i^cU— ELEMENTS OF HO MYOPATHIC PRACTICE OF PHYSIC: *, AN APPENDIX TO -"V DR. A. Gr. HULL'S LAUEIE'S " HOMEOPATHIC DOMESTIC MEDICINE." ARRANGED AS A PRACTICAL WORK FOR STUDENTS. CONTAINING ALSO THE DISEASES OF THE nRINARY AND GENITAL ORGANS. « 10^7i-Q>.% •OB-K^fcgAjC*-^ NEW-Y< WILLIAM RADDE, 322 BROADWAY. 18 50. I LlSU^ **. '•**'' ENTERED According to Act of Congress, in the year 1849, by WILLIAM fiADDE, In the Clerk's Office of the District Court of the Southern District of New-York. ,- 17 371 247 ib. Table of medicines with ab- breviations . Teething, derangements du- ring .... Testis, inflammation of the Testicle, swelled inflammation of the 247 Toothache . . .360 Tongue, inflammation of the 302 Tussis . . . 124 Typhus pestilentialis . . 37 icterodes . . 40 Ulcers . . . .215 Ulcer of the rectum (see Stricture of the Rec- tum Urethra, stricture of the discharge of blood from the . inflammation of the 239 Urethritis . . . . ib. Urethrorrhagia . . . 238 Urine, retention of . .219 difficulty in discharging 222 suppression of . . 225 incontinence of . . 230 Urinary abscess and fistula 229 81 227 238 Vagina, inflammation of the Varicocele Venereal disease 359 249 253 364 351 Ub WILLIAM RADDE, PUBLISHER, 322 BROADWAY, NEW-YORK. . HOMOEOPATHIC MEDICINES. Win. Radde, 322 Broadway, New-York, respectfully informs the Homcec-» pathic Physicians, and the friends of the System, that he is the sole Agent for the Leipzig Central Homoeopathic Pharmacy, and that he has always on hand a good assortment of the best Homoeopathic Medicines, in complete sets or by single vials, in Tinctures, Dilutions and Triturations; also, Pocket Cases of Medicines; Physicians'' and Family Medicine Chests to Laurie's Domestic (60 to 82 Remedies)—EPFS (58 Remedies)—HERING'S (82 Remedies).—Small Pocket-Cases, at $3, with Family Guide and 27 Remedies.—Cases containing 415 Vials with Tinctures and Triturations for Physicians.—Cases with 260 Vials of Tinctures and Triturations to Jahr's New Manual, or Symptomen-Codex.—Physicians' Pocket Cases with 60 Vials of Tinctures and Triturations.—Cases from SCO to 300 Vials with low and high dilutions of medicated pellets.— Cast s from 50 to 80 Vials of low and high dilutions, etc., etc. Homoeopathic Chocolate. Refined Sugar of Milk, pure Globules, etc. Arnica Tincture, the best specific remedy for bruises, sprains, wounds, etc. Arnica Plaster, the best application for Corns. Vrtica urens, the best specific remedy for Burns. Also, Books, Pamphlets, and Standard Works on the System, in the English, French, and German lan- guages. INTRODUCTION. NATURE AND FORM OF HOMCEOPATHIC MEDICINES. We make use of the same simple substances in homoeopa- thy 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 ad- mixture which might alter its proper virtues. Without going into detail here on the preference to be given to this mode of ad- ministration, we should, nevertheless, observe, that it is bound to the principle of homoeopathy in so firm a manner, that it can- not 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 expe- rimented 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 produc- tions of nature exhibit at all times and in every place the same properties. In thus rejecting all the compound remedies of the old school, as improper 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 the contrary, her medicines from three kingdoms of nature, the same as the old school, and all the various chemical combina- tions, which, after invariable laws, are constantly produced in the same manner, can be of use to it as remedial means. In one word, the simplicitv of homoeopathic preparations, 1 2 INTRODUCTION, 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 sub- stance be as pure and as develope 1 as possible. 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 ex- cept by the destruction of the primitive matter, and the addi- tion of another substance, which in quality of simple vehicle, re- ceives 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 dispen- sation as preservation, and which, in consequence, equally exacts the addition of foreign substances in order to be conveniently prepared for use. The preparation and administration of medicines being then impossible under any mixture, it is important to discover sub- stances 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, per- haps, 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 medi- cine with which it may be mixed. Even pure water, the sub- stance the most innocent that we know, is not completely ex- empt 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 INTRODUCTION. 3 other vehicles, viz. : 1. Alcohol or spirits of wine, for the pre- paration of liquid or soluble substances ; 2. Sugar of milk, for the preparation of dry substances ; and though these two sub- stances are not entirely void of medicinal effects, the practi- cal 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. By means of these two substances, pure alcohol and sugar of milk, homoeopathy makes all its medicinal preparations, with- out 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 in- fusing in this liquid the dry substances, the active principles of which can be extracted in this way. The powders, on the other hand, are obtained by the trituration of the insoluble substances with a suitable quantity of sugar of milk. The alcoholic tinc- tures 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. 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 ob- tain this end by the simple attenuation of the primitive sub- stance. 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 atfenua'ionsof which the following one contains ordinarily the 100th or sometimes the 10th part of the active principle of the preceding one, and it is generally from one of these attenua- tions, and rarely from the primitive preparation of a medicine, that the homoeopathic physician administers to his patients. 4 INTRODUCTION. Finally, as to the form under which the homoeopathic physi- cian dispenses his medicines, it is not less simple than the pre- paration, and is equally made without any other mixture, than that of the least medical substances, such as alcohol, pure water, sugar of milk, and globules composed of sugar and sugar of milk. The attenuations of each medicine being previously pre- pared, 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. OF HOMCEOPATHIC ATTENUATIONS. In speaking of the nature and form of homoeopathic medi- cines, instead of correcting the too energetic effects of some substances by the addition of another medicinal substance, ho- moeopathy seeks to mollify them by the preparation of a series of attenuations, in which the medicine is found mingled in the vehicle but in a very small proportion. In the commencement of his medical career, Hahnemann limited himself in these at- tenuations to 1 to 100 ; that is to say, in mingling a very small quantity of the concentrated substance with a quantity 100 times larger of a substance non-medicinal; but seeing that these preparations often acted too powerfully still, he soon went fur- ther, and prepared a second, and then a third attenuation, in mingling for the second the 100th part of the first, and for the third the 100th part of the second with 100 parts of the vehi- cle. This third attenuation, though only containing the medi- cine in the proportion of 1 to 100-3, or of 1 to 1 000,000, Hahnemann still found at times too active, which induced him to carry the attenuations yet further, and to go from attenua- tion to attenuation, in order to find the one the most appropri- ate. It is thus that, latterly, he has carried the number of at- tenuations, for all the medicinal substances without distinction, up to 30, so that, in this last attenuation, the medicine is found mingled with the vehicle but in the proportion of 1 to 100-30 or of 1 to 1,000,000-10. INTRODUCTION. 5 However absurd the first view of these infinitesimal attenua- tions may appear, it is not the less true that, even the 30th, far from having lost all efficacy, often shows itself too energetic; and Dr. Korsakow, of St. Petersburg, who has carried the attenua- tions as high as 1500, has declared the same fact as to the last preparation of his series. In effect, on examining attentively the degree of intensity with which the various homoeopathic at- tenuations act, we may easily perceive that the diminution of their energy is in no way proportioned to the diminution of their matter. On the contrary, many substances which, in their state of concentration, have little or no action on the body, as lycopodium, vegetable charcoal, etc., often become very active at the second or third attenuation, so that we are almost inclined to believe that the mode of preparation adopted by Hahnemann rather contributes to develop than to weaken the virtues of medi- cines ; or, at any rate, to render them more apt to exercise, in the smallest doses, their influence on the organism. Hence Hahnemann has, for a long time, ceased to look upon these pre- parations as dilutions, in the true acceptation of this word; and if, at the present time, he wishes all the medicines to be carried to the 30th attenuation, it is only in the supposition that by this procedure they can best develop all their active principles,* and become more suitable for practice. To explain the extraordinary fact of the%fficacy of his atten- uations, Hahnemann has endeavoured to set down as a princi- ple, that the more we destroy the material parts of a substance, so much the more we developer loosen the dynamic force, or, in other words, the spirit of the medicine; and that, to augment the energy of preparations to an incredible extent, we have only to carry them from attenuation to attenuation, in submit- ting them at the same time to a great number of triturations and shakes. If this principle were conformable to experience, it would result that, from a substance, for example, of which one grain would be sufficient to cause death, the same dose of the 30th attenuation would produce the same effect in a much more certain manner; which, however, is not the fact. If we would * Or be more readily received into the system in consequence minute subdivision or segregation of the particles.—J. L. 6 INTRODUCTION. even limit this principle to those substances which only exhibit their virtues by attenuation, it is still equally adverse to observa- tion that the 30th attenuation, for example, of these substances, have an action absolutely more energetic than the 6th, 12th, 15th, etc. On the contrary, to judge from the experience of many homoeopaths, the degrees of energy among the attenua- tions of a medicine are so small, that thus far a decision has not been formed with certainty whether it is the first or the last at- tenuations which exhibit the strongest action, This is the rea- son why, in admitting the efficacy of the attenuations, many ho- moeopaths have rejected the explanation given by Hahnemann, and have considered the procedure by which they acquire their efficacy as analogous to the infection by miasm. According to them, the active principle of the drug being set free by the de- struction of the matter, it communicates itself to the vehicle, which thereby becomes infected and as active as the drug itself. As to the comparison with miasms, this last opinion is, with- out contradiction, that which merits the most attention; but the explanation it gives is far from satisfying all demands, since, instead of explaining the difficulty, it refers it to another order of facts, which, though generally admitted, are not, however, themselves yet explained. Miasm, though being an imponder- able bodv, it is noMhe less for that, a body ; that is to say, matter, and amenable to the laws of matter. Now, every action of matter, whether mechanical or dynamical, is proportionate to the quantity of active atoms which a given volume presents; and every one knows, that not only a large stone weighs more than a small one, but also that a magnet of considerable volume is capable of developing and of manifesting a much stronger ac- tion than another which is less voluminous. If, then, we would pretend that there is manifested somewhere the action of a body, either ponderable or imponderable, we are abso- lutely obliged to admit also the presence of a certain quantity of atoms ; and, what is still more certain, is, that as this quan- tity diminishes in a given volume, the action of it will also dimi- nish in energy. Thus we see that, even should we prove that 'our attenuations, to be able to act, only require to be impreg- nated with imponderable particles, like miasms, we shall still INTRODUCTION. 7 have accomplished nothing in demonstrating that their energy does not diminish in proportion to the loss of matter which they suffer; or in explaining how an attenuation, for example, which contains but the billionth part of the medicinal atoms of another, manifests an intensity not only equal, but often also superior to that of this last. These facts are, however, such as we cite them; and. per- haps, we should not have found anything astonishing if, at the * beginning, we had reflected better on the manner in which our medicines act in general, and on the changes which substances undergo by our mode of preparation. We ought to have no- ticed that each medicinal dose contains a great number of atoms which are perfectly inactive, in consequence of their being shut up in the interior of the molecules, and not brought into contact with our organs; it therefore follows, that every time we, by any means whatever, come to divide these molecules into smaller corpuscules, and thus augment their whole surface, the energy of the dose will so increase that the smallest part will become capable of exercising an influence, if not superior, at any rate equal to that of the entire dose in its primitive con- dition. It is thus that Dr. Doppler, of Prague, has explained the efficacy of our attenuations; and such is, according to him, the effect which the infinite division produces on the molecules, that if the molecules of a fine powder are, at the dose of 5 cen- tigrammes (1 grain), in a condition to constitute, by the sum of their surface, a total superficies of 100 metres square, and if each trituration of 20 minutes only divided each molecule into 100 lesser corpuscules, the molecules of the 30th attenuation would be so divided that, at the dose of one drop only, they would occupy, by the sum of their surfaces, a total superficies of many millions of decametres square. If this calculation, which any one can easily verify, is just, there is nothing, in truth, more easy than to conceive, not only how the 30th attenuation may yet be able to exhibit efficacy, but also how a single globule of this attenuation may still have virtue enough to render a tumbler of water almost as energetic as the pure drug. For let us suppose that the total superficies of a drop of the 30th attenuation can cover, by the surfaces of 8 INTRODUCTION. its infinitely small molecules, even only four thousand deca- metres square, on imbibing with this drop 200 sugar-globules, each globule will contain enough to cover a superficies of at least 200 metres square, and will act, in consequence, with a force not less than that which ten centigrammes (2 grains) of a non-attenuated substance would exhibit, but which will be re- duced to a powder fine enough for the molecules of each centi- gramme to cover a total superficies of 20 metres square. Now, if one globule of the 30th attenuation has such power, it is clear that, in dissolving it in a volume of 8 spoonfuls (4 ounces, or 120 grammes) of water, the preparation we shall obtain will in no instance be less efficacious than a mother tincture, which, in 30 grammes (one ounce) of liquid, will con- tain 5 centigrammes (one grain) of the preceding, and dissolved so that the molecules of this grain may cover a total super- ficies of 500 metres square. All these calculations are, it is true, not rigorously exact; but if there is error, it is rather on account of having placed the ciphers too low than too high; and if we suppose, which is more than probable, that each tri- turation of 20 minutes changes each molecule of the primitive substance into more than two or three smaller corpuscules, the result will be still more astonishing. Arguments have been raised against homoeopathic prepara- tions, that if the influence exercised by trituration and succus- sion were really such as the homoeopaths pretend, the energy of the attenuations ought not only to increase with the number, but also increase in a prodigious manner, since more powerful means are employed in each attenuation to effect the division of the molecules. This is undoubtedly true in principle, and we should daily obtain practical evidence of the fact, were it always possible to make use of the increase in surface which a given volume has gained in the said manner. But the total surface which, after the usual triturations and successions, a single globule of the 20th attenuation would afford is really so vast, that if time be not allowed, it will never find sufficient space in the organs to develop itself so that all its infinity of molecules can enter into action; and it is thus that all that we could add to this quantity of molecules would only increase the INTRODUCTION. 9 number of those which remain inactive. This is the explana- tion, also, why two, three, or four globules, and even a whole drop of an attenuation, often appear to produce no more effect than a single spoonful of a solution of a globule in eight spoon- fuls of water ; and if we seek the reason why these last atten- uations are not distinguishable from the first by any other qua- lity th n that of a more prolonged action, it is still in the same way that we j^iall find the means to account for it. There arc, however, certain substances whose energy really augments in a sensible manner as the attenuations advance, and which, often altogether inert in their natural condition, become by this method of preparation not less active than the most energetic medicines. Such are those substances which, even in the state of the finest powder, have probably their truly active molecules still shut up in a species of envelope, which prevents them from coming into immediate contact with the organs, and which the ordinary means of pulverization and of solution are incapable of destroying. For in rubbing, as is ordinarily done, the substances by themselves, the molecules of a powder, al- ready very fine, escape the force which tends to render them still finer, and it is only in"triturating them with another sub- stance, against the corpuscules of which they can be rubbed, that we can succeed in accomplishing an infinite division. But we shall only accomplish this in a very incomplete way, if, at the same time, we do not take care to separate the newly ob- tained particles as much as possible, in proportion as the tritu- ration increases the number; since the more the molecules remain agglomerated one with the other, so much the less easily will the whole be divided. This is the reason why many substances frequently do not seem to develop all their virtue till after three successive triturations, prepared so that each new trituration shall contain the 100th part of the preceding. What we have just said of the trituration of substances in powders, equally applies, in the same way. to the attenuation of liquid substances, and to the succussion of soluble sub- stances with a liquid vehicle. For though the molecules of liquids, on account of their globular nature, are absolutely in- capable of being divided by any kind of ordinary rubbing, 10 INTRODUCTION. being triturated with a vehicle in form of powder, or being treated by succussion with a liquid vehicle, they undergo, as well as solid substances, infinite division. The same holds good for all substances ordinarily insoluble in water or alcohol, whilst, by sufficient triturations, their molecules are sufficiently divided to be held in suspension between the molecules of these liquids; they then become abstracted not only from the law which held them in a state of aggregation, but being shaken with the vehicle, which has dissolved them, they also receive all the other ulterior divisions of which liquid sub- stances are susceptible. It is thus that, after the third tritu- ration, the attenuation even of metals may be continued, with- out the least inconvenience, by the succussion of these sub- stances with the liquid vehicles; and it is thus also that all the attenuations made in this way tend, as well as the triturations, to increase the resources of our doses, so that if we submit to new succussions, the solution made with a single globule of the 30th in 8 ounces of water, we may render this solution such that each drop of it shall form a dose much stronger than that of the globule which was dissolved in it. If then there is a method more than any other capable of furnishing energetic medicines, it is, without contradiction, the mode of preparation adopted by homoeopathy. As to the substances which, in their natural state, have their virtues already suitably developed, this proceeding will not, it is true, augment the energy of the usual doses of the school, since, as we have above said, there is scarcely a means of making use of all the resources which these doses may create; but the ad- vantage we shall derive from them will always be that of finding the attenuations of these substances, at the dose of a single globule, not only equally as efficacious as the entire dose of which they have been made, but also more appropriate in exercising a longer and more continued action. The same may be said of those substances whose virtues are latent, when their virtues have been fully developed; the attenuations made beyond this point cannot act with any more striking effect over the energy of usual doses, but the farther we carry them, the more we shall see that the smallest possible dose is still more INTRODUCTION. 11 than sufficient to produce all the effects that can be produced by medicines, given in the strongest usual doses; that may even be carried to the point that if, by simple mixture and without any succussion, we dissolve a single globule of a sufficiently high attenuation in a volume of three or four glasses of water, and even more, each teaspoonful of this mixture would still be equal to produce all that could be ob- tained from an entire drop of the ordinary medicinal prepara- tions. From this we see, that if we wish to obtain much from little (multum p°r pauca), it is indispensable to prepare the medicines after the prescribed method of homoeopathy ; whilst, if we wish to render the effects of the usual doses, at times already too violent, more prompt and more violent still, this proceeding will be not only useless, but altogether contrary to the end we propose. For though the resources of doses augment by this method of preparation, it is, however, not the less ascertained, that many substances also lose their primitive energy by attenuation, as for example, all poisons, which, as all homoeopaths well know, are much less to be feared in their attenuations than in their primitive state. This will even be the case with all substances whose molecules, besides the property of being easily absorbed and spread in the organism, have likewise that of undergoing a certain solu- tion or division. In the attenuations they will still possess the first of these properties ; but as soon as art has divided them more than the organism can do, none of the subsequent at- tenuations can, at a given dose, be in a state to furnish to the absorbing faculty as many active elements as the substance in its primitive condition. Up to this point the energy of doses will even gradually diminish ; whilst, this limit passed, their resources will augment in proportion as art shall operate, in the subsequent attenuations, the ulterior division of mole- cules, the same as that which takes place in other sub- stances. All the theoretic explanations which we have just given> would be entirely without value, if practice did not confirm all the facts which we have above mentioned. Many homoeopaths 12 INTRODUCTION. it is true, have supposed that they have observed that the last attenuations which they make use of do not always pro- duce effects conformable to those which they had the right to look for, if the theory, upon which this doctrine is based, were correct. But, according to our view, these exceptions are rather made to confirm the theory than to destroy it; above all, if we remember that these contradictory observations have been made for the most part by individuals who did not prepare the attenuations they employed,' or who did not con- form more or less exactly to the indispensable rules to be attended to in their preparation. For it is certain that if we neglect to produce in each new attenuations a new division of molecules, the first attenuations thus obtained may still have sufficient resources; but as we advance in this way, the more will they become exhausted. If the division of molecules in the first triturations has been carried to a sufficiently high degree, it is even possible that, without any new division, we may continue the simple partition of doses up to the 30th, without this last failing in its resources; but the preparations thus obtained will not the less be pure dilutions, and not dyna-> mizations, as they would be if, in each one, we had anew aug- _ mented the resources of the doses.* OF THE DISPENSATION AND PRESERVATION OF HOMOEOPATHIC MEDICINES. 1. Of the Dispensation of Homoeopathic Med'cines. Homoeopathic medicines are generally administered in the form of powder. To effect this, we mix the drop or the pre- scribed number of globules with a few grains of sugar of milk, and inclose it in a paper, to be administered to the patient either dissolved in a spoonful of water, or in the dry state. The sugar of milk being only intended in this case to act as the vehicle, and not to produce a new dynamization, we have no need of rubbing it up with the medicinal dose ; we should even guard against doing it, if we wish that this last should not act with too much force, since by doing so we should still increase * For preparing Homoeopathic medicines, see: Jahr's New Homoeo- pathic Pharmacopoeia and Posology. INTRODUCTION 13 the power. Again, should we wish this dose to act more promptly and with more energy, we dissolve it in a spoonful of water, which immediately develops m re powers, and presents them to the organs in a greater extension than when the dose is taken dry. In some cases also, in order to avoid the continued administration of a white powder, which might in time become disgusting to the patient, we may add to the sugar of milk a small portion of the powder of cocoa, liquorice, or salep ; these powders will give to the doses another colour, without interfer- ing in the least with their virtues. The quantity of sugar of milk we ought to add to the dose is usually two, three, or four grains; but for those patients who would not be satisfied with such small powders, we may add as much as they seem to wish. Another method, not less frequently made use of in homoeo- pathy, is to dissolve the dose we wish to administer in four or Bix ounces of water, and to give to the patient a single spoonful, or several, at intervals, more or less extended. As, in this case, the water is no more designed than the sugar of milk to aug. ment thepowers of the doses, but only to develop them, and render the reception easier, it would be equally adverse to the end proposed to submit this solution to new suecussions. In general, the best way to obtain these solutions is, to put the dosa in a bottle of a suffieiently large size to permit the wished- for quantity of filtered water to be poured on it, and to leave the medicine to dissolve of-itself; after which we give a few shakes to this solution, sufficient only to mingle the parts well, without, however, operating a new division of molecules. We will only add, that if for each solution we employ a new bottle, we shall do better than if we make the solution in a tumbler belonging to the patient himself ; for, notwithstanding the most careful re- commendations on the part of the physician, these tumblers are scarcely ever cleansed with sufficient care to prevent an alter- ation of the medicine by the particles which might remain of the preceding one. In cases where the imagination of the patient must be gratified, we add to the medicinal doses a few powders of sugar of milk alone.* Thus, for example, if we wish to give the patient six powders, of which three only contain the medicine (Aurvm for instance), we should write, if these powders are to be taken alternately, Aur. 3 15. No. 1. 3. 5. Pulv. sacch. lact. q. s. No. 2. 4. 6. » A procedure which is often necessary where patients have long been ■ccustomed to the daily use of medicine under allopathic treatment—J.L. 14 INTRODUCTION. Or else, if the first three are to contain the medicine : Aur. 3/ 15. No. 1. 2. 3. Pulv. sacch. lact. q. s. No. 4. 5. 6. A still more simple plan consists in not indicating the sugar of milk in the prescription, but placing the numbers which are to contain this vehicle behind those which are to contain the medi- cine, and separating them by the following sign (#) as for ex- ample : Aur. 3/15. No. 1. 3. 5. * 2. 4. 6. Or else • ' Aur. 3/15. No. 1. 2. 3. # 4. 5. 6. 2. On the Preservation of Homaiopathic Medicines. All the medicines, not excepting the powders, ought to be preserved in bottles; boxes afford too great access to air, and allow too much evaporation. For the alcoholic tinctures, cork stoppers are the best, since they adapt themselves to the bottle in a more exact manner than those of glass, and more effectu- ally guard against evaporation. As to very strong and very volatile substances, it is better to tie a piece of prepared blad- der over the stopper. Moreover, these stoppers ought to be changed from time to time, above all, those of bottles which contain metallic solutions ; and in general, we should not neg- lect to do so as soon as we discover that, their extremity begins to change colour ; for in the latter case, alcohol may, without this precaution, dissolve a little of their medicinal virtue, and impair the efficacy of the preparation. As nothing has more influence on the preservation of ho- moeopathic medicines than heat, the rays of the sun, and light of the day, we must be very careful to exclude these as much as possible. The action of the solar light and of the light of the day easily acidifies alcohol, and, besides, destroys the virtues of the medicines. This is the reason why we should preserve homoeopathic preparations in a cool and dark place, and assure ourselves, from time to time, that they are in a good state of preservation. As to substances and their dilutions, which are more especially sensible to the action of the light, as the prussic acid, phosphoric acid, &c, it is prudent to preserve them in bottles of black glass, or, at any rate, covered with black paper. Finally, it is also advisable to put the homoeopathic medicines particularly the acetate of lime, hepar sulphuris, barytes, and all the preparations which are preserved in the form of powder, beyond the reach of humidity,—as they .become deteriorated when exposed thereto. LIST OF MEDICINES which are well adapted to particular TEMPERAMENTS, CONSTITUTIONS, AND DISPOSITIONS. Lymphatic Temperament (characterized by superabundance of the hu- mours with repletion of the cellular tissue, giving a considerable bulk to the whole body, which is, moreover, distinguished by roundness of form, softness of the muscular system, fair hair, pale clear skin, and a lustreless, or hazy, inanimate eye. The circulation is slow, the brain inactive, and the passions languid). Merc., Sulph, Calc, Puis., Caps., China, Ars., Acid, nit., Bella , Hyos., Phosph., Hell., Dulc, Sep., Ant , Lye, Curb, v., Am., Dig., Con., Clem., Sil., etc. Sanguine Temperament (indicated by predominant activity in the circula- ting system, with a moderately full habit, soft skin, florid complexion, blue eyes, red, auburn, or yellow hair; corporal and mental activity). Aeon., Am., Bella., Calc., Hep., Merc., Cham., Nux v., Bry., Lack., Phosph., Ac. nitr., Ars., Cocc, etc. Bilious Temperaments. (By this term is meant that habit of body which is distinguished by black hair, dark eyes and skin, the latter generally in- clining to yellow, moderate fulness, but much firmness of flesh ; the coun- tenance strongly marked, and expressive of the great energy of character which this temperament obtains ; the passions violent, the pulse strong, hard, and frequent.) Aeon., Bry., Nux v., Cham., Cocc, Ars., Am., China, Sulph., Plat., etc. Melancholic Temperament. (A modification of the bilious, with less ac- tivity of the nervous and muscular systems ; black hair, dark complexion ; the disposition grave, meditative, suspicious, and gloomy. Derangement of the functions of the nervous system, with sluggish bowels, dry habit of body, hard, slow, and habitually contracted pulse, usually attend this, so to speak, abnormal modification of the bilious temperament.) Nux v., Loch., Sulph., Aurum, Staph., Veratr., China, Con., Grat., Mosch. natr., 16 LIST 07 MEDICINES. Phosph., Stann., Viol odor., Acid, nitr., Plat, Ambra, Ars , Bry., Sit., Puis., Sep., Magn. m., etc. Nervous Temperament. (Defined by fine thin hair, thin skin, small, at- tenuated muscles, paleness of countenance, aud often indifferent or delicate health. Predominant activity of the brain and entire nervous system ; suddenness and mutability of decision and judgment; quickness in muscular motion.) Aeon., Coffea, Bry., Cham., Nux v., Sep., Plat., Lack., Ac. nitr., Cocc, Ambr., Ars., China, Zinc, Cup., Ign,, Phosph., etc. Constitution or Habit of Body, Cachectic Ars., Sulph., Calc, China, Merc, Ac. nitr., Phosph., Sit., Natr. m.. Carb v. Am., etc. ----Debilitated or Exhausted : Ars., Sulph., Calc, Phosph., Phosph. ac. Ars., Carb. v., Nux v., China, Lach., Merc, Natr. m., Staph., Ac. nit., Sep., Veratr., Sit., Ant. c, Kali, Am., Can., etc. ----Dry : Bry., Nux v., Ac. nitr., Ambra, China, etc. ----Plethoric, Corpulent, Leuco-phlegmatic : Aeon., Bella., Calc, Arn., Baryt. c, Ant., Sulph., Puis., Hell., Merc, Sep., etc. Lean Habit of Body: Nux v., Sil., Lach., Ac. nitr., China, Ambra, Bry., etc. Disposition, Choleric : Bry., Nux v., Cham., Cocc, Aeon., Sulph., China, etc. ----Hypochondriacal: Nux v., Sulph, Staph., Veratr., Aurum, China, Con., Stann., Phosph., Grat., Mosch., Puis., Asa., Bella., Cham., Magn. m , Hell., Plumb., Mez., Val., Zinc, etc. ----Melancholy : Aeon., Ign., Natr. m„ Lach., Ars., Nux v., Bry., China, Sulph., Af«r„ Graph., Calc., Staph., Aur.,Lyc„ Plat., Puis., Veratr., Sil., Sep., Ac,nitr., Stram., Calc, Con., Chel., etc. ---- Mild (quiet, easy) : Puis., Ign., Ambra, Cic, Mag. arct., Stann., Sulph., Calad., Lye, Sil., etc. ----Phlegmatic, (inactive, inanimate, indolent): Caps., Cocc, Puis., Ac, phos., Sep., Anac , Ars., Hell., Bella., ScilL, Sil., Sulph., Zinc., Ac. mur., Natr. m„ Cyc, Euph., etc ---Sensitive : Ign., Cap., Phosph., etc. As we very frequently meet with mixed forms of temperament, such as a combina- tion of the sanguine and lymphatic, the nervous and lymphatic, and the nervous and bilious, forming the sanguine-lymphatic, the nervo-sanguine and the nervo- bilious temperaments, the remedies which correspond to the two pure varieties which form the compound one ought to be selected where possible, or those which correspond best to the more prominent development of temperament, when a medicament cannot be found which is equally well adapted to the two different temperaments forming the mixed variety. We must, of course, be guided by the entire morbid picture in making a selection from amongst the medicaments which are most applicable to particular temperaments. TABLE OF MEDICINES CONTAINED IN THIS WORK, TOGETHER WITH THE ABBREVIATIONS AND ANTIDOTES EMPLOYED. Remedies. 1. Aeon.—Aconitum napellus. 2. Act —Acta? spicata 3. iEth.—iEthusa Cynapium. 4. Aaar.—Agaricus muscarius. 5. Ago.—Agnus castus. 6. A1-—Ak'es. 7. Alum —Alumina. 8. Ambr —Ambra grisea. 9. Am- c—Ammonium carbonicum. 10. Am m.—Ammonium muriati- cum. 11. Anac.—Anacardium. 12. Anis.—Anisum stellatum. 13 Ang-—Angostura vera. 14. Ant-—Antimonium crudum. 15. Arg.—Argentum. 16. Am.—Arnica montana. 17. Art.—Artemesia vulgaris. 18. Ars —Arsenicum album. 19. Arum.—Arum maculatum. 20. Asa.—Asafcetida. 21. Asar.—Asarum enropsum. 22. Aur.—Aurum foliatum. 23. Aur. m.—Aurum muriat. 24. Bar. c —Baryta carbonica. 25. Bar. m —Baryta muriatica. 26. Bell.—Belladonna. 27. Berb.-Berberis vulgaris. 28. Bis—Bismuthum. 29. Bor—Borax veneta. 30. Bov.—Bovista. 31. Brom.—Bromi m. 32. Bry— Bryonia a'ba. 33. Bruc—Brucea anti-dysenterica. 34. Cal —Caladium seguinum. 35. Calc.—Calcarea carbonica. 36. Calc. ph.—Calcar. phosphorata. 37. Calend.—Calendula. 38. Camph.—Cam phora. 39. Cann — Cannabis. 40. Canths.—Cantharis. 41 Caps.—Capsicum. 42 Carb. an.—Carbo animalis- 43 Carb. v.—Carbo vegetabilu. Antidotes. 1. Acetum, Camph., Nux. v 2. Camph. 1 3. Vegetable acids. 4 Camph, Coff., Puis. 5. Camph. 6. Vinegar. t 7. Bry on , Cham., Ipec. 8. Cainph , Nux v., Puis. 9 Arn , Camph , Hep. 10. Ars , Camph., Con. 11. Camph , Coff. 12 Cham , Coff., Opium. 13. Camph. 1 14. Hep. s , Merc, Puis. 15. Merc , Puis. 16. Camph., Ipec, Verat. 17. Camph. 1 18. Camph., Op., (Sugar 1) 19. Vinegar. 2». Camph., China. 21. Camph., Vinegar. 22. Bell , China, Merc. 23. Merc. ? 24. Bell., Camph. 25. The white of an egg. 26. Coff , Camph., Puis. 27. Camph. 28. Calc. c, Caps., Nux v. 29 Cham , Coff. 30. Camph. 31. Opium, Coff. 32 Aeon, Cham, Nux v. 33. Cham., Coff, Op. 34. Caps. 35 Camph., Nitr. ac. 36. Camph. 37. Camph. 38. Opium, Vinegar. 39. Cam|ih. 40. Camph., Vinegar. 41 Camph. 42 Camph., Ars., Coff. 43. Ars , Coff., Camph. 18 TABLE 01 MEDICINES. Remedies. 44. Case.—Cascarilla. 45. Cast.—Castoreum. 46. Cans.—Causticum. 47. Cham.—Chamomilla. 48. Chel.—Chelidonium. 49. Cin—Cina. 50. Cic—Cicuta virosa. 51. Cinch., Chin.—Cinchona officinalis, China. 52. Cinn —Cinnabaris. 53. Cinnam.—Cinnamomum. 54. Cist.—Cistus canadensis. 55. Citr.—Citri acidum. 56. Clem.—Clematis erecta. 57. Coccion.—Coccionella. 58. Cocc—Cocculus. 59. Coff. Coffea cruda. 60. Colch.—Colchicum. 61. Coloc—Colocynthis. 62. Con.—Conium maculatum. 63. Conv.—Convolvulus arvensis. 64. Cop. Copaiva; balsamum. 65. Coral.—Corallia rubra. 66. Croc.—Crocus sativus. 67. Crot —Crotum Tiglium. 68. Cub.—Cubebae. 69. Cupr.—Cuprum. 70. Cyc—Cyclamen. 71. Daph.—Daphnse indica. 72. Diad.—Diadema. 73 Diet.—Dictamus albus. 74. Dig —Digitalis purpurea. 75. Dros.—Drosera rotundifolia. 76. Dulc.—Dulcamara. 77. Eug.—Eugenia Iarabos. 78. Euphor.—Euphorbiom officinale. 79. Euphr.—Euphrasia. 80. Evon.—Kvonymus europ*us. 81. Fer.—Ferrum. 82. Fer. ch.—Ferrum chloratum. 83. Fer. ing.—Ferrum magneticum. 84. Fil.— Filix mas. 85. Frag.—Fragaria vesca. 86. Gran.—Granatum. 87. Graph.—Graphites. 88. Grat.—Gratiola officinalis. 89. Guai.—Guaicum officinale. 90. Haem.—Hsmatoxyl. camp. 91. Hell.—Helleborus niger. 92. Hep.—Hepar sulphuris calcare- um. 93. Hyos.—Hyoscyamus niger. 94 Hyper.—Hypericum. 95. Jalap.—Jalappa. 96. Iatr.—Iatropha. 97. Ign.—Ignatia amara. 98. Ind.— Indigo. 99. Iod.—lodium. 100. Ipec—Ipecacuanha. 101 Kal. —Kali carbonicum. 102. Kal-ch.— Kali chloroticum. Antidotes. 44. Camph. ? 45. Camph., Opium. 46. Coff , Coloc, Nux v. 47. Aeon., Coff., Nux v. 48. Camph. 49. Bryon., China, Ipec 50. Arn., Tabac 51. Arn., Ars., Bell., Nux v. 52. Nitr. ac, China, Op., Sulph. 53. Camph. 1 54. Camph. 1 55. It antidotes Euphor., Stram. 56. Bryon. 57. Camph. 1 58. Nux v. 59. Aeon , Cham., Nux v. 60. Cocc , Nux v., Puis. 61. Camph., Caust., Coff. 62. Coff., Nitrum. 63. Camph 1 64. Merc, Merc. corr. 65. Calc. c 66. Aeon., Bell , Op. 67 It antidotes Plumb. 68. Opium. 69. Bell , Nux v., Sulph. 70. Pulsat. 71. Bry., Dig., Rhus, Sil. 72. Merc. 73. Camph. 1 74. Vinegar, Camph. 75. Camph. 76. Camph., Ipec, Merc. 77. Coffea. 78. Camph. 79. Camph., Pulsat. 80. Camph. 1 81. Ars., Ipec, Puis. 82. China, Hep. s. 83. Ars , Ipec, Puis. 84. Camph. 85. Camph. 1 86. Camph. 1 87. Ars., Nux v. 88 Camph. 1 89. Camph. 1 90. Camph. 91. Camph, China. 92. Bell., Cham. 93. Bell, Camph, China. 94. Mesmerism. 95. Camph. 96 Ol. a., Crot , Camph. 97. Puis., Cham. 98. Camph., Op. 99 Merc, Ars , Op., Hyos. 100. Arn., China, Nux v. 101 Camph , Coff. 102. Puis., Bell. TABLE OT MEDICINES. 103 104. 105 106. 107 108. 109. 110 111. 112 113 114 115. 116 117. 118 119 120. 121. 122. 123. 124 125 126. 127 128 129. 130. 131. 132. 133. 134. 135 136. 137. 138 139. 140. 141. 142 143. 144. 145. 146. 147. 148. 149. 150. 151. 152 153. 154 155. 156. 157. 158 159 160. Remedies. Kal. h.—Kali hydryodicum. Kreos.— Kreosotum. Lach.—Lachesis. Lac.—Lactuca virosa. Lam.—Lamium album. Laur. —Laurocerasus. Led.—Ledum palustre. Lye—Lycopodium Magn —Magnesia carbonica. Magn m.—Magnesia muriat. Magn. s.—Maguesia sulphur. Mang. —Manganum oxydat. Men—Menyanthes. Meph.—Mephitis putorius. Merc.—Mercurius. Merc, c—Mercur. subl. corr. Mez.—Mezereum. Mil.-Millefolium. Mosc —Moschus. Mur. ac—Muriatis acidum. Natr.—Natrum carbonicum. Natr. m.—Natrum muriaticum. Natr. n.—Natrum nitricum. Natr. s.—Natrum sulphuricum. Nic—Niccolum. Nitr.—Nitrum. Nitr. ac.—Nitri acidum. Nitr. sp.—Nitri spirit, dul. Nux mos.—Nux moschata. Nux. vom.—Nux vomica. Oleand.—Oleander. 01. an.—Oleum anim. a?ther. Ol jec—Oleum jecoris morhux. Onis.—Oniscus asellus. Op.—Opium. Pceon —Poeonia. Par.—Paris quadrifolia. Petr.—Petroleum. Pefros.—Petroselinum. Phell —Phellandrium aquat. Phos.—Phosphorus Phos. ac.—Phosphori acidum. Pin.—Pinus. Plat.—Platina. Plumb. —Plumbum. Prun —Prunus spinosa. Puis—Pulsatilla. Ran.—Ranunculus bulbosus. Ran. sc—Ranunculus scelera- tus. Rat.—Ratanhia. Rhab.—Rhabarbarum (Rheum palmatum) Rhod.—Rhododendron. Rhus.—Rhus toxicodendron. Rhus v.—Rhus vernix Rut. g.—Ruta graveolens. Sabad.—Sabadilla. Sabin.—Sabina. Samb. —Sambucus nigra. Antidotes. 103. Am. m., Ars., Sulph. 104. China, Ars., Ipec. 105. Alum., Ars., Bell. 106. Coffea 107. Camph. 1 108. Amm. c. 109. Camph. 110. Camph , Puis., Coff. 111. Cham., Puis., Merc. s. 112. Ars , Cham. 113. Camph. 114. Coff, Merc. 115. Camph. 116. Campb. 117. Nitr. ac, Nitr. ph., Hep. ». Sulph. 118. China, Hep. s., Calc. c. 119. Vinegar, Camph. 120. Camph. 1 121. Camph., Coff. 122. Bry., Camph. 123. Ars., Camph. 124. Ars., Camph. 125. Ars., Camph. 126. Camph. 1 127. Camph. 1 128. Camph. 1 129. Calc, Camph. 130. Camph. ? 131. Camph. 1 132. Coff, Camph.. Op. (Wine.) 133. Camph , Cocc, Nux v. 134. Camph , Nux v., Op. 135. Camph 1 136 Camph.1? 137. Coff, Camph. 138 Camph. 139. Camph., Coff. 140. Aeon , Nux v. 141. Camph 1 142. Camph. 1 143. Camph , Nux v., Coff. 144 Camph., Coff. 145 Camph. 1 146. Puis., Spir. n. 147. Bell., Hyos , Nux y., Op. 148. Camph. 149. Cham., Coff., Nux v., Sulph. 150. Bry., Camph., Puis. 151. Puis. 152. Camph. 153. Camph., Cham , Coff. 154. Camph , Clem, Rhus. 155. Bry., Camph., Coff., Sulph 156. Camph. 157. Camph. 158. Camph., Puis. 159. Camph., Puis. 160. Ars., Camph. 20 TABLE Of MEDICINES. 161. 162 163. 164. 165. 166. 167 168. 169 170. 171. 172 173 174. 175 176 177. 178 179 180. 181 182. 183. 184 185 186. 187. 188 189. 190 191. 192 193 194 195 196. 197. 198. 199 200 201 202 203. 204 Remedies. Fang.—Sanguinarius canadensis. Sap. — Sapo dcmesticus. Sass.—Sassaparilla. Sec — Secale cornutum. Selen —Selenium. Seneg. — Senega. Senn —Senna. Sep.—Sepias succus. Sil —Silicoa Sol m.—Solanum mammosum. Sol. n —Solanum nigrum. S|ig.-Spigelia. Spong —Spongia. SquiQ.—Squilla (scilla) mari- tima. Stann—Stannum Staph —Staphysagria. St ram.—Stramonium. Stront.—Strontiana. Sulph.—Sulphur Sulph. ac—Sulphuris acidum. Tab —Tabacum. Tan—Tanacetum vulgare. Tarax.—Taraxacum. Tart.—Tartarus emeticus. Tart, ac—Tartari acioum. Tax—Taxus baccata. Tereb.—Terebinthina. Teucr.—Teucrium marum ve- rum. The —Thea caesarea. Ther.—Theridion curassavicum. Thuj.—Thuja occidentalis. Tong—Tongo. Tussil—Tussilago pet. Urt—Urtica mens. Uva—Uva Ursi. Valer. —Valeriana. Verat —Veratrum album. Verb.— Verbascum thapsus. Vine.—Vinca minor. Viol. od.—Viola odorata. Viol, tr.—Viola tricolor. Zinc —Zincum. Zinc s.—Zincum sulphuricum. Zing.—Zingiber. 205. Mgs.—Magnus artificialis. 206. Marc—Magnetis polus arcti- cus. 207. M. aus.—Magnetis polus aus- tralis. Antidotes. 161. Camph. 1 IGi. Camph. 1 163 Camph. 1 164. Camph., Sol. nigr. 165. Ign , Puis. 166. Arn . Bell., Bry. 167. Camph. 1 168 Aeon , Tart c, Dulc. 169. Camph., Hep. sulph. 170 Camph. 1 171. Camph. T 172. Aur , Camph. 173 Camph. 174. Camph. 175. Pulsat. 176 Camph. 177. Vinegar, Nux v., Op. 178. Camph. 179. Ac«m , Camph , Nux v. 180. Pulsat. 1H1. Camph , Ipec, Nux v. 1S2. Camph. 1 183. Camph 184. China, Ipec., Op. 185. Camph. 1 186. Camph. 187. Camph., Canthar. 188. Camph., Ignat. 189. China, Ferr., Thuja. 190 Camph. ? 191. Cham., Cocc, Merc. 192. Acetum. 193 Camph 1 194. Camph. 1 195. Camph. 1 196. Camph., Coff. 197. Aeon., Camph., Coff. 198. Camph. 199. Vegetable acids. 200 Camph. 201. Camph. 202. Camph , Hep. sulph., Ignat. 203 Camph , Hep. s., Ignat. 204. Camph. 1 205. 1 206. 1 207. 1 INFLAMMATORY FEVER. . (Addition to page 24.) • Cantharis has been recommended in irritative fever bear- ing a close resemblance to pure synocha, and especially when the following symptoms become developed: the fever is very intense during the night, and is accompanied by burning heat of skin, strong accelerated pulse, general redness of the surface, dryness of the mouth, and violent thirst. Further, when pains are- complained of in the right side of the body, attended with great anxiety and raving. Chamomilla is useful in pseudo synochal fever, with burning beat and bright redness of the cheeks, tremulous, anxious palpitation of the heart, extreme irritability of temper, and over-sensibility of the senses, alter- nate heats and chills, and, sometimes, spasmodic attacks, &c. Chamomilla is peculiarly applicable when the above symp- toms have been excited by a fit of passion or vexation. A dose or two of Acomte is, however, generally requisite in the first place, when the derangement has been excited by the aforesaid cause. Dose: °|° or °£°. NERVOUS FEVER. (Addition to page 35.) The prognosis in typhus is to be formed by the type of the fever, the regularity of its course, the local complications, the greater or lesser intensity of the symptoms, and the tendency to a dissolved state of the fluids;—continued delirium and stu- por ; carpologia, subsultus tendinum, impeded speech and de- * These Additions refer to the larger Work of Laurie's Homoeopathic Domestic Medicine, by A. G. Hull, M. D , and the page referred to is to be found in that work, a new edition of which has just left the pre**. 22 NERVOUS FEVER. glutition, tremulous or paralytic state of the tongue; a fetid exhalation from the body; excessively offensive, dark, dysen- teric stools; effusions of blood under the skin, or the early ap- pearance of miliary eruption; involuntary evacuation of faeces and urine ; hemorrhages and hiccough are highly unfavourable signs. On the other hand, the absence of stupor and delirium, or abatement of febrile heat and thirst, returning strength of pulse, a gentle transpiration over the whole body, loose bilious stools, gradual clearing of the previously turb"id urine, or mode- rate cloudiness in place of the former clear or colourless urine, and deposition of a lateritious sediment, are to be held as fa- vourable indications. Typhus fever generally begins to sub- side in this and other temperate or cold climates about the fourteenth or sixteenth day, but is frequently protracted to a much longer period. In warm climates, again, the fever com- monly terminates in six or eight days. The following remedies have been found the best adapted to the different forms of typhus : Dose ~- or °|°. Aeon., Bella., Bryon., Rhus., Nux, Acid, m , Lycop., Hyosc, Stram., Cham., Natrum m,.—in nervous fever, characterized by erythismus (Febris nervosa versatilis.) Bella., Rhus, Arsenic, Bryon., Op., Hyosc, Stram., China, Cocc, Nux v., Veratr., Arn., Nitr. sp.—in Febris nervosa stupida, or slow typhus. Aeon., Bella., Hyosc, Bry., Lach., Op., Stram., Rhus, Acid. phosph., Cupr. ac.—in Typhus cerebralis. Bryon., Rhus, or Aeon., Merc, Cham., Nux, Veratr., Bell., Hyosc, Arsenic, China, Sulph., and Senega,—in Pneumo- typhus, Typhus pulmonalis. Ipecac, Pids., Cham., Bryon., Nux, Ignat., Cocc, Arn. China, Digit,—in Typhus biliosus s. Typhus gastrtcus. Rhus, Bryon., or Arsenic, Merc, China, Carb. v., Phosph. Canth., Pids., Sulph., Calc, Acid, nitr., Nux mosch.—in Ty- phus abdiminalis, Typhus gravior (malignant, putrid, or pe- techial fever.) During the period of incubation the development of the dis- ease may sometimes be prevented, or the attack rendered much milder by the employment of Bryonia or Rhus, or both of these NERVOUS FEVEH. 23 remedies in alternation (see the indications given further on). In the Inflammatory period Bryonia is one of the most impor- tant remedies, but it will not unfrequently be found necessary to select one or more of the following in this stage : Aeon., Bell., Cham. Hyosc Nux v., Lycopod., Stram. In the period of debility, Rhus is almost always of a greater or less degree of utility, and is often alone sufficient to effect such a favourable change as to render it a comparatively easy task to conduct the fever to a successful issue. The other re- medies, which are often required at the debile stage, are : Ar- senicum, Carbo vegetabilis, Acidum muriaticum, Mercurius, and Cinchona; or, Acid, phosph., Lach., Arn., Nux mosch., and Sulph. In ILEO-TYPHUS, with ulcerations, Carbo v., Rhus, Acid, nitr., Phosphor., and Lycop., are the most deserving of attention. Carb. v. is occasionally of service in cases which seem utterly hopeless; the pulse, from being almost imperceptible, becoming stronger, and the sinking energies rallying in such a manner, after the employment of this remedy, that the patient is readily placed out of danger by the aid of one or more of the medica- ments above enumerated, and particularly such as Rhus, China, Arsenic, etc. Carb. veg., with symptoms of incipient ulceration, or with signs of so-called putrescency, and tendency to metastases. Carb. v. is, moreover, a most serviceable remedy; and in the second stage of malignant typhus, or typhus abdominalis, it may be employed with decided advantage when the symptoms are as follows: Burning, lancinating pains in the epigastrium and deep in the abdomen, which become renewed after partaking of nourishment of any kind, and are accompanied by great anguish, excessive flatulency, and the evacuation of burning, light-colour- ed, fetid, watery, sanguineous stools, with tenesmus; desire for salt food, and for coffee, but aversion to meat,—the patient, however,' generally dreads to satisfy any inclination which he may have for food, on account of the above-mentioned suffer- ings which such indulgence entails;—anxiety and burning heat of skin, arising from congestion to the head and chest; agglu- 24 nervous fever. tination of the eyelids during the night ; deafness and ringing in the ears, as also bleeding from the nose, and obstruction of the latter from the formation of incrustations; eruption around the nose, and the brown or blackish-looking cracked lips; the legs are drawn up, during sleep, which is restless and disturbed by frequent waking. Digitalis is indicated when Nervous Fever, or rather typhus biliosus is ushered in by yellow, jaundiced hue of the skin, violent bilious vomiting, spasmodic pains in the stomach; sensibility of the left hypochondrium on pressure; frequent desire to make water, particularly at nig'.t, with scanty, bilious urine; burning heat of the head and face ; anxiety of mind, and dread of some imaginary impending misfortune ; urination pain- ful and difficult, or entirely suppressed. Rhus tox. In Typhus abdominalis, characterized by con- tinued heat and dryness of the skin ; violent delirium ; oppres- sion at the heart, with sighing and moaning; pains in the limbs; extreme debility; tongue and lips dry, or covered with a brown or blackish tenacious fur; red, burning cheeks, subsultus ten- dinum; carpologia; coma somnolentum, with muttering and stertor; weak, accelerated pulse; anxious expression of coun- tenance ; sleep disturbed, or prevented by the frequeut recur- rence of sudden starts; eyes inflamed, watery, and insensible; features collapsed; breath highly offensive; involuntary evacu- ations of faeces and urine; coldness of the extremities ; sinking energies; petechiae; miliaria.—Rhus is, moreover, a most effi- cient medicament. During the period of incubation, or the pre- monitory stage of typhus (particularly of Febris nervosa stupida) it is also of great value. Its employment is called for here when, either after exposure to a thorough wetting, or without any assignable reason, the patient is seized with diarrhoea, accompani- ed by colic, and complains of chilliness even when seated close by the fire; further, when aching pains (or pains as if arising from the effects of contusions) are experienced in particular parts of the body, or when a painful sensation is experienced as if the flesh had been torn from the bones; the tongue is furred white, and there is giddiness, inclination to vomit, or ac- tual vomiting of mucus; the patient is tormented by numbness, creeping and tingling in the parts of the body on which he nervous fever. 25 lies, together with lancinations, drawing pains, and stiffness in the nape of the neck and in the back, rigidity and feeling of paralysis in the extremities ; all the symptoms are, generally speaking, exacerbated during rest and at night. Again, in the period of convalescence, it is a remedy of considerable im- portance, especially when the progress towards recovery proceeds slowly, the pulse retaining a febrile character, the appetite, al- though improved, being caprickms, the bowels prone to become relaxed, and the chest not yet exempt from feelings of oppres- sion.* In many cases it will be found useful to give Bryonia and Rhus in alternation, at intervals of from three to six hours. Camphora frequently proves useful after Rhus (according to the experience of some of the continental homoeopathists); it is indicated especially when the symptoms are chiefly as follows: heat of the head, with confusion of ideas; or violent delirium; giddiness; throbbing headache ; burning heat in the forehead; cold and clammy skin; continuous coldness of the hands and feet- debilitating and clammy sweat; tendency to diarrhoea; scanty, cloudy urine, which deposits a thick sediment; great weakness, and. feeble, scarcely perceptible pulse. Dose. A drop of the tincture every quarter. of an hour until symptoms of amendment supervene, and a change of prescription is called for. Cocculus is often serviceable after the previous employ- ment of Rhus or Camphora, especially when the great debility continues, and the patient complains of giddiness and headache; or when there is a tendency to syncope, or paralysis of the limbs, and when there are prominent symptoms of gastric disturbance. Arnica is also of some importance in febris nervosa stupida, with coma somnolentum, or delirium and carpologia; or when the patient lies in a state of unconsciousness, as if he had been stunned by a concussion of the brain. Nitri «pir. In desperate cases of Febris nervosa stupida, with complete apathy or insensibility, and fixed, expressionless, * See Hartrnann's » Acute and Chronic Diseases," by Chs. Hempel, M. D., vol. ii., p. 230,-4 vols., 1849, bound, $6. 26 NEBVOU9 FEVER. or haggard eyes; dry, brown, or blackish lips; sopor, with low muttering delirium. As soon as signs of improvement set in from the employment of this remedy, it will in general be found requisite to follow up the treatment by prescribing some one or other of the remedies mentioned above, such as Rhus., Ac-ph., Nux-v., Bell. (See Hartmann's Acute dis- eases.) Lycopodium is often a valuable remedy after Calc. in the second stage of typhus, when miliaria is slowly and scantily de- veloped, and there is sopor with muttering delirium ; confound- ing of words; stammering; subsultus tendiuum; carpologia; meteorismus, with constipation; affections of the bladder; or, when there are shiverings alternating with heat; circumscribed redness of the cheeks; debilitating sweats ; excessive debility ; complete hanging of the lower jaw ; half-closed eyes ; slow re- piration ; or, state of excitement without heat or congestion in the head or face; redness of the tongue; constipation ; burning urine; tranquil and resigned state of mind, or surliness and malevolence, especially on waking. Lachksis is spoken of as being likely to prove serviceable in typhoid fever, attended with vertigo on rising or sitting up ; muttering delirium ; hanging of the lower jaw; vacant expres- sion of countenance; sunken features; bitter taste; yellowish tongue, with bright red margins; cracked tongue; smooth dry tongue; or furred, white slimy tongue; heaviness of the tongue, with difficulty of protruding it, and inarticulate speech ; seeming paralysis of the eyelids ; lethargic sleep, and tendency to lie in the prone position ; thirst, with disinclination to drink ; brownish-red, copious urine. Secale cornutum is, in like manner with Natrum m. and Helleborus, recommended by many homceopathists who have had frequent opportunities of treating nervous fevers, particu- larly in cases occurring in the wake of other diseases; but is more especially appropriate where the symptoms developed clearly proceed from irritation of the spinal nerves, with wan- dering, fugitive, spasmodic pains extending from the dorsum and sacrum into different parts of the body ; the spasms which affect the face, become subsequently chronic; whilst those that NERVOUS FEVER. 27 have their seat in the hands and feet, partake of a chronio character. This remedy is further indicated by dry heat of skin, insatiable thirst, accelerated pulse, great restlessness and sleeplessness; excessive languor: aversion to food. Should the spasmodic affections readily yield to the employment of secale, but the febrile symptoms continue, some other remedy appropriate thereto must be prescribed. Phosphorus is also serviceable when, notwithstanding the pneumonic concentration, there is, moreover, sensibility and rumbling in the CEecal region, or when there is continued heat of skin, with small, hard accelerated pulse, throbbing of the caro- tids, and nocturnal sweats; sleep disturbed by crowding of ideas, weeping, whimpering, sudden cries, and restlessness. The patient awakes from sleep complaining of great thirst and dryness of the mouth, excessive heat, and aching of the whole body. In addition to these symptoms, there is burning sensa- tion in the abdomen and anus, with frequent semifluid stools Btreaked with blood; giddiness, confusion, and throbbing pains in the head; deafness, frequent discharge of blood on blowing the nose, and heat in the face; tongue and lips dry and crack- ed ; bitter taste ; copious evacuation of urine, which deposits a whitish or reddish sediment; venereal orgasm; delirium ; ob- stupefaction. Natrum mur. with great debility, insatiable thirst, dryness of the tongue, and loss of consciousness, and particularly when they follow in the course of antecedent debilitated diseases. Helleborus in febris nervosa, occurring after other febrile affections, such as scarlatina, rubeola, febris gastrica, febris verminosa, and cholera, with pain as from contusion, combined with tumefaction, in the integuments of the head ; disposition to somnolency, with confusion of ideas and extreme restlessness; dark cloudy urine; heaviness, or feeling of stiffness and power- lessn'ess in the limbs; depression of spirits, and obtuseness of faculties In prescribing the above remedies, it will generally be found necessary to order the dose to be repeated every three or four hours ; but as soon as an amendment sets in or even if the symptoms become stationary, the medicine should be dis- continued for a time, and only resumed (or changed, if called 28 NERVOUS FEVER. for by the invasion of new symptoms requiring a different re- medy) when the slightest signs of a relapse or an alteration for the worse can be detected. Against the following sequela:—Decubitus, compresses with diluted alcohol, or a very weak lotion of Arnica, may be employed at the commencement; but when there is violent in- flammation Belladonna, sometimes in alternation with Sulphur, Bhould be had recourse to ; when sphacelus supervenes, Carb. v. internally and externally, or Arsen. or Cinchona ; where the bones are implicated, Silicea ; and when granulation is retarded, Sulphur and Cinchona will generally prove the most useful me- dicaments. Metastatic Abscess : Bella., and Hepar sulph. Furunculi : Arnica, Bella., and Sulph., or Lycopod., or Sili- cea. Frequent tendency to Diarrhoea : China. Obstinate night-sweats, sometimes with dry nocturnal cough, Sulph. (Edema of the feet: Bryonia, Lycopod., Puis.,China, Sulph., according to the concomitant symptoms. Intestinal ulcerations : Acid, nitr., Arsenic, Phosph., Carb. v., Sulph., Calc, Puis., Bella. After severe cases of Typhus, a period of debility generally supervenes, of greater or less duration,according to the violence of the attack. In such instances the invigorating effects of pure air is for the most part preferable to all other roborants; the patient ought, therefore, under favourable circumstances, to get out of doors as soon as possible. In some cases, however, a dose or two of Cinchona may prove serviceable, particularly if the patient has suffered much from diarrhoea during the course of the disease. In others, Valeriana, Cocculus, Nux v., or Veratrum, may be better indicated. Ferrum c in repeated doses, is often more efficacious than China, where the pulse continues very weak and frequent after the cessation of profuse hemorrhage, particularly in the case of chlorotic females, or those who have previously suffered from chlorosis. Again, when the fever has completely subsided, as also the diarrhoea, and there remains only great debility with slow, small, feeble pulse with profuse sweating towards evening, Ruta and Sulph., in alternation, are of great utility. When debilitating sweats su- pervene, Cinchona should be administered, followed by Sulphur NERVOUS FEVER. 