ENCHIRIDION MEDICUM: 
OR 
MANUAL OF THE PRACTICE OF MEDICINE. 
THE RESULT OF FIFTY YEARS’ EXPERIENCE. 
BY 
C. W. HUFELAND, 
COUNSELLOR OF STATE, PHYSICIAN IN ORDINARY TO THE LATE KING OF PRUSSIA, 
PROFESSOR IN THE UNIVERSITY OF BERLIN. 
FROM THE SIXTH GERMAN EDITION 
TRANSLATED BY 
'ASPAR BRUCHHAUSEN, M. S. 
REVISED FOR THE PROPRIETOR 
BY 
ROBERT NELSON, M. D. 
NE W-Y 0 R K: 
PUBLISHED BY WILLIAM RADDE, 322 BROADWAY. 
1842. Was mich das Leben gelehrt, was mir durchs Leben geholfen, 
Leg’ ich dankbar und treu hier auf Hygieens Altar. 
Helfen durch Lehre und That, war meines Lebens Bestimmung, 
Mochte im Tode auch nocb Lehrer und Heifer euch sein. 
Entered according to Act of Congress, in the year 1842, by 
WILLIAM RADDE, 
in the Clerk’s Office of the District Court of the Southern District of 
New-York. LIFE OF THE AUTHOR. 
Christopher William Hufeland was born at Langensalza, 
August 12, 1762. His father held some rank in the medical 
profession, was Aulic counsellor and physician in ordinary to 
the court of \Veimar. After our author had finished his studies 
he began practice as a physician at Weimar. In 1793 he was 
appointed professor of medicine in Jena ; and in 1796 the title 
of Aulic counsellor of Weimar and physician in ordinary to 
the Duke was conferred on him. He left Weimar for Berlin 
in 180 L, where he was employed as one of the physicians to 
the King of Prussia; here he was made Director of the Medico- 
chirurgical Academy, and appointed superintendent physician 
to the Charity—both renowned institutions. In 1810 he was 
raised to the rank of counsellor of state, became a member 
of the medical section of the Home Department, knight of the 
Red Order of the Eagle, and professor of the New University 
established at Berlin in 1809. Such were his honorable 
titles and his external relations, and he enjoyed them until 
his death. We shall now review his labors; works which 
gained him a reputation that was European and almost uni- 
versal. 
In a pamphlet “ On the Uncertainty of the Signs of Death, 
and hints for the establishment of burial houses,” published at 
Weimar in 1791 and republished in 1824 at Berlin, he broach- 
ed the subject of the burial of persons apparently dead. It is 
m a great measure owing to his indefatigable efforts and 
representations that such houses are now so general through- 
out Germany,—receptacles which remove from the feeling 
mind that horror which is inseparable from the idea of living 
sepulture. 
Of almost equal importance are his “ Remarks on Small- 
pox which prevailed epidemically at Weimar,” first published 
at -Leipzig in 1789, and in a3d edition in 1798. His “ Ex- 
use effecfs of Muriate of Barytes,” first 
F ls p at Erfurt in 1792, and again at Berlin in 1794, has 
Use *n f-reatment of scrofula. In 1795 he 
pu is ed his “ Ideas on Pathogeny,” which work was re- VI 
LIFE OF THE AUTHOR. 
printed in 179S under the name of “ Pathology,” and later 
as his “ System of Practical Medicine.” He derived great 
reputation by his “ Journal of Practical Medicine,” not only 
from the usefulness of that work, but also from the ability he 
displayed in it as its editor. It first appeared at Jena in 1795; 
subsequently he had Himly and Harless as associate editors ; 
and since 1824, Osann. This Journal soon became, and con- 
tinued to be the vehicle through which the most eminent 
German practitioners communicated their ideas and discover- 
ies to their brethren, and was emphatically called the Ger- 
man Medical Journal. It ranked with that of Edinburgh. 
Hufeland, unlike sectarian writers, of whom we have too 
many, was a sincere searcher after truth, and readily admitted 
into his journal every thing which promised advancement to 
science, in order that it might get an impartial hearing. 
He endeavored to convey useful information to non-pro- 
fessional people in his work “ Macrobioticon, or the art of 
prolonging human life.” It gained great favor in the es- 
timation of those for whom it was composed, and has been 
translated into several languages. 
The same philanthropic purpose he tried to serve by 
editing Darwin’s book “ On the physical and moral educa- 
tion of females,’’ with annotations and additions of his own. 
In 1822—24 he published his “ Minor Medical Writings” in 
3 vols.* The last, but not the least of his works was his En- 
chiridion Medicum, which we now offer to the public, and 
which he considered as his Legacy, to be useful even after 
his death, which soon followed its publication. It was at 
the same time an act of charity, for the proceeds went to a 
fund for the support of indigent physicians. 
Hufeland possessed a great mind, the strength of which 
shone brightly in the investigation of Nature. He was never 
limited in his view by the narrowness of systems, but was 
eclectic, impartial, unprejudiced and a competent judge ; in- 
defatigable in the promotion of the best interests of mankind, 
and took an elevated stand not only in his profession as a 
physician, but also in society as a truly moral and philan- 
thropic man. 
* In 1833 this noble old man celebrated the jubilee of his Doctor- 
ship with honors commensurate with his merits. PREFACE. 
There are already so many Manuals of the 
practice of medicine, that it seems almost useless 
to add a new one to the number. But a mere 
glance at this branch of medical literature will 
detect a deficiency. While our bookstores 
abound in epitomies of English, and translations 
of French practice, they are destitute of any 
thing on the subject from the rest of Europe. 
This is the more to be regretted, since we know 
that Germany has long been celebrated, not only 
for the profound abstractions and vast erudition 
which distinguish every branch of science in that 
country; but also, for many practical, though 
peculiar, methods of exercising the healing art. 
This hiatus has not escaped the observation of 
the publisher,—himself a German, and from this 
circumstance capable of selecting the most cele- 
brated work of his countrymen. He, therefore, 
thinks that such a work as he now offers to the 
English reader is not only wanted, but that he 
has chosen as a specimen of German medicine 
the best manual extant; for, who is there that 
enjoys a higher reputation in the medical profes- 
sion than did the late venerable and learned 
Hufeland 1 This work of the patriarch of Ger- 
man medicine first appeared in 1836, and has al- 
ready passed through eight large editions in Ger- 
many ; has been translated into French by that 
great judge of medical literature, Jourdan, mem- 
ber of almost all the scientific societies of Eu- 
rope, and in this language it has already passed 
through several editions. 
In order to expose the object and plan of the 
work, we shall let the author speak for himself. PREFACE. 
VIII 
In his preface he says : “ This book is intended to 
be a clinical guide for junior practitioners; for 
such as just enter into practice;—to serve them 
as a guide and give to the mind a right direction ; 
to point out every disease; to point out that 
which is essential in a practical point of view; to 
point out the treatment to be adopted, and the 
most approved remedies;—in short, it is intended 
to be a complete, though a compact manual, di- 
vested of all hypothesis. 
£t In the second place, this book is the Deposi- 
tory into which I cast the final result of my long 
experience. 
“ As regards the Classification which I have 
adopted, I may simply say that it is the same as 
that which I followed when a teacher, and which 
I ever found to be the most appropriate for clini- 
cal instruction; the principal feature of which is: 
—the division of diseases into species according 
to the most prominent morbid phenomena, this 
being the path traced to us by Nature herself. 
The first thing which she presents to us is the 
external appearance—the image of disease; she 
strikes our senses with it; through this physiog- 
nomy we must penetrate ere we reach the inte- 
rior in search of the invisible, there to investi- 
gate the nature of disease, its seat and causal 
relations; and it is on all these that we must 
base the method of our treatment. 
££ Such a course presents one great advantage 
—that of making us familiar with the generali- 
ties which belong to all the classes—with the fun- 
damental ideas of pathogeny, and thereby with 
the chief indications of cure: hence results a cor- 
rect view of all the species belonging to a class 
so seen, and consequently an equally correct plan 
of treatment, making allowance only for differ- 
ence of location.” TABLE OF CONTENTS. 
THE RELATIONS OF 
THE PHYSICIAN , 1 
THERAPEUTICS . P7O 
Order of the rational 
mode ofhealing . . 73 
NATURE AND ART— 
Physiatric . . .19 
PRACTICE ... 75 
Sanative power of Na-. 
ture . . . .19 
Maxims and general 
rules for beginning 
practitioners . .75 
Medicine, its idea and 
limits . . . .22 
First Class. Acute Fe- 
vers . . . .79 
Its tendency, recogni- 
tion and action . .23 
Generalities . . .79 
DIAGNOSTICS, latrog- 
NOMIC . . . .24 
Cognition of the sick 25 
Simple Fever . . 84 
Inflammatory Fever . 85 
Nervous Fever . . 90 
Constitution of Patient 25 
Hereditariness . . 26 
Putrid Fever . . 99 
Gastric F ever . . 100 
Sex .... 27 
Age and period of life . 27 
Rheumatic, Catarrhal 
Fever . . . 105 
Temperaments . . 28 
Idiosyncrasy . , .29 
Contagious Fever . 107 
Typhus Contagiosus . 110 
Weak part . . .29 
Habit, Mode of Living, 
Occupation . . 29 
Levantine, or Bubon 
plague . . .11l 
Yellow Fever, Black 
Habitual Diseases and 
Crises . . .30 
Vomit . . . 112 
Climate . . . . 30 
Oriental Cholera . . 112 
Hydrophobia . . 113 
Cognition of Disease . 30 
Pathogenesis . .31 
Carbuncle . . . 115 
Second Class. Intermit- 
tent and Chronic Fe- 
vers .... 116 
Symptomatology . . .32 
Pulse . . . .33 
Art of feeling the Pulse 44 
Respiration . . .45 
Blood . . . .52 
Fever and Ague . . 117 
Chronic, Symptomatic, 
Hectic, , Consumptive 
Fevers . . . 123 
Digestion . . .53 
Secretions and Excre- 
tions , . . .56 
Third Class. Inflamma- 
tions and Sanguineous 
Congestions . .125 
Affections of the mind 
and nerves . .61 
Complexion, Structure, 
External appearance, 
Carriage, Position ,67 
Generalities . . . 125 
Inflammat. of the Brain 138 
Myelitis, Spondilitis . 142 
Anginas , . . 143 X 
CONTENTS. 
Stomaitis . . . 146 
Glossitis . . . 147 
Cough .... 228 
Hooping cough . . 232 
Pneumonia . . .147 
Carditis . . .157 
Chronic vomiting . 235 
Hickup .... 239 
Abdominal Inflamma- 
tions . . • • 158 
Neuralgia . . . 240 
Pruritus . . .240 
Gastritis . • ■ 158 
Enteritis . • • 159 
Hepatitis . • • 161 
Headache . . .241 
Tic Douloureux . . 242 
Toothache . . . 243 
Splenitis . • • 163 
Diaphragmatis . . 163 
Earache . . . 244 
Cardialgia, Gastrodynia 244 
Mesenteritis . . 163 
Pancreatitis . . . 164 
Pyrosis .... 245 
Colic . . , . 245 
Peritonitis . . . 164 
Omentitis . , . 164 
Hydrophobia . . 249 
Polydipsia . . . 249 
Nephritis . . . 164 
Cystitis . , . 165 
Pseudacusis, Paracusis 250 
Pseudopia . . . 250 
Metritis . . . 166 
Oophoritis . . . 166 
Nymphomania, Satyria- 
sis, Onanismus . . 251 
Psoitis j 167 
Ophthalmitis . . 168 
3. Paralytic diseases . 252 
Apoplexy of the brain . 253 
Otitis . . . .168 
Erysipelas . . . 169 
Apoplexy of the lungs . 259 
Syncope . , . 259 
Asphyxia . . .261 
Fourth Class. Rheuma- 
toses .... 
Zona .... 172 
Vertigo . . .263 
Lethargy . . . 263 
Generalities . . , 172 
Rheumatism . . 173 
Local paralysis . . 264 
Dysphagia . . . 270 
Ischias . . , . 180 
Lumbago . . .181 
Aphony, Dysphony, Dys- 
logy .... 271 
Fifth Class. Gastroses. 184 
Gastric diseases. Gas- 
Catarrhus . . .181 
Apepsy, Dyspepsy . 273 
Pica. Malacia . . 274 
tric Impurities . . 184 
Impotency . . . 274 
Amaurosis , . . 276 
Sixth Class. Nervous 
Diseases . . .190 
Various Species . . 187 
Deafness . . . 277 
Anosmia, Agustia . 278 
Generalities . . .190 
Anaesthesia . . . 278 
Anorexia . . . 279 
1. Mental diseases . . 196 
Insania . . . 196 
Hypochondria, Hysteria 203 
Seventh Class, Emacia- 
tions .... 280 
Anaphrodisia . . 279 
2. Spasmodic diseases . 210 
Epilepsy . . .210 
1. Phthisis . . .281 
Generalities . , . 280 
St. Vitus’Dance . . 214 
Catalepsy . . .215 
Pulmonary consumption 281 
Phthisis purulenta , 291 
Somnambulism . ,216 
Nightmare . . .217 
Vomica . . , 296 
Phthisis Florida . . 298 
Agripnia . . .218 
Raphania • . . 218 
Tracheitis, Laryngites . 298 
Phthisis hepatica, rena- 
lis vesicalis, mesente- 
rica .... 299 
Tremor . . , 219 
Tetanus, Trismus . . 219 
Asthma . . . 222 
Palpitation of the heart 227 
2. Tabes .... 300 
Pituitous consumption . 301 CONTENTS. 
XI 
Nervous consumption . 302 
Dorsal consumption . 304 
Constipation . .371 
Ileus .... 372 
Marasmus . . . 305 
3. Atrophy . . . 306 
Tuberculous consump- 
Ischury, Dysury, Stran- 
gury, Anury . . 375 
tion .... 307 
Anidrosis . . . 378 
Eleventh Class. Cuta- 
neous diseases . . 380 
4. Hectica . . . 309 
Eighth Class, Hydro- 
pes, Pneumatoses . 310 
Generalities . . . 380 
1. Accumulations of water 310 
Variola . . . 386 
Varicella . . . 395 
Generalities . . . 310 
Ascites . ... . 312 
Vaccinella . . . 396 
Varioloides . . . 398 
Hydro thorax . . 315 
Hydrops Pericardii . 316 
Morbilli . . . 400 
Scarlatina . . . 405 
Hydrocephalus . . 317 
Anasarca, Oedema . 317 
2. Accumulations of air . 318 
Rubeolse . . . 409 
Essera .... 409 
Urticaria . . . 410 
Generalities . . . 318 
Flatulency . . . 319 
Miliaria . . . 410 
Petechiae . . . 413 
Tympanitis . . . 321 
Emphysema . . 322 
Pemphigus . . . 414 
Aphthae . . . 415 
Physometra , . , 323 
Ninth Class. Projluvia 323 
Scabies . . , 417 
Herpes . . . 420 
Generalities . . 323 
1. Hmmorrhagiae . . 324 
Crusta serpiginosa . 423 
Lepra .... 423 
Generalities . . . 324 
Epistaxis . . . 326 
Haemoptysis . . . 327 
Erythema, Phlyctaense . 424 
Tinea capitis . . 425 
Hsematemesis . . 331 
Haemorrhoids . . 332 
Gutta rosacea. Vari . 426 
Furuncle, Carbuncle . 427 
Intertrigo. Rhagades . 428 
Melaena . . . 341 
Haematuria . . , 343 
Freckles . . . 429 
Comedones . . . 429 
Haematosis ,• . . 345 
2. Blennorrhceae , , 346 
Callositas cutis. Excre- 
scentise. Clavus. Ver- 
rucas .... 430 
Generalities . . . 346 
Ptyalismus . . , 347 
Plica polonica . .431 
Epidrosis . . . 347 
Enuresis . . . 348 
Mole .... 432 
Alopecia . . . 433 
Diabetes . . . 350 
Cystorrhoea . . , 353 
Ulcera .... 434 
Twelfth Class. Dyscra- 
sies .... 434 
Gonorrhoea . . . 353 
Pollutio . , . 354 
Generalities . . . 434 
Otorrhoea . . . 356 
Lienteria . . . 357 
Fluxus coeliacus . . 358 
Chlorosis . . . 438 
Cyanosis . . . 439 
Fluxus hepaticus . . 358 
Diarrhoea . . . 359 
Scorbutus , . . 440 
Icterus . . . 441 
Scrofula . . . 444 
Dysenceria . . , 363 
Cholera . . . 367 
Struma .... 452 
Rhachitis . , . 452 
Tenth Class. Suppres- 
sions . . . .369 
Arthritis . . . 453 
Syphilis . . . 462 
Generalities . . , 369 
Polysarca . . . 480 CONTENTS. 
Thirteenth Class. Dis- 
organizations, Pseudo- 
organizations, Para- 
sites . . . ,481 
Helminthiasis . • 486 
Diseases of Children. 
Characteristics of In- 
fancy and its Diseases 529 
Barrenness . . . 526 
Lithiasis . . . 492 
Diagnostics in children 531 
Therapeutics for chil- 
dren .... 532 
Stone in the Bladder . 493 
Stone in the Kidneys . 493 
Regimen for children . 535 
Diseases of Females. 
Sexual Diseases of 
Females . . . 498 
Gall-stone . • • 496 
Diseases of the new-born 
and infants . . 536 
Physical characteristics 
of the female . . 498 
Asphyxia neonatorum . 537 
Icterus neonatorum . 538 
Excoriationes neonato- 
rum .... 538 
Menstruation . . 499 
Thrush . . . 539 
Diseases of menstruation 500 
First development of 
menstruation, Puberty, 
Morbid obstruction of 
it ... 500 
Ophthalmia neonato- 
rum .... 539 
Erysipelas of infants . 540 
Trismus and tetanus of 
Neonatorum . • 540 
Regimen menstruale . 503 
Asthma thymicum . 541 
Suppression of the men- 
ses .... 503 
Syphilis congenita . 541 
Diarrhosa . , . 542 
Immoderate flow of the 
menses. Metrorrhagia 505 
Vomiting . ' . . 544 
Nervous attacks, spasms, 
convulsions . . 545 
Painful, difficult mens- 
truation. Menstrual 
spasms . , . 507 
Fevers .... 546 
Gastric fever . . 546 
Cessation of the menses 508 
Pregnancy . . . 510 
Catarrhal fever . . 547 
Worm fever . . . 547 
General rules for preg- 
nant women . . 511 
Inflammatory, Pectoral, 
Brain fever . . 547 
Headache and tooth- 
ache . • . 513 
Exanthematic fevers . 548 
Difficult teething . . 548 
Vomiting of pregnant 
women . • . 513 
Cutaneous acrimony. 
Biles. Crusta lactea. 
Scaldhead . . 550 
Prevention of abortion . 514 
Convulsions of pregnant 
women . • • 515 
Croup .... 551 
Parturition and childbed 516 
Millar’s Asthma . . 553 
Dropsies of the head and 
brain . • • 554 
Characteristics of this 
state . . . 516 
Treatment after delivery 517 
Decay of Children . 557 
Limping . • . 558 
Puerperal fever . . 519 
Lacteal secretion, and 
its treatment in cases 
of suckling and not 
suckling . . . 521 
INDEX . . ... 621 
Receipts . . . 561 
APPENDIX, OR THE 
THREE CARDINAL 
MEANS: 
Flux of milk . . 522 
Venesection ... 4 
White swelling of lying- 
in women . . . 523 
Opium . . . .15 
Vomits . . . .49 
Whites . • .524 £l)c Helationo of tl)c |)l)})oman. 
An instinctive impulse to relieve a sufferer was the ori- 
gin of the healing art. This pure and noble sentiment must 
always prevail, to make the practice of medicine answer its 
ideal, and render it a blessing to both physician and patient. 
To live for others and not for himself is a physician’s 
vocation. He must be ever ready t6 sacrifice his repose, 
advantages and comforts, yea, even higher considerations, 
to the end of saving the life and health of his fellow-men. 
The healing art, therefore, is something sublime and 
really divine ; for its duties coincide with the first and 
most sacred laws of religion and philanthropy, and require 
resignation and an elevation of mind far above worldly de- 
sires. None but a really moral man can be a physician in 
the true sense of the word, and it is such a one only that 
can find satisfaction in his vocation ; for he alone is con- 
scious of a higher end of existence, which exalts him above 
earthly considerations and the joys and troubles of life. 
To improve his mind, to sacrifice his person for the public 
good and a better world, and to disseminate good around 
him as much as lies in his power—is what he aims at; and 
where can he attain that end better than in a profession 
which gives him daily opportunities, yea, compels him to 
perform philanthropic acts, acts that are incompatible with 
selfishness! His professional duties therefore will always 
beautifully harmonize with his convictions and principles, 
and, so to say, flow from them. What he ought to do, he 
does with pleasure; and the consequence will be the high- 
est happiness of man, a consonance of external and internal 
life. Wo to the physician, who makes honor with men, 
or money the end of his efforts! He will be in continual 
contradiction with himself and his duties; he will find his 
hopes disappointed and his efforts unproductive; he will 
curse a vocation which does not reward—because he knows 
not true reward. THE RELATIONS 
This simple view embodies the whole moral or policy so 
called of the physician. Policy—an improper word ; for 
nowhere more than in the medical profession do we see it 
exemplified, that the best and only policy is that which 
emanates from an honest and sensitive man. The rule re- 
sulting therefrom, and which must remain a fundamental 
law for all the relations of a physician is: “ Regulate all 
your actions in a manner, that the highest end of your voca- 
tion, which is saving life, restoring health, and relieving the 
sufferings of humanity, be attained as far as possible.” 
This rule must ever be present to our mind ; it will al- 
ways direct us to the right point, and guide us safely in 
the most complicated cases. 
From this point of view let us now consider and regu- 
late the duties of a physician. They are triple : towards 
the sick, towards the public, and towards his colleagues. 
A. RELATION TO THE SICK. 
The physician in the exercise of his art must regard only 
man, and make no difference between rich and poor, high 
or low. He who suffers most or is in the greatest danger, 
has a privilege over all others, whatever be their station or 
condition in society. I pity the physician who appreciates 
his patients according to rank or fortune j he knows not 
the finest reward of a physician. What is a hand full of 
gold compared with the tears of gratitude shed by the 
poor, who, unable to speak or to give, pours out a confes- 
sion of eternal indebtedness! But the rich man believes 
himself redeemed by his donations of all obligations of 
thankfulness, not aware that the fee receives its value only 
through a deeper feeling; and the assistance rendered, 
without this, is placed in the range of common services 
and works of trade. How often is the physician the sole 
friend left to the poor in distress ! Like an angel of con- 
solation he appears to him, and raises the vanishing hopes 
by the interest he takes, and by his art he pours new 
strength into his veins. 
Should some one be so unfortunate as not to find satis- 
faction in this sublime feeling, or should he believe the 
practice among the poor will not promote his interests, he 
may remember, that the voice of the poor who has been 
saved, speaks much louder and in a more thrilling tone 
than that of the rich, who frequently, by his compensation, OF THE PHYSICIAN. 
3 
thinks himself entitled to be ungrateful and to undervalue 
the services rendered. 
In medical treatment the physician must exercise his 
greatest attention, accuracy and conscientiousness. He must 
not proceed superficially, but with research and knowledge. 
He must never consider the patient as a means, but always 
as an end 5 never as an object of a natural experiment or 
of art alone, but as a man, as the highest scope of nature 
itself.—Seldom, it is true, can the faults of the physician 
be brought before, and punished by, a tribunal, as this re- 
tribution depends upon accurate evidence of the case, but 
which is scarcely ever obtained. However, the most cer- 
tain and the most formidable tribunal is waiting for him— 
his conscience—where no subterfuge, no palliation, no want 
of a complainant can guard him, where nothing will ab- 
solve him but a pure and guiltless mind, and the convic- 
tion of having done all within his power and knowledge 
towards saving his patient. Though he may learn through 
improved knowledge and experience subsequently acquired 
that he might have done more and better, he may regret 
his former deficiency, but not feel remorse, for at that time 
he did all he was capable of performing. He must, how- 
ever, be mindful that neither levity, his own ease, or any 
personal consideration, or—what may happen to a better 
one—that no predilection for a system or fondness of ex- 
perimenting, lead him to neglect his duties; for then the 
internal judge will not remain silent. Such cases will 
sooner or later meet with adequate punishment from tor- 
menting reproaches. 
But skill and art alone are not sufficient. He must be 
particularly mindful of his conduct. It is this which recom- 
mends him to the public, and creates confidence and ad- 
mittance ; for the generality of people are incompetent 
of pronouncing on his science; it is, then, natural for them 
to take their measure of his ability from the measure of 
his conduct. By force of conduct alone a physician of very 
moderate talents can become the favorite of the public, and 
without it the most skillful professional man remain unno- 
ticed and unappreciated. Of his external appearance also he 
must not be regardless ; it should comport with the dignity 
of his station and the importance ofhis duties.—The main 
features ofhis conduct should be: aptitude to create con- 
fidence, friendly with dignity, decent without affectation, 
gay but not ludricous, serious when he ought to give im- 
portance to his subject and his words, complaisant and in- 
dulgent in all insignificant matters, but firm while execut- 4 
THE RELATIONS 
ing important measures and sustaining the pronounced 
sentence 5 sympathizing and cordial, of sound sense and 
regard for religion and its consolations; neither taciturn 
nor loquacious, much less a messenger of news, but de- 
voting his whole attention to the sick, noticing every cir- 
cumstance, careful in the examination of the patient, ob- 
serving even those around him, neither eccentric nor vulgar, 
neither coxcomb nor pedant, but holding to the middle way 
in all things; especially not passionate and angry, but 
calm and circumspect; for a quiet and sober sense creates 
confidence.—It is a great fault common to young practi- 
tioners, particularly of late, that they strive principally to 
create sensation, whether it be by the newest fashion of 
dress or science, or by paradoxism and singularities, or 
even by charlatanism. 
But there is a great difference between exciting sensa- 
tion and creating confidence ; yea, the former prevents the 
latter from taking place, and it is only by the latter that a 
lasting prosperity is founded. Exciting sensation can, of 
course, have the effect of making a physician the topic of 
conversation for some time, even of procuring him a large 
concourse of patients, but the attraction of novelty soon 
ceases, and the meteor vanishes into nothingness. On the 
other hand, the silently meritorious, honestly persevering 
and unwearied may remain for a time unnoticed, but in 
establishing himself slowly in the love and confidence of 
the better ones, he lays a surer and firmer foundation for 
future prosperity. 
A most important point for attaining this end, but rather 
too much neglected by our young practitioners, is keeping 
a journal of cases. When the noise of the day has termi- 
nated, and the silence of the evening invites to reflection, 
then the physician may yet devote a few hours of calm 
contemplation to his patients, write down the most im- 
portant points in the history of a malady, the alterations 
which have occurred, his remarks and ideas on the origin 
and treatment of disease, the remedies prescribed, and 
reconsider the whole maturely.—No evening must pass 
without paying this last duty to his patients, and thereby 
adding the keystone to his work. Here, in the silence of 
night, many a thing will appear to him in quite a different 
light than during the day ; revelations and inspirations will 
come over him, such as cannot find birth in the distrac- 
tion of busy day. Only in this period when internal life 
awakens, also this subject can enter into internal life, and 
only now it will receive true interest and reflection. For OF THE PHYSICIAN. 
5 
that alone which affects and fills our mind, which accom- 
panies us always even unconsciously, is ours ; and solely 
penetrated by such an object, we may hope to become 
great and perfect in it and to arrive at new discoveries.— 
Great Newton once was asked, how he had come to his 
extraordinary discoveries. “I always thought of them,” 
was his reply, simple but certainly all embracing. 
It is not mechanical dexterity, however careful it be, 
but a deep conception of his object, which makes the ac- 
complished artist. Every cure, in order to be good, must 
not be a servile imitation of others, but an original in 
itself. 
I do not, therefore, deny that I consider this daily habit 
not solely a principal means, but an indispensable condi- 
tion for becoming great and perfect in the practice as well 
as in the art;—an assertion which is confirmed by the ex- 
amples of our most eminent physicians, of Boerhaave, Fr. 
Hofmann, Stoll, Lentin, etc., who all observed this habit 
and praised its utility. Moreover, there grows out of it 
this other great advantage—that of obtaining a collection 
of complete histories of maladies upon which we have, 
ourselves, reflected,—a treasure of experience, which will 
not fail in after-times to yield much instruction, and en- 
lighten us by a comparison of the successive changes of 
our opinions and methods;—to say nothing of the great 
utility which may be derived therefrom for the patient, 
serving as an accurate register of his state of health, of 
his maladies, the remedies which proved particularly bene- 
ficial in such or such a case,—a circumstance of egregious 
moment. 
The same is true in regard to visiting the sick. When 
shall we cease to place confidence in the mere presence of 
the physician, and to esteem his care by the number of his 
visits! Alas! the head cannot keep pace with the feet, as 
Zimmermann has well remarked. Such mere corporeal 
presence and looking-on, however often repeated, will not 
promote a cure; and, properly speaking, amounts to no- 
thing more than rendering honors—paying one’s respects 
—to the disease according to its rank. A visit must be 
made with deliberation, a collected mind, and be of suf- 
ficient duration. The physician must not be present in 
body only, but in mind ; and must direct his whole atten- 
tion to his patient and study him. It is only such visits 
that will answer the purpose sought. They will result in 
a double advantage to the physician, firstly, in convincing 
the patient of the interest which he takes in him, and there- 
X* 6 
f'HE RELATIONS 
by gaining his confidence; secondly, in creating that reci- 
procity of feeling and familiarity, which permits of a deep 
insight into the nature of the case ; in short, to use an ex- 
pression of the magnetizers, “place the sick in perfect rap- 
port with the physician,”—certainly, in quite a particular 
state of mind ; one which admits of particularization and 
a deep insight into the “inward man teaches us to form 
more correct feelings and ideas regarding the suffering of 
nature and her wants from art, and gives thoughts which 
strike us the more forcibly since they arise directly from 
the patient. One such visit is worth more than many made 
in haste. Too many visits in chronic cases, since they 
render the patient too common to our senses, may blunt 
the keenness of our perception, and obstruct our vision ; as 
the saying is—“we cannot see the forest for the trees.” I 
have experienced, in such cases, that an interruption of 
the usual visits for several days will enable us to gain a 
new view of the subject, and to bring phenomena to light 
which heretofore had escaped observation. It must, how- 
ever, be remarked here, on account of young physicians, 
who, through delicacy confine their visits to too small a 
number, that in general frequent visits are more requisite, 
since they enable one to arrive at a more perfect know- 
ledge of the disease, and also preserve the confidence of 
the patient. Too frequent visits, unnecessary visits, are 
to be avoided, for they give useless anxiety to the patient, 
and expose the physician to be suspected of interested 
motives. 
The office of the physician is not confined to curing dis- 
eases; it behooves him as a duty and merit also to prolong 
life, and relieve sufferings in maladies pronounced incur- 
able. How much, then, at fault are they who grow dis- 
gusted or lazy, and neglect or forsake a patient when there 
is no prospect of cure ! The interest of the artist, it is true, 
may be annihilated ; but humanity must persist, yea, in- 
crease. Verily, the unfortunate, who labors under tortur- 
ing pain, distress and despair, is still more entitled to our 
commiseration than he, to whom the prospect of recovery 
lessens all suffering. It is an act of pity, natural to every 
generous heart, in such cases to make life tolerable, to 
raise dying hope, and to bring consolation at least where 
there is no salvation. Moreover, we are too short-sighted 
to be capable of always deciding with certainty that help 
is not possible. In the course of a disease favorable in- 
ternal revolutions may take place, or external influences 
may operate and give a new turn, or give to art oppor- OF THE PHYSICIAN. 
7 
tunity for successful interference.—Yea, I consider it as 
one of the most important rules of practice, never to give 
up hope. Hope generates ideas, elevates the mind to new 
views and new endeavors, and can render impossibility 
possible. He who has given up hope, has given up reflec- 
tion, to which apathy and paralysis of the mind follow, and 
the sick must invariably die, because he who has been 
called to his assistance is already dead. Even in the stage 
of dying the physician ought not to forsake the sick; even 
then he may become a benefactor, and if he cannot save, 
may at least relieve departing life. 
To preserve and, if possible, to prolong life is the highest 
end of the medical art; every physician has vowed to do 
nothing which might shorten the days of a man. This 
point is of great weight, and is one of those from which 
he must not depart the breadth of a line, lest his practice 
be productive of uncountable distress. Now, is it always 
pondered on with sufficient conscientiousness and strict- 
ness 1 When a patient is tortured by incurable evils, when 
he prays for death as the end of his suffering, when preg- 
nancy engenders disease and danger to life, how readily, 
even from the mind of the best the idea will emerge : 
would it not be permitted, be even a duty, to rid the mis- 
erable sufferer of his burden a little earlier, or to sacrifice 
the life of the foetus to the safety of the mother 1 Though 
such reasoning be plausible, be supported even by the sug- 
gestions of the heart, it is false, and a mode of action 
based upon such principles would be a crime. It annihi- 
lates the vocation of the physician. He is bound in duty 
to do nothing but what tends to save life ; whether exist- 
ence be fortunate or unfortunate, whether life be valuable 
or not, is not for the physician to decide. If he once per- 
mits such considerations to influence his actions, the con- 
sequences cannot be estimated, and he becomes the most 
dangerous person of the community. For if he once tres- 
pass his line of duty, and think himself entitled to decide 
on the necessity of an individual’s life, he may by gradual 
progressions apply that measure to other cases. 
Now, the life of a sick person can be shortened not only 
by acts, but also by the words or the manner of a physi- 
cian, and that most unintentionally on his part. It is, there- 
fore, his sacred duty to guard himself carefully in this re- 
spect, and to avoid all things which have a tendency to 
discourage the patient and lower his spirits. He must 
never forget that nothing ought to emanate from him, 
which might have the effect of injuring the patient or of 8 
THE RELATIONS 
shortening his days ; every word, every look, his whole 
conduct must be of an enlivening tendency. He must not 
forget that his patient looks upon him as judge of life and 
death, and anxiously scrutinizes the glances of his eyes, 
the gay or sad features of his countenance, in order to dis- 
cover.his sentence. Is it not a fact that fear, especially of 
death, anxiety and fright are pernicious poisons, that they 
directly paralyze the vital power; while hope and courage 
are the most efficacious animatives, frequently surpassing 
all medicines, nay, without which even the best medicines 
are unavailing I The physician, therefore, must be care- 
ful to preserve hope and courage in the patient’s mind, re- 
present his case in a favorable light, conceal all danger 
from him, and, the more serious it becomes, show a more 
cheerful appearance; and least of all betray uncertainty 
and irresolution, although there be cause for doubt. He 
can guard himself from the suspicion of not having fully 
appreciated the nature of the case, by giving a true de- 
scription of the patient’s situation to the relatives, and if 
they be fickle and negligent, to state it rather darker than 
lighter. Hence it will appear, how blamable is the con- 
duct of those physicians, who do not hesitate to announce 
to the sick the danger, even fatality of their situation, and 
how injudiciously those relatives act, who desire the physi- 
cian to do so. To announce death is to give death, which 
is never the business of him, who is employed to save life. 
•—Even if the sick person desires to know the truth, under 
a pretence of arranging his affairs or the like, it is not ad- 
visable to pronounce his sentence. I have heard of two 
cases, wherein two excellent practitioners were induced 
by the entreaties of the patient, to reveal to him the incura- 
bility of his evil, and the consequence was that each pa- 
tient committed suicide. 
It is not life alone, but what is still more, reputation, 
that the physician must risk, when the life of a sick 
person is at stake. We meet here with a case, which un- 
doubtedly is one of the most difficult in the medical pro- 
fession, and in which a false sense of honor is so apt to 
mislead, while nothing but correct considerations and true 
principles can safely guide us. The physician sees, that 
the patient can be saved only by one means; but that 
means is dubious and the trial is dangerous, and at the 
same time there is nothing more certain, should it prove a 
failure, than guilt will be attributed to him. The false po- 
litician will be prevailed on by this consideration, think- 
ing it were better that the sick die than that he appear OF THE PHYSICIAN. 
9 
to be killed by the prescription, and will neglect to make 
this trial. But the honest physician knows of no other 
consideration, than benefiting the sick ; he conceives that 
to estimate his reputation higher than the life of the pa- 
tient, is to be guilty of an act of selfishness totally incom- 
patible with his vocation; he believes that it is not a hope 
of success but an honest intention which is to direct his 
actions, and that he has only to consult duty and con- 
science, regardless of the result. Therefore, he does not 
hesitate to use also this last resort in order to save his pa- 
tient, and will either enjoy the triumph of seeinghis ho- 
nest attempt crowned with success, or the still greater 
triumph, of having sacrificed to his duty that which is 
most dear to him; and the more he is misjudged by the 
public, the more he feels himself exalted above all opinions 
of men, and rewarded in a more divine manner, than by the 
honor and fame which men can bestow. In general, the 
physician must be prepared to bear the false and unjust 
judgment of the public, as soon as he engages in the treat- 
ment of a patient. The result and the opinions based upon 
it are not within our power, and must consequently be 
quite indifferent to us. Interrogate the best physicians, 
and they will tell you, that they, in cases which terminated 
fatally, have often used more pains and skill, redounding in 
intrinsic merit, than in some most successful cures. In the 
cure of disease, all that we may glory in, is to have com- 
plied with our duty. This conviction is sufficient; of this 
reward nobody can deprive us, for it places us above the 
injustice done to us by others, in the same proportion that 
a rational soul is exalted above brute temporality. 
A circumstance which frequently gives him more dis- 
tress than the disease, and renders his profession a painful 
one, is the humor of men. Prejudices of all kinds, the 
difference of education, character, temper, and surround- 
ing objects, unite in 'hindering good. In such an instance 
the physician must be deeply skilled in human nature. But 
what physician will not become familiar with it, provided 
he is not destitute of common sense ! I do not know of any 
profession which affords so many opportunities. 
Knowledge of man is derived through correct feeling, 
and prudence, which alone can rightly guide him in this 
point, and, in spite of all obstacles, lead to an accomplish- 
ment of his end. I shall only mention the most usual of 
these characters:—the anxious, the fickle, the credulous, 
the incredulous, the obedient, the taciturn, the loquacious, 
the conceited, the demiphysician. The most troublesome 10 
THE RELATIONS 
are the two latter, for they do not say what they really 
feel; they are not satisfied with good advice, they want 
to reason with and consult, and they arrogantly make al- 
terations in the use of the remedies. To such patients we 
must particularly inculcate the general rule, to throw the 
care of the disease, as well as the contemplation of it, 
which is sometimes more painful than disease itself, upon 
the physician, and free themselves entirely of it. 
The art of writing 'prescriptions is very important, and 
worthy of more attention than is generally bestowed upon 
it. It is the last result of the whole examination of the 
physician, and the only perpetual document of his insight 
and skill (genius), which has even legal authority bearing 
for or against him. How readily a little fault committed 
in precipitation, an error in writing, may decide the fate of 
the patient and the physician’s reputation ! Therefore, it 
should always be made with a mind most concentrated and 
attentive, and it ought to be an inviolable rule with every 
physician, “ to peruse every prescription after it has been 
written.” 
Dangerous remedies ought never to pass into the hands 
of the patient, at least not in such a quantity as might en- 
danger life. It is a horrible sight to see vials of an ounce 
or half an ounce of opium in the sick room. If an accident 
happens in such a case, the fault lies always with the phy- 
sician. 
No honest practitioner will sell, nor even allow to pa- 
tients, nostrums ; for how can he judge of things which he 
does not know himselfl 
Wherever it is possible without detriment to the main 
end, the practitioner must always prefer the cheaper to the 
more precious, the native to the foreign remedies. It- is 
also a relief of the evil, with which the physician is charged, 
to diminish the expenses, at least not to increase them 
without necessity, and it is one of the duties of a good 
citizen, by using domestic remedies, to save the common- 
wealth from sending money into foreign countries. It is 
indeed cruel to neglect this consideration in the case of 
indigent people, and to take away the means of living in 
saving their lives. 
In this respect he can become a real benefactor to his 
patients, if he regards their financial circumstances not 
only with benevolence but with delicacy. Ido not speak 
here of the really poor, whom the state or public charity 
takes care of, but of that class of persons, who, whilst in 
good health, barely make their living, and as soon as at- OF THE PHYSICIAN. 
tacked by sickness are thrown into indigence, and those 
who are really poor, although they do not wish to seem so 
—the bashful poor. It is almost only the physician who 
has a chance to find them out, and he also is best able to 
relieve their misery, and—what is the main thing—with- 
out allowing them to perceive it. I will only refer to one 
means, by which the expenses of cure may be exceedingly 
diminished without the appearance of gratuitous medica- 
tion, which would place the patient amongst the poor : it 
is to make an agreement with an apothecary of a charitable 
mind to this effect, that he will not charge profit on re- 
ceipts marked with a concerted sign, by which expedient 
the sick may save a third, sometimes a half, of the ex- 
penses. In this way we may succor the indigent, and not 
offend the feeling of honor, so sacred a circumstance. To 
do this is really to benefit. In extending benefits all de- 
pends upon the manner in which it is done. How happy 
is the physician when he is enabled by his profession to do 
••good, complying with the injunction, that the “ left hand 
must not know what the right does,” and that even the in- 
digent does not know whence the benefit comes, and re- 
ceives it, thanking God as he would for a heavenly dona- 
tion. It is in this way that in every act of kindness, the 
true sense and object on the part of the giver as well as of 
the receiver, is attained. 
B. RELATION TO THE PUBLIC. 
To no one is public opinion so important as to the phy- 
sician. He is the man of the people in a true sense; the 
voice of the people decides what shall be his station. He 
must, therefore, be most anxious to win reputation, and not 
unmindful of the means proper for that purpose. It is a 
vain and unseasonable pride in young practitioners, to 
boast of being elevated above public opinion and not to 
care for it. The pride of a wise man is, to accomplish his 
end in the most correct manner: now he who aims at an 
end, must use also the means necessary for attaining it. 
The principal end of the physician is curing; the more op- 
portunity he can find for practising it, the more completely 
he will attain it, and become a benefactor of mankind. 
Nowt, that depends mainly on the good opinion of the com- 
munity, and consequently it devolves upon the physician 
as a duty, to make efforts for acquiring and establishing 
himself in it. 12 
THE RELATIONS 
Extraordinary talents and striking success, it is true, can, 
so to say, force public opinion, and raise a physician even 
in spite of general dislike. But these are rare exceptions. 
The common course is this : the young practitioner has 
gradually to raise a public sentiment in his favor, by Avhich 
the public may be encouraged to commit to him the high- 
est earthly goods—life and health. 
The principal means for obtaining that end, are, (besides 
careful and conscientious attendance on his patients,) un- 
shaken probity, regularity of habits, temperance, prudent 
conduct, as previously described, modesty, discretion in ail 
his utterances and judgments, precaution in the selection 
of his company, attention, not alone to essentials but also 
to appearances. The physician, especially the beginner, 
must never forget that he is more observed than other 
men. He belongs to the community; it is the interest of 
every one to become acquainted with him, lest he may at 
some time have to commit his life to his care; and every 
one arrogates for himself a right to judge him. 
The physician is of no party, he belongs to all. Popu- 
larity is his element, and freedom of mind and of political 
relations his noblest prerogative. He must therefore care- 
fully avoid to join a party, or enter into connections which 
compel him to do so. On the contrary he may congratulate 
himself, that his vocation permits, even obliges him, to take 
no notice of parties and the external relations of men, and 
see only mere man. 
It is also highly recommendable and advantageous to 
disseminate, by conversation or by writing, sound ideas, 
and correct notions respecting the preservation of health 
and a rational treatment of diseases, to combat prejudices, 
and to promote institutions ameliorative of the general 
state of health. This is certainly one of the surest and 
most glorious ways, by which the physician can be use- 
ful, bring his name into notice, and acquire a reputa- 
tion and public confidence. He must, however, proceed 
cautiously and prudently, in attacking deeply rooted pre- 
judices and favorite habits of the public; for, by treating 
them impetuously and sarcastically, he is likely to fail and 
render himself hateful without correcting the evil. 
Wit and a satyrical disposition are dangerous gifts to a 
young practitioner. In no man are they so prejudicial and 
incompatible with the nature of his vocation, as in the per- 
son, to whom-man has to expose himself in all his naked- 
ness, and has to detect infirmities and secrets, which no- 
body else is destined to learn. The greater part of the OF THE PHYSICIAN. 
13 
public will rather have recourse to a man of small capacity, 
than to a scoffer and witling. How many have contracted 
inreconcilable enemies by a single pun ! A real injury is 
more readily pardoned than mockery. 
Secrecy is one of the first and indispensable qualities of 
a physician; for, by his vocation he learns the most im- 
portant secrets, and takes the place of a confessor. The 
happiness, not only of single men, but of whole families, 
lies at his discretion, and it would be an act of baseness to 
betray such confidence, or abuse it intentionally. He is to 
avoid not only being, but even appearing to be indiscreet; 
therefore, he must speak as little as possible of other pa- 
tients, answer laconically and indefinitely questions asked 
about others, and the least of all to go into particulars and 
narratives of domestic life. 
Above all things the physician should not be reputed a 
gamester, a tippler, or a libertine, for these habits are in 
strict contradiction with his profession, and infallibly will 
take from him the confidence of the public. The first of 
these vices interferes with that interest which is due to the 
patient; the second deprives him of the command of his 
senses ; and the third of that purity and respectability of 
character, which is absolutely indispensable in his profes- 
sional relations. It is, therefore, an advantage that the 
physician be married, and lead a good domestic life. He 
hereby will acquire more confidence, especially among 
females, and also escape many a suspicion, even improper 
desires. 
He must not appear too desirous of gain. It debases the 
physician and his art, deters the poor from applying to 
him, and takes away that which is worth more than all 
riches—good repute. 
C. RELATION TO COLLEAGUES, 
Is double, partly general, partly in regard to the sick. 
The first embraces mutual respect, and wrhen that is not 
possible, let at least-indulgence be the principal law of 
conduct. Nothing is more difficult than to judge others; 
but nowhere is it more so than in the practice of medicine, 
ft is, therefore, unpardonable in the public; but it is revolt- 
ing to hear physicians, who know the difficulties of the art 
and of forming opinions regarding it, judge their colleagues 
with severity, harshness, contempt, or disclose their faults, 
and try to raise themselves by lowering others. 
2 14 
THE RELATIONS 
Oh! that I were as able to impress the minds of my bre- 
thren with the truism, as forcibly as I am penetrated by it: 
He who degrades a colleague, degrades himself and his 
art.—For, in the first place, the more the public becomes 
acquainted with faults of physicians, the more will physi- 
cians become exposed as contemptible and suspicious, and 
the more will such exposure impair confidence ; and con- 
fidence in the whole body being diminished, every single 
one, and the censurer included, will lose a share of it. 
The public would be less prone to censure the medical 
profession, and its faults would not be a favorite topic of 
conversation, if the members themselves did not broach it, 
and set the bad example. It shows a shortsighted selfish- 
ness, and want of all common spirit, when a physician acts 
in such a manner, and thereby hopes to raise himself in 
the same proportion as he degrades others. Further, such 
conduct is in opposition to the first principles of morals 
and religion, which command us, not to lay bare the faults 
of others, but to overlook and excuse them. Such a cha- 
racter will be more lowered in the esteem of sensible men, 
than he whom he endeavored to degrade ; for, the detracted 
loses only as an artist, while he loses as a man, and a bad 
action is esteemed worse than a bad medical treatment. 
Finally, they should reflect, that the same measure they 
apply to others is applied to themselves. He, who treats 
others in a harsh and haughty manner, may rest assured, 
that he will be dealt with in the same way—which is but 
justice. Modesty in conduct and judgment behooves every 
one, most of all a young physician; it will procure him 
friends and opportunities for instruction, and promote his 
external interests as well as his internal improvement. 
The medical art is still far from that degree of perfec- 
tion and certainty, which would enable us to pronounce 
sentence on all methods of curing diseases; we do not yet 
possess a legitimate universal code ; every one is still at 
liberty to form his own views about the human system and 
its treatment, provided they are not against reason and 
experience. Nobody will deny, that cures may be effected 
in quite different ways, and that the apparent contradic- 
tions in treatment may dissolve into unity, by the various 
operations of the organism. Organic nature is not confined 
within such narrow limits as are our systems; if it were so, 
one after the other would not have had its ascendency, and 
been applied with success.—’After all, our experience, and 
the result rightly derived therefrom, are the only true and 
constant rules to be followed in medicine ; and the longer OF THE PHYSICIAN. 
15 
and the more sagaciously a physician has observed the ope- 
ration of the living organism against the influence of the 
external world, and especially the influence of medica- 
ments ; the more he has learnt to appreciate the powers of 
the latter, and to use them with adroitness, the more per- 
fect physician has he become. Let every one, therefore, 
have his own system, his own views of things; let, espe- 
cially, the young practitioner feel happy to possess the 
newest and most finished theory, and to be able to deduct 
all according to the rules of the school ; but none must be- 
lieve that he is alone in possession of truth; he must re- 
spect the opinions of other physicians, particularly of old 
ones, matured in experience ; and he must often admonish 
himself that he, who believes himself sage, is only on the 
threshold of art, and that to doubt, and to search for that 
which is unknown to us, is the surest sign, and at the same 
time the only means, of proficiency. 
The young physician will see in the old practitioner ma- 
turity of experience ; profound practical scrutiny ; extent 
and solidity of knowledge : discrimination of what is essen- 
tial and proper in art from what is accessory and vain ; 
practical tact; the art to transfer generalities into the spe- 
cific form of the subject, and to individualize the case as 
well as its treatment—an art which is not to be acquired by 
science, but by practice, and which makes the great prac- 
titioner ; a knowledge and appreciation of the medicaments 
and their specific niceties; and finally, an adroitness in 
hitting the right place, time and measure. He must try to 
acquire the confidence and friendship of the elder one by 
modesty, and a desire of knowledge ; to profit by his con- 
versation, and in this he will not only improve himself, but 
also gain a support, of which a young practitioner is so 
much in need. On the other hand, it behooves the old 
practitioner, to respect in the younger one the freshness 
of his insight; the modern view he has learnt regarding 
nature and art; the vigor, desire for knowledge, research 
after truth, diligence and application, the merit of honest 
earnestness, the scientific and systematic education ; the 
old one will remember that he had to travel the same road, 
and how difficult it was to the beginner; and will not with- 
hold from him that paternal benevolence, but give to him 
Irom the treasure of his experience ; point out to him his 
faults with friendship, palliating and excusing them before 
the public ; especially in case of treatment and consulta- 
tion m common, he may be cautious and kind, for it is here 
that a word from the old master may be decisive of the fate 
of the young man. 16 
THE RELATIONS 
Moreover, it is an axiom in medicine, that the most 
trifling circumstance is capable of altering the state of 
things and their signification, and it is utterly impossible 
to judge of the medical treatment of another, unless one 
has himself been present, and has been informed of all the 
particulars. 
It consequently follows that it is always indicative of a 
deficiency of mind, or of knowledge, or of malignity and 
bad conscience, in a physician, to speak ill of his col- 
leagues, and it behooves the honest practitioner, when he 
is asked his opinion, to excuse himself from giving it, by 
saying that it is impossible to judge in medicine, without 
a most accurate knowledge of the case; or if this is not 
practicable, to give explanations favorable to his profes- 
sional brother, which is not a difficult thing to do. Thus 
he will ever respect himself and his profession. 
As to the second point,—the relation of colleagues to the 
sick,—consultation is first to be discussed. 
In general, the use of consultations, especially when they 
are numerous, is very problematical. When opinions are 
alike, consultation is of no avail; when they are diverse, 
confusion and disorder in the treatment is likely to ensue. 
It too easily happens that passions and personal feeling get 
mixed up in a consultation ; and what is still worse, a re- 
gard for the sick and desire of cure are but too readily 
divided and diminished, even in a well disposed physician, 
by the interference of plurality. But there may be cases, 
in which consultations are useful, yea, unavoidable: as 
when a disease is very complicated and obstinate, and the 
physician grows uncertain in his view and his course ; when 
the patient hesitates and loses confidence in him; when 
there is great responsibility attached to the treatment, or 
there intervenes the feeling of a relative, in which we dare 
not trust ourselves. 
However, in order that a consultation may prove really 
useful, the following conditions must be complied with : 
The consultations must not be numerous ; two, at most 
three physicians are sufficient; and they must not be de- 
cided enemies of each other, obstinate partisans of different 
sects, but be ripened by mature experience, and have a 
talent to understand and to enter into the ideas of others. 
Their office is principally to ascertain the diagnostic 
causes and character of the disease, and then the mode of 
cure to be pursued. The execution and guidance of a cure, 
however, must not devolve on a committee, but only on 
one, the physician in ordinary. 
The great principle to be observed by every consulting OF THE PHYSICIAN. 
17 
physician, must, however, always remain this, namely, to 
have in view nothing but the welfare of the patient, and to 
that end he must entirely sacrifice his personal feeling, in 
order that all his powers may unite for a common purpose. 
If physicians in their consultations would be penetrated by 
this simple sentiment, there never would be altercations, 
scandalous scenes, and misunderstandings; and consulta- 
tions would always prove beneficial to the patient. But on 
the contrary, physicians often seem to assemble only to 
show their reciprocal importance, and to discredit the treat- 
ment of the ordinary; and instead of harmonizing together, 
to sustain their individual opinions. 
Consequently, in the first place, the patient is never per- 
mitted to be witness of the consultation, but learns the re- 
sult of it as well as he is able, after the deliberation is over. 
It would be most ungenerous, and at the same time cruelty 
to the sick in the consulted physician, to intimate that the 
treatment hitherto used had been wrong. Every one should 
express his opinion modestly and show his reasons for it, 
and if the opinions differ, they must mutually try to make 
themselves understood, to give explanations without ca- 
price, and to enter into the ideas of each other, in order 
either to join opinions, or by a more efficacious persua- 
sion to create a better one. For, now-a-days especially, 
the cause of quarrel lies only in a difference of view and of 
language, and it is only necessary to translate the opinion 
of one, into the parlance of the other, to do away with all 
difference. Should one be prepossessed of a favorite idea, 
or of a favorite remedy, the other ought to yield willingly, if 
there is nothing injurious to the patient in it; to do so will 
make it apparent, that we are not led by caprice, and the 
more complaisance in return may we expect in the main 
matter. But should it happen, that the opinions and the 
plan of treatment can by no means be agreed on, there is 
no other expedient left, but an appeal to the decision of the 
patient. He must declare to whom his confidence leans, 
and the plan of this one must be prosecuted. 
Nothing is worse than the habit of some patients to 
clandestinely consult other physicians, besides the physi- 
cian m ordinary; and nothing is more reproachable than 
the habit of some physicians to yield to such demands, even 
to profit by them, to raise suspicion against the ordinary, 
and to procure admittance for themselves. No honest 
professional man can act so base a part; he will rebut 
such a demand, and insinuate to its authors, how indiscreet 
and impossible it is, to judge and to give advice without 
2* 18 
THE RELATIONS OF THE PHYSICIAN. 
consulting the physician in ordinary, and without knowing 
the plan of cure which he pursues. No one must think 
that there is no harm in giving a general opinion on a dis- 
ease and a cure. Such utterances made without the least 
bad intention, tend to raise doubts and suspicions in the 
mind of the sick, and create difficulties and disagreeable 
embarrassment for the ordinary physician. But should he 
be convinced that the sick is falsely treated—salvation of 
the patient being the supreme end of the healing art—re- 
gardless of all political and collegial considerations it must 
prevail. This end must be attained, and in cases of urgent 
danger, he must immediately do what conscience and duty 
advise, without farther reference. No physician of a rea- 
sonable mind can find fault with such a proceeding. But on 
the contrary, when the case is not urgent, he must either 
propose a consultation, or, if the patient will not agree to 
this, he must clandestinely suggest to the physician in 
ordinary, what kind of treatment would be better accord- 
ing to his opinion. Thus he can comply simultaneously 
with the obligations towards the sick as well as his col- 
league, and relieve the one, without injuring the other. 
But when the sick has entirely lost confidence in his phy- 
sician, and he is resolved, to give himself up to the care 
of another, the latter dare not and cannot refuse to com- 
ply, nor the other take it ill, for the confidence of a man 
rests with himself and is to be respected. Each one must, 
however, proceed with that frankness and forbearance 
which becomes well educated gentlemen. 
When a sick person passes from one physician to an- 
other, it is very common, in order to excuse this step, that 
he speaks ill of the former physician, right or wrong, and, 
alas! it is the policy of the common practitioners to coun- 
tenance this conduct, and to find the treatment hitherto 
used erroneous. But it is not so with the honest profes- 
sional man. He is aware, that such conduct is ungenerous 
towards his colleague, and cruel towards the patient, who 
will certainly feel double grief on becoming convinced, 
that he has lost, not only time and pain, but that his dis- 
ease has perhaps become worse and incurable. I cannot 
conceive how it is possible for a man of sense and feel- 
ing to embitter the last days of a sufferer’s life hy such 
declarations. Consequently, the treatment hitherto pur- 
sued is to be approved, if not as a matter of collegial po- 
liteness, at least in pity for the patient; the doubts of the 
patient are to be appeased, and the want of success in the 
treatment attributed to other causes. 19 
NATURE AND ART. 
Nature an!t '“UI 
PHYSIATEIC. 
Natura sanat, Medicus curat morbos. 
All cures of diseases are effected by nature; art is only 
her assistant and cures but by her means. 
As the external appearance of a disease is caused and 
exists only by an internal morbid state of organic life, an 
internal process of disease, so is every external cure de- 
pendent on an internal curative process, an activity of or- 
ganic life for altering and restoring the abnormal condition 
into the normal, and it is in this way alone, that cure is 
possible. 
This is true of all diseases without exception. In visible 
diseases, surgical so called, nobody doubts that this is the 
case. Every surgeon admits, that it is not he who cures 
a fracture, a wound, or an ulcer; but it is Nature, the vital 
power, which restores health through her wonderful ope- 
rations of exsudation, conglutination, suppuration, expul- 
sion of corrupt matter and regeneration ; and that his office 
is merely to guide these operations regularly and properly, 
and to remove obstacles. 
The same principle holds good in internal diseases, the 
internal relations of which are hidden from our senses; 
differing only in this, that in the latter case we cannot see 
with our eyes the curative operations of alteration, secre- 
tion of corrupt matter, regeneration and restoration of the 
balance. This observation applies not only to acute dis- 
eases, in which life is most agitated, but also to chronic 
maladies, where vital activity is less prominent. In slight 
cases we daily see health restored without the assistance 
°t art; the same, however, may be met with in serious, 
even in the most serious maladies. In the whole catalogue 
of diseases there is none, from the most violent inflamma- 
tory fever to the putrid plague, from suppressions to pro- 20 
NATURE AND ART. 
fluvia, from dynamic diseases to dyscrasias, that has not 
been cured by Nature alone. What then does art do to- 
wards curing 1 We bleed in inflammations, abstract powers, 
and are under the impression, that we have cured by that 
process. But the sole merit, which we can claim is, that 
we have removed impediments, excess of blood and agita- 
tion; and have thereby enabled nature to accomplish that 
internal healing process, which is peculiarly her own, and 
which must always take place, when our treatment is suc- 
cessful. In the adynamic nervous state we support the 
powers, and believe we thereby make a cure; but in so 
doing we only raise the curative power of nature to a de- 
gree that is requisite for performing those internal curative 
operations, which are necessary to recovery. Even the 
direct cure of diseases by specifics, so called, is the work 
of nature ; for the remedy used acts only as an excitative, 
and the reaction it awakens, and the alteration for the bet- 
ter, are solely owing to the internally working power of 
nature. Thus far also hommopathy, which claims so high 
a stand above nature, is the best proof of her power; for 
Hahnemann’s doctrine is nothing more than a method of 
curing diseases by specifics, and in selecting such a remedy 
as will create a disease similar to that which already ex- 
ists, affecting the very organ diseased, excites the reaction 
of nature in this part, and produces that internal curative 
process which heals the disease. Even in dyscrasias, where 
a specific poison has been received into the system, the 
curative power of nature might possibly suffice. Need we 
mention the thousands who have been restored without any 
remedy in venereal affections; yea, intentionally without 
the use of mercury 1 Now, in venereal diseases deeply 
seated in the organism, what could mercury do without the 
co-operation of this internal curative power, which alone 
effects the secretion of the virus and simultaneously of the 
poisonous remedy administered against it, the regenera- 
tion of healthy humors indispensable for completing the 
cure, the normalization of specifically altered secretions, 
and the restoration of disorganized organs'! How often 
does the use of quicksilver in its different forms prove use- 
less, until the vital power of the enfeebled body is raised 
by generous diet and strengthening medicines, to that de- 
gree of energy which is requisite for the internal curative 
operation and even for mercurial action 1 
The internal curative power is most conspicuous in 
those wonderful changes which are often produced by it 
alone, in quite an unexpected and most surprising manner, NATURE AND ART. 
21 
to wit—in crises, metaschematisms and metastases, which 
entirely remove or alter severe chronic maladies that have 
withstood for a long time all artificial means. The patient 
whom we in the evening considered fated to death, has in 
the night a profuse perspiration, and we find him in the 
morning out of danger. In a severe acute disease, which 
we combat in vain by our remedies, suddenly an abscess is 
formed in some external part, and the disease is gone. The 
greatest triumph yet of the curative power of nature is 
manifested in her conquering the multifarious, most oppo- 
site and injudicious methods of medical treatment. Is it 
not of daily occurrence that sick people living in the coun- 
try get well without any assistance, yea, in spite of the 
most perverse treatment! And even as regards rational 
treatment, I have long since become convinced, that the 
greater number of cures are not due to the labors of the 
physician, but to nature ; the patients get well with the 
physician assisting, but by far the least solely by his as- 
sistance. 
This is the true meaning of the great word crisis, handed 
down to us from the remotest antiquity with sublime and 
mysterious significance ! Not the critical evacuation, not 
the external change, but the internal healing process, the 
disease internally operated upon, the work of the internal 
vital power, which assimilates, secretes, metamorphoses 
and creates anew, that alone lies at the bottom of those 
external appearances: this is what is comprised in that 
word, and was understood by it by all professional men, 
who, true to nature, penetrated into her mysteries, un- 
blinded by scholastic systems, since the time of Hippo- 
crates to the days of Sydenham, Hofmann and Boerhaave. 
A system of medicine which embraces nature in this 
sense,—which acknowledges and respects the laws of life, 
and the activity of nature as its superior,—which regards 
not itself as the agent, but merely as an instrument of this 
internal healing process, which takes its indications for 
acting only from the -wants and demands of morbid nature, 
and determines accordingly,—which appreciates all that is 
going on in the organism (disease as well as its own cura- 
tive operations, and the effects of medicaments) as living 
and as actions of life ;—in short, which lives in life itself, 
and as it considers all that lives, exalted by life to a higher 
sphere of existence, and which therefore only moves and 
acts m this sphere and becomes one and the same with 
curative nature,—such a system I call Physiatric. 
In a general sense this word signifies natural cure; I NATURE AND ART. 
mean to designate by it the healing art founded on natural 
principles. It is the only true art of healing, based on the 
eternal laws of nature. It is this system which since the 
time of Hippocrates has been the Ideal of physicians, and 
which has never departed from skillful practitioners, even 
amid the changes of schools. It is this which I profess and 
have ever professed. 
From these preliminaries a correct idea may be formed 
of art, of its relation to nature, and of the position of the 
physician. As certain as it is that every recovery depends 
upon the curative process of nature, and cannot be accom- 
plished without it, as certain is it too, that the cure can be 
facilitated, aided, promoted, yea, sometimes made possible 
only by art. In this truth resides the necessity and the 
value of art. 
I shall now point out its province more distinctly in the 
following lines. 
1. Art sometimes can take away the whole disease by 
removing the exciting cause, and so dispense with the in- 
ternal curative process of nature, e.g. by removing a fo- 
reign body, a poison, a gastric accumulation which pro- 
duces the disease. 
2. The vital power is sometimes too exalted, and its ope- 
rations too impetuous and violent, so much so, that it may 
consume itself or injure noble organs. Here art can effect 
that degree of reduction and depression, which is requisite 
to bring on a perfect crisis, and to prevent dangerous oc- 
currences. 
3. On the other hand nature may not have sufficient 
power, to perform the internal curative process. Here art 
interferes, raises and makes up, by suitable strengthening 
remedies, the deficiency, and thereby only renders the in- 
ternal cure possible. 
4. Art can remove obstacles, which render the curative 
process of nature difficult or impossible. Under this head 
falls the important point of a proper diet, quietness in 
febrile-diseases, guarding from the influence of impure air, 
injurious aliments and the like. 
5. Art can support nature in combating particular forms 
of disease by appropriate remedies, conformable to the 
malady. 
6. Art can assist nature in the commencing crisis and 
bring it to perfection. 
7. Finally, there are morbific matters and conditions of 
which unassisted nature cannot get rid, e.g. the syphilitic 
virus, mechanical lesions. In such cases the assistance of NATURE AND ART. 
23 
art is indispensable either for improving the quality of that 
matter by means of agents counteracting its virulence, or 
for lending mechanical or surgical assistance. 
Such is the province of the art of healing, and such are 
its limits. The physician must not pretend to be magister, 
but minister naturae, her servant or rather assistant, ally, 
friend. He is to go with nature hand in hand, and in per- 
forming his great task he must never forget that it is not 
he, but nature who operates ,*—regard nature, be always 
guided by her, and never interfere to disturb her. 
Two errors hence may originate, which the physician 
must carefully avoid. 
The first is doing too little, the negative treatment which 
leaves all to nature. To this fault especially is the new 
(homoeopathic) school liable ; a fault which may be follow- 
ed by fatal consequences in those cases, where there is 
really something positive to be done. Such a course is 
proper only when there is no definite indication for action ; 
where time and patience are necessary for a cure, or 
where nature takes upon herself, her powers being well 
balanced, to carry the disease through a certain space of 
time and wear it out, e.g. mild small pox, measles and the 
like. 
A second error is that of doing too much. Here it will 
not be amiss to caution against carrying venesection and 
the use of other remedies to such an extent, that the or- 
ganism suffers more by their administration than by the 
disease. 
The art of healing comprises two parts: recognizing dis- 
eases, and acting against them. 24 
DIAGNOSTICS, lATROGNOMIC. 
Diaguostu©, Satrogmnnic. 
COGNITION OF THE OBJECT TO BE CURED. 
Cognition of disease is the first condition of cure. Now, 
what is meant by cognition of disease 1 It does not mean 
to give a name to disease, or to conceive solely its exter- 
nal phenomena. Such is nominal, physio-historical, noso- 
logical diagnostics, which can only lead to an external, 
superficial, symptomatic method of curing. What is meant 
by cognition of disease, is a knowledge of the internal 
morbid state, which causes the external phenomena: this 
alone is the object of every radically curative treatment. 
This is the idea of practical diagnostics, of which I am 
now going to speak. It is the art of recognizing the in- 
ternal morbid state, the seat of disease, and consequently 
the object of cure ; the demands of morbid nature on art, 
and thereby the indication of treatment, as far as it is 
founded on these premises. 
Practical diagnostics not only comprises the cognition of 
disease, but also a knowledge of the sick person, i. e. of 
the individual affected with disease, and the most accurate 
determination of his individuality and his characteristics. 
For there is a vast difference between the same disease exist- 
ing in this or in that subject,—a difference which influences 
most essentially the formation, modification, and treatment 
of disease. The niceties of it can be determined upon only 
by a knowledge and consideration of these particularities. 
Experience teaches us, that in the judicious observation of 
them rests the eminency of the most skilled and successful 
practitioners. 
We shall first treat of the cognition of the sick, and then 
pass on to the cognition of the disease. 25 
DIAGNOSTICS, lATROGNOMIC. 
I. 
COGNITION OF THE SICK. 
CHARACTERISTICS OF THE INDIVIDUAL 
We have to consider: 
We distinguish the following principal species of phy- 
sical difference in man. 
1. Constitution of the Patient. 
a. The plethoric, phlogistic, or sthenitic constitution. The 
sanguineous system is predominant; quick and rich san- 
guification, full, strong pulse, florid complexion, warmth 
of body, energy in all the manifestations of life, disposition 
to congestions of blood, hemorrhages and inflamhiations. 
b. The adynamic, weak, feeble constitution. Pulse weak, 
easily compressible, deficiency of warmth, weakness of all 
the functions, particularly the voluntary; easily fatigued, 
dyspnoe in exercise, necessity of frequent restoration by 
nutriment as well as by fresh air, perverse condition of ex- 
citability, either too much exalted or diminished ; the same 
habitude as regards secretions, which are either too co- 
pious or too scanty. Disposition to adynamic diseases, 
stagnations, profluvia. 
c. The nervous constitution. Nervous system predomi- 
nant, great irritability and sensibility of both body and 
mind ; inequality and changeability of habit; disposition 
to spasms, and other anomalies. 
d. The dry or rigid constitution. (Constitutio rigida, 
sicca.) Firm fibre, dryness, meagerness of the whole body, 
scanty secretions and excretions, deeply colored urine, 
small and hard stools, dry skin, and commonly of brown 
complexion, disposition to congestions of blood, obstruc- 
tions, especially in the abdomen, sthenic diseases. 
e. The lax, spungy constitution. (Constitutio laxa, hu- 
mida.) Lax fibre, soft spungy flesh, bloatedness, pale color, 
deficiency of warmth, chilliness, generally a fair com- 
plexion, liable to catarrhs, mucous accumulations in all 
organs, which secrete mucus, either in the head, chest, or 
abdomen, to serous and lymphatic accumulations and ex- 
travasations, to profluvia, obstructions, and imperfect 
chronic character of diseases. 26 
f. The lymphatic, mucous constitution coincides with the 
foregoing. 
g. The gastric, bilious, atrabilious constitution. Irregular 
and imperfect digestion and evacuations, constant disposi- 
tion to disorders of the stomach and intestines, hypochon- 
driasis, in the bilious a morbid irritability of the liver, so 
that from the most trifling cause effusions or retentions of 
gall arise, in the atrabilious yellowish hue of the skin, dark 
urine, constipation of the bowels, hemorrhoidal complaints. 
k. The rheumatic, catarrhal constitution. Feebleness, mor- 
bid sensitiveness of the skin, therefore defective and easily 
suppressed perspiration, great disposition to rheums and 
catarrhs. 
DIAGNOSTICS, lATROGNOMIC. 
i. The psoric constitution. Apt to disordered secretion 
of the skin and appendages, hence always foul skin, prone 
to eruptions and ulcers ; therefore in all diseases and crises 
a tendency to shift to the skin. 
k. The venous hemorrhoidal constitution. The venous 
system and venous blood predominate, especially in the 
abdomen, the portal system is liable to plethora, causing 
hemorrhoidal congestions. 
l. The phthisical constitution. A long slender body, ra- 
pid growth, long neck, flat chest, depressed thorax, wing- 
like protruding shoulder-blades, excitable vascular system, 
quick pulse, red circumscribed cheeks, hot hands after 
eating, disposition to ebullitions and congestions of blood, 
want of breath in exercise, great liability to diseases of the 
lungs, pneumony, hemoptysis and pthisis throughout life. 
m. The apoplectic constitution. Short thick neck, large 
head, closely attached to the shoulders, short stout body. 
Disposition to affections of the head, to apoplexy. 
2. Hereditariness. 
The state of health the parents have enjoyed, or the dis- 
eases they may have suffered under, is of the greatest im- 
portance for the recognition and characteristics of the in- 
dividual state of health of a patient. For by procreation 
not only real diseases are transmitted, but also the dispo- 
sition to diseases, which at certain periods of life, or under 
favoring circumstances, will break out into actual mala- 
dies. Of that number are consumption, gout, calculus, 
scrofula, piles. Enfeebled and aged parents engender 
weakly children. Even syphilis is transmissible to offspring. DIAGNOSTICS, lATROGNOMIC. 
27 
3. Sex. 
Sexual difference imparts to the organism a different 
pathological character, and establishes a disposition to 
different maladies. The male possesses more power, en- 
ergy, constancy, and disposition to sthenic diseases ; the 
female more sensibility, greater excitability, with less en- 
ergy and stability of reaction, delicacy and laxity of fibre, 
is liable to lymphatic and adipose accumulations, to nerv- 
ous diseases, hysterics. Powerful influence of the sexual 
organization and its functions, menstruation, pregnancy, 
parturition, lactation, cessation of the sexual functions, 
(catamenia.) 
4. Jlge and Period of Life. 
Every age has its peculiar character and maladies, arid, 
disposition to diseases of its own; mortality also varies 
according to the periods of life. 
From birth to first dentition presents an imperfect half 
finished life, progressive development and creation, great 
irritability and sensitiveness, violent excitability from 
slight irritating causes, disposition to spasms and conges- 
tions to the head ; the largest mortality, one-fourth die. 
Infancy, up to the 7th year, is marked by laxity of fibre, 
great excitability and little strength, easy exhaustion and 
easy restoration, disposition to congestions, inflammations, 
disorders of the vegetative and productive system (ence- 
phalitis, exsudatoria, angina polyposa, hypertrophy and atro- 
phy, dyscrasias, scrofulosis, helminthiasis). Great mortali- 
ty, one sixth of all born. The second period of infancy (from 
the 7th to the 14th year,) or age of puberty, shows more 
harmony in the functions and powers, less disposition to 
diseases, a smaller amount of mortality. 
The period of youth from the 14th to the 21st or 24th 
year, (young man and virgin,) is distinguished by growth, 
predominance of the vascular system, disposition to inflam- 
mations, particularly congestions to the lungs and the 
brain ; commencing of the sexual functions. 
The period of the full-grown, from the 24th to the 50th 
year, is of a stationary character, showing no increase or 
°eqnfase ’ .ecluihbrium, the least of sickness or mortality. 
ihe period of advancing age, from the 50th to the 60th 
year, may be recognized by decrease of strength, Indolence 
and disturbance of functions, cessation of sexual desires. 
Semlity is characterized by decreasing sensibility, by 28 
DIAGNOSTICS, lATROGNOMIC. 
diminution of the five senses and of memory, of muscular 
strength, of secretions, of nutrition, rigidity, dryness, even 
tendency to ossification, disposition to dyscrasias, degen- 
erations and disorganizations, to lithiasis. 
Exhibit the relation of the mental influence on organism, 
and the different characters resulting therefrom. The 
temperaments are infinitely diversified ; they may, how- 
ever, he reduced to four principal categories ; each of 
them admits of two subdivisions ; either irritability is eas- 
ily aroused (irritable temper), with reaction of short dura- 
tion in the sanguine, or with reaction long and lasting in 
the choleric ; or the irritability is defective which forms 
the torpid temperament, called phlegmatic, if of short and 
difficult reaction ; melancholic, if of lasting and strong re- 
action. 
5. The Temperaments, 
The following is a delineation of the different tempera- 
ments. 
The sanguine temperament. All irritations and impres- 
sions, corporeal as well as mental, are easily aroused, hut 
transient; which is productive of an easy mind, hilarity 
and gayety. As for the body, it is easily excited, but long 
intervals of ill health are of rare occurrence. It is fur- 
ther marked by quick and abundant sanguification, which 
gives rise to plethora, predominance of the vascular sys- 
tem, and creates disposition to congestions of blood and 
inflammations. 
The choleric temperament exhibits great excitability 
with violent reaction of the whole organism, but particu- 
larly of the biliar system. Thence all irritations and ex- 
citements readily create an increased secretion of bile al- 
tered in its quality ; but on the other hand the biliar stim- 
ulus reacts and imparts even to the mental more inclina- 
tion for anger, bitterness and violence of effect. Abun- 
dance of bile, yellowish or brownish tint ; black hair; 
firm dry fibre. Disposition to violent excitements and 
inflammatory diseases, to bilious affections ; also all other 
diseases are prone to partake of the bilious character. 
The phlegmatic temperament is characterized by not being 
easily affected, and exhibiting only weak, tardy reaction, 
tardiness in all functions, corporeal as well as mental ; 
betrays a deficiency of warmth, laxity of fibre, disposition 
to lymphatic accumulations, profluvia, chronic diseases of 
atony and weakness. DIAGNOSTICS, lATRONOMIC. 
29 
The melancholic temperament is excited with difficulty, 
but exhibits deeply seated, not violent but lasting reaction. 
The feelings are not lively nor easily excited ; but such 
impressions as are made, penetrate deep and are lasting, pro- 
ducing physical as well as mental effects which progress 
in a concealed manner. Hence a tendency to reflect, to 
meditate, a disposition to hypochondriasis, sadness and 
melancholy. As for the physical, a disposition to all 
chronic diseases, especially of the abdomen, obstructions 
of the intestines. 
It is well to observe that the temperaments do not al- 
ways occur simple, but are more frequently mixed, com- 
pound of several. 
6. Idiosyncracy. 
A mode of perceiving impressions and reacting upon 
them, which is peculiar only to certain individuals. Such 
oddities are of physiological, pathological and therapeuti- 
cal importance, and must be carefully regarded by the 
physician, since they are essential to recognition and treat- 
ment of diseases. 
7. The Weak Part. 
Every man has an organ relatively weak, which is most 
susceptible of disease, and which deserves particular atten- 
tion. We may ascertain which it is, by inquiring what 
part is most frequently subject to morbid affections, what 
part is most directly influenced by morbific causes, Colds, 
heat, mental affections. 
8. Habit, Mode of Living, Occupation. 
Habit becomes second nature. Reference to this has 
diet, the usual articles of food and the usual remedies, e.g. 
of bleeding, purging, etc. at a certain time. 
As for occupation, all that live can, pathogenetically, be 
divided into two principal classes,—each of which imparts 
to man an essentially different character, thus constituting 
two classes of men differently characterized; the sedenta- 
ryi,116’ and the motory life. 
he sedentary life, which is usually connected with 
confined air, predisposes to maladies of the abdomen, ob- 
SbrU'^tlonS ntest’nes5 especially of the liver, hemor- 
rhoids, hypochondriasis, and by corrupt air to diseases of 
the lungs. 1 30 
The motory life in free air (the life of the country peo- 
ple) is in accordance with nature, and secures against the 
disease before mentioned. This accounts for the striking 
disproportion of consumption between the inhabitants of 
cities and those of the country. Also the various ways of 
living, whether rich, luxurious, idle, poor, or exhaust- 
ing ; the occupation, whether more mental or corporeal, 
makes momentous differences and forms the character of 
the individual. 
DIAGNOSTICS, lATROGNOMIC. 
9. Habitual Diseases and Crises. 
Every man has his particular disposition to disease and 
to crises. In one, nature has a tendency to restore all mor- 
bid disturbances by sweat, in the other by diarrhoea, etc. 
This the physician must not disregard. 
10. Climate. 
The influence of climate on the character of the inhabit- 
ants is exceedingly great. Remember the difference be- 
tween the inhabitants of warm and cold regions, of the 
coast and of the continent, of mountains and of plains. 
11. 
COGNITION OF DISEASE, 
Is obtained from the following sources : 
Pathogenesis, which embraces what has past—a know- 
ledge of the preceding and actual state of internal and ex- 
ternal morbific influences, the phenomena of an actual mor- 
bid state which strike the senses ; analogy, reagency. 
The two first sources, namely, pathogenesis and symp- 
tomatology are the most important. Analogy, which com- 
pares the case under consideration with similar cases 
which have been observed by us or others,—is an auxilia- 
ry for distinguishing disease in difficult cases, where the 
first do not furnish sufficient light. The same maybe said 
of reagency—the administration of external agents, in or- 
der to judge by tbe reaction they produce, what may be 
the state of organic life—as the chemist uses reagents for 
his purposes : abstraction of a little blood, the use of wine 
in order to determine in dubious cases, whether there is 
an inflammatory or an adynamic state. DIAGNOSTICS, IATROGNOMic. 
31 
By the proper use of these modes we arrive at a rational 
idea of the essence of the disease—the image of the inter- 
nal state of the sick, of the internal change of organic life 
which lies at the bottom of the external phenomena—the 
very object of cure. 
I. PATHOGENESIS. 
To determine the origin of disease, we have to ascertain 
the following points : 
1. The prevalent constitution of disease. It deserves the 
first attention of the practitioner. He must always live in 
and be familiar with it; it is to him of the same importance 
as the spirit of the age is to the philosopher, or the state 
of the money market to the merchant. It is the product 
of generally predominant influences, therefore, of universal 
nature, of which man is a component part, and which is 
manifested in and by him. The means for ascertaining this 
condition are a daily observation of the barometer and 
thermometer ; the direction of the winds ; humidity and 
dryness; sudden changes ; state of atmospheric electricity. 
Besides these, we must also regard the generally prevalent 
injurious influences of moral and physical causes, e.g. 
universal failure of the crops, famine, anxiety, calamities, 
horrors of war. 
The morbific constitution is either subject to regular 
changes dependent on the seasons (constitutio annua), or 
to a character persisting through all changes of season, 
even for years (c. stationaria) ; or is accidentally created 
anew (epidemica) ; finally, a real epidemy, that is to say a 
newly created disease of a decided form and character, 
often quite a novel pathological creation, which never ex- 
isted before, which seizes a multitude of persons simulta- 
neously and irresistibly, continues a while, and runs, like 
any other disease, through its stages of increase, acme and 
decline. It bears to the epidemic constitution the same 
relation as disease does to a morbid disposition. 
2. The genius loci, the endemic constitution—climatic 
influence. Every place has its own peculiar character, 
and which it impresses on its inhabitants, influences their 
health and modifies their diseases. The physician must 
carefully study it; for it will afford him excellent informa- 
tion both for distinguishing diseases, and treating them ; 
indeed there are diseases which are peculiar only to such 
and such a place or climate (endemic maladies). 32 
DIAGNOSTICS, lATKOGNOMIC. 
The circumstances which determine the genius loci, and 
the climatic influence are : the degree of latitude, elevation 
above the surface of the sea,—the prevalent winds, the 
drafts of air, frequent and sudden change of temperature— 
quality of the ground (mountainous or flat), quality of the 
soil (moist, marshy or dry, sandy or rocky), vegetation 
(sterile, meadows, cultivated fields, forest),—water (stag- 
nant, running),—neighborhood of the sea (important diff. 
erence between islands and ripuarian countries of conti- 
nental regions),—way of living and occupation, (difference 
between the pathological character of large populous cities 
and the plain country,—between the inhabitants of manu- 
facturing places and those of agricultural districts.) 
3. Predisposing causes (morbific disposition), are such 
as are inherent to the individual—hereditariness, one part 
of the body weaker than the rest, long continued external 
influences, e.g. dwelling, business, surrounding persons, 
disposition of mind, etc. 
4. Exciting causes (causae occasionales). Of that num- 
ber are all potencies pathogenetically affecting the human 
system, mechanical, chemical, psychical, especially air, 
temperature, food and drinks, poisons, contagions, over- 
heating, taking cold, excessive exertion and prostration, 
suppressed secretions, passions. 
5. Preceding or lingering diseases. The whole patho- 
logical life of the patient may be a remote cause of the 
actual state ; for the present evil is often traceable to an 
ancient one, and not to be discovered but by a careful ex- 
amination of the intermediate metamorphoses. Here may 
be mentioned also the method of curing and the medicines 
previously used, yea, all other habits. 
In order to find out those pathogenetic relations, the 
physician must necessarily command a thorough know- 
ledge of anatomy and physiology, of general pathology, 
especially setiology, as well as of natural philosophy, chem- 
istry, and of nature in general, as far as it respects living 
organization. 
11. SYMPTOMATOLOGY. 
Interpretatio Natures. 
The physician must be the interpres et minister natures. 
The first requirement and essential qualification of a prac- 
titioner is to understand the language of nature,—the voice DIAGNOSTICS, lATROGNOMIC. 
33 
in which she utters her sufferings and demands relief. This 
language consists in the perceptible phenomena of the 
morbid action, generally called symptoms or signs (signa). 
They are a vocabulary, in which each word has its definite 
and original meaning. As words are susceptible of differ- 
ent significations by combination with other words, so in 
diseases does the simple meaning of a sign, when connect- 
ed with other signs, become susceptible of various signifi- 
cations and interpretations. In this instance, however, as 
well as in others, the original import remains always the 
principal one, and diseases as well as compositions will be 
never correctly understood and interpreted without reflect- 
ing on this truth. 
It is impossible for me to expose all the inferences which 
these signs tend to, unless 1 were to write a complete 
semiotic, for which space is here wanting. I shall content 
myself with laying before the eyes of the beginner the ori- 
ginal signification of the most important phenomena and 
their practical value ; I cannot omit to recommend to him 
the careful study of a complete system of semiology.* 
1. THE PULSE. 
When you see a sick person for the first time, the pulse 
may guide you in determining upon the four principal ques- 
tions: what state of life is existing, what kind of disease 
is he affected with, of which character is the disease, and 
whether there is danger of life or not I It would be more 
practicable to judge and treat rightly the patient according 
to the pulse, without knowing any thing else of his malady, 
than to do so without the pulse, after having been made 
acquainted with all other symptoms.f Even of life the 
pulse is decisive. There are cases, in which we may learn 
only by this sign, if the sick person is really or only appa- 
rently dead. 
As for the first question, that of life, the pulse is the only 
certain determinative, for it indicates the power of the 
heart and blood; the first being the central point of life, 
the latter is the vehicle of the vital power. 
* Besides the older writings on that subject, I would recommend 
particularly the Semiotic of Professor Albers of Bonn, as a classical 
Work. 
t Ihe Chinese physicians prove, in a most striking manner, how 
much may be ascertained by the pulse by a competent person. They 
rarely ask a single question, they go only by feeling. DIAGNOSTICS, lATROGNOMIC. 
The second and most important diagnosis afforded by the 
pulse is, whether the disease is febrile or not. This ques- 
tion is only answered by the quickness or slowness of the 
pulse. 
We distinguish farther by the pulse the two principal 
forms of fever,—the intermittent and the remittent. In the 
first the pulse is at certain periods entirely free of fever, 
and calm ; in the latter it never becomes entirely calm, but 
is always, sometimes more, sometimes less agitated ; by 
which in remittents the period of remission and exacerba- 
tion, in the former that of apyrexia and paroxysmus is de- 
termined.—This distinction is very momentous towards a 
cure ; for, in complete intermission some remedies, e.g. 
cinchona, can be used, which would be injurious in the 
remittent state. Yea, in the febris intermittens perniciosa 
life depends upon this distinction, for an apoplexia inter- 
mittens must be treated in quite a different way from an 
intermittent fever. 
It is by the pulse that we recognise in chronic diseases, 
whether they have already attained to the hectic stage, 
i. e. lingering fever, or not. 
By the pulse we distinguish between asthma and phthisis, 
for in the first disease the pulse is quiet, in the latter quick 
and feverish. 
In all fevers the pulse is the main sign for determining 
the increasing or decreasing febrile action, and, conse- 
quently, danger. Increasing quickness of the pulse shows 
always increase of disease and danger, diminution of quick- 
ness decrease of disease and danger. The more the pulse 
approaches to the normal one, the more the sick approaches 
to health.—This sign is the most certain of all; so that, 
notwithstanding all other symptoms being unfavorable, if 
the pulse becomes more tranquil and normal, amelioration 
is to be expected ; and on the other hand, though all other 
symptoms appear favorable, yet if the pulse be frequent, a 
bad issue is to be looked for. 
In termination of the fevers, in the period of crisis, it is 
the pulse alone which decides, whether the crisis was per- 
fect or imperfect, i. e. if the disease has entirely ended. 
When the pulse continues irritated and quick, we may rest 
assured, in spite of all other important signs, that the cu- 
rative process is not finished, and that either a relapse or 
a metastasis, or a metascheraatism, that is to say, a transi- 
tion into hectic fever, in short no perfect recovery is to be 
expected.—An exception to this rule marks the nervous 
fevers, wherein the pulse retains an unusual frequency some- 35 
times for weeks, solely by a continuation of increased irri- 
tability in the vascular system; and here, also, it indicates 
a slow convalescency. 
The third question : whether disease be of a sthenic or 
of an adynamic character, is likewise best determined by 
the pulse : a strong hard pulse, difficult to compress, is 
always indicative of a sthenic character ; a soft pulse, easily 
compressible (unless local causes impart to it this cha- 
racter), is indicative of an adynamic state. In this respect 
it is very important to observe what are direct and indi- 
rect relations, which heat and other febrile symptoms bear 
to the pulse.—When the relation is direct, i. e. when the 
heat, pain, delirium, or any other symptom is increased, in 
proportion as the pulse rises and becomes more frequent, 
the disease is of an inflammatory character, and requires a 
debilitating method. When, on the contrary, the relation is 
indirect, i. e. the more the pulse decreases, the more does 
heat, pain, delirium, etc., increase, in such a case it is 
a sure sign of an adynamic character, and indicates a 
strengthening method. In the first case an abundance of 
power, in the latter a deficiency of it is the cause j in the 
first, diminution, in the last augmentation of power corrects 
the attacks. Wine cools, and assuages the pulse, the de- 
lirious state, arffi the pains. 
Moreover, by the pulse the nervous character is best re- 
cognised, in acute as well as in chronic diseases. When 
the pulse is unequal (one beat different from the other), or 
changeable (for some minutes or even hours slow, full, 
large, then small or quick) in fevers, it is a sign, that the 
fever under consideration is not inflammatory but nervous; 
and in chronic diseases, that the blood is not affected, but 
only the nerves, hypochondriac or hysteric, and conse- 
quently requires quite a different treatment. Here must 
be mentioned a most important distinction between the 
character of different local affections, and merely spasmo- 
dic inflammations. There can be a most violent pleuritic 
pain, with oppression and threatening suffocation ; or the 
most violent fixed pain in a part of the abdomen, which 
might lead one to consider it a violent local inflammation ; 
and yet a venesection would kill the patient. Here it is 
only the pulse, and some other accessory circumstances 
which can inform us of the true nature of the case. If the 
DIAGNOSTICS, lATROGNOMIC. 
pulse be at the same time small, unequal or remittent; urine 
pale and watery ; the extremities cold; and the patient in- 
clined to weeping, the disorder is spasmodic and requires 
the use of nervina. If, on the contrary, the pulse be hard. 36 
DIAGNOSTICS, lATROGNOMIC. 
full, and strong; the urine red and fiery ; and the patient 
hot, then it is inflammation, and bleeding is called for. 
The fourth question—how far has danger advanced 1 is 
likewise decided most satisfactorily by the pulse ; for, it is 
from the exertions of the heart, as punctum movens of all 
life, and from the phenomena exhibited by the circulation 
and the impediments to vital action as immediately con- 
nected with it, that the actual stock of vital power is as- 
certained. The more unequal and remittent therefore the 
pulse is, or extremely small and quick, the more imminent 
will be the danger. 
But also in the selection of medicaments the pulse is a 
principal guide; yea, in some cases of danger of life, it is 
the only one on which salvation depends. I allude here to 
those cases in which the administration of Peruvian bark 
prevents fatal apoplexy (F. inter mittens perniciosa), and to 
some dangerous inflammations and congestions of blood, 
where phlebotomy must be resorted to. 
Even for appreciating the effects of medicines and deter- 
mining their application, the pulse is a principal sign. In 
the first place, it indicates generally whether the remedies 
affect the system or not; and in the second place, whether 
that effect is good or pernicious, whether to be increased 
or to be diminished.—This observation applies to either 
species of fever. 
In inflammatory fevers the pulse is the chief guide, in 
resorting to the most important remedy—venesection. 
Blood must be abstracted, until the pulse is reduced from 
its inflammatory height and strength to one that is normal; 
the pulse is here the votum decisivum. Although the local 
affection (pppressio pectoris, dolorespleuritici, delirium, etc.), 
to relieve which bleeding has been resorted to, does not 
cease; if the pulse sinks, venesection must be disconti- 
nued. In like manner the repetition of phlebotomy is de- 
cided upon, according as the pulse again increases in height, 
or is contra-indicated by its decrease. 
To ascertain, in a dubious case, whether the state is a 
phlogistic, or an adynamic one, the pulse, as qualified by 
venesections, is the best diagnostic sign. But this requires 
accurate and practical observers. If you feel the pulse, as 
soon as blood begins to run, simultaneously becoming 
smaller and quicker, it surely shows an asthenic character, 
and the vein is immediately to be closed. But when the 
pulse from the beginning becomes somewhat fuller, and 
then softer, more quiet and not smaller, there is certainly 
an inflammatory disease. DIAGNOSTICS, lATKOGNOMIC, 
37 
In adynamic fevers the pulse is the only sign even for 
knowing whether the organism reacts against the medi- 
cines, and whether they have produced a sufficient degree 
of irritation. 
All depends on this—whether the administration of a 
new remedy is followed by a change in the pulse for the 
better; whether the quick, small pulse becomes slower 
and fuller; the tardy oppressed one more vivacious. This 
alone is sufficient to prove the curability of the disease, 
and at the same time the propriety of the remedy, for its 
quantity as well as for its quality. When there is no 
change at all in the pulse, even by increased doses, it is 
the worst sign and announces a bad issue.—Augmented 
quickness and irritation of the pulse is generally a proof 
that our remedies are too strong and ardent, and we must 
diminish them, unless we would kill the patient by over- 
action. 
(In general the young practitioner must be very cautious, 
not to consider the increasing rapidity of the pulse always 
as a sign of increasing weakness, but first to examine whe- 
ther it is not rather the consequence of too strong irrila- 
tives, and of which he will soon be made aware by a small 
diminution of them ; while on the contrary, led by the 
former supposition, he will attack the patient with stronger 
irritant medicines and destroy him.) 
In all evacuations, whether of blood or of other humors, 
jn fevers as well as in chronic diseases, the pulse is the 
only sure sign, whether they are critical or symptomatica!, 
wholesome or injurious, and consequently to be suppressed 
or allowed to go on. 
From the pulse in general we may recognise the fol- 
lowing : 
1. The power of the heart, and, by this, the vigor of the 
vital power in the whole body. The pulse is nothing else 
but the rebounding of blood in the arteries, caused by the 
contraction of the heart; and it is therefore evident, that 
by the stronger or weaker resistance, which the blood 
makes against the pressure of the finger, the stronger or 
weaker power of the heart, and consequently of the whole 
vital power, of which the heart is the principal source and 
central seat, may be recognised. Therefore, it is by the 
pulse that the greatest abundance of vital energy (inflam- 
matory state) as well as vital weakness is so surely recog- 
nised. The greater the power of the heart, the more pow- 
erfully will it impel the blood into the arteries, causing it 
to strike harder against the fingers placed over the vessels, 
4 38 
DIAGNOSTICS, lATROGNOMIC. 
and make them more resistant against compression. The 
Aveaker the heart, the weaker will be that rebound and 
counterpressure. 
2. The quality of the irritability of the vascular and nervous 
systems * The contraction of the heart is caused by the 
entering blood operating as an irritative on the internal 
partitions, and brings their irritability into action. The 
greater the irritability, the quicker and livelier will the 
contractions be excited, and the more rapid and frequent 
will be the pulse ", the weaker the irritability, the slower 
and tardier the pulse will be. This does not apply to the 
arterial system. But, as the nervous system is intimately 
connected with it, it will also express the changes which 
occur in nervous irritability, and the pulse becomes thereby 
a very important sign of nervous irritations, such as—pain, 
emotions, gastric irritants, rvorms, flatulency, etc. being 
present. By change of irritability the pulse is altered, not 
alone in regard of quickness and frequency, but also of re- 
gularity and equality (unequal, remittent pulse), and even 
abnormal irritability is communicated to the heart and ex- 
hibited by the pulse,; therefore, inequality and remission. 
Likewise, by the influence of nervous irritation the ves- 
sels can be affected, and become harder, tenser, and more 
contracted. 
3. The quantity and quality of the blood. The more blood, 
the fuller and less yielding the artery ; the less, the Jess 
distended and empty is the to the touch. Even the 
quality of the blood may be recognised in the pulse : inas- 
much as it is richer in cruor and fibrine, the firmer and 
more difficult to compress will it be ; the more watery and 
serous the blood, the softer and more yielding the puls'- , 
* In modern times, especially since Parry’s experiments, the part 
Avhich the arteries take in pulsation, has been too much undervalued. 
It is forgotten, as it happens too frequently now-a-days, that the pa- 
thological state is different from the physiological ; and that in the 
former, powers may become effective in some part or other, of which 
the physiological condition might not give the least anticipation. It 
is undeniable and is plain to the touch, that the contractility of the 
arteries is increased by inflammatory or nervous irritation and by 
spasm ; and that the arteries acquire by increased contractility more 
hardness, tension, and even diminution ; whereas they become softer 
and more extensile by an absence of such influences. Yea, that the 
operation of the arteries is essential for moving the blood we clearly 
perceive in paralyses of single limbs, where the pulse is much 
weaker, and sometimes even entirely stopped, although the heart 
propels the blood into them with the same power as into the rest of 
the arterial system. Even the increased in an inflamed 
part, as well as the difference of the pulse in different arteries, which 
is observed in some diseases, is a proof in favor of my assertion. DIAGNOSTICS, IATROGNOMIC. 
39 
farther, the richer the blood in irritant substances or calo- 
ric, the more frequent and rapid it is. 
4. Mechanical impediments in the vascular system, which 
are due to obstructions, hepatisation of the lungs, polypi, 
enlargement of the heart and the large vessels, hydropic 
accumulations in the pericardium and the chest, also to con- 
siderable impediments in more remote systems, especially 
of the abdomen. 
The Most Important Varieties of Pulse, 
Are the frequent and rare {pulsusfrequens et rants)’, 
the quick and clow (pulsus celer et tardus). 
The pulse is called frequens, when the heart contracts 
oftener than in the healthy state, in adults more than 70 
times in a minute, varying however according to indivi- 
duality; in children of less than two years more than 90 
times. Celer, when the act of contraction of the heart is 
quicker than in the normal state. It is rants, when it beats 
less frequently than in the healthy state, i. e. less than 70 
times in a minute; tardus, when a single contraction hap- 
pens more slowly and tardily. 
Frequentia and raritas have reference to the number, 
celeritas and tarditas to the quality of contraction. 
Acceleration of the pulse indicates either an increase of 
irritability, or an increase of irritation. It is therefore, in 
the first case, the most common sign of fever ; and as aug- 
mented irritability can be the consequence of exalted as 
well as of sinking vital power, quickness of pulse can arise 
from either state ; nay, be still greater in weakness, inas- 
much as the irritability from weakness is still more ab- 
normal than that from strength. In the latter case it is due 
either to idiopathic augmentation of the irritant mass in 
the vascular system, i. e. an increase of the quantity of 
blood, or apparent plethora occasioned by distention, or 
relatively greater accumulation of blood in the heart, 
owing to retrocession from the periphery occasioned by 
cold, contraction of the skin, tight lacing or mechanical 
pressure ; or sympathetic irritation arising from the mind, 
the senses, pain, inflauapiation; in short any irritation in 
whatever part of the body has a tendency to produce it, 
the more so, the more sensitive the part is. 
diminishing frequency of the pulse in fevers is the surest 
sign of abating disease ; continued frequency after the 
crisis shows that the crisis is not perfect, that something 40 
DIAGNOSTICS, lATEO6NOMIC. 
of the disease remains, and that there is reason to fear 
metastases. 
The utmost frequency (150—200 beatings in a minute ; 
a greater number cannot be counted, and becomes trem- 
bling of the artery) indicates extreme weakness or a putrid 
state. The weak heart tries to make up by frequent and 
imperfect contractions, to carry off the blood, what it is 
not able to perform by slow and energetic ones 3 hence the 
pulse is frequent and small. We need not therefore con- 
clude from the increased frequency in such cases, that the 
circulation of the blood en masse is accelerated 5 quite the 
contrary.—The utmost frequency accompanied with small- 
ness, celerity and cessations, is the pulse of the dying. 
Pulsus rarus. Rareness of the pulse is natural to some 
individuals ; there are men, who have only 50, nay 30 beat- 
ings per minute. In diseases it indicates decrease of irri- 
tability, therefore decrease or entire intermission of fever 
(apyrexia) ; decrease of the quantity of blood (therefore to 
be found after great loss of blood) ; old age ; also in cases 
of pressure on the brain, which diminishes the sensibility 
and irritability of the vascular system. 
Pulsus celer is produced by the heart contracting too 
quickly, so that no perfect distention is possible, and in 
this case the pulse is pointed to the touch. It is gene- 
rally connected with frequency ; it can, however, be also 
rarus. It indicates a spasmodic state and great weakness, 
the last in most cases, where it is rarus at the same time. 
Pulsus tardus, tardy contraction of the heart, indicates 
great deficiency of irritability, a typhoid, or a torpid state 
in fevers, especially a pressure on the brain. For that rea- 
son pulsus rarus et tardus is called pulsus cephalicus, apo- 
plecticus, and is indicative of pressure on the brain, which 
brings on the threatening or already existing apoplectic 
states such a pulse is therefore ominous after injuries re- 
ceived on the head, also in other diseases, which threaten 
exsudation. 
The hard and soft pulse (pulsus durus et mollis). The 
feeling of hardness or softness determines this difference. 
Hardness of pulse depends either upon the membranes of 
the artery, and then indicates a distended and irritated 
state of the vessel, a most impoijtejnt sign of local inflam- 
mation and of con vulsions, which uie accompanying symp- 
toms are to decide. Sometimes it (hardness) is owing to 
exsiccation, approaching to ossification of the arteries, 
which happens in old age; it is therefore the usual pulse 
of persons advanced in years. Or it is caused by a forced DIAGNOSTICS, lATROGNOMIC. 
41 
action of the heart, which impels the-blood with great 
power into the arteries ; here the pulse is at the same time 
magnus, and accompanied with great warmth of the body. 
Or it is due to great solidity, dryness, or coagulability of 
the blood. Thin watery blood renders the pulse soft. 
Softness of the pulse is indicative of the reverse, of ab- 
sence of inflammation and convulsions. 
The strong pulse, difficult to compress (pulsusfortes'), 
and the feeble pulse (pulsus debilis). 
The pulse is called fortis, when it strikes powerfully the 
finger placed upon it; in a high degree it cannot be com- 
pressed at all, but leaves a feeling of puffing up under the 
strongest pressure. 
Debilis, when it strikes but feebly and can be easily or 
entirely compressed. 
Pulsus frequens, fortis et durus, always indicates inflam- 
matory fever, and in consequence the propriety of vene- 
section. Sydenham says: In such a pulse bleeding must 
be resorted to, even if the disease was the plague. 
If with such a pulse there is also pain in some one of the 
important viscera, an inflammation is supposed to be com- 
ing on or to exist already. Inflammation of the internal 
substance of the lungs, and inflammations of the abdominal 
viscera, especially of the intestinal canal, are not to be 
judged of by this rule. Here the pulse is often very small; 
in the first case small and soft; in abdominal inflammation 
small and hard, like a tense string. The cause of it in pul- 
monary inflammations is due to the passage of the blood 
through the lungs being obstructed, or the inspiration im- 
peded by pain ; by which too small a quantity of blood en- 
ters into the aorta and the general circulation. 
But we must be careful not to confound it with the pulse 
of debility. The discriminative signs of which are the 
preceding spmptoms expressive of an inflammatory cha- 
racter, the accompanying symptoms and the momentary 
rising of the pulse, if you cause, in the first case, the breath 
to be forcibly retained, and in both cases the pulse becom- 
ing fuller, as soon as a vein is opened and some blood 
let out. 
On that the following maxim is founded: Pulsus debilis 
et facile comprimendus (if the local affections just mentioned 
do not exist), shows always vital weakness and indicates 
the administration of wine. 
The large and the small pulse (pulsus magnus et parvus), 
the full and the empty pulse (pulsus plenus et vacuus). 
The pulse is called magnus, when the artery is large and 
4* 42 
DIAGNOSTICS, lATROGNOMIC. 
extended to the touch ; parvus, when on the contrary, the 
artery appears diminished, almost as thin to the touch as 
a thread. 
Largeness indicates full extensibility of the artery (there- 
fore absence of cramp and irritation, a fine sign of perfect 
crisis), plenitude of blood (which however may be a tur- 
gescence, a distention produced by heat, fever, abnormal 
irritation of the nerves, distinguishable by being at the 
same time full or not), and vigor of the heart. 
The small pulse indicates that the artery is not suffi- 
ciently distended by the blood. This may result from two 
causes, cramp or weakness. We must also discriminate, 
whether it is at the same time hard or soft. 
Pulsus parvus et durus is the convulsive pulse; it shows 
that the artery is so contracted by spasm as not to allow 
of proper distention. 
Pulsus parvus et mollis indicates that the heart has not 
sufficient power to force enough blood into the arteries; 
therefore it is a pulse of the utmost debility or deficiency 
of blood. 
Pulsus phnus, the full pulse, differs from the magnus in 
this, that the artery is not only perfectly distended, but 
presents to the touch a feeling of being entirely filled; 
wherefore it is more difficult to compress it. It is indica- 
tive of that sanguineous plenitude called plethora. When 
large and at the same time easily compressed, the fullness 
exists only in appearance,—turgescence of blood. This is 
particularly observable in adynamic typhous fevers, in 
which the pulse sometimes appears full; but to take this 
for a sign of real plenitude and act accordingly would be 
a dangerous mistake. It is discriminated by being easily 
compressed. 
Pulsus vacuus, the empty pulse, is always small, and 
therefore coincides with the pulsus parvus et mollis, and is 
indicative of the same state. 
I will further remark that the pulse can appear periodi- 
cally; large and full on account of local congestions of 
blood to the heart, especially of a hemorrhoidal character, 
and it is then a sign of accumulation of blood in the portal 
system. 
The unequal pulse (pulsus incequalis), the intermittent 
pulse (pulsus inter mittens'). 
The pulse is called unequal, when the beatings do not 
follow each other regularly in number, or when the beat- 
ings differ from each other in largeness, fullness, vigor. 
It indicates a disturbance of the regular motions of the DIAGNOSTICS, lATROGNOMIC. 
43 
dependent either upon spasm, to which the heart, 
dike every other muscle is liable, or upon deficiency of 
vigor in it, sometimes also, but more seldom, upon obstruc- 
tion of the circulation either in the lungs (as in the last 
stage of pneumonia), or upon organic derangement of the 
heart. Therefore it is a principal sign of nervous and ady- 
namic fevers, and in general of a nervous state. 
The intermittent pulse (when one or more beats entirely 
fail) indicates in the first place a momentary stoppage of 
the contractions of the heart, which is most frequently 
owing to spasm, sometimes also to weakness and organic 
derangement. Most commonly, however, this pulse is in- 
dicative of a spasmodic affection .of the heart, created by 
sympathy with the abdomen, and it is therefore rightly 
termed pulsus abdominalis et intestinalis, for it arises most 
commonly from diarrhoea or a disposition to it,* likewise 
from local congestion of blood in the abdomen caused by 
hemorrhoids. Is it at the same time full and strong ; it 
shows then abundance of blood and indicates phlebotomy. 
A few particular kinds of the pulsus incequalis deserve 
special attention. 
Pulsus myurus, where a series of beatings becomes 
smaller and smaller, so that they cannot be felt; it is the, 
pulse of the dying. 
Pulsus dicrotus, where one beat seems to be divided in 
two ; generally a foreboding of critical bleeding at the nose. 
Pulsus inciduus, where a series of beatings succeeds be- 
coming slower and slower, and then again quicker and 
quicker; it is commonly a sign of an approaching crisis, 
especially by perspiration. 
Palpitatio Cordis. 
The beating of the heart, a too violent and irregular mo- 
tion of the heart, ■which can be felt and sometimes heard, 
when it is called the sounding heart. It is indicative either 
of too much rushing of blood to the heart, which can arise 
from plethora general as well as local, e.g. hemorrhoidal 
and menstrual congestion; or it shows nervous irritation, 
especially violent emotions, as fright or anxiety, violent 
pains, consensual irritations from the abdomen, particularly 
■worms, spasms, especially hysteria and hypochondria, me- 
tastases ; or it indicates great weakness (spasmus a deple- 
tione), e.g. in too profuse evacuations of blood and other 44 
DIAGNOSTICS, lATROGNOMIC. 
humors, and is then a forerunner of fainting; or finally, local 
diseases of the heart and organic derangement, hypertro- 
phy, aneurisms, polypus, hydrops pericardii. In hysterical 
and hypochondriacal subjects it is of no significance. A 
continual or always returning beating of the heart with 
fainting leads to suspect organic diseases of the heart. 
Jlrt of Feeling the Pulse. 
In order to arrive at such conclusions as we have stated 
above, we must know how to feel the pulse. It is not suf- 
ficient to place carelessly the finger over the artery. We 
must apply three or four fingers, so as to be able to observe 
a piece of several inches of it at once; we must continue 
touching it at least a minute, sometimes longer, with our 
attention intensely concentrated to that point; we must in- 
crease, diminish and variously modify the pressure of the 
fingers, compressing sometimes the artery, then quickly 
letting loose, in order to ascertain whether the blood can 
be entirely displaced by this compression, or not, whether 
the artery refills quickly or slowly, etc. In short, one must 
have practice in it. The physician must act with the pulse, 
like the virtuoso with his instrument; he must learn to play 
it and become familiar with it just as well as the musician 
with his instrument. It is only such a physician that will 
make discoveries in and by the pulse which another one 
cannot think of. Such an adept discovered by this means 
a concealed love as the cause of a malady. It is therefore 
advisable, that tyros in medicine should very frequently 
feel the pulse, even in healthy persons. 
Nor must the physician feel the pulse immediately after 
entering the sick room; for being looked upon as a judge 
of life and death, his visit will not fail to produce an alte- 
ration in the pulse of a sick person. He will soothe the pa- 
tient by friendly conversation, and then proceed calmly 
and naturally to feel the pulse. 
Not less recommendable, in order to avoid delusion, is 
a careful attention to those accessory circumstances which 
often alter the pulse. These are especially warmth, or 
certain stimulants, by which the pulse small in itself can 
be made full and large,—preceding emotions, and corpo- 
real exercise. DIAGNOSTICS, lATKOGNOMIC. 
45 
2. RESPIRATION, 
Next after the pulse this function affords the most mo- 
mentous signs, penetrating into the innermost life, as it 
is immediately connected with life and its conservation. 
Hippocrates says: Respiratione bond semper salus speranda 
est, etiamsi reliqua non bona essent. (Respiration being 
good, salvation may always be hoped, although the rest be 
not good.) This is true especially of fevers. Farther, it 
is in many diseases the only signum diagnosticum in asth- 
ma, tussis, pneumonia, catarrhus suffocativus and apoplexia. 
Respiration indicates: 
1. The state of the lungs, as regards their mobility, and ex- 
tensibility, or the hinderances to these, arising from in- 
flammation, or spasm, or accumulation of mucus and other 
matters in the bronchia or in the substance of the lungs, 
hepatisation, emphysema, oedema, tubercles, vomica and 
other organic disorders. 
2. The state of the trachea, its permeability or obstruction 
caused either by inflammation or spasms, or foreign bodies 
therein, which close or straiten it mechanically, or exter- 
nal compression from strumatose tumors. 
3. Obstacles within the pleura to the free motion and exten- 
sion of the lungs, consist of either an accumulation of water, 
air, fat, pus ; or by inflammation of the membranes, spasm, 
or inactivity of the muscles, ossification of the costal carti- 
lages, malformations of the osseous system ; also impeded 
motion of the diaphragm from inflammation, abdominal in- 
tumescence caused by water and swellings of the viscera. 
4. Organic disorders of the heart, hypertrophy, aneurisms; 
5. Condition of the circulation, especially the important 
distinction between a truly accelerated motion of the blood 
from only an apparent one, since a quickness of the pulse 
is by no means always a proof of a truly accelerated mo- 
tion of the sanguineous mass. To discriminate this dif- 
ference, observation of the proportion of pulsations to 
respiration is serviceable. For there are in a perfectly 
normal circulation four pulsations to one respiration, and 
in the healthy normal state this proportion remains the 
same in the accelerated, as well as in the retarded circula- 
tion ; likewise in all fevers, and it serves to prove a truly 
accelerated motion of the sanguineous mass. But when 
this proportion ceases and the breathing is not accelerated 
proportionally with the accelerated pulse, it proves that 
the contractions are augmented, but that the sanguineous 46 
DIAGNOSTICS, lATROGNOMIC. 
mass itself, from want of power, is not quickened, and the 
necessity of accelerated respiration is not called for. 
6. The condition of the vital power in general,—as far as 
a sufficient degree of power is required to put the pectoral 
muscles and lungs into proper activity. Therefore great 
prostration renders breathing difficult; weak men are very 
apt to get out of breath by exercise. 
7. The condition of the nervous system. As respiration is 
a voluntary operation, it is influenced by the different de- 
grees of sensibility. Thus a state of low sensibility, or of 
surprise, can have this effect, to cause the sick person to 
feel less the want of respiration, and therefore breathes 
more slowly, as it should happen in accordance with the 
condition of the circulation, as in typhous fevers, in a pres- 
sure on the brain, the snoring in apoplexy. 
8. The condition of external air. Air saturated with im- 
purities, not fit for breathing, can be a cause of difficult 
respiration. 
Varieties of Anomalous Respiration. 
The frequent and rare respiration (respiratio frequens et 
rara). 
Respiration is called frequens when it happens in a cer- 
tain space of time oftener than in the normal state ; rara, 
if it is the contrary. 
Frequency indicates : in the first place accelerated cir- 
culation, therefore, is met with in fevers; and the more 
frequent the respiration, the more violent the fever; 
weak lungs, when it is produced by the least exercise ; in 
men who get easily out of breath, the lungs try to make 
up by frequent repetition what they are unable to accom- 
plish by energy in single, respirations ; finally, an impedi- 
ment, which hinders the lungs from perfectly distending 
themselves; therefore the respiration is at the same time 
qmrva, e.g. in pneumonia, hepatis, hydrothorax, flatulency- 
Respiratio rara is indicative of easy circulation of the 
blood, of sound lungs, free circulation through them and 
unimpeded distention of them. 
Respiratio magna et rara (deep and unfrequent breathing) 
accompanied with great exertion of the muscles, shows 
great deficiency of power ; mixed with groaning, threaten- 
ing fainting and spasms. Resp. rara, parva et frigida is a 
sign of dying. 
The quick and tardy respiration (resp. velox et tarda) has 
reference to the mode in which the act of respiration is DIAGNOSTICS, lATROGNOMIC. 
47 
performed, whether the expiration succeeds the inspira- 
tion quickly or tardily. 
Velox indicates: painful affections of the chest and the 
abdomen, which are increased by a distention of the chest ; 
therefore we endeavor to diminish and shorten these affec- 
tions as in cases of abdominal and pulmonic inflammations ; 
or such an irritability of the bronchia, that the extension 
causes at the same time spasmodic contraction, (generally 
connected with convulsio pectoris (tussis) as in catarrhs); 
or an obstacle which does not allow the lungs to expand, 
e.g. tuberculous condition, suppuration. 
Tarda is indicative of the contrary, free extensibility of 
the lungs, free circulation through them, absence of irrita- 
tion and spasm. It is therefore the fairest sign of pectoral 
health, and the best test of the lungs, when a man can take 
a deep inspiration and retain the air for a long time. There 
is, however, also an excessive tarditas in diseases indica- 
tive of great weakness. 
The long (deep) and the short respiration (resp. magna 
[profunda] et parva). 
It is called magna, when a great quantity of air is t-ken 
in by inspiration and thrown out by expiration ; it is in 
general a good sign that the lungs and circulation are free ; 
of absence of spasms and power of the muscles for the per- 
fect dilatation of the thorax. But it must be simultaneously 
long and without any difficulty, when it is at the same 
time tardy. 
It has a different meaning when, with great exertion of 
power and force it is accompanied with anxiety and audi- 
bility (magna cum molestiis). Then it indicates plethora, 
spasms, especially in the prsecordia, also a soporous and 
delirious state, particularly when the intervals are long. 
Parva is indicative of the contrary. Here the distention 
is impeded by spasm and weakness. 
The difficult and the easy respiration (respiratio diffici- 
Hs et facilis). 
Dijjicilis has various degrees: dyspnoea, oppression of 
the chest; resp. anhelosa, the panting (asthmatic), suspiri- 
OSa-> the groaning, orthopncea, the suffocating respiration, 
the highest degree, of which the following is a description, 
fhe patient can breathe only in a sitting or upright pos- 
ture, with his neck protracted and great exertion of all pec- 
toral muscles. 
In every kind of difficult respiration the circulation of 
blood through the lungs is more or less impeded ; and in 
consequence a smaller quantity of blood streams to the 48 
DIAGNOSTICS, lATROGNOMIC. 
left of the heart, whence arises either an accumulation of 
blood in the head by the reflux being obstructed, therefore 
a soporous state, or diminished influx of the blood through 
the aorta into the whole body, and therefore small, empty, 
and remittent pulse, and cold extremities. 
Difficulty of breathing indicates either an impediment 
within or without the respiratory organs (in men, besides 
a good state of health, plethora, and abundance of blood in 
the lungs) ; or a spasmodic condition of the respiratory 
organs ; orthopnoea; an insurmountable obstacle, the 
highest degree of pneumony, hepatisation of the lungs, 
extravasated matter in the bronchia, trachea, external com- 
pression of the lungs by water, pus and the like, suffoca- 
tion. 
The equal and the unequal respiration (respiratio cequa- 
lis et incequalis). 
Incequalis indicates either an irritation which affects 
spasmodically the pulmonary nerves, or an impediment to 
respiration. 
The sonorous respiration (resp. sonora). There are the 
following varieties; 
Stertorosa,—a rattling respiration ; it indicates an accu- 
mulation of mucus or pus, or blood in the bronchia, or a 
paralytic state of the lungs, consequently the rattling of 
the dying. 
Clangosa, sibilans,—the whizzing respiration, shows a 
straitening of the tracheal tube, which is due either to 
spasm (as in spasmodic asthma) or to exsudation of coagu- 
lable lymph, as in angina polyposa. 
Crepitans, uttering a crackling noise at every inspiration 
like that of dry paper or parchment, shows great dryness 
in the mucous membrane of the bronchia, or accumulation 
of very tenacious mucus or pus. 
The hot and the cold respiration calida et frigid a). 
Calida indicates, in general, an accelerated circulation 
of the blood ; fervens,—very hot breath, either universal 
inflammatory diathesis, or inflammation of the lungs, also 
of other abdominal viscera situated near by, (is especially 
important for their diagnosis, in infants often the only sign.) 
In consequence, the worst sign of an inflammation is hot 
respiration, and at the same time cold extremities. 
Fngida,—cool respiration indicates a slow, tardy circu- 
lation of the blood, watery blood, stoppages in the lungs ; 
cold respiration indicates departing life, therefore is pres- 
ent in internal mortification (gangrene) and in dying per- 
sons. DIAGNOSTICS, lATROGNOMIC. 
49 
Offensive breath (resp. male olens), indicates often only 
nncleanliness of the sick, decayed teeth ; besides impuri- 
ties in the stomach, worms, or long fasting ; or a putrid 
diathesis of the blood (therefore in excess of animal food, 
especially of raw meat, as in all carnivorous animals), 
scorbutus, of which it is a principal sign ; putrid typhus ; 
purulent cacochymy, or suppuration of the lungs, of the 
larynx ; likewise abuse of mercury. In some females it 
is indicative of menstruation. 
Pressure., Straining, Pain in the Chest. 
All these complaints point either to congestion in the 
lungs, or to a spasmodic affection, a nervous irritation 
(frequently merely consensual or metastastical), or local 
derangement of the Jungs. Therefore, they are of mo- 
mentous significance only in a phthisical disposition. 
Pain in the chest with fever indicates either a rheumatic or 
an inflammatory affection of the pleura. 
Sounds in the Chest. 
We d istinguish two kinds,—the sound which the chest 
renders on percussion, and that which one perceives in the 
chest during inspiration, either by placing the ear or the 
stethoscope on it. 
The sound from percussion is either clear as from an 
empty barrel, or dull as from a full barrel. The first shows 
the lungs and thorax free of morbid accumulation, the latter 
the presence of it. 
The various sounds different from the normal one, which 
are heard by means of the stethoscope during inspiration, 
may indicate either an impervious spot in the lungs (there- 
fore inflammation, hepatisation, tubercles, vomica), or mat- 
ter existing in the bronchia (mucus, blood, pus) ; or 
hydropic accumulations in the thorax and adhesions of the 
pleurae. Also organic disorders of the heart are recogni- 
zable by particular sounds. 
But all these'audible signs are only auxiliary, they prove 
nothing, when are not other signs which confirm and 
rectify the sentence. 
Cough, 
Indicates next, and in general, an irritation and momentary 
convulsion of the respiratory organs, and is therefore of 
various significance. For the irritation which excites it, 50 
DIAGNOSTICS, IATRCGXOMIC. 
may originate in enhanced irritability of the lungs, as well 
as in something irritant, which may be either idiopathic, 
i e. having its seat in the lungs, or consensual and antag- 
onistic, i. e. out of the lungs. It may consequently be a sign 
both of an affection of the lungs, either of an irritability of 
them augmented by inflammation, or nervousness, or ca- 
tarrh, or of something irritating, e.g. congestion of blood, 
tubercles, metastasis, suppuration, as well as a sign of dis- 
ordered digestion and gastric impurities (stomach cough) ; 
or of morbid liver, spleen, and other abdominal viscera. 
This word therefore, in order to be explicit, always requires 
an attributive which points out the special diagnosis. 
The following generalities will be serviceable in practical 
cases. 
In every acute (not catarrhal) fever a cough setting in 
deserves the greatest attention ; for it may be the first in- 
dication of a commencing pneumonia. It may, however, 
arise also from the irritation of an exanthemalic matter; 
for instance, a short dry cough with much sneezing and 
lachryraaiion, in the onset, is indicative of the measles. 
In all individuals of a phthisical disposition every attack 
of cough must be carefully attended to; for it indicates 
the commencement of consumption. 
Men, in whom every morbid irritation excites coughing, 
and such as are affected with cough after the least exer- 
tion of the lungs, as running, speaking, laughing, even 
emotions, labor under a morbid irritability of the lungs and 
phthisical disposition. 
Chronic dry cough, easily excited by the least exertion 
of the lungs, with stitches in»the chest once in a while ap- 
pearing, and breath not entirely free, indicate the exist- 
ence of tubercles. 
Chronic cough with much expectoration of mucus leads 
to suspect the beginning of phthisis pituitosa. 
Absence of cough is the best sign of pulmonary health. 
In healthy as wTell as in sick persons, in acute as well as in 
chronic maladies, it is the best test of the lungs. We may 
cause the patient to make a deep inspiration and to retain 
the breath for some time. If he is capable of doing this, 
without perceiving an irritation to cougfi, his lungs are 
sound ; the reverse is always suspicious. 
Voice and Speech, 
Vox rauca—hoarseness—indicates that mucus or pus ex- 
ists in the larynx, or an inflammation of the mucous mem- DIAGNOSTICS, lATROGNOMIC. 
51 
brane ; therefore it is a sign of catarrh, phthisis laryngea 
and angina. 
Aphonia indicates the highest degree of inflammation of 
the throat or phthisis of the throat, or spasm or paralysis 
of the vocal organs. 
Loss of speech indicates either spasm when it appears 
periodically, most frequently caused by hysterics and con- 
sensual gastric irritations, especially verminous ; or paraly- 
sis of the organs of speech, as in apoplexy and typhous 
fevers, injuries of the head, in which cases it is always 
ominous. 
Vox balbutiens—stammering—indicates in fevers always 
a dangerous affection of the nerves of speech and of the 
brain, bordering on a paralytic state, which very often in 
the onset of fevers is manifested by the patient not clearly 
pronouncing single letters; a circumstance worthy of the 
physician’s attention. 
Yawning, Groaning, Sneezing, 
Yawning always indicates a too tardy circulation of the 
blood through the lungs, which nature endeavors to pro- 
mote by a very deep inspiration and forced expansion of 
the respiratory organs. It indicates therefore weakness or 
spasm, in the onset of the fever and ague. 
Groaning without moral cause, is of the same significa- 
tion. 
Sneezing is a convulsive expiration, and indicates an 
irritation of the nose, therefore catarrh or measles ; or of 
the lungs, therefore it is present in pneumonia, commencing 
suppuration ; or an irritation in the abdomen, therefore the 
frequent sneezing of children indicates worms. 
Weeping and Laughing. 
Weeping in disease always indicates spasm, nervousness ; 
therefore an inclination to weep is a principal sign of a 
hysteric state. 
Profuse lachrymation in fevers indicates congestion in 
the head ; in the beginning of fevers it indicates measles. 
Laughing always indicates considerable irritation of the 
nervous system, mental or physical; therefore, in fevers it 
is often foreboding of delirium and convulsions. An incli- 
nation to laugh at trifles indicates a hysterical state, as 
inclination to weeping does, and therefore often pass from 
one into the other. 5 2 
DIAGNOSTICS, TATROGNOMIC. 
Risus sardonicus, violent convulsive laughter, may set in 
as a symptom of ciiaphragmitis. 
3. THE BLOOD. 
The blood evacuated by venesection or hemorrhage 
shows various anomalies differing from the normal state, 
whichmay serve as signs of diseases or morbid dispositions. 
In the first place the varieties of consistency come into 
consideration. They indicate either an abnormal coagula- 
bility, or an abnormal proportion of the watery constituents 
to the cruor. 
Too firm consistency indicates: 
Either an increised coagulability, plasticity of the blood 
(the inflammatory consistence). The blood coagulates 
quickly and forms a firm mass, from which only a little se- 
rum is separated. It indicates in healthy persons a strong 
constitution and an inflammatory disposition in diseases, 
art inflammatory diathesis, or an already existing inflamma- 
tion. The signs of inflamed blood are :—it coagulates 
quickly, often immediately after escaping from the vein, 
into a very firm cake, from which only a little serum is sep- 
arated, on the surface of which a white firm coriaceous coat 
(icorium, crusta pleuritica) is formed ; the firmer and thicker 
it is, the higher the degree of inflammation, yea, in the high- 
est degrees it is so firm that it is difficult to cut through it. 
But it may be well to observe, that it is sometimes want- 
ing in inflammations, and that its absence must not lead to 
a conclusion that there is no inflammation ; farther, that its 
formation may depend upon the opening in the vein, and that 
a small opening, where the blood does not run freely, pre- 
vents it ; and finally, that it may be found also in rheu- 
matic complaints and in pregnant women. But in this last 
case this coriaceous crust is not solid, and is less tough. 
The genuine inflammatory corium is distinguished by its 
whiteness and solidity. When it is yellowish, greenish, 
flocky, loose, it indicates a nervous state, not genuine in- 
flammation. 
Or deficiency of water,—dryness of blood,—atrabilious 
condition. 
Too little consistency indicates either a deficiency of 
plastic constituency and coagulability or an abundance of 
lymph (the watery part of the blood), and is therefore of a 
double kind. 
Thinness (fluidity) of blood (tenuitas serosa). Abundance 
of serum indicates feeble assimilation, chlorotic diathesis, 53 
DIAGNOSTIC?, lATROGNOMIC. 
hydropic disposition ; dissolution of blood (colhquatio son- 
gum is), deficiency of coagulability and plasticity ; the 
blood is dark and does not form into a solid coagulum, but 
into a pap-like mass, in which cruor and serum remain 
mixed, indicates a disposition to putrid dissolution, a scor- 
butic state, putrid typhus. 
Secondly, the color. Dark red and solidly coagulable 
blood indicates a strong constitution. Too dark, black blood 
indicates an abundance of carbon, of venosity | it is iound 
in scorbutic atrabilious diseases of the abdomen, cyanosis. 
Too pale, limpid blood, indicates an abundance of serum, 
and is indicative of weakness. If it is at the same time light 
red, it indicates dyscrasia, e.g. an arthritic or rheumatic 
state. Also the color of the serum deserves attention. If 
it be distinctly separated, it is an excellent sign of good 
sanguification and health; if it be cloudy, milky, it indi- 
cates weakness; if it be very yellow, bile in the blood ; if 
it be bloody, a putrid state. 
4. DIGESTION. 
After the circulation of blood and the respiration, diges- 
tion is the most important function of the human system, 
and therefore also the most important for the practitioner 
to understand ; for we may recognize by it 
1. The state of the digestive organs, which is the chief 
source of support. 
2. The state of the whole organism by reason of the in- 
numerous nervous combinations which connect this sys- 
tem with all parts of the body. 
3. The quality of the humors, for this system is the seat 
of the principal emunctory and secretory organs. 
In general a good digestion indicates a strong, vigor- 
ous constitution, little susceptibility' to external physical or 
mental morbific influences, vivid and easy reaction in dis- 
eases, and a macrobiotic disposition. 
Men of strong digestive power are more liable to acute, 
those of weak digestion, to chronic diseases. 
Hiccough. 
Impeded swallowing indicates either, if connected with 
pain, inflammation of the throat, or spasm, or paralysis, or 
a mechanical obstruction ; or, if it be only for fluids, hydro- 
phobia. 54 
DIAGNOSTICS, lATROGNOMIC. 
Hunger. 
Want of appetite is next in order, and indicates most fre- 
quently noxious indigestible matters existing in the stom- 
ach, besides a febrile state, for all fevers take away 
appetite, except the rheumatic and hectic ; or finally, ner- 
vous discordance, as in hysterics, melancholy, weakness of 
the stomach or organic disorder of it. 
Excessive appetite, greediness—pica—indicates want of 
nutritious substance in the stomach as well as in the blood ; 
therefore accompanies diseases which evacuate quickly the 
food from the stomach, chronic vomiting, diarrhoea, like- 
wise in hectic and phthisical maladies ; or an irritation of 
the nerves of the stomach and intestines, as in worms, ac- 
rid gastric matters, metastases ; or morbidly increased irri- 
tability of the stomachical nerves, as in nervous diseases, 
hysterics, frenzy, picay in pregnant women. 
Extraordinarily strong desire of certain things is a sign, 
of a salutary and natural instinct, and must be profited of 
in diagnostics as well as in therapeutics. Thus an appetite 
for lime and earth, for salted things, is indicative of slime 
in the stomach ; for acids, of putrid corruption ; for wine, 
of weakness and a need of strengthening. 
O O 
Indicates dryness of the mouth, want of exhalation, con- 
sequently internal heat (is therefore a sign of fever and 
inflammation) ; or of spasm as in chills ; or an acidity in the 
stomach or blood ; or finally, a deficiency of water in the 
blood, hence the insatiable thirst in fevers, a sign of the 
highest inflammatory degree of the blood. 
Thirst, 
Nausea and Vomiting. 
