indicated from the commencement, and is in some cases alone sufficient to effect a radical cure. It is especially called for in lymphatic, leuco-phlegmatic habits, with tendency to frequent attacks of coryza and other mucous dis- charges ; bitter, slimy taste, aversion to meat; irresistible longing for sugar ; alternations of loss of appetite and voracity ; frequent regurgi- tation of ingesta, together with pyrosis, hiccough, retching, vomiting, and borborygmus ; also when the before-mentioned itching and feeling of soreness in the anus and rectum are extremely distressing. Calcarea is, if anything, still better calculated than Sulphur to eradicate the tendency to worms. It is peculiarly well adapted to children of lymphatic constitution, with disposition to blenorrhoea; cold in the head and diarrhoea ; feeble debilitated frame ; defective nutrition; face pale and hollow, or puffy, and of diminished temperature ; weakness of the ankles ; complications with scrofula and rickets ; chronic derange- ment of the digestive functions. Silicea is often of essential service after Sulphur or Calcarea, Avhen the symptoms are generally much exacerbated at the first quarter, or at the period of full moon, as is very frequently the case in helminthiasis. Some of the other medicaments, such as Mercurius, Nux v., or Pulsatilla, Ipecacuanha, Antimonium, may be required after a few doses of Sul- phur or Calcarea, when indicated by the turn the symptoms may take; moreover the beneficial action of Sulphur or Calcarea, is often mate- rially assisted by the intermediate use of one or more of the aforesaid remedies. An interval of from six to ten days and sometimes upwards, must generally be alloAved to elapse between the different remedies, in chronic cases. This course of treatment, persevered in for a short time, has often proved successful in most obstinate cases, by purifying the constitution, and restoring the mucous membrane to a healthy state. When excessive irritation is present, and does not appear to diminish readily under the action of the preceding remedies, we may give a drop of the tincture of TJrtica urens, in a little Avater, or on a piece of loaf sugar, every night or morning for several successive days, and should this not relieve the annoyance, we may administer an enema of a dessert-spoonful of salt to a pint of Avater, of which from two to six fluid ounces, according to age, may be injected ; if this produces a relaxed state of the boAvels a mixture of vinegar and Avater, in the proportion of one-fourth part of the former, may be used.1 After this palliative course of treatment, the course above mentioned may again be adopted, should it appear necessary. 1 Hering's Hausartz. INVERMINATION. 233 Cina.—This is an eminently useful medicine in the case of worms, and is generally indicated where the following symptoms are met with: frequent boring at the nose, obstruction of the nose, great perverseness of temper, bashfulness, heat and irritation, constant inquietude and restlessness, with, in children, a desire for things which are rejected Avhen offered ; fits of crying when touched, paleness of face, with livid circle round the eyes ; constant- craving for food, even after a meal; griping, distension, heat, and hardness in the abdomen, with discharge of thread- and round-worms, costiveness, constipation, or loose evacua- tions ; fever-chills towards evening, hard, quick pulse; little sleep, or restlessness, tossing about, startings, talking or calling out suddenly during sleep ; transitory paroxysms of delirium ; heaviness of the limbs; changing of colour, the face being at one time pale and cold, at another red and hot; pupils dilated, tongue covered with tenacious mucus ; disa- greeable eructations, vomiting ; itching in the anus, and crawling out of thread-worms, involuntary micturition, and white, turbid urine; occa- sional convulsive movements in the limbs; weakness and lassitude. This medicine is particularly indicated in Colic produced by Avorms. Nux vomica is a valuable adjunct in cases of worms, Avith conside- rable derangement of the digestive functions, irritability of temper, and constipation ; or excessive distension and sensibility of the abdomen and epigastric region ; feeling of heat in the abdomen; inclination to vomit; exacerbation of symptoms early in the morning. (See also Dys- pepsia, Gastric or Mucous Fever.) Mercurius.—When we find diarrhoea, distension of the abdomen, and hardness in the umbilical region, with increased secretion of saliva. China is appropriate when the symptoms are generally exacerbated at night, particularly the abdominal sufferings; or, when pressive aching pains are experienced below the umbilical region after every meal, and are attended with distension of the abdomen, pyrosis, pains in the epi- gastrium, and retching; also, when in addition to the foregoing, there is an over-excitability of the nervous system, with spasmodic twitchings of the muscles in various parts, tremulousness and debility. (Valeriana and Veratrum are also deserving of attention here.) Spigelia in cases, with colic, voracity, diarrhoea, and chilliness; or nausea in the morning, accompanied by a sensation as if something were ascending from the stomach into the throat; smarting in the nostrils, paleness of face, palpitation and anxiety; exacerbation of symptoms particularly after dinner. Belladonna is best adapted to cases with cerebral disturbance, great nervous excitement; nocturnal delirium, with startings during sleep; tendency to be startled or frightened by the most trivial cause; also colic, headache, thirst, quick pulse, hot, dry skin. Should these symp- toms not yield to Belladonna, recourse must be had to Lachesis, or to Silicea, if the febrile symptoms continue, and the patient be of a scro- fulous diathesis. Cicuta atirosa.—Severe Avorm-colic with febrile irritation and con- vulsions. {Bella., Ignatia, Hyoscyamus, are also valuable in the event of convulsions. See that article.) The treatment of taenia, although similar to the above, has some 234 digestive system. modifications. In most cases Aconitum may be prescribed, followed by Cina, after which considerable relief is often experienced; subsequently Filix mas, a drop of the concentrated tincture, night and morning for four or five days.1 Punica granatum has been employed with much success by Drs. Lo- bethal and T. 0. Miiller. The latter gives the following symptoms as the principal indications for this remedy: convulsive movements, cata- lepsy and epilepsy, syncope, emaciation with voracious appetite, sudden starting from sleep, hallucinations, hypochondriasis, vertigo, confusion in the head, dilated pupils, yellow colour of the face, grinding of the teeth, accumulation of water in the mouth, capricious appetite, eructa- tions of watery fluid, vomiting, sensation as if something were rising up in the stomach, distended abdomen, colic, palpitation of the heart, &c. (Hyg, Bd. x, pp. 137-93.) In chronic cases, the folloAving treatment has proved successful: Nux vomica, Mercurius, Sulphur, and Calcarea. Dose, four globules of each remedy in rotation in tAvo doses, two globules at night and two in the morning,—an interval of from six to ten days to be observed between the different remedies. When any improvement takes place after the administration of any one of these remedies in particular, it will be well to repeat that medicine at the stated intervals, as long as it appears to do good, instead of going on to the next remedy in rotation. In addi- tion to these medicines, the following, as already observed, are more or less useful in taenia: Carbo a. et v., Kali, Magnes. m., Petrol., Plat., Tereb., Natrum muriaticum, Lycopodium, Sabadilla, Frag aria, Gra- phites, Baryta, Stannum, Phosp>horus, as the one or the other may appear the best suited to the case. In the selection of these or other remedies, we must be guided by the entire group of symptoms. In many cases of tape-worm, a cure has been performed, and the parasite discharged, when the slightest suspicion had not been entertained that the sufferings of the patient arose from such a source,—by administering a remedy in strict accord- ance with the symptoms complained of by the patient. When the symptoms are few, or not well marked, we may derive considerable as- sistance by paying attention to such particulars as—the disposition and temperament of the patient; the periods of the day Avhen the sufferings make their appearance or become exacerbated; the part of the body affected (right or left side); the partialities, or peculiar dislikes of the patient; the agreeing or disagreeing of different kinds of food or drinks, &c. Regimen.—The food ought to be wholesome and nutritious; and consist chiefly of meat, such as roast or boiled beef, or mutton, some- times chicken, and occasionally a light pudding; fruits or vegetables must be prohibited, as also milk, pastry, and sweetmeats: and the 1 Dr. Wahle, of Rome, considers the Filix mas a specific remedy in taenia, when any- thing sweet invariably disagrees with the patient, or rather with the worm. He has repeatedly found only a few doses of this medicine sufficient to remove all the symptoms and sufferings arising from tape-worm, when the aforesaid peculiarity formed a marked symptom; and that every trace of the worm disappeared after the employment of the remedy, if the patient paid strict attention to diet—carefully avoiding indigestible food for the space of a few months. (Neues Arch., Dritter Band, Erstes Heft, p. 3.) BLENNORRHEA. 235 utmost care should be taken to prevent children from eating raw herbs, roots, &c, which they are so prone to pick up in their rambles, when not looked after. Plenty of exercise in the open air is of essential service, and must on no account be neglected. BLENNORRHEA. This epithet is given to an increased secretion or discharge from any of the mucous surfaces. We purpose to restrict ourselves here to the consideration of the affection as it occurs in the stomach and bowels. Blennorrhoea ventriculi.—This form of the complaint is chiefly charac- terized by loss of appetite, insipid, clammy, nauseating, sweetish taste in the mouth, furred, or white and thickly-coated tongue and fauces, flatulence, absence of thirst, constipation, or slimy stools, pale, cloudy and slimy urine. In addition to these symptoms, a sensation of cold- ness, Avith pressure and aching, or gnawing, throbbing, and spasmodic tension is experienced in the epigastrium, frequently attended with an oppressive feeling of sinking and emptiness in the stomach while fasting, and distressing fulness or weight after meals; the sleep is restless or dis- turbed by frightful dreams, or night-mare; the natural temperature of the body diminished, the countenance pale, and the physical powers much depressed. Accumulation of fluid in the mouth, nausea, and vomiting frequently take place early in the morning or after dinner, and occasionally at other times. Sometimes there is merely an adhe- sive, tasteless, rarely acidulous, inodorous mucus ejected by the act of vomiting. The prolonged use of imperfectly azotized and indigestible food, sedentary habits, the presence of worms in the alimentary canal, damp, ill-ventilated dAvellings, or other debilitating influences—such as excessive evacuations of blood, immoderate excess in the use of ardent liquors, depressing passions, and a lymphatic temperament are the general predisposing or exciting causes of blenorrhoea in general. A moist, relaxing, and changeable state of the atmosphere, errors in diet, mental emotions of all kinds, materially aggravate the symptoms, and are readily productive of pituitous fever {febris pituitosa, febris mucosa). Therapeutics.—Ipecacuanha is one of the most important remedies in the early stage of the disorder, and is in most instances the best with which to commence the treatment. It must be given in repeated doses, until it has produced all the amendment that it seems capable of pro- ducing, after Avhich another remedy must be selected in accordance with the remaining symptoms. Against these, Ave shall generally find either Nux vomica, Arsenicum album, Pulsatilla, Veratrum album, Tartarus emeticus, or Rheum palmatum, &c, the most appropriate. Nux v. is particularly indicated when spasmodic sufferings in the stomach, with accumulation of Avatery fluid in the mouth, acid taste, vomiting of sour-smelling and tasting mucus, and constipation, some- times in alternation with slimy stools, form the most prominent features of the case; and especially Avhen these symptoms occur in individuals given to sedentary habits, or to habitual over-indulgence in spirituous, vinous, or malt liquors. Arsenicum may be frequently prescribed with 236 digestive system. advantage after, or alternately with, Nux v., where there is an extreme degree of debility, and burning heat in the throat, or stomach, &c. When the last-named symptoms occur in lymphatic subjects, and especially females, Capsicum may be preferred to Arsenicum. Pulsatilla is productive of considerable alleviation where the pitui- tous state is accompanied by continued shivering, frequent slimy evacu- ations, and vomiting of mucus, and occurs in debilitated, irritable, and relaxed constitutions, but more particularly in chlorotic females. Sul- phur may follow Pulsatilla with advantage when the latter is insufficient to remedy the state of matters. (See Chlorosis.) In cases of an inveterate character, attended with repeated and painful attacks of vomiting not only of mucus, but also of bile, from the violence of the act of vomiting, Veratrum rarely fails to afford prompt relief. Tartarus emeticus is sometimes useful after, or alternately with Ipecacuanha, when in addition to the frequent recurrences of vomiting, there is also a constant tendency to slimy diarrhoea. Rheum may be given with advantage where there is much abdominal flatulence, tension at the pit of the stomach and epigastrium, insipid slimy taste, disposition to diarrhoea; with brown-coloured stools mixed with mucus. Gratiola has been chiefly recommended as being of considerable efficacy in rebellious or chronic cases where the foregoing remedies have only effected a degree of melioration. Along with Gratiola, the fol- lowing may be mentioned as being useful in the treatment of inveterate cases : Sulphur, Carbo vegetabilis, Veratrum album, Calcarea carbonica, Hepar sulphuris, Lachesis, Lycopodium, Natrum muriaticum, Stannum, Acidum nitricum, Plumbum, Magnes., Assafoetida, Bovista, and occa- sionally Squilla, Cinchona, Ferrum, he. When the affection arises from Avorms, Cina, Spigelia, Ferrum, Valerian, and Mercurius, &c, are the principal remedies. (See Invermination.) Blennorrhoea intestinorum is chiefly characterized by a distressing tension and constrictive sensations in the abdomen, accompanied with flatulent distension, spasms, and obtuse griping pains. Sometimes the bowels are sluggish, or there is obstinate constipation complained of; and the motions that are passed are either intermixed with more or less mucus, or are formed exclusively of masses of thick, tenacious mucus. At other times the bowels are relaxed, the evacuations consisting of large quantities of watery or bilious-looking mucus, "passed in rapid succession, and preceded by griping pains. The remedies required here are nearly the same as those given in the foregoing variety of the disorder. When diarrhoea is present, Pulsatilla, Rheum, Arsenicum, Phosphorus, Mercurius, Cinchona, or Ferrum will commonly be found the most appropriate, the latter tAVO particularly when the pro- longed use of laxatives, or other debilitating losses have been the pre- disposing cause of the malady. When the bowels are inactive, but the motions coated or mixed with considerable quantities of mucus, or consist entirely of slimy substances,—Nux vomica, Sulphur, Sepia, Stannum, Alumina, Lachesis, &c, are usually the most suitable. Blennorrhoea recti. {Hcemorrhoides mucosa?.) This variety of the dis- order is most frequently met with in the male subject, and particularly BLENNORRHEA. 237 in those of a debilitated habit. It may occur in the idiopathic form, but is often purely hemorrhoidal, and in such cases partakes wholly of the characteristic features of hemorrhoids. On other occasions the com- plaint appears in connexion with blind piles. Frequently again it either immediately precedes a fit of bleeding piles, or exhibits itself in alterna- tion therewith. The mucous discharge takes place for the most part periodically, generally subsequent or anterior to an evacuation, but oc- casionally at other times, and involuntarily. It is usually attended with more or less tenesmus, spasmodic and burning pains in the rectum. The discharge for several days is either watery or A7iscid, sometimes streaked or mixed with blood, and, though small in quantity, commonly continues for several days. This form of blennorrhoea is not unfrequently preceded by indigestion, flatulence, colic, spasms in the stomach, bowels, and abdominal muscles, local intestinal constrictions, pains in the hips and sacrum, spasm of the bladder, scanty urine, itching in the glans. These symptoms in- crease in intensity as the period for the flow of mucus approaches, but as soon as it makes its appearance they commence to subside in a similar ratio. The exciting causes of blennorrhoea recti, as well as blennorrhoea intes- tinorum, of which the former is but a variety, are nearly the same as those we have given under Blennorrhoea Ventriculi, to which may be added the debilitating effects or the transposition {Blennorrhoea metasta- tica) of catarrhal, venereal, or rheumatic, gouty and other more purely dyscratic diseases. Therapeutics.—Helleborus niger, Colchicum autumnale, Mercurius, Spigelia, Capsicum, Pulsatilla, Nux vomica, Carbo vegetabilis, and Sul- phur, Avill in the majority of cases prove of the greatest efficacy. Helleborus is extremely serviceable when the stools consist of mu- cus, generally in solid pieces, and without any admixture of proper faecal matter. Colchicum is equally serviceable under such circumstances; but particularly when the motions are preceded by severe griping, in which event it may be exhibited in preference to Hellebore. Where the presence of worms in the alimentary canal, or the existence of hemorrhoids from the exciting cause of the malady, Mercurius is one of the most important medicaments, especially Avhen at the same time the evacuations consist of mucus intermingled with degenerate faecal matter, during the expulsion of which, violent colic and tenesmus are experienced. Spigelia is useful under nearly similar conditions ; it may consequently be had recourse to with advantage in many instances where Mercurius affords only partial relief. Capsicum is an excellent remedy when the disorder occurs in lymphatic subjects, and is connected or not with hemorrhoidal disease; the motions copious, somewhat fre- quent, and accompanied with distressing burning pain in the rectum and anus. Pulsatilla may follow, or be given in alternation Avith Capsicum, when the pains are in a great measure removed, but the stools unaltered in character. Nux v., will be found of essential service in meagre, debilitated subjects, of sanguine or bilious temperament, addicted to sedentary or intemperate habits. Carbo v., may be prescribed with 238 RESPIRATORY SYSTEM. benefit after Nux when there is excessive flatulence, or burning pains in the loAver intestine, especially after stool. When we have obtained from the action of Nux v., and Carb. v., all the improvement that they are evidently capable of effecting, we may follow up the treatment by the administration of Sulphur, by means of Avhich a cure will often be obtained in cases of the most obstinate character. Lachesis, Rhus toxicodendron, Ignatia, Antimonium cru- dum, and Borax, &c, have also been recommended as being capable of affording considerable assistance in the treatment of this variety of blennorrhoea. DISEASES OF THE ORGANS CONNECTED WITH THE RESPIRATORY SYSTEM. CATARRH, OR COMMON COLD. CATARRHAL FEVER. This term is given to an affection, Avhich consists of a mild degree of inflammation of the lining membrane of the nostrils, and windpipe, and occasionally also of the ramifications of the latter, induced by exposure to sudden changes of temperature, or to a damp or chilly atmosphere, with insufficient clothing, particularly as regards children. This com- plaint is characterized by slight fever, impaired appetite, obstruction of the nose, sneezing, unusual languor, pains in the head or in the back and extremities, and subsequently hoarseness or cough, generally pre- ceded by transitory chills or shiverings; there is also a slight degree of wheezing and difficulty of breathing. When the disease is confined to the nose and sinuses it is termed a cold in the head ; of Avhich latter affection, as well as hoarseness and cough, we shall treat separately. Therapeutics.—In many instances catarrh is carried off, or runs to a salutary termination in a day or two. This desirable result is fre- quently obtained by having timely recourse to the simple proceeding of remaining a little longer in bed, and encouraging a gentle sweat by drinking a warm demulcent fluid, such as gruel; bathing the feet and legs in warm Avater, at the temperature of about 98-100 degrees of Fah- renheit, is also a useful auxiliary mode of restoring perspiration, but the patient should go to bed immediately afterwards. Very robust persons, who are accustomed to be in the open air in all Aveathers, but who have caught cold after having overheated themselves, will frequently prevent any bad effects by drinking one or two glasses of cold water on going to bed ; when, however, they have learned by experience that little benefit is to be derived therefrom, a few globules of Carb. v. or Silicea should be taken instead. A moderate degree of abstinence should, at the same time, be observed; veal or chicken-broth, bread, sago, or semolina pud- ding, being substituted for the ordinary diet. The drink may consist of water-gruel, barley-water or toast-water. All strong liquors must be abstained from. COMMON COLD. 239 The following are the principal medicines to be employed in the majority of cases, when called for :—■ Aconitum, Bryonia, Camphora, Nux vomica, Chamomilla, Coffea cruda, Belladonna, China, Dulcamara, Arnica montana, Mercurius, Acidum phosphoricum, Sulphur, Calcarea, Ipecacuanha, Arsenicum, Silicea. Nux vomica, when the symptoms of common cold declare themselves, will often check the attack. It is especially indicated by the following symptoms: Tickling or scratching irritation in the larynx, dry cough, particularly in the morning, and sometimes during the day, rarely during the night; occasionally a small quantity of adhesive mucus is with difficulty expectorated after a fit of coughing; and the paroxysms are frequently attended with a painful sensation in the umbilical region, as if arising from the effects of a bruise or blow. This remedy is further of great utility in catarrhal fever with disposition to chilliness, or wan- dering fever chills, Avorse during movement, coming on, and gradually increasing, in the after part of the day, and alternating Avith flushes of heat. Warmth and absolute rest mitigate these symptoms. When convenient, it is preferable that this remedy should be taken toAvards eArening. Chamomilla :—In the treatment of children this medicine is gene- rally more efficacious than Nux vomica in arresting the attack. It is (like Belladonna, Bryonia, China, Dulcamara, Sulphur, and Silicea) extremely valuable in restoring the suppressed perspiration, and removing the following symptoms: colic, with pains in the head, ears, and teeth, thirst, ill humour, and impatience ; or dry heat of skin with chilliness (in any part of the body, which may happen to be uncovered for a short time), or on lifting up the bedclothes; burning heat in one part (as for instance one cheek) and chilliness in another; severe, dry cough, espe- cially at night, excited by tickling in the larynx. Coffea cruda.—This remedy is indicated where there is excessive sensibility, fretfulness, and sleeplessness, with general pains, especially in young persons. Belladonna, Avhen there is a throbbing, bursting headache, attended with determination of the blood to the head, and increase of the pain from movement or exposure to cold air. Cinchona :—Aching pains in the shoulder-blades, and in the ex- tremities, increased by the slightest pressure on the affected parts, with great restlessness, and constant desire to change the position of the limbs. Dulcamara, when the pain is more of a passive or dull, aching de- scription, and felt only in particular parts of the head, with humming in the ears, and obtuseness of hearing; catarrhal fever with hoarseness, dry, rough cough, or cough with copious mucous expectoration, severe coryza, great heat, dryness, and burning of the skin; pains in the limbs, increased when at rest, and attended with a feeling of coldness, stiffness, and numbness; or Avhen an offensive perspiration breaks out after an attack of cold ; and when the affection has been brought on by suppressed perspiration, from exposure to a cold and humid atmosphere. Drosera :—Painful or bruised-like pains, and paralytic weakness in 240 respiratory system. the extremities; frequent rigors, with coldness of the hands and heat in the face; hoarseness, and cough excited by roughness and scraping in the throat, aggravated by talking. Arnica Montana, when aching pains, or pains as if arising from a bruise, are felt in the limbs after exposure to cold, causing excessive restlessness and a constant disposition to change the position of the affected parts, and increase of pain from the slightest touch or move- ment. Mercurius, when the lining membrane of the eyelids, nostrils, and bronchi, is highly irritated, and gives rise to copious lachrymation, coryza and cough with profuse expectoration ; headache, or feeling of tightness, and fulness in the head, with pulsation extending to the nose; general heats predominate over the chills. When the pains in the limbs and joints are accompanied with profuse sweating, which affords no re- lief; this remedy may be followed by Dulcamara should the sweat con- tinue, and be of an offensive odour, or by Euphrasia, if the lachryma- tion and coryza remain unmitigated. Conium maculatum is of great service in catarrhal fever with internal heat, much thirst, and great debility, scraping or scratching, itching and creeping sensations in the throat, which produce a dry, almost in- cessant cough. The patient dreads the slightest noise or whisper; passes a restless night, the sleep being unrefreshing, and disturbed by anxious dreams ; urine cloudy and whitish. Acidum phosphoricum, aching pains, relieved by movement. Silicea, pains in the limbs, colic and general derangement arising from suppressed perspiration, particularly in those who are subject to sweating at the feet. Sulphur, in cases of swelling of the knee, or of the joints of the hand and fingers, from taking cold. It may, in many such cases, be followed by Calcarea carbonica in a week or ten days. Mezereum :—Alternate heats and chills (the febrile heat occurring chiefly in bed, and the chills when out of bed); extreme sensibility to cold air, acrid coryza, burning irritation in the larynx and trachea, which provokes cough, attended with difficult mucous expectoration. Lycopodium :—Inveterate catarrh, with lemon-coloured, often bitter- tasting, mucous sputa : tearing, throbbing, frontal headache, aggravated in the afternoon or evening. (Goullon, Arch, xx., 3-54.) Ipecacuanha :—Nausea and inclination to vomit, or Dyspnoea, almost amounting to suffocation, arising from having taken cold, followed by— Arsenicum, should no amelioration declare itself in six or eight hours. (See also the indications for this remedy in the article on Cough and Influenza.) Hepar s. is indicated by many of the symptoms which call for Merc, Euphr., and Nux. It is moreover of service, where the respi- ratory organs are solely or particularly affected, the cough loose and attended Avith mucous rattling in the chest; pain in the larynx while coughing, and a feeling of weakness of chest which renders talking oppressive. Pulsatilla :—Useful in cold in the head, with loss of the senses of taste and of smelling in consequence of a chill,—followed or preceded COMMON cold. 241 by Belladonna, should there be an uncomfortable sensation of heat in the eyes and head, and heat and smarting in the nose : or by Nux v., should there be complete stuffing or dryness of the nose. (See Coryza and Cough.) Rhus toxicodendron :—General indisposition from exposure to a thorough wetting, Avhen in a state of perspiration; followed by Bryonia in a few hours, if no improvement is experienced. Sepia.—Catarrhal fever, with shivering chills on every movement in a warm room, rarely alternating with heat; nocturnal spasmodic cough, Avith shortness of breath and inclination to vomit, coryza, occipital headache. Aconitum is one of the principal remedies in febrile attacks, pro- voked by cold, and particularly from exposure to a dry, cold wind, or to a draught, with hot, dry skin, or general shivering chills, alternating with burning heat of the surface, great thirst, especially towards evening, sensation of dryness, and roughness or scraping, slight burning, and excoriation in the region of the larynx, or even throughout the whole of the chest, which gives rise to an incessant, short, dry, hollow cough (more of a hoarse or rough description at night); restless sleep, dis- turbed by confusing dreams, or crowding of fantastic ideas, when not by the cough. Bryonia may follow Aconitum, or it may be selected in preference at the commencement of the attack, when there is an excessively dry, hollow cough, accompanied by tenderness of the larynx on pressure, inclination to vomit, and pain in the chest, as if it Avould be torn asun- der, severe headache, aching pains in the limbs, increased by the slightest movement, violent coryza, thirst and coldness of the right half of the body. Camphora.—Incipient catarrh, coming on after getting the feet wet, is frequently cut short by smelling spirits of camphor. When there is usually weariness, heaviness, and general uneasiness, attended with shivering, and dryness or coldness of the skin, and symptoms of ap- proaching fever, one to tAVO drops, every ten minutes, for two or three times, will generally succeed in preventing the development of an attack, either of common catarrhal fever, or of influenza. The remedies for any other effects, arising from cold, will be found under the different heads, such as Sore Throat, Diarrhea, Cough, Hoarseness, &c. Some individuals, particularly among those of the fair sex, are tor- mented with an extreme degree of susceptibility to cold ; the best cor- rective of Avhich is, to rub the throat, chest, and indeed the whole body, every morning with a wet towel, until a glow of heat is produced,—drying one part before another is commenced,—also to acquire a habit of going out every day, provided there is no inherent predisposition to pulmonary consumption; all extremes, either of heat or cold, should at the same time be avoided, and care taken, when the body is heated, to let it cool gradually. When these means are not sufficient to remove the tendency to suffer from the slightest exposure to cold, the practitioner will find Silicea, Carb. v., and Calcarea, administered at intervals of from two to three weeks, of considerable poAver in removing this constitutional 242 respiratory system. delicacy. In other cases, one or more of the following remedies must be had recourse to:—Bryonia, Belladonna, Dulcamara, Nux v., China, Mercurius, Rhus, Chamomilla, Arsenicum, Lachesis, Rhododendron, according to the character of the sufferings, A\-hich are experienced after each exposure to the influence of the atmosphere. INFLAMMATION OF THE LARYNX. Laryngitis. This disease consists in a suppurative inflammation, having its seat in the lining membrane of the larynx, or the connecting cellular tissue between it and the subjacent parts. The disease bears a considerable resemblance to croup, of which it very generally forms a part; but occa- sionally the inflammation is exclusively restricted to the larynx; and it is a frequent cause of a fatal termination in scarlet fever and small-pox. It is distinguished from croup by a constant hawking (which the patient voluntarily exercises in order to clear the air-passages) rather than a Adolent and involuntary cough,—and by the character of the sputa, which consists of a thick, tenacious mucus rather than a coagulable and membranaceous-looking exudation. The invasion of the disorder is announced by the usual signs of inflammatory fever; the voice soon becomes hoarse and inarticulate, whilst a painful sense of constriction is experienced in the throat; the breathing is laborious and shrill during inspiration; the larynx extremely sensitive to the touch, so that the slightest pressure against it, either externally by the hand, or internally from the performance of the act of deglutition, is productive of the most distressing spasms, and threaten death from suffocation. The heat of skin is great, the pulse rapid and hard, the thirst considerable, but in- capable of being satisfied from the suffering that is occasioned by the attempt. On examining the throat, the fauces are often found to pre- sent a red, inflamed, and turgid appearance; in some cases the epiglottis is involved, and the motions of the tongue thereby rendered painful and difficult. As the disease gains ground, the face becomes swollen and sometimes livid; the eyes protruded as in threatened strangulation, and life is speedilycut short by asphyxia. The disease if not arrested, occasionally runs its course in a few hours to a day or two at the farthest. Therapeutics.—We have stated that the symptoms of laryngitis bear a close analogy to those of croup; and experience has proved that the same remedies, which are so eminently successful in the treatment of that affection, are equally efficacious here. The principal of these are: Aconitum, Spongia, Hepar Sulphuris, Lachesis, Belladonna, Phosphorus. In some cases of a less formidable nature, Chamomilla, Mercurius, or Drosera rotundifolia may prove serviceable. Aconitum must be immediately exhibited when the signs of inflam- matory fever declare themselves, and continued until it gives evidence of having effected an abatement of the febrile movement; on the con- summation of which, or as soon as the breathing becomes shrill, and the pain and sensibility of the larynx more decided, with increase of hoarseness and difficulty of articulation,—Spongia must be adminis- hoarseness. 243 tered, and will, for the most part, be found of great efficacy in forward- ing the curative process. When we have satisfied ourselves that we have obtained from the action of Spongia all the benefit which it is capable of effecting, we may then prescribe Hepar s., which will gene- rally be found sufficient to complete the cure, or at all events to place the patient out of danger, and thereby enable us to make a careful selection of the remedy required to combat the remaining symptoms. {Hepar may be selected in preference to Spongia, if the fever and burning heat of skin continue, notwithstanding the previous employment of a dose or two of Aconite.) In some instances it will be found neces- sary to return to Aconite again, or to exhibit Aconite, Hepar s., and Spongia in alternation, but the remedy from which we have derived the most marked benefit, when the more prominent features of the malady did not yield to, or were only palliated by, the use of Aconite, Spongia, or Hepar, is Lachesis, the pathogenetic properties of which correspond very accurately to the symptoms of the malady, particularly the extreme sensibility of the larynx, and the pain and difficulty experienced in per- forming the act of deglutition. From Belladonna we have likewise derived very appreciable service, especially when there was considerable heat of skin, much thirst, but complete inability to satisfy its cravings from the spasms which the attempt occasioned: further, when, on look- ing into the throat, it is found to present an inflamed and swollen appearance. Should Belladonna have previously been employed, as would naturally be the case if the disease made its access during, or im- mediately after, an attack of Scarlatina pura, the substitution of Hyos- cyamus for Belladonna may be found advantageous. Phosphorus may prove useful against remaining hoarseness with more or less pain and frequent expectoration of viscid mucus. Or Carbo v. when the hoarseness is accompanied by a burning and scraping sensation in the larynx, and some degree of cough or hawking up of phlegm of a less viscid nature than in the preceding instance. (See also the articles on Hoarseness, Chronic Laryngitis, and Croup.) HOARSENESS. Raucitas. Hoarseness, or roughness of the voice, arises from some abnormal condition of the larynx or trachea. In the majority of cases the seat of the affection is in the mucous lining of the larynx, which is extremely liable to be affected by the common causes of catarrh; hence it is a fre- quent accompaniment of the latter disorder. The remedies, mentioned under Catarrh and Cough, are generally found the most useful in this complaint. Amongst these, in cases of recent origin, the following deserve particular notice : namely Pulsa- tilla, Mercurius, Nux vomica, Capsicum, Rhus toxicodendron, Sam- bucus nigra, Chamomilla, Carbo vegetabilis, Drosera, Sulphur, and Hepar sulphuris. The indications for the employment of these medicines are as follows : Pulsatilla.—Almost complete aphonia, particularly when accom- panied with loose cough, or thick yellow coryza. 244 respiratory system. Mercurius.—This remedy will often be found useful in removing any symptoms remaining after the above, but is to be preferred should the hoarseness, from the commencement, be attended with thin coryza,1 and when a sensation of burning or tickling is complained of, in the larynx, with the characteristic indication of Mercurius, namely, a dis- position to profuse sweating, especially at night. Nux vomica.—Hoarseness, accompanied by a dry fatiguing cough, worse in the early hours of the morning, with dry obstruction of the nose. Capsicum.—Hoarseness, and dry obstruction in the nose, attended with an unpleasant sensation of crawling and tickling in the nose; a severe cough, worse towards evening; and pains in other parts of the body, such as the head and abdomen. It is better suited than Nux vomica for individuals of a lymphatic temperament. Rhus toxicodendron:—Hoarseness, accompanied by sensation of excoriation in the chest; oppressed breathing with frequent and violent sneezing, unaccompanied by coryza, but occasionally by a great discharge of mucus from the nose, during the attacks of sternutation. Sambucus nigra :—Hoarseness, with deep, hollow cough ; oppres- sion at the chest; frequent yawning ; restlessness and thirst. Chamomilla:—Hoarseness, with accumulation of mucus, in the throat; cough worse at night, continuing even during sleep, and fre quently with a degree of fever towards evening, and great irritability of temper. This remedy is frequently specific in cases of children. Drosera :—Hoarseness, with very low, or deep and hollow voice. Carbo vegetabilis :—Chronic hoarseness, worse in the morning and towards evening, with aggravation after talking. Sulphur :—Hoarseness attended with roughness and scraping in the throat; and of great value in obstinate cases, where the voice is low, and nearly extinct, particularly in cold damp weather. {Sulphur is especially useful after Puis.) Hepar sulphuris is a most useful remedy in chronic hoarseness, particularly in individuals who have taken large quantities of mercurial preparations; otherwise Ammonium carbonicum is of equal efficacy. (See Coryza, Catarrh and Cough.) When we find individuals in whom this affection occurs frequently at different seasons, or on the slightest exposure to cold or damp, we may naturally infer that there is a constitutional predisposition to chronic laryngitis, a malady requiring the most careful and judicious treatment, as, if neglected, it may eventually end in Chronic laryngitis.—{Phthisis laryngea.)—This is a comparatively rare disease,* and, when present, is generally attended with a degree of ulceration. The following are its principal symptoms: pain in the larynx, and round the glottis ; pain and difficulty in swallowing; hoarseness, and difficulty of respiration; frequent attacks of severe cough, with scanty, and occasionally sanious expectoration; it sometimes ends in hectic fever, which carries the patient off. 1 Sulph., Calcarea, and Silicea are of great service in obstinate hoarseness attended with coryza. cold in the head. 245 The medicines, to which we would particularly direct the attention of the practitioner in the treatment of this malady, are Hepar sulphuris, Lachesis, Phosphorus, Carbo vegetabilis, Acidum nitricum, Calcarea carbonica, Arsenicum, Spongia, Sanguinaria canadensis—(this remedy proved of singular efficacy, after the previous employment of Sulphur, in chronic laryngitis with the following symptoms : sensation of swelling, and pain as if arising from excoriation, in the larynx, during empty deglutition; expectoration of whitish, saline-tasting mucus; hectic fever)1—and Argentum fol. (The latter has been found very efficacious in affections of the larynx occurring in public speakers, with a sensation at a small spot in the forepart of the larynx, as if a foreign substance were sticking there, and giving rise to a feeling of coldness and some degree of pressure, with frequent inclination to cough, but no abate- ment of the irritation in the larynx after coughing.)2 The patient should adhere rigidly to dietetic rules, avoid unnecessary exposure, and enter as little as possible into conversation. Tracheitis.—For the treatment of this disorder, see Croup. COLD IN THE HEAD. Coryza. This affection is a very general attendant upon common catarrh. Therapeutics.—When it is the leading symptom, or exists inde- pendently of those already mentioned, the best medicines for expediting its removal are: Nux vomica, Euphrasia, Pulsatilla, Chamomilla, Mer- curius, Hepar sulphuris, Belladonna, Ammonium, Natrum, and Arse- nicum, Lachesis, Silicea, &c. Nux vomica :—Dry obstruction, especially during the night only, with pressive heaviness in the forehead, and confusion in the head ; heat in the face, increasing towards evening. If these sensations occur in combination with other catarrhal symptoms, see the indications already given for the exhibition of this remedy under the several heads of Catarrh, Hoarseness, and Cough. This direction equally applies to the other medicaments here quoted. Lycopodium, will often be found efficacious after Nux v., in obstinate cases of stuffing of the nose, particularly at night, rendering it neces- sary to sleep with the mouth open, which causes a disagreeable dryness without much thirst, attended with confusion in the head, and burning pain in the forehead. This remedy is frequently more or less useful in colds in the head of all kinds. Pulsatilla :—The discharge thick, fetid, greenish yellow, or mixed with clots of blood; loss of taste and smell, headaches, sneezing, chill, especially towards evening; disposition to weep, lowness of spirits, heavi- ness or confusion of the head in a warm room. Chamomilla:—When the affection has arisen from checked perspi- ration, and there is an acrid discharge from the nose, causing redness of the nostrils, and excoriation or soreness under the nose; chapped lips ; shivering, with thirst. 1 Neues Archiv. Zweiter Band, Zweites Heft, p. 148. 2 Neues Archiv. III. Band, 1 Heft, p. 99. 246 RESPIRATORY SYSTEM. Mercurius :—Dryness of the nose, Avith obstruction; profuse dis- charge, producing excoriation, swelling, or redness of the nose, pains in the head and face. This is a valuable remedy in the generality of ordi- nary cases of cold in the head, particularly when the complaint is, as it were, epidemic.1 Hepar sulphuris :—Chiefly when only one nostril is affected, or when there is headache which is aggravated by the slightest movement; or when the complaint is renewed on each exposure to cold air; further, in most cases in which Mercurius, though apparently indicated, has produced little or no improvement. Belladonna may follow the above, after an interval of a few hours, if the headache continues unabated. When the sense of smelling is variously affected, being at one time too acute, and another too dull, there Avill be additional reason for resorting to this remedy. Ammonium :—Stuffed nose, especially at night; swelling and painful sensibility of the nostrils ; dryness of the nose. Natrum :—Cold in the head, renewed by the slightest chill, or expo- sure to a current of air; obstruction of the nose every second day. Lachesis :—Swelling and soreness of the nose and nostrils, with copious watery secretion. Arsenicum :—Obstruction of the nose, with, at the same time, dis- charge of thin, acrid, excoriating mucus, and burning heat in the nos- trils, &c. Suffering relieved by heat; pain in the back, feeling of general debility, or prostration of strength. Dulcamara is useful when fresh obstructions arise from every trivial exposure to the air. Ipecacuanha may be had recourse to after Arsenicum, if the latter has only partially relieved. Ammon. carb. :—Cold in the head with copious discharge, particu- larly of an acrimonious, burning, watery fluid; hoarseness, tickling, suffocating cough, with alternate heats and chills. Graphites, and also Silicea, are useful in all cases which are of frequent recurrence, and always of a most obstinate character. Camphor :—In the premonitory stage of the complaint, with shiver- ing and headache, the attack may frequently be checked by a drop or tAvo of spirits of Aveak camphor administered, &c. Sulphur, Calcarea, Silicea, Natrum, and Pulsatilla, are the best remedies for removing extreme susceptibility to colds in the head.2 Against the effects of a suddenly suppressed catarrh, the folloAving are the most important remedies: Aconite against headache, followed by Pulsatilla, and then Cinchona, if the secretion does not return; diffi- culty of breathing,—Ipecacuanha, followed, if required, by Bryonia and • 1 When the secretion from the nose is excessive, and there is, at the same time, con- fusion in the head, with redness and soreness of the eyes and eyelids, and copious acrid or scalding lachrymation, Euphrasia should be prescribed. 2 In other cases, this desirable result may be attained by the administration of Mer- curius, Hepar s., and Belladonna, on each successive attack (when the symptoms resemble those which have been described under these remedies)—and failing these, Silicea, Sul- phur and Calcarea ; the other remedies also, mentioned above as useful in removing this susceptibility, must sometimes be had recourse to. The state of the digestive functions ought, at the same time, to be attended to; and if found to be in a disordered state, such remedies as Nux v., Pulsatilla, Bryonia, &c., must, in addition to Sulph., Silie, Calc, be had recourse to. (See Dyspepsia.) COUGH. 247 Sulphur. In other cases Nux v., Arsenicum or Cina, may be required to remove the sequelae resulting from the suppression. (See also Hoarseness, Cough, and other affections of the organs of respiration.) COUGH. Tussis. Diagnosis.—Forced and audible expiration without fever ; or a symp- tom in acute diseases,—such as fever, pneumonia, or phthisis; either dry or accompanied with expectoration. Cough, although not dangerous of itself, may become so, or form an important feature of other diseases. As a precursor of phthisis, it is too often neglected. It may arise from an irritation of the air-passages or lungs, from disease of these organs, or from cold or other causes; or be merely sympathetic or the consequence of derangements of other important viscera. We purpose here to treat more particularly of idiopathic, mucous or moist, and dry cough. Therapeutics.—The following are the medicines most useful in this affection: Aconitum, Dulcamara, Belladonna, Hyoscyamus, Nux vomica, Pulsatilla, Ammonium carbonicum, Ammonium muriaticum, Chamo- milla, Hepar sulphuris, Ignatia, Ipecacuanha, Mercurius, Carbo vege- tabilis, Capsicum, Bryonia, Rhus toxicodendron, Arsenicum album, Drosera, Silicea, Lachesis, Causticum, Sulphur, Calcarea carbonica, Euphrasia, Sepia, Stannum, Verbascum, Arnica montana, Squilla, &c. Aconitum.—Violent short cough, with quick hard pulse and feverish heat; pricking in the chest when coughing, or during inspiration. (See Acute Bronchitis.) Dulcamara.—The following are indications for the selection of this remedy: moist or loose cough, with copious expectoration after exposure to wet; or cough with hoarseness and copious secretion of mucus in the bronchial tubes, sometimes accompanied by expectora- tion of bright-coloured blood during the night; barking, shaking cough, increased or excited by taking a deep breath. (Compare with Rhus.) Belladonna.—Short, dry, barking {spasmodic, catarrhal, or nervous) cough at night in bed, and also during sleep, renewed by the slightest movement; dry cough day and night, with irritation or tickling in the pit of the throat, or sensation as if a foreign body were in the larynx, or as if dust had been inhaled ; spasmodic cough, which scarcely allows time for respiration. This medicine is also sometimes useful in cough with rattling of mucus in the chest, pricking in the sternum or in the hypochondria, and expectoration of thick white mucus, coming on espe- cially after meals ; lancinating pains in the abdomen ; hoarseness, red- ness of the face, headache, sneezing after coughing, and pain in the nape of the neck.1 Nux vomica.—This is a valuable remedy in many cases either of a 1 Hyoscyamus frequently answers when Belladonna has only afforded partial relief, and may be preferred to that remedy, when the dry, tickling, nocturnal cough is mitigated for the time by sitting up in bed; also, when there is mucus rattling in the throat. In dry, spasmodic cough, increased at night, Conium is a valuable remedy. 248 respiratory system. catarrhal or nervous character, and is particularly efficacious Avhere there is a dry, hoarse, fatiguing, and sometimes spasmodic cough, which occurs in an aggravated form in the morning, and occasionally also toAvards evening, and attacks more or less during the day, but relaxes again at night, when, however, it is occasionally supplanted by oppression at the chest, on lying down or on awaking during the night, accompanied with a feeling of heat, and dryness in the mouth; if there be any expectora- tion, it consists merely of a little mucus, which is detached with great difficulty. The cough is generally excited by a disagreeable tickling or scraping, with a feeling of roughness and rawness in the throat, some- times attended with Hoarseness and feeling of roughness in the chest, but more frequently with severe headache, or pain, as if from a blow or bruise in the epigastrium, and hypochondria; it is frequently aggra- vated after meals, or by movement, not unfrequently also by reading or meditation, and is occasionally followed by vomiting. Pulsatilla.—Severe shaking, catarrhal or nervous spasmodic cough, worse towards evening and at night, frequently followed by vomiting; sensation of suffocation, as if from the vapour of sulphur ; increase of cough when in the recumbent posture; cough which is at first dry, then followed by copious expectoration of yellowish or whitish mucus, some- times of a salt or bitter taste ; or expectoration of mucus streaked with blood; wheezing, or rattling of mucus in the chest; the paroxysms of coughing are frequently accompanied with soreness in the abdomen, as if from a bruise or blow, or painful shocks in the arms, shoulders, or back, and sometimes followed by a sensation as if the stomach became inverted from the violence of the cough; involuntary emission of urine when coughing; loose cough, with aching in the chest, hoarseness, cold in the head; excited by a sensation of scraping or of erosion in the throat; shivering. Chamomilla.—Dry cough, excited by continued tickling or irritation in the larynx and chest, and increased by talking ; the cough is most troublesome during the night, but also occurs during the day, particu- larly in the morning and towards evening; accumulation of tenacious mucus in the throat; wheezing in the chest; cough during sleep, some- times accompanied with paroxysms, as of threatening suffocation; cough with scanty expectoration of tenacious bitter mucus. This medicine is well adapted to the treatment of coughs in children, accompanied with more or less of the symptoms above described, or Avith hoarseness, cold in the head, dryness in the throat and thirst; great fretfulness; fever towards evening; paroxysms of coughing after crying, or after a fit of passion. Bryonia :—Catarrhal cough occurring in Avinter during the preva- lence of frost and cold easterly winds, Avith aggravation of the fits of coughing on coming from the open air into a warm room. The follow- ing are the general indications for its employment: Dry cough, excited by constant irritation in the throat, or as if caused by vapour in the larynx and windpipe, Avith greatly accelerated respiration, as if it were impos- sible to obtain sufficient air ; spasmodic, suffocating cough, after par- taking of food or drinks, and also after midnight; cough Avith prickings in the chest, and violent bursting headache, especially at the temples, cough. 249 also with prickings in the pit of the stomach, or in the side ; further, in loose cough with yellowish expectoration or slight spitting of blood, this remedy will frequently be found of great service ; and likewise in dry nervous cough. Rhus toxicodendron :—Short, dry cough, worse towards evening, and before midnight, excited by tickling in the chest, attended with hoarseness, or a feeling of roughness or rawness in the throat, congestion in the chest, a sensation of suffocating constriction, anxiety and short- ness of breath; cough on waking in the morning, or short cough with bitter taste in the mouth, on lying down at night and on waking in the morning, with expectoration of viscid mucus, sometimes followed by vomiting. Cough, with expectoration of bright blood, with sensation of insipidity or exhaustion in the chest, or shooting pains in the chest and sides. Ipecacuanha :—Catarrhal, nervous, or spasmodic cough, particularly at night, attended with painful shocks in the head and stomach, and followed by nausea, retching, and vomiting ; or dry cough, arising from tickling in the throat; or severe, shaking, spasmodic cough, with oppressed breathing, almost amounting to suffocation. In the case of children, this remedy is frequently valuable, when they appear to be threatened with suffocation from the accumulation of mucus, or where the paroxysm is so severe as scarcely to afford time for respiration, causing the face to assume a livid hue, and the frame to become quite rigid. {Calc is often used after Ipec.) Mercurius.—Catarrhal cough, with hoarseness, or watery coryza, or accompanied by diarrhoea ; or dry cough, excited by irritation in the throat, or the upper part of the chest, Avhich becomes particularly trou- blesome towards evening, and at night; sometimes Avith slight prickings in the chest when coughing or sneezing; excited or increased by talk- ing ; cough in children with discharge of blood from the nose, which coagulates as it flows, vomiturition, and headache; dry spasmodic cough, with retching after the paroxysms, and expectoration of blood. Carbo vegetabilis.—HoIIoav cough excited by irritation, or a trou- blesome sensation of crawling in the throat and attended with burning pain and sensation as if from excoriation in the chest; catarrhal or nervous spasmodic cough, frequently followed by inclination to vomit or vomiting, occurring in paroxysms throughout the day; cough with hoarseness, especially towards evening, or morning and evening, increased by speaking. Chronic cough with expectoration of greenish mucus, or even of yellowish pus—or Avith expectoration of blood and burning sen- sations in the chest (a characteristic indication for this remedy as well as Arsenicum). Capsicum.—This remedy is frequently very efficacious in cases of cough occurring in individuals of the lymphatic temperament. It is par- ticularly indicated when the paroxysms are more severe towards evening and at night, frequently attended Avith unsettled pains in various parts of the body, and bursting headache ; also painful pressure and aching in the throat and ears; cough with offensive breath, and disagreeable taste in the mouth. Hepar sulphuris.—Obstinate cases of violent dry, hoarse cough, 250 respiratory system. sometimes attended with a dread of suffocation, and ending in lachryma- tion. The attacks are frequently excited or aggravated on any part of the body being exposed or becoming cold from the bedclothes slipping off, and are generally worse at night;—also dry deep cough excited by a feeling of tightness in the chest, or by talking, stooping, or ascending stairs; hoarseness. Ignatia.—Shaking spasmodic cough, or short hacking cough, as if arising from the presence of dust or feather-down in the throat, which becomes aggravated the longer the paroxysm of coughing continues; dry tickling cough with coryza, occurring both day and night. This remedy is, further, particularly efficacious, when the attacks of coughing become aggravated after eating, or on lying down at night, or on rising in the morning, and wljen the patient is of a mild and placid temper, or subject to alternations of high and low spirits. Arsenicum.—Cough with oppression at the chest, and tenacious mucus in the larynx and chest; cough excited by a sensation of dryness and in the larynx. Dry cough chiefly in the evening after lying down, often with difficult respiration and fear of suffocation {suffocative catarrh, catarrhal asthma), as if arising from inhaling the vapour of sulphur ; dry cough, excited by eating or drinking, or by ascending stairs, or cough which arises as. soon as the open air is encountered; thin acrid coryza ; sneezing ; periodic dry cough—nocturnal cough with general burning heat; cough with expectoration of sanguineous mucus : pulmo- nary catarrh in old people, attended with tenacious mucous sputa, which is extremely difficult to eject, and causes rattling in the chest, oppressed respiration, and frequently symptoms of impending suffocation, or para- lysis of the lungs. {Ipecac, Tartarus emet., and Baryta c, are some- times required after, or in alternation with, Arsenicum.) Ammonium carbonicum :—Dry, tickling, suffocating cough, espe- cially in the morning, sometimes with fever, occurring during the preva- lence of a cold, stormy, bleak state of the atmosphere, and attended with a sensation of heat or burning behind the sternum, resembling that which is occasioned by drinking spirits; hoarseness; cold in the head with copious discharge of acrid watery fluid. Ammonium muriaticum :—This remedy is sometimes serviceable after the former, when the cough sounds looser, yet is unattended with expectoration. Drosera :—In many cases of chronic cough with hoarseness ; or deep hollow cough, with pain in the chest and under the ribs, alleviated by pressing the hand on the side, excited or aggravated by laughing; cough on lying down in the evening and during the night. Matutinal cough, with bitter and nauseous expectoration; dry, spasmodic cough, aggravated at night, or towards evening, and frequently followed by vomiting of ingesta, or bleeding from the nose and mouth. Silicea :—Cough with oppressed breathing on lying on the back, or cough attended Avith tightness and oppression at the chest, as if some- thing stopped the respiration while speaking, or coughing. Fatiguing, or deep hollow cough, day and night, aggravated by movement or speak- ing, and sometimes attended with aching and pain, as if from a bruise, in the chest; cough with copious expectoration of transparent mucus, COUGH. 251 or pus, sometimes streaked with blood; cough with asthmatic breathing and emaciation, with dread of suffocation at night; cough irritated or excited by a sensation as if a hair were on the tongue. Lachesis :—Fatiguing cough, excited by dryness or continual tickling in the larynx or chest; or by pain or tickling in the pit of the stomach or the epigastrium ; also by the slightest pressure on the exterior of the throat; cough excited by talking, laughing, or reading aloud, or any- thing which may tend to increase the dryness or irritation in the throat; short, dry, suffocating cough, as if caused by the presence of a crumb of bread sticking in the throat, with ineffectual efforts to expectorate. Cough on rising from the recumbent posture, or attacks of cough always after sleeping, or on lying down to sleep; or cough during the day, and at night during the sleep, so that the patient is unconscious of it; continual hoarseness, with a sensation as if something were in the throat Avhich could not be detached. Sulphur :—In some cases of chronic cough, and particularly in dry cough, which disturbs the patient at night as well as during the day ; the cough is frequently excited after partaking of food, or during deep inspiration, and is generally attended with a sensation of spasmodic con- striction in the chest, sometimes followed by inclination to vomit, or the involuntary escape of urine, or pain as if from excoriation, or pricking pains in the chest; headache, pains in the chest, abdomen, loins, and hips; also cough, with expectoration of thick, whitish or yellowish mucus, or of a greenish yellow, fetid mucus, or pus, of a saltish or sweetish taste ; feverish cough with spitting of blood. Calcarea carbonica :—Dry cough, aggravated towards evening, or at night, excited by tickling in the throat, or by a sensation as if there were a feather down in the throat; also loose cough, with rat- tling of mucus in the chest, and expectoration of offensive thick, yellow mucus; anxiety. Euphrasia :—Cough, with violent coryza and lachrymotion ; diurnal cough, with difficult expectoration of mucus; or matutinal cough, with copious expectoration, and oppressed breathing. Sepia :—Cough, with copious expectoration of mucus of a saltish taste, of a yellow or greenish colour; also dry spasmodic cough, par- ticularly at night, or on first lying doAvn, attended, in children, with crying, fits of threatening suffocation, nausea, retching, and bilious vomiting. This remedy is especially adapted to individuals having a constitutional taint, such as the scrofulous, scorbutic, &c.; and in chro- nic coughs, with thick, yellowish, greenish, or even puriform expectora- tion, Avith a putrid taste, it is also a valuable remedy. Stannum :—Cough, with copious greenish yellow sputa, of a sweetish or saltish taste, attended with great weakness and disposition to sweats; soreness at the chest as from internal excoriation; feeling of weakness or sinking in the chest, as if it Avere empty, particularly after expecto- rating, or even after speaking; or dry shaking cough, worse at night or towards morning, excited or aggravated by speaking or laughing, and occasionally followed by vomiting of ingesta. Lycopodium is very efficacious in obstinate coughs which are worse at night, and are attended with expectoration of tenacious mucus, and 252 respiratory system. sometimes vomiting; paleness of the face, emaciation, precordial pains and oppression, flatulence, ill-humour. Cinchona :—Paroxysms of cough as if excited by the vapour of sul- phur, with Avhistling or rattling in the throat from mucus; expectora- tion difficult, consisting of clear tenacious mucus, sometimes streaked with blood; pains in the shoulders, or prickings in the chest and wind- pipe ; cough, sometimes with bilious vomitings; cough after hemoptysis. Verbascum :—This remedy is frequently of great service in children, though less frequently so than Chamomilla. Indications: dry, hoarse cough, Avorse towards evening and at night, occurring during sleep. Iodium :—Cough in plethoric children, with copious accumulation of mucus in the bronchi, and ineffectual efforts to expectorate. Phosphorus :—Dry cough excited by tickling irritation in the throat or chest, or by laughing, talking, or drinking, or by cold air, and accom- panied with pricking in the larynx; hoarseness, or pains in the chest as if from excoriation; cough with hoarseness, fever, and depression of spirits, sometimes with apprehensions of death; dry sounding cough, followed by expectoration of viscous or sanguineous mucus. Arnica, is of great value in coughs attended with bleeding from the nose and mouth; headache, pricking in the chest (pleurodynia), rheu- matic pains in the loins and extremities, and soreness or pain, as from a bruise in the chest and abdomen. Staphysagria :—Cough attended with pain under the sternum, as if arising from excoriation or ulceration; expectoration of yelloAv, puru- lent-looking mucus; sometimes spitting of blood, and involuntary dis- charge of urine ; exacerbations at night. Argentum foliatum :—Cough excited by laughing; or cough attended with a feeling of rawness or soreness in the throat, and some- times with accumulations of viscid mucus on the palate, which causes a disagreeable scratching or scraping sensation. Squilla :—In short, dry cough, excited by a full inspiration, or chro- nic cough, or catarrh with copious secretion of whitish, viscous mucus, which is alternately expectorated with ease and difficulty, this remedy is useful. Spongia :—In acute inflammation of the bronchial membrane, this remedy is often of essential service (see Bronchitis),—but it is of equal utility in the chronic variety when the following symptoms prevail: cough with expectoration of muco-purulent sputa, emaciation, redness and deformity of points of the fingers, lividity and incurvation of the nails, hectic fever. These are the principal remedies to be had recourse to in this disor- der ; but in complicated cases, we may have to call in the aid of other medicaments. When the symptoms take on an inflammatory character, the treatment recommended in acute bronchitis Avill generally be found applicable. In obstinate nervous or stomach or duodenal coughs, which frequently occur in highly irritable, nervous, and hysterical habits, or in Avomen during the last months of pregnancy, and which are generally dry, or attended with scanty and difficult expectoration, consisting of a little clear mucus, are to be relieved by the remedies mentioned under Dyspepsia. Change of air is often beneficial in such cases. For COUGH. 253 cough arising from Worms, see the remedies mentioned under that head; or from teething, see Dentition. Finally, the following summary of a few characteristic indications may prove useful in selecting the appropriate remedy. Cough, increased or excited by cold air: Lachesis, Arsenicum, Phosphorus. Cough, excited by a feeling of dryness in the chest: Lachesis, Pulsatilla, Mer- curius. Cough provoked by a tickling sensation in the throat: Nux v., Merc, Cham., Arnica, Bryonia, Phosph., Sep., Sulph., Lycop., Kali, Dros., Puis., &c (see also the other indications, given above for most of these medicines). From tickling in the pit of the throat: Cham., Bella., Silicea. Cough from a sensation of down in the throat: Cal- carea, Ignatia, Amm. c From a sensation as if from dust in the throat: Bella., Teuc, Ferr. mag. Cough from a sensation of scraping, or a feeling of roughness or rawness in the throat: Nux v., Puis. Cough from a feeling of dryness in the throat: Puis., Lach., Carbo a., Mang., Petr. Cough excited by a tickling in the chest: Veratrum, Phosphorus, Cham., Lach., Puis., Ammon. c, Sep., Stann., &c. From a burning sensation in the chest: Phosph., Euphorb., &c. From accu- mulation of mucus in the chest: Stannum, Arsenicum, Ipecac, Tart., Kreos., &c. From roughness or scraping in the chest: Puis., Acid. phosph., Grat. nitr. Cough, particularly Avhen in the recumbent pos- ture: Arsenicum, Lachesis, Hyoscyamus, Puis., Sulph., Nux v., Merc, Hepar, Con. Cough when lying on the back : Phosph., Nux, &c. When on the right side: Am. m., Stann. On the left: Ipecac, Par., &c. Cough which comes on chiefly after eating: Nux v., Bryon., Tartarus, Cham., Bella., Sulph., Amm. m., China, Digit., Fer., &c. Cough after drinking: Arsen., Lach., Bryon., Aeon., Dros., Hepar, Lye, Phosph. After eating and drinking : Bryon. Cough on exerting the intellectual faculties : Nux v., Mgs., &c. Cough, especially in the morning : Pids., Nux, Laches., Calc, Euphr., Sep., Stann., Sulph., Rhus, &c. Cough, chiefly at night: Bella., Puis., Nux, Ars., Lach., Merc, Sulph., Tart., Veratr., Verb., Cham., Hyose, Phosph., Con., Sep., Silie, Rhus, Staph., &c. Midnight (towards): Bella., Mgs. arct. During the day, exclu- sively or principally: Calc, Laches., Nux, Phosph., Stann., Am. c, Alum., Euphr., Nitr., Rhus, &c. Day and night: Bella., Nux, Puis., Dulc, Stann., Sulph., Silie, Lycop., Natr. m., Ignatia, Euphorb., Bismuth, Spong., &c. Cough excited or aggravated by laughing: Phosph., Stann., China, Argent., Dros. Cough during sleep: Lach., Cham., Verb., Bella., Calc, Am., Merc, &c. Cough excited by speaking: Merc, Phosph., Cham., Lach., China, Silie, Stann., Sulph., Canst., Anae, &c. Cough Avhich comes on periodically (every second or third day): Nux v., Ars., Lach. Cough when reading aloud: Phosph., Magn., Staph., &c. When singing: Stann., Dros., &c. Cough exa- cerbated or excited by movement: Nux v., Lachesis, Arsenicum, Bella., China, Ferr., Silie Cough on entering a heated room : Bryon., Natr., Veratr. Cough on touching the larynx: Lachesis, Spongia, Hepar. On pressing against the pit of the stomach : Calad. Dry cough: Aeon., Nux, Bella., Cham., Bryon., Laches., Mere, Lye, Phosph., Hepar, Ign., Sulph., Spongia, Natr. m., &c, &c. Cough with expectoration: Dulc, Puis., Stann., Tart, Sepia, Sulph., Calc, Kali, Euph., Caustic, 254 RESPIRATORY SYSTEM. Merc,__Bryon., Carb. v., Lye, Phosph., Bella., Squill, Staph., Natr. m. Acid, nitr., &c, &c. Cough Avith difficult expectoration: Lachesis, Aur., Staph., Sulph., Sep., Kali, Zinc, Euph., Am., Caust. Cough with easy expectoration : Dulc, Stann., Alum., Veratr., Kreos. Cough with offensive expectoration: Sanguinaria canad., Kreosotum, Carb. v., Sulph., Calc,—Guai., Sed., Natr., Arsen., Stann. With expectoration of mucus: Bella., Dulc, Pids., Bryonia, Am. c, Lachesis, Squilla, Hepar,Carb. v., Phosph., Merc, Stann., Sep., Sulph., Tart., Sil, Thuja, &c. With purulent expectoration: Sulph., Sil, Staph., Calc, Phosph., Acid, phosph., Guaiac, Acid, nitr., Kali, Lycop., Carb. v. et a., Plumb., Stann., Dros., China, Sep., &c. With expectoration of a bitter taste: Puis.,—Ars., Cham., Dros. With expectoration of a putrid taste: Carb. v., Kreos., Sep., Stann., Con., Puis., Ferr., Cupr. With expec- toration of a saline taste: Lycopod., Natr., Sep.,—Phosph., Stann., Sulph.,—Ambra., Magn., Samb. Of a sour taste: Lachesis. Of a sweetish taste: Stann., Phosph., Calc, Kreos., Samb. Cough with greenish sputa: Stann., Sulph., Thuja, Cann., Lye, Sep., Phosph., Carb. v. et a., &c. With grayish sputa : Lycopod., Dros., Thuja. With frothy sputa: Lach., Ars., Daph., Op., &c. Cough with thick sputa: Puis., Sulph., Stann., Calc, Phosph., Am. m., Argent., Bella., Kreos., Ruta, Op. Cough with transparent sputa: Ars., Silie, Fer., Sen., Nux. With viscid, tenacious sputa: Phosph., Senega, Laches., Nux, Puis., Stann., Staph., Cann., Par.,—Spong., Arsen., Cham., China, Fer. With serous or watery sputa: Arg., Magn., Stann., Daph. Cough with whitish sputa : Sulph., Puis., Am. m., Arg., Ambr., Aeon., China, Cupr., Ac. phosph., Kreos. Cough with yellowish sputa: Sulph., Calc, Puis., Staph., Thuja, Con.,—Lycop., Stan., Sep., Acid, nit., Acid. phosph., Carbo v., Kreos., Daph., Spong., Dros., Aug., Eug., Magn., Mang., Carbo v., Arsen., Bryon., Ruta, &c. Cough with expectora- tion of mucus mixed or streaked with blood : Aeon., Phosph., Bryon., Am., Lach., China, Fer., Natr. m., Sab., Silie, Daph., Eug., Euph., Laur., Iod., Op., Zinc, &c. Deep cough: Hepar, Veratr., Verb.,— Arsen., Lach., Aug., Sil, Samb. Hollow cough: Veratr., Spong., Verb., Carbo v., Tart.,—Phosph., Sil, Kreos., Caust, Euph., Sed., Merc, Op., Samb., Staph., Spig. Hoarse cough : Hep., Merc, Verb., —Carb. v., Cham., Kreos., Nux, Natr., Natr. m., Verat, Cina. Shak- ing cough: Ipecac, Bella., Hyoscy., Puis., Sulph., Anae, Lachesis, Ars., Ign., Lycop., Mere, Sed., Caust, Ac. nitr., Rhus, Sil, China, Ant, Sen., Mgs. arct. Spasmodic cough: Bella., Hyos., Ipec, Cupr., Drosera, Veratr., Nux, Puis., Sulph., Hepar, Cina, Merc, Carbo v., Bryon.,—Aeon., Ambra., Calc, China, Con., Dig., Fer., Ign., Iod., Kali, Kreos., Lact, Sed., Magn., Magn. m., Natr. m., Nitr. ac, Plumb., Sil, Mags., Mags. arc. Short cough: Bella., Coff., Lach., Laur., Natr. m., Nux v., Squilla,—Aeon., Alum., Anae, Arg., Asa., Ign., Nitr. ac, Cham., Petr., Plat., Rhus, Sabad., Sulph. ac. Suffocating cough: Ipecac, Arsenic, Tart., Samb., Hep., Lach., Dros., Cham., Bryon., China, SpigeL, Sulph.,—Con., Ind., Led., Op., Natrum m., Petr., Phell, Tab., Mags., arc Cough attended with pain in the abdo- men during the paroxysms: Ars., Bella., Coloc, Con., Nux, Phosph., Stann., Sulph., Ver. Cough with pain, as if from a blow or bruise in cough. 255 the chest: Am., Ferr., Veratr., Zinc In the hypochondria: Nux v. Cough with burning in the chest: Carb. v., Ant, Caustic, Seneg., Iod., Magn., Spong., Zinc. With coldness in the chest (after coughing): Zinc With constriction in the chest (while coughing): Ars., Lach., Sulph. With pain, as from excoriation or soreness in the chest: Carb. v., Puis., Phosph., Stann., Caust., Am. c, Sulph.,—Nux v., Lach., Acid, nitr., Calc, Magn. m., Magn. s., Merc, Natr. s. Nitr. ac, Sep., Sil, Spig., Spong., Zinc, &c. Cough with rattling (mucus) in the chest: Ipec, Tart, Natr. m., Bella.,—Puis., Sep., Arg., &c. Cough with shooting pains in the chest: Aeon., Bryon.,Phosph., Nitr., Squil, Sulph.,—Bella., Lach., Ac. nitr., Kali, Puis., Natr. m., Sep., Con., Dros., &c. Cough with pain as if the chest would burst: Bryon., Merc, Zinc, &c. Cough with pain in the chest as if arising from ulceration, Staph., Rat., &c. Cough followed by eructations, or regurgitation of ingesta: Ac. sulph. Cough attended with pain in the eyes, Lach. Cough accompanied by sensations of shocks or concussions in the head: Ipecac, Lach., Natr. m., Rhus. Cough with pain in the head: Nux v., Bryon., Sulph., Calc, Arnica, Ipecac, Bella., Con., Mere, Phosph., Carb. v., Rhus, Lycopod., Alum., Ambr., Natr. m., Nitr., Nitr. ac, Squil, Sabad. With pain as if the head would split: Nux v., Bryon., Sulph., Phosph., Natr. m., Caps. With pains in the hips: Sulphur, Causticum, Bella. With pains in the hypochondria : Nux v., Drosera, Bryonia, Lycopod., Lachesis, Am., Arsenic, Bryon., Lachesis, Am. m., Helleb. With pain in the loins: Merc, Sulph., Am. c, Acid. nitr. With pain in the nape of the neck: Bella., Alum. With pain in the occiput: Merc, Ferr. Cough preceded by pain in the stomach: Bella. Cough, with pain in the stomach (epigastric region): Bryon., Laches., Arsen., Am. c, Phosph., Thuja. Cough accompanied by a sensation as if the stomach turned round during the paroxysms, Pulsatilla. Cough with scraping or a feeling of roughness in the larynx: Kreos., Natr. s. With pains in the throat: Nux v., Hep., Phosph., Caps., Magn. s., China, Carb. a. Cough with lancinating pains in the throat: Nux v., Merc, Kali, Acid. nitr. With involuntary emission of urine : Puis., Sulph., Kreos., Natr. m., Ant, Staph., Squilla, Zinc. (See the addi- tional indications which have been given under some of the foregoing remedies, at the commencement of this chapter; as also those which are mentioned in the articles on Bronchitis, Croup, and Hoarseness.) Unmedicated jujubes, sugar-candy, or gum arabic may be allowed occasionally, to moisten the throat or mouth, in cases of dry irritating coughs. HOOPING-COUGH. Tussis Convulsiva. Pertussis. This is almost peculiarly a disease of childhood, and one which few individuals escape during that period; it generally appears as an epidemy ; and is, by the majority of physiologists, acknowledged to be communicable by contagion ; we seldom find an instance of a person suffering a second time from its attacks. Over many the affection passes lightly, but in the majority of cases 256 RESPIRATORY SYSTEM. it proves a distressing, and in some a fatal malady, baffling especially all the ill-directed efforts of the allopathic physician to conduct it to a favourable termination. Under the old practice, not only Avas a great deal of valuable time frequently lost in endeavouring to subdue inflammation by antiphlogistic measures, but the patient's vital energies were weakened, and rendered less capable of contending with the disease, when it assumed the spasmodic type. Now, however, on the contrary, we have it in our power, by the administration of remedies specific to the affection, sometimes to check the inflammation at its outset, subdue the distressing attendant symptoms, and almost invariably to shorten the duration of the complaint, without allowing it to leave after it any of those evil consequences, such as debility and emaciation, which oblige the patient to endure a tedious and protracted period of convalescence. Diagnosis.—Paroxysms of violent and convulsive expirations, in rapid succession, interrupted by long whistling inspirations, and in young subjects a loud shrill whoop, terminated by the expectoration of a quantity of mucus, or a fit of vomiting, after Avhich the attack ceases for some time. If the case is severe, the features swell and become livid; blood escapes from the nose, and mouth, and even from the ears. A complete cessation of respiration with threatening suffocation takes place in the more violent paroxysms, as if from spasms of the lungs. The attacks return every three or four hours, and oftener in severe cases; the least excitement brings them on; they are more frequent and violent at night. Respiration is free during the intervals, and the patient in every respect healthy, although suffering from weakness. Pathologists generally consider this disease under three stages; the distinction between the second and third is, however, not often very clearly marked. The first or febrile stage commences with the symptoms of an ordi- nary catarrh, attended with slight fever, which gradually increases, the breathing becomes more difficult, and is accompanied with irritative cough and pains in the chest. In the second or convulsive stage1 the febrile activity disappears, and the characteristic cough and other symptoms of the disease develope themselves. In the third or nervous stage there are longer intermissions between the paroxysms, but increased weakness from the duration of the cough. Therapeutics.—In the incipient, febrile, irritative, or catarrhal stage of the cough, the most appropriate remedies are to be found amongst those we have already pointed out in the treatment of common Cough, and must be selected according to the indications there given, and administered in the same manner, unless otherwise specified. By a careful selection of these remedies it is frequently possible to check the disorder in the first stage. Accordingly, the most suitable medica- ments for this purpose are Dulcamara, Pulsatilla, Mercurius, Bella- donna, Hepar sulphuris, Chamomilla, Nux vomica, Arnica, Ipecacuanha, Aconite, Bryonia, and Phosphorus. The congestive and nervous of some authors. hooping-cough. 257 Dulcamara.—When the attack has apparently been excited by ex- posure to wet (a thorough wetting); the cough loose, with copious and easy expectoration. Pulsatilla.—Cough loose, and accompanied with lachrymation, weakness of the eyes, sneezing, thick discoloured coryza and slight hoarseness, and inclination to vomit after coughing; occasional diar- rhoea, especially at night. Mercurius.—Hoarseness, Avatery coryza, with soreness of the nos- trils ; dry fatiguing cough, generally occurring in two successive fits. Belladonna is one of the most important remedies in the catarrhal stage of hooping-cough, when there is dry, hollow, or harsh and barking nocturnal cough, or which becomes materially aggravated at night. This medicine is also particularly well adapted to the angina or sore throat, which is not an unfrequent concomitant at the commencement of the affection. Hepar sulphuris.—Cough worse at night, but looser than that in- dicating Belladonna. This medicine is also useful in forwarding the secretory process. Chamomilla.—Dry hoarse cough, or cough with difficult expectora- tion of tenacious mucus, followed by a feeling of soreness at the part from which the mucus seems to have been detached. The paroxysms of coughing are excited by an almost incessant irritation of the larynx, and in the upper part of the chest. Nux vomica, is of great service, when the cough approaches the second stage. It is indicated by the following symptoms: dry, fatiguing cough, attended with vomiting, and occurring particularly from about midnight until morning, the paroxysms so protracted and violent as to produce apparent danger of suffocation, with blueness of the face, and occasionally bleeding from the mouth and nose. (Arnica is better adapted to this latter symptom, when it occurs with a copious discharge of blood.) Ipecacuanha is, like the former, of great value when the cough is attended with danger of suffocation, and each inspiration appears to excite a fresh fit of coughing. It is further indicated when the fits are attended with spasmodic stiffness of the body, and blueness of the face, great anxiety, and accumulation of mucus in the chest. Aconite may be had recourse to from time to time, when marked febrile or inflammatory symptoms are present, it being carefully borne in mind that the action of this medicine is of short duration, and may be folloAved in a few hours by any other of the remedies which appear more particularly indicated. Bryonia and Phosphorus are chiefly called for, Avhen the cough threatens to become associated with inflammatory action in the lungs, &c. Second, or convulsive stage.—Therapeutics.—Drosera, Vera- trum album, Cuprum aceticum, Arnica, Ferrum metallicum, and Conium maculatum. Drosera is one of the principal remedies in the treatment of the disease, when it has reached this stage ; and in cases where the consti- tution has not been enfeebled by the transmission of hereditary weak- ness or other causes, it will speedily declare its beneficial effects, and 17 258 RESPIRATORY SYSTEM. materially shorten this trying and painful period of the disorder. The particular indications for the use of this medicine are: violent paroxysms of cough, occurring in such rapid succession, as to threaten suffocation, and attended with the characteristic shrill sound during inspiration, and sometimes fever; after each fit of coughing, vomiting of food, or of stringy mucus ; relief on moving about. Veratrum album is indicated when the child has become reduced in strength and emaciated ; or when it suffers from cold sweats, particularly on the forehead, with excessive thirst, involuntary emission of urine, vomiting, and other symptoms common to this stage ; also pain in the chest and inguinal region ; fever.1 When the vomiting, as also the cough, become more distressing at night than at any other time, Conium may follow Veratrum, if the lat- ter fails to relieve this peculiarity. Cuprum aceticum.—This remedy is found most useful in the nervous stage, particularly when convulsions with loss of consciousness ensue after each paroxysm. Also when Ave find vomiting after the attacks, and rattling of mucus in the chest, and wheezing at all times. In almost all cases a marked benefit has followed the employment of this remedy; sometimes it has been found sufficient of itself to cut short the disease, and in others, has so far modified it, that other remedies, which had before seemed to fail, have, after its exhibition, acted with the most marked effect, and completed the cure.2 Arnica is serviceable as an intercurrent medicine when the epistaxis or hemorrhage from the mouth is considerable; and also against the affection itself, when each paroxysm is succeeded by crying. {Hepar s., is also useful, Avhen the latter symptom followed a hoarse dry cough.) Ferrum metallicum, is often very efficacious as an intermediate remedy, when there is, invariably, vomiting of food on coughing soon after a meal. Conium :—When the paroxysms occur particularly at night, and with great severity, and are generally followed by vomiting of mucus or of ingesta. (Veratr. and Tartarus emet. are also useful when the vomiting is liable to take place during the night.) Third or nervous stage. Therapeutics.—The same medicines as have already been given, according to the indications that present themselves. On the suppression of all the more serious symptoms, the remedies which have been recommended in the first stage, are also use- ful in removing any catarrhal cough which may remain behind. Change of air is likewise beneficial.3 Diet.—The diet must be light and of easy digestion; bread-pudding, 1 Carbo vegetabilis is frequently useful in bringing this stage of the affection to an early and successful termination, after the previous use of Veratrum or Drosera, or both of these important remedies; particularly when, notwithstanding the decrease of cough, the tendency to vomit still remains. (See also Ferrum.) 2 Cina is also a useful remedy when there are convulsions, or tetanic rigidity of the whole body during or immediately after the fits of coughing, particularly in children affected with worms. 3 In neglected or obstinate cases occurring in delicate constitutions, Sulphuris linctura and Sepia have been found useful. See also the remedies for coughs of a bad character under the head of Cough. croup. 259 semolina, and other light puddings of this description, provided the fever be not high, in which case, weak gruel, barley-Avater, and the like, must alone be partaken of; when the more serious symptoms have been sub- dued, or in all mild cases, we may give a little chicken-broth, or beef- tea,—and so on, gradually increasing the amount of nutriment, as the disease declines. The drinks should consist of toast-water or barley- water. croup. Angina membranacea. Angina, perniciosa. Cynanche laryngea. Cynanche tracheitis, s. traehealis, &e., &c Diagnosis.—Short, difficult, and hoarse respiration, accompanied by a shrill whistling, squeaking, harsh, rattling, or metallic sound, with cough of the same character ; the patient throws the head back ; fever, and sometimes comatose state of the brain. This well-known disease is one that requires the promptest treatment, to avert the danger. From the moment we are assured of the nature of the complaint, recourse must be had to the remedy most clearly indi- cated by the assemblage of the symptoms, so that not an instant be lost in arresting its further progress, since, if not skilfully kept in check, it sometimes runs to a fatal termination Avithin twenty-four hours ; although in the generality of cases, when such an event does take place, it hap- pens about the fourth or fifth day. Croup consists of a peculiar inflammation of the lining membrane of the windpipe, causing the secretion of a thick, viscid substance, gene- rally opaque, of about the consistency of the boiled white of an egg, which adheres to the interior of the windpipe, and takes the form of the parts it covers; when this, generally denominated the false mem- brane, has been allowed to form, the case becomes extremely critical. That croup arises from inherent constitutional taint is evident, from the fact of some families having a peculiar tendency to this disorder. It particularly affects early childhood. The principal exciting causes seem to be exposure to cold or damp, and derangement of the digestive functions, from a too nutritious or heating diet, too much animal food, or stimulants, such as wine or coffee. It seldom attacks adults, though we occasionally see exceptions to this rule, and is not unfrequently found in complication with other affections both of the lungs and wind- pipe. The attack generally commences with the symptoms of a common catarrh, such as cough, sneezing, and hoarseness, with a greater or less degree of fever; in a day or two the cough changes its character and becomes shrill and squeaking, or deep, hoarse, or sonorous, attended with a ringing sound during speaking and respiration, as if the air were passing through a metallic tube; as the disease progresses, the cough becomes more°shrill, and when long continued, resembles the crowing of a youno- cock. There is seldom much expectoration, and when any matter comes up in coughing, it has a stringy appearance, resembling portions of a membrane. After inflammation has set in, considerable fever and restlessness continue, occasionally varying in intensity, but 260 respiratory system. never wholly remitting ; the countenance expresses great anxiety, and alternates from a red to a livid hue; the paroxysms are followed by a profuse and clammy perspiration of the Avhole body, more particularly of the head and face. When danger threatens, the pulse is hard, fre- quent, and occasionally intermittent; the breathing, particularly during inspiration, difficult and audible; the features become livid, and almost purple from the sense of suffocation; the head is thrown back; the cough assumes a veiled and husky tone; the voice sinks to a whisper; the eye has a dull, glassy, or dilated appearance, and the whole system seems in a state of utter prostration. Therapeutics.—The medicines which, for the most part, will be found most appropriate to meet the incipient catarrhal symptoms, and thereby prevent, in many cases, the development of croup, are Cha- momilla, Bryonia, and Aconitum (see Cough for indications); but those upon which the greatest reliance is to be placed in the treatment of the disease itself, are Aconite, Hepar sulphuris, Spongia, and Lachesis. Aconite is called for during the inflammatory period of this dan- gerous disease, when attended Avith great febrile burning heat, thirst, short dry cough, and hurried, laborious breathing. It may be exhibited as beloAV specified, until these symptoms begin to abate. R Tinct. Aeon. 3, gtt. ij. Aq. pur. 3ij. Dose.—A teaspoonful every half hour to six hours, according to the violence of the fever. Hepar sulphuris :—Either when the febrile symptoms are partially subdued by Aconitum, the skin having become moist or covered with a profuse SAveat, the cough more loose and the breathing freer, but there remains a dry, harsh, deep, holloAV cough, with a weak, hoarse voice, and more or less difficulty of breathing; or when, from the commence- ment, the cough, so peculiar to croup has already set in, and is accom- panied by a constant mucous rattling in the respiratory organs, during which the patient is incessantly but ineffectually occupied in endeavour- ing to obtain relief by expectoration; or frequently grasps at his throat and tosses back the head;—when, moreover, there is a considerable degree of fever and restlessness, together with a burning hot skin, and excessively quick and laborious respiration.1 R Hepar Sulph. Calc. 3, gr. j. Aq. pur. 3j. M. Dose.—A tea-spoonful every two to six hours, or oftener (even every half or quarter of an hour) if required. So soon, however, as the medicine begins to make a favourable impression, the doses must be given at much longer intervals until recovery is complete. Spongia, is chiefly useful after Aconitum or Hepar, when the skin has become moist, the breathing somewhat easier, but still very laboured, loud, grating, and wheezing, the patient appearing to carry on the pro- cess of respiration more readily with the head thrown backwards, yet, is 1 This remedy is of itself sufficient, in many instances, to arrest the progress of the disease, if administered as soon as the incipient symptoms of the attack are observed; but Aconite, Hepar sulphuris, and Spongia, generally in alternation, become necessary when the affection is more developed.—Gross. croup. 261 even then occasionally threatened with suffocation; further, when the cough is hoarse, ringing, hollow, and squeaking. R Spong. tost. 6, gr. j. Aq. pur. 3j. JM. Dose.—A teaspoonful every quarter or every half hour, or only every three to six hours, according to the intensity of the symptoms, and the effects produced by each dose. Phosphorus has been recommended in cases where Hepar might fail to remove the symptoms we have enumerated under that remedy ; or when Aeon, and Spong., as well as Hepar have been merely produc- tive of temporary benefit. Lachesis :—In very serious and obstinate cases, to which there is short dry cough with hoarseness : great sensitiveness of the larynx and trachea to the touch, the slightest pressure affecting almost to suffoca- tion ; voice very low and hollow, with a sound like that of a person speaking through the nose ; fainting ; nausea ; swooning; loss of sense ; rigidity of frame; great prostration of strength, especially towards evening. R Laches. 6, glob. vj. Aq. pur. 3j. Dose.—A teaspoonful every half hour, hour, or two hours, according to the intensity of the symptoms, and their abatement. After having subdued these threatening symptoms by the adminis- tration of the last-mentioned remedy, we may, if the disease is not wholly vanquished, again fall back upon Hepar sulphuris, or Spongia, according to the indications given for those remedies. There are other remedies Avhich may afford valuable assistance in the treatment of complicated attacks ; but in truth it may be said, that in the majority of cases, Aconitum, Hepar sulphuris, and Spongia, admi- nistered alternately, when individually inadequate, are sufficient to effect a cure in a few hours. It need scarcely be stated, however, that it will be imperative to discontinue the administration of these remedies when improvement does not soon become apparent during their employment, or to select others from the commencement, if, from the symptoms and character of the case, they distinctly seem to merit a preference. It may consequently be added, that Tartarus emeticus has been found valuable after Phosphorus, in some apparently hopeless cases with threatening paralysis of the lungs ; Arsenicum, Sambucus, and Moschus in complications Avith Asthma Millari; and lodium either alone or in repeated doses, or alternately with Aconite, has been much recommended in obstinate cases, particularly Avhen occurring in plethoric subjects. Kali, Sulph., Kali hydriod., Bella., Bryon., Cham., Can., 3Iosch., Sanguinaria canad., Cup., Dros., Merc, Veratr., &c, may be found useful in particular cases, either of croup or of affections of the air-pas- sages, bearing a close analogy thereto.1 Hepar sulphuris, Phosphorus, and Lycopodium have been found use- ful in eradicating a susceptibility to this affection. (See also Laryn- gitis, Raucitas, and Bronchitis.) 1 From some provings and experiments which were made with Bromium, it would appear to be a medicine which bids fair to be of great value in croup. (Vide Arch., II. Bd., 2 Heft; as also Noack and Trink's A. M. L.) 262 RESPIRATORY SYSTEM. INFLUENZA. Diagnosis.—Catarrh appearing in an epidemic form, attended, in addition to the symptoms described at the commencement of the article on common cold, with extreme oppression and prostration of strength ; sleepiness, followed by shuddering and general chilliness; rheumatic pains, or pains as if caused by contusions, in the back and limbs ; intense frontal headache, sometimes extending to the bones of the face, with pressive aching pains in the other parts of the head, giddiness, earache; slight redness of the eyes, with painful weight or heaviness, and sensi- bility to light; coryza, or obstruction of the nose ; dry shaking cough, which produces distressing fatigue in the chest; dryness of the throat, and, subsequently, dry, burning heat of the skin, loss of appetite, nau- sea, together with soreness of the throat and some degree of hoarse- ness ; and, in some cases, swelling of the parotid glands, or offensive sweats. Therapeutics. — The principal medicines in ordinary cases are Camphora, Aconitum, Mercurius, Arsenicum, Phosphorus, Belladonna, Pulsatilla. Camphora.—One or two drops of weak spirits of Camphor Avhen taken at the commencement of the attack, and repeated until the chilli- ness or shivering begins to subside, will frequently check the further progress of the disease. In a more advanced stage of the affection, with (laborious) asthmatic breathing, accumulation of mucus in the bronchi, and cold, dry skin, Camphora is further of considerable service. Aconitum.—When the disorder assumes an inflammatory character, with quickness of pulse, dry hot skin, and short, harsh, shaking cough. Nux vomica.—This remedy has repeatedly proved of great efficacy in influenza or grippe, after the previous employment of Aconite, when the inflammatory action predominated in the chest; or when the symp- toms complained of AArere chiefly as follows: obstruction of the nose, hoarse hollow cough, excited by tickling in the throat, and attended with severe headache, confusion in the head, giddiness, want of appetite, or sickness, thirst, pain as from a bruise in the hypochondria, aching pain in the lower part of the back, constipation, pain in the chest as if from exco- riation. Mercurius.—Dry or fluent coryza ; pains in the head, face, teeth, and chest; sore throat ; swelling of the parotids ; violent shaking cough, at first dry, but subsequently moist, the paroxysms being commonly ex- cited by irritation in the throat and chest; shivering or heat with profuse perspiration ; aching in the bones and slimy bilious diarrhoea, attended with tenesmus. This remedy has also proved of great efficacy when symptoms of pleurisy, with copious, unmitigating perspiration, super- vened; as also when the liver became implicated in the general derange- ment, the pains in that organ partaking more of an obtuse than an acute description. Arsenicum.—The following are the characteristic indications for the employment of this important remedy: heaviness and rheumatic pain in the head; profuse watery and corrosive discharge from the nose, causing INFLUENZA. 263 a disagreeable burning sensation in the nostrils; violent sneezing; shiver- ings and shudderings, with severe pains in the limbs ; oppression of the chest; difficulty of breathing ; thirst; anxiety; restlessness; great pros- tration OF strength, with aggravation of sufferings at night, or after a meal; inflammation of the eyes, with sensibility to light.—These symp- toms may be attended with a deep, dry, fatiguing cough, exacerbated in the evening, at night, or after drinking, or sensations of dryness and burning, with mucus in the throat, which is difficult to detach. If this remedy be not sufficient to remove the disorder, we may have recourse to the following medicines : Camphora, Aconitum, Nux vomica, Mercurius, Phosphorus, Belladonna, Pulsatilla. Phosphorus has frequently been found exceedingly useful when there Avas excessive irritation in the larynx and bronchi, bordering on inflam- mation, with alteration of the voice, and pain during articulation. Bryonia has often proved of great service in relieving the violent, pressive, aching, bursting, frontal headache, and cough with easily loosened mucous sputa. It has further been found of great efficacy when the liver was tumefied, painful to the touch, or on coughing, or taking a full inspiration; also Avhen vomiting was liable to take place after coughing, or when the cough produced pain in the upper part of the abdomen, and caused a pain as if arising from the effects of a blow beneath the short ribs. (See Nux, which accords with Bryonia in the latter case.) Belladonna.—Dry spasmodic cough, aggravated toAvards night; sore throat, excessive, almost insupportable, headache, increased by talking, moving, or bright light; fixed look ; confusion of ideas on closing the eyes. Carbo v. has been found useful in old people, sometimes in alternation with Bryonia, Avhen the chest Avas considerably affected, the breathing oppressive, the extremities cold, with threatening paralysis of the lungs. Pulsatilla.—Loose cough day and night, exacerbated by lying down, thick offensive coryza, tendency to relaxation in the bowels, loss of appetite, foul tongue, disagreeable or insipid taste in the mouth. Rhus.—In cases arising after exposure to a thorough wetting, and accompanied by great anxiety, frequent involuntary fetching of a deep inspiration, corporeal restlessness with incessant changing of posture, this remedy is indicated. Distressing, dry cough, or cough Avith difficulty in expectorating the sputum which has been detached, the paroxysms of which were always followed by yawning, has frequently been cured by Opium, after many other remedies had failed to relieve. Sulphuris tinct. has repeatedly proved useful Avhen at the termina- tion of the disorder, dull pricking pains are experienced in the chest on taking a deep breath, or after a severe fit of coughing; also when there is oppressed respiration as if arising from a heavy weight resting on the chest. Senega.—Tickling irritation and continual burning in the larynx or throat, with loud mucous rale, and fear of suffocation on lying down. Stannum in neglected or protracted cases, Avith easy but excessive expec- toration of mucus, and great Aveakness. Cinchona may advantageously 264 RESPIRATORY SYSTEM. follow the last remedy Avhen the expectoration has diminished, or when the fits of coughing are excited by a rattling under the sternum as if arising from an accumulation of mucus. Finally:—Arnica may be administered with advantage in some cases, particularly when pricking pains are experienced in the chest during inspiration (pseudo-pleurisy), with aching pains over the whole body, headache, and hemorrhage from the nose; Ipecacuanha, after Arsenicum or any of the other prescribed remedies, Avhen there is vomiting or violent retching during or after each fit of coughing; Hyo- scyamus, and in some cases Belladonna, against distressing spasmodic cough remaining after the acute symptoms of influenza have been sub- dued ; or Conium, when the cough continued almost incessantly during the night until relieved by vomiting a quantity of frothy mucus ; Ferrum aceticum, cough after eating, with vomiting of the ingesta ; Kali hy- driod., cough, with wheezing and rattling in the chest, and expectoration of a gray-coloured, saline or SAveetish-tasted sputum. Stannum and Carbo v., in alternation frequently served to prevent the development of phthisis, where there was a predisposition to that disease before the in- vasion of influenza ; and Arsenicum and Lachesis have been employed with much success against sequelae in the form of obstinate inflammation of the eye and ulceration of the cornea. (See also art. Cough.) determination of blood to the chest. Congestio ad Pectus. Diagnosis.