20 if required. Magnes. m. is useful when, in nervous subjects, general aching pains remain behind, with great weariness and weakness of the limbs, and lowness of spirits ; disturbed nights ; giddiness; feeling of weight and confusion in the head. Staphysagkia : Putrid smelling night-sweats ; night-sweata smelling like rotten eggs. Costiveness for several days; copious red urine ; oppressive, stupifying headache. FEBRIS LENTA NERVOSA. Lingering nervous fever is characterized by a predominance of fever chills and coldness over heat, little or no sweats, or only fugitive sweats; pulse variable, but generally small and quiet. The fever commonly becomes increased in the morning, or while the patient is fasting, and is attended with great de- pression of spirits. After a meal it generally subsides, and leaves the patient in a more cheerful mood. Headache, spas- modic sufferings, and general uneasiness, are frequent attendants on this form of fever. The causes of the disease are generally attributable to those influences which exercise a debilitating effect upon the nervous system, as over-indulgence in venery, or self-abuse ; the excessive loss of blood, either by artificial or natural means; protracted blenorrhcea; the weakening effects of nervous and other fevers; severe and prolonged mental and corporal exertion; care, grief, &c. The fever develops itself slowly and gradually, and continues for months without giving rise to any inflammatory appearances. The treatment must be regulated by the cause, and the nature of the symp- toms. When the former is unknown, we must direct our at- tention carefully and minutely to the symptoms, and select a remedy in accordance therewith. When vexation, care, or debility from venereal excess, has given rise to the disease, Acid, phosph. will rarely fail to effect a greater or less degree of improvement. The alternate em- ployment of Arsenicum and Acid, phosph. has proved useful in some cases. When deep and concealed grief has been the ex- citing cause, Ignatia will, if administered early, generally suo- so INTERMITTENT FEVERS. ceed in arresting the disease, and will be found more or less useful in cases of long standing proceeding from the aforesaid cause. Cinchona will prove very useful, when constitutional debility, arising from the excessive loss of blood, or from prolonged self-abuse (onanism), has developed the fever. (Acid. phosph., Nux, Sulph., Calc. may be required after China.) In cases resulting from debilitating acute diseases, Veratrum, China, Hepar, Silic, or Acid, phosph., Calc, Lachesrs, and Natrum m., will usually answer best. In other cases, Ipecac, Camph., Hel'eb., Coccul., Merc, Plumb., Lycop., Can., Cupr., Stann. may be called for. Dose : *£*■ or *%*-. INTERMITTENT FEVERS. Ague. (Addition to page 47.) The medicines should generally be administered in the apy- rexia or interval between the paroxysms; but when the inter- vals are extremely short, or when they are attended with after- pains of the preceding paroxysms, they should be administered when the sweats, or other concluding features of the attacks, begin to subside.' In the treatment of ague, the type, although by no means to be held as unimportant, is yet of very secondary consideration to the other features of the malady. The following remedies have been found most appropriate in ordinary cases. Against MARSH FEVERS the principal remedies are : Cinchona, Arsenicum, and Ipecacuanha; but the following are also useful in particular cases : Carb. v., Rhus, Veratrum, Natr. m-, Fer., Arnica, and in some severe and very obstinate cases, Cimex lectul. Against intermittents which prevail in spring or summer, and in warm climates : Bella., Ipecac, Veratr., Caps., Am., Lach., Calc, Cine, Sulph.; Bryon. Carb. veg. eta., Puis., Digi'., ., Calc, Sec. Dose : *f *, or ^, or %%. CONSTIPATION. COSTIVENESS. OBSTIPATION. (Additions to page 128.) In Constipation with indurated faeces, formed into hard balls (eeybala), Plumb., Magn. m., Sep., Ruta, Verb., and sometimes Nux v., Op., Veratr., Sulph., df-c, are useful; but in obstiuate and complicated forms of this affection, the treat- ment requires" considerable experience, in addition to a thorough knowledge of the Materia Medica. In all cases of constipation of an obstinate or chronic nature, recourse may occasionally 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 suffering, or defeat the object we have in view, by exhausting instead of giving tone to the energies of the patient,) will be found useful auxiliaries in promoting a regular action of the bowels. The diet ought to be regulated according to the state of the primary digestive organs,* and highly-seasoned food, or that which contains much fibrous or ligneous matter, such as ra- dishes, 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 * See Dyspepsia, rules for diet in. 80 • constipation. inertia recti, or from atony of the intestinal canal, Sepia, Ve- ratrum, Aurum muriaticum, Alumina, Natrum m., and Padus avium, have been recommended as the best general remedies; but when the indications for the selection of any of the re- medies we have given in the preceding part of this article manifest themselves, we must not hesitate to prescribe ac- cordingly. 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, 6fC In that which is prone to occur when travelling: Platina, Opium, or Alumina, Calcarea, Cocculus, Conium, Graphites, Gratiola, Arsenicum, Kali, Baryta c, Agaricus m., or Am- mon., Sfc 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 alternation, or China, Aurum m., Natr. m., Pad. prud., Lachesis, Anfim., Ruta, usually answer best. Against constipation from exposure to the Vapour of Lead : Opium, Alumina, Platina, are, in general cases, the most im- portant remedies. That from congestion or fulness of the vessels of the head : Aconitum, Belladonna, and, still better, Opium, * Nux v., * Opium is strongly recommended by Dr. Perry, as the best palliative remedy in constipation 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 consti- pation has arisen from affections of the stomach or liver, Opium is contra-indicated. 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 containing a mixture of epiritus and aqu.) stricture of the rectum. 81 Pulsatilla, Sulphur, Calcarea, Lycopodium, , or §§. 94 ASIATIC CHOLERA. MALIGNANT CHOLERA. (Additions to page 155.) We quote the following accounts of malignant cholera, as it has appeared in India, in the north of Europe, and in this coun. try, 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, from a state of apparent good health, or with the feeling only of trifling ailment, an individual sustains as rapid a loss of bodily power as if he were 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 sen- sation 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 in 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 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, recom- mended 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 cholera. 95 contents; what happens to be lodged in the rectum is passed more or less in its natural state; the next discharges are simi- lar 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 abdo- men. 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 con- siderable ; 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 com- plains of intense heat, and has an almost insuperable aversion to any application of it to the skin. The spasms increase, sometimes spreading gradually, sometimes suddenly, to the ab- domen, as high as the scrobiculus cordis. The next severe symptoms are, an intolerable sense of weight and constriction felt upon the chest, accompanied with anxious breathing, the spasms continuing at the same time ; a leaden or bluish ap- pearance of the countenance, the tongue, fingers, and toes assuming the same colour ; the palms of the hands and soles of the feet becoming shrivelled; the fingers and toes giving the appearance of having been corrugated by long immersion in hot water. There is, throughout, a suppression of the secre- tion of urine, of the secretions of the mouth and nose; no bile is seen in the evacuations; and it may be generally observed, that all the functions employed in carrying on life are suspend- ed, or alarmingly weakened, except that of the brain,—which appears," in these extreme cases, to suffer little, the intellectual powers usually remaining perfect to the last moment of exist- ence. At length a calm succeeds,—and death. The last pe- riod is commonly marked by a subsidence of the severe symp- toms, without improvement of the pulse or return of natural heat; but, occasionally, it terminates in convulsive spasm. 96 cholera. 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 constitu- tion often yield to such an attack at the end of four hours; and seldom sustain it longer than eight. " In the less rapid and more ordinary form, sickness at the stomach, slight vomiting, or perhaps two or three loose evacu- ations of the bowels, which do not attract much attention, mark the commencement of the attack ; a sense of burning heat soon felt at the praecordia excites suspicion of the disease; an in- creased purging and vomiting of the peculiar liquid gives certain indication of its presence, if this has not been previously declared by the prostration of strength, and an expression of the countenance not often exhibited, except when death is to be expected within a few hours. The symptoms before de- scribed, 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 twelve 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 remark- able distinction well worthy of attention. It has been ob- served before, that in the more rapid cases, the intellectual fa- culties 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 cholera. 97 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 recover—but there are exceptions to this; for al- th*igh, 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 pre- vious ailment of the individual; yet the Bengal Report details a series of subsequent symptoms resembling those of low ner- vous fever, which, when they proved fatal, usually terminated within eleven days from the commencement of the seizure called Cholera. To complete the outline, an account of these symptoms, extracted from the Bengal Report, 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 beginning 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 re- covery from this seizure commonly takes place. The first symptoms are, the abatement 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 amendment: sleep and warm perspiration attending it are of more importance, and more certain signs of recovery. The re- turn 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 established, and accompanied with 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 se- rious stao-e of disease to encounter ; the description of which is 5 98 cholera. given in the words of the author. Before, however, we pro- ceed to this, we must remark, that the seizure, when not fatal, has three modes of termination : one in immediate convales- eence, 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 pe- culiar pains in the bowels, particularly in the rectum. The third is of a febrile nature, of which the following acccfunt is supplied from the information given in the Bengal Re- port, 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, watchfulness, 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, be- came 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 be- came extremely quick, weak, and tremulous; hiccough, catch- ing of the breath, great restlessness and deep moaning succeeded, and the patient soon sunk incoherent and insensible under the debilitating effects of low nervous fever, and frequent dark, tarry alvine discharges.' It is to be observed, that the able author of the Bengal Report doubts whether 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 showing 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 col- cholera. 99 lapsed stage ; and by a third set, which characterize the second stage, that of reaction, heat, and fever. " Preliminary Symptoms.—We have bad. but few oppor- tunities 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 pa- tient and the physician together, after their occurrence, before the disease is fully formed. Diarrhoea, at first feculent, with slight cramps in the legs, nausea, paiu or heat about the pit of the stomach, malaise, give the longest warning. Indeed, purging, or ordinary diarrhoea, has been frequently known to continue for one, two, 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, ner- vous agitation, intermittent, slow, or small pulse, cramps be- ginning at the tips of the fingers and toes, and rapidly ap- proaching the trunk, give the first warning, then there is scarcely an interval. " First stage-—Vomiting or purging, or both these evacua- tions, 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 sufferer, 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 complexion 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 100 cholera. imperfectly performed. Inspiration appears to be effected by an immense effort of the chest, whilst the ala nasi (in the most hopeless cases and towards 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 plaintive whisper (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 irregu- lar folds, whilst the belly itself is violently drawn in, the dia- phragm 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 oc- casionally a low 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, and which in a very great number of cases of the present epi- demic 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, par- ticularly the face, the liver 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, flows by drops, is thick, and feels to the finger colder than na- tural. Towards the close of this scene the respiration becomes very slow; there 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, however, 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 CHOLERA. 101 such cases just carried to the hospital from their homes or their barracks. In by far the greater number vomiting had ceased; in some, however, it was still going, and invariably of the true, serous kind. Many confessed that they had concealed a diar- rhoea for a day or two. Others had been suddenly seized, ge- nerally 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 com- menced. 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, hiccough, 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 em- barrassed ; the oppression 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 alteration 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, af- ter 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 feverr> 102 CHOLERA. not to be distinguished from ordinary fever. A profuse, criti- cal 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 becjmes 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, squa- lid, and low, with the pulse and heat below natural: but with the typhous stupor, delirium supervenes; and death takes place from the fourth to the eighth day, or even later, in the very individual, too, whom the most assiduous attention 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, du- ring its blue or cold period. After reaction has been estab- lished, 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, when they are attacked, are nev r seized with ordinary fever, but with the genuine, cold, blue cholera. " 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 consecutive fever. " The first stage is characterized by symptoms of indigestion, flatulent disturbance in the abdomen, praeeordial weight or op- pression, slight nausea, acidity, griping pains, diarrhoea, vertigo, CHOLERA. 103 some degree of headache, 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 so- ciety, but particularly among the poor, because few of the more severe maladies to which flesh is heir are so remediable as cho- lera 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, knd 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 the prcecordia, indigestion, pain in the belly, and looseness of bowels. Many instances of disorder of the sto- mach and bowels prevailed during the epidemic season, and for some weeks before there was a well-marked case of cholera in Edinburgh. " Second stage.—The duration of the premonitory or first stage is various; sometimes the unpleasant symptoms sudden- ly cease, and the patients recover quickly; but this happy issue is comparatively rare, when 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, limpid, with small flakes of curdy-looking matter inter- mixed ; 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, which struck me to resemble that produced by macerat- • ing fish in water; 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 re- covered who passed " port-wine stools ;" I recollect at present one recovery only in which there was this appearance. Th« 104 cholera. desire to go to stool is irresistible and instantaneous; tenesmus is great in some cases, sometimes preceded or accompanied by a sense of heat or griping. The stools are generally very co- pious, — sometimes, however, scanty; often accompanied 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 attend- ants,—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 voice 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; occasionally, 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 tumultuous; 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 perceptible at the wrist for some hours before death. The tongue is cold and shrunk. It is quite painful to a bystander to watch the restlessness and impatience of the sufferers, who are constantly in a state of jactitation, more par- ticularly when restrained, and when heat is applied. Indeed, they seem to have a horror at, and to suffer pain from, warm ap- plications. The temperature of the body, but more particu- larly of the extremities, diminishes early in the disease, and goes on sinking. It is often impossible to raise the tempera- ture of the body during life, but the moment death takes place, and for two or three hours afterwards, the body becomes warm,—even the icy coldness of the extremities gives place to a genial warmth. The colour of the hands and feet becomes CHOLERA. 105 changed, more particularly the nails assume a blue appear- ance; the face often is similarly affected; occasionally the whole surface 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 com- plaint,—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 artery or vein during this stage, flows with difficulty, is of a dark colour, does not coagulate, or separate any serum. It re- mains in a semi-fluid state, and has the appearance which the ancients called ' el is solved bloorl.' 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 de- bility is occasioned by the vertigo, which renders the gait un- steady and tottering, as well as by the dread of motion produc- ing 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 was known to have laboured under slight bowel . 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 wis 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 eases where the urine was not entirely suppressed, and others in which the stools were feculent and bilious up to the moment of 5* 106 CHOLERA. death. But those cases are to be regarded as exceptions "to the rule, which they do not contravene. The symptoms in this disease, as in all others, must suffer modifications from peculi- arity of constitution, previous condition of health, and habits of the patient affected. " The symptoms which present the most unerring character- istics 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 probably 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 downwards, cramps, suppression of urine, excessive thirst, weak faltering pulse, weak respiration, coldness of extremities, shrivel- led 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 fea- tures takes place. The patients appear to dread hot applica- tions. 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 stage ; there were few immediate recoveries from col- lapse, without undergoing the danger and miseries of a con- secutive fever, which is now to be described. I shall never for. get the joy expressed by all who .were watching the first case of cholera in which death did not take place in the stage of col- lapse. This feeling was increased as the watery diarrhoea, vo- miting and cramps diminished, and at last ceased, and as re- action 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 pa- CHOLERA 107 tient, although he had made an escape from one set of dangers, was still surrounded by another, which experience speedily proved to us were extremely formidable. " The symptoms that denoted an escape from the horrors of the second stage, were, diminution in the number and quan- tity 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 ap- pearance, 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 circum- stance rarely occurred so soon. In some cases, after everything appeared to be going on well, the vomiting and purging sudden- ly returned, the pulse became weak and quick, and the patient rapidly died. " The phenomena of the third stage presented every appear- ance 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 maintained, that cholera is nothing but a fever, with violent irritability of stomach and bowels, sup- pression of the secretions of bile and urine, with a cold stage, appeared to derive support from the resemblance to the pheno- mena 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 much in different cases, depending on the previous state of health and habits of the patient, and his peculiarities of constitution, as well 108 CHOLERA. as on the phenomena of the previous stage, and the treat- ment pursued. " These symptoms were, lethargy or coma, which were frequent; delirium ; convulsions; paralysis; rigidity of the flexor muscles of the extremities; 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 pres- sure, in some part of the abdomen. Of all these symptoms, convulsions were the most rare. The others existed variously combined and modified. " 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 dis- ease had been modified by climate, and the habits of the people in Europe; that it had more resemblance to a fever, and was highly contagious. There were few medical men who 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 appearance 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 dispelled, 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 was intimated to me, by authority, that as the disease was 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 at- tendance on the sick, or to hinder my investigations alter 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 CHOLERA. 109 dying person, and slept for above an hour, at a time when my animal spirits were 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 un- fortunate 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 were seldom out of the wards, had the disease, although their bodies must have been ready to receive the contagion, if fatigue of body, anxiety of mind, and want of sleep, ever predisposed any person to take a disease. Two male nurses had cholera. One was a sober man, and although he had the warning diarrhoea, he neglected himself, but bad the disease slightly. The other was a complete tippler; he had a slight bowel complaint, which he concealed, and by way of curing, obtained leave to go home to see his family; he got drunk, and was brought to the hospital with cholera, but never became collapsed. Several female nurses were also attacked; but that is no wonder, for, independent of the fatigue they underwent, they were drunkards, and bad cha- racters in other respects, and were actually in the habit of drinking the spirits and wine served out to their patients. Two of these characters, after much fatigue and a hard course of drinking, went to bed one night quite drunk; they were both speedily seized with cholera—ono died. But there is no proof of the influence of contagion 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 satis- factory principles. Is it because four children, with father and mother, in one family, have had cholera, and because communi- cation can be proved between them and an infected house, by means of a bundle of dirty clothes, or a web of linen, or actual personal 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, who 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 se- no CHOLERA. veral days or weeks. The explanation is easy to show the strong predisposing cause—insufficient clothing, deficiency of food, &c. What answer can be made to this fact, that I have seen several mothers suckle their children, when they them. selves 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 afterwards 1 .... From the economical arrangements of the Board of Health, and the difficulty of procuring a proper apartment, the dead-room, where these examinations were conducted, was a miserable place about eight feet square; generally six or eight persons were present, sometimes more; and in an inner apart- ment, about ten feet square, there sometimes 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 iis own victims—exercised its poisonous qualities in one district, or town, 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 important 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 instances may be quoted to the contrary; but these are very few in- deed, 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 what had been stated; but when we opened the bodies, in the careful CHOLERA. Ill and minute manner in which the dissections were conducted, we had the best evidence that few subjects were even toler- ably 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 woman we opened, un- der a certain age, had the catamenia; and we 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. When the premonitory symptoms of this disease, as above noted, exhibit themselves, its complete development is frequent- ly prevented, by the administration of the saturated solution OF CAMPHOR. Dose : One or two drops of the above, every five minutes, in a teaspoonful 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 fright- ful forms, we should have immediate recourse to Veratrum, a remedy which all, who have had an opportunity of trying, have eulogized. fy. Tinct. Veratr. 3, gtt. viij. Aq. pur. § iv. Duxr. A teaspoonful 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 con- striction of the chest, which obstructs respiration,— Cuprum (third trituration, or sixth dilution) must be had recourse to, 112 CHOLERA. in the manner as prescribed for Veratrum; and if Cuprum be productive of only partial melioration, Veratrum may be admin- istered in alternation with it. When symptoms of trismus and tetanus supervene, Camphora has been recommended as pre- ferable to Cuprum. Arsenicum should be selected in pre- ference to, or given alternately with Veratrum, when an intense burning sensation is experienced in the stomach and bowels, with extreme prostration of strength, great thirst, &c. (Vide the indications for both these remedies.) Ipecacuanha and Nux v. have been found efficacious be- fore or after Veratrum, or any of the other medicaments, when the symptoms assumed the character mentioned in a former page of this article. (The Russian homoeopathic prac- titioners found Ipecac, of peculiar efficacy.) Phosphorus (followed by Acidum phosphoricum, should great clamminess of the tongue supervene) is particularly use- ful in cases of diarrhoea, which 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 in cholerine. The Russian practitioners found Mercurius, often useful in cholera proper. See also art. Diarrhea, as any of the reme- dies mentioned 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. 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 service?ble remedies against the obstinate diarrhoea which sometimes remains after an attack. Tartarus emeticus. Amongst the physiological effects of this medicament, we find those spasmodic movements, or jerk- ing and twitching of the muscles; the trembling of the limbs, prostration of strength, or weakness to fainting ; tremulous or imperceptible pulse ; peculiar paleness 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 CHOLERA. 113 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 indie a., or also at the termination of the sume, where the functions of the abdominal viscera are not yet re- stored to a normal state, Tartarus is, at all events, well deserv- ing of attention. 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 ne- glected cases, and consequently more in the sequelae of cho- lera than in the disease itself, that this remedy is more generally indicated. Stramonium may likewise be useful in similar cases. When patients affected with cholera sought the aid of a ho- moeopathic practitioner, after having been previously treated allopathically, it was found essential to give Camphora in re- peated 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. They may be prescribed as follows : fy. 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. PJ. Cupr. 30, glob. xxiv. (red. in pulv.) Pulv. sacch lact q. s. Misce intiine 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 : ty.. Veratr. alb. 6, gtt. iij. Spirit vin. rectif. 3j. Aq. distil. § iij. 114 CHOLERA. fy.. Cupr. 6, gtt. iij. Spirit, v. rectif. 3j. Aq. distil § iij. N.B —The mixtures to be taken alternately ; the dose to consist of a table-spoonful night and morning, every third day. Or thus: ty. Veratr. alb. 3, gtt. j. Pulv. sacch. lact. q. s. F. pulv. tales sex. Sign. 1, 3, 5, 7. ty. Cupr. 3, gr. vj. Divide in chart, aequales 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 preserva- tives are being taken, as those we have notified in the article on Scarlatina. The patient at the same time avoiding ex- cesses 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 happens to break out, notwithstanding these precautions, it is almost invariably in a mild form. During the prevalence of cholera the clothing should be suf- ficient 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 who have habitually considerable per- spiration 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 aside, even when the danger seems to have passed away; constant exercise should likewise be taken, during the day, in the open air. Ad- herence to the homoeopathic rules is a sufficient dietetic guide, but too sudden a change of diet is not advisable ; raw vege- tables 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 wines are unobjectionable for in- dividuals not attacked, and accustomed to their daily use, with the same limitation. It may appear almost supererogatory to BLENORRHEA. 115 observe, that purity of air and thorough ventilation are highly necessary. But if the appetite remain for a long time afterwards in an impaired state, the employment of such remedies as Arsenic, Nux vom., Puis., Rhus, Veratr., Cyclamen, or Acid, nitr., will, according to the peculiarities of the individual cases, prove of considerable service. BLENORRHCEA. This epithet is given to an increased secretion or discharge from any of the mucous surfaces. We purpose to restrict our- selves here to the consideration of the affection as it occurs in the stomach and bowels. Blenorrhcea ventricali. This form of the complaint is chief- ly characterized 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 coldness, with 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 dis- tressing fulness or weight after meals; the sleep is restless or disturbed by frightful dreams, or nightmare; the natural tem- perature of the body diminished, the countenance pale, and the physical powers much depressed. Accumulation of fluid in the mouth, itausea and vomiting, frequently take place early in the morning or after dinner, and occasionally at other times. Sometimes there is merely an adhesive, tasteless, rarely acidu- lous, inodorous mucus ejected by the act of vomiting. The prolonged use of imperfectly azotized and indigestible food, se- dentary habits, the presence of worms in the alimentary canal, damp, ill-ventilated dwellings, 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 116 BLENORRHEA. blenorrhcea 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 pro- ductive 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 in- stances 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 producing, after which another remedy must be selected in accordance with the re- maining symptoms. Against these, we shall generally find either Nix vomica,' Arsenicum album,* Pulsatilla, Veratrum album, Tirtarus emeticus, or Rheum palmatum, See., the most appropriate. Nux vom. is particularly indicated when spasmodic sufferings in the stomach with accumulation of watery fluid in the mouth, acid taste, vomiting of sour-smelling and tasting mucus, and constipation, sometimes in alternation with slimy stools, form the most prominent features of the case ; and especially when these symptoms occur in individuals given to sedentary habits, or to habitual over-indulgence in spirituous, vinous, or malt li- quors. Arsenicum may be frequently prescribed with advan- tage 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 sub- jects, and especially females, Capsicum may be preferred to Arsenicum. Pulsatilla is productive of considerable alleviation where the pituitous state is accompanied by continued shivering, fre- quent slimy evacuations, and vomiting of mucus, and occurs in debilitated, irritable, and relaxed constitutions, but more parti- cularly in chlorotic females. Sulphur 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 BLENORRHEA. 117 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 ab- dominal flutulence, tension at the pit of the stomach and epi- gastrium, insipid, slimy taste, disposition tp diarrhoea; with brown-coloured stools mixed with mucus. Gratiola has been chiefly recommended as being of consi- derable efficacy in rebellious or chronic cases where the forego- ing remedies have only effected a degree of melioration. Along with Gratiolo, the following may be mentioned as being useful in the treatment of inveterate cases : Sulphur, Carbo vegeta- bilis, Veratrum album, Calcarea carbonica, Hepar sulphuris, Lachesis, Lycopodium, Natrum muriaticum, Stannum, Aci- dum nitricum, Plumbum, Magnesia, Assafcetida, Bovista, and occasionally Squilla, Cinchona, Ferrum, Sec. When the affec- tion arises from worms, Cina, Spigelia, Ferrum, Valerian, and Mercurius, Sec. are the principal remedies. (See Inver- mination. ) Blenorrhcea intesfinorum, is chiefly characterized by a dis- tressing tension and constrictive sensations in the abdomen, ac- companied with flatulent distention, spasms, and obtuse griping pains. Sometimes the bowels are sluggish, or there is obsti. nate 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 reme- dies 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, Cin- chona, or Ferrum, will commonly be found the most appropriate, the latter two particularly when the prolonged use of laxa- tives, or other debilitating losses, have been the predisposing 118 BLENORRHEA. 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, See., are usually the most suitable. Blenorrhcea recti. (Hcemorrhoides mucosa.) This variety of the disorder is .most frequently met with in the male subject, and particularly 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, complaint appears in connexion with blind piles. Frequently again it either imme- diately precedes a fit of bleeding piles, or exhibits itself in al- ternation therewith. The mucous discharge takes place for the most part periodically, generally subsequent or anterior to an evacuation, but occasionally at other times, and involun- tarily. 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 viscid, sometimes streaked or mixed with blood, and, though small in quantity, commonly continues for several days. This form of blenorrhcea is not unfrequently preceded by in- digestion, 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 increase 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 si- milar ratio. The exciting causes of blenorrhcea recti, as well as blenor- rhcea intestinorum, of which the former is but a variety, are nearly the same as those we have given under Blenorrhoea Ventriculi, to which may be added the debilitating effects or the transposition (Blenorrhcea metasiatica) of catarrhal, venereal, or rheumatic, gouty and other more purely dyscratic diseases. BLENORRHCEA. 119 Therapeutics. Helleborus niger, Colchicum autnmnale, Mercurius, Spigelia, Capsicum, Pulsatilla, Nux vom., Carbo vegelabilis, and Sulphur, will in the majority of cases prove of the greatest efficacy. Helleborus is extremely serviceable when the stools con- sist of mucus, generally in solid pieces, and without any admix- ture of proper fecal matter. Colchicum is equally service- able under such circumstances; but particularly when the mo- tions 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, form the exciting cause of the malady, Mercurius is one of the most important medicaments, espe- cially when at the same time the evacuations consist of mucus intermingled with degenerate fecal matter, during the expulsion of which, violent colic and tenesmus are experienced. Spi- gelia is useful under nearly similar conditions; it may conse- quently 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 sub- jects, and is connected or not with hemorrhoidal disease; the motions copious, somewhat frequent, and accompanied with distressing burning pain in the rectum and anus. Pulsatilla may follow, or be given in alternation with 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 tempera. ment, addicted to sedentary or intemperate habits. Carbo v. may be prescribed with benefit after Nux when there is exces- sive flatulence, or burning pains in the lower intestine, especially after stool. When we have obtained from the action of Nux vom. and Carbo veo-., all the improvement that they are evidently ca- pable of effecting, we may follow up the treatment by the ad- ministration of Sulphur, by means of which a cure will often be obtained in cases of the most obstinate character. Lache- sis. Rhus toxicodendron, Ignatia, Anfimonium crudum, and Borax, Sec, have also been recommended as being capable 120 CATARRH. of affording considerable assistance in the treatment of this variety of blenorrhcea. Dose: °-|°, or °|°, or §f. CATARRH, or Common Cold. (Additions to page 191.) Drosera : — Painful or bruised-like pains, and paralytic weakness in the extremities; frequent rigors, with coldness of the hands, and heat in the face; hoarseness, and cough ex- cited by roughness and scraping in the throat, aggravated by talking. Mercurius, when the lining membrane of the eyelids, nos- trils, 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 pulsatiou extending to the nose, general heats predominate over the chills. Conium maculatum is of great service in ca- tarrhal fever with internal heat, much thirst, and great debility, scraping or scratching, itching and creeping sensations in the throat, which produce a dry, almost incessant cough. The pa- tient dreads the slightest noise or whisper; passes a restless night, the sleep being unrefreshing, and disturbed by anxious dreams; urine cloudy and whitish. When the pains in the limbs and joints are accompanied with profuse sweating, which affords no relief, this remedy may be followed by Dulca- mara should the sweat continue, and be of an offensive odour ; or by Euphrasia, if the lachrymation and coryza remain un- mitigated. Mkzereum :—Alternate heats and chills (the febrile heat oc- curring chiefly in bed, and the chills when out of bed) ; extreme sensibility to cold air, acrid coryza, burning irritation in the la- rynx and trachea, which provokes cough, attended with difficult mucous expectoration. Lycopodium :—Inveterate catarrh, with lemon-coloured, of- ten bitter-tasting, mucous sputa; tearing, throbbing, frontal laryngitis. 121 headache, aggravated in the afternoon or evening. (G-oullon, Arch. XX., 3-54.) Hepar s. is indicated by many of the symptoms which call for Mere, Euphr., and Nux. It is moreover of service, where the respiratory organs are solely or particularly affected, the cough loose and attended with mucous rattling in the chest; pain in the larynx while coughing, and a feeling of weakness of chest which renders talking oppressive. Sepia. Catarrhal fever, with shivering chills on every movement in a warm room, rarely alternating with heat; noc- turnal spasmodic cough, with shortness of breath and inclina- tion to vomit; coryza; occipital headache. Aconitum is one of the principal remedies in febrile attacks provoked 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 rough- ness 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, disturbed by confusing dreams, or crowding of fantastic ideas, when not by the cough. Bryonia may follow Aconitum, or it may be selected in pre- ference 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 would be torn asunder, severe headache, aching pains in the limbs, increased by the slightest move- ment, violent coryza, thirst and coldness of the right half of the body. 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 6 122 LARYNGITIS. cellular tissue between it and the subjacent parts. The dis- ease bears a considerable resemblance to croup, of which it very generally forms a part; but occasionally the inflammation is exclusively restricted to the larynx; and it is a frequent cause of a fatal termination in scarlet fever and smallpox. It is distinguished from croup by a constant hawking (which the patient voluntarily exercises in order to clear the air-passages) rather than a violent and involuntary cough, — and by the character of the sputa, which consists of a thick tenacious mu- cus rather than a coagulable and membranaceous-looking exu- dation. 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 exter- nally 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 incapable of being satisfied from the suffering that is oc- casioned by the attempt. On examining the throat, the fauces are often found to present a red, inflamed, and turgid appear. ance; 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 speedily cut short by asphyxia. The disease, if not ar- rested, occasionally runs its course in a few hours, to a day or two at the farthest. Therapeutics. We have stated that the symptoms of la- ryngitis bear a close analogy to those of croup ; and experience has proved that the same remedies, which are so eminently suc- cessful in the treatment of that affection, are equally efficacious here. The principal of these are : Aconitum, Spongia, Hepar sulphuric, Lachesis, Belladonna, Phosphorus. In some cases LARYNGITIS. 123 of a less formidable nature, Chamomilla, Mercur/us, or Drose- ra rotundifolia may prove serviceable. Aconitum must be immediately exhibited when the signs of inflammatory fever declare themselves, and continued until it gives evidence of having effected an abatement of the febrile movement; on the consummation 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 administered, and will, for the most part, be found of great efficacy in forwarding 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 generally 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 sulph. and Spongia in alternation ; but the remedy from which we have derived the most marked benefit, when the more pro- minent features of the malady did not yield to, or were only palliated by, the use of Aconite, $)>ongia, or Hepar, is La- chesis, 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 performing the act of deglutition. From Bel- ladonna we have likewise derived very appreciable service, es- pecially 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 looking into the throat, it is found to present an inflamed and swollen ap- pearance. Should Belladonna have previously been employed, as would naturally be the case if the disease made its access during, or immediately after an attack of Scarlatina pura, the 124 tOUGH. substitution of Hyoscyamus for Belladonna may be found ad- vantageous. 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 Hoarse- ness, Chronic Laryngitis, and Croup.) Dose : &%*■ or ±%&, or §£. COUOH. TUSSIS. (Additions to p. 204.) Lycopodium is very efficacious in obstinate coughs which are worst at night, and are attended with expectoration of te- nacious mucus, and sometimes vomiting; paleness of the face, emaciation, precordial pains and oppression, flatulence, ill- humour. Staphysagria: — Cough attended with pain under the sternum, as if arising from excoriation or ulceration ; expecto- ration of yellow, purulent-looking mucus; sometimes spitting of blood, and involuntary discharge 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 sometimes with accumulations of viscid mucus on the palate, which causes a disagreeable scratching or scraping sensation. Spongia:—In acute inflammation of the bronchial mem- brane, this remedy is often of essential service (see Bron- chitis),—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, hec- tic fever. The following summary of a few characteristic indications cough. 125 may prove useful in selecting the appropriate remedy. Cough increased or excited by cold air: Lachesis, Arsenicum, Phos- phorus. Cough, excited by a feeling of dryness in the chest: Lachesis, Pulsatilla, Mercurius. Cough provoked by a tick- ling sensation in the throat : Nux v., Merc, Cham., Arnica, Bryonia, Phosph., Sep., Sulph., Lycop., Kali, Dros. Puis., Sec. (See also the other indications given above for most of these medicines.) From tickling in the pit of the throat: Cham., Bellad., Silicea. Cough from a sensation of down in the throat : Calcarea, Ignatia, Amm. c From a sensation as if from dust in the throat : Bellad., Teuc, Ferr. mag. Cough from a sensation of scraping, or a feeling of roughness or raw- ness in the throat: Nux vom., 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, Phosph., Cham., Ijach., Puis., Ammon. c, Sep , Stann., Sec. From a burning sensation in the chest: Phosph., Euphorb., Sec. From accumulation of mucus in the chest: Staryium, Arsenicum, Ipe i/c, Tart, Kreos., Sec From roughness or scraping in the chest : Pu*s., Acid, phosph., Graf. nitr. Cough, particu- larly when in the recumbent posture : Arsenicum, Lachesis, H/osryamu; Puts., Sulph., Nux vom., Merc, Hepar, Con. Cough when lying on the back : Phosph., Nux, Sec. When on the right side : Am. m., Stann. On the left: Ipecac, Par., Sec. Cough which comes on chiefly after eating : Nux vom., Bryon., Tar'arus, ('ham., BeVad., Sulph., Amm. m, China, D'-gi'., Fer., See. Cough after drinking: Arsen., Lachesis, Bryo-K, Aeon., Dros., Hepar, Lye, Phosph. After eating and drinking : Bryon. Cough on exerting the intellectual fa- culties : Nux v., Mgs., See. Cough, especially in the morning: Puis., Nu.r, Ltches., Calc, Euphr., Sep., Stann., Sulph., Rhus, Sec Cough chiefly at night: Bellad., Pulsat, Nux, Ars., Lach., Mere, Sulph., Tart, Veratr., Verb., Cham., Hyosc, Phosph., Con., Sep., Silic, Rhus, Staph., Sec. Mid- night (towards) : Bellad., Mgs. arct During the day, exclu- sively or principally : Calc, Laches., Nux, Phosph., Stann., Am. c, Alum., Euphr., Nitr., Rhus, Sec. Day and night: Bellad., Nux, Puis., Dulc, Stann., S«Zp/j., Silic., Lycop., 126 COUGH. Natr. m., Ignatia, Euphorh., Bismu'h, Spong., See. Cough excited or aggravated by laughing : Phosph., Stann., China, Argent., Dros. Cough during sleep : Lach., Cham., Verb., Bellad., Calc, Arn., Merc, See. Cough excited by speaking : Merc, Phosph., Cham., Lach., China, Silic, Stann. Sulph., Caust, Anae, Sec. Cough which comes on periodically (every second or third day) : Nux v., Ars., Lach. Cough when read- ing aloud : Phosph., Magn., Staph., Sec. When singing : Stann., Dros., Sec. Cough exacerbated or excited by move- ment : Nux v., Lachesis, Arsenicum, Bellad., China, Ferr., Silic 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, Bellad., Cham., Bryon., Lachesis, Merc, Lye, Phosph., Hepar, Ign., Sulph., Spongia, Natr. m., Sec. Sec. Cough with expectoration: Dulc, Puis., Stann., Tart., Sepia, Sulph., Calc, Kali, Euph., Caustic , Merc,— Bryon., Carbo v%, Lye, Phosph., Bellad., Squill., Staph., Natr. m., Acid, nitr., Sec. Sec. Cough with difficult expecto- ration : Lachesis, Aur., Staph., Sulph., Sep., Kali, Zinc, Euph., Arn., Caust. Cough with easy expectoration : Dulc, Stann., Alum., Veratr., Kreos. Cough with offensive expecto- ration : Sahguin. canad., Kreos., Carbo v., Sulph., Calc,— Guaj., Seel, Natr., Arsen., Stann. With expectoration of mucus: Bella., Dulc, Puis., Bryonia, Am. c, Lachesis, Squilla, Hepar, Carbo v., Phosph., Mere, Stann., Sep., Sulph., Tart., Sil., Thuja, Sec. With purulent expectoration : Sulph., Sil., Staph., Calc, Phosph., Acid, phosph., Guaiac, Acid. nitr., Kali, Lycop., Carbo v. et a., Plumb., Stann., Dros., China, Sep., Sec. With expectoration of a bitter taste : Puis., —Ars., Cham., Dros. With expectoration of a putrid taste : Carbo v., Kreos., Sep., Stann., Con., Puis., Fer., Cupr. With expectoration of a saline taste : Lycopod., Nalr., Sep., —Phosph., Stann., Sulph.,—Ambra., Magn., Sa/nb. Of a sour taste : Lachesis. Of a sweetish taste : Stann., Phosph., Sulph., Calc, Kreos., Samb. Cough with greenish sputa : Stann., Sulph., Thuja, Cann., Lye, Sep., Phosph., Carbo v. et a., See. With grayish sputa: Lycopod., Dros., Thuja. cough. 127 With frothy sputa : Lach., Ars., Daph., Op., Sec. Cough with thick sputa : Puis., Sulph., Stann., Calc, Phosph., Am. m., Argent, Bellad., Kreos., Ruta, Op. Cough with transpa- rent sputa : Ars., Silic, Fer., Senega, Nux. With viscid, tenacious sputa: Piuu-ih., Senega, Lachesis, Nux, Puis., Stann., Staph., Conn., Par.,—Spong., Arsen., Cham., China, Fer. With serous or watery sputa: Arg., Magn., Stann., Daph. Cough with whitish sputa: Sulph., Puis., Am. m., A -g., Ambr., Aeon., China, Cupr., Ac. phosph., Kreos. Cough with yellowish sputa: Sulph., Calc, Pids., Staph., Thuja, Con ,—Lycop., Stan., Sep., Acid, nitr., Acid, phosph., Carbo v., Kreos., Daph., Spong., Dros., Aug., Eug., Magn., Mang., Arsen., Bryon., Rata, See. Cough with expectoration of mu- cus mixed or streaked with blood: Aeon., Phosph., Bryon., Am., Lach., China, Fer., Natr. m., Sab., Silic, Daph., Eug., Euph., Laur., Lei-, Op., Zinc, See. 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.,—Carbo v., Cham., Kros., Nux, Natr., Natr. m., Verat., Cina. Shaking cough: Ipecac, Bellad., Hyoscyamus, Puis., Sulph., Anae, Lachesis, Ars., Ign., Lycop., Merc, Sed., Caust., Ac. nitr., Rhus, Sil, China, Ant, Sen., Mgs. arct. Spasmodic cough: Bellad., Hyosc, 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., Natrum m., Nitr. ac, Plumb., Sil., Mags. arc. Short cough : Bellad., Coffea, Lach., Laur., Natr. m., Nux v., Squilla,—Acon., 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., 0V., Natrum m., Petr., Phell., Tab., Mags, arc Cough attended with pain in the abdomen during the pa- roxysms : Ars., Bellad., Coloc, Con., Nux, Phosph., Stann., Suhh., Ver. Cough with pain as if from a blow or bruise in the chest: Arn., Ferr, Veratr., Zinc In the hypochondria : 129 COCGH. Nux v. Cough with burning in the chest: Carbo ©., 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: Carbo 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, See. Cough with rattling (mucus) in the chest: Ipec, Tart, Natr. m., Bellad.,—Puis., Sep., Arg., See. Cough with shooting pains in the chest: Aeon., Bryon., Phosph., Nitr., Squill., Sulph.,—Bella., Lach., M re, Ac. ni'r., Kali, Puis., Natr. m., Sep., Con., Dros., Sec. Cough with pain as if the chest would burst : Bryon., Merc, Zinc, Sec. Cough with pain in the chest as if arising from ulceration : Staph., Rat, Sec. Cough followed by eruc- tations, or regurgitation of ingesta : Ac. sulph. Cough at- tended with pain in the eyes : Lach. Cough accompanied by sensation of shocks or concussions in the head : Ipecac, Lach., Natr. m., Rhus. Cough with pain in the head : Nux v., Bry., Sulph., Calc, Arnica, Ipecac, Bellad., Con., Merc, Phosph., Carbo 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, Bellad. With pains in the hypochondria : Nux v., Drosera, Bryonia, Lycop., Lachesis, Am., Arsenic Am. m , Helleb. With pain in the loins : Merc, Sulph., Am. c, Acid. nitr. With pain in the nape of the neck : Bellad., Alum. With pain in the occiput: Merc, Ferr. Cough preceded by pain in the stomach : Bell. Cough, with pain in the stomach, (epigastric region): Bryon., Lachesis, Arsen., Am c, Phosph , Thuja. Cough accom- panied 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, Carbo 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 inflammation of the lungs. 129 (See the additional indications which have been given u ider 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.) Dose : ^, or ***■, or §&. Unmedicated jujubes, sugar-candy, or gum arabic, may be allowed occasionally, to moisten the throat or mouth, in cases of dry irritating coughs. INFLAMMATION OF THE LUNGS. (Additions to p. 238.) Bellaelonna* is generally required before Bryonia, when the fever returns after having been apparently subdued by Aconi- tum, and the difficulty of breathing, and pain, or feeling of un- easiness in the chest continue (particularly when the pain ex- perienced 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, expec- toration of viscid sputa, with little or no dulness of percussion or other signs of hepatization, readily yield to the employment of Br you i >. Bryonia may, however, be prescribed at the com- mencement, when the following indications present themselves: * When Aconitum does not effect the desired amendment, Belladonna is generally of greater service than Bryonia in pulmonic inflammation. Again, if Azonitum produces only a slight degree of improvement when prescribed at the third or sixth dilution, the employment of a higher at- tenuation, such as the twelfth or twenty-fourth, is often followed by the happiest success. I consider Aconitum, Belladonna, and Phosphorus, to be the most important remedies in pneumonia.—Rummell. Allg. Horn Zeit. No. 21. 32ster Bd. 6* 130 inflammation of the lungs. cough, attended with expectoration of viscid or tenacious mucus, of a brick-dust colour, oppression at the chest accompa- nied 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, constipation, and other signs of gastric derangement. A complication with pleurisy (pneumo- pleuritis), indicated by increased dulness on percussion, and in some instances a double-sounding voice, central bronchial respiration, and bronchophony, is "often an additional reason for the selection of this remedy. (See also Pleuritis.) $ Tinct. Bryon. alb. 3, gtt. iij. Aq. pur. § iij. Dose. A dessert-spoonful every four, six, or eight hours, according to the severity of the case. Bromium and Nitrum, particularly the former, promise to be of as much importance as Phosphorus in so-called complicated cases of pneumonia, and where there is incipient hepatization. In obstinate or chronic cases, with weak, thread-like pulse and clammy sweats, Lachesis and Lycopodium have been found very useful after, or in alternation with, Sulphur, Kali n., Sec. Carb. v. and Am. m. have also been suggested as likely to be of service in some cases of the foregoing description.* Sanguinariu canadensis. This important medicament is considered by Constantine Hering as likely to prove a valuable remedy in certain cases of pneumonia. Cantharidcs seems calculated to prove serviceable in pneumo-pleuritis. Ere we conclude this chapter, we trust we shall be excused for introducing the following somewhat diffuse but important remarks of Dr. C. Mliller, on the employment of Tartarus emetic us and Phospharus in pneumonia, as also some extracts from the observations of Dr. H. Gr Schneider and Dr. Watzke on the treatment of pneumonic inflammation. " The information to be gleaned from homozopathic authors, as to the efficacy of Tartarus emeticus in pulmonary affections, * 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 L0NO3. 131 is nearly as follows : Dr. Wurm recommends it in pleuritis com- plicated with bronchitis, when the expectoration is difficult. Dr. Buchner recommends its employment in pneumonia when the fever and the typical signs have, for the most part, disap- peared, but the patient is affected with constant rattling in the chest, and expectorates large confluent masses ; the expectora- tion being, at the same time, difficult, the respiration oppres- sive, the chest affected with a burning sensation extending to the throat, and gastric symptoms predominating. An anonymous writer considers Tartarus emeticus the only specific remedy in Pneumonia gnstrlca, and in the second stage of pure pneumonia. Dr. Bosch gives, several detailed cures of pneumonia by ^neans of emetic tartar, and intimates that he has always 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 holds Tart. erne}, 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, which 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 cough- ing ; burning sensation under the sternum; continuous 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, ren- dering it necessary to sit up in bed,—relieved after coughing and expectorating; nocturnal paroxysms of orthopnoea; irregu- lar or unequal, intermittent respiration during sleep; less fre- quent inspiration; interrupted or oppressed breathing, with dysphagia; unusual oppression at the chest. As already shown, the homoeopathic physicians have, upon the whole, employed Tart. emet. but rarely in thoracic inflam- 132 INFLAMMATION OF THE LUNGS. mations, 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 recom- mendations emanating from allopathic practitioners, rather than that any want of confidence in the remedy had arisen from established trials. No homceopathist, however, ever expected to find in Tart emet. a never-failing specific in pulmonic inflam- mations. It therefore remains for us, from the physiological effects of this remedy, and the experience which has been de- rived 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 paini'ul 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 tie serous covering of the lungs, however, it is far otherwise; for if the pleura be affected, and particularly when inflamed, acute pain is always present, but this pain is almost constantly of a shooting or cut- ting description (as is for the most part the case in all serous membrane<), and consequently not continual or incessant, but intermitting, excited by movement, breathing, &c. As the above-mentioned pain is, strictly speaking, 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 complaint, is untenable. Concerning the phrase "rheumatic pain," there is some diffi- culty 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 com- monly employed in reference to pains arising from exposure to cold, such a signification ought not to find place in a scientific (homoeopathic) work; most probably, therefore, it is intended INFLAMMATION OF THE LUNGS. 133 to be implied that the pain has its seat in the pectoral muscles, inasmuch 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 would seem to be unjustifiable, since the aforesaid pains counter-indicate the employment of this remedy. The paucity of painful pectoral symptoms speaks much more in favour of the application of Tart. emet. in pneumonia. The following three symptoms ought to be taken into con- sideration here : sensation as if the chest were lined with velvet; soreness or pain as from excoriation in the chest, occurring in paroxysms; burning sensations behind the sternum, evidently arising from affections of the mucous lining of the bronchi, and their ramifications; they therefore denote the existence of com- mon catarrh, or of the catarrhal affection which always accom- panies inflammation of the lungs, and do not correspond to pleurisy, from the circumstance that catarrhal symptoms more rarely attend the latter affection. The symptoms of abnormal respiration are strongly marked : short, oppressed breathing, rendering it necessary for the patient to sit up in bed; frequent fits of unequal, intermittent respiration during sleep ; extreme pectoral oppression; dyspnoea, compelling the patient to sit up, meliorated after coughing and expectorating; nocturnal attacks of orthopncea ; respiratory disturbance with dysphagia. When we compare these numerous symptoms with those of 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 cor- respond particularly with those of pneumonia; for in that affec- tion, 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 re- ferring to the expectoration are of a less satisfactory nature; the cough is certainly chiefly loose, and even accompanied with 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 notification. But although this de. 134 INFLAMMATION OF THE LUNGS. ficiency of observation is much to be regretted, 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 symp- tom would most assuredly have been recorded. The following two symptoms may also be said to be of considerable import- ance : gasping for breath at the commencement of every fit of coughing; and dyspnoea, diminished after coughing and expec- torating; since this dependence of the oppression on the accu- mulation of mucus in the bronchi, and its disappearance and cessation for some time after expectorating, is in like manner to be observed in certain forms of pneumonia, viz., after the act of coughing, or merely by expectoration, the bronchial ramifica- tions which intercept the hepatized portion of lung may be cleared of the fluids or the hard substances 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 subse- quent to expectorating, and also by the circumstance that bronchophony, the bronchial respiration, the simultaneous rat- tling rhonchi, sibilus, &c, previously absent, often follow a paroxysm of coughing. Had any doubt remained as to the specific relation of Tar- tarus to the lungs and pulmonic inflammations, it would have been unconditionally removed by the results which have been ob- tained 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 in- flammation. 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 ramolissement rouge by Andral. Taking everything into consideration, therefore we shall find that the following are the indications for Tartarus erne- INFLAMMATION OF THE LUNGS. 135 ticus: it is particularly applicable in pneumonia, and espe- cially in the so-called second stage, when little or no pain, but an extreme degree of oppression and obstructed respi- ration, 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 con- ' tains very little or no blood, and consists chiefly of mucous masses; and when percussion 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 surface, 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 diameter, the percussion-sound would again be normal, but this is naturally of rare occurrence. Auscultation, over the spot where the stroke-sound was dull, will afford more or less distinct bronchophony (when, namely, the hepatized portion is sufficiently large to embrace one of the larger bronchial rami- fications, 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 respira- tion and consonant rattling, or one or the other. The presence of bronchophony does not, however, necessarily imply the existence of bronchial respiration or consonant sibilus, or rhonchi; and vice versa, bronchophony is not always heard when bronchial respiration is present; these signs are some- times only perceptible after the act of expectoration, as has been stated above. At those parts of the thorax where the lung is not hepatized, 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 136 INFLAMMATION OF THE LUNGS. signs remain the same in the third stage of pneumonia, the so- called gray hepatization, hepatization 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 general symptoms would lead sooner to the se- lection of Phosph., Arc., Rhus, Lachesis, Sec, than to Tart. emet, which has either none or but a limited number of the said symptoms. It now remains to be ascertained whether, in addition to the symptoms which have already been notified, there are any pe- culiar 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 de- rangement, the so-called pneumonia biiiosa (erysipelas pul- monum) that emetic tartar is particularly appropriate. The characteristic marks which distinguish the said form of pneu- monia from the common species are, the light bilious discolor- ation of the skin, and especially of the albuginea, alae nasi, and corners of the mouth; further, the coating of the tongue, merg- ing 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 instantane- ously a saffron-yellow colour under the test of nitric acid ) Along with the foregoing, a lancinating pain is commonly ex- perienced under the right false ribs, or pain and distention are complained of in the scrobiculus, with frequent eructation and hiccough ; moreover, a peculiar pressive, severe piercing pain is centered in the forehead, which sometimes gives place to- wards 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 cer- tainly be found the maj< rity, but not the whole, of those above given The yell w colour of the skin, for instance, as also the browmsh-yullow coating of the tongue aud the bitter taste, are INFLAMMATION OF THE LUNGS. 