Vomiting is a convulsive affection of the stomach, and 
indicates either an extraordinary irritation in the stomach 
or without it, which affects the stomach consensually ; 
or an increased irritability, consequently injurious irrita- 
ting matters in the stomach itself, which is proved by the 
condition of the tonaue, and the vomited matter ; or spas- 
modically increased irritability ; or inflammation, if the 
patient instantly ejects food and drink ; or a consensually 
operating irritation, as from inflammation of the liver, of 
the intestines, accumulation of fteces in the intestines, 
gall, or nephritic stones, concussion of the brain, and accu- DIAGNOSTICS, lATROGTOMIC. 
55 
mulation of water ; or finally, organic derangements of the 
stomach and neighboring viscera. 
Nausea or vomiting in the morning without signs of 
gastric impurities is often a sign of gravel; in women, of 
incipient pregnancy. 
Flatulence, Meteorismus. 
Frequent winds indicate accumulations of injurious sub- 
stances which disengage much air, ructus if in the stem- 
ach, flatus if in the intestinal canal. A continual dispo- 
sition to it indicates weakness, especially atony. 
Meteorismus or flatus in fevers is always a bad sign, and 
indicates either a great accumulation of corrupt and putrid 
matters, at the same time great atony ; or if the belly is 
much distended and painful, inflammability. Meteoric dis- 
tention of the abdomen in children indicates worms. 
The examination of the matter discharged from the 
intestines is important ; partly to recognize the matters 
contained in them ; partly to distinguish their morbid 
state and that of the abdominal viscera connected with 
them ; partly to discover the substances separated from 
the blood in the intestinal canal, and in consequence, the 
disordered quality of humors in general; partly for ascer- 
taining the dynamic consensual and antagonistic affections 
of the organism. 
It is therefore necessary in all diseases of the abdomen 
to examine the quality of the excrements; in gastric mal- 
adies their morbid quality calls for the administration of 
evacuants. 
Evacuation from the Intestines. 
We must regard their consistency, color, smell and kind 
of discharge. 
We must distinguish between increased and diminished 
evacuation from the rectum. 
Increased evacuation (diarrhoea) indicates either the 
presence of injurious and excessively irritating substances 
|n the intestinal canal, of which number are worms ; or an 
irritation in its membranes, as ulcers, metastases ; or in- 
creased irritability of the canal, either inflammatory or 
nervous ; or a deposition of injurious matters in it, such as 
pus, critical secretions ; or consensual, even mental (c. g. 
fright) and antagonistic irritation, that is to say, suppressed 
function of the skin; or finally, the highest degree of 56 
DIAGNOSTICS, lATROGNOMIC. 
weakness of the intestinal canal, even of the whole system, 
colliqnation. 
Green stools in infants indicate acidity ; dark brown 
ones, abundance of bile ; not colored ones, want of bile. 
Diminution of discharge from the rectum (obstructio nlvi), 
indicates either a deficiency of the natural irritability of 
the intestines, of bile ; or atony, spasmodic contraction, or 
want of fluids, neglect of drinking, or turning of the hu- 
mors towards other parts, especially to the skin by perspi- 
ration, or mechanical obstacles, organic disorders. 
Painful discharge from the rectum (colicn) and forced 
straining to stool (tenesmus) indicates either irritating 
acrid matters in the intestinal canal or increased sensibil- 
ity of it, which may be either nervous or inflammatory. 
Tenesmus indicates hemorrhoids or dysentery. 
Involuntary discharge from the rectum. We must dis- 
tinguish the unconscious (inscia) which happens in dreams, 
in delirium or by too fluid excrements, and is insignificant, 
from the involuntary (involuntaria), which indicates a par- 
alytic state, and is indicative of great danger in fevers. 
5. SECRETIONS AND EXCRETIONS. 
Perspiration and Sweat. 
From the state of cutaneous secretion we may in general 
deduce the following inferences : in the first place, the state 
of vital power. The more vigorous the impulse is towards 
the periphery, the more lively, i. e. gas-like, will be the se- 
cretion, the more vital power. Secondly, the free unimpe- 
ded condition of the blood. Thirdly, the quality of the 
blood and humors. Fourthly, the crisis, the critical pro- 
cess of healing ; for sweat produces the most perfect crisis, 
and without the perspiration accompanying, all other crises 
are imperfect. 
We must make a distinction between perspiration (tran- 
spiratio insemibilis) and sweat (sudor). The first one is an 
imperceptible gas-like secretion, never ceasing and indis- 
pensable to life ; the latter is a dropping, watery secretion, 
taking place only under certain circumstances.—The first, 
gas-like, is the living normal secretion ; the sweat a newly 
created abnormal chemical process, even sometimes a 
merely passive profluvium. 
A soft, open, slightly perspiring skin shows undisturbed 
imperceptible perspiration, and is therefore in all diseases, DIAGNOSTICS, lATROGNOMIC. 
57 
particularly in fevers, a favorable sign, and a proof that 
there is no spasm, no disturbance of circulation, and no 
impediment to the crisis. 
Dry, rough, parchrnent-like skin is indicative of the con- 
trary. 
In diseases, especially the febrile, it is most important 
to discriminate between critical sweats and symptomatic 
sweats. The former is a salutary operation of nature, the 
latter is a sign of a morbid state. 
Critical sweat may be distinguished by the following 
observations : When it does not arise immediately in the 
commencement, but in the critical period, that is to say, 
about the seventh or fourteenth day of the fever (mere 
catarrhal and rheumatic fevers make an exception) ; when 
it is general (local sweats, e.g. on the head, on the chest, 
indicate congestion or inflammation in these parts); when 
it is clammy ; when it is warm (cold sweats indicate exces- 
sive weakness, and are forerunners of death) ; when it is 
not light and disappears quickly, but continuous, and when 
it alleviates the malady, and soothes the pulse in fevers. 
Symptomatic, premature, excessive, not alleviating sweats 
indicate either a very violent motion of the blood with de- 
bilitated skin (frequently caused only by too warm cloth- 
ing, feather beds, confined air); or gastric accumulations ; 
or great general weakness and colliquative disposition. 
They always lead us to expect febris or petechite. 
Sour-smelling sweats indicate miliary fever; fetid sweats 
putrid typhus. 
Sweats in the morning, not usual, indicate a hectic 
fever. 
To be easily thrown into perspiration shows a weak 
constitution. 
Secretion of Urine. 
The urine affords the most important diagnostic sign 
for distinguishing the quality of the blood, and the chemi- 
cal processes going on in the system, since no secretion is 
so immediately connected with the circulation as this one ; 
Pr may already be conceived by the circumstance 
t at the nutriments taken, and the admixture of chyle are 
recognized in it. It therefore deserves the greatest pro- 
essioual attention that has been bestowed upon it in so 
ig a degree by the ancient physicians, and is now-a-days 
too much neglected. 
n Older to judge rightly concerning morbid urine, we 58 
DIAGNOSTICS, lATROGNOMIC. 
must first know the discriminating signs of that which is 
healthy. They are the following : It is straw-colored, of 
a specific but not fetid odor ; and remains clear. The fol- 
lowing circumstances, however, which the physician must 
carefully consider, have an influence on it. 
The constitution—a strong one has higher colored and 
more odorous urine, weak persons more pale and frothy 
urine with some sediment. 
Season—in summer it is scanty and more dark colored, 
in winter more copious and paler. 
Mode of living—motory labor reduces its quantity, and 
makes it darker ; sedentary life increases the quantity and 
the paleness. 
Age—in old persons it is diminished, darker, and fetid. 
Sex—females have always paler urine and more sedi- 
ment in it. 
Digestion and food.—Much drinking augments the urine 
more in quantity and paleness ; rhubarb and curcuma 
make it light yellow; asparagus, fetid. During digestion 
it is cloudy on account of the admixed chyle. We distin- 
guish, therefore, urina potus, 1 to 4 hours after a meal, which 
proves nothing ; and urina sanguiras, 6 hours after a meal, 
which alone is to be used for examination. 
In order to form a correct judgment it is farther neces- 
sary, that the urine be left untroubled for 2 hours in a cool 
temperature, and be not brought quickly from a cold into 
a warm place, or the reverse. 
We recognize by it, 
1. The condition of the blood, of the organic matter, and 
of the chemical process of life.—Especially the presence 
of the phlogistic state ; therefore the red (rubra) urine with 
accelerated pulse is the principal sign of fever, internal 
heat and inflammation ; this sign is so momentous, that it 
is decisive in dubious cases, whether the affection be in- 
flammatory or spasmodic.—Farther, the colliquative state 
of the blood inclined to dissolution, is indicated by a muddy 
thick urine, with much sediment, and bloody (turbida, 
crassa) ; a high degree of putridity, and inflammation ter- 
minating in gangrene, by a thick black urine (nigra) ; in 
a high degree of hectic dissolution, it is greasy on its 
surface. Also foreign substances contained in the blood, 
e.g. bile, which is seen in the saffron-colored urine (cro- 
cea), is a sign of gall-stones, and if it gives a yellow color 
to linen or paper dipped in it, is a principal sign of icterus ; 
urina viridis is a sign of corrupt bile ; of matter in internal 
suppuration. DIAGNOSTICS, lATROGNOMIC. 
59 
2. The internal chemical process accompanies every 
general curative process, and is the process of crisis. This 
imparts to urine a diagnostic importance in fevers. We 
distinguish here three stages of critical operation ; the 
crudity, that state in which there is not yet a vestige of 
critical working ; the coction, a commencement of critical 
operation in which particular indications of the crisis are 
visible; the crisis, the finished critical operation, and the 
secretion of the morbid substance. This affords the three 
varieties of critical urine : urina cruda, cocta, critica. 
Urina cruda. Signs of crudity exist when the urine, (the 
pale as well as the red,) is perfectly clear and pellucid, 
and remains so ; or when it (as it happens often in nervous 
and gastric fevers) is cloudy, thick, and jumentous (like 
turbid water or a cooled decoction of Peruvian bark), and 
remains so. 
Urina cocta. Signs of coction, when the urine, heretofore 
clear, grows muddy and exhibits a light little cloud. This 
happens sometimes only on the 4th or 11th day (dies index) 
and then disappears, but leads to a hope, that a critical 
urine will succeed the 7th or 14th day. The coction and 
beginning crisis show themselves sometimes also in the 
clear urine by a nubecula (a light little cloud which 
remains on the surface), or by an enceorema (a cloud which 
sinks to the bottom of the glass). The latter is a favorable 
foreboding of an approaching crisis; but the little cloud 
which temains on the surface, or after it had subsided, 
rises up again, indicates, it is true, a commencement of 
crisis, but leads to a fear that it will be imperfect. 
Urina critica, sign of completed crisis, when the urine, 
before clear, leaves a sediment, or the urine, before thick 
and turbid, decants clear from above, and leaves a sediment 
below. 
But the sediment maybe also critical and not critical, the 
knowledge and discrimination of which are very important. 
The critica] sediment is of this character: it falls down 
soon after urination, is not too much nor too little in quan- 
tity (about f or £ of the whole), white or grayish, light, 
uniform, and a little convex on the surface. 
The sediment is not critical and ominous when it is too 
large, filling £ or f of the glass, thick and heavy, distracted 
and livid. Red, bile-colored sediment indicates intermit- 
tent fever, or a rheumatic character of the disease ; a white 
chal.kY sediment in thick dark-colored urine, indicates an 
athriiic character, also urinary calculus ; dark, black sed- 
iment, a putrid state. 60 
DIAGNOSTICS, lATROONOMIC. 
3. The nervous spasmodic state, limpid, aqueous urine, 
which is generally accompanied with frequent to 
urinate, indicates spasm ; pale, turbid urine, but particularly 
changeable urine in fevers, indicates a nervous character. 
4. The condition of the digestive system. Urina jumen- 
tosa is a principal sign of a gastric state ; milky urine in 
children, of worms. 
5. Augmentation or diminution of other serous secre- 
tions. Thus sweat and diarrhoea, even the use of purga- 
tives, produce dark-colored urine. Suppression of perspi- 
ration by the skin renders it watery and increased in 
quantity, even to diabetes. 
6. Local diseases of the kidneys and the bladder. Slimy 
urine indicates blennorrhoea vesicas or calculus vesicas; pur- 
rulent urine, suppuration of the bladder or prostate gland; 
bloody urine, a bleeding from the kidneys or bladder ; ex- 
cessive quantity and aqueous quality of urine, diabetes. 
Also the chemical examination must not be neglected in 
some cases ; the most usual is that on litmus paper, in or- 
der to ascertain the presence of a free acid ; still more im- 
portant is the discovery of sugar in it, in order to discover 
diabetes mellitus, a disease, the existence of which cannot 
be recognized in any other way, and which may terminate 
fatally by emaciation. Never omit this examination in all 
kinds of emaciation which cannot be accounted for. 
Also the manner of discharge is of diagnostic importance 
in the evacuation of urine as well as is that of fames. It 
is either painful, difficult, impeded, and then indicates 
spasm, inflammation, local diseases ; or it is passed invol- 
untarily, indicating paralysis; in fevers the highest, fatal 
weakness, in which, however, as in the evacuation of fee- 
ces, the unknowing is to be distinguished. 
Salivary Secretion, Expectoration. 
Increased flux of saliva indicates either a local irritation 
of,the salivary glands, e.g. angina, or is consensual with 
the abdominal disorders, especially impurities in the stom- 
ach, worms, constipation of the abdominal viscera, par- 
ticularly of the pancreas, therefore frequent spitting is a 
sign of hypochondriasis ; also congestion of the salivary 
glands, and the head, as in apoplectic dispositions. Here 
critical salivation is to be also mentioned, which in diseases 
may arise from suppressed perspiration of the skin, in lin- 
gering nervous fevers, and in small-pox. DIAGNOSTICS, lATROGNOMIC. 
61 
Deficiency of saliva indicates spasm and great dryness of 
the blood. 
Expectoration (sputa). All that which is expectorated 
after hawking or coughing, indicates increased secretion 
in the mucous membrane of the throat or trachea, or of 
the lungs, or also the existence of foreign matter in these 
organs, e.g. pus, blood, tubercles, even calculary substan- 
ces ; pituitous mucus, continually discharged, and in great 
quantity, blennorrhoea pulmonum, phthisis pituitosa, pu- 
rulent matter, phthisis purulenta ; sweet salty matter, gray, 
blackish, cloddy tubercles ; yellow-colored bitter bile in 
the blood, liver complaints. 
In inflammatory pulmonary diseases the expectoration 
is the most important local crisis, and is indispensable to 
a perfect resolution of the disease. The signs of the critical 
expectoration are : sputa cocta, subacta, i. e. expectoration 
thick, yellowish, like a thick emulsion, sometimes mixed 
with small streaks of blood and easily expectorated. 
We must distinguish spitting of blood (sputum sangui- 
neum) and bloody cough. The first is only a secretion of 
blood from the mouth and the upper parts of the throat 
and the windpipe, which is in nowise related to the lungs. 
Evacuations of Blood, 
Indicate either true plenitude or turgescence of blood, 
distention by the blood, or local congestion, or inflamma- 
tion of a part, or relative weakness of a part, so that it 
cannot resist the impetus of the blood; or a dissolution, 
putrid state of the blood ; sometimes also a crisis, espe- 
cially in acute fevers. Thus bleeding at the nose in 
inflammatory fevers, congestion and inflammation of the 
brain, is the most salutary and decisive crisis. 
6. AFFECTIONS OF THE MIND AND NERVES. 
Activity of the Mind, Senses, Feeling. 
Delirium—raving—indicates always an affection of the 
brain ; but, as this may arise from various causes, it is also 
of different significance and importance. 
In the first place, however, we must remark, that there 
are persons who, in the slightest feverish indisposition, 
even in a slight catarrhal fever, rave during sleep, yea, who 
speak while asleep even in good health ; hence, in judging 
of delirium, we have to make inquiries on that account. 
6 62 
DIAGNOSTICS, lATROGNOMIC. 
Morbid raving always indicates a disturbance of the nor- 
mal activity of the brain, either an excitement of it, in 
which case the delirium is active, with excitement, accom- 
panied frequently with violent exertion or fury (delirium 
activum, furibundum) ; is either idiopathic, such as arises 
from a violent rushing of blood to the brain, indicative in 
fevers of the higher degrees of inflammatory diathesis, or 
real inflammation of the brain, metasastes, the irritation of 
exanthematic matters, e.g. of small-pox ; or consensual, 
and here especially proceeding from the stomach and in- 
testinal canal, e.g. accumulation of bile, worms, narcotic 
poisons. 
Or want of cerebral action. Here the delirium is silent, 
internal, as it were, accompanied with slumber and other 
signs of weakness (delirium hlandum, somnolentum typho- 
sum), such as in nervous fevers, in typhus, pressure on the 
brain, parenchymatic accumulation of blood in cerebral 
inflammation, or extravasation, hydropic accumulation. 
Also chronic deliria may arise from both sources. Here, 
however, it will be well to observe two points: hypochon- 
driacal and hysterical persons are very liable to delirious 
attacks, which are only symptoms of these diseases and of 
no other signification. We must distinguish delirium from 
insanity and frenzy. We call a person insane, in whom 
delirium has become permanent and isolate. 
Sleep and waking. A quiet, natural, and not too long 
continued sleep is in all diseases one of the most favorable 
signs, in crises the best companion, and a sign that they 
are perfect. Children sleep generally more than adults, 
and we must not conclude too quickly, that there is here an 
affection of the brain. There are also men who, in fevers, 
like animals, sleep continually and recover best by it. 
Sleep is morbid when it is connected with delirium, con- 
vulsive movements and starting up, which is continual, and 
in which the patient awakes by the slightest noise and falls 
again asleep instantly (coma vigil), or cannot at all be 
roused (coma somnolentum, sopor). It indicates great af- 
fection of the brain (hence a sign of typhus or cerebral 
inflammation); the worst, when it sets in immediately 
from the commencement of the fever. 
Restlessness (agrypnia.) is less dangerous than somno- 
lency, but in fevers is a sign of a continued irritation of 
the sensorial system. 
Giddiness (vertigo), indicates either plenitude of blood 
(general or local congestion of the brain), or a nervous 
affection, most frequently proceeding from the stom- DIAGNOSTICS, lATRONOMIC. 
63 
ach and abdomen, in which case it is a principal sign of 
gastric turgescence upwards. In old age and in persons 
disposed to apoplexy, it is a bad omen of that disease. 
Eye and sight. The eye and look afford very important 
expressions of internal life in general, and of the sensorium 
in particular ; and are worthy, therefore, of the greatest 
attention on the part of the diagnostician. 
Squinting (strabismus), when it is not habitual, always 
indicates spasm of the ophthalmic nerves, and shows either 
an affection of the sensorium (thus in the commencement 
of the hydrops cerebri acutus of children), or consensual 
gastric irritation, imparities in the stomach, especially 
worms. Staring look, fixed on one object, betrays deliri- 
um. Languid look of the eyes suddenly setting in, indi- 
cates either sinking of the vital powers or gastric turges- 
cence, or imminent vomiting. Dilatation of the pupil indi- 
cates either pressure on the brain, a principal sign of 
encephalitis and hydrops cerebri; or gastric irritation, 
especially from worms; also abdominal stagnation and 
amaurosis. Contracted pupil and great sensibility to light 
indicates increased sensibility ; on the contrary, a desire 
for light great weakness, and is a bad omen in fevers. 
Black flocks before the eyes or obscuration of sight indi- 
cate either congestion of blood to the head or gastric 
turgescence, or sinking of power, imminent fainting. 
Double-seeing (diplopia), and half-seeing is always a 
sign of spasm, and indicates commonly gastric irritation, 
frequently it is also only a hypochondriac or hysterical 
symptom. Protruded, reddened, glittering eyes indicate 
great sanguineous congestion in the brain ; sunken eyes, 
weakness. 
Hearing. Too sensible hearing indicates in fevers an 
excessive sensibility of the whole nervous system, or an 
inflammatory affection of the brain. In fevers weak hear- 
ing is better than too sharp hearing. Tingling and buzzing 
in the ears indicate sanguineous congestion, frequently 
also catarrhal, serous congestion to the ears. Weak hear- 
ing, deafness in fevers, especially typhus, is a good sign. 
Smelling. Loss of smell indicates either a catarrhal 
state or an important nervous affection ; putrid smell indi- 
cates a putrid ulcerous local disease in the nose, or 
Pa a|e’:.or a Putrid diathesis of the blood ; an uncommon 
sme like to burnt feathers, spasmodic nervous affection. 
laste. Loss of taste is indicative of the same as that of 
smelling, also great stoppage with phlegm. Foreign taste 
indicates either diseases of the mouth and throat, or of the 64 
DIAGNOSTICS, lATROGNOMIC. 
lungs (thus the putrid or salty taste in phthisis purulentd), 
or gastric impurities (the bitter bile, the slimy phlegm, the 
sour acidity) ; or where these causes do not exist, either a 
false tone of the nervous system (as for instance in hyster- 
ical, also in some pregnant women), or in fevers a putrid 
diathesis of the blood. 
Cutaneous feeling. Chill and heat, itching without 
eruption, indicate in fevers imminent eruption of critical 
sweat, without fever-acrimony of humors ; deafness, want 
of feeling in single parts, stagnation of the blood or nervous 
affection, spasm, sometimes concealed gout. 
In the changes of temperature we must distinguish the 
sensation of it (frigus et calor ad sensum) and the real phy- 
sical alteration (frigus et calor ad thermometrum) ; for 
both cold as well as heat may sometimes be only a sensa- 
tion of the skin, a nervous affection, without a real increase 
or diminution of caloric. 
The sensation of chill is always due to a cutaneous 
spasm, and is of different degrees : shivering, chair depoule, 
cold trembling fit, numbness (horripilatio, horror, rigor). 
It is always a momentous sign- We must distinguish 
chills in the commencement of fever and in the course of 
it. When the first chill is very violent, it indicates either a 
violent fever, generally of an inflammatory character, or the 
beginning of an intermittent fever ; when it is weak, alter- 
nating with heat, either a catarrhal, rheumatic or a ner- 
vous fever. In acute fevers it sets in only once, in inter- 
mittent fevers it repeats with every paroxysm. When a 
chill sets in in the course of an acute fever, it must always 
excite the greatest attention of the physician, and is indi- 
cative of the following : either an intermittent fever, added 
to the acute (hemitritaeus), or an incipient local inflam- 
mation, and in inflammations already existing, a transi- 
tion into suppuration (very important in pneumonias), or 
into gangrene, or a metastasis, or also sometimes an immi- 
nent crisis, especially by the skin. In intermittent fevers, 
slight chill with great heat indicates an inclination to 
change into an acute fever ; great and long-continued 
chill with little heat, inclination to a chronic state. 
Coldness of the extremities indicates impeded circulation 
of the blood (hence accompanies fevers, internal inflam- 
mations), or spasm, or vital weakness 5 and hence the icy 
cold of the dying. 
Heat in diseases indicates either an accelerated cireula- 
tion of the blood and of vital action, and is therefore a 
general sign of acute fevers, which are thence called hoi 65 
DIAGNOSTICS, IATROGNOMIC. 
fevers, and of inflammation, color vivus ; or commencing 
dissolution of the blood and of organic matter, color chemi- 
cus s. mortuus, as seen in putrid fevers. On this depends the 
important distinction of heat in inflammatory and in putrid 
fevers. In the first it is a vital heat, and is distinguished 
by this, that it is very violent but not disagreeable to the 
touch of the hand laid on the sick body, assimilates, so to 
say, with the sense of feeling after being dwell upon for 
some time, and corresponds with the strength and hardness 
of the pulse. In putrid fevers it is the product of an inci- 
pient chemical dissolution, a chemical dead heat (color 
mordox), and is distinguished by its violence, and a sensa- 
tion of burning and stinging to the touch, and is disagree- 
able, and this effect increases, the longer the hand is held 
on the sick body, leaving that impression for some time 
after the hand is removed : it is further to be remarked, 
that this kind of heat augments in proportion as the pulse 
sinks and becomes weaker. 
Heat of one part, either to be felt externally or internally 
by the patient himself, indicates sanguineous congestion or 
inflammation of that part. Thus heat in the preecordia is 
always a critical sign of an internal inflammatory state.—• 
Flying heat is a nervous symptom, and common in females 
after the cessotio mensium. Hot hands after eating, indi- 
cate hectic, and in healthy persons a hectic disposition. 
Pain and anxiety. Pain is the most general expression 
of nature, to indicate the existence of a local complaint. 
This can be either inflammatory or spasmodic ; and we 
can therefore always conclude regarding one or the other ; 
every pain, however, if it be violent, creates at last san- 
guineous congestion. One of the worst signs is, when the 
patient does not feel any pain, although there exist causes 
of pain. Sudden ceasing of violent pains in inflammations 
indicates transition into gangrene, if there does not follow 
a metastasis. 
Pressing headache in the forehead with vertigo indicates 
gastric impurities j in the back part of the head, sangui- 
neous congestion ; semilateral cephalagia or headache of 
only a small spot of the head, hypochondriasis and hyster- 
ics ; pain in the back and the loins, piles. Pain in the 
preecordia by external pressure, is in fevers always omin- 
ous, and indicates, especially if connected with heat and 
straining of this region—inflammation of the abdomen or 
chest. 
Anxiety, a particular sensation of the pramordial nerves, 
still more disagreeable and insupportable than pain, indi- 
-6* 66 
DIAGNOSTICS, lATKOGNOMLC. 
cates either great sanguineous congestion in the prsecordi- 
al region, and hence is present in inflammation of the heart, 
lungs, liver, stomach, and other abdominal viscera, organic 
diseases of the heart, plethora abdominalis, or accumulation 
of injurious, irritating, flatulent substances in the stomach, 
especially of bile and eructations; or a mechanical hinder- 
ance to expansion of the lungs, seen in pectoral and abdo- 
minal hydrops; or mere spasm ; of this kind is the anxiety 
of hypochondriacs, which may increase to desperation. 
Muscular Motion. 
Trembling (tremor) indicates either weakness or plenitude 
of the vessels, (e.g. plethora) or nervous irritation ; thus it 
is in the beginning of a fever a principal sign of its nervous 
character., 
Spasjns with convulsions are indicative either of a ner- 
vous irritation, such as gastric irritation owing to impuri- 
ties, worms, exanthematic and contagious irritatives, small- 
pox, purples, typhus, foreign bodies which affect the nerves, 
brain, or spinal marrow ; wounds of tendons ; or they indi- 
cate plenitude of the vessels and sanguineous congestion to 
the head and spinal marrow ; or exhaustion of power (hence 
most ominous in hemorrhages and other profluvia). But 
we must bear in mind, that in children and hysterical per- 
sons they may arise from trifling causes, and are not so sig- 
nificant ; generally, in either of them, they originate in the 
intestinal canal. 
By cramps (spasmus) we understand, accurately speak- 
ing, a continued contraction of the muscular fibre, by 
convulsio—contraction and relaxation alternating. The 
highest degree of spasm is tetanus ; the highest degree of 
convulsion is epilepsy. Spasm and convulsion may take 
place alike internally and externally ; thus a number of 
internal affections, e.g. palpitatio, vomitus, tussis, colica, 
ischuria, singultus, fall under this category. In the widest 
sense, also, all anomalies of sensibility, are called spas- 
modic affections. 
Singultus indicates in the first place a Ijttle convulsion 
of the diaphragm which arises from very different causes, 
and therefore is of different significance. Thus it is com- 
monly indicative of distention of the stomach in infants; 
also of cold, and is of no significance at all. But in hot 
fevers it indicates either abdominal inflammation, or is in 
nervous fevers a malignant nervous symptom. 
Paralysis indicates an enfeebled or annihilated activity DIAGNOSTICS, lATROGNOMIO. 
67 
of the motory organs of the muscles, in a more extensive 
sense, also of sensation even of the mental faculties, e.g. 
loss of memory, stupor, fatuitas, and in all these cases is 
either a sign of nervous power impeded and bound up by 
external influence, or weakened and annihilated in its in- 
ternal sources ; hence of different significance. In the first 
case it is often very insignificant and transitory ; in the 
latter case it is very momentous and dangerous, most so 
when it proceeds from a weakness or affection of the ori- 
ginal source of sensibility, of the brain and spinal marrow, 
e.g. from apoplexy. 
Fainting (Lipothymia, Syncope), and Jlpoplexy (Apoplexia.) 
In either there is debilitation or entire annihilation of 
nervous activity, sensation, motion and consciousness, with 
this difference, that in syncope there is also a reduction of 
the activity of the heart and circulation, hence pulsation 
and warmth are alike weakened, even sometimes entirely 
annihilated ; in apoplexy on the contrary, the circulation 
continues undebilitated, even frequently is increased ; and 
it often leaves the body paralyzed, which is not the case in 
faintings. Syncope, therefore, indicates a momentary an- 
nihilation of the activity of the heart; apoplexy, a ceasing 
of the activity of the brain and nervous life. Faintino- 
therefore, is of little significance in hysterical persons, and 
is to be considered only as a common attack of spasm. It 
is of consequence in the onset of fever, and a certain smn 
of its nervous character; and in cardial affections is con- 
firmatory of an organic derangement of the heart. Apo- 
plexy indicates always the most important and highest 
affection of the brain in its inmost life. 
7. COMPLEXION, STRUCTURE, EXTERNAL APPEARANCE, CARRIAGE, 
POSITION, 
Serve as signs, not only of actual diseases, but also of 
morbid dispositions. 
Fiame and structure.—Broad, high chest, and a good 
proportion of all the limbs, indicates a robust constitution, 
and durable health. Tall, slender and quick grown bodies 
with a long neck, flat chest and wing-Jikeshoulders, are 
fee e, and show a constitution disposed to consumption, 
bhort, stout bodies are always stronger, and with a short 
neck, are liable to apoplexy. In general, inequality in the 68 
DIAGNOSTICS, lATROGNOMIC. 
proportion of the limbs indicates a disposition to disturb- 
ances of circulation and sanguineous congestions, e.g. too 
short feet or curvations of the spine. 
Excessive emaciation, when not due to a want of ali- 
ments or mental affections, or fever, must always lead 
our attention to a disorder in the abdominal and digestive 
organs, or in the lungs, or to a morbid excretion, e.g. of 
blood or of semen, diabetes. Extraordinary obesity is al- 
ways suspicious, and generally indicates disease of the liver. 
In all chronic diseases, examination of the abdomen 
ought never to be neglected, in order to discover whether 
one part of it be distended more than another, or hardness, 
indicative of physcony, obstruction, or other organic de- 
rangements of some one of the viscera. But we must not 
allow ourselves to be deceived by this appearance in in- 
farctions, and accumulation of hard excrements in the co- 
lon, which are recognizable by their being movable from 
one place to another. 
Complexion. Pale color indicates the presence of mor- 
bid substances in the primee vire, especially acidity and 
worms, or spasm, or want of blood, or watery blood, or 
tardy sanguineous circulation and weakness ; white com- 
plexion, chlorosis ; red complexion, plethora or sangui- 
neous congestion to the head ; circumscribed red cheeks, 
hectic disposition. Light yellow complexion (abdominal 
complexion), diseases of the abdominal viscera ; yellow 
complexion, diseases of the liver, icterus ; blue complex- 
ion, cyanosis; blue spots, scorbutis, dissolution of the 
blood i in old age, stagnation of it, danger of apoplexy. 
Suddenly and entirely changed appearance of the sick, indi- 
cates great danger 5 the same is true of an entire change 
of habit. 
Position of the sick. The more it is in accordance with 
his natural habit, the better. To lay immovably in one 
spot, shows either stupor or great weakness. Continual 
moving about, indicates either internal anxiety and pains, or 
some irritating quality in the blood, e.g. an exanthematic 
matter, frequently also gastric accumulations, and on criti- 
cal days, a coming crisis. To be able to lay on either side 
and on the back equally well, indicates that the chest and 
abdomen are free from considerable disorders of the visce- 
ra ; the first especially when the patient can breathe well 
with the head bent back. Not to be able to lay well on one 
side indicates, generally, a disorder of a viscus in the op- 
posite side. Throwing the feet towards the abdomen, 
indicates abdominal pains ; indecent denudation, either DIAGNOSTICS, lATROGNOMIC. 
69 
great delirium or great anxiety ; the same, when the sick 
cannot endure clothing on the body ; still more, when he 
continually rises and starts; the sinking of the patient in 
his feet, greatest vital weakness ; still more the catching 
after illusory objects, which is generally, but not always, 
the forerunner of death. 
Also the chemical examination of the evacuated sub- 
stances may be used for throwing light on the disease, 
especially for discovering its chemical character. This 
applies mostly to the analysis of urine. 
Also the examination of animal electricity, whether it 
be positive or negative, and the examination by the stetho- 
scope, both of which, however, give disclosures more of a 
physical and material than of a dynamic state of the sys- 
tem, and are consequently of more value in regard to the 
natural history of the patient at the time, than of practical 
utility. 70 
THERAPEUTICS. 
®l)crapcutico. 
Disease is a deviation of life from the normal state; 
consequently an internal change of life itself. Cure is a re- 
duction of this deviation to the normal state, and resto- 
ration of health. Disease, therefore, as well as cure, must 
be regarded as vital operations, and in order to conceive 
and appreciate them, we need correct ideas of life and of 
the origin of disease. 
All external phenomena of life, and also the abnormal 
one, disease, are nothing else than the manifestation of 
an internal prevailing power, which cannot be seen or ima- 
gined the vital power. 
This manifestation appears in a threefold manner 5 and in 
these actions consist the phenomena of life and the dis- 
tinction between living and dead bodies. 
In the first place, the body enters into a particular rela- 
tion towards external things,—into the irritative relation. 
It perceives and reacts differently on external influences 
from what the dead body does. It is irritable, excitable, 
and external impressions become irritations to it. This 
quality of the living body is manifested in two principal 
forms,—firstly, by a contraction and oscillation of the fibre 
(irritability, contractility), and secondly, without a percep- 
tible alteration of the fibre, by internal reception and pro- 
pagation of the irritation (sensibility)—a property of the 
nervous fibre. 
In the second place, the general chemical laws of nature 
are thereby partly annihilated, partly modified, so that 
matter puts on a particular character (living organic chem- 
ismus, vitality of organic matter), and in so far also the 
humors, especially the blood, are animated. 
In the third place, all ingredients, powers and operations 
of the body constitute a unity, and tend and are excited to 
one end—its formation and preservation ; i. e. the body be- THERAPEUTICS. 
71 
comes an individual, possessed of the power to form and 
develop itself, according to a specific character, and to de- 
fend itself against injurious influences, to transmute and 
excrete the incongruous, to regenerate the loss, to keep the 
whole in balance and proper mutuality, and to restore it 
when disturbances occur (the plastic creative power, in 
diseases the healing pow'er of the organism). 
Every living body is consequently elevated to a higher 
degree of existence. 
Every action in the living body is a living action, and 
comprises always an alteration of all the relations men- 
tioned heretofore, material as well as dynamic. 
Every morbific influence operates as an actio viva, and 
only as such can excite disease. 
Every effect of a remedy is likewise an actio viva, and 
can only as such produce a healing effect. 
In every disease we must, therefore, ascertain the in- 
ternal change of life, a change which lies at the bottom of 
the malady, and the perceptible external phenomena pro- 
duced by it, and w'hich are called the symptoms of disease. 
These are differently related to disease. Some are insep- 
arably connected with it (symptomata essentialia, pathogno- 
mica) ; some are not so, and are only accidental (sympto- 
mata accidentalia) 
The internal alteration of life, which gives rise to the 
external phenomena, is termed the proximate cause (causa 
proximo). A causa proximo, therefore, is one, in which 
disease originates, with whose existence the disease exists, 
and with whose removal disease ceases. 
The causes which produce the internal alterations are 
termed remote causes, and bear a different relation to the 
generation of disease, sometimes nearer, sometimes re- 
moter. They may be external and internal, and are dis- 
criminated from the proximate cause by this, that their ex- 
istence does not always give rise to the disease; therefore 
they al so can exist without producing disease. 
These remote causes are divided into predisposing and 
exciting (occasionales). 
To cure is to change the abnormal state of life into the 
normal; that is to say, not only to take away the external 
phenomena of disease (symptoms), which never wull effect 
a radical, permanent cure, since the symptoms, when the 
internal cause continues, of necessity return (symptomatic 72 
THERAPEUTICS. 
cure), but to remove and annihilate the internal change of 
life, the proximate cause, which lies at the bottom of the per- 
ceptible disease ; thus by pulling out the root, the fruits and 
blossoms fail of themselves (the radical cure). 
Now this can be effected either by taking away the remote 
cause, which gave occasion to that internal change; as when 
we take away a splinter, or any other foreign body, we re- 
move the irritation and inflammation created by it; by re- 
moving gastric impurities the complaints arising therefrom ; 
in suppressed excretions by restoring them; in too pro- 
fuse ones by stopping them. Thus, even other diseases can 
be causes of the present malady, and the cure of the first 
will effect the cure of the latter (causal cure). We easily 
conceive, that this cure is preferable to any other; for if 
the cause continues, either amelioration is impossible, or 
if it is effected in another way, the evil will return. Or a 
cure may be effected, by attacking the internal alteration 
of life, which is indispensable to disease, indeed is the dis- 
ease itself, and changing it into the normal slate (direct or 
specific method).—-This method is adopted when no rational 
cure is indicated or possible. 
But since every abnormal slate of life can be changed 
into the normal, only, by the reaction and co-operation of 
the vital power, and every cure depends on an interna] cu- 
rative process (as shown above), it follows that direct 
curing by art consists only in supporting this internal cura- 
tive process of nature and bringing it to perfection. This 
is done either 
By removing the cause of disturbance and the obstacles 
to its action ; 
Or, by supporting and raising the vital power when it is 
too weak; , 
Or, by reducing it, when it is too strongly and tumultu- 
ously excited; 
Or, by remedies, which have either a specific action on 
the suffering organ, so as to give it another character, or 
to arouse properly the vital activity, or which are capable 
of producing an amelioration of the morbific matter and all 
the material relations. 
This is the causal, rational, radical method of curing. 
We can also perform cures which are only apparent, as 
removing the morbid symptoms while the cause of the dis- 
ease continues (the symptomatic palliative method of cur- 
ing). This is only sometimes practicable; but we may THERAPEUTICS. 
73 
easily conceive that this cure cannot he permanent and 
radical. The accidents sooner or later reappear, either in 
their former shape, or, what is still worse, in another and 
more dangerous form. It is the method of quacks, and will 
he avoided by every rational physician. It is only in two 
cases that it may be resorted to: in the first, when a 
symptom is accompanied with imminent danger of life ; in 
the second place, if one symptom hinders even the radical 
cure, or makes it difficult, such as violent pain and diar- 
rhoea, which evacuates the remedies as soon as taken. 
Finally, the treatment can refer to a disease not actually 
existing, and have for its end prevention of it (the preser- 
vative cure). This is done either by removing the dispo- 
sition, or taking away the causes as far as they are within 
our control. But we must here be careful not to carry 
it to abuse, or undertake it without sufficient reason. 
The means for obtaining the end of healing embrace all 
nature, not alone corporeal but also spiritual and mental. 
All that affects the human system, can be used as a remedy. 
The selection (heuristic) of the remedies is made : 
Either in the rational way, as by a plain recognition of 
the wants of morbid nature, and of a remedy which has re- 
ference to them,—a venesection in plethora or excessive 
sanguineous excitement, wine and cinchona in deficiency 
of power: 
Or in an empirical way, i. e. through the knowledge ac- 
quired by experience, that such or such a remedy has a 
particular relation, and curative power, as regards a cer- 
tain organ or morbid condition of the system ; such are the 
effects of cantharides on the urinary organs, of mercury 
on syphilis—specifica.— Also the principle: “ Similia 
similibus curantur” the knowledge of medicines, which 
produce in a healthy state symptoms similar to the disease, 
may be very well profited of, in order to discover such re- 
medies. 
The order of a rational mode of healing is therefore as 
follows; 
birst, to recognise the present morbid state, which re- 
quires of us to carefully ascertain all phenomena hetero- 
geneous to a normal state. In doing so, we must not con- 
sider any thing as trifling and insignificant; for a symptom 
may in the beginning appear trifling and insignificant, but 
7 74 
THERAPEUTICS. 
which will become very important and momentous. It will 
be best—that we may not forget any thing—to observe a 
certain order in our method, and that according to the 
functions. First the vital functions, pulse and respiration ; 
then digestion, secretions, and excretions; mental and 
nervous condition. 
Then to inquire for the precedent or causal relations. 
It is not proper to commence with this, as some do ; for 
the mind gets thereby preoccupied with an idea of the dis- 
ease, and then it considers also the phenomena in and by 
this view, consequently not in a mere objective manner, 
as they are and ought to be seen by him. Every prejudiced 
opinion disturbs the correct and complete conception of 
the actual image of disease. In the anamnestic investiga- 
tion we must go back as far as possible. 
Then examine the constitution, the individuality of the 
patient as well as the general prevailing epidemic, endemic, 
stationary constitution. 
This finished, we must turn our attention to the internal 
state, and try to form a correct idea of the internal morbid 
condition, the seat and character of the disease, whether it 
be inflammatory, nervous, adynamic, dyscrasic ; and in dif- 
ficult cases we may have recourse to analogy and reagen- 
cies. 
By this will appear the object of cure and the indication, 
for whose fulfillment the proper remedies will be found 
either in the rational or in the empiric way. 75 
PRACTICE. 
practice. 
MAXIMS AND GENERAL RULES FOR BEGINNING PRACTITIONERS. 
Art is eternal, system transient. 
Art pertains to the internal sanctuary of man; system to 
time, whose product it is. 
We have names, even forms of diseases, remedies, no- 
tions and explanations different from those of antiquity ; 
but the art of healing is still the same, nature the same, 
and the same capacities are required for becoming an adept 
in medicine as at the time of Hippocrates. 
There is only one art of healing ; for it is something in- 
ternal resting on the eternal laws of nature ; but there are 
many systems, and they are of necessity; for they are 
something'external, dependent upon the spirit prevailing at 
the time, and on the degree of external knowledge which 
we have attained. 
We have had systems enough to know, that medicine 
does not lie in scholastic systems. This has been incon- 
testably demonstrated by history, especially of the last 30 
years. Every one pretended to be the only true one, the 
only beatifying one, until it was destroyed by a new one, 
which made the same pretensions as its predecessor. This 
will always continue, to the end of time. 
But there is a consolation and a gratification in observ- 
ing, that amid all the changes of systems, and the greatest 
aberrations of schools, the sense of true art has been pre- 
served in the minds of some single individuals. There has 
ever been an invisible church of genuine physicians, who, 
always faithful to nature, animated by her spirit, acted ac- 
cording to her intimation, and preserved her holy word; 
who ever and anon thought and willed one and the same 
thing, who understood and ever will understand each other 
through all changes of ages and languages. There have 
always been such men as Hippocrates, Aetius, Aretseus, 
Baglivi, Sydenham, Huxham, Boerhaave, Werlhof, Brendel, 
Zimmermann, Lentin, Frank, 76 
PRACTICE. 
Let us then no longer catch at shadows, but seize the in- 
ternal essence of science itself; let us discriminate between 
word and spirit, form and life, or—what is the same'— 
system and art, that we may no more lose the spirit by the 
letter, the art by the system, as but lately it threatened to 
happen. 
Every art has a secret of its own. This cannot be learnt 
or acquired from without, nor can it be conjured by cer- 
tain formula; and ceremonies; every one must have it ge- 
nerated within himself, and only such a one will participate 
in it, as he who imbibes it from the spirit of nature, con- 
ceives it purely in his inmost mind ; lives in and becomes 
familiar with it. Such a one only is initiated and receives 
revelations ; he alone understands the word. 
Without reflection there is no reasonable action. Thus 
also medical action presupposes something reflected upon 
(theory). But the practitioner’s reflection must proceed 
from nature and life,—not from a system. 
There is therefore a particular theory of practice, as 
there is a theory of science. The latter always appears 
more consequent in itself; for it is mind’s own primitive 
product, and holds good in the school. The first appears 
less agreeing with scholastic rules; for it is the reflection 
of nature, and its principles are derived from nature, a 
datum, not an excogitatum ; and it holds good in the opera- 
tion of nature, i. e. by the sick bed. 
As organic life is nothing else, but an exaltation of things 
to a higher degree of existence, thus also the essence of 
the healing art is nothing else but an exaltation of empirico- 
historical knowledge to a higher degree of existence in 
mind. All knowledge must become animated, every phe- 
nomenon elevated to a higher sphere, every action to an 
act of life ; then art lives in life, then it is true art. Hence 
true medicine has had a language of its own, since the 
days of Hippocrates, to designate the world of life, which 
is its element, and which is properly inexpressible. Hence 
such wdrds as coction, crisis, metastasis, even reproduc- 
tion, assimilation, and metamorphosis, etc., are ever like 
symbola or mythes, inaccessible to systems, but intelligible 
to him wrho can fathom the depths of life. 
The most accurate systematizers are the worst empirics. PRACTICE. 
77 
It is far worse to urge a system than a medicament or. 
nature. 
What is developed, so to say, in conversation with and 
intuition of nature, is of more value than all that which has 
been excogitated and learnt. It alone is possessed of true 
life, i. e. the spirit of nature, and is as eternally true as na- 
ture is. 
Familiarity with nature, intuition, and observation are 
the only true ways to obtain it, and the internal require- 
ment for it is a direction and exertion of an appropriate 
mind—a spirit of observation. It is acquired partly by the 
careful study of nature itself, partly by studying the works 
of such men, who observed her, who looked at her and de- 
scribed her in a pure unadulterated Hippocratic light. What 
the study of anticks is to the artist, the study of Hippo- 
crates is to the physician. 
Every sick person is a temple of nature ;—-approach it 
with awe and devotion, devoid of frivolity, egotism and 
want of principles ; then nature will look at yoffwith grace 
and disclose you her secret. 
Bear always in mind, who you are and what your office 
is. You are employed by God as a priest of the holy flame 
of life, and as administrator and distributor of the high- 
est gifts, health and life, and of the secret powers, which 
he has bestowed throughout nature for the benefit of man- 
kind. A sublime, a sacred task ! Perform it purely, not to 
your advantage, nor to your fame, but to the glory of the 
Lord, and to the salvation of your fellow man. You shall 
have once to give an account for it. 
Maintain always the dignity of the profession in your- 
self and in others; and never degrade it so as to make it a 
trade, and the means of bad purposes. 
Discriminate well the malady and the patient, and always 
regard both in the act of curing. The same disease in 
one individual requires often a method of cure quite differ- 
ent from wha.t is proper in another. 
The principle of the art consists in generalizing diseases, 
and individualizing the patient as much as is possible. 
It is better that the patient die than be killed by you. 78 
PRACTICE. 
If you cannot help, at least do no harm. 
The cure must not be more pernicious than the disease. 
Dubious remedies are better than none. 
In imminent danger to the sick you must risk all, even 
reputation. 
In general, never think of yourself, but of the patient. 
Be not tardy to do what is necessary. The favorable 
moment does never return. 
Do nothing without sufficient reason. It is better to let 
nature operate alone, than to do something wrong or un- 
seasonable. 
Especially in chronic diseases, get accustomed to pa- 
tience, and know how to wait for the time. For they are 
curable at one time, and incurable at another. You will 
not succeed by impetuosity, but more frequently do injury. 
Nature undisturbed often continues her work secretly, and 
effects improvement, even cure ; or changes the form of 
the disease into another which is curable ; or creates a 
crisis, a metastasis, of which the physician can profit to 
perform a cure. 
Never forget, that it is not you who heals diseases; but 
that it is nature which accomplishes the cure ; and that 
you have to consider yourselves only as assistants, who 
can promote, support, aid her work, even make it possible 
and introduce it, but also, alas ! hinder and render it im- 
possible. 
Never forget to regulate the diet of the patient. Many 
a cure has been effected by a strict regimen, excluding all 
injurious matters, which nourish the disease ; and on the 
other hand, the best medicinal treatment can be frustrated 
by excess or faults in diet. We have in this to regard not 
only the quantity, but also the quality of the aliments ; a 
department which requires a competent acquaintance with 
the qualitative differences of food, etc. 
The most sublime vocation of man, after worship of the 
Deity, is that of being priest of the holy vital flame, and 
an administrator of the highest divine goods, .and the most 
secret powers of nature—physician. 
Do you think, when you appear before the throne of 
eternal truth, you will be asked, According to what system 
did you actl Did you comply with it, and have you 
brought it to perfection 1 The question will be this : I ACUTE FEVERS. 
79 
made you steward of the wonderful powers which I have 
placed in nature, and of her products to benefit man- 
kind ; how did you distribute those treasures 1 To the 
benefit of mankind, with gratitude and veneration 1 or to 
honor your name,—with selfishness and egotism ? Did you, 
in your researches and actions, strive merely for truth, to 
save your brethren, or was it all for self-interest 1 
To him, to whom medicine becomes not a religion, it is 
the most disconsolate, troublesome and ungrateful art on 
earth ; yea, it must become with him the greatest frivolity 
and sin, for only that which is done in God, is holy and 
beatifying. How is it now-a-days with many 1 Nothing 
but mere speculation, a means to make a fortune, to win 
money ; notoriety ; even with the better sort of practi- 
tioners, the pursuit of the healing art reaches no higher 
than an investigation of Nature. 
FIRST CLASS. 
ACUTE FEYEES. 
FEBRES ACUTJE, FEBRES CONTINUE 
There is only one acute disease,—it is fever. The 
fundamental character of it is : increased activity of the 
vascular system, and accelerated vital action, indispensably 
accompanied with increased generation of warmth. Every 
fever, consequently, has for its essential character a phlo- 
gistic (i. e. inflammatory) state, from which a real inflam- 
mation may easily be developed merely by graduation. 
Therefore, it is confined within certain limits of duration. 
Life cannot long continue in such an exalted, accelerated 
state, without either destroying itself, or retrograding, or 
assuming another form of malady. Every fever, in the very 
same individual, can be transformed into all the different 
species of fever, and exhibit them successively. It may 
be first a simple irritative fever, w'hich, by hot drinks may 
be changed into an inflammatory one, and again altered 
into a nervous one by too much bloodletting or an omis- 
sion of it and over-action ; finally, it can pass into an in- 
termittent. 
Generalities 80 
ACUTE FEVERS. 
Diagnosis. Cold, heat, accelerated pulse, lassitude, al- 
tered urine. The fever never entirely leaves the patient ; 
sometimes it persists in an unvarying degree {feb. conti- 
nens) ; more frequently in a degree varying in virulence 
(feb. remittens, excerhatio, remissio). 
Course, duration and crisis. The duration is from 7to 14, 
21, 28 days, which are called critical days, since the deci- 
sion of the morbid state happens on them. The course 
comprises five stages ; the onset, the increase, the acme, 
decrease, convalescency. 
The acme, the point of culmination, is the period when 
the crisis, the decision, succeeds. A good and perfect cri- 
sis is always accompanied with critical evacuations ; espe- 
cially by the skin, and sediment in the urine. This con- 
tinues through the whole stage of decrease. The imperfect 
crisis creates, either a local change ([metastasis), or a change 
of form (metaschematismus) of disease. It terminates in 
either health or another malady, or in death. Death fol- 
lows either by a general exhaustion of the vital power, or 
by the disease attacking an organ, the disorder of which 
(especially of the lungs) impedes directly the process of 
life, or whose affection injures the whole system. 
The only sure signs of a perfect crisis and of real im- 
provement are: a uniformly open, moist skin, a critical 
urine, (i. e. a urine, which after it has previously been en- 
tirely clear or thick and turbid, clears up and becomes 
straw-colored on the surface, and has a uniform, gray, 
white, or reddish sediment on the bottom) ; but before all 
stands the pulse,—a decrease in its quickness, and a tran- 
sition into a calm, soft one. Without this diminution of 
the pulse, all other signs of improvement, even the feeling 
ease and comfort, are illusory. If the pulse remains quick 
and irritated, even whilst the other symptoms have ceased, 
a transition into an after-malady is to be feared. 
Pathogenesis. The causes may be manifold ; all that can 
excite a considerable irritation, or disturb the equilibrium 
of the organism, can excite fever; most frequently change 
of temperature, gastric accumulations, epidemic and con- 
tagious influence. There is also a certain disposition not 
to be denied. It rests more in the irritable than in the 
sensitive system, for nervous, hypochondriacal, and hyster- 
ical persons are much less liable to acute fevers than 
others. 
It is an error to suppose, that fever always originates in 
a local irritation. This is, of course, true in the plurality 
of cases; but very often a general feverish excitement ACUTE FEVERS. 
81 
appears first, and the local irritation, inflammation, etc., is 
only the effect of the former. 
Variety of the Acute Fevers, Practical Division of them. 
Fever, although essentially one and the same thing, as- 
sumes several modifications by the variety of the system, 
from which it proceeds, or which it particularly attacks. 
We determine accordingly the various kinds, or character 
of fever, and base upon them the various methods of cure. 
Either no system is particularly affected, or there exists 
at least, no symptom of the various species—in this case 
it is simple fever (febris simplex). 
Or the system most affected is the cordial and vascular 
system, which always acquires an increased vital activity 
in the heart and blood—this is inflammatory or vascular fe- 
ver {febris inflammatoria, synocha). 
Or the nervous system is particularly affected, always 
accompanied with an inclination to diminished vital energy, 
nervous fever {febris nervosa, typhus). When the vital 
power of the blood is destroyed by the disease, it is termed 
putrid fever {typhus putridus, febris putrida). 
Or the gastric system is particularly affected by morbid 
substances {febris gastrica). 
Or the fever proceeds from the cutaneous system, and 
affects chiefly the serous and mucous membranes, and is 
accompanied with a serous morbific matter {febris rheu- 
matica, catarrhalis). 
The causes producing the various febrile characters are: 
. character of the exciting causes which imparts 
itself immediately to the whole fever succeeding ; e.g. 
violent fright creates a nervous fever, violent anger a bil- 
ious fever, excess in overheating and wine, an inflammatory 
fever, communication of putrid substances or contagion, a 
putrid fever. 
2. The constitution and disposition of the individual, on 
whom the exciting cause operates, as the soil in which the 
seed is developed. Thus, e.g. the very same exciting cause 
produces in a debilitated person a nervous fever, in a ple- 
thoric one, an inflammatory fever. 
3. The prevalent epidemic constitution. Its power is 
extraordinary, and it can impart to all individuals an iden- 
tical febrile character. 
4. file course of the fever itself can alter its character. 
Thus e.g. exhaustion follows immoderate exertion. Thus, 82 
ACUTE FEVERS. 
an inflammatory fever passes into a nervous one ; thus, by 
febrile irritation, corrupt secretions of the intestinal canal, 
and gastric impurities, are frequently engendered. 
5. From accidental causes.—Thus, fright operating du- 
ring the fever, or anger, or faulty diet, even the medical 
treatment. Very often a simple fever is transmuted into 
an inflammatory ; a simple or inflammatory into a nervous 
or putrid fever, by excessive overheating. 
Therapeutics.—Every acute fever is a phlogistic state of 
the body, and consequently the remedial means called for 
is antiphlogistic. Therefore, in the commencement, and 
as long as the character of the fever is not established, the 
antiphlogistic treatment is the best. 
Further, we must never forget, that in every acute fever 
the healing principle and the vital power are one and the 
same thing ; nay more, fever itself is nothing else than a 
curative process which brings about critical alterations, 
termination, and a restoration from disturbance to healthy 
equilibrium,—yea, in many cases, nature uses no other 
means than fever to cure disease. Therefore the office of 
art is by no means to remove fever itself, but solely to 
guide its operation in such a manner, that it attains the end 
of effecting a perfect crisis ; art can do no more than to 
clear away obstacles which oppose it, to moderate the vital 
power, when too violently excited, to raise and strengthen 
it when too weak ; in short, to confine it within that medi- 
um degree of activity, which alone can effectuate a critical 
operation. 
The general indications are the following: 
The first is, to remove the exciting cause, e.g. gastric 
matter. 
The second is, to ascertain what is the febrile character, 
and to adapt to it a method of cure. 
The following principal methods for curing a fever are 
advised : the antiphlogistic ; the nervine ; and the exciting ; 
the roborant, antiseptic ; the gastric ; and the diaphoretic or 
anti-rheumatic. 
The third, to treat the local affections according to cir- 
cumstances. 
The fourth, to regard carefully the crisis and curative 
operations of nature, here so important, and to aid them, 
the least of all to counteract them. 
The fifth, to watch attentively the changes going on in 
the fever, and the transition of its character into another. 
Here it may be well to remark, that the species of fever 
are by no means so clearly and distinctly separated from acute fevers. 
83 
each other by nature as they appear in a printed compen- 
dium. Frequently, several become mixed ; and there often 
occur complications of several species, e.g. of the inflam- 
matory and nervous, of the gastric, with all other kinds of 
fever, etc.; often the' species shows itself only in a low 
degree, e.g. the nervous fever merely as a nervous 
state. . . . . 
The practitioner has to look upon the original fever as a 
unity, as a phlogosis ; and all the so called species and 
sorts as mere deviations and modifications of this funda- 
mental state, which they always retain as their base, and 
to which they may easily return again. 
Therefore, in a case of decidedly and clearly marked fe- 
brile character, the best mode of treatment is to use op- 
posite means ; but in all other cases, a more negative 
course is to be observed—an antiphlogistic temporizing 
one, and a vegetable diet. 
General Diet in Fevers. 
1. Every febrile patient must lie down and res?, corpore- 
ally as well as mentally. This is an essential rule, which 
nature herself prescribes through a feeling of fatigue felt 
in every fever. It is incredible, how much a horizontal 
position contributes towards diminishing a fever ; it calms 
the pulse, renders the circulation of the blood uniform, 
permits nature to dispose of all her vital powers for cura- 
tive operations, and thus promotes and alleviates a crisis. 
In short, it is an indispensable condition in the cure of 
every fever. 
2. Every febrile patient must drink freely of diluents, for 
the thirst which accompanies every fever is the voice of 
nature calling for fluid. Water is the best beverage ; but 
when the stomach is weak, let the water be boiled—as bar- 
ley, toast, or apple water ; in this form it is more readily 
taken into the circulation. 
3. A febrile patient must not he allowed food. This, also, 
is a commandment of nature, for she refuses appetite in 
fever. Let no substantial food be taken. Nature cannot 
bear it; she wants the digestive powers to aid in pro- 
curing a crisis. Should aliment be taken, it would remain 
undigested in the stomach, and form sordes. It will nour- 
ish the disease, not the sick. Nothing stronger than gruel 
and the like, and stewed fruit should be allowed. All ani- 84 
SIMPLE FEVER, 
mal food is generally forbidden, since it increases phlo- 
gosis. 
4. The air of the apartment must always be cool and 
pure, an essential rule for diminishing febrile actions, and 
preventing them from being changed into inflammatory or 
putrid fevers. Impure, hot, confined air of the sick room 
is sufficient to transform a simple fever into a putrid ty- 
phus. The temperature must range between 14—15° of 
Eeaumur (50 to 55° Fahrenheit). 
The best means for purifying the air of a sick room is 
by renovation—admitting fresh air. All chemical amelio- 
ratives do not accomplish this end, and they are especially 
apt to injure the lungs. The only chemical means advisa- 
ble is to sprinkle the apartment with vinegar. 
5. The covering of the sick must be sufficient but light. 
Discard feather beds, and take matresses and a woollen 
covering (blankets). 
6. The greatest mental tranquillity is indispensable. 
Every emotion, of joy as well as of grief, is pernicious. 
7. Daily discharge from the bowels is necessary, if only 
to expel flatulencies. Therefore, if stewed fruits have not 
the effect of moving them, emollient injections must be 
administered in the evening. 
SIMPLE FEVER. 
Febris Simplex, Nullius Generis. 
Diagnosis.' The general symptoms of that fever which 
has no distinct character. It lasts sometimes only 24- 
hours, and performs in this short time its course and crisis 
(-ephemera, fever of a day). 
The simple irritative fever occurs commonly in healthy 
individuals, in the middle and stationary period of life ;it 
is acted on by slight causes or even by contagious influ- 
ences, giving rise to what is called mild small-pox, measles, 
scarlatina, and the like. 
Simple fever is very often the commencement—the 
morbus fiens—of a case, the character of which is not yet 
apparent, but is about to be developed. While the case 
retains this undecided character, we must look upon it 
simply as one of irritative fever, and be careful not to de- 
cide upon what it may turn out to be, without sufficient rea- 
son i nor to attack the system vigorously, since it ispossible 85 
INFLAMMATORY FEVER. 
that the fever, if left to itself, might have easily yielded, 
but now increased by our treatment is made a dangerous 
malady. An erroneous anticipation of what the fever is to 
be, may lead to the application of irritants in an incipient 
inflammation, or to debilitating means in an incipient ner- 
vous fever. 
Therapeutics. The cure is the general cure of lever and 
the general febrile diet, described above. 
The best treatment is a negative, temporizing, indirect 
one ; consisting in rest, horizontal position, abstaining fi om 
food, and slight antiphlogistic remedies, such as the Rive- 
rian saturation (s. No. 1.) or pulvis aerophorus (s. No. 2), 
cremor tartari, especially in solution (s. No. 3), frequent 
drinking ; and this will often suffice for a cure. 
It will, however, be very useful to give a mild, cooling 
purgative of sulph. soda;, tamarinds, or manna, because, 
very frequently impurities in the primre vise do exist, and 
are retained there by the fever. Besides, it is of great ad- 
vantage in cases of incipient violent fever to clear the pri- 
mse vise early. 
INFLAMMATORY FEVER. 
Febris Injiammatoria, Synocha. 
Diagnosis. Great chill in the onset,- hard, strong and 
frequent pulse ; great but lively heat; thirst ; red urine ; 
dryness of the skin and tongue ; continuance of the same 
state of the pulse and all the other symptoms; pulse 
harmonizing with the respiration ; increase and decrease 
of all the symptoms in accordance with the pulse. Rapid- 
ity and regularity of the course ; strict observance of the 
stages and critical days; perfect crises by sweat, urine, 
or hemorrhages. 
Duration. It does not exceed 14 days. Sometimes it 
mutates into nervous and putrid fever. 
The character is not malignant. It is ardent, hut easily 
soothed by an appropriate antiphlogistic treatment in the 
beginning. Apt to local inflammations. 
Pathogenesis. The proximate cause is excessively increas- 
ed sanguine life; therefore increased energy and irritability 
th® arterial system, and augmented coagulability and 
plasticity of the blood. It coincides with what the mod- 
erns term phlebitis universalis : for in so general an inflam- 86 
INFLAMMATORY FEVER. 
matory diathesis of the blood, the internal surfaces of the 
vessels cannot fail to become inflamed. 
The remote causes are : epidemical, endemical, an in- 
dividually inflammatory constitution, dry severe cold, high 
stand of the barometer, north and northeast winds, age of 
15 to 30 years, sanguineous plenitude, motory life in free 
air, living on meat and wine. 
Exciting causes ; violent overheating, taking cold, vio- 
lent emotions, wounds, local inflammations; and in general 
every febrile irritation, which affects internally or exter- 
nally, an individual disposed to synocha; every pyrexia 
enhanced by mismanagement. 
Therapeutics. The indications are : to reduce the vital 
power, and that of the cardial and sanguineous systems ; 
to relax the fibre ; to fluidify the coagulable blood, to ab- 
stract warmth. The remedies are very simple : in the 
first place bleeding, nitre and all antiphlogistic salts, 
cooling purgatives; secondly: water, drinking largely ; in 
the third place: calomel and nitre, potassa, soda ; fourthly : 
cool air and cool water. 
The chief remedy for this fever is venesection ; it com- 
bines the attainment of all the indications. But we must 
never forget that it is the most potent remedy within our 
reach, since it takes away from the patient a part of life 
itself, a bold liberty which our art must not abuse. As cer- 
tain as it is that bleeding is the only remedy in high in- 
flammations, and one that cannot be replaced by any other, 
and that life exalted by inflammation often requires and bears 
large abstractions of blood, we must nevertheless be cau- 
tious not to lavish it to too great an extent, or to no pur- 
pose, since grave and irreparable consequences may follow 
such prodigality. For, in the first place, a merely inflam- 
matory state may suddenly change into a nervous one, 
yea, into an adynamic or putrid state; in the second place, 
it may deprive nature of the power requisite for effect- 
ing what is indispensable—a crisis; in local affections, 
resolution, without which no perfect restoration and re- 
turn to the normal state is possible ; and finally, in the 
third place, it may bring on a chronic weakness and slow 
recovery, and even important subsequent maladies. 
It is therefore necessary to make a distinction between 
the two degrees, in which this fever occurs. 
1. The mild degree. Here the indirect method of 
cure is needed. It consists in withholding aliments from 
the patient; in a strictly antiphlogistic diet, rest, drinking 
water, in short, has reference to the general cure of fever ; INFLAMMATORY FEVER. 
87 
and the use of cooling purgatives and of nitre. Should 
the digestive powers be impaired, and nitre purge too 
much, sal ammoniacum, with a little addition, of emetic tar- 
tar will be proper (vide No. 4). Should it be necessary to 
continue the use of nitre, while there is some fear of debi- 
lity, nitrate of soda in the same dose and form will prove 
serviceable (vide No. 5). Here, also a cooling purgative is 
very recommendable (No. 6). 
2. The higher degree is indicated by great violence in 
all symptoms, but especially by a strong, full, hard pulse. 
Here venesection is the principal agent, and it often hap- 
pens that nothing else is required, besides a proper regimen, 
to perform the cure. But in this case, as in many others, 
all depends upon the right form and the quantity of bleed- 
ing, to attain fully the desired result. When too small, it 
will be unavailing; when too large, it will prove perni- 
cious. By a judicious, a right administration of it, we 
may even save much blood ; for a single venesection done 
in the right manner, operates more decisively towards the 
removal of inflammation, than several repeated abstractions 
of blood inappropriately performed. 
The following are the rules to be complied with, which 
I cannot recommend too urgently : 
Venesection must be performed at an early time. The ear- 
lier it is resorted to in the incipient inflammatory state, with 
the more certainty, and with less loss of blood shall we sub- 
due the inflammation in its rise ; but at a later period, when 
the inflammation is fully formed, the same effect can 
scarcely be accomplished by three or four times as many 
repeated venesections, and the loss of much blood. 
A quantity of blood requisite to annihilate inflamma- 
tion, and no more, must be abstracted. This quantity is not 
to be determined by measure and weight, but by the state 
of the pulse ; for a pound in one constitution will equal 
one and a half or even two pounds in another. We must 
therefore feel the pulse during the venesection, and allow 
the blood to flow until the hard, strong, full, frequent pulse 
becomes soft, less agitated, and calm. But we must, how- 
ever, not continue bleeding unto fainting; for when there 
is a great disposition to coagulability, a coagulation of 
blood in the heart or the great vessels, and thereby poly- 
pous formations, even pneumony might arise during the stop- 
page of the circulation. This danger will be prevented by 
a horizontal position, and by closing the vein as soon as 
the pulse becomes unequal. 
We must effect a quick evacuation, which, is best done 88 
INFLAMMATORY FEVER. 
by a sufficiently large opening of the vein. It is only when 
the blood spouts out arch-like, that it produces the salutary 
collapsus vasorum, which is indispensable for subduing in- 
flammation. When the blood trickles down the arm, or is 
forced out by pressing, no benefit will result. The 
velocity of discharge will supply the quantity, and one 
pound evacuated in this manner, is of more use than three 
or four pounds abstracted slowly. 
The best place for venesection in inflammatory diseases, 
is the arm, and as near to the heart as possible. 
The indication for venesection is urgent in the following 
cases : when the constitution of the patient is plethoric, ro- 
bust, youthful—between 18 and 30 years ; when he is accus- 
tomed to bloodletting, or the usual time for habitual venesec- 
tion isarrived,at whichnatural hemorrhages, such ashemor- 
rhoidal flux, bleeding at the nose, would relieve him ; when 
the prevalent (morbid) constitution or epidemy is of an in- 
flammatory character, in the months of January, February, 
March, especially when severe dry cold, with a high stand 
of the barometer, shows the period at which the human 
system bears venesection best, and in large quantity ; final- 
ly, when there are indications of an incipient local inflam- 
mation, as a short cough, a little pain in breathing. 
These considerations can serve as auxiliary indications, 
and confirmatory in those cases where we are in doubt, 
whether we are to let blood or not; and where the physi- 
cian finds himself in the dilemma, that if he does not bleed, 
the patient must die under an inflammatory fever, if he 
does, under a nervous one. Here one expedient is yet 
left: a testing venesection cautiously performed. We 
open the vein, and observe accurately the pulse whilst the 
blood flows. If, after a few ounces are drawn, the pulse 
becomes smaller and quicker, the vein must immediately 
be closed. So small a loss of blood can do no injury to 
the patient, and by its effect we discover what is the real 
condition of the system—a local inflammation. 
It is an error of judgment to believe that leeching or 
cupping can replace venesection ; for, the inflammatory 
germ in the blood can only be annihilated by a quick and 
large evacuation of blood so as to produce collapsus cordis 
et vasorum. It is a great mistake to believe that a gradual 
evacuation of the cuticular vessels, even if 40 or 60 leeches 
are applied, and they draw several pounds of blood, would 
answer the same end. It is only in infants, or in very feeble 
persons, laboring under local inflammations, that we may 
substitute leeches for venesection. One venesection is INFLAMMATORY FEVER. 
89 
not alwavs sufficient. Inflammation is not always entirely 
subdued by the first evacuation. It may attain, after the lapse 
of 8, 12, or 24 hours, new vigor and ascendency ; the fever 
reaching again to its former height. Here a repetition of 
phlebotomy is necessary. Ihe rule is to repeat venesec- 
tion as often as the pulse reacquires its former hardness 
and strength ; the more will this practice be usefu , the 
quicker it is done, and the less blood has been ab- 
stracted formerly and the firmer and stronger the inflam- 
matory crust on the blood. Thus we are sometimes 
obliged to repeat venesection three or four times. As for 
the quantity, we must always be guided by the state of the 
pulse, since the inflammatory crust does not always give a 
decisive sign ; for we might take away all the blood the 
patient has, and the crust still continue. 
Conjoined with, or after venesection, an antiphlogistic 
purgative must be given in divided doses, so as to produce 
three or four stools. Here also it is to be borne in mind, 
that an excess of purging is noxious, and can operate as 
an irritation to increase the fever. After this, two to three 
drachms of nitre may be given within 24 hours, along with 
small doses of emetic tartar ; also sal ammoniac, according 
to the prescription already given. 
By such treatment a favorable case of fever will entirely 
cease, and we shall have nothing else to do from the begin- 
ning to the end, but to continue the antiphlogistic diet and 
to attend to the crisis, and keep the patient in bed. 
Metastasis is not uncommon in this fever, especially 
when the general crises have been disturbed by colds or 
other accidents ; but this happens more frequently in ner- 
vous and putrid fevers. Such metastases are either dyna- 
mic, as when the morbific principle acts on the nerves, 
producing paralysis, deafness, loss of memory ; or material, 
as when abscesses, or exanthemata appear. In the first 
case, vesicatories, kept up for a long lime, will be proper; 
and in the second, to acc?lerate suppuration and breaking, 
we must apply emollient, or even stimulating cataplasms. 
Sometimes, however, the fever continues, or even it in- 
creases, without showing signs of an inflammatory state ; 
or the crises do not duly succeed on the sixth or seventh 
day. Here spiritus Mindereri, 30 to 60 drops every two 
hours is the best remedy to bring about the crisis, and to 
pass from a debilitating to a mild stimulating method of 
cure. In these cases we must carefully avoid the use of 
such stimulants as would tend to reproduce the phlogistic 
state. If this be unavailing, the case must be of a double 90 
NERVOUS FEVER. 
nature : Either that which is the most frequent, the phlo- 
gistic state is removed, but an erethic (nervous) irritability 
of the vascular system has remained. Here we must com- 
bine with spirit. Mindereri aqua laurocerasi one drachm 
within 24 hours. Or, as it commonly happens after too 
copious bleeding, there has been a transition into an ady- 
namic state ; nervous, putrid, or hectic fever, are the con- 
sequences. Now the treatment must accord with the 
respective species of fevers. 
After simple fever, strengthening remedies are seldom 
needed ; on the contrary, we must avoid cinchona and 
similar medicines, which might easily again create sangui- 
neous agitation. The most serviceable remedy is elixir 
viscerale Hofmanni, 60 drops to be taken twice a day. 
NERVOUS FEVER. 
Febris Nervosa, Typhus Nervosus. 
Diagnosis. The beginning is not announced by a severe 
chill as in inflammatory fevers, but imperceptibly sets in with 
slight chills, alternating with heat. The head and nervous 
system are particularly affected, as is made manifest in the 
commencement by headache, giddiness, and vertigo ; 
sometimes there is also fainting and trembling ; and later 
in the disease, we meet with delirium, stupor, spasms of 
all kinds, external as well as internal, convulsions ; great 
debility and lassitude ; the pulse is small, weak, soft, easily 
compressible, moderately frequent, sometimes even slow, 
and very changeable, not harmonizing with respiration, 
being quick, while the latter is moderate. In general there 
is great changeability in all the symptoms, especially of 
the urine, which is sometimes red, sometimes pale, most 
frequently jumentous ; discordance between the symptoms 
themselves and the condition of the disease : dryness in 
the mouth, and no thirst; cause for pain, as from sina- 
pisms, yet no pain felt; violent sickness, and no perception 
of it, yea, assurance of feeling well; hence the name ma- 
ligna, malicious (specie levis, revera gravis), absence of 
the signs of other species of fever, particularly of the 
purely inflammatory, which is characterized by the strength 
and hardness of the pulse, constancy of symptoms, espe- 
cially of the pulse and urine, the regularity of the course 
of the malady, and the harmony of the phenomena among 
each other, especially the correspondence of the pulse 
with respiration. NERVOUS FEVER. 
91 
Sometimes, however, all signs are so uncertain that it 
becomes very difficult, especially in severe local affections 
of noble viscera, to decide whether the fever is purely ner- 
vous or inflammatory. Here it may be permitted to use 
with cautiousness reagencies, in order to discover the true 
character of the malady. Of this number is a testing vene- 
section, performed with great care. We let a few ounces 
of blood run, and attentively observe the effect. If the 
pulse is raised and becomes slow, it indicates an inflamma- 
tory character, and you may let more blood flow; if it 
sinks, becomes smaller and quicker, the disease is evidently 
of a nervous character. In this case, the vein must imme- 
diately be closed and an anti-nervous treatment is to be pur- 
sued. 
I he difficulty of diagnosis produced by the deceitfulness, 
contradiction and inequality of the phenomena, has often 
been the cause of mistaking and confounding these fevers. 
-They have been called nervous fevers, w'hen they were not 
such, and the reverse.—We must also distinguish a ner- 
vous state from an actual nervous fever. The first asso- 
ciates itself easily with all other kinds of fevers in nervous 
and sensitive persons, without being therefore a real ner- 
vous fever. 
r The course is likewise very irregular and uncertain. 
The forerunners (cloudiness, dizziness of the head, vertigo, 
somewhat trembling in the limbs, headache, sleeplessness’ 
dreams and visions) generally last for several days or even 
weeks. Duration, 21 to 28 days, or even longer. Conva- 
Jescency is slow and troublesome, and apt to relapses; 
a ter violent nervous fever, a perfect restoration does not 
,PPen before two or three months, 
he issue seldom occurs by a perfect crisis (whence 
■ e?e. eversj have been termed acriticce, and on account of 
ien irregularity atactcß), but these fevers are characterized 
/ imper ect crises, metastases, or metaschematisms, pur- 
p es (w ich are commonly symptomatic, but, if they appear 
er on the critical days, can be critical), boils, abscesses, 
nerv ®anprenous {Sarigre7ia critica), or metastases to the 
mental f ea(n.ess’ blindness, losg of memory and other 
and t|eS’. nervous complaints, pulmonary 
the vital SUCCee<^s ebber through extreme exhaustion of 
through locaKffl1!6^008 ?aralysis’ nervous apoplexy, or 
nr b-ir nr,ir and inflammations of noble viscera, 
Tb c? equation, putrid dissolution. 
anger in nervous fevers depends on exhaustion of 92 
NERVOUS FEVER. 
the vital power, on colJiquation or a local affection of some 
noble viscus, most frequently of the head ; and it is very 
apt to pass into paralysis, or inflammation, or gangrene. 
The discrimination of danger is difficult on account of 
the deceitfulness of the patient’s feelings, on account of 
the uncertainly and fluctuation of the symptoms, and their 
discordance with the internal parts. The principal rule is: 
spera infestis, vietue secundis. With the most favorable 
signs, a patient may suddenly die by the supervening of a 
nervous paralysis, and may recover, though the most des- 
perate appearance exists with all the general lethal signs. 
The chief sources for forming a judgment are : 
a. The pulse. It is here the main sign for determining 
the danger of life, chiefly its quickness. The more accel- 
erated the pulse, the more the danger increases; the more 
quiet and equal, the more hope. 
b. The urine. When it is perfectly clear, very thick, 
brown, bloody, or with a cloud floating in, or rising towards 
the surface, or with a very copious sediment, and which, 
does not clear the urine above, great danger is indicated ; 
on the contrary, gradual clearing up of a previously thick 
or moderate turbidness of the previously clear urine, is in- 
dicative of improvement; finally, moderate sediment suc- 
ceeding, and the urine above it being entirely clear, citron 
or straw-yellow, points to recovery. 
c. The head and nervous system. The more dizzy, 
soporous and insensible the head is, when the patient feels 
well in a severe malady, the more local paralysis shows 
itself, as of the tongue in speaking, in protruding it, diffi- 
cult swallowing, incontinence of urine and stool, or violent 
convulsions, tetanus opisthotonus: the greater is the dan- 
ger. 
d. The skin. The more it is unequally warm or dry and 
languid, or covered with immoderate local viscous sweat 
or premature symptomatic purples and petechia?, the worse. 
e. Finally, The signs of colJiquation, of putrid dissolu- 
tion ,* hemorrhages, especially by urine and stool, colliqua- 
tive diarrhoea, petechiae, putrid, fetid smell, local gangrene, 
decubitus. 
The signs of the approaching death are : stupor with 
silent delirium, coma vigil, crocidismus, carpologia, meteo- 
rismus, with colliquative diarrhoea, deglutitio difficilis ; but 
also these are sometimes illusory. I have seen patients who 
labored under all these symptoms, recover. 
It is remarkable that deafness is generally a good sign. 
Variety and division.—The difference is in the first place NERVOUS FEVER. 
93 
determined by the degree of virulence : febris nervosa mitis 
and gravis ; then by the type : febris nervosa continua and 
intermittens; then by the duration : febr. new. acuta and 
chronica, finally by complication, which constitutes the 
most important difference for practice. We have here to 
regard chiefly whether the nervous fever attacks more or 
less the vascular system and the sanguineous mass. Is the 
affection inconsiderable, it is termed febr. nerv. simplex. 
Is the sanguineous system more violently seized, and aug- 
mented in its energy (which is likely to happen in young, 
robust persons, in rapidly attacking contagious nervous fe- 
vers), it becomes febr. nerv. inflammatoria. On the other 
hand, when the sanguineous system is much debilitated, 
and even the vitality and plasticity of the blood diminished, 
so that a disposition to dissolution exists, it is called febrxs 
nervosa putrida. Is the gastric system at the same time af- 
fected,—febris nervosa gastrica ; and does rheumatic or 
catarrhal complication exist, febris nervosa rheumatica et 
catarrhalis (catarrhus malignus). 
Pathogenesis. Proximate cause. The power of the fever 
concentrates in an affection of the brain and nervous sys- 
tem, with more or less sympathy of the vascular system 
and inclination to debility. Therefore the principal, often 
the only signs of its existence, are cerebral and nervous 
symptoms. Hence the varieties of vascular fever, which 
occur in it. Sometimes the vascular system, the pulse, 
and warmth, are not in the least altered. Sometimes in 
an inflammatory disposition there is an inflammatory state, 
with an asthenic disposition, an anasthenic state, which is 
apt to pass into a putrid one, by reason of the great disturb- 
ance in the nervous systems which preside over nutrition 
and reproduction. 
Remote causes. All that has a tendency to lower and impair 
the vital power, and especially the nervouspower, such as : 
deprivation of the necessaries of life, starvation, scarcity, 
corrupt food, deficient vitality of the air (animalized air), 
crowding many men into small rooms, uncleanliness, de- 
bilitating epidemic constitution, great loss of blood or other 
umors ; thus excessive venesections can change every 
ever into a nervous one. Or exhaustion, consumption of 
16 Vltal) especially nervous power. Overaction, imrnod- 
era e exertion, corporeal or mental, excesses in venery, 
excessive heat, loaded beds, confined sick rooms, over-irri- 
ation from ardent medicaments, or omission of a neces- 
sary abstraction of blood, previous disease, the fever itself; 
every acute fever can in this manner, by the exhaustion of 94 
NERVOUS FEVER. 
power connected with it, pass into a nervous fever. Or 
finally, the influence of potences directly depressing the 
vital or nervous power : grief, sorrow, contagia of nervous'' 
or putrid character, dampness, cold, atmospherical consti- 
tution, deficient in vital power, the epidemic nervous con- 
stitution, which is observed especially in continued damps, 
(wrest) wind, and low stand of the barometer. 
Therapeutics. The fundamental indication is to restore 
the normal action of the nervous system, and the balance 
between the vascular and nervous systems ; with continued 
attention to the existing weakness. Therefore, when there 
is inflammability, depression of the vascular system by an- 
tiphlogistics, but never so free and large as in pure syno- 
chus, since the inflammation is nervous; in great debility of 
the vital power, and a disposition to putrescency, vigorous 
elevation and invigoration of the vital power ; in predomi- 
nant and threatening spasms, and nervous attacks, the 
soothing antispasmodic method ; especially a careful indi- 
vidualization of both the subject and the epidemic, and re- 
gard to the exciting cause, whether the disease has been 
engendered by an external contagion or internal develop- 
ment. This latter circumstance is momentous in the 
treatment. For, when the fever is due to the contagium 
typhosum, i. e. to an external cause (which can even 
happen in a perfectly healthy and strong person), there ex- 
ists always a state of excitement and inclination to inflam- 
mability ; on the contrary, in internal development, it has 
more the character of weakness. We must ever bear in 
mind, that in this fever the vital power of nature, and the 
crisis, are less to be depended upon ; that it does not ter- 
minate within a less period than three weeks ; and that the 
assistance of art consists in keeping the patient alive du- 
ring this space of time, dangerous to life, and which com- 
monly lasts to the 18th day. 
The special treatment is very various, according to the 
numerous modifications in which nervous fever manifests 
itself. They are : the simple, mild nervous fever; the 
violent nervous fever (brain fever) ; the inflammatory ner- 
vous fever, and the putrid ; which sometimes succeed each 
other in the same malady, as so many stages, sometimes 
remain in one and the same form from the beginning to 
the end of the disease. 
1. The simple nervous fever of a mild degree, often the 
first stage of the violent. 
Diagnosis. The general symptoms of nervous fever in 
a mild degree, with moderate frequency of the pulse, and NERVOUS FEVER. 
95 
only transitory, or no delirium. Here the main rule is 
more a negative treatment than a positive one, to do rather 
too little than too much. 
The best remedy, and often alone sufficient, is chlorid 
water, acidum muriat. oxygeuatum (vide No. 7), -J- to 1 
ounce daily, rest, horizontal position, uniform temperature, 
sinapisms on the lower extremities. I can assure, that I 
have seen a great many cases of nervous fever perfectly 
cured by this simple treatment. Is this not sufficient, then 
a weak infusion of valerian (vide No. 8), spiritus Minde- 
reri, liquor anodyn. Hofmanni ; acet. vin. mixed with the 
beverage ; sinapisms, particularly lukewarm baths, to invite 
perspiration. The cutaneous crisis is the most important. 
But we must never neglect to pay attention to the compli- 
cations, and to act accordingly. In gastric accumulations, 
an emetic and laxatives, in a rheumatic admixture, mild, not 
heating diaphoretica, spiritus Mindereri. 
2. Violent nervous fever, typhus. Great affections of 
the head, increasing delirium, or a soporous state, incipient 
convulsive movements of the tendons, are significative of 
this degree of typhus. 
The first question must here be: whether these accidents 
arise from an inflammatory state of the brain, or from a 
nervous irritation of this part. 
The first—inflammatory state—will be recognized by the 
eyes of the patient being reddened and glittering ; the 
whole face more red and bloated, the vessels of the head 
and neck swollen and pulsating, the head hot, the urine red, 
the pulse more frequent and filled ; it may, however, be 
more slow, occasioned by the pressure on the brain. 
Auxiliary signs are: the inflammatory character of the 
epidemy, the youthful and strong constitution of the pa- 
tient, and in dubious cases even by the use of reagencies, 
as some spoonfuls of wine, whereby delirium and pulse 
will increase in an inflammatory, but decrease in a nervous 
state. Even a small testing venesection is permitted, with 
the indispensable condition, that the physician be present, 
and ready to close the vein as soon as the pulse sinks and 
becomes smaller and more rapid. 
Here antiphlogistics are to be resorted to, always bear- 
ing in mind the fundamental character of the fever—which 
is a debility of the nervous system ; therefore local ab- 
stractions of blood (by leeches, on the temples, by the 
ears, or the neck, or cupping the neck) are preferable to a 
general venesection, which is allowed only in youthful ple- 
thoric individuals, and subjects accustomed to venesection, 96 
NERVOUS FEVER. 
the pulse being strong and full, and in the first stage, espe- 
cially in the typhus contagiosus, and must be made with 
precaution, not too great a loss of blood at once, but 
rather to be repeated. Hence no nitre, which would 
weaken too much the whole tone of the system, but sal. 
ammoniacum, tartarus potassae, with small doses of tartar 
emetic ; but especially cold fomentations on the head and 
ice cataplasms,* finally, every two hours cold affusions, 
and injections with three or four ounces of vinegar, and 
daily repeated sinapisms on the calves of the legs. If this 
be not soon followed by an alleviation of the cephalic 
symptoms, then one to two grains of calomel every two or 
three hours. Generally in every phlogistic nervous fever, 
cold lotions of the body cannot be too strongly recom- 
mended. They ought to be repeated several times a day, 
as often as a great dry heat sets in ; but not during perspi- 
ration. Should the pertinent application of these remedies 
fail to produce within a few days an amelioration of the 
cephalic symptoms, though the redness and heat may have 
decreased ; should the pulse become small and soft, then 
the inflammatory irritation has changed into a nervous one 
of the brain, and the principal, indeed only salvative reme- 
dy is opium combined with calomel (every two* hours 
grain of opium with 1 grain of calomel), and a vesicatory 
on the neck. 
Does no inflammability exist, or is it removed and the 
fever continues violent notwithstanding ; or the symptoms 
even increase—there is always debility of the whole ner- 
vous system, yes, of the whole organism, and now the fun- 
damental indication becomes striking : Invigorate, animate 
and soothe the nervous disorder ! Excitantia, analeptica, 
antispasmodica, acida and fixed roborantia are the reme- 
dies. Here the case is the reverse of inflammatory fever. 
All symptoms, most violent deliria, pain, acceleration of 
the pulse, indicate weakness, and excitantia are here of the 
same effects as venesection there. Vinum refrigerate sopit, 
pulsum retardat. As in the former case, a decrease in the 
celerity and vigor of the pulse is a sign of amelioration ; 
here an increase and a rising of the pulse is desirable. 
But we must here discriminate three states, which mod- 
ify the cure : the spasmodic, irritable, eretkic, the paralytic, 
and the putrid. 
The first and most common is the spasmodic, irritable, 
merely nervous state (typhus irritativus, erethicus, versa- 
tills). 
All the symptoms betray spasm and increased irritability nebvous eeVeß. 
97 
and sensibility, photophobia, violent phrenetic deliria, con* 
vulsions, spasms, even tetanus.—The pulse is small but 
somewhat hard. 
Here, caution is to be observed from the commencement, 
not to over-excite a system already suffering under exalted 
irritability, lest by so doing we create an inflammatory 
state. In this respect we must be guided by the pulse and 
the symptoms. We may use nervina, antispasmodica, and 
excitantia both externally and internally, beginning with 
small doses, and gradually increasing them, if the symp* 
toms do not yield. This increase consists in the augmen* 
tation of the doses, in the frequency of repeating them, in 
varying their quality, and in their mode of application. 
The remedies are acida rnineralia and sulphuricum, the 
first to acidulate the beverage, the latter when there is too 
great a disposition to diarrhoea ; Rhenish wine, (better, if 
twenty years old,) should be given from the commence- 
ment until the end of the disease. It alone is often capable 
to cure, administered in small or large doses, according to 
the degree of debility ; strong infusion of valerian with 
angelica, arnica (vide No. 9 and 10) ; olea setheriea (vale- 
riana, cajeputi, cinnarnomi) diluted in liquor anod. Hof'man- 
ni, as debility increases ; also aqua ammonias succinata. 
Should these not suffice, give aromalica balsarnica (balsam. 
Peruvian. Balsam vitae Hofmanni), naphtha, sulphuric, mu- 
riatic, and acetic acids. Finally, in great debility and 
affections of the head, and small, soft, empty pulse, cam- 
phor ; in violent spasms, with a small and somewhat hard 
pulse, musk ; castoreum, and especially opium in violent 
delirium, spasms, pains, vomiting, diarrhoea, very small and 
rapid pulse; opium in large doses, however, it must be 
remembered, operates more as a narcotic, in small doses 
as a stimulant; hence large doses are proper in violent 
nervous attacks, and small doses in great debility. At the 
same lime lotions, aromatic fomentations to the pit of the 
stomach, sinapisms every twenty-four hours, in imminent 
danger to be repeated every twelve hours; strengthening 
injections, particularly the lukewarm (28°) aromatic bath 
often minutes duration repeated daily. Also lightly nour- 
is mg, animating substances, water with eggs and wine, 
hartshorn jefiy with 
wine and broth. 
. <f,n state changes into paralysis, or when paralysis 
i* s trotn the beginning (a state recognisable by insensi- 
•V f’ StpP°r’ sopor, bland delirium, coma, and finally pa- 
talyus of the sphincters), the united and most vigorous 
9 98 
NERVOUS FEVER. 
application of the above named irritative remedies is re- 
quired, to which must be added ammonium, old wine, alco- 
hol, phosphorus, and the application of cold, cold fresh 
air, current of air. Life in these cases is often nothing but 
an artificial state of existence, a true product of art, where 
the spark of life always near extinction is maintained, and 
ever rekindled by the renewal of strong irritants. 
Even in the highest degree of this state, the approach- 
ing weakness of death, when the patient lies debilitated, 
stupid, unconscious* senseless and motionless ; meteoris- 
mus, even involuntary discharge of stool and urine have 
set in, sometimes the following remedies have proved ser- 
viceable : very old Rhenish wine, poured in by spoonfuls, 
four vesicatories simultaneously applied, one on the pit of 
the stomach, the others on the extremities, a vigorous ro- 
borative bath at 28° along with aromatic herbs, mixed with 
wine or brandy ; ice-cold fomentations on the abdomen and 
head, injections of a few ounces of wine, the analeptic 
drops (vid. No. 11), even the application of a cautery to 
the head. 
Lastly, the putrid state, which may likewise grow out of 
the foregoing, or, in very malignant fever, can set in im- 
mediately from the beginning (vide putrid fever). 
Especial consideration is due to 
Typhus abdominalis. 
What is meant by this, is 
1. Typhus gastricus, the combination of a gastric, or, 
what occurs frequently, of a verminous state with nervous 
fever. It has for signs those of the gastric state and of 
the nervous fever united. Commonly the first cause of this 
fever is a gastric putrescency, an accumulation of gastric 
putrid substances in the intestinal canal, from which the 
most malignant putrid fevers may arise. The treatment is 
that which is proper for the cure of nervous and gastric 
fevers combined, the nervines and gastric purgatives, where 
great caution is to be observed, lest great debilitation 
happen. 
2. Typhus enteriticus, is that state, when the glands of 
the intestines, especially those of the ileum, become in- 
flamed, forming small inflamed spots, which pass into pus- 
tules and ulcers, as have been discovered after death. 
They are not genuine inflammations, but exanthematic and 
metastatic depositions of the febrile substance on the in- 
testinal glands, similar to the aphthte, which are formed in PUTRID FEVER. 
99 
the upper part of the intestinal canal under similar circum- 
stances, and the formation of pimples on the skin. The 
signs of this condition are very obscure: diarrhoea with 
dull pain in the lower abdominal region, especially of the 
left side, only complained of when pressed upon, and 
bloatedness of that region. 
The treatment consists (besides the general cure of the 
nervous fever) in the application of leeches to the painful 
spot, cold fomentations on it, and the internal use of chlorid 
water (acidiun muriaticum oxygenatum), with gum arabic; 
when more violent and obstinate, calomel 3 to 4 grains two 
or three times a day. 
In every nervous fever, that becomes protracted and 
commences to be chronic, I know of no remedy which is 
more efficacious for its quick removal than the daily use of 
lukewarm baths. 
The consecutive debility, also, cannot better be removed, 
and the recovery hastened, than by these daily lukewarm 
baths, in which malt has been boiled. 
PUTRID FEVER. 
Typhus Putridus, Febris Putrida. 
Diagnosis. The symptoms of typhus, together with the 
highest degree of vital debility, very rapid, small, easily com- 
pressible pulse, color mordax (a particular heat, which com- 
municates to the hand placed on it a disagreeable feeling of 
pungency and burning, which, instead of abating gradually, 
and, so to say, assimilating, increases more and more the 
longer the hand lies on the patient, and leaves an after- 
feeling—a mixture of the living and dead chemical heat, 
which is not the product of active secretion, but of already 
commencing dissolution),—putrid odor of the perspiration, 
of the breath, and other secretions; the signs of a com- 
mencing organic dissolution (coliiquation). Such are: 
petechise, profuse, oily, clammy sweats, thick, dark urine, 
colliquative diarrhoea, discharge of blood by the nose, urine 
and stool, decubitus, tendency to gangrene ; the blood ab- 
stracted in venesection is dark colored and does not sepa- 
rate mto cruor and serum, but forms a pappy mixture. 
Pathogenesis. It is either a consequence or a transition 
of a preceding ardent fever, most frequently of the nervous 
lever ; it can, however, be developed from every other, 
even from an inflammatory fever, by keeping too warm, by 
uncleanliness, corrupt air, ardent remedies; or it appears 100 
GASTRIC FEVER. 
from the beginning as a putrid fever, engendered by a con- 
tagium putridum, or in men with very corrupt humors, scor- 
butic diathesis, and after the abuse of mercury. 
The essential character is an extreme vital debility, to- 
gether with a disposition to putrid dissolution. 
Therapeutics. The indications call for a lively arousing 
and elevation of the prostrated vital power, by which the 
operation of the dead chemismus in the organism may be 
counteracted, and dissolution checked by chemically anti- 
dotive remedies. This is the particular discrimination 
which is to be observed in the treatment of the putrid from 
the purely nervous fever. The first indication is answered 
by the most efficacious excitantia, especially wine, and all 
remedies recommended in the more violent degrees of ty- 
phus nervosus. The second—by such remedies, as increase 
the cohesion and contraction of the organic fibre and mat- 
ter, and chemically resist the putrescent process. Of hat 
number are principally cinchona (also its surrogate, cortex 
salicis), mineral acids, alum (vid. No. 12), and cold, which 
latter may be used either in the way of cold fomentations 
on the head, pit of the stomach, and cold lotions with vine- 
gar of wine, even rubbing with ice, or in cold beverage, 
but particularly in frequently renewed cold air, since a con- 
tinual renewal of the atmosphere, which surrounds and 
evaporates from the sick, is of the greatest importance. 
Vesicatories are to be avoided, because they have a tend- 
ency to pass into mortification.—In local gangrene fomen- 
tations of cinchona with wine, alum, sal ammoniac, myrrh, 
and in order to absorb the fetid smell, chloride of lime. 
Febris Gastrica, Mesenterica, Intestinalis, Biliosa, Mucosa, 
etci 
GASTRIC FEVER. 
Diagnosis. Foul tongue, with a yellowish or brownish 
coat, aversion to food, nausea, bad taste, either bitter, pu- 
trid, or slimy, a feeling of pressure, or fullness at the pit 
of the stomach, unusual lassitude, headache, dizziness, ra- 
pid pulse, but it is not so hard as to be considered inflam- 
matory, nor so weak and small as to be mistaken for debi- 
lity or a putrid fever. Negatively—the signs of another 
febrile genus are wanting, and a regard to the exciting 
causes that relate to the gastric system and the constitu- 
tion of the patient, are here of great moment. Frequently, 101 
GASTRIC FEVER. 
when the gastric character of the disease is not apparent, 
the effect of reagencies,—such as the fruitless application, 
or the apparent noxious operation of stimulant and deplet- 
ing remedies, must be consulted. 
Duration and course are very indefinitei simple sabur- 
ral fevers often last only a few days ; others, especially 
bilious and mucous fevers, several weeks. The stages no 
less vary: often merely gastric from the beginning to the 
end; sometimes first gastric, then general; either nervous 
or inflammatory ; sometimes also, in the beginning gene- 
ral, then gastric, then again general, and of various febrile 
character.—The same is true of crises. In one gastric 
fever there is only one crisis, gastric evacuations by vomit- 
ing or purging ; in that which is connected with or passing 
into a general fever, general crises by sweat and urine suc- 
ceed and are necessary. Frequently, however, it is imper- 
fect, and there succeed eruptions, aphthae, petechiae, ab- 
scesses, and other metastases, which happen especially, 
when in the beginning the necessary evacuants have been 
neglected, and diaphoretics and stimulants have been ad- 
ministered instead of them, whereby a part of the gastric 
morbid matters pass into the* second ways—the blood. Be- 
sides, it is possible for the gastric fever to pass into a ner- 
vous, a putrid, or a chronic and hectic fever. 
Gastric fever may differ by reason of the different quali- 
ties of the gastric contents; it is therefore divided into 
fehris gastrica saburralis (from indigestibles); biliosa, mu- 
cosa, verminosa ; or by the difference in the general febrile 
character, into fehris gastrica inflammatoria, nervosa, pu- 
trida; or from the organ which it particularly affects into 
febris gastrica pleuritica, hepatica, cephalica, phrenitica. 
. Pathogenesis. The essential of the gastric fevers consists 
m this—that they cannot be cured but by cleansing the 
first ways. Impurities, morbid matters in the intestinal 
canal, which cannot be conquered by the ordinary digestive 
power, and their immediate effects on the intestinal canal, 
and sympathetically on the whole vascular and nervous 
system, are consequently to be considered the proximate 
cause of this fever (vid. gastrosis). 
These impurities may originate in a double way, either 
externally or internally. Externally by taking aliments, 
which surpass the powers of digestion by their quantity or 
by their quality, and therefore remain undigested masses 
(crudities) ; internally from secretions of the stomach and 
* Primcß via, the whole digestive tube ; vice secunda, chyliferous 
and sanguineous canals. 102 
GASTRIC FEVER. 
intestinal canal, or of their annexes—as that from the liver, 
either increased in quantity or variously corrupted in qua- 
lity ; hence the formation of bilious and mucous accumula- 
tions to an incredible extent. Although in the latter case, 
the liver and its morbid irritation and secretion are to be 
considered the source of the impurities, and these not as 
the primary cause but as the material product of it; they 
are to be regarded in the treatment of the case as the prox- 
imate cause of the disease, for no cure is possible with- 
out removing them. 
The disposition to this fever may be partly individual, 
partly general. Individual—weakness of the stomach and 
the digestive organs, irritability of the liver; men, who al- 
most continually labor under phlegmasia of the primae vise, 
and from slight causes under bilious accumulations. Se- 
dentary life, debauchery, indigestible aliments. General 
—continued moist and changeable atmosphere (thence 
especially accumulation of phlegm), continual heat (by 
which bilious accumulation is brought on), habitual use of 
indigestible aliments, melancholy. 
Occasional causes must be mentioned; overloading of 
the stomach, anger, pain, taking cold, every violent irrita- 
tion in predisposed persons; hence fever of any other kind 
may excite gastric complications. 
In this way gastric fevers become epidemic. These fevers 
are most frequent in the intermediate climates, in those 
regions where cold and heat alternate, and the seasons par- 
taking of this character, end of the summer, autumn, and 
in places where gluttony is indulged in (vide gnstrosis). 
Therapeutics. The cure consists merely in solution and 
discharge of gastric . impurities ; for the very doctrine of 
gastric fevers has originated in the observation of those 
fevers which yield to no other remedies than emetics and 
purgatives. At the same time the character of the fever is 
to be regarded. 
Here three cases may possibly occur: 
1. The patient shows all the symptoms of gastric fever, 
but without accumulation of impurities. Here digestive 
remedies are indicated, as the dissolving neutral and pur- 
gative sabs, in such doses as do not excite purging : Cream 
of tartar, Glauber salts in small doses; in tenacious phlegm, 
sal ammoniacum, sulphate of potash. In very sensitive sub- 
jects, pul vis aerophorus, spiritue Mindereri; should watery 
diarrhma exist, sal ammoniacum. These remedies mildly 
promote secretions and excretions, causing the fever to 
disappear, or produce an accumulation of impurities either 103 
GASTRIC FEVER. 
in the stomach, or In the intestines, whence, either emetics 
or purgatives will discharge them. Sometimes none ot 
these effects take place. rl he gastric symptoms continue, 
hut show no definite accumulation, and the fever increases. 
Here, either a phlogistic state exists, which calls for a 
cautious venesection; or a nervous state with spasmodic 
symptoms in the abdomen and the prsecordia, for which a 
combination of digestive with antispasmodic remedies, as 
valerian, hyoscyamus, castoreum, musk, are serviceable. 
2. The patient exhibits all the symptoms of accumulation 
in the stomach. Here an emetic in divided doses must im- 
mediately be given (vide No. 13). Let half an hour elapse 
after the first effect of the emetic, and then repeat the dose, 
in order that the patient may throw up three times, which 
is indispensable ; after each operation give a cup of cha- 
momile tea. In inflammatory complications, hard full pulse, 
a venesection first, and immediately after the emetic, next 
a purgative. The emetic must always be given in divided 
doses; for we cannot exactly anticipate the degree of irri- 
tability of the stomach, which is sometimes very great, 
and a full dose of the emetic administered at once mmht 
produce hyperemesis, which may prove dangerous. In great 
irritability and spontaneous vomiting, it need only be 
aided, and brought into full operation. Oxymel scilliticum 
and tea of chamomile will suffice. There is only one excep- 
tion, when the emetic has been neglected and the stomach 
has become inactive and inirritahle, and the patient labors 
under watery diarrhoea, every thing tending that way, 
small doses of the emetic would only increase the diar- 
ihcca, without clearing the stomach. In such a case let the 
emetic be administered in a full dose, and not tartar, emet. 
but ipecacuanha; and when the sensibility of the stomach 
and diarrhoea! disposition is too great, let a vesicatory on 
the gastric region and a few drops of laudanum internally 
precede the remedy. 
One of the greatest and most dangerous errors of prac- 
tice is to consider the effect of emetics and purgatives 
alike, and to believe one may be substituted for the other. 
That which nature will evacuate by emetics, cannot be dis- 
charged by purgatives ; nor can the dynamic change, which 
an emetic produces in the nervous and secretory system 
oi the stomach and liver (and which stops in bilious fevers 
the source of all impurities), be effectuated by purgatives. 
a purgative is more tardy, thence much more 
weakening, and favors absorption. Never give an emetic 104 
GASTRIC FEVER. 
while the bowels are constipated ; for it is apt to create 
ileus ; in such cases precede the emetic by an injection, in 
order to free the intestines. 
3. The patient has symptoms of intestinal accumulation, 
pain in the back and loins, rumbling- bloated abdomen, bor- 
borigmi, discharge of fetid winds, and vitiated stools. Here 
purgatives are to be used, also in divided doses, choosing 
for irritable persons tartarized soda, Glauber salts, manna; 
in torpid cases Epsom salts and sulphate of potassa, in still 
more torpid ones the same mixed with folia senate (vide 
No. 14), in much debilitated nervous individuals, rhubarb, 
calomel, oleum Ricini. 
The continuance and repetition of the evacuants is de- 
termined upon only by the signs of impurities, and the in- 
crease or decrease of the fever. If the fever and the gas- 
tric signs decrease, under the use of laxatives, and the 
stools continue vitiated, we must persevere in this course 
until the symptoms disappear and appetite returns, after 
which we give roborants. Do the evacuations become 
watery, and the gastric symptoms continue, digestives are 
again to be resorted to. If new embarrassments appear, 
we have again to give emetics or purgatives. The cure, 
therefore, may last three days or three weeks. 
Nor must we neglect the complications that may belong 
to the fever: in the inflammatory—proper antiphlogistics; 
in the nervous or putrid—stimulants, roborants, antisep- 
tics j in bilious—tartaric acid and tamarinds; in putrid— 
sulphuric and muriatic acid, also mucilaginous beverages; 
in mucose—acrid incidentia, sal ammoniac, squills, senega, 
emetic-tartar. 
If, after the proper evacuations and the removal of the 
gastric symptoms, the fever continues, it is either in con- 
sequence of the gastric acidity having passed into the 
blood, or a persisting febrile complication; this requires 
the general crisis, which is best produced by spiritus Min- 
dereri, antimonials, Sellers water, or by treating the promi- 
nent complicated fever present, which is commonly ner- 
vous; or, if there is great weakness, by roborantia. 
Every gastric fever calls at its close for roborantia; they 
may be required even whilst the gastric signs continue in 
feeble persons, and when the gastric state is protracted, in 
order to guard against impurities, which are often engen- 
dered by debility. 
It is best to prescribe at first dissolving, slightly bitter 
extracts: Extr. taraxaci, marrubii, trifolii fibrini (vide RHEUMATIC, CATARRHAL FEVER. 
105 
No. 15), and then quassia (vide No. 16) according to cir- 
cumstances mixed with rhubarb, which is best borne by the 
weakened intestinal canal. 
RHEUMATIC FEVER, CATARRHAL FEVER. 
Febris Rheumatica, Fehris Catarrkalis. 
Diagnosis. Chills and heats alternate, painful stretching 
in the limbs, frequent desire to urinate, which is accompa- 
nied with pain, urine turbid and deposits a tile-colored se- 
diment, disposition to perspiration, which evacuation gives 
immediate relief, while cold, on the contrary, as constantly 
aggravates. These symptoms are preceded, accompanied, 
or followed by a local affection, wrhich may be either rheu- 
matism or catarrh. 
If rheumatism, there is local pain without swelling most 
commonly in an aponeurosis, osseous membranes, or mus- 
cular structures. It may be fixed or wandering, shifting 
from part to part, even to distant ones, and when from the 
surface to an internal organ, there is danger. 
If catarrh, the local affection, may be, of the nasal mu- 
cous membranes (coryza) : there is frequent sneezing, ac- 
companied with an acrid watery discharge, which is some- 
times mixed with blood at the commencement, and gra- 
dually changes into purulent matter w7hen the local and 
febrile symptoms abate:—or it may be of the trachea 
(tracheal, pectoral catarrh), frequent cough, hoarseness, 
and roughness in the throat, at first expectoration of thin 
acrid matter, becoming at last concocted and purulent, with 
a corresponding diminution of the fever. Not unfre- 
quently both kinds of local affection coexist, or one may 
pass into the other. 
Pathogenesis. The proximate cause is an inflammatory 
irritation, either of a muscular or a membraneous part, or 
of a mucous membrane, due to a disturbance in the func- 
tion of the skin (therefore antagonistic), combined with a 
serous acidity, which has thereby been created, and which 
keeps up the irritation. Every rheumatic or catarrhal af- 
fection is therefore a superficial inflammation, but only of 
the serous vessels; this is evident from the slight redness 
and heat, and the rare transition into suppuration. It can, 
"however, by aggravation or additional causes, easily affect 
the blood-vessels and become true inflammation. 
Remote causes. The disposing are : either individual, 
weakness and morbid irritability of the skin, sweaty skin, 106 
RHEUMATIC, CATARRHAL 
general debility produced by bad habit, too warm rooms, 
too warm clothing, exclusion of free air, a particular muco- 
serous dyscrasiasis of the blood; or general epidemic: 
rheumatic catarrhal disposition in the spring and autumn, 
particular atmospheric constitution, by which eatarrho- 
rheumatic epidemics are formed, endemic and climatic dis- 
position, whole countries (the mountainous), places, even 
single houses, which by their situation and construction 
are exposed to continual draught of air or change of tem- 
perature. 
The occasional causes: Taking cold, quick change from 
warmth to cold, or vice versa, the worst draught of air, 
leaving off an habitual warm piece of dress. 
Therapeutics. The fundamental idea of cure is restora- 
tion of the cutaneous action, paying at the same time re- 
gard to inflammability, which exists locally as well as ge- 
nerally in every acute rheumatism and catarrh. All de- 
pends upon the virulency of the fever ; for every rheumatic 
affection can be changed into a true inflammation merely 
by augmenting the degree of its intensity. Is the fever 
violent, or an indication of plethora, venesection is to be 
resorted to, and nitre with antimonial salts to be adminis- 
tered : a strict antiphlogistic regimen, with a uniform and 
not too hot temperature must be observed. 
Rheumatismus universalis, one of the most painful and 
afflicting maladies, throws the patient into a state similar 
to tetanus, yea can pass into it, always requires general 
venesection, which will often suffice alone to cure. When 
the fever is slight, or abated by the above treatment, dia- 
phoretic, but not stimulant remedies are of use, such as: 
spiritus Mindereri, antimonials, flores sambuci (vide 
No. 17), vesicatories. In still slighter cases camphor with 
nitre (vide No. 18), aconitum (vide No. 19), radix senegse, 
slip, dulcamara, gummi guaiaci, sulphur; a principal re- 
medy are vesicatories; in a nervous constitution with vio- 
lent spasmodic pains, opium. 
Too large or unnecessary abstractions of blood will tend 
to protract rheumatism and make it chronic; nor ought 
blood to be taken from a rheumatically affected part, [n pec- 
toral catarrhs, on the contrary, venesection is indicated 
not only by the general febrile symptoms, but also by 
stitches or pains of the chest, dyspnoe, and dry couwh. 
(signs of a beginning pneumony, bronchitis), also by phthi- 
sical disposition and pulmonary maladies, in which catarrh 
is apt to change into a pneumony, capable of passing into 
phthisis. CONTAGIOUS FEVERS. 
107 
Generally, we must never forget that catarrhal and rheu- 
matic fever may be complicated with every other genus of 
fever, with the gastric and nervous, and then the treatment 
Must be varied to meet that which these states indicate. 
Especial attention is due to the momentous, sometimes 
fatal nervous complications (Hofmann’s febns catarrhahs 
maligna) which call for commensurate treatment. 
Local treatment. The catarrh requires a diminution of 
irritation in the mucous membrane, proportioned to the 
concoction of the expectoration. For that purpose give 
emollient mucilaginous beverages, warm vapors, mellagi- 
nea, linctus, antimonials, sulphur, flor. sambuci, sem. foeni- 
culi, anisi, rad. and succus liquiritise, (vide No. 20 and 21), 
flannel on the chest. 
In local pains of chest without indication of venesec- 
tion, vesicatories on the spot (vide catarrhus, bronchitis, 
pleuritis rheumat.). 
Rheumatism requires a local crisis by sweat, which may 
be brought on by uniform warm covering of flannel, wool, 
or oiled silk. In very violent pains, vesicatories and keep- 
ing up a suppuration near the part; in inflammatory indi- 
cation, redness, heat of the part, leeches or cups; in irri- 
tability and increased sensibility, opiate; ointment and 
plaster (vide No. 22). 
Does the fever cease and rheumatism remain, or catarrh 
exceed the duration of acute disease, then we are to fol- 
low the treatment for chronic rheumatism and catarrh. 
Febres Acuta Contagiosa. 
CONTAGIOUS FEVERS. 
They are distinguished by this, that they are caused by 
contagious matter received from without, that each kind 
has its peculiar symptoms, course and duration thereby de- 
termined, and that the treatment must be modified accord- 
iugly, especially in regard to the danger of communication 
with others. 
Of this class are : the typhus contagiosus, typhus icterodes, 
pestis carbunculus malignus contagiosus, cholera orientalis, 
variola, morbilli, scarlatinamiliaria, and petechia conta- 
giosa, tussis convulsion, hydrophobia. 
Pathogenesis. The proximate cause of all is in the com- 
munication and operation of a foreign matter, which has 
the peculiarity of producing the same disease in every in- 108 
CONTAGIOUS FEVERS; 
dividual, and of engendering its like. It is either the pto* 
duct of a morbid organic body (contagium), or is formed in 
the atmosphere out of an organic matter (miasma, epidemic 
contagious matter). 
This contagious matter has a double effect,—first, repro- 
duction of itself; secondly, irritation and excitement, but 
only where it finds the receptivity requisite for its per-* 
ception. 
The effect of contagious matter has two analogies in na- 
ture, fermentation and procreation. In either case the 
communication of a matter is capable of producing- a trans- 
mutative or assimilative process in other matter, and of 
creating its like (a new living something). Every conta- 
gion is to be regarded as a semen possessing its own vital 
and procreative power, parasitic in the system, capable of 
reproducing its like and the effects dependent on it. Thus 
far every contagious disease is to be regarded as a hete- 
rogeneous pathological vegetation and fructification of two 
classes: one is remarkable for the fixed duration of its pe- 
riods of blossom and fruit, quick and regular in its phases 
like the short-lived or annual plants; it includes the febrile 
and acute contagia, called exanthemata, and the other 
secretive products striking the senses;—the other vege- 
tates and is reproduced perpetually in the system compa- 
rable to perennial plants, and embraces the permanent 
contagia. This view is of practical importance, for it shows 
that we have to treat not the virus communicated, but that 
which has been generated, multiplied, and reproduced in 
the system. 
Hence arise certain peculiarities proper to this class of 
fevers, which are; 1. In all there is excitement (on ac- 
count of the heterogeneous admixed matter), the first and 
fundamental effect. Thence in the first period an inflam- 
matory character. 2. But this inflammation, since it does 
not originate from internal causes, but is excited and urged 
on from without, is not genuine inflammation, therefore it 
is less permanent, less affecting, apt to pass into a con- 
trary character, except where it finds a soil predisposed to 
genuine inflammation. 3. Its effect is always modified by 
the variety of the irritant rhatter itself, and by the variety 
of susceptibility in the recipient body. 
Firstly, the contagion or miasma by its very nature dif- 
fers in quality : the one directly asthenizing and depress- 
ing the vital power, as the contagium putridum, the other 
exciting it. The .second variety, that of the constitution 
of the individual, is the most frequent cause of the various CONTAGIOUS FEVERS. 
109 
reaction ; thus the very same contagious irritants may pro- 
duce multifarious fevers, inflammatory, nervous, putrid, 
gastric. Moreover, the influence of the epidemic constitu- 
tion is here most momentous, since it can impart to all or- 
ganizations a certain tone and disposition to a certain 
morbid character; hence at particular times small pox, 
measles, nervous fevers, etc., have an inflammatory, at 
other times an adynamic, and again a gastric character. 
4. All contagious fevers have a disposition to exanthematic 
phenomena, to metastases, and in general to imperfect 
crises, since the heterogeneousness and poisonlike quality 
of the matter does not admit of a perfect assimilation and 
crisis. 5. In all, the reproduction and multiplication of 
the contagious matter is proportionate to the height of the 
fever as well as to the external circumstances favoring 
or hindering the febrile reaction. 
Thereby arise certain external alterations or stages 
(stadia), which every contagious fever goes through : 1. 
The stage of infection, the period of communication, of 
sowing, without perceptible effect 5 it is of uncertain du- 
ration, varying from 3to 14 days. 2. The stage of irrita- 
tion or fever, the period when the poisonous fferm is en- 
livened and reaction exists. 3. The stage of efflorescence 
and fructification, the period when the pathological vege- 
tation arrives at blossoming and fruit (exanthema). 4. The 
stage of decrease, the period when the contagious plant 
dies and fades away. 
Therapeutics. The fundamental indication in all is to 
ascertain what is, and to treat in a proper manner the febrile 
character, pertinent respect being paid to the contagion 
and its variable character. 
The disease, or the fever, is to be looked upon as the 
endeavor of nature to operate on and to throw out the poi- 
sonous matter, so that in a slight degree of fever nature 
alone performs the whole cure according to certain stadia, 
and within a definite time, and art ought not to interfere. 
In violent and decidedly characterized fevers the treatment 
must be co-ordinate with the variety of febrile character. 
It is, however, always better in the onset to use antiphlo- 
gistics. Every contagious fever must be regarded as a poi- 
soning, and at the same time as a reproductive and multiplica- 
tive process of the poison, and we are to consider, that the 
more violent the fever and the greater the heat, the more 
poison is created in the patient. Hence, it appears evident, 
how great and obnoxious was the error, under which phy- 
sicians of former times labored, in striving to drive out the 
10 TYPHUS CONTAGIOSUS. 
virus by heat and heating diaphoretics, a practice which 
could only increase the quantity of the virus, and thereby 
the force of the disease. Hence also appears the moment- 
ous advantage of modern practice, which has for rule to 
moderate the fever and heat as much as possible, and 
thereby to diminish the regeneration of the virus and aug- 
mentation of the disease. It is, consequently, indispensable 
to keep the patient cool, in an atmosphere not exceeding 
14) degrees of Reaumur, to cool and refresh it in the sum- 
mer season, by placing vessels tilled with cold water in 
and sprinkling the room. Discard feather beds, which 
keep up heat, and retain noxious exhalations, and substi- 
tute a matress and a light covering, and have recourse to 
cold fomentations even in the higher degrees of putrid 
fever. 
In all contagious fever the chief rule is; to purify and 
renew the air, to observe cleanliness and separation of 
the sick. 
Hence results the second rule: to consider the patient 
as surrounded by a poisonous atmosphere, ever exhaling 
from his own body, and which continually reacts on him- 
self, consequently careful attention must be paid to its re- 
moval, and to renew the atmosphere. Of late many 
chemical means have been recommended for destroying 
contagion in the atmosphere. The chief are fumigations 
of chlorine and nitric acid; but their usefulness has not been 
confirmed, and their detriment, particularly to the lungs, 
is certain. 
Renewal of air, then, continues to be the best purifying 
remedy, which is best effected by a draught of air, which, 
however, must run diagonally through the sick room, com- 
ing in at an opening near the floor, and going out at an- 
other near the ceiling, for the corrupt atmosphere forms 
heavier and lighter strata. It is a matter of course that the 
patient must be protected from the immediate impression of 
that draught on his body. 
Several patients should not be permitted to lie together 
in one bed or in one room, or in a crowd of men, since that 
favors the multiplication of the contagion, and all secre- 
tions must be speedily removed. 
TYPHUS CONTAGIOSUS. 
Diagnosis. The symptoms of the nervous or putrid fever 
generated by infection. 
The character is inflammatory in the first stage, and LEVANTINE PLAGUE. 
passes later into the nervous and putrid ; the first character 
may, however, remain. That depends partly on indivi- 
dual disposition, partly on the prevailing epidemic constitu- 
tion. Therefore we meet with inflammatory, putrid, and 
nervous epidemics of typhus and military plague. 
Therapeutics. The treatment is that which is laid down 
for typhus, but with a special regard to the variety of cha- 
racter, and particularly to antiphlogistic treatment in the 
first stage (vide typhus), besides an observance of the ge- 
neral rules for contagious diseases, especially free and al- 
ways renewed air. 
THE LEVANTINE OU BUBON PLAGUE. 
Pestis Bubonica. 
Diagnosis. The appearance of buboes and anthraces, 
i. e. inflamed glandular swellings, which are gangrenous 
from the beginning, and pass rapidly into sphacelus, espe- 
cially below the shoulders and in the inguinal region ; like- 
wise of petechise and ecchymoses in the first days of the 
disease, connected with a very violent fever, great anxiety, 
vomiting and cerebral affections, putrid fetid smell of all 
secretions, the highest degree of prostration and vital de- 
bility. The fever is acutissima, proving fatal often within 
the first twenty-four hours, generally decided by the third 
or fourth day; the mortality enormous, generally three- 
fourths die. 
Origin—the coast of the Levant (thence it is also called 
the Levantine plague), especially Egypt, Smyrna, Constan- 
tinople ; but by infection it can be spread everywhere, 
even in the most northern regions (London, Koenigsberg, 
Moscow). 
The infection takes place only by contact, never by the at- 
mosphere ; therefore by avoiding to touch the sick, or bodies 
which have been touched by him, it can be prevented from 
spreading. On that rests the great benefit of complete ex- 
tinction and removal by mere separation, by means of qua- 
rantine and boundary cordons, a practice observed in all 
civilized countries since the eighteenth century. 
The treatment must conform to the varieties of its cha- 
racter ; it may just as well be antiphlogistic as antiseptic, 
exciting, roborating; even venesection has proved service- 
able in some epidemics and constitutions. The main thing 
is to promote the crisis by a good suppuration of the bu- 112 
YELLOW FEVER. CHOLERA. 
boes. The greatest care is to be directed to free ventila- 
tion. In the highest degrees of the putrid state, rubbing 
with ice has sometimes worked wonders; persons already 
apparently dead have thereby been restored to life. 
THE YELLOW FEVER, OR BLACK VOMIT. 
Typhus Icterodes. 
Diagtiosis. Yellow color of the skin ; vomiting and pur- 
ging of black matters, great anxiety and prostration, vio- 
lent fever. Rapid course, and great fatality, as in the 
plague. It originates in the coastward regions of the 
West Indies and the Southern States of North America, 
but only to the 46th degree of northern latitude. By in- 
fection it can be transplanted into Europe, but will not 
become epidemic above the degree of latitude mentioned. 
Therapeutics. Like the plague it is to be treated accord- 
ing to its different febrile characters. Venesection and 
large doses of calomel have proved the most serviceable. 
THE COLD PLAGUE, 
Cholera Orientalis. 
Diagnosis. Evacuations of thin, gruel-like matter by 
vomiting and purging, great anxiety, bluish tint of the 
skin, hoarse voice, pains in the stomach and abdomen, vi- 
olent cramps in the lower extremities, especially in the 
calves of the legs, marmorlike coldness of the extremities, 
of the body, and even of the tongue, suppression of urine, 
small, intermittent, imperceptible pulse, total want of cu- 
taneous action, asphyxia. 
Course as rapid as in the plague and yellow fever, fre- 
quently fatal within the first twenty-four hours by asphyxia, 
generally within two or three days. Mortality always 
equals one half, even two thirds of the affected. Often, 
when the cholera abates, it passes into a typhus fever, 
which may also terminate fatally. For a long time after, 
there remains a nervous debility, and weakness of the di- 
gestive organs. 
It originates in the litoral regions of the East Indies 
especially of the Ganges, but may spread farther by infec- 
tion and progressive miasmatic generation over the whole 
globe, crossing even the ocean (to America). But in this 
disease, as in the yellow fever and the plague, elevated dry CHOLERA. HYDROPHOBIA. 
113 
regions are less exposed to infection \ and personal mfec- 
tion is far more dependent on circumstances, and occurs 
more rarely than in the plague. 
Therapeutics. The principal remedies are, in all cases 
where the debility of the individual does not forbid, to im- 
mediately administer a venesection and an emetic, the 
latter often removes the whole attack. Sinapisms and warm 
aromatic fomentations on the stomachical regions are use- 
ful. Should it not abate after this, give calomel, injections, 
and order frequent drinking of cold" water ; cold injections, 
cold applications on the abdomen ; and rhubarb to evacuate 
the retained bile, in the higher degrees, even cold allu- 
sions. The typhus which follows, must be adequately 
treated, particular attention being paid to the sanguineous 
congestion to the head, which often requires abstractions of 
blood. 
HYDROPHOBIA. 
Rabies. 
Diagnosis. Impossibility of swallowing water or fluids 
in general, extreme aversion, even so as to excite convul- 
sions, against touching, yea, looking at fluid or even bright 
objects (e.g. looking-glasses) ,* and yet the individual is 
able to swallow solid things freely, and without pain. 
Such are the diagnostic symptoms of rabies canina, either 
in the onset or associated with it subsequently, a period of 
anxiety, lassitude, various nervous affections, watchfulness, 
and frightful dreams, especially of dogs, having preceded, 
"With the appearance of hydrophobia the proper rabies sets 
in. It is morbus acutissimus, lasting not longer than three 
or four days, and terminates in death under convulsions 
and apoplexia nervosa. It may exist with or without fever, 
the sensorium commonly remains free, and the patient is 
conscious to the last. There occur, however, often violent 
attacks of rage, compelling the patient to spit out, to bite, 
to imitate the barking of dogs, intermixed with fits of faint- 
ing and convulsions,- great anxiety, and excitement of the 
genital organs (priapismus) particularly appertains to this 
malady. 
Pathogenesis. The essence of the disease is a poisoning of 
the nerves, generated by the infection of the canine virus, 
through wounds or parts covered with tender epidermis as 
lips, eyelids, internal surface of the nose, genitals. 'I he 
infection may be direct (by bite), as well as indirect (by 
10* 114 
HYDROPHOBIA. 
transferring objects). The virus can remain for a long 
time latent on the spot of infection, commonly two to 
three weeks, sometimes months, even years. Then ap- 
pears an itching or smarting, with redness in the place of 
the bite, long since healed and forgotten ; and from this 
the disease breaks out. An occasion for breaking out, or 
awakening and enlivening the dormant germ, is given by 
violent over-heating, passions, ardent spirits. 
The fundamental character of the disease is therefore 
only nervous, not inflammatory. This is proved by all the 
symptoms, the absence of fever, and the manner of death; 
also in dissections we generally find no vestige of an inter- 
nal inflammation, for the reddened spots perchance here 
and there exhibited, may be explained as merely secondary 
effects of the violent irritation. 
The hydrophobic virus seems capable of being generated 
not only by a system laboring under it, but also by a very 
violent rabid affection of mind; at least there are in- 
stances recorded, that bites of extremely exasperated crea- 
tures have produced rabies. 
Therapeutics. The only sure cure is prophylactic ; the 
cure of the developed malady is rarely possible. 
For that purpose, the diagnosis of the infection is requi- 
site, but this is not always easy, since the dog often es- 
capes or is killed before we can ascertain the existence of 
the disease in him. In dubious cases, however, it is 
always better to use the preservatives, since the danger to 
which one is exposed, is so horrible, that a mere possibility 
of doing good is sufficient reason for their employment. 
The principal indication in the preservative cure is to 
destroy the poison in the place of application, since expe- 
rience teaches, that it can there remain locally fixed for a 
long time. 
The second indication is to destroy and neutralize the 
poison already received in the organism, for which pur- 
pose mercury is the principal remedy. 
The third indication, to remove the receptivity of the 
nervous system against the poison ; for which, according 
to all experience, belladonna is most efficacious. 
We must therefore hasten to act as follows: First, scari- 
fication, cupping, and cauterizing the wound by gunpow- 
der, which is preferable to hot iron, for the flame penetrates 
into the fissures and cavities of the bite, carbonizing them. 
In this way, the poison, as well as the organ which received 
it, is destroyed. Next, dress the wound with an ointment 
containing red precipitate and canlharides, and keep it in CARBUNCLE. 
115 
free suppuration for six weeks ; even at the expiration of 
this time the sore is not to be closed, for we learn that the 
disease has broken out, after such a sore has long been cica- 
trized ; change the wound then into a fontanel, which must 
he kept open a year.—When the wound is so situated, as 
m the eyelid, the lips, the face, as not to admit of this treat- 
ment, we must content ourselves with scarifying and wash- 
ing it with salt water and lye. 
With this local, the following general treatment must be 
connected. One drachm of mercurial ointment must be 
rubbed twice every day into the circumference of the 
wound and to a distance around it, and two grains of calo- 
mel, together with one grain of rad. belladonnas, be taken 
morning and evening, until a moderate salivation com- 
mences, which must be kept up for a fortnight. 
The treatment of rabies when broken out. The most 
serviceable has been the following : As soon as the first in- 
dication of the disease appears, we must re-apply the local 
treatment to the original sore as above described, and use 
embrocations of unguent, mercur. on different parts of the 
body, especially on the neck, in order to produce saliva- 
tion as quickly as possible, which alone may create a cura- 
tive crisis. At the same time administer two grains of 
calomel together with one grain of rad. belladonna;, in in- 
creasing doses every three hours. In young, plethoric 
persons, venesection to fainting is good; if it is practicable 
m any way, warm baths. 
CARBUNCLE. 
Carbunculus Contagiosus. 
zagnosis. The carbuncle virus is communicated either 
by being wounded by animals affected with it, or by eating 
of their flesh. In either case a fever ensues, which is 
marked by great prostration, vertigo, anxiety, frequently 
also by vomiting and diarrhoea, followed after a few days 
by the eruption of one or several carbuncles. They appear 
irst as little blisters, which are followed by an eruption of 
several small ones filled with lymph, which assume after 
a e'VR d^S 3 rown’ a black color, and form finally 
an ant rax, larger or smaller, which often penetrates deeply 
irl ? *le substance, sometimes only superficially ; absence 
o animation or pain ; the limb swells and becomes in- 
sensiule, and even perishes. 
riom the commencement, especially after eating much 116 
INTERMITTENT AND CHRONIC FEVERS. 
of the poisonous meat, the fever may pass into a putrid 
one, generating rapidly spreading putrefaction, and ending 
in death before pustules can form. Such a case is accom- 
panied with general colliquation, intense anxiety, abdomi- 
nal pains, bloody diarrhoea, and terminates fatally in twen- 
ty-four or forty-eight hours. More frequently, however, it 
abates on the appearance of a carbuncle, critical perspira- 
tion or diarrhoea, and becomes localized, the danger being 
now confined to the virulency of the local gangrene which 
can prove fatal in its course. In favorable cases a sepa- 
ration succeeds, with expulsion of the carbuncle ; this, 
however, always takes a long time (six or eight weeks), 
and is accompanied with weak and bad suppuration, termi- 
nating in recovery. 
The cause of this malady is infection of the carbuncle 
virus, which takes effect only by contact, external as well 
as internal application, never by the atmosphere. 
The cure consists in the treatment of the fever and the 
local one of the carbuncle. The fever calls for an emetic 
in the onset j and when it is violent, for that which is laid 
down in the cure of putrid fever, especially camphor and 
cinchona, vinegar mixed with the beverage ; also butter- 
milk has proved very salutary. The boil must be surgically 
treated by incisions, and antiseptic cataplasms, to promote 
reaction and suppuration. Experience has, however, 
taught that the continued application of warm emollient 
cataplasms of linseed and the like, perfectly suffice for the 
cure, 
SECOND CLASS. 
INTERMITTENT AND CHRONIC FEVERS. 
FEBKES INTERMITTENTES, LENTAE, CHROKICAE. 