— Sensation of great fulness, throbbing, weight, or pressure in the chest and palpitation of the heart, attended Avith anxiety, short sighing respiration, and dyspnoea. We find that the predisposition to affections of the chest and lungs is greater during the period preceding puberty, and for some years after, than at any other epoch of man's existence. As remarked in the Diseases of Children, in infancy and during very early childhood, from the disproportion between the cerebral system and other portions of the economy, the diseases which the physician has chiefly to combat, are those arising from over-excitement of the nervous organization. In maturer years the tendency to abdominal congestion generally developes itself. This is easily explained by entering into the physiology of these different.periods of human life ; but as my object is rather the treatment of disease than the elucidation of these interesting points, I shall here content myself with briefly alluding to them. There is no doubt, as already remarked, that a particular period of human life is peculiarly liable to chest affections, and, among others, to this disorder, which is but too frequently the precursor of other more serious maladies. Some constitutions, however, especially those in which an hereditary phthisical taint exists, exhibit a marked predisposi- tion to pectoral congestion. Amongst the most frequent causes of this predisposition being called into dangerous activity are, exposure to ex- tremes of heat or cold; stimulants, such as alcoholic, vinous, or fer- mented beverages, or coffee; the abuse of narcotic drugs; violent exercise, such as running, dancing, &c, or over-exertion even of the DETERMINATION OF BLOOD TO THE CHEST. 265 voice in speaking or singing; a sudden check of perspiration ; cold or damp feet; sedentary habits; metastases ; repercussed cutaneous erup- tions ; or suppression of customary discharges, such as the catamenial and hemorrhoidal flux. Therapeutics.—Aconitum, Nux vomica, Ipecacuanha, Belladonna, Aurum foliatum, Mercurius, Pulsatilla, Spongia, Cinchona, Sulphur, are the best remedies in general cases. Aconitum is especially indicated, when there is violent oppression with great heat and thirst, palpitation of the heart, great anxiety, and shaking cough. It will be found particularly valuable for plethoric females of sedentary habits, who suffer considerably from congestion before and during the catamenia. In such cases it may be advan- tageously folloAved by Mercurius, to prevent a relapse (in others by Belladonna). Nux atomica :—When the affection has been developed by sedentary habits or by habitual indulgence in the stimulants already alluded to, or from hemorrhoidal metastasis or suppression: in which cases this remedy is frequently sufficient to effect a radical cure. Ipecacuanha will frequently complete the cure, when Nux vomica has not removed the whole of the symptoms. In other cases Sulphur will answer better after the previous employment of Nux. (See Sulph.) Belladonna :—Oppression and throbbing at the chest, with short- ness of breath and strong palpitation of the heart, extending into the head; short cough, chiefly at night; internal; heat and considerable thirst. Aurum :—Extreme oppression of the chest, as if suffocation im- pended, sometimes Avith loss of consciousness and livid hue of counte- nance ; palpitation of the heart; and excessive anguish. Mercurius, as already remarked, is valuable after Aconitum, on certain occasions (see that remedy); and also when there is burning heat and oppression at the chest, and frequent desire to take a deep inspiration; or cough with expectoration streaked with blood, and palpitation of the heart. Pulsatilla :—Ebullition of blood in the chest with external heat; constriction in the chest with impeded respiration; palpitation of the heart; anxiety and aggravation of the symptoms towards evening; also when pectoral congestion has arisen in phlegmatic subjects from hemor- rhoidal suppression, or in females from stoppage of the menstrual flux. Spongia tosta :—When the symptoms are provoked by the slightest exertion or even movement, and are attended with anguish, sensation of threatened suffocation, nausea, prostration, and fainting. Bryonia :—Burning heat in the chest, Avith sensation of tightness, dyspnoea, and anxiety ; palpitation of the heart, occasional prickings in the chest during inspiration. Cinchona, Avhen Ave can trace the affection to debilitating losses, with palpitation of the heart and oppressed breathing. Sulphur:—Ebullition of blood, Aveight, fulness, and pressure in the chest, aggravated by coughing, palpitation of the heart, dyspnoea, chiefly on lying down at night; it is also most serviceable in suppressing hemor- 266 RESPIRATORY SYSTEM. rhoids, after Nux vomica or Pulsatilla, and after the latter remedy in checked catamenia. * Phosphorus.—In some obstinate cases this remedy is often successful in affording speedy relief, particularly when, in addition to the more usual symptoms, shooting or pricking pains are frequently experienced on laughing, speaking, or walking quickly; palpitation of the heart, anxiety, sensation of heat extending from the chest into the throat. Some one or more of the preceding remedies, if judiciously selected, and timely administered, will generally check the disease, and prevent it assuming a more dangerous form: as, for example, running into hemoptysis, phthisis, pneumonia, carditis, &c. The following, among others, have also been found useful in peculiar cases : Rhus toxicoden- dron, Sepia, Natrum muriaticum, Phosphorus, Carbo vegetabilis, Acidum nitricum, Ammoniacum carbonicum, and Ferrum metallicum. INFLAMMATION OF THE MUCOUS MEMBRANE OF THE BRONCHIAL TUBES. COLD ON THE CHEST. PULMONARY CATARRH. Bronchitis. This disease consists of a greater or less degree of inflammation of the mucous membrane of the bronchi, and is divided into acute and chronic. Of the former it is intended more particularly to treat. The disorder is of frequent occurrence both as an idiopathic affection, and as a concomitant of measles, scarlatina, small-pox, hooping-cough, &c. Symptoms of Acute Bronchitis.—Chilliness, succeeded by fever; hoarseness, difficulty of respiration; severe, frequent, and distressing cough, at first dry or with scanty expectoration of frothy or viscid mucus, Avhich subsequently becomes copious and occasionally streaked with blood ; excessively laborious respiration, attended with a feeling of constriction and oppression of the chest, which sometimes increases to such a degree as to threaten suffocation; general weakness, foul tongue, and loss of appetite; paleness of the lips, cadaverous and anxious countenance, loud wheezing, and, on applying the ear to the chest, a louder sound is heard than the natural respiration, either rattling, whistling, or droning, or harsh and broken, according to the advance of the disease.1 In the cases which terminate favourably, the first symptom of im- provement which sets in, is a greater freedom of breathing, Avith remission of the fever, and an alteration in the expectoration, which becomes thicker, whiter, and diminished in quantity. But when the disease takes an unfavourable turn the difficulty of breathing increases; a state of excessive debility and collapse supervenes; the face becomes livid, the body covered with a cold and clammy sweat; the mucus accumulates rapidly in the bronchial tubes, and the cough, which has become feeble through the exhausted and sinking energies of the patient, is insufficient for its ejection; aeration of the blood in the cells of the lungs is prevented; cerebral symptoms declare themselves from impeded 1 Sibilant and sonorous rhonchi, in the early stage, and mucous or bubbling rhon- chus when the secretion becomes increased, indicate both the nature and extent of the disease. BRONCHITIS. 267 circulation, or the effect of unarterialized blood circulating in the brain and the patient is carried off in a state of asphyxia. In many cases of acute bronchitis, although a degree of oppression at the chest be present, no particular pain, heat of skin, or fever may exist; this is a most insidious form of the disease, and one in which the com- plaint is but too frequently neglected until beyond the power of the physician's art: it occurs most frequently in children who may appa- rently be only troubled with a slight Avheezing, of which scarcely any notice is taken or any medical aid called in, until suddenly suffocation threatens, or some organic lesion is produced, so that an affection which probably might have been easily subdued at the commencement, is noAV beyond control. The frequency of the disease in infancy and early life deserves a par- ticular notice. It generally begins, as in adults, Avith the symptoms of a common catarrh ; the breathing becomes quick and oppressed, and from the increased action of the diaphragm, the abdomen is rendered promi- nent; both the shoulders and nostrils are in continual motion, but the wheezing is often more marked than the difficulty of respiration, and on applying the ear to the chest a mucous rattle is heard over almost every part; expectoration sometimes temporarily relieves, and occasionally the mucus is expelled from the air-passages by vomiting; the counte- nance is pale and anxious, and somewhat livid:—these symptoms are interrupted and relieved by occasional remissions, during which the child generally appears drowsy; but they return Avith additional severity, and, if not checked, an accession of extreme dyspnoea ensues, and death takes place from suffocation. When sore throat is also present, cough- ing produces considerable pain, and the child for that reason frequently endeavours to suppress it. There is also impaired appetite with thirst, although when the disease has advanced, it is found difficult to take a long draught from its impeding respiration ; this is very observable with children at the breast, who, after eagerly seizing the nipple, will bite it, and discontinue sucking, cry, and throAV back the head, and even after vomiting up the phlegm, continue for some time in that position. In some cases, from the character of the voice and cough, bronchitis has been mistaken for croup. The tubes of one lobe, or of one lung only, may be affected, but fre- quently those of both lungs are attacked by the disease. The exacerbation of suffering at night is a very remarkable symptom in this complaint. The causes are the same as those of common catarrh. Therapeutics.—The remedies Avhich are the most appropriate in ordinary cases of this affection are : Aconitum, Bryonia alba, Pulsatilla, Spongia, Belladonna, Nux vomica, Lachesis, Phosphorus, Mercurius, Cannabis, &c. Aconitum is the remedy upon which Ave must place our chief reliance in the inflammatory stage of the disease, and throughout its course whenever high febrile action sets in. Its more marked indications are hot, dry skin, with strong, hard, and accelerated pulse ; hoarseness, with roughness of the voice; short, dry and frequent cough, excited by tick- ling in the throat and chest; obstructed respiration, sibilant or sonorous 268 RESPIRATORY SYSTEM. rhonchus, anxiety, restlessness, headache, and thirst, with occasionally scanty expectoration of viscid mucus. R Tinct. Aeon. 3, gtt. iij. Aq. pur. 3iij. M. Dose. To adults a tablespoonful, to children a teaspoonful every three to six hours, according to the urgency of the case, until relief be obtained, after which we may either lengthen the intervals, or select some other remedy more appropriate to the remaining symptoms. It will sometimes be found necessary, as above remarked, to return to this remedy, during the course of the disease, particularly during the nocturnal febrile exacerbations. Should the skin not become moist, the respiration easier, and the cough looser after the second or third dose of Aconitum, Bryonia will, in most cases, be required (see Bryonia). But it rarely happens that Aeon., Avhen at all indicated, does not produce a favourable effect, even after the first dose. As soon as a decided melioration has been effected, the repetition of the dose must be restricted to intervals of eight to tAvelve hours, or even longer; or another medicine must be selected if Aeon, be found inadequate to complete the cure. (See Pulsatilla.) Bryonia is of great service in a large number of cases of bronchitis, at the commencement of the attack. We should therefore not hesitate to prescribe it immediately when we meet with laborious, rapid, and anxious breathing, with constant inclination to take a deep inspiration; hoarseness ; headache ; dry cough, attended with a burning pricking pain extending from the throat to the middle of the sternum ; or cough with scanty and difficult expectoration of viscid sputa, in some instances streaked with blood ; sibilant rhonchus ; dryness of the mouth and lips, excessive thirst. When, moreover, the respiration is impeded by shoot- ings in the chest, and the affection threatens to become complicated with pleurisy, this remedy is still more particularly called for. (Hepar S. is sometimes required after Bryon. in bronchitis, particularly when the latter remedy produces only temporary relief.) Form of prescription, same as Aconite. Spongia is often of great service after the previous administration of Aconite, when there still remains a considerable degree of inflammation in the bronchial tubes, especially the larger, Avith sibilant or sonorous rhonchus ; and also, at a more advanced stage of the disease, when the mucous rhonchus is distinctly audible ; with hollo'w, dry cough day and night, but worse toAvards evening ; or cough with scanty, viscid, ropy expectoration; heat in the chest, burning, tickling irritation in the larynx, quick, anxious, laborious respiration; inability to breathe unless the head is thrown backwards; hoarseness. (Hepar s. is sometimes useful after Spongia, especially when the mucous rhonchus is pre- dominant, the skin hot and dry, and the efforts to expectorate inef- fectual.) Belladonna.—This remedy is useful when there is severe headache, materially aggravated by coughing; oppression of the chest, and con- striction, as if bound, with loud, wheezing, and rattling of mucus in the bronchi; short, anxious, and rapid respiration; dry, fatiguing cough, especially at night, which is endeavoured to be suppressed on account BRONCHITIS. 269 of the pains it creates ; heat of the skin and thirst; soreness of the throat. Belladonna is often exceedingly efficacious in children, par- ticularly in those insidious cases Avhich commence with a slight wheezing, and then suddenly become aggravated to such a degree as to threaten suffocation ; the heat of skin being at the same time considerable, and the pulse excessively rapid, and sometimes even intermittent. Sulphur is, in some instances, required to establish the cure after Bella. Form of prescription, the same as Aconite, but the repetition of the dose at intervals of eight or twelve hours. Nux vomica.—Dyspnoea, with excessive tightness of the chest, par- ticularly at night; hoarseness ; dry cough, worse towards morning, at- tended with pain, as if caused by a blow or bruise, in the epigastric or hypochondriac regions; cough, with difficult and scanty expectoration of viscid mucus; dryness of the mouth and lips, thirst, constipation, peevishness. Prescription, the same as directed under Belladonna. Lachesis.—Oppression at the chest, with short and hurried respira- tion, anxiety, and dejection ; mucous rdle; dry, fatiguing cough, some- times followed by the expectoration of a little tenacious ox frothy mucus, after much effort, occasionally streaked with blood; hoarseness. Prescription, as directed under Belladonna. Phosphorus.—This important remedy is frequently of great utility in bronchitis when the more inflammatory symptoms have been subdued by Aconite, but the respiration continues much oppressed, accompanied with great anxiety, and heat in the chest; dry cough, excited by tickling in the throat or chest, aggravated by talking or laughing, and followed by expectoration of stringy mucus of a saltish taste. Further, when the disease has been neglected, or when, from the phenomena which present themselves at the commencement, we have reason to dread com- plication, or an extension of the inflammation to the substance of the lungs, which we generally recognise by the invasion of crepitation, rusty sputa, &c,—there Avill be additional reason for employing Phosphorus. (See Pneumonia.) Pulsatilla.—This remedy is often required in the second stage to complete the cure, after the previous exhibition of Aconitum, when the acute inflammatory symptoms have been subdued, and the expectoration has become thicker and more copious. It may, hoAvever, be prescribed before or after any of the medicaments we have named, especially when the disease occurs in persons of mild disposition, or of lymphatic consti- tution, and the symptoms are as follows : Respiration short, accelerated, and impeded, attended with rattling of mucus, heat in the chest, and anxiety ; hoarseness ; shaking cough, Avorse toAvards evening, at night, or in the morning, accompanied with considerable expectoration of tena- cious, or thick, yelloAvish mucus, sometimes mixed Avith blood; coryza with copious discharge of thick, discoloured mucus. Prescription and dose the same as mentioned under Belladonna. Sepia may be selected in preference to Pulsatilla, when the expec- toration is very copious, though somewhat difficult, and of a salt taste ; exacerbation of cough in the morning and towards evening. (If the 270 RESPIRATORY SYSTEM. sputa be still profuse, but more easily detached and ejected, greenish, and less saline, or of a sweetish taste, Stannum may follow Sepia.) Lycopodium :—When the cough is materially worse at night, and attended with thirst and quickness of pulse, but moist skin or tendency to sweat; the sputa yellowish gray, and of a saltish taste; oppression at the chest. Mercurius.—This remedy may occasionally be found useful when the symptoms of bronchitis are accompanied by excessive perspiration; when the cough is fatiguing, worse in the evening, and at night, and excited by a tickling irritation, or sensation of dryness in the chest, with quick, short, oppressed breathing, and louder respiration than ordinary; hoarseness; coryza with watery, acrid discharge ; SAvelling of nose. Dulcamara is occasionally serviceable after Mercurius, when there is a continuance of night sweats of an offensive odour. Chamomilla is often a most useful remedy in cases of children, after the previous exhibition of Aconite, when a slight degree of whistling or sonorous rhonchus still remains; dry cough Avorse at night, occurring even during sleep. For further indications, see this remedy under the head of Cough. Ipecacuanha is also very valuable as a remedy for children, but generally at a more advanced stage of the disorder, with mucous rhon- chus in the chest, and when on coughing they are almost suffocated by the excessive secretion of mucus, and become livid in the face; short- ness of breath, and perspiration on the forehead after each fit of cough- ing. Dose.—One globule of the sixth dilution, in a teaspoonful of water, every two to six hours, until improvement results.' There are other remedies which have been found of great value in the treatment of this affection, such as Tartarus emeticus, Arsenicum, Sulphur, &c. Tartarus emeticus is chiefly found useful in those extreme cases where the smaller tubes are clogged with mucus, and suffocation threatens; when the cough suddenly ceases either from weakness or other causes. Dose.—A grain, of the second or third trituration, in four dessert-spoonfuls of water, one dessert-spoonful to adults and a teaspoonful to children every quarter, every half, every hour, or every three or four hours, according to the severity of the symptoms, or the effects produced. Arsenicum is occasionally of the utmost service in those unfavourable cases in which the pulse becomes very quick, feeble, and irregular, and the patient is reduced to a state of extreme debility and collapse. Dose.—One or two drops of the sixth dilution to an ounce of water, a teaspoonful to be given from time to time, as required.1 Sulphur is frequently useful in winding up a cure, and preventing the disease running on to the chronic form, or when the expectoration has increased in quantity and become whitish and less viscid. It may be added that Hepar sulphuris, Ammonium carbonicum, Can- 1 See the " Rules for the administration of the remedies," given in the Introduction. BRONCHITIS. 271 nobis, Bromium,1 &c, may also be found useful in some particular cases; and that Belladonna, Lachesis, and perhaps also Opium, in addition to Tart, em., may prove serviceable against the symptoms of stupor, which are so liable to set in in severe attacks of this disorder. Where there is a peculiar tendency to inflammation or cold on the chest, whenever an easterly wind prevails, Aconitum and Belladonna have been recom- mended as two of the most useful remedies by means of which this predisposition is to be overcome. (Gross, Allg. Horn. Zeit. No. 12, 19ter Bd.) Diet.—In the severe forms of bronchitis, the diet to be observed, should be the same as that mentioned under Fever ; but Avhen the febrile and inflammatory symptoms have been completely removed, the patient should gradually return to a more nutritious diet, even though a con- siderable degree of cough and expectoration remain. In the slighter forms of the complaint, spare diet, confinement to the house, in short, the simple measures laid down for the treatment of common colds in another part of this work, will frequently check or at all events materially shorten the attack. See also article Cough, in which further indications will be found for the selection of the remedies. Chronic Bronchitis. Bronchitis chronica.—This complaint may be the result of the acute affection, or it may arise as a gradual and insidious inflammation of the mucous membrane of the bronchial tubes, or proceed from the inhalation of dust or other minute particles carried into the lungs; it may also be coeval with diseases of the heart, or declare itself after eruptive fevers. It differs from acute bronchitis chiefly in the greater mildness and longer duration of its symptoms, the continuance of which varies from several weeks or months to many years. It affects elderly persons more frequently than the young, but is of course liable to occur at all ages as the result of an acute attack (although such a circumstance is comparatively of rare occurrence under proper homoeopathic treatment), the sequel of measles, &c. A compa- rative exemption from cough, is frequently experienced during summer ; but in winter, or in inclement springs, the patient is tormented with harassing cough, and copious viscid expectoration, especially in the morning, which in the severer forms of the disorder is peculiarly dis- tressing. The expectorated matter in the chronic affection is of a dif- ferent nature from that in the acute, being of a thicker consistence, and of a greenish or yellowish-white colour, it is not unfrequently muco- purulent, and sometimes decidedly purulent, and occasionally streaked Avith blood, particularly in obstinate, inveterate cases. There is gene- rally more or less dyspnoea, Avith acceleration of pulse after slight cor- poreal exertion ; but in other respects the health may be good, and con- tinue so. In the more trying forms of the disorder, an aggravated state of all the symptoms enumerated is met with ; moreover where the sputa is of a purulent nature, hectic fever, extreme emaciation, noctur- nal sweats, and occasional attacks of diarrhoea are frequent adjuncts: the latter symptoms are sometimes liable to cause the disease to be mis- taken for tubercular consumption ; but in the majority of cases, auscul- 1 The provings of this medicine are given in the " Nues Arch." Zweiter band, Drittes heft. 272 RESPIRATORY SYSTEM. tation, and percussion, together with a careful attention to the symp- toms and the history of the case, enable us to form an accurate diagnosis between them. In chronic bronchitis, the resonance of the chest is, on percussion, little if at all diminished. On applying the ear or stethoscope to the chest, the respiratory murmur is found to vary much in intensity, but is never permanently absent in any part of the chest, and is frequently even puerile. The mucous rhonchus, in most of its diversified forms, is heard in various parts of the chest at different times, and occasionally the whistling and sonorous rattles are discernible. When the dilatation of the bronchial tubes is considerable, as is not unfrequently the case in this affection, a loud bronchophony is heard, which is with difficulty if at all to be distinguished from pectoriloquy, and a rale, closely re- sembling the cavernous, is apparent in the vicinity of the dilated tube. The sound on percussion Avill, however, generally enable us to form a distinction; the dulness of tone being not so great over a dilated tube, as it is in the vicinity of a vomica; the difference of the situation of the cavity in the two cases, is also a useful discriminating guide; dilated bronchi being, as is well known, most frequently detected in the scapu- lar, mammary, and lateral regions, and vomicae in the subclavian and axillary regions.1 However, as before said, we must, in all doubtful cases, combine the history of the attack, the constitution of the patient, the progress of emaciation, &c, with the symptoms to be heard by the ear after repeated examinations, ere we come to a definite conclusion as to the exact nature of the complaint, where that is of material conse- quence ; but as regards the prognosis, chronic bronchitis, with purulent expectoration, dilated tubes, and hectic fever, has been truly considered to be nearly as formidable and serious a malady as phthisis itself, and hence ultimate recovery almost as doubtful. As this is a disease which requires a long and judicious treatment for its removal, I shall merely confine myself to the enumeration of the remedies hitherto found most useful in cases of this nature. These are Sulphur, Calcarea carbonica, Carbo vegetabilis, Pulsatilla, Hepar sulphuris, Phosphorus, Stannum, Sepia, Lycopodium, Kali c, Natrum carbonicum, Natrum muriaticum, Baryta c, Lachesis, Causti- cum, Arsenicum, Silicea, Staphysagria, Acidum nitricum, and Conium maculatum. See, however, the article Cough, where indications for the selection of most of the above remedies will be met with. INFLAMMATION OF THE LUNGS. Pneumonia vera, Peripneumonia, Pneumonitis, Pulmonitis. This disorder consists in an inflammation of the parenchyma of the lungs. Diagnosis.—Rigor, followed by heat; dyspnoea ; respiration short and hurried; cough short, continuous, and distressing, dry at the com- mencement, afterwards attended with scanty expectoration of viscid, 1 A peculiar fetor of the sputa is deemed by M. Louis as a characteristic indication of a dilated state of the tubes. INFLAMMATION OF THE LUNGS. 273 lumpy, and extremely tenacious or glutinous mucus, of various shades of colour, but generally of a dingy, brick-red, or rusty hue,1 when the proportion of colouring matter is greater. The cough is invariably excited or aggravated by every deep inspiration, or on every attempt to speak ; the speech is interrupted,.or there is a pause after every arti- culation ; the respiration is abdominal; a dull pain is occasionally felt in the chest, but more frequently rather a tightness than pain; the pulse is variable, sometimes not beyond the normal standard, but more generally full, strong, and quick at the commencement, or, when the inflammation runs high, hard, wiry, and greatly accelerated; the tongue parched and dark-coloured. The fever is usually of the inflammatory type, but is sometimes typhoid. The patient, particularly in severe attacks, lies upon his back. In the first stage2 of many cases, when not marked by complication with bronchitis, on application of the stethoscope, or the ear to the chest, the crepitous rdle may be heard; but the sound on percussion may appear to be only slightly impaired. As the inflammation gains ground, and the substance of the lung becomes altered in structure (second stage or that of hepatization), bronchial or tubular respiration is perceptible, with louder respiratory murmur than natural, in the sound parts of the lung, particularly in severe attacks ; also bronchophony may be present, and the tone elicited by percussion (excepting when the inflammation is restricted to a small central spot in the parenchyma- tous substance), more or less dull according to the seat of the structural derangement, but rarely so complete or extensive as in pleuritis with copious liquid effusion. In the third, or suppurative stage of the disorder, the sound on per- cussion becomes more dull, the tubular respiration and vocal resonance commonly disappear (a gurgling mucous rale is occasionally substituted, denoting the existence of a fluid in the larger bronchi), and the expecto- ration becomes muco-purulent or converted into a brown serous fluid. Slight shiverings generally attend the invasion of suppuration, and the pain, or sense of fulness or tightness, becomes abated; the patient is, moreover, commonly enabled to lie on the side which Avas affected, with- out much inconvenience. If the disease be not checked in the second stage, the face becomes patched with red, and sometimes livid, and is of considerable extent, the vessels of the neck swollen and turgid, the pulse weak and irregular, and the patient is deprived of life by the obstruction which is offered to the circulation in the lungs. In the third stage the pulse becomes weak and thready, and the strength commonly sinks rapidly ; but a fatal re- sult is often averted by proper homoeopathic treatment. When an abscess forms in the solidified lung, a cavernous or gurgling rhonchus will be heard, as the air passes through the pus; and pectoriloquy with cavernous respiration will supervene,—when the cavity has been emptied of the fluid by expectoration. 1 This rusty or sanguinolent hue is intimately combined, not in streaks. It appears usually about the second or third day, and is a characteristic indication of the presence of the disease in question ; at the same time it must be borne in mind, that its absence is by no means a certain criterion of the non-existence of inflammation of the lungs. 2 That of simple inflammatory injection or engorgement. 18 274 RESPIRATORY SYSTEM. Such are the general symptoms of pure Pneumonia, but in severe cases it is often found combined Avith pleurisy, in which case the pains of the chest are intense, and mostly of an acute shooting character. Another and still more frequent complication is formed with bronchitis. When pneumonia terminates by resolution, some striking evacuation fre- quently attends it, such as a very free and abundant expectoration of thick Avhite or yellow matter, often slightly streaked with blood ; or a profuse and general SAveat; diarrhoea ; a profuse discharge of urine, with a copious sediment; or an attack of epistaxis. If no hepatization have taken place, the crepitous rale, at first audi- ble, becomes gradually less perceptible, and the natural respiration is heard, till at last the former wholly disappears ; if the lung have already partly solidified, but the disease is approaching a cure, the crepitous rale is first heard, then gradually yields to the natural respiration; in tact, the disease, so to speak, runs its course back again. Therapeutics.— Aconitum, Bryonia alba, Phosphorus, Tartarus emeticus, Tmciura sulphuris, Rhus toxicodendron, Belladonna, &c. Aconite.—In the stage of simple inflammatory congestion, with severe inflammatory fever, whether or not accompanied or followed by severe shooting pains in the chest, this remedy is unquestionably of great service. Form of prescription, the same as in Inflammatory Fever. Bryonia is frequently the best remedy to follow Aconite, when the more severe febrile symptoms have been lowered by that medicine. But Belladonna1 is generally required before Bryonia, when the fever returns after having been apparently subdued by Aconitum, and the difficulty of breathing, and pain, or feeling of uneasiness in the chest continue (particularly when the pain experienced seems more at the sternum), the sputa tinged with blood, and difficult to expectorate, the cheeks flushed, lips and tongue dry and parched, the skin hot, and the thirst incessant. In young plethoric subjects, Aconitum and Belladonna may be given, in rapid alternation, with the most satisfactory results during the first or congestive stage. In such cases indeed the further progress of the disease is not_ unfrequently arrested, or at all events such a degree of improvement is effected, that any remaining symptoms, such as some degree of oppression, expectoration of viscid sputa, with little or no dulness of percussion or other signs of hepatization, readily yield to the employment of Bryonia. Bryonia may, hoAvever, be prescribed at the commencement, when the following indications present themselves :— cough attended with expectoration of viscid or tenacious mucus, of a brick-dust colour, oppression at the chest accompanied by acute shooting pain, or rheumatic pains in the pleura, and pectoral muscles, or in the extremities, with increase of pain on movement; foul tongue,' constipa- tion, and other signs of gastric derangement. A complication with ' When Aconitum does not effect the desired amendment, Belladonna is eenerallv nf greater service than Bryonia in pulmonic inflammation. Again, if Aconitom^vadnof, only a slight degree of improvement when prescribed at the third or SdlntianZ aW1' hl?her attenuation, such as the twelfth or twenty-fourth is ofZ' f„l lowed by the happiest success. I consider Aconitum, Belladonna, ana j^Lw,//" sis SET4 ^^ rMnedies * P^umonia.-Rummell, Allg. HornJ z2 7 *£ 21° INFLAMMATION OF THE LUNG 275 pleurisy (pneumo-pleuritis), indicated by increased dulness on percus- sion, and in some instances a double-sounding voice, central bronchial respiration, and bronchophony, is often an additional reason for the selec- tion of this remedy. (See also Pleuritis.) R Tinct. Bryon. alb. 3, gtt. iij. Aq. pur. 3iij. Dose. A dessert-spoonful every four, six, or eight hours, according to the severity of the case.' Phosphorus.2—This remedy has been lately almost exclusively employed by Dr. Fleischmann, of Vienna, in almost every stage of pneumonia, under whatever form it may present itself, and with the most marked success, even when extreme hepatization has taken place. Although the homoeopathic treatment hitherto adopted with Aconitum, Bryonia, Merc, Sulph., &c, has proved eminently successful, yet this remedy, which seems to have such a specific influence over this serious disease, deserves a more extensive trial: at the same time we cannot too strongly reprobate the impropriety of blindly selecting this remedy, Avhen others, such as Bryonia, Tartarus, Sulphur, &c, may, on a careful comparison of the symptoms, be found better indicated; or of persevering in its employment, in cases where no signs of improvement have set in, after we have allowed a sufficiency of time to elapse to admit of the manifestation of its favourable action. R Tinct. Phosph. 3, gtt. vj. Aq. destil. 3ij. Dose. One dessert-spoonful every four hours, lengthening the intervals according to the effects produced. Tartarus emeticus s. stibiatus has been chiefly recommended as valuable in promoting resolution after hepatization has taken place, which is indicated by the greater or less degree of dulness on percus- sion, the bronchial or tubular respiration ; and the peculiar pectoral sounds given by the voice. Oppression at the chest, laborious respira- tion, no expectoration, or expectoration of mucus (untinged with blood) chiefly during the night; or, mucous rattling in the chest Avith temporary diminution of the obstructed respiration after expectorating the sputa detached by the cough, appear to be the principal general indications for the selection of Tartarus emeticus? R Tart, stibiat. 3, gr. iv. Aq. dest. 3iij. Dose. A dessert-spoonful three times a day. 1 "Vide "Rules for the repetition of the dose," in the Introduction. 2 I have cured some of the most desperate cases of pneumonia by means of Phospho- rus, although prescribed only in the form of globules, but always at low potencies (3-6).—Rummell, Allg. Horn. Zeit. No. 21. 32ster Band. 3 Bosch, in his remarks on the treatment of pneumonia, states, that although the fever may have abated under the employment of A con., Bella., or Bryon., whenever the oppression at the chest and anxiety continue or increase, the pulse at the same time becoming small, soft, and irregular, and auscultation clearly indicating the establish- ment of hepatization, he resorts to Tartarus stibiatus, and with such striking success, as cannot be surpassed by any remedy, not even by Phosphorus. The latter he always considered called for when solidification had made some progress, and was accompanied by signs of incipient paralysis of the lungs; symptoms which are prone to threaten even in the first stage of pneumonia, when the disease occurs in old people, especially those who are subject to asthma, or have been affected with chronic mucous (pituitoua coughs.—Hygea, XX Band, 4 Heft. 276 RESPIRATORY SYSTEM. Tinctura sulphuris may deserve a preference to the last-mentioned remedy in similar cases, when they occur in strumous habits, also where hepatization has advanced to some extent, and where Phosphorus, or other remedies, may have only effected a degree of improvement; also where there is complication with pleurisy, and obstinate constipation. R Tinct. Sulph. 3, gtt. iij. Aq. dest. gij. Dose. A dessert-spoonful every six to twelve hours, according to circumstances; if amendment ensues, the medicine should be allowed to continue its action undisturbed, as long as the improvement continues. Bromium and Nitrum, particularly the former, promise to be of as much importance as Phosphorus in so-called complicated cases of pneu: monia, and where there is incipient hepatization.1 In obstinate or chronic cases, with weak, thread-like pulse and clam- my sweats, Lachesis and Lycopodium have been found very useful after, or in alternation with, Sulphur, Kalin., &c. Carb. n. and Am. m. have also been suggested as likely to be of service in some cases of the fore- going description. The preceding are the principal remedies used in the majority of cases of this disease; but the following have likewise been found excellent auxiliaries in some instances, and merit attention. Acidum nitricum has been of service in some cases, where, after Aconite, a cessation of pain has taken place with increase of fever. Squilla has been recommended as useful in forwarding the crisis: further, in pneumonia accompanied with gastric symptoms, and where the expectoration is copious, or in cases which had previously been treated by venesection, and China has not proved sufficient to rouse the sinking energies of the patient. Mercurius, when the fever has been lowered by the employment of Aconite, but pain and difficulty of breathing remain, or copious noctur- nal sweats exhaust the patient's strength, and the pulse is small and quick ; also where there is prominent bronchitic complication. In the latter instance Capsicum, Nux v., Pulsatilla, and Bryonia, have also proved efficacious ; Capsicum particularly in the case of phlegmatic sub- jects ; Nux v., alternately with Phosphorus, especially in the case of drunkards; and Pulsatilla in chlorotic females. The indications for Bryonia have already been given. Cannabis has also been found useful in this frequent complication, and, moreover, in one or two cases where there was disease of the heart and large vessels, with greenish vomiting and delirium.2 Arnica—against effusion into the air-passages, with local congestions and hemoptysis {pulmonary hemorrhage or apoplexy of the lungs). Rhus toxicodendron may be found serviceable in the congestive stage of pneumonia, when we meet with extreme restlessness, anxiety, palpita- tion of the heart, and excessive redness of the face. But should diar- rhoea supervene, accompanied by clammy sweats and great frequency of pulse, Arsenicum will generally be required. 1 Neues Arch., Zw. Bd., Drit. Heft, p. 113. 2 Cannabis is sometimes useful in pneumonia, when the oppression and dyspnoea is greater than the other symptoms, such as the state of the pulse, &c, would lead us to anticipate.—Rummell. INFLAMMATION OF THE LUNGS. 277 Sanguinaria canadensis.—This important medicament is considered by Constantine Herring as likely to prove a valuable remedy in certain cases of pneumonia. Cantharides seems calculated to prove serviceable in pneumo-pleuritis. When the inflammatory symptoms have been subdued, but the expec- toration presents a muco-purulent appearance, and there is great pros- tration with nocturnal sweats, Lycopodium has been found very effica- cious. When the disease has gone on to the third stage, announced by attacks of shivering succeeded by heat, and other signs of suppurative fever, together with the physical changes already mentioned,— Sulphur, Lycopodium, and Kali c, form, along with others, such as Mere, Hepar, China, &c, the principal remedies by means of which we may entertain some hope of averting a fatal issue. Lachesis has proved beneficial, sometimes in alternation with Arseni- cum and Cinchona, in those almost desperate cases which threaten to turn to gangrene of the lungs (with fetid breath and sputa). Phosphorus, Kali, and Lycopodium are efficacious remedies in pneu- monia occurring in phthisical subjects. When there exists a tendency to suffer from inflammatory injection in the chest, whenever an easterly wind prevails, Aconitum and Belladonna {Bryonia ?) have been recom- mended as prophylactic remedies. The state of the digestive functions ought, at the same time, to be attended to. But when this predisposi- tion arises in consequence of an attack of pneumonia, which had degene- rated into the chronic form, and left certain portions of the lung in an indurated state, Avith more or less bronchial voice and breath-sounds at the seat of the previous inflammation, such remedies as Sulph., Lache- sis, Phosph., and Lycopod., must be resorted to. Ere we conclude this chapter, we trust we shall be excused for intro- ducing the following somewhat diffuse but important remarks of Dr. C. Miiller,1 on the employment of Tartarus emeticus and Phosphorus in pneumonia, as also some extracts from the observations of Dr. H. G. Schneider2 and Dr. Watzke3 on the treatment of pneumonic inflam- mation. "The information to be gleaned from homoeopathic authors, as to the efficacy of Tartarus emeticus in pulmonary affections, is nearly as fol- lows : Dr. Wurm (Hygea, xii. 1, p. 41) recommends it in pleuritis com- plicated with bronchitis, when the expectoration is difficult. Dr. Buchner (Hygea, xv. 6, p. 509) recommends its employment in pneumonia Avhen the fev"er and the typical signs have, for the most part, disappeared, but the patient is affected with constant rattling in the chest, and expectorates large confluent masses; the expectoration being, at the same time, difficult, the respiration oppressive, the chest affected Avith a burning sensation extending to the throat, and gastric symptoms predominating. An anonymous Avriter (Horn. Archiv, xix. 2, p. 31) considers Tartarus emeticus the only specific remedy in Pneumonia gastrica, and in the second stage of pure pneumonia. 1 Tartarus emeticus und Phosphorus in Lungenentziindungen, von Dr. CI. Miiller. Allg. Horn. Zeit., No. 4-5. 30 Bd. * Ibid. No. 1. 21 Bd. 3 Ibid. No. 7. 21 Bd. 278 RESPIRATORY SYSTEM. Dr. Bosch (Hygea, xx. 4, p. 304) gives several detailed cures of pneu- monia by means of emetic tartar, and intimates that he has ahvays found it useful when, on the abatement of the symptoms of inflamma- tory fever, the oppression at the chest and the anxiety increased, the pulse became small, soft, and frequently unequal, and the physical signs afford distinct indications of hepatization (dull-stroke sound, and crepitation or bronchial respiration). Dr. Kurtz (Hygea, v. 2, p. 141) holds Tart. emet. to be a really specific remedy only in the stage of hepatization. The following pathogenetic effects of Tart. emet. denote its action on the bronchi, lungs, and pleura : much coughing, and sneezing violent, tickling in the air-passages, Avhich provokes cough; loose night cough; mucous rhonchus ; cough after a meal, with vomiting of the contents of the stomach; gasping for breath at the commencement of every paroxysm of coughing ; burning sensation under the sternum ; con- tinuous violent, rheumatic pain in the (left) side of the thorax ; fits of soreness in the chest, attended with hopeless despair; sensation as if the chest were lined with velvet; short, laborious breathing, render- ing it necessary to sit up in bed,—relieved after coughing and expec- torating ; nocturnal paroxysms of orthopnoea; irregular or unequal, intermittent respiration during sleep ; less frequent inspiration; inter- rupted or oppressed breathing, with dysphagia; unusual oppression at the chest. The symptoms which have been attained from animals that have been poisoned by Tartarus emeticus are as follows: lungs congested and dis- tinctly inflamed, and in a state of splenization, in some parts even in that of hepatization, of a violet colour, and deprived of crepitation (Magendie—arising from the injection of 6-8 grs. into a vein. Orfil. Toxicologia, Bd. 1, p. 460); lungs materially altered, of an orange- yellow or violet-blue colour, increpitating, gorged with dark blood, and of dense texture; inflammation of the bronchial tubes, and, to a greater extent, of the lungs also. (Schrbpfer, in Christison's " Treatise on Poisons," p. 503, from 1 scr. injected into the trachea of a dog.) The lungs of those of the human species who have been poisoned by Tart. emet., exhibit black discoloration in several parts. That emetic tartar exerts a specific action on the bronchi, pleura, and lungs, and that the alterations which it is capable of producing on these parts correspond to those Avhich are commonly and intrinsically met Avith in inflammatory affections of these organs, there cannot be the slightest shade of doubt; the more precise indications for its application are, hoAvever, less de- termined. The majority of physicians (allopathic) understood the multifarious recommendations of Tart. emet. in the sense that it was immaterial in what description of inflammation in the chest it was employed, provided only the affection was either pneumonia or pleuritis ; the solitary ques- tion on which they were not united Avas, whether blood should be ab- stracted or not in the first instance. The result of this summary mode of proceeding was naturally very variable; and it accordingly happened that, whilst one party spoke in the most enthusiastic terms of praise, another gave a depreciatory opinion; others, again, felt that the sphere INFLAMMATION OF THE LUNGS. 279 of its efficacy must be somewhat narroAved, and therefore recommended Tart. emet. in those instances of pectoral inflammation in which it was uncertain Avhether to bleed or not. (Bersius, Miguel, and others.) A similar discrepancy of opinion arose as to the time and stage of the disease in which the remedy was more appropriate; some employed it at the very commencement of the disorder, others, particularly in pleu- ritis, only when effusion had taken place, making the Tart. emet. a sort of resolvent and substitute for the ordinary mercurial friction. As already shown, the homoeopathic physicians have, upon the whole, em- ployed Tart, emet., but rarely in thoracic inflammations, and that more apparently from the circumstance that they conceived they possessed sufficient resources in their other remedies, or because they attached but little credit to recommendations emanating from allopathic practition- ers, rather than that any want of confidence in the remedy had arisen from established trials. No homoeopathist, hoAvever, ever expected to find in Tart. emet. a never-failing specific in pulmonic inflammations. It therefore remains for us, from the physiological effects of this remedy, and the experience which has been derived from clinical observation, to consider more narrowly those symptoms which, when encountered in pulmonic inflammation, justify us, according to homoeopathic principles, in selecting emetic tartar as an appropriate remedy. In the first place, then, as regards the painful sensations which Tart. emet. is capable of exciting in the chest, we find only a single symptom : violent fixed rheumatic pain in the (left) side of the thorax. Now, we know that in pneumonia the pain is commonly either very trivial or altogether absent, from the circumstance that the parenchymatous substance of the lungs is but little qualified to give rise to painful sensations. With the serous covering of the lungs, however, it is far otherwise ; for if the pleura be affected, and particularly when inflamed, acute pain is ahvays present, but this pain is almost constantly of a shooting or cutting description (as is for the most part the case in all serous membranes), and conse- quently not continual or incessant, but intermitting, excited by move- ment, breathing, &c. As the above-mentioned pain is, strictly speak- ing, the only one that is proper to Tart, emet., it therefore follows that its applicability in pleuritis, at least in the first two stages of that com- plaint, is untenable. Concerning the phrase "rheumatic pain," there is some difficulty in finding a positive definition: if employed to designate the changing or erratic nature of the pain, it contradicts the succeeding term "fixed;" if, on the other hand, the expression is received in the sense in which, in popular language, it is commonly employed in reference to pains aris- ing from exposure to cold, such a signification ought not to find place in a scientific (homoeopathic) work ; most probably, therefore, it is intend- ed to be implied that the pain has its seat in the pectoral muscles, inas- much as rheumatic affections are especially seated in fibrous structures. Consequently, although Peschier regarded pricking or darting pains in the chest as an especial indication for Tart emet. in pleurisy, his opinion Avould seem to be unjustifiable, since the aforesaid pains counter- indicate the employment of this remedy. The paucity of painful pec- 280 RESPIRATORY SYSTEM. toral symptoms speaks much more in favour of the application of Tart. emet. in pneumonia. The following three symptoms ought to be taken into consideration here: sensation as if the chest were lined Avith velvet; soreness or pain as from excoriation in the chest, occurring in paroxysms; burning sen- sations behind the sternum, evidently arising from affections of the mucous lining of the bronchi, and their ramifications; they therefore denote the existence of common catarrh, or of the catarrhal affection which ahvays accompanies inflammation of the lungs, and do not corres- pond to pleurisy, from the circumstance that catarrhal symptoms more rarely attend the latter affection. The symptoms of abnormal respira- tion are strongly marked: short, oppressed breathing, rendering it necessary for the patient to sit up in bed ; frequent fits of unequal, inter- mittent respiration during sleep; extreme pectoral oppression ; dyspnoea, compelling the patient to sit up, meliorated after coughing and expecto- rating ; nocturnal attacks of orthopnoea; respiratory disturbance with dysphagia. When we compare these numerous symptoms with the few which were previously mentioned as appertaining to Tart, emet., it will be seen that they predominate so much over the latter, as to be evidently of much greater importance, and correspond particularly with those of pneumonia, for in that affection, as is well known, the oppression and disturbance to the respiratory functions hold a prominent place, and the remaining symptoms are of a less decided character. The symptoms referring to the expectoration are of a less satisfactory nature ; the cough is certainly chiefly loose, and even accompanied Avith mucous rhonchus, but with regard to the character of the sputa, a point of considerable moment in inflammation of the lungs, we have not the slightest notifica- tion. But although this deficiency of observation is much to be regret- ted, we yet may reasonably conclude that sanguineous sputa can hardly have been met with either during the provings of Tartarus, or in cases of poisoning therefrom, otherwise, so important a symptom would most assuredly have been recorded. The following two symptoms may also be said to be of considerable importance : gasping for breath at the com- mencement of every fit of coughing; and dyspnoea, diminished after coughing and expectorating; since this dependence of the oppression on the accumulation of mucus in the bronchi, and its disappearance and cessation for some time after expectorating, is in like manner to be ob- served in certain forms of pneumonia, viz. after the act of coughing, or merely by expectoration, the bronchial ramifications Avhich intercept the hepatized portion of lung may be cleared of the fluids or the hard sub- stances which have been secreted, or the communication between the bronchi and the trachea, which had been obstructed by mucus, may be restored by the aforesaid means; which fact can in some measure be accounted for, by the sudden decrease of the oppression subsequent to expectorating, and also by the circumstance that bronchophony, the bronchial respiration, the simultaneous rattling rhonchi, sibilus, &c, previously absent, often follow a paroxysm of coughing. (Vide Scoda, p. 251.) Had any doubt remained as to the specific relation of Tartarus to the lungs and pulmonic inflammations, it would have been unconditionally INFLAMMATION OF THE LUNGS. 281 removed by the results which have been obtained from post-mortem examinations after cases of poisoning, the phenomena there met with having exhibited the greatest possible similarity to those which are found after pulmonic inflammation. The symptoms indicated unequivocally that stage of pneumonia in which the lung or a portion of the same, after previous simple engorgement with blood {engouement), has become more solid, compact, heavy, and no longer possessed crepitation; which condition has been named that of the red hepatization by most authors, and ramollissement rouge by Andral. Taking everything into consideration therefore, we shall find that the following are the indications for Tartarus emeticus: it is particu- larly applicable in pneumonia, and especially in the so-called second stage, when little or no pain, but an extreme degree of oppression and obstructed respiration, is encountered; when there is a loose cough attended with mucous rattling and considerable expectoration, followed by melioration of the pectoral oppression; when the sputa contains very little or no blood, and consists chiefly of mucous masses; and when per- cussion and auscultation demonstrate that a portion of the lung no longer contains air, and is consequently hepatized. With reference to the said physical signs, the following particulars may be determined: percussion will elicit a dull sound over a greater or lesser extent of sur- face, with increased resistance,—but it may also yield a hollow or tubulous tone (viz. when the subjacent portion of lung is hepatized throughout); the parts of the chest immediately adjacent to this spot, may emit a tympanitic sound (when, as is often the case, the portions of the lung bordering on that which is hepatized, are emphysematous), or, like the remaining extent of the lung, the usual normal sound. Should the hepatized portion be very small in circumference and dia- meter, the percussion-sound would again be normal, but this is natu- rally of rare occurrence. Auscultation, over the spot where the stroke- sound Avas dull, will afford more or less distinct bronchophony (when, namely, the hepatized portion is sufficiently large to embrace one of the larger bronchial ramifications, and the latter is not filled with fluid, or a dense exudation, or a coagulum of blood, and the communication with the trachea thereby intercepted), and, further, bronchial respiration and consonant rattling, or one or the other. The presence of bronchophony does not, however, necessarily imply the existence of bronchial respira- tion or consonant sibilus, or rhonchi, and vice versa, bronchophony is not always heard when bronchial respiration is present; these signs are sometimes only perceptible after the act of expectoration, as has been stated above. At those parts of the thorax where the lung is not hepa- tized, auscultation will detect weak, vesicular, or puerile respiration, or indefinite respiration, and various kinds of rhonchi. It must yet be observed that the cited physical signs remain the same in the third stage of pneumonia, the so-called gray hepatization, hepatisation grise, ramollisement gris (in which Tart. emet. is inapplicable, at least the symptoms do not indicate it): but this conversion of the effused lymph in the hepatized lung into purulent matter will not be readily mistaken or confounded, because the accompanying group of characteristic gene- ral symptoms would lead sooner to the selection of Phosph., Ars., Rhus, 282 RESPIRATORY SYSTEM. Lachesis, &c, than to Tart, emet, which has either none or but a limited iiumber of the said symptoms. It now remains to be ascertained whether, in addition to the symp- toms which have already been notified, there are any peculiar general indications for the employment of Tart. emet. According to the usual opinions, derived from theory and practice, it is in pneumonia attended with gastric or bilious derangement, the so-called pneumonia biliosa {erysipelas pulmonum), that emetic tartar is particularly appropriate. The characteristic marks which distinguish the said form of pneumonia from the common species are, the light bilious discoloration of the skin, and especially of the albuginea, alas nasi, and corners of the mouth; further, the coating of the tongue, merging from light yellow into a brownish colour, the bitter taste, nausea, or vomiting, the brownish- yellow bilious urine (the blood drawn by venesection is also stated to exhibit instantaneously a saffron-yellow colour under the test of nitric acid). Along with the foregoing, a lancinating pain is commonly expe- rienced under the right false ribs, or pain and distension are complained of in the scrobiculus, with frequent eructation and hiccough; moreover, a peculiar pressive, severe piercing pain is centered in the forehead, Avhich sometimes gives place towards evening to violent delirium ; frothy mucus of a saffron-yellow or greenish hue, rarely combined with blood, is ejected after the fits of coughing, which are often accompanied by vomiting. Amongst the pathogenetic symptoms of Tart. emet. will certainly be found the majority, but not the whole, of those above given. The yel- low colour of the skin, for instance, as also the brownish-yellow coating of the tongue and the bitter taste are wanting; it must be admitted, however, that even in pneumonia biliosa, the bilious aspect of the skin is only occasionally a well-marked symptom. On the other hand, the distension and sensibility of the epigastrium and hypochondria, together with the eructations, hiccough, and vomiting, the dark reddish-brown coloured, cloudy urine, and pressive frontal headache, and the cough with vomiting, are well-determined symptoms of Emet. tart. ; concern- ing the sputa, as has already been observed, we are in the possession of no positive testimony. It therefore follows that Tartarus (as also Senega, Merc, or Nux v.) may without doubt be deemed a useful remedy in pneumonia associated with so-called bilious and gastric states ; but to maintain that it alone corresponds to pneumonia with such com- plications is unjustifiable. Phosphorus.—The experience of homoeopathists as to the efficacy of Phosphorus in inflammations of the respiratory organs, is more exten- sive ; the observations detailed thereon, in various journals and essays, are so numerous that we shall here quote merely a selection of the most appropriate and authentic amongst them. Dr. Wurm (Hygea, xii. 1, p. 38, and ix. 1, p. 55) recommends it in pleuritis and pneumonia, in connexion with tuberculosis pulmonum ; as also in complications of pleuritis with pneumonia or bronchitis. Dr. G. Schmidt expresses himself in accordance with the foregoing. (Hygea, iv. p. 68.) Dr. Griesselich (Hygea, xiii. 6, p. 528) cured a case of pleuro-pneu- PNEUMONIA. 283 monia by Phosphorus which had continued to gain ground notwithstand- ing the employment of Aeon., Bryonia, Mosch., and Arnica, when, in consequence of the existence of muttering delirium and carpologia, paroxysms of threatening suffocation, extremely laborious respiration, critical debility, small, quick pulse, paralysis of the lungs was momen- tarily to be dreaded ; in the right lung there was no longer any respi- ratory murmur, but loud rubbing sound was distinctly audible. Very shortly after the administration of Phosphorus expectoration set in, and the breathing became freer, so that after twenty-four hours inci- pient slight respiratory murmur, pectoriloquy, oegophony became audi- ble, and recovery followed soon afterwards. Dr. Buchner (Hygea, xv. 6, p. 507) recommends Phosphorus where great prostration, paleness of face, dimness of the eyes, powerless, dry cough, particularly at night, are encountered; further, when the follow- ing state of matters is met with : difficult expectoration from exhaus- tion, burning, darting, rattling in the chest, danger of paralysis of the lungs, complication with bronchitis, imperfect crisis from depressed phy- sical power. Dr. Horner (Archiv, xx. 1. p. 118) found Phosphorus curative in an extremely severe case of peripneumony, in which, after the employment of Aconitum and Bryonia, exhausting epistaxis, subsultus tendinum, delirium furibundum, and involuntary stools had supervened. Schellhammer (Archiv, xx. 3, p. 120) found benefit still to arise from the employment of Phosphorus in neglected pulmonic inflammations, where there was coldness of the breath, cold, clammy sweats, tremulous, scarcely perceptible pulse, rusty, with difficultly-expectorated sputa, extreme anxiety, facies Hippocratica, and frequently such absolute dul- ness of tone on percussion, that it seemed as if a wall were struck instead of the chest. Dr. Eichhorn (Hygea, xix. 1, p. 31) found Phosphorus particularly to be approved of, when incipient hepatization, in pure and (so-called) asthenic pneumonia, is indicated, in addition to the known physical signs, by the livid, sharp face, cold sweats, small, quick, and hard pulse, frequent cough, with frothy or brown (sometimes gelatinous-looking) sputa, &c. ; and also in those cases of typhus, where, notwithstanding the pneumonic concentration, sensibility to the touch, and borborygmus in the csecal region as well as diarrhoea, are present. Dr. Schneider (A. H. Zeitung, 21 Bd. p. 4) saw greater benefit from Phosphorus in 1839-40 than from any other remedy; in general he also found this remedy indicated, where Aeon., Bryon., Merc, had not rendered the expected relief before the pneumonic crisis; and in neglected cases with rattling rhonchus in the bronchi, difficult purulent- looking, copious sputa, and great debility. Dr. Watzke (A. H. Zeitung, 21 Bd., p. 109) states Phosphorus to be appropriate in the second stage of primary pneumonic croup ; further, in pneumonia complicated with pleuritic exudation, or with bronchitis. The most decided defender of Phosphorus in pneumonia is Dr. Fleisch- mann; in the year 1840 he employed it (Hyg., xiv. 4, p. 358) exclu- sively with success in 51 cases of inflammation of the lungs, and found it equally useful in nearly eArery stage of the disease; the same striking 284 RESPIRATORY SYSTEM. results ensued in the following year (Hyg., xviii. 5, p. 468). The physi- cal signs were almost constantly as follows : dulness of sound on percus- sion, bronchial respiration, frequently attended with crepitation or rattling. Descriptions of cures performed by means of Phosphorus in severe, partly so-termed, nervous pulmonic inflammations, have also been given by Dr. A. Noack (A. H. Zeit., 21 Bd. p. 321); Dr. Bethmann (An- nalen, 14 Bd., 3 Stuck, p. 459); Dr. Hartlaub (Annalen, 4 Bd., 4 Stuck, p. 459). The known pathogenetic symptoms which Phosphorus exerts upon the organs of respiration are about as follow: shooting and violent stitches in various parts of the thorax, right and left side, sometimes with burn- ing at rest and during movement, especially while sitting and during respiration; pain in the chest, particularly during inspiration, itching in the interior of the chest with dry cough. Oppression at the chest; precordial anxiety with obstructed respiration, and throbbing in the right side of the chest; great oppression and shortness of breath; tight- ness of chest as if caused by a band; tension and dryness in the chest; constrictive pressure in the upper part of the thorax; loud rattling res- piration ; dry, hollow cough without subsequent expectoration; hacking cough, with a suffocating sensation in the chest, and some mucous expec- toration ; cough with expectoration of transparent mucus accompanied by tensive and subsequently pricking pain in the chest; straining cough with white, viscid sputa, which is difficult to loosen or detach; streaks of blood in the mucous sputa; muco-purulent sputa; expectoration of blood with mucus during a short, slight cough; pricking pain in the scrobiculus cordis while coughing, rendering it necessary to support the part with the hand; great startness after each fit of coughing." The symptoms which have been obtained from the dissection of dogs, which had been poisoned by Phosphorus, are as follows : "A few minutes after the introduction of a solution of Phosphorus in oil into the jugular vein, the dog emitted, at each respiration, a voluminous white vapour, which contained a considerable quantity of phosphoric acid, and died soon afterwards; on dissection the vessels of the lungs exhibited a state of obstruction (hepatization)." (Magendie, Experiences pour servir a l'histoire de la transpiration pulmonaire, 1811, p. 19.) In like manner Orfila observed : " The dog soon began to pant and breathe with extreme difficulty, and vomited a large quantity of a bloody serous-looking sub- stance. At the sectio cadaveris, the lungs presented several blue patches of a dense and less crepitating texture than in the normal state; in the remainder of their extent they were of a rose colour. In another dog the lungs were found red and congested, and did not crepitate." (Orfil. Toxicol. Ge^r., Bd. I., p. 56.) In cases of poisoning in the human subject, the inferior lobes were of firm consistence and gorged with ve- nous blood. (Oesterreich. Med. Wochenschrift, 1843, No. 39.) The above-mentioned symptoms of Phosphorus are characteristics, and dis- tinctly correspond to the appearances which are commonly observed in certain inflammations of the lungs. The sensations of pain which Phos- phorus is capable of producing consists, for the most part, of stitches and shootings, which are more particularly excited or increased by respira- PNEUMONIA. 285 tion, coughing, and movement. Identical symptoms are met with in pleuro-pneumony, the pain, which is almost constantly of a shooting or darting description, being, in the said disease, all but exclusively expe- rienced during a deep inspiration or the act of coughing. The symptoms of tightness of chest and dyspnoea form a prominent feature in the pathogenesy of Phosphorus, but they undergo no mitigation from the acts of coughing and expectorating, as is the case with Tart emet.; on the contrary, each paroxysm of coughing is productive of increased difficulty of breathing. The cough is either perfectly dry and hollow, or it is loose, yet straining, fatiguing, and generally productive of severe pain : the sputa consists of white, transparent, tenacious mucus, or of mucus intermingled with blood, or it is purulent. The results obtained from the cases of poisoning and post-mortem examinations are very similar to those detailed under Tart, emet, i. e. the lung or a portion of the same was firmer, more solid and impermeable, and consequently in a state of so-called hepatization. If, from the foregoing, we now attempt to deter- mine the kinds of pneumonia, the time and stage in which Phosphorus is appropriate, it is requisite in the first place to point out those pulmo- nic inflammations, where (in contradistinction to Tart, emet.) the shooting pectoral pains, as well as the dyspnoea and the respiratory disturbances, are especially excited and aggravated by coughing and respiration,— and these are the so-called pleuro-pneumonic inflammations in which the pleura is pretty extensively (for perhaps in no case of pneumonia does it wholly escape) implicated, and more particularly in the second stage Avhen mucus or sanguineous mucus is expectorated, and the physical signs are the same as those mentioned under Tart, emet, viz., dull stroke-sound and bronchophony or bronchial respiration, and perhaps consonant rales*. So far, therefore, it would seem that Phosphorus cor- responds somewhat closely with Tart. emet. in its sphere of action, differing only from the latter in certain isolated instances. But there yet remains a group of symptoms under the head of Phosphorus which have not yet been taken into consideration, and in reference to which the sphere of action of Phosphorus is altered and considerably extended, viz., those general appearances, which, without inducing any peculiar change in the local and physical symptoms, sometimes connect them- selves Avith pneumonic inflammations, and have by the older physicians been denominated nervous. These " nervous" appearances develope them- selves probably only when the pulmonic inflammation enters, unchecked, into the third stage, that of the gray hepatization {hepatisation grise, ramollisement gris) with threatening paralysis of the lungs ; and perhaps also in the first stage of those inflammations which occasionally occupy the lungs in typhus. When pneumonia is verging on the third stage, the purulent infiltration of the parenchyma, the following symptoms chiefly declare themselves: mental depression, slight delirium, with carpologia and subsultus tendinum, rapid prostration of strength, cold, clammy sweats, small, feeble, frequent pulse, dim eyes, sunken features, dry lips and tongue, short, laborious breathing, oppression and anxiety, tedious cough and expectoration, frequently loose and involuntary stools. The physical symptoms, as already stated, remain the same as in the second stage, excepting that the sound, on percussion, becomes perfectly 286 RESPIRATORY SYSTEM. dull and deprived of resonance over a larger surface, and the respira- tory murmur, at that spot, inaudible or extremely faint. The expecto- ration either ceases altogether or consists of a purulent mucus or a brown serous liquid. Nearly the whole of these symptoms are also to be found amongst the pathogenetic properties of Phosphorus ; and more particu- larly the delirium with carpologia, the sunken, Hippocratic visage, with deep-set eyes, dryness of the lips and tongue without thirst, the short and anxious respiration, with slight tedious cough and expectoration, the purulent sputa, clammy sweat with coldness of the face, small, quick pulse. Hereunto must be added the numerous and, in great part, authentic clinical observations which almost unanimously recommend Phosphorus in the so-called slow, asthenic, nervous pneumonic inflamma- tions,—corroborated, moreover, by the testimony of Dr. Fleischmann, whose position as the physician to an hospital gives additional Aveight to his evidence. It consequently follows that Phosphorus, according to homoeopathic principles, must prove valuable at the commencement of the third stage, with so-called nervous symptoms and threatening para- lysis of the lungs, as well as in the second stage. On comparing, therefore, its sphere of action with that of emetic tartar it will be seen, in addition to the distinctive marks already given, that the field embraced by Phos- phorus is greater than that of Tart, emet., and that the former may be advantageously employed in pneumonic inflammations of a more advanced stage than where there could be the slightest prospect of obtaining a favourable result from the administration of the latter. But that Phos- phorus should still be capable of affecting a cure, when extensive puru- lent infiltration of the parenchymatous substance of the lungs has taken place, is as little to be expected as the attainment of so desirable an event by means of any other remedy. Dr. Schneider1 writes :— I. For the last eight years, i. e., from the time that I commenced to substitute the specific or homoeopathic for the antiphlogistic method, I have usually seen pneumonia last only four to five days, and terminate on the fifth inclusive, at most on the seventh inclusive, by profuse sweats and hypostatic urine. II. I seldom met with epistaxis in pneumonia,—although artificial bleedings had not been employed, and I never (which may certainly depend upon the stadium) saw this or any other hemorrhage appear critically. I have moreover never observed critical diarrhoeas in pneumonia. in. If, in addition to critical sweats and urine, the evolution of a scabby eruption about the mouth appeared to be necessary to insure the termination of the inflammation, the decrease of the disease proceeded somewhat slower, and that more especially when the urine was at the same time of a light colour. iv. If critical sweats made their appearance on the fourth or fifth day, without effecting a decrease of the pneumony, and they were moreover accompanied by anxiety and restlessness, with increased oppression, cough, and pain during the act of coughing, the eruption of a critical miliaria Avas to be expected. 1 Klinische Aphorismen. Allg. Hom.»Zeit. No. 1, 21 ter Band. PNEUMONIA. 287 v. A miliary eruption (consisting of small Avhitish vesicles on a red ground) was always sufficient (when the inflammation could not other- wise be removed) to terminate the pneumony within nine days. In the meanwhile the sweats diminished, and the miliaria soon afterwards scaled off. VI. In one case, where the patient had wantonly exposed herself to cold on the fifth day of the disease,1 about the termination of the crisis bona (by sweat, hypostatic urine, and eruption about the mouth) relapse took place, accompanied by great anxiety, restlessness, and sleepless- ness, excessive oppression and tightness of the chest, and very difficult, painful cough, which indicated a termination (on the ninth day reckoned from the first appearance of the disease) in a miliary eruption. vii. On the decline of the pneumonic inflammation, the oppression at the chest, and the obstructed inspiration, as also the pricking pain whilst making a moderate inspiration, and the frequent pulse, were generally the first symptoms that Avere alleviated; at the same time the rust-coloured sputa became more and more light-coloured (subsequently dirty-white and globular), the cough gradually easier, and the expecto- ration less troublesome; somewhat later, the stitches during -coughing disappeared, and lastly the cough itself, after having (in the form of a normal cough) removed the last trace of the disease. viii. For the last eight years I have invariably seen pneumonia simplex when treated homoeopathically (provided the treatment com- menced as early as the third day of the existence of the disease), termi- nate favourably, and always more regular and speedily than during the ten preceding years, when the treatment Avas conducted according to the principles of the old school. ix. During the last eight years I have lost eight patients, of neglected2 and badly-treated pneumonia: two women of the age of 60, two men of the same age, one man of 40, one man of 30, and two children. The person of the age of 30 was already in a dying state when I arrived. On the other hand, I have saved, during the same space of time, six other patients similarly affected: four men in the third stage of the disease, one boy of 12, and one girl of 13 years, both were in a hectic state, &c, and had already commenced to expectorate large quantities of purulent matter, of an offensive, pungent smell. X. Two cases of pneumony occurring in previously-diseased lungs terminated fatally,—the one on the seventh day suddenly, in consequence of the bursting of a vomica,3 the other on the sixth day, through paralysis of the lungs.4 Some other cases, in phthisis exulcerata, termi- nated favourably. 1 The patient, a woman of very violent, impatient temper, being tired of the sweating, and feeling herself otherwise well, left the bed and seated herself in the passage, in a current of air coming from two opposite open doors. 2 By neglected pneumonia, I mean a case in which the period of the first normal crisis has passed unfavourably. 3 The patient had, several years before, been severely contused by being pressed by his horse against a tree, and subsequently suffered from frequent attacks of pneumonia, accompanied by very copious expectoration. 4 The patient, a woman, had suffered two years before she was attacked with this 288 RESPIRATORY SYSTEM. With the exception of those mentioned under ix. and x. I have never met with a fatal case of pneumonia during the last eight years. xi. I generally prescribe Aconitum for only one day at the utmost in pneumonia ; I only continued it the day following if the fever was still very violent; and in that case I gave it alternately with the other appropriate remedy. xn. If the patient came under my treatment only on the third day of the existence of pneumonia, I immediately gave Aconit alternately with the other medicine indicated. xiii. If the vascular irritation was very great at the beginning of the pneumony, and accompanied by determination of blood to the head, or also by talking in the sleep, I gave Aconite and Belladonna alternately. xiv. The second remedy which I employed in pneumony was generally Bryonia; I soon discovered, however, that this medicament operated much better when given alternately with some other which was appropriate to the genus morborum, or the individuality of the patient, or also the causa occasionalis of the pneumony, with Belladonna or Mercury (most frequently with the latter) or with Nux v. (e. g., with drunkards) or with Arnic or Rhus (after external causes). xv. In 1839 and 1840, about the time when ganglionic typhus prevailed, Phosphorus proved more effective than any other remedy in pneumonia. During the prevalence of scarlet fevers and anginas, Belladonna deserves particular attention ; and during that of influenza, Mercury. xvi. I usually employed Mercurius with good effect with that other- wise indicated remedy, if a critical eruption about the mouth was to be foreseen. xvn. When a critical eruption about the mouth was foreseen, the employment of Mercurius in alternation with the remedy otherwise indicated, was attended with good results. If all remedies above men- tioned did not effect the desired amendment before the crisis of the pneumonia, I usually found, after a renewed examination, Phosphorus or Sulph. indicated, more rarely Rhus, or Sepia, or Squilla, and still more so, some other remedy. xvin. On appearance of great anguish and restlessness, and oppres- sion in the chest (iv.), &c, before the evolution of miliaria, I found either Arsen., or Veratr., or Hyoscy am. indicated, and effective. xix. In neglected pneumony, with rattling noise in the bronchi, dif- ficult, purulent and copious expectoration, great weakness, &c, I have found Belladonna, Arsen., Phosphor., and Lycop. very beneficial. xx. In neglected pneumony, with copious, very offensive, purulent expectoration (ix.) I found especially Sepia, Conium, Carb., Silie, and China effective. xxi. Latterly, I commonly prescribed Aconitum, Bryon., and Bellad. in the 1—I dilution, and the other medicines in the 4—II, as folloAvs: fatal (asthenic) pneumonia, from complaints of the chest; and during the latter months she had experienced increasing tightness about the chest, attended with cough and expectoration, and very perceptible emaciation and diminution of strength. I saw her for the first time on the third day of the disease. The expectoration was nearly black. PNEUMONIA. 289 gtt. iv.—gtt. viij. in 3iv. of water, 1 tablespoonful to be taken every 1-2 hours." Dr. Watzke1 states that— " The homoeopathic or specific treatment of pneumonia presents very considerable advantages—although more in reference to the direct and indirect consequences, and period of convalescence, than with regard to the course of the disease. In our hands, as a general rule, more or less distinct indications of critical symptoms make their appear- ance on the fifth day; on the seventh, the perfect crisis takes place, and on the fourteenth day the patient is enabled to attend to his usual occupations. Aconitum has been too unconditionally and generally recommended and employed against pneumonia. We only expect direct benefit from it in active hyperemia, and incipient splenization. Bryonia we employ only in those forms of pneumonia which are sym- pathetically founded on pleuritic inflammation with predominating plastic—serous exudations. In the first stage of pneumony in robust individuals, with existing consensual irritation of the brain, as also in pulmonic inflammations in general, resulting from severe and continuous exertion, or from me- chanical lesion, the best remedies are Arnica, Rhus, and Conium. Belladonna is indicated when pneumonia is accompanied by an acute exanthema, with violent cerebral symptoms and general turgor venosus. In pneumonia occurring in females labouring under primary or second- ary chlorosis, or associated with chronic, neglected, or acute bronchial catarrh, measles, or small-pox, Pulsatilla will not easily be excelled by any other remedy. In the second stage of primary pneumonic croup we would call at- tention, besides, to the well-known and successfully-employed Phosphor. and Antimonium, to Bismuth magesterium, and Arg. nitr.: in addition to the well-known and successfully-employed Phosphorus and Antimon. tart. Arg. nitr. promises to be more especially of service against lobular hepatization occurring as a sequela. In the stage of purulent or serous infiltration Bromium is, next to Sulphur, Senega, and Carbo v., the most worthy of attention. In irregular reactions, insufficient crisis in asthenic, torpid inflamma- tions of the lungs, which frequently take place in consequence of bleed- ings, China, Camphor, Ol. tereb., and Moschus, are often beneficial even in apparently hopeless cases. Opium, Nux vomica, Hyoscyamus, Lachesis, Conium, Cocculus, Stram., do not appear to have any primary and direct effect upon the lungs; they are indicated in secondary pneumonic processes, in pneumo-typhus, in delirium tremens complicated with inflammations of the lungs, and in various forms of so-called nervous pneumony. In pneumonia catarrhalis, or in pneumony occurring in lymphatic, flaccid, fat habits, Senega is indicated; in pneumonia complicated with bronchitis, Senega, Mercury, Phosphor., Brom., Nux mosch.; in that with hepatitis (pneumonia biliosa ?) Senega, Mercury, Nux vomica ; and in pneumonia interstitialis, Aur. chlor. 1 Allg. Horn. Zeit. No. 7, 21ter Band. 19 290 RESPIRATORY SYSTEM. Pneumonic states, which originate from tubercles in the lungs, arc sometimes to be cured by means of Mercury, Iod., Sulphur, Spongia, and Ol. jecoris aselli. In the pneumonia of old persons, Arsenicum is the principal remedy ; in that arising from repercussed eruptions, Arsenicum and Sulphur; in complications with endocarditis, Arsenicum, Camphora, Mercurius, Bromium; and in those with pleuritic exudations, Arsenicum, Cam- phora, Phosphorus, Scilla, and Acidum muriaticum are the most im- portant medicaments." Diet.—It is scarcely necessary to remark that during the inflamma- tory period of pneumonia, an almost total abstinence must be observed: even during convalescence there is caution required, and care must be taken not to allow the patient to over-indulge his returning appetite, as any error in this respect may entail troublesome consequences. The drinks may consist of water, toast-water, and sometimes whey, rice- or barley-water, sweetened with a little sugar if desired. PERIPNEUMONIA NOTHAS. OCCULTA. CATARRHUS BRONCHIORUM. Spurious Peripneumony. This affection, which is usually most insidious in its approach, is more frequently met with in old than in young or middle-aged subjects, and is liable to terminate in paralysis of the lungs. Sometimes the attack is preceded by a feeling of general prostration; or comes on like an attack of common cold, with cough and alternate heats and chills. The cough is generally loose from the commencement; the sputa, white, yellow, slimy and generally blood-streaked. There is great weight or oppression at the chest, with quick laborious breathing; pain only when taking a deep inspiration, and generally in a small circumscribed spot. All these symptoms are usually aggravated by anything which calls for an increased play of the lungs, such as talking, or laughing loudly, ascending stairs, &c, lying upon either side, particularly in the more severe attacks, becomes oppressive, so that the decubitus is generally on the back. Pulse soft but quick, the cheeks slightly flushed; the skin moist and damp, and sometimes there is nocturnal sweating which affords no relief; towards morning the febrile action subsides a little, and the patient feels somewhat easier. The voice is low and weak, occa- sionally dying away to a whisper. In the treatment of this affection a dose or two of Aconite may be given when the fever runs rather high, but Mercurius is more frequently called for even at the very commence- ment, and particularly Avhen there is nocturnal sweating, and moist or clammy skin during the day; after the employment of Mercurius, Bel- ladonna will generally be found useful, and especially when a short dry cough remains, attended with spasmodic constriction in the chest which impedes respiration and causes an oppressive sensation of suffocation. If Belladonna does not complete the cure, and the cough is accom- panied Avith sibilant or wheezing respiration, a dose of Aconite may be given, followed, after an interval of a few hours, by Chamomilla. Nux vomica is serviceable Avhen there is dry cough, or cough with difficult expectoration of a little slimy mucus, and excessive tension and oppres- TYPHOID PNEUMONIA. 291 sion in the chest. In those cases in which Mercurius affords little relief, and the breathing continues quick and laborious, and the counte- nance is expressive of great anxiety, Ipecacuanha in repeated doses is frequently followed by satisfactory results; but should the extremities become cold, and the sensation of constrictions in the chest, with ex- treme anxiety increase, Veratrum should be prescribed ; on the other hand, if the paroxysms of threatening suffocation become more and more distressing, and the patient appears sinking from exhaustion, Arsenicum must claim a preference, and will often succeed in restor- ing the expiring energies of the patient when the case has assumed an almost hopeless appearance. {Tartarus emet. may be substituted for, or administered alternately with Arsenic, when there is an excessive accumulation of mucus in the bronchial tubes.) It may be added that Arnica has been found useful in some instances, in the early stage of the disorder, when the pleura costalis and the intercostal muscles seemed to be the principal seats of pain, which was rendered more acute by pressing the fingers against, or drawing them along the spaces between the ribs ; or when a bruised or beaten pain was experienced in the chest, and the cough not very troublesome, but attended with blood-streaked slimy sputa. Pulsatilla has been employed with advantage after Arnica, as soon as the expectoration became more considerable, attended with melioration of the pectoral symptoms. Pulsatilla and Sulphur are two of the best remedies to prevent the dis- ease from assuming the chronic form, when the more acute symptoms have become subdued. (See also Bronchitis Pneumonia vera, and Pleuritis, and select any of the remedies given under these different heads, if the symptoms, general or physical, call for them.) TYPHOID OR CONGESTIVE PNEUMONIA. In this variety of pneumonia the local symptoms are usually very obscure, and the accompanying fever is of the typhoid kind, the pulse quick and very weak, the skin harsh, dry, or clammy, tongue brown and parched, and the urine of greatly diminished quantity and high coloured. In some cases the folloAving physical signs can be detected: dul- ness on percussion, and absence of respiratory murmur in the lower and back parts of the chest, and occasionally bronchophony and bron- chial respiration when the central or middle portion of the lung is the part affected. The remedies Avhich have been used with the most advantage in typhoid pneumonia, are Opium, Arnica, Veratrum, Arsenicum, Phos- phorus, &c. Opium.—This remedy is generally the most appropriate as soon as the disease becomes clearly defined, and may be repeated once or tAvice, after which, if no change be effected, Arnica should be employed. If no improvement result from the foregoing remedies, Veratrum may be administered, particularly Avhen there is clammy sweat on the forehead, with coldness of the extremities and great weakness, and the respiration unequal, laborious, and rattling. 292 RESPIRATORY SYSTEM. Arsenicum may follow Veratrum if the prostration, and rattling respiration increase, the pulse become irregular, and the tongue dark brown or black: the alternate administration of these two remedies every half hour, to every hour or two hours, according to the urgency of the symptoms, is frequently attended with the best results ; in other cases, Veratrum, Ipecacuanha, and Arsenicum answer better. But when only temporary improvement results, a few globules of Sulphur may be administered; and then again Veratrum, and Arsenicum, or Veratrum, Ipecacuanha, and Arsenicum alternately, or any one of these remedies alone from Avhich any marked degree of improvement may previously have been observed to arise. Bryonia, Rhus, Senega, and Phosphorus will be found useful in certain cases. Some of the leading indications for the employment of the two former will be found under the head of Nervous Fever (which see). Senega is chiefly service- able when the lungs are loaded Avith mucus. Phosphorus when we find great debility, black incrustations on the lips, rapid and laborious breathing, and bronchial respiration. Belladonna will commonly be found serviceable when temporary blindness is complained of, and Natrum m. when the prostration of strength increases, notwithstanding the administration of Arsenicum, which is generally so valuable in such cases. When galling or excoriation has ensued from lying in bed, Cinchona and Arsenicum must be administered alternately; in milder cases, Arnica in the form of lotion (one part in ten) will frequently remove this evil. INFLAMMATION OF THE PLEURA. PLEURISY. Pleuritis. Diagnosis.—Severe cutting, lancinating pain in the side, confined to one circumscribed spot, interfering with breathing, and acutely increased by taking a deep inspiration, or by coughing; difficult and anxious respiration, but not so oppressed as in pneumonia and bron- chitis ; quick hard pulse; hot skin, particularly over the chest, or the seat of the disease; (short dry cough;) parched tongue; scanty and high-coloured urine; and occasional cerebral symptoms. Position in bed, usually dorsal; and if the effusion be free and partial, a change to the sound side creates great uneasiness. The prognosis must be formed accord- ing to the severity and character of the symptoms. If the heat and other febrile indications gradually subside, and if the performance of the act of respiration becomes more free and less painful, and a copious and free expectoration ensues,1 an early recovery may be expected ; but if the fever and inflammation have been intense, and the pain should suddenly terminate, followed by sinking of the pulse and a change of countenance, danger is to be apprehended. Pleurisy seems to consist in a peculiar inflammation in the pleura, with a disposition to effusion or to the secretion of plastic lymph ; and 1 Care should be taken not to allow this profuse expectoration to go on too long, which it is sometimes prone to do in certain constitutions, otherwise it might degenerate into a chronic affection. Its suppression, when called for, may be effected by means of such remedies as Pulsatilla, Dulc, Stann., Sulph., Ipecac, Seneg., Scilla, Bryon., Sep., Lach., Calc, &c. INFLAMMATION OF THE PLEURA. 293 it may run its whole course without any of the symptoms above given, declaring themselves. At the commencement of the disease there is diminution of motion and respiratory murmur from pain (subsequently these abnormal signs arise from effusion), and a rubbing sound is not unfrequently heard, generally about the centre of the chest, accompanying the pectoral movements. Soon after the onset of the inflammation, in the greater number of cases, exudation ensues, and, if not encysted, accumulates at the lowest parts of the chest. When, in such instances, the quantity exuded is considerable, and the lung is not restrained by adhesions, that organ will be floated upwards to some extent and a dull stroke- sound elicited from the parts beneath it, whilst the upper parts will be found unusually resonant. As the fluid accumulates and ascends in the chest, the antecedent clearness of stroke-sound becomes impaired, as is more especially obvious on gentle percussion,—the breath-sound diminished, and respiration more impeded. When these latter abnormal symptoms are met with as high as the middle regions of the thorax, the vocal resonance there, and particularly anteriorly, becomes preternaturally distinct, and is changed to a small, sharp, and tremulous note resembling the bleating of a goat, and hence termed oegophony; posteriorly the resonance partakes some- what more of the character of bronchophony from the greater calibre of the tubes at the root of the lung. (Egophony and all sound of the voice ceases at the affected side of the chest, as the liquid effusion increases, except at those portions where the lung may have been adhe- rent, or at the space within an inch or two of the spine; percussion now gives an extremely dull sound from the lung being deprived of and rendered impermeable to air by compression, and the respiratory mur- mur is no longer audible, or only heard in the interscapular and sub- clavicular regions, particularly the former. In those cases in which the effusion is very considerable, enlargement of the affected side takes place. This enlargement is generally dis- cernible only during expiration at first, but as the exudation increases, the difference can readily be detected during the entire performance of respiration. In attenuated subjects, the intercostal spaces will also be observed to have become prominent instead of presenting their natural depression. But should absorption be effected after such an enlarge- ment, the state of matters is reversed, and the side which was previously enlarged becomes abnormally contracted—the result of atmospheric pressure, and unantagonised muscular action. Displacement of organs adjoining the seat of the effusion, such as the heart, liver, and mediastinum, is also an occasional result of extensive effusion. On examining the sound side of the chest, in addition to the negative proofs of the absence of disease, an excess of the usual normal signs will also be perceived, indicated by an accelerated and deeper action, together with a greatly increased degree of respiratory murmur, resem- bling that of children, and hence denominated puerile. The signs of improvement and approaching recovery are marked by a diminution of pain, feArer, dyspnoea, and enlargement of the side; and 294 RESPIRATORY SYSTEM. by a return of the respiratory murmur, together with an increasing clearness of sound on percussion. When the result is fatal, death occa- sionally supervenes very rapidly from the compression of both lungs; but in most cases, this event is more gradual, and arises from atrophy of the lungs, as also affections of the heart, with consequent dropsy, caused by the efforts required to propel the blood through the com- pressed lung. In all cases of pleurisy the whole of the above-detailed symptoms are not to be deemed constant, or even certain diagnostic signs. The absence of marked dulness on percussion, is not a conclusive test that effusion has not taken place. The greater or less degree of clear- ness of tone appears to depend upon the condition of the lung under effusion, and the elasticity of the parietes that cover it. If the quantity of the effusion be very considerable, and the lung deprived of its air by compression, the sound on percussion is necessarily almost uniformly dull; but when the exudation is inconsiderable and the compression is not sufficient to deprive the lung of its air, the stroke-sound will be found to consist more of a tympanitic, and frequently even a louder tone, than that of the normal expanded lung. Subsequently, however, if the pressure be unrestrained, the lung will be deprived of its air, and the part formerly so resonant will then yield a dull sound. The ausculta- tory phenomena are, in like manner, naturally liable to be materially modified by circumstances. Much depends on the extent of the exuda- tion, and also on the state of the lung on which it rests. If the lung still contain air, both voice and respiratory sound will be found indis- tinct or inaudible. If, from the extent of the effusion, or from the long continuance of the disorder, the portion of lung be entirely emptied of air, weak bronchophony and bronchial respiration will be discernible ; but when the amount of effusion is very great, possibly filling the whole cavity of the pleura, no sound whatever will be heard.1 On the other hand, when the quantity effused is inconsiderable, the normal sounds frequently remain unchanged. Again, the physical signs are liable to be further modified by old and close adhesions of the lung to the walls of the chest, resulting from previous disease, which renders the lung adherent to the Avails of the chest. The upper lobes are the most sub- ject to these adhesions; and in such cases the free portion of the lung is pressed upwards by the subjacent effusion, against the superior part of the thorax. And although the lung may yet admit air, still, from the degree of compression to which its vesicular structure is subjected, both breath- and stroke-sound will be bronchial, and loud bronchophony will pervade the upper part of the affected side. The lower part of the chest, from whence the lung has been separated or raised upwards by the effusion, will necessarily emit decided dulness on percussion. Finally, it may be added that oegophony, although a frequent phe- nomenon in pleuritis, has no necessary connexion with the presence of liquid in the pleural sac, and is consequently not to be held as an essential link in the chain of evidence for determining the existence of this disease. 1 British Journal of Homoeopathy, vol. i. p. 42. INFLAMMATION OF THE PLEURA. 295 The same remarks will, in a great measure, apply to the intercepted vibration of the voice, usually felt by the hand when placed against the chest,—for this, although a very useful and early corroborative indica- tion of the accumulation of fluid in the cavity of the pleura, is yet liable to some exceptions both positive and negative. The rubbing sound already referred to is an important sign; it is not so audible at the commencement of the attack, as it is at a later period when the effusion becomes more consistent, and then it is rarely absent. Pain is, with few exceptions, an invariable concomitant on pleurisy, still if it be unaccompanied by the confirmatory evidence of other im- portant symptoms, it must not be implicitly relied on, as it may arise from a totally different cause than an inflammatory condition of the pleura. But when taken in combination with other signs, its presence and intensity have been found of great use in estimating the amount as well as the quality of the effusion ; for it has been ascertained that the greater the quantity of plastic lymph it contains the greater will be the pain.1 Great rapidity of effusion is also a frequent, though not an in- fallible source of extreme pain. The greater or minor degree of dyspnoea depends on the quantity and rapidity of the effusion, as well as on the condition of the lungs ; when both sides of the chest are the seat of the effusion, the oppression is usually excessive. The fever is in like man- ner modified by the nature and extent of the exudation, being generally slight, or altogether absent, when the quantity is trivial; slow, and not unfrequently intermittent, when more extensive but of a serous charac- ter ; and highly inflammatory, when much plastic lymph is contained in the effusion.2 From what has been stated, it will be seen that most of the so-called characteristics of pleurisy cannot, individually considered, be taken as conclusive indications of the existence of that disease. The collective physical signs, however, in the majority of cases, are far from equivocal, and are mainly to be depended on in forming the diagnosis. Cough is not an accompaniment of simple pleurisy, so that when this symptom is present there is either bronchitic or pneumonic complication, or the case may be one of hemorrhagic pleuritis. Therapeutics.