137 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 distention and sensibility of the epigastrium and hypochondria, together with the eructations, hiccough, and vomiting, and the dark reddish- brown coloured, cloudy urine, the pressive frontal headache, and the cough with vomiting, are well determined symptoms of Emet. tart; concerning the sputa, as has already been observ ed, we are in the possession of no positive testimony. It there- fore 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 complications is unjustifiable. Phosphorus. The experience of homceopathists as to the efficacy of Phosphorus in inflammations of the respiratory organs, is more extensive; the observations detailed thereon, in various journals and essay3, are so numerous that we shall here quote merely a selection of the most appropriate and authentic amongst them. Dr. Wurm recommends it in pleuritis and pneumonia, in con- nexion with tuberculosis puhnonum ; as also in complications of pleuritis with pneumonia or bronchitis. Dr. Gr. Schmidt ex- presses himself in accordance with the foregoing. Dr. Grriesselich cured a case of pleuro-pneumonia by Phos- phorus which had continued to gain ground notwithstanding 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, pa- ralysis of the lungs was momentarily to be dreaded; in the right lung there was no longer any respiratory 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 incipient slight respiratory murmur, pectoriloquy, oegophony, became audible, and recovery followed soon afterwards. Dr. Buchner recommends Phosphorus where great prostra- • 138 INFLAMMATION OF THE LUNGS. tion, 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 exhaustion, burning, darting, rattling in the chest, danger of paralysis of the lungs, complication with bronchitis, imperfect crisis from depressed physical power. Dr. Horner found Phosphorus curative in an extremely severe case of peripneumony, in which, after the employment of Aconi- tum and. B yonia, exhausting epistaxis, subsultus tendinum, delirium furibundum and involuntary stools had supervened. Schellhammer found benefit still to arise from the employ. ment 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 dullness of tone on percussion, that it seemed as if a wall were struck instead of the chest. Dr. Eichhorn 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 (some- times gelatinous-looking) sputa, Sec.; and also in those cases of typhus, where, notwithstanding the pneumonic concentration, sensibility to the touch, and borborygmus in the ccecal region as well as diarrhoea, are present. Dr. Schneider 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 neglect- ed cases, with rattling rhonchus in the bronchi, difficult purulent- looking, copious sputa, and great debility. Dr. Watzke states Phosphorus to be appropriate in the se- cond 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. Fleischmann; in the year 1840 he employed it exclusively with success in 51 cases of inflammation of the lungs, and found • INFLAMMATION OF THE LUNGS. 139 it equally useful in nearly every stage of the disease; the same striking results ensued in the following year. The physical signs were almost constantly as follows : dullness of sound on percussion, 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, Dr. Bethmann, and Dr. Hartlaub. 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 burning at rest and during movement, especially while sitting and during respiration; pain in the chest, particularly during inspiration, itching in the in- terior 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; tightness 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 respiration; dry, hollow cough without subsequent expectoration ; hacking cough, with a suffocating sensation in the chest, and some mucous expectoration; 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, render- ing it necessary to support the part with the hand; great start- ness after each fit of coughing. The sensations of pain which Phosphorus is capable of pro- ducing consists, for the most part, of stitches and shootings, whictfare more particularly excited or increased by respiration, 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 experienced during a deep inspiration or the act 140 INFLAMMATION OF THE LUNGS. 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 Tent. 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 determine the kinds of pneumonia, the time and stage in which Phosphorus is appropriate, it is requisite in the first place to point out those pulmonic inflammations where (in contradis- tinction 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 extensivly (for perhaps in no case of pneu- monia does it wholly escape) implicated, and more particularly in the second stage when mucus or sanguineous mucus is ex- pectorated, and the physical signs are the same as those men- tioned under Tart, emet, viz dull stroke-sound and broncho- phony or bronchial respiration, and perhaps consonant rales. So far, therefore, it would seem that Phosphorus corresponds somewhat closely with Tart, emet in its sphere of action, dif- fering 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 appear- ances, which, without inducing any peculiar change in the local and physical symptoms, sometimes connect themselves with pneumonic inflammations, and have by the older physicians been denominated nervous. These "nervous" appearances INFLAMMATION OF THE LUNG?. 14.1 develop themselves probably only when the pulmonic inflamma. tion enters, unchecked, into the third stage, that of the gray hepatization (hepatization grise, ramollisement grise) 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 carphologia and subsultus tendinum, rapid pros- tration of strength, cold, clammy sweats, small, feeble, frequent pulse, dim eyes, sunken features, dry lips and tongue, short, la- borious 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 Jhe sound, on percussion, be- comes perfectly dull and deprived of resonance over a larger surface, and the respiratory murmur, at that spot, inaudible or extremely faint. The expectoration 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 particularly the delirium with carphologia, 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 ob- servations which almost unanimously recommend Phosphorus in the so-called slow, asthenic, nervous pneumonic inflammations, —corroborated, moreover, by the testimony of Dr. Fleisch- mann, whose position as the physician to an hospital gives ad- ditional weight 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 paralysis 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 142 INFLAMMATION OF THE LUNGS. embraced by Phosphorus is greater than that of Tart, emet, and that the former may be advantageously employed in pneu- monic 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 Phosphorus should still be capable of effecting 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. Schneider 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. n. 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 pneu- monia. in. If, in addition to critical sweat and urine, the evolution of a scabby eruption about the mouth appeared to be ne- cessary to ensure the termination of the inflammation, the de- crease 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 restless- ness, with increased oppression, cough, and pain during the act of coughing, the eruption of a critical miliaria was to be expected. v. A miliary eruption (consisting of small whitish vesicles on a red ground) was always sufficient (when the inflammation could not otherwise be removed) to terminate the pneumony within nine days. In the meanwhile the sweats diminished ami the miliaria soon afterwards scaled off. INFLAMMATION OF THE LUNflS. 143 vi. In one case, where the patient had wantonly exposed herself to cold on the fifth day of the disease,* about the ter- mination of the crisis bona (by sweat, hypostatic urine, and efuption about the mouth) relapse took place, accompanied by great anxiety, restlessness, and sleeplessness, excessive oppres- sion and tightness of the chest, and very difficult, painful cough, which indicated a termination (on the ninth day, reck- oned from the first appearance of the disease) in a miliary eruption. vn. 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 were 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 ex- pectoration 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. I generally prescribed 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. ix. 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. x. 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. xi. The second remedy which I employed in pneumony was generally Bryonia; I soon discovered, however, that this me- dicament operated much better when given alternately with * 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. 144 INFLAMMATION OF THE LUNGS 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 Amic or Rhus (after external causes). xn. 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 angina?, Belladonna deserves particular attention ; and during that of influenza, Mercury. xni. I usually employed Mercurius with good effect with that otherwise indicated remedy, if a critical eruption about the mouth was to be foreseen. xiv. When the critical eruption about the mouth was fore- seen, the employment of Mercurius in alternation with the re- medy otherwise indicated, was attended with good results. If all remedies above-mentioned did not effect the desired amend- ment 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. xv. On appearance of great anguish and restlessness, and oppression of the chest (iv.), &c, before the evolution of mili- aria, I found either Arsen. or Veratr., or Hyoscyam. indicated, and effective. xvi. In neglected pneumony, with rattling noise in the bronchi, difficult, purulent and copious expectoration, great weakness, &c, I have found Belladonna, Arsen., Phosph., and Lycop. very beneficial. xvn. In neglected pneumony, with copious, very offensive, purulent expectoration, (ix.) I found especially Sepia, Conium, Carb., Silic and China effective. xviii. Latterly, I commonly prescribed Aconitum, Bryon., and Bellad., in the 1—I. dilution, and the other medicines in the 4—II., as follows: gtt. iv.—gtt. viij. in §iv. of water 1 tablespoonful to be taken every 1—2 hours. Dr. Watzke states that: " The homoeopathic or specific treatment of pneumonia presents very considerable advantages__ INFLAMMATION OF THE LUNGS. 145 although more in reference to the direct and indirect conse- quences, 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 ap- pearance 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 recom- mended and employed against pneumonia. We only ex- pect direct benefit from it in active hypersemia, and incipient splenization. Bryonia we employ only in those forms of pneumonia which are sympathetically founded on pleuritic inflammation with pre- dominating 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 mechanical lesion, the best remedies are Ar- nica, Rhus, and Conium. Belladonna is indicated when pneumonia is accompanied by an acute exanthema, with violent cerebral symptoms and ge- neral turgor venosus. In pneumonia occurring in females la- bouring under primary or secondary chlorosis, or associated with chronic, neglected, or acute bronchial catarrh, measles, or smallpox, Pulsatilla will not easily be excelled by any other remedy. " In the second stage of primary pneumonic croup we would call attention, besides, to the well-known and successfully em- ployed Phosphor, and Anlimonium, to Bismuth magesterium, and Arg. nitr., in addition to the well-known and successfully employed Phosphorus and Anlimon. tart. Arg. nitr. promises to be more especially of service against lobular hepatization oc- curring as a sequela. In the stage of purulent or serous infiltration, Bromium is, next to Sulphur, Senega, and Carbo veg., the most worthy of attention. In irregular reactions, insufficient crisis in asthenic, torpid inflammations of the lungs, which frequently take place in con^ 7 146 DIAPHRAGMITIS. sequence of bleedings, China, Camphor, Of. tereb., and Mos- chus, are often beneficial even in apparently hopeless eases. Opium, Nux vomica, Hyoscyamus, Lachesis, Coniu/n, Coc- culus, Stram., do not appear to have any primary and direct effect upon the lungs; they are indicated in secondary pneu- monic processes, in pneumo-typhus, in delirium tremens compli- cated with inflammations of the lungs, and in various forms of so-called nervous pneumony. In pneumonia catarrhalis, or in pneumony occurring in lym- phatic, flaccid, fat habits, Senega is indicated; in pneumonia complicated with bronchitis, Seneca, Mercury, Phosph., Brom., Nux mosch.; in that with hepatitis (pneumonia biliosa ?) Se- nega, Mercury, Nux vomica, and in pneumonia interstitialis— Aur-ehlor. Pneumonic states which originate from tubercles in the lungs, are sometimes to be cured by means of Mercury, Iod., Sulphur, Spongia, and Ol.jecoris ase-li. In the pneumonia of old persons, Arsenicum, is the principal remedy ; in that arising from repercussed eruptions, Arseni- cum and Sulphur; in complications with endocarditis, Arse- nicum, Camphora, Mercurius, Bromium ; and in those with pleuritic exudations, Arsenicum, Camphora, Phosphorus, Scilla, and Acidum muriaticum, are the most important me- dicaments." DIAPHRAOMITIS. Inflammation of tie D'aphragm (muscular partition between the thorax and abdomen). Inflammation confined to the muscular structure of the dia- phragm is considered to be of extremely rare occurrence, the disorder in almost every case appearing in combination with inflammation of the pleural or peritoneal covering ; in either of which investing membranes, moreover, 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 DIAPHRAGMITIB. 147 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 vertebrae, 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 vio- lent ; simulating 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 prin- cipal seat of the inflammation. Along with the foregoing symptoms there is frequently ob- structed deglutition, severe hiccup or vomiting, extreme anxiety and restlessness, 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 exces- sive, 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 resolution, or in the effusion of fluid either into the cavity of the pleura or perito- neum, 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 when the accompanying fever partakes of the char- acter of synochus, Bryonia is to be preferred, and may, in most cases of the said description, be prescribed at the very com- mencement of the attack. If the scrobiculus and the region of the false or lower ribs be swollen, and pressure increase the short and distressingly interrupted breathing, as also the pul- sating burning pain which extends from the stated points 148 CONSUMPTION. backwards towards the spine; moreover, when there is a dry, fatiguing cough, or violent vomiting and convulsions, great agi- tation and constant moaning,—Chamomilla is the best remedy. But should there be great tightness, as if caused by the constric- tion of a cord drawn around, the chest, with dry, short cough, anxiety, and constipation,-—Nux vom., is the most appropriate remedial agent. ' Cannabis, Pulsatilla, Cocc have been recom- mended as being useful where the symptoms of inflammation continue to occupy a prominent place ; and Hyoscyamus, Ve- ratrum alb., Arsenicum, Stramonium, and Ipecacuanha, where a nervous condition predominates. When diaphragmitis exists in connexion with pleuritis, Bry- onia 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 agitation, cough. Nux vomica 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 selection. (See also Pleu- ritis, Pneumonia, Peritonitis, Splenitis, and He- patitis.) Diaphragmitis arising from antecedent gout or rheumatism, is the most dangerous and fatal form in which the affection is met. The remedies chiefly to be relied on under such serious circumstances, are the same as the fore- going. Dose: °|<>,or °£°, or ff. PULMONARY CONSUMPTION. Phthisis Pulmonalis. (Additions to p. 259.) One of the earliest symptoms of tuberculous phthisis is a short cough, which is either dry or accompanied by the expec- toration of a frothy mucus, and is generally slight at the com- Consumption. 149 mencement, but more or less constant. Shortness of breath, proceeding from obstruction, caused by the granular and dif- fused indurations, is another early symptom of consumption. 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 slight- est movement. Symptoms of gastric derangement are fre- quently present, with redness of the tongue, or white furred centre, with inflamed and projecting papillae, and vivid red tip and margins; the patient falls off in flesh, becomes indolent, dejected, and overpowered with languor. A feeling of soreness is often complained of behind the sternum, or under the cla- vicles, particularly after any fatigue, or after a fit of coughing, and sometimes 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 declares itself most towards night, remits from about two in the morning until the following day at noon, when it returns in a slighter degree, and continues until about five in the afternoon, and is then followed by another remission. This hectic fever is, in the first instance, chiefly 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 exhaus- tion in the morning. As the expectoration increases, it be- comes more viscid and opaque, and is often tinged with blood, or a considerable quantity of florid, frothy blood is ejected in consequence of the obstruction offered to the blood-vessels, by the indurations 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 ren- dered 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 150 CONSUMPTION. 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 excitement, 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 dejected expression. In the third (or suppurative and ulcerative) stage of the dis- order 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 occa- sionally, 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 re- laxed, so that attacks of diarrhoea often recur frequently, and, by alternating with colliquative sweats, induce an excessive de- gree of weakness 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 hol- low, the hair falls off, the nails are livid and incurvated, and the feet cedomatous; but, notwithstanding all this, the coun- tenance 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 condi- tion, 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 delirium precedes death and continues until life is extinct. The usual duration 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 emaciation, chiefly in winter and spring, and in many respects restored to comparative 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 CONSUMPTION. 151 time, sometimes even for several years, until at length the symptoms of confirmed consumption are developed by the in- vasion of an inflammatory attack proceeding from cold or some other irritating cause.* ' When we take the general symptoms in conjunction with the physical signs, the diagnosis of phthysis pulmonalis is, in ge- neral, unattended with difficulty. It is true that in the early stage, when the miliary indurations are equally diffused or scat- tered through both lungs, they do not give rise to any marked diminution or change in the respiratory murmur, or in the reso- nance of the thorax on percussion. But it much more fre- quently 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 expiration will, at the same time, be unusually audible, and the voice will transmit a diffu- sed 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 scapulae in the case of children in particular). A slight flatten- ing is sometimes observable under the clavicles. On comparing the movements of the two sides of the'chest, when the patient breathes deeply, a difference in their individual mobility 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 scapula). As the evacuation of the softened matter of the vomica progresses, a more continued gurgling, or the so- called cavernous rhonchus, will then be heard. Again, when * Hoarseness is often an early accompanying symptom of phthisis. Laryngeal phthisis, with thickening and ulceration of the lining mem- brane of the larynx, independently of its own serious character as a dis- ease, is moreover very frequently complicated with tubercular formations in the lungs. 152 CONSUMPTION. the vomica or abscess has become completely softened and eva- cuated by ulceration into the bronchial tubes, a cavity is left, over the seat of which, cavernous respiration, and, when the pa- tient speaks, the phenomenon designated pectoriloquy are en- countered. 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 cha- racteristic 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 read- ers with a brief notice of the principal remedies which are em- ployed in homoeopathic practice against the inflammatory, sup- purative, 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 com- mencing to soften, the remedies by means of which the malady may be retarded, if not arrested, and, with due collateral precau- tions, kept harmless for years, are chiefly Aconitum, Bryonia, Belladonna, Lachesis, Hepar, Spongia, Phosphorus, Dulca- mara, Pulsatilla, Arsenicum, Nux v., Hyoscyamus, Silicea, Calcarea c, Carbo v., Acidum nitricum, and Sulphur. These must be selected according to the aggregate symptoms of the case under treatment. Their leading indications may be glean- ed 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, Spongia, Cinchona, Ferrum, Co- nium, Zincum, Ammon. c, Laurocerasus, Graphites, Nilrumi Podium, Drosera. Plumbum, Sec. In the third, or ulcerative stage, the same remedies as the foregoing, together with Guaiacum, Sepia, Sleennum, Staphy- sagria, Acidum phosphorieum, Sanguinaria canadensis are those by means of which the symptoms may be materially miti- CONSUMPTION. 153 gated, and the fatal issue of the disease postponed. A few general indications for most of these will be found in the chap- ter on Cough. When the colliquative sweats are peculiarly distressing, Sambucvs, Stannum, Cinchona, Phosphorus, Ar- senicum, Carbo v. et a., Silicea, Mercurius, Nitrum, Lachesis, Sulphur and Lycopodium, are the medicines which are of the greatest service. The remaining morbid symptoms must regu- late their selection. When colliquative diarrhoea predominates : China, Ferrum, Arsenicum, Phosphorus, Acidum phosphori- cum, and Sepia, are the most useful. (See Diarrhoea.) In phthisis resulting from imperfectly treated pulmonic in- flammation, or from excessive pulmonary hemorrhage, and occurring in habits which are not of the consumptive diathesis, the remedies which are best calculated, under favourable cir- cumstances, to effect a cure, are : • Lachesis, Lycopodium, Sul- phur, 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 blennorrhea of the lungs, the most effective medicines are Stannum, Dulcamara, Pulsatilla, Sul- phur, Sepia; and Calcarea, Lycopodium, Cinchona, Phospho- rus, Silicea, Arsenicum, Zincum, Copaiva, Sec. WThile 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 practi- tioner, a3 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 which is so repeatedly created in the lungs by the vicissitudes of climate, so constantly occurring in most parts of this country, forms a great drawback to the more or less successful treatment 7* 154 APOPLEXY. of pulmonary consumption, it is of great moment that every pos- sible means be taken to avoid that pernicious influence. It has been much in vogue with many medical 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 we are inclined to side with those who do not ob- ject to a somewhat bracing and cold atmosphere, provided it be dry and not of very variabLe temperature. Much, however, de- pends upon the peculiarity of the case, —the air, as well as the food, which may be well adapted to one patient, being often per- fectly inappropriate and therefore injurious to another. APOPLEXY. (Additions to page 271.) Apoplexy. The following are the principal remedies, which have hitherto been chiefly recommended, or found most suc- cessful, in the treatment of the disease itself:—Opium, Nux vomica, Belladonna, Lachesis, Arnica, Pulsatilla, Baryta car- bonica, Silicea, Stramonium, Zincum metallicum, Acidum hy- drocyanicum, Agaricve, See. In sanguineous or sthenic apoplexy, (generally characterized by bloodshot eyes, redness of the face, full, hard pulse, op- pressed and stertorous breathing. The paroxysm more usually comes on without warning.—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., Strain., Ant, Coff., Hyos., Puis., Sec, are the principal remedies. In asthenic apoplexy, (chiefly defined by pale and sallow, but puffy, bloated countenance; feeble and easily compressible pulse, heavy, laborious respiration. This variety is more com- monly ushered in by premonitory symptoms than the prece- ding, such as headache, giddiness, loss of memory, illusions of hearing, inarticulate speech, somnolency, and a disposition to clonic spasms,) Ipecac, Merc, Dig. Arn.,—Baryt. c, Cocc, EPILEPSY. 155 Con., Nux v., Puis., Zinc. Bella. Coff., Hyos., Stram., Cup. Sec., are more frequently called for. EPILEPSY Epilepsia. Morbus sacer. Morbus caducus. Morbus divinus. Morbus herculeus. Morbus comitialis. (Additions to page 395.) This is a malady which consists of clonic spasms, or convul- sions, with loss of consciousness and voluntary motion, and ge- nerally foaming at the mouth. It comes on by fits, and is usually characterized by the sud- denness of the attack, although it is occasionally preceded by pain in the head, dimness of vision, flashes or sparks of fire, tinnitus aurium, palpitations, 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 upwards 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 on the other, and those con- cerned in the performance of respiration are always 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 conse- quence of which the tongue is sometimes lacerated by being thrust out immediately before the sudden and violent approxi- mation 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 fseces aud urine are sometimes passed involuntarily. On the abatement of the spasms the patient gradually recovers. Sometimes a fit of vomiting terminates the attack. The me- mory and judgment are generally somewhat impaired for some 156 BPILEPSY. k little time after the fit, and a sensation of languor and exhaus- tion, or weight and other uncomfortable feelings in the head are complained of. Comparatively few patients are carried off dur- ing a fit, but it sometimes happens that one fit succeeds another in rapid succession, or with increasing intensity, until a coma- tose state ensues, and the patient sinks. Idiocy is an occa- sional 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 sym- pathetic, 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 ac- complished. 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 selection of one from amongst a class of re- medies. When the disease proceeds from plethora with deter- mination of blood to the head, Aeon., Bella., Op., Nux v., Puis., Bry., Merc, Ign., Sulph., Veratr., Silic, 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, Mere, Sulph. (See In. vermination.) When from that of teething : Bella., Cham., Cina, Ign., Sulph., Calc, Stann. (See Dentition and Convulsions in Children.) When from hysterical affec- tions (Epilepsia uterina): Bella., Plat, Sep., Ign., Sulph., Mosch., Nux, Cocc, Veratr., Puis., Aur., Magn., Magn. m, Cec corn., Stram., Hyos., Ac hydroc (See Hysteria and Metritis.) When from the retropulsion of an eruption : EPILEPSY. 157 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, (adulterated): Nux v., Lach., Ign., Bell., Hyos., Cupr., Cham., Op., Calc, See. From exposure to the fumes of arsenic and copper : Camph., Cupr., Merc, Ipecac, Chin., Nux v., Veratr., Ars. To those of mercury, Stramonium chiefly, in the first place. From checked perspiration: Cham., Sulph., Aeon., Bella., Nux v., Leich., Cic, Sil, Chin., See. From moral causes, such as fright, fear, &c. : Art em., Op., Aeon., Cham., Hyos, Nux v., Plat, Cupr. (See Moral Emotions.) From crudities of the stomach: Ipec, Nux v., Puis., Sec. (See Dyspepsia and Derangement of Stomach.) And when from an injury of the head (Epilepsia traumatica): Arnica, Aeon., Aug., Cic; and 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 spicula or morbid growth of bone is pressing upon the brain. In recent cases of idiopathic epilepsy, either attacking sud- denly without manifest cause (Epilepsia cerebralis), or pre- ceded by a peculiar and disagreeable or painful sensation ascend- ing from some part of the body (Epilepsia sympathica), Bel- ladonna, Hyosc, Ignatia, Nux vom., Opium, Cocculus, Sec, are most frequently indicated; and those which are chronic : Sulphur, Calcarea carbonica, Silicea, and Cuprum, chiefly; but also, Bellad., Lachesis, Hepar, Stann., S'ram., Ars., Agar., Camph., Merc, Sec, and likewise 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 sensa- tion of crawling and torpor in the upper extremities ; jerking of the limbs, especially of the arms, convulsive movements of the mouth, muscles of the face and eyes; congestion in the head, with vertigo, deep reelness, heat and bloatedness of the face, or paleness and coldness of the face, with shivering; photophobia ; convulsed or fixed eyes; dilated pupil ; cramps 158 EPILEPSY. in the larynx and fhroa\ wi'h obstructed deglutition and dan- ger of suffocation ; foam at the mouth ; unnoticed emission of faeces- (and of urine), or loose evacuation of ingesta; oppression on the chest and anxious respiration ; renewal of the Jits on the slightest contact or the least contradiction ; dizziness, or com- plete loss of consciousness , sleeplessness between the fits, with agitation and tossing, or deep and lethargic sleep, with smiles and grimaces; waking with a start, with cries. (Compare with 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 con- sciousness and of speech ; saliva'ion, sometimes frothy ; red- ness of the face and eyes; recurrence of the fits every month, and especially at the catamenia. Hyoscyamus :—Bluish colour and bloatedness of the face; foam at the mouth; prominent eyes; convulsive movements of certain limbs, or of the whole body; violent jactita- tion ; retraction of the thumbs; renewal of the fits, on endea- vouring 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 ; re- traction of the thumbs ; red and bluish face; or redness of one side and paleness of the other, or paleness and redness alter- nately ; frothy salivation; spasms in the throat and larynx, with threatening suffocation and difficult deglutition; loss of consciousness ; frequent yawning, or drowsy sleep; great anxi- ety 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 ab- domen, coma somnolentum, nausea, &c. Nux vomica :—Shrieks, throning back of the head, trem- bling or convulsive jerks of the limbs or muscles; renewal of the fits after contradiction or an angry emotion ; unnoticed eva- epilepsy. 159 cuation of faeces and urine; sensation of torpor and, numbness in 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 lethar- gic sleep after or between the paroxysms. (See Bellad., Hyosc., Ign.) Stramonium :—Throwing 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 bloateeJness of the face, loss of con- sciousness and of sensation, sometimes with cries, Sec, renewal of the fits by contact, and also by the sight of bright and bril- liant 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 sensa- tion as if a mouse, or some other small animal, were running over the muscles; cries, stiffness of the body, fits excited by cold air, or by a current of air. (Bella, is very useful before or af- ter Sulph. in some cases.) Calcarea :—Especially when the fits occur at night, and in chronic cases. (After Sulph.) Silicea — is chiefly useful in chronic epilepsy. (After Calc.) Camphora—against epilepsy, with'snoring, red and puffed face, coma somnolentum. Ciccta -.—Paleness, or yellowish colour of the face, trismus, distortion 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, distention of the abdomen, itching in the nose, thirst, and nocturnal attacks. Stannum: — Jactitation of the limbs, retraction of the 160 ANGINA PECTORIS. thumbs, paleness 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, dis- couragement 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 vio- lence 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 where 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 corporal or mental exertion must be abstained from. Dose : ^, or ^, or \y>, according to circumstances. ANGINA PECTORIS. The pathology of this disease is very obscure. It is fre- quently associated with organic lesions of the heart and large vessels. Many authors have accordingly attributed such de- rangements as the cause of this disorder; others have consi- dered it as depending on a species of spasm of the diaphragm and other muscles concerned in the process of respiration on diseases of the pericardium, ossification of the coronary arteries and on inflammation of the mediastinum. There are manv ANGINA PECTORIS. 161 again, who are of opinion that it is produced by asthma, by scro- fula, or by syphilis,—by general plethora with accumulation of blood in the heart and large vessels, or by disordered action of the cardiac and pneumogastric nerves. The disease seldom attacks individuals under forty; it ap- pears to occur more frequently in men than in women, and par- ticularly in those who are of a corpulent paake, of a rheumatic or gouty diathesis, and are exposed to much mental uneasiness, or are addicted to habits of intemperance. The pain of this distressing malady is always severe, and sometimes excruciat- ing. The paroxysm usually comes on in the following man- ner : the patient is suddenly seized with an agonizing sensation in the chest, especially about the lower part of the sternum, a little towards the left side ; a painful feeling of constriction and suff'jcation is generally experienced, and if the party affected be walking, he is compelled to stop until the attack is over. In the early career of the affection, the paroxysms are commonly only brought on by some exertion, such as walking up a hill; but when it has reached a more advanced stage, the most trivial degree of excitement, or mental or corporal exertion, as also an error in diet, such as partaking of some indigestible article of food, • is sufficient to excite an attack ; and, finally, the incur- sions come on suddenly and unexpectedly without any manifest cause, even when in bed and during slumber. At the first invasion of angina pectoris the pain is ordinarily confined to the chest; but subsequently it extends to the left shoulder, or to the deltoid muscle, and frequently it affects the entire length of both superior extremities. In the milder forms of the disease the paroxysms terminate in from a few minutes to half an hour ; but in those of a sever- er character it continues for several hours, and in some cases the unfortunate patient is never perfectly free from distressing uneasiness and constriction in the chest. Occasionally the attack goes off as suddenly as it made its onset; while at other times more or less soreness remains about the chest, or in other parts for many hours or days. In severe cases the patient is pale, the features haggard and contracted, the eyes sunk, and the countenance bears an ex- 162 ANGINA PECTORIS. pression of extreme anguish ; the body is frequently cold, or covered with a cold and clammy sweat; the action of the heart and lungs variously disordered ; and although the patient is capable of taking a full inspiration, his respiration is rapid and difficult, and is accompanied with palpitation of the heart, ex- cessive anxiety, and a feeling of approaching dissolution. The pulse is sometimes not much affected, but in the generality of cases it is slow, feeble, oppressed, and intermittent; occasion- ally, however, it is quick, strong, and irregular, under which circumstances the skin will usually be found warm and the face flushed. There is often considerable derangement of the func- tions of digestion ; and an attack is frequently terminated with a discharge of flatus. Therapeutics. Aconitum, Arsenicum album, and Digita- lis purpurea, are the remedies which have chiefly been recom- mended in the treatment of angina pectoris. Aconitum is of considerable service in recent cases, and even in those of a more advanced stage, occurring in strong plethoric subjects, in whom the paroxysms are attended with flushing of the face, some heat of skin, with a full, strong, and throbbing pulse; it is a most valuable palliative when adminis- tered at the commencement of each attack. But in order to diminish the frequency of the returns, where there is local con- gestion, it will be necessary to have recourse to such remedies as Belladonna, Lachesis, Nux vomi-a, Carbo v., and Sulphur. The three last-named are, moreover, of service when the di- gestive functions are in a deranged state, and the attacks are attended or succeeded by excessive flatulence. In cases of local congestion combined with debility : Ferrum, Cinchona, Nux v., Acidum phosphoricum, and Sulphur, are the most useful. Arsenicum is one of the most important medicines, and one from which the most complete success has been derived in cases when the sufferings were exceedingly severe, but unattended with any signs of serious organic lesion. The indications by which we are chiefly to be guided in prescribing it are : exces- sive dyspnoea from the slightest movement, but especially on PERICARDITIS. 163 getting into bed, sometimes with renewal of the paroxysm on turning in bed ; palpitation of the heart, extreme anguish, and a feeling of impending dissolution; paleness of the face, hag- gard and contracted features, great debility, with feeble, irre- gular, or intermittent pulse. (Kali hydrocianicum or Acidum hydroe-ianicum may be substituted for Arsenicum when the latter does not afford much relief; in other cases Ipecacuanha and Veratrum may be more useful,—Ipecacuanha when Arse- nicum or Kali hydr. fail to produce any amendment,— Veratr. when the paroxysms are accompanied by coldness of the ex- tremities, cold sweats, and slow, depressed, intermittent pulse.) Digitalis purpurea : — In more advanced cases, or in those in which the attacks come on suddenly without any as- signable reason; also when the intervals between each recur- rence appear to decrease in length with the duration of the dis- order. In most cases of this dreadful affection, where no serious structural derangement has taken place, the aforesaid remedies are not only of great service in alleviating the sufferings, and in curtailing the frequency of the attacks, but are even capable of effecting a cure when timely and appropriately administered. In those unfortunate cases, on the other hand, in which we meet with unequivocal symptoms of concomitant organic disease of a formidable character, although we cannot entertain any hope of correcting the dangerous state of matters, we may yet succeed in affording some relief by means of Arsenicum and Digitalis, together with the following in particular instances : Veratrum, Lactuca virosa, Assafozt'ula, Sepia, Spigelia, Cannabis, Au- rum, Natrum muriaticum, Ignatia, Sec. PERICARDITIS. Pericarditis, or inflammation of the serous membrane which lines the pericardium and is reflected over the heart and the roots of the large vessels, is a disease which is frequently not well marked in its external characters, at least by no means so much so as an affection so intimately connected with an organ 164 pericarditis. of such importance as the heart would lead us to conceive. The symptoms are exceedingly variable, and sometimes so in- sidious and deceptive as to go on until considerable disorgan- ization is produced, before attracting our attention by their se- verity. In many instances, indeed, the disease has been found, on dissection, to have existed to a severe extent, where it had entirely escaped the attention of the practitioner. The following have been given as the principal symptoms in the general run of cases of acute pericarditis : sharp, burning, pricking, or darting pain in the region of the heart, accompanied by fever of an acute inflammatory type; the pain shoots to the left shoulder and scapula, and frequently extends some distance down the arm; it is aggravated by a deep inspiration, by pres- sure at the intercostal spaces over the apex of the heart, and on the epigastrium ; the patient is incapacitated from lying on the left side, and commonly feels easiest in the dorsal posture; the breathing is accelerated and laborious, or irregular, espe- cially on moving; a feeling of contraction is experienced in the precordial region, and there is extreme restlessness, anxiety, and frequent syncope. The state of the pulse varies a good deal; it is always accelerated but is sometimes hard, full, and vibratory, while at others it is feeble, irregular, or intermmit- tent; in the advanced stage of the affection it is usually feeble and irregular, although, on applying the ear to the region of the heart, the action of the latter will be found tumultuous and violent. This inequality is of great importance in the diagnosis, since even in insidious cases an inequality will some- times be perceptible on comparing the strength of the heart's action with that of the pulse at the wrist. The physical signs of pericarditis are—increased and more abrupt impulse of the heart, and an unusual dullness on percussion in the cardiac region when there is considerable effusion. The sounds of superficial friction are very generally discernible when there are partial exudations of lymph on the opposite surfaces of the pe- ricardium. They commonly set in from twenty-four to forty- eight hours after the invasion of the inflammation, but, for the most part, do not continue for many days in succession__the lymph being either absorbed or changed into false membrane PERICARDITIS. 166 forming a more or less complete band of adhesion between the heart and the lung, which is productive of a gradual extinction of the sound; or serum is secreted in such abundance that the heart plays freely in the distended sac, and ceases to rub against it. At the commencement, the sound is soft, resem- bling the rustling of silk, and is usually heard toward the left or about the centre of the sternum, corresponding with the base of the heart. Subsequently it becomes louder and more pro- longed, and is audible beyond the immediate vicinity of the heart, the natural sounds of which it considerably disguises. In some cases the pericarditic friction resembles a crackling noise ; but in others, and particularly when it has increased in hardness or roughness, it is closely to be compared to the creaking of a new saddle (the new-leather sound). The nor- mal sounds of the heart are completely muffled or disguised by a loud friction-sound; they are sometimes to be heard, how- ever, in the carotid arteries and at the top of the sternum. The dullness arising from effusion of serum in the pericar- dium, may, when the effused fluid is very copious, extend up the whole anterior surface of the left side of the chest as high as the second rib, and spread even to the right sternum; but it is generally limited to a space or area of two or three inches at the lower part and towards the left of the sternum. An extensive effusion commonly renders the sounds more distant and feeble, and impairs the impulse in a greater or less degree. The sounds of respiration and percussion being still found good in the back and below the axilla, and not much altered by the change of position, the case is thereby distinguished from pleuritic effusion. Again, though the friction-sound is gene- rally stopped and the impulse and normal sounds are commonly rendered distant by displacement of the heart from copious effu- sion, they may be heard with their usual distinctness and inten- sity on listening to them in the carotid or subclavian arteries, or at the head of the sternum. By means of this circumstance we are empowered to draw a distinction between hydro-pericar- dium and an excessively enlarged heart acting with great feeblviiess ; for in the latter, in addition to the weak sound and 166 PERICARDITIS. impulse in the usual region, they would, moreover, be weak in the course of the arteries. Infiltration of the extremities is occasionally met with ; when present it ought to claim attention, as it is one of the symp- toms of disease of the heart. The physical signs, taken in conjunction with the general symptoms, tend much to remove obscurity from the diagnosis. The region of the heart should, therefore, be always examined whenever there is a probability of implication of that organ during the prevalence of some other disease. The duration of the affection, like that of pleuritis, varies according to the nature, rapidity, and extent of the effu- sion, from a few days to several weeks. Causes. Pericarditis, like other inflammatory affections of the chest, is more prone to occur in persons of a plethoric ha- bit, who are subject to derangement in the digestive organs. It is very frequently occasioned by a metastasis during an attack of rheumatism or gout. Prolonged grief or anxiety, and exposure to cold, may be named as means which tend to excite or develop it.* Therapeutics. The under-mentioned may be considered as the most important remedies in the homoeopathic treatment of pericarditis: Aconitum, Belladonna, Cannabis, Spigelia, Bryonia, Sulphur, Arsenicum, Lachesis, Arnica, Croton, See. In acute cases, accompanied by synochal fever, Aconitum should be given in frequently repeated doses; when so em- ployed at a sufficiently early stage, in cases uncomplicated with previous disease of the heart, effusion may be prevented, and a speedy cure effected. In plethoric subjects of sanguine lym- phatic temperament, it may be found requisite to prescribe Belladonna in alternation with Aconitum. Should the inflam- mation not yield to the employment of these remedies, although the febrile symptoms may have considerably subsided, Canna- bis may be had recourse to if the action of the heart continues * The prognosis, in the acute stage, may, generally speaking, be considered favourable when the affection is not complicated with pre- vious disease of the heart. PERICARDITIS. 167 to be tumultuous, and is attended with oppression, anxiety, and a feeling of constriction in the precordial region; also when signs of effusion have become apparent. Bryonia may claim a preference to Cannabis, when the patient complains of sharp, pricking pains in the region of the heart, which are in- creased by taking a full inspiration and by movement; and when there are symptoms of slight effusion. Spigelia may be substituted for Cannabis, in the early stage of the dis- ease, when the patient complains of severe lancinations in the cardiac region, or a pain as if the heart were violently com- pressed or squeezed, and when the oppression at the chest is extremely distressing, particularly on movement, or even whilst speaking; also when there is endocarditic complication, with valvular murmur. Sulphur may be used with advantage after Bryonia in some cases. Arsenicum has been strongly recommended in diseases of the heart of various kinds. In this inflammation it may be employed immediately after Aconitum, or independently of that remedy, either in the early stage — whether the attack has arisen from the metastasis of gout or rheumatism, or from the repercussion of an eruption; when there is violent palpitation, excessive rapidity of pulse, intense thirst, burning pain in the seat of the surface ; anxiety, fainting, extreme restlessness, and when a burning pain is experienced in the seat of the heart— or in a more advanced stage of the disease, when the respira- tion is hurried and laborious, particularly on the slightest movement, and there is incapability of lying on the left side ; pulse feeble and irregular. Veratrum may be administered to some advantage when the extremities become cold, and a cold sweat covers the forehead and other parts of the body, the pulse slow and intermittent, the nose sharp, the features sunk and contracted. &c. (Fades hippocratica.) Carbo v. may also be of service in cases of this all but hopeless description. It is particularly in conjunction with rheumatism, and espe- cially the acute variety, that pericarditis is met with. We should, therefore, as already observed, never omit to examine the reoion of the heart in such instances, otherwise tne dis- ease may attain a dangerous and even incurable height before 168 PERICARDITIS. it is detected, as the general symptoms are often so imper- fectly marked as not to create the slightest suspicion of its existence; whereas the physical signs can never fail, where any ordinary attention is paid, to apprize us of the invasion of pericarditis before it has reached a very serious, if not an in- curable height. The following cases are not inserted here from anything very remarkable in their features, but simply as illustrative of the power of the homoeopathic remedies in arresting a disorder which, in allopathic practice, is considered to require what are denominated the most prompt and vigorous measures, such as a free and bold use of the lancet, &c. Case 1. A. M., 13 years of age, of sanguine lymphatic temperament, was seized on the 4th of March, 1845, with acute rheumatism, for which, according to time-honoured rule, an aperient was first given, and the pains were sought to be re- lieved by means of fomentations, and hartshorn embrocations. Delirium having supervened, on the morning of the 8th, I was sent for in the evening, and found the patient lying on her back, in bed, complaining of severe darting, aching, rending pains in all the joints, but particularly those of the shoulders, elbows, and wrists, the affected parts being at the same time much swollen, tense, shining, and very sensitive to the touch ; countenance flushed, and wearing an expression of anxiety; tongue furred white ; mouth parched ; thirst considerable; skin hot and dry; pulse 130, full, bounding, but regular; respira- tion hurried, but unattended with pain; no cough. On exa- mining the region of the heart, the impulse was abnormally strong, the pulsations loud, accelerated, and occasionally redu- plicated. About the middle of the sternum, a gentle superfi- cial rustling sound was distinctly audible, particularly while I kept the patient in a sitting posture; there was no dulness on percussion, and tdtal absence of pain in the region of the heart. t^. Tinct. Aeon. 3, gtt. iij. Aq. pur. % iij. Dosis. Cochleare mediocre, tertia quaque hora. PERICARDITIS. 169 March 9. Fever diminished, pulse 120, not so full; skin moist; mouth not so parched ; thirst lessened ; recumbency on the right side supportable, not so on the left; respiration labo- rious and quick ; sound of superficial friction increased in ex- tent and loudness, audible in all positions, and in the interval between the heart-sounds as well as during their occurrence ; no perceptible dullness on percussion. The patient had passed a restless night, and was now and then "delirious ; joints still inflamed and painful. ft. Tinct. Bellad. 3, gtt. ij. Aq. pur. §ij. Dosis. Cochleare medioc. tertia quaque hora. On repeating my visit in the evening, I found the rheumatic sufferings of the patient considerably alleviated, the redness of the joints no longer so intense, and the tumefaction much re- duced ; heart-symptoms little changed, perhaps a slight diminu- tion of the friction-sound ; skin inclined to be hot and dry, pulse the same as in the morning. ft. Tinct Aeon. 3, gtt. ij. Aq. pur. g ij- _ Dosis. Coch. med. sexta quaque hora. March 10. Patient has passed a good night, perspired co- piously soon after the first dose of the medicine; skin still moist; no thirst, yellow furred, moist tongue; aversion to all food; pulse 100, somewhat hard; patient cannot yet lie on the left side, and on sitting up in bed she complained of a dart- in* pain proceeding from the region of the heart to the left shoulder and scapula, with aggravation of the pains in the joints on movement; sound of friction same as on the previous evening; no perceptible dullness at or near the sternum, and no abnormal sound in any other part of the chest; respiration free slightly hurried, but occasionally interrupted by the dart- ing'pain already noticed, on making a succession of deep m. spirations. ty. Tinct. Bryon. 3, gtt. iij. Aq. pur. ^ "j- Dosis. Coch. med. quarta quaque hora. S 170 PERICARDITIS. March 11. Considerable improvement in every respect. Prescription as before. March 12. Further improvement,—the patient can lie on both sides; tongue clean ; appetite returning; pulse 84, feeble but regular; action of the heart still rather powerful, particu- larly on the least movement; friction-sound only audible after any slight exertion, such as turning in bed or sitting up; all redness and swelling of the joints has disappeared, some stiffness and pain on movement alone remaining. $. Bryon. 6, glob. xxiv. (redig. in pulv.) Pulv. Sacch. lactis gr. iv. Misce intime, et divide in partes sequales iv., quarum capiat unam quotidie. March 17. Convalescent. A year afterwards I saw the patient, and discovered no traces of disease of the heart of any description. Case 2. R. H., 21 years old, of bilious temperament, was attacked with rheumatic fever about the middle of Nov., 1845, after having been exposed to a cold and damp atmosphere for se- veral hours. During the three following days the sufferings were so severe that the patient was unable to remain at rest in any posture, feeling, if anything, rather easier whilst sitting up in bed with his head between his hands, resting his elbows on his knees, and giving a rocking motion to the body; towards evening, fits of coldness and shivering alternating with heat, accompanied the pains; and about midnight copious sweats supervened, which were followed by remission of pain and some sleep. Early in the morning, however, there was recurrence of sufferings, with increased violence. On the evening of the 5th day of his illness the patient was induced te drink some hot gin and water, in the double hope of arresting the chills and allaying the pain. The day afterwards, the rheumatic pains had nearly vanished, but were substituted by intense headache, nausea, giddiness, palpitation of the heart, and sharp pains in the left breast. These symptoms continued in an un- mitigated form for five days, and on the day following__the tenth of the patient's illness—I was requested to visit him. I PERICARDITIS. 171 found him sitting on his bed, half dressed, having been unable to complete his toilet in consequence of the distressing dyspnoea and palpitation which he experienced on making any slight exertion; his countenance wore an expression of intense anx- iety, which, together with the history of the case, led me at once to infer, before resorting to auscultation, that some affec- tion of the heart had arisen from rheumatic metastasis ;—no pain was complained of beyond an occasional twitch in the left side of the chest, during the performance of a somewhat full in- spiration, or on turning the body towards the right side; a de- gree of stiffness in the back and limbs was the only incon. venience complained of in the parts which had been previously so severely affected with rheumatism. The pulse was feeble, irregular, occasionally intermittent, and rather frequent; the tongue furred white, loaded with mucus, and increased in vol- ume ; appetite wanting; taste metallic; no thirst; bowels confined for four days. On auscultation, the sounds of the heart were somewhat muffled at the cardiac region, but the im- pulse greater than natural, and there was distinct, though not loud, friction-sound immediately to the left of the inferior third of the sternum, particularly when the patient inclined the trunk forwards, or made any trivial effort, such as rising from his seat, or raising up the left arm quickly. On percussion there was decided dullness, confined to an area of three inches, at the lower end of the sternum. In the carotid and subclavian arteries, the normal heart-sounds were audible in their natural strength. The case thus afforded unequivocal evidence of pe- ricarditis, from the metastasis of rheumatism, resulting in liquid effusion. ty. Laches. 6, gl. xij. Aq. pur. I). M. Dosis. Cochl. medioc. ter die. Nov. 27. The patient intimated that he felt easier; had passed a better night than he had done since the day he was first seized with indisposition; the bowels had been freely moved early in the morning ; pulse same as yesterday; dull- ness on percussion, sounds and impulse of the heart unchanged; 172 PERICARDITIS. expression of countenance still anxious. Former prescription repeated. On the 28th, and two succeeding days, the patient remained in much the same state; he imagined himself better, but his countenance bore the same anxious expression; and, if any- thing, an increase' of dyspnoea with tendency to syncope on movement seemed to have taken place; the pulse was rather more feeble and intermittent; Arsenicum 6 (dose, gl. 6 every four hours) was substituted for Lachesis, on the 1st of Dec, and continued until the morning of the 3d, when the patient's state was as follows : Dullness on percussion over a larger space, nevertheless the friction-noise at the sternum was somewhat stronger than it had been the four previous days; the impulse was also some- what more powerful, but the natural heart-sounds impaired and distant; great dyspnoea and faintness on the slightest move- ment ; pulse still weak and quick, but not so intermittent; some appetite, but increased oppression on the introduction of the smallest morsel either of liquid or solid food into the sto- mach ; no pain in the region of the heart; sleep restless ; de- cubitus dorsal, with the head and shoulders raised. B- Arsenic. 3, gtt. iij. Aq. pur. § iss. M. Dosis. Coch. med. quarta quaque hora. Dec. 4. Patient felt stronger, and had passed a tolerable night; no thirst ; tongue foul; in all other respects the same as on the day previous. ty. Colch. 3, gtt. iij. Aq. pur. § iij. M. Dosis. Coch. ampl. tertia quaque hora. Under the employment of this remedy, a striking improve- ment soon became manifest,—the patient began to breathe more freely, and to be enabled to move about without much incon- venience arising from palpitation, dyspnoea, or faintness ; the dullness on percussion commenced gradually to give way, and the sounds of the heart resumed a normal intensity. Colchi- PERICARDITIS. 173 cum was continued for six days, latterly at longer intervals between the doses. On the 11th of Dec. Nux vomica and Arsenicum were prescribed in alternation, at intervals of twelve hours,—the former in consequence of the deranged state of the digestive organs, and some slight rheumatic pains, of a drag- ging, aching description, in the back, chest, and joints, accom- panied by a feeling of torpor in the fore-arms,—the latter, from the circumstance that the patient complained of occasional at- tacks of dyspnoea, and palpitation of the heart at night. A week afterwards convalescence was not only firmly estab- lished, but the patient was, moreover, restored to a much better state of health than he had enjoyed for a year or two past. No relapse has taken place, and recovery appears to be complete. Case 3. C W., aged 15, of melancholic temperament, and somewhat robust and muscular build for his years, but disposed to suffer from deranged digestion in consequence of frequently over-indulging a naturally keen appetite, to which an additional stimulus was usually given by the amount of severe exercise he was daily in the habit of taking, had been confined to the house for a week with a severe attack of acute rheumatism. March 3d, 1846, the patient was seen by me for the first'time, when I was instructed that, three days previously, he had been seized with an increase of fever attended with palpitation of the heart and some oppression at the chest. These symptoms had continued to gain ground, and formed the reason that in- duced the parents of the patient to send for me, (previous to which they had been allowing the disease to take its course, __the father having become a complete sceptic in medical sci- ence.) I found distinct indications of inflammation of the pe- ricardium, with some symptoms of complication with endocar- ditis, as was evinced by the existence of the Mowing physical signs : loud friction-sound, not only about the middle of the sternum, but also, pretty clearly, beyond the proper cardiac re- gion, in various directions, and greatly disguising the natural sounds of the heart; strong and very abrupt impulse, accele- rated pulsations, and prolonged first sound. On listening at the top of the sternum, and also in the carotids, the normal 174 PERICARDITIS. heart-sounds were heard with tolerable distinctness, attended with a grating murmur, which, although somewhat faint, was yet sufficiently well marked to denote endocarditic implication with regurgitation through the semilunar valves of the aorta. The expression of countenance was painfully anxious, the rest- lessness great, the skin hot and dry, and the pulse full, strong, rapid, but regular. I£. Tinct. Aeon. 3, gtt. iij. Aq. pur. § iij. Dosis. §ss. quarta quaque hora. * March 4. Patient somewhat easier; perspired freely after the second dose of Aconite ; countenance not quite so anxious; physical signs as before, impulse of the heart perhaps rather less violent; pulse still full, but softer and rather slower; no pain in the region of the heart when the patient lay perfectly quiet, but any sudden movement was immediately followed by excessively increased action of the heart, dread of suffocation, and a sensation of severe constriction as if the heart were vio- lently squeezed or drawn together. Position in bed either dor- sal or on the right side, with the head raised,—a sense of suffo- cation being experienced whenever the patient attempted to re- cline sinistrad. ty. Tinct. Spig. 6, gtt. iij. Aqu. destil. § iij. M. Dosis. Coch. ampl. sexta quaqne hora. The general symptoms having much improved under the em- ployment of the Spigelia, that remedy was continued until the 7th of March, on which day the symptoms encountered were as follows: respiration freer, anxiety of expression only per- ceptible after the performance of any slight exertion, which was still followed by violent palpitation; valvular murmur no longer audible ; friction-sound only perceptible when the heart is tu- multuously agitated; pulse quick, somewhat irregular, and rather feeble, even when the action of the heart is powerful. On percussion a slight degree of dullness was discernible to the left of the sternum. The appetite, which had returned imme- PERICARDITIS. 