The difference between the class of fevers we have now 
described, and the one we are now entering upon, consists 
in this—in the former, fever essentially constitutes the 
disease ; while in the second class, fever is only a form, 
producible by various causes, indefinite in its duration, 
and variable in its treatment. INTERMITTENT FEVERS. 
117 
INTERMITTENT FEVERS, FEVER AND AGUE. 
Febres Inter mitt entls. 
Diagnosis. A chill, followed by heat, terminating m 
sweat, with a urinary deposite of red sediment, constitutes 
a paroxysm. It returns at definite, sometimes at indefi- 
nite periods, leaving an interval entirely free from fever, 
with good pulse and health. The state of fever is termed 
paroxysmus, and its absence, apyrexia. Every paroxysm is 
an acute fever on a small scale, a series of which consti- 
tutes the malady. Generally the paroxysms return at reg- 
ular and certain periods of time, once in twenty-four hours 
(quotidance), or every forty-eight hours (tertiance), or every 
seventy-two hours (quartance) ; even greater intervals have 
been observed, as of seven days (octance) ; or two par- 
oxysms take place within each period of time (febris du- 
plicata, quotidian., tertian., quartan, duplex). They are 
recognizable by the paroxysms which are alternately simi- 
lar to each other in regard to time, violence, and duration. 
Commonly the febrile symptoms are clearly exhibited 
(febris intermittens manifesto) ; but sometimes they are 
wanting, being replaced by periodical morbid symptoms, 
as cephalaea, colica, cholera, odontalgia, ophthalmia, and pneu- 
monia ; even any kind of disease may put on this form, 
ceasing in the intervals (febris inter mittens larvat a). They 
are principally recognized by Intentions sediment appear- 
ing in the urine, after the paroxysm. When the attack 
exhibits danger of life, the cases are termed febres intermitt, 
malignce s. perniciosce s. lethales, such as apoplectics, sopo- 
ross, convulsivce, suffocatorice. 
They may be either simple (simplices), or, like any other 
fever, complicated with a variety of febrile character ; in- 
flammatory, gastric, rheumatic, nervous. They can also be 
combined with acute fever (hemitritczus). 
The duration is indefinite. Sometimes they terminate 
with the third or fourth paroxysm, sometimes they last for 
weeks, months, years, especially the quartans. 
Intermittent fever in itself is perilless, but it may become 
dangerous, either by accidental symptoms or by long dura- 
tion, which may bring on a particular- cachexia, obstruc- 
tion, and physcony of the abdominal viscera, dropsy, and 
nervous diseases ; it may also be very wholesome, and cure 
obstinate maladies. 
Pathogenesis. Intermittent fever presents a particular mix- 118 
INTERMITTENT FEVERS. 
ture of acute and chronic disease. Every paroxysm is a 
febris acuta on a small scale, fostered by, and dependent 
on, a nervous state. The essential character is periodicity, 
an appearance and disappearance of symptoms at certain 
periods, not the disease itself; for that can exist without 
periodicity, as we frequently see an intermittent fever pass 
into an acute one, and vice versa. It is this periodicity 
alone which makes the fever an intermittent one. The 
cause of the periodicity resides in the nervous system ; 
therefore an intermittent fever is essentially a nervous dis- 
temper, the proximate cause of which is both the material 
of the fever and that which imparts to it the intermitting 
form, the latter being due to a particular state of the ner- 
vous system. Hence the causes of intermittent fever may 
exist even in its absence. Hence for a series of years in- 
termittents may frequently occur, and for another series 
happen rarely. Hence, also, mere mental affections can 
excite and also cure them ; and hence the febrifuge pow- 
ers of all nervine medicines. 
The remote causes are all those which can impart to the 
nervous system a periodic disposition ; such are: the en- 
demic constitution, created by marshy regions and stagnant 
%vaters j the epidemic constitution, the effect of actual epi- 
demics, frequently subsisting for years, due to atmospheric 
relations ; farinaceous or fish diet for habitual food. 
Exciting causes are the same, which generally produce 
fever, assuming under this disposition the character of an 
intermittent. The most frequent are ; indigestion, taking 
cold, infarcts and obstructions of the abdominal viscera, also 
lurking morbid matters, as gout, syphilis, even a mere local 
irritation, as a carious tooth. But when the fever continues 
for some time, causes are created by itself, which influence 
its duration. Here habitus is to be mentioned. 
Therapeutics. Two principles must be borne in mind in 
the cure of intermittent fever. 
The first: that a too rapid suppression of it may be per- 
nicious, since something critical must be attributed to 
every intermittent fever, and it is often a very salutary en- 
deavor of Nature, and which a cure would suppress. 
The second : that, as every intermittent fever weakens, 
and can produce bad consequences, an unnecessary con- 
tinuance of it is just as much to be avoided. It is fre- 
quently a difficult task to unite both considerations ; there- 
fore I submit the following rules. 
The first indication, is to remove the remote cause, and 
to treat the fever like a remittent. In this way we can INTERMITTENT FEVERS. 
119 
accomplish a cure, especially in the onset of vernal cases, 
and in those wherein a febrile pulse continues in theapyrex- 
ial stage, and where they are disposed to change into acute 
fever. Therefore, in foul stomachs from overloading or other 
impurities—emetics, purgatives and digestives 5 after ta- 
king cold or a merely epidemical atmospheric influence * 
the treatment for rheumatic fever : sal ammoniac, spiritus 
Mindereri, diaphoretic regimen ; in worms, anthelminthica, 
etc. This treatment will at the same time be the best pre- 
paration for the administration of cinchona and other sup- 
pressing remedies. 
The second indication, is to operate directly on the 
proximate cause,—the nervous anomaly ; it is the methodus 
direcia, specified, antifebrilis. It must take place, when the 
fever still continues after the remote cause has ceased, or 
no remote cause can be discovered. In common fevers, 
and where there is nothing particular to be considered, it 
is always advisable to wrait for five or six paroxysms be- 
fore we suppress it violently ; commencing with such 
remedies as will cure the fever but not stop it too rapidly. 
Of that number are sal. ammoniac (two drachms daily), 
emetics a few hours previous to the paroxysm, flor. cham- 
omillte romana.', herb, trifol. fibrin, millefol. in substance 
or extract. Should the fever not cease by these means, or 
other reasons exist for stopping it quickly, then cinchona 
is the principal remedy, and by which we can immediately 
suppress every fever and have it entirely under our con- 
trol, provided we understand its power and the manner of 
administering it. For this purpose, a knowledge of the 
conditions and rules for its administration is required. 
The conditions are the following : 
1. Ihe principal one is that the stomach be clean, and 
the tongue not furred. 
2. That the apyrexia be perfect, i. e. the pulse during it 
entirely normal. 
3. T hat the fever be not complicated, but a pure, simple 
intermittent. 
Cinchona is more sure and safe after an emetic has been 
given. The mode of administration is this; In the inter- 
vals of the paroxysms, one ounce of finely pulverized cor- 
tex chinae regalis is to be taken in doses of half a drachm 
every two hours, or if the interval is short, every' one hour 
(vide No. 23 and 2T). The same effect is obtained by 
quinine, eight to twelve grains to be taken in the apyrexia, 
one grain every two hours (vide No. 25). The last dose 
mast be the strongest, and be given immediately before the 120 
INTERMITTENT FEVERS. 
paroxysm. If quinine creates purging, it will not cure the 
intermittent fever ; this may easily be prevented by adding 
one drop of tinctura opii every three or four hours. When 
it creates costiveness, a few grains of rhubarb may be ad- 
mixed. When it produces pressure on the stomach, nau- 
sea or vomiting, cinnamon or a spoonful of wine must be 
admixed with every dose ; in cramp-like affections, Valeri- 
ana or castoreum. 
This method is generally sufficient; the fever ceases 
after the first or second paroxysm. In two consecutive 
apyrexial stages we give a whole dose ; in the next two 
apyrexias only one half, then one third, finally one fourth, 
and continue thus some eight or fourteen days. The time 
is determined on according to the duration of the fever. 
The longer it lasts, the longer must be its subsequent use; 
as the surest means to prevent a recidive. Simultaneously 
the patient must observe proper diet, avoid ail indigestible, 
farinaceous food, fish, taking cold, and coitus, and ap- 
proaching to waters; also purgatives, which are capable 
of immediately exciting a paroxysm. 
Now, the effect of quinine is double. It can increase the 
fever, give an uneasy feeling in the stomach, and keep the 
pulse irritated during the apyrexia. This proves that Pe- 
ruvian bark has been given too early, and it may tend to 
change the intermittent into an acute fever. When this is 
the effect, it must be discontinued, and an emetic and pur- 
gatives are to be administered ; or if there is a complica- 
tion of deep-seated visceral affections or other complica- 
tions, they must be removed ; after which bark is again 
admissible. Or it does not make the fever worse nor 
remove it. Here nothing but an addition of opium is 
wanted ; one grain added to the last dose previous to the 
paroxysm. In children, or where there is an impossibility 
of taking this medicine, the same effect may be obtained 
by injections of cinchona, and at the same time applying a 
few ounces of the powdered bark steeped in wine to the 
stomachical and abdominal regions ; also according to the 
endermic method. When quinine cannot be obtained, or 
the patient is too poor to pay for it, substitutes may be 
used. The best of them are cortex salicis, hippocastanus, 
rad. caryophyllat. They are administered in the same form 
and dose as cinchona. Besides, nearly all amara, nervinse, 
setherea, aromata (especially pepper) and astringents are 
also febrifuges; even mechanical means, as hoisting up of 
the extremities; and superstitiosa, amulets, the efficacy of 
imagination, of faith, may prove serviceable. INTERMITTENT FEVER. 
121 
It is of the greatest moment in the use of the bark not to 
administer it too early, nor too late, nor for too short a 
time. 
Obstinate Fevers, Quartan Fevers, Rea dives. 
The cure is sometimes very difficult. Either the fever 
does not cease under the use of cinchona, or it disappears 
and returns after a longer or shorter interval. The cause 
of this may be triple. Either the cinchona or another feb- 
rifuge has been given too early, and without previously 
removing the remote cause, which continues to operate 
and to regenerate the fever. In such a case the remote 
cause must be first annihilated, and emetics, resolventia, 
resorted to ; sometimes also deeper seated dyscrasias, as la- 
tent syphilis, etc., are to be combated. Or cinchona has 
been given too late, not in sufficient quantity nor for a suf- 
ficient time. Here a repeated and long continued use is 
necessary. 
But sometimes all this is unavailing, and the fever per- 
sists in returning, which is especially the case with quar- 
tans. Here the principal remedy is belladonna, two or 
four grains a day ; more so especially when there is an 
indication of obstructio viscerum. Calomel, together with 
extract, chelidonii; iron, particularly flores ammoniac, mar- 
tiales. Finally, if all prove inefficacious, phosphorus re- 
mains, a remedy, which I can recommend on my own expe- 
rience (vide No. 26). 
Some advise arsenic in these obstinate cases ; but it is a 
remedy too unsafe, inimical to all living organism, and too 
perilous in its consequences. I have always succeeded 
with the remedies above stated. 
I understand by it a case where intermittent fever is con- 
nected with afebris continua. The original disease or its com- 
mencement is a continua, which associates earlier or later 
with an intermittent. The patient is continually feverish, the 
pulse also remains accelerated; but from time to time, at defi- 
nite or indefinite periods, he is attacked by chills, followed by 
increase of heat, accelerated pulse, and other febrile symp- 
toms. It is a complicated morbid state, which makes the 
malady doubly affective and dangerous. We must hasten to 
remove at least one of the fevers, in order to simplify the 
disease. That which may most easily be removed, is the in- 
termittent. Generally, the character of the fever is nervo- 
gastric. We must, therefore, after having administered erne- 
Hemitritsus. 122 
INTERMITTENT FEVER, 
tics, prescribe cinchona according to the rules before men- 
tioned, in the intervals of paroxysms, notwithstanding that 
the febrile irritation continues; in this way we generally 
are able to remove the admixed fever. 
Febris Intermittent Maligna S. Perniciosa. 
Thus the intermittent is called, when every paroxysm is 
associated with some fatal symptom, as sopor, apoplexia, 
cholera, suffocatio; according to which the fever receives 
different names: jeb. soporosa, apoplectica, cholerica, etc. 
Such a variety of the disease is most dangerous; for the 
patient often dies in the first attack, leaving it, of course, 
doubtful whether it was an intermittent fever or not ; or 
he dies in the second, certainly in the third attack. Here 
all depends on preventing the next paroxysm; and that is 
done by taking in the interval one ounce of pulvis cincho- 
nte regalis, and shortly before the attack a double dose, to- 
gether with one grain of opium. Opium is also the chief 
remedy during the apoplectic fit. One grain must be 
taken every two hours, and in increasing doses, until the 
patient recovers his mental and other powers. When he 
is unable to swallow, an injection of two drachms of lau- 
danum is to be given. We would find ourselves greatly 
mistaken in attempting to cure such an apoplexy by vene- 
section. For it is not genuine apoplexy, but only a spasmodic 
symptom of the paroxysm of an intermittent fever, which 
exists and is cured only in this way. It is only in very ple- 
thoric persons that a moderate venesection may be made in 
the interval, but only as an alleviating, not as a curing rem- 
edy. In the apyrexia which succeeds, the same proceeding 
must be followed as in the first. This suppressive method 
must, on account of the imminent danger to life, be resorted 
to even where gastric impurities and indications for pur- 
gatives are present. The latter must be retrieved after- 
wards, after the fever is suppressed. 
The Consequences of Intermittent Fever 
Are multifarious; almost all kinds of diseases can result 
from it. Sometimes it is changed into an acute ; but more 
frequently it terminates in chronic distempers, cachexia, 
hydrops, icterus, asthma, phthisis, nervous maladies, colics, 
oftenest in obstructions and physconias of the liver, and 
most frequently of the spleen, in those indurations called 
ague-cakes. 
The causes are either a too quick and premature sup- CHRONIC FEVERS. 
123 
pression of the fever, without having previously done away 
with the remote causes, or a too long duration of the fever 
and too late or too weak use of cinchona ; or finally, the 
continuance of a disease which originated the fever, in the 
intermittent or another form. 
The cure must vary accordingly* The acute after-fe- 
vers are treated according to their character and indica- 
tions ; in the chronic after-maladies it is best to use first 
resolventia of the strongest kind, calomel, gummi ammoniac, 
sal ammoniac, chelidonium, belladonna; intermixed be- 
tween them, evacuants.—Regard must be had to the form 
of the disease, e.g. hydrops, for which diuretica are ser- 
viceable ; in physconia viscerum, the eraplastr. de galbano 
worn on the spot. If the patient be feeble, and have taken 
hut little or no cinchona, then the use of bark and mar- 
tial remedies are proper. In physconias of the spleen 
(ague-cakes) the use of cinchona has proved exceedingly 
efficacious. Is there continuance of a previous disease, the 
cure must be adapted to that, e.g. to syphilis larvata, mer- 
cury. If all should fail, the intermittent fever must be 
regenerated—a difficult task—which may be accomplished 
by saline purgatives, sometimes also by belladonna. 
CHRONIC SYMPTOMATIC FEVERS, HECTIC, CONSUMPTIVE FEVERS, 
Febres Chronicce, Lentce. 
Diagnosis. All fevers, which exceed the space of time, 
which an acute fever would take. They can continue for 
months, for years, have the intermittent type so that the 
pulse always appears irritated and frequent, even in the 
morning; and when of long duration, are connected with 
disturbed reproduction (emaciation), finally with dissolu- 
tion of the organic matter, colliquation, by which they ter- 
minate fatally. 
Pathogenesis. They originate either in general debility, by 
which this increased irritability of the vascular system is 
produced, in consequence of violent, ardent corporeal fa- 
tigue, excess in venere et onania, loss of blood, or in a gen- 
eral chronic irritation, caused by heterogeneous matters 
received into the body or engendered in it, e.g. poisons, 
arthritic, psoric, scrofulous matters ; chronic pains, even 
long continued mental excitement, grief; or in a chronic 
local irritation, e.g. chronic inflammation, suppuration, 
disorganization of an organ. 124 
CHRONIC FEVERS. 
Therapeutics. The cure of these fevers consists in taking 
away the causes, the debilitating potencies, dyscrasias, he- 
terogeneous bodies, chronic inflammation or suppuration, 
and in raising the sunken vital power by roborantia, and 
in restoration by nourishing food. 
We distinguish 
Febris lenta nervosa. It is characterized by this, that it 
is not causally connected with any local affection of a vis- 
cus, exhibits a great debility of the nerves and all functions 
dependent on them, a quick, small, but variable pulse, 
variable urine, more chilliness and cold than heat, no or 
only slight sweats, affections of the head, spasmodic com- 
plaints, hypochondriac humor, low spirits, mutability of 
mental disposition, especially a feeling worse, and in- 
crease of fever in the morning, and when jejune ; feeling 
well and the fever diminished after a meal,—the contrary 
of hectic fever. 
It results often as a consequence and continuation of an 
acute, particularly the nervous fever ; after violent and 
continued exertions of the body or mind, and after violent 
excess in coitus or masturbation ; also from continued loss 
of humors and blood, chronic hemorrhages and blennor- 
rhoeas, fluoralbus, gonorrhoea, diarrhoea, epidrosis. 
Therapeutics. The cure requires the removal of the de- 
bilitating causes—the profluvia, nervous irritation, exer- 
tion ; a soothing of the increased nervous irritability, and 
a proper invigoration and a restoration commensurate with 
the degree of irritability. 
Particularly salutary are lukewarm baths, impregnated 
with aromatic herbs and malt, a pure country air, exhilara- 
tion, the use of cinchona in all forms, of iron, especially in 
subtile, easily digestible mineral waters, mixed with milk; 
in great irritability, rad. Colombo, caryophyllat,; easily di- 
gestible animal food, a mild, sweet, but generous wine, as 
Alicant, Malaga, Xeres, Tokay; a milder, warmer climate. 
Febris phthisic a. It differs from the slow nervous fever, 
before mentioned, in this, that there exists more increased 
warmth and disposition to overheating and inflammatory 
affections; that the fever is greater after a meal, and the 
patient gets hot hands, hot and red cheeks; soon also the 
morning sweat supervenes, as in general a greater disposi- 
tion to colliquation exists than in any other lingering kind 
of fever. At the same time there are signs of an internal 
or external suppuration, with which this fever is always 
combined, and in which it originates. 
Febris hectica is similar to the preceding one, except that INFLAMM. AND SANGUIN. CONGESTIONS. 
125 
it has less heat and inflammability, and does not pass so 
quickly into colliquation as the suppurative fever does. It 
originates in indurations or other disorganizations of 
essential viscera (vide f. hectica, atrophia, tabes). 
Febris lenta symptomatica—that chronic fever, which as- 
sociates with chronic dyscrasias, arthritis, syphilis, scrqfu- 
losis, etc. The cure consists in the cure of the original 
disease, united with nourishing and roborating remedies, 
especially milk and cinchona. 
THIRD CLASS. 
inflammations, and sanguineous conges- 
tions. 
INFLAMMATIONES TOPICJE, CONGESTIONES SANGUINjE. 
Diagnosis. Redness, swelling, heat and pain of a part.— 
In inflammations of the viscera, of course, many of these 
signs do not exist; often only one of them, pain, besides 
the disturbance in the function of the part affected, together 
with an inflammatory fever. Sometimes, however, the heat 
of the internal part maybe perceived by our feeling, when 
the affected part is near the surface, e.g. the liver ;or 
by the hot condition of its secretion, as of the breath in 
pulmonary inflammation, of the urine in inflammation of 
the bladder. The swelling likewise may be recognized by 
feeling, when the part affected is superficial and not cov- 
ered by bones. Pain also, which is sometimes great, as in 
pleuritis, gastritis. But this sign is fallacious, for sometimes 
there are violent inflammations unaccompanied by pain, 
and which terminate in death (infiammationes occulta) 
This discrepancy depends on the seat of the inflammation : 
When it is located in membranes, or the membranous sur- 
faces, there is much pain ; less when in the parenchyma of 
an organ (pleuritis, peripneumonia, encephalitis dolorijica 
and stupida) ; also less when situated in the gangliary 
system, the innervation of which is normally insensitive. 
By an inflammatory action the natural condition may be 
altered, and the part become affected, sensitively or not. 
Therefore the physician must not omit to feel and press 
Generalities. 126 
INFLAMM. AND SANGUIN. CONGESTIONS. 
the body of the patient in cases of abdominal inflammation j 
doing which will enliven the patient’s feeling, and cause 
him to complain of pain, of which he was not before aware, 
or which he seemed to feel in another spot than the real 
seat of disease. 
It is often very difficult, and always very important in 
practice, to discriminate internal inflammations from vio- 
lent internal neuralgias or other spasmodic affections. 
Pain and oppression of the chest, or pain in the stomach 
and abdomen can be as violent as in the highest inflamma- 
tion, although it be but spasm and nervosity which cause 
it. This discrimination is of the highest importance, yea, 
often decisive of life ; for in the first case, a venesection is 
the only serviceable means ; in the latter, opium, and this 
might prove fatal in the first. Here, therefore, great pre- 
caution is to be used, and I recommend the following points 
for research : 1. The presence of fever, whether the local 
complaint has set in with chill or heat, thirst, accelerated 
pulse ; if so, we always suppose the existence of inflam- 
mation. 2. Hardness, fulness and strength of the pulse, 
however, may not exist in abdominal inflammations, and 
in the higher degrees of pneumonia. 3. The urine, which 
deserves special attention-, if red, is indicative of fever 
and inflammation j if pale and watery, a principal sign, 
often the only one, to distinguish spasm from inflamma- 
tion. 4. Permanency. Pain always permanent, points 
to inflammation ; if changeable, to spasm. Finally, 5. In 
abdominal inflammation, external pressure. If the patient 
can bear it, even feels the pain diminished by it,his disease 
is not inflammation. But we must remember, that every 
long continued painful affection of a viscus, although in the 
beginning only spasmodic, can at last create inflammation. 
In dubious cases, a cautious test by abstraction of blood, 
best local, near the seat of the pain will set us aright. 
The duration of an acute inflammation is seven to four- 
teen days, rarely longer. It terminates either in perfect 
resolution, which is always accompanied by general and 
local crises of sweat, critical urine, hemorrhages, local secre- 
tions, as expectoration after pulmonary inflammation ;or 
glides into chronic inflammation, or induration, formation 
of tubercles, all kinds of pseudo-organization, hypertrophy, 
or suppuration, or mortification. Frequently it gives rise 
to after-maladies; exsudation of lymphatic and serous hu- 
mors in the neighboring cavities, as hydrops cerebri, h. 
thoracis,—adhesions after cerebral and pulmonary inflam- 
mations. Finally, local weakness, even paralysis of the INFLAMM. AND SANGUIN. CONGESTIONS. 
127 
inflamed part, as imbecility after cerebral inflammation ; 
blennorrhoea pulmonum after pulmonary inflammation ; 
amaurosis after the ophthalmic inflammations ; as well as 
'morbidly increased local irritability. 
Perfect discussion of an internal inflammation is recog- 
nized by cessation of the fever and the accompanying 
crises. Continuation of feverish excitement in the pulse, 
although the local symptoms have abated, always indicates 
that the discussion is imperfect. Transition into suppura- 
tion is recognized by a chill suddenly setting in, abatement 
of pain, but not an entire cessation of the local complaint, 
and continuation of fever ;—into gangrene, by sudden and 
complete cessation of pain and local complaints, immedi- 
ately followed by a sinking, small, intermittent pulse, and 
coldness of the extremities. 
Pathogenesis. The proximate cause is increased vitality 
of the vascular system and of the blood ; an increased 
vital and formative process of one part, exhibited by aug- 
mented irritability and increased action of the vessels, by 
equally increased sensibility of the nerves, and by aug- 
mented plasticity of the blood. 
The immediate consequence is (on account of the in- 
creased action of the arterial, and not equally increased 
action of the less irritable venous vessels), a sanguineous 
overloading of the part, causing extravasation in the cellu- 
lar tissue, exsudation of lymph, even of blood, and hence 
swelling of the part. From the same cause, and from the 
increased vitality, proceed the augmented -warmth, redness, 
and from enhanced sensibility, pain. Therefore, in the 
essence of inflammation a double character appears: phlo- 
gosis (the augmented irritability of the solid parts), and 
plasticity (the augmented vitality of the blood), and on 
thr. are founded the two principal varieties of inflamma- 
tion,'when one of both elements is overpowering. The 
dry (injiam. sicca), where tension, irritability of the fibre 
prevails; the moist {injiam. exsudatoria), where lymphatic 
coagulability and exsudation preponderates. 
A sanguineous congestion exists in every inflammation, 
but not an inflammation in every congestion. It may exist 
and continue without inflammation, but can also create 
inflammation. Congestion becomes inflammation, only 
when it produces in the part a new state of vitality, that 
one alone which constitutes the essence and existence of 
inflammation.—There is likewise irritation in every inflam- 
mation ; but every irritation is not an inflammation. There 
is a purely nervous irritation, of which the vascular system 128 
INFLAMM. AND SANGUIN. CONGESTIONS. 
does not partake at all. There is even vascular irritation, 
which is not inflammation. Therefore, we can call irrita- 
tion inflammation only when there is generated in the 
irritated part a new plastic reproductive life in the blood; 
and which is made apparent by the signs before stated. 
This newly created pathological vital process, like a 
local fever, goes through its stages of increase, acme, and 
decline, within certain periods of seven, fourteen, or twenty- 
one days, and may undergo the following internal changes: 
a. Perfect crisis (complete resolution), where the phlo- 
gosis and extravasation is simultaneously removed, but 
b. The plasticity and stagnation (stasis injiammatoria) re- 
mains, by which are subsequently formed indurations (most 
frequently due to weakness or abstraction of blood carried 
too far, or warmth, or local application of cooling remedies 
which suppress the inflammatory process). 
c. Exalted irritability is removed, but augmented sensi- 
bility of the part remains (pain, erethismus nervosus, most 
commonly met with in sensitive persons, or in those in 
whom sanguineous abstraction has been carried too far). 
d. Or the inflammation arrives at its height while the 
vital power continues in force. Here an entirely new and 
particular vital process, possible only after this augmenta- 
tion of vitality, is produced,—suppuration, which generally 
takes place when the debilitating remedies have been neg- 
lected, or the inflammatory irritation has been increased by 
stimulants. 
e. Or the inflammation not only reaches its height, but 
simultaneously consumes the vital power of the part. Here 
succeeds mortification, when the system or the part was 
previously feeble or disposed to putrefaction, or has been 
extravagantly debilitated, or when the necessary debili- 
tating remedies have been neglected ; and when on the con- 
trary additional stimulants have been administered, causing 
excess of irritation. Summits gradus injiammationis est 
initium putredinis. 
f. Or finally, there remain watery effusions or pseudo- 
organic productions and adhesions. 
Of the remote causes the predisposing ones are, augment- 
ed irritability of a part, either innate or acquired ; general 
inflammatory diathesis, youth, high living ; general inflam- 
matory fever, apt to be associated with local inflammation as 
effect, as local concentration of the inflammatory state, san- 
guineous plenitude of a part either natural (as in the lungs) 
or acquired, as by chronic congestion, local weakness. 
The exciting are: all that can produce an adequate irri- INFLAMM. AND SANGUIN. CONGESTIONS. 
129 
tation, either local, such as : mechanical irritation, wounds, 
concussions, poisons, acids, morbid matters (e.g. arthritic, 
syphilitic, acid bile); warmth and cold ; extravagant exer- 
tion (even of thinking) in the brain ; local spasm—summus 
gradus spasmi est initium inflammationis—sanguineous con- 
gestions, organic disorders, e.g. tubercles in the lungs; 
or by sympathy which can transfer an irritation to remote 
parts, especially gastric sympathy, or the generation of 
inflammation by gastric irritants in remote parts, the throat, 
lungs, brain, skin ; in the liver by concussion of the brain ; 
or antagonistic by suppression of organic action, by which 
another can be produced and increased to the degree of 
inflammation, e.g. inflammation of internal parts by taking 
cold ; suppressed cutaneous action, by metastases. 
Variety of inflammation. Inflammation, therefore, differs 
greatly, 
1. As regards its degree ; it may be violent or mild. 
2. As regards its seat, the constitution, and age of the 
person affected. It is more violent in the superior vital 
organs ; more chronic in the inferior mucous membranes, 
lymphatic vessels, bones ; more phlogistic and distinguished 
by increased sensibility in the nerves (inflammatio erethica 
nervosa). 
3. In reference to its origin: either in the inflamed part itself 
(inflam. idiopathica) ; or by a remote cause, engendering it 
sympathetically (inflam. sympxthica which is either consen- 
sualis orantagonistica, e.g. the gastric biliousinflammation). 
4. As to its character. The inflammation is phlogistic 
or phlegmonous, dependent on the blood ; nervous or ere- 
thic, affecting the nerves, and less distinguished by phlo- 
gosis than by augmented sensibility''; rheumatic or serous 
(less phlogistic and less resting in the blood and sanguine- 
ous vessels, but more in the serous) ; erysipelatous (slight, 
more exanthematic, existing only in the epidermis and de- 
pendent on a gastric state) ; putrid (generally secondary, 
sometimes primary, where the inflammation is accompanied 
with weakness and exhaustion of the vitality of the part, 
e.g. the scorbutic, the pestilential, carbunculus malignus, 
angina gangraenosa) ; specific (engendered by a particu- 
lar morbific matter, e.g. the syphilitic, scrofulous, arth- 
ritic, etc.). 
Finally, the difference of inflam, sicca and exsudatoria, 
which is often accompanied from the beginning by lym- 
phatic extravasation, e.g. anginapolyposa, peritonitis, puer- 
perahs, encephalitis exsudatoria. 
Especially important in practice, is the difference be- 130 
INFLAMM. AND SANGUIN. CONGESTIONS. 
tween the proportion of the vital power to the inflamma- 
tion. In this respect it is divided into inflam. activa, where 
the local inflammation is combined with a generally in- 
creased vital energy; and into passiva, where vital energy 
is wanting either in the whole or in the affected part. Of 
this there are different degrees : the nervous, which, so to 
say, keeps the middle between active and passive inflam- 
mation, and where a certain degree of energy in the vascu- 
lar system may exist ; the atonica, caused "by a violent 
stroke, a contusion or commotion, by which the power is 
impaired ; the putrid ox gangrenosa s. maligna, which exhi- 
bits vitality annihilated, a transition into dissolution and 
putrescence, created either by general debility of the sys- 
tem, putrid diathesis, or by the paralyzing power of the 
matter which excites the inflammation, e.g. contagium pu- 
tridum, carbuncle matter, therefore receiving that character 
either immediately from the beginning or in the course of 
the disease ; chronica, where an inflammatory irritation of 
a part continues for months and years, without really in- 
creased energy of its vascular system, even frequently with 
impaired energy of it, rather a congestive state than real 
inflammation, brought on either by former active and not 
fully resolved inflammation as a consequence, or by con- 
tinued local irritation, either mechanical or chemical, or 
metastatic, or organic (tubercles) ; or by local debility of 
the part. 
Periodical inflammation must yet be mentioned ; it is one, 
which returns according to certain times, and entirely fails 
in the intervals. It must by no means be considered a 
real inflammation, but is always the product of the nervous 
system, on which in general depends all morbid periodicity. 
The notion of inflammation, especially of the chronic, as 
well as the application of the antiphlogistic method, espe- 
cially of abstractions of blood, has recently been too much 
extended. Inflammation isthought to exist in every topical 
affection with pain, or with increased irritability ; in every 
disease, where, after death, redness, or extravasation, or 
pseudo-organization is found. But that topical affection 
may depend merely on local erethism, and may be purely 
nervous ; that redness may be merely the consequence of a 
congestion or sugillation arisen after, or with death. The 
exsudation and pseudo-organization may be brought on by 
inactivity and stoppages of reproduction, as well as by in- 
flammation. Even genuine inflammation, as soon as it 
becomes chronic, is founded on weakness of the part, and 
must always be considered with the passive. INFLAMM. AND SANGUIN. CONGESTIONS. 
131 
Therapeutics. The first indication must always be to 
remove as quickly as possible the irritant morbific matter, 
that causes the inflammation, e.g. the splinter, poison, or 
gastric humor. The second : to examine into the charac- 
ter of the inflammation, which may be multifarious, and to 
adapt to it a proper treatment. dhe third : to effectuate a 
perfect resolution of the inflammation, i. e. a perfect local 
crisis, by which, not only the actual inflammatory affec- 
tions, but also its consequences, are annihilated. 
Perfect resolution, therefore, must be the principal idea 
and the chief object in the cure of inflammation. Now, 
this resolution, it is true, is the work of the healing power 
of Nature, a local as well as a general crisis in the fever ; 
but it must be well understood and pertinently supported 
by the physician, and in this regard mistakes frequently are 
committed. Therefore the physician must be careful while 
annihilating the inflammation not to disturb, nor to impede 
the operation of healing nature. 
Not alone diminution of vital action in the inflamed 
part, but also removal and re-absorption of the stasis pro- 
duced by inflammation, stagnation in the venous vessels, 
even extravasation and exsudation of coagulable lymph are 
understood by the word of entire resolution of the inflam- 
mation. This must always be the object of cure. It com- 
prises, therefore, not only debilitation, but also a solvent 
and re-absorbent action, a negative and positive part. 
Hence debilitation (antiphlogosis) is the principal indi- 
cation, but always observe not to carry it too far, so that 
power may remain to effect solution and resorption of the 
effusion, and that a transition into a nervous or a paralytic 
state be prevented, nor stagnations, indurations, exsuda- 
tions in the inflamed part be left behind. 
The principal remedy is abstraction of blood, local and gen- 
eral ; above all, venesection, which, if made in time, in the 
proper quantity, and with quick evacuation, will annihilate 
the very germ of the inflammatory process and effect the 
whole cure ; but, if carried too far, may cause an imperfect 
resolution, a transition into induration, gangrene, or into a 
nervous and putrid febrile state. It is indicated where 
there exists a general inflammatory diathesis (signs o{ febr. 
inflam, universalis), and is to be repeated until these symp- 
toms are removed. The first venesection must be made 
early and boldly, allowing the blood to flow until the hard, 
full pulse becomes softer and smaller, or the suppressed, 
small pulse fuller, and the inflammatory symptoms have 
disappeared or abated. The pulse is the chief sign to 132 
INFLAMM. AND SANGtJIN. CONGESTIONS. 
guide us in this case. Generally it is full and hard, but 
sometimes also small, as in inflammation of the lungs 
(which impede respiration and the circulation through the 
lungs), and inflammation of the abdominal viscera, and 
calls the more urgently for venesection. The main pre- 
caution is to prevent fainting, by which, where there is 
gr.eat coagulability, coagulata and concrements are apt to 
form during the stoppage. Local abstractions of blood are 
advisable only when a full flow of blood and the general 
phlogistic diathesis are already diminished by general 
phlebotomy, since retarded circulation and moderated 
phlogosis tend to sanguineous congestions in the inf.amed 
part; or in such cases, where general phlebotomy is not 
necessary, or is injurious on account of a nervous or de- 
bilitated state. With abstraction of blood must be com- 
bined directly debilitating antiphlogistic remedies, the 
appropriate application of which can save much blood to 
the patient. The principal remedies are nitre, and vege- 
table acids and water, cold, applied locally (vide inflamma- 
tory fever). 
We must next resort to derivation of the irritation by 
contrastiraulants, for which purpose, stirring up the intes- 
tinal action and secretion, and cutaneous irritation (by 
sinapisms, vesicatories), are serviceable ; but only, when 
the violence of the sanguineous phlogosis has been assuaged 
by abstraction of blood, without which every additional ir- 
ritation augments inflammation. These derivatives will 
often remove the remainder of local irritation. In such 
cases the application of dry cups (ventoses) in the neigh- 
borhood of the inflamed part, is also of use. They with- 
draw a part of the blood from the circulation in the inflamed 
part, without causing debility by direct loss. 
While doing all this, we must not lose sight of the ne- 
cessary dissolution of the inflammatory stagnation, and of 
resorption. This end is sometimes obtained by the reme- 
dies mentioned above ; but the symptoms of local stagna- 
tion often remain. For this purpose tartar emet., calomel 
and potasses carb. are of use, and are the principal remedies 
for the perfect solution of the inflammation. They must be 
used in the beginning in exsudatory inflammations, such 
as angina polyposa, peritonitis, puerperalis, hydrocephalus 
acutus. 
Now, the phlogistic state of inflammation may have been 
removed, and in consequence of having carried'debilitation 
too far, its nervous property may continue as augmented 
sensibility, erethismus, spasm in the inflamed part. The INFLAMM. AND SANGUIN. CONGESTIONS. 
133 
local symptoms of irritation do not abate, and there is no 
further indication for phlebotomy, on the contrary, the 
pulse and other symptoms indicate nervosity. In this case 
the phlogistic inflammation has passed into a nervous (ere- 
thic) one, and now antispasmodic and narcotic remedies 
(hyoscyamus, aqua laurocerasi, opium), with derivative con- 
tra-stimulants, as vesicatories, are the best, yea, the only 
means for entirely annihilating the remaining inflammatory 
state. Regarding vesicatories it is well to observe, that if 
they are to be of any service in local inflammations, they 
must be sufficiently large, and remain applied until they 
draw blisters 5 for the local evacuation is also important. 
When the inflammation passes into gangrene, or shows a 
tendency to it from the beginning, as in angina gangrsenosa, 
and carbuncles, roborant, animative, antiseptic, anti-dissol- 
vent remedies are called for: acida mineralia, cinchona, 
serpentaria, arnica, wine, camphor. 
It is of great moment to pay due regard to the different 
causes, species, character, and localities of inflammation. 
As for the first (causes), we must distinguish : 
The purely phlogistic, phlegmonous inflammation. Here 
the treatment just mentioned is to be applied in its full 
extent. 
Nervous (erethic) inflammation requires from the begin- 
ning cautiousness in the abstraction of blood, especially 
general bloodletting. Cupping and leeching are preferable. 
Here derivatives, especially anti-stimulants, mild, not heat- 
ing nervines, as aqua laurocerasi, hyoscyamus, connected, 
with antiphlogistics, are most useful; and in extreme weak- 
ness, valeriana, arnica, and lukewarm baths. 
The putrid gangrenous inflammation totally prohibits ab- 
straction of blood, and requires from the commencement 
the use of strong roboratives and antiseptics. 
Gastric, especially bilious inflammation, requires emetics 
and purgatives, combined with antiphlogistics. Sometimes 
they alone suffice for curing the inflammation, and there is 
no need of phlebotomy. 
Exsudatory inflammation calls for abstractions of blood 
from the onset, and for the use of dissolvent, resorptive 
remedies, calomel, digitalis. 
Rheumatic and catarrhal inflammation, as it is not phleg- 
monous by its nature, does not call for abstractions of 
blood, by which, on the contrary, it would be made chronic 
and its crisis disturbed; but only for antiphlogistic reme- 
dies, diaphoretics, antimonialia, cutaneous irritations, espe- 
cially vesicatories. It is only when the rheumatic catarrhal 134 
INFLAMM. AND SANGUIN. CONGESTIONS. 
inflammation is increased to a phlegmonous one, that phle- 
botomy is required ; generally, however, local abstractions 
of blood are sufficient. 
Erysipelatous inflammation requires, on account of its 
nature, no abstractions of blood, which on the contrary are 
unavailing, or render it chronic, or effect a rapid disap- 
pearance and metastasis; but it calls for purgatives which 
here fully replace abstractions of blood. When erysipela- 
tous inflammation reaches to a phlegmonous one, abstrac- 
tions of blood are necessary. 
Metastatic, specific inflammation (the arthritic, syphilitic, 
scrofulous, psoric), requires, besides the antiphlogosis, par- 
ticular attention and regard to the morbific matter, in order 
to annihilate, derivate or evacuate it; that is, in the arth- 
ritic, vesicatories, sinapisms, antarthritica; in the syphilitic, 
mercury, etc. 
Atonic inflammation after commotions, calls for cold and 
arnica. 
Periodic, intermittent inflammation is cured by cinchona, 
given during the intervals. 
Every acute febrile inflammation requires for its perfect 
cure universal crises by the skin and urine (vide inflamma- 
tory fever). 
Chronic Inflammation. 
Its fundamental character must always he considered as 
weakness, passivity, and therefore the treatment must tend 
to a proper invigoration, modified according to the differ- 
ent degrees of vascular irritation, which may be sometimes 
effected by cooling strengthening remedies (cold and cold 
water are the principal means); sometimes also by the 
strongest and most ardent roborantia, as cinchona, iron. 
At the same time a special regard must be paid to the san- 
guineous congestion already existing or accruing from 
time to time, and which requires in the meanwhile, local 
abstraction of blood ; and also to the morbific matters and 
metastases, all which perpetuate the irritation and organic 
disorders. However, here also let it not be forgotten that 
sanguineous congestions may be caused by local weakness, 
and call for abstraction of blood ; a local one is best, and 
must be done with due respect to the original character of 
the disease, being regarded only as a palliative and symp- 
tomatic not as a radical remedy. INFLAMM. AND SANGUIN. CONGESTIONS. 
135 
Sanguineous Congestion. 
The doctrine of sanguineous congestion is one of the 
most important of the medical art; for sanguineous con- 
gestions are among the most frequent affections, are the 
foundation of innumerous maladies, and as such, also the 
true, the only objects of treatment. 
Diagnosis. We understand by it every abnormal pleni- 
tude of blood in a single organ or system of the body. The 
signs are; More or less disturbed function of the organ, 
increased or diminished irritability and sensibility, varying 
according to the different degrees of congestion ; in mode- 
rate sanguineous plenitude these symptoms are augmented, 
and are diminished in great accumulation, distention, and 
pressure of the vessels, which cause want of action, and 
even paralysis ; especially in cerebral congestions ; in mod- 
erate accumulation there is liveliness of thoughts ; in greater 
there is stupefaction; in still greater, paralysis, apoplexy, 
feeling of fullness ; increased warmth in the organ affected, 
the fits augmented by exercise, ardent beverages and 
meals. 
The next effects are all accidents of disturbed function, 
and thus they can produce all kind of nervous diseases, 
from the most simple spasm to hypochondria and epilepsy; 
likewise all kind of local diseases; in the stomach, spasm 
of this viscus and indigestion; in the intestinal canal, colic, 
diarrhoea ; in the liver, disordered secretion of bile ; in the 
lungs, asthma, cough, phthisis; in the brain, cephalalgia, 
delirium, madness; in the organs of the senses all kind of 
diseases peculiar to them; in the secretory organs, pro- 
fluvia, suppressions, etc. Farther, inflammation of the or- 
gan too rich in blood by too highly increased irritation. In. 
an increased degree paralysis, apoplexia, paralysis dorsa- 
lis s. medullaris. In still a higher degree of distention, 
ampliation, tenderness of the vessels, varicous, aneuris- 
tnatic distention, finally rupture- 
The best instance of all these effects is exhibited in the 
hemorrhoidal disease, which is nothing else than a conges- 
tion of the abdomen, plethora abdominalis (vide hemor- 
rhoids.') 
Pathogenesis. Sanguineous congestion consists in too 
great an accumulation in the vessels of an organ. It differs 
therefore from inflammation in this, that augmented pro- 
ductivity, that new pathological life, which constitutes the 
essence of inflammation, is here wanting; but it is com- 136 
INFLAMM. AND SANGUIN. CONGESTIONS. 
bined with every inflammation, and inflammation may arise 
from every congestion. 
Sanguineous congestion may originate in three different 
ways: 
1. In local weakness of a part (passive congestion)—the 
most frequent cause of congestion, which acts in a double 
manner. In the first place it is a fundamental law, not only 
of the human system but of all nature, that an equal impulse 
given to a fluid, will cause it to accumulate most, where 
it finds the least resistance ; therefore, congestion will take 
place where there is debility, be it vital weakness, atony, 
or relaxation. Thus congestion arises in every part debili- 
tated by violent concussion ; thus it arises in every relaxed 
vessel, e.g. the local hemorrhoidal congestion, when the 
rectum is relaxed by too frequent injections. In the second 
place, by local weakness: the power of the blood-vessels, 
principally of the venous, being diminished in an organ, 
the circulating action is made more difficult and inert, the 
necessary consequence of which must be stagnation and 
accumulation of blood in them. Thus hereditary weakness 
of the lungs engenders continual sanguineous congestion 
in them (dispositio phthisica); the innate weakness of the 
portal system the dispoaicio husmarrhoidalts. Thus the most 
innate or hereditary dispositions may be derived from that 
original cause. 
2. In local irritation of a part (active congestion). Irri- 
tatio attrahit is a fundamental law of organic life. Every 
local irritation of a part, be it mechanical, chemical, or 
organic, produces by the thereby increased action of the 
arterial vessels an increased afflux; and as the action of 
the venous vessels is not equally increased, an accumula- 
tion of blood in the irritated parts follows. Thus irritation 
of the skin generates cutaneous congestion, irritation of 
the eye by a grain of sand, ophthalmic congestion. Thus 
perpetual mental irritation of the brain by meditation, cere- 
bral congestion. In the same way operate pathological 
irritations. Tubercles in the lungs entertain, like hetero- 
geneous bodies, a constant irritation; thereby a continual 
sanguineous congestion in them, which gives rise to 
hsemoptysis and phthisis. Indurations in the uterus sustain 
a constant sanguineous congestion in it, thereby frequent 
hemorrhages. Of particular moment, deserving especial 
attention, are the metastatic irritation, the shifting of a 
morbific matter into an internal organ, by which chronic 
irritation and chronic sanguineous congestion is enter- 
tained. INFLAMM. AND SANGUIN. CONGESTIONS. 
137 
We now come to an important consideration—variety 
of irritation. It may be either local (idiopathic), or re- 
mote (sympathetic), and thus congestion also may be 
created by local or by remote irritation (idiopathic or sym- 
pathetic congestion). The sympathetic, again, may be 
double, either consensual or antagonistic. 
Consensual irritation is that kind which happens accord- 
ing to the law of consensus y is a reciprocal concordance, 
especially of the nerves, a propagation of an irritation from 
one part to another; it is capable of producing a sangui- 
neous congestion, the primary irritation of which lies re- 
mote from the seat of the congestion. The most important 
centre of irritation lies in the nervous system of the abdo- 
men ; whence proceeds the frequent occurrence of consen- 
sual sanguineous congestions to the head and lungs. 
•Antagonistic irritation is that which arises according to 
the law of opposition (antagonismus), which means: the 
suppression of an organic action (also of a pathological 
one) calls forth another, operates as an irritant to excite 
another. It is a rich source of congestions. Thus, sup- 
pressed action of the skin generates violent congestions 
in internal organs ; suppression of the catamenia, of the 
hemorrhoidal flux, congestions to the lungs, stomach, 
brain, etc. 
3. In mechanism. Congestions may arise in obedience 
to purely mechanical laws, and are of frequent occurrence. 
A common case is found in the mechanical stoppage of the 
circulation of the blood in one part, by which there must 
necessarily occur an accumulation of it in some other cor- 
related part. Thus a ligature produces congestion in parts 
situated above it. In the same way operates the pressure 
of tumors, of enlarged viscera, of indurations, as from a 
wen, sanguineous congestions in the head, from enlarged 
indurated liver, sanguineous congestions in the portal sys- 
tem, piles. The same effect is produced by tight dress ; 
thus, tight lacing, and compression of the abdomen by con- 
tinued sitting, produce sanguineous congestions in the 
portal system. Even the law of gravity produces conges- 
tions ; as a low position of the head may bring on cerebral 
congestion, or hanging down of the legs one in the feet. 
Hence result two essential differences in regard to the 
character of congestion : the active and the passive. 
Therapeutics. In the first place we must examine, whe- 
ther general plethora is at the bottom of the congestion. 
This is recognizable by a full incompressible pulse, con- 
nected with heaviness in the limbs, dyspnoe and palpita- 138 
BRAIN-FEVER. 
tion of the heart in all kind of exercise. In this case ge- 
neral and local abstractions of blood, cooling derivative 
remedies ; and for a radical cure of the sanguineous pleni- 
tude, meagre diet, diminution of sleep, drinking of water, 
and consumption of the humors by strong exercise, and a 
cool regimen, are the principal means of cure. We must 
next ascertain, whether it is a local irritation (idiopathic 
or consensual), or a specific humor that gives rise to and 
sustains the congestion. If so, it must be removed, and it 
will often suffice alone to cure the congestion ; and with- 
out the removal of i't all other remedies are of no avail. 
Regarding the first, attention must be paid to local habitual 
irritation, as of the brain from continued study; of the 
lungs from crying and too loud singing, etc. If from the 
consensual irritation excited by gastric sordes, infarcts, or 
worms; these are to be removed. As for the second, we 
must investigate, whether there exist a syphilitic, psoric, 
rheumatic, arthritic cause. But when it is the conse- 
quence of a debilitated or spasmodic state, strengthening, 
antispasmodic remedies are serviceable ; bearing constant 
respect to the excitement of the vascular system, which 
forbids the use of heating remedies. At the same time 
local diminution of the plethora must be resorted to, 
partly by local abstraction of blood or other humors (arti- 
ficial sores, derivatives), partly by a local application of 
repelling and astringent potences, among which cold ranks 
first. 
BRAIN-FEVER, INFLAMMATION OF THE BRAIN. 
Encephalitis, Phrenitis. 
Modern authors make a further distinction into menin- 
gitis (inflammation of the dura mater), and arachnoitis (in- 
flammation of the arachnoidea) ; but these subdivisions are 
only of anatomical, not of practical value, and furnish no 
particular indication. 
Diagnosis. Constant delirium or sopor, or both united 
together, with fever and indications of sanguineous con- 
gestion in the head, redness and fullness of the face and 
eyes, hot forehead, pulsation of the cervical veins, and fre- 
quent attempts to grasp the head. 
But it is well to remark, that every delirium or sopor 
together with fever is not inflammation of the brain ; for 
then every violent inflammatory fever, every nervous fever, 139 
BRAIN-FEVER. 
would also be one; but this is not the case. The essential 
symptoms are: the signs of sanguineous congestion to the 
head, and the permanence of delirium or sopor. Some- 
times also very violent pains in the head are combined 
with it, sometimes not. This seems to depend on the seat 
of the inflammation, for when it seizes on the membranes 
of the brain, there is pain; when it affects the substance 
of the brain, instead of pain there is a pressing, dull sensa- 
tion, (similar to the difference between pleuritis and peri- 
pneumonia'). 
This inflammation terminates either in perfect resolu- 
tion, or it leaves debility and derangement in the cerebral 
action (chronic madness, imbecility, loss of single senses) ; 
or, what is very common, it ends in effusion, dropsy of the 
brain ; or it passes into disorganizations, as induration, 
even suppuration of the brain ; finally, into gangrene ; this 
is however a rare occurrence, for it is generally anticipat- 
ed by death. It proves fatal by paralysis of the brain 
(apoplexia). 
Pathogenesis. The proximate cause of the phenomena is 
irritatio cerebralis injiammatoria. As every other kind of 
violent cerebral irritation can create the same apparent 
phenomena, delirium and sopor, so also the symptoms of 
inflammation of the brain may be present when there is 
none. Hence arose the old dispute whether phrenitis were 
or not of an inflammatory nature, the decision of which is 
to be found in the varieties of encephalitis, which practice 
admits and must admit. Irritation of the brain is either 
of a sanguine character (enceph. injiammatoria), or it is 
merely nervous, without partaking in the vascular system 
(enceph. nervosa), or it is purely consensual, arising from 
the abdomen, especially from prajcordial irritations ('enceph. 
gastrica), which also may have an inflammatory or a nerv- 
ous character. 
The remote causes are : all that has a tendency to violent- 
ly irritate the brain, and bring it into increased and anom- 
alous action : as great heat and cold, mental emotions, too 
great exertion of the intellectual faculties, excess in alco- 
holic spirits, concussions and wounds of the head, re- 
bounding concussion from falls on the back or buttocks, 
great sanguineous congestion, rnetastases, contagia, espe- 
cially those which tend to the brain, typhous and scarla- 
tina; lacteal, bilious and helmenthio irritation, every vio- 
lent febrile irritation, and finally, great debilitation of the 
brain ; and as every debilitation may augment irritation 
and bring on anomalous action, so will excessus in venere BRAIN-FEVER. 
et onania, hysteria, hypochondria, nervous fever by 
weakness. 
The variety of character always depends, partly on the 
quality of the causes, partly on the existing disposition. 
As for the first, it is noticeable that the same cause in pro- 
portion as it operates quickly and concentratedly, or chro- 
nically, may have a quite different effect in regard to cha- 
racter; as when spirituous liquors are taken in large quan- 
tity within a short space of time by persons unaccustomed 
to them will produce inflammatory encephalitis, but when 
long continued, and become habitual, create a nervous, 
atonic encephalitis (delirium tremens, which has been mis- 
taken and considered as a particular disease, but which is 
nothing else than encephalitis nervosa). 
Therapeutics. The fundamental idea of the treatment is 
to remove the irritatio cerebralis. But to do so it is most 
important to discriminate its different causes and character, 
by which this end may be attained in quite different ways. 
We must examine and distinguish carefully the following 
cases: 
1. Encephalitis injlammatoria. The patient is all the 
time in a delirious state, stupid or raging; or lies soporous, 
with reddened eyes, red tumid face, pulsating arteries, dis- 
tended veins of the head and throat, heat of the head and 
forehead, full strong frequent pulse (which, however, may 
sometimes be rather impeded and suppressed), red urine. 
Here copious bleeding, general at first, then local by 
leeches on the neck, temples, or behind the ears, cupping 
on the neck (in case of necessity opening of the temporal 
artery); after proper abstraction of blood vesicatories in 
the neck, cold fomentation on the shaved head, and if these 
do not suffice, cold affusions of the head every two hours, 
sinapisms on the calves of the legs; internally nitre, ex- 
citing the intestinal canal to frequent evacuations by anti- 
phlogistic purgatives, sulphate of magnesia, tartar, emet., 
calomel every two hours in one or two grains doses. Re- 
gard must be had to the causa remota, as to arthritic me- 
tastasis. 
Now, if the inflammatory state has disappeared, which 
will be perceived by the fever, redness of the face and 
eyes, pulsation of tracheal arteries abating, but the deliri- 
um and sopor still continuing, then we have reason to sup- 
pose that the malady has passed into the stadium nervosum 
lymphaticum. When this happens, the cerebral affection 
has ceased to be sanguine, inflammatory, and there only 
remains nervous irritation, dependent on debility, perhaps BRAIN-FEVER. 
141 
already combined with incipient exsudation. Here the 
aaode of cure must immediately be changed, and opium 
together with calomel and vesicatories on the neck must 
be employed ; also musk, camphor, arnica, digitalis; and 
when sopor continues, the head must be shaved and a large 
vesicatory, even cauteries, applied. 
2. Encephalitis nervosa and adynamica ; ought properly to 
bo called phrenitis nervosa, since in this case there is no in- 
flammation present. The patient is furious, often most 
violently so, without the least signs of sanguineous conges- 
tion to the head, has a febrile but small pulse, and most 
frequently trembling and other spasmodic symptoms. Under 
this head falls the delirium febrile potatorum (tremens), ona- 
mticorum, also hystericum, on which the preceding causes 
throw much light. Here nothing more is necessary than, 
to remove the nervous irritation of the brain (cerebral 
spasm), and opium is most useful for this purpose, toge- 
ther with derivatives, contra-stimulants, tepid baths; in 
obstinate cases, musk, camphor, castoreum, liq. c. c suc- 
cin. ; in great debility, cinchona, arnica, wine.- Also 
emetics as strong contra-irritants are often the best seda- 
tives of the brain. Here, however, in plethoric persons, 
by accidental exciting influences, a sanguine, yea inflam- 
matory complication may be admixed, recognisable by the 
signs of congestion. The same must be removed by ab- 
stractions of blood and other antiphlogistics, but then the 
antispasmodic exciting method must be again resorted to. 
3. Encephalitis gastrica, hiliosa, verminosa. The signs 
of a cerebral affection combined with the signs of gastric 
or verminous.accumulation. The cure consists in cleans- 
ing the primse vise by emetics, laxatives, and vermifuges. 
This consensual affection however produces a merely 
nervous as well as a really inflammatory irritation of the 
brain, and in the latter case the venesection, and in gene- 
ral a combination of antiphlogistic with antigastric reme- 
dies are necessary. 
In the treatment of all cerebral inflammations respect 
naust be paid to the exciting cause, e. g- metastasis arthri- 
tica, psorica, suppressed catamenia, and hemorrhoids, 
especially to that caused by commotion or vulneration of 
the brain, in which the necessary surgical assistance must 
not be neglected ; in other cases, however, the entire treat- 
ment for enceph. inflammatoria is to be employed. This 
applies also to the encephalitis of lying-in women. It is to 
be treated in accordance with its character, either anti- 
phlogistically or antispasmodically (especially by camphor, 142 
MYELITIS, SPONDILITIS. 
opium, also by belladonna), but with a perpetual regard to 
lacteal metastasis to the brain and abstraction of milk from 
the breasts. 
When the stadium acutum is over, and mental derange- 
ment or paralysis remains, the treatment for madness or 
paralysis must be resorted to. 
Exsudatory inflammation of the brain, hydrops cerebri 
acutus infantum, hydrencephalus (vide diseases of children). 
INFLAMMATION OF THE SPINAL BIARROW, INFLAMMATION 
OF THE DORSAL VERTEBRAS. 
Myelitis, Spondilitis. 
Diagnosis. Pain in some spot of the spine, either per- 
manent or returning always on the same side; to which 
paralysis of the extremities, commonly of the lower, some- 
times of the upper, associates sooner or later, and gene- 
rally beginning at the peripheral termination of the nerves. 
The pain is sometimes very insignificant, or even entirely 
wanting. Therefore, to discover the disease, we must feel 
and press each single vertebra of the whole spinal column ; 
and if there be an inflamed spot, this pressure will cause 
the patient to feel sensitive there; more so, when the spine 
is touched by a sponge and warm water. 
The inflammation may be acute and febrile ; but more 
frequently it is chronic, and then very difficult to be recog- 
nised. This malady brings on paralysis, which affects not 
only external but also internal parts, e.g. if the disease 
lies at the upper dorsal vertebrae, single cervical and pec- 
toral nerves will be affected, causing dysphagia, dyspnoe, 
palpitation ; if at the lower dorsal vertebra—complaints of 
the stomach and intestinal canal. Thus inflammation of 
the spinal marrow can assume the form of the most dif- 
ferent chronic diseases, and is frequently mistaken for 
such (vide paralysis, tabes dorsalis). 
The issue is, if it is not resolved, exsudation, hydrops 
vertebralis, adhesion, exsiccation, callosity, atrophy of the 
spinal marrow, suppuration, caries. 
The causes are, besides the general, sanguineous con- 
gestion, especially hemorrhoidal; rheumatism, metastasis, 
mechanical lesions. 
The cure is antiphlogistic, especially leeches on the af- 
fected part and mercurial embrocations, calomel, purga- 
tives, long continued vesicatories on the morbid spot; 
treatment of the metastasis. ANGINAE. 
143 
INFLAMMATION OF THE THROAT, QUINSY. 
Angina. 
Diagnosis. Painful, difficult, often impeded swallowing-, 
or altered voice, difficult, sometimes whistling respiration, 
or both together. 
The variety is determined by the different seats of the 
inflammation, when it occupies the pharynx (angina pha- 
ryngea, pharyngitis), the larynx (angina laryngea, laryngitis, 
tracheitis), the tonsils (angina tonsillaris), the uvula (ang. 
uvularis), or the tongue (glossitis). 
The accompanying symptoms are : Afflux of saliva and 
expectoration (on account of the impeded swallowing); 
exsudation of viscous mucus from the inflamed parts of 
the mouth and coating of them thereby ; oppression and 
hinderance of the circulation of the blood partly of the re- 
flux from the head, by the pressure on the tracheal veins, 
partly of the circulation in the lungs by the oppressed 
imperfect respiration, hence in the higher degree of in- 
flammation peripneumonia, sopor, even apoplexy. 
The disease is often one of the slightest and most insig- 
nificant complaints, but is also liable to become dangerous, 
even fatal. This depends partly on the intensity of the 
disease and the swelling of the inflamed parts; partly on 
the seat, and in this respect tracheal inflammation is the 
most perilous. 
It terminates either in perfect resolution or passes into 
induration, or suppuration (especially angina tonsillaris); 
in chronic inflammation of the throat, or in death. This 
follows either by suffocation or by apoplexy. The cause 
of suffocation is frequently only mechanical, as a swelling 
of the internal parts compressing the trachea and vessels 
of the throat, or sometimes merely a spasmodic contrac- 
tion in consequence of inflammatory irritation. 
Pathogenesis. Besides general, local taking cold in the 
throat, from without, or from within, by cold drinking 
whilst heated, or by the influence of cold and northeast 
winds* in the open mouth. Some contagia, e.g. scarla- 
tina and syphilis, specifically affect the throat. 
Therapeutics. The cure of inflammation according to 
its different degrees. In lower degrees, general antiphlo- 
gistics, with local dissolvent remedies are sufficient. Such 
are: gargles (the common elder-tea, with vinegar and 
honey, vide No. 39), linctus No. 40, or borax half a 
* In Europe. 144 
ANGINAE. 
drachm, with two ounces of mulberry syrup (syrup, moro- 
rum) ; still more efficacious is alum, injections of the same, 
vapors. Externally,—the throat is to be thickly wrapped 
in flannel; embrocated with linimentum volatile; sinap- 
isms, general and local abstractions of blood. Local bleed- 
ing by leeches or by cups on the neck, is often more benefi- 
cial than general ; but the latter must precede when there 
is a high degree of inflammatory fever and plethora. In a 
lower degree, leeches alone are sufficient. The higher 
degree, like peripneumonia, sopor, oppression of the chest, 
and small, soft pulse, earnestly call for venesection. If the 
difficulty of swallowing or breathing does not abate, after all 
the antiphlogistics have been employed, continued spasm 
is to be considered as the cause ; in which case, opium 
with calomel, a vesicatory around the neck, and narcotic 
cataplasmata often bring speedy relief; also an emetic may 
here be serviceable ; the difficulty of swallowing is no 
contra indication; the patient throws up easier than he 
swallows. 
The variety of location requires particular auxiliaries. 
In inflammation of the pharynx, linctus and gargarisms ; of 
the larynx, vapors ; of the tonsils, which threaten suffoca- 
tion by the swelling, scarification of it by means of the 
pharyngoton, by tvhich the most imminent danger of life 
may instantaneously be removed; likewise in inflammation 
of the tongue, the swelling of which frequently fills the 
whole cavity of the mouth, scarification of the tongue by 
longitudinal incisions on both sides are necessary. 
Especial attention is due to the variety of character, 
whether it is purely inflammatory, or catarrhal, or gastric, 
or mixed of several. 
Inflammation of the throat .of a gastric character (angina 
gastrica, hiliosa). The signs are those of the inflammation of 
the throat, together with the symptoms of a gastric state, 
coated tongue, etc. Here an emetic is the principal rem- 
edy, which often makes a cure by itself; afterward* a pur- 
gative. In complication with genuine inflammation, ab- 
stractions of blood, and the means necessary on such an 
occurrence. 
Inflammation of the throat of catarrhal character (an- 
gina serosa, catarrhalis, rheumatica). Signs : little pain but 
more swelling, more white, covered with viscous mucus ; 
most frequently seizing the tonsils (ang. tonsillaris) or the 
uvula (ang. uvularis), but sometimes also the glottis, with 
or after a rheumatic affection. The fever is slight or en- 
tirely absent. The disease in itself is free from peril, being ANGINAS. 
145 
only a rheum of the mucous membrane of these parts ; but 
it can even endanger life by the local swelling of the ton- 
sils, or uvula, by a mere mechanical closing up. The cure 
requires: first, regard to gastric complication, which here 
exists very frequently. In this case, an emetic, and then 
purgatives afford the best and quickest relief. When there 
is no gastric complication, cooling diaphoretics, and above 
all sal. ammoniac, are the principal remedies; externally, 
embrocations of linim. volat. on the throat, and wrapping 
it in wadding or leaven, emplastrum sinap. around the 
neck, gargling with stimulant astringent remedies, espe- 
cially rad. pimpinell. (vide 41, 42, 43), alum, sal. ammo- 
niac, friction, also injections of similar fluids are here 
particularly necessary, in order to rinse and evacuate the 
gathering tenacious slime. If this does not succeed, and 
fever and inflammation increase, then leeches, even vene- 
section, and calomel must be applied. Does the swelling 
of the tonsils or uvula increase to such a degree as to 
threaten suffocation, then incisions in the uvula (longitu- 
dinal) are the safest and quickest means for relief and 
saving life. 
Inflammation of the parotid glands (ang. parotidea, paro- 
titis), mumps, exhibits a swelling of the parotid and sub- 
maxillary glands, which sometimes can attain a very high 
degree, and make even the internal parts swell, even unto 
suffocation. It is of a purely catarrhal character, and pre- 
vails commonly epidemically during ocher catarrhal mala- 
dies. Generally it yields to diaphoretic treatment (by 
keeping warm externally, being wrapped in worsted) and 
to antiphlogistic cathartics; when of a higher degree, to 
calomel, leeches, and particularly to emetics. It is notice- 
able that this affection is apt to produce consensual swell- 
ing of the testicles, and in general to make metastases ; 
hence cold lead, camphor, or other repelling remedies 
must not be applied. 
Inflammation of the throat of a putrid character {ang. 
gangrcenosa, putrida). Signs: inflammation, swelling of 
the internal, commonly also of the external parts of the 
throat, exhibiting immediately from the beginning, bluish, 
violet-colored spots and putrid stinking smell ; violent fe- 
ver, delirium, difficult breathing ; black scurfs as early as 
the second or third day, issuing a very acrid, stinking 
ichor, which corrodes all parts, evep the palate and nasal 
membrane ; rattling respiration, increase of sopor and suf- 
focative symptoms. Death ensues frequently on the fourth, 
at latest on the sixth day. 146 
STOMACACE. 
The disease is rare in. our climate, and generally a symp- 
tom of scarlet fever, often of a concealed one. The dire 
requires first emetics, and then the most vigorous applica- 
tion of antiseptic, roborant and stimulant remedies: cin- 
chona, serpentaria, wine, mineral acids, externally injec- 
tions and frictions with the same substances, calx chlo- 
rut., vapors of vinegar mixed with myrrh ; of great efficacy 
is also cold, frequent drinking of ice-water, little bags of 
ice put into the mouth. 
Angina pectoris, vide asthma syncopticum. 
Angina habitualis, angina chronica, is called so, since it 
always returns on the least occasion. It is a very trouble- 
some evil, and likely to follow violent inflammations of the 
throat. It is dependent on continual disposition from re- 
maining local weakness. 
The best cure consists in continued gargling with alum- 
water (two drachms to one pound of water mixed with an 
agreeable syrup) ; daily cold washing of the throat, and a 
neckcloth of flannel or silk, on the bare skin. If this treat- 
ment is unavailing, we must search more deeply for the 
root of the disease—metastasis—specific morbific matters, 
local derangements. 
The chronic angina is sometimes generated also by mere 
weakness, and is removed by the remedies just mentioned. 
But more frequently the cause is a metastasis, of which 
the most frequent are the rheumatic, arthritic, syphilitic, 
scrofulous. Here the only treatment is that of the rheuma- 
tism, of arthritis, or syphilis, or scrofulosis. Intermediately, 
when it becomes more phlogistic, application of leeches. 
Careful attention must be paid to hemorrhoidal congestion 
and other abdominal accumulations, which but too often 
are at the bottom of the malady; in this case, the best 
treatment to remove the angina is, derivation of the piles, a 
well-conducted dissolving and evacuating visceral course. 
Not unfrequently I succeeded to cure it by the use of the 
Carlsbad well, the natural as well as the artificial. Finally, 
we must not neglect to have regard, whether there exist 
organic disorders, indurations, ulcers and the like. 
Angina polyposa, membranacea, laryngitis exsudatoria, 
quincy, croup (vide diseases of children). 
STOMACACE. 
Stomaitis. 
Diagnosis. Inflammatory phenomena in the mouth, ac- 
companied by a putrid smell, tongue and gums much GLOSSITIS. PULMONARY INFLAMMATIONS. 
147 
coated. It occurs most frequently among children, and is 
epidemical. 
The cause is catarrhal or gastric. In grown persons it 
is often a symptom of scorbutis. 
The cure consists principally in the prompt administra- 
tion of an emetic, which alone often removes the whole 
evil; afterwards laxatives, acids. Locally, gargling and 
swabbing with a solution of chloride of lime in water. 
When it is a symptom of scorbutis, it must be treated 
accordingly. 
GLOSSITIS. 
Diagnosis. Inflammation of the tongue exhibits the fol- 
lowing signs : swelling, redness, heat of the tongue, great 
difficulty of swallowing, in a high degree total impossibility, 
danger of suffocation ; it may swell so as to fill the whole 
mouth ; yea, as not to leave room for itself. 
Issue, if not in resolution, it terminates in induration, 
suppuration, or gangrene. 
Causes are, besides the general, local lesions, acrid sub- 
stances, points of decayed teeth, rheumatism, catarrh, me- 
tastasis. 
The treatment is similar to that for inflammation; as 
general and local abstractions of blood ; in great swelling, 
longitudinal incisions into the tongue, which quickly cause 
a subsidence of the swelling and removal of the danger. In 
obstinate cases, mercurial embrocations may be used. 
INFLAMMATION OF THE CHEST AND LUNGS. 
Pneumonitis, Pneumonia. 
It appears under various forms—painful and painless, 
and accordingly receives various names. It is called 
Pleuritis, when it is accompanied with stitches or pain 
in drawing breath, the pleura, the costal muscles, or the 
surface of the lungs being the seat of the inflammation. 
Peripeneumonia (inflammation of the lungs properly so 
called), when it is not accompanied by any pain, b&t with 
oppression, difficulty of respiration and anxiety, the par- 
enchyma of the lungs being the seat of inflammation. 
Pleuro-peripneumonia, when both pain and oppression 
are present, and in this case, superficial and parenchyma- 
tous inflammation are combined. 148 
PULMONARY INFLAMMATION. 
Bronchitis (inflammation of the mucous membrane of 
the bronchia), when marked by a constant and violent irri- 
tation, tickling cough and hoarse voice. It is only a ca- 
tarrhal inflammatory irritation of the mucous membrane 
(vide calarrhus pulmonum inflammatorius). 
The distinction is, however, more anatomical than prac- 
tical ; for the phenomena are rarely thus isolated ; at least 
they do not continue so, and the treatment is the same 
in all cases. However, parenchymatous inflammation of 
the lungs (peripneumony) is particularly noticeable on 
account of the absence of pain, and the small pulse, lest 
these negative symptoms lead us into error. 
Diagnosis. Stitches or pain in one part of the chest, in- 
creased by inspiration, and which frequently prevent full 
breathing, pulse hard and full. 
Or pressure, oppression of the chest, anxiety ; pulse soft, 
small, sometimes unequal and remittent. 
Cough produced by deep inspiration, or in violent inflam- 
mation, even by speaking, or the least exertion of the chest, 
is a principal sign and constant accompaniment of every 
inflammation of the chest. Where there is no cough there 
is no inflammation, even if pain and other signs were pres- 
ent. The cough may be either dry or moist, with expec- 
toration. When dry it indicates either an inflammation of 
the pleura, or in peripneumonia, the highest degree of in- 
flammation. Expectoration is either serous, mucous, or 
bloody ; pure blood may be expectorated in the highest 
degrees of the disease. 
Inflammatory fever with all its signs, heat, thirst, red 
urine, hard pulse, is present. The pulse, however, is liable 
to deviations, which are apt to create illusions, and render 
diagnosis difficult. It may, in spite of the most violent 
inflammation, and on account of it, become small and soft, 
and lead the tyro to consider it the pulse of weakness. 
The cause of this is double : Either the violent felt 
in inspiration (as in pleuritis), prevents the patient from 
distending the thorax, and therefore causes imperfect res- 
piration, which prevents the free circulation of the blood 
through the lungs, and thence only partially into the heart 
and the general circulation ; or the stagnation of the blood 
in the substance of the lungs causes incipient hepatisation 
(as in peripneumony). This also impedes the course of the 
blood through the lungs, into the heart, and in the general 
circulation. Hence the pulse is made small and soft, some- 
times unequal and remittent, in short, very similar to the 
pulse of weakness. But this illusion of the pulse, as well PULMONARY INFLAMMATION. 
149 
as that of the oppression, can be easily discriminated from 
real weakness, by ordering the patient to cough or to 
take a deep inspiration. On doing so the pulse will in- 
stantly become full and hard, and its true inflammatory 
character apparent. 
The signs afforded through hearing by means of the ste- 
thoscope or percussion, have recently been highly recom- 
mended for the diagnosis of pulmonary diseases. But 
these signs are very illusory, nor will the existence of an 
inflammation ever be discovered bjr them alone ; while the 
other signs are sufficient of themselves for the purpose of 
diagnosis. At most, they may serve to detect the locality 
of disease, but this affords no indication, and has no influ- 
ence on the treatment. At best, it will aid to define more 
accurately the limits of the after-maladies, induration or 
suppuration. 
The disease varies in its severity from slight to most 
violent degrees, and in the latter case there is delirium 
(produced by the violence of the fever), and sopor (by the 
impeded return of the blood from the brain, on account of 
its stagnation in the lungs). 
Pulmonary inflammation is either primary, appearing 
simultaneously with the setting-in of the fever, commencing 
commonly with a violent chill; or is secondary, setting in 
only in the course of the fever. 
The course and duration are very regular, occupying 
seven, fourteen, rarely twenty-one days. 
Of crises, the general, is manifested by sweat and urine, 
often also by epistaxis; the local, by pulmonary secretion, 
and expectoration, which are indispensable to perfect 
resolution. The wholesome critical sputa is yellowish 
white, similar to a thick emulsion ; and in the beginning 
may be mixed with dark blood-streaks (the older sanguine- 
ous extravasation now becoming loose), and is thrown up 
easily. 
The issue is either : 
A perfect resolution, recognizable by the general crisis ; 
and the local one of sputa, cessation of the cough and 
fever ; 
Or is a transition into suppuration, either open or incist- 
ed {vomica), marked by abatement of the pain, but contin- 
uance of the feeling of pressure, especially in drawing a 
deep breath or lying on one side ; a not entirely free respi- 
ration, cough when deep inspiration is made, also by speak- 
ing and walking ; feverish pulse, apparent good health, 
returning appetite for three or four weeks: but then a 150 
PULMONARY INFLAMMATION. 
hectic evening fever commences, hot hands, hot, red 
cheeks after a meal, expectoration of matter; or in the 
case of vomica, increase of cough and local complaints, 
phthisis purulenta ; 
Or is a transition into induration, tubercles, characterized 
by the fever abating, but respiration not entirely free ; 
short, dry cough, especially in drawing a deep breath ; 
sometimes fugitive stitches in the chest ; and as for the 
rest, there is an apparent restoration of health ; 
Or is a transition into blennorrhcea of the lu?igs, which is 
distinguished by the fever abating, but copious mucous 
expectoration continuing, emaciation, finally phthisis pitu- 
itosa ; 
Or death from suffocation, complete hepatization of the 
lungs or gangrene, but rarely the two last, since the patient 
is previously choked. 
Not seldom hydrothornx is formed during the disease, 
and becomes a morbus secundarius. 
Pathogenesis. Besides the general causes of inflamma- 
tion, there are particularly the following : 
1. The natural inflammatory disposition of the lungs 
themselves. No part of the body is so liable to inflamma- 
tion as this ; hence pulmonary inflammations are the most 
frequent of all. This is due to the abundance of blood it 
contains, rendering it the most plethoric portion of the 
body, since it must receive the whale mass of blood; 
moreover, the lungs are subject to the immediate influence 
of all nuisances they are exposed to, and finally to their 
own constant creation of warmth, since they are the hearth 
of the vital flame, which is kindled anew by every respi- 
ration. 
2. Fever. Every fever increases the circulation, hence 
congestion in the lungs ; and when violent, is so far an 
inflammatory or morbidly irritated condition, able to bring 
on pulmonary inflammation. 
3. High standing of the barometer and dry cold ; it there- 
fore is more frequent and epidemical in a severe winter, 
and its passing into spring. 
4. Much animal food and ardent beverages. 
Exciting causes are especially taking cold, catarrh, rheu- 
matism, suppressed usual hemorrhages, measles, also vio- 
lent concussions of the body, of the chest as well as of 
other parts, particularly falls and blows on the back. 
Therapeutics. Venesection, tartar emetic, and vesicato- 
ries are the principal remedies. First a venesection on the 
arm of the affected side as soon as possible, and by a large opening, so that the blood may spout arch like, and allow 
it to flow until the hard, full pulse becomes softer and 
smaller; or the small, soft (in oppression of the chest, or 
very violent stitches) becomes fuller and larger, and the 
stitches or oppression abate or entirely cease ;—but with 
constant regard to the pulse, so that the patient approaches 
to syncope, but does not faint quite away, for this is apt to 
create stagnation and coagulation of blood in the lungs, 
heart and great vessels. Accordingly, the patient must lie 
down during the venesection, and as soon as the pulse 
becomes unequal or remittent, the vein must be closed. 
Phlebotomy is to be repeated according to these principles 
should the same indications return. This inflammation 
requires and bears most copious bleeding. The earlier 
venesection is made, and the more copious the first one is, 
the more decisive is its effect for annihilating the whole 
inflammatory process. In this way a repetition of vene- 
section may be made superfluous, and much blood saved to 
the patient. Weak, tuberculous lungs, and phthisical dis- 
position strongly call for abstraction of blood. In such 
cases, even a lower degree of inflammation, requires at 
least a moderate venesection ; and in the violent degrees 
of peripneumonia, the veins in both arms should be opened 
simultaneously. Immediately after venesection, tartar 
emet., which is the principal and really specific remedy in 
this disease, must be given together with nitre (vide No. 
44), and if the local affection do not entirely abate, a large 
vesicatory must be applied on the affected part. These 
remedies will perfectly suffice in most cases. 
But when, after a longer or shorter space of time, 
stitches and oppression return, or, if they had not been 
entirely removed, increase, and the pulse becomes fuller 
and harder; or in oppression smaller, then venesection is 
to be repeated according to the rules mentioned above. 
There are cases, where venesection is salutary and 
necessary, even in'the third or fourth week ; as when the 
pneumonic complaints continue, especially if it has been 
neglected at the commencement, the abstractions have 
not been sufficiently copious, and in tuberculous lungs. 
But, should the pain increase, without fullness and 
hardness of the pulse also increasing, ten or twelve leeches 
ought to be applied on the most suffering or oppressed 
part; after this, should the pneumonic affections persist, 
calomel together with opium (vide No. 45) is to be admin- 
istered. Also senna with sal ammoniac (vide No. 46) will 
prove very wholesome, especially in peripneumonic diffi- 
PULBIONARY INFLAMMATION. 
151 152 
PULMONARY INFLAMMATION. 
culties, and for promoting the local pulmonary crisis (ex- 
pectoration). 
In the stadio erethico of pulmonary as well as in all other 
local inflammations, the following mixture has an excel- 
lent effect: 
Y}c Supertart, potass. 3ij. 
Nitr. pot. si. 
Aquae laurocerasie 3ij. 
Yini. antimonii 3i. 
Aquse fontan. gvij. 
Succi Glycirrh. 3iij. 
Syrupi Alth. g/j. 
M. S. Two table spoonfuls every 2 hours. 
Drinking largely of mucilaginous dissolvent fluids, decoct, 
hordei with honey, or oxymel simplex, weak elder tea, spec, 
pectoral, must accompany all these remedies. In those vio- 
lent pains or great difficulty of breathing, also spasm, which 
sometimes continue notwithstanding the loss ofblood, em- 
brocations of linim. volat. together with opium and warm 
cataplasms of narcotic herbs, are of excellent use. Expec- 
toration must be properly regarded and supported, since it 
is a local crisis, indispensable for perfect resolution. For 
that purpose, lukewarm, dissolvent mucilaginous bever- 
ages, as decoct, of barley, gruel, groats, rad. althaese, hb. 
tussilag. with honey must be taken in considerable quan- 
tity ; also warm vapors of flor. sambuc. are to be inhaled, 
when the expectoration is very viscous and difficult. 
Linctus of syrup, liquirit. together with sulph. antimon. 
aur., oxymel scillit., syrup, senegae, vapors of flor. sambuc. 
steeped with water and vinegar ; when the expectoration is 
watery and acrid, and there is a continual irritating cough, 
mucilaginosa, salep-decoction ; linctus of oleum amygdal. 
one drachm, mucilag. gumm. arab. q. s. ad subact., aq. 
font., syrup, amygd. aa one ounce, extract, hyoscyam. 
four grains ; and a vesicatory on the breast, are proper. 
When the patient expectorates pure blood, caused by 
violent inflammation, a venesection must be resorted to; 
or, if it be black, dissolved and connected with symptoms of 
debility, acid, sulphur, with mucilage. 
In a lower degree of pneumony, the mixture mentioned 
above (vide No. 44), together with tart, emetic, may im- 
mediately be administered. It will often effect the whole 
cure. If it do not suffice, a venesection is to be made. PULMONARY INFLAMMATION. 
153 
But all pneumonias cannot be cured in that manner; 
there are some in which venesection is unavailing-, even 
injurious. Each different character calls for a different 
method of cure, and must be carefully discriminated. The 
following are the varieties, which require difference in the 
treatment: 
1. The gastric, especially bilious inflammation of the 
lungs. 
There are cases, tvhere the pulmonary affection is not 
real inflammation, but only a consensual affection of conges- 
tion, or merely an erysipelatous irritation of the pectoral 
viscera, caused by a gastric accumulation in the stomach, 
or a biliary one in the hepatic system, in which a pure phlo- 
gistic treatment, especially abstraction of blood is of no 
use, but on the contrary most pernicious. They are recog- 
nized by the absence of hardness and fullness of the pulse, 
which is frequent and soft, and at the same time the signs 
of gastric accumulation which bear a clear relation to the 
affection of the chest, notwithstanding the presence of 
violent stitches and oppression in the chest. Here the 
cure must be directed not to the pulmonary and vascular, 
but to the gastric system. 
The case can be double : 
Either all the signs of high gastric turgescence are 
present, such as a thickly pappy-coated tongue, bitter, 
foul taste, nausea, inclination to vomit or actual vomiting, 
headache, often also something yellowish in the face, espe- 
cially about the mouth. Here tart. emet. is to be given, 
so as to cause sufficient vomiting ; the patient will evacu- 
ate a great quantity of bile ; this treatment will frequently 
immediately remove the most violent pleuritic pain and 
other symptoms of inflammation, and cooling laxatives will 
finish the cure. 
Or the signs of gastric impurities are present (vide gas- 
tric fever), but at the same time hard, full pulse, red coun- 
tenance, plethoric constitution. Here a venesection in the 
arm must first be made, and then tart. emet. is to be given, 
so as to make vomit; afterwards cooling laxatives. The 
emetic may be repeated on return of indication. Some- 
times the inflammatory symptoms appear only in the 
course of the disease. In such a case, also, are phlebo- 
tomy and leeches to be used. 
2- The rheumatic pneumony (pleuritis rheumatica). The 
patient, after taking cold or previously existing rheuma- 
tism, is affected by violent stitches, or pain on one spot of 
the chest, which is increased«by pressure. This is the 154 
PULMONARY INFLAMMATION. 
distinctive sign of this species. It may be connected with 
cough (by consensual irritation) and difficult breathing, 
(since pain prevents the patient from distending the tho- 
rax). Here the disease is nothing but rheumatism in the 
pectoral and intercostal muscles, sometimes also of the 
pleura itself. A vesicatory on the painful part, covering 
it with flannel, and the internal use of tart, emetic, half a 
grain every two hours, and a diaphoretic regimen, are the 
principal remedies. In young plethoric persons, leeches 
may be previously applied. This rheumatism, however, 
partly by increase and communication of the irritation, 
partly by the obstructed respiration, may associate with 
a sanguineous congestion and inflammation of the lungs; 
in this case also venesection in the arm is not to be 
omitted. 
3. Putrid inflammation of the lungs (pleuritis putri- 
da, gangrosnosa), exhibits immediately at the onset the 
highest vital debility and disposition to putrid dissolution. 
The signs are those of putrid fever with very low pulse, 
fetid breath, dark-colored, dissolved bloody sputa. The 
malady rarely occurs with us, and only epidemically. The 
cure is the same as that for putrid fever,—mineral acids, 
Peruvian bark, alum, balsamic, antiseptic inhalations of 
warm vinegar and myrrh ; also cold fomentations on the 
chest. Venesection is fatal. 
4. The adynamic inflammation of the lungs (pleur. no- 
tha). It occurs in aged people, and is marked with diffi- 
culty of breathing and weak pulse. It easily passes into 
a complete paralysis of the lungs and catarrhus suffbca- 
tivus. The chief remedies are: arnica, senega, sulphur 
antimon. aur., kermes, liquor c. c. succin., vesicatories, 
sinapisms. Venesection will be but rarely needed, and 
when so, always, however, with precaution. 
Pleuritis Chronica. 
By this name are signified chronic pains in the chest, 
either constant or returning from time to time, generally 
connected with cough and difficulty of respiration. They 
are of various kind and significance, and therefore require 
the most careful examination and discrimination. They 
are commonly due to chronic rheumatisms of the thorax. 
Here a vesicatorium perpetuum on the spot, covering of 
flannel, and anti-rheumatic remedies are of use. 
Or they are caused by hemorrhoidal congestions to the PULMONARY INFLAMMATION. 
155 
chest, Avhich may be recognized by the disposition, or piles 
previously existing. Here leeches on the chest, as well as 
at the anus, cooling laxatives, sulphur, in plethoric persons 
even venesection are requisite. In the female sex, men- 
strual congestion may have the same effect. 
Or the evil originates in the lungs themselves. This is 
an important point for discrimination and diagnosis ; for 
the two first kinds are not dangerous ; but they may ter- 
minate in phthisis. 
This case is double : either there are tubercles in the 
lungs, which inflame from time to time, and then create 
pain, accompanied by stronger or weaker febrile motions, 
dry cough, sometimes bloody expectoration, and a little 
dyspnoe. It lasts for several days, then abates, and after 
a longer or shorter time the pains return in the same spot. 
Such attacks deserve the greatest attention and most 
speedy removal, for every inflammation increases the tu- 
bercles or causes them to pass into suppuration. There- 
fore a small venesection, leeches on the painful part, and 
antiphlogistic remedies, must not be delayed, followed by 
a vesicatory, which must be kept open for sometime (vide 
phthisis tuberculosa). 
Or there are vomicce, or inclosed abscesses, which be- 
come inflamed from time to time, causing pain. Also here 
the antiphlogistic treatment is necessary (vide vomica). 
Belated Assistance, and Perilous State of Life. 
The cases are not rare where the physician is called to 
the patient after the seventh day; or where, in spite of 
medical aid, a state endangering life has been developed 
within this period. Here nothing Jess than a proper and 
vigorous assistance can save the life of the already des- 
paired-of patient; but for this purpose the various cases 
must be carefully discriminated. 
1, The patient lies in the highest degree of oppres- 
sion, with short, panting, rattling, hot breath, orthopnoe, 
frequent, short cough, expectorating nothing but blood; 
dizziness of the head, or delirium, sopor, hot, red face ; 
quick, sometimes full, but most frequently small and weak 
pulse ; red urine. When this is the case, venesection has 
been either entirely omitted, or but imperfectly resorted 
to. This condition is that of the highest degree of inflam- 
mation, over-filling and obstruction of the lungs. Here 
a venesection alone may yet save the patient, and has done 156 
PULMONARY INFLAMMATION. 
so as late as the tenth or twelfth day. But here a case may 
occur, which is one of the most painful and anxious in the 
whole course of practice. It is possible that hepatization 
of the lungs is already formed, and advanced to such a de- 
gree, that but little blood can penetrate through the lungs 
to the heart. Venesection can no further remove the 
inflammation, but takes away only that small quantity of 
blood which is left for circulation, and the patient dies 
durino- or soon after its performance. The physician can- 
not foresee such an emergency with certainty ; however, 
if the inflammation be still removable, salvation is depend- 
ent on venesection. Here all must be left to a most accu- 
rate consideration of all the circumstances, and to the 
conscience of the physician. It is one of those cases, 
•where he has to sacrifice his reputation to his duty and his 
conscience. Afterwards a large vesicatory to the chest, 
calomel with opium, inhalations of flor. sambuci, steeped 
in water and vinegar. 
2. The patient labors under the same difficulties of 
respiration, but all the symptoms exhibit the greatest vital 
debility and a nervous state, as pale urine, cold extrerni- 
ties. The patient has undergone sufficient, perhaps too 
copious bleeding.—Here a quite opposite condition exists, 
a want of action in the lungs, incipient paralysis; now 
nothing short of the most active exciiantia and resolventia 
are capable of saving life ; a large vesicatory on the chest, 
sinapisms on the calves of the legs, continual inhalations 
of the vapors from flor. sambuc. or, arnica, with water and 
vinegar ; internally, musk, together with opium and calo- 
mel, kerrnes mineralis, ammonium in infus. arnicre. In 
case of necessity, also an emetic may be given. 
3. Great difficulty of breathing, the most intense anxiety, 
dizziness of the head, delirium, great prostration, frequently 
to fainting, pulse frequent but not inflammatory, urina 
jumentosa, and sometimes watery diarrhoea; anxiety and 
difficulty of respiration increase and decrease; very un- 
clean tongue, covered with a pappy coat, yellow, brown or 
blackish ; bad taste, nausea, inclination to vomit, eructa- 
tions ; and frequently the skin is yellowish about the 
mouth. This is a purely gastric state, and the whole op- 
pression and anxiety arise from a consensual irritation by 
gastric impurities. The necessary evacuants have either 
been neglected in the beginning, or in the course of the 
disease gastric accumulations have been engendered. In 
short, the only remedy for saving life in this case is an 
emetic, best fifteen grains of ipecacuanha given at once, CARDITIS. 
157 
and then five grains every quarter of an hour, until vomit- 
ing succeeds. 
Subsequent Cure. 
The after-cure of pulmonary inflammation often requires 
great attention, partly to remove the remains of inflamma- 
tory obstructions in the lungs, and thereby to prevent the 
formation of tubercles and consecutive phthisis tuberculosa, 
partly to make good the state of debility generated by the 
inflammation, and to guard against the transition into 
phthisis pituitosa. The case is therefore double : Either 
the patient continues to cough, but the cough is dry, and 
there is but little expectoration. Here the best remedies 
are the use of whey, of Sellers water mixed with milk, 
hyoscyamus, digitalis in small doses, and a vesieatorium 
perpetuum on the upper arm. Or there remains copious 
expectoration of mucus, which in the beginning relieved, 
but now, instead of diminishing, gradually increases and 
weakens the patient. In such cases, the surest and really 
specific remedy is lichen islandicum, given in the form of 
gelatina to the extent of two or three ounces daily ; if it 
irritates too much in the beginning, it may be mixed with 
dulcamara and liquiritia. 
INFLAMMATION OF THE HEART. 
Carditis. 
Great anxiety hut without that cough which is excited by 
inspiration, very violent fever, very quick but soft, small, 
unequal, remittent pulse ; fits of fainting, cool extremities, 
and generally a painful pressure on the left of the sternum, 
in the cardial region. The symptoms resemble very much 
those of a high degree of peripneumony, for in both cases 
they are due to obstruction of the circulation of the blood, 
here in the heart, there in the lungs. However, the ab- 
sence of pulmonary cough, and short respiration ; and the 
presence of oppression, sighing and swooning ; and a hori- 
zontal position, which is insupportable in pulmonary in- 
flammation, are discriminative of the two diseases. But 
high inflammation of the heart is always followed by 
inflammation of the lungs. This discrimination is of no 
importance as regards the treatment; for in carditis the 
same treatment is to be followed and the same principles 158 
observed as in pneumonia. Frequent and copious vene- 
sections are especially advised, and are the more necessary 
the smaller and the more remittent the pulse is. 
GASTRITIS. 
ABDOMINAL INFLAMMATIONS. 
In all inflammations of the abdomen within the perito- 
neum, three things are noticeable : 
1. The pulse is small, suppressed, often thread-like, and 
is then indicative of the highest inflammation. 
2. The sensibility of the inflamed part is very illusory ; 
pain is frequently entirely absent, or is discoverable only 
by hard pressure. 
3. It is on these accounts, that injiammationes acuta are 
so likely to occur in the abdominal region. 
INFLAMMATION OF THE STOMACH. 
Gastritis. 
Diagnosis. A constant violent burning, stitching pain 
in the gastric region, increased by inspiration, by pressure, 
and taking any kind of ingesta, bloatedness, tension, swell- 
ing, heat, and pain of the stomachical region, frequently 
combined with pulsation ; throwing up, all that is swal- 
lowed, even pure, water ; sobbing, great anxiety, small, 
thread-like pulse, cool extremities, violent nervous fits and 
consensual spasms, prostration, fits of fainting; convul- 
sions to tetanusand opisthotonus, sometimes even to hydro- 
phobia. It is a dangerous disease, and very rapid in its 
course. No inflammation affects so much the nervous 
system (on account of the extreme sympathy of the stom- 
ach), and it may prove fatal by this relation alone. Death 
follows, either by gangrene, which is announced by sudden 
cessation of all pains, small, scarcely perceptible, remitting 
pulse, and coldness of the extremities (the pain abating 
and the pulse becoming larger, are here not to be mistaken 
for a sign of amelioration); or by nervous paralysis (apo■ 
plexia nervosa) under spasms or fits of fainting, and symp- 
toms of the utmost debility. But often it passes into 
chronic inflammation, spasm, induration or suppuration of 
the stomach. 
The signs of danger are found in the pulse, which is 
small, becoming smaller and smaller ; and those of im- 
provement by the pulse becoming larger and broader. 159 
ENTERITIS. 
Special causes are, suddenly stopped bilious diarrhoea, 
the use of violent remedies, dysentery, cholera, vomiting 
of blood, acrid poisons, hyperemesis, arthritic metastases 
to the stomach, suppressed menstrua, or hemorrhoids, or 
external lesion. 
Therapeutics. The general cure of inflammation, with 
only two particularities: 1. The smaller the pulse, the 
more urgent and the more copious venesection is required. 
2. The antiphlogistic method is here confined to general 
and local abstraction of blood (especially by cupping) ; 
and external remedies; for all internal ones, particularly 
the saline, are poison, and increase the inflammation by 
directly irritating the inflamed surface ; therefore mucila- 
ginous remedies, oily emulsions (vide No. 47), milk with 
water, especially buttermilk, are best. 
On account of the general nervous affection, which is 
apt to prove fatal, we must immediately after the necessary 
abstractions of blood, apply antispasmodic and narcotic 
remedies ; such as antispasmodic and narcotic embroca- 
tions, cataplasms and fomentations along with opium over 
the stomach, also mercurial ointment with opium, a vesi- 
catory, opiate injections, and most of all, lukewarm baths. 
In cases of poisoning with acrid corrosive substances 
(arsenic, sublimate, and other metallic salts), milk drank in 
abundance, oil, and the salt-dissolving alkalis, kali, and 
soap are to be used. In gastric inflammation owing to 
arthritic or podagral metastasis, a large vesicatory on the 
stomachical region is of more use than all other remedies. 
A chronic inflammatory state of the stomach is met 
with more frequently than acute gastritis. Recent writers 
erroneously call it gastritis chronica, for it is only a con- 
gestive state of the stomach. It is manifested by chronic 
pains and spasms of the stomach, and is treated on as car- 
dialgia sanguinea. 
INTESTINAL INFLAMMATION. 
Enteritis. 
Ileus Injiammatorius, Colica Injlammatoria. 
Diagnosis. Violent, pungent, permanent pain on one 
spot of the abdomen, which is also very sensitive to touch ; 
the abdomen is bloated, hot, painful, often so much so as 
not to bear the least touch ; obstinate constipation, vomit- 
ing, first of slime and gall, finally of excrements (ileus, 
miserere); sobbing, anxiety, violent thirst, and the head 160 
ENTERITIS. 
generally free to the last; the pulse is small and contract- 
ed, with all the other signs of inflammatory fever. 
The course is very acute. The issue is either perfect 
resolution or death by gangrene ; the latter being recog- 
nizable by the sudden disappearance of the pain, which 
shortly before was increased to its acme, the pulse sinking, 
becoming remittent and imperceptible involuntary cada- 
verously fetid stools ; to which applies the same remark 
that was made in gastritis, not to consider it as a sign of 
improvement ; or the malady passes into induration (cal- 
lositas, scirrhosilns intzstinorum) ; or into suppuration ; in 
the first case, obstructio alvi hahitualis; in the latter, 
phthisis intestinalis is the consequence. But there are, 
even in gangrene, a few single instances in which nature 
has removed the gangrenous matter, effected reunion of 
the part, and restoration of the patient. Also here the 
increase of inflammation and danger is measured by the 
pulse becoming smaller. 
Besides the general causes, taking cold in the feet and 
the abdomen, suppressed menstrua and hemorrhoids, par- 
turition, drastic purgatives, worms and metastases bring 
on this inflammation. 
The proximate cause of the constipation and vomiting 
of faeces is not so much a mechanical impediment afforded 
by the inflammatory swelling, but rather a motus antiperi- 
stalticus created by inflammatory irritation, which, after the 
inflammation has been removed, may still continue, being 
kept up by a remaining nervous irritation (spasm). 
The treatment is the same as in gastritis; general and 
local abstractions of blood ; and here also, the smaller the 
pulse, the more urgent is venesection, and which must be 
repeated until the pulse becomes fuller and broader. In- 
ternally the oily emulsion with hyoscyamus, or fresh lin- 
seed-oil, given by spoonfuls, buttermilk, emollient narcotic 
cataplasms, antispasraodic and mercurial ointments, cups, 
a vesicatory on the abdomen, and oily-mucilaginous injec- 
tions every six hours. No purgatives, no salts as long as 
the inflammation is violent. They only increase the in- 
flammation, and do not effect an evacuation. The removal 
of the inflammation opens the bowels. Preferable to all, 
after proper bleeding, is a lukewarm bath, which often best 
resolves the spasm and on that account serves to save life. 
Generally, in order to remove the spasm remaining from 
the inflammation, which keeps up the costiveness, vomiting 
and pain, opium, the oily emulsion with extr. opii. aquos. 
three grains, or opium together with calomel, and opiate HEPATITIS. 
161 
injections, are proper. This done we may resort to pur- 
gatives, of which oleum Ricini is the most proper, every 
two hours one table spoonful; also in injections, or in lieu 
of it oleum papaveris two ounces, oleum crotonis one drop. 
When constipation continues, injections of vinegar or cold 
water, also cold fomentations on the abdomen. 
Particular regard must be paid to the remote cause, es- 
pecially if it is owing to a hernia incarcerata. We must, 
therefore, examine accurately all parts, where the like 
could arise ; and if there be hernia, the only cure is reduc- 
tion. Likewise regard to worms. 
After the disease, the abdomen must be kept warm by 
flannel vests ; all food which is apt to cause flatulency, or 
is heavy and indigestible, and ardent drinks are to be 
avoided. 
INFLAMMATION OF THE LIVER 
Hepatitis. 
Diagnosis. It is different according to the different seat 
of the inflammation. When it is located more in the sur- 
face and the convex side, the phenomena are pain in the 
right hypochondrium, sometimes stitches, sometimes burn- 
ing, sometimes as violent as in pleuritis, shooting to the 
sternum, the right scapula, extending sgmetimes even to 
the right foot, increased by inspiration ; cough ; frequently 
also vomiting, and lying on the right side is impossible. 
When it occupies the concave part of the liver, or the 
substance of that organ, then the feeling is more pressing 
than painful, but the biliary system is more affected ; yel- 
lowish color of the eyes, of the countenance, sometimes 
complete jaundice; bitter taste, urina crocea, vomiting, 
sobbing, lying on the left side impossible, on the right side 
alleviating. 
In either case, on examination, the right hypochondrium 
will appear bloated, painful to pressure, and is hot. 
These local symptoms are accompanied by the general 
signs of an inflammatory fever. 
The first species might easily be mistaken for pleuritis ; 
as they often offer very similar phenomena ; but this mis- 
take is without detriment, since the treatment is the same. 
As in general the liver has a chronic character, its in- 
flammation has a tendency to pass into a chronic state. It 
is also apt to affect the lungs, and to combine with a pul- 
monary inflammation. 
14* 162 
The issue is either perfect resolution under general and 
local crises, especially bleeding at the nose, hemorrhoidal 
flaxes, erysipelatous metastases to external parts, diar- 
rhoea,; or transition into chronic inflammation, adhesion, 
induration, and other disorganizations, to which the liver 
is particularly liable. Or it terminates in suppuration, 
whence phthisis hepatica. The matter forms either a vomica, 
which can destroy the whole substance of the liver ; or 
penetrates to without and engenders a liver-abscess; or 
into the lungs, generating expectoration of matter (phthisis 
hepatico-pul/nonalis); or makes its way into the intestinal 
canal, whence arises diarrhoea purulenta, sometimes fol- 
lowed by perfect recovery ; finally gangrene. 
Causes, besides the general, are gall-stones, violent 
anger, especially when accompanied with drinking ardent 
spirits ; too strong emetics, external lesions, concussion 
ol the brain, suddenly suppressed diarrhoea or dysentery, 
hemorrhoidal congestion. Summer heat and hot climate 
are most predisposing to this disease. 
The cure is as in pleuritis: genera] and local abstrac- 
tions of blood, in which especially the application of 
leeches to the rectum as a derivative through the hemor- 
rhoidal vessels directly anastomosing with the liver, is 
recommendable; antiphlogistic salts, especial regard to 
the evacuation of bile by acid laxatives (tamarinds), whey 
prepared with cremor tartaris or tamarinds, injections, 
which will here operate simultaneously, as internal fomen- 
tations of the liver; and if these remedies do not suffice, 
the use of mercury internally and externally, which is par- 
ticularly appropriate to inflammations of the liver, espe- 
cially those of a chronic character. 
Frequently chronic hepatitis is met with either as a con- 
sequence of the acute, or is generated by local organic 
disorders. Its signs are: a continual or periodically re- 
turning bloatedness in the hepatic region, thirst, complaints 
of the stomach, red urine, febrile motions from time to 
time, and a yellowish tint. The cure consists in the ad- 
ministration of calomel, unguent mercur., natr. and kali 
(the carbonic alkaline waters of Fachingen and the Kreuz- 
brunnen in Germany) ; whey, extract, graminis, taraxaci, 
chelidonii, or the fresh expressed juices of those herbs; 
cicuta, digitalis, lukewarm baths of soap and alkali; the 
constant wearing of emplastr. sapon. or galban, and in the 
intermediate time, as soon as the pain increases, applica- 
tion of leeches. 
HEPATITIS. 163 
SPLENITIS. DIAPHRAGMITIS. MESENTERITIS. 
INFLAMMATION OF THE SPLEEN. 
Splenitis. 
Diagnosis. Pains pressing and pungent in the region of 
the spleen, which is bloated and painful under external 
pressure ; in a high degree of it there are consensual 
symptoms of the stomach, especially apt to vomiius cru- 
entus. 
Causes and treatment the same as in hepatitis. 
INFLAMMATION OF THE MIDRIFF. 
D iaphragmitis. 
Diagnosis, Pain on one spot within the costal margin 
or the short ribs, which is increased if the finger presses 
below the ribs ; the same takes place in inspiration or 
stretching of the body, hence the patient feels alleviated 
only with the body bent forwards. At the same time 
there is cough, and when the inflammation extends far, 
singultus. If it extends farther, the back is also affected 
with pain, which may become extremely formidable. The 
pulse is quick and small, may be also remittent. In gen- 
eral there is much resemblance to pleuritis, for which it is 
often mistaken. In the highest degree risus sardonius 
associates with it. 
Causes, the same as in pneumonia. 
The treatment is also the same ; venesection and leeches 
are the principal remedies ; frequent injections are very 
useful. Against sobbing (singultus) external embrocations, 
narcotic cataplasms, irritatives of the skin, hyoscyamus 
aqua laurocerasi, and musk are the best. 
INFLAMMATION OF THE MESENTERY. 
Mesenteritis. 
Diagnosis. A deeply seated, dull, pressing pain in the 
lower abdomen, which is bloated and painful under any 
pressure ; it is generally connected with constipation; and 
there may be also ischuria. Fever as in all inflammations. 
More frequently chronic than acute ; is met with oftener 164 
in children than in adults, especially in such children as 
labor under scrofula and indurations of the mesentery. 
Treatment the same as in peritonitis. 
PANCREATITIS. NEPHRITIS. 
INFLAMMATION OF THE PANCREAS. 
Pancreatitis. 
Diagnosis. Similar symptoms in the region between the 
pit of the stomach and navel, accompanied with vomiting. 
Treatment the same. 
INFLAMMATION OF THE PERITONEUM. 
Diagnosis. Tumefaction and painful tension of the abdo- 
men, with great sensibility to touch, so much so, that in a 
high degree the patient cannot suffer any thing on the 
belly. Constipation or ischury is frequently connected 
with it; being dependent on the extent of the inflamma- 
tion. In a high degree all the accidents of enteritis, as 
vomiting, etc. often occur. When peritonitis is not cured 
by resolution, it runs into indurations or suppurations, 
and the latter may form an external abscess. 
Causes, besides the general, are, external lesion, preg- 
nancy, parturition, metastases, taking cold in the abdomen. 
The treatment is the general antiphlogistic, especially 
leeches, mercurial embrocations, fomentations, lukewarm 
baths. 
Peritonitis. 
Peritonitis exsudatoria puerper alls (vide diseases of fe- 
males). 
INFLAMMATION OF THE CAUL 
Omentitis. 
Diagnosis. The same symptoms as in peritonitis, only 
more confined to the epigastric region, and accompanied 
with vomilino-. More frequently chronic than acute. 
Treatment is also the same. 
INFLAMMATION OF THE KIDNEYS. 
Nephritis. 
Diagnosis. Pungent, pressing pain in the renal region, 
shooting along the urethra to the bladder; difficulty to CYSTITIS. 
165 
urinate, strangury, or ischury (only when both kidneys are 
inflamed, which rarely happens) ; hot, red urine, the testi- 
cle drawn near to the abdomen on the affected side, painful 
and swollen ; often numbness of the whole foot, which is 
spasmodically affected ; vomiting, colic pains, tenesmus ; 
lying on the affected part and the back, as well as standing 
and walking, increase the pains. 
Issue. Resolution or induration (the kidneys are subject 
to the most various disorganizations of substance) ; or sup- 
puration (phthisis renalis), in which either evacuation of 
urine, and thereby also a complete cure can succeed ; or 
the matter works its way to the external surface (abscessus 
renalis), or internally and opens into the intestinal canal. 
Causes. Nephritic stones, especially violent concus- 
sions of the body, or excess in wine, continual riding on 
horseback or in jolting carriages, falls and blows on the 
back ; long lying on the back, great exertion to lift heavy 
loads, hemorrhoidal congestion, acrid diuretics, or can- 
tharides. 
Therapeutics. The cure of this inflammation is the same 
as in the foregoing, with this additional remark, that 
blister plasters and nitre are to be avoided ; oily remedies 
and mucilaginous drinks, mild laxatives of manna and tam- 
arinds, frequent emollient clysters, cataplasms, and, above 
all, after proper abstraction of blood, a lukewarm bath, 
are most beneficial j when the attack is obstinate, calomel 
and opium. 
Should chronic inflammation or induration remain, the 
continued use of mild, dissolvent remedies, solutions of 
extracts with terra foliat. tart., natrum, lukewarm baths, 
and leeches occasionally are recommendable ; in indica- 
tions of suppuration, Selters or Spa water with milk. 
INFLAMMATION OF THE BLADDER 
Cystitis. 
Diagnosis. Burning pain in the vesical region, with 
external swelling, tension, heat, and pain when touched ; 
urine red and hot, strangury, dysury and ischury ; even 
tenesmus and constipation, a hard pulse and fever ; also in 
a high degree consensual accidents, as vomitus, singultus. 
The issue is either resolution, accompanied with thick 
urine, or suppuration, discharged with the urine, or ab- 
scesses, and finally urinary fistulas in the perinseum, 166 
METRITIS. OOPHORITIS. 
scrotum, or rectum ; or induration, which, by repeated 
inflammations, may gradually increase the vesical parietes 
to the thickness of an inch, a state which causes continual 
vesical and urinal difficulties ; or gangrene. 
The causes, besides the general, are external lesion, he- 
morrhoidal congestion ; rheumatic, arthritic and syphilitic 
metastases ; urinary calculus, pregnancy, parturition, and 
suppressed menstruation. 
The cure is like that of nephritis. Should there be 
ischuria, and the catheter needed, it must be cautiously 
introduced, and without force as long as its application is 
painful and difficult ; but first, let the inflammation and 
spasm be removed by abstractions of blood, calomel, opi- 
um, lukewarm baths, emollient injections, embrocations, 
and cataplasms, after which, if necessary, a flexible cathe- 
ter may be introduced, and left in as long as circumstances 
require. 
INFLAMMATION OF THE WOMB 
Metritis. 
Diagnosis. External tension, tumefaction and pain in 
the hypogastric region, the pain being increased by pres- 
sure ; heat and pain in the vagina, and pain on touching 
the mouth of the womb; pain in urinating, and defeca- 
tion, strangury, ischury, tenesmus and constipation. When 
in a high degree, consensual symptoms as in cystitis. 
Issue. Resolution (frequently accompanied with dis- 
charge of blood), or suppuration, flowing of matter from 
the vagina, or induration, or gangrene. 
Causes are difficult paturition, violence in confinement, 
suddenly suppressed menstrua or lochia, version of the 
womb, ill applied pessaries, retained placenta, suppression 
of metrorhagias by cold fomentations or ardent irritants, 
ardent abortives. 
The treatment is the same as in cystitis ; and in addition, 
emollient injections into the vagina. 
INFLAMMATION OF THE OVARIA. 
Oophoritis. 
Diagnosis. Pain in the right or left inguinal region ;in 
a high degree of inflammation, circumscript swelling of PSOITIS. 
167 
that region clearly perceptible, and it is painful under pres- 
sure ; frequently also consensual affections of the neigh- 
boring parts, and a febrile state. In a lower degree of this 
inflammation, especially in the beginning or in the chronic 
state, the diagnosis is not so easy, although of great im- 
portance, since it can lay the foundation of multifarious 
disorganizations and degenerations of the ovary, and which 
can only be prevented by early discovery and treatment. 
The only sign we have here is pain in the inguinal region, 
which in a quiet position is commonly imperceptible, but 
sensible by a deep pressure on that region; little perceiv- 
able in standing, without swelling ; hot feeling in the vagi- 
na, sometimes ardor of urine or pain in the thigh of the side 
affected. 
Pathogenesis. It originates in pregnancy, especially in 
the beginning, but more frequently in parturition ; finally, 
in unmarried females, in congestions to the ovaries, which 
most frequently are caused by sexual desire, excited by 
physical or moral onania, or imperfect coitus without sat- 
isfaction. 
Therapeutics. The cure of inflammations; especially the 
application of leeches, also venesection if indicated ; cool- 
ing purgatives, calomel and embrocations of volat. liniment 
and unguent mercur. 
INFLAMMATION OF THE PSOAS-MUSCLE 
Psoitis. 
Diagnosis. Pain in the renal region, hip, and down- 
wards to the leg ; the leg cannot be stretched or drawn 
near to the abdomen without pain ; turning when lying, and 
lifting, increases the pains; walking is possible only in 
hobbling, and with the body bent forwards. Karely there 
is external swelling along the psoas muscle, and in the 
inguinal region. Signs discriminative of nephritis, to 
which it has resemblance, are the absence of urinary diffi- 
•culty and costiveness. It is more frequently chronic than 
acute. It is not lethal, but very important in its conse- 
quences; for suppuration often exists, though unperceived, 
and the matter breaks through and empties into the abdo- 
minal cavity, bringing on a fatal issue ; or (what happens 
more frequently), the matter burrows downward, hence a 
phthisis lumbaris, abscessus lumba?'is, which opens in very 
remote parts, as in the groins, anus, perinseum, thigh, or 168 
OPHTHALMITIS. OTITIS. 
above the knee. Not seldom also are the vertebral bones 
or the hip-joint affected by it, and rendered carious. 
The causes, besides the general, are : violent exertion 
in lifting and carrying,' blows, falls on the back or the 
nates; rheumatism and hemorrhoids. 
The treatment is the same as in peritonitis ; especially 
leeches, lukewarm baths, vesicatories, mercury, applied 
externally and internally. 
INFLAMMATION OF THE EYES 
Diagnosis. Redness, heat and pain of the eye in variable 
degrees, either with dryness or increased secretion of tears 
and other ophthalmic humors (ophth. sicca et humida), in the 
highest degree, headache and fever. 
It can be caused by all that is capable of violently irrita- 
ting the eyes from without, as well as from within ; of the lat- 
ter kind are sanguineous congestions, catarrh, rheumatism, 
consensual gastric irritants and specific morbid matters. 
The treatment must be adapted to the causes, and to the 
difference of character. In the acute and high degrees of 
inflammation it is most momentous to resolve it speedily, 
in order to prevent suppuration, obscuration and other 
destructions of this tender organ. The remedies most 
efficacious for that purpose, are : venesection, leeches, 
large doses of calomel (three to six grains every four 
hours), and cool fomentations of weak lead-water to the 
eye. 
Ophthalmitis. 
In chronic ophthalmitis the treatment varies according 
to the varieties of cause and character. The general 
treatment is the same in any case, and in regard to local 
remedies we must remark, that dry inflammation bears 
collyria better ; the moist only salves, amongst which that 
of red precipitate deserves the palm of all. 
For more accurate information, I recommend the study 
of writings on ophthalmialogia, which has been raised to 
a particular science. 
INFLAMMATION OF THE EARS. 
Otitis. 
Violent, often insupportable pain in the ear, with heat, 
even external sensibility of the meatus auditorius, and 
febrile irritation. ERYSIPELAS. 
169 
The pain easily communicates to the whole head, and 
when in a high degree, brings on even delirium. Inflam- 
mation of the brain may arise in consequence. If com- 
plete resolution does not succeed, suppuration or otorrhcea 
ensues, which, however, may be critical. 
The cause is most frequently rheumatic. Every otalgia, 
however, may be increased into otitis. 
The treatment must be prompt and actively antiphlogis- 
tic ; leeches on the ears, in plethoric persons even general 
venesection, are the principal means. At the same time, 
antiphlogistic remedies and regimen, cooling laxatives. 
St. Anthony’s fire. 
Erysipelas. 
Diagnosis. Superficial shining redness, which disap- 
pears under pressure of the finger; is of a flying character, 
therefore apt to wander from one place to another. Some- 
times blisters shoot up on it (erysip. bullosum). 
The inflammation has its seat in the epidermis ; but in 
the more violent degrees it affects also the subjacent tissue 
(erys. phlegmonodes). 
Generally, previous to, and at the eruption, there exists 
a slight fever, which is distinguished by an inclination to 
sleep, and disappears after the eruption has broken out. 
Sometimes, however, it is violent and precedes the erup- 
tion for several days, together with a soporous state which 
continues afterwards, and by which the higher degree of 
the disease is characterized. Such a degree is not decided 
before the seventh or ninth day. Always also gastric, 
especially bilious symptoms, are connected with it. 
The issue is either resolution, or induration running into 
very chronic callosities ; or suppuration, which may spread 
deeply into the cellular tissue, and be followed by chronic 
fistulous ulcers ,• or gangrene. It is generally a slight dis- 
ease and without danger, but it may endanger life by its 
seat, as when situated on the face, tending to communi- 
cate to the brain ; by its character, when it is putrid j by 
retrocession to noble internal organs. 
e must distinguish the genuine erysipelas from the 
pseudo-erysipelas, associated as a symptom to wounds and 
°^er, ex':ernal lesions. But also here we must well re- 
member, that a true erysipelas can throw itself on such 
parts by the irritation of external lesion- 170 
ERYSIPELAS. 
The causes are most frequently bilious or mental affec- 
tions, as anger, wrath and fright ; or taking cold, vulnera- 
tions ; also idiosyncrasies against certain dishes, e.g. crabs, 
shell fish, produce in some individuals erysipelas. But here 
the disposition is of particular importance of a ten- 
der, white skin, fat, choleric persons, who have an easily 
irritated or morbid liver are most liable to this malady, and 
thereby arises the habitual erysipelas, a very troublesome 
evil, excited by trifling causes. It appears also often at the 
time of menstruation, as its surrogate. 
The treatment must be accommodated to the degree, vio- 
lence and character of the fever. The principal remedies 
are gastric evacuations, according to the indication, either 
by emetics or purgatives, especially with tamarinds and cre- 
mor tartari as arnelioratives of bile, and in a slight degree, 
the same, connected with mild diaphoretics and an anti- 
phlogistic diet, at the same time avoiding to take cold, are 
sufficient for a cure. Externally, only moderate, not too 
hot covering ; in order to diminish the pain, farina fabae, 
s. semin. lin. and pulvis flor. sambuci, but without camphor 
or lead, may be strewed on the inflamed part. Camphor 
and lead, as well as cold and cold fomentations, are care- 
fully to be avoided ; they, it is true, dispel quickly the 
erysipelas, but can produce dangerous metastases unto 
internal parts. It is only in pseudo-erysipelas, which asso- 
ciates as a symptom to wounds, ulcers and other external 
lesions, that lead-water may be applied. Warm, wet fo- 
mentations are also improper, since they likewise are apt 
to produce retrocession, or transition into suppuration. 
In the higher degrees, marked by violence of fever and in- 
flammation, and when the individual is young and plethoric, 
abstractions of blood may be necessary ; precaution, how- 
ever, is to be used, since they are apt to cause a retroces- 
sion of the erysipelatous eruption ; in general, leeches only 
are to be applied, and venesection only in extreme neces- 
sity, and in evident plethora, or truly inflammatory com- 
plication, or the affection of noble parts (of the eyes or 
brain). Purgatives are more serviceable than bleeding, as 
antiphlogistics. 
Especial attention is due to the erysipelas of the face, 
which is frequently connected with violent cerebral affec- 
tions, sopor and delirium. Here also, relief is not procured 
by abstraction of blood, but by gastric evacuations, espe- 
cially by emetics ; they remove promptest and most surely 
the delirium, and promote the crises. 
Erysipelas bullosum s. pustulosura is treated according ERYSIPELAS, 
171 
to the same principles. The blisters are not to be cut, but 
only pierced, so that the water contained in them may ooze 
out, and they remain’ covered with the epidermis ; other- 
wise very painful and malignant suppurations might ensue. 
When these happen, in order to assuage the burning and to 
heal them, it is best to cover them with cream, or in obsti- 
nate cases, with ointment of lime (fresh pressed poppy-oil or 
linseed-oil with equal parts of lime-water). Remedies of 
lead are to be carefully avoided, as they can produce most 
dangerous metastases. 
When erysipelas exhibits a disposition to putrescence 
and gangrene, which is discovered by the bluish redness 
or the dark spots on the part, or by a nervous or putrid 
febrile character, the treatment of the putrid typhus must 
be resorted to, and vigorous roboratives and antiseptics, 
externally Peruvian bark with sal. ammoniac, scordium, 
arnica, wine and acids must be applied. 
Retrocession of the erysipelas. A sudden disappearance 
of the erysipelas, caused by cold, lead-remedies and the 
like, can bring on the most violent, even fatal internal in- 
flammatory affections. Here prompt means to make it 
reappear, or at least to compensate it, are wanted. In 
slighter cases a sinapism on the erysipelatous spot, and in- 
ternally spiritus Mindereri, camphor with nitre are of use; 
in violent inflammations of internal parts, a venesection, 
vesicatories on the spot which was previously erysipela- 
tous ; likewise sinapisms over the place now affected; in- 
ternally nitre with camphor. 
Convalescence. Erysipelas requires most careful atten- 
tion, after it is subdued ; for swelling, induration, and a 
disposition to recidives are likely to remain. The patient, 
therefore, must continue a diaphoretic regimen, and keep 
the erysipelatous part warm, and cover it with dissolvent 
herbs, until every vestige of oedema is gone. 
The chronic habitual erysipelas originates partly in a parti- 
cular weakness and secretion of the skin ; partly in remote 
causes, disorders of the liver and bilious acidity, men- 
strual disorders, dyscrasias of various kinds, especially 
arthritic, psoric and syphilitic. The cure requires partly 
invigoration of the skin by baths, cold washing and rubbing; 
partly removal of abdominal obstructions by dissolvent, 
purgative and roborative remedies ; regulation of the cata- 
menia ; cure of the various dyscrasias, for which the 
drinking of Sedlitz-water, continued for several days, is 
particularly useful, cupping every eight weeks, also fon- 
tanels. 172 
ZONA. RHEUMATISM. 
ZONA. ZOSTER. 
Diagnosis. Red, burning- and itching spots, occupied 
with little pustels, or stripes in the region of the girdle, 
frequently forming a complete belt round the body, accu- 
rately circumscribed and separated from the healthy skin. 
The disease is sometimes acute, combined with fever, 
more frequently chronic, and then of long duration and 
obstinacy. 
As for its nature it is between erysipelas and herpes ; of- 
ten arises from the same cause as erysipelas, but more fre- 
quently from deeper located and general dyscrasias. 
The treatment is the same as in erysipelas; in the chronic 
state like that of herpes. Particularly recommendable in 
the latter case, is the internal use of sethiops mineralis, 
one half or one scruple daily, together with res. guaiaci, 
and externally sublimate-water ; in obstinate cases a weak 
solution of lapis infernalis. 
FOURTH CLASS. 
RHEUM AT OSES. 
Generalities. 
I understand by this name every affection which ori- 
ginates in suppressed or disturbed function of the skin and 
is generated and entertained by an acrid serum (perspirabile 
retentuTii), produced by this impeded secretion. 
It appears in two principal forms, rheumatismus and ca- 
tarrhus. The former is the rheumatic affection in the mus- 
cles, ligaments, aponeuroses : the second in the mucous 
membranes, especially the bronchia, trachea and nose. 
Both are of the same nature, and one can change into the 
other ; the difference rests only in the location. 
Pathogenesis. The proximate cause of either is a local irri- 
tation, created by the antagonistic reflection of the skin and 
the acidity thereby generated. The rheumatic affection, 
therefore has, besides the dynamic, a material serous char- 
acter. Ihe proof of this is it is always brought on by sup- 
pression of the cutaneous secretion ; it is cured only by RHEUMATISM. 
173 
serous secretion, either general (perspiration), or local 
(local sweat, or artificially excited vesication) ; the least 
taking cold increases the evil ; it is generally accompanied 
by a serous exsudation in the cellular tissue. 
Therapeutics. Every rheumatic affection has two indi- 
cations of cure ; in the first place, to restore the cutaneous 
function, the crisis by the skin generally as well as locally, 
and in its absence to replace it by artificial serous evacua- 
tion (vesicatories) 5 secondly, to regard duly the various 
dynamic characters, which happen to accompany the rheu- 
matic affection, which is by no means inflammatory, but 
sometimes of a quite opposite nature. 
RHEUMATISM. 
Rheumatismus, Rheumatalgia. 
Diagnosis. After having previously taken cold, pain in 
a muscular, membranous or aponeurotic part, together with 
swelling of the surrounding cellular tissue, light redness 
and warmth. 
This is the appearance of rheumatism in its original 
form ; but there are many deviations. 
1. The local affection is not always accompanied with 
redness and heat, hence the division into rheumatismus fri- 
gidus and calidus. 
2. The affection is not always accompanied by pain, it 
may immediately affect the nerves paralytically, and de- 
prive the part of sensation and motion; e.g. surdiias, 
amaurosis, paralysis rheumatica. 
3. It is not always located in an external part, for it can 
just as well attack all internal organs; this, however, gen- 
erally happens in a secondary way and per metastasin ; 
sometimes it can immediately from the beginning seize on 
an internal part. 
Thus rheumatism can exhibit and generate most vio- 
lent and multifarious internal diseases, of an acute as well 
as of a chronic nature, e.g. pleuritis, enteritis, cardialgia, 
nervous diseases. 
A principal means for the diagnosis of rheumatism, or 
for recognizing the rheumatic character of a disease in 
concealed and metamorphosed kinds of rheumatism, is the 
close relation which it bears to the atmospheric, especially 
the barometrical condition, or so to say, a barometrical 
nature of the sick, in which the least change of weather 
immediately aggravates the evil. 174 
RHEUMATISM. 
Rheumatism either remains on one spot (rheumat, fixus), 
or it wanders from one part to another (rheumat. vagus). 
It is either accompanied by fever (rhe.um.at. acutus), or 
not (rheumat. chronicus). The first lasts for a definite rime; 
the latter is of uncertain duration, and may become chro- 
nic, even last the whole period of life. 
Rheumatism and arthritis very much resemble each 
other in their phenomena, are easily confused, but are very 
different in respect to their original character (vide patho- 
genesis). The principal discriminative signs are : Rheu- 
matism attacks more the muscular and membranous parts, 
arthritis the joints ; rheumatism is not necessarily con- 
nected with digestive difficulties, quite the contrary, with 
the best appetite; but arthritis always shows itself con- 
nected with or succeeding to digestive difficulties; arthri- 
tis exhibits in the urine and other secretions more the signs 
of a singular dyscrasla, such as the knotty calcareous 
concrements on the joints, and the calcareous sediment in 
the urine; rheumatism does not. Rheumatism sets in after 
taking cold, an external influence operating from without 
to within ; arthritis after, and by disorders of digestion 
and chylification, from within to without, and appears as a 
critical deposite of a qualified morbific matter to the sur- 
face. It is not rare for rheumatism to assume an arthritic 
form, and vice versa {rheumatismus arthriticus). 
Also several other diseases can assume the form of a 
rheumatic affection, e.g. syphilis, scorbutic, psoric, can- 
orous dyscrasias. We distinguish therefore, rheumatismus 
verus1 which is owing to taking cold, and spurius ; a diffe- 
rence of great importance for the treatment. 
The effects and consequences of rheumatism are: serous 
exsudation in the neighboring cellular tissue, induration, 
anchylosis, very rarely suppuration, paralysis, exanthe- 
mata, blenorrhocas ; and, per metastasin, almost all forms of 
diseases, especially nervous, hypochondria, at last in long 
duration a particular dyscrasia and cachexia. 
The crises are by sweat and urine, exanthemata, some- 
times also by salivation. 
Pathogenesis. The proximate cause of rheumatism is an 
antagonistic irritation, produced by checked perspiration, 
Avhich irritation is of a double nature,—dynamic, as far as 
the equilibrium of the system is disturbed,—material, in 
regard to the morbific serous acrid matter (materia rheu- 
matica). It is well to remember, that it is owing not only 
to suppressed sweat, but far more to the suppression of the 
imperceptible gas-like perspiration, which is the most im- RHEUMATISM. 
175 
portant, most general and perpetual emunctory of organic 
life, and by which two thirds of all corrupt matters are dis- 
charged from the system, the retention of which, must of 
necessity, engender a very nuisible morbific matter, that, 
in course of time will injure the integrity and mixture of 
the humors. Rheumatism, therefore, is only irritation, but 
by no means a genuine (phlogistic) inflammation ; is an 
irritation approaching to inflammation, located not in the 
vessels, but in the serous membranes; injiammntio serosa, 
not sanguinea. Thereby the rheumatismus verus differs 
from the rheumatismus spurius, which may arise in many 
other ways. The notion of suppressed cutaneous action, 
taking cold, must here be taken in its widest sense. Not 
only the suddenly suppressed perspiration (taking cold 
properly speaking, which gives occasion to acute rheuma- 
tisms), but much more, the chronic, gradual, frequently im- 
perceptible, diminution and suppression of cutaneous per- 
spiration, which generates the chronic (often so obstinate) 
rheumatisms and rheumatic maladies, is here to be count- 
ed. The latter kind is caused by living in moist dwellings, 
moist and changeable climate ; hence it occurs most fre- 
quently in the middle climates and middle seasons (spring, 
fall). It is farther caused by too light clothing, which 
often unknowingly brings on rheumatism in females; and 
by neglected cultivation of the skin, uncleanliness. 
The predisposing causes are: too tvarm regimen, by 
which the sensibility of the skin is morbidly increased ; 
disuse of air, living in closed rooms, want of exercise, ge- 
neral and local weakness, cold, pituitous, lymphatic, phleg- 
matic constitution. But rheumatism can also arise with- 
out any predisposition, and there is no disease, which can 
be generated so certainly. A person needs only to expose 
himself with an overheated sweating body, to a great 
draught of air, and rheumatism will follow. 
“Rheuma” itself may give rise to various diseases, that 
is, to' all kinds of acute fevers and inflammations ; and as 
regards every kind of chronic diseases, the rheumatic dia- 
thesis is one of the most prolific sources, a fact, which we 
cannot too strongly promulgate. 
Therapeutics. In the treatment of all rheumatic diseases 
we must adhere to the idea, that the skin is their source, 
and that retained perspirable matter, a serous acrimony is 
their matter morbific. The original indication is therefore 
double : to restore or replace the cutaneous function, and 
to remove the serous acrimony either by a natural crisis 176 
RHEUMATISM. 
(especially of the skin) or by an artificial one (drawing 
blisters, suppuration). 
The special treatment is determined on by the two prin- 
cipal species, the febrile rheumatism (vide rheumatic fever), 
and the non-febrile rheumatism {jheumatismus chronicus). 
1. Apply internal remedies, which unitedly fulfill the 
above-stated indications, and are termed on that account 
specified antirheumatica. The most efficacious are: spiritus 
Mindereri, guaiacum (vide No. 27, 28, 29 a), aconite, cam- 
phor, dulcamara, nitre (a great remedy especially when 
there is a phlogistic state, but in large doses up to one half 
ounce within 24 hours), antimonium and all its prepara- 
tions, sulphur, warm baths, especially soap and culinary 
salt-baths. 
2. Apply external means, which fulfill locally the same 
indication, i. e. effect a local crisis. For we must remem- 
ber that rheumatism can be treated locally in a double 
manner, namely, by means which support the local reac- 
tion necessary for a complete crisis (radical method), and 
by such means as suppress reaction, and thereby take away 
the pain and irritation for a moment, but which are apt to 
cause rheumatism to shift to another, perhaps internal no- 
ble part; or effect an incomplete crisis and its conse- 
quences, i. e. retain the rheumatic matter in the affected 
part, and bring on stiffness, swelling, or frequent returns of 
rheumatism, even paralysis. 