—The chief remedies are Aconitum napellas, Bryonia alba, Sulphur, Belladonna, Mercurius, Arsenicum, Arnica montana, Hepar sulphuris calcarea, Phosphorus, Lycopodium clavatum, Carbo vegetabilis ct animalis, Cinchona officinalis, Digitalis purpurea, Kali carbonicum, Ipecacuanha, Helleborus niger, Sabadilla, Scilla maritima. Aconitum is an indispensable remedy in allaying inflammatory fever when attendant on pleurisy; and is in many cases, indeed, when timely administered, alone sufficient to cure the disease. It rarely fails to produce a favourable impression in from six to eight hours ; should it not do so in that space of time, another remedy must be selected. In most instances Bryonia will be the most appropriate, but we must not hesitate to select Sulphur in preference, if called for, or indeed any other remedy that may seem more strikingly indicated. 1 Brit. Homoeop. Jour., vol. i., p. 44. 2 Ibid. 296 respiratory system. R Tinct. Aeon. 3, gtt. vj. Aq. pur. 3iij. Dose. A dessert-spoonful every two to six hours.1 Bryonia alba should, in general cases, follow Aconitum when the fever has been somewhat allayed by that remedy. It is more particu- larly indicated, either in simple or complicated pleurisy, when the fol- lowing symptoms are encountered at an early stage of the disease ; ach- ing, burning, but more especially acute shooting or cutting pains in the chest, much increased during inspiration or on movement; dry cough, or dry sounding cough, followed by expectoration of dirty yellow- coloured mucus, streaked or tinged with blood, and attended with great aggravation of pain; oppressed and anxious respiration ; palpitation of the heart; dry, cracked, brown, or yellow coated tongue; bitter taste, nausea, and occasionally vomiting of mucus, or of a bitter bilious-looking fluid; aching or painful pressure at the scrobiculus and hypochondria ; intense thirst, especially at night; constipation; head confused and heavy ; giddiness on sitting up in bed; aching and shooting pains in the head, or pain as if the head would burst, particularly at the temples, with exacerbation on coughing, or moving; fiery, or bluish redness, and puffiness of the face; restless, dirturbed sleep, frequent startings ; nocturnal delirium, with alternations of comatose sleep; burning heat of skin ; occasionally, partial, clammy perspiration; pulse generally frequent, hard and small, but sometimes full, unequal, intermittent, and weak; aching in the limbs. Lastly, when in connexion with any of the above, the following symptoms are met with : dulness on percussion, with puerile respiration ; cough on lying on the side, or impossibility of lying otherwise than on the back,—Bryonia will rarely fail to render undeniable service, and can indeed with difficulty be dispensed with. (See the symptoms mentioned under this remedy in the chapter on Pneumonia.) R Tinct. Bryon. alb. 3, gtt. vj. Aq. pur. 3iij. Dose. A dessert-spoonful every three to six hours. Sulphur may with advantage follow Bryonia when the pain men- tioned has been removed by that medicine, but the inflammation is not wholly subdued, and often completes the cure. It is also of value when the fever continues after the administration of Aconite, and may be administered without the previous employment of Aconitum, when, although the fever is not violent, we have reason to suspect recent effu- sion of plastic lymph. Again, when the affection has already been of some days' duration, and is complicated with pneumonia, it is our chief stay in preventing solidification, or effecting resolution where that has already commenced, and may therefore generally be selected in prefe- rence to Bryonia, in such cases, unless the latter be otherwise strongly indicated, in which event a dose or two of that medicine, previous to the employment of Sulphur, will be found serviceable. R Tinct. Sulph. 6, gtt. vj. Aq. pur. 3iij. Dose. A dessert-spoonful every six hours; or, in very severe cases, every two hours. 1 Vide Rules for the repetition of the dose, in the Introduction. INFLAMMATION OF THE PLEURA. 297 These three are the most important remedies in the greater number of cases of pleuritis, and are frequently found sufficient to effect a speedy cure. There are often occasions, however, in which it will be found necessary to select one or more of the following remedies : Bella- donna, Mercurius, Arnica, Arsenicum, Hepar s., Phosphorus, Carbo v., China, Lycopodium, Digitalis, &c. Belladonna has been recommended in cases where the fever returns, and pain and dyspnoea continue notwithstanding the employment of Aconite. R Tinct. Bellad. 6, gtt. iij. Aq. pur. 3ij. Dose. A dessert-spoonful every six hours Mercurius has been found very useful in cases where the fever has been subdued, but pain and dyspnoea have not been relieved by Aconite, and the patient's strength is becoming exhausted by copious nocturnal sweats. R Merc. v. 6, gtt. iij. Aq. pur. 3ij. Dose. Same as Belladonna. Arnica Montana,—principally when pleuritis has been caused by external injury ; but also in other cases when the more inflammatory symptoms have been subdued by Aconite, &c.; and pain in the chest, with oppressed respiration, only remains; it is also useful to promote absorption when considerable effusion has taken place. R Tinct. Arn. mont. 3, gtt. iij. Aq. pur. 3ij. Dose. A dessert-spoonful every three or four hours, until the pain begins to yield, and the breathing becomes freer, when the intervals between the doses must be length- ened, or the medicine discontinued, and only resumed should the improvement proceed tardily; but if pain return, Aconitum must again be resorted to, after which, Belladonna is often of great efficacy. In other cases, Bryonia or Sulphur will be seen to be more appropriate, and must be selected accordingly. Arsenicum is the remedy on which we mainly depend in those serious cases, where serous effusion to a very great extent has taken place, and where the respiration, is painfully impeded and asthmatic, attended with extreme prostration of strength. R Arsenic, alb. 6, gtt. iij. Aq. pur. 3ij. Dose. A dessert-spoonful every two hours, until a beneficial effect is produced. Hepar sulphuris has been particularly recommended when the effusion is plastic, and the disease is of some duration (chronic plastic pleurisy), or where, even at the commencement, there appears—from the pain, fever and dyspnoea, continuing with but slightly diminished severity after Aconite,—every probability that the case will prove ex- tremely obstinate and tenacious. Complication with pericarditis or bronchitis is an additional indication for the employment of Hepar under the above circumstances. {Lachesis, Digitalis, Arsenicum, and Belladonna are also deserving of attention when there is pericarditic complication.) 298 RESPIRATORY SYSTEM. K Pulv. Hep. 3, gr. vj.. Dose. As much as will lie on the point of a penknife, every two to six hours, according to circumstances. Phosphorus.—From what has been said of this remedy in Pneu- monia, it will readily be conjectured to be useful in cases of compli- cation of pleuritis therewith, as indeed it has repeatedly proved. In complications with bronchitis, and in that form of pleuritis which so frequently shows itself in phthisis pulmonalis, it has further been found of essential service. (Vide Pneumonia and Bronchitis.) R Tinct. Phosph. 3, gtt. vi. Aq. destil. 3iij. Dose. A dessert-spoonful every three or four hours, or oftener if necessary, until the respiration becomes easier. Carbo vegetabilis is a good remedy when pleuritis is complicated with chronic bronchitis; or at an advanced stage of the disorder, when the patient is much emaciated and hectic at night, presenting in short the usual symptoms of threatening purulent degeneration. It is also peculiarly useful against asthmatic sufferings resulting from an attack of pleurisy, in chronic cases. Dose. Same as Arsenicum, except in the latter instance, when it must be given at longer intervals. Cinchona is chiefly useful after severe depletion, to restore the energies of the patient. Lycopodium will be found serviceable in similar cases to those in which both Arsenicum and Carb. vegetabilis (or animalis) have been found applicable, also where there are considerable dropsical swellings and obstinate constipation. Digitalis has proved useful in many cases of serous pleurisy with slow fever, small weak pulse, accelerated by the slightest movement; and coldness of the extremities, with internal heat.1 In conclusion, Kali carbonicum may be instanced as serviceable in pleuritis occurring in tuberculous subjects ; and Ipecacuanha as a useful palliative against dyspnoea and convulsive cough in complications Avith bronchitis. Helle- borus niger, has been recommended in some cases of serous, and Scilla in plastic pleurisy, but they, as well as Colchicum, Lachesis, and some others which need not be mentioned here, require the test of further experience to corroborate even the little that has been adduced in their favour in the treatment of pleuritis.2 When, either through neglect or otherwise, pleuritis has terminated in purulent degeneration, and become chronic, Arsenicum, Carbo, Lycopodium, Hepar s., and Kali carbonicum, are the principal remedies from which the greatest assistance can be obtained where the cure is at all practicable. (See also Hydrothorax.) Pains in the chest arising from adhesions or from thickening of the pleura, after an attack of 1 The British Journal of Homoeopathy, No. 1, p. 53. 2 Rhus toxicodendron has been strongly recommended in serous pleurisy. When low, typhoid symptoms become apparent, this remedy will deserve an additional claim on our attention. Typhoid appearances, and important complications of any kind, a bad habit of body, or indications of a purulent, sanious, or hemorrhagic effusion, are all to be held as unfavourable signs. PLEURODYNIA. 299 pleuritis, are often relieved by Ranunculus bulbosus, Euphorb., Mez., Nitr.; Thuja may also be found serviceable. In chronic pleurisy, Sulphur, Sepia, Kali c, Ammon. c, Lycopodium, and Mezereum, may prove useful. Diet.—The same rules are to be observed as in Pneumonia. SPURIOUS OR BASTARD PLEURISY. Pleurodynia, Pseudo-Pleuritis, Pleuritis Muscularis. By these terms is here meant that painful affection usually referred to the intercostal muscles, which is productive of many of the symptoms described under true pleurisy, and is consequently liable to be mistaken for that disease, particularly when attended with febrile excitement, as is frequently the case in hysterical females. The history of the com- mencement of the affection, together with the aid of auscultation and percussion, enables us to draw a correct distinction between the two diseases. When, therefore, we have satisfied ourselves from the normal condi- tion of the auscultatory phenomena, &c, that the case we have to deal with is one of pseudo-pleurisy, we must select a remedy from amongst the following: Arnica montana, Bryonia, Nux v., Pulsatilla, Ranun- culus bulbosus, Sabadilla. In the majority of cases Arnica is the principal remedy, and is occa- sionally sufficient to effect a speedy cure after a single dose. In other instances, however, the disorder does not yield so readily, and conse- quently one or more of the other remedies enumerated must be had re- course to. Bryonia.—When the pain is of an acute darting description, as if from a sharp instrument running into the side, and is at times almost insupportable during inspiration or even the slightest movement of the body, and when the patient is of a nervous or bilious temperament. Pulsatilla.—This remedy is frequently very useful in alternation with Arnica ; it is more particularly indicated when the pain is occa- sionally of a fugitive character, moving from one part of the chest to another, becoming increased towards evening, and sometimes experienced more during expiration than inspiration. Temperament phlegmatic. Nux vomica.—Shooting pains in the hypochondria, increased by the respiratory movements of the chest; especially when the affection occurs in hypochondriacal subjects, or in those Avho are addicted to indulgence in vinous or spirituous drinks. Temperament bilious or sanguine. It is, moreover, one of the best remedies in this complaint; the cha- racteristic indications are as follows, and show a marked resemblance to the symptoms which are so frequently met with in, and are in some re- spects peculiar to pseudo-pleurisy: stitch in the side, or shootings, Avith painful sensibility of the external parts of the chest, but particularly of the intercostal spaces, aggravated by any movement, and especially by taking a deep inspiration, yaAvning, or stretching. Ranunculus bulbosus.—The value of this medicine in pains result- ing from adhesion of the pleura has already been alluded to. (Vide Pleuritis.) 300 respiratory system. In acute pains in the chest of every description of a purely nervous character, depending upon an abnormally exalted sensibility of the pleura, this remedy is one of primary importance. Sabadilla has always been recommended as a useful medicine in pseudo-pleuritis. Administration of the remedies.—In some cases a single dose of one or two globules is sufficient to effect a cure, in others it will be found necessary to repeat the dose every six, twelve, or twenty-four hours, according to the severity of the attack, until relief is obtained. DIAPHRAGMITIS. Inflammation confined to the muscular structure of the diaphragm is considered to be of extremely rare occurrence, the disorder in almost every case appearing in combination Avith inflammation of the pleural or peritoneal covering; in either of which investing membranes, more- over, the disease, for the most part, seems primarily to commence, and only subsequently to extend itself to the connecting cellular tissue and muscular or tendinous substance of the diaphragm. Whether the disease arises in the upper or lower surface or covering, the symptoms are closely analogous. If the inflammation be extensive the pain is extremely violent, spreading from the lower ribs to the dorsal vertebras, and accompanied with intense fever. The upper part of the abdomen, and particularly the scrobiculus cordis, is usually hot, very sensitive to the touch, and retracted, but often distended, tense, and accompanied with throbbing and deep-seated burning. There is often at first low mutter- ing delirium, but as the fever increases it becomes more violent; simulat- ing phrenitis, from the circumstance, as has been supposed, of the irritation which is communicated to the phrenic nerve. Owing to the interruption which is caused to the functions of the diaphragm the respiration is always impeded, and a dry, extremely distressing cough is commonly present, especially when the upper or pleural surface of the diaphragm is the principal seat of the inflam- mation. Along with the foregoing symptoms there is frequently obstructed deglutition, severe hiccup or vomiting, extreme anxiety and restless- ness, twitchings, or spasmodic retractions of the angles of the mouth {risus sardonicus). The exacerbations on movement or on attempting to take a deep breath are excessive, and the only position in which the patient experiences any degree of amelioration is when sitting up with the body inclined forwards. The affection may terminate in resolu- tion, or in the effusion of fluid either into the cavity of the pleura or peritoneum, or the patient may speedily sink under the intensity of the fever. Therapeutics.—When the fever runs high and is of the synochal type it is necessary to exhibit Aconitum in repeated doses; but Avhen the accompanying fever partakes of the character of synochus, Bryonia is to be preferred, and may, in most cases of the said description, be prescribed at the very commencement of the attack. If the scrobiculus and the region of the false or loAver ribs be swollen, and pressure in- crease the short and distressingly interrupted breathing, as also the SPITTING OF BLOOD. 301 pulsating burning pain, which extends from the stated points backwards towards the spine ; moreover when there is a dry, fatiguing cough, or violent vomiting and convulsions, great agitation and constant moan- ing,— Chamomilla is the best remedy. But should there be great tight- ness, as if caused by the constriction of a cord drawn around the chest, with dry, short cough, anxiety, and constipation,—Nux vomica is the most appropriate remedial agent. Cannabis, Pulsatilla, Cocculus have been recommended as being useful where the symptoms of inflammation continue to occupy a prominent place ; and Hyoscyamus, Veratrum album, Arsenicum, Stramonium, and Ipecacuanha where a nervous con- dition predominates. When diaphragmitis exists in connexion with pleuritis Bryonia is one of the most important remedies ; as also when it is symptomatic of pneumonia, peritonitis, splenitis, and hepatitis, particularly when the pains are aggravated by the slightest movement and are attended with violent fever, small, quick, hard pulse, delirium, extreme agita- tion, cough. Nux v. is equally useful when the disease occurs as symptomatic of the above-named disorders, provided the symptoms encountered are analogous to those we have given as characteristic indications for its se- lection. (See also Pleuritis, Pneumonia, Peritonitis, Splenitis, and Hepatitis.) Diaphragmitis arising from antecedent gout or rheu- matism, is the most dangerous and fatal form in which the affection is met. The remedies chiefly to be relied on under such serious circum- stances are the same as the foregoing. SPITTING OF BLOOD. HEMORRHAGE FROM THE LUNGS. Sputum Omentum. Haemorrhagia Pulmonum. Haemoptysis. Diagnosis.—Expectoration of blood by coughing, in greater or less quantity, attended by symptoms more or less severe. This disease displays itself in three varieties: first, by an effusion of blood from the mucous lining of the bronchial tubes ; secondly, by con- gestion of the lungs, with engorgement of the parenchyma from effu- sions ; and, thirdly, by the rupture of a blood-vessel in the tubercular cavity of the, lungs, during the course of phthisis pulmonalis. It is, however, proposed to deal generally with the subject, and to point out the different remedies found useful in the treatment, according to the symptoms present. We must be careful not to confound this disease with affections of the mouth or gums, or the occurrence of blood from the nose escaping through the posterior nares, and being returned by the mouth. When the blood proceeds from the chest, it is almost in- variably attended with a sensation as if it came from a deep-seated source, is Avarm, generally tastes sweet, and there is frequently a simul- taneous burning and painful sensation in the thorax. When the attack is preceded by well-known premonitory symptoms, the patient should refrain from loud or prolonged speaking, calling, singing, blowing Avind instruments, violent exercise of the arms, running, ascending stairs, or, in short, anything calculated to increase the respira- tory action, or otherwise fatigue the chest. 302 RESPIRATORY SYSTEM. When spitting of blood occurs in a robust and healthy person of sound constitution, it is not very dangerous, but when it attacks slender and delicate persons of weak lax fibre, it is more serious and delicate of re- moval. It is, however, chiefly when the patient has had a succession of severe attacks, and the blood is discharged in a large quantity, that the case may be considered dangerous. The disease may present itself without any marked pains or difficulty of breathing, and pass off with no return of the attack ; or be preceded by a dry cough, oppression, or tightness at the chest, shivering, cold- ness of the extremities, great lassitude, and high pulse,—and be accompanied by hacking or husky and distressing cough, anxiety, quick pulse, pale and livid countenance,—cease, and then return in a few hours, and be followed by difficulty of respiration and cough; in still more serious cases, when a marked tendency to phthisis exists, anxiety, oppression at the chest and febrile symptoms are more severe, pure blood is coughed up, and the paroxysms frequently return. The rupture of a blood-vessel is a rare occurrence, although it sometimes occurs in phthisis. When, however, a blood-vessel of any consequence, included in a tuberculous excavation, does give way, the result is generally fatal. Causes.—Indulgence in spirituous beverages, over-heating the body by immoderate exertion, or too great external heat; blowing wind instru- ments ; contusion of the chest or back; falls; lesion of the lungs; breathing a vitiated atmosphere, or vapours charged Avith acrid sub- stances ; colds or coughs ; violent mental emotions; diseased state of the lungs, whether from pneumonia or phthisis; a general strumous habit; suppressed menstrual, hemorrhoidal, or other discharges; or repercussed cutaneous eruptions. Therapeutics.—In by far the greater number of cases, the discharge or spitting of blood soon ceases of its own accord; the most important object, therefore, is to seek the cure of the complaint when the hemor- rhage has ceased, and thereby prevent its return, or check the develop- ment of organic disease of the lungs. The principal homoeopathic remedies are: Pulsatilla, Nux vomica, Bryonia, Sulphur, Arnica montana, Aconitum, Ipecacuanha, Acidum sulphuricum, Arsenicum, Opium, Cinchona, Carbo, Ferrum metallicum, Rhus, Phosphorus and Sepia. These are not only calculated to arrest the hemorrhage, but also to prevent a relapse, where that is practicable. Pulsatilla :—In cases of females, arising from suppression of the monthly discharge, or, in either sex, of a hemorrhoidal flux (particularly Avhen the individual is of leucophlegmatic temperament), and also in other instances, with the following symptoms: expectoration of dark coagulated blood, attended with shivering, especially towards evening, or at night, and great anxiety; pain in the lower part of the chest; feeling of flaccidity in the epigastrium, and weakness. {Hcemoptysis vicaria.) When, in females, the menses do not return, notwithstanding the employment of Pulsatilla,—Cocculus, Sepia, Sulphur, or any other remedy better adapted to the entire case, should be selected. (Vide Chlorosis, Amenorrhea, or Catamenia, Suppression of.) Bryonia is a good remedy in cases where the expectorated blood is SPITTING OF BLOOD. 303 excited by a tickling cough, and is often in a coagulated state; and where there is oppression at the chest, with frequent necessity to take a deep inspiration; anxiety and irascibility. Nux vomica is adapted to individuals of an irritable temper, in whom this affection owes its origin to a hemorrhoidal suppression, a fit of passion, or exposure to cold. {Hcemoptysis vicaria.) It is further indicated by dry cough, which causes headache, with excessive tickling in the chest and exacerbation of the symptoms towards morning. When Nux v. does not afford speedy relief, Sulphur will generally be found to succeed ; but should any other remedy appear to be more appropriate, it should unhesitatingly be selected in preference. Rhus :—When the blood expectorated is of a bright red, the mind much agitated, and the patient irritable and rendered worse after the slightest vexation or contradiction. Arnica Montana :—Principally in cases arising from external lesion, such as a severe blow in the chest, or from lifting a heavy weight, or any other exertion, even blowing wind instruments; but also in almost all cases, where the stethoscope detects effusion of- blood into the parenchyma, attended with a sensation of constriction and burning in the chest, pain as from contusion in the scapular and dorsal regions, and dyspnoea. Moreover, profuse expectoration of dark-coloured blood or coagula, brought up without much exertion, or bright frothy blood, mixed with mucus and clots ; sensation of tickling behind the sternum; general heat, great weakness and syncope. {Aconite is sometimes necessary before, or alternately with Arnica, &c.) Acidum sulphuricum is frequently of service after Arnica Avhen the cough continues, and brings on fresh bleeding. In severe cases attended with manifest danger: Aconitum, Ipecacu- anha, Arsenicum, Opium, Cinchona, and Kreosotum are the most use- ful, and must as usual be selected according to the prevailing symptoms. When one of these is insufficient to check the hemorrhage entirely, another must be chosen to meet the remaining symptoms. Aconitum is often found exceedingly serviceable in warding off an attack, by the great power it possesses in controlling the circulation, and is indicated, previous to the paroxysm, by the premonitory symptoms of shivering, with accelerated pulse, palpitation of the heart, a sensation of ebullition of blood in the chest, with burning and fulness in the same region ; paleness and expression of anxiety in the face; great anguish and anxiety, aggravated by lying down; or during the attack when the expectoration is profuse, coming on in gushes, and excited by a slight dry cough. {Hcemoptysis plethorica.) Ipecacuanha :—When a taste of blood remains in the mouth a feAV hours after the employment of Aconite has been commenced, when there is frequent tussiculation, Avith nausea, weakness, and expectoration streaked with blood. Arsenicum :—When the anxiety, anguish, and palpitation of the heart increases, notAvithstanding the administration of Aconite; and when, in addition, Ave find extreme restlessness and general dry burning heat. The employment of this remedy alternately with Ipecacuanha has 304 RESPIRATORY SYSTEM. been found to succeed in many instances, when neither of them sepa- rately have been found sufficient to conquer the disease; an occasional dose of Nux vomica should be prescribed as soon as the hemorrhage has in a great measure been checked, to such individuals as have been in the habit of indulging in spirituous, vinous, or fermented liquors, or coffee. Should hemorrhage return after a temporary cessation, Sulphur may be given, followed in turn, if required, by Arnica. Opium :—Heat, dyspnoea, with sensation of burning heat at the re- gion of the heart; coldness, particularly of the extremities; tremor in the arms; dry hollow cough, with expectoration of blood and frothy mucus, and sometimes also Aveakness of the voice ; drowsiness, with sud- den starts; aggravation of cough after swallowing. It will be found useful in the most serious cases, particularly to persons addicted to spirituous liquors; in the latter case it may be useful to follow up the treatment with Nux vomica. Cinchona, as already mentioned in several places in this work, is one of our best remedies in restoring the vital energies of the patient after considerable loss of fluids, whether of blood or other secretions ; it is therefore particularly efficacious after a severe attack of this affection, but is also indicated during its course, when the spitting of blood takes place after a violent cough, or when there is a continual taste of blood in the mouth, or when we find shivering alternately with accesses of heat, frequent and short-lived perspirations ; tremor, and confusion of vision, with a sensation of vacuity or lightness in the head, Aveakness and desire to remain constantly recumbent. Ferrum metallicum, may be used with advantage after Cinchona in severe cases, or may be preferred if the expectoration follows a slight cough, and is scanty, but consists of pure bright red blood, attended with pain between the scapulae, with inability to remain long in a sitting posture: the patient feels the concomitant symptoms relieved by move- ment, but is speedily fatigued, especially by conversation. It may, in some cases, be advantageously alternated with Cinchona, Carbo v., Ar- nica and Arsenicum,—in others Sulphur may be required to complete the cure in some cases. Sulphur.—This remedy is frequently useful in winding up the treat- ment after the employment of other medicines; and it is also particu- larly suitable for individuals disposed to hemorrhoidal affections, in derangement of the menstrual flux, or hemoptysis arising from suppressed cutaneous eruptions, such as scabies, &c. {Haemoptysis vicaria, &c.) Nux v. and Arsenicum may occasionally be advantageously given in alternation with Sulphur at intervals of five to ten days, particularly when the disease occurs in drunkards. Kreosotum has been found of great efficacy in cases where the patient has had a succession of severe attacks, and the blood is thrown off in large quantities; also when the patient complains of a feeling of burning heat in the chest, or a pain as if from a bruise, together with oppression in the chest and frequent desire to take a deep inspiration. After hemoptysis has disappeared (besides having to guard against a relapse, in which, as above stated, Sulphur is our chief auxiliary), we have to take every precaution lest inflammation arise in the part prima- consumption. 305 rily affected, or the disease degenerate into Phthisis, which objects will sometimes be best attained by the administration of Phosphorus, in combination with a strict observance of an antiphlogistic regimen, and the other rules about to be given for the conduct of patients suffering from this affection. Phosphorus, it may be added, is, in conjunction with Aconitum, one of our chief remedies in hemorrhages from the lungs during the course of phthisis. Sepia is also useful in this affection occurring in Phthisis, but when it is rather to be looked upon as one of the general symptoms, than as forming a disease of itself; by its power over the economy of the uterus, it is also of great service in cases of hemoptysis, arising from derangements connected with that organ. {Haemoptysis phthisica et vicaria.) The following remedies may also be noted as worthy the attention of the practitioner in peculiar cases : Kreosotum, Belladonna, Acid. nitricum, Bryonia, Carbo vegetabilis, Hyoscyamus, Ignatia, Dulcamara, Cocculus, Crocus, Conium maculatum, Lachesis, Acidum sulphuricum, Ledum palustre, Lycopodium, Millefolium, Silicea, Staphysagria, and Cuprum metallicum, &c. Diet, &c.—The rules given under H^imatemesis ought to be ob- served as regards regimen ; both mind and body should be kept perfectly quiet; the patient should speak as little as possible, and be kept in a semi-recumbent posture, or, if his strength allow, sit upright. PULMONARY CONSUMPTION. Phthisis Pulmonalis. One of the earliest symptoms of tuberculous phthisis is a short cough, which is either dry or accompanied by the expectoration of a frothy mucus, and is generally slight at the commencement, but more or less constant. Shortness of breath, proceeding from obstruction, caused by the granular and diffused indurations, is another early symptom of con- sumption. It is, at first, experienced only during exertion, but subse- quently comes on after every fit of coughing, or on lying on the one or the other side, and is much increased by the slightest movement. Symptoms of gastric derangement are frequently present, with redness of the tongue, or white furred centre, Avith inflamed and projecting pa- pillae, and vivid red tip and margins ; the patient falls off in flesh, be- comes indolent, dejected, and overpowered with languor. A feeling of soreness is often complained of behind the sternum, or under the clavi- cles, particularly after any fatigue, or after a fit of coughing, and some- times on exposure to cold air. The pulse is often normal in the first stage of the disease, but soon becomes full, hard, and accelerated. Fever of an intermittent character soon makes its appearance; it de- clares itself most towards night, remits from about two in the morning until the folloAving day at noon, Avhen it returns in a slighter degree, and continues until about five in the afternoon, and is then folloAved by another remission. This hectic fever is, in the first instance, chiefly 306 RESPIRATORY SYSTEM. manifested by flushing of the face (which is often most apparent after a meal), and heat in the palms of the hands and soles of the feet; but, as the disease advances, night sweats supervene, which leave the patient in a state of great exhaustion in the morning. As the expectoration in- creases it becomes more viscid and opaque, and is often tinged with blood, or a considerable quantity of florid, frothy blood is ejected in con- sequence of the obstruction offered to the blood-vessels, by the indura- tions or granulations already alluded to. As the disease advances and passes into the second stage, or that in which the dark red or grayish indurations are converted into crude Yellow tubercles, the respiration becomes more difficult, the emaciation and debility go on increasing, the cough is rendered more severe and troublesome, particularly at night, and the fever, though of shorter duration, is attended with more profuse sweating, and the pulse loses tone. The expectoration becomes, at the same time, more free and copious, particularly towards morning, and is less thin and transparent. During the febrile exacerbations, or after meals, or at times of excite- ment, a circumscribed red patch still appears on each cheek, but at other times the colour of the cheek is faded, and the countenance wears a de- jected expression. In the third (or suppurative and ulcerative) stage of the disorder the tubercles become soft, and are expectorated at first in the form of curd or cheese-like particles, and subsequently mixed up with pus, mucus, shreds of lymph, blood, and occasionally, though rarely, portions of pulmonary tissue. The bowels, from having been more inclined to be costive at the commencement of the disease, are now more prone to be relaxed, so that attacks of diarrhoea often recur frequently, and, by alternating with colliquative sweats, induce an excessive degree of weak- ness and prostration. In this, the last stage of the disease, the patient becomes reduced to a skeleton; the face is thinned, the cheek-bones prominent, the eyes look hollow, the hair falls off, the nails are livid and incurvated, and the feet ^edematous ; but, notwithstanding all this, the countenance presents a degree of clearness, and the eyes a lustre that are rarely, if ever, met with in other maladies, moreover, the state of mind is generally so serene and hopeful, that the patient seems often quite unconscious of his dangerous condition, and speaks and acts as if in full anticipation of a speedy recovery. The senses commonly remain entire and collected to the end of the disorder, but in some cases deli- rium precedes death and continues until life is extinct. The usual dura- tion of phthisis pulmonalis is from eight or nine months to a year and a half; but circumstances tend much to vary the length of the disease; and there is a rapidly fatal form which runs its course in from two to three months, sometimes indeed only in one. When the malady makes slow progress, the patient is affected with cough, weakness, and emacia- tion chiefly in winter and spring, and in many respects restored to com- parative health in summer; but is always extremely susceptible to cold, and commonly complains of breathlessness on the slightest exertion. In this state the patient continues for a considerable time, sometimes even for several years, until at length the symptoms of confirmed consump- CONSUMPTION. 307 tion are developed by the inA'asion of an inflammatory attack proceeding from cold or some other irritating cause.1 _ When we take the general symptoms in conjunction with the physical signs, the diagnosis of phthisis pulmonalis is, in general, unattended with difficulty. It is true that in the early stage, when the miliary indurations are equally diffused or scattered through both lungs, they do not give rise to any marked diminution or change in the respiratory murmur, or in the resonance of the thorax on percussion. But it much more frequently happens that the indurations, even in the early stage, accumulate in clusters, particularly about the apices of the lungs, and usually more on one side than the other. The sound, on percussion, will therefore generally be found dull at the clavicle (more commonly the left) and the subclavicular region; the breath-sound during expira- tion will, at the same time, be unusually audible, and the voice will transmit a diffused resonance or preternatural clearness. ^ When the spaces immediately beneath the clavicles give no signs of disease or discrepancy of sound, the regions below, at the sides, and at the back should be examined (between the scapulas in the case of children in particular). A slight flattening is sometimes observable under the clavicles. On comparing the movements of the tAvo sides of the chest, when the patient breathes deeply, a difference in their individual mobi- lity will frequently be perceived. When the disease has attained the suppurative stage, and the tubercles have consequently become soft, or entirely liquid, a clicking or bubbling sound will be heard either under one of the clavicles or above the spine of one of the scapulae. As the evacuation of the softened matter of the vomica progresses, a more con- tinued gurgling, or the so-called cavernous rhonchus, will then be heard. Again, Avhen the vomica or abscess has become completely softened and evacuated by ulceration into the bronchial tubes, a cavity is left, over the seat of which, cavernous respiration, and, when the patient speaks, the phenomenon designated pectoriloquy, are encountered. Therapeutics.—It would require a separate treatise to do justice to the treatment of this deplorable disease, by giving or attempting to give a full and minute description of the characteristic indications for the medicines which are appropriate to the various forms of the different stages of the disorder. We must therefore content ourselves here, by presenting our readers with a brief notice of the principal remedies which are employed in homoeopathic practice against the inflammatory, suppurative, and ulcerative stage of tubercular consumption. In the first stage of the malady, when the tubercles are in a crude, unsoftened state, or when they are inflamed and commencing to soften, the remedies by means of which the malady may be retarded, if not ar- rested, and, with due collateral precautions, kept harmless for years, are chiefly Aconitum, Bryonia, Belladonna, Lachesis, Hepar, Spongia, Phosphorus, Dulcamara, Pulsatilla, Arsenicum, Nux v., Hyoscyamus, Silicea, Calcarea c, Carbo v., Acidum nitricum, and Sulphur. These 1 Hoarseness is often an early accompanying symptom of phthisis. Laryngeal phthisis, with thickening and ulceration of the lining membrane of the larynx, inde- pendently of its own serious character as a disease, is moreover very frequently com- plicated with tubercular formations in the lungs. 308 RESPIRATORY SYSTEM. must be selected according to the aggregate symptoms of the case under treatment. Their leading indications may be. gleaned from the chapters on Cough, Pleuritis, Pneumonia, and Hemoptysis. In the second stage, with more free, copious, and somewhat purulent expectoration, the most important remedies are : Acidum nitricum, Silicea, Kali c, Sulphur, Calcarea, Natrum m., Mercurius, Lachesis, Phosphorus, Lycopodium, Carbo v., Sambucus, Hepar sulphuris, Spon- gia, Cinchona, Ferrum, Conium, Zincum, Ammon. e, Laurocerasus, Gfraphites, Nitrum, Iodium, Drosera, Plumbum, &c. In the third, or ulcerative stage, the same remedies as the foregoing, together with Cfuaiacum, Sepia, Stannum, Staphysagria, Acidum phosphoricum, Sanguinaria canadensis, are those by means of which the symptoms may be materially mitigated, and the fatal issue of the disease postponed. A few general indications for most of these will be found in the chapter on Cough. When the colliquative sweats are peculiarly distressing, Sambucus, Stannum, Cinchona, Phosphorus, Arsenicum, Carbo v. et a., Silicea, Mercurius, Nitrum, Lachesis, Sul- phur, and Lycopodium are the medicines which are of the greatest service. The remaining morbid symptoms must regulate their selection. When colliquative diarrhoea predominates : China, Ferrum, Arsenicum, Phosphorus, Acid, phosphoricum, and Sepia are the most useful. (See Diarrhcea.) In phthisis resulting from imperfectly treated pulmonic inflammation, or from excessive pulmonary hemorrhage, and occurring in habits which are not of the consumptive diathesis, the remedies which are best calcu- lated, under favourable circumstances, to effect a cure are: Lachesis, Lycopodium, Sulphur, Mercurius, and Ledum. But, in some cases, one or more of the other medicaments noticed under tubercular con- sumption may be better indicated. (See also Pneumonia.) In pituitous phthisis, or blennorrhoea of the lungs, the most effective medicines are Stannum, Dulcamara, Pulsatilla, Sulphur, Sepia; and Calcarea, Lycopodium, Cinchona, Phosphorus, Silicea, Arsenicum, Zincum, Copaiva, &c. While conducting the treatment of consumption the state of the digestive functions, and in females the condition of the uterine system likewise, must be strictly attended to. This is, however, a superfluous precaution to the homoeopathic practitioner, as he is ever careful to pay due regard to every symptom not only in this, but in every other disease. Should none of the remedies above quoted correspond to the derangements alluded to in particular cases, although they may be otherwise indicated, an intercurrent remedy may be selected from amongst those we have mentioned in the articles on Dyspepsia, Chlo- rosis, &c. The temperament and constitution of the patient ought also to claim attention in the selection of the remedies. In conclusion, it must be remarked that as the irritation Avhich is so repeatedly created in the lungs by the vicissitudes of climate, so con- stantly occurring in most parts of this country, forms a great drawback to the more or less successful treatment of pulmonary consumption, it is of great moment that every possible means be taken to avoid that pernicious influence. It has been much in vogue with many medical ASTHMA. 309 men to recommend warm climates, or well-sheltered situations, even, although the atmosphere might be of a humid and relaxing nature. But we confess that Ave are inclined to side with those who do not object to a somewhat bracing and cold atmosphere, provided it be dry and not of very variable temperature. Much, however, depends upon the peculiarity of the case,—the air, as Avell as the food, which may be well adapted to one patient, being often perfectly inappropriate and therefore injurious to another. ASTHMA. This affection is characterized by the following phenomena: difficulty of breathing, recurring in paroxysms, attended with a sensation of suffocating constriction in the chest, cough, and wheezing. The parox- ysm is frequently preceded by a sense of coldness, languor, headache, heaA'iness over the eyes, sickness or flatulence, and a sense of oppression in the chest. During the attack, the patient feels much worse in the recumbent posture, and consequently sits up, requests the door or windoAv to be throAvn open, to admit more air into his apartment, and uses every effort to dilate and empty the lungs. He also experiences great restlessness, making frequent efforts to force something out of the air-passages, which he thinks impedes the breathing, by coughing. The face is pale or livid, and wears an anxious expression. The extremities, and even the nose and ears, are frequently cold, and the face and chest are covered Avith cold perspiration ; the heart palpitates; the pulse is variable, being quick and full, or small and quick, or weak and irregular; often intermitting. These symptoms continue with a greater or less degree of violence for some hours or even days, until expectoration takes place, which affords relief as it increases in quantity. A remission also sometimes takes place soon after an acces- sion of copious perspiration or a profuse discharge of urine. The disease is more frequently met with at an advanced than an early stage of life, and oftener in men than women. The attacks occasionally come on in the afternoon, or on retiring to rest, but much more fre- quently during the night, and in the midst of a sound sleep, from which the patient is suddenly awoke by a sense of suffocation. The recurrence, as Avell as the duration, of the attacks, is very various. One attack generally leads to another, and the paroxysms commonly become more and more frequent and distressing; still if no organic disease result, patients who are subject to returns in considerable fre- quency, sometimes survive to an advanced age. But this is unfortu- nately not often the case, for unless the disease be arrested, the repeated obstruction and disturbance Avhich is offered to the respiration and circulation seldom fails, in the majority of cases, to induce organic lesions either of the heart or large vessels, or of the lungs, with the usual concomitants of water in the chest or abdomen. The quantity of expectoration is small, and even entirely absent in some cases of asthma, Avhilst in others it is exceedingly copious; and hence the disease has been divided into dry and humid asthma. In the former {Asthma siccum), the attack is usually sudden, violent, and of short duration; the cough slight; the expectoration scanty, appearing only towards the 310 RESPIRATORY SYSTEM. termination of the fit, and in some instances entirely wanting. In the lat- ter {Asthma humidum), the paroxysm is gradual and protracted ; the cough severe; the expectoration supervenes early, is at first scanty and glutinous, and afterwards copious, and productive of great relief. Therapeutics.—In nervous or convulsive asthm? {Asthma siccum), the remedies which have been employed with the most satisfactory results are: Arsenicum, Cuprum, Ipecacuanha.—Nux v., Bryonia, Pulsa- tilla.—Opium, Tartarus, Sambucus.—Aconitum, Belladonna, Phospho- rus.—Sulphur, Lachesis, Sambucus.—Ferrum, Veratrum, Moschus, Stannum, Hyoscyamus, Stramonium, Chamomilla, Carbo v., Aurum, Lycopodium, Acidum nitr., Ignatia, Kali, Ambra, Mercurius, Silicea, Calcarea, Dulcamara, Coffea, Lobelia inflata, &c. In moist, humid, pituitous asthma {asthma humidum): Pulsatilla, Dulcamara, Stan- num.—Sulphur, Sepia, Tartarus, Cuprum, Sambucus.—Ipecacuanha, Belladonna, Bryonia.—Ferrum, Calcarea, Lachesis, G-raphites, China, Silicea, Hepar, Baryta c, Conium, Camphora, Zincum, Mercurius. In flatulent asthma : Nux v., Cinchona, Carbo v., Lycopodium, Chamo- milla, Phosphorus, Sulphur, Opium, Zincum, &c. In spasmodic asthma, pulmonary spasm {cramps in the chest): Cuprum, Nux v., Bryonia, Belladonna, Hyoscyamus, Arsenicum, Lachesis, Stramonium, Cocculus, Nux m., Sambucus, Tartarus, Zincum, Sulphur, Kali, Causticum, Sepia, Stannum, Lycopodium, &c. Asthma arising from exposure to irritating vapours, such as copper or arsenic {asthma vaporosum) : Ipe- cacuanha, Mercurius, Hepar s.—Camphora, Cuprum, or Arsenicum. From the vapour of sulphur: Pulsatilla chiefly; and when caused by the continued inhalation of stone dust, and other irritating particles : Sulphur, Calcarea, Silicea, Hepar, have principally been recommended, and in some cases, also, the following: Arsenicum, Belladonna, Nux v., Phosphorus, Ipecacuanha, and Cinchona. Where the repercussion or retropulsion of an eruption, or the suppression of an habitual discharge has been the occasional cause {asthma metastaticum) : Sulphur, Carbo v., Arsenicum, Bryonia, and Phosphorus are the most appropriate remedies in the majority of cases. If the affection is attributable to suppressed catarrh: Arsenicum, Ipecacuanha, Nux v., &c. Where a chill has given rise to an attack of asthmatical breathing : Ipecacu- anha, and Arsenicum ; or, Dulcamara, Aconitum, Belladonna, Bryonia, Chamomilla. And when mental disturbance has brought on a paroxysm of dyspnoea: Aconitum, Chamomilla, Ignatia, Coffea, Nux v., Pulsa- tilla, Veratrum. When congestion of blood in the chest forms the occa- sional cause of dyspnoea, see that article. When the disorder occurs as a sequela of bronchitis, see Bronchitis. The remedies which are best calculated to afford relief during a par- oxysm of asthma are, Ipecacuanha, followed, if it produces but little benefit, by Arsenicum. In other cases Cuprum, Moschus, Opium, Tartarus and Sambucus; or, Nux v., Bryonia, Chamomilla, Bella- donna, Cinchona, Nux moschata, or Pulsatilla will prove more useful. And those which have principally been recommended to eradicate the tendency to suffer from continual recurrences of the disorder,—Avhere that is practicable from the absence of serious organic disease, &c.—are as follows: Sulphur, Calcarea, Arsenicum, Nux v., Antimonium, ASTHMA. 311 —Stannum, Sepia, Silicea, Cuprum, Lachesis, Carbo v.,—Lycopodium, Causticum, Graphites, Acidum nitricum, Phosphorus, Ammonium c, Ferrum, Zincum, Tussilago. In ordinary cases the subjoined remedies will be found serviceable, when the leading symptoms are in accordance with those which are described. Ipecacuanha.—During the paroxysm of acute asthma, this remedy is one of the most frequently useful, whether the attack occurs in chil- dren or adults. It is more especially indicated when the patient is awoke from a sound sleep, with a suffocating sensation of constriction in the windpipe, Avith quick laborious breathing and gasping for breath: wheezing and mucous rattling in the chest; short dry cough ; paleness and coldness of the face, sometimes alternately with heat and redness : coldness of the feet; anxiety and dread of suffocation ; feeling as if dust were inhaled during the act of respiration, and caused the suffocating sensation in the chest; spasmodic rigidity of the body, and livid hue of the face. After a dose or two of Ipecac, it is occasionally requisite to have recourse to Arsenicum to afford further relief. In other instances Nux v. or Bryonia will be found better adapted to remove the re- maining symptoms. Arsenicum is chiefly called for (either in acute or chronic asthma), when, during the attack, the respiration appears to become more and more laborious, and is attended with extreme agitation, moaning, and jactitation ; great exhaustion and anguish, as if at the point of death, with cold perspiration. In confirmed asthmatics, it forms a most im- portant remedy, when the breathing is liable to become much oppressed when walking rather quickly, or when going up a hill, or ascending stairs; and when, particularly in the case of old people, even the effort of laughing, or the exertion of getting into bed brings on a fit of dyspnoea. Arsenicum, as well as Ipecacuanha, is further indicated when the paroxysms of asthma are most liable to occur on retiring to rest, or before midnight, the patient being disturbed from sleep by a sense of spasmodic constriction in the chest and larynx, which is soon followed by laborious, panting, and whistling respiration with gasping for breath. These symptoms are occasionally relieved by remissions, but the attack is prone to recur on using the slightest exertion: for the most part, however, the paroxysm continues with more or less intensity until relieved by the accession of a fit of coughing, with expectoration of viscid mucus filled with vesicles. Arsenicum, though principally called for in cases in which the attacks come on at night, is also useful when they are liable to be excited during the day, on exposure to a cold bracing air, or on going out during the prevalence of disagreeable, damp, or stormy weather. LikeAvise when changes of temperature, or tight and very warm clothing are frequent sources of fits of dyspnoea. Sensation of burning heat in the chest during the fit of asthma, is an additional indication for Arsenicum. {Acid, hydrocy. or Kali hydro. may sometimes be had recourse to with decided advantage when Arseni- cum fails to give much relief.) Bryonia.—This medicine, as already mentioned, is frequently useful after the previous employment of Ipecacuanha. The indications are chiefly : obstructed respiration at night or towards morning, with fre- 312 respiratory system. quent cough, pains in the hypochondria, and inability to recline on the right side, and not Avithout inconvenience on the left, so that the patient is constrained to lie on the back ; frequent coughing, Avith expectoration at first frothy, and subsequently thick and glutinous, and frequently attended with retching or vomiting; aggravation of the dyspnoea from talking, or from the slightest movement; frequent efforts to obtain suffi- cient air by deep inspirations, accompanied with moaning, palpitation of the heart, and great anxiety. The attacks are often attended by shootings in the chest on taking a full inspiration, also on coughing, or after any movement of the arms or trunk. At other times there is colic, eructations of the taste of the food partaken of, irritability of temper, and disposition to find fault Avith everything. {Bryonia and Nux v., are often administered with great advantage in alternation.) Nux vomica.—Nocturnal attacks of suffocating tightness, especially at the lower part of the chest, preceded by disagreeable or anxious dreams; also when the paroxysms are prone to occur in the morning or after a meal, and are attended with anxiety, aching and pressive pains in the precordial region, as also in the hypochondria ; feeling of disten- sion in the abdomen and epigastrium; flatulence ; tension, pressure, and aching in the chest; palpitation of the heart; short hacking cough, with difficult expectoration; inability to bear the slightest pressure from the clothing, particularly around the chest and waist; the clothes seem to fit tightly and increase the difficulty of breathing, whilst in reality they are quite the reverse ; dyspnoea when walking and conversing in the open air, especially if the temperature be somewhat cold; dyspnoea after trivial corporeal exertion of any kind. Melioration of the asthmatic sufferings when reclining on the back, or on changing from one posture to another, such as sitting up, and then lying doAvn again, or turning from one side to the other. Disposition irritable and passionate. Pulsatilla.—Oppressed, rapid, and laborious breathing from a feel- ing of spasmodic constriction in the chest, especially at the inferior por- tions; or suffocating feeling in the windpipe as if caused by the vapour of sulphur: tension, and sensation of fulness, pressure and aching, attended Avith mucous rattling in the chest; short fits of coughing in rapid succession, and appearing to threaten suffocation ; or cough with copious expectoration of mucus. The attacks usually coming on at night, or in the evening when in a horizontal posture ; extreme anguish, palpitation of the heart, and sometimes lancinating pains in the chest during the paroxysms. Pulsatilla, is generally more suitable for hysterical females, or indi- viduals, of a mild, timid, sensitive, or fretful disposition. In dyspnoea, with mucous rattling, and cough, occurring in children from taking cold, it is likewise a most useful remedy. Tartarus emeticus :—Dyspnoea with suffocating cough and anxious oppression at the preecordia, arising from an excessive secretion of mucus in the bronchi; this remedy is frequently of great service, either in aged persons or in children. Opium:—Obstructed breathing, either from congestion or from pul- monary spasms, with suffocating cough and livid hue of the face; loud ASTHMA. 313 mucous rattling in the chest, Avith extreme anguish from dread of suffo- cation ; dyspnoea during sleep resembling nightmare (incubus). China :—Paroxysms of asthma at night, as if caused by an accumu- lation of mucus in the windpipe : wheezing in the chest during inspira- tion ; difficult expectoration of thick transparent mucus; oppression at the chest, palpitation of the heart, and inability to breathe, unless the head and shoulders are propped up with pillows; great weakness, and tendency to copious sweating at the slightest exertion, or when too warmly clothed. Sambucus:—Rapid and laborious respiration with loud wheezing; oppression of the chest as if from a weight, attended with anguish and dread of suffocation, and sometimes swelling and livid hue of the face and hands, general heat, tremor, inability to talk much above a whisper ; suffocating cough ; aggravation of the symptoms in the recumbent pos- ture. In the case of children this remedy is often of great service, when, in consequence of a chill, they are seized with spasm in the chest, and awake from sleep with a start, and exhibit many of the symptoms detailed. (See Spasms in the Chest.) Moschus :—Acute asthma occurring in hysterical females, or in chil- dren from exposure to cold; sense of spasmodic constriction in the larynx and bronchi ; or oppression at the chest with paroxysms of suffo- cating feelings, as if caused by the inhalation of the vapour of sulphur, commencing with a fit of coughing and succeeded by distressing oppres- sive constriction, sometimes to such a degree as almost to drive the patient to exasperation and distraction. Belladonna :—Difficulty of breathing, particularly when occurring in females of an irritable habit, and subject to spasms, with tension in the chest, and lancinating pain behind the sternum; dry cough at night, with moaning respiration, which is sometimes deep and full, and at others short and rapid, with gasping for breath and great efforts to dilate the chest to the utmost to obtain a sufficient supply of air; sen- sation of constriction in the larynx, and feeling as if suffocation would ensue on putting the hand to the larynx, or on turning the neck; paroxysms of asthma, Avith loss of consciousness, &c. Lachesis is often useful Avhen only partial relief has been effected by the action of Belladonna. Veratrum.—In violent attacks of acute spasmodic asthma, with symptoms of threatening suffocation, cold perspiration, coldness of the nose, ears, and lower extremities, this remedy will often afford relief Avhen Cinchona, Ipecacuanha and Arsenicum have failed to do so. Dulcamara.—In moist asthma {Asthma humidum) this medicine is one of the most useful remedies, particularly when the attacks are liable to be excited by a cold and damp state of the atmosphere. In severe dyspnoea, Avith loose sounding cough, rattling of phlegm in the chest, and copious expectoration, arising from exposure to wet, it is likewise a valuable remedy. Stannum:—Humid asthma, with wheezing and obstructed respira- tion, particularly at night, or on preparing for bed; but also when the paroxysms come on during the day, and render it necessary to loosen the clothing. The attacks are attended with oppression at the chest, 314 nervous system. and mucous rattling: cough, with copious expectoration of viscid or grumous, or transparent and watery, or yellowish mucus of a sweetish or saline taste. Phosphorus, Sulphur, Calcarea, Sepia, and Lycopo- dium, are also of much value in humid asthma, and of great service in some of the most obstinate cases. In chronic asthma, a dose of the medicine required may be taken at intervals of from four to eight days or so; but in acute cases, or when the remedy is prescribed during the paroxysm, the dose may be repeated at intervals of from half an hour to two hours and upwards, according to the severity of the case. When the medicine first prescribed affords no relief after from two to three repetitions, another must be selected, preference being given to that remedy which corresponds the nearest to the existing symptoms. DISEASES OF OR CONNECTED WITH THE BRAIN, AND OTHER PARTS OF THE NERVOUS SYSTEM. determination of blood to the head. Congestio ad Caput. This is an affection to which many individuals who lead a sedentary life are subject: intense mental application and habitual indulgence in the use of spirituous liquors, or other stimulating liquids, such as coffee, &c, are also its frequent exciting causes, particularly in those who in- herit a predisposition to the disorder. Diagnosis.—Fulness of the vessels of the head and neck, the pulsa- tion of which the patient experiences through the entire frame ; heat, redness, and turgidity, or pallor and puffiness of the face, with anxious expression of countenance; repeated attacks of giddiness, particularly after sleeping, or sitting in a warm, confined apartment, or on exposure to the rays of the sun when exercising in the open air; headache, generally above the orbits, and in the forehead, increased by stooping or coughing; dimness of vision; buzzing in the ears; tightness around the throat; oppressed breathing; furred, red-pointed, or enlarged, and very red-looking tongue; dyspepsia, constipation, disturbed, unrefresh- ing sleep ; drowsiness during the day. Therapeutics.—Aconitum napellus, Nux vomica, Belladonna, Opium, Coffea, Chamomilla, Ignatia, Arnica, Mercurius, Pulsatilla, Dulcamara, Cinchona, Sanguinaria canadensis, &c. Aconitum.—This is the principal remedy to commence with in all recent cases, and is alone sufficient speedily to remove the affection, particularly in children, when fright and anger combined have been the exciting causes. Nux vomica.—As has already been repeatedly observed, this remedy is exceedingly efficacious in complaints arising from sedentary habits, determination of blood to the head. 315 intense study, or that much more culpable habit, the excessive indul- gence in spirituous or vinous liquors, &c.; it is accordingly one of the most useful remedies in determination of blood to the head, induced by such causes; it is also very serviceable in cases arising from a violent fit of passion, and is more particularly indicated when we meet with the following symptoms: distension of the veins, with violent pulsation in the head; heat and redness, or paleness, or sickly hue of the face; attacks of giddiness, violent headache, particularly in the forehead and over the orbits, aggravated by reflecting, or by any attempts at mental application, also by stooping or coughing; disturbed sleep; nervous excitability, and disposition to be angry at trifles; constipation. ^ Cal- carea will frequently be found of signal benefit after Nux v., in ob- stinate cases occurring in persons addicted to indulgence in spirituous liquors. Belladonna.—After a previous administration of Aconite, when necessary, this is one of our most important remedies in the treatment of congestion to the head. Indications : great distension of the vessels of the head, attended with severe jerking burning pains in one half of the head, aggravated by the slightest movement or the least noise ; fiery redness, and bloatedness of the face, redness and protrusion of the eyes, sparks before them, and sometimes dimness of vision ; darkness before the eyes (obscurity); diplopia; buzzing in the ears ; bright redness of the throat; attacks of fainting ; somnolency. Opium is of speedy service in cases arising from fright; but it is, moreover, a remedy of extreme value in the most serious cases of con- gestion, either arising suddenly from the effects of a draught of cold or iced-water, especially when heated, or from other causes, with the fol- lowing symptoms : vertigo, heaviness of the head, humming in the ears, dulness of hearing, stupor ; also when the attack is occasioned by con- stipation, or the effects of a debauch, with pressure in the forehead from within outwards, with redness and bloatedness of the face, great depres- sion, fugitive heat; violent thirst; dryness of the mouth; acid regurgi- tations, nausea or vomiting. Coffea.—In cases arising from excessive joy, this remedy will be found to exert a salutary influence. Symptoms: excessive and uncon- trollable liveliness; great heaviness of the head, or aggravation of the sensations when speaking; sleeplessness. Chamomilla.—Congestion caused by vexation, or a fit of passion, particularly in children, is speedily relieved by this remedy. Ignatia, when induced by stifled vexation, or harrowing, concentrated 3 Arnica.—In cases arising from external violence, such as severe falls or contusions, followed by stupefaction, vertigo, sensation of pressure or coldness over a small circumscribed space ; tendency to close the eyes ; disposition to be frightened, and vomiting,—the external and in- ternal administration of Arnica, when timely had recourse to, will fre- quently be found specific. This remedy is, however, equally useful in other cases with the following symptoms : heat in the head, with cold- ness of other parts of the body; sensation of obtuse pressure on the brain ; painful burning or throbbing in the cranium ; humming in the 316 NERVOUS SYSTEM. ears; vertigo, with confused vision, especially on assuming the erect posture after sitting for some time. Mercurius.—Congestion with sensation of fulness, or, as if the head were compressed by a band; nocturnal aggravation, with darting, piercing, tearing, or burning pains ; disposition to sweating. After Arnica, Belladonna, or Opium, Mercurius is frequently found service- able in completing the cure. Pulsatilla.—This remedy, as will be found stated in the proper place, is well adapted to many cases of congestion occurring in young girls at the critical age, or to all cases occurring in cold, lymphatic temperaments with the following symptoms : distressing semi-lateral pain in the head, particularly of a pressive character, or if the pain in the head commences at the occiput and extends to the root of the nose, or invertedly. Amelioration of the symptoms from exercise, or from pressing or binding the head; exacerbation while sitting: sense of Aveight in the head; vertigo ; face pale and wan-like, or red and bloated; inclination to weep ; anxiety; coldness, or shivering. Lycopodium is a valuable remedy in some obstinate cases of conges- tion attended with giddiness, ebullition, flatulence, anxiety, and habitual constipation. Dulcamara.—Congestion attended with continual buzzing in the ears, dulness of hearing, and particularly when the affection has arisen from getting the feet wet, or from a chill in cold, damp weather. Sanguinaria canadensis.—Distension of the vessels, heaviness of the head, with fulness and aching, as if the head Avould burst; pressure behind the orbits. The pains are chiefly complained of in the forehead, sinciput and right sideof the head. Cinchona.—Congestion occurring after repeated bloodlettings, or hemorrhage in general, is generally relieved by this remedy. After the completed action of Cinchona, a dose or two of Sulphur and Calcarea carbonica, at intervals of about a week, will materially tend to strengthen the impaired constitution, when Cinchona is not of itself sufficient to effect that desirable object. Nux v., Veratrum, and Valerian are also valuable remedies in par- ticular cases arising from debilitating losses. Attention may also be directed to the following remedies: Rhus toxicodendron, Bryonia alba, Cicuta virosa, Hepar sulphuris, Silicea; the two latter, togethei with Sulphur and Calcarea, are more particularly adapted to the treatment of chronic cases. (See also Dyspepsia and Apoplexy.) In those cases where patients have habituated themselves to the pe- riodical abstractions of blood, as a temporary mode of relief, the employ- ment of Aconitum and Belladonna, in alternation, commonly suffices to obviate the necessity of having recourse to such a culpable practice. Occasionally, it Avill be found requisite to select other remedies, such as Nux v., Sulph., China, &c, in addition, or in preference to, Aconitum and Belladonna. In cases of giddiness simply, or when that is the prevailing symptom, the folloAving remedies are amongst the most useful: Mercurius, when the giddiness comes on only in the evening, especially on assuming the erect posture; or in the morning on getting out of bed; and is attended DETERMINATION OF BLOOD TO THE HEAD. 317 with nausea, dimness of sight, heat, anxiety, and desire to lie down. Nux vomica,—giddiness during mental application, or after a meal, or when in the recumbent posture, particularly in nervous or bilious sub- jects ; and in cases where sedentary habits or dissipation have given rise to the affection. Pulsatilla,—giddiness, especially on looking upwards, or when sitting, or at other times, such as during or after meals, attended with heaviness of the head, buzzing in the ears, head- ache, and paleness of the face, sometimes alternating with heat; confu- sion of sight; lowness of spirits ; nausea, and inclination to vomit; phlegmatic temperament. Cinchona,—giddiness on elevating the head, or during movement, relieved by reclining. Rhus,—giddiness on lying down, but which becomes relieved after retaining the recumbent posture for some time, and then returns on assuming the erect posture, sometimes to such an extent as to occasion falling, attended with fear of dissolution; giddiness after a hearty meal Chamomilla,—giddiness on rising, with tendency to faint; giddiness during a meal; irritability. Arnica,—violent giddiness during dinner or after a hearty meal; in the latter instance, Nux v., Pulsatilla, Rhus, or Chamomilla, are also very useful, and must be selected according as they may be otherwise indicated. Giddiness on rising from the recumbent posture, or on stooping: Aconitum, followed by Belladonna, particularly if, in addi- tion to the foregoing symptoms, there is frequently partial loss of con- sciousness, with cloudiness of vision. Giddiness from the motion of a carriage, sometimes Avith disposition to faint: Hepar s.,—followed by Silicea, should the former not suffice, or afford only a slight degree of improvement. Sulphur is often very serviceable after Pulsatilla, when the attacks of giddiness are most liable to come on while sitting; or it may be selected in preference to the said remedy, Avhen the gid- diness generally comes on whilst walking up a hill or ascending stairs; or is at other times attended with nausea, fainting, or bleeding from the nose. Lycopodium,—giddiness Avith tendency to congestion, ac- companied with flatulence, headache, anxiety, and obstinate constipa- tion. Lachesis,—giddiness with confusion of ideas, or paleness of the face, nausea, and vomiting ; fainting, bleeding from the nose, particu- larly Avhen the attacks come on chiefly in the morning on waking. Opium:—Threatening vertigo with confusion of ideas; or decided giddiness, Avith humming in the ears, and clouded vision on sitting up in bed, which renders it necessary to lie down again; vertigo from fright. Conium :— Violent giddiness, with dread of falling to one side when looking backwards. Giddiness arising from disordered stomach, with nausea or vomit- ing : Aconitum, followed by Antimonium crudum, and subsequently Pulsatilla, if necessary from a continuance of the symptoms in a greater or less degree. Diet.—The homoeopathic regimen already given in the Introduc- tion should be rigidly adhered to, and stimulants of all kinds carefully avoided; moreover, early rising, and daily exercise in the open air should not be neglected; the use of the flesh-brush in the evening is also of some service. 318 nervous system. INFLAMMATION OF THE BRAIN AND ITS TISSUES. BRAIN FEVER. Phrenitis. Encephalitis. Diagnosis.—Coma, or constant delirium, or both, with signs of deter- mination of blood to the head ; fulness and redness of the face and eyes; beating of the carotid and temporal arteries; occasional attempts to grasp the head. When it is caused by inflammation of the tissues, the pain is more acute than that arising from inflammation of the substance of the brain. Paralysis also more frequently accompanies the latter form. In inflammation of the brain or its membranes, the symptoms are exceedingly diversified; the extent and duration of the disease, the age, the sex, and constitution of the patient, all combine to give to the affec- tion a variety of character. Much assistance may be derived, in ascer- taining whether the brain is affected or not, from examining the eyes and general expression of the countenance. The pupils in the first stages are commonly found more or less contracted, but as the disease advances, they often become dilated. Occasionally the attack is pre- ceded by premonitory symptoms, such as congestion of blood to the head, attended with sensations of weight or stupifying, pressive, constrictive, and sometimes shooting pains in the head. In some instances slight feverish symptoms are complained of, with ringing in the ears for about the space of a week; giddiness, and a sense of weight on the crown of the head; pulse rather quick, and the heat of the skin somewhat increased at night, attended with restlessness and a difficulty of lying long in one position; moreover, the patient is observed to be irritable and annoyed at trifles; anomalies in the mental powers may next be observed, such as obstupefaction, drowsiness, with slight delirium ; or a high degree of excitement, in which the patient is affected by the slight- est noise, and the eyes have a brilliant and animated expression, or are bloodshot, with fiery redness of the face, violent delirium {delirium ferox). According to the seat of the inflammation, or the constitution of the patient, the accompanying fever is of greater or less intensity; the pulse is very variable in the course of the same day; it may be regular, intermitting, quick and weak, or very slow and strong. A very slow or very quick pulse generally indicates danger. The patient frequently complains of heat in the head, whereas the extremities are cold. When there is stupor, or a tendency to it, the eyes look heavy and void of all expression; vomiting sometimes takes place, and proves very intractable; the stupor becomes more profound, convulsions appear, and death sooner or later ensues. The peculiar and delicate structure of the brain and its membranes in children, render them much more susceptible of the attacks of this serious disease, and great atten- tion ought to be paid to the following symptoms: heaviness and ten- dency of the head to gravitate backwards, attended with pain (of which latter circumstance we are sometimes made aware, in very young chil- dren, by the little sufferer frequently raising its hands to the head); alternation of temper; intolerance of light; nausea, occasionally fol- lowed by vomiting; tendency to costiveness ; drowsiness ; wakefulness, INFLAMMATION OF THE BRAIN. 319 or starting during sleep. Secondly, continuous boring of the head against the pillow ; a high state of excitement, in which the slightest noise or ray of light throws the child into a fit of screaming, or a state of discontentment; heavy sleep; great heat in the head ; redness and swelling of the face, Avith perceptible throbbing in the vessels of the head and neck ; great agitation, with continued tossing about, especially at night; eyes red, sparkling, convulsed, or fixed; pupils immovable, and generally dilated. Causes.—Anything tending to irritate the brain, such as extremes of heat or cold; the abuse of ardent spirits; external injuries of the head; concussion from falls ; mental emotions, or over-exertion of the faculties; excesses of all kinds; sanguineous congestion; metastases; contagious diseases ; repressed eruptions, &c. Therapeutics.—We should have immediate recourse to Aconite at the commencement of the attack, when the skin is hot and dry, and the pulse rapid, with the ordinary indications of pure Inflammatory Fever, which is especially liable to be the case in young plethoric sub- jects. After the employment of Aconite, we may have recourse to any of the following remedies as indicated ; namely, Belladonna, Hyoscyamus, Opium, Stramonium, and Cuprum aceticum. Belladonna.—This medicine seems to possess a certain specific influence over inflammation of the brain and its meninges ; and is gene- rally the remedy we should select, when the following, amongst other symptoms, present themselves: great heat of the head; redness and bloatedness of the face, with violent pulsation of the carotids; boring of the head in the pillow, and increase of suffering from the slightest noise, Avith extreme sensibility to light; violent shooting and burning pains in the head; eyes red and sparkling, with protrusion or ivild ex- pression ; contraction or dilatation of the pupils ; violent and furious delirium; loss of consciousness ; sometimes low muttering; convulsions, occasionally symptomatic hydrophobia; vomiting; involuntary evacua- tions of fseces and urine. Bryonia.—This remedy will frequently be found of great efficacy in children, when Aconite and Belladonna have produced but trivial im- provement, and the symptoms indicate a tendency to rapid effusion; in which case also Helleborus may folloAv Bryonia if required. (Vide Hydrocephalus.) Hyoscyamus is appropriate when there is drowsiness, loss of conscious- ness, delirium about one's own affairs; inarticulate speech; tongue coated white, with frothy mucus about the lips ; dilatation of the pupils; fixedness of vision; skin dry and parched; redness of the face; and picking of the bedclothes with the fingers. Opium :—When there is lethargic sleep, with stertorous breathing; half open eyes, and confusion or giddiness after waking; sanguineous congestion; complete apathy and absence of complaint. Stramonium.—When there is starting or jerking in the limbs; sleep almost natural, followed by absence of mind after waking, but sometimes attended with moaning and tossing about; vision fixed, and the patient 320 NERVOUS SYSTEM. frequently appears in a state of dread, and utters cries; redness of the face; feverish heat, with moisture of the skin. In many of the symp- toms this remedy bears a close resemblance to Belladonna, with the exceptions of being indicated by the more prominent existence of spasms, and less acuteness of pain in the head. Zincum may be employed after, or in alternation with Belladonna, when that remedy produces only a partial degree of amendment. In those extreme cases where symptoms of threatening paralysis of the brain are manifested by the following indications : loss of consciousness ; half closed eyes ; dilated, insensible pupils ; icy coldness of the extremi- ties, or of the entire body; blueness of the hands and feet; impeded respiration; small, weak, scarcely perceptible pulse—Zincum has re- peatedly been found effectual in preventing a fatal issue.1 Dose.—Gr. ss. to gr. j. of the first trituration, every hour, until signs of improvement set in, in which case the intervals between the doses must be lengthened. (See also Hydrocephalus.) Cuprum aceticum.—The reputed value of this remedy in cases of repercussed exanthemata, and the consequences therefrom arising, have been already noticed under Scarlet Fever ; under which also some of the symptoms indicating its employment are commented upon ; it is also called for in a peculiarly sensitive rather than an inflammatory or irritable state of the brain, which not unfrequently appears in children, during the course of catarrhal fever or difficult dentition, of which affec- tion the following are the symptoms: at the commencement, crossness or fretfulness, or apathy and indifference: sleep disturbed and restless. As the disease gains ground, drowsiness, Avith inability to sleep ; incapa- bility of holding the head erect, and flushing of the face; dryness of the mouth AArithout increase of thirst; disgust to food, nausea, even vomit- ing ; torpor of the bowels, rarely diarrhoea; shudderings; followed by heat, and occasionally burning, unfrequent perspiration ; pulse \rariable, generally rather accelerated and full; exacerbations of fever (synocha) towards evening and at night; subsultus tendinum, and grinding of the teeth during the exacerbations. Belladonna, Rhus, Lachesis, and Mercurius have also proved ser- viceable in cases arising from repercussed exanthemata. Cina is useful in irritation of the brain in children, apparently arising from helminthiasis. In chronic cases, Sulphur, Helleborus niger, Arsenicum, and Lachesis, are the more generally useful. It may be added, that Aconite, followed, if required, by Belladonna, Camphora, or Lachesis, is the most appropriate course of treatment, when the affection has arisen from exposure to the sun {coup de soleil). Aconite, Bryonia, Arsenicum, Hyoscyamus, when resulting from a violent chill in the head. From suppressed otorrhoea, Sulphur, Pulsa- tilla. External injury, Arnica, Belladonna, Mercurius. Abuse of ardent spirits, Opium, Lachesis. And when from intense mental appli- cation, Belladonna, &c, according to the symptoms. 1 Allg. Horn. Zeit. No. 15. 31ster Bd. APOPLEXY. 321 Antimon. tart, has been recommended as deserving of attention in inflammation of the brain and its* membranes. APOPLEXY. Apoplexia. Diagnosis.—Sudden or gradual loss of consciousness, sensation, and motion, with greater or less disturbance of the pulse and respiration. FeAv diseases offer a greater number of varieties in form than apoplexy ; and there is scarcely a single classification of the many, that eminent medical writers have given to the world, which is not more or less liable to objection. It is also extremely difficult to diagnose clearly between the different varieties, the external symptoms not always bearing a uniform relation to the internal injury ; thus all the indications of serous apoplexy may declare themselves from sanguineous extravasation ; and it is not always possible to decide in apoplexy whether effusion or simply congestion of the vessels of the brain has taken place. Premonitory Symptoms.—Continued inclination to somnolence, heavy profound sleep, with stertorous breathing, incubus, grinding of the teeth, shocks or cramps, a general feeling of heaviness or disincli- nation to the least exertion; frequent yawning and fatigue after the slightest exercise. A sense of weight and fulness, and pains in different parts of the head, sometimes very deep-seated. Cephalalgia and megrim, or vertigo and fainting; pulsation of the temporal and carotid arteries, with swelling of the veins of the head and forehead ; disturbance of the cerebral system, evinced by loss of memory, forgetfulness of words and things, irritability of temper, or mildness and indifference, despondency and weeping; infiltration of the conjunctiva, dimness of vision, specks or motes before the eyes, or flashes of fire or sparks during darkness ; acuteness of vision or diplopia, sometimes also the words in a line appear to run into one another; difficulty of opening or closing the eyes ; noises, humming, singing, &c, in the ears; dulness of hearing, dryness of the nostrils, pinched appearance of the nose, with false perception of an unpleasant odour, sneezing, and slight epistaxis; stammering, and indistinct enunciation; difficulty of deglutition, numbness or torpor, or pricking sensation in the extremities, with occasional partial attacks of paralysis in the face, distorting the features and affecting the utterance, or in some of the muscles of the limbs; pains in the joints ; Aveak or unsteady mode of progression, difficulty of micturition, &c. Their Treatment.—Against the preceding, Homoeopathy possesses remedies, by whose proper application the practitioner may, if consulted in time, succeed in warding off the attack of this dreaded malady. The following are the medicines most appropriate to the treatment of the foregoing symptoms, and also most generally called for in the treat- ment of the disease itself: Aconitum, Belladonna, Nux vomica, Lache- sis, Opium. Aconitum.—In all cases Avhere there are evident symptoms of plethora, determination of blood to the head, characterized by redness 322 NERVOUS SYSTEM. and fulness of the face, distension of the veins of the forehead, quick full pulse, restlessness, and anxiety.1 Belladonna :—Should the symptoms of congestion not speedily yield to Aconite, or should only a partial degree of amelioration have taken place; or further, should the following symptoms present themselves: redness and bloatedness of the face, injection of the conjunctiva, violent beating of the carotid and temporal arteries, noises in the ears, darting pains in the head, with violent pressure at the forehead, increased by movement, by the least noise or bright light; or diplopia, and almost all the symptoms relative to the eyes already mentioned ; dryness of the nose, with unpleasant smell and epistaxis; difficulty of deglutition; slight attacks of paralysis in the face; paralytic weakness or heaviness in the limbs. Nux vomica is particularly suited to cases in which the apoplexy threatens individuals of sedentary habits addicted to the use of ardent spirits, or too great an indulgence in the pleasures of the table, or in those who have long been affected with dyspepsia, either bilious or ner- vous, and have consequently more or less of the rheumatic or gouty diathesis, and also when the following symptoms present themselves: headache, deep-seated or frontal, but more especially at the right side, with vertigo, confusion and humming in the ears, nausea, and inclination to vomit; turgescence of the capillaries of the face, or redness only of one cheek: drowsiness, feeling of languor, with great disinclination to exertion, either mental or bodily, cramps of the limbs, especially at night, and weakness in the joints ; constipation and dysuria, irritability of temper, aggravation of the symptoms in the morning, or after a meal, and also in the open air, bilious, sanguine, or nervous temperament. Opium is a most important remedy in almost all severe attacks, but particularly in old people, when we find the following symptoms : mark- ed congestion to the head, indicated by stupor, vertigo, heaviness in the head, and violent pressure in the forehead, singing in the ears, and obtuseness of hearing, sleeplessness or agitating dreams, or frequent and almost overpowering drowsiness during the day, redness of the face, and constipation ; pulse slow, but full. Lachesis is indicated by many of the same symptoms which have been enumerated under Nux v., together with the following distinctive characteristics : frequent abstraction of mind, or vertigo with conges- tion, pains deep in the brain, or severe aching pains at the left side of the head, and lowness of spirits; face pale and puffy, or turgid and somewhat livid ; pulse weak and slow. The moment any of the symptoms before noticed present themselves is the proper time to prevent the attack running on to apoplexy; some- times the signs are so marked, that we can have but little doubt of the result, unless timely precautions are taken ; at other times, so slightly as to be almost imperceptible; and at others again, the attack comes on 1 Some homceopathists persist in employing the lancet here ; but we believe there are few instances, if any, in which the use of Aconite, followed, if required, by Belladonna or Opium, and sometimes Nux v., according to the characteristic features of the remaining symptoms and the nature of the case, will fail to act as speedily, and certainly with more beneficial ultimate results. APOPLEXY. 323 suddenly, without any marked premonitory symptoms whatever. (See also Congestio ad Caput.) Apoplexy. The following are the principal remedies which have hith- erto been chiefly recommended, or found most successful, in the treat- ment of the disease itself:—Opium, Nux vomica, Belladonna, Lachesis, Arnica, Pidsatilla, Baryta carbonica, Silicea, Stramonium, Zincum metallicum, Acidum hydrocyanicum, Agaricus, &c. In sanguineous or sthenic apoplexy (generally characterized by blood- shot eyes, redness of the face, full, hard pulse, oppressed and stertorous breathing. The paroxysm more usually comes on without Avarning,— although sometimes preceded by fulness, weight, and a dull pain in the head, attended with giddiness and drowsiness,—the patient suddenly falling to the ground, and seeming as if in a heavy sleep), Opium, Aeon., Bella., Nux v., Lach., Stram., Ant., Coff., Hyos., Puis., &c, are the principal remedies. In asthenic apoplexy (chiefly defined by pale and sallow, but puffy, bloated countenance; feeble and easily compressible pulse, heavy, la- borious respiration. This variety is more commonly ushered in by pre- monitory symptoms than the preceding, such as headache, giddiness, loss of memory, illusions of hearing, inarticulate speech, somnolency, and a disposition to clonic spasms), Ipecac, Merc, Dig., Am.,— Baryt. c, Cocc, Con., Nux v., Puis., Zinc, Bella., Coff., Hyos., Stram., Cup., &c, are more frequently called for. Opium is held as a most important remedy in all cases of apoplexy when the disease has attained considerable height. It is one of the best remedies to commence Avith, when the attack has arisen from excess in drinking, and the symptoms are as follows : slow, stertorous breathing ; red and bloated face ; heat of the face and head, which latter is also co- vered with sweat: insensible and dilated pupils; stupor ; tetanic rigidity of the entire frame, or convulsive movements and trembling in the ex- tremities ; foaming at the mouth. In elderly persons, Opium is, as has already been stated, a remedy of primary importance. Baryta c, as will be hereafter noted, is also valuable in such cases, but chiefly, per- haps, after the previous use of Opium. Digitalis, Merc, or Con., &c, may, however, be required subsequent to Baryta or Opium, and even in preference to these in some instances, especially when of the serous type. Nux vomica has been found of great service in completing the cure after the previous use of the above remedy; but may also be employed at the commencement, when the attack has occurred in an individual of bilious, sanguine or nervous temperament, and of irritable temper, in consequence of over-indulgence in vinous or spirituous liquors ; or when the attack has resulted during or after a fit of passion, and the patient appears in a state of drowsiness approaching to stupor ; the breathing stertorous; eyes dull and glassy; hanging of the lower jaw, with copious secretion of saliva; paralysis, particularly of the inferior extre- mities (paralysis paraplegica); hemiplegia. Lachesis is also a valuable remedy in this disease, especially when occurring in habitual drunkards ; or in choleric, hypochondriacal per- sons or those who are frequently affected with melancholy, and are of 324 NERVOUS system. a spare habit, or of exhausted constitution, with droAVsiness or loss of consciousness ; lividity of countenance, convulsive movements or tremor in the extremities ; stupor or paralysis, especially of the left side ; pulse weak and slow. Arnica.—Apoplexy after too hearty a meal, with loss of conscious- ness (drowsiness or stupor); stertorous breathing ; moaning or inarticu- late muttering; involuntary evacuations; paralysis of the extremities (hemiplegia, left side) ; pulse strong and full. Belladonna.—Lethargy, loss of consciousness; the patient lies speechless, with the mouth drawn to one side; convulsive movements of the limbs or facial muscles ; hemiplegia, particularly of the right side ; dilated immovable pupils ; red and bloated face. Pulsatilla.—Lethargy, loss of consciousness; bloatedness and blue- ish-red hue of the face, occurring after a full meal, which has been hur- riedly swallowed ;J or sudden loss of the power of moATement; palpita- tion of heart; pulse almost entirely suppressed ; respiration stertorous; temperament phlegmatic. Baryta carbonica :—This remedy, like Opium, is peculiarly well adapted to the treatment of many of the affections of old people. It has, accordingly, like the latter medicine, been found very serviceable, when the serious affection at present under consideration is met with in patients of advanced age, particularly when the following symptoms are encountered: Coma somnolentum, with moaning and muttering, circumscribed redness of the cheeks; mouth drawn to one side ; para- lysis of the tongue, or of the upper extremities; hemiplegia (right side); confusion of ideas, childish manners. The following remedies may also be pointed out as being worthy of the attention of the homoeo- pathic practitioner; Ignatia, Tart, emet., China, and Cocculus (the two last named, particularly in cases which have been brought on by excessive depletion, by loss of blood, &c.); and in the paralysis result- ing from apoplexy, Belladonna, Baryta carbonica, Nux vomica, Rhus, Silicea, Lycopodium, Lachesis, Graphites, Carb. v., Olean., Bryonia, Cocculus, Plumbum, Stramonium, Stannum, Sulphur, Calcarea, Zin- cum metallicum, and Plectro-magnetism, particularly when occasional twitchings take place in the limbs. During the paroxysm of apoplexy, the patient ought to be placed in a cool room, with the head raised, or put, in short, in such a position as will least favour determination of blood to the head. The clothes ought to be loosened, especially about the neck ; and the feet or legs allowed to hang down. It may also be useful to increase the force of the circu- lation in the feet and legs by means of friction, or by putting them in Avarm water. We cannot conclude this article without giving expression to the gra- tification we feel, in common with the majority of the most eminent of our homoeopathic medical brethren, at the gradually increasing distaste to bloodletting evinced by our allopathic colleagues. Many have renounced the use of the lancet altogether; and others, Avhile they do 1 Ipecacuanha is equally indicated when the attack has arisen from such a cause, and may therefore be employed after, or in alternation with, Pulsatilla, should the latter remedy not afford speedy relief. MY EL IT I?. 325 not wholly discountenance its employment, surround the cases, in which they allow it ought to be had recourse to, with so many restrictions as almost to amount to a prohibition of its use. At all events, we may hope that the time has already arrived, at least for the more enlightened of our profession, when even those who still adhere to the practice in particular cases, will not rashly prescribe bleeding in all instances of cerebral compression, where, if it be had recourse to before a reac- tion has set in, it may destroy the patient, either by causing him to sink under it, or by producing effusion, if that has not already taken place, or by increasing it if it has. ACUTE INFLAMMATION OF THE SPINAL CORD AND ITS MEMBRANES. Myelitis. Meningitis spinalis. This affection is indicated by pain, more or less severe, in some cases of an intermittent character, either confined to the lumbar, dorsal, or cervical region, or embracing the entire length of the spine. The pain is aggravated by the slightest movement, and an exalted sensibility of various parts of the cutaneous surface is often perceptible from the dread and shrinking which the patient exhibits at the slightest touch. Sharp pain at the epigastrium, sometimes spreading over the whole of the abdominal region, and increased on pressure; palpitation of the heart, sensation of constriction and weight in the fore part of the chest, with oppressed respiration; small, quick, hard pulse,—are symp- toms which are generally encountered in the course of the disorder. When the inflammation occupies only a part of the cord, the symp- toms vary according to its locality. Thus, when the commencement, or the cervical portion is principally affected, strabismus, spasm of the pharynx, trismus with loss of voice, spasm, or other abnormal condi- tions of the muscles of the neck, chest, and superior extremities, with general clonic convulsions, declare themselves. When the dorsal portion of the cord is the seat of the inflammation, opisthotonos usually results ; and when that of the lumbar region is attacked, retention of urine, or paralytic or spasmodic affections of the pelvic viscera generally, are met with. In each of the latter cases, the inferior extremities are commonly convulsed or paralysed. When the membranes of the cord are principally or solely affected, the sensibility of the surface is said to be always increased, and the spasms more frequently general, and of a tonic character. While in inflammation confined to the substance of the cord, the sensibility is usually lessened, the muscles of the extremities are affected with clonic spasm or paralysis, and only those of the back in a state of tonic contraction. In the former, moreover, the bowels are for the most part constipated,—while in the latter, diarrhoea has almost uniformly been found to predominate. Finally, according as the power of motion or the sensibility is abnormally altered, so it may be concluded will the anterior or posterior columns of the spinal cord form the seat of the inflammation. Causes.__Exposure to cold and damp, and external injuries, appear to form the leading exciting causes of this inflammation. 326 NERVOUS SYSTEM. Chronic Inflammation of the spinal cord and its coverings is generally accompanied with a trivial degree of local pain, and its prominent features chiefly consist in derangement of the functions of the viscera, deprivation or diminution of the sense of feeling, paralysis, cramp, and emaciation. The chronic variety is even more dangerous than the acute. The disease, when confined to the substance of the cord, may termi- nate in softening (ramollissement); induration; suppuration; gan- grene ; in effusions of serum, pus, or blood; or thickenening of their structure, when the membranes have been the seat of the inflammation. Therapeutics.—Aconitum must be prescribed in repeated doses, in all cases where the accompanying feArer is intense; and on the comple- tion of its beneficial action, recourse must be had to Belladonna, Dulca- mara, Arsenicum, Digitalis, Pulsatilla, Bryonia, Nux v., Cocculus, Rhus, Ignatia, Opium, Veratrum,—according to the portion of the cord which is evidently attacked. Belladonna is the most important remedy when the upper part is the seat of the disorder. If, from the invasion of delirium, &c, there is some reason to apprehend an extension of the inflammation to the brain, this remedy will still be the most appropriate, and, indeed, that on which we must rest our chief hope in so serious a complication of a malady sufficiently dangerous in its simple form. Hyoscyamus, Stra- monium, Bryonia, Zincum (particularly with signs of threatening paralysis of the brain,) and in some instances Sulphur may, however, be found necessary and prove useful in warding off a fatal result. (Vide Phrenitis.) Dulcamara1 may follow Aconitum and Belladonna, when the more acute symptoms of myelitis have been removed, and particu- larly Avhen the disease has been excited by exposure to cold and wet. Arsenicum, Pulsatilla, and Digitalis have been recommended as use- ful auxiliary remedies, when the thoracic viscera are prominently affected, evidenced by laborious and anxious respiration, palpitation of the heart, &c. ; and Veratrum, Nux v., Cocculus, and Ignatia when the abdominal viscera are seized with coldness and spasms. Should opisthotonos result from inflammation of the dorsal division of the cord: Belladonna, Rhus, Ignatia, and Opium are chiefly to be recommended. Again, when the inflammation is restricted to the lumbar portion of the cord: Nux v., Cocculus, Digitalis, and Bryonia; or Pulsatilla, Rhus, Veratrum, and Sulphur. In general tonic spasms resulting from inflammation of the entire cord, or rather its enveloping membranes,—Belladonna, Lachesis, Hyoscyamus, Opium, Natrum m., and Ignatia are the remedies from which, in general cases, we may expect to derive the greatest benefit. Arnica, Hyoscyamus, and Opium may claim a preference in myelitis arising from external injury ; but we must be guided in our selection by the nature of the symptoms, and not hesitate to have recourse to one or more of the above-mentioned medi- cines if called for. (Vide Hydrophobia and Tetanus.) In the chronic form of the malady, the medicines from which the most benefit may be 1 Rhus is perhaps still more appropriate than Dulcamara in such cases. The instances in which the latter remedy has been reported to have acted beneficially are involved in some degree of obscurity. PALSY — TETANUS. 327 looked for, when the disease has not reached an irremediable stage, are, in addition to most of those required in the acute variety,—Sulphur, Silicea, Lachesis, Baryta c, Stannum, &c. PALSY. PARALYSIS. This affection consists in the abolition or diminution of the power of voluntary motion. It usually comes on suddenly, but in some instances it is preceded by numbness, coldness, paleness, and slight convulsive jerking or twitching in the parts affected. The treatment must be re- gulated according to the originating cause. When it results from apo- plexy, see that article. When we find it occurring as a sequel of rheu- matism : Arnica, Ferrum, Ruta,—as also Bryonia, Rhus, Lycopodium, Sulphur, Silicea, &c. When in consequence of debility from loss of fluids : China, Ferrum, Baryta c, and Sulphur. From the sudden sup- pression of an eruption, or of a wonted discharge : Sulphur, Lachesis, &c. And when it is attributable to exposure to the fumes of lead, or the frequent handling of white-lead: Opium and Belladonna ; or Pla- tina, Alumina, Pulsatilla, and Nux v. (These remedies are equally useful in Lead Colic, Colic of Painters, Colic of Poictou, colica saturnina, colica pictonum, colica plumbariorum s. pictorum, colica damnoniorum.) With reference to the parts Avhich are affected with the disorder: Belladonna, Graphites, and Causticum are chiefly recommended in paralysis of the facial muscles. Belladonna, Opium, Hyoscyamus, Stramonium, Lachesis, and Graphites, in that of the tongue. Bella- donna, Nux v., Cocculus, Lycopodium, Calcarea, Silicea, Opium, Zincum, Ruta, &c, in paralysis of the upper extremities. And in that of the inferior extremities: Cocculus, Nux v., Opium, Sulphur, Silicea, Stan- num, and Oleander principally. Electricity or galvanism {electro-magnetism), in moderation, is fre- quently of considerable service in facilitating the cure, or, at all events, in promoting improvement in obstinate cases, and particularly when painful jerkings or twitchings frequently take place in the affected parts. TETANUS. This is a disease characterized by a general spastic rigidity of the muscles. Its varieties are Trismus, the lock-jaw. Opisthotonos,— which is the most common,—when the body is drawn or bent back- wards by the spasmodic contraction of the muscles, sometimes to such a degree that the occiput touches the heels. Emprosthotonos, when the body is bent forwards; a rare form of the disease. Pleuros- THOTONOS, in which the body is bent to one side; a still more rare variety. . ,.,. The disorder is chiefly occasioned either by exposure to cold (idio- pathic tetanus), or by some irritation of the nerves resulting from local injury, particularly of tendinous parts (traumatic tetanus). It is of much more frequent occurrence in warm than in cold climates. In this 328 NERVOUS SYSTEM. and in other climates the amputation of a limb, or the twitching of a nerve by a ligature, are not unfrequent sources of its occurrence. When it takes place in consequence of such a cause, or of any other ex- ternal lesion, the symptoms generally set in about the eighth day, and sometimes later ; but when it supervenes on exposure to cold, they usually declare themselves much earlier. In some cases the attack comes on suddenly, and with extreme violence ; but it more generally approaches in a gradual manner; a slight stiffness being at first expe- rienced in the back part of the neck, together with an uneasy sensation at the root of the tongue, and a difficulty in performing the act of deglu- tition, an oppressive tightness is complained of in the chest, with a pain at the inferior extremity of the sternum, or the scrobiculus cordis, ex- tending into the back; the respiration is impeded; the countenance pale, pulse small, bowels constipated, and urine high-coloured; a stiff- ness also takes place in the lower jaw, which ere long increases to such an extent, and compresses the jaws so closely and firmly, that the smallest opening is unattainable, and the patient is now afflicted with Avhat is termed lock-jaw. In some instances the spasmodic contractions proceed no further ; in others they return with great frequency and in- creased severity, and also extend to the arms, the abdominal muscles, the back, and inferior extremities, so as to bend the body forcibly in one or other of the directions before stated. Finally, the arms, lower extremities, head, and trunk become rigidly extended from an equi- poised spasmodic action of the flexor and extensor muscles. The tongue is also seized with spasm, and is, not unfrequently, injured by the teeth becoming clenched together, just as it happens to be convul- sively darted out. As the affection advances, the eyes become fixed and immovable, the whole countenance frightfully distorted and expressive of extreme anguish, the pulse irregular, the strength completely exhausted, and a termination is put to the sufferings, generally about the fourth day in acute cases, by one concentrated spasm. In some cases the fatal ter- mination is protracted considerably beyond the stated period. The spasmodic action does not continue unremittingly, the muscular contractions occasionally admitting of some abatement, but is generally immediately renewed as soon as the patient makes an effort to speak, drink, or change his posture. Therapeutics.