175 diately after the improvement effected by Aconite, and could with difficulty be kept within the proper limits necessary in such a disease, was now supplanted by a strong aversion even to the smell of food of every description, and there was considerable thirst, which seemed to be materially caused by a sensation of intolerable dryness and burning heat in the throat, as the pa- tient drank but little at a time, and seemed to experience tempo- rary relief from sipping a little cold water every now and then; tongue rather dry and furred; bowels had not been relieved for five days. No pain was complained or in the region of the heart,—the feeling of severe constriction having readily yielded to Spigelia. ft. Arsenic, alb. 6, gtt. iij. Aq. destil. 5 ij- Dosis. § ss. quartis horis. March 8. General symptoms considerably amended; physi- cal signs the same. Medicine continued. March 9. Appetite returning, dryness of mouth and throat, together with the thirst, removed; palpitation of the heart somewhat diminished; friction-sound still perceptible on par- ticular occasions, such as after a sudden movement of the body, or even of the arms, but only to a slight degree; dullness on percussion neither increased nor diminished since the 7th; bow- els not yet relieved; spirits very depressed. ft. Lachesis 6, gtt. iij. Aq. destil. %\j- Dosis. Coch. maj. j. quarta quaque hora. March 10. Rather less dullness on percussion; friction- sound no longer audible ; pulse more regular, but still weak and accelerated; impulse of the heart stronger, rather more abrupt, and the palpitation very distressing on movement, but particularly on turning in bed during the night; the patient can lie on either side, yet prefers lying on the right or on the back; spirits better, although sudden fits of indescribable an- xiety still occur at intervals. Arsenicum and Lachesis were given in alternation every twelve hours, during the six succeed. 176 PERICARDITIS. ing days. At their expiration the patient was convalescent. The bowels were copiously relieved on the 12th without the aid of an enema. For the space of a fortnight afterwards there was some tendency to violent palpitation of the heart on going up stairs rather quickly, but this completely subsided under the action of the remedies (such as Sulphur, Bryonia, Nux vom., Natr. m., and Acid, n.) which were called for by the chronic derangement of the digestive functions. In cases of pericarditis arising from external injury, Aconitum and Arnica should be employed. When moral causes, such as prolonged vexation, seem to have assisted in developing this disease, — Arsenicum, Veratrum, Lachesis, Belladonna, and perhaps also Hyoscyamus, are medicines which should chiefly claim our attention. Chronic pericarditis. The symptoms here are the same as those of the acute variety, differing merely in degree. When there is fever, it is of the hectic type. When dense adhesions form between the apex of the heart and the pericardium, they, by interfering with, and confining the motions of the heart, are consequently sooner or later pro- ductive of serious organic disease, more particularly hyper- trophy with dilatation. The signs by which these adhesions are to be detected are not always distinctly marked. They may only be said to be decidedly appreciable when they are close and rigid, and the pericardium has, moreover, been ren- dered adherent to the walls of the chest. In such a state of matters, the heart will constantly be found pulsating in close contact to the ribs, its motions will be seen and felt more plainly than usual (drawing in the intercostal spaces at each systole), and there will be dullness of sound on percussion, over a space proportioned to the adhesion and the size of the heart, during every stage of respiration, and in every position of the body. A projection is strikingly observable about the ends and cartilages of the middle ribs, in those cases in which an enlarge- ment of the heart, upwards and downwards, ensues, in conse- quence of its general adherence to the pericardium, and of the latter to the diaphragm and walls of the thorax. ENDOCARDITIS. 17/ Therapeutics. When lymph has been effused, and be- come organized, and the adhesions formed materially interfere with the motions of the heart, the case is beyond the reach of medicine. When the exudation ia serous, a cure may, in some cases, be eventually accomplished by means of such remedies as Arsenicum, Digitalis, Veratrum, Cannabis, Sulphur, Phos- phorus, Carbo v., See. ENDOCARDITIS. The general symptoms of inflammation of the lining mem- brane of the heart are, commonly, still more uncertain and ob- scure than those of pericarditis. There may be tumultuous action of the heart, with fever, irregular action, palpitation, op- pression, anxiety, faintness, and some degree of pain, which is generally referred to the sternum or epigastrium ; but these symptoms sometimes exist in so trivial a degree as to be en- tirely overlooked. The physical signs are, consequently, to be chiefly relied on, in distinguishing this inflammation, as well as in pericarditis. The sounds of the heart are louder at first, the pulse greater, and frequently attended with a vibration or tre- mor, but the pulsations are not in every instance more frequent. Soon afterwards the first sound seems double, and is prolonged, or it is accompanied by a slight roughness, which ere long be- comes converted into a blowing or grating noise, forming the characteristic valvular murmur, produced by the regurgitation of blood through the diseased or defectively-closed valves. By paying attention to the nature of the sound, and the si- tuation where it is most distinctly heard, we may generally determine with considerable certainty in what part of the heart it occurs. The left side of the heart i3 where we may almost in- variably expect to meet with the deranged valves, so that when the bellows-sound or murmur is perceived, we have, in nearly every instance, simply to discriminate whether the noise is produced at the mitral or aortic valves. The mitral valve, or inlet of the left ventricle, is more commonly the seat of the 8* 178 ENDOCARDITIS. disease than the semilunar valves of the aorta. Whether the mitral or the aortic valves form the seat of the murmur, it will always be heard over the left side of the heart, synchronous with the first sound. If it is heard loudest an inch or so below, and a little to the inside of the nipple, where the apex strikes, becoming more indistinct as we ascend or approach be- yond the upper half of the sternum, it is occasioned by mitral regurgitation, in consequence of the imperfect closure of the valve caused by the exudation of serum or lymph between its layers, and the irregular spasmodic action of the columnae car- neae. On the other hand, if the murmur be heard most clearly at the base of the heart, along the upper half of the sternum, particularly on a level with the margin of the third rib, and even in the carotid arteries, where it usually has a harsher, more grating tone, but decreases in intensity as we approach the apex of the heart, we may be satisfied that it is generated at the aortic orifice, and is caused by tumefaction of the semilunar valves, or deposition of lymph between their surfaces. The second sound is also frequently impaired in the latter instance, or it is accompanied or altogether supplanted by a grating noise. The pulse varies much in endocarditis, but does not partake of the violence of the heart's action. It is generally small, feeble, irregular, and not in harmony with the impulse of the heart, when the mitral valve is affected; and more or less full, sharp, jerking, quick, but regular, when the semilunar valves are the seat of de- rangement. Causes. These may in general be considered the same as those of pericarditis. The great majority of cases arise from the metastasis of rheumatism, or occur during the course of pleuritis. There are few instances of acute rheumatism in which some of the signs of obstruction to the current of blood through the mitral or semilunar valves are not discoverable, and the younger the patient is, the greater is the probability of his being affected with rheumatic endocarditis. ENDOCARDITIS. 17f Prognosis. This malady may be held as rarely fatal during its acute stage. If the valvular murmur be not removed in from ten to fourteen days, it is prone to remain permanent, and the patient will eventually sink under disease of the heart, al- though the fatal issue is not unfrequently delayed for from five to ten, or twenty years, and even somewhat upwards. It is consequently of the utmost importance to detect the disease early, as it is only during the acute stage that we may entertain any confident hope of preventing it from degenerating into a chronic, and but too often incurable disease of the heart, parti- cularly cartilaginous or osseous disease of the valves and hyper- trophy of the ventricles. Therapeutics. The remedies which have hitherto been prin- cipally recommended in the treatment of endocarditis are, Aco- nitum, Arsenicum, Lachesis, Spigelia, Bismuth, Belladonna, Digitalis, Veratrum, Nux v., Pulsatilla, Asparagus, See. Aconitum is, generally speaking, only useful in acute cases, when the pulse is full, hard, and vibrating, and there is pain of a sharp or pricking description in the cardiac region, with op- pression, anxiety, faintness, and tumultuous action of the heart. We have found it, together with Belladonna, of speedy and most effectual service at the commencement of endocarditis, with indications of affection of the aortic orifice, and secondary implication of the brain evinced by delirium and occasional stu- por. Arsenicum is one of the most important of our remedies in diseases of the heart, and we should say, is all but indis- pensable in endocarditis with disease of the mitral valves. It may, however, be of fully equal service when the outlet of the left ventricle is affected; and is, moreover, to be considered as an invaluable remedy in complication with pericarditis. Spi- gelia, Digitalis, and Lachesis, are also deserving of notice in the latter instance, and may sometimes be of great service after, or in alternation with Arsenicum. The observations of Dr. Clotar Mueller, jun., on " Endocarditis Rheumatica," (which is by far the most frequent form in which inflammation of the lining membrane of the heart is encountered,) and other dis- eases of the heart, appear to us to be of such striking interest, 180 ENDOCARDITIS. that we gladly avail ourselves of Dr. J. C. Peters's translation,* to introduce an extract here : "It is our intention here to show more particularly that physical examinations are always of importance in the selec- tion of homoeopathic remedies, and that a continued attention to this point must lead to the most important results in the cure of disease. The present condition of our Materia Me- dica, at the first glance, would seem not to favour or allow of such an attempt, for we look in vain in it for even a single physical sign, which is as subtle and exact in its signification as ' bronchial respiration,' or ' bellows-murmur with the second sound of the heart,' &c. It could not and perhaps cannot be otherwise, for the greater part of the experiments and in- vestigations with drugs, which constitute our Materia Medica, were made at a time when auscultation and percussion were but little known, and less practised; and even nowitwjuld be extremely difficult to produce physical signs and symptoms in previously healthy persons, by means of drugs; experiments with drugs on the healthy must be confined to certain, and those very narrow limits, whilst natural disease may progress to total disorganization, and often acknowledges no limits short of death. We must even do, in the treatment of or- ganic diseases of the heart and lungs, what has been done in the treatment of other diseases, viz., conclude from slight indi- cations what greater results might have followed, if the ex- periments with drugs could have been pushed far enough ; if one attempt *to produce in the healthy subject, with Sulphur, Baryta, Calcarea, Sec, the extensive ulcers and scrofulous de- rangements which have been cured hundreds of times with these remedies, he will probably be disappointed; one will certainly wait in vain to see Kali carb. produce purulent ex- pectoration, and genuine svmptoms of phthisis; or for Silex to produce the manifold alterations, and new formations in the tendons, bursas mucosae, joints, &c, which it cures with won- * Endocarditis Rheumatica, by Dr. CI. Mueller. Translated, with notes, by John C. Peters, M. D. Homoeopathic Examiner, Vol. v. No. 1. ENDOCAREITIS. 181 derful celerity, &c. But there is also another source of infor- mation open to us, which was not sufficiently cultivated during the early career of Hahnemann, viz., Pathological Anatomy. When we once succeed in establishing certain constant organic lesions to be produced by drugs, as learned by post-mortem exa- minations in cases of poisoning with these drugs, then we come in possession of strictly homoeopathic remedies against similar diseases; this pathological knowledge of the effects of drugs, is of especial importance in the homoeopathic treatment of endocarditis, for this disease, as it progresses, becomes attended with almost all the symptoms which attend diseases of the heart in general. "Arsenicum :—It produces anxiety in the region of the heart; irritable and frequent beating of the heart, with great feebleness of the pulse ; frequent, violent, irritable beating of the heart; frightful and very troublesome palpitations, espe- cially at night; nocturnal, irregular and violent palpitations, with anxiety; very much quickened, violent, stormy, irregu- lar and painful beating of the heart; loss of contractility of the heart; piercing, burning, and soreness in the region of the heart. " Pathological Anatomy.—Very much relaxed or violently contracted heart; much thickly-fluid, tar-like blood in the right auricle; opalescent spots upon the inner surface of the left ventricle, from the presence of false membranes ; violet-red spots with softening of the internal coat of the heart (endo- cardium) ; red-marbled spots in the left auricle and ventricle; smaller carmine-red spots, especially on the papillary muscles, and penetrating into the substance of the heart; much darker redness, almost blackness of the right cavities of the heart, and some spots on the papillary muscles; red or black broad spots in the left ventricle ; inflammation of the semi-lunar valves of the aorta. " If we recollect, in addition, that Arsenic has been found serviceable in palpitations, carditis, endocarditis, rheumatic and organic diseases, especially in the left side of thp heart; in the most frightful paroxysms occasioned by hypertrophy, dilatation or valvular diseases of the heart, it will become evident that 182 ENDOCARDITIS. Arsenic possesses the most perfect specifie and homoeopathic relation to endocarditis. It is indicated not only in the com- mencement of the disease, but also when exudations and vege- tations have formed on the endocardium and valves, especially of the left ventricle. It is hence the main remedy in Bouil- laud's so-called chronic endocarditis. It is indicated when the following physical signs are present: dullness over a greater extent than usual in the cardiac region, especially in a vertical direction ; violent and irregular action of the heart, with feeble- ness or almost complete extinction of the pulse; indistinctness, or roughness of both sounds of the heart, or a bellows-murmur with the first sound, heard over the left ventricle, (and along the aorta, but loudest over the aortic valves, viz., at the edge of the third rib, near the left edge of the sternum.) "Bismuth: — It produces violent beating of the heart; violent palpitations, visible at a considerable distance; a symptom which is almost peculiar to hypertrophy of both ventricles. " Pathological Anatomy.—An intensely bright inflammatory redness in both ventricles ; in the left ventricle several cherry- red, pretty broad, but not very deep spots. This evidently must prove a very important remedy in diseases of the heart, especially in the acutely inflammatory stage, although it may also prove useful in valvular disease and hypertrophy. It is in- dicated when the following physical signs are present: dullness on percussion over a great extent of surface ; violent beating of the heart, distinctly elevating the walls of the chest (or the hand or head of the auscultator when applied) ; bellows-murmur with the systole of the heart, and heard both over the right and left ventricles. " Colchicum : — It causes rending pain in the region of the heart; very violent palpitations, followed by very weak beating of the heart. " Pathological Anatomy:—Several ecchymosed spots on the pericardium; effusion of serum into the pericardium; heart large and lax, its external surface marked by dark, violet or brownish spots, and with large circumscribed patches of lymph. endocarditis. 183 It would seem more homoeopathic to pericarditis* than to endo- carditis. It may be used when the following physical signs are present: dullness over a small, or very great extent of sur- face (when there is effusion into the pericardium the dullness mounts higher up the sternum, in the direction of the great vessels, than when it is occasioned by mere enlargement of the heart; distinct bulging of the ribs over the heart); action of the heart violent at first, and attended with a marked friction- sound (a vibratory tremor, generally perceptible to the hand; Stokes noticed this tremor in five cases out of six ; the friction- sound is a to-and-fro sound, corresponding with the movements of the heart backwards and forwards; it is generally more or less rough, sometimes like the rasping of wood, or the grating of a nutmeg, crackling of parchment, rustling of silk ; very rarely it resembles the creaking of the new sole leather; when the quantity of effusion increases, these sounds may change to a continuous hollow rumble, owing to the agitation of as large a quantity of fluid as is compatible with the production of a mur- mur). When the quantity of serum becomes great, the heart is pushed back from the wall of the chest; hence its impulse can scarcely be felt, all friction and other murmurs cease, and the natural sounds of the heart are heard very indistinctly, and at a great distance. " Croton : — It causes piercing pain in the region of the heart; loud and perceptible pulsation and throbbing of the heart, especially when lying down; sudden throbbing in the re- gion of the aorta. « Pathological Anatomy. — Sixteen ounces of dark bloody. serum in the pericardium; softening of the heart; actual ex- travasation of blood into the substance of the heart; dark Stripes and ecchymoses on the endocardium of both ventricles; inflammation of the pulmonary arteries and veins; redness of the valves. »The marked amendment which speedily followed the employment of Colchicum in case No. 2, article PEKiCAHurr.s, inclines me to cor- roborate this.—J. L. 184 endocarditis. " This is evidently one of the most important homoeopathic remedies in diseases of the heart (and perhaps the most homoeo- pathic remedy to effusion into the pericardium, especially the hemorrhagic variety). The physical signs indicating its use are the same as those requiring the use of Colchicum, with the addition that there may- be valvular murmurs heard to the right of the sternum, over the right ventricle, and during the diastole of the heart. " Aconite :—It causes pressing together of the chest in the region of the heart; palpitation in young plethoric per- sons ; palpitations with great anxiety, oppression of the chest, general heat, especially in the face, great relaxation of the limbs; slow throbs in the cardiac region ; aching compressing pain below the sternum ; pain in the left side of the chest, between the fourth and sixth ribs ; disproportion between the heart and the pulse beats; for the pulse beats three times, while the apex of the heart strikes the walls of the chest once; the right auricle, however, seeming to be persistently and con- vulsively contracted. " Pathological Anatomy. — No peculiar and characteristic alterations are found, viz., no signs of inflammation, or its consequences, but merely signs of relaxation and debility of the heart; with more or less of venous congestion : the heart relaxed and dilated : the left side filled with fluid red blood, and the right with fluid or coagulated black blood, or in general, containing much black, coagulated, or brownish blood. Hence the pathological appearances afford no warrant for the use of Aconite in inflammatory affections of the heart; still it is advised in predominant arteriality, in palpitations, in endocarditis, with or without articular rheumatism; also as an invaluable palliative remedy in organic affections of the left side of the heart, and large vessels, dilatation of the left ventricle, &c.; in endocarditis it can only be homoeopathic in the very commencement of the disease, before extensive exu- dations or alterations of the surface of the endocardium and valves have taken place. " Physical Signs :—Judging from the above, Aconite will be indicated when there is dullness on percussion over the ENDOCARDITIS. 185 heart, when the motions of the heart are quick and violent, but do not evidently and visibly raise the walls of the chest at each impulse, and are not synchronous with the beats of the radial pulse; when both sounds of the heart are heard louder, clearer [the first sound being almost as clear and clacking as the second, which is the most characteristic sign of dilatation of the left ventricle], and heard most distinctly over the left ventricle [when the apex of the heart is found beating nearer to the nipple than one inch below and within it, viz., very near the nipple, or just below it, or outside of it, or even above it, for the larger a heart becomes, the more is the apex carried outwards and upwards]. " Asparagus :—It causes : An indistinct sensation of piercing in the cardiac region; frequent violent palpitation while sitting; palpitation with anxious restlessness, caused by motion or ascending stairs; feelable and audible throbbing of the heart from moderate exercise; irregular, quick, double beating of the heart; scarcely perceptible action of the heart. It is less homoeopathic to the inflammatory stage, than to the consequences of endocarditis, more especially to hypertrophy of both, or only of the left ventricle. " Physical Signs : — Dullness on percussion over a very extensive surface; the action of the heart violent, elevating at each beat the corresponding portion of the chest, [so that when the hand or head of the examiner is placed over the cardiac region it will evidently be seen to rise and sink with every con- traction and dilatation of the heart; however violent the palpi- tations may be in simple nervous affections of the heart, no permanent bulging of the ribs over the heart is noticed, and the action of the heart never lifts the hand or head of the ausculta- tor]; violent pulsation of the carotids; sounds of the heart natural, but louder, or attended with murmurs or other abnormal sounds 'at various parts, either during the systole alone, or also during the diastole. " [Riccke says that a man in Paris, suffering with palpitations, thought he felt relief every time he ate of Asparagus; hence he prepared a syrup in order to have some when it was out of season: this also helped him; and he mentioned it to his 186 ENDOCARDITIS. physician, who made farther and satisfactory experiments, and communicated their results to Bronpais, who wrpte a short article about it in 1839 ; then its use became quite fashionable, but lately it has fallen into neglect. Bronpais says, like Digitalis, it possesses the power of diminishing the action of the heart, and of increasing the urine, without irritating the stomach; hence it is serviceable in hypertrophy and palpitations of the heart, and also relieves the nervous pains, even when de- pendent upon organic disease. Heyfelder found it very bene- ficial in hypertrophy; Andral, Fougier, Serres, &c, saw good effects from it in Cardiogmus, even Organicus; while Buchner, in his experiments with the tincture, often felt violent palpitations with anxious restlessness, both while sitting still or moving about.] "Belladonna: — It causes aching in the cardiac region, taking one's breath away, and causing anxiety ; anxious feeling in the region of the heart, with occasional intermittence of the pulse; irregular, unequal contractions of the heart; clucking about the heart, when going up stairs, with palpitation; trem- bling of the heart; throbbing pain beneath the sternum, near the epigastrium; very feeble beating of the heart; violent and persistent palpitations; violent heart-throbbing, with jarring of the head and neck. " Pathological Anatomy : — Partly fluid, partly coagulated blood in the ventricles; blackish coagula; lividity and great softness of the heart; blackish and very thin blood in the arteries. " From the above it is evident that Belladonna is not a truly homoeopathic remedy for endocarditis, but it is an admirable remedy in congestion of the chest, preventing the occurrence of actual inflammation, and moderating the stormy vascular com- motions which attend organic diseases of the heart, and cutting short the frequent exacerbations of the disease which threaten to light up inflammation anew. " Physical Signs. — Percussion sound normal, or dull over a rather large extent of surface ; action of the heart alternately violeut, then weak, or even intermitting; sounds of the heart ENDOCARDITIS. 187 natural, except clearer than usual, of irregular rhythm, first stronger, then weaker, then absent. "Veratrum album; — It causes extreme agony, which takes away the breath; palpitations, with anxiety and quick, audible respiration; paroxysms of agony about the heart, which then beats very violently and feels as if it were too warm; violent beating of the heart, which forces up the ribs; the heart beats up very high and forcibly, so as to force the hand away, without pain. In cases of poisoning of dogs with it, the heart beats stronger, quickly, and irregularly, in strong contrast with the great general prostration and stupefaction of the animal; even an hour after death the heart still moved feebly. " The entire absence of pain about the heart, while this organ beats so violently as to shake the chest, elevate the ribs, and lift the hand of the auscultator, deserves particular atten- tion, for this almost never occurs except in hypertrophy with dilatation. " Physical Signs .-— The percussion sound may be dull over a very large space; (the apex of the heart may beat directly beneath, or outside of, or above the nipple; bulging of the ribs over the heart;) action of the heart visibly very violent; sounds of the heart either very loud and clear, or else one or both sounds accompanied with abnormal murmurs. " (From the well-known action of Veratrum on the stomach and bowels, it deserves particular attention in those affections of the heart dependent upon or attended by derangement of the stomach; ' in some forms of nervous palpitation there is an increase of suffering after meals, or when the stomach is deranged, while amelioration is produced by dyspeptic remedies; but, as the stomach produces the same effects when there is disease of the heart, these signs are not pathognomonic of nervous palpitation. To this point I [Hope] would particularly direct the attention of physicians; because many, in forming their symptomatic diagnosis of the affections in question, regard the dyspeptic signs as paramount in value to all others, and are apt to refer to the stomach the palpitation which may really beloug-to organic disease of the heart.' It is easy to show that Veratrum is homoeopathic to both these varieties. Hutchinson 188 ENDOCARDITIS. remarks that, in poisoning with Veratrum, violent palpitations, intermittent pulse, and a condition of things which presents much similarity to organic disease, are very apt to ensue. In the Med. Chir. Rev., vol. II., page 196, we find an article headed, ' Veratrum album used for producing artificial disease of the heart? A man by the name of Chapman, belonging to the Marine Artillery, had found out the secret virtues of the white Hellebore, and turned it to the advantage, or rather disadvantage of himself and others, to whom he sold his powders at a high price. By taking the Hellebore, every appearance of' dyspepsia, attended with great nervous irritability, and violent and continued palpitations, were produced. This Chapman had deserted, and was taken in a remote part of the country, where he completely succeeded in deceiving the staff-surgeon, who examined him, and reported his incapacity for military service in consequence of having organic disease of the heart!! Dr. Quavier states that this practice of taking Hellebore was productive of some alarming consequences for a considerable period ; some were permanently injured, having actually produced the disease which they "merely intended to counterfeit.)" " Digitalis :—It causes in the healthy subject, slight pain, aching and heaviness about the heart; increased activity of the heart, with slowness of the pulse ; increased throbbing of the heart; palpitations which arouse one from sleep; palpitation, and commotion of the blood, with great anxiety, forcing one to get out of bed, with quickness of the pulse, congestion to the head, noises and roaring in the ears; diminished action of the heart; scarcely perceptible beating of the heart; very soft and weak beating of the heart; evident throbbing in the right side of the chest. " Pathological Anatomy.—Several blackish and quite volu- minous coagula in the right ventricle; bright-red and fluid blood in the left ventricle (in a vast majority of instances no blood is found in the left side of the heart after death,—the powerful muscular development of the left ventricle almost al- ways seems sufficient to empty that cavity, even at the last throb which marks the cessation of life; hence, whenever blood is found there after death, it denotes an unusual degree of relax- ENDOCARDITIS. 189 ation, debility, and utter exhaustion of the muscular structure of the heart), fluid, dark-red blood in the heart; extinguishing of the irritability of the heart. "(Digitaline, i. e., the active principle of Digitalis, according to Bouchardat and Sandras, in doses of one-tenth of a grain, singularly modifies the circulation, and is capable of irritating the digestive organs in a high degree ; all the patients to whom it was administered experienced a marked slowness of the pulse, the greatest depression taking place in general, some hours after the exhibition of the drug; in several instances it was diminished in frequency to the extent of nearly one-half of the normal condition, very often only one-third or one-fourth; the next morning it became rather more frequent, but always remained from ten to more beats below the normal pulse. In all these cases the pulse was also irregular, the irregularity being of two kinds—the first and most remarkable irregularity was that the intervals between the pulsations were unequal; sometimes the pulse would be hard and very quick, then hard and slow ; at others it would be soft at times, then hard ; again it would remain soft persistently. Some patients would expe- rience light-headedness, annoying dreams and hallucinations, soon followed by more or less frequently repeated diarrhoea or bilious vomiting, which, in spite of all precautions, sometimes lasted two or three days; the appetite was lost at the same time ; whenever it induced irritation of the digestive organs, the pulse again becomes frequent.) , " (The marked depressant action of Digitalis on the heart, renders it homoeopathic to dilatation, with thinning of that or- gan, which state, according to Hope, depends upon direct debi- lity, or deficient power. In this effect the palpitations are of a feeble, oppressed kind, and more or less distressing, frequent and prolonged, according to the extent of the dilatation : in ge- neral they are protracted ; the pulse is soft and feeble, and if the debility of the heart be great, the pulse is small; irregular- ity and intermittence are common during the protracted and distressing paroxysms of palpitation and dyspnoea; when the dilatation°is attended with softening of the substance of the heart, the pulse is apt to be as small, weak, intermittent, irre- 190 ENDOCARDITIS. gular and unequal, as in the worst cases of disease of the mi- tral valve ; oedema of the limbs is very common in this variety; also lividity of the face, lips, &c.; one of the most constant and characteristic of the equivocal signs of dilatation of the right side of the heart, is, permanent turgescence of the exter- nal jugular veins, without sensible pulsation. Among the phy- sical signs of dilatation is a change in the character of the first sound of the heart; this, which is naturally dull and indistinct, becomes louder, shorter and clearer, so as to resemble the clear, distinct clacking of the normal second sound; the degree of the dilatation can be judged of by observing how far the first sound resembles the second. The greater the shortness and clear. ness of the first sound, the thinner will the walls of the heart be found. The dullness on percussion is increased, and is found lower down than natural ; dullness over the inferior part of the sternum denotes dilatation of the right ventricle in par- ticular. Although the heart be enlarged, the impulse is dimin- ished, and in extreme cases absent, even during palpitation; when felt, it is only a brief percussion of the chest, not elevat- ing the hand or ear of the examiner; sometimes several beats of the heart are heard, while one only is felt (Hope). There is old school authority for the use of Digitalis in this disease; Dr. Holland says : ' The enlarged and flaccid heart, though on first view it might seem the least favourable for the use of this medicine, is perhaps not so ; at least I have reason to believe, that, in the dropsical affections so often connected with this state of the heart, the action of Digitalis is peculiarly of avail.' (see Med. Notes, &c. p. 574.) Old school physicians also say that it helps in intermittent and otherwise irregular pulse ; Pereira says : ' In patients affected with an intermittent and otherwise irregular pulse, I have several times observed this medicine produce regularity of pulsation ;' a circumstance also noticed by Dr. Holland. Dilatation of the heart is a treacher- ous disease to those who auscultate and percuss carelessly, as well as to the mere symptomatologist; for the heart may be two and a half times its natural size, and yet the impulse be by no means remarkably strong; and when the heart is much loaded and oppressed with blood, the sound of the valves, and ENDOCARDITIS. 191 even of valvular murmurs, may become so faint that they can- not be heard, without the patient holds his breath. In a pre- vious article we have referred to the homoeopathicity of Digi- talis to diseases of the mitral valve). " Spigelia :—It causes oppression of the chest and palpita- tions ; dull stitches occurring synchronously with the pulse, and felt where the apex of the heart strikes the chest; violent and audible beating of the heart, which may also be felt through the clothes, attended with anxious oppression of the chest, es- pecially in the morning, soon after rising, also while sitting down; wave-like motion of the heart ; want of harmony between the heart and pulse-beats; purring sound in the chest, especially in the cardiac region, resembling the purring of cats. " Spigelia has been recommended in inflammations and or- ganic diseases of the heart, but we have as yet no pathologioo- anatomical proof that it is really homoeopathic to these affec- tions. It may prove homoeopathic to pericardial chorea; Eberlee says that it causes spasmodic twitching of the face, alternate fits of laughing and crying, incessant inclination to run and skip about; Pereira says it often causes spasms of the facial muscles, and even general convulsions; but spasmodic movements of the eyelids have been observed among the most common attendants of its narcotic action. It is not generally known that chorea may depend upon and mask acute pericar. ditis; Dr. Bright has seen cases in which there were peculiar spasmodic symptoms, like most fully developed severe chorea, except the convulsion was more violent than is almost ever seen in chorea; the head being thrown from one side of the bed to the other; the lips closed and opened with a smacking sound ; the tongue protruded with all the grimace and difficulty as in chorea, and yet the only appearances found after death were recent and profuse effusion of lymph on the heart and pe- ricardium, and recent vegetations of the semilunar and mitral valves. Spigelia may prove homoeopathic and curative to this singular form of disease ; cantharides also produce chorea, and may light up inflammation in almost any organ). •' Physical Signs.—Spigelia may be indicated when the 192 ENDOCARDITIS. percussion sound is normal over the heart, or dull over a very large surface; the impulse of the heart increased, evidently and visibly elevating the walls of the chest at each beat; waut of harmony between the heart and pulse-beats; (apex of the heart beating nearer the nipple than usual, or even outside of it;) valvular murmurs at various parts of the heart, as well as with the systole as the diastole, or with both (friction or to-and-fro sound of pericarditis). " Nux vomica : — It causes palpitation in frequent short paroxysms, with commotion of the blood ; pulsating throbs in the direction of the heart; great anxiety with severe palpitation. " In the numerous and careful post-mortem examinations which have been made in cases of poisoning with Nux, no organic alterations about the heart have been found; its influence upon the heart must be referred to the nervous system. It causes increased activity and evident irritation of the gang- lionic system, which may be propagated to the mind and senses; hence the above-mentioned heart-symptoms may arise in consequence of sympathy with the ganglionic and mental affections. For this reason Hahnemann laid so much stress on the mental symptoms excited by Nux, and mentioned the presence of vexability over sensitiveness to all impressions, hypochondriacal humour, passionate irritability and sudden choler, great anxiousness, starting in affright, fearful anxious dreams, &c, as strong indications for the use of Nux vomica. Hence Nux cannot prove homoeopathic to endocarditis, or any other heart affection dependent upon any organic or material change of structure. From the above it becomes evident that even the negative results of physical examinations are of importance in the selection of a remedy. " (We take a different view of the action of Nux : it acts predominantly and specifically upon the motion-side of the spinal marrow and the muscular system in general, and tends more particularly to cause tetanic spasms. As the heart is a very muscular organ, it is very probable that it exerts a similar action upon it; in fact, the spasm of the heart may become so complete and persistent, that this organ remains tightly con- tracted for some time, during which little or no impulse is felt, ENDOCARDITIS. 193 the respiration being difficult and the pulse extinct; if the spasm of the heart be less complete and tonic, i. e., more clonic, then violent palpitation may ensue, but Nux constantly tends to produce long-continued spasmodic contraction of the heart; according to Sobernheim, it often causes an asphyxic condition, dependent upon an extremely violent contraction of the respiratory muscles and heart. Every one familiar with diseases of the heart, must be familiar with this state of things; a patient with organic disease of the heart will be suddenly taken with what he calls spasms: he sits in speechless agony, his hands clasped over the cardiac region, his eyes protruded, his face livid, &c; the physician attempts to feel the pulse, and can scarcely find it; he places his hand or ear over the heart, and finds everything as still and motionless as death itself: after a while the spasm relaxes ; more or less palpitation follows, and the patient recovers for a time. Such attacks are often mistaken for paralysis, exhaustion, or debility of the heart, and treated with, stimulants. Hence it will be seen that the action of Nux is exactly the opposite of that of Digitalis upon the heart; if the latter be homoeopathic to dilatation with attenuation, the former will be so to contraction with thickening, i. e., to concentric hypertrophy, if any such disease exist. Iron, Bark, Nux vomica, Ignatia, Sec, must prove the most homoeopathic remedies to simple hypertrophy, i. e., where the walls of the heart are thickened, the cavity retaining its natural dimensions; also in that variety of hypertrophy in which the walls are considerably thickened and the cavity dilated; and in hypertrophy with contraction, in which the walls are thick- ened and the cavity diminished in size)." Pulsatilla :—It causes stitches and anxious aching in the cardiac region, with difficulty of breathing, relieved by walking ; heaviness, aching and burning about the heart; pal- pitation after slight mental emotions, from speaking, and after eating; palpitation with anxiety, forcing one to throw off his clothes; palpitation in violent paroxysms, with darkness be- fore the eyes, want of breath, especially while lying on the left side. •" Hahnemann has taught us that PuhniiHa is especially 9 194 ENDOCARDITIS. suitable for the female organism, for the sluggish, phlegmatic temperament, for gentle, quiet, and lachrymose individuals. If we seek for a reason for this, we will find it in a consideration of the general action and sphere of Pulsatilla; in its specific relation to the digestive process it exerts a marked influence upon the formation of blood, and upon the venous circulation; every alteration of the chyme and chylification must produce changes in the blood; excessive exaggeration of the digestive process must produce increased formation of lymph and blood, and predominant venosity (?). As women, in virtue of their sexual formation, require and use a greater quantity of blood, they are more subject to venous derangement, and hence Pulsatilla is particularly applicable to the female organism. Among the venous symptoms produced by Pulsatilla are: swelling of the hemorrhoidal tumours, enlargement of the cutaneous veins, bleeding from the nose, cough with expecto- ration of pieces of black coagulated blood; redness of the con- junctiva; the presence of chills, constant internal coldness, predominant coldness of the body, all point to a marked predominance of venosity over arteriality; as a consequence of overfilling of the large veins of the chest, and of the right side of the heart, we find anxiety, great agony with palpitation of the heart, agony in the cardiac or praecordial region, driving one to suicide; trembling anxiety, as if death were about to ensue, with fleeting heat of the body, coldness of the hands, paleness of the face, inclination to weep, &c. "At the bedside it has been found useful in passive congestion, With distention of the veins, and in tedious heart affections ; it acts principally upon the venous, i. e., the right side of the heart, and hence is rarely useful in the inflammatory stage of endocarditis; but when insufficiency of the mitral valve has occurred, causing, as it almost always ■ does, hypertrophy with dilatation of the right side of the heart, and consequent excessive accumulation and activity of the venous blood in the heart and chest, then Pulsatilla comes in play. " Physical signs :—Percussion sound dull, over a large ex- tent of surface, especially in a horizontal direction ; the impulse of the heart either increased or normal; the sounds of the ENDOCARDITIS. 195 heart increased over the right ventricle, or a bellows-murmur in the same place; the second sound of the pulmonary artery distinctly louder than the second sound of the aorta ; .normal sounds of the heart over the left ventricle, or a murmur with the systole ; the jugular veins distended, and pulsating evi- dently (one of the most certain signs of enlargement of the right ventricle)." "Rhus toxicodendron.* Symptoms which it is capable of producing in the healthy subject: violent throbbing stitches over the region of the heart, whilst in a sitting posture, so as to cause loud cries; stitches in the region of the heart, with painful paralysis and numbness of the left arm; palpitation of the heart, whilst sitting still, so violent that the whole body moves at each pulsation; a sensation of weakness and trem- bling in the heart; excessive anxiety, with aching in the region of the heart, and tearing in the region of the os-sacrum; ex- cessive anguish, which prevents sleep during half of the night." There is, in addition to many others, one circumstance in par- ticular which offers considerable difficulty to the correct selec- tion of a homoeopathic medicine, viz., the apparently great identity and similarity which exists between the individual symptoms of many medicaments; if the effects of the various remedies differed more distinctly and strikingly, if the natural boundaries and deviations were more prominent, the selection of the proper remedy would be materially facilitated. It is manifest that this difficulty arises rather from the character and arrangement of our Materia Medica, than from the nature of the medicaments themselves, since it is probable that no two of them possess pathogenetic properties which entirely, or even only partially coincide in essential and particular points, excepting, perhaps, different preparations and combinations of one and the same substance. It is, therefore, of the highest importance to isolate the effects of each medicament by deter- mining and establishing its essential and characteristic qua- * The Nos. of the " Homoeopathic Examiner," containing the re- maining remarks on this and the consecutive medicines, not having reached us as yet, we have attempted to supply the deficiency by re- ferring to and translating from the original treatise.—J. L. 196 ENDOCARDITIS. lities, and to point out distinctly its distinguishing and differing marks and peculiarities. And in fact, when reading the ac- counts of successful homoeopathic cures, we may easily perceive what a decided influence a single characteristic symptom often exercised upon the correct selection of the remedy; how often, only by such means, the right path was entered upon; and that a single such essential and peculiarly characteristic symptom is of much greater consideration than many unimportant symp- toms which are only vaguely or not at all connected with the disease. This is undoubtedly the reason why, when two reme- dies appear to be equally well indicated, according to the simi- larity of their general symptoms, still only the one is actually suited to the case under treatment, and it is also partly owing to the same reason that the thinking physician holds an advan- tage over the layman, who only tries to accomplish cures by opposing symptom against symptom. Hahnemann himself often directs our attention to this point, and ingeniously points out such characteristics in several medicaments." Speaking of Rhus toxicodendron, he mentions as its peculiarity, " that it produces the more violent paroxysms and sufferings, whilst the body, or the affected limb, is kept in a state of perfect rest; but that, on the contrary, a remission of the paroxysms and im- provement is induced by motion." This assertion is also dis- tinctly suggested and fully borne out by the above-mentioned symptoms of the heart, and it deserves here the greater consi- deration from the fact that all the remedies hitherto mentioned yield no similarity to this, but quite the contrary, viz., increase of the symptoms on movement. " Now, if we apply this pecu- liarity of Rhus to Endocarditis and to diseases of the heart in general, we shall unquestionably find that it greatly limits the field of operation of this remedy; for although, in every in- flammation, an increase of the symptoms generally ensues from motion, whereas considerable remission follows if the body or the seat of the derangement is kept quiet, still this is more especially the case in inflammations and chronic affections of the heart. For in these, a considerable increase of the parox- ysms is almost invariably created by any degree of active corporal exertion, and by any other circumstance which is ENDOCARDITIS. 197 capable of producing an exciting effect upon the circulation of the blood. Nevertheless, there are some affections of the heart in which we meet with a certain analogy with this peculiarity of Rhus ; viz., the symptoms assume absolutely no precarious or dangerous violence, in consequence of an insufficiency or de- fective state of the valves (usually the valves of the aorta,) as long as the heart retains its contractile power in an undimin- ished ratio, and is yet strong enough to overcome and press on the blood in its impeded current, from regurgitation through the deteriorated and imperfectly closing valves, no interruption is given to the circulation. Everything which, in such cases, exerts a depressive influence upon the energetic action of the heart, as bleeding, large doses of digitalis, &c, superinduces considerable derangements and dangerous symptoms; on the other hand, the evil is always relieved, if we succeed in strengthening the constitution generally, and in imparting to the heart that amount of energy which enables it to keep up the circulation of the blood in its normal state; hence, also, it happens that bodily exercise, judiciously undertaken, is some- times more beneficial to persons thus affected than uninterrupt- ed rest. " The increase of the symptoms during rest, and their alle- viation through the act of motion, consequently form decidedly characteristic and striking indications for the employment of Rhus. It is certainly not adapted to the pure inflammatory stadium, but will be found appropriate to the subsequent dis- eases of the valves, and the derangements ensuing therefrom, especially in the case of insufficiency of the valves and constric- tion of the ostia. As physical signs, we may point out the fol- lowing : the sound on percussion is normal, or dull chiefly throughout the greater part of the longitudinal direction of the heart; the impulse of the heart is mostly increased, and that to such a degree as to shake the entire thorax ; in place of the second sound, a prolonged murmur is audible over the whole ' heart; during the systole, there is either a sound, or an indis- tinct one, or none at all. « Natrum muriaticum. It produces continual pains, vio- lent stitches, and pain in the heart as if from contusion; at 198 ENDOCARDITIS. night in bed aching beneath the heart, as if ascending from the abdomen, with palpitation of the heart, which is increased by lying on the left side, and lessened by changing to the right; palpitation of the heart on the slightest movement, whilst in the erect posture, accompanied by anxiety; fluttering mo- tion of the heart; irregular pulsation of the heart; intermit- tent pulsations of the heart; strong pulsation throughout the whole body. "The importance of these symptoms is confirmed and in- creased by experience derived from the practical use of this remedy; it is said to be of great advantage particu- larly in organic diseases of the heart, chronic palpitation of the heart, and in irregular pulsation of the same. Its effects, however, do not correspond as closely with acute en- docarditis, but rather with the sequelae of that inflamma- tion. The physical symptoms for its application would be : sound on percussion mostly dull throughout the greater ex- tent of surface; the impulse of the heart violent, irregular, and intermittent; the sounds unequal, louder, or supplanted murmurs. " Natrum carronicum. It causes aching pain in the re- gion of the heart; stitches in the heart, sometimes increased by inspiration ; pressive aching sensation, as if some hard sub- stance were placed in, and occupied a space extending from the region of the heart to the scrobiculus, with a sense of constric- tion in the stomach; painful clucking in the cardiac region; palpitation of the heart on ascending stairs ; anxious palpitation of the heart during the act of stooping ; nocturnal palpitation of the heart, awakening from sleep when reclining on the left side; palpitation of the heart, which does not admit of rest on either side. " The symptoms of this salt bear so strong a resemblance to those of the foregoing (they are almost verbatim the same, with the distinction that, amongst those which appertain to Natrum muriaticum, we meet with, in addition, * an irregular and inter- * mittent pulsation of the heart,' a symptom, which, as has al- ready been mentioned, is not at all very characteristic or of any importance for any given abnormal state) that we cannot dis- endocarditis. 199 criminate between them by the physical signs, but, at the ut- most, only by the general symptoms. " Phosphorus :—It gives rise to congestions to the heart, with palpitations, which become very violent after dinner; palpitation of the heart accompanied by anxiety in the evening, and in the morning in bed on awaking; frequent paroxysms of violent palpitation of the heart; violent palpi- tation of the heart in the afternoon after a slight mental emotion, lasting for an hour, and rendering it impossible to remain in a reclining position ; recurrence of the attack on going to bed, but to a milder extent; palpitation of the heart, early in the morning, alter the usual breakfast; pal- pitation of the heart, sometimes several (two, three, six) violent pulsations (when walking or sitting after dinner), one or two pulsations during the night, whilst lying on the left side; some violent paroxysms of palpitation of the heart, after a slight movement, chiefly of the left arm, on sitting up in bed, or stretching, &c, which disappeared again, when at rest; violent palpitation of the heart in the morning in bed on awaking, and in the evening after lying down; violent nocturnal palpitations of the heart; accele- rated circulation of the blood; palpitation of the arteries of the neck. " The experiments hitherto made by Orfila have been tried with too large doses, and death followed too quickly (after twenty minutes to a few hours) to allow of the development of any pathological alterations in those organs which did not come in direct contact with the poison. It was only observed that the blood contained in the left ventricle was liquid and black, like that contained in the right. " Phosphorus has been chiefly recommended in palpitations of the heart with abdominal derangements and flatulence; also when many of the described symptoms of the heart appear or become exacerbated, particularly after dinner. When we consider that in organic diseases of the heart (especially in hypertrophy) the paroxysms are often increased soon after a meal and render it necessary for the patient to abstain from all indigestible, flatulent food, this coincidence, taken in con- 200 endocarditis. junction with the other confirmatory symptoms, cannot appear unimportant. In pure, acute endocarditis, Phosphorus can only rarely be indicated. The following physical signs are in its favour : the sound on percussion normal, or dull over a con- siderable extent of surface; the impulse of the heart increased; the sounds louder, or supplanted by murmur. " Sepia :—It produces stitches in the heart; throbbing in the pit of the stomach early in the morning, then undulating or fluttering sensations in the chest, similar to palpitation of the heart, followed by burning heat in the face and body; throbbing in the left chest; palpitation of the heart in the evening, for a quarter of an hour; palpitation of the heart, with stitches in the left side of the chest; the heart beats con- vulsively, attended with great anxiety, and trembling of the fingers and legs; palpitation of the heart, lasting for several days, accompanied by a sensation of anguish, and rendering it necessary to take a deep inspiration, but unattended with any moral impression; intermittent pulsation of the heart, with anxiety; intermittent pulsation of the heart, mostly after dinner; in the evening, when in bed, violent palpitation of the heart, and beating of all the pulses ; waking from sleep at night, in consequence of violent colic, with an unusually per- ceptible trembling motion of the heart (without palpitation), and a full pulse. " Notwithstanding the rather numerous symptoms which Sepia gives rise to, connected with the heart, it has been but little employed against diseases of that organ, and indeed none of its symptoms can be considered as sufficiently in- dicative of any special form of heart-disease, the more so, as those very symptoms which are peculiar to it, viz., the trembling convulsive action and intermitting pulsation of the heart are no fixed diagnostic signs of any particular disease, but merely an irregularity in the rhythmus, which may take place in the most opposite abnormal states of the heart, and even in an apparently perfectly normal condition of the same. " It appears to be indicated when, on auscultation, the fol- lowing are the principal results : sound on percussion natural, ENDOCARDITIS. 201 or dull over a large extent of surface ; the action of the heart violent, unequal, intermittent, convulsive and trembling; the sounds more violent and louder than usual, sometimes iutermit- ting ; or murmurs instead of the natural sounds. " Graphites :—It produces tightness in the left side of the thorax, and about the heart early in the morning, for several hours, aching in the region of the heart during respiration; stitches in the cardiac region ; after retiring to rest for the night, and while lying on the left side, throbbing in the region of the heart; the paroxysm is attended with anxiety, and is of so violent a character as to cause the bedclothes to be moved by it, but disappears on turning; violent throbbing of the blood at the heart, and in the rest of the body at the slightest motion ; strong pulsation of the heart, which moves the arm and the hand, and is productive of anxiety : violent palpitation ».of the heart; violent palpitation of the heart several times, like an electric stroke from the heart towards the neck. "Although I have not hitherto heard of anything, established by experience, concerning the use and effect of Graphites in diseases of the heart, still the above-mentioned symptoms are too important, and partly too characteristic, as to have ad- mitted of its having been omitted here. The action or efficacy of this remedy embraces a pretty extensive sphere : certain symptoms correspond strikingly with organic lesions of the heart, which have already attained a somewhat advanced stage, particularly hypertrophy and dilatation. The following signs may be considered as appropriate indications for its employment: dullness on percussion over a considerable surface; the action of the heart so violent as to shake and raise the thorax and the head of the auscultator ; the sounds of the heart loud and vio- lent, or supplanted by murmurs. " Calcarea carbonica : — It causes painful aching in the reo-ion of the heart; precordial anxiety; strong pulsation of the heart after a meal; violent palpitation of the heart, with great anguish and restlessness, oppression at the chest, and pain in the back ; palpitation of the heart; violent palpitation of the heart ; a long-continued spasmodic constriction in the region of the heart, which interrupts the act of respiration, with 9* 202 ENDOCARDITIS. subsequent violent shocks; great anguish and palpitation of the heart; stitches in the heart, obstructing the breath, and leaving behind it an aching pain in the cardiac region ; very vio- lent palpitation of the heart, with an unequal pulse ; pulsation of the large vessels in the chest. " The annals of homoeopathy mention several cures of rheu- matic, anomalous gouty affections of the heart. It corresponds, as may easily be supposed, not with the pure inflammatory sta- dium, but with the sequelae. Physical signs : the sound on percussion normal, or dull to the greater extent; the impulse of the heart violent, often not synchronous with the pulse in the wrist; the sounds of the heart louder, or supplanted by murmurs. " In conclusion, we may yet venture to make some general observations on the occurrence of organic diseases of the heart, and on the possibility of their cure. Doubts have repeatedly^ been raised, and principally in homoeopathic writings, on the actual existence of affections of the heart in rheumatismus acutus, and more particularly on the safety of depending on auscultatory phenomena for the discovery of organic diseases of the heart, as, for example, copious loss of blood, and peculiar chlorotic and gouty dyscrasiae, are in themselves sufficient to produce similar consecutive murmurs, and changes in the sounds of the heart, without the actual coexistence of the least organic metamorphosis; many are inclined to consider the sup- posed rheumatismus of the heart as nothing else than a conse- quence of copious bleeding. Although it must be confessed that Bouillaud, who particularly (and was almost the first who did so) directed our attention to the close relation of rheuma- tismus to the heart, has given occasion to this supposition by his coup-sur-coup conducted venesections, and that others have committed exaggerations, by trying to discover inflamma- tion of the heart in every case of rheumatismus, still innumer- able cases (which had run their course without the employment of bleeding, and in which the correctness of the auscultatory diagnosis could be established by autopsy), have but too often proved the existence of structural derangements of the heart. It is certainly true, that in chlorotic persons, and under parti- ENDOCARDITIS. 