Of the first class, the radical, the sure external means 
are : warmth, oiled silk, flannel, greasy wool, fur, espe- 
cially of the wild cat, embrocations of liniment, amnion,, 
but without camphor, since this is apt to operate suppres- 
singly ; in order to do away with the pains emplastr. de 
hyoscyamo with opium ; in very violent pains narcotic ca- 
taplasms, but only for a few hours, since too long an ap- 
plication might produce chronic exsudation and suppura- 
tion. But vesicatories, applied until they draw blisters, on 
or next the affected part, are the principal means; they 
remove the pain promptly, and render the crisis complete 
by serous evacuation. If one does not suffice, another is 
to be applied the following day near the first. 
Of the second class, the suppressive, are : cold and lead, 
of which especially saturnine plasters are favorites. Both 
it is true, are able to dispel the pain quickly, but are very 
apt to generate a dangerous metastasis of the rheumatism 
to some internal organ, and produce chronic distempers. 
Also local abstractions of blood may be included in that RHEUMATISM. 
177 
class, since they likewise quickly remove the active in- 
ternal reaction of nature, thereby removing the pain and 
irritation (so that the ignorant are impressed with the be- 
lief that they really cure), but they never annihilate rheu- 
matism itself, a disease that never calls for evacuation of 
blood but only of serous matter; on the contrary, they 
have like the above-mentioned, a tendency to produce me- 
tastases and chronic local evils, even obstinacy of rheuma- 
tism itself. An exception to this statement is found in 
rheumatismus calidus, when rheumatism is combined with 
true inflammation, exhibited by heat and redness of the 
part affected. Here leeches or cups are salutary, not to 
remove rheumatism, but only to do away with the inflam- 
mation connected with it. 
Regard must be paid to constitution and complication. 
Three varieties under this head deserve particular atten- 
tion: 1. The phlogistic, when rheumatism occurs in a ple- 
thoric youthful person, or exhibits all the symptoms of an 
inflammatory disposition. Here, a strict antiphlogistic 
diet and treatment must be employed, consisting of local 
and general blood-letting, nitre, and diaphoretica frigida. 
2. The nervous, in sensitive individuals. Here antispas- 
modic remedies, even opium must be used along with the 
first. 3. Finally, the gastric, especially the bilious, which 
can render the rheumatism violent and obstinate. Here 
emetics and purgatives frequently effect the cure more 
quickly than all other antirheumatics. 
Cure of Obstinate Chronic Rheumatism. 
Sometimes, however, the afore-mentioned treatment is 
not sufficient. The case does not yield, or if it abates 
a little, it returns with renewed vigor. Rheumatism may 
become one of the most obstinate maladies, and its cure 
one of the most difficult tasks in the whole round of prac- 
tice, requiring a deeper penetration into the organism and 
the multifarious sources of the complaint. I here give the 
following rules: 
The use of the above-mentioned antirheumatic remedies 
may be increased and prolonged; for the want of success 
is often owing to the irregularity and short time of employ- 
ing them, and to the impatience of the sick, who does not 
allow time for their operation. 
A stronger preparation of the same remedies may be ad- 
ministered ; or such other more vigorously penetrating 
means as experience confirms. Of that number are, ac- 178 
RHEUMATISM. 
cording to my experience, the tinct. guaiaci volat., tincture 
of guaiacum, arnica, tinct. fulig., oleum jecoris aselli (one 
or two ounces several times a clay), petroleum, tinct. anti- 
mon. acris (30 drops several times daily), ammonium sul- 
phuret. (two or three drops daily several times), calx anti- 
mon. sulphuret., and the sulph. water prepared of it (vide 
No. 29 b), the mercurials, especially sublimate, which I 
consider one of the most efficient means of this class, 
either as an addition to the decoct, of guaiac. (vide No. 
30), or in the form of pills (vide No. 31), or as sether mer- 
curialis. 
Finally emetics may be resorted to, repeated every se- 
cond day. They are of great use- We must, however, 
never forget, that they attack the system violently and are 
apt to injure the stomach and digestive power ; hence they 
are recommended only in cases of necessity, when other 
means have been tried without benefit. 
Externally, embrocations of mercurial ointment, of strong 
etherial oils, oleum cajeput., petroleum, may be applied ; 
for assuaging the pain, emplastr. hyoscyam. with opium; 
also decoction of tobacco (one ounce in sixteen ounces of 
water reduced to eight ounces), used as lukewarm fomen- 
tations constantly continued are most efficacious. More- 
over, emplastr. de galbano one ounce, camphor, petroleum, 
carb. ammonise opium drachm, malax. ; scarification, 
electricity, and galvanism are advised. 
This treatment must he connected with baths, general 
and local, in which are mixed seasalt, alkali, sulphur, par- 
ticularly sublimate or 1 ounce for one bath). The most 
efficacious are the hot thermal baths at Wiesbaden, Top- 
litz, Aachen, Baden (near Vienna), Warmbrunn. As local 
baths, the douche (shower-bath) and sprinkling are of exi- 
mious power. In a state of great debility cold baths are 
also serviceable. 
Great is the effect of artificial ulcers, strong cutaneous 
irritation and suppuration entertained for a longtime; yea 
they are often indispensable in obstinate rheumatisms. Of 
this description are fontanels, mezereum, antiraonial oint- 
ment, moxa, actual cautery. 
Finally, it is necessary to inquire accurately into the 
diet and mode of living of the patient, in order to discover 
whether the unperceived cause may not be found in the 
moist, draughty dwelling, too light clothing, etc.; and if 
so, must be remedied. 
Besides this mode of directly attacking rheumatism, we 
must take the constitution of the patient into considera- 179 
RHEUMATIISM. 
tion. Frequently, a constitutional disorder is the sole root 
of the disease ; and a cure is impossible without remedying 
it, which alone is often sufficient to effect the cure. 
Of this description the principal one is debility, general 
as well as local, often produced solely by the malady. 
Here roborants are beneficial, and in the first rank stands 
quassia; then strengthening baths, cold baths, sea-baths. 
The nervous constitution calls for a nervous treatment. In 
the succulent, lax, phlegmatic constitution, warming pti- 
sanes, such as excite all the secretions and irritate the vas- 
cular system, especially the use of drastic purgatives, since 
the cutaneous action is here less to be relied on, are of 
excellent effect. This is the case, where the Zittmann’s 
decoction (vide No. 204), even inunction and fasting are 
serviceable. The plethoric constitution, inclined to san- 
guineous congestion, of which character is the hemorr- 
hoidal disposition, is often at the bottom of the most obsti- 
nate rheumatisms ; when this is the case, abstraction of 
blood, leeches applied to the rectum, and the cure of piles 
are required. In the gastric, especially the atrabilious con- 
stitution, the dissolving evacuating visceral treatment con- 
tributes most towards curing rheumatism. 
Finally, in obstinate rheumatisms a complication with 
other diseases is to be considered and well ascertained ; 
and here a syphilitic or psoric dyscrasy is most suspected, 
for they often originate the evil and its obstinacy. 
A regard to the periodical character of rheumatism is of 
great importance. When it returns typically, at certain, 
definite periods, cinchona or quinine, also iron, especially 
the carbonate, are the principal remedies. 
Cure of Rheumatosis. 
The rheumatic constitution, the disposition to rheuma- 
tisms, returning constantly, and from the slightest cause, 
requires the following treatment. The chief indication is 
to remedy the excessive sensitiveness and debility of the 
skin, in which that constitution is founded. Therefore 
cultivation of the skin by strengthening, vivifying and 
hardening it, is advised. This is effected by daily washing 
the whole body with cold water (for which purpose also 
the Schneiderian apparatus may be used), combined with 
frictions, a lukewarm bath once or twice a week, cleanli- 
ness, frequent changes of linen, pure air, muscular exer- 
cise. In effeminate and sensitive persons, or patients 
highly disposed to rheumatisms, flannel clothing near the 180 
SCIATICA. 
skin, a Russian steam-bath every 14 days. In order to pre- 
vent rheumatism, and remove the accumulated rheumatic 
matter, it will also be very useful to take every three or 
four weeks for a few days resina guaiaci together with 
sulphur (vide No. 32), so that two or three evacuations 
occur every day. 
Some local diseases deserve to be particularly mention- 
ed, since they are frequently of a rheumatic nature. 
Ischias, Coxagra. 
HIPS. 
Diagnosis. Pain in the region of the hip-joint, which 
often extends to the knee, even to the foot, accurately fol- 
lowing the course of the sciatic nerve. Its severity may 
impede the motion of the foot, and bring on stiffness and 
contraction ; finally, by its long continuance and violence, 
disturbing nightly rest, it may induce general marasmus 
and emaciation. 
By coxagra an inflammatory affection of the hip-joint it- 
self is understood, recognisable by pain in stepping and 
moving, but not felt during rest—a character which dis- 
tinguishes it from sciatica. The pain in this case is pro- 
pagated to the front of the knee (while in sciatica it is only 
to the external side), and the leg is protruded and length- 
ened. 
Pathogenesis. It is most frequently a rheumatic affec- 
tion of the hip-joint, sometimes only of the ischiatic nerve 
in its whole extent. After death exsudation is discovered 
in the nervous sheath. This affection, however, can in- 
crease even into inflammation and attack the joint (cox- 
agra), causing an exsudation sometimes within eight days, 
and protruding the head of the femur. Psoric, scrofulous, 
and other metastases may act as remote causes, especially 
in children, in whom it often occurs under the name of 
claudicatio spontanea. 
Therapeutics. In common cases and in the beginning it 
is sufficient to prescribe resina guaiaci ta 1 drachm a 
day, together with aconite; wrap the joint in wool, make 
embrocations of liniment, volat., put a vesicatory on the 
hip-joint (by which the exsudation there is most surely 
prevented) and sweat for a few days. In obstinate cases, 
in plethoric persons, and when there is suspicion of he- 
morrhoidal congestions, leeches must be applied. In ner- 
vous sciatica a vesicatory is to be applied in the course of 181 
lumbago, catarrh. 
the nerve on the external side of the hip-joint, the follow- 
ing day another On the external side, immediately above 
the knee, and on the third day one towards the external 
part of the leg, above the malleolus. The case proving still 
obstinate, it will call for antirheumalics and mercurials, 
especially sublimate, drastic purgatives, the use of liver- 
oil, and all the remedies already recommended for chronic 
rheumatism. A combination of tinct. antirnonii acris, gua- 
iac. volat., 30 to 40 drops three times a day, with an addi- 
tion of some drops of laudanum liquidum is of great use. 
Externally, baths, with the addition of soap, culinary salt, 
sulphur, and sublimate are serviceable, also those of Wies- 
baden, Teplitz, Aix la Chapelle, steam-baths; perpetual 
resicatories, fontanels, moxes, cauteries. 
LUMBAGO. 
Diagnosis. Violent pain in the region of the loins, some- 
times periodical, sometimes permanent. An important 
variety of lumbago is one which follows any quick motion 
of the back, as in rising from a stooping position. The pa- 
tient is suddenly seized with a violent pain as if produced 
by an arrow shot into the part; it pins him, as it were, 
into a fixed attitude, from which he cannot stir without 
suffering torture, and so confines him for many days. 
It is caused like sciatica frequently by rheumatism, but 
more frequently by a hemorrhoidal congestion of blood, 
which may even pass into inflammation (myelitis). 
The cure, therefore, requires:—first, leeches, in pletho- 
ric subjects and in a feverish state even venesection, and 
cooling laxative remedies, lukewarm baths, especially 
steam-baths on the affected part; then sulphurous 
guaiac., vesicatories ; in short, the cure of sciatica and 
rheumatism. 
In cases of chronic pain in the sacrum, and when meta- 
static (scrofulous, psoric, syphilitic) causes are present, 
caries of the vertebral bones may imperceptibly arise, and 
thereby engender an abscessus lumbaris, which breaks at 
remote places, as the groin or leg. 
rheumatic affection of the mucous membrane. 
Catarrhus. 
Diagnosis, Rheumatic affection of the mucous mem- 
brane, most commonly that of the nose (coryza, gravedo). 
16 182 
CATARRHUS. 
Its signs are : sneezing, running of acrid serum and mucus, 
or the contrary, dryness, stopping in the nose, with irrita- 
tion and swelling of the membrane ; in a high degree also 
lachrymation and irritation of the eyes; tension, pressing 
headache above the eyes, with or without fever (on the 
first, vide febris catarrhalis). 
Or it atfects the cavity of the mouth and the throat. 
Signs: redness of the internal parts, palate, uvula, tonsils, 
accompanied with pain in swallow'ing (vide angina catarr- 
halis). 
Or it affects the windpipe and bronchia. Signs; cough, 
dry at first, or expectoration of acrid serum or mucus ; 
hoarseness, in severe cases a painful sensation in the 
trachea and the lungs [catarrhus pulmonum). 
But a catarrhal affection can seize every other part of 
the body, and generate all kinds of blenorrhoe’a, which then 
are nothing but catarrhs, such as catarrhus intestinorum 
(diarrhoea, dysenteria), aurium (ctturrhcea), oculorum (oph- 
thalmia humida), vagina? et uteri (jluor albvs), vesicas (cys- 
torrhcea), and must be treated according to the principles 
already mentioned. 
Course. Every catarrh runs through two stages; the 
first, stadium cruditatis s. irritaiionis, when irritation of the 
mucous membrane, accompanied with secretion of a watery 
acrid serous matter is the prevailing character ; the se- 
cond, stadium coctionis s. secundarium, when the irritation 
abates and the matter appears cocted, mild, and thick. 
This period is of indefinite duration, sometimes very short, 
sometimes very long, and not unfrequenlly passes into 
tussis chronica, even phthisis. Thus this disease, though in- 
significant in itself, may become fatal in a double way : 
either by transition into inflammation of the lungs, or into 
phthisis, and we may rightly presume, that it has brought 
on the greatest number of consumptions. 
The causes are the same as in rheumatism ; living and 
sleeping in a warm atmosphere are especially noticeable. 
The treatment is fundamentally the same as in rheuma- 
tism. We have chiefly to consider whether the catarrh is 
accompanied by fever, or not. The treatment of the 
febrile variety is like that of catarrhal fever. 
T-he cure of the non-febrile is generally performed by 
nature herself through coclion and crises, local as well as 
cutaneous, to support which, drinking freely of gruel, elder 
tea, species pectoral., and remedies promotive of expectora- 
tion, as licorice and syrup, is proper. In high degrees, and 
when nature’s healing power is not sufficient, the best re- CATARRHUS. 
183 
tnedies are sulphur (vide No. 33), dulcamara, sal ammon., 
spirit. Mindereri, antimonials, ammonium anisat., rad. se- 
nega?, extract, helenii; in tickling cough, tinct. pirnpi- 
nellee is of specific efficacy ; also vesicatories on the chest 
and arm. In gastric complication emetics are advised. In 
every obstinate cough we must not neglect to wear flannel 
on the chest next to the skin, which often is sufficient of 
itself to cure. But good care, avoiding to take cold, and 
antiphlogistic diet are always necessary ; for it must never 
he forgotten, that in every catarrh there exists a sub-in- 
flammatory irritation of the mucous membranes, which 
may be increased to real inflammation by cold, overheat- 
ing, wine and the like ; or may pass into a chronic stage, 
altering the substance of the lungs itself in a morbid man- 
ner, giving rise to either tubercles, atony, or relaxation of 
the mucous membranes. The utmost precaution and care 
is to be observed by persons of a hectic disposition, or 
having morbid, tuberculous, or weakened lungs. As soon 
as fixed pains in the chest associate with the catarrh, a 
vesicatory must be put over the affected spot; when fever 
sets in and the cough becomes dry, antiphlogistics are to 
be administered internally, even leeches or a moderate ve- 
nesection may be needed (vide catarrhal fever). 
The treatment of a lingering protracted cough is of great 
moment; for this is one of the most common though im- 
perceptible ways of transition into consumption. The pa- 
tient may feel comfortable, but continues coughing, and 
finds himself after six or eight weeks in the first starve of 
i•. . o O 
phthisis. Either, by the continued catarrhal irritation of 
the bronchia, tubercles are formed, phthisis sicca, tubercu- 
losa ; or relaxation, atony of the lungs is the consequence, 
and blenorrhcea pulmoaum, phthisis pituitosa succeeds. 
The cure resides in a proper discrimination of the case, 
especially as regards the cough, whether it be dry or pi- 
tuitous. In the first case it is either a continuance of ca- 
tarrhal irritation, or a disturbed local crisis of the catarrh, 
a fixed chronic cough. Here a decoction of dulcamara is 
the principal remedy (vide No. 3i), next senega, antimo- 
nials, carduus benedictus (a remedy of prompt efficacy is 
the elixir cardui benedicti, as stated in No. 72, b), marru- 
bium (vide No. 35), solution of the extract (vide No. 36), 
vesicatorium perpetuum on the upper arm or chest (on the 
spot, which the patient complains of as sore), entertained 
in suppuration for several weeks, flannel, best on the bare 
skin; Sellers water, mixed with milk; I can recommend 
from my own experience also the Eger salt-well. 184 
GASTROSES. 
Or it is due to weakness of the lungs with copious ex- 
pectoration of mucus. Here the principal remedy is 
lichen islandicus, in the beginning with dulcamara (vide 
No. 87), afterwards alone as gelatine, 2 ounces daily. 
Or it is due to nervous irritability, only spasm, which is 
recognised by the dry spasmodic cough and the other 
symptoms of nervousness ; here extract, hyoscyami, 2 to 
4*grains daily, liquor ammonii anisat., spiritus Mindereri, 
liquor c. c. succin., aqua laurocerasi, and in obstinate cases 
opium (1 scruple of Dover’s powder every evening). 
Catarrhosis. 
The habitual disposition to catarrh&is best overcome by 
daily cold washing of the chest; in spring and fall the use 
of lichen islandicus for 3 or 4 weeks, daily enjoyment of 
the free air, exercise, and wearing of flannel on the chest, 
where there is great sensibility of the skin, a moist climate, 
and suspicion of pulmonary disorders. 
FIFTH CLASS. 
GASTROSES. 
GASTRIC DISEASE, GASTRIC IMPURITIES. 
Sordes Primarum Viarum, Infarctus. 
Gastrosis exhibits a particular form of disease, since it 
has symptoms peculiar to itself, and indications which call 
for a particular mode of cure—the evacuant ; hence, it is 
rightly denominated a malady curable by purgatives, as 
rheumatism is one curable by serous and cutaneous eva- 
cuations, and inflammation by bleeding. This malady de- 
serves the best attention of the physician for three reasons : 
First, on account of the great importance of the system 
in which it is situated; for the digestive system is the 
source of assimilation and growth, the representative of 
reproduction, as the nervous is that of nervous life, the ir- 
ritable system that of sanguineous life,—therefore, it must 
not be considered, as frequently happens, in the light of a 
local, but as the third principal system of the body. 
Secondly, on account of the vast pathogenetic influence GASTRIC DISEASES. 
185 
which it exercises, whether healthy or diseased, over the 
whole body, by arresting or alienating reproduction, or af- 
fecting the humors; as well as by its extensive connection 
with all parts of the body through the medium of the 
ganglionic nervous system, and by which it is possible that 
gastric disturbance can produce almost any kind of dis- 
ease, and may form the object of cure in all, especially in 
chronic maladies. Hence we derive the gastric method of 
cleansing the intestinal canal and abdominal system, a fun- 
damental practice, which has resisted the changes of theory 
and the course of time from the ancients until now, con- 
firming according to my own experience the old adage 
Qui bene purgat, bene curat. 
Thirdly, because this system is a principal seat of crisis 
and critical secretion, especially in these climates. It per- 
forms not only the purification of the liver, so important to 
the whole organism, but it sometimes replaces cutaneous 
functions, and it secretes and is the receptacle of injurious 
morbid substances, wherefore we say : the intestinal canal 
is a scene of action, on which the most important maladies 
are decided. 
Diagnosis. The tongue is generally unclean, want of ap- 
petite, corrupt taste; the seat of the impurities, however, 
makes a difference. When they are in the stomach, the 
tongue is unclean, white, yellow, or brown-coated, want of 
appetite, pressure, tension, sometimes painful sensations in 
the region of the stomach, eructation, nausea, or vomiting, 
consensual symptoms, of which headache is particularly to 
be mentioned. When seated in the intestines, the abdomen 
is tumid, tense, and rumbling, feels as if pressed and heavy; 
colic, pains in the back, fetid flatus, sometimes diarrhoea. 
At the same time more or less consensual symptoms, 
which have this peculiarity, that they are in causal con- 
nection with the gastric augment with their increase 
and diminish with their decline.3 All gastric diseases are 
marked by a lassitude disproportioned to the rest of the 
symptoms. 
The gastric signs are either combined with fever (vide 
gastric fever), or without it (gastrosis chronica). The spe- 
cial diagnosis is mentioned in the various species. 
The chief kinds of gastric matter are : snburra, bile, 
phlegm, acidity, infarcts, accumulated or formed in the in- 
testinal canal. 
Pathogenesis. Accumulation of impurities in the stom- 
ach and intestinal canal may take place in a double manner: 
either by imperfect digestion, owing to an excess, or the 
16* 186 
GASTRIC DISEASES. 
indigestible nature of food, and its imperfect evacuation ; 
or by disordered secretion from the organs lining or con- 
nected with the stomach and intestinal canal, as regards 
quantity or quality, and effusion into it of noxious matters, 
such as chyle, phlegm and bile. From the extensive sym- 
pathetic nervous connections of the stomach and intestinal 
canal, it is very likely that gastric impurities are generated, 
either by sympathy and consensual communication with 
general and local irritation of remote parts, such as of men- 
tal affections, pains and even febrile irritation ; or by anta- 
gonismus, as in consequence of taking cold and suppressed 
cutaneous function. Even a crisis may produce a meta- 
static secretion in the intestinal canal, and thus engender a 
secondary gastrosis ora gastric febrile complication in the 
course of a fever. 
For special causes, see under the species. Disposition 
to gastrosis is due to weakness of the digestive organs, 
habitual costiveness, faulty diet, abuse of emetics and pur- 
gatives, irritability and consensual sensibility of the diges- 
tive organs and the gangliary system relating to it, hyster- 
icism of the stomach, liver, etc., whereby it happens that 
the least nervous irritation or morbid affection influences 
this system ; also to atmospheric and climatic influences 
(thence the epidemic and endemic character), especially 
moist or very changeable weather. 
But most important is the pathogenetic influence which, 
crudities can exercise over the organism, and by which 
they can become the source of innumerable diseases. This 
deserves the greatest attention of the practitioner as an 
object of cure in many cases. 
Next they affect the intestinal canal itself, creating im- 
peded as well as morbidly increased activity of it; irritation 
and spasm, which frequently attain an inflammatory degree. 
They also operate sympathetically on the brain, the lungs, 
the skin, the abdominal viscera, the whole nervous system ; 
produce delirium, pectoral and tracheal affections, cutane- 
ous eruptions, especially erysipelas, congestions, local in- 
flammations in remote parts, general febrile excitement— 
evils, which may be removed by a single emetic or purga- 
tive. 
Therapeutics. The general indication is, to evacuate the 
offensive matter, after having previously prepared the pa- 
tient ; to remove their injurious effects and to prevent their 
regeneration. 
For the precautionary measures proper to be observed in 
the administration of emetics and purgatives, see gastric GASTRIC DISEASES. 
187 
fever. I need only remark, that they are to be repeated/ 
when gastric accumulations continue; emetics in turges- 
cence upwards, purgatives, when the faeces continue bad 
and morbid, to ascertain which due attention and examin- 
ation of the stools are necessary. 
1. Saburral Accumulation, Indigestion. 
In this case an emetic or a purgative is generally needed, 
according to the seat of turgescence, and afterwards elixir 
viscerale Hofmanni. Gormandizers, who frequently over- 
load the stomach, will do well to keep on hand what is 
called a digestive powder (vide No. 48), in order to be im- 
mediately able to give themselves relief. 
2. Accumulation of Bile, 
Occurs frequently after violent angry mental emotions, 
likewise in an epidemically prevailing bilious constitution 
after hot summers. Those whose liver is irritable and 
easily excitable by mental or physical causes, are subject 
to effusions of bile into the stomach. 
The are : the preceding mental affection, the pre- 
vailing constitution, the temperament, the yellow or brown 
coated tongue, the bitter taste, generally also nausea or 
bilious vomiting, headache, or bilious diarrhoea, with pains 
in the abdomen. The bile sometimes may acquire such an 
acridity as to affect the throat and cause violent spasmodic 
reactions, which may increase to an inflammatory state, 
similar to the effects of poison. 
Also here evacuations by emetics and purgatives, accor- 
ding to the respective indications, are called for. Regarding 
emetics, precaution is to be used, since the stomach is al- 
ready much irritated ; therefore the dose must be divided 
if there is already bilious vomiting, otherwise hyperemesis, 
even inflammation might be created. The purgatives, also, 
must be selected from the cooling and acetous class, bile- 
correctives, neutral salts, tamarinds and cream of tartar 
water. In a high degree of irritation, pain in the stomach 
and intestines, mucilaginous beverages in large quantity 
and clysters, also warm fomentations are to be used ; and 
in plethoric persons, a moderate venesection previous to 
the emetic, are the proper remedies. 188 
GASTRIC DISEASES. 
3. Mucosity of the Stomach. 
Signs : No desire for food or drink, feeling of pressure 
and fullness in the proecordia, especially after taking food, 
white mucous fur on the tongue, phlegmy taste, much flat- 
ulency 5 in the morning nausea, even vomiturition, slimy 
stools, constipation, deficiency of warmth, particularly a 
cold sensation in the stomach, pallor, lassitude, insensibili- 
ty, slow pulse, emetics and purgatives have little effect ; 
subject to worms. 
The special causes of mucosity are : infant age, phleg- 
matic temperament, sedentary life, excesses in eating 
heavy, farinaceous, fatty food. 
The cure always requires, previous to evacuation, the 
use of strongly dissolvent, stimulant and incisive remedies; 
the mucous coating must be dissolved, before operating on 
the membranes of the stomach and intestinal canal, and on 
account of the insensibility, all the remedies must be 
strongly irritative. For that purpose are serviceable : sal 
ammoniac, sulphate of potash, natr., soap, sulphur, sulphu- 
ret. of antimony, kermes mineralis, rad. pimpinell, ari, sen- 
egse, squills, gummi ammoniac, asa foetida. The disposi- 
tion being duly affected, vomits (tartar emetic), and pur- 
gatives (salts combined with senna, jalap., alces) may be 
resorted to. 
This done, in order to remove the chronic state, much 
exercise is to be taken, aliments which tend to create mu- 
cosity must be avoided, and strengthening remedies used 
(vide weakness of the stomach). 
4>. Acidity, Acrimony of the Stomach. 
Signs: Hunger, sometimes a canine appetite, but no 
thirst; sour eructations, and sour breath, colic, pallor, foul 
teeth, symptoms increased by taking vegetables, which 
create acidity, especially milk, on the contrary, meat 
agrees well. 
The special causes are the infantile age, which has al- 
ways a tendency to create acrimony ; weak bile ; a hypo- 
chondriacal and hysterical state, also plethora, particularly 
of the stomach, and anomalous hemorrhoids. 
The treatment is double ; palliative, neutralizing the acids 
by absorbents, such as magnesia, lapis cancrorum, concha 
preepar., aqua calcis viv. and clay (bolus alba), the most effi- 
cacious of all, but not in excess or for too long a time, since GASTRIC DISEASES, 
189 
it is apt to produce obstruction of the vessels, also lac 
sulph. The alkalines, soap, carbonate of soda, potash, 
ammonia and bitters similar to bile : beef s gall, quassia, 
absinth., aloes. Radical cure is effected by remedying the 
generation of acidity, much muscular exercise, flesh meats, 
strengthening the digestive organs by bitters and tonics, 
as well as by martials (vide weakness of the stomach). 
5. Saburral Ac cumulations in the Intestines {lnfarcts'). 
Signs: Tumid abdomen, in which are frequently felt 
knots and indurations, changing from place to place, hard, 
knotty stools, alternating sometimes with diarrhoea, con- 
taining gelatinous matter, or pituita vitrea, or real mem- 
braneous concrements, bilious and atrabilious infarcts, 
pressure and heaviness in the abdomen, sallow counte- 
nance, chilliness ; slow, but sometimes uncommonly full 
pulse, hemorrhoidal complaints. 
Causes are: sometimes only retention and gradual accu- 
mulation and induration of excrements in the great intes- 
tines, particularly in constipated habits, sedentary persons, 
and strictures of the rectum, or they are owing to deposites 
in the intestinal canal of atrabilious concretions from the 
liver, or concretions formed in the intestinal canal itself, 
or generated by a special secretive product, similar to the 
membraneous formations generated in the uterus. Gen- 
erally they are connected with obstructions of the abdomi- 
nal viscera. They are of great moment, as frequently 
causing most obstinate chronic maladies, for the cure of 
which their removal is the only means. Their effects may 
be local, causing obstinate colics, cramps of the stomach, 
difficulties of digestion, hemorrhoids ; or consensually gen- 
eral, giving rise to all kinds of diseases, hypochondria, 
hysterics, epilepsy, melancholy, paralysis, hemorrhages, 
blenorrhoeas. Therefore the cure of these maladies re- 
quires the removal of such accumulations. 
Therapeutics. The principal means are one or two injec- 
tions a-day, especially the visceral clysters of rad. tarax., 
saponar. and similar resolvents, which have become re- 
nowned through Koempf. It is essential that they should be 
retained some time, therefore they are to be given in small 
quantity (six ounces), after which the patient must rest 
quietly on the left side for half an hour. In more obstinate 
infarcts or very viscous phlegmosity, stronger dissolvents 
. are admixed with the enema, such as soap, a table-spoonful 
of fresh ox-gall or lime-water. 190 
NERVOUS DISEASES. 
SIXTH CLASS. 
NERVOUS DISEASES. 
NEUROSES. 
Generalities. 
Diagnosis. Every morbid action of sensation or motion, 
or thinking, if primarily and idiopathically founded in the 
nervous system, and not merely a symptom of another 
malady, or if dependent on another disease, exhibiting itself 
purely as an anomaly of the nervous system, belongs to 
this class. 
The anomaly may be : either increased action (erethis- 
mus) or diminished {adynamia, paralysis), or altered {ab~ 
normitas, alienatio), which is true in regard to the functions 
of sensation as well as of motion (muscular action) and 
mental action. 
Their course and duration are very indefinite, sometimes 
transient, sometimes rapidly fatal, sometimes lingering 
through life, sometimes interrupted by long intervals, pass- 
ing from one form into another form, frequently connected 
with the periods of development, appearing and disappear- 
ing with them. 
They may spontaneously cease with their causes, changes 
in the mode of life, or the periods of growth, since old age, 
by a gradual decrease of sensibility often cures the most 
obstinate nervous diseases; or may attack other systems 
by a transmutation into material diseases, crises, metasta- 
ses, new formations. 
In general they are not fatal, but may rapidly become so 
by paralyzing an organ indispensable to life, as the brain 
(apoplexy), the heart (asphyxia), the lungs (catarrhus suf- 
focativus), or slowly, by affecting nutrition (tabes nervosa, 
or dropsy, phthisis). 
Pathogenesis. The proximate cause is an abnormal con- 
dition of the internal nervous life. It is manifested partly 
by a disturbance in its functions, partly in an unusual con- 
sensus, partly in a morbid affection of organic life. NERVOUS DISEASES. 
191 
The reinote causes are best divided into four principal 
classes. 
1. Disposition, hereditariness, relaxed fibre, infantile age, 
female sex, female education, periods of development, that 
of the teeth and speech, of puberty ; moist climate, city 
life and sedentary life, epidemic constitution, low state of 
the barometer, west wind [in Europe]. 
2. Debility.’ It can be brought on > 
Either by withholding the excitants and necessary sup- 
port of life, deficiency or bad quality of food, bad air, cold, 
especially damps, loss of blood, menstrua nimia (often a 
hidden cause), too great loss of semen by venery or mas- 
turbation, too frequent parturition, long continued lacta- 
tion, chronic, serous and mucous profluvia, diarrhoea, 
fluor albus, gonorrhoea, salivation, sweats. 
Or by over-irritation and exhaustion of the powers, ex- 
cessive mental exertion, acute and chronic diseases, exces- 
sive heat, intemperance in spirituous liquors, coffee and 
tea. 
Or by want of exercise, of use ; hence idleness is one of 
the richest sources of nervous diseases. 
Or by influence of potences, which directly weaken the 
nerves, such as: sorrow, grief, sadness, longing, envy, 
weariness, passiveness of the mind, indulging the feelings, 
abuse of directly weakening narcotic substances. 
3. Disturbed equilibrium (antagonismus), sanguineous 
plenitude (disproportion between power and weight), sup- 
pression of muscular action, of cutaneous secretion, the 
action of the abdominal system, sexual functions, men- 
strual and hemorrhoidal discharges. 
4. Local and specific irritations. Of this kind the first to 
be mentioned are abdominal irritatives, worms, gastric 
matter, saburra, obstructions of the viscera. Secondly: san- 
guineous congestion, especially of the brain and the abdo- 
men, plethora abdorninalis ; hemorrhoidal disease is one of 
the most frequent causes of numerous nervous disorders. 
Thirdly : metastases of morbid matters, as the arthritic, 
rheumatic, scrofulous, syphilitic, psoric. Fourthly : me- 
chanical irritations, foreign bodies, insetted from without 
(splinters), as well as local disorganizations generated in 
the body itself, indurations, stones, ganglia (which cause fre- 
quently extremely tormenting and obstinate local neural- 
gias), hydropic accumulations, exostoses, caries. Finally, 
morbid affections of the mind, fixed ideas, exaltation of 
imagination.—The secondary causes, generated by the 
disease itself, and on which its continuance depends; fre- 192 
NERVOUS DISEASES. 
quently without any other cause co-operating-, are habit 
and weakness. The worst is habit, when it becomes typi- 
cal, and the worst and most obstinate of all is, when this 
type is complicated with organic functions, which are in- 
dispensable to life, e.g. the catamenia, sleep ; hence the 
menstrual spasms, mental diseases and nocturnal epilepsy 
are so difficult to cure. 
On that is founded the practical division of nervous dis- 
eases, which points out simultaneously the object of cure 
and the indication : neurosis simplex s. nervosa, neurosis 
adynamica, neurosis sanguinea, neurosis metastatica, neurosis 
ahdominalis, gastrica, neurosis organica. 
Therapeutics. The treatment is double : of the disease 
itself (radical cure) ; of its phenomena, symptoms (pallia- 
tive cure). 
Radical cure. In treating a nervous disease our first 
question must be : is the cause material or not, i. e. is it 
purely nervous, or is it nothing but the product of other 
material disorders'? In the first case we direct the cure to 
the nervous system (direct nervous cure), and thereby re- 
move the disturbances obvious in it. In the second case, 
we are to take away the material disorders and maladies, 
on which the nervous disease depends, which done, the 
disease disappears by itself, and the cure is finished (indi- 
rect nervous cure). If it persists notwithstanding, it is to 
be regarded as purely nervous, and to be treated as such. 
The fundamental indication, therefore, always remains, 
to regulate the anomalous action of the nervous system, be 
it excessively increased, or debilitated, or alienated. 
For accomplishing this end, it is necessary to seek for the 
various causes of the disturbance, and accordingly the treat- 
ment of nervous diseases is manifold. When it proceeds 
from debility (after great loss of blood, of semen, extrava- 
gant corporeal or mental exertions), invigoration and res- 
toration by roborantia and nutrienlia is most called for and 
often sufficient for the cure. When there is plenitude or 
local congestion of blood, repose is necessary, for muscu- 
lar action tends to augment it; also general and local 
derivation of blood are of greatest use. We have then to 
look particularly to concealed congestion, caused by hem- 
orrhoids and menstrua. When abdominal irritatives, in- 
farcts, worms, visceral obstructions exist, then the resolv- 
ing, evacuating, anthelminthic method is often the best treat- 
ment of the nervous disease. Particular attention must be 
paid to dyscrasias and metastases to the nerves. Thus it 
often happens that a nervous disease is nothing but a rheu- NERVOUS DISEASES. 
193 
ttiatic or chronic affection, an antagonistic reflex of the 
disturbed cutaneous function to the nervous system, and 
“ere merely covering the skin with flannel, likewise baths, 
cutaneous irritatives, internal antirheumatica are service- 
able. The affection may also be arthritic ; here the cure of 
gout is to be pursued. Thus also psoric, especially scabi- 
ous and herpetic acrimony is frequently the sole cause of 
chronic nervous irritation. Every lurking syphilitic dys- 
crasias, also an imperfect mercurial treatment may be the 
cause, and the cure is to be made by mercurials. Finally, 
he psychical influence deserves essential regard, and the 
Discovery and removal of a secret grief, of a secret longing 
(particularly in females), are often the only remedies 
needed. 
Eut if a remote cause cannot be discovered, or the dis- 
temper continues after its removal, then the direct ner- 
vous cure must take its place, i. e. the internal abnormity 
of the nervous life and its organization, which is at the 
bottom of the nervous disease, must be operated upon and 
annihilated. If the direct method is used whilst the remote 
cause is present, it will* prove entirely inefficacious ; or if 
it assuage the evil for a time, it will soon reappear, and 
frequently with increased violence. 
The direct or specific cure is effected by the following 
remedies: first, the application of such means as have a 
specific relation to the nervous system (nervina, antispas* 
modica). Of that number are all etheric vegetables and 
animal substances, the narcotica, balsamica and gummata 
ferulacea, the ethers and mineral acids, the acria metallica, 
the alkalies and earths, the imponderable natural agents, 
electricity, galvanism, magnetism, mineral as well as ani- 
tfial. In order to find out the proper nervine, it is very 
useful and important to look for those remedies which, in 
a healthy state, would specifically affect the laboring part, 
or are capable of producing attacks similar to the actual 
one. 
In the administration of these remedies, especially of 
the stronger and narcotic kinds, the following rules are to 
be observed : 
I. We must always begin by small and cautious doses, 
since we can never determine beforehand the degree of 
irritability present. Then gradually increase to°such a 
dose, as would produce a slight attack of narcosis (glitter- 
ing of the eyes, drowsiness, slight vertigo), by the metallic 
nausea, and then decrease the doses in the same manner, 
as they were increased. Then a small pause is to be al- 
-17 194 
NERVOUS DISEASES. 
lowed, during which, if the evil does not yield, the remedy 
is to be repeated in the same manner, and may be continued 
for months, in obstinate cases. Ibis alternating augmen- 
tation, and diminution, and entire pausing is the safest, and 
at the same time the most efficacious, manner of using the 
stronger and more offensive nervines, since it allows time 
to the organism to recover its irritability, thereby rendering 
the remedy a new one, and avoiding the risk of injuring 
the system byatoolongcontinuanceofiargedoses, adanger 
always to be feared, as debilitation of the mental and sensual 
faculties is likely to follow the use of narcotics. M creover, 
it is also important in lingering nervous diseases, to change 
the remedies, in order to create a new impression. Finally, 
when single remedies are inefficacious, we must combine 
several together. As for the weaker nervines, which are 
of an animating, roborating and permanent efficacy, their 
use must be continued for a considerable time, sometimes 
for years, in order to gradually attain the intended amelio- 
ration of the morbid condition. 
2. By contrastimulants and derivatives. This purpose 
is fulfilled by baths, cutaneous irritetives, artificial ulcers, 
abdominal irritatives (especially when the cerebral system 
is affected). 
3. By restoring the organic balance in the action of the 
nerves, especially in the relation of the irritable to the sen- 
sitive system, the disturbance of which is frequently the 
sole cause of nervous disease ; for which end muscular 
exercise and lukewarm baths are useful. 
4. By strengthening. Every nervous disease, although 
it may not have originated in weakness, finally creates de- 
bility of the nervous system, and is entertained by this 
very state. Therefore the use of roborants (amara, arnara 
adstringentia, aslringentia, acida mineralia, martialia, cold, 
cold baths), and restaurantia (nourishing diet, living in free 
salubrious air, in the country, travelling, exhilaration of 
mind) are salutary. 
5. Change of habitual mode of living, of situation, envi- 
rons of the residence. Often a mere change of climate will 
effect a cure. Especially low, moist regions must be 
changed for high dry ones. 
6. Sometimes, particularly in very tender, irritable sub- 
jects, who have used an abundance of irritative means, the 
best cure consists in withholding all heterogeneous, medi- 
cinal and dietetic irritants, especially such as strongly 
affect the nerves,—abstraction of irritation ; at the same 
time, milk diet, quiet country-life, lukewarm baths, avoid- MENTAL DISEASES. 
195 
ing tea, coffee, spices, etc. Here the homoeopathic cure 
and the application of the remedies in homoeopathic doses 
can also prove very useful. 
Finally, in very obstinate diseases it is advised to excite 
artificial crises, or to shift the malady to other systems. 
The greatest and most general roborative for the brain 
and the whole nervous system is the daily affusion of the 
head with cold water. 
Of great moment in the treatment, is a regard to period- 
icity of the nervous attacks, whether they be spasms, pains 
or other alienations, even paralyses. When they return at 
definite intervals, cinchona given in the absence of the at- 
tacks, is the sole and certain remedy. 
Palliative curt. It only assuages the phenomena, the 
symptoms of the disease ; it is, however, of great import- 
ance, in the first place, as relieving the patient; secondly, 
since even the symptoms can bring on danger ; and thirdly, 
because by the outbreaking (e.g. epilepsy) the morbid 
character is more and more impressed on the nerves, there- 
fore a palliative treatment becomes an important part 
of the cure. The remedies fulfilling that end are the anti- 
spasmodica and contrastim ulants. 
1. MENTAL DISEASES. 
INSANITY, INSANIA. 
Mania, Melancholia, Amentia, Fatuitas. 
Diagnosis. Disturbance of the normal action of the mind. 
It is called melancholia, when connected with timidity, un- 
sociability, sadness, listlessness, debility ; madness {mania') 
when accompanied with rage, vigor and pugnaciousness; 
frenzy (moria, amentia), with fixed ideas, partial disturb- 
ance of the imagination (conceptions), or of discrimination 
(conclusions) ; imbecility (fatuitas), when marked by weak- 
ness or total loss of the faculty of thinking; somnamhulis- 
mus, a continuous action of the mind, fancy, or volition 
during sleep. 
The diagnosis is often very difficult,since the alienation 
frequently has reference to only one object (fixed ideas), 
while the individual is of sound mind towards all ethers; 
diagnosis is also difficult in slight degrees, and when the 
disease is periodical. We must exclude those mental dis- 196 
MENTAL DISEASES. 
turbances which are symptoms of diseases, and which pass 
away with them, as those caused by fever, hysterics, 
vioJent passions ; for every violent affection makes man 
temporarily insane. 
Delirium must be carefully distinguished from insanity. 
In hysterical and hypochondriacal persons, delirium often 
lasts long, and may be accompanied with fixed ideas, which, 
however, are only symptomatical, and not a mental disease. 
The same is true of febrile deliria, for they are not only 
symptoms of acute, but also of chronic nervous fevers, and 
may continue for months, and wholly disappear with the 
febrile excitement. Therefore, we should never call a men- 
tal disturbance connected with fever, insanity. Young 
practitioners cannot be too cautious in the diagnostics of 
mental symptoms, and in pronouncing the word insanity, 
for to declare a person insane, is morally to kill him. 
Insanity is permanent or periodical, is of long duration, 
the cure difficult, and amelioration uncertain, and apt to be 
interrupted by relapses. Sometimes it passes into other 
nervous maladies, as catalepsy, epilepsy, paralysis (transi- 
tion from the mental to the material nervous system), or 
into still more material diseases (corporification of the 
mental disease, transition from the mental to the vegetative 
sphere), as gout, cutaneous eruptions, ulcers, hemorrhoids, 
phthisis. It may terminate fatally by apoplexy, consump- 
tion, or dropsy. 
Pathogenesis. The immortal spirit, as such, cannot be- 
come sick in the common earthly sense of the word. Mind 
belongs to another world. There is only one disease to 
which it is liable—moral corruptness, sinfulness. Spirit— 
thought, is not matter, nor the product of matter ; for that 
which can view and contemplate both itself and matter, 
must be superior to, and independent of, matter ; what is 
free cannot be the product of necessity. This immortal 
spirit during its earthly existence, is inseparably interwo- 
ven and combined with the body, most intimately with the 
nervous system, and particularly with its most refined 
part, the brain. By this connection its earthly limit and 
manner of action is confined. Hence it becomes, like all 
things which enter into organization, subject to the laws 
of life. It is only by this means that it can manifest exter- 
nal phenomena and its internal actions (hence the brain is 
properly called the organ of the mind), and through this 
it may be affected and altered by the organism, as well as 
the organism by it ; and only in this way can it be impaired, 
disturbed, or totally impeded in its functions. All mental MENTAL DISEASES. 
197 
diseases, therefore, belong to the category of nervous dis- 
eases.* 
The proximate cause of a mental disease, therefore, lies 
in an abnormal state of this material organ, either its ac- 
tivity being excessively enhanced or diminished, or altered 
inmodo (in its normal laws and proportions). This is made 
evident by the fact, that mere corporeal causes (intoxica- 
tion, fever, narcotics) can produce a mental disturbance, 
and that insanity may cease on transferring the affection to 
other organs of the body, as it were, to corporify it, as 
when it gives rise to phthisis, epilepsy, dropsy. 
fhe disturbance can be created in two ways,—by spirit- 
ual as well as by corporeal influences. 
Th e remote causes are : 
1. Spiritual or mental : violent passions, rapidly working, 
as fright, joy, anger, as well as concealed and lingering, as 
continual grief, sorrow, chagrin, envy, jealousy, especially 
egotism, hatred, melancholy, unrequited love, ambition, 
disappointed hope, deep continuous mortification, exces- 
sive mental exertion, especially when combined with a 
sedentary life and solitude, reflection on subjects which 
surpass human capacity or that of the individual (mystic 
religion, transcendental philosophical meditation) ; exertion 
of the mind, particularly involuntary, enforced by stimu- 
lants, wine, coffee and the like, scruples of conscience, 
every kind of enthusiasm, political as well as religious, 
wrong cultivation of the mind, unequal exercise of the 
mental faculties, especially imagination excessively en- 
hanced by the reading of novels, attending theatres and 
the like, persisting in a fixed idea, instinct, or passion, 
which must be considered a transient insanity, and if not 
combatted, may pass into real insanity; finally, lucubra- 
tions, sleeplessness ; for daily interruption of mental activ- 
ity is essential to the preservation of mind, i. e. sound 
reason. 
2. Corporeal. Such, especially, are influences which 
excite and change directly the brain and its action, as 
excess of spirituous liquors, particularly of brandy. The 
excessive use of narcotic substances, as opium, belladonna, 
(both even given as remedies, especially in children), ope- 
rates in a similar manner. Stimulants consensually or 
* 1 he most appropriate likeness is that of the relation of a musi- 
cian to a stringed instiument. Without it the best player is unable 
to utter a tone, and only when it is well tuned (in good healthy order), 
a pure tone. It the instrument is not well tuned, disharmonious tones 
are heard, though the player be the same. 
17* 198 
MENTAL DISEASES. 
antagonistically operating on the brain, particularly such 
as affect the gangliary system of the abdomen, a system 
closely in connection, partly consensual, partly antagonis- 
tic, with the brain ; abdominal irritants, accumulations, 
infarcts, stoppages in the portal system, obstructions, 
physconias of the viscera, worms. Here, particularly, the 
remarkable antagonism of the abdominal nervous system 
against the cerebral one is to be regarded ; for a sup- 
pressed or debilitated action of the first is capable of pro- 
ducing increased and abnormal action of the latter. San- 
guineous congestions of the brain, passive as well as 
active, an inflammatory state, especially from suppressed 
piles, menstruation, bleeding at the nose. Debility of the 
brain from general causes, exhaustion of power (here in- 
sanity is often only a symptom of general nervousness, 
hysterics, etc.), frequently by excesses in venery, still more 
in onany in both sexes, since the generative system and 
the brain are in particular relation, and mutually operate 
on each other.—Metastases to the brain, especially arthri- 
tic and psoric.—Mechanical lesion, a fall, stroke or wound. 
These may produce insanity by mere commotion of the 
brain, by bloody and serous extravasations, or by depres- 
sion of the skull, thickening and exostosis of the bones of 
the head, or by pseudo-organization.—Organic disorders, 
indurations, callosities, scrofula, hydatids, excrescences, 
softening, suppuration, or atrophy of the brain ; exostoses, 
ossification, hydropic accumulations. 
Frequently several causes simultaneously exist, render- 
ing the disease more difficult of cure and dangerous; thus, 
when mental exertions frequently recur, are combined with 
a sedentary life, sorrow, heavy indigestible food. 
Particular regard is due to predisposition (predisposing 
cause) of mental maladies. Hereditariness is first to be 
mentioned, which, alas ! experience too well confirms, may 
be handed down from parent to offspring, and become pecu- 
liar to families. 
The temperament.—The melancholic and choleric are 
most liable to insanity. 
Further, irascibility. The more passionate a man is, the 
more is he disposed to mental diseases. Every passion is 
a temporary insanity, a suppression of reason ; if it be- 
comes prevalent, it may induce permanent insanity. 
Mode of living, when accompanied by the foregoing 
causes, that is, sedentary life, solitude, partial exertion of 
the mind. Therefore weavers and shoemakers are partic- 
ularly disposed to it. MENTAL DISEASES. 
199 
Finally, generally prevalent mental dispositions, excite- 
ments, mental confusions, particularly false ideas of reli- 
gion, immorality, irreligiousness and mysticism. 
Wherefore insanity may become endemic, epidemic, or 
climatic. We find it prevalent at one time, rare at another ; 
more frequent in certain regions, nations, or classes of 
people than in others. Thus it rarely occurred in the 
nations of antiquity, and is scarce even now among uncivi- 
lized nations (in England 1 in 800, in France 1 in 1200); 
it is likewise more frequent in great, luxurious and im- 
moral cities, than among country people. 
The best practical division of insanity is into: vesania 
nervosa, sanguinea, adynamica, metastatica, abdominalis, or- 
ganica. 
Therapeutics. The object of cure is to restore the mental 
action to its normal state. This may be effected, partly by 
removing the remote cause, partly by a direct operation on 
the mind. 
The first step is to discover the remote cause, and to 
act accordingly (the indirect mode of curing). If it is san- 
guineous, or inflammatory, or there is great determination 
to the brain, general and local bloodletting is called for j 
and in violent rage, arteriotomy, antiphlogistics, purga- 
tives, tartar emetic, calomel, cold fomentations and allu- 
sions on the head are the remedies. If it is nervous, from 
weakness of the brain and nervous system, then nervines, 
excitantia, valerian, arnica, serpentaria,’wine, ether, opium, 
rubefacientia, warln baths, cold fomentations on the head, 
are the proper remedies. This treatment applies to deliri- 
um tremens s. potatorum and to insanity, arising from 
excesses in venery and masturbation. 
We are not to forget that this species often arises from 
over-irritation of the first, and the insania nervosahecomes 
the second stage of the phlogistic one, according to which 
the mode of treatment has to be modified ; whereas on the 
contrary, the nervosa may associate with transitory con- 
gestions of blood to the brain, and render abstractions of 
blood, at least local, necessary. If the cause is abdominal, 
owing to gastric accumulations, infarcts, especially atra- 
bilious, stoppages of the viscera, worms, the resolvent 
method is required, removing the abdominal irritatives. If 
it is metastatic, then the metastasis must be treated. If it 
is psychical, longing, unsatisfied passion, then the same, if 
possible, must be done away with. 
The second indication is to operate directly on the 
proximate cause, that is to say, to operate immediately on 200 
MENTAL DISEASES. 
the mind and its organ, in order to restore the thinking 
faculty (direct cure of insanity). 
There are two ways by which we may reach the mind, 
the corporeal and the spiritual. The corporeal is the most 
essential in mental diseases. Of all insanities cured, cer- 
tainly two thirds have been healed by physical means. It 
is, however, proper and most efficacious, to unite both 
modes. 
Thephysical treatment has two indications. 
The first is to produce, by contraslimulants, a derivation 
from the sensorium, and thereby to restore its balance and 
normal action. The most important counter-point of the 
brain is the abdominal nervous system (whence the inac- 
tivity of the intestines and abdominal viscera in every vio- 
lent insanity). To bring these viscera into greater activity 
must, therefore, be our first endeavor,’ by this proceeding 
the cure is most frequently successful, and the balance of 
the nervous action is restored. In addition to this, the 
continued use of cream of tartar, soluble tartar, and emetic 
tartar, in divided doses, with dissolvent extracts ; in greater 
degrees of inactivity, rad. and extract of hellebor. nigr., rad. 
veratri albi, herba gratiolaq tinct. colocynth., calomel. The 
nauseating treatment and hunger must also be mentioned 
here, since they operate strongly on the nerves. Next to 
them, the contraslimulants by cutaneous irritatives, sus- 
tains an important place ; the application of vesicatories 
artificial ulcers (especially a seton in the neck), anlimonial 
ointment, artificial creation of exanthematous maladies 
(infection of the itch has cured insanity), application of 
moxa, actual cautery on the neck and head (accidental 
burning cured insanity) j generally, creation of corporeal 
pains and complaints. 
The second is to produce an alteration of the brain by 
remedies acting directly and specifically on it. The most 
valuable and confirmed by experience are : herba digitalis, 
in large doses, thirty to forty grains daily in infusion, hy- 
oscyamus, herb, and rad. belladonnas, aqua laurocerasi, 
stramonium, camphor; a combination of belladonna with 
aq. laurocerasi (liquor, belladonnas cyanicus, vide No. 50), 
1 have found particularly efficacious. If the vascular sys- 
tem is simultaneously excited, digitalis combined with 
nitre (vide No. 51), cannot be sufficiently recommended ; 
and in intervals, small doses of tartar emetic ; cold water, 
externally in affusions, and taken internally to the amount 
of sixteen to twenty pounds daily. In the use of narcotics 
precaution is necessary, lest excess and too long continu- MENTAL DISEASES. 
ance might change insanity into imbecility. Opium is less 
appropriate, on account of its constipating quality, and 
causing congestions to the head ; it is salutary only in 
very debilitated individuals, after sanguineous excitement 
has abated, or in cases which are due to nervous debility, 
©• g. in delirium potatorum. 
Th e psychical treatment maybe divided into two classes ; 
the first embracing that which is common to all kinds of 
insanity, and the second relating to the special and indi- 
vidual particularity of the patient, which is to be sought 
from the first, and must be adapted to it. 
The General Psychical Treatment. 
Psychical treatment has for its end to make reason pre- 
dominate over irrationality. This end is attained by edu- 
cation ; for ill-bred children resemble the insane ; caprice, 
ill-nature, irrationality prevail over reason. The psychical 
cure is nothing but the art of education applied to insanity, 
and the rules and means of every kind of education are 
applicable to insanity. Therefore, the first consideration 
is obedience. It is the foundation of education. Obedi- 
ence is the habit to subordinate one’s own will to that of 
another, and thereby learn to subject it to the supreme 
will of reason. The insane, like obstinate, capricious chil- 
dren, are first to be accustomed to discipline. In all things, 
even in trifles, he must learn to obey. They must fre- 
quently be commanded to do that which is contrary to 
their will. 
The second means is work, occupation, partly mental, 
partly corporeal, but mostly the latter, connected with ex- 
ercise and the enjoyment of free air. By this the mind is 
withdrawn from indulging too much in its own thoughts, 
attracted elsewhere, and placed again in connection with 
the external world. Idleness is the mother of all evil. 
The choice of occupation must be suited to the education 
of the person, and the species of insanity. 
The third is exact order, strict distribution of time, and 
subjection to authority. 
The fourth is, to exhilarate by agreeable impressions on 
the senses, especially by music, the power of which on the 
mind is far greater than is generally imagined. 
The fifth is punishments and rewards, as with children. 
With this view, strait jackets, cold shower-bath, tread-mill, 202 
MENTAL DISEASES. 
in extreme cases, even corporeal chastisement, but only 
when the patient is strong and obstinate. 
The sixth, belief and confidence in one person, especially 
in the physician. The insane must be brought to the full 
conviction that he is his friend, and thinks and does his 
best for him, therefore the physician must be without 
defects. 
The seventh, crowning the whole mental cure, is to 
awaken and fortify the moral and religious principle of the 
patient. Religion is the best thing in man ; it is that which 
properly constitutes him such a one ; it is the essential 
part of his life ; therefore it is religion, when all other 
means fail, that the patient’s thoughts and actions must be 
referred to. On this account, going to church and conver- 
sation with a sensible clergyman are advised. 
Finally, change of place, habitual attendants and objects 
are mighty auxiliaries. 
In violently excited, raging individuals, mental irritation 
and exercise must be withdrawn, and compulsory measures 
must be taken, of which the strait jacket, convincing the 
patient of his impotency, and the darkness of a cushioned 
room are of great effect. 
The Special Treatment. 
Besides these general rules, the individuality of the mind 
affected, and the various species of insanity must be con- 
sidered. The proud must be humbled, the timid and de- 
jected raised ; the monomania, illusion of the senses, or of 
the imagination, are to be treated according to their nature, 
and the patient will be best undeceived by entering into his 
hallucination and annihilating it by itself. 
The psychical treatment can, it is true, do much, some- 
times all, towards curing ; but cases merely psychical are 
rare ; for the body always partakes more or less of the 
disease. Therefore, it is best to unite both methods, the 
corporeal and the mental, as the surest means to attain the 
end. 
The curability of insanity is in the average of one to 
five, at highest four. HYPOCHONDRIASIS. 
203 
hypochondria, hysteria 
Male, Female 
Hypochondriasis. 
Diagnosis. Great disposition to spasms and nervous at- 
tacks of many forms, great variation and contrariety in the 
natural phenomena of the system, remarkable idiosyncras- 
ies and sympathies, disorders of the digestive system, and 
great consequent sympathetic influence on the whole body, 
disposition to flatulency, constipation, inclination to solitude 
and sadness, mind continually occupied about imaginary 
diseases, which belief becomes a fixed idea and predomi- 
nates over reason; singular fancies, incessant meditation. 
In general, there is anxiety, pusillanimity, sadness, or ex- 
travagant mirth without cause, rapidly alternating with, 
each other; inclination to weep. Paie, watery urine and 
frequent urgency to pass it (a sure indication of threaten- 
ing spasms), globus hystericus. 
symptoms are spasmodic sensations, and fits of all 
kinds, which in slight cases are of a light character; but 
in high decrees of hypochondria they are violent, dan- 
gerous and even fatal, e.g. catalepsy, asphyxia, hydropho- 
bia, epilepsy, deliria, violent frenzy, somnambulism; in 
which cases we must carefully distinguish between deli- 
rium, true insanity and epilepsy. 
Hypochondria and hysteria are but sexually, not essen- 
tially different. Hypochondria is the male, hysteria the 
female form of the same malady. The difference between a 
phlogistic and a nervous hypochondriasis is very important. 
The duration is indefinite ; it may last years or lor life, 
interrupted by long intervals. 
It is not a fatal disease, but is very troublesome to the 
sufferer as well as to others ; on this account, two methods 
of treatment are required: to encourage the patient while 
he suffers under the apparently dangerous attacks of suf- 
focation, epileptic fits, swoons, lasting for hours, asphyxia, 
(as long as they are of hysteric nature, they are not 
perilous) ; and to inculcate patience, and particularly to ad- 
monish against the deception of hallucinations. 
Pathogenesis. The proximate cause is morbidly exalted 
and unnatural sensibility of the nervous system ; especially 
of the digestive organs, which may create extraordinary 
reactions, novel and uncommon sympathies. 204 
HYPOCHONDRIA. HYSTERIA. 
The remote causes may be divided into the following 
chief classes. 
1. Debility of the nerves, especially from excesses in 
venery and onanism in both sexes ; immoderate exertion of 
the faculty of thinking, also of feeling, perpetual physical 
or moral sufferings, as pains, sorrow, excessive corporeal 
exertion, continuous debilitating evacuations, especially 
loss of blood by too frequent venesections, menstrua, hem- 
orrhoids, chronic diarrhma (also hypercatharsis), gonor- 
rhoea, in the female sex (often as secret cause) fluor albus. 
2. Irritation, especially that caused by suppressions, ac- 
cumulations in the abdomen, plethora abdominalis (anom- 
alous or suppressed piles, dysmenorrhoea), worms, gout 
(atonic, irregular, suppressed). Hypochondria is often 
nothing but a gouty affection—arthritic matter thrown on 
the nerves, and disappears as soon as local podagra ap- 
pears, leaving the patient gay and free from spasms. In the 
female sex, increased and unsatisfied sexual desire is a fre- 
quent cause of hysterics, therefore it is common in such as 
exalt their imagination by reading novels, plays and ro- 
mances 5 in young widows. Also psoric or rheumatic 
irritation (from light dress, by antagonism) and metastases 
of other morbid matters, lurking syphilis. Of all this, the 
physician must carefully inquire. Several causes united, 
frequently conspire to produce the disease. 
Therapeutics. The fundamental idea of treatment is to 
diminish the morbidly increased sensibility of the nervous 
system, especially of the gangliary portion of it, and to 
restore the balance of its action, by removing the morbid 
irritating and debilitating causes which affect and disturb 
it, or by immediately altering and invigorating the nervous 
system. 
1. The first question is : does the disease arise from 
material causes or not 1 Most frequently accumulations 
and obstructions in the abdomen, constipation and hemor- 
rhoidal plenitude are at the bottom, as is implied in the 
name morbus ex hypochondriis, and claim the first and most 
momentous consideration. 
The symptoms are as follows : regarding the causes— 
sedentary life, compression of the abdomen by lacing, long 
continuance of sorrow, indigestible food, sallow complex- 
ion, and conjunctiva, the same around the mouth and nose, 
belly tumid, and also on accurate examination an enlarge- 
ment or hardness of single viscera ; appetite bad or very 
unequal ; tension in the stomach after eating ; stools gen- 
erally tardy, hard, sometimes also constipation for several hypochondria, hysteria. 
205 
days, then sudden diarrhoea ; piles, or at least hemorrhoidal 
disposition ; finally, the long duration of the disease, which 
always produces abdominal obstructions, so that roborantia 
are injurious, but solvents are beneficial. 
The method of cure is the solvent, the visceral cure. 
Succi recens expressi, or extr. taraxaci, gramin., fumar., 
millefol, centaur, min., marrub, chelidon., serum lactis, 
terra foliata tart., tartar tartarisat, antimonials, alkalines, 
especially nitre, medicated soap, lime water, sulphur, gum- 
mi ammoniac, guaiac., asa foetida. Drinking largely of 
"Water, the solvent mineral waters, Sellers, Fachinger, 
Sedlitz waters. In obstinate constipations, mercury, in- 
ternally and externally, pulv. Plummeri, baryt. rnuriat., 
cicuta, belladonna, aloe, tr. colocynth., pil. balsam., elixir 
aperit. pharm. Pruss., tr. antimonii acris, Carlsbad, Mari- 
enbad, clysters, tepid baths, especially soap and salt baths. 
This treatment is often alone sufficient for a cure, for 
freeing and restoring the abdominal functions and the bal- 
ance of the nervous system. 
It is of consequence to observe the following rules: For 
irritable, plethoric, phlogistic, atrabilious individuals, dis- 
posed to hemorrhoids, we are to give cooling dissolvents, 
juices of herbs, extracts, saline solutions (vide No. 52), 
alkaline mineral waters; for relaxed, cold, phlegmatic, 
mucous subjects the stronger (vide No. 53), and more 
ardent are only to be used, as aloetica (vide No. 54) ; in 
sanguineous accumulations in the abdomen, sulphurica, and 
from time to time, leeches ad anum. 
To purge is not to resolve, but on the contrary, to im- 
pede a solvent effect. Therefore we ought to prescribe 
the resolventia only in such doses as will produce one or 
two stools a day. This is often sufficient for the whole 
cure. But when signs of turgescence, loss of appetite, 
tumefaction of the abdomen, tension and colic set in, pur- 
gatives must be resorted to (especially Saidschutz or Pill- 
na bitter water), or also emetics, according to indication. 
In obstinate constipation and infarcts, clysters are the 
principal remedy. 
In individuals very liable to spasms we must combine 
the resolvents with antispasmodics; in great debility, 
with roborants, bitters and saline remedies ; and towards 
the end of the malady, where weakness keeps up the ob- 
structions, chalybeate waters. 
Corporeal exercise, especially on horseback, is indispen- 
sable to the cure. It is often alone sufficient to effectuate 
the solution and to free the abdomen : likewise friction of 206 
HYPOCHONDRIA.' HYSTERIA. 
the abdomen, which is more efficacious if performed in the 
morning, when in a jejune state. 
Moreover, we must not neglect to take into consideration 
other material causes of the disease which lie latent, as the 
arthritic, scrofulous, rheumatic, psoric, syphilitic dyscrasia 
and worms, and to remove them. 
2. When debility is the only cause (merely nervous hy- 
pochondria), recognizable by the pre-existing debilitating 
circumstances, as fluor albus, chronic diarrhoea, loss of 
blood, especially menstrua nimia, frequent waste of semen, 
gonorrhoea chronica, even the evacuating and resolvent 
method carried too far, as shown by the signs of general 
weakness, weak pulse, being easily fatigued, deficiency of 
animal warmth, etc., and by the absence of other material 
causes: its removal is the principal object of cure, and this 
alone is sufficient ; for no cure can be effected while these 
causes of debility are suffered to exist. Therefore, the 
diarrhoea, gonorrhoea, hsemorrhagia, fluor albus, particularly 
pollutions, which are frequent causes of nervous hypochon- 
dria must be remedied. The cure of the latter is not easy, 
since weakness of the genitals is always combined with in- 
creased irritability, and the usual strengthening and restora- 
tive remedies would simultaneously increase the irritation 
and afflux of humors, and thereby their discharge. On this 
account we give only cooling, strengthening, astringent and. 
nutritive remedies, such as the elixir acidum Halleri (vide 
No. 55), alum, terra catechu (vide No, 56), kino ; and the 
maxim, “ fast and work,” is to he observed ; stimulant ali- 
ments avoided, and much muscular exercise performed. 
When the irritability has been diminished, quinine,quassia, 
columbo, iron, gelatin of lichen island., cold baths, general 
and local—douches on the genitals, the perimeum, or sa- 
crum, strengthening embrocations on the lower part of the 
spine, finally sea bathing, the baths of Pyrmont and Dry- 
burg are useful. 
3. The third point of treatment consists in changingand 
invigorating nervous life ; a treatment which, in purely 
nervous hypochondria, may be pursued from the beginning, 
and is all that is requisite. In the material hypochondria 
the nervous treatment must be combined with a material 
one. The modifying, antispasmodic method is intended to 
improve the internal anomalous state of nervous life, the 
morbidly increased sensitiveness of the whole economy, 
and particularly of the digestive system. It is to be ob- 
served, that the diminishing of this increased sensibility and 
of the constantly irritated "state connected with it, amounts 207 
HYPOCHONDRIA. HYSTERIA. 
to invigoration, and is even the best treatment for irritable 
individuals. It is effected by the use of antispasmodic 
nervines : rad. valeriana, fob and cort. aurant., rad. cary- 
ophyllat., castoreum, galbanum, asa feet., elix. acid. Halleri 
and Mynsicht., liquor anodyn. Hofmanni, phosphoric acid., 
and tepid baths, either simple or mixed with herbs, which 
strengthen the nerves. The use of these mild remedies 
continued for a long time (several months), can prove very 
beneficial. Even an infusion of a few green orange leaves, 
taken cold morning and evening, can be most serviceable. 
The tea No. 57 1 can recommend from my own experience, 
as often sufficient for a cure. 
A principal part of this treatment, which must never be 
neglected in the cure of hypochondria and hysterics, is to 
restore the disturbed balance of the nervous action (espe- 
cially between the irritable and sensitive systems), by 
much muscular exercise and tepid baths; and to animate 
the nerves by the universal, subtile, invisible and impon- 
derable vital substance of the atmosphere by daily exercise 
in the free air, living in the country, travelling. Daily air- 
ing is, in nervous weakness, the most invigorating means 
of all, not to be replaced by any other, more efficacious 
than all others, and has no contra-indication. 
The properly strengthening method may sometimes be 
of use in unison with the modifying, but it must always be 
had recourse to at the end of the cure ; for weakness arises 
in every kind of hypochondria by the disease itself, and in- 
vigoration is necessary for the confirmation of the cure, 
and preventing a recurrence of the disease. The degree 
of irritability and the state of the digestive organs must be 
carefully regarded, in order to succeed. 
The fixed astringent roborantia, given immediately in 
the beginning, or while great irritability exists, do not 
digest, but create complaints of the stomach, anxiety, 
spasms, diminish the appetite and fail to strengthen. If 
the same are given while the digestive ways are embar- 
rassed, they will create the same troubles. We must there- 
fore distinguish the various degrees of irritability. The 
greater it fs, the more caution is to be used in selecting 
the decree of irritative and roborative remedies, especially 
when there is great irritability of the vascular system and 
a disposition to congestions. Here the continued use of 
elixir acid. Halleri, and if that be too strong, of acid, phos- 
phor. in connection with valerian, fol. aurant., herb, millef. 
and tepid medicated (herb) baths are often the best robora- 
tives, and it is only by degrees that we may pass to stronger 208 
HYPOCHONDRIA. HYSTERIA. 
bitters and roborantia. Likewise, when the digestive or- 
gans are not entirely free of impurities (which cannot be 
obtained in some hypochondriacs on account of weakness), 
the pure bitters, and in the first place the resolvent, infus. 
and extract, taraxac., millefol., centaur, minor, trifol. fibr., 
marrub. are to be used, after which absinth., then rad. co- 
lumbo, lign. quass. (this especially as a cold infusion) ; in 
such cases, also a combination of rhubarb or tart. emet. is re- 
commendable. Gradually we may proceed, prescribing the 
stronger astringent roborantia, Peruvian bark, cort. aurant., 
cascarill., iron, chalybeate waters, Pyrmont, Dryburg, Spa, 
Schwalbach, Cudowa. But also here it is important to 
remark, that it will be well to commence with volatile 
forms of these remedies, e.g. with the tincture cinchonse 
Whytii, tinctura ferri eetherea (vide No. 58), or flor. sal. 
ammon. martial, or mineral water, and to pass but gradu- 
ally to the fixed forms. Baths, first strengthening herb- 
baths, then chalybeate baths (green vitriol, three drachms 
for one bath), cold bathing in the river, still better in the 
sea, are here indispensable, even frequently more strength- 
ening than internal remedies. 
There are cases, where the nervous irritability and 
irritation are so great, that every thing, even the mildest 
medicament creates excitement. In these cases the best 
roborative treatment will be negative invigoration by rest 
of the body and mind, by withdrawing irritations, espe- 
cially all substances which have a tendency to the nerves, 
tranquil life in the country, milk diet (vide general cure of 
nervous disease). 
In the general treatment, but especially in the strength- 
ening, a strict diet is essential. It consists in avoiding 
warm beverages, coffee, tea, all flatulent indigestive vege- 
tables, especially onions, pulse, cabbage, and all excess in 
food. For the hypochondriacal are very liable to indiges- 
tion, which requires gastric evacuants, and these always 
lessen the roborative treatment. 
The palliative treatment is of great moment to hypo- 
chondriacs and hysterical persons, since it is not only in- 
dispensable for alleviating life, but also composes a part of 
the general treatment, inasmuch as to appease the nerves 
is essentially to cure. Such patients must have always a 
palliative on hand. Their principal complaints are spasms, 
constipation of the bowels, acidity in the priime via; and 
flatulency, for these are the principal causes and com- 
plaints. Thence antispasmodica, antacida, carminativa, 
and open bowels are the best palliative remedies. On this HYPOCHONDRIA. HYSTERIA. 
209 
principle rests tb e solamen hypochondriac or um (a compound 
powder of magnesia carb., tartar, vitriol., rhubarb, rad. 
valerianse together with semen foeniculi), which every hy- 
pochondriac ought to have by him. Besides, injections (of 
asa foctida 1 to 2 drachms triturated with gurnrni arable, 
for hysterical persons) and footbaths are of great relief; 
for frequently the whole attack passes away, when the pa- 
tient gets rid of flatus. Farther, all kinds of antispasmodics 
especially liquor anodyn. Hofmanni, tinct. valerianse, cas- 
torei, liq. c. c. succin., asa foetida, embrocations of anti- 
spasmodic ointment on the pit of the stomach and spine ; in 
swoonings the forehead and temples are to be washed with 
aromatic water, burning feathers, cut onion to be held to the 
nose. It may be well to remark that, in order to meet the va- 
rious sensibilities that exist in a case of hypochondria, it will 
be proper to combine several antispasmodics together ; that 
the odoriferous, as musk, are to be avoided, also opium, be- 
cause this last constipates, and easily becomes a habit diffi- 
cult to be dispensed with, for which reason it ought to be 
seldom prescribed. The most general and the safest anti- 
spasmodic for such patients is hyoscyamus, in preference 
to opium. It does not constipate, nor heat as opium does, 
but operates assuagingly on the mental disposition of the 
patient, which is very important in this malady. 
In all nervous attacks it is important to distinguish the 
constitutio calida phlogistica from the comtitutiu frigida ner- 
vosa, i. e. the combination of nervous weakness with ple- 
thora and irritability of the vascular system, or its absence. 
In the first case all ardent antispasmodics and irritatives 
are to be avoided, and cooling ones, as flor. zinci, hyoscy- 
amus, aqua lanrocerasi, spirit, nitric, seth , antistimuli, de- 
rivations by foot-baths, sinapisms, injections are to be 
used in preference. 
Generally, abstraction of blood, especially by venesec- 
tion, is injurious in all purely nervous, particularly hyste- 
rical cases; it can even make them extremely violent and 
dangerous. 
The hypochondriacal and hysterical attacks, it is true, 
attain a degree of violence, which is apt to create anx- 
iety, especially in inexperienced young practitioners, and 
to misguide them. Of that number are the swoonings, in- 
creased to asphyxia, which may last for hours, even days; 
the strangulatio and suffocatio hysterica, in which the pa- 
tients lie for hours in constant danger of suffocation, with- 
out breathing, exhibiting convulsions apparently epileptical 
and violent fixed pains in the chest and the abdomen, might 
18* 210 
SPASMODIC DISEASES, 
easily be taken for local inflammations. Here a right diag- 
nosis is most important to distinguish those fits from the 
hypochondriacal and hysterical, that is, the merely spas- 
modic, and to discern them from inflammatory ones. The 
signs are, pale, limpid urine, with trequent urgency to pass 
it; globus hystericus, inclination to weep, previous know- 
ledge of the hysterical character, the trifling occasion of 
those attacks, and the absence of fever. 
As soon as their nature is recognised as such, the dan- 
ger of the attack ceases, and the remedies above-mention- 
ed suffice to remove it. We except the only case, when 
the patient is young and plethoric, or suppression of a 
preceding hemorrhage has preceded. Here, a long dura- 
tion and violence may of course cause a dangerous ac- 
cumulation of blood in noble parts, as apoplexy and the 
like ; in such a case abstraction of blood, which elsewhere 
would be injurious and even dangerous, is necessary as a 
symptomatic means. 
Anomalies of Motion and Sensation. 
2. SPASMODIC DISEASES 
We comprise under the word spasm in its most extended 
sense, all anomalies of nervous action, not only of motion 
(spasmi tonici et clonici, convulsiones), but also of sensation 
(pseudcssthesice), in its increased as well as in its alienated 
form. They are variously modified, according to the di- 
versity of the organ, in which they are located, but are all 
one and the same in character. The same is true in re- 
gard to their fundamental indication, which is variously 
modified by variety of locality. 
FALLING SICKNESS. 
Epilepsia. 
Diagnosis. Convulsive motions with loss of conscious- 
ness. Falling down with cries, foam at the«mouth, the 
thumbs flexed into the palms (the only muscles which, 
while all others are convulsively moved, remain tetani- 
cally stiff). The consciousness is the most essential pa- 
thognomic symptom, and not the violency of convulsions. 
The weakest convulsion with unconsciousness is epilepsyj 
the most violent, consciousness existing, are not epileptic. 
The attacks occur by paroxysms. Every paroxysm has 211 
EPILEPSY. 
two stages, the convulsive, lasting for some minutes up to 
two or three hours, and the soporous apoplectic. Presages 
are sometimes entirely wanting, and the patient uttering a 
cry, falls suddenly, as thunderstruck, to the floor. Some- 
times signs precede, anxiety, headache, nausea ; the most 
remarkable is the aura epileptica, the feeling of a cool breath 
or wind, which commences at the point of a finger or a toe, 
raises upwards, and then, as soon as it reaches the brain, 
produces the fit. Sometimes the aura proceeds from an 
organ of the senses, and exhibits itself as a foreign smell, 
taste, color, double sight, and the like. 
The attacks occur sometimes typically, at certain periods 
and days, sometimes every night (epilepsia nocturna) ; but 
more frequently at indefinite times, weekly, monthly, even 
yearly once or twice. 
Duration most indefinite, often through life. The prog- 
nosis is unfavorable, the disease is difficult to cure, not 
fatal, but dangerous on account of falling and accidental 
lesions, troublesome and horrible to behold, perilous even 
by possibly communicating itself by infection ; ending in 
weakness of the mental faculties, even in stupidity. 
Curability in proportion of 1 to 20 ; a fatal issue rare. 
Transition into imbecility, fatuitas, also into insanity (some- 
times alternating), hydrops, tabes. 
Pathogenesis. The proximate cause is a great anorma- 
lity of nervous action, always seated in the brain, probably 
in the cerebral organ of motion, medulla oblongata. This 
forms the most essential difference between epilepsia and 
chorea and other convulsions. There are no organic faults ; 
for many epileptical individuals have been dissected, with- 
out discovering them. They can operate only as remote 
causes. 
The remote causes, besides the general, are: hereditary 
disposition, debilitation of the nervous system, especially 
by onanism and excessive venery, violent fright, infection 
by the sight of it, worms, particularly tape-worms, gastric 
accumulations, infarcts, obstructions of the viscera, meta- 
stases to the nerves, especially scabious and herpetic, le- 
sions of the head, local and mechanical irritations, splint- 
ers of bone, caries occulta, suppressed hemorrhages, espe- 
cially epistaxis. 
To this must be added, when epilepsy has lasted for a 
considerable time, habitus, the disposition of the nervous 
system to this anomalous action having become a habit. 
Therapeutics. The radical cure has the following indi- 
cations : 212 
EPILEPSY. 
1. Look for the remote cause and remove it. This is 
often alone sufficient to perform a cure, and such a causal 
cure is always more permanent than the specific. The most 
frequent causes are three, to which I would lead attention ; 
the abdominal irritants, such as worms, infarcts, obstruc- 
tion of the viscera. Here resolventia must be used and 
continued for a long time ; at the same time emetics every 
eight days, in obstinate cases drastics in small doses (scam- 
monium, aloe, calomel, tinct. colocynth.), clysters (I saw 
a case, in which a cure was effected by persisting in them 
for a year). Debility from onanism. Here the treatment 
of tabes nervosa and dorsalis, especially cinchona in sub- 
stance and chalybeates. Psoric acrimony shifted to the 
nerves. Here sulphur, antimonium, guaiac, sarsaparilla, 
dulcamara, mercury, sulphur-baths, artificial ulcers enter- 
tained for a long time in suppuration. 
2. Examine whether a constitutional fault originated and 
keeps up the disease. Here must be considered especially 
the disproportion between the vascular and nervous sys- 
tem, youthful plethoric individuality, suppressed hemorr- 
hoids, and menstrua. In such cases food and sleep are to 
be diminished, watery vegetable diet, much corporeal la- 
bor, venesection every six or eight weeks, a purgative ora 
bottle of bitter water every fortnight, fontanels, are advis- 
ed, the hemorrhoids and menstruation must be restored 
or compensated. I have succeeded to perform some cures 
by this treatment.—On the contrary, when there is exhaus- 
tion of the humors and vital powers, the restaurant and ro- 
borant method is necessary. 
3. If the disease, in spite of this indirect treatment, does 
not cease, or if none of the above-stated indications is 
present, then the direct or specific treatment of epilepsy 
takes place, which consists in operating immediately on 
the nervous system, to change and annihilate its anomalous 
action. 
Specifica anti-epileptica. Of the great number only six 
have proved to me most serviceable: zinc, cuprum, vale- 
rian folia aurantiorura, cinchona, cold affusions of the 
head, sea-bath. The most valuable of all, most frequently 
confirmed in my experience, is zinc, in large doses and con- 
tinued for a good while. T-he patient may commence with 
taking 1 grain morning and evening, best in the form of 
pills (vide No. 59), and increase the dose every other day 
one half grain, until nausea succeeds ; when the dose is not 
to be augmented, but diminished. Thus, gradually rising 
up to 10, even 20 grains may be given without detriment, 213 
and must be continued in a high degree of the disease for 
months, yea for years; in a lower degree at least 14 days 
in every month. Very efficacious is a combination of se- 
veral of the above-named remedies (vide No. 60). I have 
found the use of valerian to be made more efficacious, by 
adding to it oleum valerianse (vide No. 61). The folia au- 
rantiorum (1 dram of the powder taken three times a-day, 
and a tea of orange-leaves after every dose), have proved 
in my experience alone sufficient to cure epilepsy arising 
from onanism. I can also confirm the rad. artemis. vulgar., 
1 drachm taken every evening in warm beer and waiting for 
a sweat, as useful. The same may be said of Ragolo’s 
powder.* In the most obstinate cases argentum nitric, 
used with great precaution (vide No. 62) is of service, 
but it has a bad consequence,—the patients turn black 
after its use. 
EPILEPSY. 
Besides these, the narcotics (with the exception of 
opium, which is not proper on account of its power of 
creating congestions to the head, even is dangerous, since 
it is apt to change epilepsy into apoplexy), stramonium, 
belladonna, hyoscyamus, aconite, digitalis; but I must not 
forbear to caution against strong doses, and for too long a 
time ; for, though they may cure epilepsy, they may cause 
a transition into fatuitas; likewise oleum animale Dippelii, 
cajeputi, mercury, vomits, phosphorus, sedumacre, galeurp 
luteum, cardaraine pratensis, electricity, setaceum nuchse, 
moxa, or the actual cautery to the cranium. 
The principal rule, to the neglect of which it is certainly 
owing, that the cure of epilepsy has been so rarely lasting, 
consists in continuing the remedies for a time sufficient, 
not only to prevent the actual paroxysms, but also to anni- 
hilate the habit, the peculiar disposition to it residing in 
the nerves. It will therefore be proper to continue the re- 
medies for several months; and, the fits having ceased, to 
persist in the same means with cinchona added, which have 
proved serviceable a fortnight in each month for several 
years. 
4. Should this method of cure be ineffective, try to cre- 
ate an artificial crisis, especially cutaneous diseases (ino- 
culation of the itch), flowing hemorrhoids. 
The palliative treatment consists in preventing the fit. It 
is only possible, when the attack is foreboded. The most 
efficient remedies are : a vomit, liquor c. c. succln. 60 
♦ According to Gmelin and Fenerlein this remedy maybe com- 
posed as follows : rad. valerian, half a drachm, magnes. alb. and sal 
ammoniac of each 3 grains, oleum cajeput. 2 drops. 214 
drops, oleum animale, particularly pulv. rad. artemis. vul- 
gar., 1 drachm in warm beer, and to retire immediately after 
taking it. In the epilepsia manu-sxjwptomatica and pedi-symp- 
tomatica, the joint of the hand or foot may be tied up, by 
which the nerves are, so to say, tied up, and the aura is 
prevented from propagating to the brain. Such men do 
best to wear a leathern band with a tourniquet on the part, 
and lighten it as soon as the aura is felt. During the fit 
itself, the patient being unable to swallow, and injection 
inapplicable, since the anus is closed, or it is imme- 
diately evacuated, nothing can be done but to put him on 
a soft bed, and let his spasms work off, taking care only 
that he may not injure himself; for any force or fastening 
increases the spasms. 
CHOREA. 
ST. VITUS5 DANCE. 
Chorea. 
Diagnosis. Involuntary motions of single members or 
the whole body, which have this peculiarity, that they re- 
present the kinds of motions most common to the patient, 
and wander from one part to another, consciousness re- 
maining, which is a distinctive feature of the latter from 
epilepsy. 
It varies very much both in degree and form. Some- 
times the involuntary motions seize only single parts, as 
the arm, the facial muscles, the tongue (even periodical 
stammering comes under this head), sometimes only one 
half of the body (chorea dimid.ata), sometimes it is perio- 
dical, sometimes permanent ; sleep alone procures rest. 
Sometimes it produces the most violent muscular exertions 
and contortions, such as dancing for hours until falling 
down from fatigue, turning on one leg, the most singular 
leaps and violent jerks of the body upwards and to a dis- 
tance. Also the running spasm, when the feet run away 
with the patient, and he is obliged to run for hours irre- 
sistibly, until he falls down, is here to be counted. 
The disease occurs most frequently at the time of the 
development of puberty, from the seventh to the sixteenth 
year of age, more among the female than amono- the male 
oftener in moist coastward regions, than in places situat- 
ed higher. It may occur also epidemical, even communi- 
catively, especially in great assemblages. 
It is not accompanied with any danger to life, and is ge- 
nerally curable, but partial contortions, e.g. of the facial CATALEPSY. 
215 
muscles, may remain a grievous inheritance throuo-h 
life. 
Pathogenesis. The proximate cause is anormality of ner- 
vous life and its action, excepting the brain, hence it is 
probably an affection of the spinal marrow. 
Remote causes are, besides the general : all nervous dis- 
eases, the developing process of puberty, irritation from 
worms, moist climate. 
Therapeutics. The treatment is the same as in epilepsy. 
The most efficacious remedy, by which the end is almost 
ever obtained, is zinc ; then valerian, copper, asa foetida, 
baths, first tepid, then cold river baths. Worms and other 
remote causes must be removed. 
CATALEPSY. 
Catalepsis. 
Diagnosis. Mutual influence of soul and body annihilat- 
ed, insensibility to external impressions, immovability, but 
at the same time no spasmodic stiffness of the muscles, but 
flexibility, so that the limbs assume and retain any posi- 
tion which is given to them; body and soul continue in the 
very situation in which the attack has befallen them ; the 
body persisting in the same position, the soul in the same 
series of thoughts, even words. The internal sense is re- 
tired and sunk into itself, without clear consciousness, 
often accompanied with dreams and visions ; organic life 
is undisturbed. The fit lasts for minutes, hours, even 
days; after it the patient awakes as from a deep sleep. 
Sometimes during the fit novel and singular consensus 
and senses are formed, as hearing and perceiving by the 
pit of the stomach or sole of the foot. 
This accident has been the foundation of many religious 
reveries and superstition, e.g. Mahomet’s inspirations, 
which he pretended to receive in that way; the belief of 
bewitching, demoniac possessions, a fate which it has 
shared with epilepsia, chorea, vesania. Medicine has bene- 
fited and may still benefit mankind in explaining these 
phenomena as natural effects of a nervous disease, not ow- 
ing to spiritual influences, and teaching how to heal them 
by natural means. Thus it has done away with witch-suits 
and funeral piles. 
Pathogenesis. The proximate cause, a most singular 
mental and nervous state, similar to sleep, when also the 
mutual influence of the soul on the body is annihilated, 216 
SOMNAMBULISM. 
therefore greatly approximating to somnambulism. The 
gangliary system seems here to take the principal part. 
The remote causes are the same as those of epilepsy and 
chorea. Most frequently it is owing to hysterics, exagge- 
rated fancy, and sensibility in the female sex, masturba- 
tion, over-excited and unsatisfied sexual desire, worms, 
metastases. 
Therapeutics. The treatment of nervous diseases in ge- 
neral; searching after and doing away with the remote 
cause. The direct cure is effected by zinc, valerian, cin- 
chona, orange leaves in powder and infusion, besides cold 
baths, enjoyment of free air, strong corporeal exercise and 
activity are, according to my experience the best,* also 
magnetism has proved beneficial. 
SOMNAMBULISM. 
Somnambulismus. 
Diagnosis. To hear, speak, walk, or perform other ac- 
tions while asleep, as if awake, but without being conscious 
of them, and without remembering them when awoke. 
A lower degree is dreaming; the higher speaking dur- 
ing sleep; still higher to hear and answer; higher yet, to 
rise, walk about, and do business; the highest is clair- 
voyance ,external and internal sensibility increased above 
the common limits (as in catalepsy). 
Both states, somnambulism and catalepsy, resemble and 
pass into each other. 
This distemper happens most frequently during child- 
hood and youth, and wears away with advancing age ;to 
some individuals, however, it is attached for life. The full- 
moon often exercises an influence on the patients, thence 
they are also called lunatics. 
It is without danger, but is troublesome, and is dangerous 
on account of the accidents to which such persons may be 
exposed in walking about during the night. 
Pathogenesis. The cause of it is too lively an imagina- 
tion and senses during sleep. 
The gangliary system, it cannot be denied, plays a prin- 
cipal part, and this state seems to reside in a preponder- 
ance of the action of this system over the cerebral; the 
perception and representation of that system (the animal 
soul) predominating over the intellectual faculties of the 
mind, the latter entirely retiring. The sexual system is of NIGHTMARE. 
217 
great influence on this malady, and this state is met with 
more frequently among females than males. 
The remote causeS"are the same as in chorea, especially 
the development of puberty, sanguineous congestion to the 
head, and worms. 
Recently it has been discovered that this state may be 
excited by the manipulations of magnetizing, and we now- 
a-days distinguish somnambulismus naturalis and artijicialis. 
Therapeutics. The causes are similar to those of nervous 
diseases in general, especially of chorea and catalepsis. In 
order to prevent walking while asleep during night, be* 
sides tying the individual, a tub may be placed before 
the bed of the patient, containing cold water, into which 
he is obliged to step, when rising, and which awakens 
him. 
NIGHTMARE. 
Epkialtes, Incubus. 
Diagnosis. During sleep the feeling of a heavy pressure 
on the prsecordial region, which impedes breathing; great 
anxiety, and many images of fancy (phantasmas, visions), 
created by the causes of the pressure, e.g. flying men, 
dogs, bears, monsters, also robbers, murderers ; in which 
the sufferer strives often for a long time in vain to raise 
and move himself, or to cry for assistance, until he finally 
succeeds to utter a cry of anguish, by which he generally 
awakes, and the painful state terminates. This commonly 
happens in the first hours of'sleep, with some rarely, with 
others almost every night, disturbing the sleep and injur- 
ing the general state of health. 
The accident depends on a particular cramp-like affec- 
tion of the prsecordial nerves, and their consensual opera- 
tion on the brain. The causes may be triple: either me- 
chanical pressure of an overloaded distended stomach (too 
rich supper of indigestible meals, accumulation of winds), 
or plethora of the abdomen, general or local; or lying on 
the back, by which likewise accumulation of blood or winds 
to the prsecordial region is favored. 
The treatment consists in removing the occasional 
causes, remedying the general or local plenitude of blood, 
accumulation of winds, constipation, avoiding supper and 
lying on the back. 218 
AGRYPNIA. RAPHANIA. 
SLEEPLESSNESS. 
Jlgrypnia. 
Diagnosis. Impossibility to get asleep, without any 
other disease, or any external or internal cause which 
might disturb rest. It may become a very tormenting evil 
lasting for months, even years, finally causing great weak- 
ness, emaciation, and disturbance of ail the functions. It 
may also be periodical, that is, return every other night. 
The causes are either morbidly increased excitability 
and mobility of the nerves 5 hence agrypnia is often a con- 
sequence of nervous fever and other nervous diseases ; or 
a deeply seated nervous irritation, either mental (secret 
grief, sorrow, suppressed passion), or corporeal, located 
most frequently in the abdomen, in the gangliary system. 
The cure must relate to the various causes, especially 
the abdominal irritations; therefore removal of the stag- 
nations of the abdominal plethora and infarcts gives the best 
relief. Besides the means which directly soporify the ner- 
vous system, tepid foot-baths before retiring, general luke- 
warm baths, the use of herb, or extr. hyoscyami, which 
is a surer and safer remedy than opium, 1 to 2 grains be- 
fore retiring, are recommendable ; also emplastr. or extract 
hyoscyami applied to both temples are advised. In non- 
plethoric, especially in debilitated old persons, a small 
glass of old Malaga wine is the best means to promote 
sleep. 
RAPHANIA 
Diagnosis. Violent convulsions and spasms with rigidity 
of the limbs, accompanied by a feeling of crawling, or a 
violent pain. 
The disease is rarely fatal, but it may pass into a chronic 
nervous one, in insanity and emaciation. 
Pathogenesis. It is always caused by living on bread 
mixed with spurred rye (seta/e cornutum) ; hence this dis- 
ease occurs in moist years, when this degeneration of corn 
is prevalent, and becomes endemical and epidemical. 
Therapeutics. The cure is easy, and surely effected by the 
following remedies; first a vomit, then a purgative, after 
this opium grain, along with sulphate of potash every 
three hours. 
The spasms, and often very painful contractions of the 
limbs are best relieved by contre-pressure and tying. TREMOR. TETANUS. TRISMUS. 
219 
TREMBLING, 
Tremor. 
Diagnosis. May be local and general, of various degrees, 
from the lowest to the most violent, passing into real con- 
vulsions and forcible involuntary motions of single limbs, 
as a forcible continued striking with one arm or foot, so 
that the patients hit themselves involuntarily; in some, 
continual shocks and shakings of all limbs, even of the 
head; a state which appears similar to chorea, but is dis- 
tinguished from it by the convulsiveness of the shocks and 
the absence of gesticulations. 
It is very difficult of cure, when it is idiopathic and arises 
from nervous weakness. 
Pathogenesis. The most common causes are: weakness 
or plethora, excessive use of ardent drinks, especially of 
brandy and coffee, metastasis, particularly arthritic. Most 
frequently a symptom or consequence of other diseases, 
especially after apoplectic fits, nervous fevers, and poison- 
ing with mercury, arsenic, and lead (particularly mercurial 
vapors and fumigations), but can finally become idiopathic 
and continue so. 
Therapeutics as in all spasms ; particular regard must be 
paid to the causes, such as metallic poisoning, metastases. 
In the idiopathic and purely nervous species, attention is 
due to the spinal marrow as being the original seat of the 
evil; therefore recourse must be had to remedies which 
have a specific tendency to this organ, as nux vomica, zinc, 
stramonium, chalybeate-baths (Pyrmont), cold baths, elec- 
tricity with strong shocks, moxa to the spine, and leeches 
on the same part, when there is suspicion of sanguineous 
congestion. 
TETANUS. TRISMUS. 
Diagnosis. Constant spasmodic contraction of one mus- 
cle (tetanus localis), or of all the musses (tetanus univer- 
salis). Of the first kind is tetanus lingual, penis (priapis- 
mus). The universal has received different names, accord- 
ing to the form which it gives to the body, which may be 
straight, rigid, and immovable; or bent forwards (em- 
prosthotonus), or bent backwards (opisthotonus'). 
The malady majr be continuous, or periodical; acute, or 
chronic. 
The duration is variable. The acute is generally very 220 
TETANUS. 
TRISMUS. 
short, lasting 3 to 7 days. The spasm finally seizes the 
chest, lungs, and heart, and kills in this manner by suffo- 
cation or apoplexy. The brain remains often free from 
disturbance to the end of the malady. The chronic form 
lasts much longer, especially if it be periodical. I have 
seen it continue for years, and in one case it would always 
return at the same period, and last eight hours each time. 
Constant trismus also may last for months, especially when 
it is of rheumatic or organic origin. 
The prognosis depends on the cause and the character. 
The disease is very dangerous, almost always fatal, in the 
idiopathic {tetanus neonatorum, and traumaticus); less so, 
when symptomatic of other maladies; least so, when it is 
a symptom of chronic nervous weakness and hysteria. 
Pathogenesis. The proximate cause is a particular affec- 
tion of the spinal marrow (not of the brain, as in epilepsy, 
for consciousness is not disturbed), and of the intercostal 
nerves. Remote causes are bilious and other gastric irri- 
tants (especially in trismus), rheumatisms, typhous, putrid, 
and miasmatic fevers, small pox, scarlatina, metastases, 
suppressed exanthemata; even suppressed gonorrhoea has 
created it; local irritation of external parts, wounds, espe- 
cially of tendinous and aponeurotic structures, punctured 
wounds, foreign bodies, as splinters, especially when thrust 
into the feet and hands, hysteria. 
Therapeutics. We must carefully discriminate whether 
tetanus or trismus is symptomatica! or idiopathic. In the 
first case, the disease of which it is a symptom is to be 
treated. In the gastric vomits and purgatives (even trismus 
yields promptly to emetics). In the inflammatory fevers, 
abstractions of blood and antiphlogistics; in the adynamic 
the most vigorous excitantia, antispasrnodica, opium and 
warm baths; in the putrid, musk, camphor, but no opium, 
for fear of increasing putrescency and colliquation ; in the 
rheumatic, camphor, liquor c. c. succin., warm baths, tar- 
tar. emetic., opium ; in hypochondriacal and hysterical per- 
sons, these diseases are to be cured and the nerves 
strengthened; in the metastatic, derivation and antistimu- 
lants ; in that which is due to suppressed gonorrhosa, the flux 
must be regenerated. 
Among the idiopathic are numbered those species, the 
cause of which is a primary irritation, idiopathically ope- 
rating on the nerves, especially foreign bodies. Their 
prompt removal, and then opium and warm baths perform 
the cure. Of special importance are two kinds, the tetanus 
neonatorum (vide diseases of children), and TETANUS. TRISMUS. 
221 
Tetanus Traumaticus, Trismus. 
It arises either immediately after a wound, in consequence 
of the violent pain or affection, nervous irritation, and. 
kills instantaneously (as soldiers are found with spasmodi- 
cally rigid limbs on the field of battle), or in the first few 
days after the wound, during its inflammatory stage, or 8 to 
14 days afterwards, whilst the wound is in the best process 
of healing and suppuration, without any inflammation and 
pain. Here the wound is apparently a predisposing cause, 
imparting increased sensibility to the nervous system. The 
exciting causes are mental affections, taking cold, corrupt 
air, or foreign bodies, also tension and distraction of single 
fibres in the wound, which are due to suppuration. The 
most perilous are punctured wounds in tendinous and apo- 
neurotic parts, as in the sole of the foot and the palm of 
the hand. Also glass and other splinters, sticking in for 
weeks, and leaving no visible wound, can cause this evil; 
the presence of which must be ascertained by a close ex- 
amination.—The pulse frequently remains normal, and the 
head is also free, but there is great anxiety and oppressed 
respiration. / 
Duration is two, three, four days; death by suffocation 
or apoplexy. 
The prognosis is most unfavorable ; mortality 20 to 1. 
Therapeutics. The foreign bodies must be removed, the 
wound enlarged, opiate ointment and cataplasms of hyos- 
cyamus and opium applied. The principal remedy is 
opium, internally administered by clysters, and rubbed on 
the spine and pit of the stomach. Internally half a grain 
every half hour is to be taken ; if that does not relieve 
after six hours, the dose is to be increased to one grain; 
and then to one and a half grains, if it produce no effect; 
and so on gradually increasing ; between these doses give 
carbonate of potass half a scruple, warm baths, mixed with 
hyoscyamus and soda. In plethora and inflammatory dia- 
thesis, first venesection, and leeches on the spine ; calomel, 
mercurial embrocations, so as to create salivation ; cold 
affusions. As soon as the spasm abates, the doses of opium 
must be decreased. Should these remedies prove unavail- 
ing, belladonna may be given and a moxa applied on the 
spine. Finally, amputation of the wounded limb ; which, 
although it might not immediately remove the spasm, will 
be preparatory to rendering the opium efficacious. 222 
ASTHMA. 
ASTHMA. 
Diagnosis. Dyspnoea without fever ; when the disease 
is slight, the difficulty of breathing is perceptible only on 
motion ; in the higher degrees it is constant and accompa- 
nied with gasping. By the absence of fever we distinguish 
it from the short breathing which is a symptom of nearly 
all acute fevers, especially the inflammatory, and from 
phthisis pulmonalis, which in some respects this malady 
resembles. There are kinds of asthma in which the patient 
labors under the same short breath, cough, and expectora- 
tion, as in phthisis, but the absence of chronic fever and 
emaciation are discriminative. 
Asthma is nearly always accompanied by cough, either 
dry (asthma siccum), or with expectoration (asthma humid- 
um, mucosum). It is either constant (continuum), or only 
attacks by paroxysms (periodicum). 
The consequences are partly local, partly general. The 
local ones are: impeded circulation of the blood through 
the lungs, hence congestion, accumulation of mucus, stag- 
nations, thickening, tubercles, bloody cough, inflammation 
of the lungs, suffocation. The general are : imperfect san- 
guification, cachexia, cyanotic as well as serous, diminished 
resorption, watery extravasation, first in the extremities, 
then in the internal cavities, especially of the chest. 
Pathogenesis. Proximate cause : disturbance and diffi- 
culty of the respirative action. The causes may be idio- 
pathic (seated in the lungs and organs of respiration them- 
selves), or consensual {asthmaidiopathicum and consensuale). 
They may, however, vary greatly; and for practical pur- 
poses may be comprised under the principal classes of all 
nervous diseases, the divisions of which will point out the 
treatment of different asthmas. They are the following : 
1. Asthma nervosum s. spasticum. Mere spasm of the 
respiratory organs. It is generally periodical. Frequently 
a product and symptom of hypochondria and hysteria 
{sujfocatio s.sirangulatw, a. hystericum), affecting the patient 
with apparent suffocation, for several minutes, even for 
hours; but this state of horror is without danger ; for, as 
soon as it is over, the patient can breathe as freely as be- 
fore. The asthma acutum infantile y the asthma spasticum 
et convulsivum belong to the same class. 
2. Asthma sanguineum, is a consequence either of gen- 
eral plethora or of local congestion in the lungs, especially 
of suppressed hemorrhoids, menstrua, epistaxis. 
3. Asthma metastaticum, owing to a morbid matter shifted 223 
to the lungs and respiratory organs; most frequently from 
gout [a. arthriticum), or syphilis (a. venereum), or scrofuli 
[a. scraphulosum), under which head also a. strumnsum., aris- 
ing from swelling of the cervical glands, must be classed, or 
to a metastasis of cutaneous diseases and inveterate ulcers 
[a. psoricum) ; or it is caused by suppression of serous 
secretions (a. serosum). This species is double: either 
rheumaticum, due to suppressed action of the skin, espe- 
cially to chronic influence of moist air, or dwelling ; and 
urinosum, owing to diminished secretion of urine ; which 
often occurs in aged persons. 
4. Asthma abdominale, arising from some cause which im- 
pedes the free motion of the diaphragm, as flatus (a.jlatulen- 
turn), from acidity in the stomach {a. saburrale), from ob- 
struction, enlargement of the liver and other abdominal 
viscera. 
ASTHMA. 
5. Asthma atonicum s. adynamicum, owing to weakness 
of the respiratory organs, either a product of general de- 
bility (as after great loss of blood, in scurvy and chlorosis), 
or of local weakness of the lungs {a. humidum). 
6. Asthma idiopathicum et organicum, due to a local me- 
chanical, chemical or organic cause, which disturbs the 
free action of the respiratory organs. Of that kind are a. 
metallicum caused by depositions of poisonous metallic 
matters (as a. saturninum, arsenicale, mercuriale), a. pul- 
verulentum, calculosum, pannijicum, brought on by dust, 
stony concretions, as in the cases of millers and wool- 
manufacturers ; a. aiireum, when air penetrates into the 
parenchyma [emphysemapulmonale), or into the pectoral ca- 
vity externally closed [tympanitis thoracis) ; a. hydropicum, 
owing to an accumulation of water either in the parenchyma 
of the lungs [cedema pulm.onum), or in the pectoral cavity ; 
a. mechanicum, such as when caused by ossification of the 
costal cartilage, [a. senile), curvations of the spine [a. gib- 
bosum) ; a. syncopticum s. cardiacum s. stenocardia ; also 
angina pectoris, Awe to enlargement, aneurisms, or other 
organic diseases of the heart ; a. humidum, owing to atony 
and blennorrhoea of the lungs. 
Therapeutics. The treatment is divided into the general 
and special. 
The general treatment looks upon the asthma, without 
regard to a remote cause. It is often the only one which 
may be applicable, and therefore of great value in those 
cases in which the remote cause is not discoverable, and in 
those where, though known, it is not removable, which 
happens, alas ! but too often in this malady. 224 
ASTHMA. 
It has the following indications : 
Free expectoration and solution of the obstruction in 
the chest as well as in the abdominal viscera, which very 
frequenlly accompanies it; for this purpose, extr. gramin., 
tarax., gummi ammoniac., tartras potassae, acetas potassae, 
tartar emetic in small doses, sulphur aurat. antimonii, are 
particularly recommendable. 
Promotion of all secretions, especially that of the kid- 
neys, partly in order to derivate the irritation, partly to 
prevent dropsy of the chest, which is to be suspected in 
every chronic asthma, either as already existing or at least 
as threatening ; flannel is to be worn on the chest, next to the 
skin ; anlimonials, sulphur, particularly diuretics, squills and 
digitalis are recommendable. Finally, continued antistim- 
uli by issues on the upper arm, foot-baths of mustard, wear- 
ing of oil-cloth socks. 
The special treatment must be appropriated to the causes 
and character of the disease. 
1. Asthma nervosum s. spasticum is recognized by the 
general signs of a nervous state. The cure requires the 
application of antispasmodic, derivative and antistimulant 
remedies ; of the first, particularly recommendable are zinc, 
copper, hyoscyamus and smoking of the leaves of stramo- 
nium ; attention must be also paid to material and metasta- 
tic causes, which may possibly lie concealed. 
Asthma periodicum, nocturnum is most promptly removed 
by a cup of one ounce of fresh roasted coffee, which may 
be repeated in obstinate cases. If a material cause does not 
exist, cinchona may be given in the intervals. 
Asthma hystericum (suffocatio, strangulatio hysterica) is 
best met by asa foetida, taken as a medicine, or by injec- 
tions. 
2. Asthma sanguineum is recognized by the general 
symptoms of plethora, or by a suppressed habitual hemor- 
rhage. The plethora must be remedied by venesection, 
frugal diet, exercise ; or by restoration and compensation 
of local sanguineous evacuations. 
3. Asthma metastaticum requires for its cure, that of the 
disease, of which it is a symptom or metastasis, and to 
create and entertain artificial ulcers on the upper arms and 
feet. 
4. Asthma adynamicum calls for active roborant and 
restorant remedies ; in asth. scorbuticum scorbutis is to be 
cured. 
5. Asthma ahdominale, if there exists indigestion, wants 
emetics and purgatives ; if flatulency, recognizable by the 225 
distention of the prsecordia, frequent eructations, and feeling 
easy after every eructation, carminativa, cumin, pepper- 
mint (vide No. 68) ; injections (vide flatulency). In con- 
stipation of the abdominal viscera the resolving method 
must be used ; also Carlsbad, Erns, Geilnau, Fachingen, 
Sellers waters. 
ASTHMA 
6. Asthma idiopathicum, mechanicum. 
Asthma saturninum, mercuriale, arscnicale. Treatment 
of these cases of poisoning, especially by sulphur (aqua cal- 
cis, antimon. sulphur, sulphur baths), opium. 
Asthma pulverulentum, pannificum, calculosum. The treat- 
ment requires dissolvent remedies, moist, warm vapors, 
oxymel scilliticum, between them emetics, but especially in 
the calculosum ; respect must also be had to local inflam- 
mation, which may possibly be present ; therefore as soon 
as pain and anxiety in the chest is manifest, venesection or 
leeches are to be used. 
Asthma strumosum, tuberculosum. The treatment of stru- 
ma ; by acetate of soda, half a drachm dissolved in water 
taken daily, I effected a perfect cure. In tubercles of the 
lungs, riding on horseback and milk diet are advised (vide 
phthisis tuberc.). 
Asthma gibbosum. Nearly all hump-backed, ill-grown 
persons labor more or less under oppression of the chest. 
The cure of the hump-back, the proper cause, is not possi- 
ble ; nothing therefore remains but relief and prevention of 
the bad consequences, such as hemoptysis, phthisis. Regard 
must chiefly be had to the disturbed circulation of blood, 
plethora ad spatium, and the impeded growth ; therefore 
abstractions of blood repeated from time to time are indis- 
pensable, and afford the best relief; likewise issues and 
other derivatives. 
Asthma syncopticum (a. cardiacum, angina pectoris, steno- 
cardia') ; that species which is due to an organic disease of 
the heart or of the great vessels (enlargement, aneurisma- 
tic ampliation, ossification of the valves, polypus and the 
like). It is marked by the following symptoms : The pa- 
tient in motions of the body is suddenly seized with violent 
oppression at the chest, sometimes with, sometimes with- 
out pain ; palpitation of the heart, anxiety ; and cloudiness 
of the head, which passes into vertigo, and, when in a high 
degree, into a fit of fainting ; irregularity of the pulse, a 
feeling of painful drawing, even numbness in one arm. 
Horizontal position relieves and appeases the attack ; 
which is peculiar to the asthma cardiacum, whereas, in the 
asthma pulmonale the upright, fonvards bent position re- 226 
ASTHMA. 
lieves. In the higher degree of the disease, the cardiac 
region is also found tumid. The diagnosis is, however, 
often very difficult, and a consideration of the preceding 
cause is important, learning that the evil has set in after 
violent exertion or exercise of the body, accompanied by 
anxiety, or after an inflammation of the heart, or by a me- 
chanical lesion. Also the stethoscope may be used for 
making out the diagnosis. It is noticeable, that frequently 
arthritic metastases to the heart can give occasion to the 
malady. The treatment, which however rarely procures a 
radical cure, consists in diminishing the action of the heart 
and preventing too strong congestion of blood to it, which 
may cause an increasing extension, and finally bursting, in 
consequence of which the disease proves fatal. The prin- 
cipal remedies are small venesections frequently repeated, 
leeches on the cardial region, the use of nitre, digitalis and 
aqua laurocerasi; the application of cold to the region of 
the heart, and cold bathings, repeated several times a day ; 
avoiding all strong exercise ; antiphlogistic vegetable diet; 
also artificial ulcers on the arm or in the cardiac region. 
I can assure that I have seen gradual decrease, even cures 
of that evil effected by these means applied for months, 
continued even for half a year. It would seem, that even 
hypertropic and aneurismatic dilatation of the heart can be 
confined and reformed (absorbed). The recognition of the 
single faults of the heart is scarcely possible, and does not 
contribute any thing towards curing. 
Asthma mucosum ([humidum), distinguished by constant 
accumulation of mucus and mucouscough, is a blennorrhoea 
pulmonum, and must be treated according to the principles 
laid down for blennorrhoea and phthisis pituitosa. Very 
frequently arthritic metastases and obstructions of the ab- 
dominal viscera are the causes, and determine the treat- 
ment. The continued use of mild, solvent remedies is 
exceedingly serviceable, especially mellago and extract, 
graminis. In the first place expectoration and freeing 
the lungs of mucus, must be attended to. If the mucus 
is very tenacious and the expectoration thrown up with 
difficulty, gummi ammoniac (No 64), sulph. antirnon. aur., 
kermes, oxymel scilliticum, liquorammon. anisat., sulphur 
are very valuable. Commonly, in order to moderately 
strengthen the lungs in too great a secretion of mucus, 
herba marrubii, rad. helenii, arnica?, senegse (vide No. 65, 
66, 67, 68), the elixir pectoral. (No. 69), are of use. Pre- 
caution, however, is to be used in the application of strong 
roborant and astringent remedies, as cinchona, lichen 227 
PALPITATION OF THE HEART. 
islandicum ; for they are apt to suddenly stop expectora- 
tion and to bring on attacks of suffocation. The only 
advisable means are pure amara, quassia, cort. or extract, 
cascarillse, but always mixed with expectorants. 
Asthma senile, is generally a consequence of weakness 
created by old age, often also of ossification of the costal 
cartilage. The first case is to be treated as asthma ady- 
namicum and mucosum ,• the latter is incurable, but relief 
may be expected from palliatives. 
Asthma emphysematicum (pneumaticum, aiireum) arises 
either from an aerial cellula of the lungs bursting by exces- 
sive distention and exertions of the lungs in lifting a load, 
blowing an instrument, after violent external commotions, 
as falls and the like, by which the air is forced into the 
cellular tissue of the lungs (emphysema pulm.on.') at each in- 
spiration; or from the external surface of the lungs being 
torn through by fractured ribs, corrosion of matter, which 
affords issue of the air into the pectoral cavity. 
The diagnosis of either case is difficult, and rests only 
on one sign, the appearance of an emphysematic swelling 
above the clavicula. The first case calls for venesection, 
and rest of the whole body and the lungs, in order that the 
lun<zs may be distended as little as possible, permitting the 
little wound to heal by itself, and the issued air to be ab- 
sorbed ; at the same lime, the inspiration of cold air may 
do good. In the second case, the emphysema must be 
operated on. 
Asthma acutum infantile (Millari) and asthma thymicum, 
vide diseases of children. 
PALPITATION OF THE HEART. 
Palpitatio. 
Diagnosis. Irregular, forced motion of the heart, or of 
vessels. The palpitation increases frequently to 
such a degree of violence as to become visible and audible 
(the sounding heart) ; in the more violent degrees by im- 
peded circulation, it becomes dyspnoea, fainting (vide 
asthma syncorticum). 
Also single vessels can undergo such an abnormal pul- 
sation, especially in the abdomen (pulsatio abdominalis), 
sometimes by aneurismatic extension, often also merely 
by local spasm, as it happens in hypochondriac and hys- 
terical persons. 228 
COUGHS. 
Pathogenesis. In most cases it is symptomatic, consen- 
sual, the effect of another disease, most frequently of hy- 
pochondria and hysterics, or it is caused by abdominal 
irritation, flatulency, obstructions, distentions of abdominal 
viscera, worms, hemorrhoidal congestions ; or it is also 
due to general plethora or metastasis of arthritic, psoric, 
morbific matters. Sometimes, but much more rarely 
(about one in six cases), it is an idiopathic disease of the 
heart. Even then it is not always organic ; but we must well 
distinguish the idiopathic dynamic from the organic. Also 
the idiopathic disease of the heart may be purely dynamic, 
a spasmodic state of this muscle, as of any other muscle ; 
but by long continuance and violence, the dynamic disor- 
der may change into an organic derangement of the heart, 
distention and the like. The organic disease of the heart 
consists either in an aneurismatic distention of single parts 
of the heart and large vessels, or in a general enlargement 
of it, or in ossification, failure of the valves, induration, 
ulcers, etc. The stethoscope may serve the purpose of 
diagnosis. 
Therapeutics. The chief rule is to consider every irreg- 
ular action of the heart first as symptomatic, and to search 
for the disease of which it is a symptom or consequence. 
By doing so, w7e shall often effect a cure, in which we 
would fail, were we to look upon it as a disorganization of 
the heart. Consequently the remote cause, hypochondria, 
hysteria, flatulency, plethora, hemorrhoidal congestion, the 
metastases must be treated. If it originates in hemorrhoi- 
dal congestion, the application of leeches to the rectum, 
and sulphur powder will bring relief. 
If it be idiopathic, a method of cure, directed to the dy- 
namic affection of the heart may be serviceable ; and 1 can 
recommend by my own experience, digitajis (No. 70), the 
external application of cold (cold bathings four times a 
day, or applying ice for a quarter or half an hour) ; riding 
on horseback. 
If the evil is an organic disease of the heart, then this is 
to be ascertained ; which, however, as well as the cure, is 
very difficult (vide asthma syncopticum). 
COUGH. 
Tussis. 
Diagnosis. Forced, audible respiration without fever, 
which is discriminative of cough, as a symptom of acute coughs. 
229 
fevers and pulmonary inflammation and phthisis pulmona- 
lis. it may be dry or accompanied by expectoration. 
Duration is indefinite ; it can last for days, weeks, 
months, years, even through life. 
It is not dangerous in itself, but may become so by its 
consequences. For it is apt to create inflammation of the 
lungs, hemoptysis, and finally phthisis; and by the latter 
it becomes one of the most perilous maladies. For it is 
proved, that two thirds of all pulmonary consumptions 
have arisen from neglected cough. Every cough, if it lasts 
long, may terminate in that destructive malady, and is 
more likely to do so if the patient is of a phthisical con- 
stitution. 
Pathogenesis. The proximate cause of every act of 
coughing is a convulsive contraction of the lungs and res- 
piratory organs. It may originate from increased irrita- 
bility of the lungs, or from a morbid irritant matter. The 
first may be a consequence of sanguineous congestion, of 
inflammability (tussis sanguinea, plethorica, phlogistica), or 
of increased nervous sensibility (tussis nervosa, spastica, 
erethica). The morbid irritation may be seated within the 
lungs and respiratory organs themselves (idiopathic cough), 
or without them (sympathetic cough), and may vary in its 
nature. Catarrhal irritation, rheumatic, gastric, abdominal 
irritants ; morbific matters, as arthritic, psoric, scrofulous 
metastases to the lungs ; organic disorders of the lungs, 
tubercles, biennorrhoEa, ulcers. Hence result the following 
varieties of cough, the knowledge of which is important 
in practice, since they call for as many different methods 
of treatment: tussis catarrhalis, abdominalis, nervosa, san- 
guinea, metastatica, pulmonnlis, phthisica. 
Therapeutics. Above all, examine the species, the respec- 
tive character, and determine accordingly on the treat- 
ment. 
1. The catarrhal or rheumatic cough, acute or chronic, 
is a consequence of taking cold. This suppresses the 
action of the skin, and alters the pulmonary secretion ; 
consequently the distemper is antagonistic, a reflex, a trans- 
lation of the cutaneous function to the lungs. The treat- 
ment must conform with the indications of the aetiology, 
that is: to increase the cutaneous action, to alter that of 
the lungs, and to restore the equilibrium and their normal 
action (vide catarrh). If the malady is recent, antimonials, 
sulphur, glycyrrhiza, extract helenii, elixir pectorale, extr. 
cardamom, benedict., sal. ammoniac, supertart, potassae 
(vide No. 21, 33, 34-, 71 72 a), constant respect, however, 230 
COUGHS, 
being paid to the gastric complication, which is apt to be 
connected with it. The mixture No. 72 b 1 can particularly 
recommend as one of the most prompt curatives. Does 
the cough become obstinate, or is it already inveterate, 
the principal remedies are stipites dulcamaras, flannel vest 
next to the skin, and a vesicatorium perpetuum on the up- 
per arm. If this should not suffice, I have seen mezereum 
on one arm, or in a more difficult case, on both upper arms, 
entertained for weeks, even months, prove efficacious. 
When dulcamara alone is not sufficient, it may be com- 
bined with lichen Islandicum (vide 73) and Sellers water. 
If all this is unavailing, it is because the catarrhal irritation 
has passed to a tuberculous state, or a blennorrhoea pulmo- 
num has succeeded, and the treatment of phthisis, tubercu- 
losa or pituitosa, is to be pursued (vide phthisis). 
The chronic catarrhal state is to be treated and carried 
through with the utmost care, and in this way it may be 
prevented from passing into pulmonary consumption. 
2. The gastric and abdominal cough (stomach, liver, worm 
cough). It is very important to distinguish this from 
the pulmonary cough, since its treatment is entirely dif- 
ferent. The discriminative signs are : the respiration is 
free, the patient can walk, run, speak, take a deep breath 
without coughing or panting. In general, affections ot the 
stomach but not of the lungs produce cough, which there- 
fore is greater after meals. At the same time there is 
imperfect digestion. If the case is recent, it requires 
nothing but sal ammoniac, or tart, potass® for some days, 
and then, according to circumstances, emetics or purga- 
tives (especially manna and folia sennse are recomrnend- 
able). When the case is older, and there are indications 
of infarcts or visceral obstructions, associated very fre- 
quently with incipient cachexy, then active resolventia are 
to be used for a considerable time (vide treatment of abdo- 
minal obstructions in hypochondriasis), intermixed with 
emetics and purgatives. I have seen such coughs, appa- 
rently phthisical,which had continued for months, disappear 
by a single emetic. Millefoil-tea is also useful, taken 
morning and evening for some time ; not less so is marrub. 
alb., quassia lign. In irritation from worms, these must be 
removed. 
3. Nervous, spasmodic cough. It is recognized by the 
absence of other causes, by the nervous habit and concom- 
itant symptoms,- that it is not increased but rather dimin- 
ished by running, speaking, motion, even over-heating ;on 
the contrary, it is excited by all things that operate on the COUGHS. 
231 
nerves, especially mental emotion. The treatment is that 
for nervous weakness, varying, however, according to its 
different forms. In great irritability, asses’ milk, free air, 
exercise on horseback, viscum quernum, hyoscyamus, opi- 
um, valeriana, tepid baths, Ems baths ; in the atonic state, 
cinchona, liquor c. c. succin., quassia (vide phthisis nervosa) 
are advised. 
A particular kind of spasmodic cough is the tussis matu- 
tina vomitoria, a disease which attacks hard drinkers, espe- 
cially brandy drinkers. They are tormented every morning 
by violent throwing up. The cure is performed by mode- 
rating the excess in spirituous liquors, by the use of quassia 
and other remedies which tend to strengthen the stomach, 
as well as of belladonna and aqua laurocerasi. 
4. The sanguineous and phlogistic cough is often a con- 
sequence and effect of general plethora, frequently occur- 
ring in young persons. The distinctive signs are : the 
general symptoms of plethora, the full, strong pulse, cough 
is excited and increased by exercise ; there are other con- 
gestions of blood ; generally also, dyspnoea or pains in the 
chest. It may run into hemoptysis and pulmonary inflam- 
mation. The treatment must tend to diminish and derivate 
the plenitude of blood, which may be attained by venesec- 
tion, antiphlogistics, low vegetable diet, corporeal exercise. 
Or it is owing to a local congestion of blood, hemorrhoidal, 
menstrua], either by suppression of previously existing evac- 
uations of blood or first wrongly directed impulse (hemor- 
rhoides anomalse, incongrute, menstrua anomala). The 
latter is of particular importance in practice, and more 
difficult of recognition when no hemorrhoidal or menstrual 
flux has preceded. I have seen persons laboring for years 
under cough, accompanied with pains in the chest, so that 
their state was considered incipient phthisis, which, how- 
ever, was nothing but molimina hemorrhoidalia, taking a 
direction towards the lungs. The diagnosis rests on the 
symptoms of the hemorrhoidal disposition, of the plethora 
abdominalis (vide hemorrhoidal disease), or the signs of fe- 
male puberty and molimina menstrua. This cough also 
occurs at the cessation of the menses. The cure consists 
in derivating the blood from the lungs j in the hemorrhoi- 
dal cough, to cure the abdominal plethora by dissolvent 
extracts, neutral salts and sulphur (vide hemorrhoids), and 
when these do not suffice, leeches must be applied to the 
rectum ,* in the menstrual cough the catamenia must be 
brought on ; in cessation of the catamenia the flux must 
be compensated by other abstractions and evacuations of 232 
HOOPING COUGH. 
blood. Or finally, the cause is a chronic inflammatory 
state of the lungs. The signs of this are frequent febrile 
motions, always irritable pulse, frequently stitches in the 
chest, dyspnoea. The cough is dry. This is already the 
commencement of phthisis florida or tuberculosa (vide 
those diseases). In every sanguineous cough whey, either 
serum lactis simplex, or prepared with cremor tartari, Set- 
ters water mixed with a little milk, Egers salt spring, the 
Kesselbrunnen in Ems are of great value. 
5. The metastatic cough, caused by deposites of arthritic, 
rheumatic, psoric, scrofulous, syphilitic or other morbific 
matters, on the lungs and respiratory organs. The treat- 
ment consists in a proper treatment of the original disease 
(gout, scabies, scrofula), and derivation by cutaneous irri- 
tants, flannel dress and artificial ulcers ; respect must also 
be paid to the dynamic character, whether it be phlogistic, 
or nervous, or atonic. 
Cough by poisoni g (vide asthma'). 
6. The idiopathic or pulmonary cough, which originates 
in a disorder that has become peculiar to the lungs. It is 
a phthisical cough ; for it is either a consequence of blen- 
norrhoeaof the lungs, which is classed under phthisis pitui- 
tosa; or of a tuberculous state of the lungs, a symptom of 
phthisis tuberculosa ; or of a chronic inflammation of the 
lungs, which belongs to phthisis florida, or of a suppuration 
of the lungs, which is placed under phthisis purulenta (vide 
phthisis pulmonalis). 
One more organic local disorder must be mentioned, 
which is often an unknown cause of obstinate cough, that 
might lead even to phthisis. It is a prolongation or swell- 
ing of the uvula, which irritates the glottis and produces 
coughing. In this case the easy and harmless operation of 
cutting off the elongated uvula is a sure and prompt remedy. 
HOOPING COUGH. 
Tussis Convulsiva. 
Diagnosis. Paroxysms of incessant expirations, occa- 
sionally interrupted by a long drawn whistling inspiration, 
similar to the cry of a hen. It lasts from a few 7 minutes to 
a quarter of an hour, and generally terminates in vomiting. 
If the case is violent, the patient’s face turns dark and 
blue, blood escapes from the nose and mouth ; the spas- 
modic motions of the lungs sometimes pass from a pulmo- HOOPING COUGH. 
233 
nary tetanus into complete cessation of respiration and 
apparent suffocation, a state that may last for several 
minutes. Such attacks may return every three or four 
hours, in severe cases more frequently ; and in all cases 
the attacks are more frequent and violent in the night; the 
least mental affection, weeping or laughing can bring them 
on. They are commonly more violent every other day 
(typus tertianus). In the intervals the chest and respira- 
tion are entirely free, and the patient, except being weak, 
is healthy in other respects. 
It attacks children in preference, and only once during 
life (like small pox and measles). 
Course, duration. We distinguish three stadia. 
Ist Stage (stadium febrile, irritationis). The commence- 
ment is generally similar to a catarrhal cough with febrile 
motions. It is apt to be associated with an inflammatory 
state of the lungs. Gradually the cough assumes more and 
more the character of hooping cough, 
2d Stage (stadium nervosum, spasticum). The cough is 
merely a spasmodic affection, without fever, and lasts for 
several weeks. 
3d Stage (stadium adynamicum). The paroxysms of 
cough continue for three or four weeks, with prominent 
intermissions and increasing weakness. 
The duration is five, eight, or twelve weeks, even lon- 
ger. Sometimes it ends in a natural crisis, by cutaneous 
eruptions, or aphthae. The consequences when it has con- 
tinued violent and for a long time, are : tabes and atrophia, 
due to great exhaustion and deficient nutrition, since the 
cough causes the food to be ejected from the stomach, and 
on account of debilitation of the lungs, phthisis pituitosa. 
Also pneumony may join it and prove fatal. 
Pathogenesis. The proximate cause is a nervous irrita- 
tion, especially of the nervus phrenicus and vagus, produced 
by a particular contagion originating in the atmosphere, 
but propagated from individual to individual; this is made 
evident by the circumstance that even old nurses may be 
infected by the children on whom they attend. The ner- 
vous irritation produces simultaneously the convulsive, as 
it were, epileptic motions, and also increased mucous se- 
cretion in the stomach and lungs, even increased secretion 
of bile ; and, when the disease is very violent, and there 
exists the disposition, an inflammatory state of the lungs. 
The disease, therefore, is nervous in its nature, but may 
assume an inflammatory character. The morbid process 234 
HOOFING COUGH. 
generated by the contagion has, like small pox and measles, 
its definite duration. 
Therapeutics. It calls for cleansing of the stomach and 
the primas vise, assuaging of the spasm by specific reme- 
dies and antistimuli ; and a regard to complication. The 
different stages constitute an essential difference in respect 
to treatment. 
The first stage is of a gastro-catarrhal character, often 
inflammatory ; the treatment therefore must be resolving, 
cooling, purging; in addition to this, emetics and the linc- 
tus No. 74. As soon as the fever increases, and the diffi- 
culty of breathing becomes greater, with irritative cough 
and pains in the chest, leeches are to be applied on the 
chest, and small doses of calomel given. 
In the second stage the spasm must be soothed partly by 
antispasmodic and narcotic remedies, especially by hyos- 
cyaraus ; asa fetida in linctus and clysters, belladonna 
(vide No. 75) ; in extreme degrees of cough, opium, but 
not long continued on account of its constipative and con- 
gestive power (vide No. 76) ; extract, lactucse virosje, dul- 
camara, cicuta, musk, ledum palustre,—the relieving effect, 
however, varies according to the epidemic ; partly by anti- 
stimuli, cutaneous irritation, embrocation of the ointment 
or tincture of cantharides, ointment of tartar emetic (vide 
No. 77), on the pit of the stomach and sides; irritating the 
kidneys (scilla, digitalis, tr. of cantharid ), injections. These 
remedies are often sufficient to effect a cure. 
In the third stage, when the remedies mentioned do 
not suffice to remove the cough, which has already lasted 
for several weeks, and the fever is gone, it is probable that 
the spasm is entertained by weakness, and then cinchona 
in connection with antispasmodics, is the principal remedy 
for finishing the cure (sulphas quinini one half or one grain 
twice a day). It is particularly appropriate, when the case 
manifests a periodical character, as an increase of the vio- 
lence of the paroxysm on every second day. 
If the cough continue, accompanied with frequent ex- 
pectoration of mucus, gelatina lichen. Islandici is the best 
remedy, and by which it may be prevented from changing 
into phthisis pituitosa (vide No. 78). 
The subsequent treatment in a very debilitated state re- 
quires tepid strengthening baths (malt baths), cinchona, 
acorn-coffee, gelatina lichen. Island. 235 
CHRONIC VOMITING. 
CHRONIC VOMITING. 
Vomitus. 
Diagnosis. Vomiting-, which, without being a symptom of 
an acute febrile state, appears as a chronic distemper. It 
is either permanent or periodical, either before or after 
taking food. 
Every violent and permanent vomition is to be consid- 
ered as an important and a perilous attack; it may prove 
fatal by inanition, or create inflammation of the stomach. 
Every chronic vomiting claims our greatest attention, since 
it may be a sign of other important, even organic disorders. 
I shall here give only a few hints. 
When it always follows a meal, throwing up the food, an 
organic disorder of the stomach may be suspected. 
When it is accompanied with violent pains and spasms in 
the ventricular region and in the abdomen, and the patient 
turns yellow, gall stones ; when in the renal region, gravel 
are supposed to exist. 
When it seizes children, the head being affected, and 
drowsiness, squinting, costiveness accompanying it, it is 
a sign of incipient hydrops cerebri. 
When it attacks children in the morning, in a jejune 
state, and is followed by bulimy, it points to worms. 