—The remedies which have chiefly been used in homoeopathy, in the treatment of this distressing disease, are: Bella- donna, Stramonium, Cicuta virosa, Arnica, Opium, Hyoscyamus, Angustura, Rhus, Ignatia, Lachesis, Natrum muriaticum, Mercurius, Aconitum, Sulphur, Veratrum, Phosphorus, Camphor, Staphysagria, and Moschus. Belladonna is one of the most important of these, particularly in idiopathic tetanus, properly so called, or in trismus; it has also proved useful in the traumatic variety after the previous employment of Arnica. It is principally indicated when a sensation of constriction is experienced in the throat, Avith tightness at the chest, grinding of the teeth, spas- modic clenching of the jaws, distortion of the mouth, foaming, obstructed deglutition, and a renewal or exacerbation of the paroxysms on attempt- DELIRIUM tremens. 329 ing to drink. In some cases of trismus the alternate use of Belladonna and Lachesis, or Belladonna, Angustura, and Cieuta virosa has been found necessary; and of Belladonna, Lachesis, Hyoscyamus, and Stra- monium, or Opium, Rhus, and Belladonna, in opisthotonos. Arnica Montana.—In cases of traumatic tetanus, which is by far the most fatal variety, this remedy is, in most instances, the most appropri- ate to commence with, and should, in addition to its internal use, be applied externally, in the form of an extremely weak lotion (about a teaspoonful or a drachm to half a pint of water). Should symptoms of improvement not set in in twenty-four to forty-eight hours, Opium and Hyoscyamus must be had recourse to. Any local irritation which may seem to have excited the disease ought, at the same time, if possible, to be carefully removed. Opium has proved extremely useful in some of the severest forms of opisthotonos arising from cold; but, as above stated, it is also valuable in traumatic tetanus. (Likewise in tetanus from fright.) Rhus and Ignatia have been found very efficacious in severe cases of opisthotonos, in which the body has been bent up in the form of an arch, and on some occasions with the back of the head touching the heels, Avhen the complaint has arisen from terror. Mercurius has frequently succeeded in curing inflammatory trismus, with swelling of the angle of the lower jaw, and tension of the muscles of the throat and neck, from cold. These are a few general indications for the employment of the fore- going medicines. The following may also prove serviceable in various forms of tetanus: Aconitum, Sulphur, Veratrum, Phosphorus, Cam- phora, Staphysagria, Moschus, Bryonia, Nux, Platina, Ipecacuanha, Secale cornutum, Cannabis indica, Cantharides, Cieuta virosa, Cina, Rhus toxicodendron, Gratiola, Stannum; but considerable care must necessarily be bestowed on the selection of the proper remedy. When, from the spasmodic clenching of the jaws, it is found impossi- ble to introduce the medicine into the mouth, the effect of olfaction must be tried; it has also been found useful to moisten the lips and nostrils Avith the medicine dissolved or diluted in water; and in some cases, the administration of the remedy in the form of enema (a feAV drops to an ounce or two of water) has been found very efficacious. (See also Hydrophobia, Hysteria, and Myelitis.) DELIRIUM TREMENS POTATORUM. This malady consists of an affection of the brain, and is nearly pecu- liar to drunkards, hence its name. There are a few instances on record, in which it has arisen from exhaustion caused by excessive depletion; from the effects of lead, and also from the prolonged use of opium. The intemperate use of ardent spirits, vinous or strong malt liquors, is, hoAvever, beyond comparison, the exciting cause in by far the major number of instances. The disease generally comes on in drunkards, during the state of prostration which ensues Avhen they have in a great measure given up, or been suddenly deprived of, their accustomed stimulus. 330 NERVOUS SYSTEM. The first symptoms of the malady are generally indicated by extreme irritability of temper, weakness of memory, but constant activity of mind, anxiety, and uncontrollable restlessness with increased muscular mobility. The appetite is often pretty good, but more frequently impaired in consequence of the previous habits, and the tongue is sometimes foul but moist. Soon after these premonitory signs, vigilance sets in, and little or no sleep can be obtained; or it is unrefreshing and disturbed by frightful dreams, imaginary visions and sounds. Fixed ideas then take firm possession of the patient's mind, such as the supposition that some one is bent upon poisoning him or doing him some other grievous injury, &c, yet he generally dreads being alone. The speech is fre- quently stuttering and inarticulate ; the countenance quick, wild, and exceedingly variable, according to the prevailing impression on the mind; the face in most cases pale or sallow ; the eye rolling, expres- sive, and restless, and the conjunctiva blanched ; the skin damp, or covered with sweat, chilly and relaxed, very rarely above the natural temperature; the hands are commonly tremulous, and muscular twitch- ings are often observable. As the disease advances, sleep is completely banished; loquacity, with perpetual bustling occupation, becomes inces- sant ; and eventually, when it is fully developed, delirium supervenes. The pulse is soft and compressible, and rarely quick when unruffled by the struggles or exertions of the patient—for his corporal activity keeps pace with the restlessness of his mind, and it is difficult to confine him to his bed or apartment; at the same time, exhaustion is liable to come on very rapidly after great exertion, and the patient is prone to drop down from fatigue. Occasionally, convulsions take place, but though sometimes serious, they are usually not of a fatal character. The his- tory of the case, together with the distinctive nature of most of the above-described symptoms, enables us to discriminate between this dis- order and that of inflammation of the brain or its membranes. Therapeutics.—Nux v., Opium (provided of course, the attack has not been excited by the effects of Opium or its alkaloid, in large doses), Aconitum, Belladonna, Lachesis, Hyoscyamus, Sulphur and Calc, form our main remedial agents. Nux v. is particularly useful in the first stage of the disorder, and may frequently be the means of arresting its further progress, when administered at that period. The dose repeated in from six, to twelve, or twenty-four hours, according to the effects produced. But when the disease has become fairly established, and the patient is affected with delirium or convulsions, and we find an aggravated degree of all the symptoms remarked at the commencement of the attack, we must have recourse to Opium, in frequently repeated doses. The curative properties of this drug, in the malady under considera- tion, do not, as is erroneously supposed by the majority of allopathic practitioners, arise from its property of producing sleep, but from its homoeopathicity, or specificity, if I may use the expressions; the patho- genetic effects which it produces being exactly similar to those symp- toms Avhich are developed in the course of the disease as it occurs in drunkards. DELIRIUM tremens. 331 In some cases, particularly where the patient exhibits extreme irrita- bility of temper, with more or less derangement of the digestive func- tions, considerable advantage will be obtained from the alternate employ- ment of Nux v. and Opium. In some rarer varieties of the affection, Avhich are more liable to occur in young, robust, or plethoric subjects, we meet with symptoms indica- tive of active cerebral congestion, which call for the administration of a dose or two of Aconite, followed in a few hours by Belladonna, or by Belladonna and Lachesis alternately, if only partial benefit is obtained from the action of Belladonna alone, and the trembling of the hands and arms forms a very prominent symptom. Hyoscyamus may be pre- scribed in preference to Belladonna, when the patient's insanity is more particularly apparent in the exhibition of excessive and uncalled- for jealousy. In extremely obstinate attacks, Sulphur, Opium, and Nux v., may be given in alternation, at longer or shorter intervals according to the greater or less severity of the symptoms. Calcarea is also a remedy of considerable importance in such cases, but more especially when they occur in plethoric or lymphatic habits. Finally,—Stramonium may be mentioned as likely to be useful when Belladonna, Hyoscyamus, and even Opium fail to do much good, and the spasms or convulsions are very severe. Coffea and Camphora have also been named as likely to prove serviceable against the vigilance, or the mental and bodily activity above described, Avhen the remedies already enumerated fail to answer the purpose required. But it may safely be averred, that there are few instances in which Nux v., and Opium, Avhen timely administered, Avill not succeed in subduing the more violent features of the disease ; and Sulphur, Opium, Nux v., and Calcarea, in removing any inveterate sequelae. These medicines, together Avith Arsenicum and Acid, sul- phuricum1 administered at interArals of from four to eight days, have also been recommended as useful in correcting the vice, Avhich gives rise to this disease as ordinarily met with.2 Delirium tremens arising from 1 In the morning sickness of drunkards, Acidum sulphuricum is a most useful medica- ment.—Gr. u. St. h. Arch., 1. 1, 173. 2 Dr. Hering, of Philadelphia, recommends, in the case of inveterate drunkards, a drop of sulphuric acid in a tumbler of water, early in the morning, every two or three days, until disagreeable symptoms arise ; in the event of which he orders the patient to smell camphor frequently. When the drunkard has an unconquerable craving for liquor, he advises his friends or relatives to proceed as follows: " Take pure sulphuric acid, mix it with a large proportion of water so that it may taste only slightly acid, and give the mixture to the patient in everything he eats or drinks, and that as liberally and as fre- quently as possible, although others should occasionally or even constantly have to participate in his meals, &c. ; mix it especially in acidulated sauces or lemonade. If it impairs the digestion, give tea made of bitter herbs, roots, or oranges, continuing the sulphuric acid at the same time, but ceasing as soon as the mouth becomes sore. Should obstinate diarrhoea, protracted derangement of the stomach, vomiting, and giddiness result, give Pulsatilla; if bad ulcers form in the mouth, give Mercurius vivus." Schreiber's method of attempting to cure the pernicious habit, consists in locking the patient up by himself, allowing him to drink brandy mixed with one-third part of water ad libitum, and adding one-third part of brandy to every other liquid, and all the food the patient par- takes of. Although intoxication may be the result of this procedure, during the first day or two, still, the subsequent disgust which takes place (generally about the fifth day) commonly puts a stop to further relish for the intoxicating beverage. Carbo v. has recently been suggested as likely to be of service in some cases of delirium tremens. (Allg. Horn. Zeit, No. 1, 33 Bd.) 332 NERVOUS SYSTEM. exposure to the vapour of lead, chiefly requires Opium, Belladonna, and Nux v.; and that from poisonous doses of Opium, is mainly to be sub- dued by Nux v., and Belladonna. EPILEPSY. Epilepsia. Morbus sacer. Morbus caducus. Morbus divinus. Morbus herculeus. Morbus comitialis. This is a malady which consists of clonic spasms, or convulsions, with loss of consciousness and voluntary motion, and generally foaming at the mouth. It comes on by fits, and is usually characterized by the suddenness of the attack, although it is occasionally preceded by pain in the head, dimness of vision, flashes or sparks of fire, tinnitus aurium, palpita- tions, flatulency, and languor ; or, by a peculiar feeling, partaking partly of pain, and partly of a sense of cold, commencing in some remote part of the body, as in the toes, abdomen, or fingers, and proceeding gradually upAvards towards the heart or head. {Aura epileptica.) During the paroxysm, the muscles of one-half of the body are commonly more severely agitated than those of the other, and those concerned in the performance of respiration are ahvays more or less implicated ; the eyes are hideously convulsed, and turned in various directions, but at length become fixed, so that the whites of them alone are seen; the fingers are firmly clenched, and the muscles of the jaws are often spasmodically affected, in consequence of which the tongue is sometimes lacerated by being thrust out immediately before the sudden and violent approxima- tion of the teeth; the mouth is frequently filled with phlegm, which is expelled with considerable force in a frothy state. The face is either of a dark-red or livid colour, or it is pale, or alternately pale and red, or pale one side and red on the other. The faeces and urine are sometimes passed involuntarily. Oh the abatement of the spasms the patient gradually recovers. Sometimes a fit of vomiting terminates the attack. The memory and judgment are generally somewhat impaired for some little time after the fit, and a sensation of languor and exhaustion, or weight and other uncomfortable feelings in the head, are complained of. Comparatively few patients are carried off during a fit, but it sometimes happens that one fit succeeds another in rapid succession, or with in- creasing intensity, until a comatose state ensues, and the patient sinks. Idiotcy is an occasional melancholy result of this distressing malady. The prognosis is more or less favourable according to the age of the patient and the species of the epilepsy. When the disease occurs before the age of puberty, or when purely sympathetic, it is generally curable without much difficulty by means of homoeopathic remedies. On the other hand, when it comes on after the age of puberty, is idiopathic, or of hereditary origin, and has been of long duration, the cure is not easily accomplished. It is generally possible, however, even in the most inveterate cases, to lengthen the intervals between the attacks, and to mitigate their violence by means of steady and judicious treatment. Therapeutics.—This must be regulated by the character and causes as well as by the symptoms of the malady; the latter guiding us in the epilepsy. 333 selection of one from amongst a class of remedies. When the disease proceeds from plethora with determination of blood to the head, Aeon., Bella., Op., Nux v., Puis., Bry., Merc, Ign., Sulph., Veratr., Silie, are the most effective remedies. (See Congestio ad caput.) When from debility, caused by loss of humours (hemorrhage, venereal excess, mas- turbation, &c): China, Phosph., Ac. phosph., Nux, Sulph., Calc, Staph., Sil., principally. When from the irritation of worms: Hyos., Bella., Cine, Cina., Merc, Sulph. (See Invermination.) When from that of teething: Bella., Cham., Cina., Ign., Sulph., Calc, Stann. (See Dentition and Convulsions in Children.) When from hysteri- cal affections {Epilepsia uterina): Bella., Plat., Sep., Ign., Sulph., Mosch., Nux, Cocc, Veratr., Puis., Aur., Magn., Magn. m., See. corn., Stram., Hyos., Ac. hydroc. (See Hysteria and Metritis.) When from the retropulsion of an eruption : Sulph., Calc, Sil., Ipecac, Tart., Bry., Lach., Nux v., Stram. From the abuse of intoxicating drinks, or narcotics—as wine, spirits, tobacco, opium, malt liquor (adul- terated) : Nux v., Lach., Ign., Bell., Hyos., Cupr., Cham., Op., Calc, &c. From exposure to the fumes of arsenic and copper: Camph., Cup., Merc, Ipecac, Chin., Nux v., Veratr., Ars. To those of Mercury, Stra- monium chiefly, in the first place. From checked perspiration: Cham., Sulph., Aeon., Bella., Nux v., Lach., Cie, Sil., Chin., &c. From moral causes, such as fright, fear, &c.: Artem., Op., Aeon., Cham., Hyos., Nux v., Plat., Cupr. (See Moral Emotions.) From crudities of the stomach: Ipec, Nux v., Puis., &c (See Dyspepsia and De- rangement of Stomach.) And when from an injury of the head {Epi- lepsia traumatica)'. Arnica, Aeon., Aug., Cie; Bella., Rhus, Sulph. An operation may sometimes be necessary to remove the source of the irritation, particularly when we have reason to apprehend that a spi- cula or morbid growth of bone is pressing upon the brain. In recent cases of idiopathic epilepsy, either attacking suddenly with- out manifest cause {Epilepsia cerebralis), or preceded by a peculiar and disagreeable or painful sensation ascending from some part of the body {Epilepsia sympathica), Bella., Hyos., Ignatia, Nux v., Op., Cocculus, &c, are most frequently indicated; and those which are chronic: Sul- phur, Calcarea carbonica, Silicea, and Cuprum chiefly ; but also Bell., Lach., Hep., Stann., Stram., Ars., Agar., Camph., Mere, &c., and likeAvise the others which have been named as the more appropriate in ordinary cases of recent origin. The following are amongst the leading indications for these remedies : Belladonna :—Commencement of the attack with a sensation of crawling and torpor in the upper extremities; jerking of the limbs espe- cially of the arms, convulsive movements of the mouth, muscles of the face and eyes; congestion in the head, with vertigo, deep redness, heat and bloatedness of the face, or paleness and coldness of the face, with shivering : photophobia; convulsed or fixed eyes ; dilated pupil; cramps in the larynx and throat, with obstructed deglutition and danger of suffocation; foam at the mouth; unnoticed emission of faeces (and of urine), or loose evacuation of ingesta; oppression on the chest and anx- ious respiration ; renewal of the fits on the slightest contact or the least contradiction ; dizziness or complete loss of consciousness ; sleeplessness 334 NERVOUS SYSTEM. between the fits, with agitation and tossing, or deep and lethargic sleep, with smiles and grimaces ; waking with a start, with cries. (Compare Avith Cham., Hyos., Ign., Op., Stram.) Cuprum :—Commencement of the paroxysm in the fingers or toes, or in the arms; retraction of the thumbs ; loss of consciousness and of speech; salivation, sometimes frothy ; redness of the face and eyes; re- currence of the fits every month, and especially at the catamenia. Hyoscyamus:—Bluish colour and bloatedness of the face, and foam at the mouth, prominent eyes ; convulsive movements of certain limbs, or of the whole body ; violent jactitation ; retraction of the thumbs ; renewal of the fits, on endeavouring to swallow the least drop of liquid; cries, grinding of the teeth; loss of consciousness; unnoticed emission of urine; cerebral congestion ; deep and lethargic sleep, with snoring. (See Bell. and Op.) Ignatia:—Convulsive movements of the limbs, eyes, eyelids, muscles of the face and lips ; throwing back of the head ; retraction of the thumbs ; red and bluish face, or redness of one side and paleness of the other, or paleness and redness alternately ; frothy salivation ; spasms in the throat and larynx, with threatening suffocation and difficult deglutition, loss of consciousness; frequent yawning, or drowsy sleep, great anxiety and deep sighs between or before the attacks; daily paroxysms. Lachesis :—Loud cries, falling, and loss of consciousness, foaming at the mouth, cold feet, eructations, pale face, vertigo, heaviness and pain in the head, palpitatio cordis, distended abdomen, coma somno- lentum, nausea, &c. Nux vomica :—Shrieks, throwing back of the head, trembling or con- vulsive jerks of the limbs or muscles; renewal of the fits after contra- diction or an angry emotion; unnoticed evacuation of faeces and urine; sensation of torpor and numbness of the limbs; vomiting, profuse perspiration, constipation, ill-humour and irascibility between the attacks. Opium :—Occurrence of the fits at night or in the evening ; throwing back of the head, or violent movements of the limbs, especially of the arms; loss of consciousness, insensibility, cries ; closed fists ; threatening suffocation ; deep and lethargic sleep after or between the paroxysms. (See Bell., Hyos., Ign.) Stramonium :—ThroAving back of the head, or convulsive movements of the limbs, and especially of the upper part of the body and of the abdomen ; pale and haggard face, with stupid expression, or redness and bloatedness of the face, loss of consciousness and of sensation, some- times with cries, &c, renewal of the fits by contact, and also by the sight of bright and brilliant objects. (See Bell.) Arsenicum—Chiefly when the fits are attended with burning in the stomach, vertebrae, and abdomen. Sulphur:—Chronic epilepsy, often preceded by a sensation as if a mouse, or some other small animal, were running over the muscles, cries, stiffness of the body, fits excited by cool air, or by a current of air. {Bella, is very useful before or after Sulph. in some cases.) Calcarea :—Especially when the fits occur at night, and in chronic cases. (After Sulph.) NEURALGIA. 335 Silicea is chiefly useful in chronic epilepsy. (After Calc.) Camphora—against epilepsy, with snoring, red and puffed face, coma somnolentum. Cicuta :—Paleness, or yellowish colour of the face, trismus, distor- tion of the limbs, cries and frothy salivation, colic, as if caused by worms, &c. Cocculus—especially in women during the catamenia, or also from a traumatic cause. Mercurius :—Cries, rigidity of the body, distension of the abdomen, itching in the nose, thirst, and nocturnal attacks. Stannum :—Jactitation of the limbs, retraction of the thumbs, pale- ness of the face, backward traction of the head, loss of consciousness, appearance of the fits in the evening. Veratrum :—Loss of sense and movement, distortion of the eyes, and convulsive movements of the eyelids; anguish, discouragement and despair, between the fits. During the epileptic seizure or paroxysms, the patient should be placed in the horizontal posture, and such precautions taken as will obviate any injury which may be sustained by the violence of the convulsive movements. In order to prevent any lesion of the tongue, something ought to be inserted between the teeth. The neckcloth should be removed, the stays loosened, and cold water sprinkled over the face, especially when the breathing is much affected by the spasms of the muscles concerned in respiration. A dose of Aconite, followed by Belladonna if relief be not speedily obtained, is necessary, when the fit occurs in plethoric subjects, and is attended with strongly marked signs of congestion of the vessels of the head and neck. The diet of epileptic patients ought to be very moderate, simple, and easy of digestion. Stimulants ought to be strictly avoided Avhere there is plethora, with tendency to congestion. Debilitated persons require a somewhat more generous diet than the robust, but in all cases care should be taken never to overload the stomach. Excessive cor- poral or mental exertion must be abstained from. nerve-pain, face-ache, face-ague. Neuralgia. Neuralgia facialis. Tic douloureux. Prosopalgia. This distressing malady consists in an excruciating pain, which has its most frequent seat in the branches of the fifth pair of nerves, and is accordingly experienced with great acuteness under the eye, and sometimes before the ear, from whence it shoots over the entire half of the face and frequently into the orbit and cranium. The paroxysms occasionally continue, with shorter or longer intervals, for several days or weeks in succession. The disease is, unfortunately, generally of great obstinacy, and, in some melancholy instances, utterly incurable. When the malady is symptomatic, remedies which are appropriate to the primary disease must be had recourse to. Thus, when from derange- ment of the digestive functions, Nux vomica, Pulsatilla, Bryonia, Cha- momilla, Ipecacuanha or Lycopodium, will usually prove the most ser- 336 NERVOUS SYSTEM. viceable medicines. When arising from or connected with uterine disease: Nux v., Puis., Plat., China, Ignatia, Bella. When connected with, or arising from invermination: Spigelia, Bella., Cina, Graph., Ferr., Stann., Sulph., chiefly. In Rheumatic face-ache, or prosopalgia,—Aconitum, Bryonia, Rhus, Mercurius, Phosphorus, Pulsatilla, Mezereum, Sulphur, Nux v., Lachesis, &c, are the remedies that have generally proved the most effectual. In Arthritic,—Nux v., Rhus, Colocynth, Mercurius, Causticum, &c. In Neuralgia, with Inflammation of the Neurilemma : Aeon., Bella., Bryon., principally; or, Merc, Phosph., Staph., Sulph., Am.; or, Spig., Lach., Plat., Veratr., Baryta e, Thuja. Face-ache from the effects of Mercury chiefly requires the employ- ment of Aurum, Hepar, Bella., Carbo v., Sulphur, China, Mezereum, &c. That from periostitis in the vicinity of the affected nerves : Aeon., Bella., Puis., Mez., Bry., Ruta, Aurum, Silicea, chiefly; and that which appears to arise from enlargement of a bone : Sulph., Calc, Silie, Aurum, Assa., Mez., Acid, nitr., &c. (See Bones, Diseases of the.) When Neuralgia facialis is attended with purulent discharge from the nose and thickening of the schneiderian membrane, or with obstruction of the lachrymal duct: Aurum, Lach., Petrol., Silie, Ars., Marum verum, kc.; and when nerve-pain has resulted from external injuries, such as accidents or surgical operations, Am., Aeon., Rhus, Calendula, are the medicaments which are chiefly to be relied on. In neuralgia occurring in young, plethoric persons: Aconitum and Belladonna ; or Calc, Phosph., Plat., Lach. That in nervous persons : Bella., Lach., Spigel., Plat. ; and that in excessively debilitated con- stitutions : Cinchona and Ferrum. When the sacro-sciatic nerve is the seat of the neuralgia: Aconitum, Chamomilla, Ignatia, Nux v., Pulsa- tilla, Colocynth, and Rhus are, in general, the most efficacious medicines. (See Sciatica.) Finally, in prosopalgia generally, the following have proved more or less useful; Aconitum, Arnica, Verbascum, Sulphur, Calcarea, Capsi- cum, Pulsatilla, Stannum, Conium, Thuja, Baryta e, Coffea, Kali, Camphora, Electro-magnetismus, &c In idiopathic neuralgia facialis or tic douloureux, the remedies which have hitherto been employed in homoeopathic practice with the most success are : Belladonna, Platina, Lycopodium, Colocynth, Arsenicum, China, Mezereum, Veratrum, Mags, are, Sulphur, &c. Belladonna.—When the pain chiefly pursues the course of the infra- orbitary nerve, but sometimes also the other branches of the fifth, and is prone to be excited, by rubbing the usual seat of the sufferings ; dart- ing pains in the cheek-bones, nose, jaws, or zygomatic process ; or cutting and tensive pains, with stiffness at the nape of the neck, and clenching of the jaws; tAvitches in the eyelid, or violent shooting and tearing and dragging pains in the ball of the eye ; jerking pains in the facial muscles, and mouth; heat and redness of the face. The pain is generally pre- ceded by itching and creeping in the affected side of the face, and at times becomes so severe as to be almost insupportable. Platina :—Feeling of coldness and torpor in the affected side of the NEURALGIA. 337 face, with severe spasmodic pain, or tensive pressure in the zygomatic process, with a sensation of creeping or craAvling, and aggravation or renewal of the sufferings in the evening, and when in a state of rest; lachrymation ; redness of the face, &c. Lycopodium is often useful when the symptoms are much the same as described under the preceding remedy, with the exception of the torpor and creeping, and particularly when the right side of the face is the part affected. Colocynth :—Violent rending and darting pains, which chiefly occupy the left side of the face, are aggravated by the slightest touch, and extend to all parts of the head, temples, nose, ears, teeth, &c. Arsenicum :—When there is a tendency to periodicity in the attacks or paroxysms, and the pains partake, more especially, of a burning, pricking, and rending character, and are experienced chiefly around the eye, and occasionally in the temples: the sufferings being occasionally of so severe a description as almost to drive the patient distracted; great anguish; excessive prostration, with desire for the recumbent posture ; sensation of coldness in the affected parts ; exacerbation during repose, from fatigue, in the evening, when in bed, or after a meal; tem- porary melioration from external heat. China :—When, as in the instance of the foregoing remedy, there is a tendency to periodicity in the attacks, and when the pains are exces- sive, attended with extreme sensibility of the skin, and consequent aggravation from the slightest touch; sensation of torpor and paralytic weakness in the affected part; great loquacity, with ill humour, pale- ness of the face, frequently followed by or alternated with redness and transient heat of the face. Mezereum.—Pains which occupy the left zygomatic process, chiefly of a spasmodic stupefying description, and extending to the eye, temple, ear, teeth, neck, and shoulder, with exacerbation from partaking of warm food or drink, or on coming into a warm room after being in the open air. Veratrum.—Insupportable pains which almost drive the patient to distraction ; excessive weakness even to fainting; general chilliness, exacerbation of suffering on getting warm in bed, or towards morning; temporary relief on moving about. Assafcetida may generally be prescribed with decided benefit Avhen the pain is chiefly of a dull, subdued description, and occurs intermit- tingly ; but also Avhen it partakes of a burning or shooting character, and proceeds from within outwards. Spigelia is frequently a useful palliative remedy in all cases when the pain is excessive ; but is more especially required when the pains are of a jerking, tearing character, exacerbated by the slightest touch or by movement of the affected parts ; or when they appear to shoot from the centre of the brain to the sides of the head or the ears ; further, when the pains partake of a burning and pressive aching cha- racter, and have their seat in the zygomatic process; glossy tumefac- tion of the affected side of the face; excessive agitation and anguish. In other cases: Lachesis, Phosphorus, Hyoscyamus, Mags, arc, Oleand., Verb., Graph., Kali, Con., Ruta, Anae, Baryta e Magn. 338 NERVOUS SYSTEM. m., Manganum, Mere, Rhus, Ignatia, Arnica, Capsicum, Staphysagria, Coffea, &c, may be found useful. HEADACHE. Cephalalgia. Cephaloea. Cephalalgia arthritica. Cephalalgia nervosa. Hemicrania (megrim). Clavus hystericus. Headache is often but symptomatic of disease, and, in such cases, is only to be cured by the removal of the primary affection. When, there- fore, it arises from derangement of the stomach, or dyspepsia, consti- pation, cold in the head, mental emotions, congestion of blood in the vessels of the head, &c, the remedies most appropriate to the treatment of these different disorders must be had recourse to. In the treatment of nervous headaches, hemicrania, or megrim, the following remedies have generally been found the most useful: Nux v., Veratrum, Colocynth, Pulsatilla, Sepia, Ignatia, Bryonia, Rhus, Ipe- cacuanha, Chamomilla, Coffea, Hepar, China, Cieuta, Belladonna, Arsenicum, Arnica, Acid, nitr., Petroleum, Sulphur, Silicea, Platina, Causticum, Graphites, Natrum m., Phosphorus, Zincum, &c. Rheu- matic headaches: Aconitum, Chamomilla, Mercurius, Nux v., Pulsa- tilla, Lycopodium, Spigelia, Sulphur, Bryonia, Belladonna, China, Ignatia, Phosphorus, &c. (In fugitive rheumatic pains in the head, or pains which are aggravated by movement and at night, and are attended with sensibility to the touch, fits of vomiting, and frequent sweating, Nux v., followed by Cham, and Puis.) Arthritic: Ipecac, Ignatia, Nux v., Coloc, Bryonia, Belladonna, Sepia, Ignatia, Veratrum, &c. Hysterical: Ignatia, Moschus, Platina, Veratrum, Valeriana, Sepia, Aurum, Acid, nitricum, Magnesia c. et m., Cocculus, Phosphorus, &c. Against headaches occurring in extremely sensitive individuals : Aconi- tum, Ignatia, Chamomilla, Coffea, Spigelia, Veratrum, Cina, or Ipeca- cuanha, have usually proved the most appropriate. Headaches arising from the habitual use of coffee are generally curable by means of Nux v., Chamomilla, or Ignatia. From gastric derangement: Pulsatilla, Antimonium crudum, Ipecacuanha, Nux v., Sulphur, Bryonia, Coccu- lus, Carbo v., or Nux moschata. From constipation: Bryonia, Nux v., Opium, Conium, or Veratrum. And those from long-continued exces- sive mental application: Nux v., Opium, and Sulphur chiefly ; but also, Lachesis, Pulsatilla, Calcarea, Aurum, Natrum m., Silicea, Lycopo- dium, &c. If the affection arises from sitting up late, or prolonged watching at the bedside of a sick person : Cocculus, Nux v., or Pulsatilla. When headache is always excited by exposure to a current of air, Aconitum, Belladonna, Colocynth, Nux v., or Cinchona have often been found suc- cessful, either in removing the said susceptibility, or in shortening the attacks, and rendering them of a much more bearable character. And when cold, damp, or boisterous weather is generally productive of head- ache : Bryonia, Nux v., Carbo v.; these last-named medicines, moreover, together Avith Silicea, are frequently equally useful, if headache is always experienced during hot, sultry Aveather,—the air being over- charged Avith electricity. Against headaches arising from the effects of HEADACHE. 339 mercury in large doses : Carbo v., Pulsatilla, Cinchona; or Hepar sul- phuris, Acidum nitricum, Aurum, or Sulphur. Headache after drink- ing cold or iced water, &c.: Aconitum, Arsenicum, Opium, Belladonna, Pulsatilla, Sulphur, and Natrum. Headaches from congestion: Aco- nitum, Belladonna, Bryonia, Sanguinaria canadensis, Opium, Mer- curius, Pulsatilla, Rhus, Nux v., Veratrum, Coffea, Lachesis, Chamo- milla, Cocculus, Sulphur, Silicea, &c. Headache from exposure to metallic vapours, Sulphur; and from that of copper especially, Hepar s. In general cases, the subjoined remedies will prove useful, and may be selected according to the indications given. Belladonna.—When headache is periodic, or nearly constant, and the pain is increased by the slightest movement either of the head or body, and particularly on stooping, or by moving the eyes; or when a bright light, or the most trivial noise tends to aggravate the pain, which consists of a dull pressure at the vertex, or is of a lancinating descrip- tion, and occupies either the entire head (cephalaea), or merely one side (hemicrania), extending from the occiput into the orbit and root of the nose, and is then described as a violent, screwing, piercing, bursting, or tearing pain, sometimes attended with great heat at the vertex; or the seat of the pain is in the forehead, and is of a dull, aching, or cut- ting description, attended with a sense of fulness or a feeling as if the brain would be forced through the forehead in stooping. At times these pains become so violently increased as almost to deprive the patient of consciousness whilst they last; or the headache is attended with extreme restlessness, sleeplessness, and delirium; and there is a falling off of the hair, in consequence of the headaches. Platina answers well, in some cases, after Belladonna, when the pain is chiefly lateral, and of the same description; or when there is, at the same time, cold- ness of one half of the face, &c, with humming or buzzing in the head. Mercurius and Hepar s., and, in very obstinate cases, Sepia and Silicea are frequently very useful after Belladonna. Bryonia :—Aching, piercing, or digging, tearing pain, at a small fixed spot (clavus hystericus); or piercing, aching pain in the forehead daily after a meal, or coming on in the morning, and afterwards becom- ing lancinating; or pain coming on in the morning, disappearing in the afternoon, and returning again in the evening with great violence, when it is attended with a sensation as if the head were pressed together, par- ticularly at the temples; burning, tearing pain over the entire head; shootings in one side of the head. The pains are increased by move- ment, and are attended with irascibility, and disposition to chilliness or shivering; they are sometimes relieved or terminated by a fit of vomit- ing. Nux v. and Rhus often serve to complete the cure of the fore- going symptoms, or, at all events, to curtail or remove each attack, after the previous administration of Bryonia. Rhus:—Shooting and rending pains, extending to the ears and root of the nose; burning or pulsative pains; headache after a meal, with desire to assume the recumbent posture, and remain quiet; fulness and weight in the head; reneAATal of the headache at the slightest contradiction, or on going into the open air: undulation of the brain at every step; or sensation as if water were in the head, or as if the contents of the cranium 340 nervous system. were in a relaxed or loosened state, and shifted about with every move- ment of the head; feeling of creeping or crawling in the head. Sepia :—Periodic cephalalgia, aggravated by mental emotion, par- ticularly in hysterical subjects; the pain is either of a lancinating descrip- tion, and affects the whole head, or is merely seated under the eye, or occupies one half of the head or forehead; in the latter case, the pain is experienced chiefly in the morning, and is frequently attended with extreme sensibility of the eyes to the light. Sepia is also very effica- cious in cases of chronic hemicrania, with violent piercing or rending pain, intermingled with lancinations, so excruciating that the patient is afraid to move, and can only obtain a trivial degree of relief by remaining perfectly quiet with the eyes closed; at other times, the pain is so vio- lent as to cause the patient to scream out, and is attended with heat in the head, or faintness and giddiness, followed by nausea and vomiting. Silicea is especially useful where a sensation is experienced as if the brain were about to protrude through the forehead or orbits ; or pain so severe that the head feels as if it would split; or semilateral, shooting, rending pains, commencing at the temple, and extending to the nose, the upper and loAver jaw-bones, and teeth of the same side. When there is a tendency to frequent sweating of the head, or when there is frequently great tenderness of the scalp, Silicea is further indicated; as also in cases A\There the parties affected are subject to the formation of small tubercles on the head. Hepar sulphuris is also a good remedy to follow Belladonna in the treatment of headaches, when only partial relief has been obtained from that medicine, or it may be administered alternately with Silicea in cases where there are painful tubercles on the head. The pains chiefly pierc- ing, generally aggravated at night, and frequently limited to a small fixed spot, with a sensation as if a nail were being driven into the head. Against this latter species of headache (clavus hystericus), Nux vomica, Ignatia, Coffea, Mosch., Magn., and Staph, are also most important remedies. Nux vomica may be selected when the following symptoms are com- plained of. Pain commencing with a slight pressure, or a sensation of coldness at the part which is subsequently affected ; succeeded by throb- bing, and then an intense shooting, piercing, rending, or stunning pain confined to a small space, which can frequently be covered with the point of the finger, and is extremely sensitive to the touch; or the pain causes a sensation as if a nail were driven into the head; at other times, the pain extends over the nose down to the lip, and also to the gums; or, on the other hand, it commences at the eyelid or the orbit, causing constant lachrymation, and extends over the forehead and temples to the ears, back of the head, and nape of the neck; or it is seated in the croAvn of the head, and produces a sensation as if the head would split, or Avere being opened at the coronal suture; or rending, aching pain, affecting only one side of the head, sometimes combined or alternating with shootings ; the pain becomes heightened to such a degree occasion- ally, and more particularly in the morning, as well-nigh to drive the patient to despair, or deprive him of consciousness ;x great heaviness 1 Compare with Belladonna and Arsenicum. headache. 341 of the head, and sensation as if the brain were bruised or lacerated ; tenderness of the scalp. The pains are aggravated by movement, such as Avalking or stooping, or by reflexion ; also after eating, or on going into the open air, and are frequently attended with considerable giddiness or confusion in the head; the headache is generally attended with ex- treme irascibility, and is renewed or aggravated after partaking of coffee, the constant habit of drinking which is not an unfrequent cause of the complaint; sudden attacks of headache are frequently excited by a fit of passion, a fright, the effects of a chili, or an overloaded stomach. Ignatia is also an excellent remedy, as already stated, in cases in which the pain is confined to a small space, and causes a sensation as if a nail were driven into the brain; and when there are nausea; dimness of the sight, and sensibility of the eyes to light; paleness of the face, and temporary alleviation from change of posture; aggravation from noise or strong odours, or after partaking of coffee. Ignatia is some- times serviceable in completing the cure after the previous administra- tion of Nux v. or Pulsatilla. It is especially applicable to nervous, hysterical females of a mild and sensitive disposition. Coffea.—In cases of megrim, brought on by meditation, vexation, or exposure to cold, attended with irritability, sensibility to noise, great anxiety, and chilliness, and a sensation as if a nail were driven into the brain, or a feeling as if the brain were bruised, occurring in individuals who are extremely impatient under suffering, and are not habituated to the use of coffee, this remedy is frequently a very efficacious one. Pulsatilla :—Megrim, characterized by rending or shooting pains, with heaviness of the head, dimness of the sight, sensibility to light; or buzzing or singing in the ears, and earache; nausea, paleness of the face, lowness of spirits; headache Avith pain in the nape of the neck; aggravation of the headache, with chilliness towards evening, during re- pose, or particularly when sitting; melioration in the open air. Dispo- sition mild; temperament phlegmatic. China:—Headache worse at night, accompanied with a sensation as if the head Avould split; or dull, aching, pressiA^e, or boring pains, par- ticularly at the crown of the head, increased by movement, or by the open air; tenderness of the scalp; great sensibility to pain; taciturnity and obstinacy. Veratrum :—Headache preceded by coldness and shivering; pain in the head as if the brain Avere bruised or lacerated; or lateral, aching, constrictive, and throbbing pains, sometimes attended with a sensation of constriction or tightness in the throat; feeling of coldness at the crown of the head, as if ice were placed upon it; or sensation both of coldness and heat on the exterior of the head, with deep-seated or inter- nal burning heat; headache Avith paleness of the face, nausea and vomit- ing, and preceded by a copious discharge of colourless urine; headache, with pain at the pit of the stomach, or painful stiffness of the neck, headache with extreme weakness and melancholy; painful sensibility of the hair to the touch; chilliness, with general cold perspiration. Ar- senicum and Acid. phos. are sometimes useful after Veratrum. Lachesis :—Deep-seated pains in the head, or severe aching pain in the occiput, in the sockets of the eye or above the orbits, with stiffness 342 NERVOUS SYSTEM. of the neck, particularly at the nape; heaviness and feeling of expansive pressure, sometimes to such an extent as if the head Avould burst; ten- sion in the head as if caused by strings or threads drawn through the occiput towards the eyes; lancinations in different parts of the head ; headache every morning on waking, or after dinner, or at every change of weather. Mercurius :—Rending and burning, or lancinating and piercing pains, generally lateral, sometimes extending to the teeth and neck, with shootings in the ears ; tightness* round the head ; excessive nocturnal aggravation of the headaches, often accompanied by profuse sweating. Colocynth :—Nervous headaches, attended with smarting in the eyes ; excruciating lateral aching; rending, dragging pains ; nausea and vomiting ; feeling of compression in the forehead increased by stooping or lying on the back; headache every afternoon or evening, with great anguish and excessive restlessness, so that it is impossible to remain in the recumbent posture; offensive perspiration; profuse discharge of co- lourless urine during the headache. Chamomilla :—Headaches occurring in individuals who are extremely impatient under suffering, and exasperated by the slightest pain, or who exhibit symptoms and expressions of suffering apparently uncalled for by the nature of the complaint; the headaches are often confined to one side of the head (hemicrania), and the pains are of a rending, aching, or shooting character, and sometimes extend into the upper and lower jaw; sweating at the head is a frequent concomitant symptom. Chamomilla is occasionally very useful after the previous administra- tion of Coffea, when not called for from the commencement. Moreover, hemicrania attended with extreme excitability, arising from the daily use of black coffee, but which is usually relieved for the time by partak- ing of a cup of that beverage, will generally be materially relieved, if not cured, by Chamomilla; sometimes a subsequent dose or two of Nux is required to complete the cure. Sulphur:—Chronic headache; headaches occurring daily, or every eight days, worse in the morning, or during the night, and attended with heaviness of the head, aching or pressive pains in the forehead above the eyes (causing the patient to knit the brows, or keep the eyes closed), or over the entire head; incapability of mental exertion from the pains in the head; pains as if the head would split; or rending, shooting, dragging, jerking pains on one side of the head; aggravation of the headaches from meditation, the open air, or movement; extreme tenderness of the scalp to the touch; falling off of the hair. Calcarea :—Chronic headaches, frequently attended with a sensa- tion of extreme coldness, either interiorly or on the scalp ; the pains either affect the entire head, or merely the forehead, the side, or the crown of the head, and are chiefly of a stunning, aching, throbbing, or hammering description, compelling the patient to retain the recumbent posture; at times the head feels as if compressed in a vice, or the fore- head feels as if it Avould burst open, particularly when in the open air; headache, with humming noise in the head, confusion of ideas, excited or aggravated by close application to study, or by movement; falling HEADACHE. 343 off of the hair. Calcarea is generally very useful after Sulphur ; and Silicea, Lycopod., and Acid. nitr. after Calc Arsenicum :—Headaches so intolerable as almost to drive the patient to despair, occurring periodically and aggravated by partaking of food : the pain sometimes extends to the gums, where it is so excruciating as to render it impossible to fall asleep ; tenderness of the scalp to the touch ; temporary amelioration of the headaches from the application of cold water. Aurum :—Headaches in hysterical persons, attended with buzzing or other noises in the head ; and pain as if the head had been bruised, especially on rising in the morning or during mental occupation. Eugenia :—Severe one-sided headache (megrim) coming on in the evening, attended with a sensation of pressure or forcing outwards behind the eyes, lachrymation, and sometimes nausea and vomiting, which produce exacerbation; aching pains in the entire head (cepha- laea) at night with burning in the eyes, thirst, and copious discharge of urine. Bromium :—Headache (weight in the forehead), in the heat of the sun, disappearing in the shade ; headache after drinking milk; relieved by resting on the right side with the arms over the head. One remedy is seldom sufficient to effect a cure of cephalalgia of long standing, particularly when of a nervous character; and indeed, in some cases of this description, it is only possible to effect a degree of melioration. In comparatively recent cases, the medicines may be repeated at intervals from an hour to six or twelve hours, when the headache is excessively severe; but in those of a more chronic and obstinate nature, in which it is necessary to have recourse to such reme- dies as Sulphur, Calcarea, Sepia, Coriaria myrtifolia, Silex, &c, con- siderably longer intervals must be observed between the doses, Avhen our object is to attempt to eradicate the disorder, or destroy the sus- ceptibility to headache from trivial causes. In chronic headaches of various kinds, and particularly in megrim, or where the pain is for the most part confined to the right side of the head, or to the forehead and sinciput, Sanguinaria canadensis promises to be one of the most valua- ble remedies. It has been employed with great benefit in cases of the folloAving symptoms. Headache commencing in the morning, relieved by sleep, or disappearing after the night's rest to that of the night fol- lowing. The pain is chiefly experienced in the right side of the head, but in some instances, it is transferred from one side to the other during the same or at the succeeding attack. More rarely, the left side alone is affected. The eyes are almost always sympathetically affected; and relief is sought by having the apartment darkened. Nausea is nearly uniformly present; but melioration is seldom derived from, or the attack ever terminated by, a fit of vomiting. Chronic headaches with the aforesaid characteristic symptoms are frequently mitigated (the attacks shortened, and the intervals between them lengthened), by means of Aconitum, and especially by Belladonna. The relief afforded by these remedies is, however, for the most part, merely temporary ; the radical cure being commonly only attainable by the employment of such medi- cines as Sulphur, Sepia, Sanguinaria canadensis, &c. Dr. Helfrich 344 circulating system. recommends chiefly Aconitum and Belladonna, at the commencement and during the height of the attack, and Sanguinaria on its decline, in all cases of nervous headaches Avhere there are no particular indica- tions for other remedies.1 DISEASES OF THE CIRCULATING SYSTEM. ANGINA PECTORIS. The pathology China> Laur-> Phosph., Natr. m., Dancing, of: Magnesia carbonica, Magnesia muriatica Disappointments, Mortifications, of: Dig., Mosch.', Ign., Staph., Rheum, 492 DISEASES OF PARTICULAR ORGANS AND REGIONS. Falling, of: Thuja.—Amm. m., Dig., Aur., Bella., Kreos., Hep., Magn. m., Mere, Sep., &c. # Fantastic dreams : Calcarea, Natrum muriaticum, Opium.— Carb. a., Con., Graph., Kail, Lye, Natr. c, Sep., Sulph.—Bary. c, Carb. v., Lach., Nux v., Si/., Spong., Led., Amb., Puis., &c. Festivities (dreams of) : Antimonium crudum, Mgs., Ac. nitr., &c. Fire, of: Hepar sulphuris, Magnesia carbonica, Magnesia muriatica.—Anae, Croc, Phosph.—Alum., Ars., Bella., Calc, Kreos., Laur., Mag. austr., Spig., Sulph., Sulph. ac, &c. Floods, of: Magnesia carb., Mercurius, Natrum carb. Flying, of: Natrum sulphuricum. Frightful dreams (sleep disturbed by): Nux v., Op., Cocc, Graph., Puis., Lye, Merc, Phosph., Ran. sc, Sass., Sep., Sulph., Calc, Bella., Ars., Lach., Ac nitr., &c. Furunculi: Primus spinosa, &c. (See Dreams of Diseases.) Haemoptysis (dreams of) : Mephites, &c. (See Dreams of Diseases.) Hemorrhage : Phosphorus, &c. (See Dreams of Diseases.) Historical dreams : Amm. c, Mercurius, &c. Indecision, of: Arnica montana. Ignominious, Humiliating dreams: Moschus, Asar., Alum., Am., Am., Con., Staph., &c. Learned Subjects, of: Ignatia, M. arct. Linen (of foul) : Kreosotum. Lively, Vivid : Phosphorus, Rhus toxicodendron, Sulphur, Silicea.—A^x v., Puis., Op., Lye, Calc, Anae, Am., Bella., Bry., Cie, Mag., Mar., Natr., Phosph. ac, Sabad., Sep., Stann., Ambra., Ars., Carb. v., Clem., Cham., Con., Lach., Croc, Graph., Dros., Mgs., Mag. arct., Magn., Mar., Mur., Mosch., Mur. ac, Natr. m., Petr., Rheum, Spig., Staph., Tart., Stram., Valer., Viol tr., &c. Losses, of: Mephites. Marriage : Alumina. Meditation, Reflection (dreams with) : Bryonia, Ignatia, Nux vomica.— Lach., Anae, Sabad., Sabin., Thuja., Aeon., Am., Camph., Carb. a., Graph., M. arct., M. austr., Puis., Rhus, &c. Misfortune (dreams of) : Nux vomica, Puhatilla, Lycopodium, Graphites, Thuja.—Amm. m., Am., Bella., Cham., China, Kali c, Phosph., Sassa., Sulph., Sulph. ac.—Alum., Anae, Ars., Cocc, Ign., Led., Merc, Ran. bidb., Staph., &c Money, of: Cyclamen, Magnesia, Pulsatilla. Murders, or crimes: Bellad., Lye, Natr. m., Nitr. ac, Rhusvemix, Silicea. Perplexing dreams: Arsenicum, Graphites. (See Complicated, Confused Dreams.) Pleasant, Agreeable : Calcarea, Natrum carbonicum, Opium, Pulsatilla, Sepia, Staphysagria, Viola tricolor.—Ant. c, Aur., Carb. a., Graph., Kali, Lach., Magn., Natr. m., Phosph., Phosph. ac, Plat, Sil, Alum., Amm. m., Carb. v., Croc, Magn., Ars., Bary., Bism., Cocc, Coff., Ign., Hyos., Magn., Merc, Ac. nitr., Olead., Spig., Thuj., Veratr., &c, &c. Poetic : Lachesis, Calcarea, Spongia, Amm. c Poisoning, of: Kreosotum, &c. , Projects, of: Anacardium. Pursuits : Kreosotum. Quarrels : Nux vomica, Am., Magn., Phosph., Stann., Alum., Aur., Calc, Hep., M. austr., Puis., Selen., Staph., &c. Realities, dreams which appear to be : Natrum carbonicum, Natrum mu- riaticum. SLEEPLESSNESS. 493 Remembrance with, of things forgotten: Caladium. Remembrance, dreams of which one loses the : Bella., Hell, Cie, Cocc, Lye, Selen., Spig., Tarax., Veratr., Vit, Am., Aur., Bry., Con., Lach., Laur., M. arct., Men., Merc, Natrum m., Rhus, Sabad., Stram., Sulph., &c. Repentance, dreams of: Arsenicum. Reproaches: A mica. Revolts : Mercurius. Robbers : Magnesia carbonica, Mere, Magn. m., Alum., Aur., Kali, Sil, Natr. e, Plumb., Veratr. Sad, Melancholy dreams: Rheum, Lye, Spong. Serpents, or Reptiles (dreams of) : Kali carbonicum. Shots : Hepar sulphuris, Mercurius. Show : Kreosotum. Spectres, or Frightful Visions: Alum., Bella., Calc, Ammon. e, Carb. v., Ign., Kali c, Merc, Ac nitr., Puis., Sil, Sulph., Nux v. Storm, of a: Arnica, Arsenicum, Euphr., Natr. Teeth, of the falling out of the : Nux vomica. Threats, of: Arsenicum. Travels, Voyages, Journeys : Magnesia carbonica, Natrum carbonicum, Opium, Amm. m., Amm. c, Magn. m. Typhus Fever, of death from : Kali chloroticum. Vermin, dreams of: Nux v., Acid, muriat., Chel, Phosph., Am. c War, of: Thuja, Verb., Plat., Fer. Water, of: Ammon. muriat, Graph., Magn., Alum., Dig., Kali, Magn. m., Merc, Ran. bulb., Sil, &c. Water, of, desire to void (of inclination to urinate) : Kreosotum. Sleep disturbed or prevented by : Excitement (nervous) : Colch., Merc, Coffea, Nux v., Lach., Amb., Camph., Canth., Caps., Chin., Hyos., Mosch., Puis., Sep., Lye, Laur., Ac. nitr., Mags, aust., Teuc, &c. Excitement, vascular: Bry., Nux v., Puis., Sep., Sil, Calc, Baryt. c, Natr. m., Carb. a., Merc, Phosph., Sabin., Sep., Am. c, Asar., Rhus, Ran., &c. Excitement, by vascular, in the chest: Puis. Cyc vascular, in the head : Puis. Abnormal states during sleep : Eyes, open: Bella., Op., Bry., Veratr., Sulph., Coloc, Phosph. ac, Fer., Hell, Tart., Samb. Eyes, convulsed: Op., Hell, Phosph. ac fixed: Tart. Face, puffiness of the : Opium. coldness of the : Belladonna. paleness of the : Belladonna. redness of the : Op., Arnica, Viola tricolor. Fatigue, feeling of, during sleep : Kreos., Antim., Ambra. Fear, during sleep : Carb. v., Puis., Cocc. or dread of losing one's reason: Calc. carb. Fright : Puis., Silica, Sulph., Veratr., Kali c, Am., Tab. Gastric sufferings: Cham., Con., Hep., Kali, Ac nitr., Sil, Rhus, Graph., kc. Grinding of the teeth : Ars. Hallucinations : Bella., Cham., Sidph., Led., Merc, Phosph., Stram. 494 DISEASES OF PARTICULAR ORGANS AND REGIONS. Hands, coldness of the : Bella., Mere, Carb. v. heat in the : Lach., Staph. Head, pain in the: Sulph., Merc, Lye, China, Calc, Carbo. v., Cham., Con., Hep., Haem., Kreos., Mag., Ac. nitr., Phosph., Phosph. ac, Puis., Sil, Mags, arc, Zinc, &c. Head, congestion in the : Pids., Sil, Am. c heat in the : Silica, Camphora. Hearing, delusions of: Cham., Sep., Carb. v. Heart, pain in the : Baryta carb. palpitation of the : Ars., Lye, Puis., Sulph., Merc, Acid, nitr., Calc, Baryt c, Natr., Agar., Dulc, kc. Heat, general: Nux v., Puis., Lach., Cham., Dulc, Hep., Merc, Magn. m., Calc, Petr., Phosph., Bry., Ars., Natr. m., Sep., Sil, Carb. a. et v., Bry., Viol, tr., Alum., Am. c, Colch., Graph., Sulph., kc. Heat, with anxiety: Puis., Natr. m. with dread of, or aversion to being uncovered : Magnesia. Ideas, sleep disturbed or prevented by flow of: Nux v., Puis., Coffea, Lye, China.—Sidph., Calc, Staph., Sil, Graph., Hep., Kal, Cocc, Led,, Sabad., Bar., kc. Ideas, by fixed : Pulsatilla. gloomy, annoying : Graph., Rhus, Alumina. Inquietude, restlessness in the limbs (sleep disturbed by): Puis., Nux v., Sulph., Kreos., China. Itching, or tickling in the body: Nux v., Puis., Merc, Sulph., Thuj., Am. c, Am. m., Baryt c, Cocc, Croc, Kreos., Mez., Berb., kc. Jactitation : Aeon., Ars., Bella., Cham.—Coffea, Alum., Asa., Calc, Lach., Hep., Kreos., Plat, Guaj., Hell, Tart., Nux v., Op., Gran., Carb. a. et v., Merc, Puis., Rhod., Phosph., Sil, Jalap, Clem., Cin., kc. Jaw, hanging of the, during sleep : Nux v., Op. Jerking, Shocks, Starts or twitchings (sudden): Amb., Ars., Bella., Cupr., Kali, Lye, Natr., Puis., Sil, Sulph., Tart, Thuj., Carb. v., Champ., Op., Ign,, Con., Staph., Sep., Mgs. arc, Merc c, Phosph., Cast, kc. Jerkings, or Convulsions in the eyes : Cocc, Puis. in the face : Op., Rheum. in the fingers : Cocc, Rheum, Ac. sulph., Anae, Ars. in the feet: Phosph., kc. of the head: Cocc, Magnetus polus Arcticus. of the legs : Phosphorus. of the mouth : Op., Anae, Puis. of the tendons (subsultus tendinum): Bella- donna. Joints, sleep disturbed by pain in the : Silicea. Lamentations (during sleep) : Stan., Nux v., Alum., Phosph., Sulph. Lancinations, or shooting pains in different parts of the body : Cann., Euph. Laughter (during sleep) : Alumina, Lycopod., Stram. Limbs, pains in the: Nux v., Lach., Sulph., Calc, Con,, Ac. nitr., Am. c, Am. m., Anae, Berb., Carb. v., Phosph. Loins, pains in the : Am. m., Berb., Kreos. Mastication (while sleeping) : Calcarea. Meditation, reflection, during sleep: Lach., Anae, Bry., Ign. Moaning, during sleep : Lach., Puis., Acid, m., Ipecac, Bella., Alum., Bry. Nux v., Cham., Op., Sulph., Lye, Veratr., Phosph., Ars., Am., Rheum, kc. Murmurs, or muttering during sleep : Op., Sulph. SLEEPLESSNESS. 495 Mouth open, during sleep: Op., Mere., Rhus, Samb., Mgs. Nightmare (Tnmbus., Ephialtes) : Nuxv., Puis., Op., Sulph.,—Silicea, Ruta, Valeriana, Aeon., Am. carb.—Lye, Magn. m., Natr. m.,Bry., Hep., Con,, Bella., Am. m., Kali, Alum., kc. Oppression at the chest (during sleep, or at night and preventing sleep) : Arsen., Carb. v., Cham., Graph., Sulph.,— Calc, Lye, Op., Aeon., Alum., Kali, Kali ch., Phosph., Ran., kc. Pollutions, during sleep: Kali c, Kali h., Sidph., Lye, Ac. phosph., Phosph., Con., Carb. v., Puis., Petr., Led., Par., kc. Quarrelling, during sleep : Ars. Respiration, intermittent during sleep : Opium. rapid, accelerated: Aeon. short: Aeon., Cham., Rhus, Merc slow: Op., Cinchona. Wheezing, whistling : Nux v. Scrobiculus cordis, pain in the : Calc c, Kali c Sighs, during sleep : Lach., Merc Singing : Bella., Croc, Phosph. ac, Mgs. arc. Sliding, or sinking down to the foot of the bed during sleep : Ars., Acid. m. Snoring loud, or stertorous breathing: Op., Carb. v., Stram., Nux v., Ign., Cham., Sulph., Sil, China, Rheum, Rhus, kc. Somnambulism : Op., Bry., Phosph.—Alum., Natr. m., Sil, Sulph. Soreness of the throat (pain in the) during sleep : Ammon. m. Starts: Amb., Ars., Bella., Cham,, Cupr., Dros., Hep., Lye, Puis., Sil, Sidph., Tart., Thuja.—Nux v., Hep., Calc, Carb. v., Chin., Cocc, Castor, Daph., Hyos., Aeon., Agn., Alum., Am. c, Ant. c, Merc, Magn., Ign., Lach,, Kali, Plumb., kc. Starts, when touched: Stram. with gestures indicative of fright or terror: Stram. Stomach, pain in the: Lye, Con., Alum., Graph., Kali, Am. c, Acid, nitr., Sulph., Sil, Rhus, Sen., kc. Talking, during sleep: Puis., Sulph., Nux v., Alum., Am., Ars., Bella., Calc, Camph., Carbo a. et v., Cham., Kali, Magn., Magn. m., Merc, Muriat. ac, Natr. m., Nitr. acid., Phosph., Phosph. acid., Plumb., Sep., Sil, Stram., kc. Toes, pains in the, during sleep : Am, carb. Trembling : Euphorbium. internal: Natrum m. Uncovering of the arms, &c, during sleep: Plat., Corr. rubra, Magn. polus arcticus. Uneasiness, general, sensation of, during sleep : Ars., Merc Urine, emission of, during sleep: Am. carb., Am. muriat, Lach., Con., Graph., Hepar, Bella,, Ars., Daph., Iod., Cup., Coffea, Natr. m., Sulph,, Calc, Carb., Op., Lye, Sep., Sil, Mere, Petr., Mgs. aus., Cin., kc. (See Enuresis.) Vertigo: Sulph., Calc, Am. c, Natr., Phosph., Spong., kc. Visions, during sleep: Bella., Cham., Led., Merc, Phosph., Phosph. ac, Stram., Sutyh., kc Visions, frightful: Bella., Sulph., Calc, Carb. v., Merc, Sil horrible : Carb. anim., kc. Voluptuous, sleep retarded or disturbed by: Calc. carb. Weeping, during sleep: Puis., Sulph., Calc, Nux v., Alum., Am., Ars., Bella., Camph., Carbo a. et v., Cham,, Kali., Magn., Magn. m., Mgs., Merc, Mur. ac, Natr. m,, Nitric acid,, Phosph., Phosph. acid., Plumb., Rhus, Sabiu., Sej)., Sil, Stann,, Tart., Zinc. 496 DISEASES OF PARTICULAR ORGANS AND REGIONS. SLEEP, Lethargic, stupefying : Aeon., Ant., Bella., Calad., Camph., Graph., Lach., Nux v., Op., Puis., Hyos., Laur., Led., Mosch., Nux mosch., Phosph. ac, Plumb., Stram., Tart., Veratr., Mag. arc, kc. Sleep lethargic, alternately with sleeplessness : Lachesis. Somnolency, or drowsiness in the open air : Tartarus. day and night: Baryta c in the eATening: Ant, Ars., Tart. in the forenoon : Ant. crudum, in the morning: Mephitesputorius. Sleep, broken, interrupted: Cocc, Ars., Dig., Par., Zinc incomplete, imperfect, half asleep: Ars., Bella., Bry., Lach., Merc, Hepar., Cham., Cocc, Op., Acid, nitr., Cie, Euph., Sil, M. are, Graph., Kali, kc. SLEEP, light: Nux v., Lach., Ign., Sulph., Merc, Aeon., Alum., Ars., Sel, Sil, Calad., 01 an., Tart. Sleep, protracted, too prolonged: Merc, Sulph., Plat., Puis., Hepar, Berb., Bar., 01 an., Phil, kc. Sleep, profound : Ant. tart,, Nux mosch., Op.—Ars., Bella., Ign., Laur., Led., Mgs., Phosph. ac, Puis., Rhod., -See corn., Seneg., Stram., Veratr., Aeon., Anae, Ant. e, Bar., Bry., Camph., Con., Croc, Cup., Hyos., Petr., Phosph., Ruta, Sep., Spig., Zinc, kc. Sleep, unrefreshing: Bry., Con., Hepar., Op., Sulph.—Amb., Bism., Calc, Cann., Lach., Lye, Natr. m., Nitric acid., Petr., Selen., Sil, Staph., Alum., Am. m., Anae, Carb. a. et v., Cham., Kali, Mag. arc, Magn,, Magn. m., Merc, Ran. bulb., Sepia, Spig., Stann., Stram., Veratr., kc. Sleep, of too short duration : Nux v., Calc carb. tendency to fall asleep when in the open air: Aeon., Tart., M. aust. Sleep, tendency to fall asleep early in the morning: Nux v., Lach., Puis., Sulph., Phosph. ac, Sil, Con., Croc, Calc, Carb. v., Lye, Plat., Sep., Kali, Hepar, China, kc. Sleep, tendency to, during exercise : Aeon. during and after a meal: Nux v., Sulph., Aeon., Anae, Arum., Aur., Bor., China, Phosph., Phosph. ac, Verb., Natr. m., Graph., Kali, Calc, Sil, Zinc, kc. Sleepiness in the afternoon: Sulph., Puis., Bor., Brue, Canth., Grat., Viol. tri., kc. (See Sleep, tendency to, after a meal.) Sleep, tendency to, during employment: Sulphur. when reading and writing : Natrum sulph. when sitting: Brue, Ferr., Mg., Petr., Tart., kc. during a storm : Silicea. retarded : Calc, Carbo a. et v., China, Cyc, Fer., Graph., Hyos., Kali, Lach., Lye, Merc, Natr., 01 an., Phel, Phosph., Phosph. ac, Puis., Ran., Stann,, Staph., Nux v., Natr. m., Nitr. ac, Sep., kc. Sleep, retarded, or difficult to be renewed after waking during the night: Natr. m., Sep., Sulph., Puis., Magn., Am. c, Ars., Berb., Bor., Per., Phosph., Ran., Ran. sc, kc. Sleeplessness, alternately with somnolency : Lachesis. after midnight: Nux v., Coffea, Ars., Cap., Kali carb., Sil, Assaf, Aur., Cann., Dulc, Hepar, Magn., Natr., Ran. seel, Sep., Sulph. ac, Aeon., Am., Ant. c, Bry., Calc, Con., Lach., Graph., Merc, Mez., Nitr. ac, Phosph. ac, Plat., Rhus, Staph., kc. Sleeplessness, before midnight: Bry., Calc. carb., Carb. v., Mere, Phosph., Puis., Rhus toxi., Sep., Ars., Bella., Bar., Calad., Carb. a., China, Graph., Hep., Ign., Kali, Lach., Led., Lye, M. aust, Mar., Mur. ac, Selen., Spil, SLEEPLESSNESS. 497 Sig., Sulph., Nux v., Con., Alum., Am. m., Ant. tart, Am., Bar., Kreos., Nitr. acid, Natr. m., Stann., Staph., Veratr., kc. Sleeplessness, with desire or inclination to sleep: Bella., Cham., Phosph., l*ids., Sep., Ars., Bry., Calc, China, Can., Hep., Kali c, Merc, Natr., Nux v., Phosph. ac, Rhus, Sil., Sulph., Carb. v., Graph., Hyos., Lach., M. arct., Natr. m., Nitr. acid., Staph., Veratr., Selen., kc. Sleeplessness, arising from griping pains in the intestines: Lye, Plumb., Sep., Staph., Kali, Ambr., Am. c, Am. m., Magn. c, Magn. s., Natr., Ac. nitr., Rhus, Phosph., kc. Waking, difficult and retarded: Nux v., Calc, Graph., Sepia.—Natr., Natr. m., Nitr. ac, Phosph. ac, Tab., Teuc, Alum., Mgs., Magn. m., Merc, Natr., Phosph., Phosph. ac, Sil, Sulph., Euphr., Anae, Am., Assaf, Carb. v., Hep., Hyos., Kali, Laur., Natr. m., Nitr. ac, Puis., Veratr., kc. Waking too early : Nux vomica, Kali carbonicum, Natrum carbonicum, Ra- nunculus bulbosus, Ars., Aur., Caps., Dulc, Magn. c, Mur. ac, Sulph. ac, Assaf, Calc, Graph., Hep., Lach., Mang., Merc, Mez., Nitr. ac, Plat., Ran. sc, Rhod., Sep., Sil, Staph., Thuja, kc. Waking early, and always at the same hour : Selenium. incomplete: Conium. with a start: Amb., Ars., Bella., Cham., Dros., Hep., Lye, Puis., Sulph., Rheum, Tart, Thuja, Bry., Graph., Carbo v., Calc, kc. Waking at the slightest touch (generally with a sudden start or cry): Seliueum. Waking at the slightest noise : Selineum. early, from a feeling of coldness : Acidum muriaticum, Fer. mg. Waking caused by violent shocks or jerks in the head and neck: Magnetis polus arcticus. Waking caused by a feeling of suffocation or obstructed respiration: Hepar, Ipecac, Sambucus nigra. Waking with a headache : Lachesis, Belladonna, Anacardium, Berb., Fer. mg., Rheum. Waking with colic : Hxmatoxylum campechianum. congestion in the head : Berberis. congestion and heat in the legs : Mephites putorius. diarrhoea: Hcematoxylum. dizziness or giddiness : Ars., China, Plat, Puis., Sol m. erections: Lachesis. fear of ghosts or spectres : Sulphur. hallucinations: Sulphur. hunger : Belladonna. vexatious thoughts or ideas: Alumina. lassitude in the arms: Ferrum magneticum. lassitude general, or fatigue. See Sleep, unrefreshing. pains in the limbs : Nux vomica, Lachesis. pains as if beaten : Lachesis, Viola odorata. pains in the loins : Lachesis. a sensation of paralysis: Kreosotum. perspiration : Merc, Clcm.,^ Chel, Cie, Dros., Fer. mg., &c. rigidity or stiffness in the limbs : Lachesis. stretchings and convulsive yawning: Nux v. bitter taste : Bryonia, Rhus toxicodendron, kc. putrid taste : Rheum, kc. tears, cries, &c. : Mercurius. thirst: Berberis. 32 498 DISEASES OF PARTICULAR ORGANS AND REGIONS. WAKING, with sore throat: Lachesis. trembling: Ratanhia, Sambucus. visions (visions are seen on waking) : Dulc, Sulph. weakness in the knees : Ferrum magneticum. Yawning, incessant■ : Bry., Can., Euph., Lye, Oleand., 01 an., Phell, Rhus, Staph., Sulph., Viol od., Zinc, Nux v., Puis., Ign., Amm., Ant. tart., Am., Ars., Bry., Cina, Kreos., Chel, Croc, Laur., M. arct., Men., Mur. ac, Natr. m., Oleand., Par., Phosph., Ph. ac, Sabad., Sassafr., Sep., Sil, Stann., Staph., Alum., China, Carb. v., Sulph., Merc, Veratr., Bella., Caps., Bar., Canth., Hep., Zinc, kc. Yawning, abortive : Lycopodium, Cham., Ruta, Aeon., Ign., Croc, Phosph. Yawning, violent: Ignatia, Hepar, Platina, Rhus, Agar., Mosch., Cor., Fer. mg., Magn., Mgs. arc Yawning, spasmodic: Platina, Rhus.—Ignatia, Hepar, M. arc, Sep., Ang., Bry., Cap., M. aust, Mosch., Laur., Natr. m., Scill. Yaavning, without feeling sleepy: Platina, Rhus.—Ign,, Mag. arc, M. aust, Sep., Bry., Hep., Lach., Scill, Aug., Natr. m., Mosch., Cham., Cup., Sulph., Staph., Alum., Amm. m., kc. Yawning, frequent, in the afternoon : Canth., Ign., Plat. morning : Nux v., Ign., Viol od, while walking : Euphorbium, Natrum sulphuricum. Cutis anserina : Laurocerasus, Paris quadrifolia. shaking, shivering, or shuddering : Laur., Kreos., Natr. s., Par., Sil lachrymalian: Memph., Viol, od., Staph., Kreos. with oppression or tightness at the chest: Stannum. stretching: Staph., Nux v., China, Guaj., Natr. s., 01 an., Ruta, Sabad., Canth., Oniscus, Tart, kc. tremor: Cina, Oleander. vertigo: Agaricus muscarius. Position during Sleep. Arms above the head (during sleep) : Pulsatilla, Nux v., Plat., Calc, Coloc.— Rheum, Ruta, Thuja, Veratr., Sulph. Arms across the abdomen: Pulsatilla, Coe, Mags. Back, on the (dorsal) : Bryonia, Pulsatilla, Rhus.—Nux v., Sulph., Calc, Lye, Ign., Cie, Ferr.—Aeon., Ant tart., Aur., China, Coloc, Dros., Mgs., Mgs. arct., Phosph., Plat., Viol, kc. Hands under the head : A^x v., Ars., Bella,, Plat., Coloc, Men.—Aeon., Ambr., Ant. tart., Ign., Mgs., M. aust, Puis., Rhus, Sabad,, Spig., Viol od. Head inclined forward, with the: Staph., Aeon., Puis., Cie, Cup., Viol. od. inclined to one side : Cina, Spong., Tarax. elevated, high, with the : Sulphur. low, or buried under the bedclothes : Spong., Am., Hep., Nux v. thrown back, with the: Bella., Cina, Spong.— Cie, Hep., Hyos., Ign., Sep.— China, Nux v., Cap., Mgs., Stan., Viol. tr. Knees, bent: Viola odorata, Ambr., Mgs. Legs, drawn up: Puis., Plat., Carb. v., Stann.—Anae, Cham., Chin., Mang., Men., Rhod. Legs, widely separated: Cham., Puis., Bella., Plat, Rhus.—Agar., China, Dulc Legs, one of the, bent, the other extended : Stannum. crossed : Rhododendron chrysanthum. stretched out: Cham., Plat, Mgs., Puis., Viol od. NIGHTMARE — RUPTURE. 499 Seated (in a sitting posture) : Sulph., Cina, Lye, Ars., Rhus.— China, Hep., Phosjth., Puis., Sabin., Spig. Forwards : Cie, Cap. Side, on the left: Baryta carbonica, Sabina. Positions in which it is impossible to recline or sleep. Back, on the : Phosphorus. Recumbent posture, inability to remain in the : Sulphur, Lycopodium. Side : Aconitum, Sulphur. left (incapability of lying on the) : Lycopodium. NIGHTMARE. Incubus. Ephialtes. When this well-known and distressing disturbance occurs very fre- quently in an aggravated form, it becomes necessary to prescribe for it. The homoeopathic remedies which have chiefly been employed against it to the best advantage are, Aconitum, Nux v., and Opium. Aconitum.—When there is considerable febrile excitement, with quickness of pulse, thirst, palpitation of the heart, oppression at the chest, anxiety, and agitation. Nux v.—When nightmare is occasioned by sedentary habits, the habitual indulgence in spirituous or malt liquors, &c. Pulsatilla.—When there is derangement in the digestive functions, arising from gross living, heavy suppers, &c. Opium is a remedy of importance in all cases of a severe character; but particularly when, during the attack, the respiration is nearly sus- pended, or stertorous, the eyes only half closed, the mouth open, the countenance expressive of extreme anguish, and bedewed with cold per- spiration ; subsultus tendinum. When any of the foregoing remedies, but especially Nux v. and Pulsatilla, are insufficient to effect a cure, Sulphur or Silicea may be resorted to in repeated doses. In other cases, one or more of the following may prove useful: Phosphorus, Ruta, Valerian, Ammonium e, and Hepar. Every apparently exciting cause of the attacks must at the same time be avoided; the diet should be light and wholesome; suppers altogether abstained from, and a glass of cold Avater taken instead, on retiring to rest. Daily exercise in the open air, the shower-bath, or sponging with cold Avater every evening, are useful preventives, or auxiliaries during treatment. RUPTURE. Hernia. By this term is understood a swelling occasioned by the protrusion of some of the viscera from the cavity of the abdomen. In the generality of cases, the displaced intestines are included or contained in a bag, derived from the peritoneum, which they push before them in their descent. The situations in which the swelling most commonly makes its appearance are the groin, the navel, the scrotum, the labia pudendi, and the upper and anterior part of the thigh. It also occurs in the 500 DISEASES OF PARTICULAR ORGANS AND REGIONS. vagina, perinaeum, foramen ovale, and sciatic notch, and occasionally at every point of the forepart of abdomen. The viscera which are most frequently protruded are the omentum and the small and large intestines, or a portion both of omentum and intestine. But the stomach, liver, spleen, bladder, uterus, and ovaria, &c, have been known to form com- ponent parts of hernial tumours. In consequence of the tumour escaping at the different situations above mentioned, it has received the appella- tions of inguinal,1 umbilical,2 scrotal,3 pudendal,* crural or femoral, vaginal, perinceal, thyroideal,5 ischiatic, and ventral, kc Further, from containing different kinds of viscera, it has been designated epiplocele, when its contents consist of a piece of the omentum only; enterocele, when of a fold or portion of intestine ; and entero-epiplocele, if both in- testine and omentum contribute to form the SAvelling. A hernia or rupture, for the most part, appears suddenly after some violent corporeal exertion, and presents an indolent, and usually soft and elastic tumour, at some of the points or situations already referred to, but most fre- quently at the lower and lateral part of the abdomen (the groin), or towards the inner part of the bend of the thigh, or at the navel (de- scending from the abdominal ring in the first-mentioned instance ; from below Poupart's ligament in the second'; and out of the umbilicus or navel in the third). The swelling is subject to a change of size : being smaller or quite imperceptible when in the recumbent position ; larger or only apparent on assuming the erect posture, and particularly when taking a full breath, coughing, or sneezing ; also on walking or standing long after a hearty meal. It is frequently diminished, or caused to recede completely when pressed upon, but returns as soon as the pres- sure is removed. Vomiting, constipation, colic, and other signs of a deranged state of the stomach and intestines, are frequent concomitants of rupture, arising from the abnormal situation of the viscera. The nature of the contents of the hernial tumour are generally known by the following distinctions: if the case be an enterocele, the swelling is smooth, elastic, rendered tense by coughing, or by holding the breath; is in general very easily returnable, and usually attended with a gurgling noise when ascending. An epiplocele, or omental hernia is, on the other hand, of a more uneven and doughy or flabby texture; is neither made tense, nor receives any impulse from coughing; is more compressible, and, if large, or in the scrotum, is more oblong and heavier than en- terocele ; it recedes very gradually, and its reduction is unattended by any gurgling noise. An entero-epiplocele, or a hernia composed both of intestine and omentum, has the characteristic marks less distinct than either of the preceding cases; when reducible, it is known, in pressing back the con- tents, by the gurgling noise which attends the ascent of the intestinal portion, while that of the omentum is reduced without noise, and with greater difficulty; otherwise, the feeling communicated to the touch is often sufficient to render this variety distinguishable from the others. Causes.—The predisposing causes of hernia are: general relaxation, 1 Or a bubonocele. 2 Or an exomphalos. Omphalocele. 3 Or an oscheocele. 4 Or a bubonocele. 5 Or hernia foraminis ovalis. RUPTURE. 501 or unusual largeness of the natural openings of the abdomen. When any such proclivity exists, particularly in children and the aged, the viscera are occasionally protruded by trivial circumstances, such as cry- ing, coughing, sneezing, or even by the act of a somewhat full inspira- tion ; but in other cases, or where there is no marked predisposition, the protrusion only takes place under great bodily exertion, or in con- sequence of external injury. When rupture ensues in consequence of predisposition, or seems to take place spontaneously, its formation is very gradual; but when it results from extreme corporeal exertion, it appears very suddenly, and if the opening through which the bowels protrude be small, as is generally the case in such instances, there is much danger of strangulation. Hernia is termed reducible when it can at any time be readily returned into the abdomen, and when, in an unreduced state, it is productive of no pain, or hinderance to the performance of the intestinal functions; irreducible, when it cannot be replaced, in consequence of its bulk, or from the contraction of adhesions; and strangulated, when the pro- truded parts are not only incapable of being returned, but are moreover affected with constriction, pain, and inflammation, attended with nausea, frequent retching or vomiting, tension of the abdomen, obstruction of the bowels, quick, hard pulse, and more or less fever. If the return of the intestine be not effected under such a state of matters, an aggrava- tion of all the said symptoms at first ensues, and subsequently the vomiting is exchanged for a convulsive hiccough, with frequent bilious eructations; after the abdominal tension, fever and extreme restless- ness have continued for a few hours in an increased degree, the patient suddenly becomes relieved from pain, the pulse low, feeble, and intermittent, the eyes dim and glassy, the belly ceases to be tumid and tense, and the skin, particularly that of the extremities, be- comes cold and moist; the hernial swelling disappears, and the integu- ments over the part often change to a livid hue, but invariably convey an emphysematous feel or crepitus to the touch, indicative of the establishment of gangrene: finally, spasmodic rigors and convulsive twitching in the tendons supervene, and death soon terminates the scene. Therapeutics.—When the disease has not been neglected, or is not of long standing, it may very generally, if not invariably, be cured by means of internal homoeopathic remedies. In effecting the reduction of a hernia by the taxis, the patient should be laid upon his back, a pillow being placed under the chest and pelvis, so as to curve the trunk of the body, and thereby relax the abdominal muscles. If the case be one of inguinal or femoral hernia, the muscles kc, of the thigh must also be relaxed, by placing the limb in a state of flexion, so as to be rotated inwards. Then gently compressing the tu- mour, Ave should push upwards and outwards, in the case of inguinal hernia; and first backwards and then upwards, in the case of femoral if the tumour be small; but first downwards, and then backwards and upwards, when it is large and reflected over Poupart's ligament.1 1 In Umbilical hernia the pressure is to be made directly backwards. 502 DISEASES OF PARTICULAR ORGANS AND REGIONS. Even strangulated hernia is capable of being reduced by the taxis with facility, after the employment of the proper remedies, particularly Aconite and Nux vom.; the operation, which is always more or less dangerous, being thereby avoided. In almost every instance, but particularly when the rupture causes pain, and is tender to the touch, the appropriate medicine ought first to be prescribed,—since, if the remedy selected should not prove adequate to produce reduction, it will at all events have the effect of removing the irritability, and, consequently, of rendering replacement by the taxis comparatively easy, and free from the danger which would other- wise have attended any attempt at manual reposition, preparatory to the dispersion of the irritation. In some cases, the application of warm fomentations to the part reduces the hernia, and the general relaxing effects of a Avarm bath are well known as being useful in facilitating reduction. The following treatment has been strongly recommended when the symptoms encountered are as described:— Aconitum :—When there is considerable fever, with quick, hard, full pulse, inflammation of the affected parts, with excessive sensibility to the touch; violent burning pain in the abdomen ; bitter, bilious vomit- ing; agonizing restlessness, and cold perspiration. A second dose to be given, if required, an hour after the first, or even a third after a similar interval. In the majority of cases, marked benefit has resulted after the administration of the first dose of Aconitum, under the cir- cumstances mentioned ; but when no change for the better resulted after the third exhibition, or when the bilious eructations and vomiting become converted into an acid character, Sulphur must be prescribed, and if the patient fall asleep thereafter, he should be allowed to repose quietly. When the tumour is not so painful or tender to the touch, and the vomiting less severe, but the respiration oppressed and laborious, and the strangulation has arisen from errors in diet, from exposure to cold, from being overheated, or from a violent fit of passion, &c, Nux v. is to be preferred, and may be repeated every two hours or so. If no change results in about two hours after the second dose of Nux v.,—Opium should be prescribed, or this remedy may be had recourse to from the first, and repeated every quarter of an hour, until improve- ment takes place, should there be hardness and distension of the abdo- men, putrid eructations, or even vomiting of faecal matter. (Plumbum may be given after the third or fourth dose of Opium, if no decided change for the better become perceptible.) When there is retching and vomiting, with cold moist skin and cold- ness of the extremities,—Veratrum should be administered and repeated in from half an hour to an hour or so; and in the event of no favour- able turn taking place after the second dose,—Belladonna should be prescribed. When the case has been neglected, or Ave find, on visiting the patient, the malady already advanced so far that the integuments over the rup- ture have assumed a livid hue, and there is reason to apprehend the invasion of gangrene, the patient may yet be saved by the administra- tion of Lachesis in repeated doses; if no relief follow in the space of RUPTURE. 503 about two hours, Arsenicum may be tried. Rhus has also been spoken of as being serviceable in extreme cases. The operation should not be delayed, when symptoms of a serious character do not speedily yield to the remedies indicated ; but the latter should always be tried first, as no bad consequences will result from the delay under the precautions stated; on the contrary, the subsequent manual treatment has been found to be thereby materially facilitated. [The following practical remarks of M. Traub,1 on the homoeopathic treatment of incarcerated hernia, appear to us to require no apology for their insertion here.] Incarcerated Ruptures. {Herniae incarcerates.) Incarcerated herniae belong undeniably to those diseases, in the treat- ment of which, the old method appeared in one of its brightest lights ; having, in most cases of incarcerated ruptures treated in accordance with its. dictates, succeeded in accomplishing the two desirable ends, viz. : the removal of the incarceration, and the reposition of the prolapsed parts, without resorting to an operation. According to my OAvn calcu- lation, this has always been the case in three out of four. But if we consider that the remedies which the old method employed for this pur- pose, were by no means of the most agreeable description to the unfor- tunate patient, but that, on the contrary, he had to suffer excessively during the treatment, we may justly rank homoeopathy above her older sister (even if Ave were to take it for granted that the former also suc- ceeds only in three cases out of four), because she attains her object by far more gentle means. But homoeopathy does more, though not so much as some exagge- rating panegyrists boast, yet decidedly more than some talented practi- tioners are disposed to admit. Dr. Lobethal, of Breslau, e. g., assures us in his contributions to the " Pharmako dynamik. nach homoeopath- ischen principien," (Allegm. Homoeop. Zeitung, 13 Band, 18 Nummer,) where he describes the effects of Nux vomica with his customary exact- ness, that he has not observed, in incarcerated herniae, the effects ascribed to and expected from this remedy, and he adds that the exter- nal treatment of hernia appears to him, according to the character of the incarceration, to be more efficacious than the employment of Nux, Belladonna, and Aurum. It were much to be regretted, if the prejudice caused and promulgated by such unfavourable experience, were to induce practitioners never to have recourse to specific medicines in cases of incarcerated hernia, or, at all events, to do so with but little confidence. In order to prevent the possibility of this prejudice taking place, it is desirable that many such cures should be made known ; and this is the reason which induces me to communicate the observations that I have hitherto had an opportu- nity of making, in my OAvn practice, on the homoeopathic treatment of incarcerated hernia. From the time that I commenced to treat my patients on the principles of homoeopathy, but few incarcerated ruptures 1 Beitrage Zur Homceopathie, vom Landchirurgus Traub in Schonigen.—Allg- Horn. Zeit. No. 12, 31ster Bd. 504 DISEASES OF PARTICULAR ORGANS AND REGIONS. have occurred to me in which the homoeopathic medicines have failed to prove their specific power, (the proportion is as one to ten), through which I have become convinced that homoeopathy has obtained a great triumph over the old method in the cure of this disorder also. ^ In treating incarcerated herniae with homoeopathic remedies, I con- sider it necessary that the patient should preserve, uninterruptedly, such a position that, after the incarceration has been removed, the pro- truded parts shall either fall back into the cavity of the abdomen by their own gravity, or be drawn back by the other intestines, and no manual efforts whatever be made to attempt the reduction. To remove the incarceration, homoeopathy selects, as is well known, such medicines, which, if taken by a healthy person in an appropriate manner and in sufficient quantity, produce positive symptoms, very simi- lar to those of Hernia incarcerata, with the view of lessening and removing the morbid muscular contraction by the reaction of the vital power (according to the unchangeable law of nature, through Avhich the reacting vital power constantly strives to call forth a tone and activity opposed to that which has been positively excited in the organismus by some extraneous influence, and thus restores the equilibrium and the harmony of the vital functions). In order to insure the most favourable action of specific remedies, the patient should be kept as quiet as possible, and allowed to remain undis- turbed, all manipulations made for the purpose of accomplishing reposi- tion, having the effect of producing a primary, or so to speak, violent or forcible dilation of the contracting muscles, by which an increased con- traction is caused through the reaction of the vital power, and in conse- quence of Avhich the beneficial effects of the medicine employed is thereby materially obstructed. The same is the case with most remedies which are applied externally, wherefore, the external treatment of an incarce- rated rupture is, in most cases where homoeopathic remedies are em- ployed, not only superfluous, but even detrimental. If, in treating an incarcerated hernia, both homoeopathic medicines and external treatment are employed, and the reposition succeeds, this result is no doubt to be looked upon rather as the effect of the latter than of the former, because the homoeopathic medicines are interrupted in the display of their positive effects, and the vital power cannot, under such circumstances, exert a beneficial reaction; in this case Dr. Lobe- thai is perfectly right when he says : The external treatment of a rup- ture appears to him to effect more than Nux, Belladonna, and Aurum. But if, under thq external treatment of a rupture, the reposition does not succeed, the bad effects of the incarceration will increase the more rapidly, and the necessity of an operation will be indicated the sooner ; moreover, the success of the latter will be rendered the more doubtful the greater the degree of external violence which may have been used, since the evil consequences of these rude interferences continue even after the operation. The homoeopathic materia medica possesses already a considerable number of remedies by which the symptoms of incarcerated hernia can be more or less simulated, but only a few of these have been employed RUPTURE. 505 up to the present time. In my own practice I found the greatest assist- ance from the following: 1. Nux VOMICA, 2. Acidum sulphuricum, 3. Lycopodium, 4. Belladonna. And, finally, I must mention one more remedy, which, although it does not offer in the series of symptoms that it is capable of producing, those which accompany the formation and incarceration of a hernia, can yet not be dispensed with as an appropriate intermediate or auxiliary remedy in certain forms of incarcerated ruptures, on account of the unlimited influence which it exercises upon the vascular, and chiefly upon the capillary system, and accordingly not only comprises among its symp- toms the type of inflammatory fever, but also the type of acute local inflammation; farther, on account of its effects upon the mind, which manifest themselves particularly in the form of inconsolable anguish, forebodings of death, and great disposition to be frightened,—states of mind which Ave not unfrequently meet with in persons affected with incarcerated hernia: I allude to Aconitum Napellus. The method I have hitherto adopted in the treatment of incarcerated ruptures is as follows :— Having convinced myself of the existence of an incarceration, I first place the patient in a comfortable reclining posture, the chest and the pelvis somewhat raised, in order that the abdominal muscles may be relaxed as much as possible; the lower extremities being, at the same time, moderately drawn up. The patient having continued in this posi- tion for a few minutes, I proceed to the selection of the remedies. In reference to the concomitant symptoms, we meet with three forms of incarcerated herniae, which present materially different marks of distinction. First form of Incarceration. The rupture has just occurred for the first time, or one that had formerly existed has reappeared, and has suddenly become incarcerated, in which case the rupture is always small, the symptoms appear suddenly and with greater intensity; they consist in a pinching or squeezing and pressive sensation in the region of the rupture; violent dragging pain with periodical tearing, and a sort of spasmodic constriction in the abdomen ; nausea, inclination to vomit, and actual vomiting of an acid mucus ; obstruction, with frequent inclinations for stool; most of these symptoms are increased by the slightest pressure on the rupture, as also by movement. Nux vomica corresponds with the symptoms of this form of incarce- ration. I accordingly give 10-15 globules of one of the higher poten- cies every half hour or every hour. Frequently a remission of the symptoms takes place after the first dose or two; if, at the same time, a sensation of movement takes place in the rupture, or if a gurgling noise be heard, then a remission of the incarcerating muscular contrac- tion, and a speedy replacement, Avithout any external treatment, may be expected. Should this not be the case, but, on the contrary, the 506 diseases of particular organs and regions. sufferings return again with unabated vigour ; or if an oppressive sore- ness or pain as if from a wound, and a violent burning, prevail in the region of the rupture, and the superincumbent integuments become very sensitive to the slightest touch; or if the heat in the affected parts increases, and thus betokens an increased determination of blood towards these parts ; or should the incarceration have been preceded by a fright, or some other mental affection, and the patient be in a state of general irritation or excitement, then I usually give one drop of Aconitum of the third to the sixth dilution, and, an hour afterwards, Nux vomica at a lower dilution than in the first instance, and in a liquid form in preference (Nux vom. 2 gtt. x.-xv.; Aq. destill. ij), a teaspoonful every half hour to an hour. Second form of Incarceration. The rupture becomes suddenly incarcerated and is generally small: tearing, dragging pain, both in the rupture itself, and in the whole abdomen predominates; the patient sometimes experiences fugitive stitches in the region of the rupture ; the pains undergo periodical re- missions—disappearing almost entirely for a time, and then returning with increased violence; the patient feels much exhausted during the remissions ; he complains of a general sensation of cold ; the abdomen is much distended by flatus; after a continued desire to vomit, the patient eventually vomits an acid-tasting fluid; and, notwithstanding a very urgent inclination for stool, no evacuation takes place. In this form of incarceration likewise, Nux vomica is an excellent medicine, but Lycopodium vies Avith it in efficacy; I generally adminis- ter both these medicines alternately, at intervals of one to two hours. If, however, these symptoms appear in a crural rupture, if they take place in a woman, or has the incarceration in the latter case taken place during or immediately after the appearance of the menses, and if, more- over, the individual is of a mild, yielding disposition, Lycopodium is to be preferred. I give this medicine in the middle attenuations (10-15) either in globules or in the liquid form (Tinct. lycop. gtt. xv.; Aq. destill. 3j), a teaspoonful every half hour, or every hour. If throbbing, burning, and other symptoms indicating Aconitum become predominant, I admi- nister the latter as an intermediate remedy. Third form of Incarceration. The third form of incarcerated hernia (which occurs chiefly in aged persons, and in ruptures of long standing, that have, for the most part, been kept back by appropriate bandages, or have been continually pro- truding, and have attained a large size) is that in which the incarcera- tion comes on insidiously and imperceptibly, and betrays itself at first only by a distressing, pinching, and constrictive sensation of the region of the rupture, by uneasiness and fulness in the abdomen, and by peri- odical sickness and constipation. The rupture is not very painful to the touch, the incarcerated part is also not so tense and hard as in the two preceding forms, but feels more doughy. This incarceration may often exist for days, without any perceptible increase in the concomi- tant symptoms; gradually, however, twitchings and pinchings, combined rupture. 507 with periodic, transitory, tearing pains, supervene in the abdomen and groin ; the sickness then becomes more lasting, a sweetish, saline, or bitter fluid is sometimes eructated, and is not unfrequently followed by vomiting of a watery fluid, and subsequently of ingesta. In this form also, two medicines concur, and the one is again Nux vomica, Avhich competes here with Acidum sulphuricum for the rank of priority. If the patient is of a sanguineo-choleric temperament, which, hoAvever, is but seldom the case, Nux vomica, at a low dilution, must be given first; and should the removal of the incarceration not be effected within twelve hours, Acidum sulphuricum must be administered. If the incarceration takes place on the left side, and the patient is of a melan- cholic-phlegmatic temperament, Acid, sulphuricum should be employed from the beginning. I have hitherto been in the habit of prescribing in the disorder in question, a drop of the tenth dilution of this medicine to be taken every hour. By means of the foregoing treatment of incarcerated hernia, I say it with heartfelt joy, I have always more readily and more frequently suc- ceeded in attaining the desired result, than was the case in my former practice, when I treated my patients in accordance with the principles of the old school. If my assistance was sought sufficiently early, it formed a rare exception to the rule, when an incarceration of the first and second form was not removed within eight hours, and that of the third form within twenty-four hours. Still more rarely did it happen that the homoeopathic medicines entirely failed to remove the incarce- ration, and where it consequently became necessary to perform an ope- ration. It is very much to be regretted that homoeopathy cannot yet renounce the operation as the last resource in the treatment of incarcerated her- nia ; whether this will ever be possible, I shall not investigate here; we may, however, presume, with every appearance of certainty, that those cases in which the operation is now deemed indispensable, will become more and more scarce, the more closely that the reprovings of medicines already knoAvn, and the provings of others yet unknown, or untried, will be discovered to approach in similarity individual forms of this disease. If the homoeopathic medicines do not remove the incarceration within a given space, to be determined by each individual case; but if, on the contrary, symptoms of a more troublesome and dangerous character make their appearance ; if not only the rupture itself, but also the abdo- men and the epigastric region become very sensible to the slightest touch; if the existing pains and the tension of the abdomen become more intensely violent; if nausea, the inclination to vomit, and the vomiting itself increase, and the patient vomit more liquid than he has taken, even during the prevalence of excessive thirst; should traces of bile or of other intestinal contents be discovered in the matter ejected; if high fever, Avith a hard, full pulse supervene, and the patient become more and more restless, it is to be presumed that the medicines admi- nistered (although no others can be found that correspond better with the form of the disease under treatment) are either not strictly homoeo- pathic to the case, or that they have been employed in an improper 508 diseases of particular organs and regions. dose, or, finally, that the medicine appropriate to this individual case is as yet unproved, and therefore unknown. Under such circumstances I never hesitate for a moment to propose an operation, and if the patient consents, to perform it as soon as possible. FAINTING. SWOONING. Syncope. Individuals of weak nerves and delicate constitutions, particularly of the female sex, are frequently subject to fainting fits, which although rarely dangerous, yet when utterly neglected, or inappropriately treated by violent or very debilitating means, are prone to become serious, and even fatal. The usual causes are sudden transitions from cold to heat; breathing vitiated atmospheres ; great fatigue; loss of blood; long fasting; grief, fear, and other mental emotions. When fainting occurs, the patient ought immediately to be removed to where a stream of pure fresh air can be obtained, and freed from all tight clothing about the neck, chest, and abdomen; he should at the same time be placed in a comfortable position, with the head low. If the foregoing prove insufficient to effect restoration, sprinkle cold fresh water on the face and neck, and, if necessary, on the pit of the stomach. Should there still be no marked benefit produced, or if the patient becomes cold, a little spirits of camphor may be applied to the nose. When the fainting has arisen from fright, the best medicines are Aconite or Opium, and sometimes Colocynth. (See Mental Emotions.) In general cases of syncope occasioned by, but more especially in those which proceed from, excessive depletion, or other debilitating causes,— Cinchona, and in some instances, when cinchona merely mitigates the attacks, Nux v., Carb. v., and Veratrum; also a little wine in very small quantities at a time, or a little bread or biscuit, soaked in wine, and sometimes a little strong soup, may be administered when the patient has rallied. Should the fainting arise from mental emotions, Ignatia and Chamomilla are the remedies in general cases. (See Mental Emotions.) When slight pain causes fainting, Hepar sulph. Fainting from violent pain, Aconite, Chamomilla, or Cocculus. (See the indications given below for these remedies.) In other cases, the following remedies have been recommended where the corresponding symptoms are met with: Aconitum.