203 cular circumstances, anomalies are sometimes observed in the beating of the heart, which disappear too quickly, and, in most cases, spontaneously, and are too isolated to warrant us in determining that they should have proceeded from organic me- tamorphosis ; still this identical sudden appearance and vanish- ing, when taken in conjunction with the other general symp- toms, and the circumstance that such inexplicable cases are of rare occurrence, ought to facilitate and correct the diagnosis, and will considerably diminish the weight of the aforesaid ob- jection. Another reason which gives rise to the doubts which many entertain of the frequent occurrence of organic diseases of the heart, and which must necessarily make them, at the same time, very indifferent and sceptical to the possible advan- tages of a correct diagnosis, appears to be the exaggerated and partly erroneous view which they harbour of the great danger and unconditional fatality of organic diseases of the heart, and of the utter fruitlessness of every attempt to cure them. And yet amongst all the organic diseases and derangements of noble organs, perhaps those of the heart, notwithstanding the great importance of this organ, are the least accompanied by imme- diate or direct danger. Now that we are so much more readily enabled by the improvements effected in medical science to dis- cover them more distinctly and more correctly, we can daily convince ourselves that they often exist for many years and even without causing any serious detriment to the whole or- ganism ; that they have absolutely not always been the causa mortis, yea, that many have only been discovered at the post- mortem examination, having remaiued quite unnoticed during the existence of the individuals, and consequently without ex- erting any considerable detrimental influence upon life. Death is, comparatively speaking, seldom directly attributable to them, e. g., by the bursting of the heart, but for the most part in- directly by the derangement of other organs and functions, and by increased disposition to other diseases, such as hydrops, apoplexy of the brain, &c. How very different, in this re- spect, is the case with other organic diseases, e. g., of the lungs, which, in most instances, produce the fatal termination in a more direct, progressive, and irresistible manner, generally 204 ENDOCARDITIS. 1 eaving but little prospect to the physician of averting the fatal issue, or often even of retarding it for any considerable time. Although, therefore, medical art may very rarely and perhaps never succeed in effecting a radical cure of advanced organic metamorphoses of the heart, nevertheless there is a much wider scope for preventing their threatened development, or ar- resting them in their progress, and consequently of obviating, meliorating, or removing the secondary, life-endangering, but not inevitable, consecutive symptoms and derangements of other functions, and of the system in general. It is just in such cases and under such circumstances that homoeopathy has already effected great things; and indeed this system can be greatly promoted by, and derive much advantage from the further cultivation and practical application of the diagnostic auxiliaries. If it appear necessary to substantiate this assertion by practical examples, I appeal, first of all, to the testimony of many practitioners, to whom such cases must have often oc- curred, if they have ever made their observations and examina- tions with .the necessary attention. For my own part, I shall in this place mention only two cases, which are interest- ing in more than one respect, and are confirmatory of what has been asserted above. The one is the case which Dr. G-oullon has fully described, (Neues Archiv, Vol. I, Heft 2, p. 44,) and which, therefore, I must content myself with simply referring to. The other came under my own observation two years ago : — " M. Held the daughter of healthy parents, was from her earliest childhood subject to frequent attacks of violent palpi- tation of the heart, attended with anguish and swooning, which were chiefly called forth by bodily exercise and exertions ; the evil increased every year in violence, prevented materially the growth of the body, and was pronounced by several physicians to be hypertrophy of the heart, and treated with leeches, cup. ping, and vesicatories. When she had reached her eleventh year, Dr. Noack was applied to, under whose homoeopathic treatment the paroxysms became more scarce and less vi lent, and the entire constitution of the patient was at the same time ENDOCARDITIS. 205 essentially ameliorated and strengthened. This gentleman left Leipsic a year and a half afterwards, at which period I was introduced by my father to 'the patient for the first time. She was then 12i years old, of small stature, emaciated, and weakly ; the left side of the thorax was protruded forwards and more elevated than the right, the sternum pressed dextrad, the spine also bent sideways, the impulse of the heart exceed- ingly violent, strongest between the sixth and seventh ribs, both to the sight and touch, and producing vibration through- out the greater part of the epigastrium ; the sounds of the heart were strong, loud, quick, irregular, and during the systole there was an additional murmur, audible particularly over the left ventricle ; the palpitation of the heart was frightfully in- creased by the slightest movement. The other functions of the body were all as yet pretty regular ; the mental capacities were somewhat precocious, the temper mild, easily excitable and anxious. After the lapse of four weeks, considerable de- terioration took place, in consequence of some external, noxious influence, the dyspnoea, the anguish, and the palpitation of the heart became almost unbearable, the patient could neither walk, nor lie down, but only sit in half erect posture, violent cough, and paroxysms of threatening suffocation appeared, par- ticularly during the night, accompanied by a continuous tor- menting thirst; the feet, and subsequently the abdomen, the hands and arms, then became in the highest degree cedematous; the urine clouded, dark and somewhat scanty; the bowels ob- structed. None of the remedies at first prescribed, (Arsen., Digit., Sec.,) succeeded in producing the slightest amendment, or in 'stemming the progress of the malady in this frightfully aggravated form ; at length, when death appeared almost un- avoidable, the violence of the most distressing symptoms abated under the employment of Prunus spinosa (second dilution, one drop every four hours), the nights became more tranquil, the paroxysms of impending suffocation became less violent, the oedema decreased, and, in short, after the continued use of this remedy for a period of three weeks, the patient was enabled to rise and to walk, and to lie down in a horizontal position ; the respiration and the sleep were quiet, the oedema had perfectly 206 CARDITIS. disappeared, with the exception of a trivial degree of swelling about the ankles; the action of the heart became more quiet, the sounds more regular and les.s loud. For nine months in succession, the patient enjoyed such a state of health as she had never before experienced, she became stronger, could bear a much greater amount of bodily and mental exertion without inconvenience, and the repeated physical examinations showed that the anomalous states of the heart were all still existing, but materially lessened in degree. The following year, in con- sequence of violent constitutional excitement proceeding from the first appearance of the menses, the patient suffered a re- lapse ; nevertheless, this event cannot in any measure be con- sidered to weaken the value of this case for proving our assertion; for this example of such a considerable, and in all probability congenital organic malformation of the heart, being borne for a period of thirteen years, notwithstanding the deformity of the thorax superinduced by it, cannot other- wise than speak forcibly against the generally received opi- nion of the absolute fatality of organic diseases of the heart; it, moreover, proves the beneficial effects which homoeopathic medicines may yet exercise, even in cases of this desperate character." CARDITIS. Inflammation of the substance of the heart, distinct from the membranous affections, is a rare disease. The general symp- toms of the cases on record present similarity to those of peri- carditis. In the event of inflammation of a large portion of the heart, a fatal termination is, in all probability, unavoidable, in consequence of the serious interruption which, in such a case, must be offered to its function. The remedies which are likely to be the most effective, in cases where there is any prospect of performing a cure, are: Aconitum, Bryonia, Lache- sis, Arsen., Pulsatilla. Cocculus, Spig., Croton, Digit, Carbo v., Natrum m., Sec. The cure of organic diseases of the heart, especially when they are of some standing, or of a complicated nature, is, unfortunately, not often within the reach of art. All that remains to be done, in the majority of such cases, is to CARDITIS. 207 mitigate the general symptoms, to render the patient's life as little oppressive yet as useful to him as possible, and to retard the onward march of premature decay, by means of appropriate medicines, diet, and rules of conduct. In Hypertrophy, or morbid thickening, or increase of vol- ume of the muscular substance of the heart, indicated chiefly by dyspnoea, increased impulse, diminished natural sounds, dullness on percussion, and full, strong, vibrating pulse, the medicaments which have been employed with more or less suc- cess, are: Ars., Spigel., Bism., Digit, Rhus, Phos.. Prunus spin., Iod., Veratr.; and also Graph., Ferr., China, Nux, Ignatia, Natr. m., Aeon, (palliative), Bella., Rhus. In Dilatation or an enlargement of the capacity of one or more of the heart's cavities, characterized by palpitation and dyspnoea on any sudden emotion, diminished impulse, increased and more extensive sound, and soft, feeble, undulating pulse, &c, or hypertrophy and dilatation, with combination of the symptoms and signs of these two states : Spigel., D'reit, Can- nab., Ars., Bism., A^parag., Laclusis. Lycop., Carbo v., Puis,, Rhus, Spigel., Veratr., Nux, Phosph., Am., Sep., Sulph., Calc, Aeon., Oleand., Sec. In Diseases of the valves, indicated by bellows- or rasp-sound, heard most distinctly over the situation of the dis- eased valve, persisting even during quietude, and occasionally accompanied by a purring tremor or vibration, felt on placing the hand on the region of the heart; palpitations and dyspnoea aggravated by exercise or by mental emotions; weak, small, and sometimes intermittent pulse; swelling of the feet towards evening; and, as the disorganization advances, discoloration of the face and extremities, extension of oedema to the legs, dropsical infiltration into the different cavities. of the body : Ars., Phosph., Argentum, Aurum. Co"c, Na'r. m., Croton, Digit , Snigel. : and Rhus, Pids., BeVa., Lach., Asa., Lycop., Veratr., See.,'Grarh., Sec. (See Dr. C.Mueller's observa- tions, page 383 where general and physical indications for most of the foregoing medicaments are enumerated.) In Aneurism of the ascending portion and arch of the aorta, which is frequently indicated by the following signs : loud 208 CARDITIS. whizzing or rushing at the superior extremity of the sternum, perceived on the application of the hand to that region; rat- tling in the throat; oppression at the chest; dissimilarity of the pulse at the wrists; dull sound, and perceptible impulse under the sternum or below the right clavicle when the tu- mour is large; single or simple pulsation, with increased im- pulse and louder sound, in contradistinction to the double pul- sation and the normal sound of the heart; bellows-sound attending the single pulsation. The general symptoms differ considerably according to the situation, shape, and size of the aneurism. Thus, when it may happen to be so formed or placed as to press against the gullet, it will cause impeded de- glutition, and sometimes a constant clucking noise; it may press upon the spine and give rise to severe dorsal pains, with nervous symptoms of various kinds, and great debility; or it may compress one of the larger bronchial tubes, or pro- duce absorption of a part of the lungs, and create difficulty of breathing, cough, &"c.) : Carbo v., Lachesis, Lycopodium, Ars., Sulph.; or Spigel., Rhus, Graph., Calc., Puis., Digit, Natrum m., Zinc, Sec, are the remedies which are likely to prove most useful. The most useful remedies, generally speaking, for removing attacks of congestion, in diseases of the heart, are : Aeon., Bell., Lachesis, Nux v., Opium, Aurum ; or Cocculus, Coffea, Phos- phorus, Ferrum, Ars., Digit., Plumb. Affections of the heart induced by the injudicious employment of Mercury, are commonly remediable by means of those medi- cines which are the more powerful antidotes to the multifarious, injurious effects which arise from the abuse of that mineral, but especially such as : H'par sulph., Acidum nitr., Aurum, Pul- satilla, Cinchona, Lachesis, Lycopod., Sec. Those which are manifested in a gouty habit, require the em- ployment of the remedies which correspond to that diathesis, as well as to diseases of the heart in general. In acute rheumatism of the heart : Acon.it, Laches., Bella., Bryonia, Arsenicum, Pulsatilla, Spigelia, Colch., and Nux v., form the principal remedies. INTERTRIGO. 209 Against arterial inflammation, in consequence of a wound, &c, Rhus has chiefly been recommended. If, at the same time, there has been considerable contusion of the adjacent parts, Arnica will be necessary. When the inflammation is intense and accompanied by great constitutional disturbance, or when it threatens to extend rapidly towards the heart, Aco- nitum must be employed. Puhaiilla and Arsenicum may be useful in certain cases, the latter more particularly in advanced stages of the affection. The same remedies are equally appli* cable in Phlcbi'is, arising from external injury. When inflam- matory action is manifested, in the vena porta, with burning pain in the seat and course of that important vessel, and the commencement of its incipient and terminal ramifications, pain and distention in the right hypochondrium, bitter taste, whity- brown, or yellowish tongue, vomiting, yellowness of the white of the eye, and of the face, Nux v. is an important medica- ment. Lachesis, Pulsatilla and Sulphur may answer bet- ter in other cases; or Arsenicum, when symptoms of ex- treme prostration, with dryness of the tongue, and deli- rium, supervene. In chronic phlebitis, Lycopod., Plumbum, Carbo c, Calc, Arnica, Sec, may prove of efficacy. (See also Varices.) INTERTRIGO. This affection consists of a galling or excoriation of the skin, accompanied with inflammatory redness and moisture around the anus, between the nates, at the inner and upper part of the thighs, the groin, or other parts of the body, such as the axillae, &c. Riding, much walking in the heat of summer, and the irritation of the urine, are the most frequent exciting causes. It is, very frequently, readily relieved by Graphites or Lycopodium, externally and internally, at low potencies. Arnica, and also Nux v., Pulsatilla, Sepia, Sulphur, Arseni- cum and Chamomilla have also been recommended in parti- cular cases : the selection being made- according to the temper- ament and complexion of the patient, as also the state of the 210 psoriasis. digestion, sexual functions, &c. (See also Excoriations in Children.) PSORIASIS. This cutaneous disorder is distinguished by a rough and scaly condition of the epidermis, sometimes in isolated spots or patches of an irregular form, at other times contin- uous, but almost always attended with clefts or fissures in the skin. It is usually accompanied by constitutional de- rangement, and recedes or recurs at particular seasons of the year. The cure of this disorder is generally difficult and tedious, especially when it occurs in the inveterate form (psoriasis in- velerata), characterized by nearly universal scaliness, with a harsh, dry, thickened and rigid state of the skin, which is at the same time red and deeply cracked, or when it is chiefly confined to the palm of the hand (psoriasis pa1maris). In the simple form (psoriasis simplex), Lycopodium at a low potency, in repeated doses, frequently effects a cure in from four to eight weeks, even when the dis< rder is of long standing; Rhus and Bryonia are also of considerable value in this variety. In other cases, Sulph., S"pia, Calc, Graphies, Clematis, and Ledum, may be called for by the nature of the case. In Psoriasis inceterala, Arsenicum is of more or less utility, as also Rhus and Sepia ; but it is often requisite to have recourse to S dphur, Antim. c, Ammon. c, Graphites, or Calc, Sec, to complete the cure. Against Psoriasis palmaris, Sulphur, Sepia, and Acid, mu- riaticum, or Zincum, have hitherto been principally employed. When there is a discharge from the rhagades of an offensive smell: Rhus, Graphites, Lycopod., Mercurius, or Hepar, Sec, are often of important service. And in Psoriasis facialis,— Sulph., Calc, Aurum, Graph., Lycopod.; or Sepia, Cicuta, Ledum, Oleander, Sec, claim a preference. The diet, in this affection, as, indeed, in all other cutaneous maladies, should be simple and unstimulating. Fruits, and also vegetables, are often hurtful when the eruption is in an aggra- pemphigus. 211 vated form, and ought, therefore, to be avoided under such cir- cumstances. PEMPHIGUS. Febris bu'losa, Pompholyx. Pemphigus consists of an eruption of yellowish and trans- parent bullae or blebs on various parts of the body, varying in size from a lentil, or a split pea, to a walnut, commonly pre- senting an inflamed base, and generally assuming the shape of an almond. Fever is a frequent accompanying symptom; but some authors maintain that the disorder occurs in two different forms, viz., the acute and chronic, and that fever is only pecu- liar to the former, and invariably absent from the latter ; whilst others again, create a further distinction by giving the name of Pemphigus to the affection, when the vesicles exhibit an in- flammatory base, and are preceded or accompanied by fever, and denominating it Pompholyx when exempt from these addi- tional symptoms. The disease occasionally comes on without precursory signs; but may also be ushered in by sickness, general uneasiness, precordial oppression, headache, lassitude, painful stiffness in the j.-ints, and violent itching of the skin ; or otherwise it com- mences with irregular chills, followed by dryness and burning heat of the skin, as also thirst, anorexia, and great rapidity of pulse. The eruption generally declares itself at first by one or more circular or oval red spots or patches, which are slightly prominent, and frequently bear a close similitude to the first signs of smallpox. These patches soon take on a dusky hue, and are preceded or attended by some degree of pain and heat in the affected parts. From the effusion of transparent serum beneath the epidermis, it becomes raised in the form of vesica- tions presenting the appearance of blisters arising from a scald, or produced by the application of cantharides to the skin The development of these blebs sometimes ensues so speedily after the evolution of the erithematous patches, that some authors have been induced to conclude that pemphigus was never pre- 212 PEMPHIGUS. ceded by any redness of the cutaneous surface. The erup- tion gradually extends over the greater part of the body, but rarely affects the hairy scalp or the genital organs. The ve- sicles increase rapidly in size, and in some, places become con- fluent. The skin between the bullae presents a natural appear- ance, except when the latter approximate closely, in which case a more or less marked erythematous blush pervades the inter- stices. When the vesicles have attained their maturity, and burst of themselves, they form incrustations of a whitish, or a pale brown colour; but if the epidermis be detached by friction soon after the bullae have broken up, painful excoriations ge- nerally result. The duration of pemphigus with fever (acute pemphigus) varies from one to four weeks, according as the eruption may have been simultaneous*or consecutive. Pemphi- gus without fever, again (or chronic pemphigus), in which the development of the bullae is always successive, generally occu- pies a period of several months, and even much longer, if un- checked, in some cases. When accompanied by nervous fever, the disorder is to be regarded as of serious character; as also when it is very extensive, frequently renewed, and associated with inflammation of the bladder, &c. Therapeutics. When the eruption is preceded or accom- panied by inflammatory fever, the employment of Aconitum be- comes more or less requisite; but as soon as the fever and restlessness have been considerably allayed, Cntharides (3—6) or Rhus (3—6) must be selected. The former is more espe- cially useful when the bullae present a close analogy to the vesication produced by a blistering plaster, when the irritation is intense and consists of a violent burning itching, or when the disorder is attended with dysuria, haematuria, cystitis, or, in the case of females, with inflammation of the vagina This remedy may at the same time be advantageously applied externally by means of a camel's hair brush. Rhus is an invaluable remedy in the majority of cases of Pemphigus, although it occasionally fails to relieve the troublesome pruritus so readily as Cinlha- rides. Should nervous fever be associated with the eruption, Rhus will be rendered still more requisite. When the blebs SHINGLES. 213 are copiously developed on the face, and there is severe head- ache, thirst, synochal fever with dry hot skin, tossing about, disturbed sleep, and even delirium, as is prone to be the case in young subjects, Belladonna should be prescribed. (See also Heat-spots in children.) After the employment of Bella- donna, Lachesis or Rhus are generally required to complete the cure in pemphigus febrilis. SHINGLES. Zona. Herpes zoster. Cingulum. Ignis sacer, Sec The term Zona or Herpes zoster, has been given to a cuta- neous disorder characterized by the formation of several clus- ters of vesicles, which usually appear on one side of the body in the shape of a semi-circular band or belt, most commonly at the waist, but sometimes across the shoulder, and occasionally on the neck, face, and scalp, or other parts of the body. The eruption is occasionally preceded, for a few days, by languor, thirst, and loss of appetite, fits of shivering, headache, sickness, restlessness, brownish or whitish coating on the tongue, ac- celerated pulse, heat and tingling in the skin. More common- ly, however, the disorder appears without any precursory symptoms, and the attention of the affected party is primarily drawn to the region where the eruption is about to be deve- loped by a sense of pricking and smarting, or burning heat and sharp pain. On examining the parts, several bright red, irre- gular blotches, more or less widely separated, are observed, and upon each of which, numbers of minute white silvery-looking vesicles show themselves, and ere long increase to the size of a lentil or pea. The vesicles are at first transparent, being filled with a clear limpid fluid, but about the fourth day they assume a milky, or yellowish, or sanguinolent colour, and the fluid con- tained becomes sero-purulent, or even converted into true pus. Soon after this, they often become somewhat confluent, and flatten or subside, leaving a very faint outline behind them, or what is still more frequently the case, they dry up and form small yellowish or brownish scabs. 214 SHINGLES, Some of the vesicles, again, burst on the second, or between that and the fourth day, and discharge a small quantity of lim- pid serum ; the epidermis being detached, suppuration of the vascular rete of the corion takes place for a few days in conse- quence of the exposure. While the vesicles of the first groups are acquiring an opalescent aspect, new clusters begin to appear in succession for three or four days, and pursue the same course. From the eighth or twelfth, to about the twenty-first day, all the incrustations of zona are detached, leaving the surface of the skin in a tender state, and covered with marks of a deep- red colour, which gradually disappear. Where the vesicles have been confluent, and the inflammation severe, the eruption is frequently of longer duration than above stated, and the skin, from occasionally becoming ulcerated below the incrustations, which in such cases are rendered very adherent, heals slowly, and presents numerous pits or cicatrices for a considerable time afterwards. The causes of herpes zoster are obscure. It is most common in summer and autumn. It is not contagious, and does not ap- pear to have ever been seen as an epidemic. The disorder is, on an average, not of a serious character, especially when occur- ring in children and adults; but in the aged, it is liable to be followed by sloughing and gangrenous ulceration, and is always distressing from the pains which accompany it. Therapeuth s. When the disease is preceded by con- siderable constitutional disturbance, with severe pain, restless- ness, deep-seated darting pains in the chest, heat of skin and quickness of pulse, a dose or two of Aconitum afford speedy relief. Spare diet must at the same time be enjoined. Should the febrile symptoms, pain, and restlessness, not completely yield to Aconitum, Sulphur may be prescribed, succeeded by a repetition of Aconitum, or by Aconitum and Coffea in alterna- tion, if there be less pain but continued restlessness. When the primary symptoms have been removed, or when the attack has commenced without any precursory symptoms, Rhus toxico- denelron generally forms the most useful remedy, and is, in most cases, sufficient to conduct the disease to a happy issue— nt.run?. 215 even in those occurring in individuals of an advanced age; it is sometimes requisite, however, to exhibit Sulphur or Graphites after, or in alternation with Rhus. The patients should, in all cases, be cautioned against lying on the affected side, as gangrene is liable to be induced by so doing, particularly in bad habits and elderly sub- jects. If sloughing and gangrenous ulceration supervene, notwithstanding all our precautions, Arsenicum must be had recourse to, succeeded or alternated with Lachesis and Cin- chona, should a favourable reaction not follow the employment of Arsenicum alone. Sulphur, and sometimes Acidum nitri- cum usually form the most appropriate remedies to forward the process of healthy granulation and cicatrization. The parts may be dressed with dry lint. Nourishing and easily digestible food must be allowed in such cases, and even wine and water, or a little pure wine, if required, as is some- times the case in old and debilitated patients. Mercurius has been recommended as likely to be useful in zona, and may occasionally, along with Hepar, prove serviceable when the inflammation has run high, and the fluid contained in the vesicles has become converted into true pus: An'imonium tar- taricum when at the very commencement there is considerable gastric disturbance with nausea and vomiting ; and Arsenicum when the cutaneous pains consist of a severe burning, and are accompanied by uncontrollable restlessness, dry heat of skin, and great thirst. ULCERS. (Additions to p. 306.) Inuolent (with thick, smooth, prominent, and rounded margins, a flat bottom, smooth, shining granulations, which are liable to be repeatedly and suddenly absorbed soon after their formation, leaving the sore as much increased in size as it had previously diminished. The pus is thin and aqueous, and con- tains flakes of lymph which adhere tenaciously to the surface 216 ULCERS, of the sore) : Sep'a Ac phosoh., Lyr., Carbo v., Ars.., Lach., Sulph., Silic, chiefly.* Inflamed: Aeon., Ars., Mere Hep., Sil., and also, Mez., Puis., Ant, Bella., or SHic, Sulph. Insensirle : Evphorbium, Ars. Irritable (painful, bleeding readily, with thin ichorous dis- charge, and imperfect or indistinct granulations) : Ars., Asset., Lye, Hepar, Carbo v., Mere, Phosph.. Silic, Mez., Acid. m., Lach., Puis., Acid, nitr., Con. Sulph., Bella, Thuja, Staph. Itching : Sulph., Silic, Ac. phosph., chiefly, but also Lye, Sep., Graph., Ars., Alum., Puis., Staph., Bov., Ran. Itching at the edges only : Tart. — at night only or chiefly : Lye, Staph. Burning: Ars., Carbo v., or Lye, Sep., Sil., Clem., Graph., Mez., Hep., Aciel. n., Acid, m., Rhus, Puis., Nux, Bov., Cham., Canth., Plumb., Ran., Lam. Burning pain during the night only : Lye, Rhus, Staph., Hepar. — pain or heat at the edges : Acid. m. — pain when touched : Lach., Lye Creeping or crawling sensations in the ulcers: Rhus, Clem., Cham., Con. Excoriation, with pains resembling a recent : Mez., Rhus, Hep., Puis., Bella., Sec. Gnawing pain, with : Staph., Merc, Phosph., Lye, Bar., Kali, Rut, Sulph., Sec. Jerking pains, with : Staph., Cham., Clem., Ac. m., Ac. s., Am., Ruta, Sec. Piercing, or boring pain, with : Sulph., Silic, China. Throbbing pain, with: Sulph., Clem., Hep., Merc, China, Bryon., Sec. Shooting, darting, pricking pains, with : Ac nitr., Merc, Silic, Hep., Puis., Sulph., Nux, chiefly; but also Staph., * Characteristic indications for many of the remedies quoted, will be found in Boeninghauseu's Manual of Homceopathic Therapeutics, by Chs. Hempel, M. D. ULCERS. 217 Sep., Lye, Ars., Mez., Clem. Graph., China, Petr, Lam., Ran. Shooting pain at night only or principally : Rhus. '— pains at the edges, and only when touched : Clem. — or pricking pains as if from splinters : Acid. nitr. Smarting : Silic, Graph., Staph., Lam., Rhus., Puis., Cham., Bry. — or soreness at night only : Rhus. Tearing, rending pain in the ulcers : Lye., Sulph., Sep., Graph., Staph., Canth. Tearing, during the night only or chiefly : Lycopodium. Tensive pain in the ulcers : Sulph., Con. Ulcers which present a blueish or livid appearance : Ars., Lach., Silicea, chiefly; but also Con., Sulph., Merc, Assa., Aur. Ulcers with blueish margins : Assa. — which have a greenish aspect: Ars. Ulcers which have a whitish appearance : Merc, Sabin., Ars. — smooth : Ac phosph., Lach , Sil., Ran. — superficial: Ac ph., Ac. nitr., Merc. — tumid : Lycop., Con., Bella. — with indurated edges : Ars., Sil. ; and also Mere, Sulph., Sep., Assa., Thuja, Puis., Petr., Lye, Bryon., Sec. Ulcers with inverted edges : Lycopodium, Ars. — with pale edges : Nux v. — with elevated edges : Ars., Sil., Sulph,, chiefly; but also Merc. Lye, Sep., Puis., Thuja, Assa., Petr., Sec. Ulcers with jagged edges: Mere, Thuja, Staph., Hep., Acid, ph., Sulph., Sil., Laeh. Ulcers surrounded by papillce : Sulph., Lach., Sep., Ars., Puis., Rhus, Sil., Lye, Sec Ulcers with unhealthy pus. Pus, serous, aqueous, sanious : Mere, Acid, nitr., Sulph., Sit, Ars., Carbo v., Lye, Graph., Clem., Ruta, Assa., Rhus., Ran., Sec. 10 218 inflammation on the bladder. Pus, albuminous: Ars., Amm., Sulph., Sil., Sep., Calc, Lye, Puis., chiefly. Pus, brownish: Ars., Carb. v., Sil., Bry., Sec. — excessive secretion of: Sep., Puis., Sil., Ac ph., Lye, Chin., Arg., Canth., Staph., Calen., Scill., Merc, Phosph., &c. Pus, gelatinous: Arg., Merc, Sep., Sil., chiefly. — gray: Ambr., Lye, Merc, Sil., See — yellow: Puis., Lye, Ars., Kreos.. Natr., Nitr., Thuja, Dulc, Aur., Sep., Sil, Clem., See. Pes, acrid, ichorous : Ars., Merc, Sil-, Rhus., Staph., Sep., Sulph., Graph., Clem., Kreos., Acid, nitr., Natr., Ac. sulph., Hep., Lye, Ran., Sec. Pus, sanguineous : Ars., Assa, Hep., Merc; and Sulph., Sep., Lach., Sil., Lye, Rhus, Kali, Carbo v., Sec. Pus, scanty secretion, or suppression of: Lach., Merc, Sil., Calc.; and Carbo v., Clem., Sassa., Phosph., Petr., Staph., Magn., Led., Bar., Graph., Sec Pus, fetid : Sulph., Ac. phosph., Hep.; and Carbo v., Ac. nitr., Aur., Ac. mur., Kreos., Staph., Sec. corn., Con., Sil., See. DISEASES OF THE URINARY AND GENITAL ORGANS. INFLAMMATION OF THE BLADDER. (Additions to page 181.) Arsenicum alb., Nux v., Sulph., Sepia, Silicea, and Kali nitricum, are the remedies on which our chief reliance may be placed when suppuration sets in. And Helleborus niger, Cap- sicum, Staphysagria, Lycopodium, or Baryta, when Blennorrhea supervenes. Chronic Inflammation of the Bladder is accompanied by an extremely irritable state of that organ, together with a profuse retention op urinb. 219 secretion of mucus which is discharged along with the urine. From the latter circumstance the designation of Catarrhus vesicae, has been given to this form of the disease. The reme- dies which are most serviceable in the treatment of chronic cystitis are: Dulcamara, Pulsatilla, Sulphur; or Merc, Calc, Nux, Phosph., Can., Kali, Antimon. c, Sec. ])0SE; m»i or ii»i or o£. alSo the tincture or trituration, according to circumstances. RETENTION OF URINE. (Ischuria.) When an obstruction to the flow of urine takes place, the fluid accumulates and distends the bladder to such an extent, that it rises up above the pubis, and forms a perceptible swell- ing in the hypogastric region ; the entire abdomen becomes tumid and tender to the touch, and a considerable degree of fever is present; the inclination to pass water is frequent and urging, but utterly ineffectual, and accompanied by intense pain. Ischury is always to be held as a dangerous affection when it continues for any length of time, for if relief be not administered, inflammation and consequent mortification ensues, the urine finds an outlet into the abdomen, and death soon follows. The causes of retention of urine are, usually, inflammation or stricture of the urethra, enlargement of the hemorrhoidal veins; suddenly suppressed hemorrhoids, either by extirpation or other- wise ; over-distention, spasm of the neck of the bladder, inflam- mation or hernia of the bladder, paialysis of the bladder, ab- sorption of cantharides applied externally, or taken internally, excess in vinous or spirituous liquors, the pressure of the rec- tum, from a lodgement of indurated faeces, or of the uterus, tumours, &c, on the neck of the bladder ; swelling or ulcer of the prostate gland, calculi, or particles of gravel lodging at the neck of the bladder, or in the urethra. Therapeutics. The following remedies may be quoted as those which are best adapted to overcome all ordinary cases of ischury: AconHum, Camphora, Cantharides, Sulphur, Calc.c, Nux v., Carb. v., and Arsenicum. 220 RETENTION OF URINE. Aconitum is peculiarly efficacious when there is considerable fever, with burning heat in the region of the bladder, outwardly perceptible to the touch. In the case of children, where, in ad- dition to the foregoing symptoms, there is also distention of the abdomen, with suppression both of faeces and urine, this medi. cine is, moreover, one of our most important remedies. In urgent cases, a dose of this remedy may be exhibited every half hour or so, until the symptoms yield. Camphora forms a valuable general remedy where no occa- sional cause of the disorder can be detected, but it is also of great service where the complaint evidently arises from spas- modic action. Burning heat in the abdomen and urethra, with shivering coldness of the surface, and shivering succeeded by a hot fit, do not contraindicate the employment of Camphora, but as soon as the incipient symptoms of fever become more deve- loped, Aconitum must be had recourse to. In administering Camphora, we shall frequently find it sufficient, particularly with children or very sensitive subjects, to make the patient smell the camphorated spirit; in other cases, a drop or two of the first attenuation, or of the common spirits of camphor, may be given on a piece of sugar, and repeated twice or thrice in a space of a quarter of an hour. The attempted cure of hemorr- hoids by the knife or ligature forms a not unfrequent source of urinary complaints, and of ischuria amongst others. When re- tention of urine has arisen from such a cause, or from excessive enlargement of the hemorrhoidal veins, the urine should be drawn off by the catheter, and the pain relieved by the admi. nistration of Sulphur, in alternation with Aconite. Should these not permanently relieve, and the pain consist of a severe burning description, Carbo v. and Arsenicum must be prescribed. Nux v. is extremely useful when the patient has been addicted to the habitual use of spirituous liquors; and is, moreover, one of the most serviceable medicaments, in conjunction with Sul- phur, Pulsatilla, Carb. v., Arsenicum, Sec , according to the characteristic features of the case, in effecting a radical cure where that is practicable. When ischury has been caused by over-distention, from want of opportunity of emptying the blad- der while travelling, &c, the catheter should be introduced to RETENTION Of URINE. 221 draw off the accumulated urine, and the contractility of the bladder restmed by means of Hyoscyamus, Arnica, Dulcamara, or Arsenicum- The repeated application of cold water to the hypogastric region may also prove beneficial in this respect. When surgical assistance is not at hand, or when, particularly in the case of females, the introduction of the catheter is object- ed to from feelings of delicacy, Aconitum or Camphora ought to be tried first, and will very frequently supersede the necessity of resorting to mechanical interference, and, moreover, materially tend to ward off any evil effects which might otherwise arise in consequence of the prolonged retention. The application of hot fomentations to the pubic region, and the use of the hip-bath, ' or large injections of tepid water, are sometimes sufficient to pro- mote the expulsion of the urine. Retention of urine depending upon spasm of the neck of the bladder frequently yields to the use of Camphora' but other remedies, such as Aconitum, Sec, may be required in particular cases. When the disorder is occasioned by distention of the rectum from alvine concretions, or flatus pressing upon the neck of the bladder, the effectual removal of the primary disorder must be obtained by means of Opium, Nux v., Pulsatilla, Plumb, c, Sulphur, and, where re- quired, Aconitum. The employment of unmedicated enemata, and of the catheter, may frequently be found requisite as auxiliary means of relief. If ischuria arise from distention of the uterus in consequence of an accumulation of the menstrual fluid, or from gas Or flatus, retrorersio u!ei, tumours (polypi), &c, pressing against the neck of the bladder or the urethra,—Sepia, Puis., Bella., Nux v., Sulph., Phosi horus, Lycopodium,—Staphysagria, Calcarea, Bellaelonna, Cant ha rides, Sec., are the remedies by which a radical cure is most likely to be accomplished. In the instance of retention of urine from hernia of the bladder, the urine should be taken away by means of the catheter, the protruded bladder reduced, and a truss applied ; if the hernia be irreducible, the swelling should be supported by a suspensory bandage, but we may frequently succeed in effecting the reduction, and of materially guarding against relapses by the aid of such re- 222 difficulty in DISCHARGING THE URINE. medies as Nux v., Aconitum, Opium, S dphur, Plumbum, Sec. (See Hernia.) If inflammation or enlargement of the prostate be the evident cause, Aconitum, Pulsatilla, and Thuja, will be found useful. If paralysis of the bladder, Hyoscyamus, Arsenicum,, Dulca- mara, or other remedies, according to the original disorder which has been productive of the paralytic affection. And when inflammation of the bladder or kidneys, or inflammation or stricture of the urethra, have given rise to the retention, see Cystitis, Gonorrhoea, and Stricture. Calculi lodging in the urethra, and occasioning obstructed micturition, require to be extracted or cut out. Dose: °|°,or °$°, or |^; also the tincture or trituration, according to circumstances. DIFFICULTY IN DISCHARGING THE URINE. Dysuria. Stranguria. Disury, or difficulty in discharging water, may arise from various causes, such as inflammation of the urethra, arising from gonorrhoea, or the employment of acrid injections, in- flammation of the kidneys or bladder, spasm in the neck of the bladder, enlargement of the hemorrhoidal veins, a collec- tion of hardened faeces in the rectum; excess in drinking intoxicating beverages, tumour or other diseases of the pros- tate gland, the suppression of an eruption or of some habitual discharge, or the prolonged application of cold, particularly in gouty habits, the lodgement of particles of gravel at the neck of the bladder or in the urethra, and the abuse of can- tharides, either externally or internally, &c. &c. Dysury is commonly attended with frequent inclination to urinate, smarting pain, heat and difficulty in voiding the water, and a sense of fulness in the region of the bladder. When there are painful or uneasy urgings, and the urine passes off only in drops or in minute quantities, the disorder is usually termed strangury. When the disease is induced by the pre- sence of a calculus in the kidney or urethra,—nausea or difficulty in discharging the urinb. 223 vomiting, and a sharp pain in the lumbar region, as also in that of the kidney or urethra, accompany the before-men- tioned symptoms. When from a similar cause, having its seat in the bladder, or when produced by gravel lodged in the urethra, an acute pain is experienced at the extremity of the penis, especially during the emission of the last drops of urine, and the stream of urine is either spiral or bifurcated. Should scirrhous enlargement of the prostate have given rise to the complaint, a hard, painless tumour may be detected by the introduction of the finger into the rectum, or it may even be felt on pressing the hand against the perinasum. Therapeutics As this disease is almost always sympto- matic, the treatment must be directed against the primary affection. We shall accordingly confine.ourselves in this place to a brief description of the indications of the remedies which have been employed with the greatest success in ordinary cases. When there is frequent inclination to make water, with great pain and difficulty in voiding it, the discharge being at the same time very small in quantity, often passed only in drops, and presenting a dark-red, muddy appearance, the symptoms will generally yield, or at all events become materially relieved by the employment of Aconitum. When a sense of fulness in the hypogastric region is complained of, together with a cutting, burning, or aching pain, Pulsatilla may be prescribed with ad- vantage ; and Belladonna when a darting or pricking pain ex- tending from the lumbar region to the bladder, agitation and colic, are encountered. Hepar s. has been found productive of permanent benefit when Bella, gave but temporary relief. If the calls to make water be extremely urgent, and the urine is passed in a very small stream, is acrid, dark-coloured, soon becomes cloudy, and exhales an offensive odour, Mercurius may be prescribed. Hpar s. is frequently useful after, or in alter- nation with Merc. For dysuria, with almost incessant inclina- tion to make water, Petroselinum is often very serviceable; and when the performance of the act of urination is at the same time extremely difficult, the urine invariably passing only in single drops, attended with severe burning pain in the region of 224 difficulty in discharging the urine. the bladder and in the urethra, Cantharides can with difficulty be dispensed with. The several causes of the disorder must always be attended to, and will, where known, prove of great assistance in selecting the homoeopathic remedy. We shall accordingly find, that when excess in drinking (either vinous or spirituous liquors) has given rise to it: Nux v., Opium, or Sul- phur and PulsatiUa are the most applicable. When disease of the prostate gland, and when enlargement of the hemorrhoidal veins, or suppressed hemorrhoids : Nux v., Pulsatilla, Sulphur, or Aconitum, Carbo v., Lachesis, Arsenicum, Lycopodium, Calcarea, Mercurius. (See art. Hemorrhoids.) Again, when the disease has been excited by a fall or blow on the back or region of the bladder, Arnica, and when it has arisen in con- sequence of a fright, Aconitum, are, for the most part, the most serviceable remedies. The abuse of Cantharides applied ex- ternally or taken internally is not an unfrequent source of the complaint, and is chiefly to be removed by Spirits of Camphor, which is, moreover, the principal remedy, particularly at the commencement of the cure, when other poisons have occasioned an attack of dysuria. Aconitum and Pulsatilla are sometimes required after Camphor. When a chill or the prolonged appli- cation of cold has induced the disease, a preference must be given to Aconite, Belladonna, or Dulcamara, or to Nux v., Pul- satilla, Mercurius, Sulphur, Calcarea, or Sarsaparilla. And when inflammation of the prostate gland* forms the primary cause, Pulsatilla and Thuja often prove of essential service. The age and sex of the patient is also a frequent guide to the selection of particular remedies. Thus, in old men, Lycopodium and Opium are almost always called for at one period or other * At the commencement of Prostatitis, Belladonna may be prescrib- ed with advantage, when the pain is increased by the slightest pressure over the seat of the gland, and when there is considerable fulness or swell- ing in the region of the neck of the bladder. Cannabis is also worthy of attention under similar circumstances. If the pains are less severe, con- sisting more of an obtuse aching description, Mercurius is useful. When prostatitis occurs as a sequela of suppressed gonorrhoea, Pulsatilla and Lycojpodium have been particularly recommended. In chronic inflam- mation of the prostate, and consecutive induration, Thuja, Merc, Carbo t>., Calc. c, and Conium, form the principal remedies. SUPPRESSION OF URINE. 225 of the treatment. In ataxic females or pregnant women, Pul- satilla, Calcarea, Acid phosphoricum, or Sulphur, Conium, Nux v.; and in children, Aconitum, Bellaelonna, Nux v., Pul- satilla, are the medicaments which have hitherto been most frequently used with the best results. In acute cases the diet must be sparing, and sometimes consist exclusively of demulcent drinks, such as gruel. &c, especially if the pain is very severe. Warm fomentations and injections of tepid water sometimes give considerable relief. In all cases, salt should be partaken of in great moderation, and acids altogether eschewed. In chronic cases, considerable relief is often obtained from drinking copiously of cold water throughout the day. Exposure to cur- rents of air ought always to be avoided by those who are sub- ject to urinary complaints. (See Nephritis, Cystitis, and also the indications which have been given for the remedies employed in Hematuria.) SUPPRESSION OF URINE. A partial and occasionally even a complete suppression of urine frequently takes place in fever. It also occurs in dropsy, and in inflammation of various organs, such as the kidneys, &c.; and finally, it may arise from loss of secreting power in the kidneys. The term is now, for the most part, confined to the latter form of the complaint; and it is our intention in this place to restrict ourselves to that variety. The disease commonly takes place in individuals beyond the meridian of life ; but it is occasionally met with at a less mature age, and is sometimes encountered even in children. Gouty habits appear to be most liable to be seized with it. and particularly after being much exposed to cold and wet, or on the suppression of an eruption, or some accustomed discharge, such as hemor- rhoids, Sec. Generally speaking, there is no desire to make water, nor is there pain or tumefaction above the pubes indicat- ing an accumulation of urine, the defective secretion of which will be farther confirmed by the introduction of the catheter. Nausea, constipation, and an occasional sense of sinking, usually accompany the disorder. Sometimes a series of other dis- 10* 226 SUPPRESSION OF URINE. tressing symptoms, such as frequent and severe fits of vomit- ing, hiccough, pain in the back, intense headache, and restless- ness, are present from the commencement. The pulse continues for some time normal; when it becomes slower it indicates danger. The skin is generally natural, but profuse sweating sometimes supervenes, and the perspiration has, in some in- stances, been found to exhale a strong urinous odour. Suppression of urine leads sooner or later to serious conse- quences, if the secretion be not restored, and is frequently very speedily fatal, in consequence, apparently, of inducing cerebral disease, and terminating in coma. Therapeutics. The homoeopathic remedies which, in most instances, may be employed with success in restoring the functions of the kidneys, are : Aconitum, Cam] hora, CanJha- rieles, Nux v., Puis., Belladonna, Opium, Lycopodium, Sul- phur, Sec. Their leading indications in suppression, or dimin- ished secretion of urine, are similar to those which have been given under the heads of Dysuria and Ischuria. Attention should in every case be directed to the causes which have ap- parently been the means of developing the disorder, and the selection of the remedies made in accordance therewith. Thus, when the suppression or retropulsion of an eruption has called forth the disorder, Su'phur will form an almost indispensable remedy. The same remedy, together with Nux v., Pulsatilla, Calcarea, or Sepi i. is equally useful where some habitual dis- charge, such as the hemorrhoidal, menstrual, &c, has been checked. The affection, as already observed, is prone to occur in gouty habits, conjoined with free living, or excessive indul- gence in spirituous liquors. In these cases Nux v. will prove of great service, especially when we meet with nausea, or fre- quent and violent vomiting, headache, or heat in the face and head after meals, constipation, nocturnal restlessness, or unre- freshing sleep with frightful dreams. Opium, Lycopodium, Lachesis, or Sulphur, may, in some cases, be found necessary, when Nux v. is inadequate to effect a radical cure. When exposure to cold and wet has given rise to the disorder, Dulca- mara may be found useful at the commencement, particularly •TR1CTURE OF THB URETHRA. 227 when there is a, copious and offensive secretion from the skin. Acidum nitricum and Colocynth may be of some utility where the perspiration is profuse and exhales an urinous odour. In all cases, any signs of an approach of cerebral disease ought to be studiously watched, and, when detected, immediately com- bated by the appropriate remedies. (See Phrenitis.) The following remedies may also be enumerated as worthy of atten- tion in this disease : Cannabis, Alumina, Kreasotum, Bry nia, Carbo v., Euphorbium, Staphysagria, Clematis, Digitalis^ Squilla, Colchicum, Graphites, Rhus, Sec. For the treatment of suppression of urine in consequence of Nephritis, Cystitis, or Hydrops, see those diseases. STRICTURE OF THE URETHRA. A stricture of the urethra may be defined to be a diminu- tion, or such an alteration of a portion of the tube as renders it, at the affected part, much narrower than what it is in the normal state, or even completely obstructed. The formation of the disease appears, in most instances, to depend upon a thickening of parts of the canal, the result of inflammatory action. The first, or at all events one of the earliest signs of stricture of the urethra, is the retention of a few drops of urine in the passage after the patient has performed the act of micturition; but these drops are soon involuntarily emitted; while another small quantity, accumulated between the cervix of the bladder and the stricture, may be expelled by the effect of pressure below the urethra. The next, and sometimes the first derangement observed, is, that there is a frequent inclina- tion to void water, the patient being under the necessity of emptying the bladder repeatedly in the course of the night. As the obstruction increases, the urine cannot be passed with- out pain and effort, and the stream becomes forked, spiral or scattered. In the advanced stage of the disease the urine comes away bv drops, and is sometimes mixed with purulent matter or glairy mucus. In addition to these symptoms, the patient is distressed with pain about the glans penis, and o* 228 stricture of the urethra. casionally in the loins, and is, moreover, often attacked with severe paroxysms of intermittent fever. Exposure to cold, violent exercise, excess in venery, and the pleasures of the table, aggravate all the symptoms, and cause entire stoppage of urine. The thin, glairy, or gleety discharge, which commonly attends, has frequently led to the mistake that the case is one of gonor- rhoea secondaria, or gleet; but the existence of the symptoms we have above enumerated, together with the unequivocal proof which is to be derived from the introduction of an appropriate bougie, remove all uncertainty. The most common seat of the stricture is just hehind the bulb ; and that which is perhaps next in frequency is about four and a half inches within the canal; then three and a half; and sometimes close to the ex- ternal orifice of the urethra. The evils which are liable to result from old and aggravated cases of stricture are : thickening of the bladder, with depriva- tion of its usual power of expansion, or inflammation accompanied with discharge of a sort of viscid secretion, bearing a re- semblance to pus; retention of urine, and dilatation and ulceration of the urethra between the bladder and the first and principal stricture. When the urethra ulcerates, and abscesses form and burst, channels are produced, through which the urine escapes into the surrounding cellular membrane, and fistula, in perinaiQ are constituted. Therapeutics. In the incipient stage of strictureof the urethra a cure may often be effected by appropriate medicines; even in a more advanced stage a cure is sometimes practicable, or at all events such a degree of improvement capable of being brought about, that the after treatment by mechanical means, where requisite, is thereby materially facilitated. The follow- ing are the principal medicines, from the employment of which results of a satisfactory nature are frequently to be obtained : Cannabis, Pe'roselinum, Cantharides, Camphora, Mercurius, Aconitum, Sulphur ; and, in some instances, with induration, and rnore or less contraction and thickening of the urethra : Clematis, Dulc, Digit, Petr., Sulph.; or Acid, nitr., Silicea, Calcarea, Lycopodium, Pulsatilla, See. A few of the leading URINARY ABSCESS AND FISTULA. 229 indications for the selection of some of these remedies will be found in the chapters on Dysuria, Hamaturia, Gonorrhoea If the symptoms are invariably exacerbated by exposure to cold, Dulcamarei may be prescribed with advantage; and when ex- cess in wine or spirituous liquors causes serious aggravation, and occasionally complete retention of urine, Nux v. is a useful palliative. (See Retention of Urine ) In old inveterate cases, and particularly in permanent bad cartilaginous strictures, recourse must be had to the ordinary mechanical means. In cases where it seems requisite from the commencement to conduct the treatment on the principle of mechanically dilating the contracted part of the urethra by means of bougies or elastic gum-catheters; but where the urethra is so irritable that the patient cannot bear the intro- duction of the instrument, or where copious hemorrhage follows its employment, Aconitum or Arnica may be prescribed with advantage. These remedies are, moreover, often of great utility in warding off inflammatory action in the testes from the use of bougies. Where the medical treatment no longer offers any reasonable prospect of success, and the stricture is so complete or extensive as entirely to arrest the introduction of the bougie, a surgical operation becomes necessary, which consists in the perforation of the stricture with a stilet ; or the plan of cutting down to the stricture, and then cutting through the diseased part of the tube, must be resorted to. Dose : See Ischuria. URINARY ABSCESS AND FISTULA. Fistula, in pcriiuco. Fistula? in perinseo are ulcerated openings in the perinaeum, which not unfrequently take place in consequence of the natural passage for the urine becoming completely impervious from stricture The urethra becomes ulcerated immediately behind the seat of the obstruction, and the urine escapes into the cel- lular membrane ; the injected parts swell and inflame ; suppura- 230 INCONTINENCE OF URISB. tion speedily supervenes ; the abscess bursts, and the fistulous opening, forming an outlet for the urine, is produced. In some instances no urine is discharged from the aperture until two or three days have elapsed ; but in others, it flows from the first, intermixed with the fetid pus. The secretion of pus then diminishes, and the urine passes out of the new channel in large quantities. Several external openings are occa ionally formed, in place of one. Fistula?, of a similar nature to the foregoing, may be produced in the groin, scrotum, and even at the base of the penis near the pubis ; and in some rare cases they form a communication between the rectum and the part of the urethra behind the obstruction. Retention of urine is no longer prone to occur when fistula? in perinaeo are established. Therapeutics. It is recommended by most surgeons to open the abscess which forms the swelling in the perinaeum early. The cure of the fistula necessarily depends upon that which has given rise to it, viz., the strictures themselves : when these are removed, either by the ulcerative process which pre- ceded the production of the fistulae, or by other means, the urine resumes its natural course, and the fistulous aperture closes. If it should not do so, we must seek to effect this ob- ject by the employment of homceopathic medicines ; and of these the following will generally answer best : Silicea, Sulphur, Calcarea, and sometimes Mercurius, Arsenicum, Lachesis, or Cantharides. The introduction of a gum-catheter into the bladder, and the confinement of the patient to bed for a few days, is in some cases sufficient; but where this is impracti- cable from the stricture remaining entire, and refusing to yield to the usual remedial agents, a staff may be passed down the urethra as far as the stricture, the canal laid open, a catheter conveyed into the bladder, and kept there until cicatrization is accomplished. Dose : See Ischuria. INCONTINENCE OF URINE. Involuntary flow of urine usually proceeds from relaxation, or a paralytic affection of the bladder; or from irritation or com- INCONTINENCE OF URINE. 281 pression of the bladder, in consequence of the secretion of acrid urine, the presence of gravel, or a diseased state of the organ itself. Therapeutics. When the incontinence proceeds from re- laxation brought on by a too free use of vinous or spirituous liquors, considerable relief, if not a radical cure, will, in most instances, be effected by the employment of Nux v. In other cases having a similar origin, Opium, Lachesis, Sulphur, Cal- carea, and sometimes Acid, muriaticum, must be had recourse to subsequent to, or in alternation with Nux v. If masturba- tion or excess of venery have induced a relaxed condition of the sphincter of the bladder, Nux v., followed by Sulphur and Cal- carea, will generally be found the more efficacious remedies; but the auxiliation of Acid, muriaticum, China, and Acidum phosphoricum, will often be required. The use of the flesh- brush and frequent sponging with cold water is also of some service in such cases. The incontinence of urine which pro- ceeds from paralysis of the vesica, or is attendant on more gene. ral paralytic derangement, has been cured by ( icuta and Magn. aust. The aid of one or more of the following medicaments, Aconitum, Belladonna, Hyoscyamus, Con ulus, Nux v., Opium, Natrum m., Arsenicum, Sulphur, Bryonia, Dulcamara, Lauro- cerasu , Sepia or Silicea, Sec, will, however, be necessary in many cases. The employment of electro-magnetism, cold bath- ing, and of friction at the upper part of the sacrum, should not be°neglected in inveterate cases of paralytic enuresis. Against spasmodic incontinency, Camphora, Belladonna, Hyoscyamas hmatia, Natrum m., Nux, Pulsatilla, Conium, Cma, and Rhus; or Lycovoel, Sulph., Lach., Baryt c, Ruta, Sec should claim most attention, and be selected according to the peculiarities of the case, and with due regard to the collateral symptoms. If inflammation about the neck of the bladder and urethra give rise to the disease, Aconitum and Canihandes should chiefly be employed. (See also Cystitis and Gonor- rhcea.) When the secretion of acrid or highly acidulated urine produces an involuntary flow of urine, considerable relief will be obtained by drinking freely of cold water, or of barley- 232 DIABETES. water or linseed-tea. Amongst the homoeopathic remedies from which the most appropriate selection may be made, to effect a radical cure of such cases, the following may be quoted : Mer- curius, Hepar s., Kreosotum, Laurocerasus, Arsenicum, Gra- phites, lodium, Veratrum, or Tartarus emet., Sec. If the presence of gravel or sand create irritation and consequent involuntary expulsion of urine as soon as it is secreted, the ex- hibition of Calcarea, Nux v., Cannabis, Uva, Phosphorus or Petroleum, is often attended with the most satisfactory results. In all cases where there is much pain and irritation, recourse may be had to the simple diluents above alluded to, together with the employment of Aconitum and Sulphur in alternation, and the injection of tepid water into the bladder. Against nocturnal enuresis, Ammonium carbonicum is often efficacious ; as likewise Belladonna, especially when the weak- ness proceeds from cerebral irritation; Kreosotum when the emission takes place only during deep, almost comatose sleep, and Cina when the existence of worms in the alimentary canal appears to be the irritating cause. (See the other remedies given under the article Invermination.) In other instances of this frequently most troublesome form of the complaint, Pulsatilla, Sepia, Sulphur, Silicea, Carb v., Arsenicum, or Hepar, Graph., Cede, Am., China. Con., Petrol, Natr., Rut., or Mags, aust., Sec, may be indicated. In the case of children, if the emission of urine take place only at an early hour in the morning, the nurse ought to be ordered to get into the habit of raising the child from bed before the time of the usual occurrence of the mishap. Dose : See Ischuria. DIABETES. By this term is understood an immoderate secretion of urine, containing a large proportion of saccharine matter. Sometimes, however, the quality of sweetness is absent and the usual urinary taste alone perceived. The complaint has, consequent- ly, been divided into two species, of which the former has received the appellation of Diabetes mclliius, aud the latter DIABETES. 