When it is chronic, obstinate in children, accompanied 
with constant thirst, diarrhoea, distended precordia, disfig- 
uration of countenance, coldness of hands and feet, drawing 
the legs towards the belly, and emaciation, gastromalakia 
is threatened. 
Pathogenesis. The proximate cause is a convulsive con- 
traction of the stomach and the neighboring muscles,—• 
entirely analogous to cough. It may originate in too great 
an irritability of the stomach itself, so that even the most 
common and innoxious stimuli, as aliments, even water, 
can excite these convulsive contractions; or be due to san- 
guineous congestion and inflammability, or increased ner- 
vous sensibility (sanguine or nervous character), or to an 
unusual morbid irritant matter. This can be located either 
in the stomach itself (idiopathic vomition) either within it 
(contentum ventriculi), as indigestives, bile, mucus, acid 
worms ; or in the substance of the stomach, such as organic 
disorders, callosities, scirrhosilies, ulcers, polypus, carcin- 
omata, metastases, of which the most frequent are the 
arthritic, psoric, rheumatic ; or without the stomach (sym- 236 
CHRONIC VOMITING. 
pathetic irritation), swelling and indurations of the liver, 
spleen, pancreas, kidneys, nephritic stones, gall-stones, the 
gravid uterus, cerebral affections, violent headache, con- 
cussion of the brain by falls or blows, even psychical irri- 
tation, squeamishness. 
Therapeutics. Investigate the different remote causes, 
and remove them (the indirect treatment), and if it persist, 
operate directly on the proximate cause, the convulsive 
state of the stomach, and calm this by remedies which 
have a direct or a derivative tendency (direct treatment). 
Consequently, 
1. When gastric impurities are the cause (vomitus gas- 
tricus, saburralis), which is recognized by the known signa 
sordium, and by the quality of the matter thrown up, bilious 
or sdburral, then emetics and purgatives are the only true 
means of cure : vomitus vomitu curatur. There is, however, 
a difference, when the evil is not a consequence of a tran- 
sient indigestion, but of a chronic mucosity and acidity of 
the stomach. Such cases require a long course of treat- 
ment, intermixed with repeated emetics and purgatives, 
and finally roborants (vide indigestion, anorexia, apepsia). 
2. When rheumatic, arthritic, psoric or any other metas- 
tasis is the cause (vomitus chronicus,rkeumaticus, arthriticus, 
etc. metastaticus). Particularly frequent is the rheumatic. 
It is recognized by a preceding chronic cold (especially 
moist, draughty dwelling) ; by the rheumatisms and ca- 
tarrhs previously existing, which now have disappeared; 
by the generally concomitant pains in the stomach (vide 
cardialgia) ; (he arthritic by the gout, especially podagra, 
previously existing, and the urina rubra ; the psoric by the 
cutaneous diseases or chronic ulcers, which existed previ- 
ously and have been suddenly suppressed. In the treatment 
of all these species, we must consider above all, whether 
an inflammatory state of the stomach has been generated 
by the metastasis (vide No. 3), and commence with reme- 
dying that. Then a vesicatory to the epigastric region, 
in retroceded (re-entered) podagra, sinapisms on the feet, 
in exsiccated ulcers, exutories on the previously affected 
spots, embrocation with antimonial ointment, mezereum. 
Besides the remedies and method of treatment which the 
various species of disease calls for, in gout, guaiac., aconite, 
in scabious metastasis, sulphur. 
4. When mere nervousness of the stomach is the cause 
(vomitus nervosus, spasticus, hystericus). The signs are the 
absence of other causes and the symptoms of a spasmodic 
hysteric state. Vomiting takes place generally in the CHRONIC VOMITING. 
237 
morning, in a jejune condition, or after mental emotions, 
or as a symptom of hemicrnnia hysterica. The treatment 
must be that of hysteria and nervous weakness ; in the 
paroxysm direct treatment of vomiting (vide cardialgia 
nervosa). 
In the troublesome and frequently returning cephalaea 
vomitoria hysterica the recipe No. 79, used in the intervals 
free of paroxysms, is an excellent remedy. 
5. When organic disorders, either in the stomach, as: 
callosities, scirrhosities, carcinoma, softening ; or in the 
neighboring parts, as phvsconias, obstruction, induration of 
the liver, pancreas or spleen are the cause : the stagnations 
are to be resolved and the spasm is to be soothed by direct 
treatment. 
The Direct Treatment of Vomiting, Anti-emetic Method, 
Is called for, when no material or remote cause can be 
discovered {v. nervosus), or when it continues after their 
removal. It is momentous as indicatio vitalis, since every 
constant vomiting can endanger life, and requires stopping. 
The remedies are : potio Riveri, the surest and safest anti- 
emetic (vide No. 1), invigorated in obstinate cases by anti- 
(vide No. 80), external means, which here 
prove often of more service than the internal ones, fomen- 
tation of the epigastric region by spirit, matrical. and 
tinct, opii (No. 81), little bags wdth mentha crispa, steeped 
in wine, sinapisms, finally, dry cups, one of the most effi- 
cient means, by which I often succeeded to stop the most 
obstinate vomiting ; injections ; at last opium, musk. Small 
pieces of ice and ice cream have often proved most useful. 
In children chronic vomiting requires our whole attention. 
We must carefully examine whether it is caused by worms, 
or is symptomatic of hydrocephalus j or of softening of 
the stomach; vide diseases of children. 
Special Treatment of Particular Species of Vomiting. 
Vomitus chronicus Ingestorum. The patient throws up 
the aliments twro or three hours, even as soon as one hour 
after taking them ; there is constant hunger, costiveness j 
in some patients pain is felt in the epigastrium, especially 
when pressed ; and in some cases a hardness may be dis- 
covered on examination. As the case advances, it goes 
through the degrees of emaciation, tabes, vomiting of dark 
green, blackish matter, death. 238 
CHRONIC VOMITING. 
The cause of this afflicting disease is scirrhus, or carci- 
noma of the stomach. The cure is rare, although some- 
times possible, when the evil has not advanced too far, 
callosity only and not true scirrhus existing. A principal 
sign is pain. As long as this is wanting, there is hope. 
But if pain is present, then scirrhus or even carcinoma 
exists and medication is useless. The following remedies, 
according to my experience, have sometimes succeeded in 
conquering it: liquor belladonnse cyanicus (No. 50), mer- 
curial embrocations, extract, cicutee and calendulae, the 
Carlsbad water, bi-carbonate of soda, perpetual cataplasms 
of cicuta over the stomach, the application of moxa on the 
epigastrium (by which I once succeeded in immediately 
curing, and for ever, a kind of vomiting, accompanied by 
abdominal pains which had lasted for several months, and 
had resisted all other means), clysters ; leeches on the 
scorbiculus cordis from time to time, especially when pains 
set in. Milk as exclusive food, is salutary. By this diet 
and milk injections, some patients have had their life pro- 
longed, have even been cured. 
Akin to the preceding is that chronic vomiting which is 
owing to induration, enlargement or other disorganization 
of the pancreas. It is distinguished from the former by 
not always taking place after eating, and that it is not food 
hut acid and salivary matters that are thrown up, and the 
patient has often a sensation of violent, deep seated pains 
in the umbilical region, sometimes extending to the back, 
and frequently an induration or swelling deeply seated can 
be discovered by pressure. In this case the cure is diffi- 
cult, but possible, particularly at the commencement. The 
treatment is the same as in the previously mentioned dis- 
ease ; more active resolventia, especially the Carlsbad 
water, however, may be used, since the stomach bears 
more. The application of leeches is not to be omitted in 
a painful state. 
Different from either of the preceding is ruminatio Hu- 
mana. The ingesta are likewise thrown up, but with ease, 
and without any emetic exertion, and they are not altered 
by incipient digestion. The cause of it is an enlargement 
of the oesophagus and saccus coccus, in which the aliment 
is collected and retained for a while. 
Vornitus matutinus, vomiting every morning under tor- 
turing'cough and choking, a quantity of viscous slime. It 
is the lot of old drinkers. The means for remedying it 
are : abstinence from drinking, regular and digestive meals, 
magnesia and rhubarb (vide No. 83), in the morning a HICCOUGH. 
239 
glass of cold water, pills of asa foetida, fel tauri, cushions 
of menthacrispa on the abdominal region, Colombo, quassia. 
Vomitus marinus (sea-sickness). The most tormenting 
nausea with vomiting, also purging and general indisposi- 
tion, even to fainting, and a feeling of universal destruction. 
It can last for two, three, or four days, and longer, caused 
only by a sea-voyage in high wind, which gives great mo- 
tion to the vessel ; it does not happen on lakes and rivers, 
and ceases as soon as we land. It occurs, as a rule, only 
once, and disappears by habit and repeated voyages. Every 
one is seized by it, but not in an equal degree. It resem- 
bles most the state of nausea and fainting to which some 
persons are liable when riding in a wagon and swinging. 
The only cause is the rocking motion of the ship. 
The means which, though they do not entirely prevent, 
at least alleviate, even sometimes prevent it, are horizontal 
position, staying on the deck near the mast, light digestible 
food, and the plaster No. 84 spread on leather, of the 
size of the hand, applied to the epigastric region. 
Vomitus calculosus. Vomiting may be a symptom of 
gall-stone as well as of gravel, and is either acute or chro- 
nic. In the first case it is a symptom of stone colic (vide 
colica calculosa). The diagnosis depends on the other 
signs of stone (vide calculus), and the treatment is the 
cure of calculus, which see ; therefore, in chronic cases, 
Carlsbad spring and similar alkaline remedies. 
Vomitus gravidarum, vide diseases of females. 
In all chronic vomiting, milk, taken one cup every two 
hours, has been observed to be the best and only remedy ; 
even when it is owing to internal indurations and strait- 
enings, it is conservative, even curative. In general, how- 
ever, the malady must be considered as arising from an 
organic disorder, and consequently incurable. Frequently, 
indurated excrements in the colon are its cause, which 
may be removed by injections and drastic purgatives. 
hiccough, hickup. 
Singultus. 
A short, convulsive contraction of the stomach and dia- 
phragm, generally periodical, arising from insignificant 
causes, overloading of the stomach, acidity, taking cold 
(especially in little children), and then insignificant and 
wearing away of itself; but sometimes a true permanent 240 
NEURALGIAS. 
spasm in these organs, which may continue for hours, 
days, and become offensive and dangerous; in fever it is 
sometimes a fatal symptom ; concomitant with internal 
inflammations. 
The cure of ordinary hickup is very easy ; slow drink- 
ing, or still better, a piece of sugar slowly melted in the 
mouth, removes it quickly. When it is nervous, a symptom 
of spasm, as well as present in nervous fever, hyoscyamus, 
mu-k, opiate embrocations over the stomach ; an antispas- 
modic cataplasm, dry cups on the same, especially a warm 
bath are serviceable. When it is inflammatory, the inflam- 
mation is to be treated. 
NEURALGIA. 
Diagnosis. Chronic, permanent, or periodical pain of a 
single nerve, or of a plexus of nerves, especially in mem- 
branous or aponeurotic parts. It may affect any part of 
the body, and receives different names according to its 
location. When it arises in the head, it is termed cephalcea, 
kemicrania, clavus y when it seizes the face, prosopalgia ; 
when the ischiatic nerves, isckias y when the back, riota/gia; 
when the lumbal region, lumbago y when the hip, coxalgia, 
Coxagra y when the stomach, gastrodynia y when the intes- 
tines, colica. 
The origin and treatment is the same as in all nervous dis- 
eases, varying only as regards location, whence are derived 
specific names. 1 will only remark in general, that nar- 
cotics, especially liquor belladonnae cyanicus, aqua lauro- 
cerasi and stramonium (one eighth to one half of a grain 
of the extract, and of the tinctura seminum up to ten d rops), 
douches, cold baths and moxa are of particular efficacy ; 
in periodical attacks, Peruvian 4>ark and iron, especially 
ferrum carbonic., half a scruple twice a day. In neuralgias 
of external parts we are carefully to examine whether a 
mechanical irritation, as induration, a ganglion, a splinter 
of a bone, an excrescence and the like are not the original 
cause. 
PRURITUS. 
Itching is a particular sensation of the skin, which gen- 
erally exists only as a symptom of cutaneous eruptions, 
and is to be treated as such ; it may, however, appear also 
independently as an isolated nervous affection, and even 
assume such a degree of violence and obstinacy as to allow HEADACHE. 
241 
no rest day and night, to become a real disease, and if it 
be general, even to endanger life. I have seen an old man, 
who had been a hussar, labor more than a year under such 
a dreadful general itching, without exanthema, that it de- 
prived him of rest day and night. In this desperate state 
he had to use the hardest scraping instruments, as curry- 
combs and the like, until blood would come, in order to get 
relief; finally he died of emaciation. 
The causes may be the same as are common to nervous 
diseases, but are particularly chronic suppressed perspira- 
tion, atrabilious and psoric acrimony. 
The treatment must be adapted to these causes. As local 
means, baths, especially Russian steam-baths, frequent cup- 
ping and artificial ulcers are most serviceable. Also a so- 
lution of two drachms of borax in six ounces of rosewater 
is often of excellent service. 
A very troublesome and frequent evil is the itching of 
the genitals, especially in the female sex (pruritus vulvas). 
It is more common to old maids and widows, owing to 
disturbances of menstruation and hemorrhoidal conges- 
tions, is very tormenting and difficult of cure. 
The treatment must first tend to the removal of hemor- 
rhoidal and menstrual congestions or other dyscrasias, 
also ascarides, which sometimes creep into the vulva; re- 
peated application of leeches is recommended. As a local 
means, I can advise from experience as most efficacious to 
wash the genital organs with soap water, composed of gen- 
uine cocoa-oil soap and a weak solution of sublimate in 
rosewater. 
HEADACHE. 
Cephalcva, Cephalalgia. 
Diagnosis. A very common complaint, frequently a 
symptom of other diseases, especially of fevers ; but is here 
considered only as an isolated affection. It is either per- 
manent (cephalm), or periodical (cephalalgia), either gen- 
eral, or occupying only single parts of the head, as one 
side (hemicrania), or a small circumscribed spot like a nail 
driven in there (clavus). Also the degree and species va- 
ries very much, as burning, tearing, pungent, boring. In 
the highest degree consensual symptoms associate with it, 
especially of the stomach, as nausea, vomiting (cephalcea 
vojnitoria). It may become an extremely obstinate and 
tormenting complaint. 242 
PROSOPALGIA. 
The origin and treatment coincides with that of general 
nervous diseases. We must carefully distinguish ceph. ner- 
vosa, sanguinea, gastrica, metastatica, organica. 
Of the specialities, the most frequent is the hysterical and 
hypochondriacal headache, for which, as a palliative, hyoscy- 
amus, aqua laurocerasi, liquor anodyn. Hofman. are useful; 
in headache accompanied by vomiting, pulvis aerophorus or 
potio Riveri together with hyoscyamus, sinapisms, mustard 
foot baths; to eradicate it, a cold infusion of quassia, cin- 
chona, particularly iron (vide No. 85, 79), ferrum carboni- 
cum, sea baths, chalybeate baths, Pyrmont spring are very 
salutary. It is very important, however, to have regard to 
local sanguineous congestions ; these call for the applica- 
tion of leeches. Of the metastatic, the most frequent and 
obstinate is the arthritic (gout in the head) and rheuma- 
tic ; when perpetual derivatives (fontanels, cort. rnezerei, 
repeated cupping in the neck), and arthritic remedies 
(guaiac, aconite); in the rheumatic, calomel, drastic pur- 
gatives, bitter water, foot baths of mustard, mustard-meal 
in the stockings, oil-cloth soles, smoking of tobacco are 
most serviceable. After fruitless use of the most active 
remedies, even of the Russian baths, I have seen perfect 
cures effected by No. 86, continued for a fortnight (vide 
arthritis, rheumatismus). In very obstinate headache in the 
forehead, we must never omit to inquire whether foreign 
bodies, as worms, insects, larvae, have not entered the frontal 
sinuses. In such cases, warm vapors drawn into the nose, 
smoke of tobacco, and between them sternutatories (vide 
No. 87), have remedied the evil by sneezing and throwing 
it off. 
PROSOPALGIA. 
Tic Douloureux. 
Diagnosis. Very tormenting pains in the face, especially 
in the region of the processus zygomaticus, in the nervous 
plexus, termed pes anserinus, from whence the pain 
spreads to all parts of the face. In the highest degree 
they resemble violent electric shocks, and create spasmo- 
dic distortions of the face. They appear periodically, 
sooner or later, sometimes typical. The complaint is one 
of the most obstinate. 
Causes and treatment are the same as in cephalsea. In the 
first place, therefore, the remote causes, congestions, ab- 
dominal stoppages and the like are to be remedied. Most ODONTALGIA. 
243 
frequently there is a rheumatic, arthritic cause, combined 
with a very tender sensitive nervous system ; hence it is 
met with most frequently in the female sex, and aconite 
and guaiac are very useful, especially in the mixture men- 
tioned under cephalsea, likewise sublimate, together with 
decoction of guaiac, sarsaparilla, and extract, hyoscyami, 
also oleum jecoris aselli. 
Finally, the disorder is to be looked upon as idiopathic, 
and must be treated accordingly. Lotions and fomenta- 
tions of aqua laurocerasi, of liquor anterethicus (vide No. 
176), opiate and saturnine plasters, frequently repeated 
cupping on the neck, a seton and moxa are very useful; 
lastly, more than all, douches of cold water, continued and 
repeated in evqry attack up to the ceasing of pain, by 
means of a small clyster pipe. Electricity and magnetism 
have sometimes proved beneficial. The proposal to divide 
the nerve is an unsafe remedy. 
TOOTHACHE 
One of the most frequent and painful neuralgias is odon- 
talgia, toothache. It can attain a degree bordering on tic 
douloureux, even surpassing it. 
The cause is either a carious tooth, or rheumatic irrita- 
tion, which is more frequent, and, associated with carious 
teeth, produces the periodical pains. Besides, there are 
two causes, sanguineous congestion (especially in young 
plethoric persons and in pregnant women), and nervous- 
ness. In obstinate, ever and anon returning toothache, 
deeper seated dyscrasias, such as arthritic, psoric, syphi- 
litic, may he the remote cause. 
The treatment must correspond to the causes ; removal 
of the carious tooth, rheumatism, plethora, nervousness. 
For a palliative cure, the removal of sanguineous con- 
gestion, which commonly exists here, by applying some 
leeches on the gum, derivation by sinapisms or horse-rad- 
ish on the arm or neck, and local antispasmodic remedies, 
embrocation of 01. cajeputi or spirit, camph. with opium on 
the cheek where the pain is, a pill of hyoscyamus or opium 
laid into the aching tooth, a mouth bath of decoct, flor. 
sambuci and herb, hyoscyami, a small piece of rad. py- 
rethrii or armorac., or a few drops of tinct. cantharidis on 
the gum, will be found serviceable ; but the most efficient 
is to wet the tooth with tincture of Para-cresses. 
Odontalgia 244 
OTALGIA. COXALGIA. CARDIALGIA, GASTRODYNIA. 
EARACHE. 
Otalgia. 
Otalgia occurs also as a pure neuralgia, and is treated 
like odontalgia; the most beneficial remedies are: cata- 
plasmata emollientia, narcotica of flor. sambuci, herb, hy- 
oscyami steeped in milk, applied to the ears. But it is 
most frequently of a rheumatic character, and when violent 
and constant, an inflammatory state is to be feared, which 
is to be treated antiphlogistically by local abstractions of 
blood (vide otitis). 
Vide coxagra, ischias (hips). 
COXALGIA, 
SPASM OF THE STOMACH, STOMACHACHE. 
Gastrodynia. 
Diagnosis. Spasmodic pains and contractions in the 
epigastrium, sometimes periodical (cardialgia in a limited 
sense), sometimes constant (gastrodynia). They vary in 
intensity, being sometimes slight, sometimes of insupport- 
able violence, spreading by consensus to the chest and 
back ; exciting nausea and vomiting, anguish, coldness of 
the extremities, and even syncope. It may become chronic 
and very obstinate. It is more common to females than 
to men. When it occurs in women after the cessation of 
the menses, and is associated with fits of fainting, it is apt 
to pass into vomiting of blood. 
Besides the general causes of nervous diseases, hysteria 
is one of the most common ; also acute and still more so 
chronic colds (owing to light clothing, moist dwelling, 
business of washing), wherefore the disease is often no- 
thing but rheumatism of the stomach; and disturbance of 
menstruation, wherefore it appears frequently at the times 
of puberty, still more after its cessation. 
The treatment, aside of that for nervous diseases in gen- 
eral, requires particular consideration, whether there is san- 
guineous congestion and chronic inflammation, in which 
case abstractions of blood, general as well as local, are not 
to be neglected ; gastric impurities must be removed by PYROSIS. COLICA. 
245 
evacuants, even emetics, which give immediate relief; in 
rheumatic, arthritic, and other rnetastases, mustard plas- 
ters, vesicatories over the stomach. In purely nervous 
spasms of the stomach, the principal and specific remedy is 
subnitrate of bismuth, two grains daily three times, tritu- 
rated with sugar j magnes. carbon, with extract hyoscyami, 
and cortex Winter., pulvis aerophorus, 01. cajeputi. In ob- 
stinate cases the mixture No. 88 has not forsaken me. 
Of particular efficacy are external remedies, embrocation 
of antispasmodic liniment (No. 89), warm cataplasms of hy- 
oscyamus and chamomile ; the mere application of a 
warm body, dry aromatic herbs, mustard plasters, and dry 
cups to the epigastrium. In chronic spasms of the stom- 
ach, I can recommend douches of cold water (or still bet- 
ter, mineral water) by my own experience. 
If the disease resists all these means, and the food is 
rejected, there is reason to suspect an organic disorder. 
PYROSIS. 
A very distressing sensation of burning, rising from the 
stomach, especially after taking fatty food. The complaint 
is more frequent in youth than in advanced age. 
The cause of it is a generation of acidity in the stomach, 
and a disposition of the stomach liable to it. Especially 
the acrimony of grease seems to have a tendency to pro- 
duce this disorder ; hence fat aliments are injurious. 
The treatment is that of acrimony of the stomach (vide 
gastrosis), and avoiding grease. For temporary relief, one 
teaspoonful of earbonas rnagnesiee or lapis cancrorum is 
serviceable ; still more efficient is ammonium carbon., three 
grains, dissolved in one ounce of melissa ; likewise char- 
coal powder. 
COLIC. 
Colica. 
Diagnosis. More or less violent pains in the intestines, 
of a contracting, pinching, tearing, or burning nature ; 
which, when severe, are accompanied by anxiety and cold 
sweat; bowels open or costive. The pain may be spread 
over the abdomen, or confined to one place. The com- 
plaint may be periodical or permanent ; when the latter, it 
mav last through life. In every violent colic there is dan- 246 
COLICA. 
ger of inflammation, especially if the pain is seated in one 
place and becomes burning, or when costiveness and vom- 
iting accompany it. 
Pathogenesis. The causes are innumerable ; however, 
they can all be reduced either to injurious matters in the 
intestines, to cramps, sanguineous congestions, or to me- 
tastases and antagonisms or organic disorders. 
Therapeutics. 
General Rules of Treatment for any Colic. 
In every colic the first thing to be done is to cleanse the 
intestinal canal by a mild laxative ; for impurities are ever 
present, partly as cause, partly as effect, and their removal 
always produces great relief, even often complete cure. 
Further, in every colic, mucilaginous and oily remedies, 
such as water-gruel, linseed tea, a spoonful of almond, 
poppy or linseed oil, spermaceti, half an ounce dissolved in 
a cup of warm water, promptly mitigate the pains ; the best 
form of administering these remedies is the combination 
No. 90 ; opium must be avoided, because it constipates the 
bowels. Externally, antispasmodic ointments, cataplasms, 
and oily injections. Further, in every violent colic there 
is danger of inflammation ; therefore, as soon as the pain 
becomes fixed, violent, and burning, when the abdomen is 
distended and painful to the touch, and there is fever, a 
venesection must immediately be made ; and in young, 
plethoric persons, when the pain is violent and permanent, 
it is advised even as a prophylactic.—Finally,, we must 
examine in every colic, whether there be hernia. 
In every chronic colic it is an indispensable condition, 
indeed often the only means of cure, to wear flannel round 
the abdomen and back. 
The special treatment depends on the causes, which are 
numerous. All kinds of colic, however, may be reduced to 
the following principal classes : 
Colica sanguinea (blood colic). Signs of general or.local 
(abdominal) plethora or inflammability. Of that character 
is also the menstrual and hemorrhoidal colic (vide menstrua 
and hemorrhoides). It is either molimina menstruorum and 
hemorrhoidum, or a consequence of their suppression. The 
treatment consists in general and local abstractions of 
blood, cooling purgatives. In the hemorrhoidal colic, 
sulphur. 
Colica nervosa. Of this class are the spasmodic and 
hysterical colic. The signs of which, see under the res- COLICA. 
247 
pective heads. It calls for oily emulsions with hyoscya- 
mus, antispasmodics, inunctions and cataplasms. In 
stubborn cases, laudanum may be added to the emulsion ; 
warm baths and injections of asa fcetida one drachm, re- 
sorted to. See cure of hysteria and hypochondria. 
Colica gastrica. Under this head falls the colica biliosa, 
which is often epidemic, especially in the heat of summer. 
It has for signs gastric impurities, bitter taste, foul, yellow- 
coated tongue, etc. For the cure, give emulsions first, also 
potio Riveri, a spoonful of orange juice and injections; 
then mild laxatives, as tamarinds, manna, soluble tartar are 
required. 
Colica saburralis calls for purgatives, or an emetic, ac- 
cording to the indication of its locality. Sometimes chronic 
colic is owing to very hard and ancient sordes, especially 
of a tenacious mucous character, atrabilis, true infarcts, 
(colica stercoracea). Here a continued use of resolvents, 
and particularly of injections, also purgatives, are neces- 
sasy. 
Colica verminosa. The symptoms are those of worms 
(vide worms). The disease is remedied by oily emulsions, 
calomel, flores zinci, afterwards santonicum ; the cure of 
worms. 
Colica flatulenta, owing to accumulation of winds (vide 
flatulency). 
Colica metastatica, is known by the disappearance or sup- 
pression of a preceding disease, on which the colic has 
followed. The treatment must be that of the metastases, 
and of the malady which originated it; as such, particularly 
fequent are chronic, rheumatic, and arthritic colic. The 
disease is nothing but a rheumatismus or arthritis intestino- 
rum, and must be treated as such, by sulphur, guaiac, aco- 
nite, antimonials, mercury (vide No. 91). In the arthritic 
species, soda with bitters, warm baths, vesicatories on the 
abdomen, fontanels, woollen clothing, are chiefly to be re- 
lied upon. 
The syphilitic colic, a consequence of an imperfect cure 
of the venereal virus, which has thrown itself on the intes- 
tinal canal, is not a rare occurrence. In this case mer- 
cury must be given, the same by inunction when it cannot 
be borne internally. 
The psoric colic, a consequence of receded cutaneous 
eruption, scabies or herpes, calls for sulphur, antimonials, 
vesicatoria perpetua, warm baths, especially sulphur baths; 
the most efficacious are the natural, such as those of Aix- 
la-Chapelle, Nenndorf, Warmbrunn. 248 
COLICA. 
Colica adynamica has for signs the symptoms of weak- 
ness and its antecedents, particularly excesses in wine and 
women. Frequently it is a remnant of other species of 
colic, especially when strong evacuants have been used 
for a long time. The only curative means are internal 
and external roborantia, amara, cinchona, especially iron, 
Pyrmont spring and bath, cold washing, and steaming of 
the abdomen. 
Colica calculosa s. consensualis, in consequence of gall or 
nephritic stones. The signs are : sudden and very violent 
pain, with forced vomiting. In the gall-stone colic, the 
pains are situated in the region of the liver and epigas- 
trium, and are followed by a yellow color of the skin; in 
the gravel colic (colica nephritica), the pains occupy the 
whole abdomen, especially the course of the urethra; 
cramp in the loins and calf of the leg, also retraction of the 
testicle on the side affected (vide lithiasis). 
The treatment consists in an abundant use of fat oils and 
emulsions, hyoscyamus, antispasmodic embrocations, cata- 
plasms, oily injections, but chiefly of warm baths, which 
alone often promptly relieve. In nephritic colic, opium 
also is to be used ; but must be avoided in gall-stone colic, 
because it stops the intestinal discharge, which is here so 
necessary. In every stone colic, the possible occurrence 
of inflammation is to be regarded, which in strong, ple- 
thoric persons, or in a febrile state, requires venesection. 
Colica visceralis et organica arises from obstructions, 
physconias, indurations, and other organic disorders of the 
liver, pancreas, spleen, and other abdominal viscera, or 
from newly generated pseudo-organizations. The signs 
are those of the existence of visceral obstructions (vide 
ohstructio). The cure requires strong resolvent remedies 
(methodus resolvens, hypochondria), especially gummi am- 
moniac, soda, soap, taraxacum, mercury,pillulse resolventes 
(vide No. 92). The most efficacious of all is the Carlsbad 
spring. 
Colica metallica (arsenicalis, saturnina, mercurialis), owing 
to metallic poisoning, not acute but chronic. It is recog- 
nized by the preceding internal or external communication 
of the poison ; and the treatment is that which is usual for 
metallic poisoning, in which sulphur, taken as a medicine 
internally and in baths, is the principal remedy. Particu- 
larly remarkable and frequent is the colica saturnina {colica 
pictonum). It is distinguished by obstinate constipation of 
the bowels, paralysis of the extremities, emaciation, and 
exsiccation of the body. HYDROPHOBIA. POLYDIPSIA. 
249 
The treatment must commence with opening the bowels, 
especially by castor-oil, rhubarb, aloes, sulphur, sulphur 
baths ; then opium and alum must be given. Colica ar- 
thritica often creates very similar paroxysms. 
HYDROPHOBIA. 
Diagnosis. Aversion to and impossibility of swallowing 
thing fluid, whilst solid food may possibly be taken. 
It is a mere spasmodic nervous affection of a particular 
character, even the highest degree of idiosyncrasy. 
It arises either by being poisoned with the hydrophobic 
virus (hydrophobia miasmatica s. contagiosa), and is a symp- 
tom of rabies (vide rabies), and is dangerous to life. Or it 
is a symptom of nervous diseases (hydrophobia spontanea 
s. symptomatica') in hysteria, by excited imagination (fancy- 
ing to have been bitten by a mad dog—hydrophobia imagi- 
naria), also in and after inflammatory affections of the 
throat, angina, gastritis. Here it is a pure symptom of 
spasm, without any danger, and is to be treated as such. 
A mustard plaster or vesicatory around the neck, narcotic 
cataplasms, injections of asa foetida and opium ; aqua lau- 
rocerasi, liquor belladonnse cyanicus are generally sufficient 
to remove it. 
POLYDIPSIA. 
Diagnosis. Insatiable thirst. Thirst, like hunger, is re- 
lative and varies according to individuality ; strong in some, 
weak in other men ; also depends very much on habit. 
Morbid thirst arises either from internal heat (thence a 
symptom of every fever, especially the inflammatory), or 
from increase of watery evacuations (thence present in 
diarrhoea, sweat, diabetes), or from spasmodic suppression 
of the internal exhalation of the mouth and throat (as in 
hysteria, hypochondria, and other nervous diseases) ; it can 
also be produced by obstructions of the liver. 
The treatment must comply with the various causes. 
Particular attention is due to it as a symptom of obscure 
diabetes mellitus, of wThich it is often the only sign ; it de- 
serves particular attention, and therefore the urine must 
be tested. The same applies to diseases of the liver. I 
have cured a case, the patient of which was obliged to 
drink 30 and more pounds of water a day, by the Carkbad 250 
DISORDERS OF HEARING AND SIGHT. 
spring, also by the use of the pills No. 93.—Nervous poly- 
dipsia I have seen perfectly cured by sea-bathing. 
The thirst for spirituous liquors, especially brandy, is 
important and destructive. It is always the consequence 
of a bad habit, leads to dropsy, delirium tremens, indura- 
tion of the stomach, emaciation, and admits of cure with 
great difficulty. 
The remedies are: gradual weaning off, substitution of 
another less injurious, even salutary stimulus, tinct. ab- 
sinthii, rendering brandy disgusting by admixtion of nau- 
seating substances, as tartar, emetic, mineral acid (elix. 
Halleri, 10, 20 drops threD times a day), and quassia (pills 
of extract, quassise, absinth., cascarilla aa) have been of use. 
polyphagia, pica, vide Jlpepsia. 
PSEUDACUSIS, PARACUSIS. 
Diagnosis. To hear something where there is no sound, 
or to perceive wrong what is audible. Of this kind is the 
tinkling and humming of the ears (susurrus aurium), the 
hearing of unusual foreign sounds and voices. 
The most troublesome, and distressing of these evils is 
buzzing in the ears. By its violence and uninterrupted 
continuance, it may attain a degree which deprives the 
sufferer of all mental tranquillity, and brings him to despe- 
ration. Besides the general treatment, I have found most 
efficacious a daily embrocation with unguentum epipasti- 
cum behind the ear, repeated cupping on the neck, foot- 
baths of mustard, and laxatives. 
PSEUDOPIA. 
To see something where there is no object, or to per- 
ceive wrong what is visible. Here must be ranged the see- 
ing of flocks and sparks before the eyes (scotomia), seeing 
colors and various apparitions, seeing half (visus duplex), 
seeing double (diplopia). 
This illusion of the senses may increase unto an exhi- 
bition of real images and aparitions (as when the sense of 
hearing is struck with sounds, voices, words) ; which the 
patient does not believe to be sensations originated within 
himself, but thinks them phenomena communicated from 
without. This accounts for people becoming visionary. NYMPHOMANIA, SATYRIASIS, ONANISMUS. 
251 
All these delusions of the senses, as well as those of 
smell, taste, and feeling, originate in an altered tone of the 
nerves, either of the external or the internal sense ; for 
every sense has a double organ, an external and an internal 
one ; and this alteration has been brought on by local or 
by sympathetic irritation, and is to be treated accordingly. 
The sympathetic is most frequently abdominal, especially 
in disorders of the sight, and therefore occurs often to hy- 
pochondriacal persons. I knew a man who, when suffering 
under an accumulation of wind would suddenly become af- 
fected with half-sight. He saw all objects only half; as 
soon as he discharged flatus, he could see them whole again. 
Besides local plethora, congestions, metastases or pure 
nervousness, are the most common causes, to which the 
treatment must be adapted. 
DISORDERS OF THE SEXUAL INSTINCT. 
Nymphomania, Satyriasis, Onanismus. 
Diagnosis. Excessively increased, insatiable sexual in- 
stinct. It is called satyriasis in men, when it is accompa- 
nied with continual erections, priapismus ; in women, nym- 
phomania, furor uterinus; with unnatural gratification, self- 
pollution, onanismus ; in the highest degree, when instinct 
or passion overpowers reason, especially in females, de- 
generating into true rage and insanity, erotomania. 
The causes can be corporeal as well as mental. Over- 
heated imagination directed to voluptuousness, too frequent 
habit of gratifying the sexual desire, and irritation of the 
genitals in the absence of true satisfaction, passionate love 
for a person, occurring more frequently in the female sex, 
in unmarried women, widows. Deficiency of coition rarely 
produces such a state, if no excitement and corruption of 
imagination, or habit of immoderate gratification, or irrita- 
tions of the sexual organs have preceded, therefore grati- 
fication does not always remove the evil. An idle, luxu- 
rious mode of living, and absence of care and trouble, are 
most apt to predispose to this state, whereas it is rarely 
found in the country among laborious people. However, 
there may exist mere corporeal irritaiives, especially 
worms (ascarides), plethora abdominalis and indurations 
in the abdomen, which irritate the sexual nerves by their 
location. Thus I have seen a very respectable old woman, 
in her 70th year of age labor under this disease, the cause 252 
PARALYTIC DISEASES. 
of which, on dissection, proved to be a scirrhous indura- 
tion near to the ovarium. 
The principal signs of nymphomania are : violent, burn- 
ing, piercing, itching pain on the clitoris and bladder, 
vesical spasms, strangury, ischury, discharge of mucus, 
frequent fits of fainting, hysterical spasms. They serve to 
discover the often concealed evil. 
It is not out of place, but is worthy of remark, to men- 
tion how frequent premature development of the sexual in- 
stinct has become. It is the consequence of too rich food, 
especially too stimulant aliments and beverages (meat, 
wine, coffee, spices), of too much rest and sitting, and too 
premature excitement of the imagination. 
The principal means to banish this demon are fasting 
and labor. As it is chiefly owing to idleness, too rich food, 
luxury, and indulgence in imagination ; therefore, lower- 
ing the diet to a few vegetable aliments, much corporeal 
labor, and exertion, until fatigue be produced, which will 
consume and translate the power ; occupation of the mind 
with serious abstract topics, cold regimen, cold lotions, 
and baths, cooling laxatives, and the use of camphor are 
the best preventive and curative means. The latter is 
really a specific antiphrodisiac ; I have seen its long con- 
tinued external and internal use produce atrophy of the 
testicles. It must be applied internally and externally in 
little bags, and lotions to the genitals. The same is true 
of the external use of lead remedies. Galen says : Plum- 
bum est domitor veneris. 
In the highest degree of nymphomania, and when it is 
incurable by the usual means, cauterizing the clitoris and 
nymphEe by lapis infernalis, or extirpation of the clitoris 
are most serviceable. 
Priapism may appear also purely syrnptomatical, as a 
mere local spasm {tetanuspenis) in hypochondriacal indivi- 
duals. Immersing the yard in cold water, or narcotic-oily, 
warm fomentations applied to the same, remove it promptly. 
3. PARALYTIC DISEASES. 
Annihilation or diminution of the two fundamental func- 
tions of the nervous system, sensation and motion, or of 
one of them. 
Proximate cause is impeded action of the nerves, which 
may be produced by real deficiency of power (true debi- 
lity), or by an external cause suppressing its energy, as APOPLEXY. 
253 
plethora of the vessels, extravasation, foreign bodies, tu- 
mors, sprains, ligatures; or by spasmodic affections, me- 
tastases, specific stimuli, consensual, especially gastric ir- 
ritatives, worms; hence paralysis may alternate with 
spasms, even be combined with spasms and pain. 
The paralysis may proceed from the peripherical as well 
as from the central termination of the nerves. 
PARALYSIS OF THE BRAIN. 
Apoplexia. 
Diagnosis. Sudden annihilation of consciousness, of the 
sensitive and motive power, while the vital functions, as 
pulse and respiration, continue undebilitated, even are in- 
creased. 
This state is to be distinguished from other states very 
similar as to their phenomena ; from epilepsy, by spasmodic 
motions,- from syncope, by the absence or great weakness 
of the pulse and respiration ; from the highest degree of 
drunkenness, by the cause preceding, the smell of spirit- 
uous liquors, and motion not being entirely suspended. 
The case may be different. Sometimes an apoplectic fit 
strikes as if lightning, and like it kills in a moment. Some- 
times it does not kill instantaneously ; in this case the pa- 
tient lies as if in a deep sleep, with snoring respiration, 
slow, frequently full, strong pulse, without consciousness, 
without perceptibility, without any power of motion (some- 
times with intermixed spasmodic motions), foam at the 
mouth, dilated pupil, eyelids and jaw hang down, impossi- 
bility of swallo ving, involuntary stools, and emission of 
urine. This is termed apoplexia co.npleta.—But sometimes 
apoplexy is incomplete, the patient retains consciousness, 
and obly single parts are seized by paralysis. Here again 
the following cases must be discriminated. The patient is 
paralyzed on all parts below the head (paraplegia), or only 
one half of the body is paralyzed (kemiphlegia). Sometimes 
only sensation or motion is paralyzed. The slightest at- 
tacks of apoplexy, which therefore are not at all noticed, 
are those, when only single rn iscles are paralyzed, as in 
the face, one eye is smaller than the other, the mouth awry. 
Complete apoplexy takes the following course. Either 
the patient does not recover consciousness, but dies in 
the fit, or he recovers consciousness, which is followed by 
fever, generally remittent with daily exacerbations, which 
either saves the patient by coction and crisis (on the 7th 254 
APOPLEXY. 
or 14th day), or in an exacerbation, generally on 3d or 7th 
day, brings on a new fit and kills him. The fever is some- 
times an intermittent, the apoplectic fit is nothing but the 
first paroxysm of the fever and ague, and the patient feels 
perfectly well after the paroxysm is over; but the follow- 
ing day the apoplectic paroxysm returns and then proves 
fatal; if this do not happen, the third attack certainly will 
terminate that way (vide febris intermittens perniciosd). 
Generally, after the attack, local paralyses remain either in 
external parts, or in internal organs, as loss of memory, 
speech. The worst of all is the paralysis of the gullet, 
swallowing being thereby impeded ; in such a case the pa- 
tient lies often 5 or 6 weeks, before he dies. 
Apoplexy is one of the most dangerous diseases 5 the 
complete is in most cases fatal, rarely perfectly curable, 
subject to relapses within longer or shorter intervals. In- 
complete apoplexy is frequently succeeded by a more vio- 
lent attack. 
The forerunners of apoplexy are : uncommon sleepiness, 
nauseating vertigo, humming in the head, partial loss of 
memory, hanging down of the eyelids, lower lip or jaw; 
thence frequent chewing with nothing in the mouth to chew 
on, involuntary flux of saliva during sleep, easy distortion 
of the countenance, especially of the angle of the mouthy 
old age. 
Pathogenesis. The proximate cause of apoplexy is a sud- 
den stoppage of the cerebral action. This can be created 
by active as well as passive, and in general by various 
causes. They may be divided for practical purposes into 
the following classes. 
1. Sanguineous congestion to the brain, the most common. 
It is created by plethora, stoppage of the reflux (by pres- 
sure on the cervical vessels from tight cravats, clothing, 
swelling on the throat, disorders of the heart, also the pres- 
sure of an overloaded stomach—thence apoplexy frequent- 
ly occurs after a hearty meal—hanging position of the 
head, angina, pneumonia); by too great an afflux (by vio- 
lent motions, passions, keeping the head too warm, insola- 
tion, and equally violent degrees of cold forcing the blood 
into the vessels, spirituosa, drunkenness, metastases, mor- 
bid irritations, idiopathic as well as consensual, lesions of 
the head, inflammation of the brain). 
2. Erethismus, nervous affections, spasm of the brain in 
nervous not plethoric individuals, by all violent irritations 
of the brain, passions, violent convulsions and spasms, as 
tetanus, metastases, consensual irritations. APOPLEXY. 
255 
3. Adynamia, real exhaustion of the vital power of the 
brain, as in old age, after great loss of blood, excesses in 
venery, nervous fevers. 
Of the pathological cerebral irritations, which are able 
to produce apoplexy, two are of particular importance to 
the practitioner, the metastatic, and most frequently shift- 
ing of arthritic matter to the brain, as the shifting of the 
scarlatine matter to the brain ; thence the sudden fatal apo- 
plexy of this disease ; and consensual gastric, where the ir- 
ritant matter is located in the preecordia; thence apoplexia 
biliosa, which may become even epidemic.—The discrimi- 
nation of the ancients between apoplexia sanguinea and se- 
rosa is perfectly correct, save that there were no accumu- 
lation of serum, but as apoplexy without sanguineous con- 
gestion, which is not found in the brain during life nor 
after death, it is the same which we now term apoplexia 
spastica, nervosa, adynamica. 
Predisposition deserves great consideration. The same 
occasional causes which operate on some persons with im- 
punity, will induce apoplexy in others, merely because 
they are predisposed to it. The predisposition consists 
chiefly in the corporeal structure, short thick neck, head 
sunk between the shoulders, short stout frame (architectura 
apoplectica); old age, the seasons, as the equinox, transit 
from winter into spring, or from autumn into winter, is fa- 
vorable to apoplexy, especially the month of December ; 
finally, rapid change in the barometric state of the atmos- 
phere. 
Every fit of apoplexy leaves a predisposition to another. 
Therapeutics. The fundamental indication is to restore 
the action of the brain. I must, however, remark that the 
disease does not always depend on a passive state, a weak- 
ness of the brain, for the cause of cerebral inactivity can 
often be of a very active character, and the brain may be 
unimpaired in its power, but only oppressed by pressure; 
and secondly, that the cause of every apoplexy is not to 
be sought for in a congestion of blood, which likewise is 
not always the case. 
The treatment of apoplexy, therefore, consists merely in 
taking away the cause, which disturbs the action of the 
brain, and, if this do not suffice, to restore its action by 
endeavoring to arouse it directly. It is best to look upon 
the internal state as a suspension of the cerebral activity, 
not as a loss of it. 
The first and most important investigation in every apo- 
plexy must be, whether there is a sanguineous accumula- 256 
APOPLEXY. 
tion in the brain. As in hanging, the first thing to he done 
is removal of the rope, so the removal of the sanguin- 
eous pressure is the first condition of cure, often suffi- 
cient in itself to effect it. This accumulation is recognised 
hy a full hard pulse, red bloated face, reddened (often pro- 
traded) eyes, increased warmth, besides the causal circum- 
stances, as suppressed hemorrhage, and drinking of spiri- 
tuous liquors, etc. In such a case a venesection in the 
arm, in suppressed hemorrhages on the foot, must imme- 
diately be instituted. The opening must be made large ; 
for it is essential that the evacuation of blood be quick and, 
copious. Let the blood flow, until the stertor abates, or 
consciousness and speech return, and the pulse loses its 
fulness and hardness. If the blood cease to flow and the 
symptoms persist, a second vein is instantly to be opened. 
If the pulse becomes small, without alleviating the symp- 
toms, the vein is to be closed, and local abstractions of 
blood substituted. Twelve cups on the throat and neck, 
twenty leeches on the head, in urgent cases ; if all this is 
unavailing, and the sanguineous congestion continues, the 
jugular vein or the temporal artery must be opened. In 
suppressed hemorrhoids or menses, leeches are to be ap- 
plied ad anum or labia vulvse. When no amelioration suc- 
ceeds, and the pulse grows again fuller, the venesection 
may be repeated after six or eight hours. In hemiplegia it 
must be made on the sound side. Simultaneously we must 
employ everything that can by derivation or contrastimu- 
lation draw the blood away from the head. This may be 
accomplished particularly by clysters (of 3 or 4 ounces of 
vinegar, salt, mustard, tartar emetic 4 grains), sinapisms 
on the calves of the legs, foot and arm, mustard-baths, cold 
fomentations on the head. When the patient is able to 
swallow, cooling purgatives, as sulphate of soda and senna, 
tartar emetic (vide No. 94). The head must be elevated, 
tight clothing removed, and the room be warm. If the pa- 
tient is unable to swallow, the remedies must be conveyed 
into the stomach by means of a flexible tube. As long as 
signs of congestion are present, all irritatives must be ab- 
stained frorn, even emetics so much cherished, since they 
are apt to increase the congestion to the brain ; also the 
aromatic lotions and olfactory remedies are to be avoided. 
If after this treatment no improvement appears, there is 
little hope. Generally on the third day a relapse takes 
place and kills the patient. If by this treatment ameliora- 
tion succeeds, no alteration is to be made, but the use of 
cooling purgatives and clysters is to be continued. It is 257 
only after a proper application of these means have failed 
that an emetic is admissible, and then it is a most excellent 
remedy, especially when the stomach has been overloaded. 
A large vesicatory on the neck is also proper. And now 
appropriate nervines and stimulants maybe resorted to, but 
always with precaution to avoid all such as create strong 
sanguineous excitement, and therefore cooling and purga- 
tive remedies may be admixed. The best are valerian, 
arnica (vide No. 95), pyrethrum, tinctura ambrse, liquor 
c. c. succin. At the same time regard must be had to the 
possibility of effusion, for which calomel and digitalis may 
he given intermediately. If, after the removal of the san- 
guineous congestion, the symptoms do not abate, the treat- 
ment for apoplexia nervosa is to be entered upon. 
The second case is a purely nervous, spasmodic and ady- 
namic apoplexy. It is recognised by the absence of the 
above-mentioned signs of sanguineous congestion and ex- 
citement. The patient looks pale, is rather cool than 
warm, his pulse small, easily compressible; debilitating 
causes, exhausting evacuations or exertions, or a chronic, 
weakly, nervous state, or old age have preceded. Here, of 
course, a stimulant nervous treatment must be prosecuted; 
valeriana, arnica, liquor c. c. succin., castoreum, ambra, 
oleum cajeputi, and similar eetherea, but particularly sti- 
mulant clysters (of vinegar, mustard, and pyrethrum), and 
cutaneous irritatives, vesicatories on the neck, sinapisms 
renewed every 12 hours on the extremities, aromatic lo- 
tions and embrocations are to be used. Should the above- 
named remedies prove inefficacious, an addition of opium 
to the other nervines may be of great service. If this 
treatment is fruitless, a moxa is to be applied to the head ; 
of the successful application of which I know one instance. 
We are, however, not to forget, that sometimes latent con- 
gestions of blood, at least local ones, hemorrhoidal, do co- 
exist, and require the application of leeches. 
The third case is the gastric and bilious apoplexy. It is 
recognised by an overloaded stomach or anger having pre- 
ceded, by the prevailing bilious epidemy, and by the fol- 
lowing signs: the patient has eructations, disposition to 
vomit, coated tongue, a wry face, the white of the eyes is 
yellowish, he carries his hand frequently to the epigastric 
region, which is distended. Here an emetic is the only 
salvative ; but previous to its administration examine well 
whether congestions and a plethoric state do not coexist, 
which is frequently the case. As a vomit tartar emetic is 
the best; after vomiting irritative injections and purgatives 
APOPLEXY. 258 
must be administered. This is often sufficient to accom- 
plish a cure. If amelioration does not succeed, or it stops, 
we are to ascertain whether there is still an indication for 
an emetic, and repeat it. If this is not the case, and gas- 
tric accumulation is no longer present, the treatment must 
be to operate on the dynamic state, and when signs of san- 
guineous congestions continue, the treatment of the apo> 
plexia sanguinea, or where the nervous state predominates, 
that of the apoplexia nervosa is to be pursued. 
The fourth case, which is of frequent occurrence, is me- 
tastatic apoplexy, especially that which arises from gout. 
It is discovered by knowing that this morbid state pre- 
existed. We must first inquire into the dynamic relation 
of the malady and remove it. Most frequently, especially 
in gout, it is sanguino-inflammatory. Consequently, we 
begin by abstraction of blood, as in apoplexia sanguinea, 
but afterwards the morbid matter must be translated by 
antistimuli (in retroceded podagra, sinapisms on the feet, 
foot-baths of mustard, dry bran-baths mixed with salt), and 
specifics corresponding to the morbific matter, such as 
guaiac and aconite, given. But if the vital condition is ady- 
namico-nervous, the treatment of apoplexia nervosa is to 
be combined with the specific and derivative. 
When apoplexy is a symptom of intermittent fever, the 
patient will be free from apoplectic symptoms as soon as 
the paroxysm is over ; and the treatment will consist in 
merely preventing another attack by the most active febri- 
fuges, among which cinchona and opium rank first (vide 
febris intermittens perniciosai). 
If apoplexy is a consequence of mechanical pressure on 
the brain, produced from without by lesions of the head, 
or from within by organic formations in the cranial ca- 
vity, or on the neck, when the cause of the pressure can- 
not be removed, the effect, the sanguineous congestion, 
may be diminished by abstractions of blood and derivatives, 
but never entirely removed. 
Paralysis remaining after apoplexy is treated as such. 
APOPLEXY. 
Every one, who has sustained an apoplectic fit, must 
carefully try to prevent its recurrence. The preventive 
rules are: to lie with a high pillow, to keep the feet warm, 
to avoid overloading the stomach and spirituous liquors, 
violent passions, suppers, and costiveness ; and to take 
mild laxatives from time to time, especially Saidschiitz bit- 
terwater ; also a moderate abstraction of blood in spring 
and previous to the winter setting in is proper. 259 
SUFFOCATIVE CATARRH. SYNCOPE. 
SUFFOCATIVE CATARRH, PARALYSIS OF THE LUNGS. 
Catarrhus Suffocaiivus, Apoplexia Pulmonvm. 
Diagnosis. Sudden attack of suffocation,-orthopnoe, rat- 
tling in the throat, cold sweat, agony, sometimes loss of 
consciousness, sometimes it is retained. 
Pathogenesis, is the same as in apoplexy, with this diffe- 
rence, that there is here a paralysis of the pectoral nerves, 
while in apoplexy it is a paralysis of the cerebral nerves. 
The occasional causes may be the same as those of apo- 
plexy ; but a material local accumulation and extravasation 
in the bronchia, as excessive accumulation of mucus in 
asthma mucosum, sanguineous extravasation, effusion of 
matter in suddenly burst vomica, may give rise to it. 
Therapeutics. The principal indication is promptly to 
free the lungs from their accumulation, and to rouse their 
action. The chief remedies are : immediately a vene- 
section in the arm, and directly after it an emetic, sina- 
pisms to the chest and upper arms, arm-baths 5 then decoc- 
tion of senega, or arnica root, and tart, emetic, liquor ano- 
dyn. Hofmanni, liquor c. c. succin., musk, vesicatories, re- 
gard being paid to remote causes, as in apoplexy. 
FAINTING. 
Lypothymia, Syncope. 
ASPHYXIA. 
Suspensio Vitce. 
Diagnosis. Loss of consciousness, sensation, and mo- 
tion ; pulse and respiration diminished or entirely annihi- 
lated. 
There are different degrees of it : the lesser, lipothymia, 
when the pulse and respiration are but moderately weak- 
ened ; syncope, when those functions are scarcely percep- 
tible ; asphyxia, when they are entirely abolished. 
The forebodings of fainting are : buzzing in the ears, 
sparkling before the eyes, and dimness of sight. 
The duration varies very much, from a few minutes up 
to several hours, even days. Recovery is generally accom- 
panied with a deep sigh. 
The prognosis differs according to the causes. Hyste- 260 
SYNCOPE. 
rical fainting is without danger, however long it may last. 
It is more dangerous when due to plethora, or stoppages 
of the circulation in the heart and to high degrees of ex- 
haustion. Syncope at the commencement of or during 
fever augurs bad. There is reason for fear in every faint- 
ing fit of long duration, on account of the stoppage of the 
circulation, stagnations and coagulations of blood, espe- 
cially when an inflammatory state of the blood exists. 
Pathogenesis. The proximate cause of syncope is debi- 
lity, or a complete cessation of the action of the central 
organs, the heart and lungs, and consequent cessation of 
nervous action ; this forms an essential difference between 
syncope and apoplexia. In the first there is impeded san- 
guine life, in the latter impeded nervous life. Fainting 
proceeds from the heart, apoplexy from the brain ; there- 
fore. in the first the pulse is weakened and annihilated, in 
the latter unaltered, even increased. There is then, no pa- 
ralysis after syncope ; but paralysis is usual after apoplexy. 
The remote causes are: nervous affections (great mental 
emotion, as fright, joy), nervous fevers, but especially hys- 
teria, and is therefore of frequent occurrence in this state, 
corrupt air, strong odors, especially the fragrance of flow- 
ers on hysterical persons, narcotic poisons, consensual ir- 
ritations, irritation by worms ; plethora of the heart, by 
which its contraction is impeded, and the motory power 
suppressed for some time (sanguineous plenitude, youth, 
violent motions, suppressed or imminent hemorrhages, 
tight lacing, diseases of the heart) ; weakness, after violent 
corporeal exertions, loss of blood, exhausting evacuations, 
as violent diarrhoea, cholera, or artificial, as in paracente- 
sis abdominis for ascites. 
Therapeutics. The action of the heart is to be roused, 
and for this purpose there is a great variety of resuscita- 
tive means, corresponding with the variety of causes. The 
only general and innocuous resuscitative is a sprinkling of 
cold water; in hysterical persons the fumes of burning 
feathers, cut onion, vinegar, acidum aceticum aromaticum 
to the nose, washing with aromatic spirit, rubbing the ex- 
tremities, injections, fresh air. In the adynamic form, a 
horizontal position, to promote the reflux of blood to the 
heart, is one of the best restoratives; volatile odors, as 
ammonium, rubbing the face, the scrobiculus, the spine 
with aromatic spirit, strong wine given as soon as it can 
be swallowed. In the sanguineous syncope place the feet 
pendent, and raise the head and chest; foot and arm-baths, 
removing every pressure and tight clothing, cold water ASPHYXIA. 
261 
dashed into the face (avoid aromatic or volatile odoratives 
and lotions), in obstinate duration venesection. 
If all these means are unavailing, the treatment of as- 
phyxia must be resorted to. 
ASPHYXIA. 
Diagnosis. Suspension of pulse and respiration, of sen- 
sation and the power of motion, consequently it is a per- 
fect image of death, for which it may be mistaken, as all 
the ordinary signs of death are here fallacious, and none 
to be relied upon excepting incipient putrescency, and its 
adjunct the soft doughy cornea, which retains any impres- 
sion that is made upon it. Internal consciousness is pos- 
sible, so that it sometimes happens that a person appa- 
rently dead, hears what passes around him, without being 
able to utter a single sign of life. 
Pathogenesis. The causes are : either a sudden mecha- 
nical stoppage of the action of the heart and lungs, (suffo- 
cation by hanging, being drowned, stopping the mouth, 
vapors and mephitic air), or the abstraction of elements 
indispensable to life, as warmth, oxygen, or influences 
which directly exhaust vitality, as lightning, intense emo- 
tions of the mind, paralyzing poisons, malignant nervous 
fever, plague). Every fit of fainting may pass into as- 
phyxia. In lying-in and hysterical women it may occur as 
a symptom, and in the latter case be only a spasmodic at- 
tack, which will last a certain time and cease of itself. 
Therapeutics. The fundamental indication is to rouse the 
latent vital power, especially that of the heart and lungs; 
and next to remove the impediments to their action. 
Therefore, we must first awaken the vital power which is 
the source of excitability ; for, unless there is excitability, 
stimulants will be unavailing ; but excitability requires for 
its support pure air and warmth. Therefore, the apparently 
dead body must be placed in pure air, and furnished with 
warmth, by means of hot sand or ashes, or what is still 
better by the contact of a living person, and this caloric 
retained by proper bed clothing; also, hot applications 
must be made, and frequently renewed, to the scrobiculus 
cordis, behind the shoulders and to the soles of the feet. 
A warm bath, strengthened with salt, ashes or spirits, is 
not to be neglected. By this process alone, persons appa- 
rently dead have been restored. It is more important of 
itself than all other means besides; is the principal thing 262 
ASPHYXIA. 
to be done, and not to be interrupted to give place for other 
remedies. Insufflation into the lungs through the mouth, 
the nose being closed, is requisite. This will be more effi- 
cacious if immediately performed by an assistant, for 
warmth and vital breath are great vivifiers of the lungs 
and heart. Pure, or oxygenated air, may also be employed 
by means of Gorcy’s bellows; but, in using this instru- 
ment much care is required, lest it over-distend the lungs. 
It will be proper to inclose the chest with a towel, and by 
alternately drawing and relaxing it imitate respiration. 
The second indication is to apply active stimulants, 
which excite directly through the medium of the nerves, or 
indirectly through sympathy the action of the heart and 
lungs. The direct stimulants are insufflation and disten- 
tion of the lungs, artificial respiration, an electric or gal- 
vanic shock passed through the heart (by the application 
of one conductor to the pit of the stomach, and the other 
to the spine); also, transfusion of living blood. The in- 
direct are : frictions to the soles of the feet and palms of 
the hands; dropping cold water and wine on the scrobicu- 
lus ; spirit of ammonia approached to the nose and dropped 
on the tongue, tickling'the fauces with a feather, irri- 
tative injections, cups on the pit of the stomach, and ex- 
citement of the nerves of hearing by loud sounds. 
As regards obstructions, besides removing that of the 
rope from the neck of persons hung, mephitic air from the 
suffocated, the water from the lungs by an inclined posi- 
tion in the case of drowned persons, venesection must be 
mentioned, as proper to relieve the surcharged lungs and 
heart, and is never to be omitted in cases of suffocation. 
Time deserves great consideration, because a certain 
lapse is necessary before life can return, as is shown by 
some cases of asphyxia, which required an interval of seve- 
ral days. Therefore, after having employed every resus- 
citative means, we must leave the individual in repose, but 
keep him warm, and repeat the stimulants every few 
hours for a space of twenty-four, waiting the signs of pu- 
trefaction. 
There remain to be mentioned a few particular rules re- 
garding some species of asphyxia. 
In frozen persons, while warmth is necessary for resus- 
citation, it must be of a low degree, approaching to the 
freezing point; for a higher one would instantaneously an- 
nihilate the remaining vital power, and produce a transi- 
tion into putrid dissolution. The body or the part affected 
is to be placed in snovy or ice-water, which will suffice for VERTIGO. LETHARGY. 
263 
recovery if there is a sufficiency of life remaining. Every 
warm application is injurious, even warm injections. 
Those struck by lightning, are to be affused with cold 
water, buried up to the neck in fresh dug earth, bled, and 
have opium administered. 
In suffocation by carbonic vapors or other mephitics, the 
body must be exposed to a current of fresh air, and be as- 
persed with cold water ; venesection must be practised, 
and injections of vinegar administered. 
Diagnosis. All objects, even the patient’s own body, 
appear to him as turning round ; when the case is severe, 
he staggers and wavers ; when the case is still more severe, 
his sight is obscured (vertigo tenebricosa) and consciousness 
suspended (vertigo caduca). 
In youth it signifies little j but in advanced age it is the 
forerunner of apoplexy. 
Pathogenesis. Its causes are the same as those of all 
other nervous diseases ; but the most frequent are gastric 
sympathies, from overloaded stomach, worms and infarcts. 
Besides these it may be produced by a sanguineous cere- 
bral congestion, organic disorders in it, plethora, or de- 
bility. 
Therapeutics, consist of gastric evacuants, abstractions 
of blood, and nervines, according to particular indications. 
Direct cure: cold bathing of the head, cold affusions, mus- 
tard foot-baths, cupping in the neck frequently repeated, 
washing the temples, forehead, behind the ears, and the 
neck with spirits and balsamics. Internally, bitterwater 
continued for some days, valerian, mustard, elixir acid. 
Halleri, issues on the neck and on the arm, worsted stock- 
ings and socks of oilcloth. I have found guaiacum with 
cream of tartar (No. 96) a true specific. 
VERTIGO. 
LETHARGY. 
Lethargus. 
Diagnosis. A sleep continued beyond the natural time 
it may extend to weeks, months, even years.* The funda- 
mental functions of organic life, as pulsation, circulation 
* An instance of 4 years’ duration is stated in Hufeland’s “ Journal 
der praktischen Heilkunde,” vol. 59, piece 3, page. 127. 264 
LOCAL PARALYSIS. 
of the blood and respiration, remain undisturbed. Nutri- 
tion is possible only by the injection of fluid aliments; se- 
cretions and excretions are trifling. In some cases short 
intervals of awaking intervene, to pass again soon into 
sleep. 
This complaint is rarely fatal, unless it is a symptom of 
some dangerous affections of the brain; it may even be 
critical in chronic, nervous, and mental diseases, and lead 
to a restoration of health. 
In a lesser degree it is drowsiness, a perpetual inclina- 
tion to sleep. 
Chronic lethargy most frequently occurs in the female 
sex. The causes are: disturbances of menstruation, espe- 
cially at the development of puberty, general nervous dis- 
eases, intense mental affections, mental diseases, and me- 
tastases to the brain (it has been observed after measles), 
exsudation into the cranial cavity, and organic disorders. 
Temporary lethargy and drowsiness in children generally 
forebode hydrops cerebri, and in aged persons, apoplexy. 
Therapeutics. The treatment must be accommodated to 
the causes, and nutrition must at the same time be attend- 
ed to; external irritative and excitative means, baths, cu- 
taneous stimuli, irritant clysters, the endermatic method, 
and moxa are to be used. I once applied galvanism (one 
pole to the pit of the stomach, the other to the ear) with 
perfect success. In metastatic lethargy the internal and 
external use of mercury has proved most serviceable. 
LOCAL PARALYSIS. 
Paralysis Localis. 
Diagnosis. Impaired or totally annihilated sensation or 
motion, or both. In a higher degree, the nervous in- 
fluence of organic life and reproduction is annihilated. 
There are consequently different degrees : 1, diminished 
sensation, or motory power; 2, entire annihilation of one 
or the other; 3, of both; 4, weak pulse and diminished 
warmth in the paralyzed part; 5, emaciation; 6, disorga- 
nization, withering, complete drying up, gangrene or dry 
mortification, necrosis, mummification. 
It can attack any part of the body, external as well as 
internal, and according to the part or the organ it affects, 
the number of which is great, it has received different 
names; as in the organs of senses amaurosis, cop ho sis ;of LOCAL PARALYSIS. 
265 
the intestinal canal, dysphagia, apepsia, of the pectoral or- 
gans, asthma. 
It frequently follows apoplexy; but often it has only a 
local origin, and may be quickly or gradually formed. It is 
sometimes connected with spasmodic affections, or alter- 
nates with them. 
The cure is always difficult. Its curability depends on 
1. Duration: the older the complaint, the more difficult 
the cure ; 
2. Seat: cure is most difficult, when the disease is lo- 
cated in the organs of the senses ; 
3. Cause: when it is owing to metastases, the cure is 
easier; more difficult when owing to real debility ; incur- 
able when caused by a mechanical pressure which cannot 
be removed, as that of exostoses; 
4. Degree : easier to be remedied, when only sensation 
or motion is lost, bat spasms and pains continue in the part; 
more difficult, when either are wanting; still more so, 
when the organic life of the part is impaired. 
Pathogenesis. The proximate cause is an affection of the 
nerve itself, annihilating its action entirely or partially. 
Here is the place to make a remark of practical import- 
ance, which is, that the impeded action may be seated in 
the place of paralysis itself, as well as in the origin and 
course of the nerve relating to this part, as in the brain, 
spinal marrow, or ganglia. Some kinds of paralysis evi- 
dently proceed from the centre ; as those which accom- 
pany apoplexy and diseases of the spinal cord ; some from 
the peripherial terminations of the nerves and are propa- 
gated to the centre. 
A deficiency of action must not be ascribed to deficiency 
of power, as is too often done ; for power may remain un- 
impaired, being only obstructed in its transmission. We 
therefore distinguish paralysis a defectu virium and paraly- 
sis ah oppressione virium. The latter is more frequent than 
the former. 
1. Paralysis by oppression. 
Sanguineous congestions produce pressure on the nerves, 
bY general as well as by. local plethora paralysis san- 
guinea). 
Metnstnses—by a morbid matter transmitted to the 
nerves, which, by a peculiar operation on the internal ner- 
vous life, obstructs or confines its activity. 
Consensual abdominal irritatives abdominal stimuli may, 
by consensuality through the sympathic nerve, produce a 
spasmodic obstruction in remote parts. 266 
LOCAL PARALYSIS. 
Mechanical pressure—caused by a ligature, the compres- 
sion of tumors and indurations, extravasations in the brain 
or on the nerves themselves, luxations and fractures. 
To this head also belongs spasmodic paralysis, which is 
an active and not a passive condition of the nerve, and is 
often mistaken for spasms in the part affected. 
2. Paralysis from weakness. 
Is due to any cause which can rapidly or slowly annihi- 
late or impair the nervous power of a part. Apoplexy, 
lightning, violent passion, especially fright may produce it 
suddenly ; and it may be brought on slowly by abstraction 
of power, over-irritation, exhaustion, immoderate exertion, 
particularly excess in venery ; as a consequence of fevers, 
especially nervous ones and other debilitating diseases, 
also by want of use and deficient exercise of a part. 
Therapeutics. The first thing we have to investigate into 
is, whether it is vis oppressa or deficiens, since the treat- 
ment will not only differ but be opposite, according as one 
or the other of these causes prevail ; in the first it will be 
to impart, in the latter to abstract power; and a confusion 
of either of these modes may lead to great injury. A great 
prejudice, which has caused unutterable mischief, is the 
idea that every paralysis is a weakness, and ought to be 
combatted by stimulants and roborants. 
When paralysis is owing to oppression of nervous powrer, 
the treatment must commence by removing the cause, 
which oppresses and binds up the power, liberating which 
will often perform a cure. 
When there is sanguineous congestion or inflammation, 
bloodletting and anliphlogistics are of service. When 
there is metastasis, vesicatories, artificial ulcers, and reme- 
dies oppo-ite to the respective morbific matter are to be 
used ; when it depends upon a consensual abdominal irri- 
tation, the gastric solvent method, even drastic remedies, 
often the most successful, are to be resorted to. When there 
is mechanical pressure, the same must be removed by me- 
chanical or surgical means. 
It is only when the paralysis continues after the use of 
all these remedies, that the nerve-animating method is to 
be adopted. 
When, on the contrary, the cause is real debility, ex- 
haustion of powrer, vigorous roborative and restaurative 
remedies must be prescribed, from the beginning, in com- 
bination wdth the nerve-animating method. 
'lhe general rules recommended for the treatment of pa- 
ralysis are: LOCAL PARALYSIS. 
267 
1. The alternating increase and diminution of doses; 
even pausing once and a while intermediately, in order to 
allow nature time to collect excitability, is of great import- 
ance ; likewise an alteration of remedies. 
2. Patience is here a virtue indispensable to the physi- 
cian. Nature wants time for a process like the gradual re- 
animation of a part; a physician who cannot wait, will have 
no success in paralysis. Not weeks, but months and years 
may be needed for such a cure ; favorable changes external 
as well as internal may happen, and what is not possible in 
this, will be practicable in a future year. 
Nerve-animative Method. 
We are always to look upon the nerves as enlivened by 
a peculiar matter ; or contemplate life as something similar 
to galvanism, as is apparent in the electrical eel, whose 
shocks on being touched are not the result of a physical 
necessity, but voluntary functions of its nervous system, a 
spiritual matter, which can be transferred, attracted, accu- 
mulated, impeded, interrupted. 
Vi vification, resuscitation of a debilitated, half dead ner- 
vous life can therefore be effected : 
1. By local irritation, which creates an excitement, and, 
in consequence of this an increased vital process and afflux 
of blood, producing an increased development of the ner- 
vous power. The irritation may be excited idiopathically 
as well as consensually. The latter is often more efficacious 
than the first, especially when proceeding from the stomach 
and intestinal canal, on account of the large consensus ner- 
vorum of these parts. 
2. By an internal animating; influence, particularly the 
mental one proceeding from the brain, and the increased 
sanguineous influence from the heart. 
The remedies to attain these ends are: 
1. Pharmaceutical: emetics, Schmucker’s pills (vide No. 
97), a nauseating treatment, drastics, in small doses (as 
tinct. colocynthidis 10 to 15 drops three times a day); all 
the ethers, nervines, balsams, particularly ammonium, liquor 
c. c. succin., arnica, valerian, cantharides, and several 
other insects, such as millepedes, ants, vespa aurata ; oleum 
aether. cajeputi, valerianae (vide No. 98, 99), roris marini, 
animale Dippelii, camphor, aether, aether mercurialis (vide 
No. 104, especially in paralysis syphilitica and in general 
7). etastatica), phosphorus, some narcotics, as belladonna, di- 
gitalis, where there is suspicion of effusion; rhus tox- 268 
LOCAL PARALYSIS. 
icodendron, capsicum, opium ; the most valuable is nux vo- 
mica (vide No. 100). 
All these means may he simultaneously applied extern- 
ally for bathing, anointing, or fomenting (vide 101, 102, 
103). 
Cutaneous irritations of all kinds, as frictions, sinapisms, 
mustard-cataplasms, and mustard-baths, vesicatories, sca- 
rification, urtication, moxa. 
Mechanical shocks, by friction, riding in a carriage, 
shaking-machine. 
Specific irritatives, peculiar to every organ, as light to 
the eye, sound to the ear, hot spices to the tongue. 
Baths, above all the hot thermal, as those ofTeplitz, 
Gastein, Wiesbaden, Aix la Chapelle, Baden, Warmbrunn: 
the chalybeate, such as Pyrmont and Driburg; the natural 
and artificial saline, sulphurous, and chalybeate ; also baths 
of fermenting matters, as of malt, wort, brandy-lees, and 
shower baths. 
2. General powers of nature. The ordinary vivifying na- 
tural agents, warmth and electricity, are of great value, in 
order to revive a half or apparently dead part. 
Warmth, woollen clothing, lambskin, or wild cat fur, 
warm baths; in severe cases steam and sweating baths, ge- 
neral as well as local; and in worse ones, cauterization. 
Vital warmth is particularly efficacious, therefore the ap- 
plication of a living creature, or placing the paralyzed part 
in a fresh killed animal, also terrestrial warmth, as the 
volcanic heat in thermal springs. 
Cold, used only momentarily as a sensitive irritant, drop- 
ping, sprinkling, or immersion baths. 
Electricity, which is important on account of its affinity 
to the nervous system, may be used in variable degrees 
of tension from the lowest to the highest, in insulation, 
by streams of aura, or sparks and shocks, the latter with 
caution. Galvanism is less safe, and apt to disorganize the 
tender organs of sense. Magnetism, animal as well as min- 
eral, in all cases where known remedies fail. 
The endermic method, also deserves attention. For this 
purpose a small portion of skin is to be denuded by means 
of an epispastic, and extract of nux vomica, morphine, bel- 
ladonna, or the like, applied on the raw surface; but great 
caution is to be observed in regard to quantity, since re- 
medies frequently operate more violently in this way than 
when given internally. The best place for this operation 
is near the origin of the nerves affected. 
Psychical stimuli are of great importance, as mental in- LOCAL PARALYSIS. 
269 
fluence, fixed volition, exertion to move, exercise, raising 
the imagination, firm confidence in one’s own or a superior 
power, faith, which can here perform wonders. 
In my experience I have found the following remedies 
most efficacious: emetics, nauseating pills, aether rnercu- 
fialis, arnica, nux vomica, tincture of colocynth (particu- 
larly in paralysis atrnbilaria), electricity, thermal baths ot 
Teplitz, Aix Ja Chapelle, Wiesbaden, Gastein, ant-baths, 
malt-baths, (6 to 12 pounds of malt, 2 pounds of hops, 6 to 
12 pound of distiller’s grains), baths of wort, of brandy- 
dregs, Russian baths, mire-baths. 
Particular notice is due to paralysis dorsalis s. medulla- 
ris, or as it is generally termed, paralysis of the lower ex- 
tremities, although it may sometimes seize the upper ex- 
tremities. It generally commences with lameness of one 
or both the lower extremities, sometimes with lameness of 
a hand and foot, and continues to extend, it is characte- 
terized in the beginning by a kind of staggering or waver- 
ing of the feet ; or sensations of pressure, pain, and crawl- 
ing in the back. In order to ascertain, whether it origi- 
nates in the back and in what part it is located, pass a hot 
sponge along the spine, which will increase the sensibility 
of the affected spot, and thus point it out. This affection 
may continue so for years, even remain fixed in an ex- 
ternal part through life, without extending further. But 
sometimes it is increased unto perfect immobility, spread- 
ing to vital organs, giving rise to inactivity of the rectum 
and the urinary bladder, and terminating in incontinence 
of their functions; finally difficulty of breathing, weakness 
of sight and of the lungs, of the intellectual faculties and 
the brain, apoplexia nervosa. 
The cause is always to be sought for in the spinal mar- 
row. Sometimes it is purely mechanical, owing to inci- 
pient curvation of the column ; but more frequency it is a 
consequence of debilitation of the spinal marrow brought 
on by venereal and onanitic excesses, or by rheumatic, ar- 
thritic, scrofulous, or other morbific metastases, sangui- 
neous congestion, and chronic inflammation. 
The treatment must be directed particularly to the spinal 
marrow ; and, besides the remedies already recommended 
against paralysis from congestion, the application of leeches 
to the suspected part of the back ; and cold fomentations ; a 
moxa, frequently repeated on the spine and long-continued 
suppuration of it the chief means. Among the excitants 
oleum terebinthinae, 30 drops four times a day, has proved 
particularly efficacious. 270 
DYSPHAGIA. 
When venereal debility is the cause, the treatment must 
be the same as for tabes dorsalis, to which the disease is 
a kindred. 
DYSPHAGIA. 
Diagnosis. Difficulty of swallowing, without pain and 
signs of inflammation. Swallowing becomes im- 
possible, and the patient dies from starvation. 
The causes discriminative of the various species are the 
following: 
Spasm. It is a symptom of hysteria, globus hystericus, 
and commonly met with periodically, but may become 
permanent. 
Atony and paralysis. Whence met with after apoplexia 
and hemiplegia. 
Metastasis. Most frequently venerea, arthritica, and 
scrophulosa. 
Finally, mechanical impediments, as swellings and indu- 
rations of the glands in the (esophagus or fauces, dilata- 
tions, by wffiich a second bag is formed in the gullet, where 
the aliments accumulate. Thence ruminatio humana. 
A moist climate and abuse of tea, too hot or too cold 
beverage, and that of ardent spirits seem most to predis- 
pose to it, hence it frequently occurs in Holland. 
Therapeutics. The treatment must conform to the causes. 
Spasmodic dysphagia. The cause of spasm, most frequent- 
ly obstructions in the abdominal viscera, must be re- 
moved ; the treatment of hypochondria and hysteria is 
therefore requisite. External fomentations of theriac, hy- 
oscyamus, cicuta, emplastrum de Galbano crocat. c. sal. 
vol. c. c. and opium.—lnternally extract, hyoscyami, opium, 
aqua laurocerasi, belladonna may be given; and sinapisms 
and vesicatories applied to the throat. Also 01. cajepuli 
on sugar is particularly recommendable in spasms of the 
gullet and stomach. 
The atonic and paralytic. Rough and solid things are 
often more easily swallowed than fluids. Here the best 
excitantia are vesicatories, 01. cajeputi, mentha piperita on 
sugar, ground mustard, tinct. cantharidum are recommend- 
ed ; externally spirituous fomentations, electricity. 
The metastatic. Here two things are to be effected, de- 
rivation of the matter and assuaging of the cramp, w’hich 
is due to irritation ; which may be accomplished by the 
afore-mentioned antispasmodics, especially vesicatoria 
nuchas, and at the same time vesicatories and issues on re- APHONIA, DYSPHONIA, DYSLOGIA. 
271 
mote parts, particularly where the matter has been pre- 
viously seated. Also foot-baths of mustard, socks of oil- 
cloth, sulphur-baths are advised. Simultaneously we must 
use the remedies, which are appropriate to the dyscrasia in 
question. In such cases salivation may prove beneficial, 
especially when a suppressed salivation, as sometimes ap- 
pens, gave rise to the disease. 
Th Most frequently depends upon swelling 
of the glands; therefore met Avith particularly in scrofu- 
lous individuals. The best remedies are cicuta, antiscro- 
phulosa: as spongia tosta, iodine, internally and externally, 
barytes (vide No. 105), mercury ; at the same time mercu- 
rial ointment externally, and a continued use of emplastrum 
de cicuta; also mezereum on the arms; trochisci e pulvere 
spongise ustse, extract, cicutse et arnica?, placed beneath 
the longue, and allowed to dissolve slowly. 
In incurable dysphagia life may be prolonged by milk, 
which even in injections and clysters does a great deal of 
good. 
APHONIA. DYSPHONIA. DYSLOGIA. 
Diagnosis. We must distinguish faults of speech and 
faults of voice. 
1. Speech is either entirely wanting (aphonia completa, 
dumbness), or is only imperfect (dysphonia, dyslogia). 
Perfect dumbness is either permanent or periodical. In 
the first case it is congenital, or is a consequence of a pa- 
ralysis, commonly of apoplexy. In the latter case it is the 
effect of a spasm. 
Congenital dumbness is always combined with deficiency 
of hearing and is owing to that ; generally it is the effect 
of an internal disorganization, and is therefore remediable 
only by the substitution of the visible and tangible means 
of language for that of the absent audition ; by these means 
it is possible, not only to acquire the faculty of recogniz- 
ing linguistical impressions, but also that of pronouncing 
letters and words;—such is the recent art of instructing 
the deaf and dumb, an admirable discovery of modern times 
and now brought to great perfection. Sometimes it is pos- 
sible by the use of anliparalytic remedies to procure to 
some children at least a certain degree of hearing. I once 
saw good effect from belladonna. I have met with a case 
of congenital dumbness, while the faculty of hearing ex- 272 
APHONIA, DYSPHONIA, DYSLOGIA. 
isted, dumbness was congenite, consequently it was due 
merely to a disorder of the cerebral organ of language. 
Paralytic aphony is treated like paralysis; chewing of 
mustard or cubebs; oleum cajeputi applied to the tongue, 
electricity and galvanism are here of use. 
Periodical dumbness is always a spasmodic affection, 
and appears in children, sometimes typically ; it is fre- 
quently caused by verminous irritation ; in grown persons it 
is a symptom of hysteria, catalepsy, or insanity, ana is to 
be treated according to the causes. 
An imperfection of speech, a difficulty of utterance can 
be of various character : it is either an incapacity to find a 
word, or making use of a wrong one (amnesia of language). 
Here, the disorder is mental, and is a deficiency of memo- 
ry. Or it is an incapacity to pronounce clearly (stammer- 
ing, stuttering, balbuties), the indistinct pronunciation of 
single letters, stuttering. Here also the defect lies in the 
mind, in its linguislical operation : the ideas anticipate the 
words; hence there is no stuttering in singing, where the 
mind is obliged to go by measure. It may, however, origin- 
ate also in an organic disorder of the tongue (as from the fre- 
num not being cut), or in a bad habit. Besides the removal of 
the organic disorder, the treatment consists in accustom- 
ing the tongue, to pronounce slowly and distinctly by fre- 
quent exercises in reading loud, or when it is inveterate 
and very bad, by the method lately invented by Lee, which 
is founded on a particular upright position of the tongue. 
2. The voice may be entirely lost, or is rough, hoarse 
(raucitas, hoarseness). The cause of this resides either in 
the mucous membrane lining the organ of voice, a com- 
mon case ; or in a morbid affection of the nerves pertain- 
ing to that organ. In the first case it is a common symp- 
tom of catarrh, and is to be treated as such (especially by 
sulphur and antimony); or it arises from a scrofulous affec- 
tion of the tracheal glands, or from a metastasis (most fre- 
quently syphilitic), to which the treatment must be adapt- 
ed by specific derivative remedies. Not unfrequently it is 
the commencement and first symptom of phthisis trachea- 
lis, which see. In the second case it is often only a symp- 
tom of general debility ; it may, however, be also a perio- 
dical spasmodic disorder; sometimes owing to deeper 
seated affections of the cardial and pulmonary nerves. 
Here, general tonics and antispasrnodics are the best re- 
medies. DYSPEPSIA. 
273 
APEPSIA. DYSPEPSIA. 
Diagnosis. Absence of appetite, or one which is weak 
and irregular ; pressure, tension in the epigastrium after 
eating ; eructations which taste of the aliments, flatulency, 
niorosity, drowsiness; aptness to indigestion, acidity, 
mucosity. 
Pathogenesis. Weakness of the stomach is caused by: 
irregular or bad diet, gluttony, warm beverages, especially 
tea, drink in excess, a sedentary life, great mental exer- 
tion, sorrow, immoderate venery. 
Therapeutics. Before commencing the treatment, we 
must first ascertain whether the debility is real or only 
apparent, as when produced by substances which fret the 
nerves of the stomach. If tonics be used in the latter case, 
they will not only fail to strengthen, but will make the dis- 
ease worse, and localize the morbid cause. The material 
causes of weakness of the stomach and indigestion, to 
which the physician must particularly direct his attention, 
are : gastric impurities, saburra, bile, or morbid metastases, 
as the rheumatic, arthritic, psoric, or local plethora. The 
treatment must be adapted to the respective causes : and 
consists of cleansing the stomach (vide gastrosis), or trans- 
lating the metastases and local plethora. Many cases of 
weakness of the stomach will require nothing else. There- 
fore, the application of leeches, or the hemorrhoidal treat- 
ment will often be the best means for strengthening the 
stomach and restoring the digestive powers. But when 
the disease originates in mere weakness, or debility re- 
mains after the material causes have been removed, stom- 
achics may be used. The best are bitters, especially 
columbo, gentian, absinth., quassia, hops, beer, and aloes in 
proper doses ; also aromatics, or six to nine corns of white 
pepper, swallowed every morning, fasting, are, according 
to my experience, very efficacious, when continued for a 
long time ; orange-peel, ginger, nutmeg, caraway, and, 
above all, generous old wine, as Madeira, Xeres, Malaga. 
In great atony : mineral acids and aromatics combined, as 
elix. acid. Halleri.cum tinct. c. aurant, tr. cinchona; Why- 
tii, elixir vitriolatum Mynsichtii, chalybeates, combined 
with aromatic bitters, chalybeate wine (vide No. 106), Pyr- 
mont or similar chalybeate waters, one glassful every morn- 
ing fasting ; also a complete course of the Pyrmont sprino-. 
Externally, frictionsof balsamic remedies on the epigastric 
region are exceedingly beneficial, often more so than the 274 
PICA, MALA CIA. IMPOTENCY. 
internal remedies : tonic ointments and stomach-plasters, 
bathing with spirit of matrical., thyme, balsamum vita;, wear- 
ing a little bag filled with spices, repeatedly moistened with 
French brandy, on the epigastric region; strengthening 
baths; finally cold, used in two ways, as cold food, ice- 
cream internally, and externally bathing the epigastric 
region, and cold douches on the same, have often removed 
the most obstinate complaints of the stomach. 
In all this treatment, the following rules are to be ob- 
served : weakness from irritability or from torpidity must 
be attended to. The first case calls only for the volatile, 
easily digestible remedies, for the tonic are too heavy. If 
it is only a nervous disease, a nervous weakness of the 
stomach, a disharmony of the gastric nerves, whence it 
derives periodicity ; nervines, antispasmodics, as valerian, 
orange-peel, elixir acid, aromat., and ethers are the best 
stomachics. 
Further, without a proper regimen, no roborant treat- 
ment will be availing. All warm beverages, especially tea, 
much milk, flatulent vegetables, grease, cheese, cakes, 
spirits, and, above all, overloading of the stomach must be 
avoided ; the best nutriment is roast meats. 
Finally, exercise is indispensable, and frequently is the 
best of all tonics. 
PICA, MALACIA. 
Appetite for unusual food. Sometimes* it is a salutary 
instinct in diseases ; as the desire for acids in putrid mal- 
adies, for earthy substances in acidity of the stomach ; 
sometimes it is merely a morbid symptom, especially that 
for lime in chlorosis, and is present in hysteria, melan- 
choly, worms. 
It is to be treated as a symptom of the respective dis- 
eases. 
IMPOTENCY. 
Diagnosis. Inability of the male to fecundate. 
Its character varies, and has different degrees. Impo- 
tency may be absolute or relative, existing at all times and 
under all circumstances; or only at certain times, under 
certain conditions, and in relation to particular persons. 
Impotentia. 1M POTENCY. 
275 
It may be perfect and imperfect, in which latter case, if 
there exists great susceptibility in the other sex, fructifi- 
cation is practicable. 
Impotency consists either in an entire want of erection, 
or in a too quick, or total want of emission of semen in 
coition. 
Pathogenesis. That coition may be fecund, three things 
are necessary : the semen must reach the place of its des- 
tination, it must be possessed of an enlivening power, it 
must be communicated and received by both parties with 
that degree of stimulation and excitement which is requi- 
site for engendering’ a new living beino-. 
o O C? O 
The obstacles, therefore, are various : 1, Phymosis, ex- 
crements and tumors, urinary fistulae, lateral openings of 
the urethra (hypospadias). 2. Dynamic: a deficiency ora 
too watery and inactive quality of the sperma, deficient or 
bad food, over-feeding, atrophy or diseases of the testicles, 
deficient nervous and muscular power, such as old age, se- 
vere maladies, excessive corporeal fatigues, excessive men- 
tal exertions, sorrow, grief, but particularly over-irritation 
and exhaustion by excesses in venery, still more in onan- 
ism; which is now-a-days the most frequent cause of im- 
potence. Another remarkable but rare cause is dys-sper- 
matism, due to excess of irritation,a continual tetanus penis 
in coition, which shuts up spasmodically the emunctories 
of semen, and renders ejaculation impossible. 
The cause, however, may only be relative and temporary, 
as a physical or moral dislike, antipathy to aryi ndividual, 
unequal temper and irritability. Thus a man may be impo- 
tent with one person, and not so with another ; thus he may 
be so during the influence of debilitating physical or moral 
causes, afterwards not. 
Therapeutics. The cure consists in general and local in- 
vigoration and vivification ; roborants, cinchona, especially 
quassia, columbo, chalybeates, ajther sulphuric, martial 
(vide No. 110, 111, 112), and generous old wine, spices, 
especially vanilla, chalybeate baths (particularly Pyrmont 
and Driburg), sea bath, cold water, and steam baths, espe- 
cially on the lower part of the spine and the perinseum, 
washing the genitals with decoction of mustard, liquor 
anodyn. Hofmanni, spirit of ants (vide No. 113), electri- 
city ; in very atonic subjects a cautious use of the tincture 
of cantharides (three or four drops), also phosphorus, dis- 
solved in sulphuric aether in doses of a quarter of a grain. 
At the same time a nutritious regimen, gelatinous sub- 
stances, eggs, strong broths, animal food, oysters, snails, 276 
STERILITAS. AMAUROSIS. 
chocolate, salep, hartshorn jelly. The most difficult im- 
potence to cure, is that which is caused by onanism and 
continuing pollutions. But it is not hopeless. I have seen 
such individuals cured by abstaining from all unnatural 
stimulants, including that of mind, by early rising, airing, 
and corporeal exercise, and the internal and external use 
of Pyrmont water, taken at the well, and become fathers of 
healthy children. 
Finally, in judging and treating impotency, the influence 
and disposition of the mind is to be considered. Want of 
self-confidence, as well as too ardent desire, may hinder 
the accomplishment of the act. Hunter relates the case of 
a man who, after a long expectation, and in spite of all his 
exertions in lire marital bed, was unable to accomplish his 
desires, until, by the advice of his physician, he resolved 
to abstain from coition for several nights ; after that he 
succeeded. 
Nor is it to be forgotten, that even in considerable weak- 
ness of the man, a youthful, very sensitive, susceptible and 
vigorous female may make up the deficiency, and render 
conception possible. 
BARRENNESS OF FEMALES. 
Sterilitas. 
(Vide Diseases of Women.) 
AMAUROSIS. 
Nervous Blindness. 
Diagnosis. Abolition of sight, without obscuration of 
the humors or membranes of the eye ; contractility of 
the iris in obedience to light, being diminished or entirely 
annihilated. 
Weakness of sight (amllyopia), is its lowest degree. It 
has for concomitant symptoms and forebodings generally, 
sparks and luminous phenomena in the eye. In rare cases 
the iris may be contracted. 
The causes are the same as in all paralyses, particularly 
over-irritation and excessive exertion of the eyes now so 
prevalent, and metastasis. It is difficult to cure, and rarely 
perfect. It is undertaken according to the same indtca- DEAFNESS. 
277 
tions as the treatment of paralysis in general; particular 
regard being paid to the delicacy of the organ. Therefore 
We are to consider whether there exists a congestive state 
which must be translated, the metastasis removed, the ab- 
domen stirred up and freed (for which purpose tart, emet., 
the nauseating treatment and Schmucker’s pills often an- 
swer well) ; and nervines, internally as well as externally, 
which latter application, on account of great delicacy and 
sensibility of the’organ, must be very cautiously used, since 
the stronger applications are apt to injure more than to do 
good. Valerian, pulsatilla, arnica, belladonna, electricity, 
and mineral magnetism have proved the most useful reme- 
dies. 
DEAFNESS. 
Cophosis. 
The causes are : most frequently metastases, of which 
the most common are catarrhal-rheumatism, sanguineous 
congestion, abdominal obstructions, nervous debilitation, 
local over-irritation by too strong a sound, organic dis- 
orders. 
The treatment must always begin with cleansing and 
rinsing the external ear, since the cause of deafness is 
often merely an accumulation and thickening of ear-wax, a 
common occurrence, by the removal of which I have cured 
the evil. But derivation, in sanguineous congestions, local 
and general abstractions of blood, especially cupping on 
the neck, in catarrho-rheumatic metastasis, exutories be- 
hind the ears (most efficacious is cantharid-ointment behind 
the flap of the ear, on the mastoid process), and strong mer- 
curial purgatives. In general, the consensus of the abdo- 
men with the organ of hearing is very noticeable and im- 
portant ; commonly the patients hear better a few days 
after having taken a purgative. In cases of catarrho-rheu- 
matic deafness, I cannot sufficiently recommend guaiac, 
combined with calomel, and sulphuret of antimony (vide 
No, lid). At the same time we must not neglect to stim- 
ulate the mucous membrane of the nose, by which, not only 
its derivative secretion, here so important, is increased, 
but also the auditory nerves and the Eustachian tube be- 
come excited, possibly resulting in great benefit. For that 
end, the errhine (No. 87) is of service. In specific metas- 
tases, as the syphilitic, the proper specifics are to be used. 
As local means, etherial oils, injections, vapors into the 
24 278 
ANOSMIA, AGUSTIA. ANAESTHESIA. 
external ear are recommended ; but here T advise the great* 
est caution, since inflammation of the external and even of 
the internal organ of hearing, is likely to follow strong 
stimulants. It will be well to distinguish those cases, in 
which hearing is better in moist or dry weather. In the lat- 
ter case, a relaxation of the internal membrane is presumed, 
and stimuli are proper. In the first case, more dryness 
and tension exists, and relaxantsare of use. In such cases 
I have seen the best effects from a little almond oil on cot- 
ton put into the ear; the oil may be mixed with ox-gall. 
Combined with this, small doses of oleum cajeputi, cam- 
phor and petroleum may be applied, or the mixture No. 
115, which 1 can recommend from my own experience. 
Injections into the Eustachian tube may become very 
useful, especially when there is reason to suspect obstruc- 
tion in it. This may be presumed when the patient cannot 
hear better with his open mouth, and through the medium 
of the teeth. Electricity is of particular efficacy, and ought 
never to be neglected. In order to cure those cases of 
cophosis which resist all other modes, two operations have 
been resorted to : the perforation of the mastoid process, 
or of the tympanum. The first is always accompanied 
with peril, even danger to life, on account of the inflam- 
mation propagating to the brain, and ought never to be 
undertaken. The latter may be serviceable, but generally 
so only for a time; it is, however, without danger. As a 
means of relief, the use of acoustic tubes is advised. 
ANOSMIA, AGUSTIA. 
The senses of smell and taste may be lost, generally 
both, but not always ; this happens most frequently from 
catarrh, and is a common symptom of coryza, and disap- 
pears with that indisposition. It may, however, also be a 
symptom of spasm and paralysis. As such, I have observed 
anosmia of periodical character. 
ANAESTHESIA. 
Loss of the feeling of the skin, either in single parts or 
of the whole. It is generally the consequence of an inter- 
nal paralysis of the part, in which the sensitive and not the 
motory portion of the nerve is affected. Sometimes, how- 
ever, it is only a spasmodic affection of the cutaneous anorexia, anaphrodisia. 
279 
nerves; often it is purely local, and confined to a small 
spot, which is numb. Then it is often a sign of latent 
arthritis. I have seen in paralysis dorsalis, the whole skin 
of the patient become numb and without feeling. 
ANOREXIA. 
We are to discriminate between hunger and appetite. 
One may have hunger, that is, the feeling of emptiness and 
a want of nourishment, and may lack appetite, which is a 
particular sensation. 
Want of appetite (anorexia) is owing most frequently 
to the presence of gastric impurities, and is cured by 
evacuants. It is farther an essential symptom of fever, 
and deserves, as such, particular attention. Sometimes, 
however, it is a peculiar affection of the nerves of the 
stomach, a disharmony, or ansesthesis of them (as well as 
is deficiency of sexual desire), and may continue for 
months, even years, in hypochondria, hysteria, melan- 
choly, and sometimes as a consequence of nervous exhaus- 
tion by continuous exertion of the mind. It is also fre- 
quently due to great torpidity, or weakness of the stomach, 
by habitual excess in eating, but never in drinking. 
The treatment is either that of the diseases from which 
it arises, or the administration of stimulants which directly 
operate on the stomach and increase its sensibility, among 
which, bitters, aromatics, salts (particularly culinary salt), 
and corporeal exercise and exhilaration are to be classed. 
ANAPHRODISIA. 
Loss of sexual desire is analogous to the loss of the nu- 
tritive instinct. It may originate in the same way as ano- 
rexia, either by a deficiency of the necessary organic and 
material conditions, deficient or inactive quality of the 
sperma, disorders of the requisite organs in either sex ; or 
by a disharmony in the nerves which belong to them, and 
here the cause can be purely psychical: as a sad disposi- 
tion of the mind, occupation with serious abstract subjects. 
It can be the consequence of impotency, but exists also 
without it, and may on the other hand, become a cause of 
impotence, but not always, and here the remarkable in- 
stance especially in the female sex, takes place, that with- 280 
EMACIATIONS. 
out any sexual instinct or desire, even without sensation, 
even in spite of it, conception is possible. 
The cure consists in that of impotency, or, if this is not 
the cause, in exciting a specific sensuality hy internal and 
external stimulants, of which cantharides are the best, and 
in directing the imagination to sensual pursuits. 
SEVENTH CLASS. 
EMACIATIONES. 
Generalities. 
We class under this head all diseases in which deficient 
nutrition of the body forms the principle of the disease, 
and is the object of cure ; and which is not, as in many 
other maladies, a mere accessory symptom. 
The proximate cause of every emaciation is a condition 
of the system, in which consumption exceeds restoration. 
Emaciation may happen in four different ways : 
1. By impeded admission of the nutritive matter, or ob- 
struction and disorganization of viscera essential to life, 
atrophia ; 
2. By excessive loss, or consumption of humors and 
powers (without suppuration), tabes ; 
3. By chronic irritation, hectica ; 
4. By suppuration, phthisis. 
Its importance, duration, and danger vary very much, 
and depend on the cause, the nature of the individual, and 
external relations. The most dangerous kind of emaciation 
is that which arises from suppuration, most so when this 
is seated in an organ indispensable to life. That which 
originates in weakness, and continues for years, as atro- 
phy and hectic, is less dangerous. The principal sign of 
danger is the lingering fever with which it is associated, 
early in some, later in others, and which greatly contributes 
to self-consumption and emaciation. In emaciation owing 
to suppuration, fever is associated from the beginning, and 
is the principal symptom for detecting its existence. Ema- 
ciation, like dropsy, is frequently no more than the last PULMONARY CONSUMPTION. 
281 
stage of another disease, leading unto death, atrium mortis. 
Death ensues, either from a complete consumption of all 
humors and powers, and is immediately preceded by colli- 
quation; or from the destruction of some noble organ in- 
dispensable to life. 
The treatment, in general, has to answer three ends : 
1. Removal of the causes, general as well as local, as 
dyscrasias, which keep up the disease. 
2. Diminution of self-consumption (the fever). 
3. Promotion of restauration, of the humors as well as 
of the powers, by vigorous restoratives, aliments and air, 
also roborants, commensurate with the state of irritabil- 
ity, lest, by too strong excitement, they might consume 
more than restore. 
PULMONARY CONSUMPTION. 
Phthisis Pulmonalis. 
Diagnosis. Cough, oppression of the chest, lingering 
fever, emaciation. These are the essential symptoms, and 
are sufficient for diagnosis. The consumptive fever, which 
accompanies this disease, distinguishes it from asthma, 
which, as regards cough, oppression and expectoration, 
may agree with phthisis. Besides fever, we must notice 
as a sign characteristic of consumptive persons: the great 
carelessness they show in regard to health, the little atten- 
tion they pay to attacks of sickness (in this respect con- 
trasting with the hypochondriac), and their inclination to 
seek for the seat of the disease not in the chest, but in the 
abdomen, also their cheerful hope, which increases as 
danger approaches- The signs which auscultation, per- 
cussion and the stethoscope afford, may serve as auxilia- 
ries, especially to ascertain the location of a vomica, but 
never to give the general diagnosis ; since by hearing alone 
we cannot even distinguish the difference between the rat- 
tle of mucus and that of pus. 
Couo-h can exist with and without expectoration. In the 
first case the disease is phthisis sicca s. tuberculosa, and 
expectoration may be absent from the beginning until 
death. The expectoration may be pituilous (phthisis p>itu- 
itosa\ or purulent (phthisis purulent a). 
Generally, pains in the chest are combined with the 
oppression, but not always ; and they are not essential to 
diagnosis. 282 
PULMONARY CONSUMPTION. 
This disease occurs more frequently, and is more dan- 
gerous than all others. The sixth part of mankind (at 
least in large cities), die of it. 
It varies very much in duration j lasting only a few 
months, sometimes years, sometimes through life. 
The curability is difficult, and is dependent on the con- 
stitution. Constitutional, hereditary consumption is never 
perfectly curable. The germ of this disease lies in the 
organization itself, and the whole life is a continual en- 
deavor to develop it; all other, even the slightest diseases 
tend towards it. In the female it may last for a long time 
without danger to life, as long as menstruation endures ; 
as soon as this ceases, the patient is lost. 
Course. 
Phthisis Incipiens, Fiens. Incipient Consumption. 
This is the most important period of the disease, and is 
the stage most necessary to be discovered ; since redress 
can be had only by preventing its complete development. 
The modes of transition into pulmonary consumption are 
different, and they exhibit as many signs of this stage. 
1. Atony of the lungs. Weakness, relaxation of the 
lungs creates a morbidly increased secretion of mucus, a 
blennorrhcea, which gradually passes into a purulent cor- 
ruption, and seizes upon the lungs. The signs are : fre- 
quent recurrence of catarrhs,which are always accompanied 
with copious and protracted expectoration of mucus. 
2. Phlogosis of the lungs. Chronic, sanguineous conges- 
tions and inflammability of the lungs (phthisis florida). 
This is either a general chronic congestive state of the 
lungs, or is confined to the mucous membrane of the bron- 
chia (bronchitis chronica). It gradually engenders tubercles 
or suppuration of the lungs, ending in pulmonary con- 
sumption. 
The signs are : a frequent, dry cough,-and recurrence of 
flying stitches and pungent pains in the chest, oppressed 
respiration, pulse always irritated, and exceedingly accele- 
rated by the least motion. Cough, stitches, and oppression 
increase by every strong over-heating, and violent exer- 
cise of the body, or by exertion of the lungs in speaking, 
laughing, etc,; also after passion and spirituous bever- 
ages. It is apt to hemoptysis. 
3. Pulmonary tubercles. They gradually pass into in- PULMONARY CONSUMPTION. 
283 
flammation and suppuration, and thus produce pulmonary- 
consumption. The signs of this stage are similar to those 
of the former, only the complaints of the chest are aug- 
mented in certain situations and positions, and a peculiar 
expectoration sets in from time to time (vide phthisis tu- 
berculosa). 
4. Nervosity of the lungs, and of the whole system. The 
nervous character and nervous disturbance predominate 
over the general and pulmonary reproduction to such a de- 
gree as to prevent nutrition, and cause disorganizations of 
the lungs. Its signs are: the nervous symptoms, phthisical 
disposition, uncommon emaciation without a definite cause, 
frequent, dry cough, which often assumes a spasmodic, 
even convulsive character, flying pains in the chest, not 
unfrequently a sanguinolent cough of a spasmodic charac- 
ter ; all without signs of inflammation and fever. Some- 
times it is preceded by a real tabes nervosa, later it seizes 
the lungs, and ends in pulmonary consumption. 
5. Abdominal consensus (phthisis abdominalis ex hypochon- 
driis. Chronic abdominal complaints, especially disorders 
of digestion, a glairy state of the stomach, obstructions of 
the liver and bilious accumulations, infarcts, glandular ob- 
structions and hemorrhoidal accumulations may keep up 
a continual sympathetic irritation and congestion in pre- 
disposed lungs—disorders which at last affect the organ 
itself, and create, first apparent, finally, a real pulmonary 
consumption. The signs are : faulty digestion, mucosity, 
hepatic diseases, and other abdominal disorders, combined 
with chronic cough, which may be dry or moist, with 
dyspnoea, even with emaciation and febrile motions and 
nightly sweats. The principal sign is: the pectoral diffi- 
culties are increased or diminished in proportion as the 
abdominal disorders increase or decrease, but are not influ- 
enced by potences which operate directly on the lungs; such 
as strong exercise, over-heating, speaking, laughing, etc. 
6. Pulmonary metastasis. Suppressed piles, menstrua- 
tion, gout, scurvy, herpes, syphilis, scrofula, old ulcers, 
fontanels, fluor albus and other secretions, which have 
become habitual; the imperfect crisis of acute, especially 
exanthematic fevers, may mutate to the lungs; by which 
their functions are disturbed, their irritability is increased, 
the organ impaired, reproduction itself rendered abnormal, 
and reproductive disorders generated ; thus a disposition 
to all kinds of pulmonary consumption is laid. The signs 
are : after suppression of another malady, cough and dys- 
pnoea, perhaps also pains in the chest. 284 
PULMONARY CONSUMPTION. 
Second Period. 
Phthisis Manifesto,. 
The principal sign is: a lingering fever associated with 
the difficulties in the chest. The febris lenta is character- 
ized by its type, which is that'of a continued remittent 
(sometimes, especially in the beginning, an intermittent), 
wherefore, the pulse remains accelerated after the remis- 
sion in the morning ; in the evening there is chilliness, 
towards morning, sweat ; as the disease increases, there is 
also an exacerbation at noon, hot hands, cheeks circum- 
scribed with red, particularly after eating ; emaciation, 
muscular weakness, appetite good, even increased as ema- 
ciation augments, good digestion, cheerfulness, levity in 
all that concerns health, underrating the danger, and dis- 
belief of a pulmonary disease. The expectoration becomes 
purulent; but, when the ulcer is closed, the cough is dry. 
Third Period. 
Phthisis Consumata. 
The principal signs are: the accidents of colliquation: 
dripping and exceedingly debilitating morning sweats, diar- 
rhoea, turbid urine, which is greasy on the surface; duplica- 
tion of the fever, that is, two exacerbations appear, one in the 
morning, the other in the evening ; extreme prostration and 
emaciation rapidly running into exhaustion, tenacious ex- 
pectoration, increasing dyspnoea, appetite remains, even in- 
creases, hope likewise. In the female menstruation ceases. 
At last, as forerunners of death appear : swelling of the 
feet, hoarseness, anginous attacks, aphtha?, colliquative 
diarrhoea increasing, extreme dyspnoea, rattling in the 
throat, stoppage of expectoration ; finally death ensues by 
quick or slow suffocation, sometimes by hemorrhage. 
Pathogenesis. The proximate cause of consumption is a 
dynamic or organic disordered state of-the lungs, which 
disables them from performing their function of preparing 
and animating the blood. The fundamental cause of it, 
and particularly of its frequent occurrence and danger, is 
the nature, situation and function of these organs them- 
selves. They are the most sanguineous of all organs; they 
receive all the blood of the body, and therefore are the most 
disposed to sanguineous congestions and inflammations. 
Moreover, the lungs are of an extremely delicate, relaxed, PULMONARY CONSUMPTION. 
285 
vascular, secerning and absorbing structure, never resting, 
incessantly collapsing and expanding themselves, and there- 
fore are liable to stagnations, effusions, vitiation of secretion 
and reproduction ; and wounds and ulcers, etc. do not 
readily heal. Finally, their position is superficial, and 
exposes them to lesions, to all the injurious influences of 
the atmosphere and the substances contained in it. 
The pulmonary disease, which originates phthisis, may 
be either a chronic inflammation or an adynamy, or a tu- 
berculous, or a suppurative state of the organ. 
The remote causes are partly predisposing, partly ex- 
citing. 
The predisposing are the following: 
1. Disposition. There is a consumptive disposition, 
which renders an individual liable to contract phthisis 
from slight causes, as a catarrh, which, in a person free 
from the disposition, is innocuous, and who can even re- 
cover from wounds in the lungs ; a disposition that may 
be so strong that the very life of the individual is a contin- 
ual tendency to create phthisis—all tends to it, and he 
cannot escape it. This disposition constitutes what is 
termed a phthisical constitution and structure. It is 
marked by a flat thorax, narrow towards the side and back, 
shoulderblades protruding wing-like, long neck, slender 
body, and very white teeth; but above all, by a peculiar 
irritability of the vascular system and lungs ; thence cir- 
cumscribed red cheeks (called phthisical roses), appearing 
especially after eating ; easily excited, over-heating and 
redness of the face on rising, hot hands after meals, cough 
easily excited, irritable, sanguine temper, but particularly 
by an indifference and a carelessness of their own health, 
especially concerning that of the lungs, so that they entire- 
ly overlook, in reporting their case, the difficulties in the 
lungs, or pass over them intentionally, and attribute their 
disease generally to some other part, especially to the ab- 
domen. The phthisical disposition in this respect forms a 
striking contrast to the hypochondriacal. 
2. Hereditariness. In no malady is the transmission of 
disposition so great as in this. But the parents must ne- 
cessarily have already had the disease before procreating 
the offspring. There are whole families, in which this dis- 
ease is inbred. 
3. Age. The period of youth, from puberty up to the 
age of twenty.five or thirty years. It is most prevalent at 
this time, when sanguine life predominates, and passion 
urges the blood to the heart and lungs ; hence the fre- 286 
PULMONARY CONSUMPTION. 
quency of phthisis in youth ; later in life these causes much 
more rarely create phthisis, in advanced age, asthma. 
4*. Quick growth. It is incredible how much quick 
growth renders a person liable to consumption ; this is 
due to the disproportionate growth of the thorax to the 
rest of the body. It is, therefore, particularly necessary 
at this period, to avoid all the occasional causes. All tall 
and slender bodies are much more liable to consumption 
than short, stout ones. 
5. The atmospherical condition, of residence, climate. 
In a disease of the respiratory organs, these are certainly 
of the greatest importance. Living in corrupt, moist, con- 
fined, particularly animalized air, predisposes to phthisis. 
Th is is made evident by its frequent occurrence in popu- 
lous cities, by the different influence of salubrious animal 
air in the country, the influence of pure, vegetable air. 
The proportion is that of one to ten. Also a moist, north- 
ern climate predisposes more to consumption than the 
southern. It is a decided fact, that the northern regions 
favor more the pulmonary, the southern,.the hepatic and 
abdominal maladies. 
6. Mode of living, occupation. All occupations in con- 
fined rooms predispose to it more than those in open air ; 
likewise the luxurious, gluttonous, dissipated life in large 
cities. 
7. Habitual over-heating of the lungs, exertion of the 
lungs. Immoderate dancing, running, singing (especially 
when combined with exertion in females at the period of 
development, during menstruation), and ardent spirits. 
8. Premature and immoderate coition, frequent pregnan- 
cies, too long lactation. 
9. Catarrhal disposition of the lungs, which is manifested 
by frequent and long continued catarrhs. 
10. Local weakness of the lungs, which is indicated 
partly by what is already mentioned, partly by this, that 
the person cannot retain breath for along time, and is apt, 
in running and ascending stairs or mountains, to stop 
short from impeded respiration. 
11. Scrofulous disposition, which is very apt to produce 
tubercles in the lungs. 
12. Malformations, curvatures of the spine, rachitic de- 
formities of the thorax, by which the lungs are prevented 
from expanding and acting freely. 
These causes will of themselves, by merely increasing 
in force, produce consumption. The following occasional 
causes will frequently make it break out when already PULMONARY consumption. 
287 
lurking in the system, and are even capable of themselves 
to generate it, though not so easily in persons who are free 
from a phthisical disposition. 
1. The most frequent of all is a neglected catarrh. In- 
numerable instances of consumption originate in a common 
catarrhal cough, or rather from one which is unceasingly 
renewed by slight causes, which in this way leads imper- 
ceptibly into this destructive malady. Tissot was right in 
maintaining that more individuals die in this way by ca- 
tarrh, than by the plague. According to my experience, 
one third of all consumptions result from catarrh. 
2. Haemoptysis. A person laboring under a phthisical 
disposition, becoming affected with bloody cough, is on the 
road to consumption ; it being the signal of transition. 
3. Pneumonia. It can give rise to chronic inflammation 
of the lungs, pulmonic blennorrhoea, or tubercles, or sup- 
puration, also to every kind of phthisis. 
4. Violent sanguineous congestions to the lungs by great 
over-healing of the body, by violent exertions of the lungs 
in singing, crying, playing on wind instruments, ardent 
beverages, excess in smoking tobacco. 
5. Inspiration of irritant or acrid substances, as dust and 
metallic vapors. 
6. Wounds and contusions of the chest. 
7. Metastases to the lungs. All morbific humors, as 
those of gout, rheumatism, scrofula, syphilis, and psora, 
when shifted to the lungs, may produce consumption. 
Suppressed habitual evacuations of blood, hemorrhoids, 
menstrua, and obstruction to the development of the first 
catamenia. Also too rapidly suppressed habitual discharge 
of mucus, fluor aibus, dysentery, diarrhoea j even inter- 
mittent fever. A remarkable metascbematismus is that of 
chronic insanity, which terminates very frequently in con- 
sumption. 
8. Measles, which, next to catarrh, is a most frequent 
cause of pulmonary consumption. It is very apt to en- 
gender tubercles. 
9. Finally, contagium phthisicum must be mentioned. 
It cannot be denied, that a high degree of phthisis ulcerosa 
generates an infective matter which may communicate 
the disease, but only to persons predisposed to it ; it may 
infect even beds and clothing, which phthisical persons 
have used for a long time ; this, however, happens more in 
southern than in northern climates. 
On the pathogeny of consumption a difference is founded, 288 
which is of the greatest importance in prognosis and the- 
rapeutics: the division into phthisis constitutionnlis and 
phthisis accidentalis. The constitutional consumption, in- 
nate in the organism by structure, hereditariness, and the 
corporeal disposition, endeavors through the whole period 
of life to develop itself it can be delayed, but never en- 
tirely annihilated, and once developed, is incurable. Ac- 
cidental consumption, on the contrary, in an otherwise 
healthy disposition, may be cured ; such an individual may 
be shot through the lungs, and no consumption follow. 
For practical purposes, the most important division is 
that into: phthisis jiorida, phthisis purulenta, phthisis tuber- 
culosa, and phthisis pituitosa. 
Therapeutics. A distinction must be made in the treat- 
ment, between incipient and confirmed consumption. 
As certain as it is, that confirmed consumption can sel- 
dom be cured, it is equally certain that it may be prevented. 
PULMONARY CONSUMPTION. 
DISPOSITION TO, AND INCIPIENT CONSUMPTION. 
Phthisiosis. 
The general signs of this period are : short breath on 
the least exercise; want of breath in ascending stairs or 
mountains, inability to hold breath for a long time, or to 
draw a deep inspiration without exciting cough; this hap- 
pens on every exertion of the lungs, as in running, speak- 
ing for a long time, affections of the mind ; after a meal 
hot hands and face, circumscribed redness on the cheeks • 
rapid, easily excitable pulse, uncommonly red tongue ; in- 
difference to diseases, especially pulmonary complaints, 
phthisical formation, hereditary disposition. 
The treatment of this period is prophylactic, the principal 
treatment for consumption. Here art is yet of some avail, 
and may prevent the disease from passing into confirmed 
phthisis. A number of instances have satisfied me in this 
respect. The whole period of life, of a constant phthisical 
disposition, may thus be steered clear of destruction, the 
more so, as the phthisical disposition decreases as age ad- 
vances. The main object of cure is to make it pass the 
thirtieth year of age without accident, which requires 
great attention on the part of the physician, and strict 
resignation on the part of the patient. PULMONARY CONSUMPTION. 
289 
General Rules of the Prophylaxis Phthisica. 
The fundamental principle of treatment is to avoid all 
that can tend to an increase of sanguineous congestion in 
the lungs, to strengthen them by appropriate means, and 
to protect them against, as well as to deviate from them 
all injurious influences. This end is attained by avoid- 
ing all violent, over-heating exercise, especially dancing, 
running, great exertion of the arms (fighting), great efforts 
in singing and speaking, all ardent and spirituous bever- 
ages, enjoyment of pure air, taking precaution against 
sharp cold (northeast) wind, living in the country on milk, 
in general, more a vegetable than animal diet, wearing 
woollen flannel next to the skin, and worsted stockings. 
Sexual cohabitation ought to be abstained from, or enjoyed 
only moderately ; all violent mental affections avoided ; 
moderate exercise on horseback; in the least indication of 
inflammation of the chest, a small venesection, and a fon- 
tanel on the upper arm continued for years. 
In regard to the special treatment, the following cases 
must be carefully distinguished : 
1. The patient is seized with flying stitches through the 
chest, a burning feeling in one spot, dry, irritable cough, 
pulse always excited, red cheeks, and sometimes bloody 
expectoration. Such symptoms are evidence of a disposi- 
tion to phthisis florida or tuberculosa. There is always a 
disposition to little pulmonary inflammations, which ought 
to be arrested as soon as formed, in order to prevent the 
increase of tubercles, and their transition into suppuration. 
Therefore, on the slightest attack of pain in the chest or 
increase of dyspnoea, a small venesection of four to six 
ounces is to be made in the arm, order the patient to keep 
very quiet for several days, observe a cooling diet and take 
antiphlogistic remedies (nitre, tartar, potassse, aqua lauro- 
cerasi and digitalis (vide No. 116). At the same time, 
whey and milk diet, particularly asses’ milk, juice of cu- 
cumbers ; in the spring, the fresh expressed juice of herba 
tussilago, cerfoil, borrage, Sellers waters mixed with milk, 
Egers salt spring ; but in a very phlogistic constitution, 
mineral waters containing iron are dangeious. Following 
this course, and making a small venesection every four or 
six weeks (from the sixteenth to the twentieth year of age, 
thirty bleedings in a case), I have succeeded in saving per- 
sons, and preventing consumption. In a tuberculous dis- 
position, the use of Ems springs (the Kesselbrunnen), 
combined with whey, is recommended at this period. PULMONARY CONSUMPTION. 
2. The patient has a disposition to atonic pituitous 
phthisis (vide the symptoms above). Here the long con- 
tinued use of gelatina lichenis Island., made in water or in 
milk, is the principal remedy. At the same time, warm 
air, confinement, warm drinks, and sleeping in warm rooms 
is to be shunned. It is in this case that riding on horse- 
back is of a wonderful effect, likewise daily exercise of the 
lungs by reading aloud. In a high degree, even cold drinks 
and washing the chest with water is salutary. 
3. The metastatic. The most frequent is the catarrhal 
and rheumatic ; and here dulcamara alone is a true spe- 
cific (ISo. 34) in a phlogistic disposition ;in one that is 
atonic, it may be combined with lichen Island. (No. 37), 
and a vesicatory entertained for a long time on the chest ; 
and in an inflammatory disposition, leeches and venesec- 
tion. If this is unavailing, cortex mezerei on both arms, 
entertained in drawing for several months, is the best de- 
rivative. In the same manner, other metastases, as the 
arthritic, psoric, scrofulous, etc., ought to be treated, but 
paying due regard to their specific character (in the pso- 
ric, a combination with sulphur, in the scrofulous, with 
baryta muriatica), and to the respective dynamic character, 
whether it be more phlogistic or atonic. Suppressed men- 
strua and piles are to be regenerated or compensated. 
_ 4. Nervous phthisis (see the signs). Milk diet, country 
life, tepid baths, riding on horseback, asses’ milk; in very 
debilitated nervous persons, cold infusion of cinchona, in 
great emaciation, gelatinosa, restaurantia, hordeum prsepa- 
ratum, salep, arrow-root, broth of shell-snails, oysters ; in 
very great irritability and frequent irritative cough, hyos- 
cyamus, aqua laurocesasi (which is here particularly suit- 
able), even small doses of opium, given for a short time in 
order to assuage the cough. 
5. Abdominal phthisis (see the signs). Injections, mild 
resolvents, extractum taraxaci, marrubii, gramin., tartras 
potassse, the fresh expressed juice of these plants, Marien- 
bad Kreuzbrunnen, Egers, Selters and Ems springs (vide 
abdominal treatment in hypochondria) are of service. 
Phthisis Formata s. Manifesto,. 
The symptoms of confirmed pulmonary consumption 
may be seen above. Its principal signs are the setting in 
of a lingering fever and morning sweats. 
The fundamental indications in any kind of phthisis are; PHTHISIS PULMONALIS PURULENTA. 
291 
1, amelioration and cure of the local disorder in the 
lungs, be it induration, suppuration or blennorrhoea ; 2, 
diminution and proper treatment of the fever ; 3, repa- 
ration of the loss of humors by suitable restoration and nu- 
trition. 
In undertaking the treatment of phthisis, we must not, 
as is usually done, doubt the possibility of a cure ; for this 
deprives us of courage, circumspection, and an enterprising 
spirit, but act as if diseases of the lungs, even purulent 
ones were curable ; for this is proved by numerous facts. 
On dissection, considerable portions of a lung, previously 
consumed by suppuration, and healed up, have been discov- 
ered in persons who had recovered and afterwards enjoyed 
the free use of this organ, as I have myself seen an in- 
stance of in a public teacher. Never give up courage or 
hope, but call to your assistance all that can tend to attain 
? •. end. 
In the first place, therefore, we have to investigate the 
character and condition of the lungs ; that is, under what 
species of phthisis the case in question is to be classed. 
PHTHISIS PULBIONALIS PURULENTA. 
The only distinctive sign is the expectoration of purulent 
matter. But this diagnosis is very difficult, especially in 
the first stage, and when the pus comes from a superficial 
surface. A chemical examination of the sputa by alkalies 
and acids has been recommended as proper to point out 
the difference between pus and mucus, but it is fallacious: 
1, since the former is never obtained pure, but mixed with 
mucus ; and 2, because the secretion of all inflamed linings 
yields this mixture. The most sure are those discriminative 
marks which strike the senses, as the sweet and saltish 
taste of the sputa, its bad smell, and its sinking in water, 
especially salt water, if purulent ; whilst mucus will swim, 
and is stringy between the fingers. 
The principal remedies called for are gelatinous restau- 
rants, but not those obtained from warm-blooded animals, 
for these heat the blood too much, and increase the fever; 
but obtained from vegetables and cold-blooded ; above all, 
milk and whey diet, particularly new milk, better if it is 
that of asses or women; a teaspoonful of prepared bar- 
ley boiled in a few cups of milk, gelatin of Island, moss, 
two or three ounces daily, boiled in milk and sweetened ; 292 
PHTHISIS PULMONALIS PURULENTA. 
salep and oat-water* and the lately recommended jelly of 
Carrageen moss ; broth of snails, oysters. These remedies 
will not only make up the loss of power and humors, espe- 
cially that of the nutritive lymph which is consumed by 
suppuration, but also serve to heal the ulcer, since they act 
in this way on external ulcers. 
The second indication, healing of the pulmonary ulcer, 
is accomplished partly by the means just stated, partly by 
remedies which have a direct influence on the lungs, the 
antiphthisica, properly so called. But the greatest precau- 
tion is needed in carefully discriminating the different 
characters of the disease, whether it is phlogistic or atonic, 
so that suitable antiphthisics may be selected, according 
to its nature. In phlogistic consumption, which is the 
most frequent form of the disease, only antiphlogistic anti- 
phthisics are to be used, that is to say, remedies which do 
not excite inflammation either in the lungs or in the vascu- 
lar system in general. It is only in the atonic form that 
irritant, ardent ones may be prescribed. 
Of the first class, the most valuable, and confirmed by 
experience in single cases, are the following : semen phel- 
landrii aquatici, one scruple up to two drachms of the pow- 
der, or half an ounce in decoction, a day, herba digitalis 
purpurese, Sellers water, mixed with milk or whey, Ems, 
Kesselbrunnen, Egers salt spring, Obersaltsbrunnen in Si- 
lesia with whey, lime-water with milk, chlorate of lime (vide 
No. 117), one half up to one drachm daily, dissolved in 
water, aqua laurocerasi, juice of cucumbers, two or three 
ounces four times a day (a great remedy!) ; likewise the 
fresh expressed juice of herb, chervil, and tussilage, stipi- 
tes dulcamaraq mineral acids, plumbum acetatum (vide 
No. 118). 
Of the second or heating class, the most confirmed are 
the following : myrrh (undoubtedly the best and most ap- 
proved, Hofmann’s myrrh-sugar ; vide No. 119), balsam de 
Mecca, copaiva, balsam. Peruvian., asphaltum (01. asphalti, 
one or three drops, triturated with sugar, daily), kreosote 
similar to the foregoing (two or three grains), arnica, fer- 
rum (Griffith’s mixture). 
But, in the use of all these remedies, we ought to be 
cautious in observing, whether they create stitches, pains, 
' One handful of oats, boiled three times in a quart of water, and 
poured off, then again boiled until the grains burst, then percolate it 
and mix it with two teaspoonfuls of milk and a teaspoonful of honey. PHTHISIS PULMONALIS PURULENTA. 
293 
and oppression in the chest, or increase the fever; if so, 
they must be abandoned, lest they augment the inflamma- 
tion of the lungs, and accelerate death. 
Besides these medicines, the following means are ad- 
vised to promote the healing of the pulmonary ulceration: 
Local applications to the internal surface of the lungs and 
the ulcer. These are inhalations of vapors, balsamic fumi- 
gations, gasses, those of hyoscyamus, majorum, fennel 
seed, myrrh steeped in water, living constantly in a room 
where tar is boiled from time to time, the usefulness of 
which I am convinced of by my own experience), inhala- 
tion of carbonic acid and chlorine gas, the atmosphere of 
cow-stables, sea air (especially a sea voyage), and residence 
in warm, uniform climates, as Nizza, Hieres, Pisa, Madeira j 
but care is required in the selection. Purulent consump- 
tion calls more for low regions, as Pisa and Rome ; tuber- 
culous consumption, bronchitis chronica, blennorrhoea pul- 
monura, for a dry air, as Nice. 
That position of .the body, in which the pus can most 
easily escape. It is found out by observing which side 
the lying on gives most cough and expectoration. On this 
side, which is generally avoided, the patient ought to lie 
several times a day for as long a time as it can be borne. 
Passive exercise, as riding on horseback, swinging, motion 
of a vessel, sea voyage. 
Promotion of free expectoration. This, for two reasons, 
is an essential condition for effecting a cure. 1. Because 
it favors the cleansing and healing of the ulcer. 2. Be- 
cause the fever is thereby diminished and colliquation 
prevented. When expectoration is easy, nothing is more 
needed than to order much diluting, mildly dissolving bev- 
erages, as barley-water, gruel, decoction of dog’s-grass 
root, Sellers water with milk, and to avoid colds and 
heats. But when it stops, the cause must be inquired into 
and acted on accordingly. The obstruction may be owing 
either to a great tenacity in the mucus, which is recognized 
by the nature of the sputa. Here inhalation of warm emol- 
lient vapors, kermes mineralis, oxymel scillitic. cum syrupo 
althese and liquor ammonii anisat., emulsio gummi ammo- 
niaci, drinking largely. Or it may be suppressed by an 
accidental irritation, most frequently a gastric one ; here 
mild laxatives, such as manna, soluble tartar, also emetics, 
if indicated, are advised. If the irritation is of a catarrho- 
rheumatic character, which may be recognized by the 
presence of catarrhal or rheumatic symptoms and frequent 
cough, with expectoration of an acrid, watery serum, in 294 
PHTHISIS PULMONALIS PURULENTA. 
which case it must be treated like catarrh, by water gruel 
with liquorice, dulcamara, and vesicatories on the chest. 
If it is due to spasm and nervosity, which is discoverable 
by the frequent, violent and spasmodic cough, without 
signs of inflammation, hyoscyamus, aqua laurocerasi, and 
opium are of use. When it is caused by inflammation, 
recognizable by increased fever, anxiety, dyspnoea and 
pungent pain in the chest, antiphlogistics, leeches, even 
small venesections are indicated. When due to weakness, 
the signs of which are the absence of other causes, weak- 
ness of the pulse and the other functions, gummi ammoni- 
ac, arnica, ammonium anisat., flores benzoes are the reme- 
dies. 
Further, issues are often of wonderful benefit, especially in 
the beginning and in the metastatic forms of consumption, 
rheumatic, psoric, and are capable of translating the inter- 
nal disease to the surface. There are instances of con- 
sumptive persons accidentally injured by fire, who, by the 
long continued suppuration of the burns, have recovered 
from consumption. The best imitation of this accident is 
the establishment of a large issue or seton on that part of 
the chest where pain is most felt; but if, however, the pa- 
tient is already debilitated, or it is observed that artificial 
suppuration weakens him, the substitute must be avoided. 
Finally, if the ulcer draws to the surface, and a disten- 
tion or fluctuation between the ribs is apparent (vide vom- 
ica), it must be opened. 
ihe third indication is to diminish the fever, and the 
local as well as general inflammatory state of the lungs 
connected with it. The fundamental causes of consump- 
tive fever are loss of humors, the irritation produced by 
absorbed pus, and the inflammatory irritation of the pul- 
monary ulcer. These, however, cannot be removed but 
by annihilation, cure of the disease, and with it the fever. 
But the fever may be prevented from increasing, and there- 
by debility and emaciation may be avoided. This depends 
on finding out the causes. The most common is the aug- 
mentation of a phlogistic state of the blood. Therefore, 
generally cooling, but not weakening remedies are most 
beneficial, such as tartar, potassse, saturations of carbonate 
of potass, or still belter, of lapis cancrorum, with lemon 
juice (vide No. T2O). Sometimes an increase of the local 
inflammation in the sphere of the ulcer is the cause, which 
is recognized by pains, stitches in the part, and oppressed 
respiration. In such a case, leeches on that spot, or a 
small venesection in the arm give most relief; indeed, a PHTHISIS PULMONALIS PURULENTA. 
295 
teacupful of blood, taken away every four weeks, is recom- 
mendable to diminish the hectic fever, to preserve life, 
even to sometimes cure the disease. In order to remove 
the general phlogosis, mineral acids, especially elixir acid. 
Halleri, largely diluted with water and mixed with gruel, 
may be used ; we must, however, be careful, that the acid 
does not increase the cough or create diarrhoea. Or a gas- 
tric complication has taken place, which is a common 
occurrence in consumption. The signs of this are com- 
mon, and the proper remedies are mild laxatives; or, if 
there is any indication for them, also slight emetics, which 
give great relief in such states. Finally, increase of fever 
may be owing to an increase of weakness and colliquation. 
Here elixir acidum and gelatins are proper (vide last stage). 
Besides the general treatment, we must not neglect and 
disregard the specific character of the disease. Thus, in 
a psoric diathesis, sulphur and artificial ulcers; in a syphi- 
litic one, mercury ; in a scrofulous one, cicuta, barytse 
raurias may be administered at once. 
Of great importance in phthisis is a palliative treatment; 
calming of the most tedious and dangerous symptoms, es- 
pecially as this is often the only method which is left to us. 