—When there is a palpitation of the heart, with deter- mination of blood to the head, humming in the ears ; or when the paroxysms come on usually on assuming the erect posture, and are ac- companied with shivering and flushing of the face, succeeded by deadly paleness. (Syncope cardiaca.) Coffea may be prescribed after Aconitum in highly ^ excitable or nervous subjects, when the fainting fit has arisen from fright, and the last-named medicine has not relieved much. Hepar sulphuris, when the fit generally comes on towards evening, and is preceded by vertigo. Lachesis, when the fainting fits are either preceded, accompanied, fainting. 509 or followed by asthmatic symptoms, vertigo, paleness of the face, nausea, vomiting, convulsions, spasms of the jaw, rigidity of the body; bloated appearance of the face ; epistaxis ; aching pain or stitches in the prce- cordia (Syncope cardiaca); cold perspirations. (See Heart, diseases of the.) (See Veratrum.) Moschus.—Fainting fits, attended with spasms in the chest, or suc- ceeded by headache, and occurring towards evening, during the night, or in the open air. Veratrum, when the attacks are excited by the slightest fatigue; or when they are often preceded by a feeling of extreme anguish and excessive dejection, or despair, and accompanied by spasmodic clenching of the teeth, and convulsive movements of the eyes and their lids. Nux v. is a beneficial remedy in syncope arising from debility, ex- cessive mental application, or from over-indulgence in intoxicating liquors; and particularly Avhen the fits take place in the morning, after a meal, or after taking exercise; and there is nausea, with paleness of the face; also, when the patient complains, on recovery, of pain in the stomach, sparks before the eyes, or dimness of sight, together with a feeling of anxiety ; and is, further, affected with anxiety, trembling, and congestion in the head, or oppression at the chest, and vomiting. Acidum phosphoricum has been found useful after Nux v., when that remedy has not removed or diminished the tendency to suffer from fainting fits after a meal. When, as is frequently the case, the fits of swooning or fainting take place in hysterical females, the remedies which will commonly be found the most appropriate are, Ignatia, Nux moschata, Cocculus, Chamomilla, Nux v., Natrum m., or Arsenicum, kc If the attacks are attended with asthmatic symptoms, Kreosotum, and Berberis in addition to Nux v. When accompanied by headache, Lycopodium, Moschus, Graphites, Natrum m., Stram.; loss of con- sciousness, Lycopodium, Oleander, Arnica, kc Creeping or crawling in the limbs, Nux v., Borax. Humming, buzzing, or tingling in the ears, Aconitum, Nux v., Petroleum, kc Paleness of the face, Berberis, Natrum m., Pulsatilla, kc, in addition to Nux v. Copious perspira- tion or sweating, Calcarea. Pain in the heart, Lachesis, kc Benumbed limbs, Natr. m. Coldness or shivering, Aconitum, Calcarea, Colocynth, kc Vertigo, Sulphur, Arsenicum, Berberis, Lachesis, kc Vomiting, Lachesis, Nux v., Pulsatilla, Kali c, kc In conclusion, it may be remarked that Caladium, in addition to Aeon., is useful in cases that are liable to come on after assuming the erect posture. Kreosotum and Spigelia when occurring from the heat of the room. Lycopodium and Silicea, when in the recumbent posture. Caladium, when engaged in meditation. Carbo v., Natrum m., Kreoso- tum in addition to Nux v., when in the morning. When writing, Persons' who are subject to fits of fainting or swooning should^ if possible, strictly avoid all those frequent causes of fainting fits which have been alluded to at the commencement of this chapter; as also, where practicable, any other cause known by experience to be produc- tive of the attack ; otherwise the cure will be rendered difficult, or even hopeless. 510 diseases of particular organs and regions. PAINS IN THE LOINS. Notalgia. As these pains are frequently purely symptomatic, the treatment must be directed against the disease from which they originate. Thus as Hemorrhoids, Leucorrhoea, Metritis, Myelitis, kc, are frequent sources of the complaint. The reader is referred to the treatment of these affections in their respective chapters. When the pains arise from the habitual indulgence in wine or spiri- tuous liquors, coupled with confirmed sedentary habits, or late hours, an occasional dose of Nux v. will generally afford relief; and when a strain from lifting a heavy weight, or from any sudden twist on turning the body, or throwing up a windoAV, &c, has given rise to the pain, Rhus toxicodendron must be had recourse to ; followed, if required, by Sulphur and Calcarea. (Vide also Lumbago, Rheumatism, &c. ; and for pains in the bach, or lumbosacral pains, occurring in females during pregnancy, see that article, Part II.) DROPSY. Hydrops. The term dropsy is used to imply an abnormal or unusual collection of serous or watery fluid in the cellular tissue, or in any of the cavities of the body. It has, consequently, received the following different appellations according to the particular seat of the effusion: Hydro- cephalus, when the fluid is deposited in the cavity of the cranium; Hydrothorax, when in the chest; Ascites, when in the abdomen; Hydrocele, when in the scrotum ; Hydrometra, when in the uterus ; and Anasarca, when it is diffused through the cellular substance. The usual symptoms of dropsy are, pale and sickly complexion; dryness of the skin ; red and parched, furred and moist, or on the con- trary, a preternaturally clean and florid tongue; failure of appetite, and impaired digestion; constipation, but sometimes diarrhoea, and, occasionally, an alternation between these two states; urine scanty, high- coloured, in some instances coagulable by heat, and of low specific gravity; pulse variable, being sometimes quick, at others slow, and frequently irregular and intermitting; general debility; feverishness, especially towards night. In some cases there is cough, with dyspnoea, or a feeling of suffocation, particularly in the recumbent posture ; and occasionally violent palpitation of the heart, with sudden starting during sleep. The remedies which have hitherto been employed, with greatest advantage, by homoeopathists, are: Arsenicum album, Helleborus niger, Lycopodium, Zincum m.,1 Ononis spin., Aurum m., Digitalis purpurea, Ledum palustre, Cinchona, Mercurius, Sulphur, Euphorbium, Kali carbonicum, Dulcamara, Colchicum autumnale, Prunus spinosa, Sepia 1 Zincum m. is one of the most important remedies in dropsical affections, and espe- cially when pains or disagreeable sensations are experienced in the region of the kidneys. Wahle, Neues Archiv. Dritter Band, Erstes Heft, p. 28. ASCITES. 511 (especially in drunkards), Bryonia, Ferrum, Phosphorus, Rhus toxico- dendron, Sambucus, Solanum nigrum, Camphora, Cantharides, Scilla maritima, Convolvulus arvensis, Veratrum, Lactuca virosa. In dropsy supervening after the retropulsion of exanthematous diseases : Helleborus, Arsenicum, Digitalis, Rhus, and Sulphur are found the most efficacious. In that resulting from intermittent fevers: Arsenicum, Ferrum, Dulcamara, Mercurius, Solanum nigrum, and Sulph. In drunkards: Arsenicum, Helleborus, Sulphur, Rhus, and Ledum. In that from depletion: Cinchona, Ferrum, Mercurius, Sulphur, and Phos- phorus. And in that from the excessive use of mercurial preparations ; Sulphur, Cinchona, Dulcamara, and Helleborus. For further particu- lars, see Ascites, Anasarca, Hydrothorax, Hydrocephalus, &c. Hydrops occurring at an advanced period of life is chiefly to be relieved by the employment of Kali c, Conium, Sulphur, Lycopodium, and Oleum terebinthince. The diet of patients affected with dropsy should be light, but of nutritive quality. ASCITES. Ascites, or dropsical effusion in the cavity of the peritoneum, may be complicated or not with hydrothorax or general anasarca. In the majority of cases there is also oedema of the lower extremities, or other parts of the body. The disease, in many cases, goes on gradually and insidiously, the abdominal distension being at first attributed to corpulency. In others, again, and especially the idiopathic and acute forms, whilst there is an equal absence of marked constitutional distur- bance, the effusion takes place so suddenly, accompanied with such characteristic indications, that there is little risk of falling into error as to the true nature of the enlargement. But on some occasions the inva- sion of the disease is announced by striking premonitory symptoms, such as fever, restless nights, thirst, impaired digestion, foul tongue, nausea or vomiting, costiveness, scanty high-coloured urine, pain in the lumbar or hepatic regions, &c. The swelling of the abdomen in ascites is somewhat tense, the sound on percussion dull, and when the quantity of the effusion is considerable, the swelling gravitates to the side towards which the patient inclines, and a sense of fluctuation will be felt on placing one hand on one side of the abdomen, and striking the opposite side sharply with the other. There is frequently more or less difficulty of breathing, with incapability of lying in the recumbent posture, either in consequence of accelerated circulation, or from the encroachment of the accumulated fluid on the thorax. Muscular attenuation is a common attendant on this form of the disorder, as well as on general dropsy. Those parts of the body which are not puffed up by serous infiltration are accordingly found to be in a state of emaciation. The prognosis in dropsy must be regulated by the nature of the case, and the age and temperament of the patient. When combined with any organic disease of the abdominal viscera, or the contents of the thorax, with effusion into its cavities, we can scarcely anticipate any other than an unfavourable termination. When occurring in individuals at an advanced time of life, or in sickly children, accompanied with emaciation 512 DISEASES OF PARTICULAR ORGANS AND REGIONS. and extreme prostration of strength, fever, cough and difficulty _ of breathing, scanty and offensive urine, feeble, irregular, and intermitting pulse, petechiae and hemorrhages, we must generally expect a like unfortunate issue. But when the disorder sets in as a consequence of scarlatina or other exanthemata, or arises suddenly after the suppression of some accustomed discharge, or from exposure to cold, or exhaustion from fatigue, although properly held as a serious malady, it is yet, in such cases, by no means to be considered in the light of a fatal one. Therapeutics.—Helleborus niger, Arsenicum, Cinchona, Mercurius, Sulphur, Bryonia alba, Ledum palustre, Kali carbonicum, and Lycopo- dium, kc, are amongst the most useful medicaments. Helleborus niger.—This important medicine is often of equal ser- vice here, and in dropsy in general, as in anasarca, and particularly in the acute idiopathic form of the disease, in which indeed it is almost superior to any other remedy. Occasionally it will be found necessary to have recourse to Aconite in the first instance, in order to allay any excessive degree of arterial excitement; but when that is inconsiderable, or when the febrile symptoms are accompanied with great debility, and a tendency to torpor or lethargy ; the urine extremely scanty, or almost suppressed, and the motions loose and gelatinous; also Avhen shooting or other pains are complained of in the extremities, Helleborus should at once be employed. In chronic dropsy, Helleborus is also sometimes of unequivocal utility as an intermediate medicament. Bryonia, Ledum, Lachesis, or Mercurius, are useful auxiliaries to Helleb., when required, in the acute variety of anasarca. Arsenicum.—As has already been stated, under the head of Ana- sarca, this remedy is peculiarly valuable when extreme debility is a characteristic feature, and has arisen from the depressing effects of other maladies. It is of speedy efficacy in acute cases, when called for, but is also valuable in the chronic forms occurring in shattered or broken-up constitutions ; and even in cases connected with organic affection of some important viscus, it will be found a most useful palliative, however inade-. quate it may be to effect a cure in such hopeless cases. Digitalis, Ledum, Bryonia, Solanum nigrum, and Helleborus are sometimes useful after Arsenicum. (See Anasarca, for some of the principal sympto- matic indications for this remedy.) Cinchona.—In ascites occurring in constitutions which have been much debilitated by loss of fluids, Cinchona can rarely be dispensed with. But also in chronic dropsy arising from organic disease of the liver or spleen, particularly the latter, considerable advantage is obtained from its employment. When, in connexion with either of the above conditions, we meet Avith a short distressing cough, accompanied or not with some expectoration, extreme paleness of the skin, general chilli- ness, small, feeble, and sIoav pulse, frequent calls to make water, which are usually ineffectual or followed by a scanty discharge,—there will be additional reason for having recourse to this remedy. Arsenicum and Ferrum are often found exceedingly useful after or in alternation with Cinchona. , Mercurius, together with Arsenicum, Cinchona, Belladonna, Bryo- nia, Lachesis, and Sulphur, forms an important remedy in chronic cases anasarca. 513 associated with disease of some viscus, such as the liver or spleen, attended with great debility, incipient, short, and shaking cough, &c. When we encounter symptoms of peritoneal inflammation Aconitum, Bryonia, Belladonna, Lachesis, or Mercurius are chiefly brought into requisition. In ascites connected with the suppression of accustomed discharges, Sulphur, and Lycopodium, as also Sepia, Calcarea, Kali, Pulsatilla, and Silicea are the most useful medicaments. Cantharides has been recommended as particularly serviceable in hydrops connected with deficiency of tone in the urinary organs, and attended Avith strangury, tenesmus, and pains in the limbs, &c. In ascites consecutive on scarlatina or other exanthemata, Helleborus, Arsenicum, Rhus,1 Belladonna, Sulphur, and Digitalis, form the most valuable remedial agents. And in the chronic forms of the malady, espe- cially when occurring at an advanced period of life, the following are the most important: Kali c, Con., Sulph., Iod., Lycopod., and Ol. tereb. (See also Hydrops and Anasarca.) DROPSY OF THE CELLULAR TISSUE. Anasarca. This form of dropsy consists in a preternatural accumulation of serous fluid in the cellular membrane, immediately under the skin. As the collection of fluid increases, the skin is frequently rendered inflamed and swollen, and exhibits an erysipelatous-like aspect. An outlet is eventually given to the effused liquid by the partition of the distended cuticle; but the serous infiltration into the cellular texture continues with undiminished rapidity. The affection is, in the greater number of cases, symptomatic of some other disease, and is most fre- quently met with in combination with general dropsy. It sometimes, however, exists as an idiopathic affection, particularly in the sthenic form. The disease in the acute form, generally affects those who are in the prime of life. It comes on suddenly, either after taking a large draught of cold water when the body is heated, or after exposure to cold under similar circumstances; and generally gives the first indica- tion of its invasion by a feeling of oppression at the chest, occasionally attended with a distressing cough and pain, particularly on drawing a full breath. In the course of a few hours, dropsical swelling becomes apparent, at first, for the most part, in the face, from whence it spreads dowmvards to the trunk and extremities. The urine in this, as in the other forms, is scanty aud high-coloured. The pulse is frequently neither above nor below the natural standard, although in some cases it is rather quick, and accompanied with heat and dryness of the skin, whilst in others it is weak or irregular. If the disease be unchecked, the swelling increases, respiration is performed with increasing difficulty, and the patient is incapacitated from assuming the recumbent posture 1 In general I found Rhus more useful than any other remedy in hydrops occurring after scarlatina, but the other remedies, and especially Helleborus, occasionally proved useful. The extent of the anasarcous swelling does not always indicate the degree of danger, as children are carried off by hydrothorax or by hydrocephalus, who have exhibited only a slight degree of tumefaction. (Rummell, Alg. horn. Zeit 21-32 ) 33 ' '' 514 DISEASES OF PARTICULAR ORGANS AND REGIONS. or at the utmost can only recline in one particular position. A fatal termination may take place in a few days, but several weeks sometimes elapse before the patient sinks exhausted. The asthenic form of anasarca generally comes on slowly. It is most frequent amongst the lower orders, who are necessitated to dwell in damp, dark, and ill-ventilated apartments, and who, from poverty, can only obtain the most unwholesome food. When met with in a higher walk of life, it is commonly superinduced by sedentary habits, depress- ing emotions, excessive depletion, arising either from the loss of blood, diarrhoea, or dysentery. The abuse of spirituous liquors, or debility resulting from chlorosis, scurvy, rheumatism, &c, may also be enume- rated as appertaining to the predisposing causes of this variety. The feet are commonly first observed to be in a swollen state, especially towards evening, and are found to pit on pressure: occasionally the face is also noticed to be puffy, and the anasarcous swelling then gradu- ally ascends higher, until it, in some cases, pervades and distends the cellular tissue of the entire body. The pulse varies ; sometimes there is considerable fever and dry skin; but the temperature of the parts' affected is in general diminished. The bowels, although usually costive, are sometimes met with in the opposite extreme; the urine, small in quantity and dark-red, depositing an abundant sediment. A great thirst is generally complained of. The skin becomes pale and often milk white; soft, but deprived of its natural moisture, and as the col- lection of fluid increases, its vitality is so depressed by the effects of prolonged distension, that the slightest injury will induce erysipelas, ulceration, and gangrene. There is another form of anasarca which, from the circumstance of its supervening after exanthemata, has received the appellation of con- secutive anasarca. This variety is much more frequently encountered in children than in adults, and especially as a consequence of scarlet fever. It is apparently of an inflammatory nature, and connected with imperfect cutaneous transpiration, or obstructed secretions and excre- tions. Exposure to cold or wet, or to a cold and damp atmosphere, favours its occurrence. Therapeutics.—The remedies required for the treatment of ana- sarca are, for the most part, the same as those which are employed in general dropsy. The following may, however, be specified as more par- ticularly applicable to meet the several varieties of this species :—Hel- lebrous niger, Bryonia, Phosphorus, Mercurius, Arsenicum, Cinchona, Ferrum, Sulphur, Ledum, Dulcamara, Colchicum, Lactuca virosa, Sepia, Lycopodium, Primus spinosa, Digitalis, kc In the acute form of anasarca, Helleborus, Bryonia, Phosphorus, Arsenicum, and Mercurius, are commonly the most serviceable. Helle- borus, especially where we encounter febrile symptoms, with constric- tion in the chest and lancinating pains in the extremities, and almost total suppression of urine; or where there is coma somnolentum, with great debility and looseness of the bowels, the motions generally pre- senting a gelatinous appearance ; prolonged shivering, short and rapid respiration, much thirst. (Arsenicum is sometimes required to com- plete the cure after the previous employment of Helleborus.) ANASARCA. 515 Bryonia is of very great service in some cases of the acute, asthenic variety, whether idiopathic or otherwise, where there is oppression at the chest, with acute pricking pain particularly during a full inspira- tion ; increase of the anasarcous swelling during the day, and diminu- tion at night; constipation. Should the foregoing symptoms have come on suddenly after partaking of a long draught of cold water when in a heated state, or should the dropsical swelling make its appearance during an attack of pneumonia, there will be additional reason for selecting this remedy. Occasionally, however, it may be found neces- sary to follow up the treatment with Cinchona or Lycopodium, the lat- ter particularly where there are obstinate constipation and diminished activity of the skin. Phosphorus is chiefly used in anasarca accompanied with inflamma- tion of the lungs; here it forms one of the most important remedies. Should it not prove sufficient to overcome the entire disease, Sulphur, Lycopodium, and perhaps also Arsenicum and Lachesis, will, in general, be found the most appropriate medicaments to combat the remaining 1 symptoms. Mercurius.—In acute or chronic anasarca, attended with oppression at the chest, incessant, short, and extremely fatiguing cough, this is a useful remedy, particularly in the asthenic form, with disordered liver, general heat, thirst, great weakness. Dulcamara and Colchicum have been found useful in anasarca resulting from the effects of a chill from exposure to cold and wet when heated. In the asthenic or in the chronic form of anasarca, Arsenicum, Cin- chona, Ferrum, Mercurius, Sulphur, Camphora, Lycopodium, Sepia, Ledumpalustre, Rhus, Helleborus, kc, form the principal medicaments. Arsenicum is one of the most invaluable remedies in anasarca with debility, either when the attack has come on suddenly as an idiopathic affection after a chill from drinking copiously of cold water while in a state of perspiration; or when it has been induced by the depressing effects of other maladies, such as dysentery, diarrhoea, scorbutus, &c, and the habitual indulgence to excess in spirituous liquors ; or further, when the disorder occurs in combination with gastritis, pericarditis, and other affections of the heart or other viscera. The following symptoms constitute some of the leading characteristic indications for the employ- ment of Arsenicum. Tightness in breathing, or attacks of the oppres- sion at the chest which threaten suffocation on assuming the recumbent posture, and particularly when lying on the back; dry, harsh, and thickened skin, which is, at the same time, of extreme paleness, or of an earthy, greenish hue, particularly at the face; parched and somewhat reddened tongue; excessive thirst; aching or dragging and rending pains in the back and limbs ; extreme weakness amounting to complete prostration: feeble or irregular pulse; coldness of the extremities. Helleborus niger occasionally proves of essential service after or alter- nately with Arsenicum. In other cases Cinchona, Bryonia, Lachesis, Ledum, or Solanum nigrum may claim a preference. Cinchona.—In anasarca combined with affections of the liver or spleen ; or when the disorder has been induced by debility arising from loss of blood, diarrhoea, or dysentery, &c, this remedial agent is of 516 DISEASES OF PARTICULAR ORGANS AND REGIONS. much utility, but will generally require to be succeeded by Arsenicum, Ferrum, Helleborus, Mercurius, or Sulphur, kc Shooting or pricking pains in the parts affected with the dropsical swelling, together with a pale, sickly, or deathlike hue of the skin, are characteristic indications for Ferrum. Mercurius.—Some general indications for the employment of this remedy have already been given. In anasarca with debility it is more frequently useful than in the sthenic form. Sulphur is a useful general remedy in chronic cases, or in those with debility induced by Chlorosis, Scurvy, Diarrhoea, Syphilis, &c, Sepia, Lycopodium, or Kali, kc, are occasionally of some service after or in alternation with Sulphur. In other cases of anasarcous swelling with a deficiency of vital energy, Camphora, Rhus, Phosphorus, Prunus spinosa, Antimonium crudum, kc, have been found of con- siderable efficacy. Against consecutive anasarca, Helleborus niger and Belladonna are the more generally appropriate remedies; but in some cases it is neces- sary to have recourse to Arsenicum, Mercurius, Rhus, Digitalis, or ' Sulphur. When mortification threatens in consequence of anasarca, Lachesis, Cinchona, and Arsenicum are the remedies from which the greatest possible assistance is to be hoped. (See also art. Hydrops.) In anasarca arising from a long-continued residence in a damp, un- wholesome dwelling, Colchicum may prove a valuable palliative, if not a curative remedy. A radical cure was performed by it in a case which appeared to have been excited by the aforesaid cause, in which the fol- lowing were the predominant symptoms: At the commencement of the attack, slight gastric derangement, then very gradual anasarcous swelling, attended with pains in the joints and extreme sensibility of the skin to the slightest breath of air, no thirst, and a perfectly normal state of the urine. (Kurtz. A. h. Zeit. xxvi., 90.) DROPSY OF THE CHEST. Hydrothorax. Hydrops pectoris. Hydrops ihoracies. Dropsy of the chest may exist without complication with effusion into the cavity of the abdomen or any other dropsical affection. The collec- tion of fluid may take place in both sides of the chest, or in one only. Occasionally the exudation is lodged in the cellular texture of the lungs as well as in the sacs of the pleura. The disease is often ushered in by a sense of uneasiness at the inferior portion of the sternum, attended by some difficulty of breathing which is greatly increased by any exertion, but more especially whenever the recumbent posture is assumed. An annoying cough, at first dry, but subsequently accompanied Avith expec- toration of thin mucus, is experienced, and the feet are observed to be in an oedematous state toAvards evening. In addition to these symptoms, we encounter those which are met Avith in all forms of dropsy, such as paleness of the skin, thirst, and diminished secretion of urine, &c.; further, a fluctuation of fluid is frequently perceived in the thorax, either by the affected party himself or by his medical adviser, on par- ticular movements of the body. DROPSY OF THE CHEST. 517 Along Avith the above symptoms the existence of hydrothorax is to be detected by means of auscultation. Percussion gives a dull sound, and the respiratory murmur is either very obscure or entirely absent except in the vicinity of the spinal column. Enlargement of one or both sides of the chest is sometimes observed, together with an increased or more prominent appearance of the intercostal spaces. As the disease advances the dyspnoea increases, particularly at night, when it sometimes creates a dread of suffocation ; the extremities become more and more swollen, and the patient is frequently affected with pal- pitation and fits of excessive anxiety. Numbness is often complained of in one or both arms. Eventually the patient finds it impossible to keep the recumbent posture, or even incline backwards, and cannot indeed fall asleep in any position, especially if the water is collected in both cavities of the pleura, without starting up suddenly with increased difficulty of breathing and apprehension of asphyxia. The cheeks and lips become pale from the impeded circulation, and the pulse becomes irregular and intermittent. Finally, the patient is carried off by suffo- cation and exhaustion, or becomes comatose. In some cases the termina- tion is sudden, but in others death is preceded by a spitting of blood for the space of five or six days. Organic lesions of the lungs, heart, or their great vessels form the most frequent sources of hydrothorax ; but disease of some of the viscera of the abdomen, and especially induration or scirrhus of the liver, is an additional frequent cause of the affection. Therapeutics.—The prognosis in this serious and distressing malady must, in a great measure, depend on the cause of the effusion. But in truth, in almost all cases we can rarely speak otherwise than in the most unfavourable terms. The remedies from which the greatest alle- viation, and occasionally the ultimate cure, has hitherto been most fre- quently attained in homoeopathic treatment, are, Aconitum, Arsenicum, Carbo v., Helleborus, China, Lycopodium, Colchicum, Digitalis, Spige- lia, Dulcamara, kc The most important and more generally applicable remedy in hydro- thorax, whether resulting from inflammation of the pleura, or organic affection of the liver or spleen, and even of the heart, is Arsenicum, par- ticularly when the following train of symptoms are encountered; dis- tressingly impeded respiration, but especially after any exertion, such as going up stairs, &c.; incessant thirst with inclination to drink but little at a time; painfully obstructed breathing on getting into bed, not- withstanding that the act is performed with the utmost caution and slowness, attended with palpitation of the heart and excessive anguish as if from impending suffocation; extreme dyspnoea on assuming the recumbent posture, or on changing the position in bed during the night; coldness of the extremities; oedema of the feet; pale or greenish hue of the skin, pains in the back and loins; complete prostration of strength. When the above symptoms do not arise from or are uncon- nected Avith organic lesion of the heart, lungs, &c, they will rarely fail to yield to the employment of Arsenicum. In complications with organic affections of the liver, spleen, or heart, a greater or less degree of melioration is generally the utmost we can 518 diseases of particular organs and regions. look for from the use of this, and but too often it must be added, of any other remedy. Carbo v., Cinchona, Ferrum, and Mercurius are of con- siderable assistance after Arsenicum, where there is disease of some one or other of the abdominal viscera, such as the liver or spleen, &c. ; and Digitalis, Colchicum, and Spigelia when there is organic lesion of the thoracic viscera, particularly the heart or large vessels. Dulcamara has been found of considerable service in alleviating the sufferings in hydrothorax when they become aggravated during the pre- valence of cold, foggy, damp, or rainy weather, and continue so until a change takes place in the form of a pure and dry state of the atmo- sphere. Colchicum, as has already been stated, is a useful palliative along with Digitalis and Spigelia in dropsy of the chest connected with organic lesions of the heart or great vessels. It is to be preferred to Dulca- mara in those cases where, in addition to the tendency to an increase of suffering during cold and humid weather, there is, moreover, extreme susceptibility to cold. In hydrothorax resulting from inflammation of the pleura (chronic' pleurisy), Arsenicum, Carbo vegetabilis, Lycopodium, Lachesis, Kali carbonicum are the most important remedies in the generality of cases. When there are febrile symptoms accompanied by sharp pains in the chest, a dose or two of Aconitum is occasionally beneficial; but in most cases of this description we shall commonly find it more advantageous to have recourse to Bryonia, without the previous employment of Aconite. The following medicines may also be enumerated as likely to prove of service in hydrothorax: Stannum, Ammonium carbonicum, Scilla mari- tima, Aurum, Mercurius, and Senna. SCROFULA. The most common form of this disease is that in which the conglobate glands in different parts of the body, but especially the neck, under the chin, and behind the ears, become converted into hard, indolent tumours, and subsequently pass through the stages of suppuration and ulceration. The discharge which succeeds, instead of consisting of pus, is found of a white curdled matter bearing some resemblance to the coagulum of milk. In some cases, and those generally of an inveterate character, the eyes are the principal seat of the disease; whilst in others, of a still more virulent description, the joints become swollen and extremely painful, and if the course of the malady be not checked, it extends to the ligaments, cartilages, and adjacent bones ; or tubercles are developed in the lungs; hectic fever is then superadded, and often puts a fatal termination to the disorder. Therapeutics.—The remedies which have hitherto been chiefly employed in homoeopathic practice in the early stage of this disorder, are Belladonna, Silicea, Sulphur,1 Calcarea, Arsenicum, Pulsatilla, 1 A one and a half year old, highly scrofulous (hereditary) child; treated for a length of time allopathically, by means of Baryt., By dr. pot., and latterly Calomel, and then Iod.: around the neck glandular swellings partly commencing to suppurate, partly open and discharging thin yellow pus; moist scabs on the head and ears, eyelids red- SCROFULA. 519 Sepia; and when the glands of the neck, &c, are prominently affected, the following, in addition to the foregoing, are commonly of the greatest efficacy: Conium,1 Dulcamara,2Mercurius, Hepar, Cistus, Staphysagria, Phosphorus, Aurum, Baryta c. et m.,3 Rhus, Clematis, kc (See Disease of the Conglobate Glands.) A careful selection from amongst these remedies, according to the nature of the symptoms, combined with great attention to cleanliness, ventilation, and the quality of the food, which should be wholesome and nourishing, will rarely fail to be attended with satisfactory results. In young subjects, indeed, it will frequently be found practicable, after patient perseverance, com- pletely to eradicate, by the said means, the scrofulous diathesis. When the joints or bones have become affected, Sulphur, Calcarea, and Silicea, are of striking utility; in other cases,—Mercurius, Aurum, Lycopo- dium, Phosphorus, Cistus, kc, may be called for. And when the glands of the mesentery are in a diseased state (scrofula mesenterica), Sulphur, and Calcarea, as also Mercurius, Arsenicum, Baryta, Lycopod., Baryta c, Bella., China, Puis., Rhus, Nux, kc, are those from which we may generally look for the most important aid. (Vide also Enlargement and Induration of the Conglobate Glands in the Neck, &c, Atrophy, Rachitis, Ostitis, Ophthalmia, and Ulcers, &c.) dened and swollen; cornea obscured by old cicatrices and fresh ulcers ; excessive salivation; dry cough; violent fever from dentition. Tinct. sulph. 1, a drop night and morning. After some little time the child became lively and vigorous, and the ulcers healed. 1 Enlarged and indurated cervical glands of scrofulous children, which, if anything, rather increased than otherwise under the employment of Calc, Iod., and Silie., became strikingly diminished and softened within eight days from the use of Conium internally and externally. (Ohlhauth, Hyg. xvii., 262.) 2 Dulcamara (Tr. gtt. x., Sacch. lact. Dr. aliq., about a fifth of a grain twice a day, for a period of from six to eight weeks), cured hard, circumscribed, painless swellings of the cervical glands, the size of a pigeon's egg, occurring in young persons of from 14 to 18 years of age, who were otherwise apparently sound and healthy. (Diez. Hyg. xvii., 262.) 3 The sphere of action of Baryta mur. is more particularly confined to the lymphatic system. I have found it useful only in scrofulous cases (inflammations of the eye, eruptions, diarrhoea, blennorrhoea of the lungs). Dosis, 3d trituration (4 : 96) scr. j, in aq. destil 3ij, for children of a twelvemonth old, a teaspoonful every three hours, and so on, increasing or diminishing the dose, according to the age and temperament of the patient. The following cases are examples of its successful employment: A child, two years of age;—the neck surrounded with glandular indurations of about the size of an egg; abdomen hard and distended ; tongue furred; appetite only for dry bread; stools hard, white, and take place only after clysters ; urine yellowish and fetid; offensive otorrhoea; emaciation; swelling of the feet, hump-back. (Had been treated allopathically for a twelvemonth.) Milk, mucilaginous diet. Baryta mur. (9xij), as above, effected a perfect cure, inclusive of the hump, in three months. A child, one year and a half old, covered with ulcers; thick offensive incrustations over the head, fetid discharge from the ears; inflammation of the eyelids, photophobia; tumid belly; stools watery and fetid; swelling of the feet. In six months restoration to sound health. A girl, six years of age, dismissed as incurable after having been under allopathic treatment for a twelvemonth. Complete dimness of the cornea, sclerotica inflamed and relaxed; both nostrils inflamed and excoriated. After three weeks the inflammation was subdued; after four months, the vision clear and normal. (Altmuller, Allg. Horn. Zeit. xxi., 213.) 520 diseases of particular organs and regions. OSTITIS. Caries. Necrosis. Exostosis. Inflammation of bone may either be acute or chronic. It is usually characterized by pain, more or less severe, followed by swelling, and often with heat and redness of the integuments covering the affected parts. In chronic cases the enlargement takes place very slowly, and the pain varies according to the cause of the attack, being much more intense, and accompanied by nocturnal exacerbation, in ostitis arising from syphilis or from the abuse of mercury, than when induced by the effects of external lesion. The accompanying fever is not often very intense, and displays itself chiefly towards evening and at night. When the inflammation is acute, it soon, if unchecked, terminates in caries, in necrosis, or in suppuration of the cancellous texture. Caries or ulcera- tion may either arise in consequence of an external injury followed by considerable inflammation and abscess ; or it may occur as a sequel of scrofula and syphilis. The latter is the more frequent source of the disorder. It may take place in any of the bones, but is most commonly encountered in those of a spongy texture, such as the bones of the tarsus and carpus, the sternum, vertebras, and the extremities of the long bones. In the commencement of caries an obtuse, deep-seated pain is experienced in the affected bone, and the superincumbent integu- ments become discoloured, flabby, and tender to the touch; the soft parts then ulcerate, and a sinus is formed, which is in communication with the caries, and from whence a dark-coloured, thin, ichorous matter, having a peculiarly offensive odour, and occasionally containing osseous particles, is discharged. The diseased part of the bone is usually soft, moist, accompanied with the production of pale, spongy granulations, and sometimes perforated at innumerable points (worm-eaten caries); at other times the surface of the bone is dry, brittle, and of a pale Avhite colour. Partial absorption of the bony texture frequently takes place, some of which is rendered so fragile as to crumble aAvay at the slightest touch. Caries may take place at any period of life, but is most frequently met Avith in young subjects, particularly when origina- ting, as it so frequently does, in scrofula. The bones which are most liable to be affected with syphilitic caries are those of the cranium, the tibia, the sternum, the palate, and the nasal bones. While those which more commonly become carious from scrofula are the vertebras, the bones of the carpus and tarsus, and the extremities of the long bones. The disease is attended with the greatest danger when it exists in the bones of the cranium, the large joints, the vertebras, the carpus and tarsus, particularly if, at the same time, it arises from a constitutional cause. Necrosis, or the death of a portion of a bone, may be induced by violent inflammation of the periosteum, or by anything which affects the substance of the bone or the medulla in such a manner as to in- terfere with or interrupt the process of nutrition. Consequently severe contusions, compound fractures, the protracted exposure of the surface of a bone, which has been deprived of its periosteum, to the air; irri- tating applications, such as strong acids, caustics, &c, are frequent DISEASES OF THE BONES. 521 causes of the disease. But, in addition to these external means, it may also proceed from an internal or constitutional source; and ac- cordingly we find some of the worst forms of it attributable to the effects of scrofula, lues venerea, scorbutus, the abuse of mercury, and the debilitating results of typhus fever, small-pox, &c. The symptoms of necrosis vary according to the nature of the cause and the extent of the disease. In scrofulous or syphilitic individuals the pain is deep- seated and extremely violent; and it is in such cases that a large por- tion, sometimes indeed the whole shaft, of a long bone is destroyed. In all cases a swelling of a greater or less extent soon takes place, and the pain, Avhen excruciating, is rarely relieved until matter forms and the abscess bursts. When the necrosis is inconsiderable and arises from external injury, the patient being, at the same time, of a healthy habit, there is little or no constitutional disturbance. But when the disease is more extensive and occurs in scrofulous or otherwise un- healthy habits, the derangement of the system is sometimes very violent. On the bursting of the abscess, and particularly in the severer forms of necrosis, there remains a large tumour of a firm, unyielding description, resulting in the effusion of coagulable lymph around the dead bone, together with the oedematous and thickened condition of the cellular membrane. If a probe be introduced through the orifice from whence the matter escaped, and passed down to the bone, the surface of the latter will often be found bare and rough. Cicatrization does not take place after the evacuation of the abscess, but, on the contrary, the openings are, for the most part, converted into fistulas, chiefly in conse- quence of the continued irritation which is caused by the dead bone, and serve as a passage for the exit of any pus that may be formed as well as for the sequestrum itself. We can never be certain of the existence of necrosis until we can touch a portion of dead bone with a probe, or can obtain a sight of the affected bone, and find it presenting either an excessive whiteness or a darker colour than natural. All the bones are liable to necrosis, but the tibia, femur, clavicle, humerus, maxilla inferior, radius, and ulna, are those which are most frequently affected. The diaphysisis the gene- ral seat of the disease. Regeneration of the long, cylindrical, or flat bones may take place, but those of the cranium, carpus, and tarsus can- not be reproduced. Old age, lues venerea, cancer, scurvy, and rickets impede the regene- rative process. Suppuration principally takes place in the spongy tex- ture, or medullary cavity of a bone. Its invasion is speedily followed by absorption to a greater or less extent: and occasionally, while the interior structure is removed by the absorbents, the external shell is expanded {spina ventosa). After the suppurative process has gone on for some time, the matter makes its way under the skin, and gives rise to the foundation of a soft swelling or abscess, which on bursting, affords considerable alleviation of suffering. Necrosis and caries frequently originate in disease of the medullary membrane, in consequence of the obstruction which is thereby offered to the nourishment of the bone. Therapeutics.—In inflammation of bone we rarely find occasion to have recourse to Aconitum; at the utmost it may only be found useful 522 diseases of particular organs and regions. as a palliative, and that chiefly in idiopathic ostitis occurring in young plethoric subjects. In some of the milder forms, attended with redness of the integuments, slight swelling of the bone and extreme sensibility to the touch, Bryonia and Pulsatilla have proved very serviceable: the former particularly in persons of nervous or bilious temperament, and of a dry meagre habit; the latter in those of phlegmatic temperament, with relaxed, lymphatic constitutions. When external violence has given rise to the disorder, and the periosteum has been considerably injured, Ruta is a valuable remedy. Lastly Mercurius may be named as one of the most important remedies in acute ostitis Avith excessive nocturnal exacerbation of pain, and especially when the disorder occurs in persons of lymphatic temperaments, or in those who have been badly fed, and ill-lodged, or have had their constitutions otherwise much reduced and enfeebled. Warm fomentations may be beneficially applied along with the internal employment of the appropriate medicines; spare diet and perfect rest must, at the same time, be enjoined. In chronic ostitis, which is the most common form of this inflammation, Sulphur, Calcarea, Silicea, Phosph., Acid, ph., Staph., and Assaf. are, in general cases, the most important remedies at the commencement of the attack. In other cases, and more particularly when the affection has originated in the abuse of mercury, Hepar sulph., and Acid, nitr., are two of the most important remedies: but when there is a considerable degree of erysipelatous redness, a dose or two of Belladonna will generally be found requisite ere we proceed to employ the aforesaid medicines, or any other remedy which may appear more appropriate to the aggregate fea- tures of the case. If traces of scorbutus accompany the inflammation, Carbo. v., Merc, Staph., Sulph., Ac. nitr., Dulc, Sepia, kc, are the most appropriate. And when syphilis, or the joint effects of mercury and syphilis, have evidently given rise to the disorder, the following medicaments, in addition to those described as the most applicable at the commencement of ostitis in general, have hitherto been found the most useful, viz., Aurum, Assafoetida, Staphysagria, Mezereum, Lyco- podium, Manganum acet., Lachesis, Dulcamara, Baryta, Carbo v., Acid. fluoricum. Manganum aceticum and Mezereum1 are more especially adapted to inflammation of the periosteum, attended with pains of an almost insup- portable nature. Mercurius, Aurum, Staphysagria, and Phosphorus generally claim a preference when the bones of the face form the seat of the inflammation; Mercurius and Staphysagria when those of the hip; and Assafoetida and Mezereum chiefly, when the shin and other super- ficial bones are affected. In the treatment of caries it is, as in ostitis, of importance to consider the cause from which the disease has arisen. In the early stage of the malady the remedies Avhich we have named as being very useful in the milder forms of acute, and at the beginning of chronic ostitis, are frequently of considerable service, and indeed will often prove sufficient, especially in cases which have arisen from a local 1 Hartmann's Therapie, zweite Ausgabe, p. 290. We have found Assafoetida and Acid, phosph., of much efficacy in periostitis. Mercu- rius and Silicea, and sometimes Bella., Staph.,Puls., China, &c, may also do good in par- ticular cases.—J. L. DISEASES OF THE BONES. 523 injury, and are unattended by signs of general constitutional derange- ment, to stay the morbid action and eventually effect a radical cure without the expediency of an operation. In cases depending upon a constitutional cause, such as scrofula, scorbutus, or from syphilis and the abuse of mercury, the same medi- cines are required as have been quoted under Chronic Ostitis. We must, in a great measure, be regulated by the law similia similibus in the selection of the different remedies; but when, from the paucity of the symptoms, or the absence of any of a characteristic or sufficiently well-marked character, there is some difficulty in finding the appropriate remedy, the alternate or successive employment of two or more medica- ments, which embrace the main features of the case, and which experi- ence has proved to be remedies of great value in caries in general, may be resorted to. Thus, Sulph. and Calc.; Sulph., Calc, and Silicea; Silicea and Phosph., administered in alternation or rotation, have often succeeded in effecting a radical cure. In like manner Perussel mentions three cases of caries which were cured by Hepar s. and Silicea in alterna- tion. In another case he had recourse to Mezereum and Rhus in addi- tion to the foregoing. And in a fifth, in which there was considerable complication with mercurial disease, Sulphur and Acid nitr. established the cure. (Bib. Horn. d. G., x. 321.) Caries articulationis cubitalis, cum ulceribus ossis fistulosis: Calcarea c, (Rhus), Silie, Lycop. et Sulph. (A. H. Z. viii. 120.) Caries femoris pueri scrophulosi: Sepia 10 et Acid. nitr. (Ann. 11, 365.) Caries fungosa manus: Rhus et Arsenic. (T. h. 1.) Caries ossium faciei: Calc. carb. et Silie (A. H. Z. viii. 309.) Caries pedis cum febre hectica: Arnica, Lycopod., et Silicea. (Arch. xii. 191.) Caries radii with bluish red swelling of the forearm and hectic fever: Pulsatilla, Mezereum, Sabina, Silicea, Calc. e, and Lycopod. (Arch. viii. 1, 42.) Caries tibiarum et antibrachii sinistri, with several fistulous passages, debilitating diarrhoea, and utter prostration of strength. Sulphur, Assafoet., Acidum nitr., and Acid, phosph., accomplished the cure. One medicine alone, when homoeopathic to the entire disease, is often sufficient to stop the caries and bring about a healthy action in the carious part. Thus, Aurum has repeatedly effected cures in caries syphilitica ossium palati et nasi; as also in caries syphi- litica processus alveolaris cum ozasna. Silicea, in several doses (at the thirtieth potency), frequently cured chronic caries in scrofulous children. Other cases required lower potencies of the same remedy (Kampfer, Allg. h. Zeit. xxiv. 135.) Silicea 30, cured, in two cases, caries of the mastoid process (Goullon, Gr. u. St. Arch. xv. 3, 55.) Caries tibise recens : Silie. 10, (Arch. viii. 1, 23.) Caries of the third phalanx of the middle finger, in a female who had applied all sorts of unguents to the part for a whole year, and from which a piece of bone had exfoliated. Eight days after the exhibition of Silicea the pain was removed, and another small exfoliation took place, after which cicatrization ensued. (RUchert's Therapie.) Acidum fluoricum1 has been employed in some cases of caries with striking effect, and promises to be a remedy of great value in diseases of the bones in general. We may quote the two fol- 1 The provings of this important remedy appeared in the Neues Archiv, zweiter Band, erstes Heft. 524 DISEASES OF PARTICULAR ORGANS AND REGIONS. loAving cases as illustrative of its curative powers in disease of the bones : "A boy became affected, after scarlet fever, with caries of the temporal bone, which, during a period of five or six years, periodically broke out afresh, discharged an offensive pus, and then healed again. The entire'left side of the cranium was arrested in its growth, and con- sequently rendered much smaller than the other side ; the left eye also appeared strikingly smaller than the right one. The intellect of the boy Avas, nevertheless not in any way affected. Several remedies im- proved, but failed in curing the caries. After the employment of fluoric acid the periodical attack came on earlier, and in a more aggravated form than usual, but never returned. From that time onward the left half of the cranium commenced to grow, and the previous inequality of size betAveen the two sides of the head became gradually less, and finally imperceptible." (Neues Arch. 3ter Bd. lstes Heft.) " The first and second phalanx of the left index finger, particularly the former, were swollen to four times their natural size, so that the finger presented the shape and appearance of a pear. On the dorsum of the finger an opening sometimes made its appearance, from which pus and ichor oozed out. The entire tumour was very hard to the touch; the skin otherwise unaltered ; the cause of the affection was not ascer- tainable ; the pains were intermittent. With exception of some degree of dyspepsia, the health of the patient was good. Of Silicea x., two doses were prescribed. Twelve days afterwards, the patient returned, and said that she thought the finger better ; but there were no outward signs of improvement. Acidum fluoricum x., in two doses, were next prescribed. The patient did not come back again until about twelve weeks after her preceding visit. The affected fore-finger was so much restored that it exhibited little or no difference in its appearance from that of the other hand. The patient had merely returned because her digestion, after having been rendered much stronger, had threatened to become somewhat disordered again. Silicea x., two doses, was pre- scribed for the general symptoms remaining. The patient did not show herself again." (Neues Arch. 3ter Bd. lstes Heft, Seite 128.) In caries of the ossa nasi, Acidum nitricum is, as well as Aurum, a most efficacious remedy. In that of the inferior maxilla (when the disease has not arisen from exposure to its vapour) Phosph. And in caries of the bones contributing to form the Antrum highmorianum, Arsenicum, Lycopodium, and Silicea, have repeatedly proved curative; but in some instances it may be found necessary to have recourse to other medicines, as Sepia, Sulph., kc Where the caries is attended with ulceration of the integuments, and thick, lemon-coloured discharge, lycopodium acts beneficially. When caries fail to yield to the agency of medicines, and the symptoms of constitutional irritation increase in intensity, an operation for the removal of the carious portion of bone becomes necessary. The medicaments employed in the treatment of the two preced- ing forms of disease of the bones, are also more or less requisite in necrosis. In the first stage of the disorder, if there be severe and extensive inflammation of the soft parts, Aconitum, Belladonna, Bryo- nia, Pulsatilla, Mercurius, and Sulphur, together with warm fomenta- DISEASES OF THE BONES. 525 tions and poultices, are more or less useful. (See Ostitis.) When matter forms, and is confined under the periosteum, it should be evacu- ated early, by means of a deep and free incision. When the disease has reached the second stage, or that in which the sequestrum has been formed, yet remains adherent to the living portion of bone, the process of absorption or of exfoliation may be aided and quickened by the administration of Symphytum officinale, or by Silicea, Phosphorus, Sulphur, and Calcarea. These remedies, especially the four latter, materially serve, moreover, to lessen the tendency to renewed inflammatory attacks and their sequelas, as also to mitigate any undue severity in the constitutional disturbance which is so prone to set in during this stage of the affection. When, notwithstanding all our efforts, the health of the patient begins to be seriously injured by the pain, profuse discharge, and hectic fever, an operation for the removal of the sequestrum, or even amputation of the affected limb, if the necrosis be extensive, becomes necessary. But as long as the health remains tolerably good, we should abstain from any harsh interference with the operations of Nature, and endeavour to forward her efforts by judicious medical treatment. The principal medicines by means of Avhich this commendable aim is most likely to be promoted are Sulphur, Calcarea, Sdicea, Lycopodium, kc These remedies are equally applicable, whether the disease may have arisen from the effects of external injury, or originated in internal causes—such as Scorbutus, Scrofula, Syphilis, or the abuse of mercury, which have affected the bones through the medium of the constitution, or has proceeded from a debilitated state of the system resulting from severe febrile disturbance. Sulphur is chiefly required Avhen necrosis occurs in persons of lymphatic or bilious tem- perament ; also in those who are disposed to eruptions, enlargement of the glands, hemorrhoids and constipation. Calcarea may generally be exhibited with advantage after the previous employment of Sulphur. Silicea is, if anything, still more frequently required than either of the tAvo preceding remedies, when the sequestrum is completely formed, but is still firmly attached to the living part of the bone (second stage); or when it is loose (third stage), and there is an excessive discharge from the fistulous openings consisting of pus and ichor ; further, when there is a considerable degree of nervous excitement, and the sleep is restless and unrefreshing. Lycopodium is often useful when the matter dis- charged is very copious, thick, and lemon-coloured. In other cases Assafoetida, Acid, nitricum, Phosphorus, Ruta, or Mezereum may be required. The alternate use of Sulphur and Calcarea, Silicea and Phosphorus, or of these four in rotation at intervals of from six to eight or ten days, is sometimes beneficial. Suppuration of the spongy texture is to be treated at the beginning of the disease in the same manner as has been described for ostitis; and on the bursting of the abscess, those remedies which have been noticed under Caries and Necrosis must be resorted to. In exostosis, or the growth of a bony tumour from the surface of a bone,—Sulphur, Calcarea, Silicea, Phosphorus, Assafoetida, Dulcamara, Mezereum, and Mercur im have chiefly been recommended. And in Tophus, or the 526 CASUALTIES. formation of a soft swelling on a bone, Bella., Mere, Phosph., Acid. nitr., Sulph., Calc, Assa., kc RICKETS. Rachitis. This malady almost invariably begins to show itself at the tender age of from one to two years, and is distinguished by great development of head, abnormally prominent forehead, projecting sternum, flattened ribs, enlarged abdomen, with emaciation of the extremities, and extreme general debility. As the disease progresses, the muscles become more flaccid, the epiphyses of the limbs increase in size, the bones and dorsal spine become more or less distorted, the bowels relaxed and the motions frequent; and frequently, if the disease be not arrested, slow fever, with cough, oppressed breathing, and atrophy supervene, and a fatal termination results. Therapeutics.—The remedies which have hitherto been employed with the greatest success in the treatment of this distressing affection by homoeopathists are: Belladonna, Mercurius, Arsenicum, Sulphur, Cal- carea, Silicea; also, Assafoetida, Acidum phosph., Phosphorus, Baryta muriatica, Staphysagria, Lycopodium, Acidum nitric, Mezereum, Pe- troleum, and Rhus. (See Atrophy, Hydrocephalus, and Scrofula.) CASUALTIES. concussion, bruises, sprains or strains, wounds, dislocations, and fractures. In Concussion of the brain (which may arise from a violent shaking of the brain or of the whole body, without any direct violence having been offered, such as a severe blow or fall on the head), the symptoms vary, according to the degree of injury which the brain has sustained. When the concussion is very severe, there is immediate deprivation of sense and power of motion, and death is the general result; but when slight, a temporary stunning or confusion, with more or less headache, is produced, followed by increased action of the pulse, vertigo and sick- ness. When, on the other hand, the violence done is greater than in the latter instance, though not so severe as to cause the fatal termina- tion alluded to in the former, the patient is rendered insensible and incapable of movement; his limbs become cold; the pulse weak, slow, and intermittent; the respiration laborious, but usually without stertor. (This has been denominated the first stage of concussion.) As the patient begins to recover from this condition, the pulse and respiration improve, and warmth begins to be felt in the extremities ; the sensibility to touch then returns, and the contents of the stomach are in most cases rejected ; CONCUSSION. 527 still he continues to remain in a dull, confused state, and inattentive to, or almost unconscious of, slight external impression (second stage). On the gradual subsidence of the first effects of the concussion, the patient becomes enabled to respond to questions spoken in a loud tone. When, however, the stupor has considerably or entirely abated, inflammation of the brain, of an active character, will, in many cases, then begin to de- velope itself (third stage), with all its wonted symptoms (see Phrenitis), and if not checked, suppuration or effusion within the head, preceded by rigors, will result. Therapeutics.—In all cases of injury arising from external violence, Arnica is an invaluable remedy, and its timely administration in cases of concussion of the brain, will in most instances, if the injury be not very severe, suffice to remove all traces and evil consequences of such misfortunes.1 We may administer internally two globules in a teaspoon- ful of water; and, if there be an external wound, we may bathe the injured part with a lotion, in the proportion of a few drops of the Tincture of Arnica to an ounce or about two tablespoonfuls of water, twice or thrice a day; should the swelling, pains, and other symptoms increase, after one or two applications, we must discontinue the lotion, but shall almost always find a marked improvement follow such aggra- vation. When, however, the contusion has been serious, and extreme rest- lessness or jactitation, and irritability of temper, with sensibility of the eyes to light, small quick pulse, delirium, or subsequently rigors, &c, supervene, the same treatment must be pursued as that described under Inflammation of the Brain, and also Hydrocephalus, which see.2 After an injury to the head, particularly if it has been of a somewhat severe character, the patient ought not to be allowed to partake of any stimulating liquids, such as wine, spirits, &c, until at least three or four weeks have elapsed, even although he may appear to have entirely recovered from the effects of the accident; he ought likewise to be kept quiet, and not be permitted to expose himself to excitement of any kind, otherwise the most serious consequences may result. When the chest has been injured by a contusion or violent concussion, &c, and soreness, or a sensation as if from incipient suppuration, with heat and throbbing, is experienced in some particular spot; fever, or alternate chilliness and heat followed by fever, which becomes aggravated in the evening; sleeplessness or disturbed sleep, with general heat, and sometimes per- spiration towards morning; short dry cough which increases the pain, or cough with spitting of blood; further, when the pain in the chest is rendered more acute by taking a full inspiration, laughing or sneezing, or when pricking pains or a sensation of fulness or pressure, as if caused by extravasated blood, is experienced, together with a feeling of constric- tion that obstructs the freedom of respiration,—it will be necessary to 1 In simple irritation of the brain, Arnica rarely fails to act beneficially. In some cases, Cieuta virosa is serviceable. 2 In fracture of the cranium, the same treatment must be pursued, but when compres- sion of the brain takes place, attended with its usual concomitants, such as stupor, stertorous breathing, &c, from the effects of a depressed portion of bone, the trephine must be employed if the symptoms continue unabated, notwithstanding the use of the medicines indicated. 528 CASUALTIES. have immediate recourse to Arnica and Aconitum alternately, at inter- vals of from three to six hours, until an improvement in the symptoms becomes manifest; but should a degree of fever continue after the exhi- bition of several doses of these remedies, attended with a sensation as if there were an internal excoriation or wound, Pulsatilla should be given. In the event of a continuance or even an increase of cough, with expec- toration of thick, yellow mucus, occasionally streaked with blood, Mercu- rius should be prescribed; if, on the other hand, the expectoration has a sweetish taste, and is accompanied by difficulty of breathing, Nux v. is to be preferred. When a degree of delicacy of chest remains behind after the employment of any of the preceding medicines, with tendency to suffer from shortness of breath, and a dry short cough, combined with paleness of the face, impaired appetite, and restless, unrefreshing sleep, Cinchona has been strongly recommended. In other cases, espe- cially those which have been neglected, where we have reason to appre- hend the development of Phthisis pulmonalis, the employment of Stannum, Acidum nitricum, Silicea, and Kali c, or Phosphorus, Sul- phur, Calcarea, and Lycopodium may yet enable us to arrest the progress of that ruthless malady. The effects of a shock to the nervous system, with pains in the limbs, &c, from stumbling or making a false step, are generally relieved by Bryonia or Pulsatilla. When the accident has been accompanied with fright, Opium may be prescribed in the first instance, Aco- nitum where there is syncope; and Chamomilla when, from extreme pain, convulsions ensue.1 But in almost all such cases, Arnica, may be employed with advantage, either subsequently or at the commencement; in the event of headache resulting from a contusion or from stumbling, and Arnica not being found to afford much relief, Belladonna may be given ;2 the patient should at the same time remain quiet, and avoid any exertion, whether of the body or mind, until the pain is removed. Sprains.—In the treatment of these troublesome casualties, at the com- mencement, prescribe a lotion of Arnica, when there is much tumefac- tion and redness, with great pain on the slightest movement. After the employment of Arnica, we may in like manner have recourse to Rhus toxicodendron,3 which is, properly speaking, more specific to this description of external injury, and is often of speedy efficacy, even in cases of some standing; the remedy should also be taken internally. If severe pain continue, notwithstanding the employment of Arnica and Rhus, the following remedies have been recommended : Bryonia, Am- monium c, and Ruta, and in some instances, Belladonna, Pulsatilla, Nux v., Agnus, or Silicea. 1 Ignatia has also been recommended in the event of convulsions; and Coffea when uncontrollable agitation and agonizing jactitation result. 2 Cocculus, Cieuta, or Acid, phosphoricum, may be required to remove prolonged head- ache arising from the above-named causes. (See also Cephalalgia.) 3 When an individual muscle has been injured by the effects of a violent strain, Rhus will more readily restore its tone and remove the pain than any other remedy. A dose may be prescribed thrice a day, and locally Tr. Rh., gtt. xv-xx, in aq. libr., as a lotion. Frequently, every symptom is removed after a few hours; but in bad constitu- tions, many troublesome sequelae occasionally arise, against which Sepia is often useful. (Goullon, Gr. u. St. Arch., xix. 3, 12.) wounds. 529 Strains.—When pricking or other pains are experienced in the back, &c, after a strain caused by any powerful or sudden exertion, such as lifting a heavy weight, or throwing up a window, with aggrava- tion from the slightest movement of the arms or trunk, Bryonia should be exhibited, and succeeded by Sulphur, if only partial relief is obtained. When headache results from a similar source, or when the pains are confined to the extremities, or if at all in the back or loins, are equally, if not more severe, during rest as Avell as on movement, Rhus may be prescribed, followed in turn by Calcarea, if the sufferings remain almost unmitigated. When sickness and great pain in the abdomen are pro- duced by the effects of a strain, Veratrum has been recommended as being speedily serviceable. Wounds are divided into incised, lacerated, contused, punctured, poisoned, and gunshot wounds. By an incised wound, is meant one which has been produced by a sharp instrument, as a sword, knife, &c, and is not accompanied with any contusion or laceration. Incised wounds, although more liable to be attended with a greater degree of hemorrhage, are, generally speak- ing, the least dangerous and the most easily healed. Lacerated wounds are those in which the muscular fibres, instead of being divided by a sharp cutting instrument, have been torn asunder Avith some violence ; the edges, in place of being even and regular, are jagged and unequal. They are commonly attended with little or no bleeding, rarely heal without suppurating, and are frequently succeeded by violent inflammation. The terms contused wounds, or bruises, are applied to those injuries which are occasioned by some blunt instrument, or hard blunt surface, being brought in violent collision with a part of the body. When severe, they are dangerous, from being prone to terminate in mortifica- tion and sloughing. Punctured wounds are those which have been caused by pointed, in- struments ; they partake more of the nature of lacerated than incised wounds, and are dangerous from the great depth to which they fre- quently penetrate, and the serious consequences they often entail, by occasioning violent inflammation of the fascia, and tetanus. Gunshot wounds partake of the character of lacerated and contused wounds. For poisoned wounds, see Hydrophobia. Therapeutics.—In the treatment of wounds of all kinds, the first object is to arrest the hemorrhage. This is to be done by means of the tourniquet, by compression, by the ligature, by cold water or ice, and astringents, &c, according to the degree and source of the discharge. Wounds of the arteries are, for the most part, the most serious ; they are to be distinguished by the bright colour of the blood, which more- over issues very rapidly and in jets ; while that from a vein flows in a smooth, uninterrupted stream, and has a dark or deep purple hue. When the injured vessels are of a small size, they spontaneously cease to bleed, or do so, at all events, as soon as the wound is dressed; but Avhen the hemorrhage is considerable, one or more of the abo\Te-men- tioned arresting measures require to be immediately resorted to. 34 530 casualties. Bleeding from wounds, &c, in the mouth, sometimes requires the application of styptics, such as alcohol, kreasote water, &c. The same may be said of slight superficial wounds, as also of fungous tumours, and other diseased surfaces, when cold water fails to answer the purpose. Arnica, Diadema, and Phosphorus, internally and externally, have like- wise been strongly recommended in such cases. Copious hemorrhage after the extraction of a tooth is usually readily suppressed, by pushing a compress of lint into the hollow space left; or by the aid of styptics, and the medicines above mentioned, Avhen requisite. A simple, and sometimes extremely efficacious mode of checking this current of blood is by replacing the extracted tooth, and keeping it in its former position, until the risk of further hemorrhage is obviated. When we find severe syncope, Avith deadly paleness of the face, or when the countenance assumes a livid appearance, and subsultus tendi- num and other signs of extreme exhaustion set in from excessive loss of blood, Cinchona ought to be prescribed; and if the patient should not exhibit any indications of rallying, a little wine may be given and sub- sequently Arnica ; but if the stimulating effects of the wine prove only of temporary service, another dose of Cinchona must previously be had recourse to. The next step to be taken in wounds of every description, after the hemorrhage is stopped, is to remove all extraneous matter, as sand, fragments of glass, splinters, shot, rags, &c.; then relax the muscles so that the wound may not gape; finally, to place the lips of the wound in accurate contact and keep them so by bandages, plasters, sutures, &c. Bandages are usually indispensable in deep, and even in small, superficial, incised wounds, but care must be taken not to apply them too tight, nor when there is excessive inflammation. Sutures are generally necessary in wounds of the face, or abdomen, and sometimes of the hands, and in old people generally. In the young and vigorous they are seldom called for, and are even improper and hurtful when the patient is of an irritable habit of body. Strips of adhesive plaster,—cut narrow in the centre or portion which is to cross the wound, and sufficiently long to retain their hold as firmly as possible, and act with the required compressive power,—form, in the majority of incised wounds, the most frequently useful means of bring- ing the sides into close approximation and effecting adhesion. It some- times happens, however, that even incised wounds, particularly when deep and of considerable magnitude, terminate in suppuration; it is consequently necessary to leave intervening spaces between the strips of plaster, to admit of the exit of the matter in such an event. Again, when it is found impracticable to cleanse the wound of all foreign sub- stances, it ought to be only lightly, and so to speak, incompletely dressed, as it will be necessary to renew the dressings repeatedly. In some cases it is necessary to dilate the wound, to facilitate the abstrac- tion of a splinter, &c. With regard to the constitutional treatment of wounds of all kinds, we should commence with the administration of Arnica,1 of which a 1 See Dr. Kaser's remarks on the employment of Calendula officinalis, at the end of this chapter. WOUNDS. 531 few globules should be given, as soon as the patient has been made as comfortable as circumstances will admit. The patient should at the same time be kept cool, free from anxiety or exertion, and as quiet as possible. He should live abstemiously, avoid everything of a heating nature, and drink cold Avater. If he be robust and strong, and sympa- thetic fever run high, a dose of Aconite should be prescribed ; followed, in the course of from three to six hours, by Arnica, and so on alter- nately as long as may be found requisite; in favourable cases one dose of each medicine is often found sufficient. The local application, in the first instance, if required by the excess of pain, heat and swelling, should consist simply of lint dipped in cold water, and frequently rcmoistened. Lacerated wounds, after having been carefully cleansed, should have all the parts, that will admit of the process, closely approximated and retained in their place by means of plasters and an appropriate position of the body or limb, for the purpose of promoting union by the first intention. Should the wound become inflamed, attended with much pain and swelling, it may be dressed with lint dipped in cold water, Avhich should be frequently renewed. If, on the other hand, copious suppuration ensue, and the pain be very severe, the cold water must be discontinued, and Chamomilla exhibited, followed by Hepar s. ; and should these remedies fail to bring on an early healing action, Silicea Avill generally ansAver, or Silicea and Sulphur in alternation, to pro- mote granulation. (See Ulcers.) In contused wounds (or bruises) Arnica must be given internally, and cold water applied externally, in the first instance. When there is con- siderable extravasation of blood, Arnica1 should be applied as a lotion, of the strength of about one part of the tincture in ten of Avater, to stimulate absorption, and otherwise forward the cure. In the event of an abscess resulting from the effects of a contusion, see that article. When the joints,2 synovial membranes, or tendons are injured by a 1 It has been already remarked that this useful medicament, when applied as a lotion to wounds, should always be discontinued whenever any aggravation of the pains, &c, is experienced; and I take the opportunity to repeat here, that it ought to be employed with caution in cases occurring in persons of what is ordinarily designated an inflamma- tory habit, or who have very irritable skins, and are liable to be affected with erysipe- las ; in such instances the tincture should invariably be diluted with a larger proportion of water than is recommended in various parts of this work, and if that fail to prevent the occurrence of medicinal aggravation, in the form of greatly increased pain, redness and inflammation in the injured parts, and other pathogenetic symptoms of Arnica, as pains from contusion or dislocation in all the limbs, miliary, papular, or pustular erup- tions, &c,—Helianthws anuus may be used as a substitute in contusions, and Aqua calen- dula} officinalis in wounds of all kinds. In recent contusions of glandular organs, such as the testes, Arnica is the best remedy; but when induration has resulted, Conium is of greater efficacy. When the mammary gland is the seat of injury, Aconite is fre- quently required in preference to Arnica, as is generally the case in wounds or contu- sions of any part when they are followed by severe or extensive inflammation. If sup- puration threatens, in a contused mamma, Phosphorus or Acidum phosph. should be em- ployed. If induration has taken place, Conium is commonly of greater and more speedy efficacy than any other remedy. In wounds of the eye, Aconite, as has elsewhere been observed (art. Ophthalmia), is the specific medicament. In superficial contusions of the trunk or limbs, and in those of long duration, Acidtim sulph. has repeatedly been used, externally and internally, with much advantage. 2 In cases of swelling, with considerable pain, stiffness, or inflexibility of the knee, from the effects of kneeling, to which housemaids (hence the name of Housemaid's knee) and others, from the nature of their occupations, are liable—and which affection, it may 532 CASUALTIES. contusion, Rhus has been particularly recommended : in some cases Silicea will be found of great utility, as we can testify from experience. If the periosteum be affected, Ruta is said to be useful; we would, how- ever, recommend an incision to be made in the membrane, if ecchy- mosed blood or matter is evidently pent up beneath it, and the patient's sufferings are great; after which the treatment to be pursued must be the same as described for open abscesses. When a bruise or contusion is so violent as to squeeze the limb nearly flat, or otherwise disfigure it, cold water ought to be constantly applied, and Arnica prescribed inter- nally. But if gangrene threatens, Cinchona must be given, and when the skin has assumed a livid and black appearance, amputation may still be avoided, and life and limb saved, by having recourse to Lachesis and Arsenicum alternately, in frequently-repeated doses. In the greater number of such unfortunate cases, however, amputation becomes impe- rative, and ought to be performed without hesitation, when it becomes evi- dent that the patient will fall a sacrifice to further delay. When ampu- tation has been found necessary, the stump ought to be dressed Avith lint dipped in cold water, and Arnica should be given internally; subse- quently the said medicine may be employed in alternation Avith Aconi- tum, if required by the accession of traumatic fever. Hepar, Silicea, and Sulphur may also be required at the ensuing stages in the healing of the stump. Subsequent trials of Calendula officinalis, as recom- mended by Dr. Thorer, may confirm his opinion as to its superiority over all other remedies in severe wounds, or after important surgical operations, where extensive suppuration is to be apprehended. (See Ulcers, for indications for the employment of these and other reme- dies.) In the case of punctured wounds, the treatment to be followed is the same as that described for Avounds in general, but unless compression, by means of adhesive plaster or a bandage, can be brought to bear against their entire extent, the cure by the first intention must not be attempted.1 When suppuration ensues, Mercurius may be prescribed, followed by Hepar s., and then Silicea, if required. Chamomilla, Belladonna, and Rhus may be found serviceable in the event of excessive local inflam- be added, consists of a degree of inflammation and consequent thickening of the bursa mucosa, situated between the patella and the skin, attended with increased secretion of the slippery lubricating fluid contained in the sac,—Silicea, either administered daily, or at intervals of four to eight days in susceptible habits, is tx most important and emi- nently successful remedy. The same medicament is equally efficacious in similar swellings in other parts such as the ball of the great toe (where the tumefaction is commonly known by the name of a bunion), or the joints of thefingers, and indeed in most of the situations where tendons play: the use of these little sacs, or bursoz mucosa}, being to facilitate the action or play of the muscles. During the treatment of these swellings, it is very necessary that the patient should at the same time be careful to avoid pressure on the affected part, and that he should walk about as little as possible. In the case of a bunion, when thtre is active inflam- mation, his own sufferings will sufficiently remind him of the necessity of these precau- tions. 1 In punctured wounds of the abdomen Aconitum should be given as soon as possible in order to prevent the development of active inflammation, which is so prone to follow in such cases. Belladonna is generally required after Aconit., when symptoms of peri- tonitis have already made their appearance. (See also Peritonitis and Enteritis. ) WOUNDS. 533 mation ; the latter two particularly, if the inflammation partake of an erysipelatous character. (See Erysipelas.) When spasmodic twitchings make their appearance, Cieuta is frequently serviceable; but Arnica Avill generally be found sufficient to subdue these symptoms when timely administered; when the constitutional disturbance is severe, Aconitum may be alternated with Arnica ; and when the Avound arises from violent inflammation of the fascia, a transverse incision may in some instances be necessary; in Avhich event a dose of Arnica must be prescribed almost immediately afterAvards. If tetanus supervene, Arnica must be employed, and followed, if required, by Angustura or Cocculus, kc (See Tetanus.) Gunshot wounds must be treated by the exhibition of Arnica inter- nally, and cold water constantly applied by means of lint, externally. In some cases it may be found advantageous to apply a very weak lotion of Arnica, in preference to Avater simply, at the commencement. When splinters of bone, a ball, &c, are lodged in the wound, they ought to be extracted with as little irritation as possible, if they press on some im- portant viscera, &c.; but if not, they may be allowed to remain, particu- larly when deeply seated or difficult to be found, until loosened by suppuration, Avhich process will be materially forwarded by the adminis- tration of Silicea. In other cases Hepar s. and Sulph. may afford valuable aid. In the event of fever, gangrene, &c, see Contused Wounds. When a joint is greatly injured, or much of the soft parts together with the blood-vessels and nerves of importance are carried away by a gunshot wound, the bone remaining entire;—when there is a fracture of a bone with destruction of the soft parts adjacent; when the bone is shattered, and the principal vessels lacerated or ruptured—or when a limb is completely shot or torn off, or other serious injury done, which renders the prospect of saving the limb hopeless, amputation should be performed.1 It may be added that Staphysagria has been recommended as a useful remedy in severe incised wounds; and Aconitum, Cieuta, or Acid. nitr. in addition to Silicea and Hepar s., in wounds from splinters, &c. * (For poisoned wounds, the treatment will be found under Hydropho- bia.) Dr. Thorer, of Gorlitz,2 strongly recommends Calendula officina- lis in preference to Arnica, in wounds of every description, but espe- cially incised, punctured, or lacerated wounds, and those with consider- able loss of substance. The sphere of the latter as a traumatic remedy he confines to contusions, sprains, bruises without abrasion of the sur- face, or laceration of the soft parts. Dr. Thorer speaks, moreover, in favourable terms of the effect which Calendula appears to exercise 1 "After amputations, extirpations, and other surgical operations, I have invariably derived the most important service from the employment of Aconitum. In most in- stances, a complete cessation of pain took place three hours after its administration; traumatic fever never supervened, and the patients almost always fell into a placid and refreshing slumber ; but rarely was it found necessary to have recourse to Opium, and that only when startings from sleep took place from local or general convulsive jerkings or twitchings."—Dr. Wurzler. Allg. Horn. Zeit., No. i., 21 Band. 2 Neues Arch., dritter Band, erster Heft. 534 casualties. over the process of granulation and cicatrization. Very frequently, even after amputations, the cure, under the employment of this remedy, was effected by the first intention, and in almost every instance where it was impossible to avoid suppuration, the extent to which it occurred was comparatively insignificant. He employed two different prepara- tions of this remedy as lotions, the one, to Avhich he gave the name of Aqua Calendulas Officinalis, he prepared as folloAvs: "I filled one-third of a clean bottle with the petals or leaves of the flowers, the remaining two-thirds with fresh, pure spring water, corked it well, and exposed it for two or three days to the warm rays of the sun. The water was, by this process, rendered slightly aromatic, and having been poured off from the leaves, it was put into a bottle, well sealed up like wine bottles, then immediately placed in the lower tem- perature of the cellar. Whilst the bottle with the mixture of the leaves and water is exposed to the higher temperature of the sun it should be narrowly watched, and the moment that any signs of incipient fermen- tation make their appearance, measures must be taken to arrest it. The second preparation was a Spiritus Calendulas, for which I employed the same quantity of the leaves of the flower as in the preceding instance, and pure rectified spirits of wine in place of the water. I employed the latter preparation only on one occasion, very much diluted, in order that the spirit of wine might not exercise a detrimental influence on the injured parts. Its effect was equally beneficial." We give the following cases as instances in which Dr. Thorer applied Calendula as a lotio vulneraria homoeopathica with success. _" 1. R. K., had the under lip much bruised and lacerated from the kick of a horse. The lips of the wound were brought into approxima- tion, and retained there by means of a strip of adhesive plaster. In addition to this, the patient was furnished with a phial containing Aqua calendul., and desired to keep the wound covered with a compress satu- rated with the lotion. Already, after an interval of three days, healthy cicatrization began to set in, without suppuration. The process of heal- ing went on quickly and uninterruptedly per primam intentionem, and the scar of the divided lip is now scarcely perceptible. "2. M. A., had the misfortune to fall down a flight of stairs, and in addition to several contusions on the chest, two extensive wounds were inflicted, one on the forehead, and the other along the ridge and at the point of the nose, produoing great disfiguration. In this case, also, the healing process proceeded most rapidly and favourably, without suppura- tion, and without leaving any disfigurement, such as a wound of so severe a character might reasonably have led me to anticipate. ** 3. This case was of infinitely greater importance than the above. Flb'der, a boy, 16 years of age, while engaged at his occupation in a cloth manufactory, had the misfortune to become entangled in the machinery; in consequence of which, the following injuries were sus- tained : " 1. Compound fracture of the left arm, the sharp extremities of the broken bone protruding through the integuments. " 2. A deep wound at the bend of the elbow. WOUNDS. 535 " 3. The bones of the left forearm completely stripped of their mus- cles, and laid bare to the extent of six inches. " 4. The hand torn off, being only kept adhering to the stump by a slip of skin. "5. The skin and portions of the muscles of the exterior surface of the right leg Avere torn off, leaving a large and deep wound extending down to the bone. " 6. Face and chest severely contused, and exhibiting many small flesh wounds. "The unfortunate patient was reduced to a state of extreme exhaus- tion by loss of blood and excessive suffering; amputation of the left upper arm was nevertheless rendered imperative, and was accordingly performed. Compresses, saturated with Aqua calendulos, were applied to the exposed lacerated muscles of the right leg, up to the period of the recovery of the patient, and it was striking to observe how dry, and without suppuration, incarnation proceeded in the parts to which the Calendula was applied, in comparison with the extensive suppuration and slow curative process Avhich took place in the stump of the ampu- tated arm, treated according to the ordinary surgical rules. I was not at the time aware of the peculiar properties of Calendula, but in conse- quence of the striking beneficial effects which it produced on the injured lower extremity of the patient, I subsequently applied it to the wound of the stump, and was gratified by the peculiarly favourable granulation which soon ensued there likewise. All the wounds henceforward filled up and healed in so satisfactory a manner, that it was scarcely possible to conceive that they could have been of so serious a character, and attended Avith such loss of substance as they in reality were. The patient Avas restored to perfect health, and I have no hesitation in attributing his recovery to the very favourable process of granulation and cicatrization which took place under the employment of the Aqua calendulas. " 4. C. in G. lost his footing when in his mill, and had the third phalanx of the left index-finger, the second and third phalanx of the ring-finger, and the flesh of the point of the middle finger torn off. A small portion of the bone of the second phalanx of the ring-finger remained, but was entirely bared and exposed; the patient was desirous that this remnant of bone should be removed. I refrained from doing so, however, in the hope that it might become covered by means of favourable, granulation. And so the result proved. After the hemorrhage had been arrested by the application of cold water dressings, Aqua calendulas was employed, two days from the occurrence of the accident. The wounds thereupon assumed a drier aspect, incarnation went on uninterruptedly, and a perfect cure was rapidly accomplished. On the ring-finger alone, a very minute exfoliation came off from the exposed bone. " Mr. Surgeon Schulze, to whom I had recommended the Calendula as a remedy in wounds, and Avho had employed it extensively with much satisfaction to himself for the past two years, recently favoured me with the following cases, amongst others, in which he had used it with success. " 5. A labourer received a comminuted fracture of the right index- 536 CASUALTIES. finger, while engaged in lifting a heavy stone. The splintered and more or less loose pieces of bone Avere removed, and the Aqua calendulas applied as a lotion. The cure followed rapidly, and without any par- ticular suppuration. " 6. A miller's apprentice had two of his fingers so completely crushed that, as in the foregoing case, it was necessary to remove the shattered particles of bone. The Calendula effected an equally rapid cure, with a very trivial degree of suppuration. " 7. In a case of complicated fracture of the leg, with a wound nine inches in length, from which the tibia was laid bare, Arnica, largely diluted, was employed for a few days, in consequence of the accom- panying extensive sugillation. The Calendula was then brought into requisition, and produced a speedy cure without extensive suppuration. " I could quote a multitude of other cases in which the Calendula alone was employed, and with singularly successful and satisfactory results; but I shall content myself with adding, that in all instances in which there is extensive loss of substance, and where it is found impracticable to bring and retain the lips of a wound together by means of adhesive plaster, &c, I consider the Calendula to be the best aqua vulneraria. It has long been occasionally employed by the lower orders in the form of an ointment, made of fresh butter, mixed up Ayith the ground or powdered leaves of the flower, and sometimes, though rarely, in the form of infusion, and taken internally. Its homoeopathicity in wounds, as well as several other affections, has moreover been demon- strated and confirmed by the provings of Dr. Franz."1 Dr. Thorer concludes his remarks by expressing the hope that his statement, in respect to the properties of Calendula, as a remedy in wounds, may have the effect of calling the attention of surgeons to it; / and that if their observations tend to confirm its healing properties in recent wounds, attended or not with loss of substance, the Chirurgia Homoeopathica will possess a new remedy which presents the advantage of causing very slight suppuration, a circumstance of no mean impor- tance in the treatment of extensive wounds where there is often exhausting suppuration, lasting a long time, and severely taxing the strength of the patient. Dislocations. Luxations.—Violent pain, swelling, distortion of the joints, loss of motion, with an alteration in the shape, length, and direction of the limb, characterize the existence of this species of injury. Therapeutics.—The reduction of a luxation ought to be effected as soon as possible by the surgeon. When there is excessive pain and inflammation, a dose of Arnica ought to be given, followed by Aconitum in an hour or two, if the pain continue violent, and the inflammatory symptoms active. Cold water, or weak Arnicated water (one part of the tincture in ten of water), should be applied locally. When the luxation is reduced, the same treatment may be pursued if called for; and the usual beneficial mechanical measures employed. In compound luxations, the same treatment must be pursued in the first instance as 'Arch., Bd. 17, Heft 3. FRACTURES. 537 above described ; and the wound treated so that it may heal if possible by the first intention. (See Wounds.) Fractures.—The symptoms of fracture are pain, swelling, deformity, and sometimes shortening of the limb ; loss of power, with preternatural mobility, Avhen we attempt to bend the limb, and crepitation on rubbing the broken surfaces of the bone together. Fractures are divided into transverse, oblique, and longitudinal; and also into simple, compound, complicated, and comminuted. By a simple fracture is understood one in which the bone is broken, without there being at the same time a wound of the soft parts. A compound fracture consists, not only of a solution in the continuity of the bone, but also in the coexistence of an external wound, caused by the protrusion of the extremity of one or both fragments of the bone through the integu- ments. Again, a fracture is termed complicated, when it is attended with a wound of a large artery, extensive laceration of the soft parts, or with dislocation of a joint. Lastly, it is designated comminuted, when the bone is broken into several pieces. Therapeutics.—As soon as a limb is discovered to be fractured, the patient ought to be placed on a litter of any kind which happens to be at hand, such as a board or shutter, and removed to some neighbouring place of shelter, or to his own abode if it be not far distant. Great care and gentleness ought to be exercised in lifting and transporting the patient from one place to another; otherwise a fracture, originally of the simple kind, is liable to be converted into a compound or at all events into a complicated one, from laceration of the soft parts, &c, by the serrated extremities of the fractured bone, whereby the probabilities of recovery will be rendered much more unfavourable, particularly if the accident has happened to a debilitated or aged individual. In the case of a simple fracture, the reduction should be immediately effected. When that is accomplished, a dose of Arnica should be administered, for the double purpose of preventing the invasion of undue inflammation, and of promoting the reunion of the fracture. Symphitum officinale has also been most favourably spoken of as being extremely valuable in facilitating the last-named important object.1 Those who have had ample opportunities of testing the virtues of these remedies, and the homoeopathic treatment generally, in cases of fracture, unhesitatingly declare that the patients are thereby enabled to regain the use of their limbs, and to be discharged with safety from the hands of the surgeon at an earlier period than when treated according to the old method; and further, that the formation of false joints is less liable to occur under the new mode of treatment. In fracture complicated with a wounded artery, or with a dislocated joint, the artery should be ligatured, and the luxation reduced before the bone is set. In compound fracture, the protruded extremities of the bone should be restored to their natural position as soon as possible, the limb sup- plied with splints, &c, and the external wound attempted to be healed by the first intention. Consecutive inflammation and constitutional dis- Ruta has likewise been mentioned as useful in some cases. 538 casualties. turbance must be suppressed by the measures alluded to in the treat- ment of wounds. It is foreign to our purpose to occupy further space, by entering into a description of the means to be adopted, in the reduction of the various specific fractures which are liable to be encountered in different parts of the body: such a proceeding would come more within the province of a purely surgical work. Let it suffice, therefore, to remark, in closing these observations, that in all cases, the same medical treatment is to be pursued, as we have already prescribed for that of contusions, wounds, and fractures in general. Finally, it may be stated, that from the great success which has attended the homoeopathic practice, as em- ployed by continental surgeons, in the treatment of those numerous and serious diseases which are usually considered of a surgical character, it is earnestly to be hoped that their colleagues in this country may be induced to emulate their example, and thereby become enabled to raise their important branch of the profession to a still higher standing than it already, in many respects, has attained. burns and scalds. Ambustiones. Burns have generally been divided by most authors into three kinds: —First, those which only excite an inflammation of the skin, accom- panied or not 'with vesication ; second, those which injure the vitality of the cutis, inducing separation of the cuticle and suppuration of the dermal surface; third, those in which the vitality of the integuments is either at once destroyed or so seriously affected that sloughing ensues. The amount of danger from the effects of a burn depends upon several conditions. A scald or burn of great extent frequently proves fatal immediately or after the lapse of a few hours, the patient never rally- ing from the collapse. The extent and depth of the burn, wherever its seat may be, together with the age, temperament, and habit of body of the patient, determine the degree of danger to be apprehended. Therapeutics.—In slight burns or scalds the injured part should be held for a couple of minutes to the fire; a temporary increase of pain will be amply repaid by the prevention of future suffering and annoyance. The application of Arnica is of speedy service in superficial burns. When the pain is excruciating, Carbo v. often relieves, and failing it Coffea. If, hoAvever, the injury be more severe, the affected part may be dressed Avith heated alcohol, or oil of turpentine, taking care to keep the surface continually moist, and well protected from the external air. The application of raw cotton to the part, is frequently found very efficacious, particularly when the injury presents a large surface ; having previously punctured any blisters that may have arisen, and bathed the sore with tepid water, cover it with carded cotton or wadding, in three layers; when suppuration sets in, remove the upper layer only, and substitute fresh. At the same time we may prescribe Hepar sulphu- ris, a grain to an ounce of water, a dessert-spoonful every twelve hours. China is sometimes serviceable after Hepar, when the discharge has been excessive. FATIGUE. 539 Soap, a remedy generally at hand, is extremely serviceable in burns, where not only the cuticle, but the true skin has been destroyed: pure Avhite or curd soap is the best for this purpose. Its application will, as in the instance of dry heat, &c, at first increase the pain; but this temporary inconvenience will be superseded by a marked amelioration ; after a lapse of about twenty-four hours, the plaster may be gently removed, and a fresh one substituted; generally speaking, however, we must be guided by the feelings of the patient, and renew it as often as a return of pain is complained of; and so continue until the injury is completely healed.1 Aconitum is essential in the event of extensive inflammation, with considerable fever; or when the system has received a severe shock from fright at the time of the injury. Opium is also of use under the latter circumstances. Urtica urens has recently come into repute as a valuable remedy in burns. The mode of application recommended consists in applying linen cloths, saturated Avith the mother tincture, to the injured part; and in severe cases, a drop of the tincture may be taken internally also, either in a little water, or on a piece of lump sugar. Kreasote water has likewise been recommended as a lotion in burns of all kinds, either at the commencement or subsequently, to induce healthy granulation and cicatrization. Crocus sativus (applied exter- nally) has also been favourably spoken of as most serviceable for the latter purpose, in burns or wounds with considerable loss of substance, and disposition to mortification and sloughing. It is probable that Calendula officin. may prove useful in similar cases. (See also Ulcers.) Arsenicum, and sometimes Acid, nitric, favour the sloughing of eschars. FATIGUE. When a feeling of contusion is experienced in all the limbs, Arnica will generally be found the most appropriate remedy to afford relief. Pains in the joints, &c, arising from lifting heavy Aveights, or from violent physical exertion of any kind, are usually speedily removed by Rhus toxicodendron. Cinchona will frequently assist in renovating the strength, when there has been profuse perspiration. Veratrum, when tendency to fainting ensues from the effects of extreme fatigue ; and Coffea, when abstinence from food, combined with violent exercise, has produced a state of exhaustion. 