233 that of Diabetes insipidus. The mellitic variety is by far the more dangerous and fatal. Diabetes, for the most part, comes on slowly and insidiously, insatiable thirst and voracious appe- tite, the usual attendant symptoms throughout the disorder, being frequently the only striking symptoms at the commence- ment. In other cases, the patient complains of great lassitude, and a tendency to perspire after any trivial exertion; the appetite, although keen, is generally accompanied by deranged digestion. Pain, sometimes of a very severe disposition, is often complained of in the lumbar region, and a sense of dis- tressing weakness is generally experienced in the said part of the body. As the disease progresses, especially in the diabetes mellitus, rapid emaciation of the whole body ensues ; the thirst continues excessive, but the quantity of urine voided exceeds in quantity that of the fluid and aliment introduced; there is a feeling of complete prostration ; the pulse becomes quick and weak ; the breathing exceedingly laborious, and dropsical infiltration takes place in the inferior extremities. The disease affects men-more frequently than women, and it frequently attends sympathetically in a milder form on hysteria, hypo- chondriasis, dyspepsia, and asthma. Those who are in the de- cline of life, or have a shattered constitution arising from in- temperance, as hard drinking, excessive venery, or from the prolonged abuse of diuretics or aperients, or other powerful- depleting measures, such as repeated venesections, &c, seem to be most subject to its attacks. Many instances, however, have occurred in which no obvious cause could be assigned. The duration of the disease has varied from five or six weeks to many months, and even several years, before terminating fatally. i Therapeutics. The very different opinions as to the proxi- mate cause of the disorder, and the contradictory pathological conclusions which have been drawn by allopathic writers, have led them to promulgate and adopt the most opposite and conflict- ing varieties of treatment. In homoeopathic writings, again, we meet with comparatively few detailed descriptions of treatment, and authentic radical cures, particularly of the mellitic form of the complaint. This is, undoubtedly, in a great measure to be 234 DIABETES. attributed to the rarity of the disease, for the very minute attention which is necessarily paid to symptoms by the homoeo- pathic practitioner, in order to enable him to reap the peculiar advantages of his materia medica without, at the same time, neglecting to pay due attention to every additional circumstance which may facilitate his choice of the appropriate remedy, such as the history of the case, and a careful discrimination between cause and effect,—must materially tend to overcome the diffi- culties which surround the allopathist, and render the disease in his hands one of so intractable a nature. The medicines which have been chiefly recommended by the limited number of homceopathic authors who, hitherto, have casually written on or referred to Diabetes mellitus, are Acidum phosphoricum, Mercurius, Sulphw; Natrum m., Carbo vegetabilis, Ledum ; and, further, Acid, muriaticum, Asclepias vincetoxicum, Am- mon. c, Arsenicum, Alumina, Graphites, Ambra, Baryta c, Bella., Con., Magn., Terebinth., and"Meph., Sec. Of these the following have, as yet, been principally employed: Mercurius solubilis, Veratrum, Kali carbonicum, and Acidum muriaticum. Their indications are mainly as follows • "Merc, sol is indicated when there is a constant desire to urinate, night and day, swollen moist prepuce and glans penis, both of them painful; drawing, squeezing sensation in the testi- cles, a cutting, tearing pain in the left kidney, painful swelling of the gums, white coated tongue, constant dryness in the mouth, a bad fetid breath, constant hunger, insatiable thirst, burning, acrid, scraping eructations, burning pain in the epigas- tric region, wakefulness, owing to the desire to urinate ; slow, languid pulse, sunken countenance, general weakness and de- bility, swelling of glands, &c. " Veratrum:—Great alteration of the countenance as of a dead person; swelling of the gums, looseness of the teeth, sticky dryness of the mouth and fauces, which cannot be removed by any liquids, great nausea and thirst, painful hunger, drawing pain in the umbilical region, excessive flow of urine, even involuntary, soreness of prepuce, extreme general prostra- * Homceop. Exam. vol. iv. No. 12, p. 525. HAMATURIA. 235 tion and weakness, especially of the extremities, trembling of the whole body, inclination to faint, weak, almost imperceptible pulse. " Kali carb. :—Jerking pains in both renal regions, especial- ly on sitting down, and protracted ; dull stitches in the left; frequent and violent desire to urinate, especially troublesome at night, the urine of a pale green colour; burning sensation in the urethra during evacuations; sharp drawing pains through the penis; pains on motion in the inguinal region; feeling of cold in the intestines, as if water were being dropped upon them; burning heat in the stomach, languor, swollen and ulce- rated gums, dry mouth, fetid breath, violent thirst, especially in the evening and at night, very pale and sunken countenance, sunken eyes, irritable surly state of mind, easily alarmed, un- easiness and wakefulness, great prostration, feeling of empti- ness in the whole body, drawing pains in the back, frequently proceeding from the sacrum. " Acidum muriaticum is preferable to all other remedies in cases where there is an entire absence of thirst, and where the urine has a milky appearance; also in cases of drunkards, where it has proved very efficacious." When diabetes is symptomatic of dyspepsia, asthma, hysteria, Sec, see the remedies which have been enumerated under these different heads. The diet in diabetes ought to be wholesome, and contain the greatest amount of nutriment in a small bulk; animal food ought to be prererred; vegetables, especially potatoes, and fruits, are to be inhibited. All kinds of liquids which exert a specific or direct effect upon the kidneys should be strictly avoided. Milk should, in general, be also abstained from. Dose : See Ischuria. HAEMATURIA.—Mictus cruentus. The passing of blood with urine may avi>e from various causes, amongst which the f llowi.g are the most frequent: falls bruises, blows, violent exertion, such a. leaping and bard riding —the lodgement of a small stone in the kidney or ureter, 236 HJEMATURIA. or by inflammation of the kidney; it may also be occasioned by irregular menstruation, hemorrhoidal disturbances, habitual and excessive indulgence in spirituous drinks, the frequent use of certain vegetables, such as asparagus, Sec, excess in venery, and by the frequent external and internal employment of Can- tharides. The blood voided is, in most instances, intermixed with the urine, but when it originates from the lacerating effects of an irregular stone, it is generally discharged in streaks and coaguli, and deposits a dark brown-coloured sediment, bearing a resemblance to coffee-grounds. The act of urination is gene- rally performed with some difficulty, and accompanied with tenesmus. When the blood proceeds from the kidney, the urine first expelled looks muddy and high-coloured, is usually very copious, and attended with acute pain in the back, anxietv,. numbness in the thighs, drawing up of the testes, constipation, and other abdominal derangements. When from the ureter, the symptoms are nearly the same as the foregoing, with the ex- ception that the pains extend from the lumbar region along the course of the ureter down into the pelvis, with strangury, and perhaps also nausea and vomiting. In hemorrhage coming from the vesica urinaria, we commonly meet with spasm, dysury, occasionally severe burning and other pains in the hypogastrium perinaoum, penis, and anus, during and subsequent to the act of micturition. To these are added, especially when the difficulty of making water is considerable, great anxietv, cold sweats, shivering chills, debility, and fits of syncope. The blood is not so intimately combined with the urine as in the immediately preceding cases, generally deposits a coherent sediment, and is sometimes emitted in a free state. The voiding of sanguineous urine is always to be regarded in a serious light, especially when it is commingled with purulent matter. The prognosis must, however, be regulated by a variety of circumstances, such as the active or passive nature of the discharge, the age and constitution of the patient, the duration and recurrences of the affection, the collateral symp- toms, and the occasional causes, &c. Therapeutics. Cantharis forms one of the more generally H.EMA11RIA. 237 useful remedies in this disease. It may be had recourse to in almost all eases where we are uncertain as to the exciting cause of the disorder, and especially where there is considerable diffi- culty in making water, with scalding in the urethra during the act of micturition, or violent cutting and spasmodic pains in the hypogastric region, the blood discharged being either pure and passed in drops, or copiously intermixed with the urine, or in streaks or coagulated. Even when the existence of purulent matter is detected in the sanguinolent urine, the employment of Cantharides may be attended with beneficial results. But the assistance of such remedies as Pulsatilla, Clematis, Mia-cunus, Hepar s., Cannabis, Sabina, or Ilea ur.si.is commonly essential in the latter case. When, on the other hand, the disorder has evidently originated in the employment of Spanish fly itself, in the form of a blister, in allopathic practice, or in large doses internally, a drop or two of Spirits of Camphor must be given, and repeated every two or three hours until relief is afforded. Should any sequelae, such as burning in the urethra, &c, &c, remain after the em- ployment of Camphor, Carbo v., and Arsenicum will usually cause them to yield. Next to Can'harides, Mrzcreum has been recommended as one of the principal remedies in the homoeopathic treatment of hematuria, more particularly where the blood passed does not appear to be in large quantity, and the accompanying pains not very severe; further, when the blood is rarely or never coagulated. When the disorder has resulted from external violence, it usually gives way readily under the use of Arnica ; but if the patient be of a plethoric habit, it will be found highly advan- tageous, if not imperative, to exhibit Aconitum in alternation with Arnica. To pursue the description of treatment required in those cases where the occasional or predisposing cause is known, we shall find that .'V//r vomica forms an eminently useful remedy, when the habitual over-indulgence , in spirituous or vinous li- quors, or suddenly suppressed or checked hemorrhoids, have given rise to it, and painful aching in the back with smarting in the urethra are complained of. After Nux v., Sulphur may 288 DISCHARGE of blood from the urethra. generally be prescribed with much* benefit; and this remedy, again, may in turn be succeeded by Calcarea with advantage, particularly when the blood is discharged in small clots. Pul- satilla is very serviceable in females affected with ataxic men- struation, but it has been found of equal value in the male sub- ject when the disease was attended with a constrictive and cut- ting pain around the umbilicus, extending with great violence to the lumbar region; or, where spasmodic pains were expe- rienced in the inferior extremities, particularly the right knee, and from thence upwards to the groin, with spasmodic retrac- tion of the scrotum and penis, and burning pain at the orifice of the urethra. Sulphur and Calcarea may often, as in the case of Nux v., follow Pulsatilla with good effect. Cases apparently arising from venereal excesses usually re- quire Cinchona in the first instance, and subsequently Nux, Su'phur, Calcarea, or Phosphorus. Mercurius, also, is some- times of much value here, particularly when the blood is often discharged during sleep, along with seminal emissions. Hepar s. may succeed Mercurius, should the latter produce merely temporary melioration. At other times, Ledum, or Me- zereum may be found better indicated. When the voiding of bloody urine arises from the presence of calculi, Nux v., Can- nab., Calc, Petrol, Phosph., Canth., Lycopod., Sass., Canth., Ac. nitr., Nux m., and Zincum, have chiefly been recommended. When the pain is excessive, Aconitum, and in some cases Ar- nica, may exert a soothing influence. Squilla, Zincum, Co- nium, and Millefolium, have also been favourably spoken of as being useful in particular cases of this affection. Water or bar- ley-water should, in most cases, be drunk in considerable quan- tities. When haematuria occurs merely as a secondary dis- order, in connexion with Nephritis or Cystitis, see these diseases. DISCHARGE OF BLOOD FROM THE URETHRA. Urethrorrhagia. Haimorrhagia urethra:. Stymatosis. This complaint, like the preceding, is frequently met with in connexion with other disorders. It may, however, exist in an inflammation of the urethra. CLAP. 239 idiopathic form, either in consequence of mechanical injury or venereal excess, in either of which cases the same remedies must be had recourse to as those given for the treatment of haema- turia arising from similar causes. When it occurs as a second- ary malady, in connexion with hemorrhoids, menstrual irregu- larity, &c, Nux v., Pulsatilla, Sulphur, Sec, are the most ap- propriate .medicaments, and may be selected according to the indications described above. Should the affection be encoun- tered as a secondary symptom of gonorrhoea, it will commonly yield to Cantharides, but Cannabis or Sulphur may sometimes be required to complete the cure. Dose : See Ischuria. INFLAMMATION OF THE URETHRA. CLAP. Urethritis. Gonorrhoea. Blennorrhea. Under the above heads we purpose to treat of inflammation of the mucous membrane of the urethra resulting from impure connexion, attended with a discharge of puriform matter. The affection commonly commences a week or ten days after the risk of taking it has been incurred ; but in some cases it begins in two or three days, and in others no perceptible symptoms be- come developed for two or three weeks. The disease varies in severity according to the extent and intensity of the inflamma- tion. In ordinary cases the latter only extends an inch and a half along the urethra, or two inches from its orifice; but in severe forms it occupies the entire course of the canal, and even affects the mucous membrane of the bladder. The ear- liest symptom of a clap consists of a sense of titillation or itching at the orifice of the urethra, which sometimes extends over the whole of the glans penis, and is accompanied by a frequent in- clination to make water. In a short time some uneasiness is experienced on passing the urine, and the orifice of the urethra is observed to be red and swollen, and perhaps a small quantity of discharge is observed. The act of urination now becomes more and more painful, sometimes almost insupportable, while the stream becomes diminished and broken, notwithstanding the increased expulsive efforts exerted by the patient. A somewhat 240 INFLAMMATION OF THE URETHRA. CLAP. copious discharge of thick, white, or yellowish puriform matter soon takes place from the urethra. As the inflammation ad- vances, or when it has been intense from the commencement, the discharge becomes greenish, acrid, and sometimes mixed with blood. The glans and prepuce frequently become red and tumified; involuntary and painful erections often occur, parti- cularly during the night, and there is sometimes considerable restlessness, headache, and other symptoms of fever. This, the acute stage of the disease, generally goes on increasing, or at least continues with unaltered violence for eight or ten days, but is sometimes prolonged to three weeks and even upwards, if unchecked, or aggravated by the thoughtlessness of the patient, in committing errors in diet, indulging in the use of ardent spi- rits, exposing himself to cold, or the excitement of sexual inter- course. When the acute stage begins to subside, its decline is marked by a diminution of the pain atid scalding sensation in making water, and in a month or six weeks none of the symp- toms may remain. It very often happens, however, that instead of undergoing a spontaneous cure of this description, the acute symptoms disappear, but a discharge of puriform fluid continues for a considerable period, the affection assuming the form of chronic inflammation. The above are the symptoms of gonorrhoea as it is usually met with. But it occasionally appears in a much more serious and distressing form, in which not only the whole course of the urethra, but even the bladder itself, becomes implicated in the inflammation. When this happens, the sufferings of the patient become materially aggravated; the calibre of the tube is much contracted, in consequence of the tumified state of the mucous membrane, and the urine is passed with the greatest difficulty and only in drops, accompanied by excruciating pain in the urethra, hips, loins, and hypogastrium; the involuntary erec- tions are frequent and attended with excessive sufferings, espe- cially when combined with distortion of the penis (chordee) from the effusion of coagulated lymph into the corpus spongio- sum urethrse. In the worst cases, small indurations may often be felt in the course of the urethra, and sometimes Cowper's glands and the prostate partake of the inflammation, in which INFLAMMATION OF THE URETHRA. 241 event a sense of heat, weight, and fulness is experienced in the perimeura, with pain in the hypogastriura ; dysuria, and tenes- mus, particularly when the disease has spread to the bladder or its cervix. Abscess, fistula, and permanent disease of the pros- tate, or stricture of the urethra, are the occasional results of the last.mentioned state of matters. Phymosis, orchitis, bubo, not unfrequently take place, from the extension of the inflam- mation to the prepuce, testes, and glands of the groin during the course of gonorrhoea. Gleet, or the existence of a serous or muco-purulent, pale green, or colourless discharge from the urethra, is not an unfrequent occurrence after an attack of acute inflammation. It is commonly attributed to chronic inflamma- tory action. The most trifling error in diet, and particularly the use of spirits, wines, and pungent condiments, is generally followed by frequent inclination to void water, a degree of ardor urinm, and increased oozing of matter. This state often con- tinues for years, and grows more and more aggravated, until at length a permanent stricture is formed, or thickening of the bladder, disease of the prostate, or even of the kidneys, be- comes established. In women, the symptoms are, generally speaking, not so dis- tressing as in men. Sometimes, however, the inflammatory action affects the mucous membrane of the vagina, and even that of the uterus itself. The discharge takes place from the secreting surfaces of the labia, nymphae, and clitoris, as well as from the lining of the meatus urinarius and vagina in severe cases. Treatment of Gonorrhoea. The disease sometimes proves very intractable even in homoeopathic practice ; but it the treatment is commenced sufficiently early, it terminates much less frequently in the secondary form of the malady, and the other serious consequences we have detailed, than it does under allopathic treatment. The remedies which have hitherto been chiefly employed by homoeapathists are : Copaiba, Petro- selinum, Cannabis, Aconitum, Sulphur, Cantharides, Capsi- cum Silicea, Lycopodium, Acidum nitricum, Sepia, Sec. In the milder forms of the affection, or in cases occurring in 11 242 inflammation of the urethra. healthy subjects, a cure is generally very easily and speedily accomplished when the patient applies before the second stage has set in. We have repeatedly succeeded in arresting the dis- ease at its outset (i. e., when the orifice of the urethra looks fuller and redder, and a disagreeable itching is felt in the tube, together with frequent desire to make water, and some pain on Voiding it) by means of the alternate employment of Aconite and Cannabis, at intervals of at first six, and subsequently twelve to twenty-four hours. So soon, however, as the dis- charge begins, and ardor urinse is experienced, Copaiba 3—6 often proves a very useful if not a specific remedy ; but should there be a perpetual urgency to make water, Pctroselinum 0 may be prescribed in preference to Copaiba. Cannabis is pre- ferable to either Copaiba or Petroselinum, when the inflamma- tion runs somewhat higher, and the pain and difficulty in pass- ing water are consequently more intense. A drop of the first, second, or third dilution may be taken every six or eight hours. In gonorrhoea with phymosis, or extension of the inflammation to the prepuce, Mercurius is the most important remedy ; but it is sometimes necessary to prescribe a dose or two of Aconitum, in the first place, when the inflammatory action is excessive, and the glans as well as the preputium very much tumefied. (See Phymosis.) Mercurius is, further, of considerable efficacy at the commencement of the second stage of the disease, when there remains a muco-purulent discharge, of a white or green- ish yellow colour, and some degree of pain in passing the last drops of water ; or when there is swelling and induration of the lymphatic glands of the penis. Silicea or Hepar s. is some- times required after Merc, in the latter case; and Capsicum is often useful in removing any ardor urinae that may remain. Sulphur is still more frequently required than Mercurius after the inflammatory stage is over, and particularly when the dis- charge has become serous, and a feeling of uneasiness alone re- mains in the urethra when voiding urine. In painless gonor- rhoea accompanied with swelling we have generally given Merc, Sulphur, or Silicea, at the sixth potency : a few globules night and morning for four successive days. We now come to the treatment of the severer forms of gonorrhoea. Here the em- INFLAMMATION of the urethra. 243 ployment of Aconitum, Cannulas, and Canth.arid.ps is especially called for. The curative power of these remedies in such cases is frequently very striking, and the rapidity with which they af- ford relief highly satisfactory. Aconitum is more or less useful in most cases of gonorrhoea occurring in young and vigorous subjects, and attended with headache, restlessness, and other febrile symptoms; but it is almost indispensable where the in- flammation is severe and extensive, the pain during micturition excruciating, the glans, or indeed the entire penis, much swol- len, and the sufferings greatly exacerbated by frequent or almost constant erections (priapismus). In such cases a drop or two of Aconitum at the third or sixth dilution may be added to an ounce of water, and a dessert-spoonful given every six hours. Relief is generally obtained after the first dose, and it is rarely necessary to continue the medicine after it has been taken for the third time. Cantharides is generally required after Aco- nitum. It may be given from six to eight hours after the se- cond or third dose of the latter, when the intensity of the pain and any febrile irritation which may have been present have yielded, but the dysuria, ardor urinpe, and chordee still continue distressing. Cantharides may be exhibited without the pre- vious employment of'Aconite, when there is no marked degree of constitutional disturbance, but the scalding during micturi- tion and the chordee are very severe, and the discharge is greenish and tinged with blood. It may be prescribed at the sixth di- lution, and the dose repeated in from six to twelve hours, accord- ing to circumstances. Cannabis is sometimes required after Cantharides, especially when the dysury proves obstinate; and when Cannabis effects little or no improvement, Petrosclinum may be administered. We have occasionally found the alter- nate employment of Pelrosel, Canth., and Cannabis requisite before the continuous urging inclination to pass water and the torture during micturition could be subdued. Mercurius or Sulphur are not unfrequently useful in completing the cure, when the before-mentioned remedies have removed the active inflammatory symptoms. 244 INFLAMMATION OF THE URETHRA. Treatment of the Second Stage of Gonorrhoea. When the disorder has reached the chronic stage before the pa- tient seeks advice, we must generally expect to encounter more difficulty in effecting a cure, than during the first or inflamma- tory stage; the more so, if the patient has previously drugged himself with large and long-continued doses of cubebs or of balsam of copaiba, or has fruitlessly persevered for some length of time in the employment of astringent injections. In a num- ber of cases, early benefit has been derived from the use of Capsicum, Mercurius, Sulphur, and Acid. nitr. Capsicum has chiefly been recommended when the discharge is whitish and purulent, and ardor urinae is still experienced when making' water. Ferrum, Pulsatilla, and also Nux v, have been stated to be useful when Capsicum failed to remove the symptoms quoted. Sulph. and Merc, are considered the most useful, in general cases, when the patient has previously been under a course of copaiba or cubebs. Acid, nitric is often very ser- viceable in gonorrhoea as soon as the inflammatory stage is over but generally requires to be followed by Sulph. if the pain has subsided, but the discharge continues. When the inflammation had evidently extended far down the urethra, we have found much advantage in the use of Cantharides and Cannabis, and in some cases from Nux v., when the discharge was serous and scanty, the desire to pass water frequent and urgent, the act of urination painful and difficult, the stream of urine broken or forked ; in short, when the symptoms presented the appearance of the formation of stricture or a tendency thereto. In addi- tion to the above medicines, Acid, nitricum may be mentioned as a useful remedy in gonorrhoea secundaria or gleet; also Se- pia, Lycopodium, Cubeba, Silicea, Calcarea, Thuja, Natrum m., and Dulcamara. When, in consequence of errors in diet, the use. of wines, spirits, acids, &c, an increased discharge takes place, accompanied by frequent desire to urinate, and some scalding pain, Nux v., or one or more of the other remedies enumerated above, as Cannabis, Sec, must be resorted to. Tussilago petasites (in the dose of two teaspoonfuls of the ex- pressed juice of the plant, or of the water containing the plant in a macerated condition) has re«ontly been recommended as a INFLAMMATION OF THE 0RETHRA. 245 ■nost efficacious remedy in recent as well as chronic gonorrhoeas. I f aggravation follows the first dose or two of the medicine, it nust be given in a weaker or more diluted form. A case of ophthalmia which had existed for two years, and had made its appearance after a suddenly suppressed clap, was cured by the employment of this remedy. When there is a complication of gonorrhoea and chancre, or when the discharge from the urethra is found to proceed from chancres within the tube, Mercurius should be prescribed. (See also Syphilis.) And when there are condylomata on or in the vicinity of the genital organs, or there is reason to sup- pose that the discharge from the urethra is of sycosic, origin, Thuja and Acidum nitric, or Cinnab., Merc, and Sulph., are the principal remedies with which the cure is to be accom- plished. (See Sycosis.) Against symptomatic buboes, Carbo animalis is considered as one of the most efficacious remedies. Silicea and Mercurius may also be named as likely to be useful in some cases. (See art. Bubo.) If cystitis ensue in consequence of the extension of the in- flammation to the mucous membrane of the bladder, Canthari- des and Cannabis will claim the principal attention. (See Cystitis.) When swelled testicle results from the sudden suppression of a clap, Clematis, Sulphur, and Pulsatilla form the most appropriate remedies. (See Orchitis.) And when rheumatism or ophthalmia are produced, the medicaments enumerated in the respective chapters on these affections must be employed. It sometimes happens that pains in the region of the prostate are complained of for a considerable length of time after an attack of gonorrhoea, which prove particularly troublesome during erections, and occasionally incapacitate the individual affected for riding on horseback. Their removal is, in general, accomplished without difficulty by means of Pulsa- tilla, Thuja, Sulphur, Lycopodium, or Capsicum. (See Prostatitis.) During the treatment of gonorrhoea, wine, spirits, and malt liquors ought to be abstained from. Pure cold water is the best diluent, and may be freely partaken of. Active exercise should be shunned during the inflammatory stage; when it 246 INFLAMMATION OF THE GLANS PENIS. cannot be wholly avoided, a suspensory bandage should be worn. If the inflammation be extensive or the parts much swollen, confinement to the recumbent posture becomes requisite. Dose': ^, or ^, or •§£ ; or the tincture or trituration, according to circumstances. INFLAMMATION OF THE GLANS PENIS. Balanitis. Balano-blennorrheea. Inflammation of the glans penis may either occur simultane- ously with inflammation of the urethra after impure connexion ; or it may arise from mechanical injury, or from the inadvertent application of poison to the part, as sometimes happens when the patient has been occupied in handling poisonous plants. When the disorder takes its rise from extension of the in- flammation of the urethra over the whole of the glans, and also the prepuce, Mercurius is, in general, the most appropriate remedy. Sometimes it may be found necessary to give a dose or two of Aconitum before Mercurius; and in other cases, Cannabis may be more prominently indicated than either of the said remedies. (See Inflammation of the Urethra, and also Phymosis.) Acidum nitricum is useful when small, superficial ulcerations form on the glans in neglected or pro- tracted cases. If the affection has been caused by a bruise, or has arisen from friction during coitus, Arnica should be ad- ministered, and alternated every eight hours with Aconitum, should the inflammation and swelling be excessive. In the event of these remedies failing to relieve the symptoms, Rhus toxicodendron must be employed. Belladonna and Bryonia, sometimes in alternation with Aconitum, have been recom- mended as the best adapted to the treatment of those cases which have originated in the accidental application of poison. Cannabis, Cantharides, Cuprum, or Ledum are considered by some homoeopathists as the most deserving of attention, when no cause can be traced or assigned as having given rise to this inflammation. If the disorder be of syphilitic or sycosic origin. inflammation of the testis. 247 the remedies which we have mentioned in the chapters on these two diseases must be resorted to. Dose: See Gonorrhoea. INFLAMMATION OF THE TESTIS. Swelled Testicle. Orchitis. Hernia humoralis. This affection is liable to arise from external injury; but it is much more frequently encountered as a sympathetic dis- ease from irritation of the urethra. The inflammation and swelling come on suddenly, and as abruptly subside, or pass from one testis to the other. At the commencement of the attack, the testicle is tumefied, soft, and sensitive to the touch; after a short period it becomes hard and excessively painful. The spermatic cord is also rendered very tender, and thickened, whilst its veins are occasionally found in a varicose state. Pain in the loins, colic, sickness, more or less fever, depression of spirits, and occasionally a difficulty of making water, are other not unfrequent concomitants of the disorder. Therapeutics. If the accompanying fever run high, a few doses of Aconitum must be exhibited. On the reduction of the fever, and diminution of local heat, Pulsatilla is one of the most efficacious remedies when irritation of the urethra, and especially that arising from suppressed gonorrhoea, has given rise to the affection. Sulphur and Clematis erecta are some- times required to complete the cure after the employment of Pulsatilla; in many cases, indeed, these remedies are prefer- able to Pulsatilla, even at the beginning of the disease. When the swelling has resulted from external injury, Arnica, exter- nally and internally, rarely fails to afford speedy relief. It may be preceded by Aconite if called for, and succeeded by Pulsatilla or by Conium if the pain and swelling do not readily diminish under the action of Arnica. In those cases where Aconite has been found necessary, the application of lint dipped in cold water and kept constantly moist, is frequently pro- ductive of great relief. Should induration in the epididymis 248 SARCOCELE. remain, Aurum, Clematis, and Sulphur will be found the more generally useful. In other instances, and especially in indura- tions of long standing, we may, in addition to the above, bear the following remedies in mind: Rhododendron crysanthum, Merc, Graph., Lycopod., Agnus castus, Staph., Spong., or Zincum. Against orchitis as a metastasis of Parotitis, Pul- satilla, Merc, and Nux v. have been strongly recommended ; and in that from the abuse of Mercury, Cinchona, Aurum, Acidum nitr., and Sulphur have proved of great efficacy. Dose : See Gonorrhea. SARCOCELE. This is an affection of the body of the testis, in which its substance is, for the most part, converted into a hard fleshy substance, hence the name. In the mild form of the com- plaint the tumour is smoother, and produces little or no pain or uneasiness beyond what is occasioned by its weight. This benign condition of matters sometimes goes on without material alteration for a considerable period; but in other cases it very speedily acquires a more serious character, by becoming unequal and knotty, increased in bulk, and attended with acute shooting pains extending up the loins and back. When it as- sumes a malignant character, it ulcerates and forms a large, foul, offensive phagedenic ulcer with indurated edges; or ex- tremely painful fungi burst forth from the ulcerated surface, subject to repeated occurrences of hemorrhage. Occasionally an accumulation of fluid in the tunica vaginalis takes place coeval with the enlargement and induration of the testis, pro- ducing that mixed variety of the disorder denominated hydro- sarcocele. Sometimes the disease appears to be merely local, particu- larly when an external injury has given rise to its formation, and the patient is of a good habit of body. But when it pro- ceeds from, or happens to become developed in a tainted con- stitution, the abdominal viscera and system at large become implicated, severe constitutional irritation supervenes, and a termination is sooner or later put to the patient's existence. VARICOCELE. 249 Therapeutics. In the mild form of the complaint, or in the first stage, resolution may be effected by means of one or more of the following remedies: Aurum, Clematis, Lycopo- dium, Agnus castas, Graphites, Rhododenelron, and Sulphur. When the scrotum presents a livid colour, and its veins are varicose, Lachesis will be found very useful. In more advanced stages, or when the tumour acquires a malignant character, Arsenicum, Lachesis, Clematis, Arenia diadema, Carb. v., or Thuja may, ie. some instances, enable us to arrest the fatal progress of the disorder, but in the majority of such cases ex- tirpation is the only resource. Dose : See Gonorrhoea. VARICOCELE. Varicocele, Ciksocele, or varicose enlargement of the spermatic veins, usually commences close to the testis, and ex- tends upwards to the abdominal ring. The tumefaction of the vessels is commonly greater the nearer they approach the testis. The swelling is knotty and unequal, bearing some resemblance to coiled-up earthworms; it is sensitive to the touch, creates a feeling of weight in the scrotum, also in the loins, and often a degree of numbness in the thigh. Prolonged retainment of the erect posture, exercise or over-exertion of any kind, produce an aggravation of symptoms Cirsocele is to be distinguished from hernia as follows : after placing the patient in the horizontal posture, proceed to reduce the swelling by compression of the scrotum ; then press the fingers against the upper part of the abdominal ring, and request the patient to get on his legs; if it be a cirsocele. the swelling will reappear with increased size, from the obstruction which is offered to the return of blood into the abdomen by the pressure; but if a hernia, the recurrence of the tumour cannot take place as long as the pressure at the ring is continued. Blows upon the groin, the violent pressure of a hernial truss over the spermatic cord tumours resting «n and interrupting the circulation in the 11* 250 hydrocele. vena cava inferior, excesses, &c., are considered as the most common exciting causes of the malady. Therapeutics. The radical cure of cirsocele is frequently attended with great difficulty; and in many cases it is only practicable to give palliative relief. Pulsatilla, Lachesis, and Arnica are the more generally useful remedies. In most cases we may commence with Pulsatilla, and desire the patient to support the testis with a suspensory bandage. Lachesis is frequently of considerable service after the previous employ- ment of Pulsatilla, but particularly when the vessels present an extremely livid appearance. When external injury, such as a blow, or the pressure arising from the pad of a truss, has given rise to the affection, Arnica, in the form of lotion (one part of the tincture to ten of water), should be applied. If, from long standing, or violent exercise, the vessels have become more than usually tumid and painful, a dose of Aconi- tum may be prescribed, the part frequently bathed with cold water, and the patient confined to the recumbent posture. Nux v. is of service where there is constipation, and neither Pulsa- tilla nor Lachesis correspond to this particular symptom. (See art. Constipation.) S dphur* will often prove useful after Nux. Arsenicum and Carbo v. may be selected when severe, burning pains are complained of in the tumour. And in in- veterate cases : Sulphur, Graphites, Lycopodium, Carbo v., Sepia, Sec, are the remedies from which we can expect to derive the most assistance; but where the symptoms do not yield to any of these or others which may have appeared better indicated, and the tumour is large, extremely painful, and threatens to waste away the testis by its pressure, the varicose veins should be removed, and inflammation subdued by the antiphlogistic measures given under the head of Wounds. Dose : See Gonorrhea. HYDROCELE. By the term hydrocele is meant a tumour arising from a preternatural accumulation of serous fluid,-having its seat in HYDROCELE. 251 the membranes of the scrotum (Anasarca integumentorum), or the coats of the testis and its vessels (Hydrocele tunica vagi- nalis). The former is common to the whole bag and envelop- ing cellular tissue; it is generally accompanied with anasarca in other parts, or ascites, and when pressed upon retains the impression of the finger. The latter is a purely local affection, and is that to which the name of hydrocele is by many writers restricted. It presents the appearance of a pyriform swelling of the scrotum ; is elastic, free from pain, and rarely occurs on both sides, but more commonly on the left than the right. The tumour is primarily manifested at the inferior part of the testis, and gradually ascends towards the abdominal ring. In some cases the accession of the disorder is sudden, and the swelling increases to a painful degree of distention ; but more frequently it takes place very slowly, and occasionally continues for many years with little disturbance. The tumour is usually hard at its posterior surface, where the testis is for the most part situated. As it enlarges, and particularly in its early stage, it is transparent, so that a shade of light pervades the whole tumour when a candle is held on the opposite side; and on compressing it with the fingers, fluctuation is perceptible,— by which circumstance, together with the absence of pain and the smoothness of the surface, it is distinguishable from hernia of the omentum or intestines, sarcocele, fungus hsematodes, or schirrus of the testis. Therapeutics. As anasarcous swelling of the scrotum is generally met with in conjunction with anasarca or ascites, we refer the reader to these different headings for particulars, and shall merely add, that when there appears to be no marked participation of the whole habit in the disorder, it will frequent- ly yield readily to the employment of Helleborus, Arsenicum, or China, Sec. The radical cure of hydrocele of the tunica vaginalis is in many cases attended with considerable difficulty. In those of recent origin, #r occurring in very young subjects, Pulsatilla will often be found an effectual remedy. In more inveterate cases, Hepar sulphuris, Graphites, Sulphur, Nux v., AniiM, Conium, Sec, externally as well as internally, become 252 HYDROCELE. requisite, the latter too especially when a contusion has given rise to the affection. Mercurius, Cinchona, and Digitalis have been employed with success in several cases. And in strumous habits, Silicea has been stated to be of greater efficacy than almost any other remedy. In all cases it ought to be the earnest and untiring aim of the practitioner to effect a cure by means of appropriate medicine, in place of resorting to the hazardous experiment of effecting a cure by the operation of injection. When the tumour, from its great bulk, has become of painful annoyance to the patient, palliative relief may, if absolutely necessary, be afforded by the evacuation of the accumulated fluid by means of a trocar. After which process, the parts may be dressed with lint dipped in cold water, and a dose or two of Arnica given internally, prior to the selection of any other remedy, according to the nature of the case, the con- stitution and temperament of the patient. Diffused Hydrocele of the Spermatic Cord (Hydro- cele funiculi spermatid) consists of a collection of watery fluid in or about the cellular membrane surrounding the spermatic cord. The tumour occupies the course of the cord, is soft, colourless, and unaccompanied by pain. It seems to diminish on the application of pressure, but speedily resumes its usual size, either in the recumbent or erect posture, as soon as the pressure is discontinued. It is often no longer than the portion of the cord which occupies the groin, but sometimes it extends as far as the testis, and produces excessive distention of the scrotum. When the swelling attains a large size, it is produc- tive of great inconvenience, and the patient complains of uneasi- ness in the lumbar region. The treatment of this form of hydrocele is closely analogous to the preceding. When the swelling is small, a suspensory bandage should be worn ; and if it appears to have originated from the pressure of an ill-made or badly-fitting truss applied to obviate hernia, the occasional#cause must necessarily be remedied, otherwise all attempts at a cure will prove abortive. When the disease is associated with anasarca in other parts, or when morbid states of the abdominal viscera, such as indura- VENEREAL DISEASE. 253 tions, See., become manifest, remedies must be selected to em- brace the whole deranged habit. (See Anasarca, Enteritis, &c.) In some desperate cases, it may be found necessary to lay open the tumour by an incision extending from the abdo- minal ring to the testis. Encysted Hydrocele of the Spermatic Cord. (Hydro- cele cystata funiculi, spermaHci.) In this variety of the com- plaint the fluid is contained in one (rarely two) distinct cell or cyst. The tumour is of an oblong shape, and is placed be- tween the abdominal ring and testis. It is always free from pain, possesses a good deal of transparency, and is commonly very tense. It differs from hydrocele of the tunica vaginalis, by not extending below the testis, feeling like a distended bladder, and throughout exempt from hardness. The testis is, however, always to be felt below or behind it; whereas in hydrocele of the vaginal tunic, when of considerable magnitude, the testicle cannot be discovered. It is distinguished from hernia by its size and form remaining unaltered in the horizontal posture, and by not becoming enlarged or receiving any impulse from sneezing or coughing; further, by its incapability of being returned into the cavity of the abdomen, and its being unat- tended with any derangement of the intestinal tract. A per- ceptible fluctuation and the absence of pitting on pressure determine its features from those of anasarcous hydrocele. The homoeopathic treatment required is the same as that de- scribed for hydrocele of the vaginal coat. Dose : See Gonorrhea. VENEREAL DISEASE.—Syphilis. Lues Venerea. The symptoms produced by the venereal disease are generally divided into primary and secondary; by the term primary is understood the ulceration, sometimes followed by a swelling of the absorbent glands, which results from the direct application of a peculiar virus to the parts. When the ulceration is situated on the organs of generation, it is denominated a chancre, and the glandular swelling receives the appellation of bubo. The ulcer may be on the prepuce, the 254 VENEREAL DISEASE. glans penis, at the angle formed by the junction of the two former, at the frtenum, the orifice of the urethra, the body of the penis, or even on the scrotum or perinseum. In the female, the ulcers are commonly formed about the labia, nymphas, clito- ris, and sometimes within the orifice of the urethra or the vagina. The first symptoms of a chancre generally set in from three to six days after coition, and are commonly announced by a feeling of itching, which upon examination is found to proceed from a small pimple or pustule having an inflamed base, which feels hard to the touch ; soon afterwards, an elevated point is observed on the minute cone, from an opening in which a limpid fluid is discharged, and succeeded by a more or less rapid de- velopment of ulceration. The primary venereal sore varies much, however, both in appearance and intensity, in different individuals, these several forms seeming in a great measure to depend on the habit of body, age, and temperament of the patient. The most common varieties are the Hunterian chan- cre, the superficial ulcer with raised edges, the phagedenic, and the sloughing ulcer. The Hunterian chancre commences in the manner we have already described. As soon as this sore is formed, it exhibits a tendency to-assume the circular form, becomes deep and spreading, is covered with a tenacious and adherent matter, and has a hard, cartilaginous base and margin; it is met with on all the parts of the genital and urinary organs we have alluded to. When on the glans, it is usually less pain- ful and less inflamed than when it is on the prepuce or ftxenum, but more inclined to hemorrhage. The superficial ulcer has its margins considerably elevated, and sometimes spongy, but it is not attended with induration; it is sometimes accompanied by two or three sores of the same character, and has its seat very often on the outside of the prepuce, but is as' frequently met with, attended by its superficial satellites, on the corona glandis, under the prepuce, or around its orifice. When located at the side of the fraenum, it usually destroys that fold of reflected integument. The phagedenic sore is destitute of any marked degree of surrounding hardness, has no granulations, but presents a livid- coloured circumference, and is liable to spread most rapidly and VENEREAL DISEASE. 255 alaf mingly, particularly when injudiciously treated by irritating external applications, or by excessive doses of Mercury. Last- ly, the sloughing ulcer is distinguished by displaying itself, at the commencement, as a black spot, which extends, then casts off, and discloses a phagedenic or corroded surface. The ulcer which remains after the slough has come away is of a painful character, and has a dark blue or livid crimson margin. A bad habit of body, combined with intemperance, insufficient or un- wholesome diet, and -a residence in an unhealthy neighbourhood, or the effects of improper treatment, and particularly the abuse of Mercury, or the employment of powerful and irritating local applications, are apparently the principal causes which give rise to the formation of this serious description of sore, which, if not checked, or if perseveringly maltreated, will frequently go on sloughing and ulcerating until nearly the whole of the external sexual organs are destroyed. The cleft of the nates, the groin, the perinaeum and the labia pudendi, are frequent seats of the sloughing ulcer. Secondary Symptoms. These most frequently consist in an ulcerated state of the fauces, mouth, and Schneiderian mem- brane. In bad constitutions,* and especially where improper treatment has been employed, such as excessive doses of Mer- cury (one of the most fruitful sources of many of the so-called secondary symptoms in general), considerable portions of the velum palati and tonsils, as also the epiglottis, the cartilages of the larynx, and eventually even the bones of the nose, become affected, and are Sometimes destroyed ; affections of the skin (syphilides) of various kinds, assuming the form of papulae, pustuhe, squamae, tuburculae, &c, also occur,' sometimes pre- ceded by febrile symptoms. The syphilitic eruptions chiefly show.themselves upon the external organs of generation, about the verge of the anus, on the face, especially the forehead and angles of the mouth; but sometimes also on the back, and indeed the whole body. They have very often a peculiar hue, varying in shade from a violet red to an earthy yellow, but * Ricord is of the opinion that secondary symptoms never arise from contagion, but are derived from hereditary taint. (TraitS Pratique des Maladies Veneriennes.) 256 SYPHILIS. commonly distinguished by the denomination " coppery," «end have usually a tendency to ulcerate. Other symptoms of con- stitutional infection almost constantly accompany the syphilitic eruptions, such as pains in the bones, ulcers in the throat, &c. Constitutional lues often affects the iris, producing inflamma- tion and ulceration. The periosteum and bones are frequently the principal seat of the constitutional symptoms, particularly the bones of the cranium, the inferior maxillary, the clavicle, sternum, distal end of the radius, and the. tibia, in addition to those of the nose, as already observed. When the disease settles in the bones, or when the bones have become involved by the employment of Mercury in large doses, the patient is tormented with nocturnal pains of a more or less excruciating character. Dose : See Gonorrhea. Treatment of the Primary Symptoms of Lues. Ricord, in opposition to Hahnemann, considers a chancre, at its commencement, as a purely local disease, and therefore recommends that it should be treated as such, and destroyed by the application of a cautery within three to five days after the contraction of the infection. He states that he never knew of a case, so treated, which terminated in the absorption of the virus into the system, followed by symptoms of general poison- ing. We have not, as yet, been so fortunate as to have had any cases submitted to our observation at so early a period of their career, and cannot therefore offer any testimony in favour of the latter part of M. Ricord's assertion, if that were needed, seeing that it is founded on extensive practical experience. We have, however, had opportunity of treating a considerable number of cases at a somewhat more advanced stage, and pro- pose to give the following brief outline of the treatment we pursued :— Dose : See Gonorrhea. The remedies we employed were Mercurius vivus, Merc cor- rosivus, Cinnabaris, Acidum nitricum, Hepar s., Acid, phosjdi., Lycopodium, Sulphur, Silicea, Arsenicum, Carbo v., Lachesis, SYPHILIS. 257 Thuja, and Sepia. In the selection of these we were guided by the state and appearance of the sore, and varied the poten- cies according to the habit of body of the patient. Where Mercury had not been previously employed, we prescribed it for all sores which presented an indurated base and margin, whether they secreted and were covered with a tenacious or a thin offensive matter, and we should certainly most unwillingly dispense with this valuable remedy in such cases, notwithstand- ing the bad repute it has acquired, from the frightful effects which have so frequently arisen from its abuse in the hands of our allopathic brethren. Such results can never take place in homceopathic practice, assuredly not, in the hands of any one at all deserving of the name of a homoeopathic practitioner. Where the health of the patient was remarkably good, and the sore neither of long duration, nor had in any way been aggravated by previous treatment, we have repeatedly succeeded in effect- ing a cure in from ten to fourteen days, by means of Mercu- rius vivus 6.* A few globules (about a dozen) night and morning, for five or six days, and subsequently, on the ulcer assuming a healing aspect, every second or third day. In other cases, especially in torpid constitutions, it was found requisite to have recourse to the third, second and first triturations,-and to the second and third of Mercurius corrosivus, giving |to{a grain daily until a copious discharge of healthy pus supervened, or the excavation began to be filled up with healthy granula- tions. As soon as either the one or the other of these changes took place, a pause of three or four .days was made. At the expiration of that period, a few more doses were generally suffi- cient to effect a cure in the last-named instance; but in the former, if no signs of granulation made their appearance, (which however, was rarely the case), a dose or two of Sulphur, 6th dilution, produced a favourable effect. If, on the other hand, granulations appeared, but instead of being firm and florid, they were pale, flabby, and prominent, Acidum nitr. 3 answered better. Again, when, after the previous employment of Mer- * The highest potencies of Mercurius (200 and upwards), are said to have recently been employed in Germany, with unequivocal benefit in the treatment of chancre. 258 SYPHILIS. cury, the sore improved somewhat, became less cartilaginous at the base, and finally filled up with florid but too elevated granu- lations, and remained hard at the edges, was very painful and irritable, bleeding rather freely at the slightest touch, and secreting a thin, acrid, offensive discharge, Arsenicum brought about a healthy and otherwise favourable action. Neverthe- less, a few doses of Sulphur or Acid. nitr. were sometimes required to complete the cure, after the employment of Arseni- cum, especially when the ulcer had spread rapidly, and attained a large size at the commencement. From four to six or eight weeks generally elapsed before a cure was established in these cases. When there was excessive pain, swelling, and inflammation, and these symptoms did not yield to the employment of Mer- curius, Sulphur and Aconitum,—in alternation, every twelve hours, gave relief. In other cases, the exposure of the part to the vapour of hot water, together with spare diet and the recum- bent position, were sufficient to allay the excessive irritation. The dressing, when the ulcer was neither very irritable nor ex- tremely painful, consisted of a small piece of lint. Great clean- liness is requisite in all kinds of sores; and when the chancre is located under the prepuce, and the latter is much swollen and inflamed, water should be thrown up between the prepuce and glans by means of an appropriate syringe. The remedies which we employed against the ulcer with raised edges were; Acid, nitricum, Hepar s., Sulphur, Arseni- cum, Silicea, Carbo v., Lycopodium, Acid, phosph., Sepia and Mercurius. Most of the cases treated had already existed from six to eight weeks, and upwards, and had been subjected to a smart Mercurial course, both outwardly and inwardly. Acid. nitricum and Hepar s. were consequently very generally re- quired. To the former the preference was given when the gums were severely affected, and when aching pains were complained of in the bones ; the sore itself not painful, yet disposed to bleed easily and profusely, presenting no signs of central gra- nulation, and having the margins elevated and spongy-looking ; or when there was a tendency to the production of condylomata (sycosic complication), with secretion of a thin sanious dis- SYPHILIS. 259 charge. The dose consisted of one drop of the third dilution, at first, night and morning, then daily, and subsequently every other day, according to the results. Sulphur 6 and Thuja were sometimes required after Acid. nitr. had effected all the benefit it seemed capable of. The former when cicatrization proceeded slowly and imperfectly; and the latter (both out- wardly and inwardly), when excrescences continued to form and to discharge profusely. Hepar sulphuris proved particular- ly useful when the mouth and gums exhibited unequivocal signs of mercurial action, and when the sore was painful, irritable, and had assumed a disposition to spread rapidly. A quarter of a grain of the third or second, and in some instances the first trituration, were given night and morning, at the commence- ment of the course, for four days ; then daily, for a like period, and subsequently every second or third day. Silicea, and at other times Acid, nitric, were sometimes called for to complete the cure, after Hepar s. had subdued the more prominent symp- toms of mercurial aggravation, and given a healthy character to the sore. Sulphur, as has already been observed, is sometimes of much utility in promoting healthy granulation in the Hunte- rian chancre, and is also of great service in sores which present a red or bluish margin, and display a tendency to take on a bad character; but it is especially in the treatment of the super- ficial ulcer with raised margins that we have derived the most satisfactory results from its employment. When a sore of that character occurred in a strumous habit, or in persons of lym- phatic or bilious temperament, who were subject to hemorrhoidal attacks and obstinate constipation—when, moreover, the edges of the sore were spongy, very sensitive, and prone to bleed rather copiously, however gently the prepuce might be drawn back—and, finally, when the secretion from the ulcer was thin and ichorous, or thick, yellow, and rather copious, but the centre of the ulcer flat and presenting no signs of incarnation,—we never failed to derive the most satisfactory results from the employ- ment of Sulphur 6, ten or twelve globules daily for from six to eight days, and then at longer intervals, if we perceived that the medicine had made a favourable alteration in the appear- ance of the sore. It was rarely that any other remedy was 260 SYPHILIS. required to complete the cure when Sulphur was indicated as above. Arsenicum, Carbo v., and Sdicea were found very useful when the ulcers had been rendered irritable by a free use of stimulating applications under allopathic treatment. Arsen. and Carbo was equally beneficial when the margins of the sore were jagged, sharp, and undermined; the dis- charge thin, acrid,. and offensive ; the ulcer painful and liable to bleed somewhat copiously when slightly touched. Carbo v. received a preference to Arsenicum when the patient bore evidence of having been under a course of Mercury, the breath emitting the peculiar fetor, and the gums looking in- flamed, spongy, and ulcerated. Silicea was sometimes requi- site after the two preceding medicines, when they had pro- duced great improvement, but seemed inadequate to effect cicatrization. When the sore was inflamed as well as painful and irritable, and the discharge discoloured, or thin and bloody, the granulations indistinct or altogether absent, Silicea was of vast service. These medicines were prescribed at the sixth potency, and in the same manner as Sulphur. Nux v. and Pulsatilla were occasionally employed with advantage when the appearance of the sore was altered by intemperance in eating and drinking. Mercurius, from the reasons already specified, was rarely an available remedy in this form of chancre ; but in two instances in which it had not previously been employed, or at all events in unusual moderation, it was productive of un- equivocal benefit at the sixth potency. The sores in the cases in question occurred in subjects of lymphatic temperament and of plethoric habit, and displayed an active, spreading charac- ter; the secretion being at the same time acrid, ichorous, and rather copious. In some very obstinate cases of superficial chancre, where the sore assumed all the characteristics of an indolent ulcer, the margins being thick, rounded, and prominent, without the slightest appearance of granulation, or if any granulations form- ed, they presented a pale and flabby appearance, Lycopodium and Phosphoric acid proved very serviceable. The former par- ticularly in persons of lymphatic temperament and mild disposi- tion, with tendency to habitual constipation; the latter iu SYPHILIS. 261 spare, debilitated subjects, who had been addicted to exces- sive indulgence in venery. When neither of these were suffi- cient to establish a cure, Sepia and Sulphur brought about the desired result. These, then, were the principal remedies which we employed with unequivocal benefit in the treatment of the Hunterian and superficial chancres; and in not one in- stance did the slightest appearance of constitutional or second- ary symptoms supervene. Considerable advantage accrued from the simultaneous external employment of the appropriate remedy in some cases, when the sores were of a very indolent character. As regards the treatment of the two other kinds of primary sores, viz., the phagedenic and the sloughing> we can- not say much, having had only three cases of the former, and none of the latter under our observation ; but we have every reason to conclude that the homceopathic remedies would, when timely resorted to, readily succeed in arresting the progress of the disease. In the three eases of phagadenic sores above al- luded to, two of them had previously been injudiciously treated by overdoses of Mercury, and had been further aggravated by the employment of irritating external applications. Hepar s. 3d, Lachesis 6th, and Acid. nitr. 3d, soon brought on a healthy action in these, and effected a cure. The remaining case, which bordered closely on the sloughing ulcer, yielded to Arsenicum 6th and Silicea 6th dilution. We found a striking change for the better in the appearance of the sores, from the internal use of Arsenicum and Lachesis, — the livid red or blueish margins soon assuming a healthier colour after their em. ployment. The other remedies exerted perhaps a more favour- able influence over the process of granulation. Against the true sloughing ulcer, Arsenicum must, doubtless, be an efficient remedy ; it corresponds, both in its pathogenetic properties and those which have been derived from clinical observation, so closely to the local and constitutional symptoms of the disease. Lachesis,—and Silicea, Bella., China, Mezereum, Hepar, or Acid. nitr., might also be found useful, if not indispensable, in many instances. Simple excoriations on the glans, resulting from coitus, will generally heal readily without any treatment whatever, if at- 262 SYPHILIS. tention be paid to cleanliness. A weak lotion of Arnica (one part in sixteen or twenty) will frequently hasten recovery. Cases which from neglect, and particularly want of cleanliness, have become converted into small, flat, superficial sores, require Acidum nitricum or Acid, phosph.; the latter we found more useful when the spots or sores were of larger size. The diet, in all primary sores, must be regulated by circumstances. In young plethoric subjects affected either with the Hunterian or with the superficial chancre with raised margins, the diet must be low, and if the sore be very painful and inflamed, the reclin- ing posture is often necessary. The drink must consist of no- thing but water, toast-, barley-, or rice-water, weak black tea, and cocoa. In somewhat debilitated subjects, or in all cases where the sore is neither in an inflamed state nor very painful, the diet need not be sparing ; but stimulants, such as wine, or spirits, are rarely, if ever, called for, and are often, if not always, objectionable under homoeopathic treatment. In the phagedenic sore, absolute rest in the recumbent posture is imperative. If there be great prostration of strength, the diet should not be too sparing, and yet not more generous than the state of the di- gestive functions will admit of. Wine may be called for, where the patient has been long accustomed to the daily use of spiritu- ous liquors, or where the constitution is extremely debilitated, and no reaction is found to take place from the employment of the appropriate or homeopathic remedy. Bubo. This term was formerly exclusively employed, as its name implies, to denote a swelling in the groin, arising from the passage of venereal matter or poison through the inguinal glands ; and yet if the patient have a primary venereal sore on one of his fingers, he may have a bubo immediately above the elbow, or in the axilla. Buboes have been divided into vene- real, sympathetic, and constitutional. The venereal bubo is supposed to arise, as above observed, from the direct irritation which the venereal poison offers to the lymphatic gland or glands as it passes through this portion of the absorbent system into the blood. But the matter of syphilis may be taken up into the circulation without exciting any inflamma- tion in the glands of the groin, or similar glands in other SYPHILIS. 