1. The most troublesome symptom is cough. It is in- 
separable from the disease, but deserves particular regard, 
since its violence can give rise to additional inflammation 
of the pulmonary ulcer, and to hemorrhage, besides tor- 
turing the patient. The mode of assuaging it depends on 
the various causes which increase it (vide expectoration). 
2. The morning sweats. They too are inseparable from 
the disease ; but their immoderate augmentation calls for 
relief, which may be obtained by light covering, frequent 
airing, and keeping out of bed. Besides laxatives and 
mineral acids (elix. acid), sage tea, alum, boletus laricis, 
four to thirty grains a day, are of use. 
3. Diarrhoea is a principal sign of incipient colliquation, 
weakens very much, and therefore must be stopped. For 
this purpose, all fermentable and acid food must be avoided, 
and cortex simarubse, rad. arnicse, ratanhia, lime-water may 
be administered; but opium is more sure, and best given 
in clysters with milk, since, by the mouth it may operate 
disadvantageously. Diarrhoea may, however, also be due 
to taking cold and to indigestion, and is to be treated ac- 
cordingly. 
Haemoptysis, is to be treated according to its causes ; as 
inflammation, gastric stimuli, purulent corrosion of the ves- 
sels, colliquation (vide hemoptysis). 296 
VOMICA. 
5. Finally, aphtha?, a very tedious symptom, appears in 
the last stage. The principal remedy for this is borax with 
syrup, mororum ; if this does no good, we may try sulphate 
of zinc, combined with catechu and syrup, althea? (vide No. 
121), as a gargle. 
The Last Stage. 
Signs, see above. 
The treatment of the last stage is, properly speaking, 
nothing more than smoothing the road to the tomb; for 
cure is impossible ; but alleviation is wanted, especially of 
the aphthae and of the want of breath. 
Besides assuaging the symptoms just mentioned, the 
only means which can take away from the patient the feel- 
ing of his physical sufferings, and raise his spirit to a 
higher and to a more agreeable world, to one free from 
pains, is opium. Who would be the physician of such a 
patient, without this remedy ! It is necessary to both phy- 
sician and patient. It is inestimable—nothing else can 
replace it—it is a gift from heaven to a miserable sufferer 
to entrance him before death. 
VOMICA. 
Pulmonary ulceration does not always present an 
open surface, but is often a collection of pus enclosed in 
more or less firm membranes. It is either the consequence 
of pneumonia, or of a tubercle which has suffered gradual 
transmutations; in the latter case, several exist at the 
same time. These may be borne through life, with no 
other knowledge of their existence than is given by a little 
irritative cough and trifling difficulties of respiration. 
They, however, most frequently break, and a person who 
did not suspect their presence, expectorates pus. This 
may happen in a double way. 
1. Either a great quantity of pus escapes into the bron- 
chia, almost suffocating the patient ; suddenly giving the 
symptoms of suffocative catarrh. The treatment consists 
in ridding the bronchia as quickly as possible from pus and 
preventing suffocation by venesection, emetics, warm va- 
pors, and a suitable position. 
2. Or the expectoration of pus gradually follows. The 
result of this is quadruple : Either the vomica is perfectly 
evacuated, contracts gradually, and cicatrizes, followed by VOMICA. 
297 
perfect recovery. Or matter continues to be expectorated, 
and the vomica, surrounded by a firm membrane, ceases to 
affect the substance of the lungs, farther, does not trouble 
the system, and remains as an isolated imposthumous cav- 
ity like a fontanel, in which a quantity of matter is daily 
separated. Or the patient daily throws up a certain quan- 
tity of matter, often very fetid, and may live in other 
respects in a perfect state of health from ten to twenty 
years. 
3. Or an open, corrosive ulcer is formed. In this case 
the patient expectorates pus continually, and all the symp- 
toms of phthisis purvlenta manifesto, set in. 
4. Or the vomica at first forms between the pleura and 
the lungs; or the matter has gradually worked its way to 
the surface, and by inflammation has formed adhesions of 
the pleura. The diagnosis of such a case is difficult at 
first; for the patient often feels but very little pain or op- 
pression of the chest, and has little or no cough. But a 
lurking fever, emaciation, red urine, and difficulty of lying 
on the opposite -side lead to a suspicion, and an examina- 
tion by the stethoscope may here procure some light. But 
if the gathering increases, this side of the thorax enlarges, 
grows hot, points somewhere between the ribs, the part 
fluctuates and finally bursts of itself, or is opened by art 
(operation of empyema) ; when the discharge is perfect, 
healing may ensue. 
Or finally, be throws up a vomica, and a short stoppage 
of expectoration succeeds ; but soon a second one opens, 
and so on until the lungs are entirely destroyed. This is 
the case in tuberculous consumption,in which new ones con- 
tinue to pass into suppuration. In these cases, absorption 
of matter and wonderful metastases and evacuations of pus 
by urine or by stool may take place, and thus a perfect 
cure be effected. 
A similar process takes place in all suppurations of (in- 
ternal) viscera. There also a closed vomica may form, 
which the person may bear for life, without becoming 
phthisical. But it may burst and kill by a sudden internal 
effusion of matter one who previously seemed healthy, 
e.g. vomicae of the liver, kidneys, by effusion of matter 
into the abdominal cavity j cerebral abscesses, by effusion 
into the cavura cranii. 298 
PHTHISIS FLORIDA, LARYNGITES. 
PHTHISIS FLORIDA. 
Diagnosis. The signs of the disposition to florid con- 
sumption (which see above), but in a more intense degree, 
particularly the circumscribed redness of the cheeks (which 
gave occasion to the term), the heat of them, and of the 
hands after a meal, associated with a lingering fever; the 
cough is commonly dry, or accompanied only with little 
expectoration, frequently more or less haemoptysis (bloody 
cough). 
Pathogenesis. This disease is essentially a chronic in- 
flammatory state, generally connected with tubercles or 
passing into them, finally leading to suppuration, when 
associated with haemoptysis. 
Therapeutics.' The treatment is the same that has been 
recommended in the florid disposition. Frequently repeated 
small venesections, leeches on the chest, milk and whey 
diet, digitalis, aqua laurocerasi, country air and fontanels 
are the principal means. Connected with this course of 
treatment, are mild, cooling jellies, prepared barley, salep, 
arrow-root, Carrageen moss and the oat-water described 
above. Respect must at the same time be paid to-phthisis 
tuberculosa, which generally is coexistent. 
PHTHISIS TRACHEALIS ET LARYNGEA. 
Diagnosis. Hoarseness and cough; at the commence- 
ment of the disease the cough is only irritative, subse- 
quently purulent expectoration comes on, and a feeling of 
soreness, or heat and pricking in the trachea ; sometimes 
there is no pain at all, but merely a sensation of external 
pressure on the wind-pipe ; speaking, laughing, every ex- 
ertion of the throat createjs cough ; swallowing, at least in 
the beginning, is free and without pain. No pain is felt in 
the lungs, nor any difficulties of respiration. Lingering 
fever is long absent, and generally sets in about the time 
of suppuration. 
The course of this disease is very chronic, often lasting 
for years before it proves fatal. Death is due to the total 
destruction of the larynx by suppuration, and the commu- 
nication of the former to the lungs. 
Pathogenesis. The proximate cause is chronic inflam- 
mation, and finally ulceration of the mucous membrane of 
the larynx. The most frequent occasional cause is a neg- PHTHISIS HEP., REN., VESIC., MESENT. 
299 
lected catarrh ; scrofulous and syphilitic metastases, and 
immoderate efforts in singing, speaking, and crying also 
produce it. The bronchial glands are frequently the seat 
of this disease, thence the gray, dark colored, cloddy sputa. 
Therapeutics. The treatment must be adapted to the 
various causes, and to the general principles of the anti- 
phthisic method, respect being paid to the location of the 
disease ; but it must be persevered in for a long time. A 
long continued exutory on the neck, cortex mezer. on the 
upper arms, strict antiphlogistic diet, avoiding all kinds of 
exertion of the throat, leeches on the neck whenever pains 
come on ; when the origin is catarrhal, hepar sulphuris, 
calc, two grains three times a day, formed into pills with 
liquorice; Plummer’s powder with digitalis; dulcamara in 
decoction and extract, serum lactis, the fresh expressed 
juice of chervil, tussilage, hoarhound, and chloride of lime, 
dissolved in aqua Jaurocerasi (vide No. 125), Egers salt 
spring, which is here really specific, Ems, Kesselbrunnen 
and bath ; in great atony these means must be combinated 
with roborants, and particularly myrrh (vide No. 126) have 
proved to me most efficacious. In scrofula or a suspicion 
of a syphilitic diathesis, calomel unto incipient salivation. 
In the commencement of the disease, the sperm of her- 
rings, taken fasting, has been of use. Inhalations of miti- 
gating, moist vapors (of decoct, malv., sambucus, cicuta, 
hyoscyamus), also dry balsams (as decoct, of myrrh, boiled 
tar) are very beneficial ; they must, however, be adapted 
to the degree of irritability, and ought never to increase 
cough. I have also seen good effect from emplastr. cicutie 
cum hyosciarao, cicuta et hyoscyamus, worn around the 
neck. 
PHTHISIS HEPATICA, RENALIS, VESICALIS, MESENTERICA, ETC. 
Diagnosis. Existence and course of a lingering fever 
(vide phth. pur. pulm.), combined with the symptoms of 
the various local suppuration peculiar to every species. 
In phthisis hepatica, pain and pressure in the hepatic re- 
gion, spreading to the right arm or leg, inability to lie on 
the left side, yellowish colored countenance and sputa, vom- 
iting and other disorders of the stomach, constipation of 
the bowels alternating with diarrhoea, and turbid red urine. 
In phthisis renalis, pain and pressure in the renal region, 
increased by lying on the back, drawings in the leg and 
lower foot of the side affected, purulent discharge in the 
urine. 300 
TABES, 
In phthisis intestinalis, pain and tension in the abdomen, 
discharge of pus and blood by stool. 
In phthisis vesicalis, discharge of matter from the blad- 
der; in phthisis uterina, from the uterus. 
The diagnosis of internal suppurations which are not 
connected with the external surface is more difficult, be- 
cause they are not manifested by purulent discharges, as 
in phthisis mesenterica, abdominalis, vomica clausa. Here, a 
lingering fever is often the only sign, accompanied by 
pain, pressure, swelling of the suppurating part. 
On the other hand, all external chronic suppuration of 
wounds, ulcers, caries, accompanied with great discharges, 
may produce phthisis. I will mention here only abscessus 
lumbalis. 
Pathogenesis. The existence of suppuration in these 
organs, which is either the consequence of inflammation, 
or of a metastasis of morbific matters, or a shifting of 
pus from other parts, which is not a rare occurrence, par- 
ticularly in phthisis renalis. 
Therapeutics. Ths loss of humors and power must be 
made good, and the lingering fever be properly treated, 
as in phthisis purulenta pulmonalis. Besides local treat- 
ment of the ulcer ; in phthisis vesicalis and uterina, injec- 
tions must be used. At the same time, attention is to be 
paid to the tendency, which the matter has to the surface, 
a common occurrence in hepatic and renal suppurations, 
which is manifested by an external swelling and fluctua- 
tion, and may be cured by opening the abscess. 
TABES. 
Besides the natural wear and consumption of the body 
by the continual operation of life itself (marasmus senilis); 
the following causes also produce tabes, as is seen in the 
emaciation which follows severe acute or chronic diseases, 
or exhausting methods of cure; as by mercury, salivation, 
and abstinence ; or strong corporeal fatigues, likewise con- 
tinued excessive mental exertions, especially when com- 
bined with lucubrations, lingering sadness and grief, me- 
lancholies; but particularly in continual loss of humors, 
as chronic hemorrhages, blennorrhoeas, diarrhoeas, loss of 
semen, saliva, sweat, and too long continued lactation ; 
most so when to the loss of these is added that of power, 
as excesses in venery and masturbation, in both sexes, too 
frequent parturitions, the abuse of spirituous liquors, opium, 
and purgatives. PHTHISIS PITUITOSA. 
301 
In all these cases the treatment must tend : 
1. To remove the debilitating cause. The hemorrhages, 
and blennorrhoeas, and other chronic evacuations are there- 
fore to be restrained, and the weakening exertions both of 
body and mind must be abstained from. 
2. To restore to the system its lost powers and humors. 
This is effected by easily digestible and concentrated ali- 
ments, tonics and nervines ; free salubrious air, restofbody 
and mind, moderate exercise commensurate to the circum- 
stances. In the selection of food and medicines we ought 
to be careful, that their stimulant power correspond to the 
patient’s irritability, because a too energetic action might 
exhaust the vital powers, and thereby annihilate the mate- 
rial effect of the restaurant. 
I take this opportunity to admonish the practitioner that 
chronic debilitating evacuations often exist unknown to 
physician and patient until the hour of death, and not to ne- 
glect their investigation. Of this class are too frequent or 
too copious menstruation, hemorrhoids, fluor albus, pol- 
lutions, and masturbation, but above all diabetes mellitus, 
from which many a person has died without the physician 
or patient being aware of its existence. For this species 
of diabetes is not so remarkable for the quantity of urine 
discharged, as for its peculiar quality, abstracting from the 
blood its most nutritive substance. Therefore it is advis- 
able when we cannot discover the cause of emaciation, to 
make a chemical examination of the urine. 
PITXJITOITS CONSUMPTION. 
Tabes Pulmonalis, 
Phthisis Pituitosn, Blennorrhcea Pulmonum. 
Diagnosis, Cough with copious expectoration of mucus 
of different colors and quality, but commonly white and in- 
sipid, sometimes milkwhite and sweetish, similar to chyle ; 
sometimes yellowish and greenish, acrid, salty, puslike, 
sometimes mixed with blood j simultaneously there is ema- 
ciation and lingering fever. 
The expectoration may continue for years, before fever 
sets in, or becomes phthisis. Generally suppuration of the 
lungs at length takes place, and leads to death. rlhe dis- 
ease, however, may prove fatal without suppuration and 
destruction of the lungs by a mere loss of humors, as dis- 
sections have proved. 302 
TABES NERVOSA. 
Pathogenesis. It is often atnere atony of the lungs ; an inhe- 
rited pulmonary weakness; or owing to excesses in venery 
and masturbation, living in confined air charged with animal 
exhalations, neglected catarrh, hemoptysis, a former pneu- 
monia, particularly one which has been treated too long a 
time by relaxing expectorants, warm vapors, and the like ; 
immoderate smoking of tobacco, asthma pituitosurn, old 
age ; but also irritation of the lungs, and thereby increased 
secretion of mucus; above all a chronic suppression of 
perspiration ; psoric, arthritic, scrofulous metaslases, sup- 
pression of other blennorrhoeas, suppressed fluor albus, go- 
norrhoea, diarrhoea, gastric accumulations, obstructions of 
the abdominal viscera. Tubercles are not unfrequently 
connected with it, partly as cause, partly as consequence. 
Therapeutics. The first thing to be done is to invigorate 
the lungs; at the same time regard must be paid to the 
possibility of metastasis, and morbid irritations to the lungs. 
Tonics may be used, but with precaution, lest strong as- 
tringents might too rapidly suppress the expectoration. 
Therefore Island, moss, mixed with dulcamara (vide No. 
122) is best given in the.beginning; and if this do not help, 
myrrh may be added (vide No. 123); besides cortex casca- 
rillte, cinchona, quassia. At the same time a flannel vest and 
a fontanel on the arm ; after these, if the violent expecto- 
ration do not abate, and respiration become free, make use 
of the strongest astringents, as terra catechu, alum, ratan- 
hia (vide No. 124), cort. quercus, vitriol, martial., inhala- 
tions of balsamic vapors, oxygen gas, strengthening baths, 
particularly sea-baths, exercise, and riding on horseback. 
There are also cases, when strong exercise carried to 
sweating and fatigue, combined with living in the open air, 
have cured pulmonary consumption. I have seen it cured 
by military service in the field. 
But when metastases lie at the bottom of the disease, 
recognisable by former diseases; and when the expectora- 
tion is of bad color and acrid, the treatment of these various 
acrimonies, the arthritic and syphilitic, must be combined 
with the tonic course. 
NERVOUS CONSUMPTION, 
Tabes Nervosa. Febris Nervosa Lenta. 
Diagnosis. Emaciation without any apparent local affec- 
tion or visceral disorganization ; but a nervous weakness 303 
prevails, with perverted or increased sensibility and spas- 
modic affections. A lingering fever gradually sets in, and 
the disease passes into nervous phthisis, or terminates in 
general debility and total abolition of nutrition. 
The disease has two degrees. The first is without fever, 
but it is recognised by the following symptoms: In the 
morning the patient is weak and listless, the pulse small; 
in the evening he is brisk, even vivacious, with a full pulse; 
he has a constant desire for restoratives, and to enjoy 
fresh air ; but eating causes pressure in the stomach and 
sleepiness; giddiness, megrim, weak sight, vertigo ; chil- 
liness and sudden alternations of heat and cold, redness 
and pallor; hypochondriacal and hysterical complaints. 
This malady may last for a long while, before it becomes 
fatal. It kills either by a total cessation of nutrition, a 
true exsiccation of the body, or by a transition into phthisis 
pulmonalis (vide phthisis'). 
Pathogenesis. The proximate cause is ; a nervous weak- 
ness, carried to a degree which is insufficient for the pur- 
poses of nutrition, and which finally fails altogether. 
Remote causes are : all protracted febrile diseases, espe- 
cially nervous fevers ; all nervous diseases that last long 
and are intense; excesses in venery and masturbation, 
long continued violent corporeal exertions, waking during 
the night, mental exertions carried too far, sorrow, prema- 
ture and too frequent parturitions, too long continued lac- 
tation, chronic diarrhoeas, salivation, particularly leucor- 
rhoea, etc. 
TABES NERVOSA. 
Among the psychical causes, despair, longing for a cher- 
ished object, also for one’s native country (nostalgia) are 
particularly noticeable. They may bring on a fatal nervous 
consumption. I have seen even children die by longing for 
the departed mother. 
Therapeutics. The principal thing to be attended to is 
invigoration, especially of the nervous system and restora- 
tion. To attain this end, great caution in the choice of 
means is to be observed for two reasons : 1, on account of 
the weak digestion, incapable of bearing the fixed roborants 
which might produce impurities in the first ways; 2, on 
account of the morbid irritability, which will not bear ex- 
citing roborants, the use of which is liable to create 
spasms. We must, therefore, comply with three rules: 
1, to begin with mild tonics easy of digestion, and gra- 
dually increase to stronger ones; 2, to keep the bowels 
open, and to cleanse the digestive organs ; 3, apply the ro- 
borants endermically. For the first purpose 1 particularly 304 
recommend radix caryophyllatce with valerian, in decoc- 
tion or infusion; next quassia, or still better columbo, gra- 
dually up to Peruvian bark, at first in cold, then in warm 
infusion, tinct. Whyttii, and lastly in decoction; finally, 
the easily digestible volatile ferruginous remedies, as the 
sether martialis, and chalybeate waters. In a febrile state 
and a hectic disposition elixir acidum Halleri will be ser- 
viceable. Intermediately bitter dissolvent extracts, rhu- 
barb and aloes may be given to open and cleanse the in- 
testinal canal; saline purgatives ought to be avoided, on 
account of their debilitating properties. Baths are highly 
serviceable ; by them alone 1 have frequently succeeded to 
make a whole cure ; even the lingering fever is readily re- 
moved by them. Simple baths of tepid water are excel- 
lent; but malt-baths are more efficacious; to which, in 
cases of great debility, aromatic herbs may be added, and 
embrocations of aromatic water applied to the skin, spirit, 
serpylh, roris marini, etc. 
The diet and mode of living of the patient also deserves 
especial regard. The food must be easy of digestion, 
concentrated into a small volume, and proportioned to the 
digestive powers of the patient; as milk, especially asses’ 
milk, salep, arrow-root, Island, moss, animal jelly, snail- 
broth, nutritious beer ; in great debility, generous old wine ; 
particularly the daily enjoyment of fresh air, that of the 
country and mountains, daily moderate exercise in the 
open air ; but when there is great debility, rest and a hori- 
zontal position. 
Finally, the greatest attention must be paid towards 
avoiding all things of a debilitating tendency, mentally as 
well as corporeally ; particularly to abstain from sexual in- 
tercourse, and to guard against pollutions, and the remote 
debilitating causes, as fluor albus, too profuse menstruation 
and diarrhoea. 
TABES DORSALIS. 
DORSAL CONSUMPTION. 
Tabes Dorsalis s. Medullaris. 
Diagnosis. Emaciation, weakness, and finally paralysis 
of the lower, and sometimes oT the upper extremities ; a 
feeling of heat or cold, crawling, and sometimes violent 
pains in the lower part of the spine. The first appearance 
of the disease is commonly announced by an unsure, tot- 
tering, wavering gait. The disease sometimes stops at this 305 
stage, without penetrating deeper into the system, leaving 
the individual in this state for 10, 20, and more years. Ge- 
nerally, however, the paralysis continuesjo spread, seizes 
upon the bladder (creating difficulties to make water) ; 
upon the great gut, causing costiveness or involuntary- 
stools alternately; upon the organs of the senses, particu- 
larly the eyes; the organs of the mind, producing defi- 
ciency of memory and judgment, fatuity ; finally upon the 
vital organs, disturbing respiration and the functions of the 
heart, causing death either by paralysis of the lungs, heart, 
or brain; or by a total emaciation and exhaustion of power. 
Pathogenesis. The proximate cause is paralysis, finally 
exsiccation, atrophy, and a disorganization of the lower 
part of the spinal marrow. The most frequent remote 
cause is debility brought on by excesses in venery and 
masturbation, a too profuse loss of semen ; it may also be 
caused by sanguineous congestions to the spinal marrow, 
myelitis chronica; metastases, particularly the arthritic 
and rheumatic, but only when combined with seminal 
losses. It therefore happens that this disease almost al- 
ways attacks males, rarely females. 
Therapeutics. The treatment consists in removing the 
enumerated causes. Congestions require leeches and mer- 
curial embrocations on the suspected part of the spine 
(vide myelitis); metastases and debilitations must be at- 
tacked in their source, e.g. the loss of semen (vide pollutio). 
The nervous system, but particularly the spinal portion 
must be invigorated and animated. But alas! experience 
teaches that this is almost always impossible, or if ever 
practicable is only rarely and imperfectly so. Besides the 
general dietetic and pharmaceutical restauratives and ro- 
borants, the use of Teplitz and Pyrmont baths ; the appli- 
cation of moxa to the lumbal region, continued a long time 
in suppuration, and repeated from time to time, have proved 
to some extent efficacious. 
MARASMUS SENILIS. 
Marasmus Senilis 
Life itself, by its continuance, finally produces a morbid 
state, which we call old age, and in which are combined 
all the peculiarities of tabes and atrophy. A gradual ex- 
haustion of the vital power, imperfect digestion and nutri- 
tion, deficient secretion and excretion, weakness of all the 
voluntary as well as involuntary corporeal and mental 
functions, exsiccation of the body, and decrease of vital 
warmth are its effects and characteristics—it is this that 306 
ATROPHY. 
we term marasmus senilis. This marasmus is a gradual 
mortification, a natural transition into death, in which it 
terminates. mortal who lives long can escape it, and 
to pretend to cure it would be ri'diculous.' All that we can 
do is to retard its progress, and render its effects tolerable. 
But this state of body, this marasmus senilis, may be 
brought on prematurely, by what is termed living quickly ; 
that is to say, by those excesses which concentrate and 
hasten self-consumption, as excessive exertions of all the 
powers, and the waste of noble humors, especially excesses 
in venery, so that the vital capital is used up within half 
the time, that it was destined for by nature. Now-a-days 
it is not rare to meet with cases of premature old age 
(marasmus senilis factitius). We see men only 30 years 
old, bearing all the characteristics of age : as gray hair, 
bald head, shrivelled, stiff and useless limbs, enfeebled sen- 
ses, and defects in all the functions. 
For such a state of ihings the treatment of tabes nervosa 
and dorsalis is to be pursued ; but we rarely, perhaps never 
attain Jile end wished for. Lost life can not be revived, 
and all that can be done is to preserve and prolong the 
semi-life which remains. 
ATROPHIA. 
Emaciation by deficient absorption or animalization of 
nutriment. 
The causes may vary. It is owing 
To exclusion of aliments : as long fasting (in melancho- 
lic, superstitious persons), a starving treatment, worms 
which share the nutriment (atrophia verminosa); diseases 
which prevent swallowing, as dysphagia, cancer of the 
tongue; maladies of the throat and stomach, in which the 
food is returned, by rumination (as in sacculated oesopha- 
gus) ; or vomiting (as in induration and cancer of the 
stomach), or its too quick discharge by stool (as in lientery) ; 
Or to defective admission of nutriment into the orga- 
nism by disturbed assimilation, animalization, sanguifica- 
tion, obstruction in the mesenteric glands (atrophia mesen- 
terica), obstruction, induration, and other disorganizations 
of important viscera, which are necessary to animalization 
and sanguification, as the liver, spleen, lungs (atrophia he- 
patica) lienalis, ahdominalis, pulmonalis, phthisis tubercu- 
losa). * 
Its signs are : disorders in the functions of the respec- PHTHISIS TUBERCULOSA. 
tive organs, without symptoms of suppuration ; in abdomi- 
nal disorders there is tension and perceptible hardness in 
that region. Hectic fever shows itself very late, generally, 
not till the induration passes into chronic inflammation or 
suppuration, indicated by increased pains, heat in the re- 
gion and fever, to which particular attention must be paid. 
Death is caused by total exhaustion, or the entire de- 
struction of some indispensable organ. 
Atrophy may also occur in some external part (atrophia 
localis externa), tabes of a single part, as of the arm, hand, 
and foot; and which in children opposes their growth; it 
may even pass into a total mummification. 
Causes, vide disorganizations. 
The cure consists in the removal of the obstructions, 
and that of the accidental formations, without neglecting 
inflammation, which is apt to set in, and for which repeat- 
ed applications of leeches are highly recommendable ; and 
in promoting restauration by nutritives and roborants. Par- 
ticular care must be taken to prevent the local disorder 
from passing into suppuration, or in scirrhosities into car- 
cinoma, accidents which are always produced by inflam- 
mation, and are therefore prevented by proper antiphlo- 
gistics. The same is true of dropsy, which is common in 
abdominal diseases. When suppuration sets in, the treat- 
ment of phthisis is to be followed. 
For the treatment of single species, see the respective 
articles atrophia stomachica et pancreatica in vomitus chro- 
nicus, atrophia mesenterica and verminosa under the diseases 
of children. 
The local atrophy of single parts requires frequent em- 
brocations of spirits and balsams, also frequent frictions 
and manipulations, which have often effected cures, as I 
have witnessed in children. 
TUBERCULOUS CONSUMPTION. 
Atrophia Puhnonalis. 
Phthisis Tuberculosa s. Sicca s. Scrophulosa. 
Diagnosis. Short dry cough, especially on taking a long 
breath, speaking loud, laughing, and exercise of the body, 
occasionally mucous expectoration, particularly in the 
morning, which is often mixed with little cheesy lumps 
that smell bad. Respiration is slightly embarrassed in 308 
PHTHISIS TUBERCULOSA. 
some, in others it is perfectly free (according to the size 
and number of.the tubercles), but exercise, certain positions 
of the body make it difficult; frequently there are flying 
stitches through the chest, a burning sensation which al- 
ways returns in the same spot ; hoarseness and catarrhs 
frequently occur, emaciation without evident cause ; fre- 
quent slight accessions of fever that finally become con- 
stant, and pass into hectic. 
Diagnosis is difficult in the beginning, and until the tu- 
bercles increase in size and number. If they are small 
and few, the patient may live long, even without knowing 
that they exist. But, by repeated little inflammations they 
may insensibly increase in size and number, and thus pass 
into phthisis. Such a case may continue without expecto- 
ration from the commencement to the end {phthisis sicca), 
and the patient dies of exsiccation, induration, vital and 
functional disability of the lungs. Or the tubercles may 
pass more or less quickly into suppuration, converting the 
dry consumption into the purulent. This may happen gra- 
dually, or suddenly by the bursting of a vomica. Some- 
times, however, the emptied tubercle may cicatrize, and 
the patient remains free from purulent expectoration, until 
a new vomica breaks, and in this way years may pass on 
interruptions and pauses of purulent expectoration. 
Pathogenesis. Scrofula, measles, pneumonia, hemorr- 
hages, weakness, and blennorrhoea of the lungs and me- 
tastasis. 
Therapeutics. For the treatment of the predisposition 
and incipient tuberculous phthisis, I refer to the respective 
heads already described. 
The treatment which is most essential, consists in dis- 
solving the tubercles, and preventing their increase and 
transition into suppuration. The two last are the effect of 
inflammation, for which a most strict antiphlogistic diet is 
necessary, and on the least accession of inflammation in a 
tubercle, which is made manifest by a fixed local pain in 
the chest, a small venesection is immediately to be made, 
leeches applied, cooling laxatives, and nitre administered; 
should these fail, we must resort to vesicatories, and main- 
tain a continued artificial ulcer over the part affected. 
The radical cure requires dissolution of the tubercles. 
In attempting this, great caution is requisite, Jest the dis- 
solving remedies create a new inflammation. For this rea- 
son all resolvents which have a tendency to irritate, are to 
be avoided, and only cooling ones administered, and in 
using them we must carefully watch their effect; and if HECTICA. 
309 
they excite pain in the chest, they must be discontinued. 
Even calomel, which is apt to cause pain and irritation, 
is dangerous. The only safe, and the most efficacious 
remedies, according to my experience, are the following, 
persevered in for a long time : the fresh expressed juices 
of tussilage, chervil, rad. graminis, juice of cucumbers, 
serum lactis, acetate of potash, mellago graminis et tar- 
axaci, barytse murias, murias calcis, aqua laurocerasi, Sel- 
lers water, Egers salt-spring, digitalis, cicuta, dulcamara, 
hyoscyamus, small doses of tartar emetic dissolved in a 
decoction of rad. althajee, fresh honey. At the same time 
moderate passive exercise, especially on horseback ; wool- 
len clothing on the chest, and fontanels on the arm. 
Long and patient continuance of these remedies is es- 
sential. 
CONSUMPTION FROM CHRONIC IRRITATION. 
Hectic a. 
A considerable and constant irritation of the principal 
systems of the economy necessarily produces—by dis- 
turbing that rest, which is requisite to organic crystalli- 
zation—a diminution of nutrition and loss of substance. 
This is produced particularly by the material irritations of 
morbid matters, generally spread through the humors; such 
as the psoric, syphilitic (in inveterate ill-treated syphilis), 
arthritic, scrofulous dyscrasias, chronic mercurial, arseni- 
cal, saturnine poisonings ; also acute fevers which have not 
terminated by a crisis ; too speedily suppressed intermittent 
fevers, which we must suppose to have left a febrile matter 
lurking in the system. In all these cases a hectic state, a 
lingering fever, an emaciation is frequently developed, 
the sole cause of which is the presence of a heterogeneous, 
continually irritating matter. In this way chronic in- 
flammations, chronic cutaneous diseases, scabies, herpes, 
lepra, even constant pains and mental affections may, by 
their continual irritation, produce hectic fever and ema- 
ciation. 
The cure depends on the removal of the causes, of the 
injurious or specific morbid irritants, and in a proper resto- 
ration and invigoration. 
In all cases, where a material dyscrasia is the cause, as 
in the syphilitic, mercurial, arsenical, psoric, and arthritic 
hectic, milk diet is the principal remedy. It fulfils both 
indications ; mitigates the irritation produced by the acri- 310 
HYDROPES. 
mony, neutralizes and destroys it, gives a new and milder 
blood, and thereby destroys the fever, restores the humors 
and strength of the system. Tepid baths, and in great 
weakness, cinchona and similar tonics may be simulta- 
neously employed. Even in cases where specifics are still 
necessary to combat a specific poison (as in syphilitic 
hectic, mercury ; in psoric, sulphur), persisting at the same 
time in milk diet, will best assist the treatment, and render 
it efficacious and the specific remedy less injurious. 
EIGHTH CLASS. 
ACCUMULATIONS OF WATER AND AIR. 
HYDROPES, PNEUMATOSES. 
I, My d ropes. 
Generalities. 
Diagnosis. Distention and swelling of a part, with fluc- 
tuations when it is soft ; when the part is hard and sur- 
rounded by bones, there is a sensation of pressure on the 
organ, and its functions are disturbed. At the same time, 
the serous secretions (especially that of urine), appear 
diminished. 
Pathogenesis. The proximate cause of dropsy is always 
a disturbance between the balance of exhalation and ab- 
sorption ; therefore, this disease may be caused as well 
by an increased secretion of serous fluid, as by deficient 
imbibition. 
The remote causes may be classed as follows: 
1. Debility, by which the activity of the absorbent sys- 
tem is weakened. All chronic diseases which exhaust the 
powers of the system, end in hydrops or consumption ; 
dropsy is only their last stage, the commencement of 
death. It is also produced by acute diseases ; especially 
by profuse waste of semen, or of blood, provoked by disease 
or by art. It may also follow a local weakness, caused by 
concussion or commotion. 311 
HYDROPES. 
2. Irritation, which augments the serous secretion of 
cavities, or converts the internal gaseous perspiration into 
fluid. Thus inflammation, by its accompanying exsudation, 
may produce consecutive dropsy ; as hydrops cerebri acu- 
tus. Under this head must be placed such specific morbid 
irritations as the syphilitic, scarlatinous, psoric, but chiefly 
the irritation produced by spirituous liquors. Those who 
indulge greatly in wine and brandy, end always by dying 
of dropsy. 
3. Antagonism, metastasis. The suppression of a natu- 
ral as well as of a pathological secretion and excretion ; 
likewise that of an external morbific deposition may create 
a morbid internal accumulation of water. The most fre- 
quent is the suppression of cutaneous perspiration. Every 
rheumatism is accompanied by a local serous exsudation, 
a rheumatic dropsy, which may invade the whole cellular 
system (anasarca), or fill the internal cavities ; hence, drop- 
sy is endemic in moist regions, as in Holland. The same 
thing is observed after suppression of urine, which fre- 
quently occurs in aged persons and children ; after sup- 
pressed hemorrhages, particularly that of menstruation ; 
also, after suppressed morbific depositions, as gout, cutane- 
ous diseases, diarrhosa, fluor albus, and suddenly arrested 
intermittent fevers. 
4. Mechanical pressure. Every pressure impedes the 
circulation of the venous and lymphatic vessels, and there- 
by creates accumulation, serous effusion and swelling. 
This is made apparent by tying a ligature round any part 
of the body. External tumors and indurations operate in 
this way ; thus indurated axillary glands cause swelling of 
the arm, and the gravid uterus an oedema pedum. This 
is true also of internal ones, as indurated pancreas, tuber- 
cles of the lungs ; but especially enlargement and obstruc- 
tion of the liver, because it is the central organ of the 
abdominal circulation and absorption. 
5. Rupture of lymphatic vessels. This, however, cre- 
ates only a local dropsy. 
6. Thin, watery blood predisposes to dropsy; particu- 
larly blood which is deficient of cruor, as after bleeding, in 
chlorosis, and the abuse of spirituous liquors. 
Therapeutics. Removal of the remote cause is the first 
thing to be done. To accomplish this object, we must first 
inquire into the dynamic character of the disease, whether 
it be inflammatory or adynamic (the latter is the most 
common). The next thing is to remove the material cause, 
which may be an obstruction, a mechanic pressure, or the 312 
ABDOMINAL DROPSY. 
like. After this, we must pay due regard to the cause of 
the specific dyscrasia and its treatment. 
The second indication is to effect the absorption of the 
effused water ; for it cannot be evacuated by the natural 
ways. With this object in view, we must prescribe such 
remedies as have a specific influence over the lymphatic 
system and augment its action ; as mercury, digitalis, and 
all the evacuants, particularly emetics, purgatives, and 
diuretics. 
The first indication is often sufficient by itself to accom- 
plish the cure ; but it is better to unite both. 
The third indication is to evacuate the water in the nat- 
ural way if it be possible, by promoting the watery secre- 
tions and excretions, particularly that of urine, and if this 
cannot be done, recourse must be had to the artificial way j 
that is, an operation. 
ABDOMINAL DROPSY. 
Hydrops Ascites. 
Diagnosis. Tumefaction and tension of the abdomen, 
following the position of the sick ; fluctuation, the wave of 
which is felt against the palm of the hand placed on one 
side of the belly, while the opposite side is percussed with 
the fingers of the other hand. In the beginning of the dis- 
ease, the fluctuation is best felt in the lower part of the 
abdomen, and while the patient stands up. The urine is 
scanty and of a dark brown color like beer (peculiar to 
ascites). The stools also are scanty and dry ; and there 
is dryness of the skin, tongue and mouth, therefore thirst. 
Eespiration is rendered difficult by the ascent of the dia- 
phragm, sometimes also by dropsy in the chest coexisting. 
The greater the tumefaction of the abdomen, the more are 
the limbs emaciated. In hydrops saccatus the tumefaction 
is unequal in the beginning, is, however, more equally dis- 
tributed as the disease advances. Also the urine is of a 
less dark color, and less scanty. 
Subsequently, as the disease increases, the feet, scrotum, 
or labia vulvse swell ; a dry cough, and towards the end 
there is lingering or acute fever, which is a sign of ap- 
proaching death. 
Death ensues either by suffocation, or by the fever assu- 
ming a putrid character, or by local inflammation and 
gangrene supervening in some abdominal viscus. abdominal dropsy. 
313 
The diagnosis may be rendered difficult by coexisting 
pregnancy. 
Hydrops ahdoninalis saccatus is distinguished by the 
swelling commencing in a particular part, and even when 
far advanced, the distention of the abdomen is not uniform ; 
and in general the urine is less dark. 
The duration of the malady varies very much, lasting 
sometimes for many years, according to the cause, and 
constitution of the patient ; hydrops saccatus lasts longest. 
Next to phthisis, this is one of the most common diseases. 
Pathogenesis. The most frequent causes are obstructions 
and other diseases of the abdominal viscera, especially of 
the liver, badly treated or too long standing intermittent 
fevers, atonic gout, and other dyscraslas, abuse of wine 
and spirituous liquors, previous acute fevers, particularly 
scarlet fever, mechanical lesions, by blows on the abdomen, 
falls, etc. 
Therapeutics. The disease belongs to that class, which, 
properly speaking, scarcely admits of a cure. The cura- 
bility depends on the cause, being incurable in indurations 
or other disorganizations of the abdomen, which are them- 
selves incurable ; or on the more or less vigorous consti- 
tution of the patient. 
In the treatment,then, we must first take the various cause 
and character of the disease into consideration. A dropsy, 
which comes on quickly, with febrile symptoms, a full 
pulse, suppressed hemorrhages or signs of a local inflam- 
mation, calls for'a treatment differing from that of one which 
is the consequence of great and chronic loss of blood or 
other great debilitating causes. In the first case, moderate 
abstractions of blood, nitre, calomel, in short, the antiphlo- 
gistic method ; in the latter case, cinchona, quassia, even 
chalybeates, the strengthening method, form the funda- 
mental character of treatment. Specific dyscrasias require 
specific remedies, as mercury in the syphilitic, sulphur in 
the psoric (suppressed itch). In obstructions of the abdo- 
minal viscera, taraxacum is to be given with diuretics ; in 
suppressed perspiration of the feet, old ulcers and hemor- 
rhages, the original complaint must be reproduced. 
Besides treatment, we must also, and at the 
same time have recourse to the direct treatment, which is 
the evacuation of the water. The principal thing to be 
done for this purpose, is excite the action of the lym- 
phatic system, which may be best attained by emetics, 
mercurials, barytes, digitalis, guaiac. Then diuresis is to 
be promoted, as most serviceable and least debilitating. 314 
ABDOMINAL DROPSY. 
Here radix scillee ranks first in all its forms, but as it is apt 
to create nausea and vomiting', it is best administered in 
pills (vide No. 152), or combined with aromatics, or given 
in vinous and spirituous tincture, tinct. sciM. kalin (Pharm- 
ac. Pauper.). Squill is also of great value, applied ender- 
mically. A small spot on the abdomen about the size of a 
sixpence is to be denuded of the epidermis by a vesicatory, 
and three grains of rad. or extract, scilla? is to be applied 
on it three times a day. Besides the foregoing, digitalis, 
nitre, cream of tartar, soda, juniper (No. 153, 154), bryo- 
ny, tobacco, cantharides, drinking largely of the diuretic 
tea (vide No. 151), as well as of cold water mixed with a 
little Rhenish wine, are the remedies most confirmed by 
experience. At the same time, diuretics (N.o. 155) may be 
applied . externally, likewise mercurial inunctions on the 
abdomen. The evacuation of water by acting on the intes- 
tinal canal is rarely practicable, and must never be resorted 
to in great weakness ; but in the commencement, and when 
strength remains, and that there is a natural tendency to- 
wards the bowels, purging is of excellent service. For this 
Surpose, gamboge, bryony, colocynth, pilul. hydragogas 
anini, elateriura (with great precaution !), rad. gratiolse, 
jalap., aloes are most recommended. Of great effect and 
confirmed in my experience, is a combination of diuretics 
with purgatives (vide No. 156, 157, 158, 159, 160, 161). 
An addition of a mercurial, particularly mercurius nitrosus 
No. 162, 163) is of great practical use, since it increases 
the efficacy of all the medicines before mentioned. 
We must always attend to the secretion which nature is 
most disposed to, and promote it. I have seen, in great 
tendencies to intestinal secretion, dropsy cured solely by 
the continued use of Glauber’s salt. Nature has some- 
times evacuated the water even by vomiting. If all kinds 
of diuretics are unavailing, discontinue them for a few 
days, replacing them by resolvents, extract, tarax., chel- 
idon., soluble tartar ; after this, return again to diuretics, 
and they will not fail. If this also fail, a high degree of 
torpor or a spasmodic state of the minute vessels must be 
the cause of the want of action ; and in such a case, an 
emetic, after which, roborants, excitants, and antispasmo- 
dics used, may likely prove efficacious. I can recommend, 
from my own experience, quassia, wine (especially Cham- 
pagne), rad. belladonnas and opium. If this also should fail, 
bandages applied moderately tight to the extremities, and 
even to the abdomen, have promoted absorption and diuresis. 
Acu-puncture of the abdomen, especially in connection with 315 
DROPSY OF THE CHEST. 
galvanism, is also a good auxiliary. If no success should 
be obtained by any of these means, paracentesis abdominis 
(tapping) may be resorted to. For it has been often ob- 
served that, as soon as the pressure of the water bad been 
removed, the absorbing vessels and the kidneys commenced 
to operate and to accomplish the cure. In the second 
place, a momentary and very great alleviation is thereby 
procured to the sufferer, and it is the best palliative. Fi- 
nally, there have been cases (especially of hydrops sacca- 
tus) in which the life of the patient has been preserved for 
many years, by this operation repeated from time to time. 
I have seen instances where the patient had his life pro- 
longed from twenty to thirty years by forty or fifty tap- 
pings, repeated every two or three months. But that 
tapping may he useful, we must be careful not to perform 
that operation too late, when the water has become putrid, 
or local inflammation or fever has set in. After the paren- 
tesis, roborants, especially quassia, combined with diuret- 
ics, are to be used. 
DROPSY OF THE CHEST. 
Hydrothorax. 
Diagnosis. The recognition of this disease is very diffi- 
cult, and in most cases not with perfect certainty until it has 
reached the last stages. The symptoms are : great op- 
pression of breath, particularly on motion, and when lying 
on the back, great anxiety, short cough, commonly dry, 
very often spasmodic, spasmodic pains between the shoul- 
ders, which are frequently very tormenting, swelling of the 
hjinds, sometimes of the face and around the eyes. When 
the patient turns quickly round, the fluctuation of the wa- 
ter may sometimes be felt or heard if the quantity be great. 
Percussion, and auscultation by means of the stethoscope 
will throw some light on the case. Principal signs : sud- 
den awaking in the night, with a feeling of great anxiety 
and suffocation, and an irresistible impulse to rise and rush 
to the window for fresh air. Impossibility to lie down 
towards the end of the disease, none but a sitting posture 
is practicable, and finally a standing position is the only 
one which affords some alleviation to respiration. The 
urine is diminished, but is not as dark as in ascites, and 
sometimes it is natural (as in hydrops saccatus). 316 
DROPSY IN THE PERICARDIUM. 
The patient dies by suffocation, or in a soporous state by 
apoplexy. Cure is rarely possible. 
Pathogenesis. All causes of dropsy in general can pro- 
duce this disease, particularly pneumonia, tubercles of the 
lungs, arthritic metastases, obstruction of the liver, chronic 
asthma, ascites. 
Therapexitics. The treatment must conform with the 
general principles laid down for dropsical maladies, in the 
same manner and by the same remedies as in ascites. 
Diuretics, digitalis, squills, and bryony are particularly 
efficacious. Nitre one scruple, along with sulph. aurat. 
antimonii, one grain, three times a day ; also tinct. nicot., 
cantharid., belladonnas, likewise artificial ulcers on the 
arms and on the chest, also foot-baths of mustard, sina- 
pisms on the calves of the legs, in order to shift the oedem 
to the feet, have proved serviceable. Towards the end, and 
when fluctuation between the ribs is clearly discriminated, 
paracentesis thoracis may be resorted to. It is always a 
great palliative, sometimes leads even to a radical cure. 
To assuage the anxiety, aqua laurocerasi, with extract, 
hyoscyami and opium may be given. 
As the rarity of cure is principally owing to the tardy 
discovery of the disease, we will do well to suppose the 
existence of incipient hydrothorax in every chronic and 
considerable asthmatic difficulty ; and to endeavor to ex- 
cite diuresis, by which the further progress of the disease 
may best be prevented. 
DROPSY OF THE PERICARDIUM. 
Hydrops Pericardii. 
Diagnosis. Presents much similarity with the signs of 
hydrothorax, with which it is frequently associated. Its 
principal characteristics are : palpitation of the heart, ex- 
tending through the whole extent of the chest, intermitting 
pulse, fainting fits, extreme anxiety. Examination by the 
stethoscope may assist in distinguishing it from organic 
disorders of the heart. 
Causes are : besides the general ones, inflammation of 
the heart, organic diseases in this organ, and metastases. 
The treatment is the same as advised in hydrothorax. HYDROCEPHALUS. ANASARCA. 
317 
DROPSY OP THE HEAD. 
Hydrocephalus. 
DROPSY OF THE BRAIN. 
Hydrencephalon. 
We distinguish hydrocephalus externus and interims. The 
first is an accumulation of water without the cranium (pro- 
perly cedema capitis) ; the latter is either accumulation of 
water between the brain and its membranes or in the cavi- 
ties of the cranium themselves (hydrencephalon). 
Hydrocephalus internus occurs only in children, and as 
a primary and independent disease (either congenital or 
acquired), (vide diseases of children, hydrops cerebri) ; but, 
by becoming chronic, it may last from infancy to a more 
advanced age. I have seen individuals live in this state to 
the age of sixteen years. In such cases the head acquires 
an enormous size, and the individual is imbecile. In grown 
persons it is always a secondary or symptomatic disease, 
succeeding to inflammation of the brain, or violent commo- 
tions ; it is a consequence of chronic insanity, and of or- 
ganic disorders within the cavity of the cranium. 
The treatment is the same as for dropsy in general. It 
is, however, worthy of remark, that the affusion of cold 
water on the head, repeated several times a day, and con- 
tinued for some time, may sometimes effect a cure of con- 
genital as well as of chronically forming hydrocephalus. 
Water is here of more use than any other means. 
DROPSY IN THE SKIN. 
Anasarca, (Edema. 
Accumulation of water in the cellular tissue, generally 
in that which lines the skin, but also in the internal viscera, 
as the lungs. The most common is cutaneous dropsy, 
either general (anasarca), or in single parts, as in the hands 
and feet (cedema). The signs are : a swelling which yields 
to the pressure of the finger, and retains the impression. 
Predisposition to it is owing to a lax constitution of the 
fibre. All individuals possessed of such a constitution are 
more liable to it than others ; therefore it is common in 318 
ACCUMULATIONS OF AIR. 
females, a sex in which laxe fibre predominates. In such 
persons oedema pedum often occurs after great exertions in 
walking or'long standing, and during the summer season is 
very common and unimportant. 
CEdema. It is either symptomatic, a consequence of an 
internal accumulation of water (as oedema of the feet, of 
the scrotum in ascites, and of the hands in hydrothorax) ; 
or it is idiopathic, contracted by colds, inflammations, es- 
pecially by rheumatism or psora, also by local debility. 
The first kind is remedied by removing the internal dropsy ; 
the latter by cushions of dry, aromatic herbs, especially of 
hops and absinth ; by balsamic fumigations, local vapor 
baths, finally by the application of rollers. We must dis- 
tinguish between hot and cold oedema. When the skin 
is painfully distended, and has an inflammatory character, 
leeches and cups are of use. Scarifications, cautiously 
made, are likewise serviceable in cold oedema, when there 
is great tension. 
Anasarca. General dropsy of the skin may be of an acute, 
character, caused by violent colds, suppressed perspiration 
or cutaneous eruptions, especially after scarlatina, and calls 
for an antiphlogistic treatment, combined with diuretics 
and diaphoretics ; particularly nitre with digitalis, squilla, 
and calomel. The chronic is owing to obstructions of the 
circulation of blood in the heart and the larger vessels, or 
is a concomitant of a general hydropic disposition and ac- 
cumulations of water. 
The treatment is the same as is usual for dropsy in gen- 
eral; at the same time, frictions, flannel clothing, aromatic 
fumigations, sweating baths, especially by spirit of wine, 
are proper. 
11. Accumulations of Air, 
Generalities. 
They may arise by the entry of atmospheric air into the 
tissues from without. 
Or by an internal formation of gas. This species may' 
originate in chemical dissolution, as by putrefaction, fer- 
mentation of aliments ; or by a conversion of the secretion 
of the internal surfaces into a gaseous form, owing to an 
abnormal influence of the nerves. 319 
The cure is effected either by the artificial evacuation 
of the air; by its absorption ; or by dissolution, and recon- 
version into liquid. 
FLATULENCY. 
FLATULENCY. 
Flatulentia. 
Diagnosis. Excessive and incessant generation of air in 
the stomach and intestinal canal, manifested by tension and 
swelling of the epigastrium, the whole abdomen, and by 
frequent discharge of flatus per os et anum, which gives 
relief. This accumulation of air creates great and manifold 
complaints, partly local by distention and pressure, partly 
consensual by nervous irritation. These are : most intense 
anxiety, difficult respiration (asthmajiatulentum), even men- 
tal anguish and phantasies (incubus), hypochondriacal in- 
disposition, violent pain in the abdomen and prsecordia, 
particularly on the left side, which might be mistaken for 
pleuritis (colica jiatulenta), palpitation of the heart, even 
spasmodic affections of remote parts, pains, illusions of 
the senses (susurrus aurium, visits duplex, diplopia). When 
it attains great height, it may excite two diseases: ructu- 
ositas, when the patient is troubled incessantly with loud 
irretainable, often crying ructus, and the murmuratio, into- 
natio intestinalis, when the air is agitated in th? intestines 
with loud and often most singular sounds, frequently re- 
sembling the quacking and crying of animals, which, in 
former times, was considered as a kind of bewitchment or 
demoniacal possession ; and now the effects of a living an- 
imal. Sometimes the air is agitated by spasms (a wan- 
dering globus hystericus). 
Pathogenesis. The primary cause is atonic weakness; that 
is, debility combined with deficient elasticity of the stomach 
and intestinal canal ; with hypochondriacal and hysterical 
nervous disposition of these organs, in which case a mere 
nervous or mental affection may produce a violent genera- 
tion of gas. The occasional transitory causes are: flatu- 
lent food, cabbage, turnips, fermenting beverages (in a very 
high state of this disease, the least piece of vegetable cre- 
ates flatulency) ; nervous or mental affections, taking cold, 
when the usual cutaneous exhalation seems suddenly to be 
transmitted antagonistically to the internal surface of the 
intestines. 
The generation of flatus originates always in atony of 3 20 
FLATULENCY. 
the stomach, slow, weak digestion, and particularly in dif- 
ficult assimilation. The more promptly and vigorously the 
food experiences the influence of vitality, and performs its 
metamorphoses into the vital substance (assimilation), the 
more will all purely chemical dissolution, and consequently 
also development of gas be prevented. There are individ- 
uals who do not labor under flatulency, even after taking 
the most flatulent kind of food; and, on the other hand, 
persons of this disposition are plagued with it by the most 
innocuous aliments. 
Therapeutics. The treatment is double, palliative and 
radical. The palliative treatment has for its end the 
prompt removal of the present flatus. This is to be ef- 
fected by carminatives and antispasmodics ; as semen foen- 
iculi, anisi, carvi., herb, menth. piperit., olea a;therea and 
etherized acids, liquor anodyn. Hofmanni, liquor amraon. 
anisati, with valerian (vide 16f), castoreum, with opium 
(No. 165); frictions of the epigastric and abdominal regions, 
the application of warm cloths or stones, inunction of vol- 
atile antispasmodic ointment, 01. destil. chamomille, four 
drops, dissolved in half a drachm of aether sulphuricum ; 
injections of peppermint, caraway, and chamomile flowers. 
Very efficacious for such patients, is to take every morn- 
ing fasting, a cup of cumin-tea (one drachm of cumin, 
steeped in a cup of water) in the bed, and sixty drops of 
elixir aurant. composit. (Pharmacop. Boruss.) in the fore- 
noon and Afternoon. It is better than the use of cumin 
liquor, which is likely to lead to habits of intoxication. 
Vegetables, drinking during meals, and warm beverages 
and soups are to be avoided. 
The radical treatment required is that of strengthening 
the stomach and intestinal canal, and restoring their tone 
(vide weakness of the stomach). Cold dry regimen, cold 
roast meat, ice-cream, ice pills, a generous wine, like old 
Madeira or Malaga, cold lotions and douches to the epigas- 
trium and abdomen, also injections of cold water, much 
and strong exercise, and internally No. 166, 167. Hypo- 
chondriasis and hysteria must be cured. In a hysterical 
person, who had suffered a long time from ructations, 
which were accompanied with loud screaming sounds, the 
treatment of stomachical spasm by magisterium bismuthi 
finally proved efficient. 321 
TYMPANITES. 
TYMPANITES. 
Diagnosis. A great and frequently an enormous elastic 
swelling of the abdomen, sometimes so large as to excite 
a fear that tbe parietes may burst. On percussion this 
tumor sounds hollow, like a drum, and does not vary in 
different positions of the body; these symptoms and the 
absence of fluctuation distinguish it from dropsy. The dis- 
tention is generally unequal ; some parts being more, and 
some less elastic to the touch (tympanites when 
the air is accumulated within the intestines). Sometimes, 
however, the abdomen is equally elastic and distended 
(tympanites abdominalis, when the air is accumulated in the 
abdominal cavity). The patient has borborygmi and roll- 
ing in the intestines, hut has no discharges of ructus or 
flatus ; respiration is difficult, the abdomen is painful, and 
at last great anxiety, cold extremities, costiveness, and 
sometimes diarrhoea supervene. 
Tympanites intestinalis is always liable to inflammation ; 
therefore, when fever associates with it, the case becomes 
more important. Finally, a rupture may take place. 
Pathogenesis. The causes of tympanites intestinalis are: 
overloading of the stomach with flatulent, heavy, and con- 
stipative food ; such as peas, lentils, beans, or with very 
fermentable substances, as cabbage and milk, mixed with 
new beer; also an accumulation of gastric, glairy, and bi- 
lious matters, and such as are apt to pass into putrid fer- 
mentation ; taking cold, especially after eating the above- 
mentioned food; obstinate costiveness, spasm ; extreme 
atony, a kind of paralysis of the intestinal canal; inflam- 
mation and gangrene, wounds in the abdomen, typhus, par- 
ticularly organic, gastric, and intestinal disorders, such as 
indurations and ulcers. 
This disease may, therefore, break out suddenly and 
idiopathically, but, in general it is only a symptom of other 
disorders. 
A predisposition to it is owing to habitual flatulency. 
The causes of tympanites abdominalis are : escape of air 
from the intestines into the abdominal cavity (which may 
happen in great tympanitic distention of the intestines, and 
when they are pierced by ulcers and wounds) ; putrid dis- 
solution (it may be a symptom of putrid fever), taking cold 
after great overheating (which may bring on also emphy- 
sema). 
Therapeutics. In the first place we have to search for 
the cause, and to consider whether a spasmodic or an in- 322 
EMPHYSEMA. 
flammatory state exists. When the latter is the case, we 
must commence by the abstraction of blood. When this 
is absent, carminatives and antispasmodiss are most called 
for : pills of asa foetida and rhubarb, Colombo and oleum 
cajeputi, and oily emulsions, embrocations of oil of mint, 
of cajeput., and camphor oil with laudanum, dry cups, in- 
jections of chamomile, or cumin with asa foetida. The 
chemical fermentation must likewise be corrected : when 
the patient has eaten of fermentable vegetables, we may 
suppose the presence of acids, for which magnesia pura, 
lapides cancrorum, and aqua calcis with rhubarb are to be 
administered ; in putrid fermentation, acids, as elixir aci- 
dum Halleri, cold (which is known to prevent all kinds of 
fermentation and the development of gases), ice, internally 
and externally, dropping of naphtha on the abdomen ; and 
when the stomach is overloaded, emetics. 
If all these remedies fail, there still remain three means 
of relief, and by which life may be saved in extreme cases. 
The first is clysma inversion, that is, drawing the air off by 
means of a syringe. A flexible tube from 12 to 18 inches 
long, attached to a syringe, must be introduced into the 
rectum, and by drawing the piston up, the air may be 
pumped out. Should the tube become obstructed, it may 
be cleared by forcing a little warm water through it. The 
second is compression. A girdle is to be applied around 
the abdomen, as tight as the patient can bear it, and gra- 
dually tightened as the swelling diminishes. The third is 
puncture. A needle or a trocar is to be thrust into the part 
which is most distended, and the tube left in until all the 
air is expelled. 
Subsequently, roborants are always to be used. 
Infants are subject to a distention of the praecordium, 
which may be readily removed by merely rubbing the part, 
and still more effectually by unguent, althaeae, with chamo- 
mile and peppermint oil j also by the use of pulvis puero- 
rum and injections. 
EMPHYSEMA. 
Diagnosis. Air in the cellular tissue. A tense, elastic 
swelling, which yields a crepitous sound under pressure. 
It may arise from lesions, which permit the external air 
to enter the cellular tissue ; or from an internal decompo- 
sition and a development of gas, which is particularly the 
case in the general emphysema that accompanies nervous physomktra. profluvia. 
323 
and putrid fevers j even from taking cold after violent over- 
heating, as sometimes suddenly occurs, even in one night. 
The cure is effected by absorption and reception of the 
air into the humors of the body, whence it is discharged 
in the form of perspiration (gas developed by the skin). 
This end is attained by frictions, and the application of dry 
aromatic herbs ; in general emphysema, by the use of in- 
ternal diaphoretic remedies, and bathing with aromatic 
spirits repeated every two or three hours. 
Emphysema pulmonum (vide asthma aereum) deserves par- 
ticular attention. 
tympanites of the uterus. 
Physometra. 
It is known by distention of the uterus, and an occa- 
sional expulsion of air the vagina (vagina crepitans). 
The causes are hysteria or infarctus uteri; to which the 
treatment must conform. 
NINTH CLASS. 
PROFLUVIA. 
Generalities. 
Diagnosis. Increased evacuations of the serous, mucous, 
and other fluids, and which are altered in quality. 
Pathogenesis. The general causes are : an increased de- 
termination (congestion) of the humors to a secretive or- 
gan ; or an increased action and irritability of the organ, 
or a local irritation excited by organic stimuli (as tuber- 
cles in the lungs), by chemical and mechanical stimuli (as 
stones and gravel in the kidneys), by metastases, which 
likewise act as stimuli, by sympathetic influences, as the 
gastric ; or a local weakness and laxity of the part, which, 
by reason of diminished resistance permits of an accumu- 
lation of humors, or by reason of the relaxation of the lin- 
ing membranes of the vessels affords a ready passage of the 
fluids. 324 
HEMORRHAGES. 
Therapeutics. The cure requires fivst the removal of the 
causes; to diminish congestion, subdue increased action 
if it be the cause, discriminating, however, phlogistic from 
erethic irritability ; to remove idiopathic as well as con- 
sensual stimuli (which frequently requires great variation 
in the treatment); to - strengthen where weakness is the 
cause ; finally, and in imminent danger, to directly and lo- 
cally impede and ameliorate the evacuation (styptic, sup- 
pressing remedies). 
S, Hemorrhages, 
HJEMORRHAGIJE. 
Generalities. 
Diagnosis.Escape of blood from its channels outwardly, 
or inwardly into cavities, or into#the cellular tissue (extra- 
vasata, sugillationes). This happens from distentions or 
ruptures of the vessels. 
The immediate effect of haemorrhage is debility, since a 
portion of the vital humor, even of life itself is lost; there- 
fore the significance and danger is measured by the quan- 
tity of blood lost. If the Joss has been great and rapid 
(hemorrhage), it may prove instantly fatal. If it is less 
abundant, but continues to escape, it produces chronic de- 
bility, and may thus become the cause of all the asthenic 
diseases. But on the other hand it may serve as a natural 
venesection, prove salutary, and act as a wholesome crisis 
in plethoric and inflammatory diseases. Besides these ge- 
neral effects it may also produce an important local one, 
especially when it affects noble organs, as the lungs, sto- 
mach, and is the result of rupture. In such cases it must 
always be considered in the light of a wound, and may 
produce all the like consequences ; as those of inflamma- 
tion, extravasation, induration, suppuration. 
Pathogenesis. Proximate cause: disturbed balance of 
the impulse of the blood and the resistance of the vessels: 
sometimes the impulse overpowers the resistance of the 
vessels, even their cohesion ; or the latter is so impaired, 
as not to be able to resist the usual afflux of blood, and 
confine it in its channels. Therefore, two principal 
classes of hemorrhages, the active and the passive, are to 
be distinguished. 
The remote causes of the first class are: HEMORRHAGES. 
325 
1. The general, and this again has a double character. 
It is either a general increased action of the vascular system 
(phlogistic sanguineous excitement), a plethora, particu- 
larly when there is excitement produced by external and 
internal over-heating, by spirituous liquors, corporeal exer- 
cise, mental affections, suppression of habitual hemor- 
rhages, fevers, an inflammatory state ; or is an irritation of 
the nervous system (nervous, erethic, spasmodic excite- 
ment). 
2. Or local: local inflammation and a disposition to in- 
flammation, local increased sensibility (spasm), local irri- 
tation by metastasis or organic disorders (tubercles, poly- 
pus, etc.), consensual and antagonistic irritation (gastric 
acrimony, worms, dentition). 
The remote causes of passive hemorrhage are: 
General: general weakness, asthenic fevers, putrid fevers, 
scorbutis, hectic colliquation. 
Or local: local weakness and relaxation caused by dis- 
ease, over-irritation, pressure, moist warmth. 
In hemorrhages owing to local weakness, it is not un- 
common to meet with the curious case of a mixed state, 
that is, a general increased activity of the whole system, 
combined with local weakness of a single organ, as in he- 
morrhage of the lungs and uterus. 
Finally, the too limpid, dissolved, uncoagulable quality of 
the blood* itself may give rise to hemorrhages, as in scurvy, 
in morbus hemorrhagicus; and the congenital disposition 
to bleeding (bleeding families). 
Therapeutics. The principal general indications of every 
hemorrhage are: 
First, to examine to what species it belongs ; whether to 
the active or to the passive, and here again whether to the 
phlogistic, which calls for purely antiphlogistic treatment ; 
or to the nervous, spasmodic (erethic) species, which re- 
quires antispasmodic assuaging remedies. 
Secondly, to remove the occasional cause, as a gastric 
matter, or a local irritation. 
Finally, if all this do not suffice, or real danger of life 
sets in from the beginning, we must endeavor to suppress 
the hemorrhage by styptics, astringents, applied internally 
and externally, also by mechanical pressure, where this is 
practicable. The signs of inanition and danger of life, 
* Modern anatomy will not admit vasa exhalantia in the internal 
surfaces ; but it must allow the existence of pores and the possibility 
of fluids perspiring through them ; which conies to the same thing in 
the pathogeny of hemorrhages and other profluvia. 326 
EPISTAXIS. 
which immediately require the use of active suppressive 
means, are: small, filiform or unequal and remittent pulse, 
cold extremities, buzzing at the ears, sparkling before the 
eyes, fits of fainting. 
A combination of a generally increased action with local 
weakness of the bleeding organ claims our greatest atten- 
tion, since such a case requires at the same time general 
debilitating means, and the local application of roborants. 
Such a mixed slate occurs in all hemorrhages due to a vio- 
lent mechanical concussion, which impairs the local struc- 
ture, and at the same time produces a general revolt of the 
vascular system, and from the union of both these causes 
an increased local plenitude (overfilling of blood). In such 
a case a venesection must be made, and immediately after- 
wards cold, arnica and other strengthening remedies re- 
sorted to. 
EPISTAXIS. 
Hcemorrhagia Narium. 
Bleeding at the nose is one of the most common hemor- 
rhages. It occurs during good health as well as in bad, 
and is most generally salutary and critical, acting as a de- 
rivative of plethora and congestion in the head ; but if the 
loss be very great, it may become dangerous, even fatal. 
In most cases it is owing to a plenitude of blood ; there- 
fore, it is must frequently met with in youth ; it may, how- 
ever, arise also from a sanguineous dissolution (scorbulis, 
morbushsemorrhagicus maculosus), heemorrhoidal and men- 
strual anomalies, even from abdominal irritations (worms). 
As a rule, we ought never to suppress bleeding at 
the nose by local means, until its injurious effects become 
evident. There are not wanting instances of the bad conse- 
quences of a sudden suppression of epistaxis, as blindness, 
deafness, and cerebral inflammation. Suppression, then, 
is to be resorted to only when the loss of blood has become 
enormous; when there is palor of the face, vertigo, small 
intermittent pulse, and fits of fainting set in ; or when the 
bleeding is evidently a consequence of weakness, and of a 
putrid dissolution of the blood. The remedies are : cold 
water applied to the forehead, drawn into the nose, vinegar, 
solution of alum, injections of sulphate of iron, foot and 
hand-baths, pledgets of lint moistened with alum, plug- 
ging the nose. Chewing of a piece of blotting paper HEMOPTYSIS. 
327 
sometimes affords the promptest relief; also cold lotions 
on the genitals. Cooling purgatives, especially cream of 
tartar dissolved in a large quantity of cold water, elixir 
acid. Halleri ; in a spasmodic state, ipecacuanha in small 
doses, even opium with acids, are the internal remedies to 
be used. 
The radical cure of the ever-and-anon returning epis- 
taxis requires a due consideration and treatment of the 
causes, especially of plethora, of abdominal stimuli, of 
scorbutis, weakness, and of a putrid diathesis in the vascu- 
lar system. In the last case, cinchona and acidum sul- 
phuricum are most serviceable. 
HEMOPTYSIS. 
Sputum Crumtum, Hcemorrhagia Pulmonum. 
Diagnosis. Expectoration of blood which is brought up 
by coughing or hawking, the only sign by which we can 
know whether the blood comes from the lungs and the up- 
per part of the trachea. A mere spitting of blood (,sputum 
crumtum), which exsudes into the mouth, or only comes 
from the nose, is to be discriminated, and we must be care- 
ful not to be deluded in this respect'. Hseraoptysis varies 
very much in intensity and importance. 
The mildest kind is that which has not been preceded or 
accompanied by difficulties in the chest (dyspnoea or 
pains), does not return, and leaves no cough or other pec- 
toral complaints behind. 
A severer kind is : that one which is preceded by the 
patient’s previous difficulties in the chest, dry cough, and 
shortly before its occurrence, shivering and excited pulse j 
and which is accompanied by anxiety and irritative cough, 
very excited pulse, palor and altered countenance; and 
which returns after a few hours cessation, followed by dys- 
pnoea and dry cough. 
The highest degree occurs in patients who previously 
had suspected lungs, are of a phthisical disposition ; and 
who, during the attack, suffer great anxiety and oppression, 
are in a febrile state, expectorate pure blood, which repeat- 
edly returns, and is followed by considerable pectoral com- 
plaints. 
The quantity of blood expectorated is of no importance ; 
all depends upon its causes and the constitution of the pa- 
tient. It may be thrown up by cupfuls without detriment, 328 
if it is owing to a hajmorrhoidal flux through the lungs, and 
the patient enjoys a sound chest, and does not labor under 
a phthisical disposition ; whereas in the latter case, even a 
small expectoration of blood is very dangerous, and may 
he the transition into phthisis. 
We must not suffer a continuance of the bleeding to 
alarm us ; but look to the color of the blood, which, if 
dark, does not indicate a continual bleeding, but that the 
blood now expectorated has been already some time 
effused. 
HAEMOPTYSIS. 
The danger is not at the moment of bleeding, but in the 
consequences, pneumonia and phthisis. We rarely meet 
with heemoptysis which is a real hemorrhage, and capable 
of causing death by suffocation. 
Pathogenesis. A knowledge of the predisposing cause is 
here of the greatest moment; for ft is by this knowledge 
that danger is knqwn. It is the dispositio phthisic a (vide 
pulmonary consumption) ; or a real phthisis does already 
exist, with which heemoptysis associates as a symptom. 
The exciting causes are: violent over-heating of the 
body by dancing or running, ardent drinks, violent mental 
affections, great external heat, immoderate exertion of the 
lungs by screaming, blowing musical instruments, strong 
concussions affecting the chest, as blows to the back, falls, 
wounds of the lungs, inhalation of corrupt air, acrid va- 
pors, suppressed piles, menstrua, and other habitual dis- 
charges of blood ; suppressed cutaneous eruptions ; pneu- 
mony, catarrh, tubercles of the lungs, scorbutic dissolution 
of the blood. 
Therapeutics, Absolute rest of mind and body, lying- 
still, abstaining from speaking (the least motion and irrita- 
tion of the lungs is injurious), removal of the pressure of 
dress, sitting upright, cool air and cool beverage, a clyster 
when there is constipation of the bowels, and a venesec- 
tion in the arm, scanty or copious, according to circum- 
stances (if extreme weakness or putrid diathesis do not 
forbid it). These are the first and general remedies. The 
promptest styptic in haimoptysis, is a teaspoonful of pul- 
verized culinary salt, taken dry into the mouth, and swal- 
lowing it gradually by drinking a little water over it, 
repeated every quarter of an hour, as circumstances may 
require. 
The different characters of htemoptysis are to be investi- 
gated. 
1. The inflammatory, plethoric, sanguineous. Signs: 
constitution, youth, fulness of the pulse, warmth, thirst, HAEMOPTYSIS. 
329 
suppressed hemorrhages, vascular exciting causes, mechan- 
ical lesions. Here a copious venesection is to be made, 
and repeated according to circumstances, as when bleeding 
returns ; the most strict antiphlogistic diet is to be ob- 
served, and nitre, with cream of tartar, hyoscyamus, and 
digitalis (vide No. 145) to be given as internal medicine. 
Nitre with cream of tartar in powder, mixed in a mucila- 
ginous vehicle, is most efficacious. P'oot-baths, hanging 
the feet down, cool lotions to the chest, injections, and in 
suppressed hemorrhages, leeches to the spot of suppression 
may all be applied. 
2. The spasmodic. Signs: absence of the signs mentioned 
in the preceding section, a perceptibly weak constitution, 
cold extremities, small pulse. In such a case, ipecacuanha 
in small doses (vide No. 14b), and tartaric acid with hyos- 
cyamus (No. 147), must be given. If this is of no use, and 
the state of the patient is purely nervous, acids with opium 
(No. 148) are advised. Sometimes, however, a sanguine- 
ous congestion is combined with the spasmodic state; then 
give nitre with hyoscyamus, and intermediately elix. acid. 
Halleri, with mucilaginous emulsions, also digitalis with 
acid, muriaticum oxygenatum (No. 149). In a spasmodic 
state of the chest, spasmodic cough, pains and the like, oily 
and mucilaginous remedies (No. 150), are of excellent ser- 
vice, combined with narcotic fomentations on the chest, 
and sinapisms on the arms. 
3. The gastric. Gastric, and particularly bilious turges- 
cences are evidently associated with haemoptysis. Here 
cooling purgatives, Glauber’s salt with tamarinds, and in- 
jections must be prescribed ; even small doses of ipecacu- 
anha, and when the patient already throw's up bile, its 
discharge is to be promoted by small doses of ipecacuanha. 
But if haemoptysis in these three stated cases does not 
abate, but persists in spite of a treatment directed against 
the causes, or is excessively copious, it must then be im- 
mediately stopped by styptic remedies, such as have been 
mentioned under No. 148. 
4. The passive, occurs in great laxity of the lungs 
(phthisis pituitosa), scorbutic dissolution of the blood, 
erosion of the vessels by matter, commotion. None of the 
signs of vascular excitement, and of a spasmodic state are 
seen here. It therefore requires only immediate stoppage 
by styptics. However, if the pulse admits of it, it will be 
well to commence by a moderate venesection in the arm. 
The remedies are: cold above all others, cold air, cold 
water, cold applications, ice on the chest, alum, particu- 330 
HAEMOPTYSIS. 
larly alum-whey (No. 135), which, according to my expe- 
rience, is the most effectual of all ; cinchona, ferrum sul- 
phuricum, terra catechu, also culinary salt, one teaspoon- 
ful at a time. 
Subsequent treatment. After every haemoptysis, besides 
the possibility of a recurrence of hemorrhage, we have 
two things to dread : inflammation of the injured spot, and 
extravasation into the substance of the lungs ; the conse- 
quence of either may be suppuration or a formation of 
tubercles ; therefore it ends either in phthisis purulenta or 
tuberculosa. The most strict antiphlogistic diet is to be 
the mode of living, the lungs must be left in repose, and if 
oppression or pain remains in the chest, a moderate venesec- 
tion on the arm, or leeches are to he applied ; after this, a 
vesicatory on the spot, kept open for some time ; nitre and 
cooling purgatives. The best means for cleansing the 
lungs is sweet whey, or whey acidulated with tartaric acid, 
solutions of mellago graminis, with tartrac potassse, after- 
wards Sellers water. If, after a lapse of three weeks, the 
patient has ceased to cough, and feels nothing more in the 
chest, he is surely safe from phthisis. We must also at- 
tend to the remote causes and their cure ; as hemorrhoids, 
abdominal diseases, dyscrasias. Be particularly careful to 
prevent relapses. For that purpose the patient must avoid 
all corporeal exercise, spirits, singing, and any exertion of 
the lungs ; constipation of the bowels guarded against, and 
a venesection applied, if the slightest difficulty is felt in the 
chest. 
The spitting of blood, sputum cruzntum, hoimorrhagia oris 
et faucium, when the blood is evacuated without hawking 
or coughing, and is also generally mixed with saliva or 
mucus, is a very common occurrence and free from danger. 
In this case, the blood comes either from the mouth, the 
teeth, the gums, or the nose. Its causes are sometimes 
local; but it may also have remote and general ones ; two 
of which deserve particular attention : anomalous piles 
(for the two terminations of the intestinal canal are in. 
antagonistic relation, hsemorrhoides faucium may stand in 
lieu of hsemorrhoides ani), and scorbutic dyscrasia. 
The spitting of blood generally takes place only early in 
the morning. The treatment consists in local application 
of astringent collutories, of sage, vinegar, mineral acids, 
alum ; and in the treatment of piles or scurvy. HjEMATEMESIS. 
331 
VOMITING OF BLOOD. 
Haemat emesis. Vomitus Cruentus. 
Diagnosis. Evacuation of blood by vomiting, which 
comes up pure, or is mixed with food, bile, etc. Its color 
may be light red, but is most frequently dark, blackish, and 
of a venous nature. The quantity is sometimes small ; at 
others it is great, several pounds at a time. The vomiting 
may be repeated twice or three times a day, and continue 
so for several days ; sometimes it is repeated only after 
the lapse of several days, sometimes it happens periodically. 
It is followed by discharges of black, coagulated blood by 
stool. The diagnosis is sometimes doubtful. 
Concomitant symptoms are: violent anxiety, nausea, 
tumefaction of the precordia, sometimes, but not always 
pains in that region ; sometimes fever, great prostration, 
chilly sweats, fits of fainting, pale collapsed face, head 
generally free until the weakness seizes the sensorium. 
Then appear deliria blanda, spasms j the pulse becomes 
smaller and smaller, and intermittent, frequent fits of faint- 
ing, death. 
It is always a dangerous accident; when it sets in with 
violent fever, it is most frequently fatal; likewise when the 
vomiting of blood returns every three or four hours. The 
same is true when it is owing to incurable causes, scirrhus, 
etc. It is less dangerous when it appears periodically, least 
so when it is the consequence of htemorrhoidal or menstrual 
anomalies. I have seen a man advanced in years, who 
threw up blood from that cause, by cupfuls, and was so 
little affected by it, that he was able to take food immedi- 
ately after its discharge. 
The danger to be apprehended is subsequent inflamma- 
tion of the. stomach or inanition. 
Pathogenesis. The proximate cause, as in all hemorrhages, 
is a dilatation or a bursting of the vessels of the stomach. 
The blood may come from the stomach or from the spleen 
by the vasa brevia. The remote causes : the most frequent 
is an anomalous hoernorrhoidal or menstrual congestion to 
the stomach ; hence it often occurs in females after the 
cessation of the menses; after this comes obstructions of 
the abdominal viscera, effusions of acrid bile, swallowed 
glass, insects, worms, particularly leeches, contusions, and 
other lesions of the stomach, acrid poisons, among which 
are violent emetics and purgatives, putrid dissolution of 
the blood. 332 
PILES. 
Therapeutics. The principal rule is not to suppress the 
bleeding suddenly by strong astringents, since to do so 
may produce inflammation of the stomach, subsequent 
induration of it, or, by the accumulated blood, a gastric 
putrid fever. Therefore the first and general means to 
be tried are mucilaginous beverages of gummi Arabic., 
acidulated with tartaric acid, or tamarinds, the Riverian 
saturation and oily emulsions ; intermediately fomentations 
of vinegar on the epigastric region, emollient clysters, foot 
baths, mustard plasters on the calves of the legs, warm, 
emollient narcotic cataplasms on the abdomen. When 
plethora, or fever, or signs of an inflammatory state exist, 
a venesection in the foot; leeches to the anus or vagina in 
suppressed hsernorrhoidal or menstrual flux. In the absence 
of these signs, or in a spasmodic state, extract of hyoscya- 
mus, ipecacuanha, one eighth of a grain every quarter of 
an hour; in violent spasms, opium and musk must be ad- 
ministered. 
If the vomiting of blood does not abate after these means, 
or if it set in with violence from the beginning, and signs 
of inanition (small, intermittent pulse, fits of fainting, etc.), 
alum whey is the best remedy; intermediately, River’s 
potion with laudanum and ice-cold water may be taken, 
and cold fomentations of vinegar applied to the stomach. 
After every fit of vomiting of blood, two indispensable 
rules must be complied with. The first is to continue for 
several days the use of mild acid laxatives ; the best tama- 
rind whey, or a decoction of tamarinds, made with cream 
of tartar; also injections, in order to evacuate the blood 
which may have passed into the intestines ; the second is, 
to avoid taking solid food for several days, since even a 
crumb of bread may irritate and renew the lesion of the 
stomach. 
PILES. 
Hcemorrhoides. 
We are to discriminate between hsemorrhoidal disease 
and. piles, as between arthritic disease and local external 
gout, or scrofula and scrofulosis : they relate to each other 
as cause and effect. The hsernorrhoidal disease is the in- 
ternal morbid state, which lies at the bottom of the piles; 
the piles are only its local external phenomena. 
The hemorrhoidal disease exhibits four principal forms: HAEMORRHOIDS. 
333 
1, predisposition {molimina hemorrhoid alia) ; 2, formed 
haemorrhoids, a disease of the rectum (hemorrhoides ani 
ccecce et fluentes) ;3, retrocession of the haemorrhoids (he- 
morrhoides retrogresses); 4, their degeneration {hemorrhoides 
anomale), which may again vary in reference to the loca- 
tion {henorrhoides incongrue), or the quality (hemorrhoides 
mucosag). 
It is rarely a merely local disease, but in most cases is 
an internal morbid state, of which the piles are the crisis. 
This ensues either at regular periods (similar to the men- 
strual flux), or at indefinite times. It is, however, always 
an imperfect crisis, which does not entirely remove the 
original disease, but may give great relief as an effect. 
This is one of the most chronic maladies, and often accom- 
panies man through all his life. It is curable only when it 
is not congenital, when it is recent, and when the remote 
causes, embracing generally the whole mode of living, may 
be corrected. It is not fatal in itself, but may turn so by 
retrocession of the congestion to noble organs, and by 
hemorrhage. Frequently, as a sanguineous evacuation, it 
is most beneficial and critical, in acute as well as in chro- 
nic diseases. 
This malady is very common, and is of great importance, 
not on its own account, but because the haernorrhoidal dis- 
position originates many diseases, and must be understood 
before they can be cured. 
Hemorrhoidal Disposition. 
Molimina He mo rrh oidali a, Dispositio Hemorrhoidulis. 
Diagnosis. Frequent pains in the back and the sacrum, 
sometimes flying stitches through the abdomen, feeling of 
fulness there and at the end of the rectum, costiveness, 
hard, knotty stools, sensation of pressing or burning and 
boring in .the rectum, tickling in the rectum, perineeum and 
genitals, local sweats in these parts, urgency to urinate, 
strangury, dysury, ischury, occasional swelling, varices on 
the end of the rectum. These signs are frequently con- 
nected with congestions of blood to other parts, as to the 
head, lungs, stomach, and flushes of heat. Hereditary pre- 
disposition, a sedentary life, immoderate enjoyment of 
heating food and drinks, may lead to a suspicion of hiem- 
orrhoidal disposition. 
The recognizance of this period is important, since this 334 
HEMORRHOIDS. 
is the stage id which a radical cere of the disease can be 
effected, and its consequences prevented. 
Pathogenesis. The proximate cause is plethora abdomi- 
nalis, plenitude of blood in the portal system, venous con- 
gestion. 
The remote causes are the same as in every congestion. 
1. Local debilitation of the abdominal viscera, especially 
of the hsemorrhoidal vessels, caused by frequent purging, 
abuse of warm drinks, especially of tea and coffee ; im- 
moderate venery; the cause may even be local, as the too 
frequent use of injections, too much warmth locally applied 
on these parts. 
2. Local irritation of the haemorrhoidal vessels: caused 
by the too frequent enjoyment of heating meals and bever- 
ages, of spices, wine, particularly Burgundy and Cham- 
pagne 5 b}' aloetic and other drastic purgatives, but also by 
morbid irritations, as raetastases of arthritic, syphilitic and 
Other morbific matters to these organs, hence it is that 
attacks of gout and piles frequently alternate. 
3. Mechanical pressure, by which the free circulation of 
blood in the abdomen is impeded, such as tight lacing of the 
abdomen, a continued sitting posture, which compresses the 
abdomen (hence haemorrhoids are a disease of the studious, 
of sedentary workmen, especially shoemakers), constipa- 
tion bowels and accumulation of faeces and infarcts, 
physconias and obstructions of the abdominal viscera, 
especially of the liver, which is the centre of the portal 
circulation, the gravid uterus ; hence piles are common in 
the last months of pregnancy. 
Finally, a hereditary predisposition may be the cause, and 
congenital local weakness of the haemorrhoidal system. 
The most healthy can contract haemorrhoids, when they 
lead a sedentary life for a year, take much coffee or high 
seasoned food, and stimulant beverages. 
The effects of this abdominal plethora (by which all 
haemorrhoidal complaints, and the importance of its patho- 
genetic influence may be explained) are the following : 
3. Local : swellings, various tumefactions of the hsemor- 
rhoidal vessels, inflammation, and hemorrhage from them ; 
costiveness, disturbed digestion, anorexia, apepsia, acidity 
of the stomach, spasms of the stomach, colic, diarrhoea, 
blennorrhoea of the rectum, vesical diseases of all kinds, 
disordered secretion of bile. 
2. General : partly by nervous consensus, partly by 
transmission of the congestion to other parts, hypochon- 
driasis, spasms, fits of fainting, vertigo, paralysis, apoplexy, HAEMORRHOIDS. 
335 
diseases of the heart, asthma, hasmoptysis, phthisis, partic- 
ularly laryngea, hsemorrhagia uteri, narium, fluor albus, vo- 
mitus cruentus, mictus cruentus, cutaneous diseases of dif- 
ferent forms, particularly herpes, first on the genital organs 
and the small of the back, and also on remote parts ; some- 
times transitory, but also sometimes permanent, even 
chronic ulcers. A peculiar acrimony (acrirnonia hcemor- 
rhoidalis) seems sometimes to be developed from the stag- 
nant hsemorrhoidal blood. 
In all these chronic disorders the physician must care- 
fully regard a hsemorrhoidal slate as the source of the 
disease ; for their radical cure often depends altogether on 
freeing the abdominal circulation. 
Therapeutics. The cure of this disease can be attempted 
in a double manner. 
1. By radical treatment (curatio causalis, treatment of 
the predisposition), when the cause of the hsemorrhoidal 
disease is operated upon, and the hsemorrhoidal symptoms 
and the necessity of flowing piles are dispensed with by its 
removal. 
2. By producing the hsemorrhoidal flux, which removes 
local plethora and also its effects for some time, but this is 
only a palliative cure; for it places the patient under the 
necessity of the hsemorrhoidal flux, which at the best is 
troublesome and tedious, and may be followed by bad, even 
by dangerous consequences. 
It must therefore be adhered to as a rule, to use the 
first mode of treatment, and to reserve the second for such 
cases only as do not admit of a radical cure (in insur- 
mountable obstructions of the circulation of blood in the 
abdomen, or other irremovable causes, also in hereditary 
disposition), or for those in which hsemorrhoidal fluxes 
have become a habit, or finally, when sudden and danger- 
ous accidents arise by hsemorrhoidal accumulation, which 
call for speedy relief. It is only in these cases that the 
palliative treatment is admissible. 
Cure of the Hemorrhoidal Disposition. 
Radical Cure. 
Continued corporeal exercise, avoiding to remain sitting, 
abstaining from heating food and beverages, and keeping 
the bowels free, are in general the most sure means to re- 
move the hsemorrhoidal predisposition. As certainly as it 336 
HEMORRHOIDS. 
can he produced by a course opposite to the one just re- 
commended, so certainly will this mode of treatment over- 
come it. I have often had occasion to observe that travel- 
ling, or an active country life continued for six months, 
combined with the diet enjoined above, has perfectly at- 
tained the end. 
The principal indication is to remove the abdominal 
plethora, which is the proximate and original cause of the 
hsemorrhoidal disease. This is done, 1. By the removal of 
all the circumstances which can favor it, namely: heating 
meals and beverages, sedentary life, compression of the ab- 
domen, excesses in venery ; and by taking daily a great deal 
of exercise, frictions on the abdomen. No hsemorrhoidal 
patient ought to work in a sitting position, but on the con- 
trary, only in a standing one, or resting on a high chair. 
2. By promoting the abdominal circulation, and removing 
the obstructions and accumulations that have formed in 
the intestines. 3. By keeping the bowels moderately open. 
The two last indications are best complied with by mild 
resolvents, extract, graminis, taraxaci, tartras potassse 
(vide No. 168), and sulphur. The latter is the true speci- 
ficum antihsernorrhoidale. It is undoubtedly possessed of 
a particular power over the haemorrhoidal vessels, to in- 
crease their action and to dissolve the stagnations in them; 
therefore it is also the most efficacious remedy against all 
the complaints which arise from that source, as phthisis, 
hydrops hsemorrhoidalis. It is best administered in pow- 
der along with cremor tart, (vide No. 169), or in nervous 
individuals with pulv, aerophorus (vide No. 170). The so- 
lution of the above-mentioned extracts, continued for seve- 
ral weeks, is often sufficient; or sulphur, continued for 
some days and repeated as occasion may require. The use 
of aloetic remedies, so much recommended by some prac- 
titioners, is to be avoided in such cases, because they in- 
crease the abdominal plethora, the original evil, and are 
apt to cause inflammatory affections in the abdomen, or 
local haemorrhoids, which are the very thing to be prevent- 
ed. Castor oil is an excellent laxative in this disease. 
4. Finally, when the remote causes are deeper seated, as 
in great and fixed visceral obstructions, vigorous resol- 
vents are to be used; above all the natural Carlsbad spring, 
and when this cannot be had, the artificial one, which is 
likewise an antihaemorrhoidal specific confirmed by expe- 
rience. Against the metastatic causes of this disease we 
must have recourse to their respective remedies; as mer- 
curials for the syphilitic. 5. In merely local haemorrhoids HAEMORRHOIDS'. 
337 
due to local debility of the rectum and the baemorrhoidal 
vessels, injections of cold water, which may be combined 
with sulphur, are the principal remedy when the accumu- 
lations are considerable. 
I must not omit to strongly recommend the use of a tea, 
made with the summitates millefolii, one cup morning' 
and evening continued for years, in hsemorrhoidal disposi- 
tion and chronic hsemorrhoidal complaints. 
Merely local treatment consists in the application of cold 
water to the hsemorrhoidal knots and disorders of the 
rectum, even in cutting them off. It is not to be denied, 
that this local treatment will promptly remove the affec- 
tion, but this method is at once irrational and dangerous. 
It is irrational, because it is only a symptomatic mode of 
curing, a removal of symptoms without vanquishing the 
cause ; and is about the same thing as attempting to cure 
scrofula by cutting and suppressing the scrofulous tumors. 
But it is also extremely dangerous; for nothing is more 
certain than that, should the abdominal plethora continue, 
the suppressed sanguineous congestion, being deprived of 
an excretory organ, will take other directions, retroceding 
to the bladder, the stomach, or other noble viscera, and 
will produce dangerous diseases of them. This mode of 
treatment is admissible only when it is evident that the 
disease is purely local (owing to local weakness of the 
rectum), and when no molimina hsemorrhoidalia, no indi- 
cations of visceral obstructions, no hereditary predisposi- 
tion are present. Farther, it is dangerous, and must be 
avoided, where flowing piles or retrocession of hsemor- 
rhoids to noble viscera has previously existed. 
Promotion of the Hemorrhoidal Flux. 
This is not a radical but only a palliative method of cure, 
and ought not to be resorted to except in the above-describ- 
ed cases. 
Its promotion is effected in a double manner; either by 
attracting the sanguineous congestion to the rectum by 
external means {attrahentia), or by exciting such a conges- 
tion from within, bv means which have a specific tendency 
to the rectum (pellentia). 
JLttrahemia are: footbaths, steanabaths, warm fomenta- 
tions ad anum, emollient mildly stimulant injections, 
leeches ad anum, cups in the region. 
Pellentia are of a double kind : the mild, as pulvis aero- 
phorus, borax; the ardent, as aloes, myrrh, crocus, hellebore, 338 
HAEMORRHOIDS. 
iron, the balsamic pills (vide No. 171), Burgundy and Cham- 
pagne wine. (For the use of these remedies look under 
menstruation.) 
In all plethoric individuals predisposed to sanguineous 
congestion, we must employ the drawing and the milder 
exciting remedies; and when the warm excitants are ad- 
missible, they must be assisted by the external ones, that 
they may not excite sanguineous congestions in remote 
noble viscera instead of in the rectum. 
Blind Piles. 
Hcemorrhoides Greece. 
Tumefactions of the vessels or effusions of blood into 
the cellular tissue of the rectum, sometimes without, 
sometimes within the orifice of the anus {haemorrhoides ex- 
ternrz et internee), sometimes small, sometimes large, some- 
times prominent, sack-like (h. saccatce), sometimes without 
pain, sometimes painful (A. dolentes), even insupportably 
painful (A. fvrentes) ; finally they may also become indu- 
rated (A. scirrhosce). 
The treatment of the blind haemorrhoids is in general 
that of the hsemorrhoidal disease (which see) : cooling diet, 
exercise, cooling purgatives, especially the sulphur pow- 
der. External cold must only be applied when local debi- 
lity is the cause, without any signs of visceral obstructions 
or abdominal plethora. 
The painful piles call for the same treatment; but at the 
same time rest, horizontal position, especially on a bolster, 
by which the pressure of the sanguineous accumulation is 
redressed. In very violent pain, when an inflammatory 
state is present, venesection, leeches on the varices, anti- 
phlogistics, externally fomentations of cold water; in great 
sensibility the unguentum de Linaria, so well renowned, 
from ancient times, and the same combined with oleum 
hyoscyarni ; a methodic pressure by a compress continued 
for half an hour ; in an extreme case fomentations with 
saturnine water, or unguentum de Linaria, oleum hyosc. 
of each ounce, sugar of lead dram, but not long con- 
tinued, are the remedies. Some individuals derive great 
benefit, from apple pulp steeped in red wine. The knots, 
particularly if they were internal and have been protruded, 
are sometimes really incarcerated by the sphincter; in 
such a case replacement is necessary. We must, however, HAEMORRHOIDS. 
339 
attend, and act according to the accessory causes which 
excite the painful state. They are hard feeces, gastric im- 
purities, taking cold, moist air, even sometimes they are 
specific, as syphilitis. Finally, the whole attack is some- 
times of a spasmodic nature. 
Hcemorrhoides Saccatce 
Here, besides the general treatment, the local applica- 
tion of cold water is required. 
The sacks grow often to a considerable size, and thus 
become very troublesome, may produce even chronic 
bleeding (daily emptying a little from the relaxed vessels), 
which weakens extremely and may cause cachexy. In 
such a case the only and sure remedy is cutting them off. 
The scirrhous haemorrhoids are often nothing but sacks, 
containing coagulated blood ; also here a surgical operation 
(opening or excision) must be resorted to. They may, 
however, pass into real indurations or suppurations, and 
originate fistulee of the rectum. Here surgical treatment 
is needed. 
Sudor, Serpigo, Rhagades Jlni, Perincei, Geniialium 
In these troublesome symptoms, besides the general 
treatment, sulphur with cream of tartar, external cleanliness 
and frequent washing with tepid (not with cold) water are 
serviceable. External astringents, saturnine and such re- 
medies are carefully to be avoided. 
Hcemorrhoides Fluentes. 
The haemorrhoidal flux is always to be considered as a 
crisis, which must not be disturbed. All that will be said 
of the menstrual flux, applies also to this. It is only when 
the discharge becomes profuse and injurious, that it is to 
be regarded as a hemorrhage, and requires to be stopped. 
It may burst out all at once in so great a quantity, as to 
prostrate the patient and endanger life; or (what is more 
common), it may put on a chronic character, discharging a 
small quantity daily, imperceptibly leading to chronic dis- 
eases, to nervous affections, cachexy, dropsy. In either 
case astringent suppressing remedies, applied internally 
and externally, are requisite (vide menstrua nimia, hcemor- 
rhagia uteri). 340 
HAEMORRHOIDS. 
Suppression of Piles. 
The haemorrhoids may suddenly slop flowing-, and give 
rise to violent inflammatory attacks, colica inflammatoria, 
etc., which require a prompt antiphlogistic treatment, 
leeches ad anum, venesection, etc.; or they may gradually 
cease to discharge. In either of these cases the treatment 
is the same as in suppressio menstruorum. 
Vesical Haemorrhoids, Mucous Haemorrhoids. 
There are anomalous haemorrhoids of two kinds ; first, as 
regards location ; second, as regards quality. 
1. Location. Hsemorrhoidal congestion may tend to 
every part of the organism, and produce in it the same ef- 
fects as in the intestinum rectum, tumefactions of the ves- 
sels, disturbed function, pains, inflammations, extravasa- 
tions, hemorrhages. Thus arise hcemorrhoides ventriculi 
(vomitus cruentus), hcemorrhoides pulmonum (haemoptysis) 
etc. These anomalies are the effects of a hsemorrhoidal 
disposition, which has not yet settled upon the rectum; or 
are the effects of a suppression of piles. The diagnosis is 
easy in the latter, difficult in the first case. The cure con- 
sists in a derivation of the piles to their legitimate place, 
the rectum, which is effected by repeated application of 
leeches and other allrahents. 
The most troublesome and painful anomalous piles are 
hcemorrhoides vesica. They can be also either ccecce or 
fiuentes. In the first case they create great difficulty to 
make water, strangury, ischury, even most violent pains, 
vesical spasms, inflammations and their consequences, 
blennorrhoea, induration, suppuration of the bladder. In 
the latter case hcematuria occurs; the blood coagulates in 
the bladder, obstructs the meatus, and prevents the dis- 
charge of the urine, and finally may lead to the generation 
of stone. The bladder is here in the same state as the 
rectum is in piles. The treatment consists in drawing the 
congestion towards the rectum, by the application of 
leeches to the anus and other attrahentia ; and in repelling 
the congestion from the bladder by cold lotions to these 
parts, in combination with the general hsemorrhoidal treat- 
ment. Four leeches are applied to the rectum every 4 
weeks, or as often as local molimina (burning, swellings) 
appear at the rectum. The use of iSelters, still better Wil- 
Hcemorrhoides Anomalce. MELjENA. 
341 
dunger waters, and the spring of Carlsbad are very recom- 
mendable.—ln blind vesical hsemorrhoids the diagnosis is 
often very difficult, they are apt to be mistaken for stone, 
Vesical gout, syphilitic affections (especially when vesical 
catarrh is present). The chief signs are the previous or 
coexisting hsemorrhoidal complaints and their periodical 
return. 
The most dangerous symptom that can set in here is 
ischury, owing to occult varicose swellings in the bladder; 
or, in fluent vesical piles, to coagula which remain in the 
bladder. In either case the catheter must be resorted to, 
but only after the inflammation has subsided. If the intro- 
duction of the catheter is difficult, bougies must be previous- 
ly passed, in order to compress the swoln vessels, or to 
force through the coagulum. 
In all cases of retroceded and anomalous haemorrhoids 
the application of leeches to the rectum has been observed 
to be more useful than general venesection. Nature re- 
quires the evacuation to take place on the critical part, 
and the loss of a few ounces of blood from the rectum pro- 
cures more relief, than pounds of blood discharged from 
the large vessels, because the former discharge acts di- 
rectly on the portal system, the latter does not. 
2. Anomaly of quality. Hcemorrhoides mucosa?. The hse- 
morrhoidal flux may be mucous as well as sanguineous, and 
this anomaly can happen by the rectum as well as by the 
bladder and vagina. Tenesmus and other hsemorrhoidal 
difficulties coexist, follow, or have preceded the piles. It 
is a jluor albus intestini recti, and like this produces ca- 
chexy. The cause may be hsemorrhoids, which are prevent- 
ed from flowing, or a local weakness, or metastasis, or ge- 
neral cachexy. The cure consists either in restoring the 
hsemorrhoidal flux, or in the general hsemorrhoidal treat- 
ment, or in the use of bitter resolvents and roborants, espe- 
cially an infusion of millefoil, and Pyrmont and other cha- 
lybeate waters. At the same time regard must be had to 
such specific causes, as may perhaps exist, especially sy- 
philis (vide blennorrhcea). 
BIELJENA. 
Morbus Niger. 
Diagnosis. Evacuation of a black tarlike, sometimes of 
a brown or grayish colored matter, by vomiting and by 342 
MELjENA. 
stool; accompanied with fits of fainting, trembling, great 
prostration, and spasms. 
It is generally preceded by diverse complaints of the 
stomach and of digestion ; as want of appetite, pressure in 
the scrobiculus, sometimes violent pains in the pit of the 
stomach, the abdomen, and back, increasing so as to cause 
syncope. Hypochondriacal and melancholic disorders, 
cachectic complexion, particularly pale yellow (habitvs luri- 
dus). Prsecordia tense, distended. Most frequently the 
pulse is unequal, intermittent, very variable; an important 
symptom, since it justifies a suspicion of considerable dis- 
orders in the abdomen and of imminent danger. Great 
trouble from flatulency.—Unquiet sleep, constipation of the 
bowels. 
Suddenly, either without cause, or by a commotion, phy- 
sical as well as moral, as a fall, fright, and disease, a vio- 
lent vomiting of black tarlike matter sets in, and the same 
kind is evacuated from the intestinal canal by stool. The 
pulse is soft, small, unequal, scarcely perceptible ; there 
are painful sensations in the abdomen, often with the most 
violent spasms, anxiety, meteorisms, trembling, a constant 
urgency to stool, cold extremities, cold sweats, fits of faint- 
ing, This state may continue in some persons fora num- 
ber of days with frequent relapses; in others for weeks, 
discontinuing a few days and returning. I have met with 
patients, where it lasted for a long time, (3 or 4 weeks,) 
ceased, then returned again, and continued so for more 
than six months. The weakness is extreme. The quan- 
tity of the evacuated black masses is often incredible; in 
some cases several pounds are evacuated daily. 
It is distinguished from vomitus cruentus, by the blood 
being old, corrupt, tarlike, while in the latter it is fresh ; 
by cachexy having preceded and increased to a high de- 
gree, and generally by being accompanied from the begin- 
ning by discharges of the same kind from the anus. 
It is always a dangerous tedious disease; death may hap- 
pen by exhaustion in the paroxysm itself, or by putrefac- 
tion and putrid fever or cachexy, hence tabes or hydrops 
is a most common sequel. 
Signs pointing to a fatal issue are: weakness always in- 
creasing, fits of fainting becoming more frequent, cold ex- 
tremities and cold sweats setting in, repeated and larger 
quantities of the matter being discharged, and the pulse 
becoming so small as scarcely to be felt. 
Pathogenesis. This disease originates in an exceedingly 
engorged state of all the vessels of the stomach, intestinal 343 
HEMATURIA. 
canal, and mesentery; chronic overfilling of all these ves- 
sels with old stagnant blood, which by length of time be- 
comes excessively tenacious, tarlike, and finally putrid, 
corrupt, and acrid. The veins, indeed, seem to be in a very 
varicose condition, for the quantity of corrupt blood evacua- 
ted is often so large, that great sacks and dilatations must 
be supposed to exist, in which it had stagnated. The ves- 
sels have been found on dissection, sometimes enormously 
dilated, resembling thick cords. 
This stagnant blood renders the vessels more and more 
fragile, so that they burst from a slight cause, and effuse 
their contents into the intestinal canal. 
The remote causes are : particularly a sedentary life, 
which compresses the abdomen (hence it is most frequent 
in sedentary workmen, as shoemakers, etc.), continuous 
sorrow, heavy, constipative, or too rich, nutritive, heating 
food, ardent beverages, suppression of piles or menses. 
Therapeutics. The indications are : to assuage the ir- 
ritation, and correct the corruption ; then to administer 
mild roborants, paying continual regard to stagnations 
in the abdominal viscera. But a sudden suppression is to 
be avoided here as well as in vomiting of blood. The best 
remedies are : tamarind-whey, tartaric acid, potio Kiveri, 
with frequent mucilaginous drinks, emollient injections; 
aromatic, narcotic fomentations with vinegar, and plasters 
on the epigastric region ; but above all tepid aromatic 
baths, from which I have seen material relief in several 
cases, when vomiting refused all internal medicine. In a 
long duration of the malady and great prostration, malt- 
baths, and nutritive injections of broth and the yolk of 
eggs. As roborants, an infusion of millefoil, centaur, minor, 
finally columbo and cinchona are to be given. 
Millefoli urn and visceral injections are particularly re- 
commendable for subsequent treatment and for preventing 
relapses. 
MICTURATION OF BLOOD. 
Hcematuria, Mictus Cruentus. 
Diagnosis. Discharge of blood with the urine, either 
mixed with it like dark beer (from the kidneys, hcematuria 
renalis), or separated from the urine, coagulated, lying on 
the bottom of the glass (from the bladder, hcematuria vesi- 
calis). In renal hsematuria difficulties and pains are felt in 344 
HiEMATURIA. 
the region of the kidneys; in vesical hsematuria the same 
are felt in the region of the bladder. The discharge of 
blood from the urethra (stymatosis) is recognised by the 
blood issuing independently of making water. 
Vesical hcematuria is most frequently hsemorrhoidal (ano- 
maly of piles, haemorrhoidal flux through the bladder; see 
hczmorrhoidal disease). Besides, it may be produced by the 
irritation of a stone in the bladder (vide lithiasis), or by 
ulcers and other organic diseases situated there. 
Renal hcematuria is owing to gravel or to debility and 
atony of the renal vessels (principally by excessive drink- 
ing, particularly diuretic beverages, as beer, tea, or diure- 
tic medicines: strong commotion from continued riding in 
a carriage or on horseback, blows, also excess in coition); 
likewise to suppression of habitual evacuations of blood, 
as piles ; to spasm and consensual irritation, especially of 
gastric accumulations, worms, violent exertions in lifting 
a heavy load, by which the blood is forcibly pressed into 
the kidneys; to inflammation of the kidneys, and finally to 
a dissolution of the blood, as in scurvy, morbus htemorrha- 
gicus, putrid fever; and to old age. 
Stymatosis is merely haemorrhoidal, a consequence of hse- 
morrhoides urethrae, varicose vessels in the urethra. 
Therapeutics. The treatment must conform to the gene- 
ral principles, especially to the various causes and charac- 
ters (vide hcemoptysis). Adynamic haematuria is the most 
common. It is recognised by the debilitating causes, ab- 
sence of pain, signs of congestion, old age, and frequent 
relapses. The best remedies are: cold washing and fomen- 
tations on the lumbar region, spirituous embrocations, infu- 
sions of agrimony, millefolium, salvia; in worse cases 
alum-whey, also chalybeates, cinchona, ratanhia, sulphate 
of iron, avoiding all fermenting drinks, mineral waters, 
and concussive motions. When there is sanguineous con- 
gestion, suppressed hemorrhages, and an inflammatory 
state, blood is to be abstracted ; the suppressed hemor- 
rhages are to be restored or compensated, cooling remedies 
(vide hcemorrhoides vesicce) are wanted. In a spasmodic 
state ipecacuanha in small doses, oily emulsions, opium; 
in commotion cold fomentations, venesection, then arnica; 
after abuse of cantharides, oily emulsions and camphor are 
advised. If it is owing to calculus, bleeding, antiphlogosis, 
and the treatment of stone (vide lithiasis) must be resort- 
ed to. When it is consensual, arising from bilious and 
gastric accumulations, purgatives, and, if indicated, an 
emetic, are best. HA2MATOSIS. 
345 
In all kinds of hsematuria a tablespoonful of poppy or 
almond-oil, taken morning and evening, has proved very 
beneficial. If stoppages of the urinary discharge are caused 
by coagula of blood in the urethra, injections, bougies and 
catheterism are required. 
Afterwards, a cleansing of the kidneys and bladder from 
coagulated blood must be effected, which may be done by 
Sellers water with milk, or still better by Wildunger water. 
METRORHAGIA. 
Vide Diseases of Women, Menstruation. 
HJEMATOSIS, PETECHIANOSIS. 
Morbus Hcemorrhagicus Maculosus Werlhofii. 
Diagnosis. Small and large dark blue, petecbia-like spots 
on different, sometimes on all parts of the body, sometimes 
also vibices, frequent epistaxis, bleeding gums and palate, 
also other hemorrhages, great prostration ; no fever. 
The disease is very similar to pectoral fever and scurvy. 
It differs from the first by the absence of fever, from the 
latter by the absence of the bad smell from the mouth, and 
is a more infantile malady. It is, however, to be classed 
among scorbutic diseases. 
The disease may last very long, and finally terminate 
fatally by entire debilitation, or by violent, ever-and-anon 
returning unsuppressible hemorrhages. 
It is always owing to a decomposition of the blood and 
weakness of the vascular system. 
The treatment requires vigorous administration of robo- 
rant and astringent remedies. Cinchona, mineral acids, 
combined with baths of oak bark are here most serviceable, 
and I have always conquered the disease by them. 
The hoematosis hereditaria, the innate disposition to all 
kinds of hemorrhages, which is peculiar to some families, 
which are called on that account bleeders, can be only pal- 
liatively assuaged, but not radically cured. It commonly 
leads to death by hemorrhages. 346 
BLENNOREHCEJE. 
11. IBlennorrhoeee. 
Generalities. 
Diagnosis. Unusual or excessive evacuations of mucous 
or serous humors. 
They can take place in all secretory organs, and constitute 
one of the most common and numerous classes of diseases. 
The effects are multifarious, partly local, partly general, 
and then often very important to the well-being of the 
whole system. The local ones are : local debilitation, 
increased irritability, constant disposition to inflammatory 
affections, various degenerations of reproduction and dis- 
organizations; the general ones are: general debilitation 
of the whole organism, increased sensibility (especially in 
fluor albus), nervous diseases, emaciations, finally, when 
the loss of humors becomes considerable or concerns a 
noble organ (as the lungs), lingering fever and fatal tabes. 
Pathogenesis. Their cause is, as in all profluvia, either 
increased action (irritation) or debilitation. 
1. The first is of an inflammatory or of a nervous nature, 
and the exciting causes may operate either idiopathically 
or sympathetically. Of the first (idiopathic) class are : 
sanguineous congestions, metastases, specific, miasmatic 
morbific matters, foreign bodies (to which also pseudo-or- 
ganizations belong), often also increased irritability of a 
single part, by which it happens, that even common irri- 
tants create too strong a reaction. The sympathetic are 
either consensual or antagonistic. The consensual irrita- 
tion originates most frequently in the intestinal canal and 
the abdominal viscera; the antagonistic in the skin. Sup- 
pression of the cutaneous action, and transmission of 
the function of the skin to another muco-secreting organ is 
frequently the sole cause of obstinate blennorrhoeas (as 
phthisis pituitosa, fluor albus). 
2. The second fundamental cause, debility, is either 
the product of general debility or only a local debility of 
the affected organ, sometimes primitive, but more fre- 
quently only consecutive of a former irritation, sometimes 
also both united ; weakness combined with increased irri- 
tability or stimulation. 
Therapeutics. The general treatment consists partly in 
doing away with the remote causes, which alone often suf- 
fices for a cure (indirect cure) ; as removal of the inflam- 
mation, sanguineous congestion, general debility, the idio- SALIVATION. SWEAT. 
347 
pathic (often specific), or consensual, or antagonistic 
morbific stimuli, etc. ; thus, the restoration of the cutane- 
ous function is in itself sufficient for curing fluor albusand 
phthisis pituitosa. The treatment may be partly direct, 
operating immediately on the morbid state of the affected 
organ ; or local weakness, morbid irritability, perverse 
secretion, disorganizations ; for which purpose general as 
well as local means are applicable. 
The blennorrhoea of single organs, see under their re- 
spective names, as blennorr/ma vagina et uteri, s. fluor 
albus, blennorrhaa pulmonum s. phthisis pituitosa. 
SALIVATION. 
Ptyalismus, 
Immoderate secretion or discharge of saliva. When of 
a long duration, it is also injurious to health, even to life ; 
as it not only is a waste of the elements of the body, but 
especially of a juice which is indispensable to digestion 
and nutrition. The consequence is emaciation, tabes. 
It is most frequently owing to an abuse of mercury, 
taken for too long a time or in too large a quantity. Be- 
sides, it may be generated by scurvy or obstruction in the 
abdominal viscera, especially in the pancreas, and even by 
the habit of constant spitting, particularly by immoderate 
smoking or chewing tobacco. 
The cure of mercurial salivation is effected by repeated 
purging, sulphur, tepid baths, opium (treatment of mercu- 
rial disease); in extreme cases by iodine. If it be the 
effect of scurvy or of abdominal obstructions, it calls in 
the first case for the antiscorbutic, in the second for the 
resolvent method of treatment. 
SWEAT. 
Epidrosis. 
Diagnosis. Immoderate and constant sweating. 
This is very rare as an independent disease ; when it 
occurs, it is generally a symptom of other diseases, espe- 
cially of the colliquative stage of consumptive maladies, of 
scurvy,, of several kinds of nervous debility, cessation of 
the menses (in this case may last for years), and of the mi- 348 
INCONTINENCE OF URINE. 
liary fever, in which it exists as a pathognomic symptom 
from the onset, and is particularly abundant. In extremely 
rare cases, it may appear without the miliary eruption as a 
febrile disease (the sweating fever), even epidemically and 
contagious, which is proved by the sudor Anglicus of the 
seventeenth century, when men wasted away by sweating 
within a few days (an external cholera). 
This profluvium prostrates the vital power exceedingly, 
and may rapidly exhaust it. 
The cause is weakness, a paralysis of the skin, too strong 
congestion of the humors towards the surface, and decom- 
position of them. 
Accordingly, the cure requires invigoration of the skin 
and arrestation of the internal dissolution and decomposi- 
tion of the humors. The principal remedy, complying 
with both indications, is mineral acid ; the most vigorous 
is acid, muriat. oxygenat. (of which I have seen excellent 
effect, when taken in the quantity of one half up to two 
ounces a day), acid, sulphur, and alum. Next to these, a 
tea or a vinous infusion of sage, has proved specific in such 
cases, and boletus laricis, five to thirty grains daily. The 
conditional cause of the disorder, such as a scorbutic dia- 
thesis, phthisis or hectica, must be attended to at the same 
time. Bathing with vinegar, cold water, diluted mineral 
acids, ice, are advised as local applications. 
Epidrosis localis (sweating of the feet, the genitals, hands 
and axilla?), occurs more frequently, and is generally con- 
nected with a qualitative corruption of the secretion by 
which a bad smell is emitted, thereby rendering the com- 
plaint very disagreeable. It can be easily suppressed by 
alum and saturnine ablutions ; but he who ventures to do 
so is threatened with blindness, deafness, asthma, phthisis, 
indeed, all kinds of metastatic disorders. The only safe 
proceeding is gradually to wean and invigorate these parts 
of the skin, by washing and bathing them with a decoction 
of chamomile and sage ; in order to smother the bad odor, 
the parts may be washed with chlorine water. 
INCONTINENCE OF URINE. 
Enuresis, Incontinentia Urince. 
Diagnosis. The patient has a constant involuntary drib- 
bling of urine (enuresis completa), or the urgency to pass it 
is so sudden and great, that he is immediately forced to INCONTINENCE OF URINE. 
349 
yield (enuresis incomplete spastica) ; or it escapes from 
him only during sleep (enuresis nocturna). 
Pathogenesis. The causes of enuresis spastica may be : a 
continual irritation in the bladder or in some contiguous 
part ; calculus, acrid, sabulous urine (as in old persons), 
worms, particularly ascarides, menstrual or hsemorrhoidal 
congestion of blood to the bladder, gastric accumulations, 
scirrhosities in the bladder, rectum, or prostate gland, or 
ulcers, fistulas. Or mechanical pressure, as that of the 
gravid uterus in the last months, or of other tumors in the 
abdomen. Finally, the bad habit of too frequently urinating, 
by which the size of the bladder is diminished. 
The causes of the enuresis completa paralytica are : atony 
and paralysis of the bladder, difficult parturition, apoplexy, 
strong commotion of the spine (after a fall on the back or 
nates), tabes and paralysis dorsalis, too great distention of 
the bladder by long retention of urine, operation of litho- 
tomy, old age. 
Therapeutics. The enuresis spastica is cured by removing 
the respective irritation. I cannot sufficiently direct the 
attention to worms and their removal, also to gastric ac- 
cumulations; the continued use of dissolvents and purga- 
tives give most relief. In sabulous accumulations in the 
bladder, pulvis aerophorus natronatus (No. 172) is advised. 
The remedies may be combined with hyoscyaraus and 
spasmodic embrocations. 
The enuresis atonica admits with difficulty of a cure. 
The remedies are : roborants, excitants, astringents, ap- 
plied internally and externally ; cold douches, electricity, 
cantharides (vide ischuria, paralysis). When the case is 
incurable, there is no expedient left, but that of wearing a 
urinal or a compressor. 
The nightly enuresis of children is most frequently only 
a bad habit, and is corrected by care, by diminishing the 
quantity of the evening potation, lying on the side, awa- 
kening them several times during the night in order to 
make water, also by chastisement in the morning, the ef- 
fects of which will be remembered, even in sleep. If all 
this do not avail, we must examine whether or not an irri- 
tation, as worms, be the cause of it, or a local weakness, 
especially in adults ; if so, roborants are to be given. In 
extreme cases, a flexible bottle properly secured, may be 
used. 350 
DIABETES. 
DIABETES. 
Diagnosis. Excessively increased secretion of urine, 
which may or may not be qualitatively altered, accompa- 
nied by a morbific influence on the whole system. It is 
merely an increase of urine, which generally becomes 
more and more watery (diabetes insipidus spurius), the 
quantity of which reaches to fifty or one hundred pounds a 
day ; or is alteration of it, milky or vinous, partaking of the 
properties of the beverages drunk (diabetes vervs). The 
most frequent and remarkable species is that in which the 
urine is inodorous, of a sweetish taste, and contains sac- 
charine matter, up to an ounce in a pound, (diabetes melli- 
tus), while the urine itself decreases. 
Ihe concomitant accidents of diabetes are: dry skin, 
thirst, drawing pains in the back and loins, disagreeable 
sensations often increasing to a violent burning in the pra> 
cordia. At last, a lingering fever, emaciation, paralysis, 
accumulations of water, finally death, under symptoms of 
colliquation or apoplexy. 
An important practical rule is, never to omit examining 
the urine of all patients who emaciate independently of 
pectoral complaints or other considerable local disorders, 
for many a person has died of this disease without its being 
suspected by the physicians, since it often happens that the 
quantity of urine is not much increased in this species (the 
diab. mellitus). 
Pathogenesis. The proximate cause is a faulty condition 
of the secretive function of the kidneys, either in quantity 
or in quality, or in both. 
The most important of the remote causes is: chronic 
suppression of the cutaneous secretion transmitted to the 
kidneys. I know an instance of a woman, who, having 
gone in a state of perspiration into a cold cellar where she 
remained long, contracted so violent a diabetes that it lasted 
for years, and could be remedied only with great difficulty. 
Another cause is debilitation of the kidneys and of the spi- 
nal marrow by excesses in venery and in drinking ; also 
sanguineous congestions to this organ, suppression of piles 
and catamenia; hysteria, hypochondria, gastric stimulants 
and worms ; metastases and local irritants of the kidneys, 
as stone and gravel. 
In diabetes mellitus a singular derangement of the ani- 
mal-chemical process of the kidneys takes place, by which 
sugar is prepared from the humors carried thither, in a DIABETES. 
351 
manner analogous to that by which stone and gravel is 
created in lithiasis, and by which starch and linen may 
be transmuted into sugar by (sulphuric) acid. This is 
formed chiefly from the chyle in the blood, which, when 
first admitted, may be easily separated by that peculiar 
chemical affinity and attraction, which seems to exist for 
it in the kidneys. This loss of chyle accounts for the ema- 
ciation and debility met with in this disorder. 
Therapeutics. The cure is very difficult. It is most 
essential to inquire into the various remote causes and to 
act accordingly. This will lead to very different modes of 
treatment. If it be owing to long checked perspiration, 
this function of the skin must be restored by diaphoretics, 
especially by camphor and ammon. sulphurat. (two grains 
daily Begum’s sulphur balsam), from both of which 1 have 
seen excellent effects in diabetes mellitus; hot baths, Rus- 
sian baths, frictions ;—a treatment which, on account of 
its vigorous derivation from the kidneys, is also beneficial 
in all other kinds of diabetes. If atony or preceding debil- 
itating causes have given rise to it, roborant remedies will 
be needed ; suppressed hemorrhages, or a plethoric inflam- 
matory constitution require abstractions of blood ; I have 
seen diabetes mellitus arise from amenorrhoea, and disap- 
pear on a return of menstruation. If the disease is due to 
gastric accumulations and worms, emetics and helminthics 
are to be administered ; if owing to visceral obstructions, 
resolvents. I have seen it happen as a consequence of 
obstruction in the liver, and cured by Carlsbad spring and 
the use of soda and bitter extract. If nervous debility, 
increased sensibility, hysteria and hypochondria are con- 
stitutional causes of diabetes, nervines, antispasmodics (asa 
feetida, belladonna, cuprum ammoniacum) are advised ; if 
nephritic calculus, gravel, lime-water, magnesia, and alka- 
lines must be prescribed. 
Should these means not suffice, it is best to operate 
directly on the renal complaint and the lumbal nervous sys- 
tem by active nervines and narcotics, by roborants (cin- 
chona, iron, particularly Spa water), by derivation to the 
skin, and artificial ulcers. Opium in increasing doses, along 
with lime-water and warm baths, have also, according to 
my experience, performed the cure of diabetes mellitus ; 
likewise kreosote in large doses, from ten to twenty drops 
a day. A consideration of the chemismus is very import- 
ant in this species. It is certain that, as long as the patient 
does not take vegetable food, and lives solely upon eggs 
and meat, he does not produce saccharine matter in the 352 
LEUCORRHCEA. CATARRHUS VESICiE. 
urine, and though no radical cure is effected, animal diet is 
promotory and essential to cure it. The ate of fresh ox- 
gall has also proved efficacious. 
LEUCORRHCEA. 
(Vide Diseases of Women.) 
CATARRHUS VESICJE. 
Cystorrhcea. 
Diagnosis. Discharge of mucus with the urine, accompa- 
nied sometimes with little, sometimes with great difficulties 
in making water. 
This disease in itself is generally without danger, except 
such as may attach to the cause, of which it is a sign. 
However, besides the difficulties of making water, it 
may itself become injurious to health and to life, even pro- 
duce tabes, when the discharge of gelatinous matter useful 
to the economy becomes very copious. We must be care- 
ful to discriminate between the discharge of mucus and 
that of pus. The corrupt secretion of mucus may (as in 
phthisis pituitosa), gradually degenerate into phthisis vesi- 
calis. 
Pathogejiesis. The causes are most frequently local; as 
a local irritation of the bladder by gravel, stone, chronic 
inflammation, induration (also of the prostate gland), the im- 
moderate use of diuretic drinks, also diuretic medicines, 
wearing a catheter or bougies for a long time, metastases, 
especially psoric, arthritic, rheumatic, syphilitic, most fre- 
quently hsemorrhoidal congestion (hcemorrhoides inucosce 
vesica;) ; or local debilitation, in consequence of a prece- 
ding irritation, inflammation (subsequent malady of the 
diseases before mentioned), or venereal excesses, or as 
a consequence of too great a distention of the bladder 
after long continence of urine. Also sympathetic irrita- 
tions of the abdomen, worms, and infarcts may contribute 
towards engendering the disorder. 
Therapeutics. For the treatment we have to carefully 
examine whether stone or gravel is not the cause ;in 
which case the correspondent course is to be taken. The 
various remote causes are also to be considered. In haemor- 
rhoidal congestion, sulphur, a solution of extractum tarax- GONORRHCEA. 
353 
aci with soluble tartar, the occasional application of leeches 
ad an urn (vide hemorrhoidal disease, vesical hemorrhoids) ; 
in catarrhal, rheumatic, arthritic, psoric rnetastases, the 
cure of chronic rheumatism, of gout, of psora must be pur- 
sued ; for which woollen clothing, warm baths, and exuto- 
ries are recoramendable. Roborants, cinchona, and iron 
may be prescribed to remedy atony, in all kinds of cys- 
torrhoea, Wildunger water is an excellent remedy. Besides 
uva ursi, lime-water, also phosphoric acid have proved very 
salutary ; likewise all remedies recommended in (iuor albus. 
Particular attention is due to the discharge, whether it 
be pus or mucus ; if the latter, the treatment of phthisis 
vesicalis is to be adopted. 
CLAP. 
Gonorrhea. 
Diagnosis. Constant or periodical flux of mucus from 
the urethra, with or without pain. 
The most frequent cause is coition with a person already 
affected with a syphilitic or other kind of floor albus, or a 
local disease of the uterus and vagina. But a gonorrhoea 
may arise also without improper connection, by metaslases 
(especially the rheumatic, arthritic, psoric), to the mucous 
membrane of the urethra ; or by hsemorrhoidal congestion, 
and by anomaly. 
The discriminative signs can be derived only from the 
origin. Gonorrhoea which follows coition must always be 
regarded as a specific syphilis; the non-specific species is 
recognized by not having been preceded by sexual connec- 
tion, but by rheumatic, arthritic or hsemorrhoidal affection 
having previously existed or alternated with them. It also 
sometimes happens that a gonorrhoea primarily specific, is 
subsequently entertained by some external or internal 
cause, and passes into a non-specific (gonorrhoea secun- 
daria). , 
Therapeutics. For the treatment of the specific, look 
under syphilis, gonorrhoea syphilitica. Ihe treatment of 
the non-specific is adapted to the respective causes. The 
arthritic and rheumatic is treated as gout and rheumatism ; 
the hsemorrhoidal as hsemorrhoidal disease. Use the rem- 
edies appropriate to the various morbid states, and if this 
do not suffice, combine with them such medicines as have 
a specific tendency to the mucous membrane of the ure- 354 
SEMINAL WEAKNESS. 
thra ; of which balsarnum Capaivae, twenty to thirty drops 
on a piece of sugar, taken several times a day, is the prin- 
cipal remedy. Avoid in such'cases astringent injections, 
by which very bad metastases may be engendered. 
SEMINAL WEAKNESS. 
Pollutio. Onania. 
Diagnosis. Involuntary and too frequent emission of 
semen ; nocturna, when it occurs only in the night in vo- 
luptuous dreams ; diurna, when it happens in day time by 
the least mechanical or physical irritation, as by riding on 
horseback, by defecation, especially when costive ; by 
every amorous thought, sight, touch.’ 
Pollutio nocturna is a natural excretion, if it occurs but 
seldom, as in young, plethoric, abstinent persons, and is 
not injurious except when it is too frequent, every two or 
three days 5 then it produces all the consequences of onan- 
ism (by which it is also generally caused), as : debilitation 
of the nerves, hypochondriacal and hysterical complaints, 
spasms, weakness of sight, of memory, of all the mental 
faculties, especially that of manliness of character and of 
love of life. The abundant loss of semen, of that substance 
which imparts life, has this peculiarity, it destroys the love, 
courage of life, and brings on a disgust of life (tcedium vita), 
becoming one of the most frequent causes of suicide. 
1 he pollutio diurna is the most debilitating and destruc- 
tive of all the proflu via, and causes, besides what has already 
been mentioned, falling out of the hair, local lameness, im- 
becility, t ibes nervosa, particularly dorsalis, and finally 
terminates in death. 
Masturbation (onania), although, properly speaking, this 
is a vice, is also to be mentioned here, since through habit, 
it at last becomes a disease, an irresistible instinct for sem- 
inal discharge. 
Pathogenesis. The proximate cause is weakness, with 
increased sensibility and irritability (irritable debility) of 
the genital organs, especially of those which procreate, 
preserve, and discharge the sperm. In the highest degree, 
that of pollutio diurna, there is extreme atony of the 
seminal vesicles and excretory canals, so that mere pres- 
sure suffices to empty them. 
3he occasional causes of too frequent pollutions may 
be all kinds of abdominal irritants, as worms, gastric SEMINAL WEAKNESS. 
accumulations, habitual obstructions, plethora of the ab- 
domen, constant sitting, but most frequently they are owing 
to masturbation, which in children and young people often 
proceeds from the same causes, the physical as well as the 
moral, that is, a corrupt imagination, constant indulgence 
in voluptuous images and thoughts. 
Pollutio diurna is the final product of long continued and 
immoderate onanism. 
Therapeutics. The cure of too frequent pollutions is si- 
multaneously the cure of self-pollution ; and is impossible 
without conquering the last. The first thing to be done is 
to annihilate the remote causes, abdominal irritations, as 
worms, gastric accumulations, cosliveness, plethora abdo- 
minalis ; to alienate the imagination from voluptuous ideas, 
and to occupy it with serious abstract topics ; to use and 
fatigue the physical powers by strong exercise and exer- 
tion of the body, so that the patient, shall be fatigued at the 
time of going to bed; to avoid a too nutritive and stimu- 
lant diet, as meat, eggs, spices, wine and spirits, and to 
live more on vegetables and fruit; to eat little or nothing 
in the evening, not to lie on the back, and to rise early in 
the morning. Masturbation, if already practised, must be 
abandoned. 
To this must be joined the cure of the proximate cause. 
The genitals must be invigorated, and their morbid irrita- 
bility diminished. Here, however, great caution is neces- 
sary. For if the roborative treatment is carried on too 
violently, too rashly, or by too stimulative means, the local 
irritation will be increased, and thereby will the pollutions 
and debility be augmented; effecting just the contrary to 
what was intended. Therefore, we are to begin with such 
roborants as cool and diminish the irritability ; as mineral 
acids, especially acid, sulphuricum. The best method, 
according to my experience, is the elix. acid. Halleri, ten 
to twenty drops three limes a day, combined with Island, 
moss, in jelly or decoction, mixed with tinct. cinchonse 
Whytii (vide No. 173), then pass to columbo (vide No. 174), 
which is here the most proper of all tonic roborants, and 
will often cure by itself. The pills No. 175, are also of 
excellent service. At the same time, local means of a sim- 
ilar tendency to diminish the irritability and to invigorate, 
may be used ; as, frequently washing the genitals, perinse- 
um, and sacrum with cold water; afterwards with the 
liquor anterethisus (No. 176), mixed with one sixth part of 
spirit of camphor; immersion ol the genitals, perineeum, 
and sacral regions in a tub of cold watei, repeated several 356 
OTORRHCEA. 
times a day ; likewise river and sea baths are necessary. 
The undeniable power of camphor to diminish the sexual 
desire and pollutions, may also be profited of with benefit: 
it may be given internally, one or two grains along with 
nitre, morning and evening ; externally, combined with 
liquor anlerethicus, or in little bags worn next the scro- 
tum (vide No. 177). See satyriasis, nymphomania. If this 
is not sufficient, or the evil has attained the highest stage, 
that is pollvtio diurna, then strengthening and astringent 
remedies, as cinchona, quassia, ratanhia, terra catechu, 
gummi kino, iron, especially sulphate of iron, and the cha- 
lybeate wine (No. 10b), the Pyrmont spring, internally and 
by baths, by which 1 have seen perfect cures performed, 
may be resorted to; when the latter cannot be had, the 
artificial chalybeate baths (half an ounce of sulphate of iron 
for each bath) may be substituted. 
OTORRHCEA. 
Diagnosis. Discharge of a serous, mucous, sometimes 
purulent matter, which is either inodorous, or of an offen- 
sive, putrid odor, from one or both ears. 