1 "AVhen erythema alone results from a burn, warm alcohol, oil of turpentine, or radiated heat are the most appropriate applications. When the epidermis is destroyed, the principal object to be kept in view, in order to facilitate the cure, is to protect the injured part from the atmospheric air, and from any other irritation or pressure. The best mode of effecting this is by covering the affected surface with thick layers of carded cotton, having previously opened the blisters with the point of a needle, and bathed the part with tepid water. Pencilling with white of egg, which has been beat into a froth, is sometimes attended with beneficial results. Should the cotton have become hard and inflexible, like a coat of mail, in which case some effluvium is also more or less percep- tible, it may be moistened once a day with largely-diluted kreasote water. If the der- mis be also injured, it cannot be healed without suppuration; in such cases thick warm soap lather or paste is the best external remedy."—(Kurtz. Allg. Horn. Zeit. xxvi. 368.) 540 casualties. Cocculus, when fatigue occurs after the most trivial exertion either of body or mind. (Veratrum and Calcarea are sometimes necessary when Cocculus does not give much relief.) In fatigue from long watching Cocculus is the most generally useful medicament; but Nux v., Ipecac, Puis., and Carbo v. are also of ser- vice occasionally. Aconitum is a valuable remedy when dyspnoea, with palpitation of the heart, pain in the side, or aching in the extremities, arises from running a short distance, or even from walking quickly. (Bryonia is sometimes necessary when these symptoms continue not- withstanding the employment of Aconitum. At other times Arnica will be found more efficacious, particularly when the pain resembles what is termed a stitch in the side. Ranunculus bulbosus is also very useful in the latter case.) OVERHEATING. EXPOSURE TO HEAT. When heat in the head and flushing of the face have arisen from over-exertion in hot weather, care should be taken not to drink cold water until a sufficient time has elapsed to admit of a diminution of the temperature of the body. The early employment of Aconitum in such cases affords speedy relief, and acts as a preventive to any ulterior troublesome consequences. Violent headache, Avith congestion, fever, vomiting, sleeplessness, great anguish or despair, and a sense of weight at the forehead on bending forward, or on stooping, as if the contents of the cranium would burst forward out of their containing cavity, Belladonna should be given, and repeated from six, twelve, or twenty- four hours. If required, shortening or lengthening the interval accord- ing to circumstances. Bryonia may be selected in preference to Bella., where there is ill-humour and apprehension of some future misfortune. When headache with loss of appetite, a degree of fever with thirst, or diarrhoea is brought on by exposure either to the rays of the sun or to the heat of the fire during any exertion, Bryonia is again the most useful remedy in most instances. If nausea is the only or principal symptom Avhich is produced by exposure to heat, Silicea will generally be found the more efficacious medicament in removing the said suscepti- bility. Against headache from over-heating, with Aveight over the orbits and pain in the ball of the eye on looking intently at any object, Carbo v. usually affords speedy relief. STINGS OF INSECTS. The severe pain and febrile irritation which sometimes ensue from the stings of insects, such as bees, wasps, &c, is frequently speedily alleviated by the olfaction of spirits of Camphor. Should, however, considerable inflammation with swelling supervene, Aconitum should be administered, and subsequently Arnica, internally and externally as described under Wounds. Should the tongue or any part of the mouth be the part where the sting has been inflicted—as occasionally happens to children when biting a piece out of an apple or pear, &c, into which a wasp may have greedily inserted itself—the mouth ought to be rinsed with diluted Arnica tincture ; and should that not suffice, Belladonna SEA-SICKNESS. 541 should be prescribed. In some instances it will be found necessary to have recourse to Mercurius after Belladonna. The bites or stings of gnats require an Arnica lotion; lemon-juice will likewise be found useful in relieving the pain and itching caused thereby. Immediate relief, when a person has been severely stung by nettles, will often be found by the application of a lotion of Arnica, prepared according to the formula given under Bruises. SEA-SICKNESS. Therapeutics.—The medicaments found most useful in the treatment of this distressing and painful malady are Nux vomica, Cocculus, Taba- cum, Arsenicum, and Ipecacuanha. Nux vomica should be taken fasting, from six to twelve hours before embarkation; this precaution will, in some cases, prove sufficient to Avard off the attack. (Nux v., and Arsenicum alternately every hour or so, at the commencement of the voyage, or oftener should a degree of nausea have already come on, frequently ward off the sickness, or at all events afford great relief. As soon as decided improvement is ex- perienced, the remedies must be discontinued, or taken at much longer intervals.) Should, however, a feeling of giddiness, or a sensation of emptiness in the head be experienced, shortly after going on board, attended with headache, nausea, and inclination to vomit, as the motion of the vessel increases, which is aggravated by standing erect, Cocculus may be had recourse to, and repeated every one, two, or three hours, as those symptoms recur. (This remedy has also been found useful in sickness arising from travelling in a carriage.) Tabacum.—Excessive giddiness, attended with distressing nausea, headache, and deadly paleness of the face; or nausea, with sickness, or a sensation of burning in the stomach, renewed by the slightest movement of the head or body. This remedy is further indicated, when the symptoms are somewhat relieved by exposure to the fresh air. Arsenicum is useful when the sickness becomes excessive, and is attended with a feeling of utter prostration and helplessness, violent retching, burning sensation in the throat, and the other severe concomi- tants of this malady. It should be administered between the paroxysms, and will rarely fail of relief. This medicine may be followed by Taba- cum or Cocculus, to dissipate the symptoms of nausea and swimming in the head that may supervene. Ipecacuanha is,serviceable in attacks of vomiting unattended with great prostration of strength given under Arsenicum. Of course, in order to avoid interfering with the action of the medicines, the homoeo- pathic regimen should be carefully observed during the period of their administration. Petroleum,1 Silicea, and Therideon, from the close analogy of 1 "I have found that Petroleum is the best specific for sea-sickness. It has become quite a celebrated remedy among those who travel on the lakes. As soon as the nausea, swimming in the head, &c, sets in the patient takes three or four pellets, 6 upon the tongue, and the symptoms disappear almost instantaneously, without ever returning. I know that numbers have been relieved by Petroleum, and that it has so far failed only in one instance."—(Dr. D. Chase, Homoeop. Examr., Vol. iv., No. 2.) 542 CASUALTIES. their pathogenetic symptoms to those of the ordinary forms of this dis- tressing malady, deserve a trial. APPARENT DEATH. Asphyxia. Apparent Death. Asphyxia.—In every instance where an indi- vidual has to all appearance suddenly expired from external causes, animation may only be suspended; there are many cases, of course, where sudden death is no mere suspension of animation, but there are others where apparent death is far from uncommon; in all cases, there- fore, where there is the least uncertainty, care should be taken to do nothing that may cause death, and interment should be avoided until certain signs of putrefaction set in.1 Apparent death from hunger.—Give small injections of warm milk repeatedly; great care must be taken to give the food when the patient begins to rally, in the smallest possible quantity at a time. Milk may be given drop by drop, and gradually increased to a teaspoonful, and after some interval a small quantity of beef tea and a few drops of wine. After a sound sleep has succeeded, but not till then, a small meal may be given; but it is best that the patient should eat little at a time, but often, so that he may gradually return to his natural mode of living. It must be borne in mind, that in all persons suffering from starvation, eating too much and too quickly, is in the highest degree dangerous. Apparent death from a fall.—Place the patient cautiously on a bed, with his head high, in a place where he can remain quiet; put a few globules of Arnica on his tongue, and wait till a medical man visits him to see if there is any fracture, or whether there are still signs of life; bleeding may be here sometimes of benefit, but it requires great caution. Arnica may be repeated, and also administered in injec- tions. If the patient has been bled, give China ; but it is obvious that if much blood has been lost by the fall or Avound, venesection would be injurious. Apparent death from suffocation (hanging, pressure, choking).—Re- move all tight clothing. Put the patient in a proper position, the head and neck rather high, the neck quite easy, not bent forward. Begin by rubbing gently but constantly with clothes, give an injection of a dozen or two globules, or a drop of Opium, dissolved in a half pint of water, and injected slowly. This may be repeated every quarter of an hour, whilst the ribs are being rubbed gently. Hold from time to time a mirror before the mouth, to see if the breath dirm? it; open the eye- lids, and see if the eyes contract; put warm clothes on ; hot stones wrapped in blankets to the feet, between the thighs, to the sides, neck, and shoulders. If in an hour no change is produced, take a bitter almond, pound it fine, mix it in a pint" of water, put a few drops into the mouth, or into the nose, and give the rest in injections. Apparent death from lightning.—The body should be immediately removed into a current of cool fresh air; and cold water dashed fre- 1 The subjoined directions have chiefly been taken from Hering's Hausarzt. APPARENT DEATH. 543 quently on the neck, face and breast. If the body be cold, warmth with friction must be employed in the same manner as recommended for the drowned in the next article; as well as the means therein prescribed for inflating the lungs. A few globules of Nux vomica may be put upon the tongue, and repeated in half an hour, when, if no effect is produced, a little Nux vomica in water rubbed on the neck, and some injected, may be of service. It has also been recommended to place the patient in a half-sitting, half-recumbent posture, and to cover him over with newly-excavated earth (leaving the face alone exposed, which should be turned towards the sun, until the first signs of returning animation become apparent), after which Nux v. is to be had recourse to, as above directed. Apparent death from drowning.—Observe the following cautions: 1, lose no time ; 2, avoid all rough usage; 3, never hold up the body by the feet; 4, do not roll the body on casks; 5, do not rub the body with salts or spirits; 6, do not inject smoke or infusion of tobacco, though clysters of Avarm water and salt, or spirits and water may be used, and the following means should not be delayed:— 1. Convey the body carefully with the head and shoulders in a raised position to the nearest house. 2. Strip the body and rub it: then wrap it in hot blankets, and place it in a warm bed in a warm room, or in warm sand or ashes. 3. Wipe and cleanse the throat, mouth, and nostrils. 4. If the foregoing measures produce no reaction, administer a few globules of Lachesis on the tongue, and in injections, and resume the rubbing. Solanum mamosum has also been recommended, and may be tried after Lachesis, when that remedy fails to do any good. 5. Again, should our efforts still fail, or should the medicines quoted not be at hand, we may in order to restore the natural heat of the body, move a heated, covered warming-pan, over the back and spine;— place bottles, or bladders filled with hot water, or hot bricks, to the pit of the stomach, the armpits, between the thighs, and to the soles of the feet;—put the body in a warm bath, in the sun, or at a proper dis- tance from the fire : use friction Avith hot flannels, flour of mustard, or other stimulants; rub the body briskly with the hand, and at the same time not suspend the employment of other means. To restore breathing, introduce the pipe of a common bellows into one nostril, carefully closing the other and also the mouth, at the same time draAving -downwards, and gently pushing backwards, the upper part of the windpipe;, to allow a more free admission of air; blow the bellows gently in order to inflate the lungs till the chest be a little raised, the mouth and nostrils should then be set free and a moderate pressure made Avith the hand upon the chest; continue this process until signs of life appear. 6. Electricity, or a stream of galvanism passed through the chest, promises to be of great service. 7. Apply pungent salts, as sal volatile or spirits of hartshorne to the nostrils. These means should be persisted in for several hours, and till there are evident signs of death. 544 CASUALTIES. When the patient shows signs of life, and can swallow, small quanti- ties of warm wine, or spirits and water may be taken; but till then, nothing should even be poured down the throat, either by a flexible tube or otherwise. At this period the patient should never be left alone, as some have been lost for want of care who might otherwise have been saved. Apparent death from being frozen.—When an individual is found in a state of frost-bitten asphyxy, arising from exposure to intense cold, he should be removed with great gentleness and caution, to guard against any injury, as fracture, &c, to a place of shelter, such as a barn or unheated apartment, since even a moderate degree of heat might anni- hilate all hope of restoring animation; at the same time the patient ought to be protected from the slightest draught. He should then, especially if the limbs have become stiffened by the frost, be covered over with snoAV to the height of several inches, the mouth and nostrils alone being left free. The patient ought to be put into such a position that the melted snow may run off readily, and its place be supplied by fresh. When there is no snow a cold bath, the temperature of which has been reduced by ice (or a bath of cold sea or salted water), may be substituted, and the body immersed therein for a few minutes. The process of thawing is by these means to be effected, and when every part has lost its rigidity, the patient should be undressed by degrees, or the clothes cut from the body, if requisite. As the muscular or soft parts become pliable they may be rubbed with snow until they become red; or the body should be wiped perfectly dry, if snow is not to be had, placed in flannel, in a moderately warm room, and rubbed with the warm hands of several parties simultaneously. In the event of no signs of returning animation declaring themselves soon after the foregoing treatment, small injections containing Camphor may be administered every quarter of an hour. As soon as any symp- toms of approaching restoration become perceptible, small injections of lukewarm black coffee (coffee without milk) may be thrown up ; and as soon as the patient is able to swallow, a little coffee may be given, in the quantity of a teaspoonful at a time. The measures above detailed ought to be persevered in for several hours. Against the excessive pain which is generally experiened when life is restored, Carbo v. should be prescribed in repeated doses, and if it fails to relieve the sufferings, Arsenicum may be given. The party rescued must avoid subjecting himself to the heat of the fire or stove for a considerable length of time after his recovery, as serious consecu- tive ailment, and particularly disease of the bones, is liable to result therefrom. Apparent death from noxious vapours.—The treatment consists in removing the body into a cool, fresh current of air ; dashing frequently cold water on the neck, face and breast; if the body be cold, applying warmth, &c, as above recommended to the drowned; inflation of the lungs ; early and judicious application of electricity or galvanism ;—after life has been restored Op. or Aeon, may be given with advantage. HYDROPHOBIA. 545 HYDROPHOBIA. It is acknowledged that no allopathic cure has hitherto been found for this disease, when fully established. The plans of treatment, which are reported to have been successful in some few instances, have gene- rally failed in all others; thus rendering it probable that in these supposititious cases of success, the persons bitten might have escaped Avithout any treatment whatever. But it is not to my purpose to enter into the multitude of ineffectual remedies which have been recommended by the allopathists. Hydrophobia is a disease which arises in consequence of the bite of a rabid animal, and sometimes spontaneously, particularly in the course of some other disease; in which form it is known under the term of symp- tomatic hydrophobia. Ere proceeding to the homoeopathic treatment, a few remarks descrip- tive of the disease as it appears in the human subject, may not be misplaced. The first symptoms that show themselves in a person who has been bitten, are usually, general uneasiness, anxiety and disturbed sleep ; the eyes are glassy, inflamed, and sensitive to light; there are also ringing in the ears, giddiness, and paleness of countenance; frequent paroxysms of chilliness; oppressed respiration, and quickness of pulse, which latter is usually at the same time small, contracted, and irregular; and loss of appetite. These symptoms generally come on at some indefinite period, occasionally after the bitten part seems quite Avell. In the second or convulsive stage, the Avound, Avhich may have already become completely cicatrized or healed, begins to assume a somewhat inflamed appearance, and a slight pain and heat, noAV and then attended with itching, is experienced in it. It now breaks out afresh, and an ulcer, Avith elevated margins of proud flesh, which secretes a dark- coloured and offensive discharge, is subsequently formed ; and AArandering, drawing, and shooting pains from the lacerated part upAvards towards the throat, present themselves. These symptoms, Avith the state of testiness and anxiety, increase daily; and the patient complains of a state of confusion in the head, or giddiness, Avith sparks before the eyes ; is afflicted Avith sudden startings, spasms, sighing, and is fond of solitude ; the pulse is small, irregular, and intermittent; the breathing laborious and uneasy ; the skin cold and dry, and general chilliness, especially in the extremities, is complained of; then hiccough, colic, and palpitation come on; the patient looks wild, and the eyes have a fixed, glassy, and shining appearance ; the act of deglutition is impeded by a sense of pressure in the gullet, Avhich occasionally renders every attempt to SAvalloAV liquids impracticable ; convulsions also take place in the muscles of the face or neck. In this stage, hoAvever, the deglutition of any solid substance is performed Avith tolerable ease. In ordinary cases the sufferer remains affected in the above manner for a few days, after Avhich, the disease passes into the hydrophobic stage, in which it is utterly impossible for him to swallow the smallest drop of liquid; and the moment that any fluid, especially water, is brought in contact Avith the lips, it occasions the individual to start back Avith dread and horror, although he may, at the same time, suffer the most excessive thirst; 546 CASUALTIES. even the sight of water, or the very noise produced by pouring it from one vessel into another, in fact, anything that reminds him of that fluid, produces indescribable anxiety, uneasiness, convulsions, and even furious paroxysms of madness; he dreads even to swallow his own saliva, and is constantly spitting; vomiting of bilious matter soon comes on, suc- ceeded by intense fever, great thirst, dryness and roughness of the tongue, hoarseness, and fits of delirium or madness, with disposition to bite and tear everything within reach, followed at intervals by convul- sive spasms. These attacks commonly last for a quarter or half an hour, and at their expiration, the patient is restored to reason, but remains in a state of great despondency ; finally, the paroxysms come on more violently and frequently, and in some instances a fit of furious delirium closes the frightful scene; in others, nature sinks exhausted after a severe attack of convulsions. The disease may be communicated to the human subject, from the bites of cats, and other animals not of the canine race, which have been previously inoculated with the virus. It may be remarked in this place, that the best and most experienced of our writers upon this subject, consider the human species as the least susceptible of contagion from the hydrophobic virus ; scarcely one out of twenty, or even thirty, of those actually bitten by an animal in a state of rabies, suffering from its effects. I consider it my duty, while making this statement, which I hope may prove a means of relieving the minds of many from painful apprehensions, to enforce, at the same time, the necessity of taking those precautions, which are about to be pointed out, against the danger. It may also be added, before proceeding to the treatment of the malady, that the possibility of the poison being communicated through the medium of the epithelium is exceedingly questionable; but scarcely a doubt exists of the incapacity of the cuticle to absorb it. As many have been made wretched from having allowed a dog, which has after- wards shown symptoms of rabies, to lick their hands, it may be stated Avith confidence that if no abrasion of surface exists, there is not the slightest danger. In the homoeopathic treatment of this disease, and its prevention, the following are the principal remedies employed: Belladonna, Lachesis, Hyoscyamus, Stramonium, and Cantharides.1 1 The use of dry or radiating heat in this disease, and in envenomed wounds by snakes, &c, is recommended by Dr. Hering, of America, whose directions for the treatment of envenomed wounds in general, are as follows : Envenomed wounds.—The best domestic remedy against the bites of venomous serpents, mad dogs, &c, is radiating heat. This should be done by the readiest means at hand,— a red-hot iron or live coal, or even a lighted cigar, for instance, must be placed as near the wound as possible, without, however, burning the skin, or causing too sharp pain; but care must be taken to have another instrument ready in the fire so as never to allow the heat to lose its intensity. It is essential also that the heat should not exercise its influence over too large a surface, but only on the wound and the parts adjacent. If oil or grease can be readily procured, it may be applied round the wound, and this ope- ration should be repeated as often as the skin becomes dry ; soap, or even saliva may be employed, where oil or grease cannot be obtained. AVhatever is dischai'ged in any way from the wound ought to be carefully removed. The application of burning heat should be continued in this manner, till the patient begins to shiver and to stretch himself; if this takes place at the end of a few minutes, it will be better to keep up the action of HYDROPHOBIA. 547 Belladonna.—Hahnemann states, in the introductory article to Belladonna, in his Materia Medica Pura, that he considers the smal- lest dose of that medicine, repeated every three or four days, to be the most certain preventive against Hydrophobia ; and when we refer to the pathogenetic effects of Belladonna, described in the aforesaid work, it is impossible not to be struck Avith the great resemblance which many of them bear to the symptoms of this malady ; and it is from this circum- stance, according to the great laAV of Nature, on which Hahnemann's doctrine of similia similibus is founded,1 that this medicine is found to be both a prophylactic and curative remedy. the heat upon the wound for an hour, or until the affections produced by the venom are observed to diminish. Internal medicines must be judiciously administered at the same time. In the case of a Bite from a Serpent, it will be advisable to take from time to time a gulp of salt and water, or a pinch of kitchen salt, or of gunpowder, or else some pieces of garlic. If, notwithstanding this, bad effects manifest themselves, a spoonful of wine or brandy, administered every two or three minutes, will be the most suitable remedy; and this should be continued till the sufferings are relieved, and repeated as often as they are renewed. If the shooting pains are aggravated, and proceed from the wound towards the heart, and if the wound becomes bluish, marbled, or swollen, with vomiting, vertigo, and fainting, the best medicine is Arsenicum. It should be administered in a dose of three globules in a tablespoonful of water; and if after this has been taken, the sufferings are still aggravated, the dose should be repeated at the end of half an hour; but if, on the contrary, the state remains the same, it should not be repeated till the end of two or three hours; if there is an amelioration, a new aggravation must be waited for, and the dose ought not to be repeated before its appearance. In cases in which Ars. exercises no influence, though repeated several times, recourse must be had to Bell.; Sen. also frequently proves efficacious. Against chronic affections arising from the bite of a serpent, Phos. ac. and Merc, will generally be most beneficial. For the treatment of persons bitten by a mad dog, after the application of dry heat, as directed and described above—see Hydrophobia (below). If morbid affections or ulcerations exhibit themselves, in consequence of a bite from a rabid man or animal, Hydrophobine, administered in homoeopathic doses, will often ren- der essential service. For wounds that are envenomed by the introduction of animal substances in a state of putrefaction, or of pus from the ulcer of a diseased man or animal, Ars. is generally the best medicine. Lastly, as a Preventive against bad effects, when obliged to touch morbid animal substances, envenomed wounds, or ulcers of men and animals, under the influence of contagious diseases, the best method that can be pursued is to expose the hands for five or ten minutes to the greatest heat that can be borne; and after this to wash them with soap. The use of Chlorine and muriatic acid, in similar cases, is well known. Hydrophobia.—Apply distant or radiated heat to the recent wound, as described under "Envenomed Wounds," or until shudderings appear; and continue this practice three or four times a day, until the wound is healed, without leaving a coloured cicatrix. At the same time the patient should take, every five or seven days, or as often as the aggravation of the wound requires it, one dose of Bell, or Lach., or of Hydrophobine, till the cure is completed. If, at the end of seven or eight days, a small vesicle shows itself under the tongue, with feverish symptoms, it will be necessary to open it with a lancet or sharp-pointed scissors, and to rinse the mouth with salt and water. If the raging state has commenced, before assistance can be procured for the patient, the medicines that ought to be administered are especially Bell, or Lach.; or else again, Canth., Hyos., Merc, or also Stram. or Verat., according to symptoms, &c. (See the indications above given for Belladonna, Lachesis, Hyoscyamus, Stramonium, and Cantha- rides ) 1 The curing of a disease by the administration of a remedy which has been found to possess the property of producing a train of symptoms in a healthy person similar to those observed in the disease. 548 CASUALTIES. These precautions taken, the patient may be alloAved to pursue his usual occupation, those around him being careful to avoid making any allusion Avhich may tend to remind him of his misfortune. Belladonna, in the same dose, should be repeated on the third or fourth day, and subsequently at longer intervals. The effect of each exhibition should be attentively watched, and care taken that a fresh one be not given, as long as any symptoms of the action of the preA'ious dose are per- ceptible. Lachesis may generally be given as soon as local or general convul- sions set in. Dose. A few globules repeated every two or three hours,or at every return of the con- vulsions, until benefit result, or decided symptoms of medicinal action make their appearance; but should this remedy appear to exert no perceptible influence in check- ing the progress of the malady, we must again have recourse to Belladonna, particularly when the following characteristics are present: drowsiness, with constant but useless efforts to sleep, chiefly in consequence of excessive anguish and great agitation : sense of burn- ing ; great burning in the throat, with accumulation of frothy mucus in the mouth or throat, frequent desire for drinks, which are immediately pushed aside when presented, or a suffocating or constricting sensation in the throat on attempting to perform the act of deglutition, or complete incapacity to swallow, with glowing redness and bloated appearance of the face ; pupils immovable, and generally dilated ; great dread ; occa- sional desire to strike, spit at, bite, or tear everything; inclination to run away; continual tossing about; and great physical activity, with twitching in various muscles, especially those of the face: ungovernable fury, with foaming at the mouth; and tetanic convulsions. Dose. A few globules to be placed on the tongue at every threatening of a return of the convulsions, but with the same precaution as enjoined under Lachesis. Hyoscyamus is more particularly indicated either before or after Belladonna, when the convulsions are severe and of long duration ; where there is not so much inclination to bite or spit, but a desire to injure those that stand around, in some manner or other. The spasms in the throat are not so violent, but great dryness and burning are com- plained of, attended with a sense of shooting or pricking, Avhich causes a difficulty in swallowing, resembling a sensation of constriction in the throat, and threatening to produce suffocation on attempting to satisfy the thirst; dread of liquids, in consequence of the pain and difficulty that is experienced in deglutition, with ejection of the saliva for the same reason; excessive convulsions, with loss of consciousness come on soon after the distressing act of swallowing has been performed. There is, moreover, foaming at the mouth, with constant raving; sometimes the patient seems wrapped up in his OAvn thoughts; or is full of fear, and inclined to run away from the house, being afflicted with a sort of Anthropophobia ; there are also attacks of excessive fury, attended with apparently supernatural physical power ; or excessive anguish and fear, alternating with fits of trembling and compulsions; the individual ex- hibits a peculiar dread of being bitten by animals; the pupils are di- HYDROPHOBIA. 549 lated : sleep is much disturbed by great nervous excitement; starts, and agonizing dreams. Dose. Same as Belladonna. Stramonium is chiefly indicated in this disease, when we observe severe convulsions taking place whenever the eye becomes fixed on brilliant objects, or on whatever tends to remind the patient of water; great thirst; dryness of the mouth and throat, with horror of water and all liquids ; spasmodic constriction in the gullet, with foaming at the mouth, and frequent spitting; mania, with great loquacity and gesticulations ; fits of laughter and singing, sometimes alternately with acute fits of passions and moaning; the convulsions, when severe, are generally at- tended with ungovernable fury, restless, agitated sleep, sudden shrieks, and starting up with wild gestures ; insensible and dilated pupils ; and great disposition to bite or tear everything with the teeth. Dose. Same as Belladonna. Cantharides.—This medicine also possesses various pathogenetic properties, which bear a close resemblance to the symptoms that are met with in many cases of this disorder,1 and should be selected in preference to any of the foregoing remedies when we meet with the fol- lowing indications : great dryness and burning in the mouth and throat, much aggravated on attempting to swallow; paroxysms of fury, alter- nating with convulsions, which are renewed by any pressure on the throat or abdomen, and also by the sight of water; fiery redness and sparkling of the eyes, which become prominent and frightfully convulsed; spasms in the throat, excited by the pain produced by the act of swal- loAving, especially fluids ; continual burning, titillation and other irritat- ing sensations in the lower part of the abdomen, &c. Dose. Same as Belladonna. We have now enumerated and described the characteristic indications for the principal homoeopathic remedies, which have been successfully employed against Hydrophobia ;2 others have also been strongly recom- mended, but those mentioned have repeatedly proved sufficient, when administered early, and exclusively adhered to throughout the course of the disease. Belladonna has frequently been tried by the allopathists, but the cases in which it seemed to fail, were evidently attributable to the improper manner in which it was administered. We shall not treat of the several remedies Avhich have from time to time appeared, and have, by their inventors, been highly eulogised, as time and experience alone will prove whether they possess any virtue or not. 1 Drs. Hartlaub and Trinks consider Cantharides to be the most certain prophylactic against hydrophobia, when administered early; they recommend a drop to be given every three or four days, and are of opinion that the virus is not eradicated as long as the cicatrized wound presents a livid hue, and is attended with induration, but affirm the danger to be over as soon as the part assumes a healthy and natural appearance. (Vide Hartlaub and Trinks, R. A. M. L., vol. i., p. 173.) 2 A'ide Hartmann's Therapie acut. Krank., vol. ii., p. 77, 2d ed. 550 mental emotions. MENTAL EMOTIONS. We shall conclude this part of the work with the consideration of those particular Mental Emotions, which exercise so great a control over the human organism, among which, fright, passion, or anger, and concentrated grief, are the most prominent and continually recur- ring. Therapeutics.—The remedies found most serviceable for derange- ments of the system, arising from the above-mentioned causes, are, Opium, Aconitum, Pulsatilla, Belladonna, Ignatia amara, Chamomilla, Nux vomica, Staphysagria, Arsenicum album, Bryonia, kc Opium, when the sufferer has been exposed to sudden fright, with terror, horror, or fear, is generally efficacious, if administered imme- diately, in restoring the patient, and obviating any evil consequences, such as convulsive fits, swooning, lethargic sleep, involuntary evacua- tions, diarrhoea, &c. (When Opium is not sufficient to remedy the mischief, Aconitum may be administered, or Aconitum and Opium alternately. In some cases Ignatia will answer better than Aconitum, especially when the convulsions continue; Belladonna or Hyoscyamus, and Veratrum, are also serviceable, when none of the other remedies are sufficient to remove all the effects. Causticum is a useful remedy Avhen a constant dread haunts the child after a previous fright, &c) See also Samb. Aconitum is the appropriate remedy, when the system is labour- ing under the joint influence of fright and passion; and especially, when there is headache, feverishness, heat in the face and head (conges- tion), fear. Pulsatilla, in cases of fright, fear, or timidity, particularly when accompanied Avith an effect upon the stomach and bowels, as also heat of the body, with coldness of the extremities; or passion, in people of generally mild temper; it is also suitable for highly sensitive persons. Belladonna.—Two globules, when there is particular liability to be startled by trifles, or extreme general nervous excitement, after a fright, &c. Ignatia :—When the cause is gnawing, inward grief. Acid, phosph. and Staphysagria are sometimes requisite after Ignatia. Chamomilla :—When, particularly in the cases of children, or females of nervous temperament, suffering has arisen from a fit of passion or vexation. And especially when inconsiderable anguish and mental depression are manifested, or when convulsions ensue. Nux vomica.—Suffering arising from a sudden fit, or outbreak of passion or rage. (Bryonia is sometimes necessary in alternation with Nux v.) Staphysagria.—Anger and vexation, arising from just cause. Arsenicum is useful Avhere passion is folloAved by great weakness and dangerous prostration of the vital powers. Bryonia is indicated where a fit of passion is followed by coldness and shivering over the whole body, great irascibility, want of appetite, nausea, vomiting, and bilious sufferings. This remedy is better adapted to adults, and particularly those of bilious temperament. MENTAL EMOTIONS. 551 Colocynth :—When indignation accompanies the above-described effects of a fit of anger. Against the injurious effects which occasionally result after excessive joy, such as headache, trembling, and tendency to fainting, Coffea is the most useful remedy. But when the consequences are more serious, and violent headache, Avith congestion to the head, frequent vomiting, diar- rhoea, swooning, &c, result, Opium must be given. Hyoscyamus is a serviceable remedy against any injurious conse- quences arising from jealousy, or disappointed love. In the latter instance Ignatia and Acid, phosphoricum are also beneficial. Against the-effects of mortification or wounded vanity or self-esteem, Colocynth, Ignatia, Staphysagria, Pulsatilla, Platina, or Belladonna have proved useful. Sambucus :—When oppression at the chest, with stertorous breath, has ensued in consequence of a fear or fright, and failed to yield to the employment of Opium. PART II. TREATMENT OF FEMALES, AND OF THEIR PECULIAR AFFECTIONS. CHLOROSIS. Emansio Mensium. This complaint generally declares itself in young females about their fourteenth year. Its proximate cause is an obstruction of the first menstruation, while its predisposing cause is generally attributable to a deranged state of the primary organs of digestion, and also the ovaries ; a disease very similar may be produced by great loss of blood. Diagnosis.—Pale, blanched complexion and lips (sometimes with flushes of heat and redness); cantus carotidum ; a depravity of appe- tite, a longing after innutritious substances, such as chalk, &c, and a general languor both mental and physical; the patient complains of weariness, lassitude, and debility, and becomes emaciated; the loAver extremities frequently assume an oedematous appearance, generally attended with cold in those parts, and headache with flatulent distension of the abdomen, particularly after meals, and in the evening; bowels irregularly confined, sometimes at a later period very easily irritated and relaxed; a harsh, harassing cough, occasionally with periodical expectoration of dark-coloured coagulated blood, and hurried respiration, frequently declares itself, if the affection has been allowed to proceed unchecked ; and to an inexperienced eye the sufferer appears to be on the verge, or even passing through the different stages in a decline, the disease appearing to stand in closer relation to the functions of the stomach and lungs than to those of the uterus and its appendages. Therapeutics.—The medicines which have hitherto been found most useful in ordinary cases of this affection are, Pulsatilla, Sepia, Bryonia, Sulphur, Natrum muriaticum, Calcarea carbonica, Ferrum, 'Lycopo- dium, and Plumbum. Pulsatilla is, together with Bryonia, Sulph., Lycop., kc, peculiarly efficacious in emansio mensium, when the complaint seems to have been excited by and is intimately connected with deranged digestion, and CHLOROSIS. 553 when it is accompanied by frequent attacks of semilateral headache, Avith shooting pains, extending to the head and teeth, sometimes shifting suddenly to the other side; also when we observe aching in the forehead, with pressure at the crown of the head, and sallow complexion; diffi- culty of breathing, and sense of suffocation after the slightest movement; palpitation of the heart, coldness of the hands and feet, often changing to sudden heat; disposition to diarrhoea and leucorrhoea ; pains in the loins ; sensation of weight in the abdomen ; almost constant chilliness and shivering ; spasms in the stomach, with nausea, inclination to vomit, and vomiting; periodical expectoration of dark, coagulated blood ; hunger, Avith repugnance to food, or want of appetite with dislike to food; swelling of the feet and ankles, great fatigue, especially in the legs. This medicine is peculiarly adapted to females of mild or phleg- matic disposition, disposed to sadness and tears. Graphites, when there is retention of the period with congestion of the vessels of the head and chest; dark red flushing of the face, oppres- sion at the chest; and a feeling of anxiety when in the recumbent position. Graphites is, moreover, one of the most important remedies in scanty, insufficient menstruation. Belladonna is often called for Avhen the congestion of the head and chest is of an active character, and accompanied with violent throbbing of the carotids. Sepia is also a very valuable remedy in this affection, Avhen many of the above symptoms are present, with, at the same time, hysterical megrims; complexion sallow, with dark-coloured spots ; frequent colic and pain as if arising from bruises in the limbs. It may, when the above symptoms declare themselves, advantageously follow Pulsatilla ; if the latter have failed to relieve, which it generally does, if the pathognomonic sign of chlorosis, denominated cantus earotidum, be absent. Bryonia :—Frequent congestion of the head or chest; bleeding at the nose ; dry cough ; coldness and frequent shivering, sometimes alter- nated with dry and burning heat; constipation or colic ; bitter taste in the mouth, tongue coated, yellow; sense of pressure in the stomach as if from a stone ; irascibility. Sulphur is more particularly indicated when there is pressive and tensive pain in the back of the head, extending to the nape of the neck ; or, pulsative pain in the head, with determination of blood; humming in the head; pimples on the forehead and round the mouth; pale and sickly complexion, with red spots on the cheeks; voracious appetite; general emaciation; sour and burning eructations; pressive fulness and heaviness in the stomach under the lower ribs and in the abdomen ; bowels irregular ; difficulty of breathing; pain in the loins and fainting; excessive fatigue, especially in the legs, with great depression after talk- ing ; great tendency to take cold; irritability, and inclination to be angry ; sadness and melancholy, with frequent weeping. Calcarea carb. is often of the most striking benefit in chlorosis. Sometimes a complete cure is effected by it alone, even in the worst cases, with oedema of the extremities, and extreme dyspnoea. Occa- sionally it is found necessary to follow up the treatment, on the disap- pearance of the more important symptoms under the employment of 554 TREATMENT OF FEMALES. Calc, with Ferrum carb. in repeated doses, in order to prevent a relapse. Ferrum is especially required when the pale and sickly hue of the face continues, as it frequently does, notwithstanding the previous use of Calc. When Ferrum is employed at the commencement of the treat- ment, it has been found to aggravate the anxiety, cough, and other pectoral symptoms. Where there is a complication with tubercular diathesis, accompanied by cough, &c, coeval with the first appearance of chlorosis, Sulphur and Calcarea often prove highly beneficial in alternation.1 In the generality of cases, during the employment of Calcarea, a dose of Lycopodium is required when there is obstinate con- stipation and extreme languor, or Sepia when oppressive headache is complained of.3 Sometimes the menses do not appear for some time afterwards, although the general health may have been thoroughly renovated by the remedies prescribed. Valeriana has been found of great service in daily repeated doses, when a feeling of constriction was experienced in the gullet or chest, accompanied with signs of threatened suffocation, and followed by fre- quent yawning, as soon as the patient sat down to dinner. Natrum muriaticum is a most valuable remedy in many obstinate cases of chlorosis with habitual constipation. Plumbum aceticum has repeatedly been found useful in inveterate cases with dyspnoea, oedema, and anasarca, but no organic disease either in the chest or abdomen. Ammonium c, Phosphorus, Conium, Lyco- podium, Kali, China, Ignatia, Aurum, Acid, nitricum, kc, have also been advantageously employed in chlorosis. In enlargement of the abdomen, occurring in young girls at the criti- cal age, Lachesis has been employed with success. AMENORRHGEA. Suppressio Mensium. Suppression of the menses occasionally takes place suddenly from some accidental cause, such as exposure to cold, powerful mental emotions, &c. In other instances the suppression is symptomatic of some other disease, either organic or functional, and can only be removed by the cure of the primary malady. It is of the former that we here propose to treat. When a suppression takes place from the sudden effects of a chill, we may have recourse to Pulsatilla, when the symptoms generally cor- respond to those of that remedy, as detailed under Chlorosis. In other cases arising from this cause, Nux moschata, Dulcamara, Sepia, or Sulphur may be necessary. (See Chlorosis for indications for Sulph. and Sep., which are remedies of great service in a large number of cases, when the affection has become chronic.) When a sudden fright has given rise to the affection, Aconitum should be immediately administered, followed by Lycopodium, Opium, or Vera- trum, if the bad consequences which frequently result do not yield, or 1 Allg. Horn. Zeit., Gr. u. St. Arch, xx., 3, 58. 2 Arch, xx., 3, 58. MENORRHAGIA. 555 if only partial relief is obtained from the employment of Aconitum. (See Mental Emotions, Parts I. and II.) In chronic cases occurring in weak or debilitated individuals, in addi- tion to Sulphur and Sepia, the following remedies are useful: Natrum m., Conium, Arsenicum, Cinchona, Qraphites, lodium. Whilst in those Avhich occur in plethoric subjects, whether of a chronic or recent descrip- tion, Aconitum, Belladonna, Sulphur, Bryonia, Nuxv., Sabina, Opium, Platina, kc, will generally be found the most serviceable. When there is not a complete suppression, but the menstrual discharge is scanty and insufficient, Grraphites,' Kali, Conium, Natrum m., Phosphorus, Pulsa- tilla, Sulphur, Lycopodium, Magnesia, Silicea, Veratrum, or Zincum, are the most important remedies. MENSTRUATIO NIMIA. MENORRHAGIA. The quantity of the menstrual discharge varies a good deal in diffe- rent women. Considerable influence is for the most part exerted by climate, constitution, and the manner of living. The duration of the discharge and the period of return are also variable. In some Avomen it continues from four to ten days, in others it lasts only a few hours; from three to six days is, however, the most usual period. The regu- larity is in many, exact to a day, or even an hour, Avhile in others a variation of several days is a usual occurrence, without the slightest disturbance to the general health resulting therefrom. When the dis- charge is excessive, and attended with pains in the back, loins, and abdomen, resembling those of labour, it becomes necessary to prescribe remedies calculated to arrest it, and to correct the tendency thereto. Amongst these the following are of great utility: Ipecacuanha, Crocus, Sabina, Cinchona, Nux v., Chamomilla, Platina, Sulphur, Calcarea, kc Ipecacuanha is one of the more generally useful medicaments in severe cases of this derangement, as well as in flooding after labour, and may, in most instances, be administered first, unless there are strong indications for a preference being given to any of the others. Crocus is more especially called for when the discharge is of a dark colour, viscid, and very copious; and the menses have appeared before the usual time. Sabina, when the discharge is excessive, of a bright colour, and occurs in plethoric females who are prone to miscarry; rheumatic pains in the head and limbs ; great weakness; pains in the loins similar to those of labour. Cinchona is of considerable utility after the previous employment of either of the foregoing, and in all cases where there is great debility in consequence of a more copious menstrual discharge than natural. Nux v. when the discharge is of too frequent occurrence, too profuse, and of too long duration ; and when it commonly stops for a day or so and then returns, attended with spasms in the abdomen; sometimes nausea and fainting, especially in the morning; pains in the limbs; restlessness ; irascibility. Nux v. is especially serviceable when the above symptoms occur in females who are addicted to the daily or fre- quent use of coffee, liqueurs, and other stimulants. Chamomilla is frequently useful after Nux v., but particularly when 556 TREATMENT OF FEMALES. there is a discharge of dark, clotted blood, with severe colic, or pains like those of labour ; great thirst; paleness of the face, and coldness of the limbs. Ignatia is of considerable service when the derangement happens is hysterical females. Platina.—Preternaturally increased menstrual discharge, Avith pain- ful bearing-down pains, and venereal orgasm ; thick, dark-coloured menstrual blood ; great excitability. Veratrum.—Too early or too copious menstrual discharge, ahvays attended with diarrhoea. Kreosotum has been found of great service in metrorrhagia, where the discharge was excessive, dark-coloured, frequently in large clots, and very offensive. The cervix uteri and uterus itself being, at the same time, swollen and very sensitive; and the accompanying pains of a severe burning or corroding description. Sulphur administered thrice during the intervals, allowing ten or twelve days to elapse between the second and third doses, and followed by Calcarea, in the same manner, has frequently been found successful when any of the previous remedies had afforded but temporary relief. In other cases, Belladonna, Cortex mali granati (often where Sabina, Bella., and other remedies fail), Bryonia, Lycopod., Natrum m., Magnesia m., Sepia, Silicea, or Phosphorus, kc, may be useful. In menorrhagia occurring at the change of life, and coming on in daily paroxysms for eight, ten, fourteen days, and then ceasing for a time, after which the discharge broke out anew, Laurocerasus has been found of great efficacy. The blood was dark-coloured, and frequently in large coagula.1 DYSMENORRHEA. In painful and difficult menstruation, or menstrual colic, the most important remedies are the same as those enumerated under Menor- rhagia and Chlorosis, but particularly Chamomilla, Pulsatilla, Bella., Nux, Coffea, Sulph., and Calc, kc When the disorder occurs Avith great vehemence at the critical age (tour dldge) Lachesis is of invalu- able assistance, and particularly when diarrhoea, attended Avith almost insupportable tormina, usually sets in before and after the menstrual period.2 The following are likewise of considerable utility against the sufferings Avhich are often experienced at the critical age: Pulsatilla, Sepia, Sulphur, Cocculus, Ruta, Conium. Against uterine spasms, .Cocculus, Pulsatilla, Ignatia, Platina, Cuprum, form the most valu- able remedial agents; but in some instances Nux v., Cinchona, Sulphur, Graphites, Conium, or Natrum m., kc, may be more appropriate. HYSTERICS. Hysteria. Passio Hysterica. This disease appears in paroxysms, is preceded generally by depres- sion of spirits, anxiety, effusion of tears, dyspnoea, nausea, and palpi- 'Allg. Horn. Zeit, vol. xxxi. 2 Against flushes of heat occurring after the change of life, Acidum sulphuricum is an excellent remedy. * HYSTERICS. 557 tatio cordis ; also with pain in the left side, which seems to advance upwards till it gets to the throat, when it feels as if a ball were lodged there (globus hystericus); if it advances further, there is a sense of suf- focation, stupor, and insensibility, with spasmodic clenching of the jaws; the trunk of the body is moved about, and the limbs agitated; alter- nate fits of laughing, crying, and screaming; incoherent expressions; foaming at the mouth ; relief ensues generally with eructation, and fre- quent sighing and sobbing, followed by a sense of soreness over the Avhole body. Hiccough is sometimes a concomitant, and a very dis- tressing one, in hysteria. These are the usual symptoms indicating this disease, but the complaint appears in a great variety of forms; and in many cases the patient is attacked with a violent spasmodic pain in the back, which extends from the spine to the .sternum, and eventually becomes fixed at the epigastric region, and is often so intense as to cause clammy perspiration, a pale cadaverous countenance; coldness of the extremities ; and a feeble, thread-like, or scarcely perceptible pulse. _ Hysteric affections are more frequent in single than in married life, and usually occur between the age of puberty and that of thirty-five, and generally about the period of menstruation. The disorder is readily excited in those who are subject to it, by sud- den mental emotions. Hysterics have also been known to arise from sympathy and imitation. Women of delicate habit, and of extreme nervous sensibility, are chiefly prone to be affected with hysteria, and are predisposed to the attack by an inactive or sedentary life, distress $f mind, suppression or obstruction of the periodical illness, excessive depletion, or constant use of spare or unwholesome diet. Females of a nervous, sanguine, or plethoric temperament are chiefly liable to this disease. The best medicines against hysterical affections are, Aurum, Bella., Calc, Caust., Cocc, Con., Crocus, Ign., Lach., Mosch., N. mosch., N. vom., Phosph., Plat,, Puis., Sepia, Sil, Stram., Sulph., Verat., Vale- riana, Viola odorata, kc When the affection arises from Chlorosis or Amenorrhea, see the remedies mentioned under these headings. When from Menorrhagia, see that article—Mental Emotions, see that subject. When the attacks are attended with clenching of the jaws, or general spasm, coldness of the extremities, and clammy sweat, particularly on the face and forehead, Veratrum is a valuable remedy. (See also the remedies mentioned under Tetanus, and likewise Lockjaw in In- fants.) . When violent, spasmodic hiccough predominates : Nux vomica, Bella- donna, and Stramonium ;—or Hyoscyamus, Veratrum, Ignatia, Pulsa- tilla, Cieuta, Bryonia, and Sulphur will be found the most frequently useful. 558 TREATMENT OF FEMALES. INFLAMMATION OF THE OVARIES. Ovaritis. Inflammation of the ovaria is more particularly liable to occur a short time after delivery; but the affection may arise at other times, and par- ticularly in highly excitable females, who are addicted to pernicious habits, such as venereal excesses, onanism, or to over-indulgence in spirituous liquors. The signs by which the disorder is to be recognised consist in pain in the ovarian region, sometimes of a severe shooting, pulsating character, Avhich is occasionally, however, only experienced under the influence of external pressure over the part. After a careful examination, per vaginam aut rectum when necessary, a small, hard, circumscribed swelling is detected. In combination Avith these symp- toms, a constant itching is frequently complained of in the internal organs of generation, also gastric disturbance, headache, constipation, diminished secretion of urine, fever, frequently of an active, inflamma- tory type, and derangement of the entire nervous system. But it is chiefly in the subacute or chronic form that the inflammation is encoun- tered ; coming on gradually and insidiously, materially implicating the nervous system, and often occurring in association with a species of nymphomania. Therapeutics.—In phlegmonous inflammation of the ovarium, attended with a high degree of fever and shooting pain, a few doses of Aconitum are necessary, after which we must select another remedy to meet the remaining local symptoms; being guided in our choice by the exciting cause of the malady, where knoAvn, as well as by the particu- lar nature of the pain, or the circumstances under which it becomes aggravated, &c, &c. When the pain in the affected parts is increased by movement, Bry- onia is, generally speaking, the most efficacious remedy, and when, on the other hand, movement somewhat relieves, whereas rest is only pro- ductive of aggravation,—Rhus will rarely fail to produce considerable relief, if not a radical cure. Should the pains be so violent as to cause the patient to toss about with agony, and continually shift the position of the feet, from experiencing some slight temporary alleviation of the sufferings by so doing, they will commonly yield to the use of Arsenicum or Colocynth. In cases where the disease has gradually arisen from the habitual use of spirituous liquors, material service will commonly be derived from the employment of Nux vomica; but Avhere there is reason to appre- hend that the inflammation has terminated in suppuration, Lachesis Avill be more appropriate, and subsequently Staphysagria, Mercurius, or Hepar s. In the event of excess in venery or onanism having given rise to the disorder, Cinchona may be employed with advantage. Nux v. and Staphy- sagria are also calculated to be of assistance in similar cases. Ignatia, Staphysagria, and Acidum phosphoricum have been recommended where unrequited love and consequent perpetual dwelling of the imagination on sensual subjects has proved the originating cause. In those cases INFLAMMATION OF THE OVARIES. 559 where the affection is accompanied with a continual prurient irritation in the internal genital organs, and where nymphomania has thereby been developed, where, moreover, the local pain which is commonly experienced changes to a beaten or bruised feeling on the application ot external pressure, and the patient is affected with anxious oppression at the chest, palpitation at the heart, pricking in the forehead, together with alternate fits of elevation and depression of spirits, Platina is often capable of effecting a radical cure. Belladonna may _ be beneficially employed Avhere there is no nymphomania, or internal itching, but the symptoms otherwise analogous to those above given. It rarely happens that a cure is to be obtained from the employment of one remedy alone ; it therefore becomes requisite to select others which seem appropriate to meet the remaining symptoms, Avhen we have derived all the assistance that the remedy first selected seems capable of accomplishing. Ambra., Cantharides, Pulsatilla, and Antim, crudum have also been named as likely to prove of efficacy in ovarian inflammation. In ovarian induration, ulceration, or dropsy, &c.: Lachesis, Platina, Belladonna, China, Cantharides, Calcarea carbonica, kc, have been found more or less successful, according to the state of the constitution and the stage of the disease. But in the great majority of pases which have been of long duration, or in which the tumour has attained a large size, all that can be done is to endeavour to afford as much palliative relief as the circumstances will admit of by means of such remedies as Aconitum, Belladonna, Bryonia, Arsenicum, Prunus spinosa, China, Sepia, Lycopodium, Kali c, Merc, Sulphur, Cannabis, Graph., Hep., Sil, kc In short all the medicines Avhich exert an influence over the menstrual flux, or the sexual passion, are more or less deserving of attention in ovarian disease. It often happens that ovarian diseases are not detected until they excite peritoneal inflammation or other disturb- ances in adjacent parts, by the pressure arising from their increasing bulk. Their progress is sometimes very rapid, but frequently it is slow, even for a succession of years. A sudden and inexplicable invasion of dangerous activity in cases which had long been in a dormant state is not of rare occurrence. INFLAMMATION OF THE LABIA MAJORA AND VAGINA. This inflammation developes a painful, burning, red, hard, dry, and very sensitive swelling of the labia pudendi. It chiefly occurs in newly- married females after the rupture of the hymen, and especially when the orifice of the vagina is of small size ; in which latter case, more- over, the sheath itself becomes implicated in the swelling, and is conse- quently productive of considerable impediment to locomotion, or even the assumption of a sitting posture. Difficult and tedious labours also form a not unfrequent source of the inflammation. The inflammation, when arising from the above causes, yields very speedily to the applica- tion of a lotion of Arnica (one part of the tincture in ten of water). When traumatic fever results, which is prone to happen in neglected cases the internal administration of Arnica becomes requisite ; but should the fever partake of an inflammatory type, Aconitum must be resorted to. 560 OBSERVATIONS ON PREGNANCY. If the inflammation and tumefaction partake of a lymphatic character, and are attended with considerable induration, Mercurius forms the specific remedy. On the other hand, when an erysipelatous swelling and inflammation affects the labia, accompanied with burning pain, and an internal feeling of fulness, tension, and bearing down is complained of, Belladonna is to be preferred, from whatever cause the disorder may have arisen. Should there be only an internal swelling of the vagina, somewhat analogous to a partial prolapsus, attended with burning, pricking pains, increased by external pressure, Nux v. will give the re- quired relief. In the event of a termination of the inflammation in ulceration, Arse- nicum and Sulphur are the remedies most likely to be required. OBSERVATIONS ON PREGNANCY. This period may be looked upon as one of the most interesting eras of a woman's life. She is noAV no longer acting for herself alone, but becomes invested with a neAV and serious responsibility, and upon some of the most apparently trifling of her actions may depend the future health and happiness of a being bound to her by the fondest ties. From the mass of evidence collected by careful observers of the ope- rations of Nature, we are warranted in drawing the conclusion, tha't the actions of the mother exercise a great influence over, not only the con- stitutional and physical, but also the mental organization of her offspring. Keeping this fact in view, we shall endeavour to point out the course that mothers, who prefer the welfare of their future offspring to their own indulgence, should pursue, and from which they will derive a double benefit, an improvement in their own health, with exemption from suf- fering, and the delight of seeing their children pass safely through the anxious period of infancy ; whilst in after life beholding them flourish- ing around them, in the full enjoyment of health and vigour, they will reap the additional rich reAvard of a slight temporary self-denial, in the delightful consciousness of having performed their duty. The leading causes of a weak and sickly offspring are, ill health, or constitutional taint of both or either of the parents; very early or late marriages; great inequality between the ages of the parents; errors in dress, diet, and general habits of life; and lastly, powerful mental emotions. Medicine, under the present enlightened system, possesses power con- siderably to obviate the first of these causes, not only by materially modifying or destroying the hereditary taint in the parents, but also by nipping it in the bud when transmitted to the infant. Whilst upon this subject, we may remark, that in many families hereditary diseases are fostered, and even exacerbated in virulence by intermarriages between their different members, sometimes disappearing in one genera- AIR AND EXERCISE. 561 tion, and again declaring themselves in the next; but when the habits or mode of life of communities become more adapted to the natural law, and Homoeopathy, as it must do eventually, completely supersedes the present system of medicine, Ave may safely calculate upon the gradual extinction of all hereditary diseases; and so far, at least, children will not have to suffer for the faults and follies of their progenitors. Females should seldom, at least in this country, enter into the mar- riage bond before their tAventy-first or tAventy-second year; prior to that period, their organization is scarcely ever fully developed; those Avho marry at sixteen or eighteen years of age incur the risk of a severe after-suffering themseh'-es, and also of giving birth to weak and delicate children. Hoav very often we see the first children of such marriages perish in infancy, or after contending through a childhood of continued delicacy, sink into a premature grave. Women Avho marry late in life incur considerable personal risk and severe suffering in giving birth to children, and the offspring is seldom healthy. The children of old men, although by a young wife, are very often extremely delicate and susceptible to illness; they not unfrequently precede their father to the grave, or linger but to drag on a miserable and Avearisome existence. In concluding these observations, Ave may remark that so far is the period of pregnancy from being destined for one of suffering or danger, that Nature has taken every precaution for the protection of the female and her future offspring. While pregnancy runs its equable and uniform course, the expectant mother enjoys an almost complete exemption from the poAver of epidemic or infectious diseases, and even chronic com- plaints are frequently suspended ; in fact, with the exception of some slight morning sickness, and occasional trifling uneasiness, a Avell-con- stituted organism should enjoy as good health during pregnancy as at any other time ; and many Avomen pass through this period, and give birth to vigorous children, without even the most trifling incon- venience. Though, as Ave have said, Nature seems during this period to adopt every possible precaution for the health and preservation of the parent and her future offspring, yet are her Avise arrangements, in too many instances, rendered nugatory by a direct contravention of her laws. The expectant mother should therefore bear in mind, that the duty of leading a regular and systematic course, so essential to every individual, devolves upon her Avith double force, since every neglect or breach of these ordinances of Nature upon her part, is frequently visited with fearful energy upon her yet unborn infant. AIR AND EXERCISE. Nothing tends more to the preservation of health than a proper attention to these two important points, and yet, unfortunately, there are perhaps feAv more completely lost sight of. Neither air nor exer- cise is individually sufficient, and females of the more opulent classes in this country, who merely take the air in their carriages, and shun the slightest physical exertion, from long-continued habits of acquired indolence, and who feel any attempt of the kind at this period attended 562 OBSERVATIONS ON PREGNANCY. with increased inconvenience, can scarcely expect to enjoy the benefit that Nature has annexed to the observance of her laws, in a course of pregnancy free from suffering, and the production of a fully developed and healthy offspring. During this epoch, therefore, passive or carriage exercise is not suffi- cient ; walking brings not only the physical, but the Avhole of the organic muscles into play, and communicates the increasing vigour of the mother to her offspring ; whilst, on the contrary, continual passive exercise in a carriage has been found particularly injurious during, and towards the end of the second period of pregnancy, and is frequently the cause of premature and abnormal births ; exercise on horseback, even without taking into consideration the risk of fright or accident to the rider, and the fearful consequences that may thence result, is still more objectionable for many reasons. A second class, that of thrifty houseAvives, take a great deal of exer- cise, yet Avithout a corresponding benefit, from their work occupy- ing them Avholly in-doors ; this is a strong proof of the inutility of exercise in itself, unless combined with pure air. Moreover, many of these women, either from too great activity of temperament, or coerced by hard necessity, frequently over-fatigue themselves, go to bed late, rise early and sometimes unrefreshed, and thus in a manner deaden the energies of the organic powers, to their OAvn injury and that of the unborn child. A third class of females injure their health, and frequently induce miscarriage, through their excessive levity and thoughtlessness, by unre- strained indulgence in active exercise, riding on horseback, dancing, &c. A female ought to recollect that, if through her own folly she has brought on miscarriage, the greatest possible care is necessary to prevent its recurrence; that a second attack increases her liability in future; and that she who has suffered tAvice or thrice from this misfortune, even when she escapes it, rarely attains her full time. Furthermore continued casualties of this nature not unfrequently terminate in premature death, from that serious and painful disease, uterine cancer. The best exercise, therefore, for a female during this epoch, is walk- ing every day (when the weather permits) in the open air. In order to prove beneficial, and not to interfere with the process of digestion, exercise ought to be taken tAvo or three hours after a moderate meal, about mid-day, or in the afternoon, except during hot weather, Avhen the evening may be preferred, care being taken to avoid the night damps, by not remaining out too late. CLOTHING. The dress of the female should, of course be suited to the season, and if she pass from a Avarm into a cold atmosphere, she ought to have her neck and throat well protected, so as to avoid any risk of taking cold. But a point of far greater importance is the adaptation of her clothing to her form, so as to preclude all unnecessary pressure upon any part of the frame, calculated to interfere with the functions of those important organs, which are destined for the birth and nourishment of the infant; tight-lacing, therefore, at all times most objectionable, is particularly so DIET. 563 during this period, inasmuch as it cramps the natural action of the body, and bearing directly upon the abdominal muscles, the blood-vessels, lymphatics, and the whole intestinal economy, produces narroAvness of the chest, disturbed circulation, and induration or other derangements of the liver, and exercises a most baneful effect upon the breasts and uterus. We should bear in mind that a pressure upon these organs during development takes place in direct contravention of the operations of nature. Females, in their efforts to preserve the elegance of their shape during pregnancy, are little aAvare that the constringing force thus exercised upon the abdominal muscles destroys their elasticity, prevents a proper retraction after parturition, and thus proves one of the most common causes of permanent abdominal deformity. Moreover, to the culpable vanity of their mothers, in this and other respects, many, it is probable owe their club-feet and other malformations; and in addition to these evils, this practice not unfrequently deranges the position of the foetus,—a displacement which, together with the consequent Avant of energy in the muscles and the parts concerned, generally brings on protracted and dangerous labours. Besides this, continual pressure on the uterus is liable to produce premature labours. To tight-lacing also may be attributed the difficulty many Avomen of the present day expe- rience in suckling their offspring, from the incipient process required for the subsequent secretion of milk being deranged by the unnatural pres- sure on the beautifully-constructed mechanism of the mammae ; from this also sometimes arise those dangerous indurations, cancers, and other affections of the breast, and also retraction and diminution of the nipple, from which the act of suckling is rendered difficult, and in some cases impracticable. Young girls of seventeen or eighteen are frequently found Avith pen- dulous breasts, owing to the artificial support having usurped the office of the muscles, intended by Nature for that purpose, and throAvn them out of employment. Garters too tightly bound are generally injurious, more particularly to pregnant females, for the pressure, thereby exercised upon the blood- vessels encourages the development of varicose vessels in the inferior extremities (to which affection the system is already sufficiently predis- posed), Avhich, in many instances, become exceedingly painful and trou- blesome. DIET. The greatest simplicity should regulate the diet of the pregnant female; she should avoid taking too great a quantity of nourishment, because any excess in this respect, besides causing dyspepsia and general uneasiness, has a bad mechanical effect upon the future offspring; and, moreover, the foetus shares in the derangements of the mother. Much depends upon the quality of her food ; nothing should be taken that is not of a simply nutritive nature, and eArerything possessing a medicinal property avoided. Coffee and strong tea should be laid aside. Wine, liquors, beer, and other stimulating beverages are also injurious. If, however, the female has been long habituated to wine, it may be taken, if of good quality, in extreme moderation, and diluted with water ; 564 OBSERVATIONS on pregnancy. but it will be far better if stimulants of every kind are altogether avoided; indeed, the usual homoeopathic diet (for Avhich see the article Regimen) should be adopted as closely as possible during pregnancy. EMPLOYMENT OF THE MIND AND HABITS DURING PREGNANCY. It is not sufficient that the body may be in perfect health; the mind must also be kept in a state of serenity. An easy cheerfulness of tem- per is essentially useful in promoting the well-being of the unborn infant. Experience has presented us with many instances in which the predomi- nant feeling on the mind of the mother during pregnancy has influence on the future mental organization of the child. This shows hoAv essen- tial it is for females to keep their minds well employed during this period, to avoid all improper meditation, and dissipation, and to abstain from reading works not calculated to improve their understanding. Nothing can act more effectually against the future mental and corporeal health of the unborn infant than an oscillatory state of intellect, in combination with physical indolence on the part of the mother ; the late hours, turning day into night, and other practices of fashionable life, injurious as they are to the most robust constitutions, are doubly repre- hensible on the part of the expectant mother. INFLUENCE OF EXTERNAL OBJECTS UPON THE UNBORN INFANT. The effect of any unpleasant or unsightly object upon the imagination of the mother, and the transmission of that effect to the offspring, evi- denced in various mental or physical peculiarities after birth, is a theory as old as tradition : Avithout entering upon the various arguments brought forward both for and against it, we would simply advise females to keep as much as possible out of the way of such objects, to preserve both. body and mind in a state of health, which will lessen every fear of being affected by such occurrences; and endeavour, as constantly as possible, to direct their attention to pleasing subjects; as it must be perfectly evident that brooding over such unpleasant impressions can scarcely fail of being both physically and mentally injurious. MENTAL EMOTIONS. This subject has been already treated of in Part I., to which the reader is referred, as the remedies there mentioned are equally applica- ble to affections arising from these sources in either sex. A not unfrequent symptom during pregnancy is great despondency of mind, and uneasiness about the future; some females, whose spirits are generally good at other times, suffer much from this affection during this period; and in others, we find the same feeling and excessive low spirits, during the time of nursing; this symptom, however, is not per- manent, and when it commences early in gestation, usually disappears before delivery, without material injury to the general health. Therapeutics.—As this affection is apt to create some uneasiness, both to the sufferer herself and her friends, we have thought it advisable to mention it, and at the same time to point out remedies which will frequently be found efficacious. MENSTRUATION. 565 Such are Aconitum, Bryonia alba, Nux vomica, Natrum muriaticum, Phosphorus, Calcarea carbonica, and Cinchona. Aconitum.—If the state of despondency is preceded by one of excite- ment, marked by heat of skin and frequency of pulse, attended with apprehension and presentiment of approaching death.1 Bryonia.—Great inquietude and fear of the future, attended with irascibility and derangement of the digestive functions. Nux vomica.—Morning sickness and melancholy, with great uneasi- ness, impaired appetite, constipation, fretfulness. Natrum muriaticum.—Melancholy, with weeping, uneasiness about the future ; also obstinate cases of morning sickness, not yielding to Nux vomica. When the affection comes on during lactation, arising from an over- secretion of milk, so that this fluid escapes involuntarily, and is attended with great emaciation, melancholy, and apprehension of the future, we may give Phosphorus. Calcarea is also efficacious when the above symptoms present them- selves, and more particularly so, when there is excessive dejection with great lassitude. This remedy is further very serviceable when there is suppression of the secretion, and also excessive obesity, or the individual is of plethoric habit. Both the last-mentioned remedies are also valuable, when there is a disposition to consumption. When there is lowness of spirits, attended Avith dyspepsia, which may arise from the energies of the mother being too severely tasked in the nourishment of her offspring, either from keeping the child too long unweaned, or from rearing tAvins, we may administer Cinchona. The practitioner will further find occasion to select the following remedies in particular cases : Belladonna, Pulsatilla, Veratrum, Stramonium, Pla- tina, Aurum, Cuprum, Lachesis, and Sulphur. DERANGEMENTS DURING PREGNANCY. MENSTRUATION. Virtual diseases during gestation are of rare occurrence, but when they do happen, they ought to be treated accordingly. A continuance of menstruation at this period is not an actual disease, but rather an exception to the general course of nature; nor must we here mistake her operation for an indication of the utility of the lancet, ' In the treatment of pregnant women of exalted nervous sensibility, considerable caution is frequently requisite in the repetition of the doses. (See also the rules laid down for the Repetition of the Dose in ordinary cases, in the Introduction.) 566 derangements during pregnancy. for neither in this, nor in any other case, can the artificial supply the place of natural bleeding ; however, when the female appears to suffer from the continuance of the menstrual flux, we must call in the assist- ance of medicaments, among which the principal are Cocculus, Phos- phorus, and Platina. Cocculus.—A sanguineous mucous discharge, and very severe spas- modic pains in the lower part of the abdomen. Phosphorus.—Discharge of blood, with incisive pains in the back, and occasionally vomiting. Platina.—Discharge very profuse, attended with a severe pain and bearing down. (See also the remedies given under Dysmenorrhea and Menstruatio nimia.) morning sickness. Morning sickness, nausea, vomiting, and heartburn, are the most dis- tressing symptoms attendant on the course of pregnancy. These trou- blesome complaints harass women most upon their first rising from a horizontal position in bed. They generally disappear soon after quick- ening, but sometimes continue during the whole period. The numerous palliative remedies recommended by allopathists — leeches, cupping- glasses, blisters, aperients, sedatives, &c, &c, unfortunately too often fail in effecting their object; and in severe cases, when the stomach becomes enfeebled, the hazardous expedient of artificially-produced pre- mature labour is resorted to. Therapeutics.—The homoeopathic treatment of this derangement, at once simple, prompt, and efficacious, has in almost all cases been stamped by the signet of success. In instances, free from complication, with a tendency to relaxation of the bowels, Ipecacuanha is generally sufficient. Nux vomica :—When there is nausea or vomiting every morning on rising, heart-burn, depraved appetite, or craving for chalk, earth, beer, &c, constipation, and irritability of temper. Arsenicum :—Excessive vomiting after eating or drinking, Avith attacks of fainting; great weakness and emaciation. Pulsatilla :—Nausea after every meal; vomiting of ingesta, heart- burn, depraved appetite, or longing for particular articles, such as acids, beer, Avine, &c. Disposition peevish and sensitive, though naturally mild. Conium, Acidum nitricum, Magnesia, Phosphorus, Bryonia, and Lycopodium, kc, Avill be found useful in particular cases. When this affection shows itself in a mild form, we may leave it to Nature, adopting, at the same time, the homoeopathic rules for regimen, and being careful not to overload the stomach. In severe cases depend- ing upon a plethoric tendency, Aconitum is an excellent substitute for the venesection recommended by the old school. constipation. Constipation is a very common attendant upon pregnancy, and those females usually suffer most from it who are naturally of a costive habit; when it does not arise from a mechanical cause, active exercise, in the open air, and avoiding indigestible food, coffee and other stimulating fainting and hysteric fits. 567 liquids are often sufficient to remove the complaint, or at all events to render it less troublesome. When Nature requires further assistance: Nux vomica will often answer the purpose; if after the completion of its action, there still remains some inconvenience, Ignatia should be given as an intermediate remedy, followed by Nux vomica; in other cases when Nux vomica does not show a marked improvement, and the temper is extremely irritable, Bryonia will sometimes cure, or Opium,1 which is especially indicated to folloAv Nux vomica when there appears to be a weight in the stomach, dryness of the mouth, and deep flushing of the face. In other cases, Sepia, Lycopodium, Alumina, kc, will be found useful. (See Constipation, Part I.) Dysuria.—Pulsatilla, Cocculus, Nux v., and Acid, phosphoricum, as also Sulphur and Conium, are the remedies which are of the greatest service in the generality of cases of this derangement in pregnant Avomen. DIARRHffiA DURING PREGNANCY. See Diarrhoea, Part I., and Diarrhcea in Lying-in Women, in this division of the work. FAINTING AND HYSTERIC FITS. Many delicate and nervous females are frequently attacked with fainting fits during pregnancy. The attack generally passes over easily and without deleterious consequences. Exercise in the open air, and attention to the rules of regimen, are the best safeguards against the affection ; but in cases Avhere these are insufficient, and the attacks prove distressing, we must endeavour to ascertain their origin. If the fits arise from tight-lacing, Avarm rooms, or any other obvious excitant, the simple removal of the cause will prove sufficient; should the sufferer remain long insensible, the speediest means of revival is sprinkling the face Avith cold water. When arising from plethoric habit returns of the attack may be prevented by Aconite, of which we have had occasion to speak several times as a general regulator of the circulation. Chamomilla :—When the fainting is excited by sudden fits of anger. Nux vomica :—When from general irritability of system, and con- sequent gastric derangement. Belladonna :—When there is determination of blood to the head, Avith simultaneous flushing of the face and perceptibly increased action of the arterial system. (Alternately Avith Aconite Avhen required.) Cinchona:—When arising from general weakness, and especially from loss of blood. Pulsatilla.—General excitability and disposition to hysteria, with hypochondriasis, and great general susceptibility. Coffea.—Abdominal spasms, Avith oppressed respiration, subsultus tendinum, cold perspiration, and uncontrollable agitation and jactita- tion. When the symptoms are generally preceded by a pain, which proceeds upwards from the lower part of the bowels, on the left side, into the stomach, and from thence into the throat, where it creates a ' See page 172 for additional indications for the employment of this remedy. 568 derangements during pregnancy. disagreeable and suffocative sensation, as if a ball Avere lodged there, Lachesis, Belladonna, Sepia, and Plumbum, or Ignatia, Sulphur, Nux v., Conium, kc, will prove useful, a preference being given to that remedy which corresponds the most closely to the Avhole features of the case. Ignatia :—When the patient suffers from severe headache, as if a nail were driven into the head; sadness ; concealed sorroAV, and sighing. (See Swooning.) Viola odorata. Constant and unassignable inclination to weep. TOOTHACHE. This is a frequent affection Avith pregnant women, and is sometimes too valuable an indication of some taint lurking in the constitution, to be neglected; the female should, as soon as she is in a proper state, put herself under a course of proper treatment, as until this tendency is eradicated, no remedies can prove otherwise than palliative. We must particularly caution females in this situation against having teeth extracted, as the affection frequently occurs in sound teeth. Therapeutics.—To relieve the sufferings, the following medicines may be often given with advantage : Sepia, Calcarea, Alumina, and Magnesia carbonica. For the Administration of the remedies, see Toothache, Part L, where, moreover, other useful remedies Avill be found. Sepia is particularly indicated where there is pulsative, shooting, drawing toothache, with pain, extending to the ears, or to the arms and fingers, excited by compressing the teeth, or by cold air, and attended with impeded respiration, swelling of the cheek, and enlargement of the submaxillary glands. Calcarea:—When the toothache is excited or aggravated by cold air or anything hot or cold, and attended with painful sensation of the gums, and pulsative gnaAving or shooting pains, Avhich are aggravated by noise. Alumina :—When the pains are excited by mastication, or in the evening in bed, and when they are of a tearing nature, extending to the cheek-bone, temple, and forehead. Magnesia carbonica:—Nocturnal pains in the teeth, insupportable when lying down, and compelling the patient to get up and walk ; pains generally boring, burning, drawing, tearing, and resembling those of ulceration, attended Avith swelling of the cheek on the side affected ; throbbing and shooting in the teeth after a meal; pain aggravated by a cold. The above are the four leading medicines, though there are others which may be called for by peculiar symptoms. Mezereum :—Continuous dull pains ; teeth feeling as if elongated; sensibility to the touch. Coccionella :—Pains in holloAv teeth, particularly of a throbbing description. (Cynips rusarum has likeAvise been found useful in similar cases.) Sarsaparilla :—Rending pains in the teeth, especially in the even- ing, on exposure to a current of air. Carbo v. :—Gnawing, pulsative constriction, or dragging pains, TOOTHACHE. 569 especially in holloAV teeth, usually increased by partaking of food or drink, whether hot or cold. (See Toothache, Part I.) The following remedies are those which are generally of the greatest efficacy when the pains are excited, aggravated, or relieved under the circumstances hereafter mentioned: Air, (toothache, on exposure to) cold: Staph., Sep., Sil, Nuxv., Sass., Merc, Hoscy. Air, (diminution of pain from) cold: Puis., Natrum s. (aggravation from exposure to) damp : Nux mosch., Rod., Bor. (aggravation from exposure to) the evening: Nux mosch., Sass., Merc. Air, (toothache excited or aggravated by inhaling, or drawing in): Natr. m., and Staph. ; or, Nux v., Alum., Mags., Mags. arc. ; or, Alum., Bella., Sil, Spig., Clem., Sabina. Air (toothache in the open): Bella., Nux v., Sulph., Phosph. ; Con., Magn. s., Ant., China. Air (diminution of, or exemption from pain in the open): Rhus, Con., Magn. s., Nux v. Bed (aggravation of pain in): Cham., Merc, Puis., Acid, sulph., chiefly; but also: Ant., Alum,, Ammon c, Graph., Phosph., Ac. nitr., Kali, Sab. Bed (diminution, or cessation of pain in): Lye, Magn. s. (diminution, or cessation of pain on getting out of): Oleander, Sabina, Antim. crudum. Clenching, or compressing the teeth, or masticating (aggravation from): Am. e, Graph., Colch., Sep., Hep., Petr., Tab., Guaj., Sab., Phosph., Thuja, Veratr., Staph., Sulph., Alum., China, Zinc, Euph. Clenching the teeth, amelioration on: Cinchona. Cold substances (aggravation from the introduction of, into the mouth): Merc, Sulph., Spig. ; Ant., Thuja, Plumb., kc Drinking (cold fluids, aggravation from): Nux v., Sulph., Staph., Graph., Ac mur., Bor., Nux mosch., Merc, chiefly; but also : Cham., Calc, Lach., Puis., Carb. a., Sass., Mags. Drinking coffee (aggravation from): Nux v., Cham. hot fluids (aggravation from): Agnus, Cham., Drosera, Nux v., Lach. Drinking tea (aggravation from): Thuja. wine (aggravation from): Nux v. Eating (aggravation while): Bella., Kali, Lye, Mere, Natr., Mags. are, chiefly; but also: Ant., Bry., Carb. a., Cocc, Graph., Hep., Ign., Magn. m., Puis., Sulph., Thuja, kc Eating (aggravation after): Bella., Cham., Lach., Nux v., Staph., Sabin., Spig., Mags, are; or, Ign., Graph., Magn., Natr. m., China, Bryonia, kc Eating cold food (aggravation from): Conium. hot food (aggravation from): Agn., Phosph., Sil. Evening (aggravation of the toothache towards): Puis., Phos., Rhus. Hot substances (aggravation from the introduction of, into the mouth): Nux v., Calc ; Bryon., Carb. v., Lach., Sulph., Merc, Phosph., kc 570 derangements during pregnancy. Hot substances (mitigation on the introduction of, into the mouth): Nux mosch., Kali h. Morning (aggravation of suffering in the): Nux v., Lach., Phosph.; Tart, emet., Kali, Kreos., Ran. Night (aggravation or accession of the toothache during the): Bella., Cham., Nux v., Ars., Puis., Rhus, Spig., Sulph., Staph., Merc, Phosph., Magn., China," Cyc, Gran., Am. c, Sep., Rhod., Baryta c et m., kc Noise (aggravation of pain from): Calc. c Noon, in the after-, Nux v., Lach., Puis., Berb. Quotidian toothache: Diadema, Tart., kc Reading, Reflecting, Meditating (aggravation from): Nux vomica, Bel- ladonna. Repose, Rest, Quietude (aggravation from): Magn. Room (aggravation in a warm): Puis., Nux v., Hepar s. Posture (aggravation while in the horizontal): Clem. (aggravation whilst lying on the affected side) : Cham., Nux v., Rhus. Salt food (toothache increased or excited by partaking of): Carb. v. Smoke (aggravation from tobacco): Spig., Clem., Sabin. (mitigation from ditto): Merc, Borax. Speaking (aggravation while): Sepia. Sucking the teeth (aggravation or accession of toothache from): Nux mosch. Sweetmeats (sugar, &c, aggravation from): Natrum. Tea (aggravation from): Thuja. Toothache, Avith extension of pain to the arms and fingers : Sepia. with extension of the pain into the ears : Merc, Ars., Nux v., Puis., Sulph., Sep., Cham., Natr. m., kc Toothache, with pains extending into the face : Merc, Puis., Nux v., Hyos., Sulph., Rhus, Mez., kc Toothache, Avith pains extending into the eyes : Puis. with pain extending into the head : Ant. c, Ars., Baryta c, Hyos., Mere, Nux v., Rhus, Puis., Sulph., Cham., chiefly. Toothache, with pain extending to the neck: Natr. muriaticum. attended Avith coldness in the ears: Lach.,—with general coldness, Veratr. alb. Toothache, attended with dyspnoea : Sep., Puis. despair: Nux v., Ars., Cham. with great irascibility: Nux v., Sep., Alum., Cham. with extreme agitation or anguish: Coffea, Clem., Spig., Ars., Magn., Mang., Natr. s. Toothache, with paleness of the face: Puis., Spig. redness of the face : Cham., Veratr., Bella., Nux. Avith virulent pulsation in all the arteries: Sepia. Avith Avhining, or plaintive humour: Nux v., Cham. Avith salivation: Merc, Daph., Phosph., Stront., chiefly. Avith tendency to shivering : Daphne indica, Lach., Merc, Puis., Sulph., Eup. Toothache, Avith tendency to sweating: Daphne indica. with cold sweat on the forehead: Veratrum album. SWELLED FACE. 571 Toothache, with tendency to syncope : Veratrum album. with vomiting: Veratrum album. Tooth-pick (accession, or aggravation of pain on using the): Puis. Vinegar (mitigation of pain from): Tongo. Walking (mitigation from): Mags. arc. in the open air (mitigation from): Mags, are, Nux v. (mitigation after): Magn. s. Warmth (aggravation, or accession of pain from): Mags, are, Puis., Nux mosch.; Hep., Graph., Hell. Warmth of the bed (aggravation or accession of the pain from): Puis., Mere, Phosph.; or Cham., Acid, phosph., Sabin., Ant., Alum., Acid, ph., Am. c, Graph., Kali, Baryta c, kc Wind (aggravation from): Puis. Wine (aggravation from): Nuxv. swelled face. Tumefaction of the cheek arises from different causes ; frequently it is the consequence of toothache, and will then be cured, or at all events much diminished, by the remedy given for the removal of that affection. Sometimes it happens, nevertheless, that whilst the toothache diminishes from the employment of the proper remedy, the swelling of the cheek remains unaltered. In this case Arnica is generally of great service, especially when the SAvelling is hard and stiff. If this treatment is of no avail we may have recourse to Pulsatilla, or to Mercurius vivus, which is of especial service when the swelling of the cheek is accom- panied Avith a drawing, tearing pain, an increased Aoav of saliva, and considerable erysipelatous redness; folloAved by Belladonna, and Hepar s., if the inflammation threatens to extend. (See Erysipelas.) Cham., Bryonia, kc, are also occasionally of service. Where the employment of the appropriate remedy has been neglected at the proper time, or the swelling has been maltreated by some exter- nal application, the tumour is frequently rendered of an obstinate character. In most cases, however, the dispersion of the tumour, or, when matter is forming, the speedy completion of the suppurative process and con- sequent bursting of the abscess, will be readily enough effected by means of Hepar sulphuris, one grain, repeated if necessary in from six to tAvelve hours. In obstinate cases, Lachesis and Hepar, or Mercurius and Hepar, in alternation, are sometimes required; and occasionally Silicea, particu- larly in strumous habits. The application of a poultice to the cheek, or a fig boiled in milk and placed in the mouth betAveen the affected cheek and gums, is sometimes useful. If the tumour has burst, and the opening is internal, no especial care need be taken of it, but if it has burst ex- ternally, a simple bandage, smeared Avith melted suet or fresh butter, must be applied. VARICES, OR SWELLED VEINS. Many females suffer much during pregnancy from distension of veins in the thigh and other parts, Avhich, becoming exacerbated, eventually 572 DERANGEMENTS DURING PREGNANCY. causes great pain and inconvenience. These varicose veins generally arise from obstructed circulation caused by the pressure of the gravid uterus upon the blood-vessels, but are also frequently a sure indication of the existence of constitutional debility, particularly Avhen they occur in an aggravated form. They are much increased by partaking of sti- mulating liquids, which should consequently be avoided. Considerable alleviation is experienced by constant bathing with water, or Avith di- luted alcohol; also by bandaging from the foot upwards with a gentle and equable pressure, and by preserving a recumbent posture, which is requisite in severe forms of the complaint, accompanied with conside- rable swelling of the feet, ankles, &c. In order to afford relief, we may have recourse to the following remedies:— Pulsatilla is one of the most useful medicines, particularly Avhen there is excessive pain and swelling, Avith a good deal of inflammation, or Avhen the veins are of a livid colour, Avhich is imparted to the whole limb. Should Pulsatilla give some relief, but the swelling and livid dis- coloration continue in much the same state, Lachesis may be substituted. Arnica is of material service when the occupations of the patient render it impossible for her to lay herself up, or avoid much standing and mov- ing about in discharge of her domestic duties. Arnica and Pulsatilla in alternation, every six or eight days, have been found of great efficacy in such cases. Nux vomica, when the affection is attended with constipation, hemor- rhoids, and irritability of temper. Sulphur is sometimes very bene- ficial after Nux v. Arsenicum, when the veins are of a livid colour, and are attended Avith severe burning pain. Carbo vegetabilis, where Arsenicum is not sufficient to subdue the constant scalding or burning. Belladonna.—Varices, Avith considerable erysipelatous inflamma- tion. Lycopodium has been employed with success in some inveterate cases. The simultaneous external application of the remedy employed is occasionally attended with benefit. For a permanent eradication of the affection, a course of treatment is requisite, in Avhich—Agaricus muscarius, Sulphur, Graphites, Carbo vegetabilis, Sepia, kc, are the most effectual medicaments. (See Ulcers, Part I.) pains in the back during pregnancy. Lumbo-sacral pains. Some females suffer much from pains in the lower part of the back during pregnancy, Avhich occasionally prove extremely distressing, par- ticularly Avhen they occur during the night, and tend to disturb sleep. They generally consist of an almost indescribable aching, or of an obtuse, heavy, dragging, or pressure, as if caused by a dead Aveight resting on the affected part. Kali carbonicum is frequently adequate to remove them, especially when they partake of the character described. In other MISCARRIAGE. 573 cases, Bryonia, Rhus, Sulph., Lycopodium, Pulsatilla, Nux v., Sepia, Platina, Natrum m., kc, may be given with advantage. If hemor- rhoidal sufferings become added to these troublesome pains, and Kali e prove insufficient to relieve the complaint in this complicated form, Nux v., Sulphur, or Sepia, may be prescribed Avith advantage. (See Hemorrhoids ; as also the indications given for the remedies under the heading of False Pains.) miscarriage. Abortus. Women who have once suffered from this affection are exceedingly obnoxious to its recurrence, and this liability is still further increased, if the event has taken place a second or third time. Miscarriage may occur at any period between the first and seventh month, but, in the majority of cases, it takes place about the third, or the beginning of the fourth. When it occurs before or about this period, it is frequently attended with but little pain or danger, although repeated miscarriages, from the great discharge that is generally present, break down the con- stitution, and frequently develope severe chronic diseases. When mis- carriage takes place at a more advanced period, it assumes a very seri- ous complexion, and is often accompanied with a considerable degree of peril to the sufferer. The premonitory and accompanying symptoms of miscarriage vary much in their nature ; sometimes the discharge is exceedingly profuse, at others moderate or inconsiderable ; the pains, in many instances, extremely severe and protracted, are in others very slight and of short continuance. Sudden mental emotions, or great physical exertion, mechanical inju- ries, a luxurious mode of life, fashionable habits, poAverful aperients, neglecting to take air and exercise, are a feAV of the exciting causes of this affection, Avhich is particularly apt to occur both in highly plethoric and delicate or nervous habits. An abnormal condition of the consti- tution is undoubtedly the predisposing cause. Miscarriage is, in most cases, preceded and attended by the majority of the folloAving symptoms:—A sensation of chill, followed by fever, Avith more or less bearing down, particularly Avhen occurring late in pregnancy ; also, severe pains in the abdomen, drawing and cutting pains in the loins, or pains frequently bearing a close resemblance to those of labour ; discharge of viscid mucus, and blood, sometimes of a bright red, not unfrequently mixed Avith coagula, at other times dark and clotted, folloAved by the emission of a serous fluid. The miscarriage generally takes place during this discharge, Avhich occasionally conti- nues, if not properly checked, to flow for hours after, placing the sufferer in considerable jeopardy. When the pains increase in intensity, and the muscular contractions become generally established, with their cha- racteristic regular throes and efforts to dilate the mouth of the Avomb, miscarriage is almost inevitable. Therapeutics.—As preventives of this affection the principal reme- dies are Sabina, Secale cornutum, Kali c, Lye, Sep., and Calc 574 derangements during pregnancy. When the premonitory symptoms declare themselves, Chamomilla, Nux vomica, Ferrum metallicum, Ipecacuanha, Sabina, and Calcarea. The same with the addition of Hyoscyamus, Crocus, and Secale cornutum, after the misfortune has taken place. Cinchona is also valuable when the indications Avhich Ave shall give for that medicine are present. In cases Avhere there is an evident disposition to miscarriage, or Avhere from a variety of reasons, it is apprehended, the employment of Sabina, in the early stage of pregnancy, will frequently prevent its occurrence. Administration.