263 parts of the body The occurrence of a bubo in consequence of ulcers on the external parts is, in reality, comparatively rare in healthy subjects, particularly when the primary sore is properly treated; and we are confident that, in many cases, the injudicious and too free use of irritating local applica- tions, such as sulphate of copper, nitrate of silver, and the red precipitate, in allopathic practice^is a frequent source of this glandular implication. The purely sympathetic, or non- venereal bubo, is generally preceded and accompanied by some degree of derangement of the health. At times it may be in- duced by causes apparently the most trivial, such as the wear- ing of a tight boot, the effects of a sprain or bruise, &c. A boil or sore on the foot, leg, thigh, or nates, an inflamed or pain- ful corn, a bunion on the great toe, are frequent causes of in- flammation and enlargement of the inguinal glands. By the constitutional bubo, we here allude to scrofulous swelling of the lymphatic glands of the axilla, or of the groin, especially the latter. Getting the feet wet, or sitting on a damp seat, in a gig, or on the top of a coach, frequently develops this form of bubo. Therapeutics. It is sometimes difficult if not impossible to arrive at the true character of a bubo; the patient, from false delicacy, often refusing to admit that he has previously been af- fected with chancre. In homoeopathic practice, this is of no material consequence; the appearance and condition of the swelling, and the state of the general health, forming a sufficient group of symptoms to enable us, in doubtful cases, to select the appropriate remedies. The .correct history of the case is, however, by no means unimportant, as it facilitates the choice of the remedy. If a bubo be a venereal one, and the chancre is in existence with it, we should not deviate from the treatment called for by the aspect of the primary sore. But if the sore assumes a somewhat improved appearance, or remains perfectly unaltered, and the bubo, on the other hand, becomes consider- ably aggravated, we ought to give the latter our chief attention, and prescribe according to the features which it presents. The following is the mode of treatment we have ourselves pursued. 264 BYPHILlS. Whenever the swellings were either small, or of considerable size, but neither excessively inflamed nor particularly painful, we prescribed Mercurius at the third trituration, quarter of a grain night and morning, until signs of improvement made their appearance. In those cases again in which the swelling was large and painful, and ^companied by intense inflammation, the integuments presenting a deep red hue extending over a considerable surface, the redness disappearing on pressure, but returning immediately after the finger was removed, Belladonna 6, every six to twelve hours, was found to be of the greatest efficacy. When suppuration threatened, or became established, Silicea 6, every twelve hours, formed an admirable remedy, having either the effect of producing absorption of the matter, and causing the tumour to subside, or of quickly forwarding the suppurative process and the discharge of the pus from the cel- lular membrane surrounding the gland. The former more de- sirable result generally took place when the preceding inflamma- tion had not been intense. Hepar s., third trituration, we pre- ferred to Silicea, if the patient had previously been subjected to a course of Mercury. Staphysagria 6th dilution was sub- stituted for Hepar s. when the mouth and gums were much in- flamed or ulcerated. When the biibo took on an indolent and indurated condition, or had remained in that state for several months prior to the adoption of the homceopathic treatment, Carb. v. was often very serviceable, having frequently the ef- fect either of dispersing the tumour, or of causing it to sup- purate. Silicea was, however, of nearly equal efficacy in such cases, and at all events rarely failed to do good, when Carbo v., or a. produced only a slight degree of amendment. A swollen, spongy, or ulcerated state of the gums was an additional indi- cation for Carbo v., Sulphur, or Aurum, and Acid, nitricum proved useful in some obstinate cases. Should the matter of a suppurated bubo exhibit a decided tendency to spread, before advice has been sought, it may sometimes be necessary to have the swelling opened by the lancet. After the pus has been dis- charged., and the bubo has become converted into a sore, the treatment must be conducted according to the character and appearance of the ulcer. (See Ulcers, as also the treatment SYPHILID. 265 described for primary sores on the glans, &c.) SVicea and Sul- phur are two of the most valuable remedies in all cases where the parts do not show a disposition to heal; but Acid, nitr., Aurum, Carb. v., Assa feet i da, or Staphysagria will sometimes be called for, particularly in cases which have evidently been aggravated by the previous use of Mercury in excessive quantities. Against sympathetic bubo, Belladonna, Hepar, Silicea, Sulphur, Carbo a., Sec, 'are the more important medicaments. The indications for Belladonna have already been given above. Hepar s. may follow Belladonna if suppuration threatens; or if, after the removal of the excessive inflammation, the gland remains in a tumefied state. Silicea is one of the most useful remedies in sympathetic bubo, either at the very commence- ment, even when there is a considerable degree of inflammation, or at a more advanced stage of the affection, when suppuration threatens or is already established. When a bunion on the great toe, or an inflamed bursa in any other part has given rise to the bubo, there will be additional reason for prescribing SVicea, as that remedy will in such a case be homceopathic to the originating cause as well as its sequel. In bubo arising from suddenly suppressed perspiration in the feet, this medicine is, moreover, a most important medicament. Sulphur is also an efficient remedy in sympathetic buboes, particularly when they occur in individuals who are subject to hemorrhoids, or to boils on the lower extremities or nates ; or when the inflammation and enlargement of the inguinal gland or glands has arisen after the suppression of an old sore on the foot, leg, or thigh. Car- bo a. has been recommended as an effective remedy in sympa- thetic bubo, from the circumstance that even when suppuration seems unavoidable, it has generally either the effect of causing the tumour to subside, or quickly suppurate and discharge. We have found Silicea to answer the purpose better. In the treatment of scrofulous bubo, Mercurius and Dulca- mara are very serviceable when the swelling is of recent origin, and has become developed after getting the feet wet,* or after * Silire.n is. however, to be preferred to either of these remedies 12 266 SYPHILIS. sitting on a damp seat. A dose or two of Belladonna will sometimes be required, especially if the inflammation runs high. In cases of longer standing, Silicea and Sulphur are generally of greater efficacy. Silicea, as has already been remarked, is a valuable remedy in suppurated buboes; in chronic cases it is particularly required where the swelling is indurated and pain- less. Sulphur is frequently of much utility when the tumour is hard, but painful to the touch, and the integuments some- what inflamed, or very liable to become so after any slight exertion. Calc. c, Clematis, and Carbo v. et a. are also de- serving of notice in scrofulous buboes. (Calc, after the pre- vious employment of Sulph. ; and Clematis, Carbo v. or a. after Silicea, in obstinate, indolent, and indurated swellings.) lodium, Acid, nitr., Arsenic, Aurum, Staph., or Spongia, Sec. have likewise been recommended in scrofulous buboes. Silicea and Sulphur are two of the principal remedies to pro- mote granulation and cicatrization when these buboes have be- come converted into ulcers. (See Venereal Buboes, and also Scrofula.) Dose : See Gonorrhea. Treatment of Secondary Symptoms. Sore Throat. This form of secondary symptoms, so-called, arises in most cases as a sequel of the abuse of Mercury, either internally or locally, in the treatment of a primary sore. It, consequently, for the most part, yields most readily to the use of anti-mercurial remedies, such as Hepar s., Acid. nitr.: Bellad., Lach., Sulph., Silic, Thuja, Staph.—Arsenic, Alu- mina, Lycopodium. When the mouth and gums likewise are inflamed or ulcerated, one or more of the same remedies, together with Carbo vegetabilis, Aurum, Natrum m., Iod., and China must be had recourse to, according to circumstances. We are generally in the habit of commencing with Hepar s., third trituration, when the patient complains chiefly of pain, dryness, and scraping in the throat, with some degree of in- when checked perspiration occurs in persons who have long been af- fected with sweating of the feet. SYPHILIS. •267 flammation and swelling of the tonsils, but little or no true ulceration. When, on the other hand, on examining the throat, the tonsils are observed to be somewhat enlarged, the fauces considerably inflamed and ulcerated, the ulcer or ulcers super- ficial, and of a gray colour, we commence with Acid. nitr. 3—6 in preference. Belladonna and Leichesis are very useful when the inflammation and swelling are more severe, and the ulcers extremely painful and irritable. After these remedies have subdued the excessive inflammation, Acidum nitr. and Sulphur are generally of great value, and often sufficient to complete the cure. In other cases, Carb. v., Aurum, Silicea, or Arsenicum,, Sec, are required. (See also the treatment of Primary Ul- cers.) In those cases where we have no reason to suspect that Mercury has not given rise to, or aggravated the symptoms, Mercurius is an important remedy,* particularly when the ulcer or ulcers are covered with a tenacious and adherent matter, and the surface considerably excavated. Acid nitri- cum and Thuja have been recommended after Mercurius or Sulphur. Silicea, or Arsenicum, Lachesis, or Carbo v., may sometimes be found better indicated than either of the preceding remedies. Lycopodium 6th or 9th dilution is c nsidered by Rummel to be a remedy which can with .difficulty be dis- pensed with in secondary syphilis. He gave it with striking advantage in a case of sore throat, which had long resisted various kinds of treatment (not homoeopathic) ; the tonsils were covered with ulcers, having a gray-coloured base. He also found it of great efficacy in several cases where the fauces and tongue were covered with an herpetic-looking eruption, bearing some resemblance to the wrinkled skin on the hands of washerwomen, and attended with a burning sensation on partaking of warm food, or after smoking. * Hartmann recommends the Mercurius pracipitatus ruber in sy- philitic ulceration of the throat, one grain of the first trituration night and morning, for from six to eight days ; at the expiration of which period, or sooner, if signs of medicinal action become earlier developed. he discontinues the prescription, and only repeats, as before, in the event of a cessation taking place in the improvement which may have resulted from the employment of this preparation. 263 SYPHILIS. Against aching pains in the bones, Acid, nitr., Aurum, and Lachesis, are of great service; and in venereal nodes or other diseases of the bones, the same remedies, together with Acid, phosph., Assafet. Sulph., Calc, Silic., Dulc, or Mer- curius, when the affection has not actually been produced or materially aggravated, as is but too often the case by the abuse of that mineral. (See Ozjena, and Diseases of the Bones.) Against syphilitic Ophthalmia (Iritis), Acidum nitric, is often a most effective remedy, particularly when severe noc- turnal pains in the bones are complained of at the same time, and the patient has previously undergone a course of Mercury. (See Iritis.) The treatment of secondary symptoms in the form of eruptions must be regulated according to the different species of cutaneous disease to which they bear the greatest resem- blance, together with the character of the other constitutional symptoms which usually attend. When the eruption par- takes of the papular form (Lichen, Strophulus, Prurigo), Aconitum, Sulphur, Aciel. nitr., Hepar s., Sepia, Dulc, Con., Thuja, Cicuta, Lycopod., Ac. muriat, Bryonia, Puis. The two last named, together with Lycopod. and Sulphur, parti- cularly when there is considerable derangement of the digestive function. When the secondary symptoms are associated with the tubercular or with the pustular form (Sycosis, Acne ro- sacea, Impetigo, Favus, Ecthyma), Acid, nitr., Thuja, Au- rum, Lachesis, Carbo v. et a., Sulph., Lycopod., Calc, Cic, Arsenic, Rhus, Staph., Sec. And when they have taken on the form of squamce (Scaly Syphilis, Lepra, Pso- riasis, Pityriasis, Pellagra, Acrodynia), Sulphur, Lyco- pod., Lachesis, Thuja, Arsenic,—Calc, Cinita, Led., Graph., Sep.. Natr., Carbo a. et v. Clem., Petr., Phosph., Olean., Alum., Zinc, Sec Secondary venereal ulceration of the skin is frequently preceded by an eruption, possessing one of the before-mentioned characters, and sometimes in the form of bulla (venereal rupia). These ulcers present no uni- form or constant aspect, sometimes assuming a circular shape, with an irregular, foul, ash-coloured surfaee; at others di»- syphilis. 269 playing the peculiarity of healing in the centre and extending at the circumference, the edges being sharp, and the unhealed part presenting the same colour and appearance as in the before- mentioned instance. The tawny hue, and the shape and situation of the ulcers, are considered as the characteristic signs of their venereal origin. In syphilitic eruptions of most kinds, Mercurius is more or less useful ; but as it so very frequently happens that that remedy has been most injudiciously and abu- sively employed before the patient seeks the aid -of homceo- pathic treatment, it is seldom that we can derive that benefit from its use which might otherwise be the case. The reme- dies which have principally been recommended against the ve- nereal ulceration of the skin, whether complicated or not with mercurial erythema, or eczema, or other symptoms of mercurial poisoning, are : Acid, nitr., Sulph., Silicea, Hepar s.. Laches., Thuja, Aurum, Carbo v., Adelum flior., and also Aconitum and Belladonna, chiefly as intermediate remedies when thei»e is ex- cessive febrile irritation. The treatment of phagedenic ulcera- tions such as occur in the advanced stages of syphilis, will chiefly consist in the employment of the same remedies as those we have named as the most suitable for primary phagedenic sores. When secondary symptoms exhibit themselves, especially in the form of venereal whitlow, with formation of a very offensive matter under the nails, and exfoliation of the latter, M rcurius, Carbo v , and SVicea are the most useful medicaments. (See Whitlow.). And when rhagades, or ragged ulcerated fis- sures, are the more prominent features of the affection, the me- dicines to be employed are: Mere, Sulph., Lycopod., Acid. nitr., Hepar s., Calc, Agnus e, and Graphites. Syphilis in Infants. The venereal poison is not unfre- quently communicated to the foetus in utero through the me- dium of the blood of the mother. The child is also said oc- casionally to contract the disease at the time of birth from the direct application of the virus of a chancre with which the mother happens to be affected. In the" former instance the child is born with the disease. The symptoms of syphilis in the new-born child, or soon after birth, are copper-coloured 270 SYPHILIS. blotches, and scaly eruption over the greater portion of the body ; pustules and superficial ulcerations about the anus and nates, and sometimes on the organs of generation ; rhagades, warts, hard and soft swellings about the head; also ulcerations and fissures at the corners of the mouth, and in the lining mem- brane of the fauces, and in some instances on the eyelids. In addition to these symptoms, there is often an obstruction of the nostrils with a thick, yellow secretion, so that the child can- not breathe freely : the cuticle peels off extensively; the child becomes excessively emaciated, and if not speedily relieved, it becomes hectic and soon perishes. Therapeutics. The disease has been found to yield readily to Mercurius v. 6 ; but the homceopathic practitioner is often prevented from having recourse to this remedy by discovering unequivocal indications that the child has previously been sub- jected to a course of some mercurial preparations, under allo- pathic treatment. Under such circumstances, it is generally re- quisite, particularly when the mouth, gums, and throat are se- verely affected, to prescribe Hepar s. or Acidum nitr. When the mischief done is more extensive, and the hard as well as the soft parts have become implicated, Aurum may be pre- scribed in the first place, and subsequently Hepar s. and Acid. nitr. in alternation. Should there be great difficulty in swal- lowing, Belladonna will generally afford relief, should Acid'. nitr. fail to do so. If the mercurial affection does not form a prominent feature, as is frequently the case when the preparation employed has been Calomel in comparatively small doses, we may then administer either Mercurius sol. or Merc, corros. at the sixth or twelfth potency, one globule daily or every other day, for four to six days, carefully watching the effect produced, and discontinuing the medicine as soon as we perceive traces of its action on the local symptoms or on the system generally. When the child exhibits great sensibility to external impres- sions, or when it is frequently seized with spasms or tremors, is very restless and sleepless, and averse to take nourishment, the extremities being at the same time cold, the countenance earth-like, and the nose pointed; when, moreover, there is a PHIMOSIS. 271 lingering, debilitating fever, with excessive thirst, and small, hard, accelerated pulse, China should be prescribed. After the employment of China, Fe'rrum has been found beneficial, when administered at a low potency. In other cases, Acid. phosph. will claim a preference to Ferrum, particularly if the tendency to colliquative sweats does not subside under the em- ployment of China. Sulphur, Silicea, and also Calcarea, Ly- copodium, and Lachesis, are also deserving of notice in such circumstances. If the eyes and eyelids are principally affected, or subsequently become so, Mercurius corros. should form the principal remedy, unless Mercury in some form or other has already been used, in which case one or more of the following must be selected : Belladonna, Acid, nitr., Hepar s., Sul- phur, Calc, Aurum, Graphites, Thuja, Cannabis. (See Ophthalmia.) Against affections of the periosteum, nodes, or other dis- eases of the bones, Assafeti la is one of the most useful me- dicaments; and the next in importance are perhaps Mezereum and Acidum phosphoricum; but Silicea, Sulphur, and Cal- carea, must also be borne in mind. (See Diseases of the Bones, and Secondary Symptoms.) When phagedenic sores appear on the genital organs or other parts of the body: La- chesis, Arsenicum, Silicea, or Mezereum, Sec, will be re- quired. (See Primary Sores.) The mother or nurse of the affected child should simultaneously be placed under treatment. It is by some thought sufficient to operate on the child through the milk of the nurse, but we are in favour of the preceding plan, with the observance of due caution in the exhibition of medicine to the child. Dose : See Gonorrhea. PHIMOSIS. Phimosis is understood to signify that contracted state of - the extremity of the prepuce which prevents its being retracted so as to expose the glans penis. It is most commonly produced by inflammation and swelling, or thickening of the prepuce. 272 PARAPHIMOSIS. Sometimes it occurs as a congenital affection. The treatment must be conducted according to the nature of the exciting cause. If friction, or any other mechanical injury, has given rise to it, Arnica should be employed. In other cases, originating in a similar cause, Calendula ofificin., Rhus, or Pulsatilla may be required. If from syphilis : Mercurius, Acidum nitr., and Thuja chiefly. Division of the prepuce may sometimes be rendered necessary in syphilitic phimosis, when the escape of the pus is entirely prevented by the extent and severity of the inflam- matory swelling. When it proceeds from uncleanliness, Aco- nitum may first be prescribed, if there be much inflammation, and then Mercurius. Tepid water should at the same time be injected between the prepuce and glans by means of a small syringe. Should the prepuce present a puffy or bladder- like appearance, Rhus may be employed with advantage. Cir- cumcision is generally employed in surgical practice against congenital phimosis. When phimosis arises from the irritation caused by excrescences. Thuja and Acid. nitr. must be re- sorted to. (See Sycosis.) PARAPHIMOSIS. What is denominated paraphimosis is that state of the pre- puce in which it is drawn behind the corona glandis, and is incapable of being again brought forward. In young sub- jects it is rarely attended with serious results, but when it takes place in adults, the prepuce often becomes intensely inflamed and ulcerated, and the glans penis destroyed by mor- tification. In recent cases, the reduction is often affected by com- pressing the glans, and simultaneously drawing the prepuce forward. When requisite, the process may be facilitated by previously immersing the peqis in cold water, or applying it to the part. In more advanced cases, when the prepuce is considerably swollen, it will be necessary to administer a dose or two of Aconitum, and sometimes Mercurius, in order HERPES PRBPUTIALIS. 273 to subdue the inflammation, before the parts can be handled. Warin fomentations are also useful. The division of the stricture is necessary if all other means fail. When suppura- tion ensues, either prior or subsequent to the reduction, Mer- curius, II par s., and Capsicum have been recommended. And when induration remains, La-hesis. Should mortification threaten, the employment of Arsenicum or Lachesis may avert its development. HERPES PREPUTIALS. Herpes preputialis. This disease is occasionally con- founded with syphilis, from the close resemblance which it sometimes bears to that affection. It consists of an eruption of vesicles which appears on various parts of the body, and not unfrequently on the penis, especially at the prepuce, and has, therefore, received the appellation of Herpes preputialis. When the foreskin is the seat of the disorder, a sensation of heat and itching is ascertained on the outer or inner, or even on both surfaces of the said part, and in the space of a day or two one or more small patches of a vivid red colour make their appearance, on each of which five or six small globular vesicles arise, containing a serous and transparent fluid. The heat and itching now increase, and on the third or fourth day the fluid grows turbid, and is converted into pus. The ve- sicles then burst, and the discharged fluid dries and forms small, thin, scaly incrustations. When the eruptions break out on the inner surface of the prepuce, the epithelium be- comes detached after the rupture of the vesicles, and exposes the inflamed vascular rete of the chorion. It is the superficial sore thus produced which is sometimes mistaken for a primary venereal ulcer. The absence of the raised or of the indurated edges, and of the small, gray-coloured secretion, covering the base of the venereal sores, forms the leading determination. In the early stage of herpes preputialis the disease is distin- guished by the evolution of a clus'er of small vesicles. When the vesicles are developed on the outer surface of the prepuce, the fluid they contain is either reabsorbed, or desiccates on the 12* 274 SYCOSIS. fifth or sixth day; in the latter event it is altered into minute dry scabs, which, provided the parts have not been irritated by friction, are thrown off about the eighth or tenth day, and the cure is then, for the time being, complete. It is not a con- tagious complaint, but is prone to occur repeatedly in the same individual. The friction of the clothes during prolonged exer- cise, and the contact of deranged vaginal secretions, aggravate and often develop the affection in those who are predisposed to it. The use of mercurial preparations in a deranged state of the digestive functions, and the previous occurrence of one or more syphilitic attacks, have all been considered as predis- posing causes. Therapeutics. In most cases the disease may be left to itself, particularly when the vesicles are situated on the ex- terior of the foreskin. But it is always necessary to protect the part from friction, as the cure is invariably delayed when the drying up of the vesicles is retarded. When the inner surface of the prepuce forms the seat of the disease, the ve- sicles or excoriations ought to be protected by the introduction of a small portion of lint between the glans penis and the prepuce. Cold water may also be freely employed. When the affection proves unusually obstinate, or is reproduced again and ao-ain, Add. phosph., Au urn, Heea.r s., and Xitnim have been strongly recommended. The state of the digestion ought to be attended to at the same time. When a chronic inflam- mation of the urethra exists simultaneously, Canth., Petrol, Petrosrlinum, Dde, Sidth., Calc, Si'ir., Sep., or Lycopod. will chiefly claim attention. Dose: See Gonorrhoea. SYCOSIS. Bv the above term we allude to the disease described by Hahnemann* as having occurred very extensively during the * Hahnemann's Chronic Diseases, by Charles Hempel, M. D. 5 vols. $7 00. sycosis. 275 last war, from 1809 to 1814, and which manifests itself exter- nally in the form of excrescences on the genital organs a few days, or even weeks, after impure connexion. " These ex- crescences are occasionally dry, resembling warts, but much more frequently soft, spongy, secreting a fetid fluid, bleeding easily, and similar to cockscombs or cauliflowers ; they appear in men upon the glans penis, at the margin and the inner sur- face of the prepuce, also on the scrotum, perineum and nates ; in women, on the vulva and adjacent parts. They are often accompanied by a gonorrhoeal discharge, which is thick and purulent from the commencement, with little pain during uri- nation, but with hard tumefaction of the penis, or lymphatic swellings on the dorsum penis, very sensitive to the touch. The disease was considered by the majority of allopathic prac- titioners, as simply a symptom or modification of syphilis, and was accordingly treated by them with Mercury, and by violent external application, cautery, excision, ligatures, &c. The im- mediate and natural sequel of this method was, that, generally, the condylomata reappeared after the expiration of a longer or shorter time, and were again subjected to the same treatment; or if the means employed succeeded in destroying them, the sycosis, deprived of its local or vicarious symptom, showed it- self in another and more aggravated manner, in the form of secondary symptoms; the external means employed, and the Mercury (which is unappropriate to the disease), given inter- nally, being inadequate to destroy, in the slightest degree, the sycosic miasm with which the system was impregnated. In addition to the injurious constitutional disturbance produced by the Mercury, particularly when given in large doses, and in the shape of the most acrid and irritating preparations—anal- ogous excrescences broke out upon other parts of the body, in some cases consisting of spongy elevations, whitish, sensible, and flat, having their seat in the mouth, on the lips, tongue, and fauces; in others, large, prominent, brownish-looking tu- bercles, situated in the armpits, on the neck and scalp, &c. ; or, again, other symptoms were developed, of which I need only mention here, retraction of the flexor tendons, particularly those of the fingers. 276 SYCOSIS. Therapeutics. Hahnemann was the first who recom- mended and employed Thuja occiden'alis in sycosis. When the disease is in its primary form, accompanied or not by a gonorrhoeal discharge, and not complicated with syphilis, or occurring in a strumous habit, a few drops of a low potency, or a few globules of the third or sixth dilution, speedily suc- ceed in effecting a radical cure ; in obstinate cases, in addition to internal administration, the condylomata may be touched daily with the diluted tincture of Thuja. In some cases the cure is materially facilitated by the use of Acidum nitricum in alternation with Thuja.* Where there is a complication of syphilis with sycosis, Mercurius and Sul- phur in alternation, at low potencies (third trituration), are very efficacious. Against the secondary symptoms of sycosis, Thuja and Acielum nitricum are still to be held as the most important remedies ; but when they are found inadequate to destroy the disease, either in consequence of complications with secondary syphilis, or some other dyscrasia, Sulphur, Acidum phbsphor., Euphr.. Cinn., Sabina, Staph., or Lycopod. Of these, Sul- phur has commonly been found the most appropriate to ad- minister when the constitutional symptoms, such as sore throat, with enlargement of the tonsils and ulceration, hoarse- ness, stains on the skin, scaly spots, or eruptions assuming the character of psoriasis or lepra, have undergone little or no improvement under the employment of Thuja and Acid, nitr.; it will, further, claim a preference when there is, at the same time, general derangement of the system, and especially when the patient is affected with symptoms of abdominal plethora, with hemorrhoids, and constipation; or when shooting pains are experienced in the joints, and the flexor tendons of the fin- gers are in a state of contraction ; tongue dry, red, rough, and fissured, lips much tumefied. Lycopodium may follow Sulphur with advantage, when there is superficial, white ulceration of * The aid of Acid, nitric, is almost indispensable in all cases in which the patient ha9 formerly been placed under a coarse of Me jay during oue or more syphilitic attacks, or some other aflwotion. SYCOSIS. 277 the tonsils ; and the tongue is fissured, or is, together with the inner surface of the lips and the fauces, covered with a scaly, herpetic-looking eruption. Staphysagria, when the gums are much affected, somewhat ulcerated, swollen, soft, or spongy, and the glans penis covered with soft, moist excrescences. Sabina has been of great service when the condylomata were large, moist, and painful even when not touched. Acidum phosphoricum will deserve attention when the sycosic excres- cences are of long standing, or when the patient has pre- viously been treated with Mercury in large doses, and Acidum nitr., Thuja, Sulphur and Staphysagria have either failed to do good, or have only effected partial improvement. Cinnabar has been strongly recommended as a valuable remedy in in- veterate or secondary sycosis. Hahnemann considered Mer- cury as inappropriate to sycosis, and as peculiarly hurtful when given in over-doses. When administered in the small doses employed by homceopathists, it appears to be of great efficacy in some obstinate cases. A complication with syphilis, or secondary symptoms in tne form of enlargement of the tongue, swelling and ulceration of the tonsils (provided these latter symptoms have not arisen from the abuse of Mercury), condylomata, &c, will justify us in anticipating a beneficial action from the use of Cinnabar. Sometimes the sore throat arising from sycosis may bear so close a resemblance to that of secondary syphilis, that it will be difficult to found a diagnosis thereupon; but the history of the commencement of the dis- order, along with the existence of tubercular or wart-like ex- crescences in the vicinity of the anus, genital organs, or other parts of the body, will enable us to discriminate the sycosic from the syphilitic origin. In sycosic buboes, Thuja and Acidum nitricum are the principal remedies, but cases may often occur in which Staphysagria, Sulphur, or Mercurius will be required. (See Bubo.) We shall conclude this portion of the work by giving a short statement of Dr. Goullon's mode of treating syphilis,* together with an extract from the more extensive and interest- * All j. Horn. Zeit., No. 17< 30ster Band, p. 2o8. 27$ SYCOSIS ing observations of Dr. Attomyr,* on the treatment of Venereal Diseases. Dr. Goullon employed Mercurius solub. and Mere sublim. corros. chiefly, in the treatment of chancres in general. The former in the dose of ^, \ of a grain, twice a day; and the latter, to which he gave the preference, as follows: r\. Merc, corros. gr. ss—j ; Aq. unc. viij ; Spir. vin. q. s. or i grain Merc. corr. 1st tritur. with 8 ounces pure water, and i ounce Spirit of wine. A tablespoonful morning and evening, (diminishing the quantity when vomiting followed the first dose or two). When the sores were foul and confluent, attended with fetid discharge, also local application of the same remedy. The greater the degree of improvement effected,'the-less frequently was the medicine ordered to be taken. In the majority of cases, scarcely gr. ij were necessary to establish a cure without risk of a relapse or the occurrence of secondary symptoms. Where syphilis and scabies were encountered in the same sub- ject, the cure of the former was commenced first. The worst complication was found to be secondary syphilis in the form of eruptions, &c, and scrofula. Baths of Merc. corr. (§j-ij) pro- duced striking benefit here; but when the patients had pre- viously undergone a course of Mercury, the medicament which, more frequently than any other, though not always, did the most good, was Acid. nitr. in repeated doses. In sore throat, Lycopodium; in ostitis, or exostitis, Silicea; and in tetters and herpetic sores, Sarsaparilla (ptisan) proved the most serviceable. Dr. Attomyr observes, that " With respect to the treatment of the various forms of the venereal disease, we have in general nothing farther to add, except that in this disease, as in all others, the homceopathic law of cure by similarity of symptoms is applicable, and here too proves its validity. " Before entering specially upon the homceopathic treatment of the venereal disease, it will be necessary to premise some few remarks, which deserve consideration when viewed in reference to my therapeutical results. * RuofF's Repertoriuin, by A.H. Okie, M.D. SYCOSIS. 279 " Syphilitic patients, with very few exceptions, are young un- married men, who either board at the hotels or sit at table with their relations, or probably superiors. In ei'.her case it is un- fortunate for the observance of the homoeopathic diet, and indeed much worse here than it would have been in Germany or in any other Austrian province, for in Hungary far greater quantities of condiments and acids are used with food than in other places. To this must be added the fact that patients conceal their dis- orders, and in order not to excite suspicion, dare not venture on the slightest aberration from their accustomed diet. In con- sequence of these uncertain dietetic circumstances, I resolved, in treating such patients, to administer larger doses than usual. " I am still of the opinion, that the lower dilutions recall re- action quicker, but that their effects are less intensive and per- manent than the higher. Four grains of calomel in the space of a few hours operate violently, and excite diarrhoea, while the same four grains, if taken in minute portions, result in an indis- position, which continues several days, and in a more intense commotion of the organism. I moreover concluded from these premises, that the larger doses could be repeated more frequent- ly, which would seem essential on account of the necessarily frequent dietetical errors. Within the period of two years I treated 156 patients labouring under the venereal disease. Every physician knows how it is with office practice, how diffi- cult to learn anything or obtain any certain experience in this manner. Generally one half of this class of patients stay away, so that it is impossible for us to decide with certainty upon the termination of their disorders. The one remains away because the effects of the treatment did not fulfil his anticipations, the other (and among syphilitic patients the majority) because he is approaching convalescence, and is desirous of avoiding the burdensome hanksgiving for his cure. This last occurred so frequently to me, that during the treatment of an interesting case, I was always tearful, as I was led to expect that as the cure progressed, my patient would remain away, and I be,un- able to arrive at any certainty with regard to the termination of the case. "I requested a patient with eleven chancres (seven of 286 SYCOSIS. which, of the size of a lupine-seed, were situated on the scrotum), after all were healed, but two of them still pre- sented cicatricular depressions, to return in eight days, and let me see if the two scars had also disappeared. My patient, however, did not return, notwithstanding I had clearly given him to understand that I had no reference to his returning thanks, but merely as a subject of scientific interest. This plan was so often adopted towards my patients, that they ironically termed me the ' Gratis Doctor,' for which I in re- turn, during the last three months of my •residence in Pres- burg, punished them very sensibly, although I am sorry that punishment in many instances fell upon those who were in- nocent. So it happened that of the 156 patients treated, I cannot cite more than 84 who persevered until perfectly cured; and most of these, at my request, returned, and were examined by me fourteen days after their convalescence. "Were cured of Chancres 34,—Gonorrhoea 24,—Gleet 9,— Balano-blennorrhcea 2,—Bubo 10,—Hernia humoralis 2,— Nodes and eruptions 2. " I have observed the following five varieties of chancre: "First form.—The edges more or less jagged, elevated, slightly painful, but sensitive when rubbed by the linen, with a copper-coloured circumference. The base of the sore is indurated, lard-like, the ichor adheres so firmly to it, that it cannot be removed by washing. The ichor is of a light yellow colour, viscid, glutinous, resembling pus, sometimes acrid, offen- sive ; it makes spots on the linen as if from melted tallow. The sore extends far more in depth than in breadth. This form appears on all parts of the glans, and also on the prepuce, but more frequently on the posterior part of the glans, near its junction with the pre mce. "Second form.—The sores are superficial, not only do not extend in depth, but are perceptibly elevated above the surface. The edges are never jagged, always sharply circumscribed, painless. The sore looks clean, of a flesh-red colour, almost spongy, it is never necessary to clean it, as the ichor does not adhere. The ichor is somewhat thinner than in the first form, usually more copious and mixed with blood. This form heala SYCOSIS. 281 sooner than the first, appears almost exclusively on the prepuce, and there are always several sores present at the same time. " Third form.—The sores of the second form gradually become elevated so much above the surface of the prepuce, that they resemble more a horizontal section of a wart than an ulcer. This form discharges very profusely. The ichor is more offensive than in the two preceding forms, but still not so bad as it is in those which follow. It is unusual for all the chancres of the second form to become converted at the same time into those of the third, therefore these two forms are usu- ally co-existent. This variety frequently heals very quickly. I have never seen true condylomatous forms of disease arise from this. In my case-nook I have given the compound name of ' chancre wart' to this form, which term, on account of its brevity, I will still retain. " Fourth form.—The corona of the glans is almost one ulcer- ated surface. This frequently extends to the posterior part of the glans; occasionally, at the same time, to the prepuce also. The sore is quite superficial, here and there lard-like, but the greater part red and thinly coated with matter, which can be readily washed off. The ichor, which is very profuse, is some- what less consistent in this than in the varieties already de- scribed, and is of a very fetid odour, which apparently depends upon the simultaneously increased secretion of smegma. The sore appears as if the skin had been torn off. This form either heals as such by contracting from the edges towards particular points, forming several chancres, which are nearly separated or only united by linear excoriations; or the above described lard- like spots extend more in depth, and chancres of the first form appear. This fourth variety of chancre has a tendency to appear in company with gonorrhoea. " Fifth form.—A chancre which in its incipient state has the appearance of the first form, in a few days becomes covered with a scab which presents the appearance of a psoric sore. The scab absorbs the fluid secreted beneath it, and thus be- comes thicker and does not fall off until the sore beneath it has healed. This variety a,,pears either on the common in- tegument of the penis or directly on the verge of the prepuce, 282 SYCOSIS. which becomes swollen, looks as if excoriated, burns severely while and after urinating, when walking is disturbed by the pressure of the linen, to which it slightly adheres. This variety I term the 'psoric chancre,' and conjecture that it arises from a complication of syphilis and psora, which conjecture is strengthened not only by the appearance of'the sore, but also by the violent pruritus and the favourable results attend- ing the administration of Sulphur. This form generally appears simultaneous with one of the varieties already described. " In the treatment of these different forms of chancre, I have by degrees been obliged to resort to the following eleven remedies : " Mercurius solubilis, Merc, elulcis, Merc, sublimatus corro- sivus, Acidum nitric, Thuja, Hepar sulphur., Corallia rubra, Acid, phosphor., Sulphur, Causticum, Staphisagria. "In the first variety of chancre, Merc solub. is the chief remedy; it is not, however, adapted to half the cases. Thuja comes next to the quicksilver in this variety. The patient usually took a few doses of Mercur., then a few doses of Thuja, and when its beneficial influence appeared to cease, the Mercury was resumed. In addition to these, I administered Merc dulcis, Sublim. corrosiv. and Causticum in several obstinate cases, and I believe I have observed considerable improve- ment in this form after each of these remedies. " In the second form, Acidum nitric, is the chief remedy. When this form is purely pronounced without complication, particularly with the third form, the Nitric acid acts very promptly, and in twenty days, at the extent, the disease is cured. I have, however, cured, or evidently assisted the cure of several of these cases with Mercur. and Thuja. " In the third form, Thuja appears preferable to Acid, nitric, although the latter as well as Mercurius solub is a very effectual remedy in this variety. In one case, Acid, phosph. acted very strikingly. Staphysagria in another in the same prompt manner. In the fourth form, preference must be given to Cor allia rubra. Although this remedy is capable of curing a chancre of this variety in fourteen, or, at the extent, eighteen days, SYCOSIS. 283 yet still it does not appear to be able to prevent this form from becoming converted into the first, by which the treat- ment is considerably prolonged. Nitric acid may be ranked with Corallia in the treatment of this form, and in several cases in which rapid improvement did not succeed the admi- nistration of Corallia; and where the pruritus was very ve- hement, I gave Sulphur, which cured the disease in toto. " In the fifth form, which was the most rare, Sulphur was the chief remedy. Hepar sulphur, operated favourably in this form, when complication with bubo existed. "At first I gave Merc, solub. in doses of a drop of the fourth dilution, and when this was all gone I resorted to the fifth. At the beginning of the treatment I repeated the medicine every six or seven days, and afterwards every three or four clays. I have, however, cured several chancres with X000 and 4000. Nitric acid and Thuja were given in similar doses, but also with effect in the thirtieth dilution. Of Corallia I gave about a grain of the third trituration. Sidjhur and the liver of sul- phur I always administered in the X000, also Causticum, Sta- physagria and Phosphoric acid, and the two other preparations of Mercury in the third potence. One month was about the average time required to cure a chancre; several healed in fourteen days, in which cases, I must remark, that these patients were individuals who were able to follow strictly the homoeo- pathic dietetic regulations. In several cases, six weeks or more were consumed in the cure of the chancres, for which the patients themselves were in fault, as several confessed to me that they were not able to refrain from coition during the treatment. " The articles of diet which I forbade were— " 1. Acids : as vinegar and lemon-juice. "2. Spirituous drinks : wine, whiskey, beer, liquor, and all alcoholic drinks; beer I would have allowed had it not been adulterated with bitter plants. " 3. Spices, or rather medicines which have crept from the apothecary's shop into the kitchen, as coffee, tea, pepper, cin- namon, vanilla, the Cayenne pepper (Capsicum annum) which is used in Hungary, cloves, caraway, and aniseed. 284 SYCOSIS. " I also advised my patients to avoid the use of pomatum, medicated dentifrice, and perfumery of every description. Smok- ing I did not forbid, because no one would have obeyed me in this particular. " One o: the most important directions during the treatment of chancre relates to mental and particularly bodily quietude. The patient should go out as little as possible, walk very slowly, not wear tight pantaloons, or remain long sta.iding, and on no account drive or take horse exercise. My attention was directed to this latter circumstance several years ago, by the experienced Dr. Mueller, attached to the medical staff in Pesth. As I treated but few venereal patients after that period, this circumstance was forgotten. In Presburg, I treated a young man more than seven weeks for a large deep chancre, which did not lose at all its lard like base, and although it did not ex- tend either in breadth or depth, it evinced no disposition to heal. The patient was too well acquainted with the superiority of homoeopathy to adopt the advice of trying allopathic treat- ment. While we were discussing the probable cause which im- peded the cure, my patient inquired whether it was not pro- bable that daily horse exercise could be an injury ; Dr. Mueller's advice now struck me. I forbad riding on horseback, and in the course of eleven days the chancre was healed, the patient having remained in his room in his drawers, generally reclining upon the sofa. Corporeal rest is decidedly the best prophy- lactic against the formation of buboes. I must mention still another serious obstacle which greatly impedes the cure of all venereal diseases. I refer to the excessive anxiety of those youths who are infected for the first time; they fancy that they see themselves walking about without their olfactory organs, and covered with eruptions and sores. " At first I applied charpie to the sores; but as this became deranged and formed lumps, I preferred fine, clean, washed linen (not new). I subsequently abandoned this also, as every foreign body adheres to the sore as soon as it commences heal- ing and discharging, and on removing, irritates the chancre, and in general incommodes more than the secretions of the sore. "I have treated patients with several chancres conjoined SYCO.MS. 2",< with phimosis, without having seen the sores more than once, as the phimosis occurred a few days afterwards and continued to the conclusion of the treatment. When the prepuce could be retracted, the chancres were either completely cured or very nearly so. " When washing the sores, care must be taken not to press too violently upon them. Many patients gave themselves much trouble in endeavouring to wash off the lard-like matter forming the base of the chancre. Patients should be informed that this is futile and injurious. It is entirely impossible to clean the base of the sore, as this must be removed by the process of suppuration, produced by the action of the appro- priate remedy. Chancres of the first form generally discharge copiously, and for a long time, so that the patient's linen appears as much soiled as in gonorrhoea. When I perceive this increased discharge make its appearance, I always con- tinue the remedy which produced it, because this increased suppuration of the sore is the most natural remedy to cleanse and heal it. The period of increased discharge frequently occupies two-thirds of the whole time employed in the cure. I have, however, frequently seen perfectly healthy sores, which were much diminished in size and superficial, remain in statu quo without healing completely. This apparently depends upon the conduct of the patient, on whom the cure has ad- vanced thus far. " If doubt arises respecting the nature of sores on the geni- tals, whether they are really chancres or not, it is advisable to wait several days before administering our remedy. If in the course of six or eight days the sores are not healed, but have become larger, deeper, and the base lard-like, there can then be no doubt; the patient may talk as much as he pleases about the fidelity of his sweetheart. " In concluding this subject, I have still to remark, that in the cases of three patients afflicted with chancres I observed vermin, which are not uncommon in syphilis, and by us termed 'FilzUiusc,' (Pediculus pubis.) One of these patients, who was somewhat of a scrofulous diathesis, was troubled with them in two instances. I need scarcely remark, that these 2S6 SYCOSIS. patients observed the utmost cleanliness; as I do not at all consider these vermin as the result of filthiness, it is not im- probable that they are produced per generationem aequivo- cam, in the same manner as in the itch, either by the dis- charge from the chancre, or in transpiration of the patient, and consequently may be ranked as the product of the venereal disease. "Bueoks. Swelling of the inguinal glands, consequent upon Syphilis, are more dreaded by patients than any other form of this disease. It is well known how under allopathic treatment they are plastered, cauterized and incised again and again. I have treated eight patients with venereal buboes, without the necessity of one of them being confined to bed for a single day. A day or two before the spontaneous rupture of the swelling, the patient experienced a slight tensive pam when walking, but not any other inconvenience either before or after that circumstance occurred. The buboes usually broke while patients were walking, and had they not experienced the sensation produced by the moisture, they would not have been • aware of its occurrence. I have witnessed neither sinuses, fistulous openings, callous edges, nor partial remaining indu- rations, &c, in any of these cases, although I never made use of cataplasms to prevent induration, leeches for inflammation, or of the knife or caustics in opening them. " There is no doubt that buboes, which appear simulta- neously with chancres or immediately after their suppression with external remedies, partake of the venereal character. Scrofulous glandular affections are usually readily recognisable from the general diathesis, and the disorders of the glands in other parts of the body which are commonly present. But there are also buboes which appear sooner or later after co- ition without any other symptom of venereal infection. Whe- ther these glandular swellings are to be considered as venereal, has not yet been determined by adequate experience. I have seen two such cases. The one an arthritic man, aged thirty- eight, the other a young man of three-and-twenty. Both cases were preceded by frequent coition, and in the case of the first individual, it was inordinate. In the first case the bubo, sycosis. 287 which was confined to one side, was cured by resolution under the use of Sulphur and Nitric acid, the second by suppuration by Nitric acid alone. In the latter case there were two buboes of the size of a hen's egg, one on each side. " Buboes are treated homceopathically by the same remedy that is indicated for the particular variety of chancre which they accompany. The medicament that cures the chancre fre- quently operates so powerfully upon the bubo, that the latter suppurates and heals before the chancre is completely cured, so that in this case the bubo does not alter the peculiar treat- ment adapted to the chancre. Sometimes, however, the bubo remains after the chancre has healed, and in this particular case does it first become necessary to adapt our therapeutical efforts to the bubo itself. " I made use of five remedies in the cure of buboes. Merc. solubilis, Acid, nitric, Sulphur, Hepar sulph., Calc, and Sili- cea. The first two remedies I gave in drop doses of the fourth dilution, at intervals of four or six days, the last three in the thirtieth dilution, every eight days. , " Mercurius and Acid, nitric, operated better during the in- flammatory state of the swellings, previous to their opening. After this had occurred, I administered Sulph., Silicea, and the liver of sulphur with good effect. " I have frequently seen swellings of the inguinal glands arise in patients afflicted with very painful gonorrhoeas, in which much violent exercise was taken, particularly in individuals in- fected for the first time. In such cases I recommend the ob- servance of strict corporeal rest for a few days, and proceeded in the treatment of the gonorrhoea without reference to the inguinal swellings, and I have never seen them pass into sup- puration or induration, or remain after the cure of the go- norrhoea. " Conuylomata. The cases of this affection which have come under my notice, are too few in number for me to deter- mine whether this form of the venereal disease belongs to the syphilitic, or whether it depends on one of the various cachexies of Hahnemannian sycosis. The first view is favoured by the fact of the concomitant presence of chancre and condylomata, 288 sycosis. as well as the degeneration of many chancres into condyloma* tous structures; while the circumstance that this form of dis- ease frequently appears entirely alone without any admixture with the other forms of venereal, and has the peculiarity which is foreign to chancre of occupying the anus at the same time, or selecting this part alone as its seat, favours the Hahneman- nian views of sycosis. Be this as it may, the distinction is of no practical utility. The symptoms of this disease direct the physician to the appropriate remedy, no matter whether he considers the first or last view as correct—a superiority pos- sessed by homoeopathy in the treatment of this as well as other diseases, which is not acknowledged only because it is desirable to arrogate the appearance of science. " In the case of a patient with two large condylomatous ex- crescences on the anus, who had been previously treated by caustics, neither Thuja, Nitric acid, Acid, phosph., Lycopod., Sulphur, Psorin, nor Sycosin, were of any benefit. Staphy- sagria. X000, repeated every five days, removed the disease al- most entirely in the course of two weeks, so that I gave the patient a few doses more of the latter remedy, in hopes that the disease would be completely overcome in a short time; the pa- tient, however, did not return; I, therefore, cannot say how the case terminated, although it is very probable that the pa- tient was cured. " The condylomatous case, which I have mentioned as cured, was that of a patient with three condylomatous excrescences, which had been cauterized, but were reproduced. I gave him Thuja X1 °, seven days after Sulphur X, seven days later Acid. nitric. 4, gutt. una, for two successive day3, all without effect. The Thuja was now repeated, but in the fourth dilution, a drop every third day, after which the excrescences were dimin- ished one half in size. The repetition of Thuja of the fourth dilution entirely cured the disease. " Throughout this work I have avoided the recital of cases, for in this disease one case very much resembles all of the others. In sycosis I have made an exception, in order to be able to introduce the remark that Thuja, which in this case was the proper curative when first administered, was not at- SYCOSIS. 289 tended with any success, and did not prove beneficial until ad- ministered in a lower dilution after two other remedies had been given. I am perfectly willing that this favourable result should be ascribed tc*the lower dilution, but must remark, that in at least ten cases of intermittent fever, in which Ipecacuanha proved fruitless, and several other remedies given subsequent to it likewise proved inefficient, that Ipecacuanha then admin- istered in the same dilution and dose, was attended with the most favourable result. " Gonorrhoea.—This form of the venereal disease is of all others the most troublesome, as well for the patient as his phy- sician. To the patient, as it is the cause of much pain, sleep- less nights, fever and other analogous symptoms, which may result in inflammation and induration of the testicles, stricture of the urethra, &c, either owing to the misconduct of the pa- tient or to the preposterous and violent allopathic^reatment. Gonorrhoea is a troublesome disease to the physician, owing to its tendency to become chronic, and in the form of a gleet to continue long and obstinately. It appears to be the general character of diseases of mucous membranes to run their course sluggishly. We frequently see catarrhs, in themselves unim- portant, continue for several weeks. This is also the case with various mucous diseases of the nose, ear, vagina, &c, which are rendered chronic as soon as an increased mucous secretion appears. The usual time required to cure an acute gonorrhoea, was one month. Several were cured in fourteen days ; a few cases de- generated into gleet. " I experienced the best effect in the treatment of this disease from the exhibition of Cann ibis in the fourth dilution, in drop doses, which were repeated at intervals of five or six days. I occasionally repeated the remedy for two or three days in suc- cession, and then waited seven or eight days. " Pulsatilla was given with effect also in drop doses of the fourth dilution, where general corporeal agitation, very dimin* ished appetite, evening chill, increased thirst, Sec, were present. In three or four days, this febrile state was usually allayed, and then continued the Cannabis. 13 290 sycosis. "A few globules of the 30th dilution of Cantharides were always effectual in very painful erections, violent burning and strangury. In one case haematuria supervened, which was not relieved by Ceintharides, but by Mezereunr. " Mercurius solub. 4 gutt. una, effected a rapid cure in a case of gonorrhoea attended with a greenish discharge. In this case, however, several sores were present, which indicated the application of Mercury. The gonorrhoea was cured before the chancres. "At first, before I had effectually tried the efficacy of Can- nabis, I tried Bienorrhin, in doses of several globules of the thirtieth dilution. A gonorrhoea in which Copaiva proved in- efficient, was cured in two weeks by two doses of Bienorrhin. In several other cases, this remedy effected considerable im- provement, although it did not produce a complete cure. But as Cannabis with an intercurrent dose of Pulsatilla, Cantha- rides, or in cases of very frequent urination, Petroselinum, acted very favourably in a majority of cases, I made no far- ther trials with Bienorrhin in acute gonorrhoea, although I made use of it in gleet. "Gleet. Nine cases of this disease were cured with Ble* norrhin 30th, Sulphur 30th, and Cannabis 4th gutt. una. I repeated Cannabis every five, and the other two remedies every eight days. I am unable to mention any particular indications for the employment of any of these remedies. Ge- nerally Sulphur, given at first, produced considerable improve- ment, diminished the discharge perceptibly, but excited slight burning in the urethra, after which I usually gave Cannabis with effect. I observed this frequently. I have, however, per- fectly cured painless gleets with Cannabis aided by Sulphur or Bienorrhin. "As regards the dietetic treatment in gonorrhoea, all violent exercise must be avoided. If the testicles are sympatheti- cally affected, the patient must wear a suspensory bandage, or at least support the testicles with a handkerchief. Beer should not be taken during the existence of acute or chronic gonorrhoea. " I saw discharges unattended with pain, reproduced in se- SYCOSIS. 