It is usually met with in children, and is almost always 
the effect of a scrofulous metastasis to the mucous mem- 
brane of the meatus auditories, being analogous to scro- 
fulous blennorrhoea of the eyes, with which it very often 
alternates. It is often owing to a rheumatic or catarrhal 
metastasis, a catarrh of the ears. It may, however, be 
concomitant or consecutive of otitis, which is recognized 
by the presence of pain. A psoric or syphilitic metastasis 
may also be the cause. Finally, an internal suppuration, 
even caries may produce it ; a cause that is recognized by 
the fetid and purulent quality of the matter. It is, how- 
ever, well to remark, that not every putrid smell of the 
discharge does indicate suppuration or caries; for this 
may also exist in a purely catarrhal otorrhoea, as is like- 
wise observed in a violent coryza. This complaint is 
insignificant in itself, especially in children. If of long 
duration, it may be followed by weakness of hearing and 
organic disorders. 
The cure must be effected by general means, and such 
remedies as have a particular tendency to the respective 
dyscrasia ; or by derivatives. Thus, the use of pulvis an- 
tidyscrasicus, intermediately purgatives, and vesicatories 
behind the ears are generally sufficient to cure the scrofu- LIENTERY. 
357 
lons and rheumatic otorrhcea. Lukewarm milk or weak 
soap water may at the same time be used for cleansing the 
ears. Be careful not to use strong, locally suppressing 
remedies, as zinc, vitriol, mercury, lead, and other metallic 
salts. They are apt, by sudden suppression of the discharge, 
to cause the most serious consequences, deafness, and 
even metastasis to the brain. It is only when the discharge 
is obstinate and continues after the use of the general 
means, or becomes malignant and purulent, that they may 
be resorted to. 
LIENTERY. 
Lienteria. 
Diagnosis. Evacuation of the aliments (solids as well as 
liquids), in an indigested state. (We must not mistake for 
it the discharge of such substances as the best stomachs 
do not digest; the hulls of peas, lentils, berries, the fibres 
of some vegetables, the green color of 
sometimes combined with vomiting, generally with insa- 
tiable hunger. Pale countenance, prostration, emaciation, 
finally lingering fever, associate with it. 
Pathogenesis. The proximate cause is a too quick pas- 
sage of the nutriments through the stomach, and without 
being digested. It can originate in a total loss of assimi- 
lative power, faulty condition of the chyle, a morbid irri- 
tability of the stomach, or in a morbid stimulus, particularly 
gastric impurities, acrimonies thrown there per metastasin, 
worms, also in organic disorders of the stomach. Gluttony, 
especially of raw, fermentive vegetable substances, sour 
wines, too rapid swallowing of the aliments, also abuse of 
purgatives, frequently give occasion to it. 
Therapeutics. When indications of impurities exist, 
cleansing the stomach by emetics and purgatives, and 
strengthening it, simultaneously diminishing its increased 
irritability. This purpose is attained by the following 
remedies: bitter roborants with aromatics and small doses 
of opium, particularly radix columbo, quassia, extract, cort. 
auranliorum, myrrh, aquosa ; also aloelics, the balsamic 
pills of Hofmann, extract of hops, tinct. cinchona; Whytii, 
rad. calam., zingiber, chalybeate milk, with the yolks of 
eggs (prepared by quenching a hot iron in it) ; salep, rice- 
pap, substantial broth, strong, sweet, or astringent wines 
without acidity (Madeira, old Malaga, Burgundy, Pontiac, 358 
FLUXUS COELIACUS. FLUXUS HEPATICUS. 
wine with nutmeg), ferruginous mineral waters in small 
doses, with milk, lime-water, acorn coffee, quinces, bitter 
beer. Externally balsamic spirits, herb cushions moistened 
with rum applied to the epigastric region, in extreme cases 
a moxa (vide weakness of the stomach, diarrhoea chronica). 
We must at the same time attend to the removal of worms, 
metastases, and other morbific causes, especially those of 
a rheumatic and arthritic character, also lurking syphilis, 
when they exist. 
Diagnosis. Evacuations from the intestinal canal of a 
white color, resembling milk or chyle, sometimes mixed 
with excrements, also with blood ; sometimes suddenly fol- 
lowed with tenesmus. Bad digestion, pale countenance, 
finally emaciation, lingering fever, death. 
Pathogenesis. The cause is a blennorrhoea intestini recti 
(similar to the blennorrhoea uteri), a fluor albus intestini 
recti. The remote cause may be the same as in fluor al- 
bus, especially a hemorrhoidal congestion (htemorrhoides 
mucosse), metastases, atony of the intestinal canal. 
Therapeutics. The cure of the hemorrhoidal disease, of 
the specific morbific matters accidentally existing, of the 
metastases, obstructions of the liver, and other abdominal 
viscera; the use of bitter tonics, as columbo, millefol., 
quassia, lignum campechiense, martials, Pyrmont water, 
visceral and roborant injections are particularly advised. 
FLUXUS COELIACUS. 
FLUXUS HEPATICUS. 
Diagnosis. Watery and mucous stools, resembling in 
color the lymph of blood, with and without excrements, 
without tenesmus and colicky pains, in greater or less 
quantity, up to ten or twelve times a day ; it is also some- 
times intermittent; very chronic, lasting for years; final- 
ly prostration, emaciation, lingering fever. (It is a rare 
disease.) 
Pathogenesis. The cause is an exhalation of serum into 
the small intestines. Most frequently it is caused by hsern- 
orrhoidal disease, by obstructions of the abdominal viscera, 
especially of the liver, also by great atony of the intestines 
and colliquation. Nor can it be denied, that the discharge 
is sometimes really hepatic ; that is, the product of soften- 359 
ing and dissolution, perhaps also of suppuration of the sub- 
stance of the liver; in which cases it is associated with 
chronic liver complaints, and ends in death. 
Therapeutics. The treatment must conform to the causes. 
Mild resolventia subarnara, millefolium, centaur, minor., 
with soluble tartar, roborants, cinchona, Campeachy wood, 
diluted mineral acids, tonic injections, Eger, Spa, Pyrmont 
water in small doses, are the most beneficial remedies. 
DIARRHOEA. 
DIARRHOEA. 
Diagnosis. Increased fluid discharge from the intestines. 
It may be free from, or accompanied with pains (diarrhoea 
torminosa)\ continue for a few days, or by becoming chro- 
nic, last tor months and even years. The matter evacu- 
ated varies very much ; may be excrements, watery fluid, 
mucus, bile, pus, blood. It differs in regard to danger; 
sometimes it is insignificant, without danger, curing by 
itself, in many cases it is even a salutary crisis; at other 
times it is very important, running into danger or indica- 
tive of already existing vital danger. 
A principal rule is, to consider every diarrhoea as 
salutary, and therefore not to stop it, as long as clear 
proofs of the contrary do not appear. These are: quite 
watery evacuations (though these also may sometimes be 
critical and wholesome ; as the rheumatic), great prostra- 
tion after each stool, increasing sometimes to fainting. 
Protracted diarrhoea is exceedingly debilitating, and may 
finally produce all the consequences of weakness, as ner- 
vous diseases, hysteria, cachexy, tabes, hydrops, and lien- 
teria. 
Pathogenesis. The proximate cause is always an in- 
creased activity of the intestinal canal, of the peristaltic 
motion as well as of that of the secretory vessels. But the 
causes may be various, even opposite, either an augmenta- 
tion of the irritability or an unusual stimulus. The irrita- 
bility may be increased in a double manner, either by 
increase of power (sanguine, phlogistic, inflammatory diar- 
rhoea); or by weakness, namely, irritable debility (to 
which belong adynamic, nervous, hysterical, finally col- 
liquative diarrhoea) ; for the torpid weakness of the intes- 
tinal canal brings on costiveness. The exciting stimulus 
may likewise vary ; be local, idiopathic, in the intestinal 
canal itself: indigestion, sordes, worms, metastases, organic 
diseases of the intestinal canal (saburral, bilious, mucous, 360 
DIARRHCEA. 
verminous, metastatic, organic diarrhoea) ; or sympathetic, 
consensual, as dental irritation, mental irritation, anguish, 
pain ; or antagonistic, as suppressed action of the skin (the 
rheumatic and catarrhal diarrhoea). It is worse when both 
irritations unite, increased irritability and increased stimu- 
lus ; as sordes in an erethic state of the intestinal canal. 
Even a fluid stool several times a day may continue through 
life, as I have observed in a man who labored under it up 
to his eightieth year without any prejudice. 
There exists also a predisposition to diarrhoea, which is 
of a double description. 1. T hat which is individual: there 
are men whose intestinal canal constantly inclines that 
way, so that they are affected with diarrhoea on the slight- 
est occasion ; becoming the common way by which nature 
excretes diseases and morbid dispositions and restores the 
normal state 2. General: there are universal constitutions 
of the atmosphere which render all men liable to diarrhoea. 
Of that character is especially that one which returns annu- 
ally in the summer time, and is due to an increased secre- 
tion of acrid bile. Similar to this is the climatic, in tropical 
regions, where bile again is the cause. 
Therapeutics. The principal indication is : to remove the 
irritant cause, or to assuage the increased irritability of the 
intestinal canal ; or to do both. This fundamental idea 
may be carried out in very various ways, according to the 
various irritant causes, or the increased irritability being 
dependent on weakness or augmented vitality. 
Hence the treatment of the single species. 
The most common and first to be mentioned is Diarrhoea 
(estiva, which springs up epidemically in the prolonged 
heat of the months of July and August, and is accompa- 
nied with more or less griping pains. It is always of a bi- 
lious nature; the bile being increased in quantity and acri- 
mony by the heat of the season. In general nothing more 
is wanted than rhubarb, which is here a specific, and a strict 
observance of diet, avoiding all acids, fruit, beer, vegeta- 
bles, and living on water gruel, pearl-barley soup, rice- 
water, chicken, or veal. The rhubarb may be taken in the 
form of tincture, as an ounce of tinct. rhei. aquos., or the 
mixture No. 178 daily. This will generally be sufficient. 
I have found pulv. rad. rhei. still more efficacious, prescrib- 
ed in doses of 3 or 4 grains every 3 or 4 hours, formed in- 
to pills with liquorice, in order to correct the taste. Some- 
times the evacuations are watery, and signa sordium sur- 
sum turgescentium exist; here sal ammoniac, dissolved in 
mucilage, will best stop the watery effusion, followed by DIARRHOEA. 
361 
an emetic of rad. ipecacuanhas (which is also a specific in 
diarrhoea), afterwards rhubarb. It may be necessary to re- 
peat the emetic several times. 
Sometimes the diarrhoea is watery, and accompanied 
with violent griping pains ; here oleosa combined with sal 
ammoniac and anodynes (vide No. 179) will give the most 
prompt relief; at the same time inunctions, cataplasms, 
oily injections may be made use of. 
In diarrhoea owing to indigestion, the same treatment is 
required ; if an emetic is indicated, let it be ipecacuanha; 
and followed by rhubarb. 
Generally, these remedies suffice to perform a cure. 
Sometimes, however, the diarrhoea will notwithstanding 
persist and continue waiery, prostrating the patient, with- 
out any signs of the presence of gastric impurities. The 
indication here, is to suppress the aqueous flux. The first 
ways must be previously cleansed, lest the suppressive 
means produce injurious and even dangerous consequences; 
and a proper succession must be observed, gradually pass- 
ing from the mild to the stronger kinds. The remedies are 
the following : Above all is antagonismus of the skin. As 
suppression of cutaneous action is able to create imme- 
diately diarrhoea, so also may its restoration instantly de- 
rivate and remove the diarrhcea; therefore let the abdomen 
and back be wrapped in double flannel, which, in many cases 
will be alone sufficient. After this rhubarb in powder lor 2 
grains, ipecacuanha in small doses (vide No. 180), and 
testaceous substances, as prepared shells, lapid. cancrorum, 
especially clay and bolus armenise (vide No. 181) ; farther, 
mucilaginous, gelatinous substances, gum arabic, salep, 
rice-pap, starch injections. I recommend extract, casca- 
rillae (vide No. 182) as a very valuable remedy, confirmed 
to me in many cases by my own experience, since it stops 
diarrhcea without the least detriment; farther, nutmeg; at 
last opium, which is the most sure of all other means, but 
for that very reason it is also the most dangerous ; there- 
fore it must always be given in combination writh eva- 
cuants (vide No. 183). 
Simple rheumatic diarrhcea, owing merely to taking cold, 
generally requires nothing but flannel around the abdomen, 
to lie in bed, to perspire,"and to take mucilaginous drinks. 
If at the same time there is a gastric complication, this 
must have its appropriate treatment. 
Habitual or chronic diarrhcea, is a continual looseness 
of the bowels, or a disposition to looseness from slight 
causes; in the latter case it is subject to alternate with 362 
DIARRHtEA. 
costiveness. It is frequently the sequel of a previous acute 
diarrhoea. A local weakness combined with increased ir- 
ritability (irritable weakness) must always be supposed to 
be the original cause and object of treatment; but it is 
equally important to pay attention to the morbid stimuli 
connected with it, which frequently excite an erethismus, 
and, without the removal ot which the use of the most 
powerful roborants will be fruitless, yea the removal of 
which alone is often sufficient to a cure. We therefore 
distinguish the following cases. 
The merely adynamic, erethic chronic diarrhoea, requires 
the continued use of tonics, especially the bitter, astrin- 
gent, narcotic, and antispasmodic kinds, and counter-irri- 
tants. Those most approved of by experience are : co- 
lumbo (vide No. 184), of the powder 1 scruple 4 times a 
day, cortex cascarillae, lign. campech. (vide No. 185), cort. 
aurantiorum, simaruba, salicaria, acorn-coffee, red French 
(claret), Pontac, Cahors wine, the same aromatized with 
orange peel, chalybeates ; particularly Pyrmont water, flan- 
nel vest, strengthening embrocation on the abdomen and 
spine, strengthening baths, douches on the abdomen. I 
have found a little spice-bag worn on the abdomen (filled 
with cloves, cinnamon, pepper, cardamomum, and ginger, 
moistened morning and evening with cold rum), very effi- 
cacious. I should not omit to remark that, while irritabi- 
lity continues, small doses of laudanum must be added to 
the tonics. In several cases, where other means failed, 
tinct. macis along with laudanum (vide No. 186), has prov- 
ed serviceable. When there is great atony, a cold diet must 
be observed. Nux vomica (vide No. 187) will often have 
an excellent effect. Terra catechu, as in the mixture No, 
188, is very rccommendable. In very obstinate cases I 
have performed perfect cures, merely by milk-diet and cold 
food ; the patient being suffered to take nothing but milk, 
cold meat and white bread. 
If one of these methods does not suffice, investigate close- 
ly whether or not a foreign irritant keeps up the diarrhoea; 
especially worms, or metastatic and specific morbid mat- 
ters ; most frequently gout, rheumatism, and psoric (parti- 
cularly herpetic) acrimony, even lurking syphilis; if so, 
each of these will require its respective remedy. In the 
hamiorrhoidal, sulphur as combined in No. 189 is most 
valuable. Even the dietetic mode of living and clothing of 
the patient is to be regarded ; too thin clothing, moist 
dwelling, frequent use of red wine are often the unknown 
causes. DYSENTERY. 
363 
Diarrhea colliquativa, which associates as a symptom 
with phthisis, tabes, hydrops, and hectica, requires the 
treatment of the original disease, and besides the use of the 
stringent remedies previously mentioned, along with opium, 
especially starch injections with opium. 
Putrid diarrhoea (which occurs in scurvy), is remedied 
by alum-whey, Peruvian bark, terra japonica, along with 
small doses of opium. 
Diarrhoea owing to obstructions in the mesentery, tu- 
bercles of the intestinal canal (frequently met with in scro- 
fulous children), requires acorn-coffee, extract of cascaril- 
la, nutritious jellies, and malt-baths. The same applies to 
that kind of diarrhoea which is caused by other abnormal 
states and organic disorders of the abdomen. The use of 
snail-broth with cascarilla has proved beneficial in hectic 
persons, laboring under diarrhoea for years. 
Diarrhoea puru/enta with discharge of real pus is indica- 
tive of suppuration in the intestinal canal, and requires the 
use of milk, whey, butter-milk, salep, snail-broth, milk with 
an addition of lime water, myrrh, copaiva balsam, cin- 
chona, injections of milk with myrrh or copaiva, 1 to 2 
drachms and a little laudanum several limes a day; even 
an addition of a few drops of aceturn plumbi may be per- 
mitted. 
Diarrhoea infantilis, vide diseases of children. 
DYSENTERY. 
Dysenteria. 
Diagnosis. Constant urgency to go to stool, tenesmus, 
violent abdominal pains, fever; only mucus and blood, but 
no fseces in the stools. Therefore the disease is not pro- 
perly a flux but a constipation, an essential difference, and 
the reverse of diarrhoea. In diarrhoea nuisible intestinal 
impurities are evacuated; in dysentery they are impeded 
and retained. Diarrhoea can get well by itself, not so dy- 
sentery. As soon as feculent impurities are discharged in 
dysentery, the disease may be said to be cured. 
The course of the disease varies. Sometimes it is an- 
nounced by previous symptoms, sometimes not. It may 
be of short duration, sometimes long, even passing into 
chronic dysentery. The precursory symptoms are fre- 
quently diarrhoea or dull pains in the abdomen. It com- 
mences by a cessation of bilious stools, which is followed 
by tenesmus with small mucous evacuations (white dy- 364 
sentery), which on account of increasing irritation subse- 
quently gets mixed with blood (red dysentery). In the be- 
ginning there are febrile motions, which soon cease in a 
slight attack of the disease. When the malady is severe, 
the pains continue to increase and the stools may augment 
to 100 in 24 hours, and their fetor increases with the fever. 
This aggravation is owing to the addition of inflammation, 
or to an excess of bilious putrid matter, or to exhaustion. 
Death ensues by inflammation and gangrene, or by exhaus- 
tion. The signs of gangrenous mortification are : sudden 
cessation of pain after having violently raged, a sunken-in 
countenance, cold extremities, small intermittent pulse, 
the evacuations are highly offensive, and are passed with- 
out consciousness. Amelioration is indicated by diminu- 
tion of the pains and fever, and the evacuations becoming 
feculent. 
Violent dysentery is frequently succeeded by paralysis, 
chronic diarrhoea, nervous fever, and lingering fever. 
Pathogenesis. The proximate cause is a violent convul- 
sive irritation of the large intestines, the secretion of mu- 
cus pathologically increased and rendered acrid. It is 
therefore not primarily an inflammation, but inflammation 
may growr out of it by an increase of irritation. It is very- 
similar to that of caiarrhal irritation of the mucous mem- 
brane of the bronchia ; (when in more severe coryza and. 
cough, streaks of blood are mixed with the mucus, and it is 
apt to pass into inflammation merely by an increase of irri- 
tation),—a catarrhus or rheumatismvs intestini crassi. 
This local irritation may have various remote causes: 
an unusual excitement or irritation of the organ. The most 
common cause is suppressed action of the skin (antago- 
nistic irritation), with increase of quantity and acrimony 
of bile. On this account it is frequently epidemical, in Au- 
gust and September, after great heat of the day (which 
renders the bile more acrid and increases it), followed by 
cool evenings and nights, which arrest the perspiration. It 
therefore has always a bilious rheumatic character. 
In severe epidemical dysentery, especially when it as- 
sumes a putrid character, a contagium dysentericum may 
be developed, which, however, seems to be only local, ad- 
hering to the intestinal evacuations, and rendering their 
emanations dangerous. 
There is also an endemic disposition to this disease. 
Low, moist, marshy regions, such as predispose to inter- 
mittent fevers, incline also to dysentery; hence they gen- 
erally prevail in such places. 
DYSENTERY. DYSENTERY. 
365 
Besides these causes of primary essential dysentery, 
there are also others which may create it symptomatically 
and secondarily, either by a violent local irritation, as 
caustic poisons, worms 5 or by an exceedingly increased 
irritability of the intestinal canal, as a hsemorrhoidal con- 
gestion, metastases; or consensually, as from difficult den- 
tilion. 
7'herapeutics. The fundamental indication is to assuage 
the excited state of the colon by removing the irritant 
cause and the increased irritability. The next thing to be 
done is to consider the respective characters of the diffe- 
irritations. 
The rheumatic-bilious character is of the most frequent 
occurrence, and is common to the autumnal dysentery. In 
this kind of dysentery we have in geneial only need of the 
following remedies: an emetic of ipecacuanha in the com- 
mencement; then a laxative mixture of manna ami tama- 
rinds, with a small addition of sulphate of soda and tartar 
emetic, continued for 24 hours; should no amelioration 
ensue, a mucilaginous emulsion containing small doses of 
opium (vide No. 190). Pearl-barley, water-gruel, gum- 
water, given at the same time as beverage, the abdomen 
and back clothed in flannel, and an embrocation of anti- 
spasmodic ointments with opium to the abdomen. Ipeca- 
cuanha given in the beginning as an emetic is generally 
necessary and of great benefit for the after treatment 
There is but one exception to this rule: it is when the pa- 
tient has no signs of saburra, and the stools contain no fe- 
culent matter. 
Should no improvement follow this treatment, it is be- 
cause of the following cases, which must be carefully dis- 
tinguished. 
1. The fever increases, the pulse becomes full and hard 5 
or the patient is young and plethoric, the pains are severe, 
or confined to one spot ; the abdomen is tense and painful 
to the touch. Here is incipient inflammation, and imme- 
diate need of venesection ; or of leeehes when the case is 
light. At the same time an oily emulsion (vide No. 47) is 
to be given, to which opium may be added as soon as ve- 
nesection has abated the pulse. 
2. Or the pulse is not full, but the tongue is undean, 
with many other indications of gastric impurities, which 
are generally of a bilious nature. In this case the primse 
vise are to be cleared, carefully distinguishing whether the 
stools contain feculent matter or not. If they do, the above- 
mentioned tamarind mixture is to be given along with mu- 366 
DYSENTERY. 
cilaginous drinks, until the stools become watery. But in 
the second case, when the evacuations are not feculent, an- 
other emetic must be prescribed which will usually render 
them feculent. Should this be unavailing, rhubarb (vide 
No. 191) or calomel with opium must be tried. 
3. Or there exist neither signs of inflammation nor of 
gastric impurities; but the patient suffers violent pains 
with tenesmus, the stools are scanty, watery, mucous or 
bloody. Such a case is caused principally by cold ; its 
character is rheumatic, a real rheumatismus intestinorum. 
Here opium with gum arabic administered internally, ex- 
ternally, and in clysters are the chief remedies.; at the same 
time a vesicatory to the abdomen and warm baths are 
proper. 
4. Or finally, the case is marked by extreme prostration 
from the beginning (dysent. nervosa adynamica). Here, the 
foregoing remedies (opium and mucilages, also emetics 
and purgatives when necessary) must be combined with 
nervines, valerian, angelica, arnica, wine, and warm baths. 
If it assumes a putrid character, which is recognised by 
extreme weakness and a cadaverous odor of the stools, 
arnica (1 scruple of the powder every 2 hours, or a de- 
coction of ounce to 8 ounces of fluid) and wines are par- 
ticularly recommeudable. 
Sometimes, however, the dysentery continues obstinate 
and will not cease, though it diminishes in force. Here, ex- 
perience has shown that the following remedies are very 
efficacious: 10 grains of powdered nux vomica daily, or 2 
to 4 grains of the extract; sulphur, calomel, even sublimate 
in minute doses grain to 4 ounces of water with 3 
ounces of mucilage of gum arab. and 12 drops of lauda- 
num, one table spoonful every 2 hours), which may also 
be given in injections, though in smaller doses, as the 
-jL 6of a grain with opium and mucilage. In such a case 
too, when all other means fail, the vitrum ceratum antimo- 
nii, in or 1 grain doses, which according to the expe- 
rience of the most approved practitioners, has been used 
with the greatest benefit ; also wax, made into emulsion 
with the yelk of eggs; warm baths, especially in rheu- 
matic dysentery. 
If dysentery becomes chronic, arnica, the root (1 scruple 
of the powder every 2 or 3 hours) is the principal remedy. 
But denudation of the intestines by loss of mucous mem- 
brane, and the rawness thereby created, deserves great at- 
tention ; for which the frequent use of salep-mucilage is 
the most efficient, and will often alone suffice. In obstinate CHOLERA. 
367 
cases it is best to hold to two ideas : that of weakness, and 
that of a chronic passive inflammatory state of the mucous 
membrane of the rectum. In the first, especially when ac- 
companied by lingering fever, rad. columbo, lignum cam- 
pechiense, and simaruba are most beneficial; in the second, 
injections of of a grain of sublimate with opium and 
mucilage or starch. 
Suppressed dysentery This name designates a case, when 
the dysenteric evacuations have been suddenly stopped by 
violent means, as by red wine, brandy, large doses of 
opium, producing bad attacks. They are of a double kind: 
acute or chronic. First are inflammatory or spasmodic ; 
known by violent pains, distention of the abdomen, totally 
suppressed discharges from the intestines, great anxiety, 
spasms. Here the discharge is to be restored as promptly 
as possible by oily remedies, manna, calomel, especially by 
frequent emollient clysters and cataplasms; where the cha- 
racter is more inflammatory, leeches; when very spasmo- 
dic, hyoscyamus, tepid baths. The chronic consequences 
are obstinate rheumatisms, paralysis, hydrops. Here re- 
solvents and purgatives must be administered, and the 
newly generated diseases treated at the same time. 
After every dysentery the use of bitter roborants, flannel 
around the abdomen, and careful diet are necessary. 
The cure of the symptomatic and chronic dysentery is ef- 
fected in conformity to the causes. Dysentery caused by 
worms, vide helminthiasis ; by dentition, vide diseases of 
children ; by metastases and ulceration or organic disor- 
ders of the intestinal canal, vide diarrhoea chronica. 
The first indication is always to assuage the irritation, 
and then to remove the jrritant cause. In every chronic 
dysentery we have carefully to examine, whether a fistula 
of the rectum may not be the concealed cause. 
The best preservative against dysentery is a flannel vest 
worn around the abdomen. Ripe fruit, when not eaten in 
excess, is not injurious. 
CHOLERA. 
Diagnosis. Incessant vomiting and purging, accompa- 
nied with pains in the stomach and abdomen, anxiety and 
tenesmus. Sometimes the disease is very violent. The 
vomiting and urgency to go to stool being incessant; but 
sometimes it is moderate. The severer kind is soon fol- 368 
CHOLERA. 
lowed by exhaustion, small, scarcely perceptible pulse, fits 
of fainting, coldness of the extremities, spasms, convul- 
sions. The discharged matter in the beginning consists of 
the contents of the stomach and bile (the latter is always 
present in cholera biliosn), afterwards of the watery 1} m- 
phatic fluids, the intestinal secretions, finally nothing at 
all, there being mere vomiturition and urgency to go to 
stool. There may also be cholera without any material 
evacuation (cholera sicca), sometimes only with a disen- 
gagement of air. Then it is a kind of windy colic (vide 
flatulency). 
The course is variable. Sometimes the disease is an- 
nounced by anxiety, pressure in the stomach, disturbed, 
appetite. Sometimes it suddenly breaks out, sometimes it 
is slight, less severe, less fatal (as when owing to indiges- 
tion). Sometimes, however, it is very virulent, forcible, 
rapid (fatal even within 24 hours, as the epidemic, espe- 
cially the oriental cholera). It cannot last longer than 3 
or 4 days, without ceasing or ending in death. Death 
is brought on by inflammation, or by total exhaustion of 
vital power. 
Pathogenesis. The proximate cause is a convulsive 
state, a true epilepsy of the stomach and intestinal canal, 
generally including the liver, as is evident in the cholera 
biliosa by the enormously increased secretion of bile. The 
proximate cause therefore is not inflammation, but this may 
easily become associated with it as an effect of violent 
nervous excitement. The exciting causes are : caustic 
poisons, indigestion (purely specific is the roe of the bar- 
bel), gall-stones, irritation by worms, dentition, parturi- 
tion. The endemic and epidemic causes are the most fre- 
quent : moist marshy regions (the same where dysentery 
is engendered), above all the season, when great heat of 
the day alternates with cold nights (month of August). 
The endemico-epidemic may sometimes be transformed 
into a true epidemy, and then become contagious, as in 
the oriental cholera. 
Therapeutics. Assistance must be prompt and efficient; 
for the time is short, only one or two days. The principal 
indication is: to assuage the convulsive excitement of the 
intestinal canal, cautiously however, not to suppress too 
quickly the evacuations. The best remedies for this pur- 
pose are : mucilaginous beverages taken frequently, such 
as pearl-barley, water gruel, gum water, weak chicken 
broth (Sydenham’s specific), River’s potion, small doses of 
hyoscyamus or ipecacuanha; oily injections, anti,spasmodic SUPPRESSIONS. 
369 
ointments, narcotic cataplasms, dry cups on the epigastric 
region (a very valuable means to stop vomiting), warm 
baths. This treatment is sufficient in ordinary cases. Two 
points must be well attended to : 1. The danger of inflam- 
mation. As soon as the pains become violent and burning; 
and in a youthful plethoric constitution or in an inflam- 
matory character of the epidemy, a venesection is imme- 
diately to be made. 2. The danger of exhaustion (of 
power). When the attacks do not abate under the above 
treatment, the pulse becomes small, the extremities cold, 
or fits of faintings set in, then there remains no other sal- 
vative for life but opium. It is best given in a mucila- 
ginous emulsion, in divided doses, 2 or 3 drops of lauda- 
num Sydenhami every half an hour ; it must at the same 
time be employed externally by embrocations and clysters ; 
always remembering that it is to diminish but not to stop 
the evacuations from the intestines, by which inflammation 
dangerous to life might be produced. In extreme prostra- 
tion, besides opium a strong tvarming wine must be admi- 
nistered, best old Malaga. 
For the treatment of the oriental cholera, vide cholera 
orientalis. 
TENTH CLASS. 
SUPPRESSIONES. 
Generalities. 
Diagnosis. Retention of normal secretions, the evacua- 
tion of which is necessary to health. 
Every interruption to the usual and necessary evacua- 
tions from the economy is important in its consequences, 
and claims the greatest attention of the physician. The 
more necessary a discharge is to the system, the more 
sudden and complete the suppression of it is, the more im- 
portant and dangerous will it be. The effects are always 
double : I, retention of a corrupt matter injurious to health 
(materia excrementitia retenta), hence the purification and 
integrity of the system are impeded and disturbed by the 
presence of acrid, irritant humors, the consequences of 370 
SUPPRESSIONS. 
which are deficient nutrition, dyscrasia and cachexy ; 
2, disturbance of the organic balance, and an excitement 
of an antagonistic reaction, which will produce acute as 
well as chronic morbid affections of the internal parts, and 
vicarious secretions of different kinds. In this manner sup- 
pressions become one of the most prolific and formidable 
sources of a great number of diseases, acute as well as 
chronic, and merit the greatest attention and regard of the 
practitioner. 
Pathogenesis. The cause of a retention or impediment 
to the flow of fluids, may be seated in the canal (continens); 
or be due to the contained matter itself (contention). 
The first may be a spasm, a cramplike contraction, or 
inverted peristaltic motion (as in some species of ileus) ; 
or inflamination, or the reverse of both states, an inactivity, 
atony, want of stimulus, or finally a mechanical impediment, 
organic induration, swelling, or excrescence in the vascu- 
lar membranes, which obstructs the passage of the fluid. It 
is not uncommon for all the three causes to follow in suc- 
cession, one engendering the other. First inflammation 
sets in, after its removal spasm continues, and finally, the 
long continued over-irritation and extension of the vessels 
create extreme atony and paralysis; they may even pass 
into disorganization. 
The second cause may reside in a qualitative alteration 
of the matter to be discharged ; an alteration which dis- 
qualifies it for motion (thickness or tenacity), an extreme 
over-filling; or finally a foreign body may be the cause. 
These material disorders may be consequences of the dy- 
namic impediment, so that both classes of causes united 
produce the retention. 
Therapeutics. The principal indication is: to remove the 
causes which give rise to the suppression ; that is, the in- 
flammatory state, when it is the cause ; the spasm, or 
weakness, or mechanical hinderance, when they are the 
causes. This alone will often suffice to re-establish the 
normal discharge. Should it not succeed, we must have 
recourse to means which operate locally and directly; as 
laxatives, irritatives, even surgical assistance in extreme 
necessity. 
When we are unable to restore a suppressed secretion, 
we have but one expedient left, which is to create a sup- 
plementary evacuation of a natural or artificial kind. 371 
CONSTIPATION OF THE BOWELS. COSTIVENESS. 
CONSTIPATION OF THE BOWELS. COSTIVENESS 
Obstructio alvi. Dyscopria. 
Diagnosis. Individuality is to be discriminated. There 
are men, to whom it is natural to have a stool only every 
two or three days, and without annoyance. It is, however, 
a rule of the normal state and proper to health, to have one 
stool every day. If constipation continuesfor too longatime, 
the consequences are: the iseces thicken, harden, accumu- 
late, and distend the colon; create abdominal obstructions, 
hsemorrhoidal complaints, and congestions to the head and 
chest, sympathetic disturbances and hypochondria. 
Pathogenesis. The causes are : insufficient drink (hence 
constipation is more frequent in females than in males), 
hard, heavy, dry aliments (farinaceous meals, potatoes, 
pulse, nuts, almonds, chestnuts), continual sitting, tight 
lacing of the abdomen, deficient and defective bile, espe- 
cially the habit of resisting and neglecting to go to stool. 
Therapeutics. To prevent this troublesome complaint, 
the patient must acquire and adhere to the habit of going 
to stool regularly every morning. This is more important 
than medicines, since nature thereby resumes her healthy 
order. To cure constipation, a larger quantity than usual of 
water must be drunk, or of light beer; the patient must live 
on vegetables, juicy greens, fruits, especially apples and 
prunes; avoid dry, heavy food ; take exercise, make frictions 
on the abdomen ; take remedies which promote, amelio- 
rate or replace the secretion of bile, even gall itself (fel 
tauri insip.) ; rhubarb (vide No. 192), aloes, senna leaves, 
herb, graiiolse, will prove serviceable. Purgative salts must 
not be used, for they leave a disposition to costiveness. A 
combination of aloes or scamraony, with a small addition 
of iron (No. 193 a), is worthy of notice, for iron greatly in- 
creases the efficacy of the first articles. The most innoc- 
uous and surest remedy, but which loses its power by habit, 
is senna, in pills (as No. 194), or the tea of St. Germain 
(No. 195), which is still better, since in this the resinous 
principle is abstracted from the senna leaves by the previ- 
ous digestion. Two ounces of this specific are to be in- 
fused in five cups of boiling water, and then digested for 
ten minutes in a warm place, without boiling; after this, 
the clear fluid is to be decanted from the sediment. Half 
a cup of this, for a weak stomach with a small addition of 
Malaga, will be a dose. I have seen persons who made use of it all their lives, without experiencing the least incon- 
venience, and with a never failing effect. 
In the most obstinate cases of constipation, in the utmost 
inactivity of the intestinal canal, and when all other means 
are inefficacious, there still remains one remedy which, 
according to my experience, is almost infallible, extractum 
colocynthidis composit. (No. 193 h), one grain for a dose. 
The use of Carlsbad water, which often removes this dispo- 
sition for ever, at least for a long time, is very recornmend- 
ahle ; besides injections of cold water j or, where there 
exist accumulations and obstructions, Kampf’s visceral 
clysters. Finally, nux vomica, given on the homoeopathic 
principle, and in minute doses, is very useful. 
ILEUS. 
ILEUS. 
J\liserere. 
Diagnosis. Obstinate constipation, vomiting of the food 
and drink taken, then of the gastric juices, finally of excre- 
ments, violent pain in the abdomen. 
The disease is always liable to inflammation, which brings 
on danger of life. If there is fever, a continual burning 
pain, impossibility to bear the pressure of touch, a distend- 
ed, hot abdomen, and quick, small pulse; inflammation is 
present. 
If the pain suddenly abate, followed by copious, fetid 
stools, the abdomen become tender and shrink, the pulse 
extremely small, weak, and intermittent, the extremities 
cold ; the inflammation has passed into gangrene, and death 
approaches and cannot be prevented, though the patient in 
general feels happy, and considers himself past danger ; 
when the physician must be very cautious, not to be de- 
ceived. 
Pathogenesis. The proximate cause is a stoppage, an 
interruption to the passage of the contents of the intestinal 
canal, owing either to stoppage, or to an antiperistallic 
motion having been created. This may arise 1. From & me- 
chanical impediment within the intestinal canal, as an accu- 
mulation of indurated excrements in the colon and rectum ; 
to foreign bodies, stones, kernels of fruit, worms ; to volvu- 
lus, imperforalio ani, callous or scirrhous straitening of the 
intestinal canal, especially where the colon terminates in 
the rectum ; or external to the intestinal canal, as from in- 
carcerated hernia, compressing indurations and tumors, 
newly formed ligaments. 2. From inflammation. Hence, ILEUS, 
373 
ileus is always a symptom of enteritis. 3. From irritation. 
and spasm. An accumulation of acrid bile, fermentive ali- 
ments, especially the antagonistic irritation by colds taken 
in the feet and in the abdomen, produce ileus, and render 
it sometimes epidemical ; spasm is also apt to associate 
secondarily with the other causes, and to entertain the evil. 
4. From torpor and atony of the intestinal canal, which may 
take place as a consequence of long constipation and dis- 
tention of the intestinal canal, and keep up the disorder. 
Therapeutics. In the treatment of ileus we must first 
proceed to examine whether the patient has a rupture ; the 
neglect to do so has often rendered the treatment futile. 
For when this cause exists, salvation lies only in the cure 
of the incarcerated hernia. We must not be satisfied with 
the affirmation of the patient that there is no rupture, since 
they often do not know it themselves (in small incarcera- 
tions), or are ashamed, especially females, to tell it; but 
we must examine, ourselves, all those places in which rup- 
ture can happen. 
The second is to investigate whether there exists inflam- 
mation of the intestines. He who neglects to do that, and 
prescribes strong purgatives in such cases, kills his patient. 
The signs are : a constant burning pain, great tenderness 
on the least pressure ; tense, hot abdomen, violent fever, 
red urine, thirst. Such a case is to be treated as en- 
teritis (vide enteritis), the cure of which also cures ileus. 
If neither is the case, or ileus continues after the inflam- 
mation has been subdued, the next indication is to conquer 
the stoppage, partly by irritatives which increase the peri- 
staltic motion, and partly by rclaxative antispasmodic 
remedies, to remove the obstructing contents and to re- 
store a normal direction to the intestinal action. The rem- 
edies most approved for this purpose are oily emulsions ; 
they are more effectual than the strongest drastics, and 
particularly valuable is the fresh expressed linseed oil, one 
tablespoonful every two hours or oftener. If this do not 
avail, a strong infusion of senna with sulphate of magnesia, 
and extract of hyoscyamus (I\o. 196); of this two table- 
spoonfuls may be given every hour, and after it a table- 
spoonful of linseed oil ; and in order to prevent vomiting, 
the Riverian saturation may be given intermediately. If 
th is also have no effect, we may give a tablespoonful of 
castor oil every hour, and half a drop of croton oil on 
sugar or in the form of pills ; also aloes and jalap. The 
mixture No. 197 has, according to my experience, some- 
times operated extremely well. In a spasmodic state these 374 
CHRONIC ILEUS. 
medicines may be mixed with extract, opii aquos.; an infu- 
sion of tobacco (No. 198) is still more efficacious. But 
more serviceable than all internal remedies, which very 
frequently are immediately rejected by vomiting, are injec- 
tions, administered every three or four hours. In the be- 
ginning they may be composed of sulphate of magnesia, 
infusion of senna, or castor oil ; then of two or three ounces 
of vinegar, four grains of tartar emetic ; the most effectual 
is half an ounce of an infusion of tobacco. It is true that 
the narcotic power of this remedy affects the nerves, and 
may even induce syncope, but a stool ensues during that 
fit. Also the “douche ascendante” into the rectum may 
be used ; it is effected by hanging a leather pipe of three 
or four feet in length, and filling it with warm water. 
To this treatment external applications may be added, 
as emollient narcotic cataplasms, sinapisms, cups, espe- 
cially warm half baths ; also embrocations of croton oil on 
the abdomen. Cold water used in any form (frequently 
repeated draughts of it, cold injections, and continual cold 
applications or ice on the abdomen), is here of extraordinary 
efficacy. 
Should ileus resist all these means, a venesection may 
be made, although no signs of inflammation exist. It will 
often instantly dissolve the incarceration ; it prevents in- 
flammation from setting in as an accessory, and allows the 
free use of opium and other heating remedies. Venesection 
is urgently required when, in the course of the disease, 
symptoms of abdominal inflammation appear ; such as a 
tense, gainful abdomen, very painful to the touch, small, 
quick pulse, cold extremities, thirst and red urine. 
Nor must we neglect to take the various remote causes 
into consideration ; as the arthritic metastasis, which re- 
quires venesection and a vesicatory on the abdomen ; or 
hysteria, spasm, when opium internally and externally may 
boldly be administered ; or worms, when anthelmintics and 
calomel are to be used. 
In extreme necessity, provided that no inflammation ex- 
ists, quicksilver may be tried. Half a pound of it may be 
swallowed at once, with a spoonful of oil or emulsion. 
It sometimes quickly produces an evacuation from the 
bowels. 
Chronic Ileus. 
Ileus may have also a chronic character. The patient 
has suffered a long time j has constipation, stools are forced ISCHURIA. DYSURIA. STRANGURIA. ANURIA. 
375 
from him with difficulty, by internal and external means; 
finally, they entirely cease to pass, and the usual remedies 
are unavailing. Here two causes are to be considered. 
The protracted costiveness has produced an engorged state 
of the colon by the long accumulation of hardened excre- 
ments which obstruct the passage; in this case one can 
often feel the whole region of the colon distended and 
hard ; also isolated, prominent knots and strictures, which 
are frequently mistaken for organic obstructions of the 
viscera, but which may be distinguished by their mobility 
from place to place, spontaneously or by pressure. In 
such a case, after death, the colon is found distended into 
an enormous sack, and full of excrements. The part of 
the rectum immediately below the distention, and in con- 
sequence of it, is often so contracted as to have been mis- 
taken for stricture. In such a case relief can only be had 
by a continual administration of emollient, dissolvent, 
soapy, oily injections; by the “douche ascendante,” and 
even by mechanical dilatation and gradual removal of the 
indurated faeces. 
A second case is that of an induration or scirrhosity 
formed in the rectum or colon. This is to be treated by 
bougies and other mechanical dilatations, combined with 
vigorous resolvents. It is in this very case, that we may 
resort with safety to quicksilver, and derive benefit from it. 
ISCHURIA. DYSURIA. STRANGURIA. ANURIA. 
Diagnosis. In strangury the discharge of urine is painful 
and difficult ; in dysury difficult and incomplete ; in ischury 
it is totally suppressed. When the latter species is ow- 
ing to an impediment in the passage, and is accompanied 
by swelling of the bladder, it is termed ischuria vera; 
when no urine is secreted, and there is no distention of 
the vesical region, the case is ischuria notha, anuria. 
They are, therefore, only different degrees of the same 
affection ; of which the slighter are only troublesome, but 
not dangerous. But true ischury, total retention of 
urine, ranks among the most dangerous diseases, and 
kills either by inflammation or by gangrene of the bladder, 
or by rupture of the bladder, the urine effusing into the 
abdomen (ascites urinosus). The urine is also sometimes 
resorbed into the mass of the circulation ; in this case the 
disease lasts for a long time, and the blood exhibits a urin- 
ous acrimony; there is violent itching in the skin, even 376 
ISCHURIA. DYSURIA. STRANGURIA. ANURIA. 
cutaneous eruptions and urinous perspiration, saliva and 
the like. 
Pathogenesis. The causes of ischury are : 
Spasmodic contraction of the vesical sphincter ; hysteria 
and hypochondria; nervous fever; every irritant, within 
as well as without the bladder, such as worms, metastases, 
piles, suppressed perspiration, gastric accumulations. It 
is also frequently the consequence of a previous inflam- 
mation. 
Or sanguineous congestion in the vesical vessels ; inflam- 
mation of the bladder (by all the above mentioned stimuli, 
when the irritation is increased to inflammation ; contu- 
sions, too long sojourn of the urine in the bladder ; fre- 
quently hcemorrhoidal congestion and syphilis; also ardent 
diuretics, as cantharides and savin). 
Or inactivity, paralysis of the bladder, which may be 
brought on by the causes previously mentioned, and by 
100 long retention, and thereby immoderate distention of 
the bladder, apoplexy, old age, violent commotion. 
Or finally, mechanical impediments, such as calculi 
sticking in the urethra, or sanguineous or mucous clots, 
varicose vessels, callosities and strictures, ascarides, hin- 
derances or external impediments, as scirrhus prostratse, 
polypus, prolapsus, and retroversio uteri and other tumors 
near the bladder, pessaries, most frequently the pressure 
of the gravid uterus in the last months of pregnancy. 
Anuria is sometimes caused merely by spasm of the 
renal vessels (hence it is often met with in hysterical per- 
sons) ; by inflammation of the kidneys ; also by accumula- 
tions of calculi and organic diseases of the kidneys; such, 
however, which affect both kidneys simultaneously, else 
one kidney would replace the function of the other. 
A slight degree of the disease is more frequent, and is 
due to a diminished secretion, which is particularly the 
case in old persons and in little children. It is often an 
unsuspected cause of many diseases and dyscrasias. 
Therapeutics. The treatment of strangury and dysury, 
as a symptom of gonorrhoea and vesical haemorrhoids, will 
be found under the heads syphilis and haemorrhoids. 
In every strangury, one drachm of semen lycopodii, 
made into an emulsion with mucilage of gum. Arabic and 
syrup, or in an oily emulsion, is a very salutary remedy. 
The treatment of ischury must strictly conform to the 
causes and the various characters of the disease ; what is 
useful in one case, may be injurious in another ; hence its 
recognition and discrimination is very important. ISCHURIA. DYSURIA. STRANGURIA. ANURIA. 
377 
1. The sanguine, the inflammatory, is recognized by vio- 
lent and painful urgency to urinate ; violent and permanent 
pain in the vesical region, augmented by external pres- 
sure ; distention of that region, heal and fever. rl he in- 
sertion of a catheter and a bougie causes great pain, and is 
impracticable. It is also recognized by a knowledge of the 
exciting cause, as abundant potation of wine, ardent diuret- 
ics, ha;morrhoidal congestion, external lesion. Here the 
promptest and most vigorous antiphlogosis is required, 
as venesection, leeches to the perinseum and vesical re- 
gion ; emollient clysters and cataplasms, embrocations of 
mercurial ointment, with oil of hyoscyamus and camphor; 
internally nitre and calomel. Due regard must be paid to 
the exciting cause : as to canlharides, for which oil and 
camphor are wanted ; haemorrhoids, metastases require 
anti-stimuli by sinapisms (plasters of canlharides are to 
be avoided), calheterism must be abstained from, for its 
use will increase the pain and inflammation, and bring 
no relief. But, if after a sufficient abstraction of blood, 
the urine does not come away, no time must be lost in 
administering opium with calomel, internally and exter- 
nally, especially in injections ; for the inflammatory one 
has a tendency to pass into the spasmodic state. Urine 
will flow after the administration of opium ; or we may 
now venture a use of the catheter. Warm baths are also 
serviceable. 
2. The spasmodic or erethic, is marked by the absence 
of fever, by the absence of violent pains, heat and external 
sensitiveness in the vesical region, sometimes also by 
a periodical return. In this case, antispasrnodics, espe- 
cially hyoscyamus and opium (emulsio oleosa cum opio}, 
must be given ; and externally it is to be treated by injec- 
tions, oily embrocations, cataplasms of hyoscyamus, linseed 
cataplasms, tepid sernicupia ; after these remedies, we may 
endeavor to introduce the catheter, but with caution, and 
if found difficult to pass, it will be better to desist. 
The remote cause must be duly considered. 
3. The adynamic or paralytic is recognized by the ab- 
sence of pains and the facility of introducing the catheter; 
also by the circumstance that some little urine may be dis- 
charged by external pressure applied to the bladder. The 
first thing to be attended to is to evacuate the urine by the 
catheter, once in every twelve hours, in order to prevent 
distention of the bladder, which might cause additional 
atony and hinder recovery ; or the constant application of 378 
ANIDROSIS, ISCHIDROSIS. 
a flexible catheter, which must be changed every eight or 
ten days. 
The next thing is to invigorate the bladder and its ner- 
vous system, by administering roborants and excitants 
(vide paralysis), especially arnica, cinchona, and stimulant 
diuretics, asjuniper (No. 199), turpentine, savin, cantharid. 
(No. 200), cold lotions to the vesical region and the sa- 
crum, cold affusions to these regions, to the feet, also cold 
injections, even injections of cold water into the bladder, 
electricity (sparks in the vesical region, shocks in the di- 
rection of the os sacrum towards the bladder), stimulant 
embrocations on the lower part of the spine, vesicatories, 
rnoxa on the same part. Wildungen water may be drank 
at the same time. 
It must be remembered, that these opposite states, ischu- 
ria and incontinentia urina?, may be produced by the same 
cause, paralysis, and are then to be treated alike, 
4. The mechanical obstruction requires suitable me- 
chanical and surgical aid. When the obstruction is caused 
by clots of mucus or blood, it is to be treated by bougies, 
injections; also by bougies when caused by strictures. 
Anuria is cured by removing the spasm or inflammation, 
or the mechanical or organic causes. 
ANIDROSIS, ISCHIDROSIS. 
Diagnosis. Diminished and suppressed perspiration ; 
the sign of which is a dry skin (chronic onidrosis) ; or sud- 
den suppression of perspiration by cold {acute anidrosis). 
The latter state is easily recognized ; but not so the for- 
mer; it requires the balance of Santorini, in order to 
determine the invisible increase or diminution of imper- 
ceptible perspiration. The diagnosis, therefore, depends 
upon a knowledge of the causes which have operated on 
the patient, as suppressive of the cutaneous perspiration ; 
and of the effects, especially of rheumatic catarrhal affec- 
tions. 
Suppressed cutaneous secretion is rarely looked upon as 
a disease, but it is the most prolific source of innumerable 
maladies; a fact easily explained, since there is no secre- 
tion which has so general and important, material as well 
as dynamic influence on the whole system, as perspiration 
has. 
1. Material. It is by perspiration that the greatest part MENOSTASIA. SUPPRESSIO HJEMORRHOIDUM. 
379 
of the materials of the fabric which are no longer fit for the 
purposes of life, which have become deteriorated and are 
heterogeneous to the body, and which amount to two 
thirds of all the excretions, is evacuated. Obstruction to 
this discharge, therefore, always engenders a morbific 
matter of a serous and acrid nature, which operates first 
as an irritant; but subsequently and in chronic suppres- 
sion, alters the quality of the humors, and generates a pecu- 
liar dyscrasy (the rheumatic). 
2. Dynamic. No secretory organ has so large an extent 
and so universal a nervous connection as the skin ; hence its 
vast antagonistic influence ; firstly, on the organs and mem- 
branes which have an affinity to the skin, as on the serous 
and mucous membranes, and particularly the lungs and the 
intestinal canal; secondly, as a reflex on the nervous sys- 
tem of other secretory organs and on all the other systems 
of the body. The diseases which arise from this double 
influence are: cutaneous diseases, inflammations of inter- 
nal and external parts, rheumatisms, catarrhs, blennor- 
rhoeas, nervous affections of all kinds, dropsy, pulmonary 
consumption, chlorosis, and other dyscrasias and cachexies. 
Pathogenesis. The suppression maybe acute or chronic; 
the first is brought on by the sudden influence of cold on 
a heated or perspiring body. The chronic, the impercep- 
tible diminution or obstruction of cutaneous secretion by 
too*light clothing, a moist atmosphere (moist climate, 
moist dwelling), frequent change of temperature (change- 
able climate, or an occupation which produces sudden 
changes), uncleanliness, neglected cultivation of the skin, 
unctions, suppressing external applications, particularly 
such as contain lead; also sadness, inactivity, idleness, 
apathy. 
Therapeutics. The treatment of the acute consists in 
warming the skin by clothing and baths, and by the use of 
diaphoretic remedies;—of the chronic, in exciting the 
cutaneous action, in directing the humors towards the sur- 
face, cleansing the skin, which is done by frictions and 
baths; corporeal exercise, pure, dry air, cleanly habits, 
exhilaration, activity of mind, medicines which have a ten- 
dency to the skin (diaphoretica, especially antimonials, 
vide rheuma). 
MENOSTASIA. SUPPRESSIO HJEMORRHOIDUM. 
Vide Menstrua and Hcemorrhoides. 380 
EXANTHEMATA. 
ELEVENTH CLASS. 
CUTANEOUS DISEASES. 
EXANTHEMATA. 
Generalities. 
Diagnosis. Alterations of the skin in regard to color 
or form (hair and nails included), not owing to external 
lesions. 
They appear in the following forms : 
1. Maculosa, without elevation of the epidermis (scar- 
latina, petechias, lentigines). 
2. Papulosa, with elevation of the skin, but without 
pustules (morbilli, essera, verrucas). 
3. Pustulosa, with elevation of the epidermis, empty or 
filled with a fluid lymph or pus (variola, miliaria, rubeola, 
pemphigus, scabies). 
4. Crustacea, with dry crusts, scurfs (herpes siccus, tinea, 
serpigo). * 
5. Ulcerosa, with purulent destruction of the skin (herpes 
ulcerosus, lepra, ulcera). 
These forms, however, especially those that are chronic, 
are very changeable, and liable to numerous modifications, 
which of late years have been carefully specified and gath- 
ered into a cutaneous flora of exanthemata. But these dis- 
criminations are only a kind of nosological natural history, 
and are of no practical value. The most of them depend 
merely on the individual peculiarity of the patient, are un- 
essential, and afford no indication. Therefore it is best to 
comprise them under the principal forms, as is done in the 
preceding statement. 
A more important distinction is that which belongs to 
their nature ; that is, whether they are necessarily accom- 
panied with fever or not. Some are only a symptom or 
exanthema of an acute fever (exanthemata acuta) ; others 
set in without fever, though it may accidentally associate 
with them in their course (exanthemata chronica). 
Their duration and course accordingly varies. The du- 
ration of the acute exanthemata is confined to that of the EXANTHEMATA. 
381 
fever which accompanies them, varying from seven to 
twenty-one and twenty-eight days. That of the chronic is 
indefinite ; they may last for days, weeks, months, years, 
even through life. 
Their importance and danger are not less variable. In 
the acute form, danger depends on the degree and charac- 
ter of the fever, which may render them very dangerous. 
The chronic, generally speaking, are not dangerous, but 
may become so by retrocession and metastasis, or by long 
continuance, an important disturbance in vital functions, 
nutrition and reproduction, and by bringing on a general 
dyscrasy and emaciation. 
Pathogenesis. The proximate cause is an alteration in 
the nutritive process appertaining to the skin, and which is 
generally connected with a little local inflammation. These 
diseases vary essentially, according as they may originate 
in a febrile or non-febrile state. 
1. Febrile or Acute Exanthemata. 
They are essentially and originally connected with fever 
(exanthemata essentialia, primaria) ; or are accidentally gen- 
erated during a febrile attack (exanthemata uccidenlalia, 
secundaria). 
The first form is always due to a contagion, which by its 
nature tends to the skin and creates a peculiar fever, the 
crisis of which, though imperfect, is a cutaneous eruption. 
This formation may properly be compared to vegetation: 
contagion is the seed, the fever is the process of develop- 
ment and reproduction, the exanthema appearing at the 
height and perfection of fever (the plant), the florifica- 
tion and fructification. 
Exanthematic contagion maybe of a double origin, atmos- 
pheric or organic (individual) ; or mixed (originally indi- 
vidual, but then communicative from one to another 
person). The same is true of a fever not originally exan- 
thematic. A cutaneous eruption may be developed, which 
exhibits a contagium exanthematicum. Every fever, ac- 
companied by an exanthema, may become contagious. 
In the second form, that of secondary or accidental 
exanthema, the eruption is not a necessary and essential 
effect of the fever, but arises from accidental, internal or 
external causes. The principal causes, by which an erup- 
tion may be created in every fever, are : 
Heat, which promotes all kinds of vegetation, and this 
so called animal vegetation also. Hence, every high de- 382 
EXANTHEMATA. 
gree of fever predisposes to eruptions by the increase of 
animal caloric which accompanies it ; but a hot regimen, 
feather beds, stove heat, heating medicines, more surely 
do so. By immoderate warmth every febrile patient is 
transmuted into an organic hot-house. 
Dyscrasia, acrimony of humors, above all the gastro-bil- 
ions (as when evacuants have been omitted in gastric 
fevers), the putrid disposition to decomposition, the rheu- 
matic, catarrhal, arthritic. 
Impure, confined air. 
Cutaneous irritation. It may be local or sympathetic. 
The first is caused by rough, woollen, unclean clothing, 
diaphoretics, and applications which irritate the skin. Of' 
the second class are verminous and other gastric irritations. 
It may depend on the season and local conditions, on the 
situation of the residence, the mode of living, atmospheric 
and epidemic constitution, and therefore be temporary, 
endemic, epidemic. Even medical treatment, the method 
of cure contributes to produce it; and it cannot be denied 
that, whilst the diaphoretic and heating method prevailed 
in fevers, purples, petechise and other eruptions appeared 
more frequently than at the present time. 
originate always in weakness or in irritation of the skin. 
Three points must ever be kept in view : 1. The skin is 
the intermediate organ between general or dead and indi- 
vidual animated nature, the boundary line between death 
and life. It is constantly exposed to the noxious influence 
of the first—the dead chemismus; between which and the 
living there is a perpetual struggle. The former may 
easily preponderate in the reproductive chemistry of the 
skin, and engender an abnormal vegetation, a bastard or- 
ganization, which shows itself in the form of exanthema. 
2. The skm is the most general, and the most powerful se- 
cretory and excretory organ of the system, the function of 
which is inseparably connected with life and circulation, 
and cannot be interrupted for a moment without detri- 
ment. It may therefore readily become the receptacle of 
injurious internal morbific matters, and is used by nature 
for their expulsion. 3. By means of the nerves it has a 
verygeneral and close connexion with the whole organism ; 
hence it may be morbidly affected by the irritation of any 
internal part. This accounts for the frequency of cutane- 
ous diseases and their vast influence on the whole system. 
The remote causes of exanthema are the following : 
Chronic Exanthemata EXANTHEMATA. 
383 
First of all is uncleanliness and neglected care of the 
skin ; hence cutaneous diseases are more common among 
the lower classes and among uncleanly nations (the Rus- 
sian protects himself against them by his steam bath); 
chronic suppression of the cutaneous secretion by moist 
air, moist dwelling, moist climate, bad diet, acrid, salt, 
smoked, corrupt fat aliments, and cheese eaten too fre- 
quently, stimulating drinks, too rich food, exuberance of 
humors; whence are generated crudities not only in the 
first but also in the second passages (that is, matters not 
properly elaborated and assimilated into the blood ; whence 
they are deposited as acrimonies in the skin—a frequent 
occurrence in children); coniagia, the scabious, the syphi- 
litic; dyscrasias of all kinds, especially the scrofulous, 
arthritic, scorbutic, atrabilious; sympathetic irritations, 
gastric accumulations, infarcts, worms; antagonistic irri- 
tation of the skin, metastases to the skin, by suppression 
of other secretions, as that of the intestinal canal, liver, 
kidneys, of menstruation, haemorrhoids, or morbid secre- 
tions and crises, of blennorrhoeas, arthritic crises, dysen- 
tery, intermittent fever ; quantitative disorders, plethora, 
over-irritation of the skin as well as weakness, deficiency 
of vitality in it (the first is met with in children and young 
persons, the latter in old people, and is often the only cause 
of cutaneous diseases); metallic poisonings, especially 
chronic ones, by mercury, lead, arsenic; local influence of 
corrupt and noxious irritant substances, expired air, new- 
built rooms, great heat, too warm regimen and clothing, 
rough woollen clothing on the bare skin. In protracted 
cutaneous diseases one more cause is to be mentioned, one 
which renders the evil obstinate, it is habit. Nature has 
finally become accustomed to the eruption, the skin has 
become the excretory organ of morbific matters which 
tend thither, and which now rank among the necessary 
secretions. Finally, also the complete destruction of the 
skin may become a cause of their continuance and incu- 
rabiiity. 
Disposition to eruptions is owing to a psoric constitu- 
tion, a proneness to cutaneous diseases, which is either 
congenital (prevailing through whole families) ; or acquir- 
ed, most commonly by too warm regimen, in the first years 
of life, at both extremities of life childhood and old age. 
In either case the secretion of the skin is altered, and 
thereby a disposition to cutaneous diseases is imparted; 
old age alone often generates obstinate cutaneous diseases, 384 
EXANTHEMATA. 
which are nothing else than incipient dying away (rnortifi. 
cation) of the skin. 
Therapeutics. The principal thing is to discover whe- 
ther the exanthema is the product and concomitant of an 
acute fever, or not. 
In the first case fever alone is the object of treatment, 
which must be adapted to its variety ; this cured, the erup- 
tion disappears. However, the difference in the nature of 
the eruption, whether it be contagious, symptomatic, or 
critical, must be taken into consideration, and requires a 
corresponding modification in the treatment. 
In the second case, in chronic exanthemata, the chief 
indication is: to restore the normal function and organi- 
zation of the skin. This can be effected by general as well 
as by local means; but in pursuing a merely local treat- 
ment, we ought to remember, that, when the cause is ge- 
neral and deeply seated, the cure is never radical and last- 
ing, but the evil will ever and anon return, or, what is still 
worse, is followed b‘y shifting to internal noble parts. A 
radical cure of cutaneous diseases, therefore, has the fol- 
lowing rules. 
1. Search for the general and remote causes and remove 
them ; therefore, remove dirt, bad diet, the dyscrasias that 
cause the disease (vide dyscrasia) ; abdominal accumula- 
tions, htemorrhoidal and menstrual disorders; in plethora 
and hypertrophy of the skin, an abstractive treatment, de- 
rivation ; in vital weakness and atrophy of the skin (as in 
exanthemata of atrophic children, and persons poor in vital 
powers by want of aliments and old age), restorative treat- 
ment, nutritive food. This often suffices for a complete 
cure ; the eruption disappears without any use of local re- 
medies. 
2. If this do not succeed, we must presume that the evil 
has already become idiopathic and independent in the skin 
itself; and then the treatment must be directed against the 
proximate cause, the abnormal slate of the skin itself,—the 
direct treatment of cutaneous diseases. It comprises two 
things: a, the use of such universal and internal remedies, 
as improve the condition of the humors in general, and are 
possessed of a power tending to the skin and ameliorative 
of its action; the application of local means, which 
have the same effect. They are : pure dry air, exercise, 
great cleanliness, frequent change of linen, washing, tepid 
baths, promotion of all secretions, especially of that of the 
skin, purgatives frequently repeated, the antipsoric speci- EXANTHEMATA. 
385 
fics, as sulphur, antimony, sethiops, Plummer’s powder, gua- 
iac, root of sarsaparilla, bardan, carex. arenar., lapath. acut., 
taraxac., graminis, stipites dulcamara?, cort. ulmi. To these 
means, when the general treatment fails, we must add such 
local ones as are able, by their dynaraico-chemical power, 
to remove the vicious organization of the skin, and stop 
the morbid secretion. They attain this end by suppressing 
the vital action (lead, vitriol, alum, astringents), or by 
qualifying it. They first are risks, since they are apt to 
produce metastases, and must on that account be avoided; 
the latter are preferable. We may use for that purpose 
the most simple and innocuous, as soap and lime-water, or 
lime-ointment; also all medicines mentioned above, mer- 
cury, sulphur, antimony ; likewise graphites, baryta? mu- 
rias, calx chlorin., coal in the form of lotion and ointment, 
the previously named depurative vegetables in decoctions, 
ointments, and baths. Simply washing and bathing are often 
alone sufficient and are the best means, they may 
be rendered more efficacious by 7 the addition of soap, culi- 
nary salt, sulphur, cort. ulmi, sublimate. 
3. When the disease is of a mere local origin, it maybe 
treated in the beginning only locally, but when protracted 
it may have generated a general dyscrasia, or be sustained 
by complication and habit, and requires a general treat- 
ment. 
4. On the other hand, a cutaneous disease, sprung up 
from general causes, may become merely local, and cannot 
be cured but by a concentrated application of local re- 
medies. 
5. In very obstinate cutaneous diseases two indications 
are recommendable for a cure: a, to investigate whether 
it is not dependent on some complication that keeps it up; 
b, whether the cutaneous disease has not become a natural 
and necessary habit of secretion. In the first case the 
complication must be remedied ; in the second derivatives 
and supplementary actions must be created ; and especially 
purgatives and artificial ulcers resorted to. 
6. It is advisable in the treatment of every protracted or 
habitual cutaneous disease, to keep open a fontanel for 
some time, and even after it has disappeared, in order to 
prevent the injurious consequences which are apt to arise 
from the suppression of a habitual secretion. This is the 
more necessary, when the cure has been performed by 
local remedies. 386 
SMALL POX. 
SMALL POX. 
Variola. 
Diagnosis. Fever, at the end of the third day of which 
red spots appear ; they grow larger during the next three 
days, and form pustules, then stand suppurating for three 
days more, begin to dry oti the seventh day of their break- 
ing out, (tiie eleventh of the disease,) and form scabs. 
Such is the course of each variolic pustule. But as new 
pustules continue to break out during the three first erup- 
tive days, and as each pock runs through its own periods, 
the whole eruptive stage lasts three days longer, so that 
the general desiccation happens only on the fourteenth 
day. 
This is the image of the normal, simple (benign) small 
pox. It cannot be mistaken. It can be confounded only 
with one of its varieties (varicella); a mistake which is 
injurious, and to be avoided only because it leads the indi- 
vidual to believe that he is safe from future infection, 
while he is not. 
Course. 
.The disease passes through the following stages : 
Stadium infectionis (communication of the virus). It is 
imperceptible, for the virus is still latent, without reaction. 
It may last seven days (as we see in inoculation), but may 
be fourteen days and longer in the natural infection. 
Stadium irritationis s. febrile. The small pox fever is 
mild in the commencement, but increases from day to day 
until the fourth, when the eruption appears. It is a f. conti- 
nua remittens. It is distinguished from other fevers by the 
following peculiar symptoms, which wfill enable us, even in 
this period, especially if variola is then prevalent, to say 
that the disease is small pox, which is of importance on ac- 
count of the treatment. Nausea, vomiting, putrid odor of the 
breath and urine (peculiar to this exanthema), epistaxis, 
headache, which in adults increases to delirium, even to 
furor, in little children to epileptic convulsions, colic, pains 
in the back. 
Stadium eruptionis et florescentice. At the end of the third 
febrile exacerbation, the small pox commences to break out, 
first on the face, the day after on the hands, the third day 
on the feet and the rest of the body. They appear first as SMALL POX. 
387 
small, red points (stigmata variolarum), but increase every 
hour in extent and elevation. As early as the first day vve 
may perceive, on close examination, a little knot, like a 
grain of millet, in every stigma (the pock to be), and there- 
by distinguish the small pox from spots of measles, pete- 
chias, and other cutaneous diseases. This stage lasts three 
or four days, when new pocks continue breaking out, so 
that the patient always has pustules of three dates, each of 
which observe this measure of time in all the following 
changes. Thus, the pustules on the face are in a state of 
suppuration, while they are only forming on other parts, 
and dry while the latter are suppurating. As soon as the 
eruption appears, in mild variola, the fever ceases, and the 
patient often feels quite well, except his suffering from the 
local irritation of the pustules. 
Stadium suppurationis. The epidermis rises up and forms 
a pustule, small at first, depressed in the centre, and filled 
with a watery fluid. It gradually increases, grows elevated 
and filled with a yellowish pus, so that a perfectly formed 
pock appears as a convex, yellowish pustule, filled unto 
bursting, and resembles a split pea. This period, too, lasts 
three or four days. During it the following symptoms 
usually take place : fever, called secondary or suppurative ; 
swelling, which generally accompanies the local suppura- 
tion, appearing first on the face, and when there are many 
pustules, the head is swollen like a deformed ball; the eyes 
are completely closed by the swelling of the lids 3 it then 
attacks the hands, at last the feet; salivation. 
But all these accidents depend on the number of pus- 
tules, for where there are but few, and they are benign, 
the suppuration goes on without any of them. 
Stadium exsiccationis. The pustules dry and form scabs in 
the same order as they broke out. This period lasts three, 
four, in many cases eight days altogether ; single pocks 
may subsequently suppurate even longer. The scabs loosen 
slowly, and leave red spots for a long time, generally also 
cicatrices. The incipient exsiccation of the face is the 
most dangerous period of the whole disease. The most 
fatal issues then ensue, either by a putrid dissolution, mor- 
tification of the pustules, haemorrhages, or local inflamma- 
tion of noble viscera (as of the lungs, the brain, the abdo- 
men), or by nervous fits and convulsions. 
Bad consequences and subsequent diseases are very apt 
to remain. They are : disfiguration of the face by cicatri- 
ces, which often totally change the physiognomy, blind- 388 
ness by destruction of the eyes, chronic ophthalmias, entire 
exhaustion of strength and humors, emaciation, pulmonary 
consumption, caries, chronic ulcers. 
We distinguish variola, discretes and confluentes. The 
first, when the pustules appear single, separate from each 
other ; the latter, when they break out in groups, and arri- 
ving at maturity, flow together into great suppurating sur- 
faces. 
SMALL POX. 
Form and course may become subject to important anom- 
alies by complication with other fevers (as the inflammatory, 
nervous, putrid, gastric). They are :in the stad. eruptionis, 
the pustulesappearall atonce in great numbers or in groups, 
or come out irregularly, tardily, interruptedly. The fever 
continues after the eruption, the pustules form imper- 
fectly, or are stopped forming ; they appear depressed 
(without areolas), watery (crystallines, lymphaticos), empty 
(siliquoscc), of a false color, filled with blood (sanguinece) ; 
during the suppuration, renewal of the fever 5 the pustules 
become suddenly depressed, and so does the swelling in 
the face ; the exsiccation comes on too quick, too early, 
and too general. 
This complication and anomaly of small pox is called 
malignant in antithesis to the simple, mild {benignas). 
Small pox is one of the most dangerous, painful and 
loathsome, even hideous diseases which we know of. It 
can transform the healthiest person within eight days into 
a putrescent, deformed, stinking corpse, which alone shows 
its foreign and tropic character. 
The danger depends especially on the number of the pus- 
tules, particularly on the face (the more, the greater the vir- 
ulence) ; on the complication (the more simple, the better), 
on the age (more perilous in adults than in children, except 
in the period of dentition), on the general constitution. It 
is always a milder disease in the beginning and at the end 
of an epidemy, than in the middle of it. Convulsions pre- 
vious to their breaking out are not dangerous, but are most 
dangerous afterwards, during exsiccation. An eruption of 
a great many pocks setting in suddenly all at once, and 
gathered in groups is dangerous and ominous. The same 
is true of depressed, pale, or badly colored pustules; still 
worse are sanguineous pocks; worst of all, is evacuation 
of blood by urine and stool during the exsiccation. 
Pathogetiesis. Proximate cause is infection by the con- 
tagium variolosum. The whole disease is nothing else than 
a poisoning process, created on one hand by the virus and 389 
its reproduction and multiplication, on the other hand by 
the reaction of the organism endeavoring to assimilate and 
expel it. 
1. The variolous virus has the following properties : it 
has been known in Europe only since the seventh century, in 
America since the fifteenth, and in Iceland not earlier than 
the eighteenth century, its origin is purely organic, not 
atmospheric; that is to say, it can only be generated by 
the living body, and after previous reception of the germ 
(infection). It is not communicated by the atmosphere, 
but only by contact, either of the patient himself or some 
solid body infected with it ; in these ways it may be pro- 
pagated for hltndreds of miles ; though the immediate 
atmosphere of the sick also is infective. It can produce 
its effect only once ; that is, create one reaction in the 
same individual, twice in very rare cases. There are at- 
mospherical constitutions, which favor its reception and 
reproduction, and vice versa; hence the disease may pre- 
vail sometimes epidemically, sometimes only sporadically, 
sometimes it does not at all appear for years. 
2. The reaction of the system against the variolous virus, 
the poisoning process, the internal disease, comprises two 
things: the poisoning: of the whole system, accompanied 
by a multiplication and reproduction of the virus ; and the 
irritation of the nervous and sanguineous systems thereby 
created (the variolous fever), also the effort of the organism 
to assimilate and expel it. This internal process continues 
during the whole course of the disease, suffering various 
modifications, which constitute the different stages, 
a. Communication of the virus. It is yet dormant, not 
yet vivified by the reaction of the living oro-anism. 
b. Perception and reaction of the system, manifested by 
fever (stad. irritationis). This is the very period in which 
the virus is reproduced and multiplied in the body ; and 
that one in which the reaction of the organism prepares the 
crisis which follows. 
SMALL POX. 
c. Elimination and deposition of the virus into the skin. 
This is a crisis, though an imperfect one—metastatic. 
Simultaneously critical urine and perspiration. By this, 
in benitrn variola, the internal disease is terminated. Fever 
O / \ 
ceases, appetite and digestion return. 
But when the number of pustules is very great, a new 
disease follows; the secondary or suppurative fever. Its 
causes are : the violent inflammatory cutaneous irritation 
accompanying the numerous little abscesses in the skin, 
the new poisoning and infection brought on by the absorp- 390 
SMALL FOX. 
tion of the pus and the suppression of perspiration, causing 
an accumulation of acrid serous humors ; hence the swel- 
ling and the salivary flux. The character of this new 
disease is therefore a mixed one and very malignant; partly 
inflammatory by the inflammatory irritation, partly ady- 
namic by the exhaustion, partly putrid by the admixture of 
purulent and contagious matters. 
d. Termination of the crisis, dying away of the conta- 
gious exanthematic efflorescences, exsiccation. 
It is at this period, in cases when the pustules have been 
very numerous, that life is most endangered by a retroces- 
sion inwardly of the virus which was hitherto confined, to 
the skin, and its attacking noble viscera. 
Therapeutics. The fundamental idea here is: respicefe- 
hrem, regarding at the same time the peculiarity of the 
variolous contagion. The treatment, therefore, varies as 
much as the fever which accompanies it does. However, 
there is one thing which never varies, because the nature 
of the variolous contagion essentially requires it, and it is 
indispensable in the treatment ; it is—cold, and fresh air. 
It is incredible what may be accomplished by these natural 
agents in this disease, partly to diminish the reproduction 
of the poison and the multitude of pustules, partly to as- 
suage the dangerous attacks inherent to this plague. We 
must consider that the patient is immersed in a poisonous 
fermentation which cold can decrease, and warmth aug- 
ment ; and at the same lime that he is surrounded by 
a cloud of poisonous vapors, the reaction of which on 
the organism is most hostile and destructive, and which 
therefore ought continually to be dispelled and supplied 
fly a constant renewal of fresh air. The experience of all, 
and also mine, have fully confirmed this great power, and it 
is certain, that a warm regimen and confined air alone 
suffices to render the mildest small pox malignant. 
The modern treatment of this disease is advantageously 
distinguished by this, that it tends to decrease the repro- 
duction and quantity of the virus ; whereas the old faulty 
method was only calculated to throw it out, by which the 
internal poisoning was increased. 
Special Treatment. 
1. Stadium irritaiionis. This stage is the most impor- 
tant, and must be turned to profit in order to restrain the 
generation of too much virus in the system. Very much 
may be done in the first and second stages towards arrest- SMALL POX. 
391 
ing an excessive formation of matter, and thereby dimin- 
ishing the violence of the disease. The principal means for 
attaining that end are : cold and a moderate use of calomel; 
for children one half to one grain, for adults two to three 
grains, several times a day. The next thing is to prevent 
complications, whi<?h is to be done by cool regimen, free 
air, keeping out of bed as much as possible, discarding fea- 
ther beds, by cold washing of the face and eyes, cleansing 
the first ways by an emetic and cooling laxatives (vide No. 
245 a.), (for children in the beginning, as much as will pro- 
duce several stools ; at a later period of the disease, in 
such doses as will give two fluid evacuations a day), and 
venesection, if the fever be violent or the patient young 
and plethoric. 
Convulsions occur very frequently in children. In gen- 
eral they require no other treatment than exposing the 
patient to the influence of cool, fresh air near an open win- 
dow. This will act like a charm in removing them. Injec- 
tions are also useful. 
Violent delirium, furor in adults, requires venesection, 
mustard plasters on the calves of the legs, foot baths, in- 
jections, cooling purgatives. 
If, in children, the convulsions and other nervous attacks 
continue, and that in the beginning the eruption comes and 
goes (eruptio difficilis), other causes are in operation, and 
the treatment must accordingly vary. We distinguish the 
following cases: 
The child’s face is pale, its extremities are rather cool 
than warm, and the urine is pale. This is merely a nervous 
condition ; for which tepid baths, injections, zinc along 
with musk, and sinapisms to the soles of the feet are the 
best remedies. 
Or gastric signs may be present, and the cleansing of 
the first ways has been neglected. It is this that causes 
the spasm and restrains the eruption ; emetics, purgatives, 
and injections best promote the eruption. 
The same is true in regard to a verminous complication, 
for which calomel and milk injections are particularly 
recommendable. 
Or finally, the convulsions having ceased, the child is 
soporous, its face is red and forehead hot. In such a case 
inflammatory irritation of the brain exists, and inflamma- 
tory irritation restrains the eruption. The application of 
a few leeches behind the ears and cold washing of the 
forehead, along with internal cooling remedies, will best 
remove the spasm and facilitate the eruption. 392 
SMALL POX. 
The same considerations must be observed in the deli- 
rium and furor of adults, which arises from the same 
causes. 
Particular attention is due to the eyes, in order to pre- 
vent pustules forming there ; for this purpose cold lotions 
and the frequent application of camphorated rags is ser- 
viceable. Even stigmata already formed may be dispersed 
by dropping weak lead water on them, 
2. Stadium, eruptionis. 
If the treatment previously advised has been complied 
with in the first stage, nothing else is to be done during 
the eruptive days. In benign pox, the cool regimen and 
No. 215 a. must be continued. But if the first stage has 
been neglected, and the same indications are still present, 
the necessary remedies, emetics, even venesections in 
adults are called for. In complicated small pox the treat- 
ment of the complicated fever is to be continued. 
3. Stadium suppurationis, suppurative fever. In mild, 
discreet small pox nothing is needed but a continuance of 
the regimen and remedies already advised. 
But when the pustules are very numerous and confluent, 
when the disease is very complicated, when a new disease, 
that is, the suppurative or secondary variolous fever springs 
up, when it is of a mixed and malignant character ; the case 
claims the whole attention of the physician on account of 
its fatality. The indications are : to mitigate the inflam- 
matory cutaneous irritation, to purify the blood of the 
absorbed purulent and retained perspirable matters, to cor- 
rect the putrid disposition of the humors. The first will 
be better and more promptly attained by opening the pus- 
tules by means of a broad vaccinating needle, by which 
the resorption of the pus will be diminished. When there 
is violent pains and inquietude, a moderate dose of opium 
is to be given in the evening. If the pustules refill, they 
must be opened again. The second indication is fulfilled 
by drinking largely of cooling acid beverages, and by pro- 
moting the intestinal and urinary secretions, since that of 
the skin is closed. The third end is accomplished by mix- 
ing sulphuric acid in the drinks. But above all, the utmost 
cleanliness, constant renewal of air, daily change of linen 
and bedclothes are necessary. 
Salivation is to bo entertained by drinking abundantly 
of cold beverages. When it is suddenly suppressed, it may 
be re-established by warm vapors, emollient gargles, and 
fomentations around the throat ; in attacks of suffocation, 
a vesicatory on the chest will be found serviceable. The SMALL POX. 
393 
eyes are closed by the swelling: which accompanies this 
stage ; the same cause and internal pustules close the 
throat. Against the first nothing can be done but foment- 
ing and washing these organs with tepid milk ; against the 
latter, injections of emollient decoctions may be used. It 
often happens during this period that a complication which 
was hitherto imperceptible, becomes clearly apparent ; in- 
deed, it is often only now that fever assumes a complicated 
character. This, in most cases, is an inflammatory move- 
ment recognizable by intense redness of the variolous are- 
olas (halones), a hard pulse, heat, thirst, and the local 
inflammations of the Jungs, brain, or abdominal viscera. It 
calls for vigorous antiphlogistics, calomel, leeches, vesica- 
tories, even for venesection in adults, especially if this has 
been previously omitted. If the complication be nervous, 
which is known by the pustules being flat, limpid, empty, 
the areolas absent, the skin pale and cool, and the swelling 
of the face imperfectly formed, and by a spasmodic trem- 
bling, opium is the principal remedy, since it diminishes 
sensibility and spasm, strengthens the vascular system, in- 
creases the impulse to the skin, and specifically promotes 
the suppurative process, it therefore unites all the requisite 
qualities needed in this case. It may be combined with 
calomel, which, by its specific power as an antidote, weak- 
ens the poisonous property of the variolous virus which 
now attains its highest degree of malignancy ; recourse 
may also be had to musk, camphor, arnica, a warm bath of 
28° Reaumur (63° Fahrenheit), sinapisms, vesicatories, even 
to embrocation of mercurial ointment. In the putrid (com- 
plication), which is marked with discolored, bluish, brown- 
ish pustules, intermixed with petechise, cadaverous fetor, 
tendency to gangrene, confluent variolous ulcers, which 
often cover the whole body and transform the patient into 
a putrid mass of flesh, with hsemorrhages from the nose, 
mouth, intestinal canal, kidneys, and the pulse extremely 
small ; the most vigorous application of cold and the 
excitant, antiseptic method is to be resorted to. Ice- 
cold air incessantly renewed, cold affusions, wrapping 
the body in cloths saturated with camphorated vinegar, or 
camphor dissolved in the yelk of eggs; wine, sulphuric 
acid, alum, cinchona, serpentaria, camphor internally, have 
sometimes procured salvation, when all seemed despaired 
of. Finally, a gastric complication manifests itself, for 
which evacuants, especially the laxative, are of the great- 
est service ; matters evidently purulent, are frequently thus 
discharged. 394 
SMALL POX- 
Sudden exsiccation, abatement of the facial swelling. This 
is the most dangerous occurrence in the whole disease, 
and is generally a signal of death. The pustules in the 
face suddenly and prematurely lose their redness, sink in, 
become dry, and the swelling of the face also disappears. 
Art must now apply and unite all that has a tendency to 
raise the sinking vital power, to increase the impulse of 
the humors to the periphery, and to prevent a metastasis 
to noble viscera, which would certainly prove fatal. For 
this purpose, sinapisms, wrapping the hands and feet in 
emollient warm cataplasms, sharpened by mustard, wine, 
opium, with calomel and camphor, must be used. 
4. Stadium exsiccationis. 
The principal indication is to purify the humors of the 
remaining variolous virus, and which have been increased 
by resorption of pus. As the skin is inaccessible and 
closed, there remains no other way than by the secretion 
of the intestinal canal and the kidneys. Purging, therefore, 
is the principal thing to be done ; indeed nature sets the 
example by a voluntary diarrhma, which sometimes carries 
off matter evidently purulent. At the same time, purifying 
beverages, as whey, Sellers wrater, decoction of radix gra- 
minis, althsese and diuretics (spirit, nitri ajther.) must be 
abundantly used. Gentle cathartics must be continued for 
three or four days, and even repeated for turn or three days 
more, according to the quantity of pustules. The purga- 
tives are best combined with small doses of calomel. This 
is all that need be done in mild small pox. But in compli- 
cated, malignant variola, the previous strengthening, ani- 
mative method of cure must be continued, especially the 
use of cinchona. It may also happen, in a sudden, prema- 
ture exsiccation, that a congestion of blood to the brain 
and lungs endangering life, may take place ; it is recog- 
nized by a soporous, apoplectic or suffocatory state. This 
requires a prompt abstraction of blood as the only salva- 
tive of life. 
Requires free air, baths, blood-purifying beverages, mild 
nutriment; animal food, which is apt to produce melastases, 
must be delayed. 
When a patient survives the highest degree of malignant 
small pox, his condition is deplorable. There is no malady 
which is capable of exhausting the humors and strength of 
the body within so short a time (a fortnight), and of im- 
Subsequent Treatment, VARICELLA. 
395 
pregnating the system with as poisonous a matter as small 
pox. The constitution wants an entire revival and resto- 
ration. 
VARICELLA. 
Variola Spuria. 
Diagnosis. Pustules sometimes small, and perfectly sim- 
ilar to genuine small pox; sometimes they are found only 
on single parts, sometimes everywhere. They break out 
after a febrile commotion of twenty-four hours, which is 
in some cases very slight and scarcely perceptible, and in 
others violent, and increases to delirium. Some pustules 
form within the first twenty-four hours, and dry up in 
twenty-four hours more ; but a few single pustules will 
continue to suppurate for a longer time. 
The distinction between this and genuine small pox, 
therefore, consists neither in the form, nor in the fever, 
which sometimes is very slight in the genuine, and violent 
in the spurious, according to variety of constitution ; but 
merely in the quickness of its course. In the genuine va- 
riolous disease, there are three days of fever before the 
eruption; in the spurious only one day; in the genuine 
there are three days for suppuration, in the spurious one 
day ; the same proportion for exsiccation, so that the gen- 
uine small pox completes its course within nine or twelve 
days ; the spurious within three or four days. 
Life is never endangered by this disease. 
Pathogenesis. The cause is a contagion similar to vari- 
ola, but much weaker and essentially different ; it may be 
communicated by inoculation, as the former, but it does 
not protect against variola ; one may have had varicella 
and be still subject to variola, and vice versa. Thus, du- 
ring the period when the small pox inoculation prevailed, 
it has happened through want of discrimination, that the 
spurious disease was inoculated instead of the genuine, 
and proved, of course, no protection. Varicella appears 
often before, during, and after a variolous epidemy, but 
often also independently of it. 
Therapeutics. Nature makes the cure. There is rarely 
need for art to interfere ; except at the end, and when the 
suppuration of single pustules lasts too long, a purgative is 
recornmendable. 396 
VACCINELLA. 
COW POX. VACCINATION. 
Vaccinella. 
Vaccination is one of the greatest and most salutary dis- 
coveries of modern times. 
Protection from small pox may be attained in two differ- 
ent ways; either by avoiding the virus, separation ; or by 
annihilating the susceptibility to it. Tne first is totally 
impracticable on account of the intercourse of mankind, 
and the impossibility there is to avoid infected substances, 
which are so without our being able to perceive it. There- 
fore there remains only the second protective method, 
annihilation of the susceptibility. An endeavor to attain 
this end was made by the artificial inoculation of the small 
pox itself; for this disease generally has the peculiarity of 
annihilating for ever a future susceptibility, and experience 
had taught that artificial infection, the patient being prop- 
erly prepared, was less dangerous than the natural one. 
But there remained still some danger (one fatal case in 
five hundred), besides a perpetuation of the variolous virus. 
In the year 1769 it was discovered in Germany, that the 
pox communicated to men from the udder of cows was a 
protection against a future infection of small pox; and in 
1798, Edward Jenner of England, made the first trial of 
vaccinating the human species, carrying in this way the 
discovery into practical use. It will easily be conceived 
how superior this vaccination is to the inoculation of hu- 
man small pox, since there is never any danger from it, 
and man escapes a formidable malady by undergoing an 
insignificant, often a scarcely perceptible cutaneous affec- 
tion, and by which he escapes a most hideous disfiguration. 
Vaccination has since been spread, not alone throughout 
Europe, but throughout the world, and in many countries 
it is enforced by legal enactments, which at the same time 
strictly prohibit the inoculation of human small pox. 
The operation of vaccination is very simple and easy. 
The principal care is to obtain genuine and perfect cow 
pox, and to watch that it turns out so, for it is subject to 
degenerate and become spurious, in which case it loses its 
protective power. 
The following points are to be complied with for that 
purpose. 
1. Selection of the vaccine matter. The lymph must be 
taken as soon as it is generated, and while it is yet pellu- VACCINELLA. 
397 
cid ; as early as the sixth or seventh day after vaccination. 
The earlier it is taken, the more infectious it is, and the 
more sure and protective will be its effect. When it has 
become yellowish and puslike, it has lost its power. We 
must also be careful that it is genuine, and that the person 
to be vaccinated be healthy. 
2. Vaccination. The principal condition for obtaining 
perfect and protective virus consists in transferring the 
lymph directly from one living person to another. A broad 
and slightly concave, very sharp needle is to be insinuated 
into the pustule, and becomes charged with the virus. 
Being so prepared, we make with it three or four punc- 
tures in each upper arm of the person to be affected. 
These punctures are made by passing the instrument be- 
tween the epidermis and the cutis, so that only a little red 
spot appear, but no bleeding follow, for this would wash 
away the vaccine matter, and thereby render the operation 
fruitless. We are next to cover the spot with a small 
piece of linen, in order to prevent it from being rubbed off, 
and this completes the operation. It may be done at any 
season and at any age, except in the two first months of 
life, for as yet the skin is too imperfectly organized, and an 
imperfect pock is apt to form. 
3. The phenomena which follow the operation are to be 
observed, in order that we may be convinced of the genu- 
ineness of the protective pox, and the protective quality of 
the generated pox. 
The diagnostic phenomena and the course of genuine 
protective pox are as follows: 
For the first two or three days after the operation no 
alteration is perceived in the vaccinated spot; on the 
fourth day it appears red and somewhat elevated, on the 
fifth day it grows still more elevated, and on the sixth a 
small pustule filled with watery lymph is evident. This 
pustule continues to increase in size on the seventh and 
eighth days, but more in breadth than in height. It attains 
a diameter of two, sometimes of four lines; is surrounded 
by a red inflammatory halo of several lines in diameter, 
and fills with a watery lymph of a bluish cast. On the 
eighth day it commences to assume a yellowish color, to 
grow thicker and purulent. The axillary glands swell a 
little, but not always; slight febrile motions are manifest 
in the pulse, by an increased warmth and a sensation of 
fatigue. In adults the irritation is sometimes more vio- 
lent. Appetite and digestion remain generally undisturb- 
ed. Only in some cases a transient diarrhoea and vomitino- 398 
VAKIOLOIDES. 
sets in. On the eighth, ninth, or tenth day a new peripheric 
inflammatory redness around the pustule is exhibited, ex- 
tending several inches, even sometimes occupying the 
whole upper-arm, and which causes more itching than pain. 
This lasts for two or three days. The pustule then dries 
up, and changes into a dark brown scab, which loosens 
after eight or more days. Now the disease is at an end. 
Generally, as many pustules as vaccinated spots are gene- 
rated. But sometimes after the eighth day little red pus- 
tules are observed also on the rest of the body, which how- 
ever disappear after a few days. No subsequent malady 
takes place; only a pale color, and sometimes an insignifi- 
cant miliary-like eruption is generally observed for some 
weeks longer. 
The imperfect, the spurious, non-protective cow pox is 
distinguished by the following signs: premature eruption 
(already on the third or fourth day after vaccination a pus- 
tule raises), the form of the pock is not flat and depressed 
in the middle, but convex and quite filled ; want of the se- 
condary peripheric redness around the genuine vaccinated 
spot on the eighth or ninth day, which is the chief sign of 
a general infection and of the protection against the human 
small pox. 
The causes of this anomaly are: matter is taken too 
late, or which is too old, and which has lost its contagious 
property; or a deficient susceptibility of the individual. 
This artificial disease requires no medical treatment. 
The vaccinated may be allowed to continue their custo- 
mary mode of living. It is advisable on the seventh or 
eighth day, when fever and general infection is expected 
to take place, to keep them at home. After the disease is 
terminated, that is, after the peripheric redness has disap- 
peared and the pustules dried up, it is recommendable to 
give several purges of calomel and jalap, in order to pre- 
vent subsequent cutaneous diseases and glandular swell- 
ings. 
VARIOLOIDES. 
A variety of genuine small pox, generated by the vario- 
lous virus, sometimes attacks an individual previously vac- 
cinated. 
It is a bastard-plant, originated by variolous seed, but 
which, by the vaccinated soil in which it springs up, is so 
modified in its development and vegetation, that it does VARIOLOIDES. 
399 
hot exhibit the genuine variola, but a milder variety of it. 
In its nature it is variola, and may again produce variola 
by infection, though sometimes only in the second gene- 
ration. 
It is distinguished from genuine variola in its external 
form by the following signs: It observes on the whole, the 
same stages as variola, differing in this respect from vari- 
cella ; but the fever is generally much lighter, and the sup- 
purative fever is in most cases entirely absent. The pus- 
tules appear in the same order, sometimes also very nume- 
rous, even confluent; but they are commonly small and. 
filled with lymph; sometimes they are entirely empty 
(siliquosce); the scabs are less thick and hard, and there- 
fore leave neither impression nor cicatrices, but only a red 
elevation on the variolous spot for some time. They ge- 
nerally do not endanger life; but there are rare cases, 
when they assume the virulence of the genuine variola, 
and may prove even fatal. 
The cause of their appearance resides in the susceptibi- 
lity of the organism for the variolous contagion, not hav- 
ing been entirely annihilated by the vaccination. It is not 
owing to time. Some have believed that it depended on 
the vaccine matter having lost its infective power by the 
length of time it has been in use, and its frequent repro- 
duction, or on the receptibility of the organism having been 
re-established by the length of time elapsed since the vac- 
cination. Both assertions are refuted by the circumstance, 
that varioloids may originate equally well in those vacci- 
nated for 20 and more years, when the vaccine matter was 
yet fresh, and in those but recently vaccinated. Nor can 
the small number of vaccine grafts be regarded as a cause, 
since it is not the quantity of virus communicated, but its 
intensity and the susceptibility of the person which are to 
be considered. Even Jenner never made more than 6 grafts, 
and these were perfectly protective. The true reason of 
receptibility not having been entirely annihilated, must be 
sought for either in a spurious, or too old and corrupted 
lymph used for vaccination, or in the imperfect reception, 
infection, on account of the organism wanting the disposi- 
tion to it at the time of vaccination, whereby also the re- 
ceptibility was but imperfectly annihilated. The best pre- 
servative therefore is revaccination, by which one may 
hope to extinguish entirely the rest of receptibility which 
might perchance have been left. 
The treatment is the same as that of variola. 400 
MEASLES. 
MEASLES. 
Morbilli. 
Diagnosis. Red spots, one or two lines in size, in most 
cases somewhat elevated, which are preceded by a catarrhal 
fever, the symptoms of which are : a dry cough, red lachry- 
mating eyes, frequent sneezing. It precedes the eruption 
for three or four days, and follows it as many. The cough 
and affections of the eyes continue with the fever, and dis- 
appear with a branny desquamation of the epidermis. This 
peculiarity of desquamation is important for the diagnosis, 
since it is often the only sign by which we are able to dis- 
criminate this exanthema from others. 
Stadium infectionis et irritationis.—This stage which lasts 
generally three days, sometimes still longer, is distinguish- 
ed by remittent fever, which is similar to a catarrhal one, 
but which is marked by a peculiar, short, dry cough, red, 
lachrymating eyes, intolerance of light, frequent sneezing 
and running of the nose. These symptoms and the fever 
increase every day until the eruption breaks out; headache, 
especially in the forehead, associates with it; when the ma- 
lady is severe, there is also delirium ; and in infants spasms 
may set in the same as in small pox, and frequently also 
diarrhoea. 
Course. 
Stadium eruptionis et fiorescentioe. —At the end of the 
third or fourth day the measles appear, generally first in 
the face and on the arms; in the shape of small red spots, 
which form sometimes little elevations, but no pustules. 
When they are very numerous, the skin of the face and 
hands swells, similarly but never so much as in small pox. 
The affection of the eyes and the cough increase at the 
same time, for it is nothing but the morbillous irritation in 
the mucous membrane of the lungs, which may sometimes 
increase to a real bronchitis and pneumony. After three 
days of florescence, the spots grow pale, and disappear in 
the same order as that in which they sprung up. Cough 
and ophthalmia decrease in the same proportion. The fe- 
ver, in mild measles, ceases after they have broken out; if it 
continues, it is indicative of a complication, or effect of 
profuseness of measles and of a too great irritation. 
Stadium desquamationis, the scaling off.—After the red- 
ness disappears, the epidermis scales off in little bran-like 
pieces, often like meal; it is the fading and the decay of MEASLES. 
401 
the blossom. This takes'place on the sixth or seventh, 
sometimes also on the ninth or tenth day of the disease, 
and lasts for several days. Sometimes however, especially 
in a slight eruption, the desquamation is so trilling, that it 
is not at all perceived. There also occurs at the same time 
a critical perspiration and critical urine; in most cases a 
diarrhoea also sets in, which is here a very salutary crisis; 
after which all morbid symptoms disappear. But some- 
times new and dangerous attacks occur in this period, a 
new fever, local inflammations, most frequently of the 
lungs, but also of the abdomen and head. 
The measles are very apt to leave subsequent diseases, 
especially of the lungs (cough, generation of tubercles, 
phthisis) ; or of the eyes, and of the glandular system, also 
of the nerves. 
The disease itself is much less dangerous than small pox; 
only pneumonia or retrocession of the eruption or compli- 
cation may make it fatal. But the consequences are dan- 
gerous, and two thirds of those who die by the measles, 
die subsequently and often without showing any signs that 
death is owing to them. It is especially dangerous to those, 
who labor under morbid lungs and a phthisical dispo- 
sition. 
Measles, like small pox, maybe simple (benign), or com- 
plicated with other species of fever, from which arise many 
anomalies in form as well as in course. When the com- 
plication is inflammatory, a very violent fever, early and 
copious eruption sets in ; but this last may also be impeded 
and accompanied with a pulmonic affection ; in the nervous 
complication, the eruption is interrupted and apt to retro- 
cession ; there are nervous attacks of all kinds, and a pale 
color; in the putrid complication, intermixed petechise, 
hemorrhages, colliquation ; in all the complications, the 
fever continues after the eruption; in the inflammatory, a 
new pneumony; in the nervous, a retrocession and metas- 
tases; in the putrid, increase of colliquation. 
Pathogenesis. The proximate cause is, as in variola, a 
specific contagion, and the disease is nothing but a reac- 
tion of the organism brought on by the contagion. Like 
the variolous virus, it is of modern origin, and has been ob- 
served only since the sixth or seventh century ; like the 
former, it infects only by immediate contact or in the 
neighborhood of the sick, but not by the atmosphere; like 
variola, it affects the system only once (to this, however, 
there are a few exceptions), and requires, like it, a specific 
disposition for its reception j the atmosphere also may favor MEASLES. 
or hinder its development, hehce it may appear sporadi- 
cally and epidemically. 
The morbillous virus is distinguished from the variolous 
and other contagia by the following peculiarities: It has a 
particular affinity for the mucous membrane, especially for 
that of the lungs, and thereby produces a state very like 
catarrh; its virulence is less intense than the former, and 
is more of a lingering than of an acute character. 
Therapeutics. The indication is the same as in small pox : 
to pay attention to the fever and the peculiarity of the 
morbillous virus. As regards the latter, the treatment is 
opposite to that of the variola, for the principal rule is to 
keep the patient moderately Avarm, as in a catarrhal fever. 
Whereas cold is the best mitigator and regulator of small 
pox ; in measles it is apt to disturb the crisis and cause a 
dangerous retrocession. The principal object of the treat- 
ment must be to promote the proper development and eva- 
poration of the virus through the skin; to prevent retro- 
cession and metastases; and to prevent the acute contami- 
nation from passing into a chronic one, and into subsequent 
diseases. The principal means in this respect is to main- 
tain a uniform moderately warm regimen (not over-heat- 
ing) and to avoid cold. As for this, especially in children, 
no other means exist but staying in bed, it must be an in- 
violable rule in measles, to confine the patient to bed for 
14 days from the commencement of the disease; and in 
winter time for 3 weeks; not in feather beds but on ma- 
tresses, and covered with blankets. The temperature of 
the room must be 15° Keaumur. In winter the open air 
must be avoided for 6 weeks, an important precaution to 
prevent metastases.—In benign measles nothing more is 
needed than this regimen, an antiphlogistic diet, much 
drinking, and at the last a laxative. 
In the first stage of benign measles this general treat- 
ment along with a cooling diaphoretic (vide No. 245, b.) is 
sufficient; at the same time due regard must be had to the 
ophthalmia and cough, which are the most troublesome 
symptoms. They are, however, a component part of the 
disease, and cannot be removed, but only mitigated; the 
ophthalmia by keeping from the light, by fomentations of 
lukewarm milk, decoct, of mallows, mucilage of quinces 
(beware of saturnine and astringent remedies) ; the cough, 
by frequent drinking of water gruel and barley water, and 
similar linctus, to which, when there is great irritability, 
oils and narcotics may be added (vide No. 246) ; by pro- 
moting perspiration; for this is in direct proportion to the MEASLES. 
403 
increase and decrease of the cough ; by removing any ac- 
cessory stimuli and complication, which may often render 
the cough extremely violent, especially the gastric irritants 
which may be removed by emetics ; and the inflammatory 
irritation, which leeches will remedy. 
In general, this is the period in which complications and 
accessory irritants are most easily combated and removed ; 
particularly gastric accumulations and an inflammatory 
diathesis, even pneumonia, which is not uncommon at the 
approach or at the time of the eruption. In such a case 
venesection is not to be omitted in plethoric subjects; in 
children leeches are to be used. 
The stage of eruption and florescence requires a conti- 
nuance of the foregoing treatment; carefully avoiding cold, 
and paying particular attention to pneumony, which may 
occur, especially if this care has been neglected in the first 
stage, in which case the abstractions of blood must be sub- 
sequently made. 
The most dangerous case that can arise is retrocession 
of the eruption, caused either by taking cold, or by a men- 
tal affection, or faults in diet. This emergency must never 
be disregarded, though it may seem in the beginning to 
have no injurious consequences; for it is always the result 
of a disturbance of crisis, which, if it does not, as often 
happens, endanger life, may give occasion to the worst 
metastases and subsequent maladies. The principal indi- 
cation is to re-establish the cutaneous crisis. All depends 
here on a due consideration of the various causes and ef- 
fects, and we distinguish three cases:—either, no bad 
symptoms appear, but critical sweats, urine, and even mo- 
derate diarrhoea follow. Here nature has herself taken 
charge of the crisis; a warm regimen, warm diaphoretic 
beverages, elder tea with small doses of vinum antimonii 
will be all that is necessary for a cure. Or dangerous at- 
tacks, inflammation of the lungs, of the throat, of the ab- 
domen, of the head set in, with violent fever and delirium, 
bordering1 often on fury. Then, above all, the metastatic 
inflammation must be subdued by abstraction of blood, and 
antistimuli applied to the skin (sinapisms,-vesicatories), 
and nitre ; and when this has subsided, the eruption must 
be re-established by diaphoretics, of which camphor with 
nitre is the most appropriate. Or the patient lies in a state 
of greatest weakness and spasm, with convulsions and cool 
extremities. Such a condition calls for antispasmodic dia- 
phoretics, first camphor along with spiritus Mindereri, 
liquor c. c. succin., musk, opium, sinapisms and particularly 404 
MEASLES. 
warm baths. Profuse diarrhoea, if such exists, must be 
slopped. If overloading of the stomach has brought on the 
retrocession, an emetic is the best means of relief. 
In complicated measles that method of treatment is con- 
tinued, which is suited to the respective febrile state. 
The stage of desquamation, in benign measles, does not 
require any thing but the continuance of a warm regimen, 
in order to make the crisis perfect; an antiphlogistic diet 
and the use of mild and cooling purgatives, manna with 
soluble tartar. We must always bear in mind the idea, that 
the virus yet lurking in the system is to be expelled, either 
through the skin, or, as the skin has been made partly im- 
practicable, by desquamation, through the intestinal ca- 
nal and the kidneys. When new local inflammations, espe- 
cially of the lungs, take place, the treatment appropriate to 
them is required, and even the abstraction of blood, calo- 
mel and vesicatories may be needed. These two remedies 
are in general those, which answer best in the metastases 
which might form; also camphor may be used. The great- 
est attention, however, is due to the remaining cough ; for 
it indicates a lurking remnant of morbillous poison in the 
mucous membranes of the lungs, and leads to fear an inci- 
pient formation of tubercles, and finally a transition into 
tuberculous consumption. We must first attempt to re- 
medy this state by a continued use of laxatives and dia- 
phoretics, calomel, vesicatories, covering the chest with 
flannel, and warm baths, which will often be followed by 
good success. If this treatment do not suffice, the repeat- 
ed use of emetics is recommendable. If this also prove 
vain, prescribe serum lactis, Sellers water with milk, calo- 
mel with sulphur aurat. antimonii and opium, senega root. 
A combination of sulphur with aqua laurocerasi and cicuta 
has likewise proved very efficacious ; also artificial ulcers, 
especially by cort. mezerei, entertained for a long time. If 
cough continues with expectoration, Iceland moss jelly is 
serviceable. 
The measles have been inoculated ; the tears flowing dur- 
ing the efflorescent stage, or the blood from a morbillous 
spot have been used for that purpose. But as the disease 
is far less dangerous to life than the small pox, this miti- 
gating method is to be recommended only in very malig- 
nant epidemics. SCARLET FEVER. 
405 
SCARLET FEVER. 
Scarlatina. 
Diagnosis. Fever with a greatly accelerated pulse, pain 
in the throat, after one or more days a breaking out of 
large scarlet-red spots, without definite limits, and like ery- 
sipelas gradually diminishing in color, as they approach 
the surrounding skin 5 they often extend over whole limbs 
with a uniform redness. They disappear after four or five 
days, when the epidermis scales off in large pieces or 
patches, and are followed by a great disposition to watery 
accumulations. The spots are generally smooth, but some- 
times little miliary-like pimples form on them. This has 
given rise to a distinction of scarlatina into two kinds (the 
smooth and the pustulous scarlet fever) ; but they are only 
varieties of one disease. 
Such are the essential pathognomic symptoms. But no 
malady affords so many anomalies in its appearance as this 
one. Sometimes there is merely an angina (internal scar- 
latina of the mucous membrane of the throat), and exter- 
nally little or no redness appears. Sometimes this is en- 
tirely wanting, and the existence of the disease is recog- 
nised only by the subsequent desquamation or hydropic 
accumulations. 
Course. 
In the first stage there is pain in the throat and the pulse 
is greatly accelerated. An equally quick pulse is not met 
with in any other disease, and is to be regarded in this 
stage as a prognostic sign of imminent scarlet fever. It is 
distinguished from measles by the absence of cough, sneez- 
ing, and lachrymation. Fever and angina increase with the 
approaching eruption ; and in some subjects delirium and 
spasms are also observed. 
In the stage of the eruption and efflorescence the spots 
appear first on the fore-arms and hands, gradually spread- 
ing over the whole body, but rarely in the face. They in- 
crease in size and redness, and are augmented by new 
ones. The angina also increases in equal proportion; for 
it is nothing but internal scarlatinous inflammation. The 
fever continues and becomes often very violent. Only in 
slight cases it ceases with the appearance of the eruption. 
In more severe attacks the brain and abdominal viscera are 
inflammatorily affected. The exanthema, like erysipelas, 
is very volatile, and apt to disappear and shift inwardly. 
This stage lasts five or six days. 406 
SCARLET FEVER. 
Stage of desquamation. On the sixth, sometimes not 
earlier than on the ninth day, the epidermis begins to scale 
off in large pieces or patches. After violent scarlatinous 
inflammation, the whole skin of a part, as of the hands, 
feet, or scrotum scales off, retaining the shape of the part., 
A similar desquamation takes place also from the internal 
membrane of the throat, after a violent angina. The de- 
squamation lasts many days, and in some cases is repeated 
several times. The fever ceases during critical secretions 
by urine and other ways, except when metastases happen. 
It is not unusual for this stage to be followed by a sta- 
dium secundarium s. metastaticum, generally hydropicum, 
most frequently the consequence of taking cold or a dis- 
turbed crisis. The most common occurrence is dropsy, a 
hydrops acutus, which may become fatal within 8 or 14 
days. Its onset is first recognised by an oedematous swell- 
ing of the eyelids, then of the extremities, succeeded by 
general anasarca, ascites, hydrothorax, and hydrocephalus. 
Metastases to the eyes, ears, glands, indurations, and ab- 
scesses are still more frequent. The scarlatinous metastases 
are very destructive. I have seen within 8 days eyes lost 
by suppuration, and the auditorial and nasal bones de- 
stroyed. 
Scarlet fever is one of the most malignant and deceitful 
of all eruptive diseases. It may, in single cases, and even 
prevailing as an epidemic, be so slight and benign that 
fatal cases seldom occur. But sometimes single cases, 
and even a whole epidemic is so virulent and dangerous, 
that its fatality equals a pestilence, one patient in every 
sixth, even fourth, or third becoming its victim. The ma- 
lignity may be so great that the patient dies on the first or 
second day, from metastasis to the brain and nervous apo- 
plexy. Thus, in single cases it may appear slight and be- 
nign at first, and nevertheless suddenly kill afterwards, by 
a metastasis to the brain, or by a rapidly generated dropsy. 
Death is most frequently caused by inflammation of the 
brain, by angina or dropsy. 
Scarlatina may associate with every species of fever and 
thereby becomes anomalous. The inflammatory complica- 
tion is remarkable for the intensity of the fever and heat, the 
high scarlet redness and the universality of the eruption, the 
intensity of the angina, and by the readiness with which in- 
flammation of internal viscera happens ; the nervous is 
distinguished by a pale, cool skin, the imperfect appear- 
ance and disappearance of the eruption, the spasms and 
nervous apoplexy, which are likely to arise, foreboded by SCARLET FEVER. 
407 
a constant urgency to urinate ; the putrid is marked by 
extreme debility, violent fever, hemorrhages, colliquative 
evacuations, livid color of the eruption, intermixed with 
petechias, and by angina rapidly passing into a gangrenous 
corruption. Most cases of angina gangrcenosa belong to 
this species of scarlatina. 
Pathogenesis. The proximate cause is an atmospheric 
contagion, but which is afterwards communicable from 
one person to another. The infection may, therefore, be 
double, atmospheric as well as individual. The effect of 
this contagion has the peculiarity of affecting specifically 
the throat and the skin, and generating in both an inflamma- 
tion similar in appearance and fugaciousness to erysipelas, 
apt to be propagated to the brain ; of prostrating particu- 
larly the action of the absorbent system, finally producing 
watery infiltration, due in part to the disorganization of the 
skin, and consequent arrestation of transpiration, partly to 
a debility of the lymphatic system. Susceptibility to a fu- 
ture attack is not so completely annihilated as in small pox 
and measles. It may, therefore, affect the same individual 
oftener than once. It also differs from those diseases in 
this, that it is not propagated by contact from one to an- 
other person like small pox and measles, but is much more 
frequently communicated by atmospheric influence. 
The disease is of modern origin, and has not been ob- 
served before the seventeenth century. 
Therapeutics. The treatment must be fundamentally an- 
tiphlogistic, excepting as regards external warmth. Stay- 
ing in bed for three weeks in order to prevent metastases, 
is to be observed, and constant attention must be directed 
to local inflammation, especially of the brain, which may 
happen. 
A difference in intensity and complications calls for cor- 
responding special treatment. 
In benign scarlet fever nothing more is needed than to 
keep the patient in bed, cooling, gentle diaphoretics and 
laxatives that will give two stools a day. A Solution of 
soluble tartar, along with small doses of vin. antimonii an- 
swers this purpose best. 
But when the disease is violent, distinguished by great 
heat, ardent fever, high redness and a general spreading of 
the eruption, the danger of approaching inflammation and 
corruption is to be subdued as quickly as possible. Two re- 
medies have proved particularly efficacious for attaining this 
end : internally the use of chlorine water (acid, muriat. oxy- 
genat.) daily, two or three drachms for children, the same 408 
SCARLET FEVER. 
number of ounces for adults, diluted in water, and agreeably 
sweetened ; and externally (but only when there is a dry 
skin, burning beat, and dizziness in the head), the skin is 
to be cooled by quick ablutions of cold water, which may be 
repeated every two or three hours. More active and debili- 
tating antiphlogistics, especially abstractions of blood are of 
dubious utility, since they tend to produce an adynamic 
state ; therefore general bleeding is improper, but leeches 
may be applied in youthful and in plethoric subjects, when 
violent angina and affections of the brain are present. 
Cold fomentations to the head, and repeated affusions of 
the head with cold water, are of excellent use when the 
fever is at its height, and the brain so affected as to pro- 
duce sopor and delirium. When angina is slight, it calls 
for gargles of infusion of elder flowers, mallows, and oxy- 
mel simplex (No. 247 a.), flannel round the throat ; when it 
is more intense, leeches and sinapisms must be applied. 
In a nervous complication the nervous power is to be 
supported from the beginning by appropriate nervines ; the 
putrid complication requires antiseptics, and the treatment 
already mentioned in putrid angina (vide angina gan- 
grcenosa), is of importance. In gastric complications, the 
first stage requires emetics and cathartics. But the most 
important treatment is that which is to be observed during 
desquamation ; and to prevent subsequent dropsy. 
The principal thing during this period, is not to permit the 
patient to leave the bed, and to confine him to the house for a 
month in the summer, and six weeks in the winter season ;to 
prevent him from taking cold, and to use gentle laxatives and 
diaphoretics ; intermediately a few doses of calomel may 
be given, in order to increase the action of the lymphatic 
system. This is generally sufficient, and prevents bad con- 
sequences. But as soon as the first vestiges of oedema ap- 
pear, prompt measures are- needed, and the most concentra- 
ted means must be used to procure absorption and secretion, 
(especially by the kidneys and intestinal canal). This end 
is best attained by calomel (one, two, or three grains, ac- 
cording to age, to be taken every three hours), combined 
with jalap and digitalis, a diuretic tea (No. 247 b.), and 
warm baths. Above all things, we must examine whether 
a febrile phlogistic state is present or not. If there is, and 
the pulse active, and the individual i? plethoric, a venesec- 
tion (of three or four ounces in children) produces a most 
excellent effect, and is an indispensable remedy. It will 
generally be followed by diuresis ; and diuretics which 
were previously inefficacious, will now operate. In aphlo- EUBEOLJE. ESSERA. 
409 
gistic state, we ought to prescribe nitre, along with cremor 
tartari, squilia, senega, wrapping the whole body in flannel 
fumigated with amber. Radix belladonnse, combined with 
calomel, has proved very serviceable in some instances ; 
and in obstinate cases so has tincture of cantharides. 
Belladonna in very small doses has been used, according 
to Hahnemann’s recommendation, as a preservative ; and 
many cases have confirmed its utility. But as the disease 
is sometimes very slight and without danger, this preserv- 
ative is to be recommended only in malignant and danger- 
ous epidemics. The prescription is : one grain of well 
prepared extract of belladonna, dissolved in half an ounce of 
cinnamon water, of which five drops may be given daily to 
children of five years of age, increasing the dose one drop 
for every additional year. 
RUBEOLJE. 
Diagnosis. Red spots, from a third to an inch in diam- 
eter, in the middle 8f which little vesicles spring up in 
groups. They appear after a few days of febrile motion, 
and sore throat; last for five or six days, after which they 
desquamate in patches larger than in measles, and smaller 
than in scarlet fever. Hydropic accumulations are apt to 
follow. 
The shape, the angina connected with it, and the subse- 
quent dropsy designate this disease as a variety of scarla- 
tina, not of measles. 
The treatment must therefore be the same as in scarlet 
fever, and it is equally necessary to remain in bed. Rube- 
ola generally is benign, and requires only three weeks of 
care, and the use of cooling, gentle cathartics and diapho- 
retics. In very severe cases, and when complications ex- 
ist, all the rules which have been given for scarlet fever 
are to be observed, and especially those which are pre- 
ventive and curative of dropsy. 
ESSERA. 
Diagnosis. Red, elevated pimples, resembling bug bites, 
accompanied with slight or scarcely perceptible febrile mo- 
tions, and disappearing again after a few days. The disease 
is never dangerous. 
The cause of it is gastric or catarrhal, and requires no- 410 
URTICARIA. MILIARIA. PURPURA. 
thing further for a cure than a few days care and a cathar- 
tic afterwards. 
URTICARIA. 
Diagnosis. Large, red, diffused patches, white in the 
centre, troublesome by itching and burning. It is similar 
in shape and sensation to lesions by burning, and is pecu- 
liar in this, that it disappears in warmth and becomes visi- 
ble in the cold. 
They set in without, sometimes with, febrile motions, 
and disappear after a few days. 
Cause and treatment is entirely the same as in essera. 
Both, urticaria as well as essera, are apt to assume a chro- 
nic character; that is, they reappear on the least occasion, 
and then become a troublesome evil. It is owing to a 
faulty condition of the skin and its secretion, or to a gen- 
eral dyscrasy. It is to be cured by a general improve- 
ment of the cutaneous action, and purging (vide above the 
general treatment of cutaneous diseases); or, when it will 
not yield by these means, by removing the deeper seated 
causes ; which requires particular attention to the scrofu- 
lous, arthritic, and syphilitic dyscrasies. 
MILIARIA. PURPURA. 
Miliaria Alba et Rubra. 
Diagnosis. Miliaria alba : small, white vesicular eleva- 
tions of the skin, resembling millet-seed, on all parts of the 
body, especially on the chest; they sometimes unite, form- 
ing large vesicles, even phlycteense, which are filled with 
a limpid serum. 
Miliaria rubra: small, purple, papular (not vesicular) 
elevations of the skin, so small as scarcely to be seen, 
though easily felt. 
The white miliary disease is more frequent than the red 
one. Both kinds are sometimes present in the same 
patient. 
The concomitant symptoms are : fever, profuse perspi- 
ration of a sour odor, dry cough, anxiety, oppression, and 
moaning. 
The appearance, course, and duration are uncertain and 
indefinite. The eruption may appear as early as the third MILIARIA. PURPURA. 
411 
°r fourth day of the fever, sometimes not until the seventh 
or eighth, and even as late as the fourteenth day. In some 
cases it appears and disappears alternately. The eruption 
may be slight, or very abundant, covering the whole body, 
but particularly the arms and chest. The face generally 
remains free from it. 
The indications of an approaching miliary eruption are : 
from the beginning of the fever very profuse perspiration, 
which emits a putrid, sour odor, anxiety, difficult (not 
short) respiration, accompanied with moaning and sighing; 
short, dry cough, inquietude, frequent chills, stinging and 
itching in the skin, sometimes there are nervous attacks, 
spasms, delirium. The fever sometimes abates after the 
eruption has come out ; so also does anxiety, cough, and 
other affections. But sometimes it continues, even in- 
creases, and eruption augments, so do the nervous attacks. 
It terminates by a light desquamation. Miliaria is always 
a redoubtable phenomenon, which rather increases than al- 
leviates the disease. It is generally symptomatic, an addi- 
tional symptom to a fever that always affects the nervous 
system in a particular way, and is apt to excite dangerous 
nervous attacks. Symptomatic miliary eruption is recog- 
nized by its appearing prematurely or very late in a dis- 
ease, and by the disease not diminishing on its appearance. 
Death, which follows a retrocession of the eruption, is 
caused by apoplexy or suffocation. The eruption, how- 
ever, is sometimes critical, if it appears on the critical 
days, the seventh, eleventh, or fourteenth, and the attacks 
abate. But even then there is danger, for the eruption is 
apt to retrocede and produce fatal consequences. 
Pathogenesis. The proximate cause is a peculiar cor- 
ruption of the perspirable matter. This is converted into 
a volatile matter particularly hostile to the nerves, and 
which sometimes becomes contagious (miliary acrimony); 
it is produced by great weakness and colliquation of the 
cutaneous system. The exciting causes are : debility of 
the cutaneous system, a rheumatic and catarrhal diathesis, 
too hot regimen in fevers, especially lying in feather beds 
and in confined air, hot diaphoretics, omission to evacuate 
gastric accumulations, and the puerperal state. 
The relation which this disease bears to the history of 
mankind and the art of healing, deserves notice. We find 
no mention of it in antiquity, nor in the earlier periods of 
modern times. It first appeared in the seventeenth century, 
at the time when the diaphoretic method of curing fevers 
prevailed, especially in those countries where feather beds 412 
MILIARIA. PURPURA. 
are used. It remained so up to the middle of the eighteenth 
century, when the antiphlogistic method and a cool regimen 
was introduced in the treatment of hot fevers. It must, 
therefore, be supposed that this pathological phenomenon 
was partly the product of the general constitution, and 
partly of art. It is seldom met with now; generally only 
in particular epidemies, or in a subject predisposed to it, 
or in a too hot treatment, and omission to cleanse the pri- 
mse vise. - 
Therapeutics. The principal indication is to anticipate 
miliaria, and always to consider it as a troublesome addi- 
tion to fever ; one rather to be avoided than promoted. 
Therefore, when light covering, moderate temperature, 
pure air, and cleansing of the primaj viae are attended to, 
miliaria will rarely break out. Even when its forerunners 
have already appeared, this treatment will check it; fre- 
quently it will be sufficient to remove a feather bed. These 
remarks do not apply to critical miliaria ; that is, when 
it appears at the critical period of the fever and is followed 
by an abatement of the fever and other symptoms. In this 
case, it must only be moderately fostered, and its retroces- 
sion prevented. 
The special treatment does not differ from that of the 
fever with which it is connected, and must comply with 
the character of the former. Miliaria and the cutaneous 
colliquation by which it is accompanied, indicate the use 
of mineral acids: as of acid, muriat. oxygenat; or, when 
the colliquation is far advanced, acid, sulphur. ; when the 
primae vise have been neglected, gentle, cooling purgatives, 
especially tamarinds, must be given. Cold must be care- 
fully avoided, lest it produce retrocession. 
When retrocession happens, its effect must be observed. 
If no injurious consequence arises, and nature replaces the 
cutaneous crisis by increasing another secretion, as that 
of the intestinal canal, nothing else is needed but a warm 
regimen. But if dangerous metastases, nervous attacks, 
cerebral or pulmonary affections follow, we must en- 
deavor to promptly re-establish the cutaneous crisis by 
sinapisms, vesicatories, camphor, musk, and warm baths. 
A local inflammation, which may perhaps happen in a pre- 
disposed individual, calls for abstraction of blood (vi le 
morbilli.) 
A miliary eruption may break out without fever, and then 
it is of indefinite, often of very long duration ; or there re- 
Chronic Miliaria. PETECHLE. 
JJJ&ins a disposition in the skin to reproduce it constantly. 
■I his eruption is in general only the form or deposition of 
a dyscrasy. Thus I have seen a miliary eruption break 
°ut in the spring in gouty persons, and leave them free of 
podagra and arthritic affections for the remainder of the 
year. The same is true of scorbutic miliaria. 
The treatment depends altogether on the dyscrasy that 
lurks in the system. Besides the general skin-cleansing 
remedies, baths and repeated cupping may especially be 
applied. 
PETECHLE. 
Diagnosis. Spots of a violet, brown, black, and some- 
times of a red color; of one or two lines in diameter. 
They are generally round, circumscribed, and accurately 
limited ; but sometimes are irregularly shaped. They ap- 
pear on all parts of the body, without order or definite pe- 
riods, accompanied by fever (petechias acutce, febrispetechia- 
Hs, spot-fever), or without fever ('petechia chronica). In 
certain cases they break out in large spots of several inches 
in circumference (ecchymoses, vibices). We must avoid the 
mistake of taking the smaller ones for flea-bites, which 
they very much resemble; but from which they may be 
distinguished by the mark of the bite. 
Febrile petechias (like miliaria) may break out on the 
first days of the disease, or at any future period, even very 
late. They continue for an indefinite time, and disappear 
without desquamation. In general their appearance brings 
with it no amelioration to the disease ('petechia symptoma- 
tica), but in some cases it does (petechia critica). 
Pathogenesis. They consist of little extravasations of 
blood under the epidermis, and ought therefore to be 
classed with haimorrhages, which they often accompany. 
They are generally caused by debility or a decomposition 
of the blood, and are consequently often a symptom of pu- 
trid fever; but sometimes they are owing to local debility 
and irritation of the skin, the effects of hot regimen and 
over-heating, in which cases the accompanying fever is of 
an inflammatory character; sometimes they are only sym- 
pathetic, of a gastric irritation, therefore, like miliaria, 
they frequently occur in gastric and verminous fevers, 
especially when purgative remedies have been neglected ; 
finally they appear as concomitants of a crisis, of which, 
however, they are only a symptom. Therefore, as regards 
35* 414 
their origin, they are to be ranked with miliaria, which 
they often accompany. They may also happen in certain 
epidemics. They are not contagious, though the typhus 
fever to which they belong may be infectious. 
Therapeutics. The principal indication is, as in miliaria, 
to prevent as far as possible their formation, and, when 
they have formed, to remove them as quickly as can be 
done. 
PEMPHIGUS. 
The first end is attained by cool regimen and cleansing 
the prima3 via 3 in the onset of the fever. 
The second is accomplished by a proper treatment of 
the fever according to its character (which is most fre- 
quently putrid, but sometimes may be inflammatory and 
then abstractions of blood may be needed), and by the use 
of gentle cathartics (especially tamarinds), mineral acids ; 
by washing the skin with vinegar; by cool and pure air 
(ventilation). Purgatives remove them most promptly. 
Chronic Petechicc, 
Appear without fever and are commonly a symptomatic 
phenomenon of various chronic diseases, especially of such 
as are of a gastric and verminous origin. They constitute 
a peculiar disease in the morbus maculosus hsemorrhagicus 
Werlhofii, which is a scorbutic dissolution of the blood, 
and must be treated accordingly (see hemorrhages). 
PEMPHIGUS. 
Blisters varying in size from a pea to a wal- 
nut; filled with a watery fluid; of a round shape, except- 
ing when several coalesce, and then it is irregular; sur- 
rounded by a more or less red margin, which feels itchy 
and prickly. Pemphigus may be accompanied with fever 
(pemphigus acutus, febris bullosa), which lasts several days, 
at the end of which the vesicles either dry up or pass into 
a protracted ulceration; or it may be unaccompanied with 
fever (pemphigus chronicus), in which case new blisters 
continue to form for months or years. 
Acute pemphigus has a great resemblance to erysipelas 
bullosum, both in its origin and in its treatment. The ge- 
neral treatment must conform to the character of the fever. 
Application of lead, vitriol, and other repulsive remedies 
are to be carefully avoided, lest they create dangerous me- 
tastases. When the blisters stay long, they ought to be cau- THRUSH. 
415 
tiously opened by puncture, through which the fluid may 
°oze, leaving the epidermis to protect the subjacent surface, 
while nature effects the exsiccation. The painful prickling 
ts to be remedied by fomentations of rosewater and muci- 
lage of quince-seeds. If suppuration ensues, fat ointments 
must be avoided ; for they are apt to render suppuration 
chronic. When they manifest a gangrenous character, as 
is likely to happen in old age and typhus fevers, fomen- 
tations of Peruvian bark, lime-water, and camphor will be 
useful. 
Chronic Pemphigus, 
Is one of those maladies, which is apt to become very 
protracted and very difficult to cure, since its remote causes 
are deeply seated and are difficult of detection. They most 
frequently reside in a suppression of distant secretions, 
especially that of urine; or in general dyscrasies. 
The cure, therefore, consists, first in the general treat- 
ment of cutaneous diseases (see generalities); and in an 
investigation and treatment of the particular causes. If 
the disease is owing to a disturbed secretion of urine, diu- 
retics are advised; if to a dyscrasy, this must be properly 
attended to. Regarding the latter I cannot forbear direct- 
ing the attention of the practitioner to a syphilitic taint of 
long standing ; in which a mercurial treatment is the only 
one capable of removing the evil. Baths of chloride of 
lime, one ounce to a bath, and sublimate baths are of excel 
lent effect. 
THRUSH. 
Jlphthoe. 
Diagnosis. Little, white, sloughy ulcers in the mouth, 
on the tongue, palate, and fauces; sometimes extending 
the whole length of the intestinal canal; causing a pungent 
pain; lasting for a few days, weeks, or months, one crop 
being replaced by a new one. The irritation from these 
little ulcers causes much local as well as sympathetic suf- 
fering, corresponding with their seat and violence. They 
cause in the throat anginous difficulties, painful degluti- 
tion ; in the trachea a cough ; in the fauces and stomach 
nausea, eructation, spasm in the stomach, vomiting; in the 
intestinal canal colicky pains, diarrhoea, even dysentery, 
charged with the sloughs, enteritis. 416 
THRUSH. 
The precursors are : dryness in the mouth and throat, 
thirst, sensation of a foreign body in the throat, nausea, vom- 
iting, cough, rawness and pungency in the throat, hoarse- 
ness, anxiety, pressure at the praecordia, soda, stupor. 
It may end fatally by angina, gangrene, and enteritis 
supervening. 
Aphtha? are an exanthema of the internal mucous mem* 
brane, the organization of which is the cause of their pecu- 
liar form ; hence it is, that persons of a delicate and relaxed 
fibre (as children) are more subject to them. They are most 
frequently occasioned by gastric impurities, the evacuation 
of which had been neglected; by suppressed secretion of 
the skin; by rheumatic and catarrhal metastases; finally 
by a general corruption of the humors, therefore apt to be 
associated with gastric putrid fevers, and to form in the 
colliquative stage of phthisis. They resemble miliaria very 
much in their origin, and may be found under similar cir- 
cumstances; therefore they happen more as a symptom 
than as a crisis of fever, and like miliaria, they may also 
appear epidemically, as a peculiar symptom of the reigning 
fever. 
They may be chronically generated as a metastasis from 
a sudden cure of ulcers on the legs or other cutaneous 
maladies. 
Therapeutics. The indications are : to remove the local 
or general causes, to attend properly to the fever or dys- 
crasy of which they are a symptom, and to cure them by 
local applications. 
In febrile aphthsethe principal thing is to clean the primae 
viee by purgatives and emetics, which are often sufficient 
to cure them. Pure air, and proper treatment of the fever, 
according to its character is needed. When the ulcers 
present a livid appearance, and there is a putrid tendency 
in the system, roborant antiseptics are called for. The 
mouth must repeatedly be cleansed by gargles (vide No. 
251) ; borax is a specific in this disease. Alum, vitriol, and 
similar astringents must be avoided, since they are apt to 
make the aphtha? disappear suddenly, and to produce dan- 
gerous metastases, especially to the brain. It is only when 
they are obstinate and pass into a chronic state, that sul- 
phate of zinc may be used as a wTash. When they are very 
painful, mucilaginous decoctions of mallow flowers, or 
marsh-mallow root may be given as gargles ; in a putrid 
disposition, Peruvian bark and alum. When the aphthae 
extend into the fauces, stomach, and intestinal canal, oily 
emulsions, also oil and milk injections are of service. ITCH. 
417 
Chronic aphthae require, besides the local treatment, that 
°f the dyscrasy, which is their remote cause, as suppressed 
cutaneous eruptions or ulcers, which must be re-estab- 
lished or replaced by artificial ones. 