—We may allow four or five days to elapse between the first and second dose, and gradually lengthen the interval betAveen each successive administration, until the period of danger be past, being careful, hoAvever, to Avatch the effect of each dose, to discontinue the medicine whenever any indications of its action on the system become apparent, and to abstain from repeating until the symptoms attributable to the medicine have passed aAvay, and then only Avith increased caution and at longer intervals. Hartmann1 strongly recommends Secale cornutum, two globules, as useful in similar cases, but particularly Avhen this misfortune has already occurred more than once ; it should be administered every four- teen days, commencing immediately after the cessation of the monthly period, and continuing until the period at Avhich miscarriage usually occurs is past; one dose more, at the utmost, being allowed after this period. Both these remedies are also extremely valuable after miscarriage has taken place, the latter particularly in weak or exhausted persons or in those cases of hemorrhage in Avhich the discharge consists of dark liquid blood, and is followed by considerable debility ; this remedy is also effi- cacious in cases of inevitable miscarriage, attended vt'ith. feeble expulsive efforts; the former (Sabina) when there are dragging and forcing pains extending doAvn the back and loins; profuse, bright-coloured hemorrhage; sensation of sinking or faintness in the abdomen ; frequent desire to relieve the boAvels ; diarrhoea ; nausea or vomiting; chilliness and heat, with fever. Lycopodium and Kali carbonicum have also been recommended as useful preventive remedies against habitual tendency to abortion, the latter especially Avhen the symptoms are always preceded or attended by severe pain in the loins. We shall now treat of miscarriage Avhen the premonitory symptoms have set in, giving, under the same head, the indications for the use of the medicaments, where the result is unavoidable or has already taken place, as even in these cases their administration is decidedly beneficial in obviating further injurious consequences, and in alleviating the suf- ferings of the patient. The remedies in these cases are, in addition to the tAvo above mentioned, Arnica, Chamomilla, Nux vomica, Ipe- cacuanha, Hyoscyamus, Belladonna, Crocus, Ferrum metallicum, and Calcarea. Arnica :—When the symptoms have been excited by an accident, 1 Therapie akut. Krank. Form., vol. ii. p. 352, 2d ed. MISCARRIAGE. 575 such as a fall, bloAv, or concussion, &c, this remedy should be imme- diately administered. Chamomilla :—When there are present: excessive restlessness, con- vulsions, tAvitching in the back and limbs : severe pains in the loins and back, Avorse at night, generally of a sharp cutting description, extend- ing downwards, strongly resembling those of labour : sometimes also abdominal spasyns, with a species of sanguineous discharge ; or discharge of deep red or dark coagulated blood ; frequent yawning ; coldness and shivering. Nux vomica :—Obstinate constipation, Avith a varicose condition of the internal organs of generation : also when the patient has been accus- tomed to a stimulating diet, and the use of coffee ; severe burning, or wrenching pains in the loins; painful pressure doAvnwards and mucous discharge. (Bryonia is sometimes of benefit when Nux v* fails to do much good.) See also Calcarea. Ipecacuanha :—Chilliness and Avith heat; violent pressure down- Avards, flooding; cramp and rigidity of the frame; sometimes convul- sions ; vomiting, or desire to vomit; disposition to faint whenever the head is raised ; cutting pains in the umbilical region. (Platina or Cina have been recommended Avhen Ipec. fails.) Hyoscyamus :—When the convulsions are very severe, with cries, great anguish, oppression of the chest, and loss of consciousness. Belladonna is perhaps more frequently required either at the com- mencement, or subsequently, than any other remedy. The following are its leading indications : great pains in the loins and entire abdomen ; severe bearing down, as if the whole of the intestines Avould be pressed out; pain in the back, as if it were dislocated or broken; bruised pain in the sacral region ; sensation either of spasmodic constriction, or of expansion in the abdomen. It is also particularly valuable in cases of profuse hemorrhage, the discharge of blood being neither very bright nor dark-coloured after miscarriage. Platina is sometimes to be pre- ferred to Belladonna, when, along with bearing-doAvn pains, there is a thick and dark-coloured discharge, attended with venereal orgasm. Ferrum metallicum. is a useful medicine in cases of miscarriage attended with fever, labour-like pains, and considerable sanguineous dis- charge. Crocus is especially indicated in cases which are attended or followed by discharge of dark, coagulated or viscid blood, with a sensation as of something moving or fluttering about in the umbilical region, and increased sanguineous discharge on the slightest movement. This medi- cine is frequently useful in obstinate cases, after the employment of one or more of the above-mentioned remedies. Cinchona is valuable in restoring the exhausted energies, after the hemorrhage, and materially assists in checking the discharge if there be spasmodic pain in the womb, or a bearing-doAvn sensation, with con- siderable discharge of blood at intervals. Calcarea is a remedy of considerable importance in the treatment of cases, where the affection has apparently been induced by a varicose state of the veins of the parts. It is also of value as a preventive, and 576 treatment before parturition. especially where the patient is of a plethoric habit, Avith a tender or irri- table skin, and other strumous appearances. Sepia :—In threatening attacks of abortus from general plethora, or from local congestions and obstructed circulation, with sensation of Aveight in the abdomen, determination to the head and chest, and exces- sive nervous excitability, this remedy has been employed with success. When Mental Emotions have given rise to the symptoms of miscar- riage, see the remedies given under that heading, Part I. Administration.—A few globules, or Avhere necessary, one minim in an ounce of water, a teaspoonful every few minutes to half an hour, or only three or four hours, according to the nature of the case, lengthen- ing the intervals or discontinuing the medicine when decided benefit, or a stoppage of the hemorrhage is effected. When a favourable effect does not fdWow after the second or third dose in serious cases, another remedy must be had recourse to. When violent hemorrhage is present, and does not cease under the employment of any of the before-men- tioned medicines, Acidum nitricum may be administered. Cold water is also useful. (See Menorrhagia.) In concluding the subject, I shall briefly notify a few precautionary measures, which the patient ought to observe while threatened with, or after having suffered from the affliction. When miscarriage is threatened, the individual must assume the recumbent posture, and in some cases indeed, should be strictly con- fined to bed, sleeping with few bed-clothes; the apartment should be kept cool, and every means must be employed to insure perfect tran- quillity of mind. The diet prescribed in cases under homoeopathic treat- ment should be closely followed, and warm fluids generally avoided. When the misfortune has proved unavoidable, or has actually taken place, before assistance has been sought, the patient ought still to be confined to bed for a few days, lest a fresh discharge should be brought about by too early a change from a horizontal to an upright posture ; and on future occasions, when a similar period comes round, great care should be taken that the mishap may not again occur: in the attain- ment of this desirable object we feel confident, that nothing will tend so fully to insure success as a timely exhibition of one or other of the pre- ventive remedies already commented on in this article. TREATMENT BEFORE PARTURITION. PREPARATION OF THE BREASTS. Young mothers frequently find great difficulty in suckling their children, in consequence of some organic defect or incapacity of the nipple. In almost every case, a preparation of the breasts is necessary some weeks before delivery, in order to prepare them for their future REMEDIES BEFORE LABOUR. 577 office. In many instances the structure of the breasts is disorganized from an ignorant nurse having compressed them in childhood, under the idea of such a process being needful for the expulsion of some matter in the breasts of a child—a vulgar error, against the practice of which mothers ought to be particularly watchful. Inability of function is also likely to occur from the pressure of stays in after life, by which the cuticle is rendered so tender, as to preclude suckling. The first two cases are beyond the power of art. If suckling be at- tempted, induration of the nipple and mamma ensues, attended with severe suffering: when, however, a simple tenderness of the_ epidermis exists, this evil is much alleviated by bathing the nipples with brandy twice a day, for several weeks anterior to delivery. Another difficulty, frequently accompanying this state, is a shortness or retraction of the nipple, so that the infant cannot take hold of it; this defect is fre- quently the cause of the first, from the ineffectual efforts of the child to suck injuring the part; in this case appropriate shields of soft wood may be applied to accustom the nipple to elongate and protrude, so as to present sufficient hold for the infant, when the period for suckling arrives, and when the efforts of the child will still further contribute to effect this object. In this case also, bathing with brandy will naturally tend to correct any tenderness of the skin, and prevent subsequent ex- coriation. It may also be here remarked, that when any tenderness exists during the period of lactation, between the intervals of the infant being applied to the breast, the shield should be resumed, and the bathing continued, due care being always taken to lave the nipple care- fully with tepid water, before it is again offered to the child.1 REMEDIES BEFORE LABOUR. Many things are recommended by the old school previous to labour, such as frequent bloodlettings and aperients; but these, instead of pro- moting the object desired, have a contrary effect, by lowering the ener- gies requisite at such an eventful period, and by placing the nervous system in an abnormal state of irritation and excitement; when this loss of humour is brought about in the first period of pregnancy, it de- feats its own object, by developing, what are commonly called plethoric symptoms, induced by the reaction in the organism, necessary to supply this uncalled-for waste, and which always takes place with a corre- spondent expenditure of vital power. Where an evident plethoric state exists the desired result may be safely and effectually attained by a dose or two of Aconite, which may be followed by Belladonna, should there be symptoms of active congestion, with fiery redness of the face, acce- lerated action of the carotids, &c. m An action on the bowels previous to delivery, may be obtained by a lavement of lukewarm water, repeated with a small quantity of linseed oil, when necessary from a failure in the first attempt to obtain the desired effect. i When severe pains are experienced in the breast after each application of the infant, the employment of Phellandrium aquaticum has been found advantageous. 578 TREATMENT BEFORE PARTURITION. FALSE PAINS. Before proceeding to notice parturition, a few words may be said upon the (so-called) false, spurious, or intestinal pains, brought about by congestion of blood to the uterus, errors in regimen, emotions of the mind, effects of chill in the abdomen, and a variety of other causes: they sometimes precede labour but a few hours, but in many cases come on some days, and even weeks, before delivery; they chiefly differ from labour-pains in the irregularity of their recurrence, in being unconnected with uterine contraction, and chiefly confined to the abdomen, with sen- sibility to touch and movement, and in not increasing in intensity as they return: sometimes, from their close resemblance, it is extremely difficult to discriminate between them and the real labour-pains, but in such cases we must be chiefly guided by the period of gestation ;J and our safest mode of procedure is to endeavour to mitigate the patient's sufferings, if they be considerable, or come on a week or two before labour is expected, by the administration of a proper remedy, as, if we allow them to proceed unchecked, they not unfrequently continue till the moment of delivery, rendering the labour much more painful, exhausting, and difficult. Therapeutics.—The following medicaments may generally be had recourse to Avith effect: Bryonia, Nux v., Pulsatilla, Dulcamara, and Aconitum,—the one most suitable for the affection being selected, according to the causes and symptoms. Bryonia, when there are pains in the loins resembling a dragging weight, attended with constipation and irritability, much increased by motion, with abdominal pains preceding those in the back. (This remedy is more particularly indicated, when the above symptoms have been excited by a fit of passion.) Nux vomica.—Similar pains in the abdomen and back; also when there is pain in the region of the pubis, as if from the effects of a bruise; the symptoms arise chiefly at night. When the exciting cause appears to be constipation, or mental irritation, or a too luxurious mode of living, stimulants, coffee, or spirituous liquors, there is additional reason for selecting Nux v. Pulsatilla.—Similar abdominal pains; pains in the loins resembling those from continued stooping, or the pressure of a tight bandage, at- tended with a sensation of rigidity, and painful dragging and aching in the thighs; constipation or relaxation; mildness of temper or great sensibility. This remedy is particularly valuable, when these pains appear to have arisen from indigestion brought on by rich, indigestible food. Dulcamara : is chiefly useful when the origin may be traced to cold, and the pains are of a violent, shooting, and drawing nature, situated in the small of the back, generally coming on at night. When spurious pains arise from emotions of the mind, we may consult Mental Emotions. 1 If the os uteri be found unaltered, and consequently not enlarged or elongated, it may with certainty be concluded that the pains are spurious. PARTURITION — TEDIOUS LABOURS. 579 Aconitum :—When these pains occur in young plethoric subjects, attended with accelerated and strong pulse, flushing of the face, and increased temperature of the skin. The employment of this remedy completely obviates the necessity for venesection. PARTURITION. Natural labour takes place at the end of the ninth month of pregnancy; the uterine contractions are regular and effective, and the whole process does not continue beyond twenty-four hours, rarely above twelve, and very frequently not longer than six. Were it not for the acquired habits of civilized life—improper diet—the distortion of the proportions of the female frame by tight-lacing,1 and the consequent displacements and disturbances of the regular functions of the abdominal viscera— diseases generated by the Avant of proper air or exercise, or both— hereditary maladies, &c, parturition would be comparatively free from pain and remote from danger, as in fact it so generally is, even at the present day, among savages. TEDIOUS OR COMPLICATED LABOURS. When labour is protracted beyond the normal period stated, or is attended Avith an excessive degree of suffering, which is more prone to happen when the female is of a slender form, and of a highly nervous and sensitive habit, it becomes incumbent on us to avail ourselves of all the means which art affords, in order to endeavour to alleviate the sufferings of the patient as much as possible. Amongst the medicines best suited to attain this desirable result, we shall frequently find Coffea cruda of considerable service in mitigating the pains, Avhen they are extremely violent and occur in rapid succession, scarcely allowing the female an interval of ease, and are attended with excessive agitation, bordering on despair. When Coffea affords but little relief, which is generally the case when the patient has constantly or frequently in the habit of using coffee as a beverage, Aconitum should be resorted to, followed by Chamomilla if required. If little or no benefit ensues after several doses, another medicine may be prescribed. When we find that the throes are insufficient to accomplish their object, and the female becomes exhausted by the pro- tracted nature of the labour,— Belladonna is a medicine of the greatest value, and will generally prove serviceable in almost every case of tedious labour, which arises from the rigidity and unyielding state of the parts (as is so frequently the case Avith elderly females giving birth to their first child); but it is more particularly Avhere labouras protracted by a spasmodic contrac- tion of the inferior portion of the uterus, owing to which circumstance, notwithstanding the existence of powerful throes, the os uteri does not become correspondingly dilated that Belladonna is indicated. On the 1 It is to be regretted that the attention of mothers is not more particularly directed to the development of the female frame by means of calisthenic exercises, instead of distorting its symmetry by means of stays and tight lacing; health being destroyed for the sake of that fashionable and unnatural absurdity—a thin waist. 580 TREATMENT BEFORE PARTURITION. other hand, this valuable remedy is further of equal efficacy when, on the escape of the waters, an almost complete cessation of labour-pains ensues, or the uterine contractions are rendered so feeble as scarcely to be perceptible, and are only made known to the patient by a periodic sensation of pressure and aching at the sacral region—Avhile the dilata- tion of the os uteri is found, as in the above instance, to make no further progress.1 The following remedies will also occasionally claim attention:— Nux v., Pulsatilla, Secale cornutum, and Opium. Nux v., when the labour is somewhat protracted, from the irregularity and insufficiency of the pains, and the female complains of a continual urgency to relieve nature. Pulsatilla, where the labour-throes are imperfect, and frequently extend upwards from the sacral to the epigastric region, attended with spasm of the stomach and vomiting; or when they are almost unfelt, and occur only at long interA'als, attended with acute pains in the loins, and painful drawing sensations in the thighs, which tend much to weaken the woman, without furthering the labour. When Pulsatilla has not had the desired effect, and there is a con- tinual deficiency of uterine contractile power ; or Avhen the labour-pains return every quarter of an hour, not increasing in intensity, Secale cornutum ought to be administered. Again, when Ave find the pains, although powerful at first, suddenly cease, followed by a tremor of the whole body, and occasionally interrupted by violent jerkings, and when the patient falls into a sort of lethargic slumber, with open mouth, stertorous breathing, eyes half closed,—and there is great difficulty in arousing the sufferer, even by violent means, Opium is indicated. Dose.—A few globules of the remedy may be dissolved in about an ounce of water, and a dessert-spoonful given between each pain, until benefit results, or a marked action of the remedy calls for a pause. When the pains suddenly disappear without other indications, one or two drops of the Mother Tincture of Cinnamon may prove of service, especially where the labour is far advanced. We have now, in a great measure, treated of the course to be pursued when Nature seems to call for our assistance to further her exertions ; but we must, at the same time, reprobate a rash and ill-advised inter- ference Avith her operations; and Ave cannot, in common with most men of eminence of the other school, too strongly reprehend the practice of administering spirituous beverages, or stimulants, such as chamomile tea, and other ptisans, coffee, &c, under the absurd idea of thereby facilitating delivery. Spirituous liquors are objectionable, from their accelerating circula- tion, and consequently producing difficult labour, and too great a loss of blood; Coffee, from its causing high nervous excitability : Chamomile, from its pathogenetic property of producing, or creating a tendency to metrorrhagia; ptisans, whose peculiar properties we need not enter upon here, are all more or less of a stimulative or irritative nature. As a general rule, every substance, possessing a medicinal property, administered upon the false premises above noticed, tends to injury, and must therefore be carefully avoided. 1 Kallenbach. PUERPERAL CONVULSIONS. 581 With regard to the after-birth, when common, gentle, and rational mechanical means1 for its expulsion fail, we may have recourse to Bella- donna, Pulsatilla, Secale cornutum, or Opium, selecting by the symp- toms already mentioned, and shall rarely be disappointed in our expec- tations of their beneficial effects. When the parturition is complete, the administration of a few globules of Arnica, in a little water, is always followed by the happiest results, frequently preventing much severe after-suffering ; and we are convinced that many critical cases of inflammation, &c, might thereby be warded off. In instances where the labour has been very protracted, the Arnica in lotion, one teaspoonful of the Tincture to two ounces of tepid water, applied externally, will be found to afford great relief. PUERPERAL CONVULSIONS. Therapeutics.—The principal remedies employed in homoeopathic • obstetric practice are Chamomilla, Belladonna, Hyoscyamus, Stramo- nium, Ignatia, Cieuta virosa, Ipecacuanha, and Cocculus. Chamomilla.—Where there is extremely acute pain, chiefly of a cutting description, extending from the lumbar to the hypogastric region, attended by convulsive movements; redness of the face, espe- cially of one cheek ; excessive sensibility of the nervous system, and ex- citement. Belladonna.—Twitching of the facial muscles; convulsive move- ments in the limbs; great agitating with continual tossing; occasional throbbing and distensions of the vessels of the head ; bloated redness of the face; delirium; excessively powerful but ineffectual bearing-down pains between the paroxysms. (See also the indications for this in- valuable remedy at page 579.) Hyoscyamus :—When the convulsions are still more severe, accom panied with great anguish and cries ; oppression of the chest and loss of consciousness. Stramonium :—Similar convulsions, but without loss of consciousness, attended with trembling of the limbs. Ignatia will claim attention in convulsions, of the several descriptions occurring in very sensitive women who have been exposed to depressing mental emotions. Cicuta virosa :—General convulsions, or cramp-like contortions of the limbs ; pallor or salloiv hue of the face. Opium :—Violent convulsions ; threatening stupor, alternating with low muttering delirium. 1 We do not understand or mean to express by the said term, the exercise of brute force; it is truly melancholy, and almost impossible to conceive, that men, who have received a medical education, and have had opportunities both of reading and hearing the warnings of enlightened and experienced obstetric practitioners, against the dis- tressing and serious consequences which almost inevitably result from the employment of harsh and inconsiderate measures, whenever the expulsion of the placenta happens to be somewhat tardy, could be guilty of such culpable and infamous conduct. Some of these reckless individuals do not appear to wait for any signs of tardiness, but as if in anticipation of an obstinate and prolonged retention, they set to work with their ruth- less proceedings immediately, and are, consequently, but too often the authors of all the mischief and danger, and even the fatal termination, which sometimes result after the natural process of labour. 582 TREATMENT after delivery. Ipecacuanha :—Spasmodic convulsions; paleness or bloatedness of the face, occasionally with desire to vomit. Acidum hydrocyanicum, Platina, Aconitum, Bryonia, Nux v., Coc- culus, Pulsatilla, and Cina have also been recommended against con- vulsions during labour. TREATMENT AFTER DELIVERY. After the termination of delivery, both body and mind must be kept in a state of perfect repose; everything which may tend to arouse the excitability of the patient, such as noise, strong light, and odours, must be carefully avoided, and the room kept at a moderate temperature. After the birth, the female should be allowed to enjoy that slumber, which in natural cases generally follows, without interruption ; but it is commendable to feel the pulse from time to time, to ascertain if a healthy action is going on. Sometimes this desirable state of rest is kept off by great nervous excitement on the part of the female, with incessant toss- ing in bed and restlessness. A few globules of Coffea cruda will often suffice to dissipate these symptoms, and procure a refreshing slumber; should it be insufficient, and any febrile symptoms* be present, Aconite will generally produce the desired effect. When these remedies, which answer in the majority of cases, fail of their accustomed success, we must endeavour to trace the cause of the derangement, and shall gene- rally discover symptoms pointing out a different remedy, which, if judi- ciously chosen, will, with almost absolute certainty, afford a satisfactory result. (See the article Sleeplessness, Part I.) Here again we must severely reprobate the practice of administering stimulating, and even spirituous, beverages to females after delivery, which, far from possessing a strengthening property, tend only to excite and irritate the Avhole nervous system. For some time after parturition, Nature calls for but little nourishment; it should be given only when the female herself expressly feels the Avant of it, and then be of the lightest and most digestible kind, and in very small quantities. It is highly reprehensible to endeavour to induce a female to partake freely of stimulating food, under the absurd idea of strengthening her. We must allow Nature to pursue her own course, which prescribes but little nourishment for the first five or six days after delivery, and thereby avoids the necessity of calling the bowels into action, Avhich state of Constipation (if it may be so called), is ordained for the wisest purposes, and attended with the most beneficial results; Avhile the temporary inactivity of the alimentary canal is compensated by the vicarious action of the skin (demonstrating itself by increased perspiration), and the balance of the system thus kept up. We cannot, therefore, sufficiently condemn the use of aperients, which only tend to promote irritation, and bring on puerperal fever, and other evil consequences; in many after-pains. 583 cases, also, this artificial relaxation interferes with the proper secretion of milk. After the fourth or sixth day, Nature generally acts sponta- neously, and when it appears necessary to afford mechanical assistance, we may do so by the application of warm friction to the abdomen, or the employment of a simple lavement, consisting of tepid water, with a little linseed oil or thin gruel. When this state, which seldom happens, con- tinues so long as to cause inconvenience, Bryonia, or Nux vomica, Pulsatilla, and Opium, may be resorted to. (See article Constipation.) AFTER-PAINS. These pains are considered salutary, and perhaps justly so to some extent; at the same time, when they occur in an aggravated form, and are unduly protracted, as frequently occurs in females of exalted ner- vous sensibility, they tend to deprive the patient of her rest, and ought, under such circumstances, to be subdued as speedily as possible; their early mitigation, in all cases, by means of homoeopathic remedies, is, moreover, always attended with the most satisfactory results. In many instances the employment of Arnica internally, and like- wise externally as a lotion (a few drops of the tincture to an ounce or so of tepid water), when the labour has been somewhat severe, is suffi- cient to prevent the excessive development of these pains, as also in most cases to ward off fever and inflammation.1 But when the pain still continues, and the patient is highiy excitable and sensitive, we should give Chamomilla, followed in about an hour by Nux v., if no change is effected by it. If the pain is of an insupportably intense description, or followed by convulsions, coldness, and rigidity of body, Coffea cruda ought to be selected. We may give Pulsatilla, when the convulsions do not supervene, but the pains are protracted, and the patient is of a mild and gentle disposition, but sensitive and easily alarmed about herself. Again, Avhen the after-pains are very severe, and there is a continual inclination to relieve the boAvels when in a recumbent posture, but passing aAvay when rising, followed by spasmodic pains in the lower parts of the abdomen, they are usually readily relieved by Nux vomica. Secale cornutum and Cuprum metallicum have been strongly recommended in preference to any of the foregoing remedies, in severe and protracted after-pains occurring in females who have already borne many children. With regard to the dose, we may dissolve a few globules in a wine- glassful of water, and give a teaspoonful every hour, or only every three or four hours, according to circumstances ; carefully watching the effect produced, and discontinuing the medicine as soon as relief is afforded; in many cases a single dose will suffice. When, on the other hand, no improvement follows after a dose or two of the same remedy, another must be selected. 1 The soothing effects of Arnica are properly appreciated by those females who have had opportunity and occasion for its employment; and we believe there are few who, having once experienced the beneficial effects of the homoeopathic treatment generally, during the entire period of confinement, would willingly return to the old method of treatment. 584 DISEASES FOLLOWING PARTURITION. In the event of flooding, the folloAving remedies must be had recourse to: Ipecacuanha—or Crocus, Platina, or Sabina; also Belladonna, Chamomilla, or Cinchona, in particular cases, according to the symp- toms. (For indications see Miscarriage.) DURATION OF CONFINEMENT. Even a strong and healthy female, during the first five days, should remain in bed; in the four following, if she feel herself perfectly strong, and desirous to rise, she may gradually accustom herself to longer periods of sitting up ; the great risk is from the extreme susceptibility of the system to cold. After this period a female who still finds herself weak and languid, should prefer the horizontal to the half-recumbent posture; and if this prove wearisome she may sit up for an hour or two, but not so as to fatigue herself. The diet should be regulated accord- ing to the habit of body and the state of the digestive functions; in all cases it should be light, and, at first, extremely light, and not of a very nutritious quality; the patient ought only gradually to partake of food of a more nourishing nature, never haAring recourse to anything in the least degree stimulating, and all strong odours, from flowers or other aromatic substances, must be carefully avoided, the mind being also kept in as perfect a state of tranquillity as possible, and the room dark. 9 DISEASES FOLLOWING PARTURITION. SUPPRESSED SECRETION OF MILK. It is of paramount importance that the normal operations of the organism peculiar to this state, proceed with due regularity. Among these the secretion of milk takes a prominent position, and its sudden suppression is apt to be followed by internal and local inflammation, determination of blood to the head, and the usual array of symptoms, which form the disease, commonly denominated puerperal fever, which, however, also results from internal injuries, consequent upon difficult or protracted labour; but if the precautions of administering Arnica, already enjoined, has been taken, that source of danger will almost always have been effectually guarded against. When, however, puerperal fever arises or threatens to set in, from a sudden suppression of the lacteal secretion, the immediate administra- tion of Pulsatilla, three globules in a teaspoonful of water, repeated in six, tAvelve, or tAventy-four hours, according to necessity, will fre- quently be found sufficient to check it at the outset, restore the flow of milk, and re-establish the equilibrium of the organism; if any unpleasant symptoms still remain, they will, in most cases, yield to the administra- tion of Calcarea, followed by Zincum, if it appear called for. In 9 EXCESSIVE SECRETION OF MILK. 585 other cases, particularly where serious metastases result, Belladonna, Bryonia, Rhus, or Sulphur may be required. If the suppression of the secretion arise from any sudden mental emotion, we may select one of the remedies mentioned in that article, which see—giving perhaps a preference to Bryonia, Chamomilla, Pul- satilla, or Coffea. Should active feverish symptoms, such as hot, dry skin, &c, set in, Aconite should be given at short intervals, until a favourable impres- sion is made :—when there is excessive restlessness along with the above, considerable advantage will accrue from the alternate use of Aconitum and Coffea. We may here refer back to our remarks upon the evil effects of aperients, which, by their action upon the intestines, frequently cause a suppression of the lacteal fluid, and the consequent fever. EXCESSIVE SECRETION OF MILK. Sometimes, on the other hand, it happens that too abundant a secre- tion takes place, 'causing distension of the breasts, and involuntary emission of milk, and productive of extreme emaciation, and sometimes development of phthisis. Calcarea will be found useful in this affec- tion ; or, should it fail to relieve, Phosphorus. When febrile symptoms arise from distension of the breasts, induced by an excessive secretion, and indications of what is generally denomi- nated milk-fever (which, however, frequently arises from other causes), we may have recourse to Rhus toxicodendron. Aconite may be exhibited as a precautionary measure, when there is high febrile action of the whole system, and we are ignorant of the exciting cause. The dose to be repeated every six hours, or oftener, if necessary, until the rapidity of the circulation is diminished, and the skin rendered moist. PERSPIRATION AFTER DELIVERY, SUPPRESSION OR EXCESS OF. The increased perspiration, which takes place after childbirth, is, as we have before observed, a substitute for the suspended action of the alimentary canal; consequently its sudden suppression is unavoidably followed by an injurious result, and not unfrequently, puerperal fever. Exposure to cold, or a sudden chill, is the most frequent cause _ of this affection ; Ave consequently find that the immediate administration of Dulcamara, will often suffice to restore the action of the skin, and prevent further injurious consequences. Should it fail, Nux vomica will frequently be found efficacious, or Chamomilla : this latter remedy particularly, when there is excessive restlessness and excitability, with colic and relaxation of the bowels. When severe, one-sided headache arises combined or not with distressing pains in the neck, Belladonna may be prescribed. In other cases, Bryonia or Sulphur may be called for. On the other hand, an excessive perspiration is almost equally pre- judicial ; it is generally brought about by keeping the room of the female at too high a temperature, the use of too great a quantity of bedclothes, or stimulating beverages; it is chiefly injurious from the 586 DISEASES FOLLOWING PARTURITION. extreme debility and high susceptibility of taking cold, which it occa- sions. Our first care must be a removal of the exciting causes ; and should the malady still continue, we may administer Sambucus niger, which will generally be found effectual in its removal. In other cases, China, Cocc, Sulph., Calc, or Acid, sulph. The latter especially when the sweating is most profuse when lying still, and diminished by move- ment. MILK FEVER. The secretion of milk must be looked upon rather as an operation of Nature, than one requiring medical aid for its regulation. Neverthe- less, many females suffer some slight uneasiness for a few days following confinement, during the first period of that process ; but when any of the under-mentioned group of symptoms present themselves, the affection is known by the name of milk-fever :— Thirst, shivering, and heat, terminating in perspiration; the pulse, at first weak, changing into various phases, sometimes quick and fre- quent, at others soft and regular; in some instances, these symptoms are attended with a drawing pain in the back, extending to the breast, a disagreeable taste in the mouth, thirst, oppressed breathing, anxiety, headache, and diminution or suppression of the secretion of milk, &c.; the exacerbation declares itself regularly about evening, and towards morning perspiration comes on, with alleviation of suffering, or tempo- rary termination of the attack, which not unfrequently recurs on the following day, but rarely rises to such a height as to threaten danger ; Nature herself, if not disturbed by improper treatment, will, in most cases, suffice to restore the equilibrium of the system. When the secretion is re-established, and the lochial discharge resumes its nor- mal course, the derangement generally ceases; should, however, the affection become aggravated, we may dread the setting in of puerperal fever. When the symptoms are as above described, and medical assistance is required for the alleviation, we must, if possible, in the first place, endeavour to discover the exciting cause -,1 when the affection is trace- able to mental emotions, we may consult that article for the remedy. Aconite may be employed in all instances, where considerable fever is present, or administered alternately every six hours, with Coffea, when there is extreme restlessness, anxiety, and dread. Bryonia may with great advantage follow Aconite, when the active febrile symptoms are in a great measure subdued ; and is further par- ticularly indicated, Avhen there are oppressed and laborious breathing, intense headache, and obstinate constipation. Pulsatilla will be found particularly useful in severe cases, especi- ally Avhen caused by taking cold, and bearing a closer approximation to a rheumatic affection than to the general symptoms of milk fever; this medicament is very efficacious in restoring the lacteal secretion, and may be regarded as a prophylactic against puerperal fever, especially 1 Neglecting to put the infant sufficiently early to the breast, with consequent absorp- tion of the milk into the circulation, is a frequent source of the derangement. IRREGULARITIES OF THE LOCHIAL DISCHARGE. 587 when the precautionary measure of the administration of Arnica has been neglected. Belladonna is very useful in particular cases: a reference to In- flammation of the Breasts, and other parts of the work where that medicament is mentioned, will serve to point out in what instances it is most likely to prove efficacious. Rhus is also of considerable service in some cases of milk fever. (See the indications given for this remedy under the heading of Ex- cessive Secretion of Milk.) irregularities of the lochial discharge. This discharge varies considerably in different females; with some it continues for several weeks, in others only a few days ; sometimes it is thin and scanty, at others so profuse and long-continued, as impera- tively to call for medical assistance, which may be frequently traced to sitting up too soon after confinement, to errors in regimen, keeping the chamber of the female at too high a temperature, or mental emotions. If, after nine days, the discharge continues profuse, containing pure blood, whereby an abnormal state is indicated, Crocus, Bryonia, and Calcarea are the principal remedies. Crocus :—In most cases where the discharge is of too long duration, and particularly when the blood is of a black or dark colour, and viscid consistency. Bryonia :—When of a deep red, with internal burning pains in the region of the uterus. . . Calcarea is more particularly indicated, when there is an itching kind of sensation in the uterus. When the lochia are suddenly suppressed, which they sometimes are, from a variety of external causes, such as mental emotions, &c, and from this source puerperal fever threatens, the danger may frequently be warded off by the employment of Pulsatilla. When the sudden suppression arises from fright, and is attended with febrile symptoms, Aconite will generally be found sufficient, or Opium, when the indications given under Mental Emotions are present. (See also the other remedies mentioned under that heading.) When the suppression is caused by exposure to cold or damp, Dulca- mara will be found efficacious, and may be advantageously followed by Pulsatilla. . , , On the other hand, when the discharge continues, but becomes sanious, fetid, and offensive, Belladonna will generally suffice to restore it to its normal state; if this remedy proves inefficient we may admi- nister Carbo animalis in the same manner; and, if the occasion still seems to require it, Secale cornutum, until benefit results. _ Silicea when pure blood is discharged with the lochia, each time that the infant is applied to the breast. The following remedies may also prove useful: Nux v., Hyoscyamus, Zincum Colocynth, Veratrum, and Secale cornutum., chiefly m the event of a suppression; and Platina, Secale cornutum, Hepar s., Rhus, against too copious or protracted lochia. 588 diseases following parturition. DIARRHOEA IN LYING-IN WOMEN. Diarrhoea, during this period, is a state to be looked upon as highly injurious, and immediate means should be taken for its suppression, by the administration of Dulcamara, Hyoscyamus, Rheum, Antimonium crudum, Phosphorus, and Acidum phosphoricum, &c. The first remedy is generally indicated by the cause being a check of the naturally-increased perspiration in lying-in women, from a chill: and, when timely administered, it will generally be found sufficient to answer the purpose required. In painless and almost involuntary evacuations, Hyoscyamus is most effectual. Rheum and Antimonium crudum, in watery or very offensive evacua- tions ; the former when they omit a sour smell. In very obstinate cases, when the discharge is watery, almost involun- tary, and painless, Phosphorus followed, if necessary, by Acidum phos- phoricum. (Vide also Diarrhosa, in the First Part of this work, and administer or repeat the remedies as there directed.) abdominal deformity. Although, in natural cases and healthy constitutions, no abnormal derangement should follow parturition, still we frequently find that a number of unpleasant symptoms, generally arising from maltreatment, supervene. Among these we may mention the thickening of the abdomi- nal coats, occasionally ending in a permanent malformation and pendu- lous appearance. Abdominal deformity is more commonly incident to females who have borne many children, or who present a predisposition to corpulency ; and is found especially difficult of treatment, when tight stays, which we have already remarked upon as one of the principal exciting causes, have relaxed the abdominal muscles, and by so doing, increased the existing bias to the affection. When, however, it is caused by the natural strain upon these muscles during pregnancy, the incon- venience may be considerably alleviated by the internal and external use of Rhus toxicodendron. The internal administration of Sepia is recommended by Dr. Gross1 as still more effectual; he, at the same time, advises the adoption of an elastic bandage, laced at the back, and exerting an equable pressure over the whole of the abdominal region. In some cases where there is a tendency to this affection, particularly in corpulent habits,2 we may, soon after delivery, have recourse to mechanical aid, by transferring the Aveight from the abdominal muscles to the shoulders, by the aid of a properly-constructed apparatus ; but we must, in the strongest manner, 1 Das Verhalten der Mutter und des Sauglings, p. 95. 2 Against Polysarcia (occurring in either sex), Calcarea is one of the most useful reme- dies, especially in lymphatic persons. In other cases, Sulphur, Arsenicum, Baryta, Anti- monium are very useful. When the abnormal secretion of fat takes place exclusively, or chiefly, in the abdomen (omentum), and forms the pot- or Falstaff-belly, Colocynth has been recommended as a medicine of considerable utility. One or more of the reme- dies mentioned as applicable to general corpulency may, however, be called for after the previous employment of Colocynth. Spare diet and regular exercise must, in both varieties of corpulency, be inculcated. FALLING OFF OF THE HAIR — LEUCORRHOEA. 589 object to this or any other pressure being exercised upon the abdominal region during pregnancy, as such a measure is obviously calculated to entail malformation, as, for instance, club-feet, &c, upon the offspring. FALLING OFF OF THE HAIR. Another evil that some females, particularly those who nurse their infants themselves, suffer after confinement, is a falling off of the hair. This frequently arises from an innate delicacy of constitution against which the following medicaments have proved efficacious, and may be repeated every eight days. Tinctura sulphuris six globules, Natrum muriaticum six globules, Carbo vegetabilis six globules, Sepia six globules, Lycopodium six globules, and Calcarea six globules. The last, particularly in those cases in which the lochial discharge has proved very profuse, or in Avhich the catamenia are generally too abundant. China, followed by Ferrum, is useful in debilitated females particularly if there has been flooding after labour. Mercurius is serviceable when there is excessive perspira- tion at the head. In females who have suffered much from hysterical affections, Hepar is often of considerable efficacy. If the hair falls off after metritis or other inflammatory attacks, Hep., Lye, and Sil,— Sulph., Calc, Ac. phosph., Natr. m., or Carbo v. may be employed with advantage. With regard to the other medicines -we would, in most instances, recommend a commencement with Tinctura sulphuris. LEUC0RRH03A AFTER PARTURITION. A third evil is Leucorrhoea, which, although at the commencement merely a consequence of the relaxation of the internal uterine economy, after the completion of the lochial discharge, and at first of an innocu- ous character, frequently proves exceedingly troublesome, and finally puts on a morbid appearance, becoming acrid, and productive of excoria- tion. We generally find a predisposition to the disease in scrofulous, torpid, and leuco-phlegmatic temperaments ; in some families this malady is hereditary, and only to be removed by a careful course of anti-dys- cratic treatment. It is frequently of a very obstinate character, requiring the exercise of considerable study and attention on the part of the medical attendant, on the one hand, with much patience and strict attention to dietetic rules on that of the patient, on the other, ere a successful result can be attained. The remedies which have been found the most efficacious against the affection, either occurring after parturition, or at other times, are Pul- satilla, Sulphur, Sepia, Bovista, Calcarea, Lycopodium, and Carbo v., Causticum, Conium, Mezereon, Natrum, Magnesia c et m., Ammonium c, Cannabis, lodium, Petroleum, Stannum, kc INTERNAL, OR UTERINE SWELLING AND PROLAPSUS. A swelling of the interior economy is frequently the result of a difficult labour and in some cases of mismanaged parturition: we sometimes find it complicated with uterine or vaginal prolapsus ; if the precaution of exhibiting Arnica, Avhich we have before noted (page 581), have been 590 DISEASES FOLLOAVING PARTURITION. taken, this will frequently be prevented; but should symptoms of pro- lapsus set in, attended with a painful burning sensation, and bearing down, a dose or two of Nux vomica will generally remove the evil. Sepia, Belladonna, Aurum, Mercurius, Lycopodium, Stannum, Can- nabis, China, Platina, and Calcarea, kc, have been employed with material benefit in cases of this description of long standing, as also in other uterine affections, such as Metritis, Retroversio uteri, &c. INFLAMMATION OF THE WOMB. Inflammatio uteri. Metritis. Diagnosis.—Continuous, burning, pricking, or shooting pain, in the hypogastric region, sometimes of a very acute description, accompanied by a sensation of weight. At the commencement of the attack, the pain occupies only a small extent of surface, but it soon afterwards ex- tends to the perineum, rectum, and even the entire abdomen. On ex- amination, the vagina and os uteri generally feel hot, and are tender to the touch. The abdomen becomes subsequently tumefied, sensible to the touch, and considerably increased in temperature. The utero-vaginal secretions are suppressed, sometimes also the evacuation of faeces and urine ; and, in lying-in Avomen, the secretion of milk is likewise arrested. These form, in general, the more constant symptoms of uterine inflam- mation ; but as the entire womb is very rarely affected, the symptoms are liable to vary somewhat according to the precise seat of the inflam- mation. Causes.—Severe, unnatural labours, maltreatment, such as harsh manual interference, the administration of powerful stimulants, &c, during protracted labours, or labours with deficient contraction, reten- tion of the placenta, coagula, mental emotions, &c, are the most frequent exciting causes of the disease ; but it is likewise prone to occur, though, for the most part, in a less active form in married women who have never borne children, or during the period of utero-gestation, in conse- quence of cold in the feet or abdomen, inflammation in neighbouring organs, external injury, &c. Organic defects and menstrual ataxia are frequent predisposing causes. Therapeutics.—The remedies which have hitherto been chiefly employed in homoeopathic practice against metritis are: Aconitum, Belladonna, Arnica, Nux, Mercurius, Chamomilla, and Coffea. When the accompanying fever partakes of a synochal type, a few doses of Aconitum are requisite, particularly at the commencement of the treatment. As soon as the violence of the fever has been mitigated some other remedy must be prescribed, according to the exciting cause of the attack, when known, and the characters of the symptoms. Bel- ladonna will thus claim a preference in cases which have resulted from adherence to the placenta; or if the inflammation has taken place after confinement, without any assignable cause, and is attended with the fol- lowing symptoms : suppression of the lochia; distressing sensation of weight, dragging, or bearing down in the hypogastric region ; burning, shooting pains in the lower part of the abdomen ; shooting pains in the hip-joint; severe pain in the back, as if it would break ; tenderness of WEAKNESS after delivery. 591 the abdomen to the touch. When metritis has arisen in consequence of severe and protracted labour, with laceration of the parts, Arnica should first be prescribed, or it should be given in alternation with Aconitum, or with any other remedy which may seem called for by the symptoms. The early employment of this remedy, both externally and internally, after delivery, is always attended with more or less benefit, and is undoubtedly frequently the means of warding off mischief in cases of unnatural labour. Nux vomica is a most useful remedy in various uterine derange- ments. In this inflammation it may be employed with advantage when the pains in the region of the uterus are very severe, partaking chiefly of a shooting or cutting description ; and are accompanied by ischuria or dysuria, constipation or costiveness, and tenesmus ; when a feeling of soreness or pain, as from a bruise, is constantly expe- rienced in the epigastrium ; when there is severe aching in the lumbo- sacral region ; and when all the symptoms become exacerbated towards morning. Mercurius is useful when frequent fits of perspiration or shivering take place, and when shooting, pressive, boring, or piercing pains are complained of in the region of the uterus. Chamomilla, Ignatia, Coffea, or Bryonia may be of much service in some cases, particularly when mental emotions have preceded the at- tacks. (See the different indications which call for the one or the other of these remedies in the article Mental Emotions.) Cinchona is indicated in metritis, by most of the symptoms which have been mentioned under Belladonna. The latter is better adapted to plethoric habits, whereas the former is more appropriate in feeble or exhausted constitutions, who have suffered from excessive hemorrhage, or other debilitating causes. In other cases recourse may be had to Lachesis, Platina, Pulsatilla, Rhus, Sec, Thuja, kc In irritable uterus, so-called, the most important remedies are: Nux v., Plat., Bella., Stan., Cham., China, Ipec.; and also: Sepia, Sulph., Calc, Coc, Con., Graph., Natr. m., Kali, Kreos., Croc, Ac. muriat., Magn., kc Against uterine spasms : Cocculus, Ignatia, Conium, Magn., Magn. m.;—Bella., Cham., Nux, Hyoscy., Natr. m., China, are the principal homoeopathic remedial agents. Against uterine polypus: Staphysagria, Thuja, Calc, Ac. nitr., Carb. v., have been chiefly recommended. Against ulcerations at the os uteri, &c.: Carbo v., Graph., Sulph., Silie, Sep., Ars., Merc, or Thuja, may be successfully employed. In indurations of the uterus : Aurum, Bella., Sep., Staph., Tad., Calendula, have hitherto claimed the principal attention. And in carcinoma: Bellad., Ars., Staph., Thuja, Carbo v. et a., Clem., Con., Sil. WEAKNESS AFTER DELIVERY. We frequently find a high degree of weakness or exhaustion re- maining after delivery; when it has been caused by very considerable 592 OBSTACLES TO SUCKLING. hemorrhage, during or after that period, Cinchona is particularly indicated, and will generally be found efficient in restoring the vital energies. When, however, the derangement is attributable to nervous weak- ness, and is attended with restlessness and want of sleep, * we may ad- minister Aconite, followed, if necessary, by Coffea, or substitute Veratrum for the latter medicine, when the prostration of strength is excessive. In some instances we must have recourse to Kali carbonicum, or to Sulphur, Calcarea, or Acid, phosphoricum. OBSTACLES TO SUCKLING. DISINCLINATION OF THE INFANT. Where there is a tendency to consumption in the mother, or she is of a strumous habit, the infant ought, for its own sake, to be reared with the spoon, or a nurse provided. But even some healthy mothers find a difficulty, before they become accustomed to it, in nursing their children, which, however, a little perseverance will soon effectually overcome; but when the child itself refuses to take the breast (a rare instance, if it be applied soon after delivery), the administration of Cina, followed, if not speedily efficacious, by Mercurius solubilis, is often found to remove this repugnance in the course of a few hours. Acthusa cynapium is also a useful remedy in some cases, particularly when the child takes the breast readily enough, but returns the milk almost immediately afterwards. Silicea is likewise occasionally very serviceable in cases of the last-named description. The remedy selected ought to be given to the mother as well as the child. When these remedies fail, a healthy wet-nurse will generally require to be produced; or the act of weaning adopted. EXCORIATION OF THE NIPPLES. In the majority of those cases in which no malformation of the parts is present, the main difficulty arises from the nipples having become sore and cracked, which the efforts of the infant tear open afresh, and cause to bleed. This excoriation of the nipples is frequently prevented by following up the treatment, of which we have already spoken, under the head of Preparation of the Breasts, of course taking the precaution of laving the nipple with a little warm milk and water, before the child is applied to the breast'; the shield before mentioned ought always to be Avorn during the intervals of suckling. When there is a tendency, however slight, to rawness or excoriation, inflammation of the breasts. 593 great care must be taken lest the shield adhere to the skin ; it ought to be frequently removed, and together with the nipple, kept perfectly dry; attention to these particulars will generally remove this difficulty. The mother ought, hoAvever, gradually to accustom herself to nourish the infant, using a sucking-glass, which should be carefully washed every day. Should, however, the nipples have already become verysore and irritable, from the neglect of these precautionary measures, it will be necessary to have recourse to specific remedies, without which, if suck- ling be persisted in, suppuration frequently ensues. In the first stage of the affection, Arnica should be employed inter- nally, and the breast laved with a weak lotion,1 say about a teaspoonful of the Mother Tincture to one ounce of water. If this fail, we must have resource to anti-dyscratic remedies, as this disease almost always arises from a constitutional cause, females of a healthy temperament being generally exempt from it. Among these Tinctura sulphuris seems particularly indicated for most cases of this affection, and a dose of one or two globules may be administered every five or six days until improvement sets in, which will generally be the case in the space of a few days ; and if this fail, Calcarea, administered in the same manner, will in most instances suffice. We may also mention Graphites, Sepia, Lycopodium, Merc, and Stlic, as remedies of much value in some obstinate cases. In the choice of the fitting medicament in compli- cated cases (as, indeed, in all others), the physician must be guided by the aggregate of the symptoms. (Nux v. has been found of considerable service in soreness of the nipple, with painful excoriation of the adjacent surface.) inflammation of the breasts. Another, and one of the greatest, obstacles to a mother nourishing her infant/is an erysipelatous inflammation and swelling of the breasts, of which anything tending to disturb the lacteal secretion, such as frio-ht, passion, cold, &c, serves for an exciting cause, although we fre- quently find it present, without being able to trace its origin ; it not unfrequently arises from a too tardy application of the breast to the infant, or from a sudden cessation of suckling,—occasioned by the death of the child, or other reasons,—causing a distension of the lactiferous tubes When a sudden suppression of the secretion occurs, the breasts become red, inflamed, and indurated, occasionally suppurating in some parts which open and discharge, while others remain still nard and inflammatory, and ultimately either ending in suppuration, or in the formation of obstinate nodosities. ' This disease, if not checked, as but too frequently happens under allopathic treatment, exhibits a variety of phases; and the suppuration that takes pleace leaves behind it disfiguring cicatrices; frequently the breasts are so far destroyed as to be rendered ever after incapable of performing their functions, and in some instances the foundation ot cancer is laid. i This lotion may also be applied with advantage in the preparation of the breasts, • When irritation or inflammation appears to arise from the pressure of the shield. 594 SUPPRESSED SECRETION OF MILK. The principal remedy in this affection, before the inflammation becomes fully developed, is Bryonia, especially Avhen the breasts are hard and tumefied, and the secretion of milk is suppressed. ^ Bella- donna, Avhen the inflammation is more intense, and the erysipelatous appearance of the skin clearly defined; after which remedy, the disease is generally vanquished. When, however, a degree of induration still remains, Mercurius solubilis, three globules, should be given, and repeated in from two to three days; in more severe cases, Acidum phosphoricum should be resorted to, or Hepar sulphuris, when suppuration has already com- menced. In instances in which we find a fetid and serous discharge, which is frequently brought about by neglect or by improper treatment, such as the application of deleterious unguents, &c, Silicea will generally have the effect to restore the breast to its former condition ; in some extreme cases, however, it will be found necessary to follow up the treatment with Phosphorus, Calcarea, or one or more of the remedies above men- tioned, such as Mercurius and Hepar sulphuris. If this disease has evidently arisen from the effect of a sudden chill, Dulcamara ought to be given immediately, and will frequently obviate all injurious consequences. In cases where the disease has arisen from external injury, Arnica should be employed, and a lotion one part of the tincture to seAren of pure water, locally applied. When the consecutive inflammation is of an intense description, Aconitum is preferable to Arnica. When indu- ration has taken place, Conium is required. And when suppuration has ensued, Phosphorus is, in general, the most effective remedy; when given sufficiently early, it will rarely fail to promote rapid absorption of the collected matter. In strumous habits, Tinctura sulphuris, Calcarea, Graphites, and Iodium, will occasionally be found necessary to complete the cure after Belladonna has removed the active inflammatory symptoms. MENTAL EMOTIONS AFFECTING THE MILK. It is a well-known fact, confirmed by numerous examples, that Men- tal Emotions have a most powerful effect upon the milk, in a moment changing it from a source of nutriment into a substance most injurious to the infant. Mothers ought to bear this in mind, and after having suffered from fright, passion, &c, should desist from suckling until they are perfectly composed; and ere the infant be again applied to the breast, a portion of the milk should be drawn off. Fortunately for evils arising from these causes, Homoeopathy presents prompt and efficacious remedies (for which see Mental Emotions,) which, if at hand, should be administered immediately, according to the cause and symptoms. DEFICIENCY IN THE SECRETION OF MILK. SUPPRESSED SECRETION OF MILK. Sometimes a deficiency of milk is found to arise from a want of energy, either functional or general. For disturbance of the secretion MOTHERS NOT SUCKLING THEIR CHILDREN. 595 arising from an inflammatory action, vide Inflammation of the Breasts. When the deficiency or suppression arises from the first cause, the chief medicines useful in restoring a proper and healthy flow of milk, are Pulsatilla and Calcarea. In simple cases Vitex agnus castus, and Pulsatilla will frequently be found efficacious ; in others, but par- ticularly where there is simply a scanty secretion without any apparent abnormal state of the system which might give rise to the deficiency, Calcarea e rarely fails to increase the secretion.1 It is, however, more generally requisite for the female to undergo a complete course of treat- ment, if she is anxious to persevere in nursing, in which the two latter remedies, together with Aconitum, Bryonia, Chamomilla, Belladonna, Sulphur, Sepia, lodium, will be found of very great value, where the case is one that is capable of being remedied. DETERIORATION 'AND DISCOLORATION OF MILK. If the milk becomes too clear and Avatery (or otherwise deteriorated in quality, or is distasteful to the child), we may endeavour to improve it by the employment of Cina, and Mercurius solubilis may be administered alternately every twenty-four hours, for threeor four days. In obstinate cases, Acthusa and Silicea will frequently bring about an amelioration, particularly if the infant vomits immediately after it has taken the breast. Rheum will frequently be found of efficacy, when the milk becomes thick and yelloAv, and disagrees with the child, rendering it restless and fretful. When these remedies fail, it will generally be found imperative to wean the child, or procure a healthy Avet-nurse. mothers not suckling their children. In the present state of society there are many mothers who, from a variety of circumstances, find themselves necessitated to engage the services of a nurse for their offspring ; in such cases, a female, who has the slightest regard for her health, should be particularly careful in her diet, and until the secreting process has completely ceased, she should live as low as possible. The employment of dry cupping at the outer surface of the arm, a little below the shoulder, or at the inferior ex- tremities, will materially hasten the suppression of the lacteal secretion. At the same time, material aid will be derived from the internal admi- nistration of Pulsatilla : indeed, the employment of that remedy alone will often be found sufficient to stop the secretion. When suffering from inflammation ensues, we may have recourse to Phosphorus, Bella- donna, and Bryonia, for which indications are given under Inflamma- tion o'f the Breasts ; Calcarea is serviceable, when the breasts are considerably distended with milk. These directions will also serve as a guide during the period of weaning. 1 Journ. de la Me"d. Horn., tome i. cap. 1. PART III. TREATMENT OF INFANTS AND CHILDREN. INTRODUCTORY REMARKS. Homeopathy possesses many peculiar advantages in the Treatment of the Diseases of Infancy and Childhood. In the first place, when any constitutional taint exists, this system, by the selection of specific reme- dies, meets disease upon the very threshold of life, and destroys it in the germ ; it substitutes a rational mode of treatment for the nostrums of the nursery, since the application of the remedies, even in the most trifling cases, requires a certain degree of education, and a careful study of medicinal action. There can, indeed, be no doubt that many lives, which have unfortunately been sacrificed by the overweening self-con- fidence and prejudices of those intrusted with the life of man, at the most precarious period of his existence, might have been preserved, had this system been more extensively known and acted upon. Again, the receptivity of the infant organism to the influence of homoeopathic remedies, is a fact established by experience. Here, therefore, from the minuteness, yet sufficiency of the dose, all risk is obviated of producing hurtful and even fatal consequences by the accidental exhibition of one medicine in place of another,—an event unfortunately of but too frequent occurrence in the old mode of practice. The tasteless nature of the medicaments is another point of no small importance in affections of infants and children, and by means of which nausea and annoyance are completely avoided. In such complaints as occur at all periods of life, and which have been treated in the First Part of this Avork, we should be guided in the selection of the dose by the age of the patient; with infants we may use the highest potencies, and rarely, even in acute diseases, give more than a single globule; children from four to eight years of age, may take about one-fourth to one-third of the dose prescribed for an adult, and above that age, one-half to two-thirds. A great deal, however, de- pends upon the constitution of the patient, whether delicate or robust, and upon the child's susceptibility to medicinal influence, a point only ASPHYXIA. 597 to be determined by experience ; in very acute diseases we may some- times be called upon to administer as low as the sixth potency, and even lower, particularly when employing such remedies as Sambucus, lar- tarus emeticus, kc ; from the great receptivity, however, of the system in early life, as above remarked, we should be particularly careful in repeating the medicines. TREATMENT AFTER BIRTH. As soon as the child is born, it should be wrapped in fine flannel, with a piece of soft linen rag inside, the flannel itself being too rough for its delicate skin ; the wrapper should be heated to a temperature of 98 degrees, as it is only gradually that the infant becomes inured to the temperature of the surrounding atmosphere. The skin should be gently washed with a little lukewarm water and bran, applied with a sponge, but care must be taken not to continue the first washing too long, for fear of irritation ; soap must on no account be used ; the room should be kept rather dark, and perfectly quiet, and all strongly-scented sub- stances removed. After washing, the body ought to be dried imme- diately, to avoid the risk of taking cold ; the child should be bathed twice a day, to keep up the action of the skin, the temperature of the water being gradually lowered, after weaning. m The best time for bathing the infant is in the morning, when it is taken out of bed, and again on returning to it for the night; im- mersing the Avhole body, with the exception of the head, is preferable to any other mode of washing, as the practice of placing it in a tub, with part of the frame alternately laved with tepid water, and exposed to the action of the atmosphere, is apt to bring on a chill. Nothing can be more evidently opposed to Nature and the dictates ot common sense—although, like many other absurdities, it bears the impress of custom—than the practice of swathing and bandaging the tender bodies of infants, and loading them with a superfluity of clothing, which, by its weight and length, presses upon their lower extremities, and is the frequent cause of deformity and Aveakness m after life ; in this opinion we are fully borne out by the corroborative testimony ot the most eminent practitioners of the old school. ASPHYXIA. The first danger that the infant incurs on its entrance into life is A SYMPTWS.-Suspension of the functions of vitality,-respiration, circulation, and motion. . . . . , Causes-Natural debility; difficult parturition; injury from the forceps- pressure of the umbilical cord round the neck; accumulation of mucus in the throat; too sudden an alteration of temperature, the respi- ratory action of the lungs not having commenced. The usual mechanical means, under the direction of a competent person, must of course, be Sstanilv had recourse to ; but should the infant continue to breathe feebly and imperfectly after animation has been restored; or should 598 treatment of infants and children. the artificial inflation of the lungs,1 and other means, such as the Avarm bath, exposure for a short time to the cold air, &c, &c, have been found ineffectual, the following homoeopathic remedies may be resorted to: Tartarus emeticus.—When the child shoAvs no signs of vitality, or there is merely a feeble pulsation of the cord, and the face pale, and the limbs relaxed; or if, on the other hand, the face is swollen and purple, and the air-passages appear to be clogged or obstructed with phlegm. Opium.—If respiration remains suspended, and the face is livid and bluish. (Aconitum is sometimes useful after Opium.) Cinchona.—If the face be pale, during the suspension of animation, and also when the infant is reviving and respiration commencing—if the same indication present itself. (See Tartarus emeticus.) Aconitum.—When the child is reviving and beginning to breathe, if the face has been previously flushed or of a bluish tint. The removal of any mucus or other substance, which is capable of preventing the entrance of air into the respiratory organs, should first be accomplished, before the above medicaments and other remedial measures are employed. SWELLING OF THE HEAD. Immediately after birth, the head of the infant appears more or less swollen; this is in most cases but a trifling affection, and generally goes off of itself. The administration of Arnica, one globule, will materially hasten its disappearance; should, however, the swelling be at all exces- sive, bathe the part affected in a weak lotion, consisting of three drops of the tincture of Arnica to a wine-glassful of water. Occasionally a considerable swelling in the larger mould (fontanel), consisting of fluid, is observable ; this affection is of greater import than the other, though seldom dangerous ; if it does not disappear in a day or two, Ave may administer Rhus toxicodendron, one globule, to the infant; or Calcarea carbonica, in cases where the fontanel is long in closing. In some instances Silicea or Sulphur is also requisite in addition, if not in preference, to Calcarea. NAVEL RUPTURE IN INFANTS. In cases where there is an evident tendency to navel rupture, a properly made bandage2 should be applied, and will usually prove suffi- cient to effect a cure; but if not we must prescribe Nux vomica ; if, 1 This is easily accomplished by an adult person applying his or her lips to those of the child, and then slowly blowing in air,—having previously gently compressed the pit of the child's stomach with the fingers of one hand to prevent the entrance of the air into that organ, and closed the nostrils with the finger and thumb of the other hand to prevent its exit from these orifices. The chest should, when it has thus been distended, be emptied again by gentle pressure with the hand. This process ought to be repeated until signs of natural respiration become apparent. 2 The following is a simple and commonly efficacious mode of applying a compress: take a piece of lint, just sufficiently large, when folded five or six times, to cover the rupture effectually ; then press in the protrusion, and keep it reduced with the hand, until the compress is rightly adjusted and secured in its position by means of two strips of adhesive plaster (which have been previously warmed by being held at the fire, so as to make them adhere) placed over the compress in the form of a cross. It is still better, however, to get an efficient bandage made to measure by an intelligent and experienced maker. EXPULSION OF MECONIUM. 599 hoAvever, we discover no amelioration from the employment of Nux vomica, we may have recourse to Veratrum. Obstinate cases are fre- quently found to yield to the application of the North Pole of the Magnet.1 These medicines are equally useful in cases of inguinal hernia. In scrotal hernia, Magn. m., Nux v., and Lycopod. have, more especially, been recommended. (See Hernia, Part I.) This disease being frequently brought on by the violent fits of crying, to which delicate children are subject, the bandage may be worn, and retained for some time after the cure, as a precautionary measure against its return. In cases of soreness of the umbilicus remaining after the falling off of the ligature, or even before, we may give Sulphur, and repeat the dose in from four to six days. If, however, during that time, no amelioration has been observable, we should exhibit Silicea, which, if marked benefit result, may be at the same intervals repeated with advantage. EXPULSION OF MECONIUM. After having been permitted to sleep for five or six hours undisturbed, the infant should be applied to the breast as soon as the mother feels herself sufficiently recovered to permit it, Avhich is generally from six to eight hours after delivery, and this should never be deferred, as we elsewhere observed, longer than twelve hours ; the milk of the mother exciting a mechanical action of the alimentary canal, and assisting in the expulsion of the meconium. Here again we cannot too strongly reprobate the too general practice of administering laxative medicines for this purpose, possessing, as they do, a most deleterious effect upon the tender organism of the infant, and, if not productive of jaundice—a too frequent consequence of their repeated administration—at least laying the foundation of bowel complaints, debility of the stomach, and a host of diseases in after-life. Mothers need not be under apprehension, should a temporary delay occur in the passing of the meconium ; far greater evil results from the violent methods taken for its expulsion, than could possibly occur from its continuance in the alimentary canal for a few hours later than 3I> Should, however, an unusually long period elapse, and the child appear costive which in many instances arises from the mother having indulged in the use of ptisans, such as chamomile tea, &c, or coffee, the admini- stration of a few teaspoonfuls of warm sugar and water will generally answer every purpose; if it should fail to produce speedy relief, we may then make use of a lavement of equal parts of sweet oil (or pure honey) and water • and if these simple means do not effectually accomplish the desired object, and the infant appear to suffer from inconvenience, more particularly when the origin of the constipation seems to be from the mother or nurse, we may administer Nux vomica, Bryonia, Tinctura sulphuris, or Opium, to the female herself—for the indications of which medicines see Constipation. i Chamomilla, Aurum, and Sulphur are occasionally found necessary, particularly the last-named, in order to effect a permanent cure. 600 TREATMENT OF INFANTS AND CHILDREN. SUCKLING OF THE INFANT. While upon this subject we shall quote the expression of a well-known writer, in whose opinion, in this respect, we perfectly coincide: " Unless very peculiar urgent reasons prohibit, a mother should sup- port her infant upon the milk she herself secretes. It is the dictate of Nature, of common sense, and of reason. Were it otherwise, it is not probable that so abundant a supply of suitable food would be provided to meet the wants of an infant, when it enters upon a new course of existence. "It is difficult to estimate the mischief resulting from infants being deprived of their natural nourishment; for, however near the resem- blance may be between food artificially prepared and breast-milk, still reason and observation demonstrate the superiority of the latter to the former." (Conquest's Outlines of Midwifery, p. 193.) And again :— " As a further inducement it should be remembered that medical men concur in their opinion, that very rarely does a constitution suffer from secreting milk; whilst the health of many women is most materially improved by the performance of the duties of a nurse." (Ibid. p. 194.) Upon this subject the same author also remarks in another place : " But few mothers, comparatively, are to be found who, if willing, would not be able to support their infants, at least for a few months; and parental affection and occasional self-denial would be abundantly recompensed by blooming and vigorous children. " Presuming that the laudable determination is formed to indulge the child with that nutriment which is designed for its support, it becomes necessary to state, that unless very strong objections should exist, twelve hours should never elapse before the infant has been put to the breast. Instinct directs it what to do, and the advantages of allowing it to suck soon after birth are many and important, both to the mother and child. " By this commendable practice, the patient is generally preserved from fever, from inflamed and broken breasts, and from the distressing and alarming consequences resulting from those complaints. " If the breasts should not have secreted milk previous to delivery, the act of sucking will encourage and expedite the secretion. Thus the mother will be saved from much of the pain connected with distended breasts. Besides which, if the infant be not put to the nipple till the breasts become full and tense, the nipple itself will sometimes almost disappear on account of its being stretched; and without much, and often ineffectual, labour on the part of the child it cannot be laid hold of, and even then the pain endured by the mother is exquisitely severe, and not unfrequently the cause of sore nipples." (Ibid. p. 195.) Having premised thus much upon the advantages resulting to both mother and child from folloAving the law of Nature, which enjoins the female to nourish her own offspring, and having, moreover, elsewhere noted some of the causes Avhich may prevent its being fully carried into effect, we shall now proceed to that important point—for those who do DIET DURING NURSING. 601 not intend nursing their own children—the choice of a nurse, and also the regimen to be observed, which is equally applicable to both parties. THE CHOICE OF A NURSE. In the selection of a nurse, the medical attendant ought generally to be consulted ; and the following points merit particular attention : She should be apparently of sound health, full and moderate plump- ness, with a fresh complexion, and clear eyelids, free from any appear- ance of redness, scurfiness, or thickening. She should be thoroughly exempt from glandular enlargements; possess deep-red lips without cracks, sound white teeth; and Avell-formed, moderately firm breasts, with nipples free from excoriation or appearance of eruptions ; the child of the nurse is one of the best criterions to judge by—its being plump and healthy is a great point in her favour. We should also endeavour to discover if she is free from any hereditary taint; she should, more- over, be of a mild, patient, and equable temper, not irritable or disposed to fits of passion, nor nervous ; of regular and temperate habits, neat in person, and fond of children. She ought also to be about the same age, and delivered about the same time, or, at least, within three months of the same period as the mother ; Avith respect to age we must, of course, avoid extremes. A woman, having given birth to a child very late in life, should choose a nurse several years her junior, and fully qualified for her duties; the reverse of the rule applies to extremely young mothers. DIET DURING NURSING. As regards the nurse's diet, it should be simple and easily digested, and she ought to live upon a proper proportion of animal and vegetable food. Nature generally provides for the increased call upon her powers, by the suppression of the menstrual discharge, and a moderate increase of appetite, Avhich may be safely indulged; but all food of a highly concentrated, nourishing nature, is injurious, causing the milk to become too rich, and unsuited to the delicate digestion of the infant; the best guide is the regular homoeopathic regimen, which maybe consulted with advantage. We cannot too strongly repudiate the too prevalent, but deeply er- roneous idea, that women, during the period of suckling, require stimu- lants to keep up their strength; under this impression, both wine and malt liquors—and, among the latter, more particularly porter—are fre- quently resorted to. Porter is not only injurious from its stimulating properties, but the deleterious effect which the different ingredients composing it produce upon the milk, forms one of the most prolific causes of the many evils that attack infancy. Our own opinions in this respect are corroborated by the physicians of the old school, though, Ave regret to say, not to the same extent. We shall conclude this part of the subject with a single quotation from a well-known medical writer: .... " There is an evil too generally prevalent, and most pernicious in its consequences on individuals and society, and by no means confined to mothers in the loAvest classes of the community, which cannot be too 602 TREATMENT OF INFANTS. severely reprobated; it is the wretched habit of taking wine or spirits to remove the languor present during pregnancy and suckling. It is a practice fraught with double mischief, being detrimental both to mother and child. The relief afforded is temporary, and is invariably followed by a greater degree of languor, which demands a more powerful stimu- lus, which at length weakens, and eventually destroys the tone of the stomach, deteriorates the milk, and renders it altogether unfit to supply that nutriment, which is essential to the existence and welfare of the child." SUPPLEMENTARY DIET OF INFANTS. Unfortunately, some mothers do not possess sufficient milk for the proper nourishment of their offspring ; if this arise merely from a de- ficiency in the secretion, and the female is in other respects healthy, we must have recourse to supplementary diet, to make up for the diminished quantity of the natural nutriment. Groats', asses', and cows' milk are excellent substitutes, especially the latter, diluted with one-third of water; goats' milk being apparently objectionable from its peculiar aroma. The milk, therefore, of the cow ought, when possible, to be ob- tained, and, if given undiluted, to be boiled ;—cows' milk being gene- rally considered too heavy, which boiling, in a great measure, obviates; it ought also to be slightly sweetened, so as to resemble as closely as possible that of the nurse; it should, moreover, be about the same tem- perature, say from ninety-six to ninety-eight degrees, a point less re- garded than it should be, and easily determinable by the thermometer. If any constitutional taint exist in the mother, the sooner the child is transferred to another breast the better for both parties ; if a nurse be not procurable, the above will generally prove sufficient nourishment until the front teeth appear, which is a clear indication that the diges- tive organs are prepared for more solid food; if, however, the milk diet appears to disagree with the infant, we may mix a little thin arrow- root, rusk, or well-toasted bread in Avater, to which the milk may be afterwards added; such alterations in diet are, hoAvever, but rarely required. We may here observe, that no portion of the milk ought to be retained for a subsequent meal, from the quickness with which it becomes sour: the same remark applies to any of the above preparations, in Avhich milk forms the principal ingredient. In the cow's milk, at first diluted as above described, we may, after two or three weeks, gradually diminish the quantity of water, as the digestive organs become stronger, but we cannot too stringently press the point that, where it is at all practicable, the child ought to derive as great a portion of its nutriment as possible from the breast, no food being able efficiently to supply the place of that which Nature intended for it at its birth. When it is necessary to give supplementary nourishment, a suckling- bottle ought to be used, as the best imitation of Nature in giving the food slowly; particular care being taken to observe the utmost cleanli- ness. The child ought, in feeding, to be kept in a reclining, not supine, position, as the latter frequently causes it to incur the risk of suffoca- DURATION OF SUCKLING—WEANING. 603 tion ; and when it evinces disinclination to its food, no more should be offered.^ When the front teeth appear, which is about the fifth or sixth month in healthy children, an alteration may take place in the diet; and a well-made panado, diluted milk sweetened, and thickened with a small quantity of arrow-root, sago, semolino, or rusk, may be given twice a day. When milk, even when prepared with farinaceous sub- stances, disagrees, we may substitute barley-Avater, fine Avell-boiled gruel, or weak chicken-broth, and beef-tea, adhering to that which seems best to agree with the infant, and taking care to vary according to circumstances, as too long an adherence to barley-water may occa- sion looseness in the bowels, while the animal diet is liable to lead, if too long continued, to a contrary result; the best precaution in these cases, when the predisposition becomes evident, is an immediate change of aliment. The child should be accustomed to take its nourishment from each breast alternately; as, if this precaution be not adopted, inflammation is likely to arise in the breast not used, and the child is apt to become crooked, from being always retained in the same position. The physician is frequently asked how often the child ought to be applied to the breast; the best rule on this point is, to give the breast when the infant appears to desire it, and to withdraw it when the child appears satisfied. As the infant increases in strength, it may easily be accustomed to regular hours, the breast being given late at night, and again early in the morning; but during the first six weeks or two months, three times during the hours of rest, late in the evening, the middle of the night, and early in the morning, will generally be found sufficient. DURATION OF SUCKLING—WEANING. The period of suckling ought seldom to last longer than forty weeks; but in this we must be guided, in a great measure, by the constitution of the infant; weak, ill-conditioned children, in whom the teeth are long in making their appearance, it has been recommended to continue at the breast for eighteen months, or even a longer period. Weaning ought, in fact, to be regulated both by the constitution and mother of the child; the full development of the front teeth, which in healthy chil- dren is from nine to ten months, but in delicate or scrofulous constitu- tions is delayed for several months later, is the best indication for weaning. If, however, the strength of the mother appear unequal to the task, and the supply of milk begin to fall off, the child may be gradually weaned, even before the teeth appear; but if the infant is healthy, a continuance of suckling beyond the tenth month is injurious to both parent and child. Weaning should not take place suddenly, but the infant should be gradually accustomed to other food, and a less frequent administration of the breast, till entirely weaned; the time to commence this gradual course is upon the first appearance of the front teeth so that the weaning may terminate with their full development; thereby the secretion lessens by degrees, preventing all evil consequences of swollen or inflamed breasts, and the child becomes quietly reconciled to the deprivation. Weaning ought not, however, to take place, if the child suffers considerably from the irritation of teeth, or any acute in- 604 TREATMENT OF INFANTS. fantile disease. When, however, it is absolutely necessary to wean, Belladonna, one globule, should be given, as a precautionary measure against the inconveniences and not unfrequent dangers which sudden weaning entails. Among these may be mentioned, restlessness, sleep- lessness, fretfulness, and excitability, nay, even a degree of irritability sometimes amounting to inflammation of the brain. The value of this remedy in affections of that organ has already been commented upon in several parts of this work. Although, perhaps, slightly out of place, it may be here remarked that Phosphorus is the remedy best calculated to prevent inflammation of the breasts consequent upon a sudden cessation of suckling.1 See the articles relative to this subject in Part II., Treat- ment of females and their peculiar Affections. After the child has been weaned, his nourishment should generally consist of the same simple food as before mentioned, with an occasional light pudding, without spice or eggs, made from semolino, tapioca, or other farinaceous substance. The transition to a more substantial diet ought to be extremely gradual and guarded, and no material alteration made, till after the appearance of the eye-teeth. SLEEP—SLEEPLESSNESS. The sleep of the child is the next consideration; from the irritability of the infant itself to maintain a proper degree of warmth, it should sleep by its mother's or nurse's side, for at least the first six weeks, particularly during winter or early spring. Care must be taken not to overburden it with bedclothes, and to place it in such a position as to prevent it slipping under them, and thereby becoming exposed to the risk of breathing a vitiated atmosphere, or even of suffocation ; after six or eight weeks, when the organism becomes stronger, and able to preserve a proper degree of natural warmth, a separate bed or cradle will be more conducive to the health of the infant; this change of arrangement will be found beneficial to both parties—to the child, from its breathing a purer air, and the continual appetite for the breast diminished ; and the mother, being freed from the necessary watchful- ness and restlessness consequent upon the child sleeping with her, will enjoy better health, and be more likely to secrete good and nutritious milk. Moreover, it is generally known, that sleeping in the same bed with an adult is detrimental to the health and proper development, not only of infants, but even of children; a child sleeping in the same bed with a very old person, will very soon begin to exhibit signs of a falling off in its general appearance. With regard to the kind of bed best suited to the infant, the suspended cradle seems the most eligible; we must, however, be careful not to allow the nurse to abuse its use by continual rocking, which frequently causes irritation of the brain: it should not be closed up with curtains, but the room may be a little darkened; and in cases where there is danger of draughts, a screen will answer every purpose. As to the length of sleep allowed to the infant, the chief business of the first months of its existence being sleep and nourishment, we may 1 A. H. Z., p. 8, No. 23. SLEEP. 605 safely leave the point to Nature, and not attempt to coerce the inclina- tions of the child; if the infant is lively on waking, we may conclude it has not slept too much ; and as it increases in vigour, and is able to endure longer intervals of wakefulness, we may proceed (recollecting that night is the proper period for sleep), so to regulate its habits of taking its food and rest, as to accustom it to a uniform system, and particular hours. Children, up to two years of age, require rest during the day, and the nurse ought to endeavour to get them into the habit of taking it in the forenoon, for if it be taken in the afternoon, it generally interferes with the night's sleep. Whether by night or day, Ave must carefully exclude both light and noise from the nursery, for although they may be insufficient to arouse the infant, still they cause its sleep to be disturbed and unrefreshing, and, by acting upon the nervous sen- sibility, predispose the child to convulsions or spasmodic attacks from slight accidental causes. It is true, that during the first month, the child sleeps immediately* on leaving the breast, and no evil consequences ensue; but it must be borne in mind, that it takes but little at a time, and the tenuity of the milk is at that time wisely adapted to its delicate digestion, but as the secretion becomes richer, and suited to the increasing power of those organs, it is injurious to put the child asleep immediately after a full meal; his rest is then unquiet and disturbed, from the process of digestion being interfered with, more particularly when nurses foolishly endeavour to force Nature, by resorting to the baneful practice of rock- ing. Nothing causes greater annoyance, and even anxiety to the mother than a disposition to wakefulness on the part of the infant. A healthy child should always be prepared for its rest at the usual hours; if, in- stead of going to sleep, it appear restless, fretful, and disinclined for its accustomed rest, it is an evident indication of some derangement of the child's general health ; frequently, through ignorance, nurses, instead of attending to this warning voice of Nature,—which by the sleepless- ness of the infant demands appropriate relief,—endeavour to stifle it, and sometimes, to free themselves from a little temporary annoyance, administer opiates, which induce an unrefreshing slumber, and not un- frequently a deep stupor, mistaken for sleep, while the original evil still continues to make head against the vital power. This baneful practice has not only been the ruin of many constitutions in after-life, but to it, conioined with improper diet, stimulating or unwholesome drinks, car- minatives, and other quack medicines, together with the highly erroneous practice—sanctioned though it be by names of medical repute—of a frequent administration of that active mineral preparation, calomel, in infant maladies, to say nothing of laxatives, an infinite number of diseases and deaths are annually attributable. Every mother should not only caution her nurse against the use of opiates, but use her utmost vigilance to detect any breach of her injunctions, which should be visited with the immediate discharge of the person so offending; for she must be truly unfitted for such an important trust, who, after being warned of its injurious tendency, will persevere in a practice placing in jeopardy the life of her infant charge. 606 TREATMENT OF INFANTS. Amongst the homoeopathic remedies Avhich have been found the most generally useful in removing restlessness and sleeplessness in children, Coffea, Opium, Chamomilla, and Belladonna, deserve notice, Coffea is very efficacious when the child seems unusually-lively, restless, and wakeful; but will commonly fail to answer its purpose when the nurse is in the daily habit of taking coffee as a beverage. In such circum- stances, Opium may be substituted, particularly if the face of the child is flushed. Chamomilla will generally answer our purpose when the child is tormented with flatulence and distension of the bowels, and appears to suffer from colic, indicated by drawing up the legs, scream- ing, &c. Aconitum is preferable to any of the preceding, when there is general febrile heat and great restlessness. Against sleeplessness after weaning, Belladonna is the most efficacious remedy. (See also Crying and Wakefulness.) exercise. For the first six or seven months the great business of Nature seems to be the proper development of the infant organism, and particularly of the respiratory and digestive functions. During this period, the car- tilage is gradually forming into bone, and the infant's delicate muscles are acquiring poAver and strength. We find also that consciousness is yet indistinct, and the infant evinces no anxiety to indulge in voluntary motion, the muscles of the neck and back not possessing sufficient power to support the head, or to keep the body in an erect position; for this reason, children during this period should, when carried in the arms, be kept in a reclining position, so as to avoid an undue pressure upon the vertebral column; a neglect of this precaution, and a premature carry- ing of the infant in an upright position, are a too frequent cause of deformities of the spine, and derangement of the internal functions in after life. As its powers gradually develope, the infant seems inclined to exer- cise them, and evinces a desire to sit upright, which we may safely indulge, taking care not to overtask its strength by keeping it sitting up during the greater part of the time it is awake. A careful attention to Nature in this, as in all other cases, is the best guide. The practice of dangling the child in an upright position, seems rather to proceed from the pleasure of indulging the feeling of parental affec- tion, than from any benefit the child can, by any possibility, be expected to derive from it; in fact, it is highly injurious, even at a rather more advanced period, as exciting a premature involuntary exercise ^»f the muscles, and consequent deformity. The act of respiration bringing into play a great variety of muscles, occasional crying seems sufficiently active exercise during this period. In mild spring and summer weather the child may, after the first fort- night has elapsed, be carried out into the air for a quarter of an hour at a time, and the period of exercise be gradually increased; in fact, if the Aveather be fine, it can scarcely be too much in the open air. Should its birth occur in winter, advantage may be taken of a fine day, after it is a month or five weeks old, as the frame is gradually acquiring the poAver of generating heat: but, at the same time, great care must be DISEASES of infancy. 