291 veral patients who indulged freely in wine immediately after their gonorrhoeas had been cured; it, however, soon disappeared; the very severe burning can be much diminished by the patient's drinking water very freely, by which means the urine is in- creased in quantity and rendered less acrid. This innocent palliative produces great relief to the patient, and should, there- fore, never be neglected. " Inflammation op the testicles. I treated but two cases. One was in company with a gonorrhoea, or rather go- norrhoea conjoined with swelled testicle. The patient being af- flicted with gonorrhoea, went out a hunting in cold damp wea- ther, and returned with violent pain in the testes. The disease increased during the night, and both testicles were swollen, hard, not bearing the slightest touch, the scrotum red and tense, some fever which continued until the evening of the succeeding day. There was scarcely any discharge from the urethra. Two doses of Clematis, 12th dilution, three globules repeated every three days, cured the disease, after which the gonorrhoeal discharge reappeared: Swelling of the epididymis of one of the testes, which still remained, was removed by Aurum iv. dis- • solved in water. " The second case was a relapse, which had previously been subjected to allopathic treatment. It wa#relieved by China S-j^2-, and Aurum —-. China was administered three times, Aurum twice. " The patient should remain in bed and have the testes pro- perly supported. " Gonorrhoea glandis. Incorrectly so termed. It could with more propriety be called inflammation of the glans penis. I treated two cases. One case was conjoined with gleet. The glans was verv red and swollen, small fissures appeared on va- vious parts of it, and in a few days, a very offensive mucous secretion succeeded, which increased very much in a short time, and affected the prepuce also. Corallia 3, one grain repeated in four days, cured the bal ano-blenorrhcea, and Canna- bis and Sulphur the gleet. The second case was connected with chancre, was not so violent, and was cured by the use of Mercury- 292 SYCOSIS. "A few years ago I cured several of these cases with Thuja «*. Nodes. The patient had been afflicted three years before with a chancre which was cauterized. After taking a violent cold from exposure to moisture, the patient had a gouty attack. It was treated without effect; a depot formed on the tibia, which was attended with such violent boring and rending pains, parti- cularly at night, that he was deprived of all nocturnal rest, and obliged to quit his bed. He then underwent a course of ' Dzondischer' pills, which rather increased than relieved his malady. After the administration of half a grain of Hepar sulph., Calc. 3d trituration, he was able to sleep several hours in the morning. Two additional doses of Hepar, given at in- tervals of eight days, removed the pain almost entirely; the patient ate, drank, and slept as in health, though the swelling was not perceptibly diminished ; this, however, disappeared en- tirely on administering three doses of Acid, nitric, x, at inter- vals of from eight to ten days. " The other patient had two osseous swellings of the size of a pigeon's egg on the head, and an eruption over the whole body, for the relief of which he had taken several hundred • baths, and as many mercurial pills. The patient was cured after eighteen monHs' treatment which was repeatedly inter- rupted. Of course he took very many homceopathic medi- cines, so that I am unable to mention the results obtained by any particular one, especially as during the latter period I treated him only by letter. " Complications. "Chancre ano Bubo.—The treatment of this form of complication has been described under Bubo. " Chancre and Gonorrhoea.—If the gonorrhoea is very painful, the treatment of the chancre, which otherwise is prefer- able, must be suspended, and Cantharides or some other ap- propriate remedy be exhibited. This also holds good if profuse and continued haematuria supervenes. "Chancre and Condylomata.—In this case, the treat- ment can be united, as Thuja and Nitric acid are particularly indicated in both forms. SYCOSIS. 293 " Gonorrhoea and Hernia humoralis.—Here of course the latter must be treated without delay. " The other complications are not of importance, and the treatment of them is obvious. " Syphilis secundaria. Secundaria Syphilis. "Aurum.—Nasal speech, stinking ichor and small pieces of bone discharged from the nose ; ulcers on the palate, the tonsils are corroded by ulcers; offensive discharge from the ears, with violent boring pains in them ; painful periosteal swelling on the hairy scalp, forearm and tibia; on the head itching nodes ; rending pains in the bones of the extremities. " Aurum.—Inveterate syphilis : the nasal, frontal and superior maxillary bones swollen and reddened, with sticking pains in them; bloody, fetid discharge from the nostrils, the margins of the eyelids reddened at their inner canthi; if the head is not kept warm, headache as if a draught of air passed through it. " Acidum nitric.—On the head isolated, humid pustules; the face full of maturated pustules, with broad red margins, which after some days form crusts; on the right ala nasi, a condylomatous protuberance of the size of a bean, covered with a scab; tonsils red and swollen; there was formerly a raw spot on the anus between the legs ; pruriency and humidity of the integuments. " Hepar sulphuris, Rhus. " Sepia.—Inveterate syphilis, with ulcers of the glans and prepuce. After Mercur., Acidum nitric, and Thuja had been given without perceptible improvement. " Thuja, with the aid of Graphit and Sepia, were given, copious discharge of pure mucus from the urethra in a subject who had previously taken much Mercury, slight burning when urinating, the bulbous portion of the urethra painful internally, the orifice of the urethra red, swollen, the inner surface of the prepuce red, pain in the region of the bladder, ulceration of the base of the glans, scrotum painful, many nocturnal pollutions, headache, melancholy, inclined to suicide." Dose : -§-, or —-, or j%; or the tincture or trituration according to circumstances. 294 RHEUMATISM. (Additions to p. 313.) Ferrum is sometimes useful in alternation with Rhus, par- ticularly when the pains are relieved by frequently shifting the position of the limbs; or after, or in alternation with Pulsa* tilla, when the pains fly about from one part to another, and are of a lancinating description. Arsenicum is a most valuable remedy when the pains are *0f a tearing, dragging, lancinating, burning character, accom- panied by anxiety and uncontrollable restlessness and sleep- lessness, with great heat of skin and excessive thirst, small accelerated pulse and swelling of the extremities. In rheu- matic metastasis to internal organs, especially the heart, Arse- nicum is one of the most important remedies. Accessions of sweat, with mitigation of suffering, is a characteristic indica- tion for Arsenicum. Colchicum :—Rheumatism, with gastric derangement and slight fever, during the prevalence of cold, damp weather; or rheumatic fever (continua remittens), exacerbated in the after- noon, with general dry heat, palpitation of the heart, thirst, and fugitive sweats; shooting, tearing pains in the affected parts, becoming almost insupportable at night, subsiding to- wards morning, and then suddenly fixing upon some other part of the body, which in its turn becomes painful and in- flamed, whilst the previously affected part loses its former redness, but remains in a tumefied state for a few hours. China is of much service at the commencement of an at- tack of rheumatic fever, when the following symptoms are met with : nocturnal, pressive, aching pains in the head, with ex- cessive general restlessness, which disturbs sleep; fugitive chills in the back, and tendency to sweat on covering up the parts, or on the slightest excess of clothing; the chilliness gradually extends over the whole body, but consists more of an internal than an external feeling of chilliness, with exception of the hands and feet, which are as cold as ice; by degrees partial heat supervenes, with exacerbation of headache, and RHEUMATISM. 295 distention of the vessels, dragging, tearing pains in the back, sacrum, thighs, and knees, with weakness in the affected parts, and aggravation or renewal of suffering on touching or handling them ; sometimes symptoms of gastric or bilious derangement make their appearance at the same time, as bitter taste, with yellow furred tongue, bitter eructations, nausea, and even vomiting, and excessive thirst.* Ranunculus bulbosus. This remedy is also of consider- able efficacy in rheumatic fever, and is indicated by some of the characteristic symptoms which call for the empl oyment of China, such as aggravation or renewal of the tearing, shoot- ing pain by the touch, or by movement, or alteration of posture. "The fever partakes of the type of a continua remit tens, becomes exacerbated towards evening, and is attended with a strong full pulse. The pains are of a fugitive character, and are, in addi- tion to the above peculiarity, which is common to China, gene- rally aggravated by cool air. Semilateral heat, with coldness of the hands and feet, is likewise an indication for Ranunculus bulb, in rheumatic fever.t Rhododendron chrysanthum. Rheumatic fever (of the character of synochus), in which the chilliness alternates with heat, accompanied with pressive headache from within outwards, and drawing in the limbs; dry heat in the trunk during the night, with restlessness and sleeplessness, followed by slight general heat towards morning, on mitigation of pain. The nocturnal drawing, or dragging and tearing pains, occupy the periosteum chiefly, are aggravated by bad, changeable weather, and by rest. Sulphur:—Drawing, pricking, or drawing, tearing pains in the extremities and joints, with slight swelling of the latter; migitation of pain from external warmth, and aggravation from cold ; exacerbation or accession of pain when at rest, and ameli- oration on movement; but chiefly when the pains are of a fixed character. Rheumatic fever, with alternate heats and chills, anxietas prEecordii, and pains in the head and neck, and * See Hartmann's Acute and Chronic Diseases. 4 vols. $6. t The same. 296 RHEUMATISM. severe pricking in the sacral region; the headache increases, by its violence, the great tendency to restlessness and disturbed sleep, and admits of no rest in any position. The accompany- ing fever is a continua remittens, with exacerbations in the evening, or after retiring to rest, consisting of shivering chills, which it is impossible to allay by warmth, and which terminates in heat after an hour or two; towards morning, sweat of an acid odour. Commonly, there is complete absence of appetite, or desire for acid food only, with great thirst, parched mouth (or sensation of dryness), sour eructations, distention of the scrobiculus and abdomen, and sensibility to the touch; costive- ness.* Arnica is characteristically indicated when the extremities are affected with tensive, tearing pains, or pains as if caused by a bruise, attended with debility, redness, and swelling, ex- acerbation from the slightest movement, and yet it is found impossible to retain the limbs long in one posture, in conse- quence of the unremitting pain and the restlessness* which arises from so doing. In pains of a similar description af- fecting the thorax, particularly the posterior portion, this reme- dy is still more e fficacious, with the contradistinction that they are mitigated by movement; chilliness and heat exist at the same time, i. e., whilst one part feels warm to the touch, an- other feels cold.f Lachesis has been found of great efficacy in rheumatic fevers, and especially in those occurring after the abuse of mer- cury. It is chiefly indicated by pain and stiffness, with swell- ing of the affected part, sensibility to the touch, and exacerba- tion of the pains during movement, towards evening and at night; sweat, which brings no relief. Mezereum is equally efficacious in rheumatic fever after a course of mercury in large doses, when the pains occupy the long bones, and are principally of a drawing and tensive de- scription. Carbo v. :—Drawing tearing pains in the thorax, with * Hartmann's Acute and Chronic Diseases. t The same. RHEUMATISM. 297 paralytic sensation, and obstructed respiration; also when ex- cessive flatulency is present. Euphorbicm. Tearing, or pressive, aching, shooting pains, exacerbated during rest, ameliorated by movement. Obstinate cases of rheumatism frequently require a long, careful, and discriminative treatment. In some cases much benefit will be obtained from repeated doses of Sulphur; in others, Calcarea, particularly when the pains are increased at every change of the weather. Hepar sulphuris and Lachesis alternately have been recommended in the severest kinds of acute rheumatism. Colocynth is frequently useful against the stiffness which remains; or Nux, Cocculus, and Ignatia, when there is stiffness of the entire frame, with threatening rheu- matic paralysis. In the event of a sudden metastasis to the chest, attended with oppressed respiration, palpitation of the heart, and excessive agitation, AconHum should be immediately administered in repeated doses until relief is obtained; but should the improvement only prove temporary, Sulphur and Pulsatilla have been recommended to be given in alternation. Bellaelonna and Bryonia may also be of service in dangerous results of this kind. When the heart becomes implicated in acute rheumatism or rheumatic fever (Endocarditis or Pericar- ditis rheumatica), Belladonna, in repeated doses, is frequently, in addition to Arsenicum, a most useful remedy if timely ad- ministered ; and may, in some cases, be advantageously em- ployed in alternation with Aconitum, and followed by S/iigelia 1st or 3d, and Digitalis 1st or 3d dilution, or Cannabis or Bry- onia, according to circumstances. These remedies, together with Cannabis, Arsenicum, Lache- sis, in some instances, are the most valuable in the treatment of idiopathic .ndocarditis, Carditis, or Pericarditis, which see. Against rheumatism with Fever (rheumatic fever), Aconitum, Belladonna, Bryonia, and Chamomilla are the most appropri- ate medicaments when the accompanying fever runs high or is of a synochal type; and Merc, Rhus, Nux v., Puis., Cocc, Calc, Chin., Ars., Ran., Rhod,., Dulc, Indig., Am., and Sulph., when it is of a sub-inflammatory type. 13* 298 RHEUMATISM. Against Non-febrile rheumatism : Argent, m., Asa. (when the pains proceed from below upwards, as, for instance, from the hand to the arm and shoulder), Clem., Hep., Lach., Lye., Phosph., Veratr., Nux, Puis., Thuja., Sang, can., Ign., Mere, Dulc, Sulph. chiefly. For rheumatism in the Joints, with or without swelling (articular rheumatism), Aeon., Bry., Bella., Rhus, Ant, Clem., Am., Led., Lye, Hep. s., Sulph., Calc, Sep., Argent, metal. (without fever). For rheumatism in the upper extremities: 1st, The Shoulder : Aeon., Bry., Puis., Rhus,—Kan, Magn., Assa., Carb. v., Sil., Thuja, Nux, Staph., Hep., See. 2d, The Arm; Assa., Cocc, Led., Pids., Sab., Veratr., Gn/aj., Chin., Ant. c, Bella., Bry., Kali, M. arct., Sec. 3d, The Forearm : Rhus, Merc, Staph., Calc, Nux v., Sulph., Sep., Sil, H^p., Lye, Ran. bulb., Ran. seel, See. Lower Extremities : 1st, The Hip or Hip-joint : Bry., Calc, Led., Rhus, Ant, Coloc, Chin., Dulc, Ign., M. austr., M'.c, Nux v., Puis., VerePr., Phosph., Arn., B-dla., Sec 2d, The Thigh: Mre, Gu ij., China., Bella., Bry., Calc, Carl, a., Clem., Coloc, Ign., Pids., Sulph., A!'n., Carb. v., Cocc, Nux v., Rhus, Thuja., Sec. 3d, The Leg: Calc, Lye, Puis., Sep., Sil, Staph.,— Ant. c, Arn., Ars., Cham., Chin., Coloc, Guaj., Led., Mag. arct., Mag. aust, Phosph., Thuja, Veratr., Mere, Nux v., Ran. seel, Sec. Against rheumatism in the Thorax (pectoral and intercostal muscles particularly): Arn., Phosph., Ran. bulb., Spig., Sulph.,—Ars., Bella., Carb v., Hep., Merc, Ran. seel., Sep., Sil, Bry., Calc, Chin., Didc, Led.. Lye, Cocc, Nux v., Rhus', Staph., Veratr., Sec. In the Heart : Aeon., Lach.; and Ars., Bry., Bella., Puis., Spig., Sulph., Calc, Cham., Chin., Mere, Nux , Thuja, Tabin,, Curb, v., Rhus, Phosph., See. Back : 1st, The Shoulder-blades (scapulae) : China, Merc, Rhus, Sep.,—Aeon., Arn., Bry., Coloc, Phosph., Ac. ph., Ran. bulb., Rhod., Staph., Assa., Bella., Cede, Cocc, Nux v., Sulph., Veratr., See. 2d, The Dorsum : Arn., Ars., Bell, Cocc, Nux, Puis., Suleh., Calc, Lye, Sep., Sil,— Assa., Bry., Cham., Dulc, Hep., Ign., Lach., Led., Mag. rheumatism. 299 aust, Phosph., Ac. ph., Rhod., Spig., Staph., Thuja, China Coff., Guaj., Merc.y Rhus, Veratr. (See Lumbago). 3d, The Sacrum : Nux v., Puis., Rhus. Sep., Sulph.,—Ars., Bella., Carb., Dulc, Hep., Mag. aust., Ac. ph., Staph., Thuja, Arn., Bry., Calc, Cham., China., Cocc, Ign., Lye, Phosph., Veratr., Sec. For rheumatism in the Head, Spigelia is one of the most effective remedies; in other cases, Aeon., Bella., Bry., Lye, Acid, nitr., Merc, Ipecac, Ign., Coloc, Sulph., Led., Lach., China, Phosph., or Cham., followed if required, by Nux v. and Puis, at intervals of twelve hours. In rheumatism arising from the abuse of Mercury : Sulph., Carbo v., Sass., Lycop., Guaj., China,—Acid, n., Hep., Lach., Bella., Calc, Ac. ph., Puis., Dulc, are the most useful in general cases. In that which has been produced by the excessive and injudicious employment of Cinchona : Puis., Ars., Carb. v., Merc., Sulph., Sep., Veratr., and Calc And in Gonorrhoeal rheumatism: Clem., Sass., Thuja., Puis., Tussilago petas., Daph., Lye, and Sulph., may be considered the most appro- priate medicines. For Chronic Rheumatism the following are the principal remedies: Veratrum, Phosphorus, Carbo v., Sulph.j Lycop., Hepar., Lach., Clem., Indigo, Valeriana. When the pains are aggravated or excited by the slightest chill,—Aconite, Calc, Bry., Dulc, Merc, Sulph., Acid, phosph., will gene- rally be found the best remedies from which to select. When the attacks are excited by unfavourable weather,—Calc, Rhus, Dulc, Rhod., Verat, or Lycop., Carbo v., Lach., Hepar, Mang., Nux m. ; and when every change of weather brings on a relapse,—Calc, Silicea, Sulph., Dulc, Merc, Lach., Rhus, and Veratrum are usually the most useful. For rheumatism arising from a chill in the water, or from cold, moist weather,—Calcarea, Nux m., Sarsaparilla, or Sulph., Dulc, Carbo v. Rheumatism with paralytic weakness,—Arnica, Ferrum, China, Sec, or Electro-magnetism, when painful jerkings are experienced in the part. Against unsettled or shifting rheumatic pains, in addition to Pulsatilla : Rhus, Arnica, Bryonia, Nux m., and in some 300 EOTROPIUM. instances, Rhod., Daphne, Mang., Plumb., or Crocus, Valeri- ana, and Assafetida, are the most appropriate medicines. Rheumatism from congelation,—Arsenicum, Bryonia, Nux moschata, chiefly. Dose: ^^, or A^, or ^f; also the tincture, according to circumstances. ECTROPIUM. This affection consists in a retraction or aversion of the eye- lids, owing to which circumstance their conjunctival tunic or internal surface is turned outwards. There are two species of the disorder: one occasioned by turgescence and relaxation of the lining of the eyelids, produced by violent inflammation; the other is caused by contractions of the skin covering the eyelids, or of that in the vicinity, induced by the cicatrices of confluent smallpox, burns, or wounds. In the former variety the morbid swelling not only pushes the margins of the eyelids from the ball, but renders them everted ; in the latter the edges are primarily displaced to some distance from the eye, and afterwards turned entirely outward, along with the whole of the affected eyelid. In both varieties the eyeball, from being exposed, and sub- mitted to constant irritation, is rendered dry and inflamed, the tears escape over the cheeks, vision is impaired, and sometimes ulceration or opacity of the cornea supervenes. The conjunc tiva, from the same circumstance, becomes thickened, fleshy, and finally indurated. Therapeutics. When ectropium arises from turgescence and relaxation of the palpebral lining, Mercurius and Hepar sulphuris are often sufficient to effect a cure; but in other cases, Arsenicum, Sulphur, or Calcarea are required, particu- larly when the affection is met with, as it commonly is, in debilitated, unhealthy subjects. — Belladonna, Euphrasia, China, Sec, have also been found useful. When contraction of the skin has produced the complaint, the cure may be said to be only attainable by means of an operation. Dose : *f a or a$* or § §. ENTROPIUM.—SCURVY. 301 ENTROPIUM.—Irichiasis. In this complaint the eyelashes and the margin of the eyelids are inverted towards the ball of the eye, and cause great pain and inflammation. Wrben it has existed for a considerable time, the cornea is rendered opaque, prominent, and indurated, or ulceration and even complete loss of vision result. Relaxa- tion of the skin of the eyelids, in consequence of previous chronic inflammation, disease of the meibomian glands, and the cicatrices of ulcerations, or wounds on the palpebral conjunc- tiva, form the general exciting causes of the disorder. Therapeutics. Pulsatilla, is one of the most serviceable medicines in entroprium, and is frequently sufficient to effect a cure. In other cases, Borax has been found useful. Bella- donna, Mercurius, Hepar s., Euphrasia, and occasionally -Nux v. and Chamomilla may also prove efficacious, particularly where the malady has originated in disease of the meibomian glands. When the contraction of cicatrices has given rise to the affection, it is to be remedied by cutting out as large a por- tion of the skin of the affected eyelid, opposite the centre of the entropium, as will be adequate, on tjie approximation of the lips of the wound, by means of adhesive plaster or a small suture, to replace the tarsus and ciliae in their normal position. Dosb : aaa 0r *■**-, or *£. SCURVY. Scorbutus. (Additions to p. 346.) Against hemorrhage from the gums, Staphysagria is one of the principal renTedies. Mercurius is also a good remedy in such cases, especially when the gums are painful, swollen, spongy, and jagged at the margins; but when the foregoing abnormal state of the gums has evidently originated in the abuse of Mercury, they must be combated by such remedies as Carbo v., China, or Hepar s., Acid, nitr., See. Acid, phos- phoricum is another important remedy in bleeding from the gums, especially when it is readily excited by touching or rub- 802 inflammation of the tongue.—bronchocrle. bing the gums, and when the gums feel as if excoriated. Alu- mina, Sepia, Natrum m., Silicea, Lycopodium, Kali c, Acid. sulph., Rhus, Ambra, and Ruta, may also be enumerated as useful remedies in affections of the gums, such as ulceration, &c, with tendency to bleeding from the most trivial cause. In the case of morbid growth or excrescences on the gums, Stapyhsa- gria is deserving of notice. Dose : ***-, or **&, or fj. INFLAMMATION OF THE TONGUE. Glossitis. (Additions to page 343.) In cases of soreness or ulceration of the tongue, Mere, Nux v., Ars., Carbo i\, Sulph., Acid, nitr., Acid, sulph., Natr. m., Acid, fluor., Silic, and Staph, are the most effective remedies. Against Ranula, or the formation of an inflammatory or in- dolent tumour under the tongue, in consequence of obstruction of the salivary ducts from cold, inflammation or other irritating causes, Mercurius, Calc, and Thuja have chiefly been em- ployed. In some cases, one or more of the following remedies may be requisite for the removal of the obstruction, after the tumour has burst, and left the usual obstinate ulcer behind: Petroleum, Sulph., Silicea, Puis., Stann., or Staphysagria, provided Mercurius or Calc. should not be more appropriate in this stage of the disease likewise. When the tumour is of an inflammatory nature, Mercurius and Silicea may generally be resorted to. Dose : "^ or *%*■ or f *. BRONCHOCELE. GOITRE. Derbyshire neck. (Additions to page 353.) Ferrum, Sepia, Thuja, particularly when the superficial veins of the swelling are in a varicose and painful state, and Carbo v. or Lycopod. fail to effect any amendment. When, sleeplessness. 303 either from exposure to cold or otherwise, the thyroid gland has become slightly tumefied, and there is at the same time redness of the integuments over and around the swelling, at- tended with impeded deglutition, violent headache, cough, and a considerable degree of fever, a dose or two of Belladonna, at intervals of twelve hours, will act beneficially; should the ac- companying fever become intense, Aconitum may be resorted to. If, on the other hand, there be no discoloration of the Surrounding skin, and the fever be of a less active character, Mercurius should be prescribed. When symptoms of suppura- tion have set in, Mercurius is still called for, and should then be administered every four to six hours, in order to forward the bursting of the abscess. Silicea is sometimes required, if the suppurative process proceeds very tardily. When the tumefied gland does not disperse under the action of Bellad. or Mere, or when it has already become indurated before medical aid has been sought, Spongia, Natrum, Co- nium, Sulphur, and Calcarea are amongst the most useful re- medial agents. Dose : -§-, or2^ or f-, according to circumstances. SLEEPLESSNESS. Agrypnia. (Additions to page 358.) When sleep is prevented, disturbed, or accompanied by the symptoms hereafter noted, the remedies mentioned will be more or less indicated, and must be selected according to the entire group of symptoms. Aching pains in the body (sleep disturbed by) : Lye, Mang., Phosph. ac, Merc, — Am. m., Anae, Aur., Baryta c, Lachesis. Anxiety (sleep disturbed or prevented by): Ars., Bell, Ferr., Kali, Op., Petr., Rhus, Veratr., Calc, Carbo v., Cham., Mere, Hep., Phosph., Puis., Nux v., Sulph., Sec. Arms, heaviness in the (sleep disturbed by a feeling of), Diad. Agitated sleep: Nux v., Led., Ac nitr., Oleand., Sulph., Zinc. 304 sleeplessness. Arms, swelling, enlargement of the (sensation of) : Diadema. Back, pain in the : Am. m. Bulimy : Cinchona, Bry., Phosph., SeL, Sulph. Burning heat in the blood-vessels : Arsenicum. Carphologia (during sleep): Op., Bell, Hyos., Cocc, Ars., Phosph., Phosph. ac, Rhus, Stram. Chest, pain in the (aching and oppression) : Alum. Am. e, Am. m. Coldness or shivering: Alum. Amb., Am. m., Carbo v. et a., Graph., Kali, Nux, Sulph., Mere, Arg., Ars. Daph., Staph., Calc , Acid, m., Are, Sec. Coldness, sensation of, during sleep : Ambra. Congestion in the chest during sleep : Puis. Colic: Lye, Plumb., Sep., Staph., Aeon., Amb., Am. c, Am. m., Kali, Magn., Magn. s,, Ac. nitr., Rhus, Ars., Aur., Merc, N. mos., Puis., Sulph., Ac. Sulph., Fer , Sec. Convulsions: Cin., Cup., Hyos., Calc, Lye, Merc, Op., Puis., Sec. Cramps (in the calves of the legs) : Anae, Kali e, Rhus, Sulph., Nux v., Lye, Bry., Carbo v., Cham., Magn., Magn. m., Sep., Staph., Veratr., Sec. (See Jerking). Cramps in the legs : Anae, Kali, Sec. (See Cramps ) Creeping, crawling sensations (formication) : Sulph., Lye, Carbo v. Cries during sleep: Puis., Sulph., Bellad., Bry., Calc, Cham., Cin., Cocc, Lye, Sep., Sil, Stram., Croc, Gran., Ac. nitr., Sec. Deglutition, during sleep : Calcarea. Delirium, wandering during sleep: Nux v., Lach., Op., Puis., Sulph., Bellad., Bry., Cham., Aur., Dig., Camph., Coloc, Sec. Dreams. Dreams, sleep disturbed by Agitated, Anxious: Nux v., Puis., Am., Graph., Magn., Phosph., Sulph., Thuja.— Alum., Ant. tart., Bar., Car., Carb. a. et v., Cham., China, Cocc, Con., Dig., Grap., Guaj., Hyos., Law., Led., Lye, M. arct, M. austr., Mang., Mez., Merc, Mur. ac, Natr., sleeplessness. 805 Natr. m., Nitr., Op., Petr., Ph. ac, Plat., Plumb., Ran. bulb., Ran. seel, Spig., Stann., Staph., Verb-, Ac, Sulph., Veratr., Zinc, Sec. Amorous Dreams (sleep disturbed by) : Lach., Viol, trie, M. arct., Natr., Nux v., Staph., Op—Alum , Bism., Calc, China, Cocc, Hyos., Led., Lye, Magn., Mere, Natr. m., Phosph. ac, Rhod., Samb., Spig., Stann. S'ram., Sulph., Thuj., Valer., Veratr., Canth., Ign., Graph., Oleand., Sep., Plat., Puis., Sabad., Par., Sec. Animals, dreams of (sleep disturbed by) : Arn., Merc. Bell, Phosph., Hyosc, Sil, Ac. sulph., Nux v., Sulph., Sec. Apprehension (attended* with) : Arsenicum. Assassins, (dreams of) : Belladonna, Silicea, Sec. Bodies, mutilated : Am., Nux v., Con. Business, Occupations, Events op the Day : Nux v., Bry., Puis., Sulph., Bella., Lye, Merc, Sil, Cic, Hep., Phosph., Rhus, Ac nitr., Magn-, Staph., Stan., Sec. Business, of urgent: Nux vomica. Cares of: Arsenicum. Complicated, confused dreams: Aeon., Alum., Bar., Bry., China, Hell , M. arct., M. aust, Magn., Phosph., Puis., Sil, Valer., Cann., Cic, Stann., Sec. Contradictory, irritating: Asar., Aeon., Ambr., Amon., Anae, Ars., Calc, China, Cina, Dig., Lye, Ign., Mag. m., Mur. ac, Natr., Nux v., Op., Phosph., Rheum, Rhus, Sil, Staph., Sulph., Bry., Calc, Sec. Continued after waking: Aeon., Bry., Natr., Calc. Ign., Natr. c, Sec. Cruelties, dreams of: Nux v., Silicea. Dangers, of : Anae, Calc. ph., Con., Hep., Kali, Nitr., Ran., Thuj., Sulph. Darkness, of: Arsenicum. Death, of: Ars., Magn., Thuja.—Anae, Am., Calc, Graph., Kali, Lye, Magn. m., Phosph., Phosph. ac, Plat, Sassa., Ac. Sulph., Verb., Lach., Cocc, Con., Puls.: Sec. Death, dreams with fear of: Alum., Thuja. Demons, dreams of: Kali carb., Natrum carb. Disease, of: Nux vomica.—Calc, Cocc, Kreos., Kali.— 306 sleeplessness. Amm. m., Bar., Hep., Phosph., Sil.—Anae, Dros., M. arct, Can., Scill, Zinc. Disgusting dreams: Nux v.—Sulph., Magn. m., Natr. m.; Zinc — Aurum, Anae, Chel., Kreos., Mur. ac. Phosph., Puis. Disagreeable, unpleasant: Nux v., China, Laur., Phosph., Natr. m., Rhus, Sec. Dancing, of: Magnesia carb., Magnesia mur. Disappointments. Mortifications, of: Dig., Mosch., Ign., Staph., Rheum, Sec. Falling, of: Thuja.—Amm. m., Dig., Aur., Bellad., Kreos., Hep., Magn. m., Mere, Sep., Sec. Fantastic dreams : Calcarea, Natrum mur., Opium.— Carbo a., Con., Graph., Kali, Lye, Natr. c, Sep., Sulph.— Bary. c, Carbo v., Lach., Nux v , Sil, Spong., Led., Amb., Puis., See. Festivities, (dreams of): Antim. crud., Mgs., Ac nitr., See. Fire, of: Hepar sulphuris, Magnesia carbonica, Magnesia muriatica.—Anae, Croc, Phosph. — Alum. Ars., Bellad., Calc, Kreos., Laur., Mag. ausir., Spig., Sulph., Sulph. ac, See. Floods of: Magnesia carb., Mercurius, Natr. carb. Flying, of: Natrum sulph. 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., Sec. Furunculi : Prunus spinosa, Sec. (See Dreams of Dis- eases.) Hemoptysis (dreams of): Mephites, Sec. (See Dreams of Diseases.) Hemorrhage : Phosphorus, Sec. (See Dreams of Diseases.) Historical dreams: Amm. c, Merc, Sec. Indecision of : Arnica monUma. Ignominious, Humiliating dreams : Moschus, Asar., Alum., Am., Am., Con., Staph., Sec. Learned Subjects, of: Ignatia, M. arct. Linen (of foul) : Kreosotum. Lively, Vivid : Phosphorus, Rhus toxicodendron, Sulphur, sleeplessness. 307 Silicea. — Nux v., Puis., Op., Lye, Calc, Anae, Arn., Bellad., Bry., Cic, Mag., Mar., Natr., Phosph. ac, Sabad., Sep., Stann., Ambra, Ars., Carbo 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., Sec. Losses, of: Mephites. Marriage : Alumina. Meditation, Reflection (dreams with): Bryonia, Ignatia, Nux vomica.—Lach., Anae, Sabad., Sabin., Thuja, Aeon., Am., Camph., Carbo a., Graph., M. arct., M. austr., Puis., Rhus, See. Misfortunes, dreams of: Nux vomica, Pulsatilla, Lycopod., Graphites, Thuja.—Amm. m., Am., Bellad., Cham., China, Kali e, Phosph., Sassa., Sulph., Sulph. ac.—Alum., Anae, Ars., Cocc, Ign., Led., Merc, Ran. bulb., Staph., Sec. Money, of: Cyclamen, Magnesia, Pulsatilla. Murders, or crimes : Bella., Lye, Natr. m., Nitr. ac, Rhus vernix, Silicea. Perplexing dreams : Arsenicum, Graphites. (See Compli- cated, Confused Dreams.) Pleasant, Agreeable : Calcarea, Natrum carbonieum, Op., Pulsatilla, Sepia, Staphysagria, Viola tricolor.—Ant. c, Aur., Carbo a., Graph., Kali, Lach., Magn., Natr. m., Phosph., Phosph. ac, Plat., Sil, Alum., mm . m., Carbo v., Croc, Magn., Ars., Bary., Bism., Cocc, Coff., Ign., Hyos., Magn. m., Merc, Ac nitr., Oleand., Spig., Thuj., Veratr., See. Sec. Poetic : Lachesis, Calc, Spong., Amm. c. Poisoning, of: Kreosotum, Sec. Projects, of: Anacardium. Pursuits : Kreosotum. Quarrels : Nux vom., Am., Magn., Phosph., Stann.. Alum,., Aur., Calc, Hip., M. austr., Puis., Sleen., Staph., Sec. Realities, dreams which appear to be : Natrum. carbonieum, Natrum muriaticum. Remembrance with, of things forgotten : Caladium. Remembrance, dreams of which one loses the : Bellad., Hell, 308 sleeplessness. Cic, Cocc, Lye, Selen., Spig., Tarax., Veratr., Vit., Arn., Aur., Bry., Con., Lach., Laur.,M. arct, Men., Mere, Natr. m., Rhus, Sabad., Stram., Sulph., Sec. Repentance, dreams of : Arsenicum. Reproaches : Arnica. Revolts : Mercurius. Robbers : Magnesia carb., Mere, Magn. m., Alum., Aur., Kali, Sil, Natr. e, Plumb., Veratr. Sad, Melancholy dreams : Rheum, Lye, Spong. Serpents, or Reptiles (dreams of) : Kali carbonieum. Shots : Hepar sulphuris, Mercurius. Show : Kreosotum. Spectres, or Frightful Visions : Alum., Bell d., Calc, Amm. e, Carbo v., Ign., Keili c, Merc, Acid, 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 carb., Natr. carb., Opium, Amm. m., Amm. c, Alagn. m. Typhus Fever, of death from : Keili chloroticum. Vermin, dreams of: Nux v., Acid, muriat., Chel, Phosph., Am. c War, of : Thuja, Verb., Plat, Fer. Water, of: Ammon. mur., Graph., Magn., Alum., Dig., Kali, Magn. m., Merc, Ran. bulb., Sil, Sec Water, of, desire to void, (of inclination to urinate): Kreos. Sleep disturbed or prere; ted hy : Excitement (nervous): Colch., Merc, Coffr.a, Nux v., Lach., Amb., Camph., Canth., Caps., Chin., Hyos. Mosch., Puis., Sep., Lye, Laur., Ac nitr., Mags, aust, Teuc, Szc. — vascular : Bry., Nux v., Puis., Sep., Sil, Calc, Baryt e, Natr. m., Carbo a., Mere, Phosph., Sabin., Sep., Am. c, Aseir., Rhus, Ran., Sec. — by vascular, in the chest: Puis., Cye — vascular, in the head : Puis. sleeplessness. 309 Abnormal states during sleep : Eyes open : Bella., Op., Bry., Veratr., Sulph., Coloc, Phos. ac, Fer., Hell, Tart, Samb. — convulsed : Op., Hell, Phos. ac. — fixed: Tart. Face, puffiness of the : Opium. — coldness of the : Belladonna. — paleness of the : Belladonna. — redness of the : Op., Arnica, Viola trie. Fatigue, feeling of, during sleep ; Kreos., Antim., Ambra. Fear, during sleep : Carbo v., Puis., Cocc. — or dread of losing one's reason : Calc. carb. Fright : Puis., Silicea, Sulph., Veratr., Kali c, Am., Tab. Gastric sufferings : Cham., Con., Hep., Kali, Ac nitr., Sil, Rhus, Graph., Sec. Grinding of the teeth: Ars. Hallucinations : Bella., Cham., Sulph., Led., Merc, Phosph.t Stram. Hands, coldness of the: Bella, Merc, 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, Sec. Head, congestion in the : Puis., Sil, Am. c — heat in the: Silicea, Camphora. Hearing, delusions of: Cham., Sep., Carb. v. Heart, pain in the : Baryta carb. — palpitation of the : Ars., Lye, Puis., Sulph., Mere, Acid, nitr., Calc, Baryt c, Natr., Agar., Dulc, See. Heat, general: Nux v., Puis., Lach., Cham., Dulc, Hep.i Mere, Magn. m., Calc, Petr., Phosph., Bry., Ars., Natr. to., Sep., Sil, Carb. a. et v., Bry., Viol tr., Alum., Am. c, Colch., Graph., Sulph., Sec. Heat, with anxiety : Puis., Natr. m. — with dread of, or aversion to being uncovered : Mag. nesia. Ideas, sleep disturbed or prevented by flow of: Nux v., Puis., 310 SLEEPLESSNESS. Coffea, Lye, China.—Sulph., Calc, Staph., Sil, Graph., Hep., Kal, Cocc, Led., Sabad., Bar., Sec. 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., See. 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., Sec. 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., TarL, Thuj., Carb. v., Cham., Op., Ign., Con., Staph., Sep., Mgs. arc, Merc, c, Phosph., Cast., Sec. 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., Sec. — — of the head: Cocc, Magnetus polus Arcticus. — — of the legs: Phosphorus. — — of the mouth: Op., Anae, Puis. — — of the tendons (subsultus tendi- num) : Belladonna. 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, pain in the : Nux v., Lach., Sulph., Cole, Con., Ac. nitr., Am. c, Am. m., Anae, Berb., Carb. v., Phosph. Loins, pains in the : Am. m., Berb., Kreos. SLEEPLESSNESS. 311 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, Ve- ratr., Phosph., Ars., Arn., Rheum, Sec. Murmurs, or muttering during sleep : Op., Sulph. Mouth open, during sleep : Op., Merc, Rhus., Samb., Mgs. Nightmare (Incubus, Ephialtes): Nux v., Puis., Op., Sulph.,—Silicea, Ruta, Valeriana, Aeon., Am. carb.—Lye, Magn. m., Natr. m., Bry., Hep., Con., Bella., Am. m., Kali, Alum., Sec. Oppression of the chest (during sleep, or at night and prevent- ing sleep) : Ars., Carb. v., Cham., Graph., Sulph.,—Calc, Lye, Op., Aeon., Alum., Kali, Kali eh., Phosph., Ran., Sec. Pollutions during sleep: Kali c, Kali h., Sulph., Lyc.i Ac. phosph., Phosph., Con., Carb. v., Puis., Petr., Led., Par., Sec. 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, Sec. 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, Sulph., Tart, Thuja.—Nux v., Hep., Calc, Carb. v., Chin., Cocc, Castor, Daph., Hyos., Aeon., 312 sleeplessness. Agn., Alum., Am. c, Ant. c, Merc, Magn., Ign., Letch., Kali, Plumb., Sec. 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., Sec. 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., Pliosph., Phosph. acid., Plumb., Sep., Sil, Stram., Sec. Toes, pains in the, during sleep : Am. carb. Trembling : Euphorbium. — internal: Natrum m. ' Uncovering of the arms, &c, during sleep: Plat.i 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., Sec. (See Enu- resis.*) Vertigo : Sulph., Calc, Am. c, Natr., Phosph., Spong., Sec. Visions, during sleep: Bella., Cham., Led., Merc, Phosph., Phosph. ac, Stram., Sulph., Sec. — frightful: Bella., Sulph., Calc, Carb. v., Merc, Sil. — horrible : Carb. anim., Sec. 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, Sabin., Sep., Sil, Stann., Tart., Zinc. Sleep, Lethargic, stupefying : Aeon., Ant, Bellas Calad., Camph., Graph., Lach., Nux v , Op., Puis., Hyos;, Laur., Led., Mosch., Nux mosch., Phosph. ac, Plumb., Stram;, Tart, Veratr., Mag. arc, Sec. SLEEPLESSNESS. 318 Sleep, lethargic, alternately with sleeplessness : Lachesis. t Somnolency, or drowsiness in the open air: Tartarus. — day and night: Baryta c — in the evening : Ant, Ars., Tart — in the forenoon : Ant. crudum. — in the morning : Mephites putorius. Sleep, broken, interrupted : Cocc, Ars., Dig., Par., Zinc. — incomplete, imperfect, half asleep : Ars., Bella., Bry., Lach., Merc, Hepar., Cham., Cocc, Op., Acid, nitr., Cic, Euph., Sil, M arc, Graph., Kali, See. 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., Ol. an., Phil, Sec. Sleep, profound : Ant. tart., Nux mosch., Op.—Ars., Bella., Ign., Laur., Led., Mgs., Phosph. ac, Puis., Rhod., Sec. corn., Seneg., Stram., Veratr., Aeon., Anae, Ant. c, Bar., Bry., Camph, Con., Croc, Cup., Hyos, Petr., Phosph., Ruta., Sep., Spig., Zinc, Sec. 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. are, Magn., Magn. m., Merc, Ran. bulb., Sepia, Spig., Stann., Stram., Veratr., Sec. *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, Sec. 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, Sec. Sleepiness in the afternoon: Sulph., Puis., Bov., Bruc, Canth., Grat, Viol, tri., Sec. (See Sleep, tendency to, after a meal.) 14 314 SLEEPLESSNESS. Sleep, tendency to, during employment: Sulphur. — when reading aud writing : Natrum sulph. — when sitting: Bruc, Ferr., Mg., Petr., Tart, See. — 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., Sulph., Nux v., Natr. m., Nitr. ac, Sep., Sec. Sleep, retarded, or difficult to be renewed after waking during the night: Natr.m., Sep., Sulph., Puis., Magn., Am. c, Ars., Berb., Bor., Fer., Phosph., Ran., Ran. se, Sec. Sleeplessness, alternately with somnolency: Lachesis. — after midnight: Nux v., Coffea, Ars., Cap., Kali carb., Sil—Assafi, 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., Sec. Sleeplessness, before midnight: Bry., Calc. carb., Carb. v., Merc, Phosph., Puis., Rhus tox., Sep.—Ars., Bella., Bar., Calad., Carb. a., China, Graph., Hep., Ign., Kali., Lach., Led,., Lye, M. aust, Mar., Mur. ac, Selen., Spil, Sig., Sulph., Nux v., Con., Alum., Am. m., Ant. tart., Am., Bar., Kreos., Nitr. acid., Natr. m., Stann, Staph., Ve- ratr., Sec. Sleeplessness, with desire or inclination to sleep : Bella., Cham., Phosph., Puis., 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. to., Nitr. add., Staph., Veratr., Selen., Sec. Sleeplessness, arising from griping pains in the intestines: Lye, Plumb., Sep., Staph., Kali., Ambr., Am. c, Am. to., Magn. c, Magn. . complained of in the region of the uterus, Chamomilla, Ignatia, Coffea, or Bryonia may be of much service in , Merc, Sulph., Ferr., Sass, Diarrhcea attended with loss of appetite: Nux mosch.— Antim. c, Puis., Sec. Diarrhoea attended with pains in the back : Ferrum. — ■— cephalalgia : Rhus tox. — — coldness: Spig., Sec. — — colic: Ars.? Merc, Puis., Cham., Nux v., Veratr., Ipec, Bry., Rheum, Jalap., Rhus, Rat., Sulph., Canth., Baryt c, Ant, Agar., Petr., Sec. Diarrhoea attended with crying or screaming (in the case of children) : Cham., Ipec.—Rheum, Jalap, Sen., Carb, v., Sulph. Diarrhcea attended with dyspnoea : Sulphur. — — eructations : Mere, Con., Dulc, Sec — — flatulency : Ferrum mg., Sec. — —• pains in the limbs : Rhus, Ammon. to. — —> lassitude, debility ; Ipec, Ars., Ve- ratr., Kali, Ferr. mg. Diarrhcea attended with nausea : Merc, Ipecac, Ars., Lach., Bella., Gran., Hell. Diarrhcea attended with cold perspiration on the face : Aleve, Veratr. Diarrhcea attended with pains in the rectum : Alum. — — shivering: Mere, Puis., Sulph., Ve- ratr., Cast, Cop., Dig. Diarrhcea attended with shuddering: Mere, Puis., Veratr., Rheum. Diarrhcea attended with inclination to sleep : Nux mosch. — — tenesmus: Mere, Lach., Ars., Nux v., Alum. Diarrhoea attended with thirst: Ars., Magn. s., Dulc. — — tremor: Merc. — — vomiting: Ipec, Ars., Veratr.— Cup., Tart, Rheum, Lach., Ant, Phosph., Sec ■ Colour of the Feces. Ash-coloured: Digitalis pu;-p:seca, Asarum europcium. diarrhcea. 369 Black, or very dark: Ars., Ipecac, China, Veratr. Camph., Ac sulph. Brownish: Ars., Rheum, Veratr., Camph., Merc e, Dulc, Sulph., Magn. to., Tart, See. Clay-coloured : Calcarea carbonica, Hepar sulphuris, Petro- selinum, Dig., Puis., Sulph., Sec. Frothy : Lach., Rhus, Calc, Coloc, Merc—lod. mag., Natr. s., Sulph. ac, Op- Grayish : Digitalis, Merc, Phosph., Rheum, Ac phos., Asar. Greenish : Chamomilla, Puis., Arsenicum, Mercurius, Sulphur, Phosph., Veratrum.—Bella., Ipecac, Hep., Nux v., Magn. to., Sep., Sec. Pale : Lycopodium, Carbo vegetabilis. Whitish : Pulsatilla, Sulphur, China, Digitalis, Cliamomilla, Hepar, Colch., Ign., Aeon.—Nux v., Mere, Rhus, Ars., Calc, Sec. Yellowish: Chamomilla, Mercurius, Puis., Ipecac, Ars., Phosph., Tart, Calc, Magn. m., Coloc, China, Sec. Nature of the Alvine Discharge. Acrid (producing excoriation in the anus): Merc, Ars., Lach., Cham., Puis., China, Ign., Veratr.—Ferr., Sass., Lach., Staph., Sulph., Kali, Phosph., Graph., Nux v., See. 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. etc.—Ant. c, Arn., Asar., Bar., Calc, Can., Nitri. ac, Rheum, Rhus, Sil, Sulph. ac Gelatinous: Colch., Hell, Rhus, Sep. ' Membranes (containing portions of false) : Cantharis, Colchic, Sepia. Mucous: Pulsatilla, Capsicum, Chamomilla, Borax, Nux vom., Phosphorus, Sulphur asarum, Am., Ars., Carb. v., Coloc, Graph., Hell, Ipec, Kali, Magn. m., Merc, Petr., Rheum, 370 diarrhoea. Rhus, Sep.—Ant. c, Canth., China, Colch., Hep., Hyos., Ign., lod., Led., Natr., Nitr. ac, Phosph. ac, Sabad., . Sabin., Stann.. Veratr., Viol, tr., Sec. Pitch, or tar, resembling : Lachesis, Ipecacuanha, Mercurius, Nux vomica. Purulent: Mercurius, Silicea.—Puis., Sulph., Canth., Arn., Lye—Col, Kali, China, Bella., Cocc, Sep., Sec Sanguineous: Mercurius, Cantharis, Nux vomica, Pulsatilla, Ipecacuanha, Sepia, Sulphur.—Am., Ars , Asar., Bry., Cole, Caps., Carbo v., China, Dros, Ferr., T^ed., Lye, . Nitr. ac, Phosph., Rhus, Sabin., Sil.—Alum., Amm., Ant c, Bella., Cham., Coloc, Con., Croc, Cupr., Dulc, Graph., Hep., Hyos., Magn. to., Mur. ac, Natr., Natr. to., Sabad., Sec. corn., Selen., Stram., Sulph. ac, Zincum, Sec Viscus, glutinous : Mercurius, Asar., Sassap., Hell, Nux v., Plumb., Ars., Cole, Carb. v., Hep., Kali, Mezer., Natr., Veratr. Watery: Ars., Puis, China, Lach., Cham., Rhus, Ferr., Hyos., Sec, Nux v., Ant, Ipecac, Phosph., Sec. Smell of the Alvine Evacuations. Acid: Rheum., Mercurius, Sulph., Calc, Graph., Natr.— Cham., Am., Hep., Sep., Magn., Phosph., Sec. Cadaverous : Bismidhum. 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., 01, Plumb., Scill, Strain., Phosp. ac, Carb. a., Dulc, Mgs., Lach., Mar., Asar., Ant. tart, lod., Sep , Sec. Involuntary discharge of faeces : Phosph. ac., Phosph., Veratr. —Ars., Bella., Muriat ac, Natr. to., Sulph.—Rhus, Bry., Lach., China, Nux v., Am., Op., Sec corn., Staph., Hyos., Colch., Dig., Hell, Merc, Laur., Puis., Sep., Zincum-, Sec. When urinating : Ac. mur. When expelling flatus : Ferr. mao. When sleeping : Rhus, Puis., Am., Moschus, Szc. In Coma occurring in children from the depleting effect? nf DERANGEMENTS DURING TEETHING. 371 neglected or protracted diarrhoea, China and Arsenicum in al- ternation are of considerable efficacy. Supplementary nour- ishment ought at the same time to be given in the case of in- fants at the breast; and diet of a nutritive quality to children of more advanced age. Diet. When the derangement can be traced to any par- ticular kind of food, an alteration in the diet becomes impera- tive ; at the same time the quantity of food or drinks must be diminished, until improvement sets in. DERANGEMENTS DURING TEETHING. (Additions to page 480.) Zincum is strongly recommended by Dr. Elb, of Dresden, in apparently hopeless cases, with symptoms of incipient para- lysis of the brain, such as sopor, half-closed eyes, or motion- less eyes with insensible pupil; loss of consciousness; moan. ing; icy coldness of the whole body, and bluish colour of the skin ; pulse nearly imperceptible ; respiration interrupted. Dose. Gr. ss. every two heurs, until the temperature of the skin increases, and consciousness 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 teeth- ing, we may administer Calcarea, and repeat it every eight days for about a month, which will materially assist the pro- trusion 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 indications will be found for the selection of Belladonna, Chamomilla, and other remedies which are fre- quently required in fever and other derangements during teething.) 372 DROPSY OF THE BRAIN. DROPSY OF THE HEAD. (Additions to page 486.) Zincum, (gr. ss, every two hours,) has been successfully em- ployed by Dr. Elb* 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 re- medy, appropriate to the remaining symptoms, should be prescribed; but it is recommended by Dr. Elb to give 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. Wahle recom- mends Helleborus, Arsenicum, and Sulphur^ in particular. (See also remedies enumerated under Scrofula and Rachi- tis, with which diseases, chronic hydrocephalus is generally connected.) * Allg. Horn. Zeit. No. 15, 31ter Bd. t According to my experience, Sulphur (30) is the most important re- medy in the treatment of inflammatory and exudatory affections of the brain. It is more effective in the erethic than in the torpid stadium. The previous or intercurrent employment of Aconitum and Belladonna is often necessary. In the torpid stage, I consider Helleborus, and, in some cases, Acid, phosphoricum, fully equal to Sulphur.—(Rummel, Allg. Horn. Zeit. No. 22, 32ster Bd.) WILLIAM RADDE, IMPORTER, BOOKSELLER, AND PUBLISHER, 322 BROADWAY, NEW-YORK. T.npxH.ifox of 3 n'ct, E iglis'i ail Foreign, for Colleges, Public an I Privati libraries, etc., etc. SINGLE BOOKS IMPORTED TO ORDER. Orders forwarded by every steamer, and also by the Liverpool Packets, mid answ-red promptly by the return of the first steamer after the receipt, if desired. W. Et would invite attention to his facilities for procuring English and Foreign Books for Colleges, Public and Private Libraries, Book-ellers, and the public generally, on at lent as good terms and with greater despatch, than they have ever before been imported into this country by any other establishment. All the German Journals, Monthlies,'Quarterlies, and Newspapers, re- ceived regularly by the steamers for subscribers and the principal periodicals HOMCEOPATHIC MEDICINES. Wm Rvd?e,322 B.-oadwiy, New-York, respectfully informs the Homoeo- pathic Physicians, and the friends of the System, that he is the sole Agent for the Leipzig Central Homeopathic Pharmacy, and that he has always on hand a good assortment of the best Homoeopathic Medicines, in complete sets or by single vials, in Tinctures, Dilution,* and Triturations ; alsc Pocket Cases of Medicines; Physician? and Fj,m\lM Vials with low and high dilutions of medicated pellets —Cases from 50 to SO Vials of low and high dilutions, &c. &c. Ho- mceopathic Chocolate. Refined Sugar of Milk, pure Globules, &c, Arnica Tincture, the best specific remedy for bruises, sprains, wounds, etc. Arnica Plaster the best application for Corns. Urtica urens, the best specific remedy for Bums. Also, Books, Pamphlets, and Standard Works on the System^ in the English, French, and German languages. HOMCEOPATHIC BOOKS. JAHR'S NEW MANUAL ; originally published under the name of Symp- tomen-Codex. (Digest of Symptoms.) This work is intended to facilitate a comparison of the parallel symptoms of the v? •••>«« homceopathic agents, 2 IIoMteopalhiv. Books. thereby enabling (he practitioner to discover the characteristic symptoms of each dru"-, and to determine with ease and correctness what remedy is most homceopathic to the exiting group of symptoms. Translated, with import- ant and extensive additions from various source.-, by Charles Julius Hempcl, M. D , assisted by James M Quin, M. D , with revisions alld clinical notes 1)7 John F. Grav.M. D. ; contributions by Drs. A. Gerald Hull, and George W. Conk, of New-York : and Drs. C. liering, J. Jeanes, C. Neidhard, W. Williamson, and .1. Kitchen of Philadelphia; with a preface by Constantino Hiring, M. D. This new Manual is distinguished from the old by many important and essential advantages. It is much more complete than the former editions of Jtihr, embracing nearly three times the amount of matter contained in the old Jahr, and furnishing, moreover, the pathogenetic symptoms of several entirely new remedies, by distinguished {>rovers. The expression of the symptoms, as recorded in the Materia Medica Pura, and in the isolated prov- ings of recent observers, has been retained, and only unnecessary repetitions have been avoided. After a very judicious and instructive preface, the whole system is here displayed with a modesty of pretension, and a scrupu- losity in statement, well calculated to bespeak candid investigation. The second volume embraces a classification of n edicines with reference to their use in practice ; explanation of terms, which, in German, have a more or less technical meaning, and for which the English language has no strictly cor- responding expression. On Doses. A complete tabic of the Homccopathis Medicines, with th* ir names in Latin, English, and German; their syno- nymes, antidotes, compare with, duration of effect, and the dose. This very laborious work is indispensable to the students and practitioners of Homoeo- pathy, and highly interesting to medical scientific men of all classes. Two volumes bound. Price $11 CO. LAURIE, DR. J. HOMCEOPATHIC DOMESTIC MEDICINE, with the Treatment and Diseases of Females, Infants, Children, and Adults. Fourth American edition, much enlarged, with additions by A. Gerald Hull, M. D. 1848. Bound, $1 50. G. L. RAU'S ORGANON of the Specific Healing Art of .Homueopathy. Translated by C. J. Hempel, M. D. 1848. $1 25. HAHNEMANN, Dr. S. MATERIA MEDICA PURA. Translated and edited by Charles Julius Hempel, M.D. 4 vols. 1846. Jftfi. E. STAPF'S ADDITIONS to the Materia Medica Pura. Translated by C. J. Hempel, M. D. $1 50. HAHNEMANN, Dr. S. THE CHRONIC DISEASES, their Specific Nature and Homceopathic Treatment. Translated and edited by Charles J. Hempcl, M. D., with a Preface, by Constantine Hering, M. D., Philadelphia. 8vo. 5 vols. Bound. 18 !5. !#'. TRANSACTIONS of the American Institute of Homoeopathy. 1846. Bound. $1 50. C. HHRIVCi'S DOMESTIC PHYSICIAN. Fourth American edition, revised with additions from the author's manuscript of the sixth German edi- tion. The part relating to the diseases of Females and Children, by Walter Williamson, M. D IS-JS. $2 Horiuropathic Boohs. 3 HOMCEOPATHIC COOEEP.Y. Second edition, with additions, by the Lady of an Ameiiean Homusnpathic Phv-ioian. Designed chiefly for the use of such persons as arc io der homceopathic treatment. 50 cts. RUECKERT'S THERAPE1 Tli'S ; or, Successful Homceopathic Cures, collected from the best Homeopathic Periodicals, translated and edited Ly C. J. Hempel. 1 large Svo. v. i , bound. 13-io. Sj'3 rj 1 IE.M PEL'S Homueopathie Domestic Physician 1'3-Kj. Bound. oOcts JAHR, G. II. G., M. D. SHORT ELEMENT \RY TL-LEATiSE upon Ilomompathea and the Manner of it; Prac'icc ; with some of the most impor- tant effects of ten of the principal HorticeopUhic remedies, (or the use of all honest men who deEre to convince them-; Ives, by experiment, of the truth of the doctrine. Second French edition, corrected and enlarged. Transla- ted by Edward Bayard, M. D. Bound. 371 cts. RCENN'NGHAUSENS ESSAY o;i the Homceopathic Treatment of In- termittent Fevers. Translated and i-.'.ited by Charles Julius Hempel, iM. D. 1315. 3S cts. A TREATISE ON THE USE OF MINICA, in cases of Contusion', Wounds, Strains, Sprains, Lacerations of the Solids, Concussions. Paralysis, Rheumatism, Soreness of the Nipples, etc. etc, with a number of cases Hl-ustrative of the list of that drug. By Charles Julius Hempel, M D. 181-3. 191 cents. RUOFF'S REPERTORY OF HOMCEOPATHIC MEDICINE, nosoio- gically arranged. Tra:nl;te:l from the German, by A. II. Okie, M. D , translator of H.irtma-.in's Remedies. Secmd American e lition, with additions and improvements, by G. Humphrey, M. D., etc. 1844. Round $1 50. THE HOMCEOPATHIC EXAMINER; hy A.Gereld HailMVl D. The second and third volume $10. Also volume IV. and V., or inder the title— The Ilonneopathic E< immer, vol. I. and II , new series, by Drs. Gray a:. 1 Ilcmpcl, lit-j-liiT, bound in two volumes, £'-3 00. This is a vary valuable collection of ii.is.iys on ths treatment of all the more important diseases, snEi as croup, iilmn Uions, Ijphin, tr.sxJei, tcar- (V.'<'?;,'/. etc , etc. The work .erv.iLiim, likewise, many valuable proving-, a number of interesting cues U\)va practice, cr.tical dis2-.is.si >:is, and original articles, and is altogether an indispci able aid to the physicians. THE BRITISH JOURNAL OF HOMEOPATHY. Edited by J. J. Prvsdaie, M. D. ; J. R. Russell, M. D. ; and R. J. Dudgeon, M. D. The two quarterly numbers of 13 B are o:i hand, at 75 cents each r.u:nber. Seve- ral volumes of 184'j and 1317 are complete, on hand, u! H3 each velum?, of lour quarterly numbers, with Title r.n.l [ode.. HEMPEIES iV.EN'NINEElAUSEX, for Homoeopathic Physicians; tube used at the Re Nile of the Patient, and in studying the Materia Medica Pura. 1 octavo vol., ran.' complete cdilioi, including ths Concordances of Homceopathic Remo lies. i related and a'..•.ptci to the use of the Ameri- can Profession, by C. J. Hempcl, M. D. 1*17. #1 ."0. riAUSEMANX'S ACUTE DISEASES, aii their H^mcnpathic Treat- moot. Third Germ i.-t cJitf-o,'rewscd and con-iiei M>l.\ Piilarjctl hy iho 4 Homceopathic Books. author. Translated, with additions, and adapted to the use of the American Profession, by C. J. Hempel, M. D. 1847. 2 vols., $2 75. BECKER, M. D , ON CONSUMPTION. Translated frcm the German. 1843. 38 cents. ---------ON DISEASES OF THE EYE. Translated from the Ger man. 1843. 38 cents. ---------ON CONSTIPATION. Tsanslation frcm the German. 1848. 38 cents. --------- ON 'DENTITION. Translated from the German. 1848. 33 cents. $5=- The above four works, bound in one volume, $1 00. BECKER M. D., Allopathy, Hahncmar.nhm and Rational Homoeopathy Compiled fioiii the German by Dr. Oriesseljch. Translated frcm the Ger- man. 1848. 13 cents. HARTMANN, Dr. F. Practical Observations en seme of the chief Ho- mceopathic Remedies. Translated from the German, by A. H. Okie, M. D First Series. Bound, $1 00 The second and last Series. Bound, $1 00. EPPS, Dr J. DOMESTIC HOMOEOPATHY; or, Rules for the Domes- tic Treatment > f the Maladies of Infants, Children, and Adults, etc. Third American fr, ».> ;he fourth London edition. Edited and erdf.iged by George VV. Cook, M D 1S48. Bound, 75 cents. J. JEANES, M. D. Homceopathic Practice of Medicine, §3. W. WILLIAMSON, M. D. Diseases of Females and Children, 38 cts. Wm. HENDERSON, M.D. Homceopathic Practice. 1S46. 50 cts. FORBES, M D. Homoeopathy, Allopathy, and Ycung Physic. 1818 If) cents Wm. HENDERSON, M. D. Letter to John Forbes. 1846. 19 cents. §C$~ The above three books, bound in one volume, $1. JAIIR'S PHAIVMACOPCEIA and Posology of the preparation of Homceo pathic Medicines and the administration of the dose. Translated by F Kitchen. $2. THE PRACTICAL ADVANTAGES OF HOMOEOPATHY, illustrated by numerous ca.-es. Dedicated by permission to Her Majesty, Queen Ade- laide. B> H. li.usford, M.D. $1. JAIIR'S MANUAL OF HOMCEOPATHIC MEDICINE. Translated from the German. With an introduction and some additions by C. Hcring, M. D. 1838. $2 50. A POPULAR VIEW OF HOMOEOPATHY. By Rev. Thomas R. Ever- est, Rector of VVickwar. With annotations, and a brief survey of the state and progress of Homceopathia in Europe. By A. Gerald Hull, M. D. From the second London edition. Bound, price S'l. , Homoeopathic Boohs. 5 THE FAMILY GUIDE to the Administration of Homoeopathic Remedies. Third edition, after the second London edition, with additions. Retail price, 25 cents. ON ECLECTICISM IN MEDICINE: or a critical review of the leading medical doctrines. An inaugural thesis, presented at the New-York Univer- sity, on the first of March, 1845. By Charles J. Hempel, M. D. 25 cts. REASONS why Homoeopathy should receive an Impartial Investigation from the Medical Profession and the Public. By B F. Bowers, M. D. 13 cents. DEFENCE OF HAHNEMANN AND HIS DOCTRINES, including au Exposure of Dr. Alex. Wood's 4i Homoeopathy Unmasked." London, 1841 50 cents. F. VANDERBURGH, M. D. An Appeal for Homoeopathy ; or, Remarks on the Decision of the late Judge Cowan, relative to the legal rights of Ho- moeopathic Physicians 1844. 12s cents. SHERRILL'S MANUAL OF HOMOEOPATHY. 37i cents. F. A. GUL'NTHER'S New Manual of Homceopathic Veterinary Medi- cine; or, the Homoeopathic Treatment of the Horse, the Ox, the Sheep, the Dog, and other domestic animals. $1 25. HYDRIATICS, or Manual of the Water Cure.—Especially as practised by Vincent Priessnitz, in Griiffenberg; compiled and translated from the writings of Charles Munde, Dr. Oertel, Dr. B Hirschel, and other eye-wit- nesses and practitioners. Fourth edition, by Francis Graeter. Price 50 cents, with one plate or six engravings. 1844. ROKYTANSKY'S PATHOLOGICAL ANATOMY. Translated from the German, with additions on Diagnosis, from Schb'nlein, Skoda, and others, by Dr. John C. Peters. 1844. 75 cents. Opinions of the Press.—"Dr. Rokytansky's book is no more than it pro- fesses to be: it is morbid Anatomy in its densest and most compact form, scarcely ever alleviated by histories, cases, or hypotheses. Id, is just such a work as might be expected from its author, who is said to have written in it the result of his experience gained in the careful examination of over 12,000 bodies, and who is possessed of a truly marvellous power of observing and amassing facts. In the course of our analysis we have said comparatively little of its merits, the best evidence of which is found in the length to which our abstracts have been carried without passing beyond the bounds of what is novel or important. Nor would this fault have been committed though much more had been borrowed, for no modern volume on morbid Anatomy contains half so many genuine facts as this; it is alone sufficient to place its author in the hi°-hest rank of European medical observers."—British and Foreign Medical Review, January, 1843. ENCHIRIDION MEDICUM, or the Practice of Medicine; the result ot fifty years' experience, by C. W. Hufeland, counsellor of state, physician in ordinary of the late King of Prussia, professor in the University of Berlin. From the sixth German edition : translated by C. Bruchhausen, M. D. Re- vised by R. Nelson, M. D. Second American Edition. 1814- Bound, $2 50. 0 Homceopathic Boohs. Opinions —The imlowing lines from Dr. Marly, formerly Presulcrt of the Medical Society ■■( the Stale of New York, contain his opinion in v fc:v words of the meri'f of the book: I am happy to ha* e the opportunity of recommending to the Medical pro- fession the Manual of the Practice of Medicine, hy Ilufeland. It i> not often -that books of thi- character, on perusal, make good the claim- which their titles assume, but this is a well marked exception: its descri; E< r of diseases, though concise, are comprehensive; its reasonings just and phiio.-ophicid, sed its practice, as a c< nrequence, intelligible and rational. The cl ara■• tt r <-f the author and his t-xperier.ee of more than half a century, together wi'.. !::e unexampled popularity of the work in its original language, render, in my opinion, nil individi al recommendation superfluous. I hope that it may M>nn be found in the hands of every medical man, whether pup.il or practitioner. James R. Maxi.v, M. 1). New-York, September, 7,1S42. Certificate of John F. Gray, M D., formerly Resident Physician t.i the New-York Hospital, Lecturer on the Theory and Practice of Physic, Censor of the State and New-York Medical Societies, etc., etc. I am very glad to find the press engaged in diffusing a knowledge of the German medical literature in this country. At the head of the German books of practice stands this book of the good Hufeland. Mr. Bruchhausen and Dr. Nelson have laboured with diligence and good faith in rendering the Enchiridion; and so far as I have had leisure to compare their work with the original, I find no error of magnitude. Another edition will, no doubt, be called for soon, and then the worthy American curators can disperse with the somewhat meagre characteristic given to it b}' their too close adherence to the letter of the author. I heartily wish success to the good enterprise. Jon:, F. Gray, M D. New-York, September 8, 1842. The reputation of the venerable eclectic of Germany scarcely requires endorsement even on this side of the Atlantic. An independent and original thinker, Hufeland labored for the cause of medical science, and has acquired a universal renown, amply attested to by his "Journal of Practical Medi- cine," " Art of Prolonging Life," " System of Practical Medicine,"' and nu- merous Essays, besides personal contributions of humane and necessary inno- vations in the treatment of " Inoculation," "Small Pox," and "Signs of Death." His last work, Enchiridion Mcdicum, concentrates the experience of his entire medical life, and fully maintains, in its careful and concise de- scription and diagnosis of diseases, all the evidence of the discriminating in- tellect of the Patriarch of German medical literature. A. Gerald IIuli., M. D. New-York, September 12, 1842. I have looked over the Enchiridion Medicum of Professor Hufeland. It is an excellent compendium of German Practice, and will be found a valuable vade mecum to the student and practitioner. It can profitably be perused, and ought to be in the hands of all physicians. The justly distinguished reputation of the author will make it a work generally sought for. VALENTINE MOTT, M. D. New-York, September, 1842. \ A* i . v //1-'/, y^Rf NLM032899524