607 taken to prevent its catching cold; and should the child exhibit the slightest sign of being affected by the atmosphere, the practice of car- rying it out of doors should be immediately discontinued, and it should be carried up and down in a well-ventilated room, the nurse moving it quietly in her arms from side to side. Many children are lost through a foolish idea of making them hardy, by accustoming them to endure cold ; this can occur only through ignorance, for Nature, in very early infancy, does not possess sufficient energy of reaction to overcome the power of a sudden or long-protracted chill. We may recommend an occasional gentle friction of the hand over the body and limbs, which materially assists in the promotion of the circulation of the blood, and will, in unfavourable weather, serve in some measure as a substitute for exercising the infant out of doors. In carrying the child, it should be from time to time transferred to different arms, as a continuance on one side is a frequent cause of deformity, and in some cases of squinting. The child, as the organization developes itself, seems to evince a desire for independent movements, in which the nurse may very properly in- dulge it, by removing every impediment in its dress, and allowing it to roll about, or crawl upon a soft carpet. The practice of assisting children to walk, or of exciting them to a premature exercise of their powers, is highly reprehensible, causing curvature of the limbs, the bones not being yet sufficiently formed to bear the burden imposed upon them. By allowing Nature to act, the infant's powers will become more gradually, but at the same time, more fully developed, its carriage will be more firm and erect, and its limbs straight and well formed; more- over, it will walk with greater confidence and independence by the ex- piration of the first year, than those Avho have been taught to walk by the assistance of the nurse, leading-strings, or mechanical inventions. When the period at which a child should make attempts to Avalk is re- tarded by evident debility of constitution, this evil is to be overcome by many of such remedies as Calcarea, Silicea, Sulphur, Belladonna, Mer- curius, or Staphysagria, kc DISEASES OF INFANCY. INFLAMMATION OF THE EYES IN NEAV-BORN INFANTS. Amongst the common casualties which befall newly-born children, we may include inflammation of the eyes (purulent ophthalmia). Various causes have been assigned as the origin of the complaint, such as cold, exposure to the light or to any kind of glare. In some cases, however, it appears to be of epidemic origin; whilst in others it is attri- butable 'to a constitutional state of the mother before delivery,_ or to contact with leucorrhoeal matter, and sometimes from worse manifesta- 608 DISEASES of infancy. tions of parental disease. The affection usually displays itself at first by an inflammatory redness of the inner surface of the eyelids, which speedily extends to the ball of the eye, and is soon aftenvards accom- panied by a profuse secretion of matter. The eyes are usually quite closed, and are so sensitive to the light, that it is generally impossible to obtain a satisfactory examination of the eye. On separating the lids, a flow of matter ensues, and the inner lining of the lid exhibits a vivid red hue. As, soon, however, as, on a careful examination, we become aware of the existence of this evil, we should administer Aconite, which will ge- nerally be found promptly efficacious in its removal. When, from the constitution of one or both of the parents, we have reason to suppose that the exposure to light or cold has been merely, if at all, the exciting cause, but that the real origin of the evil is more deeply seated,—or if the Aconite seems to produce no effect, and the disease continues to increase,—we may have recourse to Tinctura sul- phuris, and in some cases Calcarea, alternating these remedies every eight or ten days, if we find it necessary to resort to the Calcarea,— Tinctura sulphuris having been found, in many cases, to act as a specific. In other cases, again, particularly with excessive secretion, Argenti nitr. is preferable.1 Chamomilla is useful some weeks after birth, when the perceptive faculties are more developed, and the child exhibits great intolerance of light; also when redness, SAvelling, and agglutinations of the eyelids, with other indications, given under Acute Inflammation of the Eye and Eyelids (Part I., which see), are present. Lycopodium clavatum, and Rhus toxicodendron may also be named as useful remedies in this inflammation, the former especially in inveterate cases. The eyes may be gently but repeatedly bathed with tepid water. cold in the head. This affection frequently becomes exceedingly distressing to the infant, when it appears in the form of an obstruction of the nose, impeding the action of sucking, by not allowing the breath to pass through the nostril, obliging the infant to release the nipple frequently in order to breathe, and causing it to become fretful and irritable; sometimes also leading to irritation and excoriation of the nipple, and thus, in its repeated efforts to suck, the child causes suffering both to itself and the nurse. Whilst this state continues, it operates considerably against the in- fant's thriving, both by hindering it from taking a sufficient quantity of nutriment, and, by the impediment it causes to respiration, preventing the child sleeping at night. When the nose is dry, and the secretion of mucus suspended, we may, whilst administering a remedy calculated permanently to relieve the evil, afford relief, by imitating the natural secretion by the application of a little almond oil or cream to the inte- rior of the nostrils with a feather. This malady is often excessively obstinate, and presents itself under many different phases, which of course demand remedies suited to the 1 The local application of a solution of nitrate of silver appears to be perfectly homoeo- pathic in Ophthalmia Neonatorum. CRYING. 609 entire group of the symptoms. Among these, Nux vomica is most fre- quently successful, particularly when the following symptoms are pre- sent :— Obstruction of the nose, with dryness or nocturnal obstruction, slight discharge during the day; irritability and peevishness. Sambucus niger is frequently efficacious when Nux v. fails to relieve; but is also of service in cases when there is an accumulation of thick and viscid mucus in the nostril; when, in addition to the cold in the head, there is a suffocating cough, with wheezing in the chest, and quick labo- rious breathing, Tartarus should be had recourse to if Sambucus does not soon relieve the latter symptoms. Chamomilla is very useful when there is cold in the head, with^ a watery discharge from the nose, more particularly when there are febrile symptoms, soreness of the nostrils, and redness of one cheek. Carbo v. is chiefly used in obstinate cases, and particularly when the cold in the head becomes aggravated towards evening. Calcarea, when the nose is stuffed with mucus, and the affection occurs in stout, lym- phatic children. Pulsatilla, thick green or yellow, or purulent-looking discharge from the nose, attended with frequent sneezing. Dose. A globule of the remedy selected, may be dissolved in half a wineglassful of water and one teaspoonful given at bedtime and another in the morning. Sulphur may follow Pulsatilla, after an interval of a few days, if the latter fails to act beneficially. Mercurius, Aurum, or Lycopodium may be required after Sulphur, if the discharge con- tinues to present a purulent appearance. (See also Coktza, Part I.) CRYING AND WAKEFULNESS OF NEW-BORN CHILDREN. As we have already remarked, the occasional crying of new-born chil- dren is a wise provision to bring the respiratory organs into play, and to expand the chest. When, however, the crying becomes excessive, and threatens to prove injurious, we must, in the first place, endeavour to discover its origin, which frequently will be found to be some mecha- nical cause, such as derangement in the infant's dress, or a pm sticking into its flesh, &c. Therapeutics.—When, however, no exciting cause or guiding symp- toms of disease present themselves, and the infant is peevish and irrita- ble, affected with incessant whimpering and wakefulness^ or prolonged fits of crying, Belladonna will frequently be found sufficient to remove When a fit of crying arises from the child having been irritated or excited by any cause, such as suddenly rousing it from its rest, and when it seems willing to sleep, but finds a difficulty in composing itself to slumber Coffea cruda will prove efficacious. (Aconitum may follow Coffea, when there are considerable heat of skin, and extreme restless- 116 Chamomilla is often more efficacious than Belladonna when the in- fant is of a very spare and delicate habit; or when we can trace the fits of screaming and wakefulness to a derangement of the digestive func- tions and the child appears to suffer from griping pains, indicated by contortions of the body, drawing up of the little limbs upon the abdomen; 39 610 DISEASES OF INFANCY. and when a whitish, yellowish, or greenish, or watery excoriating diar- rhoea is present. Jalapa, in similar cases, but without diarrhoea, or with motions tinged with blood. In other cases, when the screaming and vigilance are attended with colic and flatulence, Senna will answer best. Rheum is more appropriate when, in addition to screaming and wake- fulness, combined with griping, there are ineffectual efforts to relieve the bowels by frequent straining, or when, at the utmost, only scanty, sour-smelling motions are passed, of grayish appearance, and which seem to afford no relief. When flatulent colic, accompanied by sudden fits of crying, drawing up of the legs or of the scrotum, and a costive state of the bowels, appears to be the source of the disturbance, Nux v. will commonly succeed in restoring ease to the little sufferer. Pulsatilla is very efficacious when the derangement arises from over- loading the stomach, or improper food, and the crying or wakefulness is accompanied with flatulence and diarrhoea, or with constipation. Remarks.—The milk of a nurse who has suckled for some months previously is much too heavy for a new-born infant; here the only al- ternative is a change of nutriment. When, however, the above-named or any other infantile derangement arises from congenital weakness of the stomach, the most useful remedies, in addition to Nux v. and Puis., are Sulphur, Calcarea carbonica, and Baryta c REGURGITATION OF MILK. ACIDITY, FLATULENCE, ETC. Children, in sucking, sometimes overload their stomachs, and regur- gitate a portion of the milk; so far, mothers have no cause for uneasi- ness, nor is medical assistance requisite; but when this changes into vomiting, and the whole of the nutriment is returned from the stomach, or when sickness and regurgitation of food occur in children who have been weaned, at times followed by mucus and a watery fluid and even bile, it must be looked upon as a disease, and treated accordingly. Therapeutics.—Ipecacuanha will generally afford relief, and may be repeated, if not soon followed by some amendment. In the case of spoon-fed infants, or in children at a more advanced age, this remedy is equally efficacious, when the derangement is evidently owing to their having been over-fed (a most culpable error, Avhich most nurses are prone to fall into by cramming the stomach of their little charges, and but too often with food of an indigestible nature, whenever they are seized with a fit of crying). Should the vomiting or flatulence, and also the diar- rhoea when present, not decrease after some doses of Ipecacuanha, Pul- satilla may be given, and succeeded in turn by Antimonium crudum, if the symptoms continue, though in a mitigated form. Nux vomica, and that failing, Bryonia may be prescribed when the disease is attended with flatulence, constipation, uneasiness, or irritability of temper. Gentle friction with the extended hand, which has previously been warmed, is a simple and frequently efficacious mode of affording tempo- rary relief in cases of flatulent distension of the stomach and bowels. spasmodic asthma—milk-crust. 611 But permanent relief is only to be attained from Pulsatilla, Nux v., Chamomilla; or Carbo v. and Sulphur, when the former are insufficient. The diet must at the same time be attended to, and altered if of an in- digestible nature and the undoubted cause of the mischief. When there are diarrhoea and excessive flatulency, China is very useful. Chamomilla :—When the disease is attended with convulsions, or di- arrhoea, as described elsewhere under this medicine (see those Articles). A single dose of Sulphur, followed by Calcarea carbonica, in from five to ten days, and then again one or more of the preceding remedies, according to indications, will often be the means of effecting a cure in inveterate cases. SPASMODIC ASTHMA. SPASMS IN THE CHEST. Children are sometimes seized during the night with sudden attacks of suffocating spasms in the chest. The little patient suddenly awakes from sleep, and utters a shrill cry, in consequence of the feeling of suffocation which is experienced. The countenance soon assumes a livid hue, and is expressive of extreme anxiety. A dull, hollow-sounding, dry cough usually accompanies the attack, and the breathing is rapid, very laborious, and painfully distressing to witness. In such cases a globule or two of Ipecacuanha ought immediately to be dissolved in about a wine-glassful of water, and a few drops of the liquid put into the mouth of the patient. If the relief follows, the medicine must be allowed to act, and only repeated when the symptoms threaten to become worse again. But in the event of no favourable signs resulting in from an hour to half an hour or so, according to the severity of the symptoms, Sambucus may be given in the same manner. In other cases Arsenicum will be found more efficacious than either of these remedies ; or Ipecacuanha and Arsenicum may be administered alternately until improvement takes place. Whenever a sudden aggra- vation ensues after the administration of any of these remedies, nothing further should be done, as on waiting patiently for a short time, if the change arise from the effects of the medicine, the symptoms will subside, and gradually give way to unequivocal signs of improvement. (See Asthma of Millar.) Some children are liable to be seized with obstructed respiration or asthma, although otherwise in good health, whenever they are exposed to sudden changes of temperature, or to a cold and high wind. This form of asthma is always attended with considerable, hard distension of the pit of the stomach and region of the lower ribs ; the child affected is at the same time thrown into a state of great anxiety and uncontrol- lable restlessness, attended with crying or screaming, tossing about, &c. Against this indisposition Chamomilla has repeatedly proved to be an effectual remedy. A dose ought therefore to be given as soon as possi- ble after the attack declares itself. MILK-CRUST. MILK-SCAB. MILK-BLOTCHES. Crusta lactea. Porrigo larvalis. Eczema faciei. Tinea faciei. This affection, as it occurs in infants at the breast, usually consists of an eruption of numerous small, whitish vesicles, which appear in 612 DISEASES OF INFANCY. clusters upon a red ground. These generally show themselves in the first instance, on the face, particularly the cheeks and forehead, but sometimes spread over the whole body. The lymph contained in them soon becomes yellow, dark, or even sanguineous, and on their bursting forms into thin, yellowish crusts. Frequently there is considerable surrounding redness and swelling, with distressing itching, which renders the little patient excessively rest- less and fretful, and causes it to keep continually rubbing the affected parts, by which the discharge and crusts are repeatedly renewed, and increased in thickness, often to such an extent that the whole face be- comes covered ; the eyes and nose alone remaining free. The eyes and eyelids, as also the parotid and mesenteric glands, occasionally become inflamed, and sometimes marasmus supervenes. Therapeutics.—The following medicines have been found serviceable in this affection: Aconitum, Rhus toxicodendron, Viola tricolor, Rhus, Sulphur, Sarsaparilla, Mezereum, Belladonna, Hepar sulphuris, Eu- phrasia, Staphysagria, kc Aconite should commence our treatment, when we find excessive restlessness and excitability produced by this affection, and when the skin around the parts is red, inflamed, and itching. As soon as beneficial effects have resulted from the employment of the above remedy, we may follow it up with Viola tricolor, which is often sufficient to effect a cure in the simple uncomplicated form of the disease. Rhus toxicodendron may sometimes succeed or supersede Viola tricolor, when the scalp is considerably affected and thickly studded with incrustations. When Rhus is insufficient to complete the cure, Calcarea or Lycopodium are generally to be selected in preference to other remedies; the former more particularly when there is little or no dis- charge, the latter when there is considerable oozing (suppuration), and the temperament of the patient lymphatic. If, after the employment of Rhus, the affection is found to have made but little favourable progress, Sulphur may be given and repeated in four days. The alternate use of Rhus and Sulphur every four or five days, has been found very efficacious in cases of the aforesaid description, and when the eyes are a good deal affected. Sarsaparilla and Mezereum have also been strongly recommended in Crusta lactea. The former in the earlier stage of the malady, when small, burning, itching pustules appear on the face. Mezereum, when from the bursting and discharge of the contents of the pustules, in- crustations have formed, from which an acrid exudation flows, and gives rise to a fresh eruption of vesicles wherever it comes in contact with the skin. Graphites, as also Sepia, Bella., Hepar, Baryta e, Dulc, Cie, Iod., Mere, Natr. m., Acid, filuor., have been recommended as likely to prove of service in complicated cases. (See also Scald Head.) thrush, or aphthae. This disease commences by the formation of small, isolated, round, white vesicles, which, if not checked, become confluent, and sometimes CONSTIPATION. 613 present an ulcerated appearance, or form a thin white crust, which lines generally the whole of the cavity of the mouth, and in severe cases extending to the throat, and even throughout the alimentary canal. Although the affection is of itself neither malignant nor dangerous, it frequently causes not only considerable suffering to the child by pre- venting it from sucking, but great pain and inconvenience to the mother, by being communicated to the nipples, and causing excoria- tion, &c. The complaint is most commonly produced by the want of proper attention to appropriate ventilation and temperature, and to cleanli- ness, as regards the constant personal laving of the infant, but more especially from the suckling-glass, when employed, not having been carefully washed after use. Improper aliment is another of the prin- cipal causes; thus we find that children who are what is commonly called reared by the hand, either partially or wholly, are more liable to this affection than those whose sole nourishment has been from the One of the remedies in this affection, although perfectly homoeo- pathic in its action, has long been in use, in its external application, hj practitioners of the old school, namely, Borax ; and a weak solution applied to the mouth with a brush has not unfrequently been found efficacious. Mercurius is, however, still more frequently useful than Borax, and especially when there is much salivation, or the thrush in- dicates a disposition to ulceration, we may administer Mercurius so- lubilis, one globule twice in forty-eight hours, followed in a few days, if the symptoms do not improve, by Sulphur, and then Acid, sul- phuricum, one globule after a similar interval, if necessary. Natr. m. and Sulph. are sometimes required after Mere, Borax, or Sulph., m protracted cases. In very bad cases, when the aphthae assume a livid, blue, or violet appearance, attended with excessive weakness and diar- rhoea, Arsenicum, one globule, is highly useful. Acidum nitr. may fol- low Arsen. if the mouth and fauces become covered with aphthous ulcera- tions. Nux v. and Pulsatilla are useful in some cases where there is much acidity and excessive regurgitation or vomiting of milk. (See Regurgitation of Milk, Acidity, Flatulence, &c.) Great cleanliness ought to be observed in all cases. When the disease, notwithstanding every precaution, frequently re- appears in infants at the breast, we may safely infer that it arises from some virus in the constitution of the mother, or nurse, who ought to be changed, or immediately put through a proper course of treatment, under the direction of an experienced homoeopathic practitioner. CONSTIPATION. Obstructio Alvi Neonatorum. This derangement generally appears in children who are either wholly or partially reared by the hand, and also in those whose mothers or nurses are similarly disposed; if it arises from a peculiar diet or want of exercise, such as too much animal food, &c, on the part of the last mentioned, it may be removed by a proper attention to these points; 614 DISEASES OF INFANCY. but in many instances it is necessary for them also to have recourse to proper remedial agents at the same time with the infant. Therapeutics.—Nux vomica, Bryonia alba, and Opium are the principal remedies, and in more obstinate cases, Sulphur, Veratrum album, Lycopodium, and Alumina. Most of the medicaments have been already mentioned under Consti- pation (Part I.), which see. Dose. One globule of the three first-mentioned remedies, every three to four days, until relief is obtained, or another remedy called for; and of the last, the dose at inter- vals of a week. An enema of tepid water may occasionally be resorted to, if required, or a suppository consisting of a small slip of paper, or linen, spirally twisted, and lubricated with oil, may be introduced by a gentle rotatory movement, until the medicine has remedied the irregularity. Rubbing the stomach and bowels, frequently in the course of the day, with a warm hand, sometimes assists the other means employed. BOWEL COMPLAINTS OF INFANTS. Diarrhoea Neonatorum. Diarrhoea, like constipation, is to be regarded merely as a symptom, not as a disease ; the real disease here consists in irritation or inflam- mation of the mucous membrane of the intestines, arising from the effects of aperients, indigestible food, cold, fright, &c. It has already been mentioned (article Meconium) that much mischief is too often occasioned by the deleterious practice of administering laxa- tive medicines, and even drastic purgatives, to the tender new-born infant, for the purpose of hurriedly expelling the blackish green-looking matter, technically known by the name of Meconium, that collects in the large intestine of the foetus during the last month or two of its ute- rine existence. This unwarrantable and extremely reprehensible con- duct is frequently persevered in, even for some time after the expulsion of the first discharge has taken place, and is in many cases the too evi- dent cause of bowel complaints and other sufferings in infants. The introduction of inappropriate, indigestible food, such as thick gruel, &c, into the delicate stomach of a new-born infant is another very frequent source of intestinal derangement; this unpardonable error is not unfrequently committed by ignorant nurses, in order, as they say, to keep it from starving during the few hours of necessary repose to which the mother is left after delivery. This disturbance is moreover likely to be excited in those cases in which, either from a deficiency in the secretion of milk or other causes, it becomes requisite to administer supplementary diet to make up for the diminished supply, and again at the period of weaning, when serious disturbances are occasionally produced in the stomach and bowels, from want of proper attention and caution in the selection and administration of the food. (See art. Supplementary Diet of Infants.) Fright and exposure to cold are, as already noted, two other most frequent exciting causes of the disorder. BOWEL COMPLAINTS. 615 Therapeutics.—A healthy child at the breast passes, on an average, from three to six motions in the twenty-four hours, but in some instances the evacuations are more frequent, while in others they are much less so, yet without in any degree affecting the health of the child; in such cases then, little or no interference ought to be made, so long as the stools remain free from foetor, possessing merely the slightly acid smell peculiar to the infantile state, and are evidently unattended with pain, or any other abnormal indication. When, however, the stools become green and watery, or yellow and watery, brown and frothy, or white and frothy, as if fermented, mixed with mucus or consisting entirely of mucus, and emit an offensive odour, and are generally preceded or accompanied by signs of suffering, it becomes imperative to have recourse to remedial aid. The following are the principal remedies employed in homoeopathic practice against this derangement: Aconitum, Belladonna, Chamomilla, Rheum, Pulsatilla, Ipecacuanha, and also Mercurius, Nux vomica, Ar- senicum album, Sulphur, Sepia, Opium, and Veratrum album. When there is inflammation, the constitutional symptoms are pretty clearly indicated by heat of the surface of the body, quickness of pulse, and rigors ; in this case, we must have immediate recourse to Aconitum, one globule, and follow it, if necessary, with Belladonna,—when the more acute symptoms have been removed, but the infant continues to suffer much and scream constantly. Lachesis may be preferred to Belladonna, when constipation suddenly supervenes, attended with swelling and apparent tenderness to the touch over the entire abdomen, but especially at one particular spot. Mercurius may follow Lachesis, if the symptoms do not yield to the latter remedy. Chamomilla is one of the most invaluable remedies in the treatment of the diseases of children, and particularly in bowel-complaints, whether arising from acidity, irritation caused by indigestible food, excited by a chill, or occurring during teething; when the following symptoms are apparent: redness of the face, or of one cheek, hardness and tension, and fulness of the abdomen, attended by severe colic, which is indicated by a state of peevishness, restlessness, constant crying, and drawing up of the legs towards the abdomen, sickness, frequent evacuations, of a bilious, watery, slimy, or frothy description, of a whitish, yellowish, or greenish colour, sometimes bearing a resemblance to beat-up eggs, and of an offensive odour, similar to that of rotten eggs. Chamomilla may be preferred to Belladonna after Aconite in cases of inflammation, when any of the above symptoms present themselves. (See also Infantile Remittent Fever.) Rheum is another remedy of great utility in the treatment of this affection provided the disorder has not been actually excited by frequent use of this medicine itself in allopathic doses, in which case it will be necessary to have recourse to Pulsatilla, Chamomilla, or Mercurius, as antidotes, according to the nature of the symptoms. Rheum is particu- lar^ appropriate when acidity or bilious derangement has been gene- rated by indigestion, or has arisen from the prolonged use of -antacids, such as mao-nesia, &c, and when there are flatulent distension of the abdomen, colic, crying, restlessness, tenesmus before and after the evacu- 616 DISEASES OF INFANCY. ations, which are either of the consistence of pap, or watery and some- what slimy, occasionally of a grayish, or of a brown colour^ and when a sour smell is emitted from the body of the infant. It is sometimes necessary to give Chamomilla after Rheum, to complete the cure; in other cases, and particularly those of an obstinate character, Magnesia c. is more efficacious. Pulsatilla:—Diarrhoea arising from "indigestion" or from a chill with watery, slimy, whitish, or bilious, greenish-XooYmg evacuations, oc- curring chiefly at night; want of appetite, fretfulness. Pulsatilla, as before stated, is also very serviceable in obstinate cases, where the affec- tion has been brought on by the abuse of Rhubarb, or by Rhubarb and Magnesia, when the symptoms are as above described ; it is further often efficacious under similar conditions, -when fright has been the exciting cause, and Opium has not sufficed, or has been administered too late to procure relief. (See Veratrum.) Ipecacuanha is particularly valuable when the diarrhoea is excited at the period of weaning (weaning'-brash), from the sudden change of food, which the stomach is unable to digest; and when the following symp- toms result in consequence: bilious derangement, with repeated attacks of vomiting, paleness of the face, frequent crying, diarrhoea with stools of a bilious, slimy, or greenish yellow, sometimes blackish, or streaked with blood, and of a putrid odour ; on other occasions, evacuations re- sembling matter in a state of fermentation, or containing substances like white flocks or flakes, followed by straining. When this remedy is insufficient to effect a complete cure, we should have recourse to Pulsa- tilla, or to Antimonium crudum, should the vomiting not speedily sub- side. Mercurius :—This medicine will be found very serviceable in some cases where the irritation owes its origin to the abuse of aperients, such as Rheum, kc ; or when it has arisen from A chill. The following are the principal indications: watery, slimy, or bilious stools (sometimes streaked, or mixed with blood), of a blackish, greenish, or whitish-yellow colour : frothy, or having the appearance of beat-up eggs; attended with symptoms of severe colic, and frequently also severe tenesmus and protrusion of the intestine ; diarrhoea, with redness of the whole body, as from general excoriation. Dulcamara :—This is an admirable remedy in derangements of every description arising from exposure to a cold, damp atmosphere; and is indicated in cases of diarrhoea from this cause with the following symp- toms : watery, bilious, or slimy evacuations, of a greenish-yellow colour, and occurring chiefly at night. (Merc, or Cham, may be required to complete the cure in some instances.) Nux vomica is very useful in cases arising from a chill, or from indi- gestible food at the period of weaning, or earlier; it is also useful in some cases, in which the disorder has been created by the frequent em- ployment of laxative medicines. Its indications are: very frequent but scanty evacuations of watery, slimy, whitish or geenish stools, attended with colic and tenesmus, some- times followed by protrusion of the intestine; extreme fretfulness. This bowel complaints. 617 medicine is also of great service in many cases when the diarrhoea alter- nates with constipation. Bryonia is a useful remedy in cases of diarrhoea, which recur when- ever the weather becomes very warm. (Carbo v. has been found efficacious, when only temporary benefit had resulted from Bryonia, in diarrhoea during the heat of summer.) Arsenicum :—This medicine becomes indispensable in neglected cases, or in those at an advanced stage of the disorder, when there is reason to fear that it will terminate in marasmus. The following are its characteristic indications: watery or slimy stools, mostly profuse, of a greenish, whitish, dark, or brownish colour, or of a putrid or gangrenous odour, taking place chiefly during the night, or after drinking or partaking of any kind of food, often preceded by cry- ing and restlessness, and followed by exhaustion or tendency to faint in children of a more advanced age ; great thirst, sleeplessness, paleness of the face, sunken cheeks, and blue circles round the eyes, enlargement of the abdomen, with extreme weakness and excessive emaciation. In diarrhoea attended with vomiting, Arsenicum is one of the most valuable remedies. Sulphur is an invaluable remedy in protracted cases, or in those oc- curring in children who are the offspring of delicate parents,—when there are great Aveakness, emaciation, distension of the abdomen, redness or soreness of the anus, and excoriations between the thighs and adjacent parts, or a sort of miliary eruption over the whole body. (Calcarea is sometimes required to complete the cure after Sulphur.) In other cases, Sepia, Hepar s., Acid, sulph., Magnesia, Graphites, or Veratrum may be required. (See Diarrhea, Part I.) Opium, as has been stated in another part of the work,1 is a most valuable remedy, when immediately employed, for averting the bad re- sults which sometimes arise in consequence of a sudden fright. When convulsions, with derangement in the stomach and bowels, are excited in children by such a cause, we ought to administer Opium, followed by Veratrum, should Opium prove insufficient, and the vomiting and diar- rhoea become excessive ; or we may select a remedy from amongst those above mentioned, in preference, such as Pulsatilla, kc, if the symptoms correspond. . . ' Against Diarrhea unattended with pam (painless diarrhoea) the most useful remedies are: Ferrum, Ars., Lye, Hyos., Phosph., Phosph. ac, Stram.—China, Sulph., Baryta m., Clem., Cina, Nitr., Mgs., Cham., Bella., Chel, Puis., Ran. bulb., Rhod., Rhus, Merc, Ign., Graph., Con., Calc, Acid nitr., Op., kc Diarrhosa, stercoral: Cin., Hep., Gran., Led., Ac. mur., Plumb., Mosch., Prun., Spig., kc „,,.., . . i \ T Diarrhea arising from acids (acid food, fruit, lemon-juice, kc): la- chesis.—Arsenicum, Pulsatilla. Diarrhea after exposure to cold: Mere, Cham., Dulc, Bry., Bella., Nux moschata.—Puis., Nux v., Sulph., Veratr., kc Diarrhea which manifests itself on exposure to the cool, fresh air of the evening: Mercurius. 1 Vide Mental Emotions. 618 DISEASES of infancy. Diarrhea which manifests itself in damp weather: Lachesis, Rhodo- dendron. Diarrhea which manifests itself day and night: Sulphur. after drinking: Ars., Cina. in the evening: Lachesis, Kali e after eating (after a meal): Ars., Col, Bry., China, Lach., Am. m., Rheum, Bor., Fer. mg., Veratr. Diarrhoea which occurs after eating and drinking: Bry., Ars., Rhus. eating fruit: Lach., China, Rhod., Cist., Ars., Puis. Diarrh(EA which occurs after drinking milk : Bry., Lye, Sepia, Sulph., Natrum. Diarrhoea which takes place in the morning: Bry., Caps., kc at night: Ars., Puis., Merc, China, Cham., Moschus, Sulph., kc Diarrhoea which takes place (during sleep): Puis., Am., Rhus, Mosch., kc Diarrhoea which occurs during warm weather: Bry., Lach. Concomitant Symptoms. Dlarrhgsa, attended with distension of the abdomen (flatulent): Veratr., Colch., Sulph., Graph., &c. Diarrhoea, attended with distension of the anus, pain (burning) in the : Merc, Puis.—Lach., Veratr., kc Diarrhoea, attended with excoriation of the anus: Cham., Merc, Sulph., Ferr., Sass. Diarrhoea, attended with loss of appetite: Nux mosch.—Antim. c, Puis., kc Diarrhoea, attended with pains in the back: Ferrum. cephalalgia: Rhus tox. coldness: Spig., kc colic: Ars., Mere, Puis., Cham., Nux v., Veratr., Ipec, Bry., Rheum, Jalap, Rhus, Rat., Sulph., Canth., Baryta c, Ant., Agar., Petr., kc Diarrhoea, attended with crying or screaming (in the case of children): Cham., Ipec—Rheum, Jalap, Sen., Carb. v., Sulph. Diarrhoea, attended with dyspnoea: Sulphur. eructations : Merc, Con., Dulc, kc flatulency: Ferrum mg., &c. pains in the limbs: Rhus, Ammon. m, lassitude, debility: Ipec, Ars., Veratr., Kali, Ferr. mg. Diarrhosa, attended with nausea: Merc, Ipecac, Ars., Lach., Bella., Gran., Hell. Diarrhea, attended with cold perspiration on the face: Merc, Veratr. pains in the rectum: Alum. shivering: Merc, Puis., jSulph., Veratr., Cast., Cop., Dig. Diarrhoea, attended with shuddering: Merc, Puis., Veratr., Rheum. inclination to sleep : Nux mosch. bowel complaints. 619 Diarrhoea, attended with tenesmus: Mere,Lach., Ars., Nuxv., Alum. thirst: Ars., Magn. s., Dulc. tremor: Merc. vomiting: Ipec, Ars., Veratr.—Cup., Tart., Rheum, Lach., Ant., Phosph., kc Colour of the Faeces. Ash-coloured : Digitalis purpurea, Asarum europosum. Black, or very dark: Ars., Ipec, China, Veratr., Camph., Ac. sulph. Brownish: 'Ars., RJieum, Veratr., Camph., Merc, e, Dulc, Sulph., Magn. m., Tart., kc Clay-coloured: Calcarea carbonica, Hepar sulphuris, Petroselinum, Puis., Sulph., kc Frothy: Lach., Rhus, Calc, Coloc, Mere.—Iod. mag., Natr. s., Sulph. ac, Op. Grayish: Digitalis, Mere, Phosph., Rheum, Ac. phosph., Asar. Greenish: Chamomilla, Puis., Arsenicum, Mercurius, Sulphur, Phosph., Veratrum.—Bella., Ipecac, Hep., Nux v., Magn. m., Sep., kc Pale : Lycopodium, Carbo vegetabilis. Whitish: Pulsatilla, Sulphur, China, Digitalis, Chamomilla, Hepar, Colch., Ign., Aeon.—Nux v., Mere, Rhus, Ars., Calc, kc Yellowish: Chamomilla, Mercurius, Puis., Ipecac, Ars., Phosph., Tart., Calc, Magn. m., Coloc, China, kc Nature of the Alvine Discharge. Acrid (producing excoriation of the .anus): Mere, Ars., Lach., Cham., Puis., China, Ign., Veratr.—Ferr., Sass., Lach., Staph., Sulph., Kali, Phosph., Graph., Nux v., kc Bilious: Pulsatilla, Chamomilla, Ipecac, Veratr.—Merc, Nux v., Dulc, Ars., Oleand., China—Bism., Coloc, Sulph. Ingesta containing (lienteria): China, Ferrum, Oleander,—Ars., Bry., Men., Phosph., Phosph. ac.—Ant. c, Am., Asar., Bar., Calc, Can., Nitri. ac, Rheum, Rhus, Sil, Sulph. ac. Gelatinous : Colch., Hell, Rhus, Sep. Membranes (containing portions of false): Cantharis, Colchicum, Sepia. Mucous: Pulsatilla, Capsicum, Chamomilla, Borax, Nux vomica, Phosphorus, Sulphur asarum, Am., Ars., Carb. v., Coloc, Graph., Hell, Ipec, Kali, Magn. m., Merc, Petr., Rheum, Rhus, Sep.— Ant. c, Canth., China, Colch., Hep., Hyos., Ign., Iod., Led., Natr., Nitr. ac, Phosph. ac, Sabad., Sabin., Stann., Veratr., Viol, tr., kc Pitch, or tar, resembling: Lachesis, Ipecacuanha, Mercurius, Nux vomica. Purulent: Mercurius, Silicea.—Puis., Sulph., Canth., Am., Lye— Col, Kali, China, Bella., Cocc, Sep., kc Sanguineous: Mercurius, Cantharis, Nux vomica, Pulsatilla, Ipeca- cuanha, Sepia, Sulphur,—Am., Ars., Asar., Bry., Cole, Caps., Carbo v. China, Dros., Ferr., Led.,Lye, Nitr. ac, Phosph., Rhus, Sabin., Sil. —Alum., Amm., Ant. c, Bella., Cham., Coloc:, Con., Croc, Cupr., 620 diseases of infancy. Dulc, Graph., Hep., Hyos., Magn. m., Mur. ac, Natr., Natr. m., Sabad., Sec. corn., Selen.,^ Stram., Sulph. ac, Zincum, kc Viscous, glutinous : Mercurius, Asar., Sarsap., Hell, Nux v., Plumb., Ars., Cole, Carb. v., Hep., Kali, Mezer., Natr., Veratr. Watery: Ars., Puis., China, Lach., Cham., Rhus, Ferr., Hyos., See, Nux v., Ant, Ipecac, Phosph., kc Smell of the Alvine Evacuations. Acid: Rheum, Mercurius, Sulph., Calc, Graph., Natr.—Cham., Am., Hep., Sep., Magn., Phosph., kc Cadaverous: Bismuthum. Mouldy: Colocynthis. Eggs, rotten, resembling: Chamomilla. Fetid, putrid: Ars., Carb. v., Ass., Puis., Sil, Sulph.—Am., Bry., Aur., Bor., Calc, Cham., China, Graph., Nitr. ac, Nux v., Ol, Plumb., Scill, Stram., Phosph. ac, Carb. a., Dulc, Mgs., Lach., Mar., Asar., Ant. tart., Iod., Sep., kc Involuntary discharge of faeces: Phosph. ac, Phosph., Veratr.—Ars., Bella., Muriat. ac, Natr. m., Sulph.—Rhus, Bry., Lach., China, Nux v., Am., Op., Sec. corn., Staph., Hyos., Colch., Dig., Hell, Merc, Laur., Puis., Sep., Zincum, kc When urinating: Ac. mur. When expelling flatus: Ferr. mag. When sleeping: Rhus, Puis., Am., Moschus, kc In Coma occurring in children from the depleting effects of neglected or protracted diarrhoea, China and Arsenicum in alternation are of con- siderable efficacy. Supplementary nourishment ought at the same time to be given in the case of infants at the breast; and diet of a nutritive quality to children of more advanced age. Diet.—When the derangement can be traced to any particular kind of food, an alteration in the diet becomes imperative; at the same time the quantity of food or drinks must be diminished, until improvement sets in. EXCORIATIONS. Excoriationes Neonatorum. Intertrigo. Against this affection cleanliness is the best preventive; however, we frequently find it proceed to such an extent as to require the aid of medicine for its removal. Chamomilla will be found, in most instances, speedily effective, when we are certain the disease is not the medicinal result of chamo- mile-tea taken by the nurse or child, in which case Ignatia, Pulsa- tilla, Borax, or Carbo vegetabilis, have been recommended to be given. Mercurius.—When a yellow colour of the skin is present, which Chamomilla has not removed, and when the excoriation is extensive and severe. In very obstinate cases we may have recourse to Carbo v., followed in four to six days by Tinctura sulphuris ; Graphites, Lyco- podium, Acidum sulphuricum, Silicea, and Sepia, are also useful in this malady. induration of the cellular tissue. 621 JAUNDICE. Icterus Neonatorum. This disease, as we have before observed, frequently takes its rise from the mischievous practice of administering aperients immediately after birth; exposure to cold is also one of its exciting causes. When it has arisen from the latter cause, and when there is, together with the distinguishing characteristic of the disease—a yelloAv hue of the skin—considerable distension of the stomach, the administration of Chamomilla will be found prompt in affording relief. Mercurius may, in many cases, follow this remedy, if it has only partially relieved; after which, if any symptoms still remain, we may exhibit Cinchona. Nux vomica, when the complaint is combined with costiveness, and the little patient appears generally of an irritable temper. For more particular indications for the medicines above given, and further information, see article Jaundice, in Part I. of this work. INDURATION OF THE CELLULAR TISSUE. INFANTILE ERYSIPELAS. Erysipelas Infantum. Symptoms.—Fever with red spots, generally appearing first upon the nates, but sometimes on the extremities, afterwards upon the abdomen and genital organs, accompanied with induration of the skin and even of the maxillary muscles, which prevents the child from uttering other than a dull sound; the skin at last becomes as dry and hard as parch- ment. Sometimes, instead of fever, the induration is accompanied with cold. , „. This affection generally presents itself in the first two months ot in- fancy ; its duration is from four to fourteen days, and if not promptly treated, it is generally fatal. # m Therapeutics.—The remedies principally required m this affection are Aconitum, Belladonna, Rhus toxicodendron, Arsenicum album, Lachesis, and Sulphur. Aconitum.—At the commencement, when fever is present. Belladonna may follow the exhibition of Aconitum, particularly when the spots present an erysipelatous appearance. Rhus toxicodendron, if the appearance of the skin exhibits a vesicular character. (In some cases Belladonna and Rhus alternately may be found necessary.) . Arsenicum, should the dryness and hardness of the skin remain undiminished, or become increased; should we also find rejection of food from the stomach, evacuations green, watery, acrid, and very offensive • moreover, when there is a tendency to gangrene, with livid spots and vesications, and when the scrotum is especially affected. Lachesis may, in some cases, be called for after Belladonna, when that remedy does not appear sufficient to combat the malady; or it may sometimes be advantageously exhibited in alternation with Ar- ?* WTren the joints, particularly the knee or ankle, are the principal 622 diseases of infancy. seat of the disease, and the bowels are in a very costive state, Nux v. is useful. Sulphur may be usefully employed against the sequelae of this affec- tion, such as torpidity of the intestines, and is also indicated where we have reason to suspect some constitutional taint. Silicea, Graphites, Hepar s., or Clematis, may also prove useful. The body, during this disease, must be kept as dry as possible, and lint applied to the parts affected; when practicable, the infant's only nourishment should be from the breast, to which it should be frequently applied, but only allowed to suck a little at a time. LOCK-JAW OF INFANTS. Trismus Nascentium. This serious and, under the old mode of treatment, so generally fatal disease, usually occurs in the first few days of infant life; at first the child vainly attempts to suck, and even if it succeed, the milk is returned. On examination, from stiffness of the masticator muscle, the lower jaw cannot be depressed—the jaws gradually close, the whole frame becomes rigid, and death ensues. The duration of the malady is from two to four days. Causes.—Foul air; vitiated milk ; taking cold; and local irritation, for example, the umbilical cord being too tightly tied. Therapeutics.—We must in the first place remove the causes where known. When local irritation has given rise to the attack, Arnica ought to be immediately given internally; at the same time the seat of the injury may be bathed once or twice with a weak arnicated lotion, a few drops of the tincture to a wineglassful of water. When we can trace the originating cause to a bad state of the milk, Lachesis may be first prescribed, followed by Belladonna (which, it may be observed, is to be held as a most important remedy in all cases where the affection cannot be assigned to any particular cause), if no signs of improvement transpire after the first or second dose. Mercurius may also prove useful in similar cases. If cold or sudden chill has evidently given rise to the disorder, Chamomilla may first be administered, and then Bella- donna, if required; or Nux v. may be given, in preference to Chamo- milla, when catarrhal symptoms are present and indicate that remedy especially. (See Cold in the Head, Parts I. and II.) Hyoscyamus,— ' or Belladonna, Lachesis, and Hyoscyamus in alternation, may be found useful in some cases. (See also Trismus and Tetanus, Part I.) HEAT SPOTS. New-born infants and young children are often affected Avith an erup- tion consisting of small vesicles filled with a pellucid or slightly-tinged fluid, surrounded by an inflamed base. When- the vesicles break, they generally form into thin incrustations, but sometimes the parts are in- clined to ulcerate. The eruption is commonly attended, especially at . the outset, by more or less fever, and is occasionally ushered in by sickness and languor. The duration of the affection is uncertain ; and it is prone to return again soon after receding. A hot state of the DERANGEMENTS DURING TEETHING. 623 atmosphere, or confinement to a close, warm apartment, and an excess of clothing, appear to favour the development of the eruption. The daily use of the bath, with proper attention to ventilation and clothing, are sufficient to remove the disorder in a few days in trivial cases ; but when there is considerable fever, restlessness and sleepless- ness, a globule of Aconite may be dissolved in three teaspoonfuls of water, and a teaspoonful given every twelve hours. Rhus, one globule, may follow Aconite after an interval of twelve to twenty-four hours, when the eruption is extensive. Should the affection continue to spread, and the vesicles increase in size, notwithstanding the employment of these remedies, Sulph., one globule, may be administered, and then again Aconitum if renewed irritation succeed the exhibition of the former. Chamomilla and Bryonia are also useful in some instances; the first- named especially when the restlessness does not yield to Aconite, and the child is fretful and much excited; the latter when it is peevish and sleepless, yet seems languid, and cannot bear to be moved. DERANGEMENTS DURING TEETHING. About the fifth or sixth month, as already stated, the teeth generally begin to protrude. Under a proper system of treatment, if due atten- tion has been paid to the rules for exercise and diet which we have already laid down, and the child is free from any constitutional infirmity, we may safely calculate upon the period of dentition being exempt from much suffering. Broths and jellies should, during the acute stages, be wholly pro- hibited, and if the infant take other nourishment than the breast, its food should be of the lightest and simplest description. The mother or nurse should also pay particular regard to her regimen, and avoid all substances of a stimulating and indigestible nature. Here, again, we may remark, that the indulgence in vinous or fermented liquors is, from their irritating properties, one of the most frequent causes of the suffer- ing of children during this period. During dentition there is always a tendency of blood to the head, which from simple irritation may, if not quickly checked, terminate in inflammation of the brain ; the best preventive against this affection is keeping the head perfectly cool. # In order, as much as possible, to allay the anxiety of parents, who may be led to mistake the natural symptoms attendant upon dentition for those of disease, we shall in the first instance briefly enumerate those which frequently take place in healthy children, and maybe safely left to Nature; and afterwards proceed to point out in what cases, from any of the symptoms diverging from the usual track, it may be necessary to have recourse to medicines, or to call in the assistance of the physician. During the teething, the child is more restless than usual, especially at night; has flushes of heat, alternating with paleness ; the gums gradually swell and become hot; it evinces a difficulty in sucking, sometimes forcibly bites, and frequently lets go the nipple; it drivels at the mouth, and its bowels become relaxed; the two latter symptoms 624 DISEASES OF INFANCY. may, in some measure, be looked upon as a wise precautionary measure of Nature, to prevent a congestion to the head and lungs, to Avhich all children are at this time more or less disposed ; and the sudden cessation of either, after having once set in, is a sign of a derangement of func- tions, demanding prompt attention. Therapeutics.—The medicines most generally required are, Coffea, Chamomilla, Nux vomica, Belladonna, Cuprum aceticum, Kali nitricum, and Calcarea carbonica. When the child is in an excited state, and unable to sleep, irritable, liable to start, and difficult to soothe, Coffea may be administered; if the symptoms remain without alteration, we may have recourse to Aconitum. When benefit results from either one or the other remedy, the dose must only be repeated in the event of a threatening relapse. Chamomilla may be given after the foregoing remedies, when they are merely productive of partial relief; or it may be given in preference thereto, if the following symptoms are encountered: extreme excitability; the infant starts at the slightest noise; evinces great thirst; spasmodic twitches or convulsions in the limbs, during sleep; short, quick, and loud respirations, sometimes with a hacking cough; excessive diarrhoea, with green, whitish, or watery evacuations; and especially when the mother has been in the habit of taking coffee, which we have already so strongly reprobated as an article of diet to women nursing. Mercurius and Sulphur are sometimes requisite after Chamomilla against the diar- rhoea. (See Diarrhoea.) When in the assemblage of these symptoms, constipation takes the place of diarrhoea, we may prescribe Nux vomica. When strong symptoms of cerebral irritation set in, we should have instant recourse to Belladonna, or Cuprum aceticum : when marked cerebral sensibility declares itself, and the child almost spasmodically clenches the spoon or cup with its gums when drinking. Zincum is strongly recommended by Dr. Elb, of Dresden, in appa- rently hopeless cases, with symptoms of incipient paralysis of the brain, such as sopor, half-closed eyes, or motionless eyes with insensible pupil; loss of consciousness; moaning; icy coldness of the whole body, and bluish colour of the skin; pulse nearly imperceptible; respiration in- terrupted. Dose. Gr. ss. every two hours, until the temperature of the skin increases, and con- sciousness returns, upon which the intervals between the doses may be lengthened; but if some other remedy, as Belladonna for instance, should be called for by the nature of some of the remaining symptoms, it ought to be given in alternation with Zincum, until all signs of danger are removed. When the irritation seems to arise from difficulty of teething, we may , administer Calcarea, and repeat it every eight days for about a month, which will materially assist the protrusion of the teeth. Kali nitricum is a useful remedy when inflammatory symptoms set in during dentition. When obstinate constipation is present, see that article in this part of the work. (See also Convulsions in Children, where additional in- dications will he found for the selection of Belladonna, Chamomilla, and other remedies which are frequently required in fever and other derange- ments during teething.) convulsions in children. 625 CONVULSIONS in children. Early childhood is, from various causes, peculiarly predisposed to this distressing malady. Convulsions generally arise from the anatomical and physical peculiarities of infancy, in the preponderance of the nervous and cerebral systems over the other parts of the frame ; hereditary pre- disposition called into activity by dentition—repelled eruptions, irrita- ting substances in the stomach, intestinal worms, mechanical injuries, fright, and lastly, from some occult cause, frequently a derangement of the organic structure, in many instances bidding defiance to the powers of medicine. When no physician or medicines are at hand, and the danger is imminent, we may, in the .first place, recommend immersing the lower extremities up to the knees in water, as hot as can be borne with safety to the infant, for the space of eight or ten minutes, until the paroxysms seem in a measure subdued; after which the child should be wiped perfectly dry, and placed in a warm wrapper; if the first immer- sion be followed by no relief, it should be repeated, at the same time we may pour a small stream of cold water upon the crown of the head, until reanimation becomes apparent; when the child ought again to be warmly covered up; this course, frequently repeated, has been found to restore children, although the prior attempts have proved inefficient; when im- proper food or foreign substances in the stomach or intestines are the causes, lavements of equal parts of sweet oil and warm milk should pre- cede the foot-bath ;x if homoeopathic medicines be not immediately at hand, the careful administration of Camphor by olfaction, or a drop or two of the tincture, considerably diluted, placed on the tongue will fre- quently be found efficacious in giving relief, awaiting the arrival of a physician. . Therapeutics.—Chamomilla, Belladonna, Ignatia amaras, Una, Mercurius, Cieuta virosa, Arsenicum, Bryonia, Sulphur, Nux vomica, Pulsatilla, Arnica, Opium, Stramonium, Secale cornutum, and Hyoscy- amus, form the most important remedies in the majority of cases.2 Among these Chamomilla stands in the first rank, particularly in very young children, when the convulsions have been excited by dentition, as ^ well as for children who have passed that period, who are of a nervo- sanquine temperament, extremely sensitive and peevish, or when the attacks have been excited by fever, colic, or chill, or a fit of passion or vexation The characteristic indications for its employment are, rest- lessness, fretfulness, and disposition to drowsiness when awake; one cheek red the other pale, diarrhoea; (if this remedy be exhibited at this stage of the disorder, it will frequently prevent the fit from becom- ing fully developed;) eyes half closed; great thirst; quick and loud breathing • rattling in the throat; moaning; cessation of consciousness ; twitches of the eyelids and muscles of the face ; contortion of the eye- balls, jerks and convulsions of the limbs, with clenched thumbs; constant • Some useful remarks upon this subject maybe found in the "Homeopathic Exami- ner" (published in New York, vol. i, No. 2). a It mav be remarked, that in plethoric, well-nourished children, great advantage will frequently be derived from administering a dose of Aconite prior to any of the other remedies. ^ 626 DISEASES of infancy. rolling of the head from side to side; loss of consciousness. (Bella- donna may be exhibited after Chamomilla, should this fail to do much good.) Dose. We may, for very young children, prescribe one globule in four teaspoonfuls of water, one teaspoonful to be given at the commencement of the attack; if fresh parox- ysms come on some hours after, but decreased in intensity, we ought not to repeat the remedy, but allow it to exhaust its action ; if the convulsions increase, on a second or third attack, we may give another spoonful; unless other symptoms declaring themselves, intimate that we ought to have recourse to any other of the under-mentioned medica- ments. Belladonna :—Besides being useful in cases of suppressed eruptions, is more particularly indicated when the child starts suddenly, when asleep, or stares about wildly; the pupils are much dilated; the body or individual members become rigid; the forehead and hands dry and burning ; occasionally followed by clenching of the hands ; involuntary micturition after returning to consciousness; the slightest touch will sometimes provoke a renewal of the attack. This medicine is also indi- cated when the paroxysms are preceded by smiles or laughter. It is frequently found that Chamomilla and Belladonna answer in alternation, and that when one has alleviated the evil, the other, some- times followed by the one first administered, will dissipate the remaining symptoms. In cases that withstand the exhibition of these two remedies, particu- larly during dentition, we frequently find Ignatia successful, more especially in children that are of a melancholy temperament, or in pale delicate infants, of peevish dispositions, with alternations of vivacity and sadness, and laughing and crying almost in the same breath. The characteristic symptoms are: the infant, while reposing in a moaning, light slumber, becomes suddenly flushed with burning heat, awakes, and springs with a convulsive start, and the utmost soothing scarcely quiets the excitement; a tremor of the entire body, attended by violent crying and agonising shrieks; and the muscles of single limbs seem convulsed. Ignatia is further indicated when the fit returns every day at a regular hour, followed by fever and perspiration, or every other ■ day at variable hours. (In other instances Belladonna will be found requisite after Ignatia.) Ipecacuanha is useful when great difficulty of breathing, nausea, aversion to food, and vomiting, either precede, accompany, or follow the attacks; and when the child has a constant inclination to remain in the recumbent posture. Cina is useful, particularly during the second teething, for children of a melancholy temperament, scrofulous constitution, and who are troubled Avith worms, or habitually wet the bed; the characteristic symptoms are : spasms, commencing with constriction of the breasts, fol- lowed by stiffness of limbs, pallor, and rigidity of the whole frame. Mercurius is useful in spasms Avhich are caused by the presence of worms: the stomach is swollen and hard before, during, and after the fit; the child is attacked Avith painful eructation, and a species of sali- vation ; the limbs tossed and convulsed, attended by fever and moist skin; after the paroxysms, the child lies for a long time exhausted and apparently dying. WATER IN THE HEAD. 627 The foregoing are the more generally useful remedies in ordinary cases; but the subjoined are sometimes called for in the particular instances specified. Cicuta virosa is exceedingly serviceable when there is a clear indi- cation of the presence of worms; when the child is first attacked with severe griping and colic, terminating in convulsions ; the characteristic features of the fit are : tremor of the limbs ; jerks like electric shocks, terminated by insensibility. Arsenicum has proved very valuable in severe cases of convulsions, during dentition, with the following symptoms: a burning heat diffuses itself over the whole body of the child; it stretches its feet out, and the hands convulsively backwards, then throws its hands about, and rolls over with violent shrieks; changes its position, and bends forward with clenched fingers and extended thumbs ; it is irritable, restless, and perverse ; evinces insatiable thirst, but drinks little at a time ; is affected Avith diarrhoea, sometimes of undigested food ; frequently vomits imme- diately after taking food, the paroxysms recur frequently, and all attempts at soothing seem only to irritate the child. Bryonia is valuable in convulsions arising from suppressed measles. (See Measles.) Sulphur is particularly indicated in spasms arising from repelled chronic eruptions. When the disease has arisen from the introduction of indigestible substances, Nux vomica or Pulsatilla may be given, according to the symptoms and disposition ; for these remedies the indications have been already given in different parts of the work, to which the reader is referred. (See Tabular Index.) In cases arising from mechanical lesion, Arnica, externally in lotion, where any wound or contusion exists. In cases of convulsions from fright, we may have recourse to Opium, when the following appearances are present; general trembling; throw- ing about of the limbs ; vacant stare; cries, seemingly unconscious ; stertorous breathing, and final insensibility. Stramonium, when the child becomes suddenly convulsed and sense- less from fright. Secale cornutum, in alternation with Stramonium, in cases where the latter does not afford relief. Hyoscyamus, when sudden fright causes very violent convulsions. (See Mental Emotions, Part I.) AArATER IN THE HEAD. DROPSY OF THE BRAIN. DROPSY OF THE HEAD. Hydrocephalus membranarum et ventricularum. General pathognomonic signs : headache, particularly frontal, nausea, vomiting, dilatation of the pupils, stupor, abnormal sloAvness of pulse, and convulsions. This fatal and frequent disease is liable to be excited by a variety of causes, and is particularly prone to take place in scrofulous children, who are born with unusually large heads, and in whom the fontanels remain long unclosed. The symptoms of acute hydrocephalus are some- 628 DISEASES OF INFANCY. times so mild and insidious, that parents are throAvn off their guard, and attribute the apparently slight indisposition of the little patient to some comparatively trivial circumstance ; such as teething, or gastric derange- ment. In other instances, the symptoms are much more striking, and in many respects strongly resemble those described under Inflamma- tion of the Brain. In general, the skin is hot; pulse rather quick, chiefly at night—but often very variable. The child becomes peevish when ever it is raised from the horizontal position ; at other times it is affected with fits of screaming; grinding of the teeth; redness of the face and eyes; peculiar expression of countenance; strabismus; con- vulsions and stupor. Dropsy of the brain is liable to be confounded with other diseases, as invermination, inflammation and ulceration of the mucous membrane of the small intestines (ileum particularly), coma from exhaustion, occurring after protracted debilitating diseases, &c. The history of the case, together with a close scrutiny of the whole of the symptoms, will rarely fail in establishing the diagnosis. Therapeutics.—The most appropriate remedies are: Aconite, Bella- donna, Bryonia, Helleborus, Mercurius, and Sulphur, or Sulphuris tinctura. The indications for the first two have already been given under Inflammation of the Brain, Part I. Bryonia may be administered after Aconite, or Belladonna, if neces- sary, or may be given at the commencement, when there are heat in the head, with dark redness of the face, and great thirst; eyes convulsed, or at one time close, and at another time wide open or fixed; delirium ; sudden starts, with cries, or constant inclination to sleep ; continual movement of the jaws as if engaged in chewing ; tongue coated yellow; abdomen distended; urine suppressed or the passing of urine appears to cause pain ; great thirst, especially at night; skin hot and dry; respiration hurried, laborious, and anxious, constipation. Helleborus niger :—This remedy, as stated by Dr. Wahle,1 will ge- nerally prevent a fatal termination, when Bryonia merely produces only temporary benefit. The same authority quotes it as being the most im- portant medicine in all serious cases, and recommends it to be given in these at the very commencement, in preference to all other remedies; followed by Sulphuris tinctura when danger is not removed within a few hours, and when spasms are present. Mercurius will sometimes be found useful after Belladonna, or pre- vious to that remedy, when the bowels are much relaxed. Hyoscyamus, Opium, Cina, and Stramonium may likewise prove valuable in cases wherein the indications correspond with those described in Part I., and in some cases, Lachesis, particularly when the disease has reached an advanced stage. Zincum (gr. ss, every two hours) has been successfully employed by Dr. Elb2 in the last stage of hydrocephalus with symptoms of incipient paralysis of the brain. As soon as the signs of immediate danger have been removed, some other remedy, appropriate to the remaining symp- toms, should be prescribed; but it is recommended by Dr. Elb to give 1 British Journal of Homoeopathy, No. vii. p. 286. 2 Allg. Horn. Zeit. No. 15, 31ter Bd. ASTHMA OF MILLAR. 629 Zinc, at first in alternation with the new remedy, otherwise a relapse is liable to happen. Kali hydriod., Digitalis, Arnica, and Conium have also been named as likely to prove serviceable in this malady. In chronic hydrocephalus, Dr. AVahle recommends Helleborus, Arsenicum, and Sul- phur1 in particular. (See also the remedies enumerated under Scrofula and Rachitis, with which diseases, chronic hydrocephalus is generally connected.) ASTHMA OF MILLAR. Laryngismus stridulus. This affection is by some denominated the Spasmodic Croup, or Acute Asthma of infants; it bears a considerable resemblance to croup, yet differs from it in many respects, as, for instance, by the extreme sudden- ness of the attack, while that of croup is generally preceded one or two days by hoarseness and a slight cough, and by the cessation from suffer- ing the patient enjoys between the attacks, whereas when croup has once set in, the excitement is permanent; moreover, this disease gene- rally attacks in the evening or at night, whereas croup in most cases makes its first appearance during the day. Croup, as we mentioned in the article upon that subject, is an inflam- mation of the membrane of the windpipe, exciting the formation of a peculiar secretion, which, if not checked, concretes into an abnormal membranous tissue, constituting what is technically called the false mem- brane of croup ; whereas, in the Asthma of Millar, the suffering appears to arise from a spasmodic contraction of the top of the windpipe, impeding the progress of respiration. The attack commences Avith a sudden spasmodic inspiration, accom- panied by a species of stridulous or crowing noise; if the fit continues, the face becomes purple, and the extremities partake of the same hue, frequently attended, as in convulsions, with a clenching of the thumbs inside the palm, and spasmodic constriction of the toes, giving an ap- pearance of distortion to the foot; if proper means are not promptly taken, these attacks recur frequently, and at short intervals, and occa- sionally the little patient perishes during one of the paroxysms. The disease rarely occurs except in infants of delicate constitution, when due means should be taken to endeavour to eradicate it by a proper course of treatment; it frequently accompanies the period of dentition, and is excited by similar causes to those bringing on convulsions. Therapeutics.—Aconite, Ipecacuanha, Arsenicum, Sambucus, Mos- chus, or Pulsatilla, are the medicines which have hitherto been employed by homoeopathists with the most successful results. The dose to be repeated every one or two hours, according to the symptoms. > According to my experience Sulphur (30) is the most important remedy in the treat- ment of inflammatory and exudatory affections of the brain. It is more effective m the "ethic than in the torpid stadium. The previous or intercurrent employment of Acom- £» and Belladonna is often necessary. In the torpid stage I consldf\™°™> «*' in some cases, Acid, phosphoricum, fully equal to Sulphur.-(Rumme\, Allg. Horn. Zeit. No. 22, 32ster Bd.) 630 diseases of infancy. Aconite, when a suffocating cough comes on at night, with shrillness and hoarseness of voice; respiration short, anxious, and difficult, more particularly if any marked febrile symptoms be present, or we have reason to dread determination of blood to the head. Ipecacuanha, when there is rattling in the chest, from an accumula- tion of mucus, with spasmodic constriction, and symptoms as from suffo- cation ; anxious and short, or sighing respiration, with purple colour of the face, and cramps, or rigidity of the frame; it may be advantage- ously followed by Arsenicum, when many of the above symptoms are still present, or in a measure subdued : also if we find great anguish, cold perspiration, and considerable prostration of strength, during and after the paroxysms; when these last indications are particularly prominent, Arsenicum may supersede Ipecacuanha at the commencement. Sambucus :—Lethargy, or ineffectual inclination to sleep, with op- pressed respiration and wheezing; livid hue of the face, agonizing jacti- tations, dry heat of the trunk ; no thirst; pulse small, irregular and intermittent. Moschus is frequently of value in cases that occur at a more advanced period of life, when a constriction in the larynx, as if caused by the vapour of sulphur, is complained of; difficult respiration and short breathing; severe spasms in the chest, with inclination to cough, after which (especially in children) the paroxysms become much exacerbated. Pulsatilla will often be found successful in cases in which the fore- going remedy fails in producing the desired effect. INFANTILE REMITTENT FEVER. By infantile remittent is here chiefly meant that form of fever which occurs in infants and children, arising from morbid irritability, inflam- mation or even ulceration in the mucous membrane of the stomach and bowels. The affection is usually preceded by languor, irritability of temper, want of appetite, nausea, thirst, slight heat of skin, and very restless nights. Ere long these symptoms present themselves in a more aggra- vated form, together with a further development of abnormal phenomena, such as hurried and oppressive breathing, quickness of pulse, with occa- sional flushes in the face, vomiting of food or bile, distension and tender- ness of the abdomen; obstinate constipation ; sometimes diarrhoea, or frequent desire to go to stool with but little effect; motions discoloured, fetid, frequently mixed with mucus, and occasionally with blood. The hands and feet are often cold, while the rest of the body is parched; the head hot and heavy, or attended with other symptoms resembling hy- drocephalus, such as coma, &c. The tongue, at first moist, loaded, and occasionally very red along the margins, often becomes dry over a trian- gular spot at the point. When the febrile exacerbation takes place at night, it is accompanied by violence and jactitation; when during the day there is, on the other hand, drowsiness and stupor. An annoying cough with bronchitic indications, succeeded by wheezing and expectoration, sometimes appears. Although, as is characteristic of remittent fever, the febrile symptoms never entirely subside, still the patient will fre- REMITTENT FEVER. 631 quently appear to be steadily recovering for a time, and the unwary or inexperienced may consequently be led to pronounce an unduly favour- able prognosis, Avhich will too often be contradicted by the occurrence of a relapse, folloAved perhaps again by another encouraging but decep- tive remission and so on, unless the progress of the disease be checked, until either the mesenteric glands become affected, or dropsical effusion into the cavity of the abdomen, or unequivocal signs of cephalic disease supervene, or the little sufferer is so emaciated and reduced by pro- tracted disease, that the vital powers give way, and he sinks exhausted. Therapeutics.—In mild attacks occurring in tolerably healthy chil- dren, the disease is generally readily subdued in a feAv days, by means of one or more of the following remedies : Ipecacuanha, Pulsatilla, China, Nux v., Aconitum, Belladonna, Mercurius, Bryonia, Lachesis, Chamomilla, and Sulphur, combined with light farinaceous diet. Solid food must be strictly prohibited, even though the appetite should be good, which it occasionally is, and even ravenous at times. With regard to the indications for the remedies quoted, Ipecacuanha may be given, if, as is commonly the case, the attack has been excited by over-feeding, or by indigestible food, and particularly Avhen the patient has contracted a habit of bolting the food without having pre- viously masticated it properly, and the symptoms encountered are as follows :—General dry heat, or harsh and parched skin, especially towards evening ; thirst, extreme restlessness, burning heat in the palms of the hands : perspiration at night, quick oppressed breathing, foul tongue, nausea, vomiting, or fastidious appetite, Avith sickness after eating; great languor, apathy, and indifference. Should these symp- toms remain unaltered after several doses of Ipecac, or should the boAvels become very relaxed, the motions fetid, whitish, bilious, or of variable colour at different times, and accompanied with griping and distension of the abdomen, fever during the night—Pulsatilla may be pre- scribed, followed, if required, by Cinchona, especially if the nausea or vomiting has subsided, but the bowels remain relaxed, and are consider- ably distended, or tense and tympanitic. Nux VOMICA is also a most efficient remedy in mild cases, or in the early stage of any variety of the disorder, when the bowels are con- fined, or very costive, with frequent inclination to go to stool; or when there is tenesmus, followed by scanty Avatery motions, generally mixed with mucus, or occasionally Avith a little blood; abdomen tumid and rather painful; further—when the child is excessively peevish and un- governable ; the tongue foul; appetite impaired, or there is nausea with disgust at food; restlessness ; fever towards morning, but also in some degree during the night. Chamomilla is sometimes useful after Nux v. when bilious diarrhoea or vomiting supervenes. It is further indicated if the tongue is red and cracked, or coated yellow; sleep lethargic, or restless and agitated, attended with frequent starts and jerkings of the limbs ; flushes of heat in Ararious parts of the body. Also when the little patient is of a ple- thoric habit, and in all cases in Avhich the head is hot and heavy, the skin hot or parched, the face flushed, the pulse quick; and when there 632 DISEASES OF INFANCY. is thirst, foul tongue, nausea, bilious vomiting, no motions, or frequent and scanty evacuations, with tenesmus. Belladonna may succeed Chamomilla, if the head continue hot, the pulse -excessively quick and full, the tongue loaded, or coated Avhite or yellow in the centre, and very red at the edges; thirst; nausea or vomiting; great heat of the abdomen with tenderness on the slightest pressure; oppressive breathing. If the more active inflammatory symptoms yield to the action of Belladonna,—Mercurius will often serve to complete the cure ; but more particularly when the folloAving symptoms remain : loaded tongue, nausea or vomiting, with continued tenderness of the abdomen; thirst, sometimes with aversion to drinks when offered; no motions, or diarrhoea Avith excessive tenesmus. If, on the other hand, the head- continue hot and heavy, the pulse quick, the tongue foul, and other symptoms of gastric derangement are prominent, together with a tumid and painful state of the abdomen, constipation, excessive restlessness, and quick, laborious respiration, particularly at night, with drowsiness during the day, Bryonia is to be preferred. Lachesis may follow Belladonna or Mercurius, when the signs of intestinal irritation or inflammation continue with but little abatement. Or it may precede these remedies, when the tenderness and distension are more marked at one particular spot (the most trivial pressure there being intolerable), than over the entire abdomen ; and when the fever is highest at night. Sulphur.—May be given with advantage to complete the cure in many cases, after the previous employment of any of the foregoing medicines. It is, however, when the attack is characterized by the fol- lowing features, that this remedy is more directly called for : feverish heat, especially towards evening, but also in the morning, or during the day ; flushes, alternately Avith paleness of the face; dryness of the skin ; hurried and laborious breathing; palpitation of the heart; nocturnal perspiration ; languor and great weakness, particularly in the inferior extremities ; tense, tumid and painful abdomen; dry, hard, or loose and slimy motions. These, then, are the most generally useful remedies in cases of the above description, and will materially tend to facilitate recovery, and prevent the disease from assuming an obstinate character. When, hoAV- ever, the malady occurs in children of relaxed and feeble habits, <5r of a decided strumous diathesis, it becomes, especially if neglected, and not checked at the commencement of its course, a most intractable and fre- quently fatal disease, from the proneness Avhich it then has to become complicated, and terminate in one or other of the serious forms alluded to in the diagnosis. The remedies from which the most benefit is to be anticipated under such unfavourable circumstances are, in addition to those previously mentioned Silicea, Sulphur, Calcarea, Baryta c, Arsenicum, Cocculus, Cina, Sabadilla, kc Silicea.—When there is great emaciation, languor and debility, paleness of the face, want of appetite, or craving for dainties; shortness of breath on movement; feverish heat in the morning or toAvards evening. This remedy is also a most important one Avhen the patient ATROPHY. 633 is afflicted with worms, and when the disease is in a great measure at- tributable to invermination. Cina and Sabadilla, may likewise be found useful along with Silicea in the latter instance. (See Invermination.) The indications for Sulphur have already been given. Calcarea :—Great debility, with flabbiness of the muscles, dryness of the skin, and excessive emaciation; frequent flushes, or general heat, followed by shivering towards evening; exhaustion, or dejection after speaking; impaired, fastidious appetite, with weak and slow digestion, or, on the contrary, extreme voracity; perspiration towards morning, hard, tense, and tumid abdomen. (Baryta c. is sometimes useful after Calcarea.) Arsenicum :—Extreme prostration of strength and emaciation, with desire to remain constantly in the recumbent posture ; dry, burning heat of the skin, with great thirst, but desire to drink a little at a time, or merely to moisten the lips, which are frequently parched; impaired ap- petite, and sometimes excessive irritability of the stomach, so that very little food can be retained; hard and tense abdomen; restless, unre- freshing sleep, and frequent starts, or subsultus tendinum; fretful and capricious disposition. Cocculus :—Great weakness, with excessive fatigue, depression, and tremor after the slightest exertion; heavy expressionless eyes ; flushes of heat in the face; nausea, or aversion to food, distension of the abdo- men, constipation; oppressed respiration; perspiration on attempting any trivial exertion ; lowness of spirits ; mildness of temper. Belladonna, Lachesis, or Baryta c, will be required when the head be- comes much affected. Belladonna, especially when there are heat, heaviness, flushing and delirium; or deep and protracted sleep, with subsultus tendinum, coldness of the hands, pale cold face, small quick pulse, hot, tumid, and tense abdomen. Lachesis :—Either before or after Belladonna, when we encounter deep, prolonged sleep ; grinding of the teeth; or somnolency alternately with sleeplessness; tremulous, intermittent, or scarcely perceptible pulse. Baryta :—Lethargy, jactitation, or agitation, moaning and muttering, feeble and accelerated pulse. (See Hydrocephalus.) Other remedies, such as Antimonium, Acid, phosphoricum, Phospho- rus, Hepar s., Kali, Acidum nitr., Lycopodium, Rhus, kc, maybe re- quired according as the symptoms happen to vary: we have merely given some of the medicines which have been found of valuable service, Avhen the indications of the disease have corresponded with those above given. It may be added, that Avhen the skin is hot and parched, the sleeplessness and restlessness are often temporarily removed by sponging the body Avith tepid water; this expedient is, however, only to be had recourse to Avhen the remedies fail to afford this relief, and that in a more permanent degree. (See also Atrophy.) atrophy. Atrophia. The medicines from which the most appreciable benefit has hitherto been obtained in this serious malady are : Sulph., followed by Calcarea; also Ars., Bar. e, Bell, Chin., Nux vom., Phosph., and Rhus. 634 DISEASES OF INFANCY. Sulphur in almost all cases at the commencement of the treatment; craving appetite ; enlargement of the inguinal or axillary glands ; slimy diarrhoea, or obstinate constipation; pale complexion, sunken eyes, &c. Calcarea :—Great emaciation, with craving appetite; enlargement and induration of the mesenteric glands; great weakness, clayey evacu- ation, a dry and flabby skin; too great a susceptibility of the nervous system.1 Arsenicum :—Dryness of skin, which resembles parchment; hollow eyes; desire to drink often, but little at a time; excessive agitation and tossing, especially at night; short sleep interrupted by jerks; faeces of greenish or brownish colour, with evacuations of ingesta; extreme pros- tration. Baryta :—Enlargement of the glands of the nape of the neck; con- tinual desire to sleep; great indolence, and aversion to exertion and amusement. Bell. :—Capriciousness and obstinacy; nocturnal cough, -with rattling of mucus; enlargement of the glands of the neck; unquiet sleep ; pre- cocity of intellect, blue eyes and fair hair. China.—Excessive emaciation ; voraciousness ; diarrhoea at night, with frequent white motions or evacuations of ingesta; frequent per- spirations, especially at night; unrefreshing sleep. Cina.—Vermiculous symptoms; wetting the bed. (See Worms.) Rhus.—Slimy or sanguineous diarrhoea ; debility ; voracity. In children past the age of infancy, great attention should be paid to the diet; pure air and exercise are also of great importance. VACCINATION. This is an operation purely homoeopathic, and one which, from its efficacy in the prevention of a disease exhibiting analogous symptoms, has been frequently quoted by our Great Founder and his disciples, as one of the best illustrations of the immutable law of similia similibus CURANTUR. Vaccination, when the child is strong and healthy, may be safely performed during the fourth or fifth month; but when the small-pox is rife as an epidemic, we may have recourse to this prophylax with in- fants of a still more tender age. If, however, we are allowed a choice of time, summer is the best period for performing the operation, as then the infant, after having taken the infection, incurs least risk of catching cold. It is of the utmost importance to obtain the lymph from a perfectly pure source, as experience has too truly proved, that other diseases have, from a neglect of this precaution, been frequently transmitted to healthy children. For this reason, a child that has suffered from eruptions of the skin, affections of the glands, or soreness of the eyes, or one born of scrofulous parents, is an unfit subject for taking the vaccine matter from, although at the time apparently in health. 1 Calc. c, 3-4, gtt. j, once or twice a day for the space of six or eight weeks, is (to- gether with embrocations of oil (?) and, perhaps also, single intermediate doses of Sul- phur) one of the most efficacious remedies in Tabes mesent. infant.; and, in general, a much superior remedy to Iod., Cieuta, Baryta, &c. In most instances the abdomen be- comes smaller, the stools more regular, in from eight to fourteen days after its employ- ment. Furuncles and a sort of miliary eruption then frequently break out.—Hygea. INDEX. Abdomen, determination of blood to the, 186, 467 Abdominal deformity, 588 Abortus, 573 Abscess, 381 acute, 381 chronic, 382 Abscessus nucleatus, 378 Abscesses in ano, 179 Acidity in children, 610 Acute inflammation of the eyes, 468 inflammation of the liver, 215 inflammation of the spinal cord, 325 rheumatism of the heart, 375 Aegylops, 472 After-pains, 582 Affections of the knee, 467 Ague, 85 Agrypnia, 488 Air and exercise, 561 Aliments allowed, lxi prohibited, lxii Alvine discharge, colour of the (see Bowel Complaints of Infants). Ambustiones, 538 Amenorrhoea, 554 Anasarca, 513 integumentorum scroti, 424 Aneurism of the aorta, 375 Angina faucium, 138 aphthosa, 138 maligna, 144 pectoris, 344 pharyngea, 147 parotidea, 148 perniciosa, 259 membranacea, 259 Anorexia, 157 Anthrax, 379 Aorta, aneurism of the, 375 Apepsia, 157 Aphthae, 612 Appetite, want of, 157 Apparent death, 542 from hunger, 542 from a fall, 542 from suffocation (hanging, pressure, choking), 542 from lightning, 542 from drowning, 543 from being frozen, 544 from noxious vapours, 544 Apoplexy, 321 Apoplexia, 321 Arteries, inflammation of the, 376 Arthritis, 454 vaga, 455 Arthritic nodes, 455 Ascites, 511 Asphyxia. 542, 597 Asthma, 309 humidum, 313 moist, 313 of Millar, 629 Atrophy, 633 Atrophia, 633 Attenuations in general, xlvi Balanitis, 421 Balano blennorrhoea, 421 Bilious fever, 105 Black water, 169 Bladder, inflammation of the, 402 chronic inflammation of, 403 Blear-eyedness, 473 Bleeding from the nose, 478 Blennorrhoea, 235, 416 ventriculi, 235 intestinorum, 236 recti, 236 Blepharitis, 236 Blindness, sudden attack of, 473 Blood, vomiting of, 473 spitting of, 301 Bloodshot eye,472 Boils, 378 Bowels, hemorrhage from the (see Hemor- rhoids). inflammation of the, 223 looseness of the, 187 Bowel complaints of infants, 614 Brain, inflammation of the, 318 fever, 318 concussion of the, 526 dropsy of the, 627 Breath, offensive, 486 Breasts, preparation of the, 576 inflammation of the, 593 Bronchial tubes, inflammation of the mucous membrane of the, 266 Bronchitis, 266 chronica, 271 Bronchocele, 487 Bruises, 529 Bubo, 432 Buboes, 448 venereal, 432 sympathetic, 432 scrofulous, 434 sycosic, 440 636 INDEX. Burns, 538 Camp fever, 84 Cancer nasi, 482 Cancrum oris, 482 Canker of the mouth, 482 Carbuncle, 379 Cardialgia, 164 Carditis, 374 Caries, 520 Catarrh, 238 pulmonary, 266 Catarrhus bronchiarum, 290 Catarrhal fever, 238 Cataract, 471 Cephalalgia, 338 arthritica, 338 nervosa, 338 Cephalaea, 338 Chancre, Hunterian, 426 superficial, with raised edges, 426 phagedenic, 426 sloughing, 426 Chest, determination of blood to the, 264 Chicken pock, 131 Chilblains, 380 Children, diseases of, 596 Chimney-sweeper's cancer, 378 Chlorosis, 552 Choice of a nurse, 601 of the remedy, xx Cholera, 197 Asiatic, 199 malignant, 199 Asiatica, 199 epidemica, 199 spasmodica, 199 preliminary symptoms of, 202 first stage of, 203 fever, or hot stage of, 204 causes of, 209 accessory treatment, 214 Cholerine, 214 Chronic abscess, 382 laryngitis, 244 bronchitis, 271 inflammation of the bladder, 403 rheumatism, 461 Cingulum, 393 Cirsocele, 423 Clap, 416 Clavi pedis, 381 Clavus hystericus, 338 Clothing during pregnancy, 562 Cold on the chest, 266 in the head, 245, 608 Colic, 183 from hemorrhoids, 183 from worms, 183 spasmodic, 184 indigestible food, 184 from passion or indignation, 184 external violence, 184 painters', 184 of Poictou, 327 lead, 184, 327 Devonshire, 184 from a chill, 184 in infants, 610 hysterical, 184 menstrual, 184 Colica pictonum, 184, 327 Common cold, 238 Concussion of the brain, 526 Condylomata, 449 Confluent small-pox, 127 Congestio ad caput, 314 viscerum abdominis, 186, 467 ad abdomen, 186, 467 ad pectus, 264 Congestive fever, 72 Constipatio, 171 Constipation, 171, 566 in children, 613 in aged persons, 174 when travelling, 174 from exposure to the vapour of lead, 174 from congestion, or fulness of the vessels of the head, 174 from duodenitis, 174 Constitutions, lviii Contagious typhus, 84 Consumption, pulmonary, 305 Convulsions during labour, 581 in children, 625 Convulsio cerealis, 93 Costiveness, 171 Corns, 381 Cornea, specks on the, or opacity, 471 ulceration of the, 471 Coryza, 245 Cough, 247 hooping, 253 Coup de soleil (see Exposure to Heat), 540 Coxalgia, 464 Coxagra, 464 Cramps in the legs, 486 Croup, 259 Crustalactea, 611 Crying and wakefulness of new-born infants, 609 Cynanche tonsillaris, 138 maligna, 144 pharyngea, 147 laryngea, 259 tracheitis, 259 Cystitis, 402 Deafness, congestive, 477 nervous, 477 catarrhal, or rheumatic, 477 from the repercussion of eruptions, 477 after scarlatina, 477 from the abuse of mercury, 477 Death, apparent, 542 Deficiency in the secretion of milk, 594 Derangement of the stomach, 160 Derangements during teething, 625 Derbyshire neck, 487 Deterioration and discoloration of milk, 595 Determination of blood to the abdomen, 186, 467 chest, 264 head,314 Delirium tremens potatorum, 329 Diabetes, 412 mellitus, 412 insipidus, 412 Diarrhoea, 187 biliosa, 187 mucosa, s. pituitosa, 187 stercoralis, 187 serosa, 187 lienteria, 187 INDEX. 637 Diarrhoea torminosa, 188 during pregnancy, 567 in lying-in women, 588 neonatorum, 614 Diaphragmitis, 300 Diet during pregnancy, 563 rules for, lxi to be observed in fevers, 65 during nursing, 601 Difficulty of discharging the urine, 403 Dilatation of the heart, 374 Discharge of blood from the urethra, 416 Disease of the conglobate glands, 381 venereal, 426 Diseases of the heart, 346 valves of the heart, 374 Disinclination of the infant to suck, 592 Dislocations, 536 Dispensation, and the preservation of homoeo- pathic medicines, lvi Dispositions, lviii Dose and its repetition, xxiv Dreams (see Sleeplessness), 491 Dropsy, 510 of the belly (see Ascites), of the pericardium (see Pericarditis, chronic). ovarium, 559 of the cellular.tissue, 513 chest, 516 brain, 627 head, 627 Duration of confinement, 584 suckling, 603 Dysecoia, or deafness, 477 Dysenteria, 191 alba, 191 rubra, 191 rheumatico-catarrhalis, 192 inflammatoria, 192 biliosa, 192 putrida, 192 Dysentery, 191 suppressed, 196 rules of conduct and diet in, 196 Dysmenorrhoea, 556 Dyspepsia, 149 Dysuria, 405 Ears, inflammation of the, 475 Earache, 475 Eclampsia typhoides, 93 Ectropium, 474 Eczema facei, 611 Emansio mensium, 552 Employment of the mind and Habits during pregnancy, 564 Encysted hydrocele of the spermatic cord, 425 Endocarditis, 355 Entropium, 474 Enteritis, 223 Encephalitis, 318 Ephialtes, 499 Epilepsy, 332 Epilepsia, 332 Epiphora, 472 Epistaxis, 478 Evacuations, abnormal, colour ot the (see Diarrhoea in Infants). Eructations, 160 Eruptive fevers, 106 Erysipelas, 376 Erysipelas bullosum, 376 phlegmonodes, 377 cedematodes, 377 erraticum, 377 pseudo, 378 gangrenosum, 378 scroti, 378 infantum, 621 Excessive secretion of milk, 585 Excoriation of the nipple, 592 Excoriations, 620 Excoriationes neonatorum, 620 Exercise of children, 606 Exostosis, 520 Exposure to heat, 540 Eyes, acute inflammation of the, 468 inflammation of, in infants, 607 Eye, fungus haematodes of the, 471 weeping or watery, 472 bloodshot, 472 Eyelids, inflammation of the margins of the, 473 catarrhal inflammation of the, 473 Face, swelled, 571 warts on the, 475 Face-ache, 335 Face-ague, 335 Fainting, 508 and hysterical fits, 567 Falling off of the hair, 589 False pains, 578 Falstaff belly, 588 Fatigue, 539 Favus confertus, 387 Febres, 65 intermittentis, 85 Febris simplex, 68 inflammatoria simplex, 68 synochalis, 68 nervosa, 71 nervosa versatilis, 76 nervosa stupida, 77 lenta nervosa, 85 hectica, 99 gastrica biliosa, 105 pituitosa, 102 mucosa, 102 dysenterica, 191 helminthiaca, 229 bullosa, 391 rheumatica, 456 Feet, sweating, 487 Females, diseases of, 552 Fevers, 65 simple or ephemeral, 68 Fever, general treatment of, 67 inflammatory, 68 synochal, 68 nervous, 71 slow, 71 typhus, 71 congestive, 72 putrid, 82 pestilential, 82 malignant, 82 jail, 84 camp, 84 petechial, 84 intermittent, 85 marsh, 88 remittent, 97 yellow, 97 638 INDEX. Fever, hectic, 99 mucous, 102 contagious, 84 gastric, 105 bilious, 105 eruptive, 106 scarlet, 107 catarrhal, 238 rheumatic, 456 Fistula in ano, 179 lachrymalis, 472 Fistula? in perinaeo, 410 Fractures, 537 Flatulence in infants, 610 Flatulency, 163 Flatulentia, 163 Flatus, 163 Furunculus, 378 malignans, 379 Fungus haematodes of the eye, 471 Gangrena oris, 482 Gastric fever, 105 Gastrodynia, 164 Gastralgia, 164 Gastritis, 221 Giddiness, 316 Glands, conglobate, disease of, 381 Glandular swellings, 381 Gleet, 450 Glossitis, 484 Goitre, 487 Gonorrhoea, 416, 450 glandis, 451 Gout, 454 Gravel (see Haematuria), 414 Gum-boil, 484 Gums, hemorrhage from the (see Cancrum oris and Odontalgia). Haematemesis, 169 Haemorrhage from the bowels (see Piles). Haemorrhagia pulmonum, 301 Haemoptysis, 301 Haematuria, 414 Haemorrhagia urethrae, 416 Head, determination of blood to the, 314 Head, cold in the, 345 water in the, 627 dropsy in the, 627 Headache, 338 Heart, diseases of the, 346 valves of the 375 dilatation of the, 374 acute rheumatism of the, 375 Heartburn, 169 Heat, exposure to, 540 spots, 622 Hectic fever, 99 Helminthiasis, 229 Hemicrania (megrim), 338 Hemorrhoids, 174 with mucous discharge, 177 Hemorrhage from the lungs, 301 Hepatitis, 215 chronica, 217 Hernia, 499 humoralis, 422 Herniae incarceratae, 503 Herpes circinnatus, 387 serpigo, 387 zoster, 393 preputialis, 439 Hip, pain in the, 464 gout, 464 rheumatism in the, 464 disease, 466 Hoarseness, 243 Homoeopathic attenuations, xlvi Hooping cough, 255 second, or convulsive stage, 257 Hordeolum, 473 Humid asthma, 313 Hydrocele, 424 funiculi spermatid, 425 encysted, of the spermatic cord, 425 cystata funiculi spermatid, 425 tunica vaginalis, 424 Hydrops, 510 pectoris, 516 thoracis, 516 Hydrothorax, 516 Hydrophobia, 545 Hydrocephalus membranarum et ventriculo- rum, 627 Hypertrophy of the heart, 374 Hypopium (see Ophthalmia gonorrhoeal), 471 Hysterics, 556 Hysteria, 556 Ictus solis (see Coup de Soleil), 540 Icterus, 218 neonatorum, 621 Ignis sacer, 393 Ileo typhus, 73 Ileus, 224 Index table of the medicines contained in this work, lxiii Incontinence of urine, 411 Induration of the cellular tissue, 621 Incubus, 499 Indigestion, 149 Infantile erysipelas, 621 remittent fever, 630 Influenza, 262 Inflammatory fever, 68 Inflammation of the oesophagus, 147 spleen, 219 stomach, 221 bowels, 223 peritoneum, 228 arteries, 376 mucous membrane of the bronchial tubes, 266 lungs, 272 pleura, 292 brain and its tissues, 318 larynx, 242 kidneys, 400 bladder, 402 urethra, 416 glans penis, 421 testes, 422 testicle, 451 psoas muscle, 462 margin of the eyelids or meibomian glands, 473 ears, earache, 475 tongue, 484 ovaries, 558 labia majora, and vagina, 559 womb, 590 breasts, 593 IND EX. 639 Inflammation of the eyes in new-born infants, 607 Inflammatio uteri, 590 Influence of external objects on the unborn in- fant, 564 Intermittent fever, 85 Intertrigo, 390, 620 Internal or uterine swelling and prolapsus, 589 Invermination, 229 Irritation or itching of the skin, 386 Iritis arthritica, 471 mercurialis, 471 Irichiasis, 474 Irregularities of the lochial discharge, 587 Ischuria, 403 Ischias, 464 Itch, 383 watery, 385 Jail fever, 84 Jaundice, 218, 621 Kidneys, inflammation of, 400 Knee, affections of the, 467 Labour, remedies before, 577 tedious or complicated, 579 Laryngitis, 242 chronic, 244 Larynx, inflammation of the, 242 Laryngismus stridulus, 629 Lead colic (see Colic and Palsy), 327 Legs, cramp in the, 486 Leucorrhoea after parturition, 589 Lienteria, 187 Liver complaint, 214 acute inflammation of, 214 chronic inflammation of, 217 Lips, swelling of the, 475 Lippitudo, 473 List of medicines adapted to particular tem- peraments, lviii Lochial discharge, 587 Lockjaw of infants, 622 Loins, pains in the, 510 Looseness of the bowels, 187 Lues venerea, 426 Lumbago, 462 Lumbo-sacral pains, 572 Lungs, inflammation of the, 272 hemorrhage from the, 301 Luxations, 536 Lymphatic tumours, 381 Mamma, diseases of the, 593 Marsh fever, 88 Malignant quinsy, 142 putrid or gangrenous sore throat, 142 Measles, 124 repercussion of the eruption in, 125 Meconium, expulsion of, 599 Menorrhagia, 555 Mental emotions, 550, 564 affecting the milk, 594 Mcnstruatio nimia, 555 Menstruation, 566 Meningitis spinalis, 325 Metritis. 590 Mictus cruentus, 414 Milk, regurgitation of the, 610 crust, 611 scab, 611 Milk blotches, 611 fever, 586 Miliara, 132 alba, 132 purpurea, 111 Miliary fever, 132 Miliaris, Hahnemanni, 111 sudatoria, 132 repercussion of the eruption, 133 Miliformis papulosa, 111 Miscarriage, 573 Moist asthma, 330 Morbus, sacer, 332 caducus, 332 divinus, 332 herculeus, 332 comitialis, 332 coxarius, 466 cerealis, 93 Mouth, canker in the, 482 scurvy in the, 482 Morning sickness, 566 Mothers not suckling their children, 595 Mucous fever, 102 Mumps, 148 Myelitis, 325 Myopia, 473 Nature and form of Homoeopathic medicines, xxix Navel rupture in infants, 598 soreness of the, 599 Necrosis, 520 Nearsightedness, 473 Nephritis, 400 Nervous fever, 71 Nerve pain, 335 Nettle rash, 134 Neuralgia, 335 facialis, 335 Nightmare, 499 Nipples, excoriation of the, 592 Nodes, 451 Nose, swelling of the, 480 caries of the bones of the, 481 Notalgia, 510 Observations on pregnancy, 560 Obstacles to suckling, 592 Obstructio alvi neonatorum, 613 Obstipatio, 171 Obstipation, 171 Obstructio alvi, 171 Occulta, 290 Odontalgia, 135 Oesophagitis, 147 Opacity, 472 Ophthalmia, 468 syphilitic, 435 catarrhal, 471 rheumatic, 471 sclerotitis, 471 scrofulous, 471 syphilitic, 471 sycosic, 471 gonorrhceal, 471 Orchitis, 422, 451 Otalgia, 475 Otitis, 475 Otorrhcea, 476 catarrhal or mucous, 477 purulent, 477 sanguineous, 477 640 INDEX. Otorrhoea, suppressed, 477 Ozaena, 481 Offensive breath, 486 Ostitis, 520 Overheating, 540 Ovaritis, 558 Ovarian disease, 559 Palsy, 327 Paralysis of the Brain (see Scarlatina, Water on the Brain, and Dentition). Paralysis of the chest (see Scarlatina). Paralysis, 327 Painters' colic, 327 Panaris, 385 Paronychia, 385 Parotitis, 148 Paraphimosis, 438 Pain in the hip, 464 Pains in the loins, 510 back during pregnancy, 572 Parulis, 484 Passio hysterica, 556 Parturition, 579 Pemphigus, 391 Pendulous belly, 588 Penis, inflammation of the, 421 Pericarditis, 346 Peritonitis, 228 Peritoneum, inflammation of the, 228 Periostitis, 522 Peripneumonia, 272 notha, 290 Perniones, 380 Perspiration after delivery, 585 Pertussis, 255 Pestis, 95 Pestilential fever, 82 Petechial fever, 84 Pharyngitis, 147 Phenomena of Asiatic cholera as it appeared in this country, 205 Phimosis, 438 Phthisis laryngea, 244 pulmonalis, 305 Phrenitis, 318 Pharmaceutical signs, xviii Piles, 174 Plague, 95 Pleura, inflammation of the, 292 Pleurisy, 292 spurious or bastard chronic (see Pleurisy), 299 Pleurodynia, 299 Pleuritis, 292 muscularis, 299 Pneumo-typhus, 73 Pneumonia vera, 272 chronic (see Pneumonia). typhoid or congestive, 291 Pneumonitis, 272 Podagra (see Gout), 454 Poictou, colic of, 327 Porrigo scutulata, 387 lupinosa, 390 furfurans, 390 favosa, 390 decalvans, 390 larvalis, 611 Polysarcia, 588 Pompholyx, 391 Pot-belly, 588 Potencies of the medicaments, xx Potency, attenuation, or dilution of the medi- cament, xxi Pregnancy, observations on the, 560 Preparation of the breasts, 576 of attenuations, lii of medicines in their primitive state, xxxix Preservatives, rules for the selection of, xxxix Prohibited aliment, Ixii Proctalgia, 182 Protrusion of the intestine, 182 Prolapsus ani, 182 uteri, 589 Prosopalgia, 335 Prostatitis (see Haematuria). Prurigo, 386 Pseudo-Pleuritis, 299 Psora, 383 Psoriasis, 391 Psoitis, 462 Psoas muscle, inflammation of the, 462 Puerperal convulsions, 581 Pulmonary catarrh, 266 consumption, 305 Pulmonitis, 272 Purpurea rubra, 111 Pustula nigra, 378 Pustular ringworm, 387 Putrid fever, 82 Pyrosis, 169 Quinsy, 138 sphacelated (see Quinsy). Rachitis, 526 Ranula, 485 Raphania, 93 Rash, scarlet, 111 nettle, 134 Raucitas, 243 Rectum, stricture of the, 177 Regurgitation of milk, 610 Regimen, xviii Remedies before labour, 577 Remarks, xxviii Remittent fever, 97 Retention of urine, 403 Rheumatic fever, 456 Rheumatism, 456 without fever, 460 chronic, 461 in the hip, 464 in the head (see Headache and Rheumatism). Rickets, 526 Ringworm, herpetic or vesicular, 387 of the scalp, 387 pustular, 387 Rose, 376 Rubeola, 124 Rupture, 499 Sarcocele, 422 Scabies, 383 papuliformis, 384 purulenta, 384 lymphatica, 385 Scald head, 387 Scalds, 538 Scarlet fever, 107 rash, 111 Scarlatina anginosa, 109 miliaris, 111 INDEX. 641 Sciatica, 463 Scirrhus, 475 Scorbutus, 483 Scrofula, 518 Scurvy, 483 in the mouth, 482 Sea-sickness, 541 Shingles, 393 Short sight, 473 Simple or ephemeral fever, 68 Skin, irritation or itching of, 386 Sleeplessness, 488 of infants, 604 Slow fever, 71 Small-pox, 127 confluent, 127 repercussion of the eruption in, 130 modified, 131 diet to be observed in, 131 Sore throat, or quinsy, 138 aphthous, 138 Spasmodic pains during labour, 581 asthma, 611 Spasms in the chest, 611 Specks on the cornea, 471 Sprains, 528 Spleen, inflammation of, 219 Splenitis, 219 Spitting of blood, 301 Spinal cord, acute inflammation of the, 325 Sputum cruentum, 301 Spurious peripneumony, 290 or bastard pleurisy, 299 St. Anthony's fire, 376 Stings of insects, 540 Stools of abnormal colour (see Diarrhoea in Infants). Stomach, inflammation of the, 221 derangement of the, 160 spasm of the, 164 Stomacace, 482 Strabismus. 472 Strains, 529 Stranguria, 405 Stricture of the rectum, 177 urethra, 409 Stye, 473 Stymatosis, 416 Suckling of the infant, 600 Sudor miliaris, 132 Suffocating breast-pang, 342 Suppressed dysentery, 196 secretion of milk, 584, 594 perspiration after delivery, 585 Suppression of urine, 407 Suppressio mensium, 554 Supplementary diet of infants, 602 Sweating feet, 487 Swelled testicle, 422 face, 571 Swelled veins, 571 Swelling of the lips, 475 of the nose, 480 of the head in infants, 598 Swooning, 508 Sycosis, 440 Syncope, 508 Synopsis of the rules for diet, lxi Synocha, 68 Synochal fever, 68 Syphilis, 426, 453 secondary symptoms of, 427, 434 in infants, 437 41 Syphilitic ophthalmia, 435 Syphilidrs, 427 Table of medicines with abbreviations, Ixiii Tabes mesenterica (see Atrophy). Tears, involuntary flow of, 472 Tedious or complicated labours, 570 Teething, or derangements during, 625 Temperaments, xxiii Testis, inflammation of the, 422 Testicle, swelled, 422 inflammation of the, 451 Tetanus, 327 Thrush,612 Tic douloureux, 335 Tinea capitis, 387 annularis, 387 Tinea faciei, 611 Toothache, 135, 568 Tongue, inflammation of the, 484 Tonsillitis phlegmonoides, 138 maligna, 144 Tophus (see article Ostitis). Tracheitis (see Croup). Treatment after delivery, 582 of infants and children, 596 after birth, 597 Trichiasis, 474 Trismus nascentium, 622 Tumours, lymphatic, 381 Tussis, 247 convulsiva, 255 Tympanitis intestinalis, 163 Typhoid or congestive pneumonia, 291 Typhus cerebralis, 73, 76 biliosus, 73 gastricus, 73 pulmonalis, 73 abdominalis, 77, 82 sequela? of;—decubitus, metastatic abscess, furunculi, diarrhoea, night- sweats, oedema of the feet, intesti- nal ulcerations, 81 malignant, 82 putridus, 82 abdominalis, 82 contagious, 84 contagiosus, 84 accessory treatment, prophylaxes in, 84 pestilentialis, 95 icterodes, 97 Ulcera, 394 Ulcerated sore throat, 144 Ulcers, 394 phagedenic, 397 scrofulous, 397 putrid, 397 gangrenous, 397 carcinomatous, 397 fistulous, 397 mercurial, 397 syphilitic, 398 indolent, 398 Ulcer of the rectum (see Stricture of the Rec- tum), 177 Urethra, stricture of the, 409 discharge of blood from the, 416 inflammation of the, 416 Urethritis, 416 Urethrorhagia, 416 Urine, retention of, 403 642 INDEX. Urine, difficulty in discharging, 405 suppression of, 407 incontinence of, 411 Urinary abscess and fistula, 410 Urticaria, 134 Vaccination, 634 Vagina, inflammation of the, 559 Varices, 571 Varicella, 131 Varicocele, 423 Variola, 127 spuria, 131 Vehicles which serve for the preparation of homoeopathic medicines, xxxii Venereal disease, 426 Vomiting of blood, 169 Wakefulness of new-born infants, 609 Want of appetite, 157 Warts on the face, 475 Water brash, 169 Watery itch, 385 Water in the head, 627 Weakness after delivery, 591 Weaning, 603 Weeping, or watery eye, 472 Whitlow, 385 Womb, inflammation of the, 590 Worms, 229 Wounds, 529 incised, 529 lacerated, 531 contused, 531 punctured, 532 gunshot, 533 poisoned, 533 Zona, 393 THE END. ** * '»% »* i*fc *;■&*<$ (ipvv W^ " '*«'"■■ '" *■* •X". • *6 i.'■'-, r*v... W rff '"^f €.*• 4^ ■•* w K&f&i to