Aphthae infantum, see diseases of children. 
ITCH. 
Scabies. 
Diagnosis. Small pustules with a reddish margin, contain- 
ing a pellucid watery fluid. They appear first between the 
fingers and on the hands, and cause a violent itching, in- 
creased by the warmth of the bed and by rubbing. When 
they last long, they form scabs which are dry, moist, 
or even suppurate. The eruption may spread over all 
parts of the body except the face, but takes most hold in 
the folds of the skin and flexures of the joints. Its loca- 
tion between the fingers is a sign characteristic and dis- 
tinctive of herpetic and other cutaneous diseases. 
It is unaccompanied by fever, and, if left to itself, may 
last for months, even years. In the beginning it does not 
affect the organism perceptibly (except a great sensibility 
to external cold and excessive hunger), but when it is pro- 
tracted and universally spread, it finally causes emaciation, 
even lingering fever. Itch is contagious. 
Pathogenesis. Genuine itdh (scabies vera) is always caused 
by a peculiar contagion (contagium scabiosum), which is of 
a fixed nature, and infectious only by immediate touch 
either of the person or of things infected by him. Infec- 
tion, however, depends greatly on individual susceptibility, 
which may sometimes be so deficient, that any communi- 
cation, even inoculation, is incapable of producing it; on 
the other hand it may be exceedingly favored and promot- 
ed by a number of circumstances, especially by uncleanli- 
uess, corrupt air, bad food or want of it, dampness and 
exposure to cold; which accounts for its spreading in hos- 
pitals, orphan asylums, armies, and in times of war. 
But itch may appear also as a product and symptom of 
internal diseases (scabies spuria). Though it is only the 
form of another disease, it may finally develop a contagion 
and thus become infectious. Of this number are the syphi- 
litic, scrofulous, arthritic, and scorbutic itch, also the cri- 
tical, an itchlike eruption, with and by which the crisis of 
acute as well as of chronic diseases follows. 418 
ITCH. 
Also in genuine itch we ought to be careful to distinguish 
the causes of its formation, and the causes of its duration 
and obstinacy. The latter are often debility brought on by 
the disease, or a complication with other maladies and dys- 
crasies.—The mites (animalcula) discovered in pustules 
are not the cause, but the effect of the itch. 
Therapeutics. The treatment has to comply with the fol- 
lowing indications : to destroy the specific contagion by a 
specific remedy, which is sulphur (as specifically curative 
of itch, as mercury of syphilis) ; to improve the action of 
the skin and to remove the accessory causes, which nou- 
rish and favor the disease. 
Many difficulties and many considerations are here met 
with. We may, for instance, by a merely local applica- 
tion of the specific on the skin, suppress the morbid cuta- 
neous action; but the contagion which has already pene- 
trated deeper is not destroyed, and in consequence itch re- 
appears, or, what is still worse, is translated to internal 
parts and creates dangerous and obstinate metastases. Thus 
it can generate pulmonary consumption, dropsy, spasm of 
the stomach, epilepsy, and all kinds of nervous diseases. 
This is still more hazardous, when itch is complicated with 
another disease, or even the product of a crisis. 
The special treatment is to be regulated in the following 
manner. 
1. Itch, engendered by infection in an otherwise healthy 
individual, and still recent, that is only since 8 to 14 days. 
In such a case we may rightly presume, that the contagion 
is superficial and still confined to the skin, and therefore 
we may immediately resort to the local application of 
sulphur. Washing the affected parts with sulphur water, 
or anointing them with sulphur ointment, or, what is most 
convenient, with sulphur soap (two parts of black soap and 
one part of sulphur rubbed in every evening, and a soap- 
bath in the morning), will destroy the contagion and thus 
remove the disease. However, it will be better to take 
sulphur (1 drachm of flor. sulphuris daily at the same time) 
internally; this mode will guard against all injurious con- 
sequences, besides helping as an external remedy, for sul- 
phur given internally ultimately reaches the surface, as is 
made manifest by the sulphureous character of the perspi- 
ration. In slight infections mere local frictions of soap, 
and a few soap-baths will suffice for a cure ; but the fric- 
tions must be so made as to rupture the pustules, and per- 
formed in the evening, that the remedy may remain ap- 
pn, d until morning, when it is to be washed off with soap- ITCH. 
419 
Water or a soap-bath. In children the unguent. Helenii 
applied daily, is an excellent and innocuous remedy, sur- 
passing all others. 
2. Itch by infection in a healthy person, but already of 
long standing. Here the internal use of sulphur for several 
days, before we proceed to an external application, is indis- 
pensable. A blood purifying potion (vide No. 202) and 
soap-baths may be used simultaneously. 
3. Itch generated by infection in an unhealthy individual. 
In such a case the treatment of itch must be combined with 
that for the disease with which it is complicated, which in 
children is most frequently scrofula. 
4. Inveterate itch, requires, besides sulphur, such re- 
medies, as excite and invigorate the action of the lymphatic 
and cutaneous systems, particularly the use of mercury. 
Aethiops mineralis, or Plummer’s powder added to sul- 
phur, answer this end. Also the use of Werlhof’s ointment 
(vide No. 252), rubbed on the wrists every evening, or sul- 
phur ointment strengthened by the addition of white vitriol, 
or of white hellebore ; washing the parts with a decoction 
of tobacco, and sulphur baths are serviceable. At the same 
time a decoction of rad. bardanas, sarsaparilla, lignum gua- 
iaci, also resina guaiaci, 4 drachm daily may be given in- 
ternally. Most recoramendable is external cleanliness; for 
the obstinacy of itch is often caused by nothing else than 
by the patient continually infecting himself; linen, bed- 
clothes and dress ought therefore frequently to be changed. 
Another cause of obstinacy often met with, especially in 
poor people, or in persons debilitated by previous diseases, 
even by the long duration of itch itself, is weakness of the 
constitution ; in such a case the best treatment is nourish- 
ing food, the use of strengthening medicines, among which 
I have found arnica very efficacious. Finally, the compli- 
cation of another malady may be the only cause of the ob- 
stinacy of itch ; in such a case it must be investigated 
whether concealed syphilis or scrofula, or a scorbutic dia- 
thesis exists, and we must act up to the indication. 
5. Itch without infection, being the mere product and 
symptom of another disease, as syphilis, scrofula. The ori- 
ginal disease is to be treated, and if its cure does not in- 
clude that of the itch, the specific treatment of scabies 
must be resorted to. 
Suppression of Itch. 
As shown above, the translation of psoric matter to inter- 
nal organs. The most dangerous and obstinate maladies 420 
HERPES. • 
may arise from a sudden suppression of the eruption, if the 
system have not been properly prepared by the treatment. 
In such a case sulphur is the true and sure remedy. Phthisis, 
nervous diseases, even dropsy, may frequently be removed 
by it alone. Artificial ulcers may be used simultaneously. 
HERPES. 
Diagnosis. Small vesicles on a red ground, in clusters, 
sometimes in one, sometimes in several places ; sometimes 
they are small and limited, sometimes continuing to spread, 
even covering whole limbs; itching, burning, and painful 
in a high degree. They may be dry (herpes siccus) ; or 
cause the epidermis to peel oft’in large patches, or like meal 
(herpes farinosus), which is renewed in successive series; 
or they discharge an acrid watery fluid (herpes humidus') ; 
or form crusts and exulcerations, which with a violent 
painful itching, extend by corrosion (herpes exedens, phage- 
dcenicus, esthiomenos, lupus), or may form a herpetic ulcer, 
which is distinguished by an ichory, imperfect suppura- 
tion, an exsudation of an acrid watery serum and a callous 
thickening of the cellular tissue.—The disease is without 
fever and not infectious. 
Herpes may assume a variety of forms, even degenerate 
into a leprous state. They have been classified into a mul- 
titude of species, and designated by different names. But 
such an attempt is a useless multiplication of nosology; 
for they are only varieties of the same disease, modified by 
individuality. They are always herpes for the practitioner, 
and the treatment is the same. 
Their course and duration vary very much ; they are of 
short, or of long duration, lasting for months and years, 
even through life ; permanent, or periodical, disappearing 
and returning; in which the seasons have a particular in- 
fluence (being less in dry summer heat, more in damp cold 
air); confined to one spot, or “ vagus,” wandering from 
place to place. 
Herpes is a very troublesome and obstinate disorder, 
though never dangerous unless greatly spread,degenerating 
and de'stroying the cutaneous function, whereby hectic 
may arise, or by retrocession and translation to internal 
parts. 
Pathogenesis. Proximate cause: A peculiar corruption 
and abnormal condition of the skin, altered in its secre- 
tion and reproduction, by which at last a general dyscra- HERPES. 
421 
sias (herpetic acrimony), but a contagion is never deve- 
loped. 
The remote causes may be referred to : hereditary dis- 
position (which cannot be denied, is the most frequent, and 
may render the evil prevalent in whole families) ; diseases 
of the liver and acrimony of bile thereby created ; glandu- 
lar diseases, scrofulosis ; long suppressed perspiration 
(damp dwelling) ; acrid, too much salted or fat food; hse- 
tnorrhoidal congestion to the skin, anomaly of haimor- 
rhoids, a frequent cause; disorders of menstruation, preg- 
nancy ; local irritation of the skin by too great heat or by 
coarse clothing; old age, which makes the skin and even 
the kidneys dry and inactive; finally a general dyscrasy, 
especially a lurking syphilis. A tender delicate skin pre- 
disposes to the disease, especially to herpes farinosus. 
Therapeutics. The first and most important thing in the 
treatment of this as well as of all other diseases, is to‘re- 
move and properly attend to the remote cause. The pa- 
tient must therefore adopt, above all other things, a mode- 
rate and rbild diet, avoid all kinds of heating food or beve- 
rage, and live in a dry pure air. If the biliary secretion 
and the liver are disordered, solvent remedies and such as 
promote the secretion of bile must be used. If the cause 
is hemorrhoidal, which is recognisable by the phlogistic 
character of the herpes, by former and occasional hemor- 
rhoidal complaints, sulphur and the treatment of piles must 
be resorted to. The same principle applies to disturbed 
menstruation. If it is owing to scrofula, mercurials and 
barytes are to be given ; if to arthritis, guaiacum and other 
arthritic remedies; if to syphilis, which is often the remote 
and concealed cause, mercury. 
If none of these causes can be detected, or they have 
been removed, then the treatment is to be directed against 
the proximate cause, the cutaneous corruption and her- 
petic acrimony (the specific herpetic treatment). Dulca- 
mara ranks first; to be taken in decoction, 2to 4 drachms 
daily ;or as extract 1 or 2 scruples a day; the next in rank 
°f efficacy is crude antimony, (one drachm or more daily 
■with magnesia). A combination of both these remedies in 
form of pills (vide No. 248), is still more powerful. 
•Recourse may likewise be had to Plummer s powder, pul- 
vis antidyscrasicus (vide No. 201), submuriate of mercury, 
a decoction of cortex ulmi, sulphur, calx antimonii sul- 
phur (the artificial sulphur water), resina guaiaci, corrosive 
sublimate in decoction of sarsaparilla, graphit 1 scruple to 1 
drachm daily, a strong decoction of pansy (herba jaceee) 422 
HERPES. 
continued for some time ; in the most obstinate herpes the 
decoctum Zittmanni has effected a cure. When herpes is 
of a phlogistic character, whey, the fresh expressed juices 
of herb and root of dandelion, of dog-grass, tussilage, nas- 
turtium aquat., fumaria, and repeated cupping are service- 
able ; also muriatic acid (10 to 25 drops three times a day) 
is of excellent use; even the most severe cases of this 
kind, even ichthyosis, have yielded to it. Baths, especially 
of soap, with one pound cortex ulmi, or the cool sulphur 
springs, particularly those of Nenndorf and Eilsen, merit 
high recommendation as true specifics in inveterate herpes. 
I have seen the most malignant, suppurating, crusty herpes, 
which would not yield to any other remedy, removed by 
these means. In obstinate cases baths of corrosive subli- 
mate also may be taken. 
Local means may be added to this treatment; but no re- 
pellents, especially lead, which are apt to cause a retroces- 
sion, and a dangerous translation to internal parts. In slight 
dry herpes, embrocation made of bruised walnuts, or what 
is better of fresh expressed nut-oil (oleum juglandum), 
likewise washing with a solution of borax (vide No. 249, 
particularly recommendable for the face), calx muviatica 
or chlorinica, lime water, especially when mixed with 
palm soap, or weak sublimate water, ointment of white 
precipitate applied to the eruption, lime-ointment, which is 
particularly salutary in facial herpes. In order to allay 
the violent burning, there is nothing better than sperma- 
ceti and almond oil, and if that do not sufficiently mitigate 
it, repeated cataplasms of cream may be tried. In inflam- 
matory and painful herpes, especially in the face, the ap- 
plication of rags, moistened with fresh water, renewed 
every hour, is often the best mitigative, even curative ; 
when the pain is very severe, recourse may be had to a 
frequent application of fresh bruised leaves of beta alba 
or plantain, by which I have seen the worst suppurating 
and corroding herpes in the face (sycosis) cured. 
Also a covering of leather is often a good curative. In 
obstinate cases, which have resisted all other remedies, 
tar (pix liquida) has proved the most vigorous and per- 
fectly curative means, in the following form : 1 cup of tar, 
2 yelks of eggs, and 1 cup of cream mixed together, and 
used twice a day. 
One of the most stubborn species of herpes is sycosis 
menti, lupus. When the remedies before mentioned are 
unavailing, Zittmann’s decoction will be the best. 
In every obstinate herpes, and especially when local re- CRUSTA LACTEA. CRUSTA SERPIGINOSA. LEPROSY. 
423 
are used, derivations by artificial ulcers and purga- 
tlv'es are recommendable, partly to promote the cure, and 
Partly to prevent metastases to internal parts. 
CRUSTA LACTEA, 
(Vide Diseases of Children.) 
CRUSTA SERPIGINOSA, 
Is an assemblage of scabs, which cover the lower part 
of the face, in adults. It is to be treated like herpes. 
LEPROSV. 
Lepra. 
Diagnosis. Uneven, tumid, knotty, entirely disorganized 
skin, covered with thick crusts and intermediate suppurat- 
ing points; violent pricking and itching, on different parts 
of the body, even in the face. Finally, a total destruction 
of the cutaneous system. 
This disease presents itself in several degrees and forms. 
In the worst species (lepra orientalis), which is no mpre 
met with in Europe, whole parts, as eyes, nose, hands and 
feet fall into gangrene and destruction. Corrosive ulcers 
are formed. The pains are excessive, especially during 
the night. The whole body is covered with scabs, and is 
deformed, especially the face. Swelling, anxiety, deafness, 
hoarseness, hectic fever associate with it, and death ensues 
by consumption. This kind is evidently infectious. 
In the milder kind (lepra occidentalis) all the accidents 
are milder, the destruction of the skin is less extensive, 
the disease is more local, does not affect the internal 
parts; therefore it is neither fatal nor infectious. 
Elephantiasis exhibits the skin of single parts, especially 
°f the feet, thickened, indurated, and covered with a thick 
rough crust, like the skin of an elephant, discharging in 
several places a fetid and corrosive ichor. 
Vitiligo is distinguished by large white spots on the skin, 
with constant scaly desquamation of it, and induration of 
the subjacent cellular tissue. 424 
ERYTHEMA. PHLYCTiENiE. 
Pellagra (which seems to be a species of this disease) 
forms on the back and the extremities large erysipelatous, 
extremely pungent spots, which pass often into blisters, with 
scaling off of the epidermis. It appears in the spring, and 
goes off in the winter time. The nervous system, espe- 
cially the brain, is simultaneously much affected, and may- 
run into mental maladies. The disease is endemial and 
occurs only in Upper Italy. 
Only the milder species of lepra are now seen in Eu- 
rope. The virulent form of this disease lias been extin- 
guished in this country, by the careful measures of isola- 
tion taken in the previous centuries, and is now only found 
in the East.* 
The cause of the violent oriental or genuine lepra is a 
peculiar contagion. The slighter occidental species seem 
to be leprous forms of other cutaneous diseases, and rather 
to be classed with the worst kinds cf herpetic corruptions. 
Cure is very difficult. It must be pursued according to 
the same principles and by the same remedies as that of 
herpes; particularly the following :—mercurials, antimo- 
nials, sublimate with opium, cicuta, decoct, of rad. caricis 
arenar., lapath. acut.; externally mercurial applications, 
salt, sulphur, and corrosive sublimate baths, the use of tinct. 
cantharid. 30 to 40 drops, acid./muriat., in the worst 
cases the external use of arsenic. 
ERYTHEMA. PHLYCTiENiE. 
Diagnosis. Bed spots, little blisters or suppurating pim- 
ples, which disappear after a few days; especially in the 
face. 
A slight, insignificant disorder of the skin, but which is 
very common and displeasing to young females. 
The common cause is plethora, sanguineous congestion 
to the head, caused frequently by tight lacing and consti- 
pation of the bowels, and tender skin. 
The treatment must be : to diminish the plenitude of 
blood by a cooling, less nutritive and vegetable food; 
a\Toiding all heating drinks, as wine, coffee, beer ; drinking 
plenty of water, to make a derivation by repeated cathar- 
tics (bitterwater, fol. sennse, rad. jalap.), foot-baths, also re- 
peated cupping; externally by washing the parts with 
aqua cosmetica every evening. 
* It is also yet met with in the negroes of the West Indies. SCALD HEAD, 
425 
It is not uncommon to meet with these temporary in- 
flammations of the skin, in catarrhal and rheumatic fevers, 
Specially in children; in which cases they are frequently 
taken for scarlatinous or morbillous spots. But they disap- 
pear very soon, do not desquamate, and are merely sympto- 
tflatical cutaneous irritations, proceeding from a catarrhal 
°r rheumatic acrimony, and which wear away with the 
fever and do not require a particular attention. 
SCALD HEAD. 
Favus, Tinea. 
Diagnosis. Little ulcers in the hairy parts of the head, 
which secrete a viscous, fetid matter, itch violently and 
form scabs. The disease exhibits two forms, favus, achores, 
the slighter kind, the common scald head; and tinea, the 
Malignant scald head, when the head is covered with, 
white, fixed crusts, and the roots of the hair areenlarged. 
Scald head is a disease very common in children; it 
has, however, become strikingly rarer, since the habit of 
going bareheaded and having the hair cut shorter. Less 
frequent is the malignant scald head; but it is a very obsti- 
nate disease. 
The causes may be referred to a neglect of cleanliness, 
keeping the head too warm, most frequently to a scrofu- 
lous dyscrasy and mesenteric obstructions, also to sup- 
pressed perspiration. Tinea is an idiopathic disease, and 
has its proximate cause in a swelling and disease of the 
roots of the hair. 
The cure of the common scald head is effected by 
cleanliness of the head ; frequent combing and cutting the 
hair (with the precaution, not to cut it too short, espe- 
cially in cold weather, since this would have the same ef- 
fect as the removal of a fur cap, and produce a retrocession 
°f the eruption), washing of the head with tepid soap- 
Water ; anointing the hard scabs with butter or oil ; inler- 
ftally sethiops rnineralis with rhubarb and magnesia, a tea 
cf sassafras, and every 8 days a cathartic o( jalap and ca- 
lomel may be used. Thereby a cure is generally effected. 
If the evil be more obstinate, baths, Plummer’s powder 
with guaiacum, and also cicuta are needed. External ro- 
horants are seldom required ; and great precaution must 
he observed in using them, since they are apt to cause re- 426 
GUTTA ROSACEA. VARI. 
trocession and dangerous metastases to the brain and the 
organs of the senses. In obstinate cases, the application 
of cabbage leaves is a very good remedy; they are to be 
applied triple, repeated three times a day, which will gra- 
dually loosen the scabs, and the cure may be finished by 
oily applications. 
Tinea calls likewise for the internal use of the remedies 
mentioned above, but the principal thing is to remove the 
diseased roots of the hair. This is done by small stripes of 
pitch plaster (resin mixed with a little flour), daily ap- 
plied to a small spot, which when taken off draws with it 
the roots of the hair. Or also gumm. ammoniac, cum acet. 
squill, coct. ad consistentiam emplastri, put on and left, 
until it can be easily taken off. When the evil is very ob- 
stinate, take a mixture of one teaspoonful of mercury dis- 
solved in muriatic acid, mixed with a like quantity of but- 
ter, anoint the part with it every day, and repeat this, until 
the whole is entirely cleansed. 
GUTTA ROSACEA. VARI. 
Diagnosis. Large purple, reddish brown or copper-color- 
ed spots on the face, especially on the nose, and sometimes 
on other parts ; elevated, and imparting a sensation of heat. 
They are called vari when they are round or conical, 
callous and elevated, with an orifice at the summit through 
which exudes a purulent or watery, sometimes even a san- 
guineous fluid. 
Each of these forms may occur separately or together, 
and both are brought on by similar causes. 
The principal cause is a peculiar disposition of the skin ; 
hence gutta rosacea may be hereditary and run through 
whole families. The most common exciting cause is an 
excess in spirituous liquors ; but disordered biliary secre- 
tion and menstruation may also produce it. 
The cure is difficult. It consists in a removal of the 
causes, in a derivation by purgatives, and long continued 
artificial ulcers on the arms, foot baths of mustard, wear- 
ing socks of oiled silk, and the application of the cosmetic 
water, No. 249 ; inunction of white precipitate ointment 
about the parts, or, when these remedies are unavailing, 
the mixture of sulphur and camphor (,\o. 250), which is 
specifically efficacious in this affection. We must be care- 
ful not to use quickly repelling remedies, for they are apt 
to produce dangerous metastases. BOILS. CARBUNCLES. 
427 
Furunculus. Carbunculus. 
BOIL. CARBUNCLE. 
Furunculus. 
Diagnosis. Round or coniform hard elevations, from the 
size of a few lines in diameter, to that of several inches, 
which slowly inflame, assume a brown-red color, break and 
discharge a purulent matter mixed with blood, but retain 
in their cavity a slough, that is to say, a portion of dead 
cellular tissue, the evacuation of which is necessary to a 
perfect cure ; but should the ulcer heal over the slough, 
this may still be felt, and will cause the part to break again 
sooner or later. Furunculi may form on all parts of the 
body, especially in the bends of the joints and where there 
is an adipose accumulation. 
The causes are the same as those of cutaneous diseases 
in general ; but the furuncular form seems to depend on a 
peculiar condition of the skin itself; hence it is that some 
persons suffer from furunculi on the least occasion, and al- 
most continually. They are frequently the crisis of, and 
follow acute fevers, acute eruptive diseases, the termina- 
tion of itch and other chronic exanthemata; and are also 
a crisis of gout. The topical treatment consists in accele- 
rating their maturation by emollient and irritant cataplasms 
(of linseed), hyoscyamus, saffron boiled in milk, and em- 
plastr. diachyli compositurn or oxycroceum, and after they 
are broken, in accelerating expulsion of the slough by di- 
gestive ointments. 
When a general disposition to furunculi exists, or when 
furunculi frequently return, vve must resort to the general 
treatment of cutaneous diseases, or to the particular dis- 
ease of which they are a form. 
Carbunculus. 
(,Malignant Furuncle, Pustula Nigra.) 
A- livid, bluish or black spot of a large surface, violently 
painful, and finally blistered. It is most apt to form in the 
neck, and between the shoulders; is a symptom of gastro- 
nervous fevers, and endangers life, for a fatal putrescency 
may readily spread from the local mortification over the 
whole organism. 
The cure consist? in the cure of the fever (first an eme- 428 
INTERTRIGO. RHAGADES. 
tic, and then the most active antiseptic excitant remedies), 
and in a proper surgical treatment. First, a deep crucial 
incision reaching to the living flesh, must be made, and 
then the most vigorous antiseptic balsamic remedies, cin- 
chona, arnica, myrrh, and camphor, the whole treatment of 
gangrene as taught by surgery, must be applied to. 
When the case is slight, merely cataplasms of aqua oxy- 
muriatica, combined with scarifications, have been suffi- 
cient. 
The carbunculus contagiosus is brought on by infection 
from without, and is a symptom of the disease whence it 
arises, as well as are bubo and anthrax symptoms of the 
plague (vide cojitagious typhus). 
INTERTRIGO. RHAGADES. 
Diagnosis. In intertrigo the skin becomes sore in the 
bendings of the joints, pubes, lips ; it cracks and causes 
It is most common in infants, and is owing to a neglect 
of cleanliness, or to the acrimony of perspiration and 
urine. 
Be careful not to apply saturnine or other quickly dry- 
ing remedies. The best is cold water and the powder of 
lycopodium. 
The same remarks apply to adults, especially to females, 
who are very subject to it. We must, however, inquire 
whether some internal disturbance may not be its remote 
cause. 
The cracked skin of the hands and feet, which happens 
at change of seasons, is generally due to cold, but also to 
general causes and dyscrasies, as the arthritic. 
The treatment consists in the application of mild unc- 
tuous remedies, as almond soap, cacao-butter, especially 
deer’s tallow, which is preferable to any other kind of 
grease, a fact which proves that fatty bodies differ from 
each other in their action as a remedy, though they are 
chemically alike as regards their composition ; for there 
are persons whose skin is so excitable as to be irritated by 
one kind of grease, and be benefitled by another ; of this 
kind is that of the deer. 
Borax may also be used in combination with the aqua 
cosmetica. x 
When the chaps are caused by cold, we must resort to 
the treatment for chilblains. Often a dyscrasy, espe- 429 
dally the arthritic, is the latent cause of the disorder, and 
must be attended to accordingly. 
Intertrigo and rhagades may also be dependent on a too 
great delicacy and tenderness of the epidermis ; when this 
is the case, astringent lotions and cold baths are recom- 
mendable. 
LENTIGO. EPHELIS. COMEDONES. 
FRECKLES. 
Lentigo. Ephelis. 
Lentigines, small, brownish-yellow spots on the face and 
on the hands, imparting no sensation, appear in spring and 
summer time, and disappear in winter. They are most 
frequently met with among females, in persons of light and 
red hair, and generally in persons of a delicate and white 
skin. 
Ephelides, yellow or brown spots, from the size of one to 
several lines, or even inches in diameter ; in single patches, 
or spread about every where, commonly divested, but some- 
times accompanied with itching and desquamation of the 
epidermis. 
Both are superficial affections of the skin ; in the ephe- 
lides, however, a bilious dyscrasy is the remote cause, as 
a polycholia or a disturbed function of the liver. Men- 
strual disorders are also capable of producing them ; so 
that there are women who discover that they are pregnant 
by the appearance of ephelides, and which disappear after 
parturition. 
The cure of lentigines requires shelter from the rays of 
the sun, abstinence of washing immediately before exposure 
to open air, and the use of aqua cosmetica in the evening 
before retiring. 
The ephelides are most certainly removed by borax (half 
a drachm of borax dissolved in an ounce of rose water ; 
moisten the spots frequently); where there is an indica- 
tion of bilious acrimony, by dissolvent remedies, which 
purify the bile and blood. 
COMEDONES. 
Diagnosis. The skin of the whole body is apparently 
dead, languid, pale and dry, beset with a quantity of small, 
elevated, black points, from which a thickened matter in 
the form of little worms, may be expressed. In a high 
degree the skin is covered with these vermiform threads. 430 
COMEDONES. CUTANEOUS EXCRESCENCES. 
It is associated with all the signs of atrophy, general ema- 
ciation, weakness, the physiognomy of old age. It ends in 
death by exhaustion. 
This disease is met with only in children in the first 
years of life, and has its cause in a want of cutaneous vital- 
ity, a suspension of secretion and absorption, which per- 
mit an accumulation of sebaceous matter in the little foli- 
cular glands, in which it becomes moulded, and gives a 
form which has been mistaken for worms ; and, as the 
whole nutritive process suffers, these worms have been 
considered as comedones (eating companions). 
The remote causes are always referable to a neglect of 
cleanliness, or of cultivation of the skin, and to the use of 
bad food. 
The cure consists in animating the skin by baths of 
soap, malt, aromatic herbs, pure air, nutritious aliments, 
and a cautious use of wine, and internally exciting reme- 
dies; when the lymphatic system, especially that of the 
abdomen, is greatly affected, aethiops mineralis, antimony, 
and rhubarb may be given (vide Diseases of Children). 
CALLOSITAS CUTIS. EXCKESCENTIjE, CLAVUS, VEERUCiE. 
Diagnosis, common to all, is an induration or a thicken- 
ing of the epidermis or the cuticle. 
Callositas, scirrhositas cutis, the induration of a great 
part of the skin. This disease is not uncommon in new 
born infants, especially in France, where it is called Ven- 
durcissemeni du tissu cellulaire, and has a fatal issue (vide 
Diseases of Children). 
An induration of the skin and cellular tissue of whole 
limbs is sometimes met with as a symptom of scrofula, and 
as a consequence of erysipelatous inflammations, and it is 
occasionally combined with considerable tumefaction and 
deformity. It has already been mentioned above as a 
symptom of several chronic, especially herpetic cutaneous 
eruptions. 
The treatment requires a most vigorous use of internal 
and external remedies ; such as have a particular tendency 
to urticate and act on the skin, as mercurials, antimonials, 
belladonna, cicuta, opium ; salt, sulphur, and alkaline baths, 
emollient cataplasms, unguentum, oxygenatum (which I 
can highly recommend) ; and of artificial ulcers. 
Verrucce, warts, are single indurations and excrescences of 
the epidermis on all parts of the body ; called clavi (corns) PLICA POLONICA. 
431 
on the toes ; cornua, when they attain a hornlike hardness ; 
and also a hornlike form and size,which sometimes happens. 
Warts sometimes spring up single, sometimes in great 
number, especially in children, and disappear again with- 
out any perceptible cause. Frequently a mechanical pres- 
sure is the evident cause ; but frequently, too, particu- 
larly when numbers come at once on various part: of the 
body, they are owing to a cutaneous disorganization; 
brought on by some internal disorder ; their formation 
seems also to depend upon the period of development (pu- 
berty), upon scrofulous, arthritic, and venereal dyscrasies. 
The topical treatment consists in the application of 
caustics, such as tinct. cantharid., nitric acid, muriate of 
antimony, nitrate of silver, hot iron or the ligature. When 
they are symptomatic, the treatment of the original disease 
must be-pursued. 
Sometimes the whole skin becomes covered with wart- 
like excrescences—morbus verrucosus universalis. 
The callous and porcupine skin is to be classed here. 
The d isease is to be treated according to the above princi- 
ples, but is rarely curable. 
PLAITED HAIR 
Plica. Trichoma. 
Diagnosis. Confusion and entangling of the hair, which 
at last forms into cues. The hair curls and mats into in- 
extricable meshes like tails, thickens and exudes a viscid 
matter, which condenses and thickens them into still 
greater masses. When the disorder is very intense, the 
disorganized hair may become painful, and excrescences 
may also be formed on the nails. It is preceded by lassi- 
tude, pain in the limbs, headache, dizziness, febrile irrita- 
tions, and fetid sweats. After the eruption has appeared, 
th«sse symptoms cease. If the plaited hair is cut off pre- 
maturely, it soon reappears, accompanied even with lame- 
ness, deafness, blindness, etc. 
It is a chronic disease, and cannot be entirely removed. 
The proximate cause is a peculiar disorganization, or 
rather hyper-organization of the skin. 
Its exciting cause is purely endemical, for it occurs only 
in Poland (plica Polonica), and when it appears in other 
regions, the matter of it has been originally brought thither 
from that country. Probably a neglect of cleanliness, the 
use of fur caps, and perhaps a peculiar condition of the 432 
PLICA POLONICA. 
water concur to originate it. The peculiarity of the race 
(the Sarmatic),* seems to be particularly liable to it, for we 
meet with it only in Sarmatic villages, and not among Ger- 
mans or Russians living under the same circumstances. 
But, according to the experience of the best observers, it 
is contagious, and may be communicated particularly by 
coition. Also the preceding complaints, their abatement 
on the appearance and return, on the suppression of the 
eruption show, that the disease is not merely local, but 
that this disorder of the hair is the product or rather the 
critical metastasis of an internal dyscrasy. 
The indications are: to remedy the general dyscrasy 
and to separate cautiously the plaited hair. 
The special treatment must be adapted to the stage of 
the malady. 
1. During the precursory stage, the general dyscrasy 
must be ameliorated and the .metastasis promoted. This 
is to be attained by general diaphoretics, especially anti- 
mony, which seems to operate specifically in this case, also 
the decoction of guaiac. In a sthenic constitution, the ex- 
citement requires a venesection. 
2. After the hair has become plaited, these remedies are 
to be continued and increased in strength, in order to ren- 
der the crisis complete. 
3. When the separation is completed, which is recog- 
nized by the hair losing its glossy appearance and fetor, 
and by its being replaced by new, healthy hair, the matted 
hair may be cut off. 
This period is to be particularly watched, and to be ac- 
celerated by employing the means before mentioned. If 
the plaited hair is cut off at an early stage of the disease, 
the most dangerous accidents happen. 
At the conclusion of the treatment, tonics must be 
S , 7 
given. 
1 cannot forbear remarking, that great attention is due to 
the concealed trichoma, which may be a cause of the most 
protracted and obstinate nervous diseases. 
MOLE. 
Jfcevus. 
Diagnosis. Congenital spots, or spongy, wartlike eleva- 
tions of the skin, of different colors, usually red, brownish, 
* It is found also among the Jews. BALD HEAD. 
433 
or violet; of various size and figures, often beset with hair, 
(which liken them, by means of imagination, to strawber- 
ries, raspberries, mice, etc.). They last for life and retain 
their original form and condition, or, by accessory causes, 
especially topical irritation, enlarge and are transmuted into 
more injurious pseudo-organizations, and into canorous dis- 
organizations. 
They are owing to the first conformation in the womb, 
and on that account they frequently appear hereditarily on 
the same spot, where the father or mother has the like. It 
is probable that a continual pressure during the foetal state, 
on the part affected, which hinders the free circulation and 
formation of the skin, may give rise to them ; but other 
causes also, even mental affections, which sometimes have 
a fatal influence on the foetus, may contribute to their ori- 
gin, and excite such disturbances in the formation of the 
skin, so that we need not presume a superstitious influence 
of th e imagination. 
The treatment must be entered into with great caution, 
for any local irritation may excite an increase and a still 
greater degeneration of this pseudo-organization. It will 
be best to consider them a '■'•noli me tangere,” and to avoid 
all touch and pressure. Such trials are most dangerous, if 
made in the face. When treatment is asked for, weak so- 
lutions of borax, alum, alkali, submuriate of mercury, and 
limewater may be used ; spongy excrescences with a small 
base may be removed by ligature. In those called wine- 
stains, tatooing into the part a color conformable to that 
of the natural skin has been done with success. 
BALD HEAD. 
Alopecia. 
Diagnosis. The hair is dry, white, cracks and falls out. 
As causes we may enumerate all such as prevent the nu- 
triiion of the hair, especially old age, preceding acute 
fevers, particularly acute diseases which affect the bead, 
as erysipelas, excesses in venery, violent grief and anxiety 
(of which there are instances in which the hair grew gray 
in a single night), chronic cutaneous diseases, dyscrasies, 
especially syphilitic. 
The treatment consists in frequent combing and brush- 
ing the hair, washing it with soapwater, with a decoction 
of burdock root; anointing it with a pomade of beef’s mar- 
-37 434 
ULCERS. DYSCRASIES. 
row and oil of cedar; powdering with a mixture of burnt 
culinary salt and hair powder, also washing with a solu- 
tion of blue vitriol. 
ULCERS. 
Ulcera. 
Ulcers of the skin and bones (caries, spina ventosa) are 
treated according to the same principles as the cutaneous 
diseases (vide generalities'). 
Here also an internal medical treatment, and an atten- 
tion to remote causes, especially to the various dyscrasies, 
is of great importance ; but of equal importance is the sur- 
gical treatment, therefore they are referred to the depart- 
ment of surgery. 
Also noma is here to be mentioned; for which we will 
only observe, that the application of pyroligneous acid has 
proved most efficacious. 
TWELFTH CLASS. 
DYSCRASIES. 
Generalities. 
Faulty condition of the humors, which operates as an 
exciting cause of disease, and is called cachexy, when it 
disturbs nutrition and reproduction. 
Diagnosis. Alteration of the complexion, cutaneous 
eruptions, secretions changed in quality (especially the 
urine, also the blood, as seen in venesection), irritations of 
the nerves as well as of the vascular system, causing thirst, 
pains, spasms, irritated pulse, febrile motions, inflamma- 
tions, faulty reproduction, and pseudo-organizations ; fre- 
quently a production of contagion, parasitic formations and 
disorganizations. 
Dyscrasies vary in their nature and in their effects. 
Sometimes they are slight and without danger ; sometimes DYSCRASIES. 
435 
very important and destructive to health and to life; they 
are chronic and sometimes last for life. Their effects are : 
all kinds of chronic and acute diseases, ending in hectic, 
atrophy, phthisis, dropsy, and terminating in a general 
consumption of the powers, or in a local destruction of 
noble viscera. 
Pathogenesis. The purity or normality of our humors 
and of organic matter in general depends on the quality of 
what enters into the body from without, on its proper ela- 
boration and animalization within the system, and on the 
due excretion of what has been used, has died away, and 
has consequently become foreign and injurious. 
Dyscrasy, impurity, anorraality (acrimony) of the hu- 
mors may therefore be caused, 
1. By a faulty accession from without. 
A. Here nutriments are first to be mentioned : food and 
beverage must be considered in regard to quantity as well 
as quality. Quantity : a, too much may be taken, over- 
taxing the digestive and assimilative powers, and there- 
fore preventing its proper conversion, suffering it to form 
crudities; hence proceed degenerated, imperfectly assimi- 
lated and consequently heterogeneous humors ; b, or too 
little. Insufficient, bad, unusual food produces dyscrasy, 
by absence of the necessary supply and consequent debi- 
lity. In regard to quality, heavy, indigestible, greasy, or 
too irritative, spicy, acrid, heating, salted or putrid food 
and beverages are injurious. 
B. Air; subject to a double consideration; a, by defi- 
ciency of oxygen ; as confined air, the oxygen of which has 
been consumed or animalized; b, by deleterious admix- 
tures. 
C. Warmth ; its excess and deficiency; the climatic in- 
fluences fall under this head. 
D. Poisons ; especially the metallic, as quicksilver, lead, 
arsenic, and silver. 
E. Contagia and miasmata, especially the syphilitic and 
the psoric ; and 
F. Neglect of cleanliness, dirt in general, which is often 
the unperceived cause of dyscrasies in the 
lower orders of people, even of certain nations. 
2. By faulty metamorphosis—the assimilation, animaliza- 
tion, and transition of the ingesta into the animal, animat- 
ed, and individual nature. It consists of three main ope- 
rations, each of which may become disordered and thereby 
cause a dyscrasy. 
A. Digestion. Weakness of the stomach, imperfect di- 436 
DYSCRASIES. 
gestion produces saburra, acrimony, and in consequence 
imperfect, vitiated, watery, and acrid blood. This is also 
true of the influence of warmth. 
B. Chylification. Disordered condition of the chylopoi- 
etic system, obstructions in the mesenteric glands, generate 
a bad chyle and faulty humors. The whole lymphatic sys- 
tem is to be ranged here, inasmuch as it introduces into 
the blood all that is received from without ; thus the dys- 
crasia scrophulosa is engendered, the original seat of which 
is in the lymphatic system. Also the dyscrasia arthritica 
has its original source and laboratory in disordered diges- 
tion and chylification. 
C. Sanguification. The proper transformation of chyle 
and lymph into healthy, well animated, and well organized 
blood may be prevented by general debility, by want of 
muscular exercise, but especially by disorders of the lungs 
and respiration, the principal organ of animalization and 
sanguification (e.g. asthma, blennorrhoea, pulmonary tu- 
bercles, phthisis, even kyphosis); and by disorders of the 
heart (especially aneurisma, ossification, persistence of the 
foramen ovale and ductus Botalli, interfering with the pas- 
sage of the blood through the lungs). Thereby are gene- 
rated various dyscrasies of the blood ; too watery or a rau- 
cous condition of it, chlorotic dyscrasy, but especially the 
deficient transmutation of the venous into arterial blood, 
the venous character, hypercarbonization of blood, the 
cyanotic and scorbutic dyscrasy. 
3. Faulty secretion and excretion. Proper secretion and 
excretion of what is corrupt, used, decayed, is an essential 
condition of pure blood ; hence disorders of these functions 
are the richest sources of dyscrasies. They may be 
double : 
Ji. Obstruction, suppression of secretion, by which the 
matters destined to be discharged are retained. The most 
common of which is: a. Suppression of the secretion of the 
skin, especially of the imperceptible one (owing to cold, 
dampness, uncleanliness, want of exercise) ; it generates 
the perspirabile retentum, the rheumatic dyscrasy, the pso- 
ric dyscrasy. b. Suppression of the secretion of the liver 
(one of the most important blood purifying organs, espe- 
cially for removing carbon) ; hence the dyscrasia biliosa, 
icterica, atrabilaria. c. Suppression of the secretion of 
the kidneys, especially the chronic ; thence the dyscrasia 
urinosa. 
B. Degeneration, qualitative alteration of the secretion 
(pathological secretion). A novel heterogeneous matter DYSCRASIES. 
437 
(morbid matter) is generated within the body, which may- 
become mixed with the humors and corrupt them. Here 
the cause of the dyscrasy may be merely local. Of that 
number is the dyscrasia purulenta, owing to absorption of 
pus, in external or internal ulcers, caries, gangrene, cuta- 
neous diseases, the dyscrasia herpetica, leprosa, cancrosa. 
Therapeutics. The principal indications are the fol- 
lt wing : 
1. To investigate into, and to remove the various causes. 
In this regard the treatment varies very much. Faults in 
the mode of living, of diet, of external influences, digestion, 
chylification, sanguification, secretion, specific miasmatic 
and contagious matters, local diseases are to be remedied. 
2. To purify the humors. This is effected by general 
blood purifying remedies (alterantia, purificantia). The 
principal one, and which is the basis of all others, is water. 
Copious drinking of pure water, and bathing in it alone is 
capable of curing the most difficult and obstinate dyscra- 
sies, as experience has sufficiently shown. Besides, such 
vegetables as are possessed of the above stated properties J 
the most efficacious are the fresh expressed juices (of ta- 
raxacum, fumaria, rad. graminis, nasturtium aquaticum), 
the decoctions and infusions of rad. bardanse, saponar., sar- 
saparillas, caric. arenarise, guaiacum, lapathum. Antimo- 
nials, sulphur, mercury (only under certain conditions), 
cathartics (especially senna leaves, indisputably the most 
efficacious of all vegetable antidyscrasic medicines, even 
in the form of powder; I have given Ito I 1 drachm of it 
in an affusion daily with the greatest benefit; and jalap). 
In obstinate cases several of these remedies may be com- 
bined, the pulvis antidyscrasicus (vide No, 201), one of 
the most usual and efficient remedies in dyscrasies ; the 
species purificantes s. lignorum (vide No. 202), the decoc- 
tum Pollini (vide No. 203), particularly the decoctum Zitt- 
manni (vide No. 204), which, in spite of its nonsensical 
mixture, has most excellent effects. The doses must, of 
course, be modified according to individuality. 
3. Abstinence, fasting cure. It operates by withholding 
the matter, as well as the power which engenders dyscra- 
sy. It is most indicated and efficacious where excessive 
nutrition and plethora are the causes of dyscrasy. 
4. Renovation of the humors. Direct correction of the 
matter by pure sound additions from without ; the genera- 
tion of a new blood. This is indeed possible, and fre- 
quently is highly efficacious. The principal means are : 
milk and pure air. Dyscrasies, which were incurable by CHLOROSIS. 
any other means, have been remedied by milk diet (living 
upon nothing but milk, white bread, and country air). The 
method of the ancients—purijicatio veteris, regeneratio novi. 
There are, however, cases in which a real want of nu- 
tritive substances in the blood is the sole cause of dyscra- 
sy, as in poor, famished persons ; after severe maladies and. 
medical treatment. In such cases good, nourishing, healthy 
food is the best curative of the dyscrasy. 
CHLOROSIS. 
Diagnosis. Pale, white color of the skin, cheeks and 
lips; deficient warmth, chilliness, lassitude, weak, slow 
pulse, want of air on the least exercise, palpitation of the 
heart, oedema of the feet, want of appetite, and on the con- 
trary a desire for substances, not usual as food, especially 
for earthy matters, as chalk, and the like ; the blood is thin, 
watery, poor in cruor, consisting almost entirely of serum. 
When the disease is protracted, general dropsy, ascites or 
tabes, also nervous diseases are apt to form. 
Pathogenesis. The essence and proximate cause of this 
cachexy is a peculiar disordered condition of the blood, in 
which the watery constituent prevails, and the cruor and 
fibrine, which contain the warmth, redness, plasticity and 
vitality, are absent. 
The most usual exciting cause is an obstruction of the 
sexual development and of the first menstruation (in the 
female sex); it may however be brought on by too great a 
loss of blood. 
Therapeutics. The principal object is to increase the 
cruor and fibrine, the caloric and coloring ingredient of the 
blood, which alone is possessed of vitality. The chief 
remedy is iron. Nothing in nature replaces so promptly 
and directly the cruor, redness, warmth, and vita! power 
of the blood, as this great and wonderful mineral, so nearly 
kindred to animal organism, so necessary to its existence, 
and so intimately related to magnetism, and the most secret 
creatory powers of nature. It is capable in young chloro- 
tic girls to produce within a few weeks a blooming com- 
plexion, and to impart new life (hence the chalybeate pills 
have received the name of red-cheek-pills). It may be used 
in all forms and preparations, but it operates most vigo- 
rously in substance (vide No. 205), in delicate individuals, 
who labor under great weakness of the stomach and muco- 
sity, dissolvent ferruginous salts, ferrum tartarisatum, CYANOSIS. 
439 
flores sal. ammon. martial, (vide No. 206), and chalybeate 
waters (Pyrmont, Driburg, Schwalbach, Cudowa). The pa- 
tient must enjoy open air, and use moderate corporeal ex- 
ercise at the same lime. 
If the disease is owing to a retention of the menses, a 
treatment appropriate to the various existing circum- 
stances, must be combined with the above remedies (vide 
Diseases of Females). 
If it is caused by onanism, iron and animal food are to 
be prescribed. 
CYANOSIS. 
Diagnosis. Livid color, frequently (after exercise) even 
a dark-blue one, of the extremities, especially of the fingers 
and toes, and of the face, sometimes of the whole body ; 
at the same time, difficulty of breathing (especially when 
exercising), palpitation of the heart, deficient warmth, gen- 
eral debility. Its duration is very indefinite, lasting some- 
times for months, but also for years, even to the age of 
25. Issue: increasing decomposition of the blood, passive 
hsemorrhages, dropsy, also death by asphyxia. 
Pathogenesis. The proximate cause is an impediment to 
the conversion of the venous blood into the arterial ; con- 
sequently the blood persists in a carbonized, venous, im- 
perfectly animated state. The causes are either congenital 
or acquired. 
The congenital (in the plurality of cases) are : the per- 
sistence of the foramen ovale, the ductus Botalli; organic 
disorders of the heart, the aorta originating from the right 
ventricle, absence of valves, undeveloped lungs (which fre- 
quently causes death immediately after birth). 
The acquired causes contracted in the course of life, 
are : the bursting of the foramen ovale (by vehement ex- 
ertions violent rushing of blood into the heart), aneurisms 
of the heart, ossification of the valves; tubercles in, and 
impermeability of the lungs (hence sometimes produced by 
asthma or phthisis). Also the scorbutic state, which is 
likewise a venous condition of the blood, may produce 
similar phenomena. 
Therapeutics. The direct cure must tend, as far as pos- 
sible, to oxydation and carbonization of the blood. Acids, 
muriatic as well as sulphuric, ought to be prescribed inter- 
nally, and as lotions and in baths (one or two ounces of 
muriatic acid to a bath), and pure air abounding in oxygen 440 
SCURVY. 
may be inhaled. The causes must also be regarded. In dis- 
eases of the heart, rest, avoiding all hard exercise, occa- 
sionally small venesections, in short, the treatment of the 
diseases of the heart (vide asthma syncopticum), are to be 
put in practice. 
In the cyanosis of the new-born, to make the infant cry 
has been recommended, as a probable means to cause the 
adhesion of the foramen ovale. 
SCURVY. 
Scorbutus. 
Diagnosis. Lassitude, spongy, livid, dirty, itchy gums, 
bleeding on the least touch ; looseness and falling out of 
the teeth, putrid breath, weak respiration, rendered diffi- 
cult by the least exertion ; feeble, lardy pulse, pale coun- 
tenance, bloated face, bluish spots on the extremities, 
swelling of the feet, sadness, saturated urine, which readily 
putrifies. When the disease is increasing, there are fre- 
quent hemorrhages from the mouth, nose, and other parts, 
which are difficult to suppress; increasing feebleness, fits 
of fainting easily brought on by exercise, unclean, livid, 
spongy ulcers on the feet, which are very apt to bleed, dull 
pains in the legs affecting the bones ; gangrene and spha- 
celus on the feet set in spontaneously—unpreceded by in- 
flammation, detaching sometimes entire parts from the 
body. 
We distinguish land-scurvy and sea-scurvy. The former 
is slight, and may last for years without dangerous occur- 
rences, though it may sometimes engender important dis- 
eases, as morbus h tumor r hagicus maculosus. Sea-scurvy is 
more formidable ; it grows rapidly worse, and is more de- 
structive. It may end fatally by loss of blood, by gan- 
grene, or by extreme exhaustion. Dropsy and emaciation 
are also apt to supervene. 
Pathogenesis. The proximate cause is a decomposition 
or dissolution of the blood, diminished vitality, and plasti- 
city of it, and a disposition to putrescency. 
The remote causes are: damp, cold air (hence is more 
prevalent in the northern coastward countries), impure, 
pent-up air, want of fresh vegetable food, salted, corrupt 
meat and putrid water, want of muscular exercise, sadness. 
All these causes are united in a long sea voyage ; there- 
fore scurvy is most frequent, formidable and fatal during JAUNDICE. 
441 
such a time. On land similar occurrences may happen ; 
as during sieges and other general calamities. There ex- 
ists, however, also a congenital dispositio scorbutica. 
Therapeutics. The principal intention is, to enliven, re- 
fresh, and oxydate the blood ; the second, to strengthen. 
Therefore the cure of the sea-scurvy is very easily effected 
by country air, fresh water, and fresh vegetables; and it 
is perfectly prevented even on board of vessels during the 
longest voyages, by cleanliness (constant ventilation and 
washing of the ship), exercise and exhilaration of the 
crew, and by sour-crout, citrons and beer. The most effi- 
cacious remedy is lemon-juice, six to twelve ounces taken, 
daily, and also externally applied to the ulcers. In land- 
scurvy, yeast of excellent service ; from four 
to twelve ounces a day must be taken, and be also applied 
externally to the ulcers. In great debility, besides the 
foregoing remedies, cinchona, calamus, acida mineralia ; 
in a disposition to hemorrhages, alum ; against the ulcers 
in the mouth and stomacace, mel rosar. with muriatic acid, 
gargling the mouth with chlorine water, decoction of Pe- 
ruvian bark, calamus with alum. Carrot pulp, frequently 
renewed, is useful, to heal the external scorbutic ulcers. 
In such cases, also, herba sabinse, used in fomentation and 
baths, has extraordinary and specific effects, even for 
curing caries. 
JAUNDICE (YELLOWS). 
Icterus. 
Diagnosis. Yellow color, perceptible in the white part 
of the eyes first, next over all the rest of the body ; vary- 
ing in degree from pale to saffron yellow, even to brown 
and blackish yellow (icterus niger) ; urine orange-colored, 
staining linen yellow ; faeces hard, and without the yellow 
color, but white or gray ; when the disease is very intense, 
even the perspiration will color the linen yellow. At the 
same time, difficult digestion, tension and tumefaction of 
the epigastrium, flatulency, mucous accumulations, acid- 
ity, deficient appetite, nausea, tension, pressure, and some- 
times pain of the hepatic region. 
Jaundice, by itself, is not a dangerous disease ; it may, 
however, become so by the causes which produced it ; as 
inflammation, incurable obstructions and disorganizations 442 
JAUNDICE. 
of the viscera, or by a long continuance creating cachexy, 
and finally hectic or dropsy. 
The first sign of improvement is the reappearance of 
color in the stools. 
Patkogenesis. The proximate cause is : the existence of 
bile in the blood and lymph, and absence of it in the intes- 
tinal canal, caused by retrocession of already secreted bile 
into the vascular system. It is therefore not impeded se- 
cretion, for without secretion there is no bile in the organ- 
ism ; but impeded excretion of bile, which is absorbed into 
the blood. The obstruction may take place in the ductus 
cysticus, or choledochus, or in the ductus hepatici, or in 
the puncta biliaria ; the latter is particularly apt to be the 
case in the inflammatory and spasmodic jaundice. 
The remote causes of jaundice may be dynamic or me- 
chanical. Such a suppression may be brought on dynami- 
cally by over-irritation, or by deficiency of irritation and 
action (atony) of the liver. The over-irritation may be 
inflammatory or spasmodic. 
The exciting causes may be ranged in three classes. 
Irritation, which retains the bile. Of this class are inflam- 
mation of the liver and contiguous parts, violent bilious 
mental affections, indigestion, gastric accumulations, cer- 
tain poisons, taking cold, strong emetics and cathartics, 
gall-stones ; in great irritability of the liver, spasms, as in 
hysterical persons. 
A mechanical obstruction to the excretion ; due to bili- 
ary concretions, gall-stones, even worms, which obstruct 
the ductus choledochus—obstructio hepatis. 
Atony of the liver, which arises very frequently second- 
arily, and entertains the disease as a secondary cause. 
Therapeutics. The principal intention is, to regulate the 
function of the liver, and to restore the free discharge of 
bile into the duodenum. This may be done in various 
ways, by varying the treatment according to the character 
of the disease. Above all, examine whether an inflamma- 
tory state is present, which may be recognized by the 
fever and by pains in the hepatic region (signs of hepatitis). 
When this is the case, abstractions of blood and the com- 
plete antiphlogistic treatment of hepatitis are indicated ; 
which will also remove the yellow color, or at least render 
the application of specific remedies practicable. 
In ordinary cases, the normal function of the liver and 
excretion of bile are restored by the continued use of dis- 
solvents and purgatives ; among which rhubarb (which has JAUNDICE. 
443 
a specific tendency to the liver) is particularly to be se- 
lected (No. 207, 208). Should these means not suffice, an 
emetic is to be given intermediately. Injections, antispas- 
modic embrocations on the regions of the liver and stom- 
ach aid the cure. Should these also fail, then aloes, which 
is an efficient excitant of the hepatic secretion, may be 
employed, and will in most cases be sufficient to accom- 
plish the task. Prescribe one grain, to be taken three or 
four times a day. 
Should even this not effect a cure, then use more vigor- 
ous resolvents, especially soap, gumrai ammoniac daily, 
up to two drachms, soda, mineral waters of Carlsbad, Ma- 
rienbad, Saidchutz, Pullna; asa foetida, calomel, sulph. 
antimon. aurat., scilla, fumaria, centaur, min., especially 
fresh expressed juice of taraxacum (herb and root), two 
or three ounces morning and afternoon, likewise extract 
of chelidonium. maj., still better the fresh expressed juice 
of it, one teaspoonful, gradually increasing to a tablespoon- 
ful, two or three times a day. At the same time, three or 
four yelks of eggs in water or broth, taken every morning; 
also rad. belladonnas, with rhubarb (No. 209). 
If even these remedies do not succeed in attaining the 
end, the cause of obstinacy must then be in a weakness and 
deficient action of the biliary organs,and it becomes a rule 
of practice to combine resolvents with roborants, especially 
quassia; even ferruginous remedies, particularly the use 
of Pyrmont or similar chalybeate waters. Sometimes a 
spasmodic state keeps up the disease ; in which case, in- 
jections with opium will prove efficient. 
In all kinds of jaundice we must attend to an ameliora- 
tion and purification of the blood, to removing the bile that 
has entered into the humors. This end is best attained by 
frequently drinking of acid beverages, cream of tartar wa- 
ter, tamarind-whey. 
Nor ouffht the remote causes to be lost sight of, such as 
worms, metastases, especially psoric acrimony, gall-stones, 
obstruction of the viscera, especially ol the liver; for 
which mercurial embrocations on the hepatic region are 
of great use. Sometimes icterus is puxely spasmodic, and 
then opium is most serviceable. The periodical, typically 
intermittent jaundice is to be treated as an intermittent 
fever. 
Icterus Niger. 
The severest kind of jaundice is when the color becomes 
dark-brown or blackish. It manifests the highest degree 444 
SCROFULA. 
of biliary obstruction (usually incurable disorganizations of 
the liver or concretions of irremovable gall-stones), and of 
bilious corruption of the blood. It rarely admits of a cure, 
and passes in most cases into dropsy ; in a few cases, the 
use of Carlsbad, the fresh expressed juice of taraxacum, 
combined with the simultaneous use of the yelks of eggs, 
also tartaric acid, and. in one case oxalic acid salt has ef- 
fected cures. 
SCROFULA. 
Diagnosis. This disease appears in two forms;—as a 
scrofulous disposition, and as a confirmed scrofulous affec- 
tion. 
1. Scrophulosis (scrofulous disposition) manifests itself 
in infantile age by the following signs: scrofulous parents 
(for hereditary transmission is so certain that we may con- 
clude that it exists in the children), an unusually large 
head, especially protuberant occiput, short, thick neck, 
compressed temples, broad jaw-bones, tumefaction of the 
face, especially of the upper lip and nose (a principal sign), 
fair hair, fine white complexion with red cheeks ; in most 
cases blue eyes and large pupils, the whole body full and 
well fed, but the flesh, instead of being full and firm, is lax 
and spongy to the touch, the abdomen large and more dis- 
tended than natural, frequent bleeding at the nose, and 
constant disposition to accumulate mucosities in the intes- 
tinal canal and to engender worms ; likewise to blennor- 
rhoeas of the lungs, nose, etc., irregular stools, costiveness 
and diarrhoea alternating ; acuteness of understanding, pre- 
cocity of genius ; whilst the corporeal development, as den- 
tition, walking, is tardy and irregular. 
2. The confirmed scrofulous disease. Its signs are: 
Glandular tumors and indurations (scrofulous glands), 
are the most universal and surest symptom. They appear 
first on the throat, under the jaws, in the neck, as larger 
or smaller knots (from the size of a pea up to that of a 
walnut), sometimes as a chain of small knots ; on other 
glandular pans of the body, below the axillae, in the groins, 
finally everywhere. In the commencement they are soft, 
without pain, movable, and may continue in this state for 
years; or they gradually grow larger, and painful, the su- 
perimposed skin reddens; they at last pass into suppura- 
tion, break and form scrofulous ulcers. Be careful to 
distinguish genuine from spurious scrofulous knots (scro- SCROFULA. 
445 
phulavera et spuria) ; the genuine are owing to a scrofulous 
diathesis, the spurious are glandular tumors, which arise 
from other causes ; as, dentition, development of growth, 
irritation of contagious matter, (as that of small pox, 
measles, scarlatina,) and local inflammations. The scrofu- 
lous nodes may form in external as well as in internal parts 
{scrophula externa et interna), especially in the mesentery, 
and in the lungs, but also in the liver, spleen, and brain. 
2. Chronic inflammations of glandular parts, especially of 
the eyes (ophthalmia scrophulosa, psorophthalmia), marked 
by great photophobia, epiphora and viscid secretion of the 
Meibomian glands. The frequent appearance of hordeola 
betrays a scrofulous diathesis. 
3. Frequent and chronic blennorrhma, in children often 
otorrhoea, also fluor albus. 
4. Cutaneous diseases; in children the most frequent 
forms are : achores, favus, tinea; besides universal erup- 
tions of various kinds, especially the herpetic. 
5. Constantly a tumid, hard abdomen, lymphatic tumors, 
extravasations, indurations, scirrhus,—scrofulous ulcers, 
which are distinguished by the absence of pain, are of a 
very passive character, have an impure surface, do not fur- 
nish a good pus, but a watery, acrid ichor, which corrodes 
the contiguous parts, dry in one place and break in an- 
other. 
6. Enlargement of bones (spina ventosa, pczdarthrocace) 
and caries ; the first is an internal, the latter an external 
corrosion of the bones ; the first is peculiar and character- 
istic of the scrofulous disease. 
7. Finally, cretinismus remains to be mentioned as the 
most complete, formed and universal scrofulous malady of 
the whole organism, in which even the mind suffers, and 
the whole body turns into scrofula. 
When scrofula is of long duration, of a high degree, or 
is inveterate, worse and more dangerous diseases form: 
they are atrophia mesenterica, tabes scrofulosa, phthisis 
tuberculosa, hydrops (especially ascites and hydrocepha- 
lus), cancer scrofulosus, especially on the lips and in the 
face. 
Scrophulosis may become fatal by these diseases, though 
it seldom goes so far; but disappears again, or accompa- 
nies the patient through life; remains his troublesome 
companion, and mingles with all other diseases that may 
attack him, frequently produces symptomatic fevers, and 
even nervous diseases. 
Its course varies much. It is usually a disease of chil- 446 
SCROFULA. 
clren, and terminates at puberty. It manifests itself some- 
times in the first year of life, generally not before the 
second or third. Its appearance is often brought forth by 
the influence of accidental causes or pathological irrita- 
tions; as by serious lesions, dentition, acute fevers, espe- 
cially exanthematic and contagious ones, as variola, mea- 
sles, scarlet fever, even vaccine. But sometimes it remains 
dormant in the earlier periods of life, and breaks out at the 
time of puberty. After this period, and during the years 
of complete growth and formation, that is, from the twen- 
tieth to the fiftieth year of age, it is less perceptible, and 
lies dormant, but sets in again, in females particularly af- 
ter the cessation of the menses. A part of those glandular 
diseases and indurations which then form, must certainly 
be attributed to this diathesis. 
The season of the spring, the formative period of nature, 
exercises an important influence on this disease ; the symp- 
toms usually are then more manifest. Even the moon, its 
increase, influences the economy in this respect. 
Pathogenesis. Scrofula is a disease of the lymphatic sys- 
tem, and of the lymph itself. It depends on weakness, de- 
ficient and irregular action of this system and its glands ; 
on faulty secretion, by which the lymph is badly prepared, 
assimilated and animalized. The effects are : imperfect, 
seemingly rich but unsound nutrition, stagnation, accumu- 
lation of lymph in the vessels, degeneration of it into scro- 
fulous acrimony (scrofulous virus), irritation, even local 
inflammation (but of a passive nature), thereby thickening, 
induration, formation of tubercles, extravasations, suppu- 
rations of the glands, of other organs also, of the bones, 
and noble viscera ; abnormal secretions ; metastases, finally 
general cachexy, deformity, rachitis, disorganization and 
destruction. 
The lymphatic system is the system of development ; 
the scrofulous disease, which originates and is located in 
this system, is therefore a disease of development ; that is 
to say, it is intimately interwoven and connected with the 
developing process of the organism. It therefore is most 
prevalent at these principal periods, that of dentition, of 
growth, sometimes not earlier than that of puberty, but it 
is also terminated by them and their happy completion. 
The double schema, which this disease is able to assume, 
the schema externum and internum, is worthy of particular 
notice. In the first case, the disease attacks chiefly the 
external glands, the lymphatic vessels, the skin, and in 
general the external parts; in the latter, the internal ones, SCROFULA. 
447 
the mesentery, lungs, brain, bones, and few or no swellings 
of the glands are observed, as happens in rachitis. 
All that has a tendency to create faulty lymph, or to 
weaken and depotenciate the lymphatic system, may act as 
an exciting cause of scrofula. 
The remote causes are: scrofulous progenitors (for this 
disease is surely a hereditary one, and is peculiar to whole 
families), also such ones as are very much debilitated by 
dissipation or old age, likewise syphilitic parents (for ex- 
perience has but too frequently shown, that the children 
of such parents are scrofulous from birth, and that scro- 
fula very often is nothing but a degenerated, a modified 
syphilis in the second generation).—Farther, bad nutrition 
in the first year of life from sickly, scrofulous, or even sy- 
philitic mothers and nurses ; particularly rearing without 
mother’s milk, by artificial nursing ;—living in impure, con- 
fined, animalized, damp, moist-cold air (hence its climatic 
diffusion, which is most frequently met with in England 
and the northern coastward regions; likewise in the deep 
vallies of mountains, where the highest degree of the dis- 
ease, cretinism, is alone bred) 5 in a general neglect of 
cleanliness ; bad, heavy, indigestible food in the first years 
of infancy, especially heavy, not well fermented, farina- 
ceous meals, potatoes, premature usage of brandy, much 
sitting, and neglect of corporeal exercise during the age of 
childhood ; premature exertion of the mind ;—acidity, ver- 
minous accumulation in the primas viae;—former diseases, 
which particularly affect and weaken the lymphatic sys- 
tem, as small pox, measles, scarlet fever, also' acute fevers, 
terminated by incomplete or disturbed crises.—Finally, 
strong astringent medicines, which impede and stop the 
salutary motions of nature, especially the abuse of opium 
in children, may give rise to this disease. 
Therapeutics. The cure of scrofula, as of a constitutional 
disease takes a long time and is difficult. For a radical 
cure requires a deep penetration into the vegetation of the 
system ; altering and improving the functions of chylifica- 
tion, assimilation, and animalization. 
The principal intention is to ameliorate and regulate the 
function of the lymphatic system, and correct the specific 
corruption of the lymph and its effects. This is accom- 
plished in part by general, especially by dietetic means, 
partly by specific remedies which have a particular ten- 
dency to the lymphatic system and the dyscrasy in ques- 
tion (antiscrophulosa). 448 
SCROFULA. 
Before entering into the details, I will give a few gene- 
ral rules concerning the cure of scrofula. 
3. In no disease does patience form so indispensable a 
part of the physician’s duty as in this malady. Months, 
even years, are required. The end is not attained by rash 
tempestuous means, but by a quiet and persevering treat- 
ment. 
2. Profit of the times, the periods of development for the 
cure. Success has often failed a long time, but suddenly 
makes rapid progress. The same remedy which previously 
proved unavailing, is now of excellent service. Also pauses 
in the administration of medicines are salutary, by which 
they often receive new efficacy. 
3. Spring is the most favorable season for the cure of 
scrofula, when the impulse, which the new life of nature 
imparts, and which is also evident in the more striking ma- 
nifestations of scrofula, increases also the efficaciousness 
of the remedies. 
4. Distinguish palliative treatment (cure of the symp- 
toms) from the radical one (cure of scrophulosis, scrofu- 
lous diathesis). The symptoms may be removed and yet 
the disease continue. 
The chief thing, the whole basis of treatment for scro- 
fula is a suitable regimen. Diet alone can ameliorate the 
growth, the material organic state, the humors, especially 
the lymph—the chief object to be attained. Without diet, 
the best antiscrofulous remedies are unavailing,* on the 
contrary, the whole cure may be effected by it alone; and 
it is by diet alone that the radical cure of scrofulous dis- 
eases is accomplished. 
It consists in the following : healthy food; that is, nu- 
tritive, easily digestible aliment, such as resists acidity; it 
is best to combine vegetables with the animal food, espe- 
cially roots (carrots, scorzonera), herb-soups, pure water, 
light beer, also egg-water, the yelk of one egg shaken with 
two pounds of water (a little culinary salt and sugar may 
be added), to be taken as beverages. Pure salubrious air 
is most essential. The best is the country air in a dry re- 
gion, living in the open air, ventilation of the bed-chamber. 
—Cleanliness, frequent, daily change of linen and bed- 
clothes ; feather-beds must be discarded, and matresses of 
hair, moss, or chopped straw substituted for them. It is 
incredible how much this alone will contribute to a cure. 
Succinous fumigation of the linen, before using it, is also 
very wholesome.—Muscular exercise, even strong, gym- SCROFULA. 
449 
nastic exercises.—Daily washing and friction of the body 
with cold water.—A tepid bath every two days. Bathing 
alone is very efficacious, and its efficacy may be increased 
by additions of soap, culinary salt, malt. Finally, I also 
mention acorn-coffee in the number of dietetic remedies. 
It greatly supports the treatment, and ought not to be 
omitted in the diet of any scrofulous child, and is at the 
same time an excellent nutriment. 
The pharmaceutic treatment. The principal remedies 
are: mercury, which is here almost as specific to annihi- 
late the symptoms as in syphilis. Usually and in ordinary 
cases no other remedy is needed. Its internal use is alone 
sufficient to remove all symptoms and forms of this dis- 
ease, such as swoln glands, indurations, tumors, cutaneous 
maladies, scrofulous ulcers, scald-head, scrofulous ophthal- 
mias, even psedarthrocace and caries. The use of it must be 
persevered in until the symptoms disappear, sometimes for 
a number of weeks, even months, but so that after two or 
three weeks using it a pause of eight days may be made, 
in order to observe the secondary effect ol the medicine j 
then begin again. It is necessary to give it in combina- 
tion with sulphur or antimony, in order to prevent saliva- 
tion, or, in children to prevent excess of purging. The best 
form for children is sethiops mineralis and antimonialis 
(vide No. 210), mixed with magnesia and rhubarb, as many 
grains as the child has attained years, up to 8 grains dailyj 
for stronger ones and adults Plummer’s powder (vide No. 
211) is best. If this prescription does not purge by itself, 
a cathartic of jsflap and calomel is to be given every fort- 
night. In obstinate cases, the effect may be increased by 
an addition of resina guaiaci, or cicuta in substance or ex- 
tract (vide No. 212). External means are generally not 
needed, and it is better to dispense with them. Next to 
mercury in efficacy is murias barytse (vide No. 213), it 
frequently surpasses even the former in this respect. Also 
calx muriatica and chlorinica, in the same form and dose 
as baryta, sassafras as a tea (vide No. 214), or a few drops 
of the ethereal oil triturated with sugar, may be adminis- 
tered.—Emetics and cathartics may be given interme- 
diately during this treatment j they assist by freeing the 
first ways from the impurities and worms, and partly by 
exciting the action of the lymphatic system. I have found 
it best to prescribe every 8 or 10 days a cathartic of jalap, 
10 to 20 grains, according to the age of the patient, com- 
bined with or without calomel. Herba conii maculati and 
digitalis have also proved serviceable in scrofula. The 450 
SCROFULA. 
vegetable resolvents, the most efficacious of which are the 
fresh expressed juice of taraxacum (herb and root), of gra- 
men, fumaria, and tussilage, particularly the latter in 
doses from 2 to 4 ounces, mixed with weak broth, taken 
every morning, I have seen produce excellent effects. 
Soda, soap, calx conchse, lime water, are likewise advised. 
Seabaths, the baths at Ems and Obersalzbrunn, salt- 
baths are of great efficacy and recommendable in obstinate 
cases. When great debility and atony exist, cinchona, 
and chalybeates are to be prescribed ; they often produce 
resolvent effects, dissolving the glandular stagnations and 
knots. lodine has lately come into use in the treatment 
of scrofula; and it must be admitted that it resolves the 
nodes and indurations very efficiently; but it may atte- 
nuate the whole system, and produce irreparable injury in 
the general nutrition, and thereby create tabes and hectic. 
Therefore it must not be used in delicate children ; but re- 
sorted to only in the most stubborn cases, and even then, 
only in the alkaline mixture (vide No. 233), or as spongia 
tosta, and not for too long a time. In very inveterate and 
obstinate scrofula, Zittmann’s decoction also merits recom- 
mendation. In general observe this rule : administer anti- 
scrofulosa until the symptoms disappear. But do not be- 
lieve, that the original disease, the diathesis scrophulosa, 
is always therewith removed ; but have the general dietetic 
treatment continued, and watch, whether symptoms do not 
reappear, when the use of the specific remedies is to be 
resumed. Also a change in medicines is recommendable 
in stubborn cases. 
As for single symptoms, the following remarks must be 
borne in mind. The glandular nodes and indurations, 
usually disappear by the internal use of mercury and by 
baths, in obstinate cases by combination of several anti- 
scrofulous remedies (vide No. 215, 216). But if this do 
not succeed, the efficacy must be supported by external 
means, among which the following are the principal: em- 
brocations of mercurial ointment, ung. digitalis, a solution 
of chloride of lime in water (vide No. 217), as a lotion and 
applied by means of linen dossils, the continual wearing of 
a solvent plaster, emplastrum cicutse, saponis mercurialis. 
In the application of plasters as well as of all external 
means, we must be attentive, that the swelling be neither 
red nor painful. As soon as this happens they are to be 
laid aside, in order to prevent the part from becoming in- 
flamed and passing into suppuration ; which is never salu- 
tary, but generates a scrofulous ulcer. Also iodine oint- SCROFULA. 
451 
merit (vide No. 218), or a lotion made of iodine; likewise 
aurum muriatic. yV grain a day, rubbed under the tongue, 
may be used. In obstinate cases artificial ulcers next to 
the tumor ; salt, sulphur, and corrosive sublimate baths. 
In a general glandular induration, I have seen excellent ef- 
fects follow the use of cicuta baths (2 to 4 ounces of cicuta 
herb for one bath). 
Scrofulous ulcers do not require an external application 
of ointments and plasters ; these only serve to make them 
more impure and phagedenic. The best treatment is a 
course of internal medicines, moistening with a solution of 
chlorine, weak corrosive sublimate water, or aqua phage- 
daenica, and an artificial ulcer contiguously. 
Scrofulous diseases of the bones (pcedarthrocace, caries,) 
are treated in the same manner. The treatment consists 
principally in internal medicines and baths, to which, in 
such cases calamus and sabina may be added. Here also the 
combination of asa foetida with internal antiscrofulous re- 
medies, as well as with external means, is of great efficacy. 
Liver oil has an excellent effect. I have seen the worst 
kind of scrofulous caries soon cured by its internal use. 
Scrofulous ophthalmia must by no means be considered 
and treated as inflammation, but only as blepharophthalmia 
(an abnormal secretion, usually attended with a passive state 
of the organ), which it really is. Leeches, therefore, are 
here unavailing, even injurious; the internal antiscrofu- 
lous treatment, especially mercury and baryta, baths, deri- 
vation by artificial ulcers, and externally nothing but fre- 
quent fomentations with a tepid decoction of mallow- 
flowers and herba hyoscyami; also an addition of aqua 
laurocerasi and prsecipitate eye salve (vide collyrium No. 
219), once or twice rubbed on the margin of the eye-lids 
daily. Borax in the formula No. 220, applied to the eyes 
on linen dossils, is also very useful. Sometimes, however, 
a really inflammatory state may set in, and then the appli- 
cation of leeches will be salutary. 
The scrofulous cutaneous eruptions do not require any 
thing to heal them but the internal use of remedies, espe- 
cially gethiops mineralis, or Plummer’s powder, good diet 
and baths mingled with cathartics. A tea of herba jaceae 
(pansy) taken at the same time will assist the cure. All 
external repulsive means must be avoided. The same 
treatment applies to favus, crusta lactea et serpiginosa, and 
tinea (vide Tinea), 452 
RICKETS. 
Struma. [Goitre, Bronchocele.] 
Tumescence of the glandula thyreoidea and the conti- 
guous cellular tissue ; frequently to an enormous size. In 
the plurality of cases it is of a scrofulous origin ; the en- 
demial constitution, however, exercises a particular in- 
fluence ; hence it occurs most frequent in mountains, espe- 
cially at their foot, and in the vallies, and the evil disap- 
pears merely by a removal from such places into a level 
region. 
If it be a scrofulous symptom, the antiscrofulous treat- 
ment is often sufficient to cure it. The principal and truly 
specific remedy is burnt sponge (spongia tosta) in all 
forms, most efficacious in powder (vide No. 221), but also 
in a decoction (lixivium spongise, vide No. 222). Be cau- 
tious however in persons that have irritable lungs, a phthi- 
sical disposition, dry cough, or disposition to hemoptysis ; 
for in such cases it may accelerate the transition of the 
morbid disposition into consumption. The use of soda is 
also recommended as able to cure struma (vide No. 223). 
Externally embrocation of hydriodic ointment. 
RICKETS. 
Rachitis. 
Diagnosis. The first indications are : slow and imperfect 
acquisition of the power of standing and walking; enlarge- 
ment of the epiphyses of the bones, especially those of the 
wrist (a principal, often the first and only sign). In its 
further course incurvation of the bones, especially of the 
tibia, sternum, and ribs (hence asthmatic complaints), and 
of the spine; tumefactions and deformities of the bones, 
frequently of the whole body, particularly of the pelvis, 
hence a hobbling, waddling gait. Usually precocity and 
acuteness of the mental faculties. 
The disease often disappears of itself with the progres- 
sive development and growth of the body. In the higher 
degrees, however, incurvation of the spine, feet, sternum, 
and ribs, even sometimes a universally crippled state, con- 
tinue through life. 
The fundamental cause is scrophulosis, and rachitis is 
nothing but a particular modification of it, a metastasis of 
it on the osseous system, a scrofula of the bones. An acid 
character is prevalent. GOUT, 
453 
The treatment is that of scrophulosis, especially the ge- 
neral regimen, animal food and baths. Malt and salt-baths, 
mixed with radix calami aromatici, also dry sand baths 
(sand heated by the sun), washing the back and the limbs 
with whisky, also with spirit of ants, are very serviceable. 
Terrea and iron (vide No. 224; children bear and digest 
iron in substance very well; in case of constipation a few 
grains of rhubarb may be added), and rad. rub. tinct, and 
calamus are very wholesome. Liver-oil (oleum jecinoris 
aselli) also has an excellent effect, a teaspoonful taken 
morning and evening. 
Claudicatio spontanea is most frequently owing to scro- 
fula or rachitis, and requires an antiscrofulous treatment; 
besides baths, embrocations, leeches, exutories (vide dis- 
eases of children). 
GOUT. 
Arthritis. 
Diagnosis. Pains in the joints, with inflammatory or 
chronic cold swelling, readily passing into arthritic nodes 
and calcareous formations; connected with digestive diffi- 
culties, flatulency, generation of acidity, mucosity, apepsia, 
obstruction. 
This original and essential form may, however, be vari- 
ously modified, so that these signs only partially exist, or 
may be entirely absent; in this case the disease may 
appear in a form foreign to gout, under the mask of any 
chronic malady, and deludes the observer ; it is therefore 
rightly termed a pathological Proteus. We cannot suffi- 
ciently bear in mind that gout can be present as an occult 
cause in all complicated, chronic, and obstinate maladies. 
Its two principal forms are consequently arthritis mani- 
festo and occulta. 
1. Arthritis manifesto is subdivided into : 
a. Arthritis regularise acuta, which makes regular at- 
tacks at the time of the equinoxes; is attended with fever 
and terminates in crises; followed by longer or shorter 
intervals (six months to a year) of entire absence of gout. 
The attack presents a perfect image of an inflammatory 
febrile crisis. The local affection consists in an accumu- 
lation of gouty itiatter in the part, a kind of critical metas- 
tasis added to the general crisis. An inflammatory affec- 
tion of a joint, with redness, heat, swelling, and pain, which 454 
GOUT 
are often considerable, accompanied with fever. It lasts 
three or four weeks, even longer, and is subject to relapses ; 
it runs through the stages of increase, acme and decline ; 
terminates in a critical perspiration, which has usually a 
sour odor; and in a thick, white, chalky, sometimes red- 
dish sediment in the urine. It is named differently, ac- 
cording to its location, podagra, gonagra, chiragra, etc. 
Sometimes it is wandering (vaga) and moves from one 
place to another, in which retrocession to internal parts is 
much to be dreaded. 
The attacks of regular gout most usually happen at the 
end of winter, in the months of February and March. 
Sometimes, instead of them, other critical secretions, 
sweats, cutaneous eruptions (purpura arthritica), lasting 
for some weeks, take place., I myself have seen critical 
salivation in the place of an attack of gout. * 
b. Arthritis chronica, irregularis. This form of gout 
occurs at indefinite times, and without fever. Its duration 
is indefinite ; it may last for days and weeks, the pain 
changing place, and frequently shifting in a moment to a 
remote part; it may also last for months, even for years 
{arthritis fix aet vaga). Crises are rare or only imperfect. 
The disease may be a primary or secondary one; or the 
consequence of another attack not entirely resolved by 
crisis. 
Arthritis JVodosa, Destructoria, Disorganisans. 
It arises and grows out of the former merely by length 
of time. It generates various disorganizations and degen- 
erations of organic matter. The most common are: 
arthritic nodes, calcareous concrements, which form about 
the joints, rendering motion difficult, even impossible. It 
is not rare to see real enlargement of the bones and exos- 
toses. 
2. Arthritis occulta, larvata, anomala, gout which does 
not appear with the usual, but with totally heterogeneous 
symptoms. It seizes either upon the internal organs, in- 
stead of the external ones (arthritis interna), when it pro- 
duces painful affections, or painless, diverse, but very often 
important and obstinate disturbances of function ; as when 
it affects the stomach, arthritis and spasm of this viscus, 
acidity, mucosity, chronic vomiting ; when the head, cepha- 
lalgia, vertigo, deafness, etc.; when th 6 chest, chronic 
cough, pains in the chest, asthma ; when the whole nervous 
system, hypochondriasis, spasms, convulsive diseases, pa- GOUT 
455 
ralysis; when the kidneys, lithiasis; when the abdominal 
vascular system, haemorrhoids ; when the lymphatic system, 
hydropic effusions.—Or it creates unusual external pheno- 
mena, as ulcers, indurations, tumors, chronic cutaneous 
eruptions. In general it is noticeable, that the internal as 
well as the external affections of anomalous gout, true to 
their original character, are apt to generate thickenings, 
indurations, exsudations of coagulable lymph, stones in all 
organs seized by it. 
Arthritis occulta and anomala may be brought on in a 
double manner, and is consequently of a double kind: 
1. By a retrocession which had already manifested itself 
externally, to internal parts (arthritis retrograda). This 
may happen either suddenly in a febrile attack of gout, 
generally by taking cold {podagra retropulsa), of which the 
consequences are likewise acute and inflammatory ; gastri- 
tis, catarrhus suffocativus, mania ; or, it may happen chro- 
nically where also the cessation of the habitual chronic 
attack is to be mentioned. 
The diagnosis of these arthritic diseases depends on the 
previous existence of arthritic attacks, after the disappear- 
ance of which the actual evil arose. 
2. By impediment to the formation and deposit of gout 
externally, confining it within the internal system (arthritis 
atonicd). It remains most frequently in the abdominal vis- 
cera and nerves (its receptacle); hence arise chronic dis- 
orders of digestion, and abdominal maladies, especially 
hypochondriasis and other nervous diseases (which, there- 
fore, are removable by a single attack of podagra). Also 
all other chronic diseases may have an arthritic source; it 
is frequently the cause of cutaneous diseases, chronic ul- 
cers (arthritic ulcer). 
In such cases the recognition of the arthritic nature of 
the disease is much more difficult. The principal signs 
are : descent from gouty parents, fugitive arthritic pains 
once in a while appearing, the beneficial effect of sweat, or 
calcareous, arthritic sediment in the urine, that it greatly 
depends on season and weather, especially on barometrical 
changes of the atmosphere. A peculiar sign of concealed 
gout which I have observed very often is, a sensation of 
local numbness on a limited part of the skin, or a feeling 
as if fur or wool was laid on the place. 
Pathogenesis. Proximate cause : a peculiar dyscrasy of 
the humors and anormality of the general nutrition, the 
character of which is a disposition to thickening, to cal- 
careous formations, development of acids, ossification, de- 456 
GOUT, 
pendent and founded on weakness of digestion and faulty 
chylification. The whole phenomenon of the arthritic dis- 
ease is nothing else than a continual attempt of nature to 
elaborate and eliminate this morbid matter. When this is 
performed with energy and fever, a perfect local and gen- 
eral crisis ensues, and the patient remains free of arthritic 
attacks for a longer or shorter time. If this energy is 
wanting, the morbid matter is either left fixed in the exter- 
nal parts, and chronic gout forms which finally affects the 
organization of these parts, and destroys them in a pecu- 
liar manner (for arthritic enlargement of the bones, exos- 
tosis and caries differ altogether from similar syphilitic and 
rachitic affections) 5 or it is deposited on internal parts and 
systems, giving rise to the occurrences of atonic and larved 
gout. 
It is this internal nature of the malady which constitutes 
the essential difference between gout and rheumatism, 
which is double : a. The gout forms from within to with- 
out, rheumatism from without to within. The former, 
therefore, is a disease developed in the internal organism, 
critically operated on by the same, and deposited by nature 
towards the exterior ; the phenomena of which are the so 
called attacks of gout, and are only to be considered as 
symptoms of a deeply seated internal morbid state. Rheu- 
matism, on the contrary, is a disease impressed on the 
organism from without by checked action and secretion of 
the skin, the character of which, therefore, always remains 
more external and local, and, by its nature, does not in the 
least disturb the functions of digestion and assimilation. 
h. Gout is combined with a specifically characterized mor- 
bid matter ; by a tendency to thickening in the tissues of the 
part affected ; by the generation of earthy matter and 
acidity, an abnormal organic matter ; not so rheumatism, 
in which the “ serum acre retentum” is the only morbid 
material. 
Remote causes: luxury in eating and drinking, connected 
with idleness (hence podagra is a disease of the rich), es- 
pecially the immoderate use of wine, particularly of acid 
wines, excesses in venery, particularly sudden continence 
after long prosecuted excesses ; damp, cold atmosphere 
(hence it is of frequent occurrence in northern littoral 
countries), moist dwellings, moist occupation (washing, 
laboring in water), colds, chronic as well as acute (rheuma- 
tism assumes the arthritic form); suppressed habitual 
hemorrhages, as that of the piles, and cessation of the 
catamenia. Women often become arthritic after this pe- GOUT, 
457 
riod, the cause of which, however, is traceable to an arth- 
ritic disposition, which hitherto had been derivated by the 
periodical evacuation of blood. Above all other causes, 
the most remarkable is a hereditary disposition, which in 
no disease is so great and striking as in gout, on which ac- 
count it may attack even children. 
The generation of the arthritic matter takes place evi- 
dently in the organs of digestion and chylification (abdomen 
ojfcina arthritidis), and Bacchus, Venus et Otium are, ac- 
cording to the testimony of the ancients, the contracting 
conditions. By the first (wine), rude, sour, acrid sub- 
stances accumulate in the chyle; by dissipation and idle- 
ness the organs are debilitated and the substances are defi- 
ciently acted on. The proofs are: the preceding cause, 
the digestive difficulties previous to, or concomitant with, 
every paroxysm of gout; and the salutary effect of cathar- 
tics for removing, and of the roborants for preventing arth- 
ritic attacks. 
Arthritic attacks frequently alternate with piles ; this 
points to a causal connection and common origin in the 
abdomen. There used to be a hypothesis, that gout was 
owing to retained spermatic matter ; but this is sufficiently 
refuted by the circumstance that eunuchs are also liable to 
gout. 
There is also an arthritis spuria ; other maladies may 
assume the form of gout. Of this class are rheumatism, 
syphilis, scurvy, metastases of suppressed cutaneous dis- 
ease, healed old ulcers. 
Therapeutics. The cure is double: the generation of 
gout, and the symptoms of gout are to be attended to. 
Unless we admit the existence of a material arthritic sub- 
stance, we cannot form a satisfactory idea, nor decide 
upon a proper treatment of gout. 
Treatment of Gout already existing ; of Arthritic Affections. 
It varies according to the different forms. 
The acute febrile gout (podagra, etc).—In such a case 
there is only one indication: to consider the arthritic 
attack as a crisis, and to do all to make it as perfect as 
possible ; but especially to avoid all that can disturb the 
crisis. In a moderate degree of fever this is best effected 
by leaving nature to operate alone, and by prescribing a 
proper regimen, which is antiphlogistic, diaphoretic, at- 
tending to perspiration by flannel, oiled silk, or what is 
better, flannel. All other external remedies are hazard- 458 
GOUT, 
ous, even injurious. Cold water, saturnine remedies, cam- 
phor, and all dissolvent remedies are apt to cause a retro- 
cession to noble parts, and to suppress at least in that part 
the vital action (the inflammation), which is necessary for 
completing the crisis, thereby giving rise to a transition 
into chronic gout. The same is true of the local abstrac- 
tions of blood, which, surely, remove local inflammation 
and pain, but not gout, render it on the contrary chronic 
and obstinate, or create such a local weakness, that topical 
evils remain for a long time. They not only take reaction 
away, but they disturb the local crisis and the operation 
going on in the arthritic matter, which is here so neces- 
sary ; consequently this matter either remains in that part, 
causing tumefaction, stiffness, anchylosis; or the gout is 
suddenly translated to another, often to a noble part, or at 
least, the disposition to a frequent return of arthritic at- 
tacks is left behind. Kelaxants and warm cataplasms are 
equally to be avoided. They, indeed, sooth the pain, but 
produce sluggishness, weakness, oedema, exsudation, even 
suppuration in the part. Nor is the use of emetics and 
strong cathartics, as recommended by many, advisable. It 
is true, the attack of gout is thereby often immediately re- 
moved, but the consequences are hazardous. In the first 
place a translation of gout from the surface to some inter- 
nal part may thereby be effected (of which I have seen 
melancholy instances), or only a temporary debilitation 
and obstruction of the arthritic crisis ensues, the gout soon 
returns in a worse form, or becomes even chronic. Even 
the specific remedies which quickly remove the evil, as 
vinum seminis colchici, are unsafe, since they are also apt 
to interrupt the crisis and to create bad metastases. 
The only cases with which art may safely interfere, are 
the following : 
1. In violent inflammation, when the patient is very pletho- 
ric, robust, the fever violent, the part affected very red and 
hot, nitre and sal. ammoniac along with tartar emetic, and 
when the pulse requires it, a venesection besides the local 
abstraction of blood is needed. 
2. In a gastric complication, gastric cleansing remedies 
must not be neglected ; especially when used previously to 
the paroxysm, they can contribute to shorten it very 
much. 
3. In very violent pains, unaccompanied by great in- 
flammation, but with a nervous spasmodic character, nar- 
cotics, of which the best is extract of hyoscyamus diluted 
with water to the consistence of ointment, may be applied GOUT, 
459 
tepid to the surface, and also taken internally ; when this 
does not sufficiently relieve, mix it with purg opium, cam- 
phor, or take a dose of Dover’s powder in the evening. 
4. When the fever ceases, but the pain and local affec- 
tion continue ; the crisis, not being perfect, must be sup- 
plied by art. Here the specific antarthritica are proper, 
above all, guaiacum, which promotes all the secretions, 
even the discharge from the intestinal canal. Give it in 
the prescription No. 225 a., so that it produces two stools 
daily. Also camphor, spiritus JVlindereri; in old persons 
disposed to atonic gout, Jiq. c. c. succin. may be adminis- 
tered ; if all this do not suffice, have recourse to the treat- 
ment of chronic gout. 
Chronic Gout. 
Here all depends on the proper operation on, mobiliza- 
tion, neutralization, and secretion of arthritic matter; in 
short, on producing by art such crises as in the former case 
nature effects. This requires : 
1. Specific remedies, which have a particular power 
to neutralize and destroy arthritic matter, and to annihi- 
late the arthritic character prevalent in the economy. For 
that purpose, the alkalines rank first: Carlsbad, soda, soda 
with bitters (No. 226), lime water, ammonium, sulphur and 
sulphur baths, as Aix la Chapelle, Neundorf, Warmbrunn, 
the alkaline preparations of sulphur, ammonium sulphura- 
tum, which is the strongest and most volatile, antimonium, 
sulphuretum antimonii auratum, tinct. antimonii acris, 
especially aqua calcis, antimonium sulphnrat. (No. 227), 
liquor c. c. succin., liq. antarthriticus Eller, (liq. anodyn. 
Hofmanni and liq. c. c. succinat. a a), 01. jecinoris aselli, 
mercury, especially corrosive sublimate, aconite, guaiacum, 
of which the solution of the resin in taffia, one tablespoon- 
ful morning and evening, and continued for some time, de- 
serves recommendation as one of the most efficacious rem- 
edies, savin (No. 228, 229), sarsaparilla, rhododendron 
chrysanlhum, colchicum. Baths of ants, of salt, of brandy 
lees, of Wiesbaden and Teplitz the springs are very effi- 
cient. 
2. To vigorously increase the secretions, to excite the cri- 
ses, artificial secretions, especially strong diaphoretics per- 
severed in, artificial ulcers. Vesicatories used consecutive- 
ly, are very efficacious. First lay one vesicatory near to the 
affected part; if it gives no relief, apply a second one next 
to it, and thus several successively, by which the most oh- 460 
stinate gout may often be conquered ; antimonial ointment, 
cortex mezerei, steam baths, Russian baths. 
3. To purify and invigorate the digestive and abdominal 
system, by warming resolvents and purgatives, emetics, the 
continued use of bitter remedies, especially of quassia. 
4. To regenerate and renovate the humors, for which 
milk diet, persevered in for several months, is the principal 
means. 
GOUT, 
5. To consider and treat the various constitutions ; the 
debilitated torpid body by restaurants and roborants ; the 
plethoric and robust by abstractions, a scanty antiphlogis- 
tic diet, evacuants, even bleeding, particularly frequently 
repeated cupping. 
6. Local treatment, which has a double end : a, to as- 
suage the local affections by means that accord with its 
degree and character ; in an inflammatory case by local 
abstractions of blood (in which, however, the rule previ- 
ously intimated, not to weaken too much, must not be lost 
sight of); in a nervous case by sinapisms, vesicatories, 
narcotic, volatile, antispasmodic embrocations and appli- 
cations ; b, to excite the formation of the arthritic matter, 
when gout is fixed in a part. 
The most approved remedies are : continued warmth, 
maintained by oiled silk cloth, wool, cat-skin, embrocation 
of petroleum, 01, cajeputi, sabinse, balsam of Peru, balsam 
vitse Hofraanni, emplastrum resinos. resolv., galbani cum 
opio., mercurial ointment, vesicatories long kept in suppu- 
ration, fontanels, in obstinate cases moxa, local steam 
baths, made stronger by ammonia, sulphur, and the like, 
douche-baths, in extreme cases, and after proper internal 
treatment, cold baths. 
Ischias, coxagra, when they arise from an arthritic cause, 
are to be treated in the same manner. 
In conclusion, we must use the radical treatment; espe- 
cially a proper invigoration. 
When contractions and disorganizations have already 
formed (arthritis nodosa,) besides the internal use of alka- 
lies, Zittmann’s decoction, baths of corrosive sublimate, 
steam baths, local douches, but especially the thermal 
baths, particularly those of Wiesbaden, Teplitz, Aix la 
Chapelle, are of excellent service. 
Retroceded Gout. 
The leading idea in the treatment is to re-establish the 
gout externally. Here we must well distinguish : 461 
1. Sudden febrile suppression. In such a case, a vene- 
section (for all gout is apt to produce internal inflamma- 
tion), antiphlogistic treatment, application of sinapisms on 
the part previously arthritic, and vesicatories on the actu- 
ally affected part. After the fever has subsided, camphor 
or sal succinatum along with nitre. In cephalic arthritis, 
one of the most painful and dangerous metastases, I can 
recommend the application of leeches and two grains of 
calomel, along with half a grain of aconite, to be taken 
every three hours, and a vesicatory on the neck, as capable 
of giving prompt relief. In arthritis of the stomach, after 
a proper abstraction of blood, but which is often unavailing 
for removing the pains and the danger of inflammation, a 
vesicatory on the epigastric region is most beneficial. 
2. Chronic suppression. Here likewise rubefacients and 
vesicatories, and internally camphor, musk, ammonia, naph- 
tha phosphorata, tinct. guaiaci volatile (No. 225 b.), are to 
be used. 
GOUT 
Atonic Gout, 
Calls for the treatment usual in retroceded chronic gout, 
especially during the violent attacks ; and the treatment of 
gout in general, invigoration and rousing of the energies. 
Particularly are to be mentioned : infusion of ginger, vinous 
infusion of mustard, tinct. guaiaci volat,, pepper, quassia, 
Pyrmont and Dryburg waters, strengthening baths. A com- 
bination of sulphur with a few grains of alcoholized iron, 
and extract of quassia formed into pills, is also of great 
use. 
Radical cure of gout, cure of the arthritic disposition, 
Has three indications : 
1. To do away the remote cause before stated, to which 
the g-eneration of gout is due ; therefore frugal meals, 
avoiding excesses in venery and wine, especially acid 
wines ; labor and strong muscular exercise, dry air and 
habitation, changing a cold for a warm climate (most effi- 
cacious). 
2. To strengthen digestion ; which calls for bitter rem- 
edies (quassia, gentian, Portland s powder, etc.), ferrugi- 
nous remedies, especially Pyrmont and Dryburg water, and 
the like baths, also cold sea bath. 
3. To promote all the secretions, especially those by 
which arthritic matter may have been engendered, and can 
be secreted and discharged ; to promote the secretion of 
the skin by motion, friction, flannel clothing, warm baths 462 
VENEREAL DISEASE. 
throughout the whole year, once a week ; the secretion of 
the kidneys by diuretics, particularly colchicum ; and the 
evacuations from the intestines by cathartics, but choose 
those of a warming character. For this purpose, the use 
of the herb-wine is very serviceable, continued for several 
weeks in the spring and autumn (infus. vinos, guaiaci, rad. 
helenii,gentianse, jalapse, fol.sennse, rad. scillse, cort. aurant, 
cardamomi, cinnamomi). Sulphur and guaiac combined 
(No. 230), administered to a person predisposed to gout 
every month for four or six days, in such doses as will cause 
two or three stools a day, fulfil this end most efficiently 
and specifically, and are the best preservatives against arth- 
ritic attacks. Warm sulphur or thermal baths, used for 
four weeks during the summer season ; in lymphatic, 
plethoric individuals, an artificial secretion by means of 
fontanels, are likewise of great benefit. 
VENEREAL DISEASE. 
Syphilis, Lues. 
Diagnosis. It presents itself in two forms, as syphilis 
localis s. primaria, and syphilis universalis s. secundaria ; 
which latter again divided, appears as syphilis manifesta or 
occulta s. larvata. 
Syphilis Localis s. Primaria. 
The diagnostic signs are : local irritation and inflamma- 
tion in the part affected, passing into increased and altered 
secretion of mucus (blennorrhcea), when the muco-secretive 
organs are affected, or into ulcers, or into both. 
1. Blennorrhcea syphilitica. It is either gonorrhoea (ure- 
thritis exsudatoria) or fluor albus. It always runs through 
two stages ; the inflammatory (when in a high degree it is 
attended with consensual irritations, phimosis, paraphimo- 
sis, buboes, tumor testiculi) ; and the abating or critical, 
which is frequently succeeded by a third stage, the sec- 
ondary or gonorrhoea chronica, fluor albus chronicus. The 
duration of the first stage is indefinite, varying from three 
to six weeks; the last to years. Generally the infection 
continues local, and when ulcers are not associated, it does 
not become universal through the system (constitutional). 
There are, however, exceptions to this statement. 
2. Ulcus syphiliticum (chancre). It is discerned by a 463 
specify surface and prominent edges, and little pain. It 
likewise excites, when the irritation is great, sympathetic 
irritative occurrences, buboes and the like. The purulent 
infection may remain also local, and die away with the 
local infection ; but the danger of general infection is by 
far greater. It may last three weeks, but also as many 
months. 
VENEREAL DISEASE. 
The most important diagnostic sign is the circumstance 
that the local affection has followed a suspected coitus, or 
a vulnerated part denuded of epidermis having touched 
another suspicious object. Therefore, every local pheno- 
menon that follows such contact, must be considered im- 
portant, although it have not the characteristic marks. 
The infection through lesions always produces the most 
dangerous accidents. 
Syphilis Universalis s. Secundaria. 
General infection follows the local affection in very inde- 
finite spaces of time, sometimes within a few weeks, some- 
times after months. It is readily communicated through 
wounds and chancres. The difference between blennor- 
rhosal and ulcerous infections deserves to be adverted to ; 
the former is always more chronic and mild, the latter more 
acute and destructive. 
The signs of universal infection are all those syphilitic 
symptoms, which appear elsewhere than in the place of in- 
fection. The principal ones are : condylomata, little ulcers 
on the palate and uvula, ophthalmia, eruptions of herpetic 
form, in the shape of small spots similar to essera, on which 
the epidermis scales off, especially on the forehead ; bu- 
boes and swellings of the testicles after the local infective 
symptoms have disappeared, swelling of the glands, and 
lymphatic tumors. 
The signs of a more severe and deeper seated infection 
are diseases of the bones, nodi, tophi, especially on the 
tibia, caries, particularly of the nasal and frontal bones, 
pains of the bones during night, scirrhous indurations, 
spongy, fleshy excrescences, polypus. 
Syphilis Occulta et Larvata s. Degenerata s. Modificata. 
Syphilis may make pauses in its action for a while, that 
is to say, it lies dormant, exhibiting no sign of its exist- 
ence ; but reappears after a while with increased virulence ; 
or it may manifest itself under entirely different and unu- 464 
VENEREAL DISEASE. 
sual forms (larved). There is no chronic disease whose 
form syphilis cannot assume. In either case the diagnosis 
is difficult. There are only two means ; a. To trace the 
evil to its often very remote origin ; in the prosecution of 
which task we will ascertain that the patient has been ve- 
nereally infected for ten, fifteen, and more years ago, and 
has had since that time a series of alternating diversified 
complaints, frequently intermixed with pauses of apparent 
health, until the accession of the present malady, b. By 
trying the use of mercury, which will give a prompt ame- 
lioration, if the disease is syphilitic, the surest confirmation 
of the diagnosis. 
This malady combines all that can render human suffer- 
ing tedious, tormenting, and distressing in body as well as 
in mind. It is a most disgusting disease ; and it is no less 
remarkable that nature has connected it with a singular 
degeneration of the human features, imparting Its stamp to 
the most noble prerogative of man, by a deformation of the 
nose, the ornament of the face, and to the voice, the high- 
est expression of human mental dignity. 
It is a protracted disease, difficult of cure, productive of 
the most hideous disorganizations and painful sufferings 
(especially those of the bones, which torture the patient 
nightly often for years), tedious and dangerous not only to 
the affected, but also to others, frequently tormenting 
through life, even to advanced age; yea, a demon which 
accompanies man through life, if not really, at least in im- 
agination ; it may become even fatal by emaciation, colli- 
quation, and dropsy. It owns farther two properties, 
which increase exceedingly its danger and obstinacy. The 
first is this, that at its commencement it appears light and 
greatly insignificant, hence it is often not at all or insuffi- 
ciently attended to, creeps imperceptibly deeper and deep- 
er, and poisons the whole system ; the second is: that the 
virus, probably in consequence of its human descent, is 
possessed of a particular affinity and homogeneousness to 
the human organism, uniting with it more intimately than 
any other infection, even becomes one and the same with 
it, so that no power in the world can separate it from the 
animal economy. 
Finally, it is one of the unfortunate properties of this 
disease, that there exists no certain sign, by which we 
may judge that the system has been entirely freed from 
it. 
Pathogenesis. The remote cause is the contagiurn syph- 
iliticum ; the proximate cause is the infection created by VENEREAL DISEASE. 
465 
the communication and reception of this contagion in the 
animal economy. 
The syphilitic contagion is of modern origin, at least in 
Europe, and known only since the year 1493. It is perma- 
nent (propagated from the first generation, and constantly 
reproduced), and fixed (not soluble in the air). 
Infection, therefore, can happen only by immediate con- 
tact with the virus itself in an infected person, or with an 
infected object ; and can only take place through parts not 
covered with epidermis, as the genitals, anus, lips, fauces, 
nipples, eyes, nasal cavity, or where the epidermis is abra- 
ded. But even then there must exist a susceptibility, and 
when this is wanting, no infection takes place. The defi- 
ciency of receptibility may depend on the whole system or 
the location where the virus has been applied. Thus infec- 
tion is more difficult through mucous surfaces, but readily 
and quickly effected through a wound or a surface denuded 
of its epidermis. 
The interval between the application of the virus and the 
eruption of the disease is variable ; being only a few days 
when received through wounds and ulcers, but otherwise 
an interval of fourteen days may occur. 
The affection thereby created is always double: irrita- 
tion and reproduction of the virus. But it is variously 
modified by the variety of the degree of infection, of local- 
ity, and primary or secondary infection. We distinguish 
the local (primary), and the constitutional (secondary) in- 
fection. 
In respect to the primary infection there are evidently 
different degrees of intensity and perfection. 
The most important to be mentioned here is the distinc- 
tion between blennorrhoeal and ulcerative infection (termed 
by some writers clap and chancre, essentially distinguished 
as such ; but they are evidently products of the same syph- 
ilitic contagion, only variously modified). 
1. Blennorrhoeal infection, the milder degree. The virus 
is enveloped in mucus, mitigated, fixed. It receives a mu- 
cous character, creates but little local irritation and inflam- 
matory reaction (clap,fluor albus), is only slightly repro- 
ductive, and is therefore less infective to the patient him- 
self and to others, and may remain local for a long time, 
even while it lasts. 
2. Ulcerous infection (chancre). This virus immediately 
produces a topical destruction and erosion of the surface, 
an ulcer. The matter thereby becomes much more cans- 466 
VENEREAL DISEASE. 
tic, poisonous, corrosive, infectious to the individual as 
well as to others. 
The length of time which the primary affection will take 
to pass into the secondary (local into constitutional syphi- 
lis), cannot be laid down. In some cases it happens after 
a few days, in others not before the expiration of weeks 
and months. The disease may remain local, especially in 
females, and in organs which secrete mucus for years, 
without the infection spreading in the individual, though 
she may infect others. 
The transition depends : a, on the liability of the indi- 
vidual ; b, on the location and quality of the primary infec- 
tion (most readily and rapidly when the infection is a puru- 
lent one, and such as proceeds from a wound) ; c, on the 
treatment (suppression of the topical affection, of gonor- 
rhoea, of chancre, may occasion the virus to be translated 
into the constitution). 
The way by which the virus is conveyed into the organ- 
ism, and the original and peculiar seat of the syphilitic in- 
fection or venereal disease, is the lymphatic and gland- 
ular system. It creates through inflammation of the lym- 
phatic vessels, swellings of the glands (buboes), first in the 
adjacent, next in the remote parts. Besides, the virus has 
a particular affinity for the mucous membrane of the pal- 
ate, the nose, the eyes, where it produces inflammations 
and ulcerations; and to the external skin, where it engen- 
ders peculiar cutaneous eruptions and chancres ; and 
finally, when it penetrates deeper, it affects the bones, 
even at last internal noble organs. 
Of the essential nature of the venereal poison we know 
as little as of any other contagion. We know only that it 
belongs to the fixed (not soluble in the air) and chronic 
(not febrile, but exciting chronic reaction) ones, that it 
loves most the lymphatic and glandular system, the mu- 
cous membranes and hones, that it imparts to the organism 
a particular disposition to abnormal productivity, to cari- 
ous and osseous excrescences and hyper-vegetation, and 
finally penetrates the whole animal economy, most inti- 
mately unites with it, so that it is difficult to separate 
them. The essence of the disease must therefore be re- 
garded not only as a dynamic, but as a chemico-organic 
poisoning process. 
Now in case of long duration, the virus may, as it were, 
assimilate with the human system, and assume a milder 
character, that of a lurking poison ; yet may eveh rest for a 467 
while, and mate pauses in its operation (latent syphilis). 
The poisonous seed is dormant, but the germ has not died; 
but may be revived by exciting reaction and re-exhibit the 
disease. The causes of such pauses are chiefly an imper- 
fect mercurial treatment, which has only suppressed the 
distemper, suspended the operation of the virus, but not 
extinguished it (the germ of the virus is not killed). 
In the same manner, and by the same causes, the disease 
may also assume another form, affect other organs, as the 
nervous system, the lungs, the abdominal viscera, and cre- 
ate unusual occurrences, the phenomena of quite a differ- 
ent disease (larved syphilis). 
Therapeutics. The treatment has two indications: the 
destruction of the poison and the cure of its effects. 
1. The cure of the venereal infection (the specific anti- 
syphilitic treatment) comprises always two things : a. The 
communicated or internally created poison is to be annihi- 
lated. b. Its regeneration is to be prevented by annihi- 
lating the capability of reproducing the virus or the gener- 
ation of the virus in the system itself. Both must be 
united to effect a perfect cure. The actual virus can be 
destroyed and the present symptoms removed; but if 
the power of the organism to engender the virus anew is 
not annihilated at the same time, the virus will be regener- 
ated within a longer or shorter time, and the disease will 
reappear in the former or in a different shape. This con- 
stitutes the difference between a symptomatic and a radi- 
cal cure. The symptomatic cure may delude for a very 
long time, for the venereal infection and the specific capa- 
bility of its reproduction may remain inactive and dormant 
in the body for a long time. 
The only means for attaining both ends is mercury ; and 
the art of curing syphilis consists in administering this 
remedy in such a manner that this double end be attained. 
It must never be used to a greater extent than is necessary 
for that purpose, paying constant regard to avoid those 
detriments which this metal itself may inflict on the animal 
economy, and never forget that mercury is a poison, and 
that a thorough mercurial treatment is an artificial mercu- 
rial poisoning. 
Mercury is capable of curing a venereal infection in 
whatever form and way it may be administered, provided 
that two essential conditions are complied with, the first of 
which is—that it penetrate into the substance of the sys- 
tem ; and secondly, that it excite such a degree of reaction 
as is requisite for subduing the virus. The proximate and 
VENEREAL DISEASE. 468 
VENEREAL DISEASE. 
original effect of mercury is on the lymphatic and 
glandular system, and this very system is the primary and 
principal seat of syphilitic infection. It is in this that the 
process of taking away the poison must next and princi- 
pally succeed. As for this process, the best idea, and 
which may safest guide in practice is this : as syphilitic 
poisoning is a specific chemico-animal abnormality and 
corruption of organic matter, so is the effect of mercury an 
opposite specific chemico-animal alteration, by which the 
former is annihilated and neutralized. It is therefore ne- 
cessary that the mercurial treatment be carried to satura- 
tion. The signs of it, showing that mercury has sufficiently 
penetrated the lymphatic system, are the forerunners of 
salvation. 
2. The cure of the effects and symptoms of the infection 
is only calculated to subdue the reaction which the infec- 
tion has aroused in the animal economy. This reaction is 
double : primary and secondary. The primary is inflam- 
mation or a nervous affection. Either of them may, indeed 
must be attended to, and if possible removed ; we may 
thereby even succeed to apparently cure the symptoms ; 
but let us be careful not to indulge in the belief that the 
infection also is removed. The secondary effects and 
symptoms are: various disorganizations, indurations, tu- 
mors, exanthemata, ulcers or dynamic anomalies, secretory 
and nervous diseases. They are attended with a continu- 
ance of the infection, or with diseases that persist subse- 
quently and without the infection. In both cases they 
require particular attention as regards the treatment ; in 
the first case as an accessory and assisting indication ; in 
the latter, as the principal indication. 
But never forget that this treatment is only palliative, if 
the infection is not overcome 5 and look not upon disap- 
pearance of the symptoms as a cure of the disease. 
The special treatment is divided into the treatment of 
primary and secondary infection. 
The first infection is always local, and may remain so 
for a long time, especially when it is blennorrhoeal, and 
may be removed and annihilated by the healing power of 
nature, and disappear as a merely local evil. Many have 
left their case entirety to nature, and have been cured 
without any further bad consequences. In modern times, 
even art holds to the maxim of leaving the primary infec- 
I. Primary or Local Infection. VENEREAL DISEASE. 
469 
tion to nature, treating it only by antiphlogistics and a 
scanty diet. Experience has also shown that the affection 
may be entirely removed in many instances without subse- 
quent constitutional infection. But experience teaches 
likewise, that in some the symptoms do not disappear with- 
out the use of mercury, and that in others, it is true, the pri- 
mary local symptoms have disappeared under such treat- 
ment, and the patients believed themselves cured,but sooner 
or later the same symptoms have reappeared (proving that 
the infection had not been fully destroyed), or syphilitic 
symptoms appeared on other parts (by which it is evident 
that the virus had penetrated deeper and produced a uni- 
versal infection). 
As it cannot be known and determined on beforehand 
that the patient is one of the happy ones, in which nature 
alone or the general treatment can and will effect the cure 
and annihilate the infection, it must remain a rule to every 
conscientious and true physician to consider every local 
infection as a source of poison, whence the virus sooner or 
later may pass into the organism and produce constitu- 
tional infection; and to do all that lies in his power to im- 
mediately annihilate the virus, and thus prevent it from 
passing into and affecting the whole system ; which must 
always be considered one of the greatest misfortunes that 
can happen to a man, since it is known how difficult the 
extinction of the virus is, when it has once passed into the 
animal economy. 
This can be effected by an early administration of the 
only specific antidote, mercury, and thence results the 
rule, to use mercury in every local syphilitic infection that 
does not heal by itself, partly in order to immediately de- 
stroy the communicated virus, partly to excite by the spe- 
cific operation of the mercury a specific antisyphilitric 
reaction in the organism, by which it is prevented from 
being received, spread and reproduced. For the possibility 
of thiscannot only be demonstrated theoretically, but is also 
sufficiently confirmed by a number of instances of experi- 
ence, to which I can add my testimony. In the commence- 
ment it requires a very moderate and minute use of mer- 
cury ; on the contrary, when some time has already elapsed, 
a tenfold larger quantity is perhaps wanted ; and which the 
patient will therefore be spared, with all the certain and of- 
ten horrible subsequent phenomena of mercurial poisoning. 
I refer for illustration, how by the timely use of mercury a 
contagion may be prevented from passing into the organ- 
ism, to hydrophobia, in which it is confirmed by a number 470 
VENEREAL DISEASE. 
of experiments, that a vigorous use of mercury resorted to 
immediately after the infection of the hydrophobic virus 
has taken place, may prevent constitutional infection, and 
thus rabies itself. 
The primary infection is either a blennorrhoea or an ul- 
cer. This makes a material difference in the treatment. 
I repeat here what 1 have previously said, of the dangers to 
which mere topical and antiphlogistic and dietetic treat- 
ment exposes. We have seen instances when the patient 
felt perfectly well for months; and then, after good health 
of several, even ten months, the most formidable constitu- 
tional lues, even enlargement of the bones, all at once 
manifested itself; an occurrence which the patient might 
have escaped by a timely use of twenty or thirty grains of 
some light mercurial. What is the detriment of such a 
trifling mercurial treatment, compared with the danger of 
a horrible constitutional malady ! 
1. Blennorrhcea (gonorrhoea, clap ; jluor albus in the 
female sex). 
Yellow-greenish mucus at the commencement, whitish 
pus subsequently escaping from the urethra. The inflam- 
matory stage is attended in the beginning with pain at the 
time of making water, and when the inflammation runs 
high, with dysury, ischury, priapism, chordee, also sympa- 
thetic swellings of the testicles and inguinal glands. It sets 
in after sexual intercourse. This latter circumstance is 
the most essential for diagnosis ; a gonorrhoea may arise 
also from other causes, as the arthritic, scrofulous meta- 
stases, heemorrhoidal anomalies (vide gonorrh&a), and then 
calls for quite a different treatment. Even that one which 
manifests itself after coition may be non-syphilitic, and 
generated by other topical diseases of the uterus; in this 
case it will nevertheless be the best plan to regard it as 
syphilitic, and to treat it as such. 
The treatment has two stages. During the first, the in- 
flammatory one, it must be antiphlogistic, negative. Com- 
plete rest, avoiding every thing heating, and animal food ; 
drinking frequently of mucilaginous beverages, linseed, 
hemp-emulsion with small doses of nitre, extract of hyos- 
cyamus, cleanliness, frequent ablution with tepid water, 
wearing a suspensorium, and in violent pains the applica- 
tion of leeches, are the principal means, and often fully 
sufficient to remove these evils without any bad conse- 
quences. Injections are not necessary, they do more in- 
jury than good. They are apt to leave strictures and 
callosities in the urethra, the present frequent occurrence VENEREAL DISEASE. 
471 
of which must be attributed to the abuse of injections. If 
painful erections, priapism, increased to chordee associate 
with blennorrhoea, the first thing to be done is to abstract 
blood (in plethoric persons venesection), and then opium, 
used internally and externally, is best given. In phi- 
mosis (contraction and swelling of the prepuce before 
the glands), the inflammatory state is first to be removed 
by abstractions of blood, and then opium must be applied 
internally and externally, connected with emollient fomen- 
tations of lead water and decoction of hyoscyamus, and 
injections between the prepuce and the glans, and local 
baths, in order to wash out the matter which may have 
gathered there. The greatest attention is needed, since 
suppuration, gangrene, and loss of the glans is very apt 
to follow. Chancres are usually present at the same time, 
and the simultaneous use of mercury is required. Para- 
phimosis (the retraction, constriction, and swelling of the 
prepuce behind the glans), is treated in a similar manner. 
•When gonorrhoea is not removed by the foregoing anti- 
phlogistic treatment, and the pains do not abate after a 
fortnight, then it is always advisable to make a moderate 
internal use of mercury (in the same way as will be direct- 
ed hereafter under the head of chancre), a remedy which 
we do not hesitate to resort to in every other kind of ob- 
stinate inflammation of the mucous membrane, as in moist 
ophthalmia, and which is here at the same time efficient, 
and indicated as the antiphlogistic specific for extirpating 
infection. 
But should the blennorrhoea pass into the secondary 
stage (g/eer, discharge of mucus without pain), balsamica 
are proper, of which two rank highest: balsamum copaivse 
(twenty-five to thirty drops three times a day, taken best 
on sugar or in pills), and turpentine; also cubebae and 
root of juniper (one ounce a day) are serviceable. I have 
found also one drachm of bary tee murias or chloride of lime 
mixed in an ounce and a half of aqua laurocerasi, thirty 
drops taken every day, very useful. When the disorder 
is obstinate, and there is suspicion of a syphilitic charac- 
ter, pulvis antidyscrasicus is most serviceable. If these in- 
ternal remedies do not suffice, injections are to be resorted 
to, first of lime water, or aqua laurocerasi mixed with it; 
then a weak solution of corrosive sublimate (one grain to 
two or one ounce of water), vitriol, zinc, copper ; still more 
vigorous is argentum nitratum. Finally, astringents, alum, 
decoction of cortex salicis with aqua laurocerasi, myrrh 
with sugar of lead, cold topical baths may be applied. But 472 
VENEREAL DISEASE. 
if the gleet continue, we must pay attention to complica- 
tions, which may perhaps exist, and are often the only 
cause of the persistence of the mucous flux, 
2. The ulcerous infection {'primary chancre,, venereal 
nicer). 
Besides originating after sexual connexion, it is suffi- 
ciently marked by its specky surface, the elevated edges, 
and the trifling sensation of pain ; it may be combined 
with gonorrhoea or not, hence examination is necessary in 
every blennorrhcea. 
Every chancre must be regarded as the beginning of 
constitutional infection, and calls for the internal use of 
mercury, in order to remove it in its onset and to check 
its progress. Therefore instantly (it is understood after 
abstractions of blood have previously been made in in- 
flammatory cases), the well prepared velvet-black mercu- 
rius solubilis Hahnemanni, which approaches the metal 
most of all mercurial preparations, consequently contains 
more of the specific antisyphilitic nature, and is at tie 
same time mild and affects the organism less injuriously 
than any other, is to be administered. Give two grains of 
it a day, and increase the dose one grain daily, until the 
specific manifests itself in the smell of the breath, pains in 
the gums, light swelling of the cervical glands, precursors 
and commencement of salivation. In such a course the 
chancre usually heals on the seventh or eighth day with- 
out any external means. Then continue the remedy for 
the same length of time, but only one grain a day. It is 
very momentous to observe the patient in this, as in every 
mercurial treatment, for some time, in order to discover 
whether any new syphilitic phenomena appear ; if so, the 
course must be continued. 
External remedies are generally not at all needed. Fre- 
quent cleansing and washing with lime-water, and covering 
the part with a little digestive salve, is all that is requisite. 
By such treatment we may be sure that the cure is pro- 
gressing from within outwardly, by extinction of the virus. 
The mere local treatment by water of corrosive sublimate, 
red precipitate, zinc, sulphate of copper, alum, even lapis 
infernalis, which is, alas! too much in vogue, has only the 
effect of a local suppression, and very often after the chan- 
cre has been cured, an ulcer in the throat, or another ve- 
nereal disorder presents itself, as an evidence that the 
cause of the disease has not been eradicated, but only its 
organ removed. 
Not unfrequently swellings of the inguinal glands (hu- VENEREAL DISEASE. 
473 
bones), and of the testicles (hernia humoralis, orchitis) accom- 
pany gonorrhoea and chancre. They are generally nothing 
but symptoms sympathetic of the inflammatory irritation, 
and disappear after the inflammation is gone ; nor do they 
require any other treatment than the antiphlogistic, and 
externally fomentations of tepid lead-water. They, how- 
ever, may also be the symptoms of a deep spread infection, 
which is recognized by their continuance after the inflam- 
mation has been removed. In such a case, the internal 
use of mercury must be resorted to, conforming with the 
directions I have already given. Buboes are also met with, 
as a symptom of primary infection, without clap or chan- 
cre; an occurrence which calls for the immediate internal 
use of mercury, taken as mentioned before. 
What here has been said of gonorrhoea and chancre, ap- 
plies to that Fluor albus which replaces gonorrhoea in the 
female. 
Condylomata require the general mercurial treatment, 
which most commonly cures them simultaneously with the 
ulcers. If they persist for a long time, the external appli- 
cation of sabina and of kreosote are the best means ; ex- 
cision and cauterization may likewise be resorted to. 
I must add a word in regard to the suppression of gon- 
orrhoea. It takes place after the use of a too irritative or 
astringent injection, or after taking cold, and may leave 
very bad consequences ; as a violent increase of the local 
and sympathetic inflammation, or a remote nervous affec- 
tion ; even trismus and tetanus have been observed to arise 
from it. The treatment must be, first to assuage the in- 
flammatory irritation (even venesection in plethoric indi- 
viduals), and the internal and external use of opium, emol- 
lient injections and warm narcotic cataplasms. 
11. Secondary, Universal (Constitutional) Infection. Syph- 
ilis, Lues Universalis. 
Eradicative treatment of the venereal disease.—In the 
first degrees and signs of the malady, which manifest 
themselves by pains in the throat, chronic inflammation, 
and ulcers in the fauces; or by ophthalmia, or cutaneous 
eruptions, especially in the forehead, the use of a mild 
mercurial oxyd, as mercurius cinereus, or solubilis or cal- 
omelas, is sufficient for a cure, and affects least the animal 
economy. The most recommendable preparation is rnercur. 
solubilis Hahnernanni, taken in the same doses and in the 
same manner as in primary chancre, in doses, however, 474 
VENEREAL DISEASE. 
to be augmented by less quantities (only for half a grain a 
day). 1 must here make a general remark, that it is possi- 
ble for the symptoms to disappear quicker by very large 
doses of mercury, but there is never a certainty that the 
remedy has properly penetrated into the organism and fully 
extinguished the internal infection.—Order at the same 
time ptisans of species purificantes (No. 202), to be taken 
as a beverage, since the drinking of much watery fluid 
greatly promotes the cure and the effect of mercury ; and 
command the patient to stay in his room during the treat- 
ment, i. e. to the termination of the precursors of saliva- 
tion and disappearance of the symptoms. At the same 
time a scanty vegetable diet, avoiding acids, salted, acrid, 
spiced nutriments, must be adhered to. 
If the disease has penetrated deeply into the system, is 
of an old date, or has been treated unsuccessfully and im- 
perfectly by other remedies, corrosive sublimate is the 
best and most penetrating remedy, and has at the same 
time the advantage of not being so apt to create salivation. 
This is particularly important in such persons as have 
taken much mercury, and are so easily affected that a few 
grains of simple oxide of mercury will bring on salivation 
and compel a discontinuance of its use. Corrosive subli- 
mate may be used without detriment and for a long time, 
by observing the following rules : let it be given in pills, 
in order that it may dissolve slowly ; in a mucilaginous 
vehicle, in order to obtund its caustic operation on the 
membranes of the stomach and intestines, and to prevent 
nausea, colic, and diarrhoea. Hence results the formule 
No. 231, which I consider the most appropriate for the 
cure of syphilis, and which I have always used, often for 
months. Prescribe half a grain, to be taken every day ;if 
the disorder is obstinate, increase the dose to three quar- 
ters of a grain daily. It is understood that a warm regi- 
men and good diet be observed. Also copious drinking of 
ptisans of sarsaparilla and the like 5 warm baths assist the 
cure. It is proper to remark, that corrosive sublimate is 
apt to affect the lungs ; therefore another preparation, as 
the following, must be resorted to in persons of a phthisi- 
cal disposition, or when pain in the chest sets in during 
its use. The use of a strong decoction of sarsaparilla (two 
ounces in two pounds of water reduced by boiling to one 
pound of fluid, taken every day), is often alone sufficient 
to perform a cure. 
Next to corrosive sublimate, red precipitate is the most 
efficient mercurial preparation to subdue syphilis, it even VENEREAL DISEASE. 
475 
surpasses it sometimes, and cures when the former proved 
abortive. Give a dose of one eighth to one sixth of a grain 
twice a day, in the same way as corrosive sublimate, in 
the form of pills (No, 232). 
It is worthy of notice, that the change of form is also 
promotive of a good effect. If one preparation does not 
prove efficient, choose another, and the cure will immedi- 
ately make better progress. It has been also observed that 
some mercurial preparations are particularly appropriate 
to, and efficient in certain forms of syphilis, as calomel, or 
soluble mercury in inflammatory affection, corrosive sub- 
limate and the red precipitate of mercury in cutaneous 
affections and ulcers in the throat. 
Pauses and omission of the use of mercury are also very 
useful. 
It has frequently been proposed to cure syphilis without 
mercury, and it cannot be denied, that this may be attained 
in hot climates by sarsaparilla, guaiac, and similar general 
antidyscrasic remedies ; but these same are not sufficient 
to eradicate the evil in our climate. On the other hand, it 
is certain, that when mercury has been sufficiently used 
and the evil will not entirely yield, the best treatment is 
to discontinue mercury, and to administer strong decoc- 
tions of guaiac or sarsaparilla for some time.* In weakly 
persons the use of roborants may exceedingly promote the 
cure and remove the remainders of the disorder. 
In speaking of venereal disease in general, it is greatly 
to be regretted that there is no certain sign by which we 
may know whether the disease is perfectly and radically 
cured ; that is to say, whether the infection as well as the 
capability of reproducing the virus is entirely annihilated ; 
for the disappearance of the symptoms is not sufficiently 
satisfactory 5 it may be demonstrative of the former, but not 
of the latter condition. There remains no other expedient 
but to continue the use of mercury in small doses for some 
time after the symptoms have disappeared. This must be 
done longer, the longer the use of mercury was required 
for removing the symptoms ; and shorter, when this re- 
quired less lime to accomplish. The patient must be 
carefully observed when he uses the above mentioned (not 
mercurial) antidyscrasic remedies, to discover whether any 
new syphilitic phenomena appear. 
* An instance of it is the celebrated Hutten, who, after having used 
mercury for a long time, even undergone inunction and salivating 
treatment without success, was perfectly cured by decoction of guaiac 
alone. 476 
VENEREAL DISEASE. 
By the uncertainty of the diagnosis, and by neglect of 
the above rales, now-a-days imperfect mercurial cures be- 
come, alas ! very frequent. The patient uses mercury for 
some time, until the symptoms disappear, exposes himself 
perhaps to taking cold and to dietetic faults, and considers 
himself restored to full health, but he is not so, and is at- 
tacked again with the original distemper after a longer or 
shorter interval. 
A second matter of much regret is, that the use of mer- 
cury itself, when long continued, may excite affections 
very similar to the syphilitic, as glandular swellings, ul- 
cers, may partly affect the economy in its innermost re- 
cesses, and create a dissolution, a scorbutic diathesis, in 
short, what we call mercurial disease (poisoning by mer- 
cury). 
111. Inveterate Syphilis (Lues Venerea Inveterata). 
When the disease is of old date and is assimilated to 
the vital principle, when it has affected and disorgan- 
ized the deeper seated organization, as the bones; when 
the usual mercurial treatment has been undergone without 
success, or imperfectly ; or when, what is of most frequent 
occurrence, the disease has been suppressed for some time, 
but has reappeared in an altered form : then a more effi- 
cient treatment is required. 
The first means is the application of mercury to the skin, 
the direct absorption of it into the lymphatic system. It is 
undeniable, that mercury used in this way, operates more 
vigorously and rudely to destroy the disease ; and this fact 
may be easily understood, by reflecting that it thus ope- 
rates in its primary strength, without having been submit- 
ted to the unavoidable alterations which the digestive 
powers of the stomach will exercise on it. 
The first application of this kind are baths of corrosive 
sublimate. One half or one ounce of corrosive sublimate 
of mercury is dissolved in the bathing water. Such baths 
are of excellent efficiency, and may be used without detri- 
ment or exciting saljvation. 
The second is inunction. Its effect is double ; by sali- 
vation or not. The latter end is attained by frictions made 
with Cirillo’s ointment (No. 254, one drachm daily applied 
to the soles of the feet), and it is preferable, and to be used 
first, in order to save the patient from salivation, which 
must always be considered a great evil. 
Inunction with salivation. One or two drachms of the VENEREAL DISEASE. 
477 
unguent, mercuriale cinereum alternately rubbed everyday 
in various parts of the surface, and continued along with 
tepid baths, strict diet or even fasting, until salivation en- 
sues, generally announced by febrile irritation, after which 
it must be moderately used for a longer or shorter time, 
according to the intensity of the malady. This method is 
undoubtedly the most powerful, but also the most rigorous 
kind of treatment for syphilis. 
It is a real crisis, attended with good as well as bad 
qualities. It is remarkable for this : the mercury is imme- 
diately introduced into the general system in its metallic 
state, and in this way it has without doubt a more power-* 
ful action over the virus ; and, therefore, it is more capa- 
ble than any other method to combat the inveterate venereal 
disease ; for the same reason it exercises on the organism a 
more destructive effect, even may remain in it in the metal- 
lic form : in the second place, for the loss of humors ; and 
that of one, the saliva, which is so indispensable to diges- 
tion and nutrition, and may be followed by great debility, 
emaciation, exhaustion, even hectic and tabes, when saliva- 
tion is carried too far on in a predisposed individual. It is, 
therefore, to be resorted to only in extreme cases, and 
even then with caution and moderation ; and must be en- 
tirely omitted in aged and very debilitated persons. 
The fasting method of treatment by itself, or combined 
with small doses of corrosive sublimate, is also very potent 
in curing inveterate syphilis. Be careful however that ex- 
ternal appearances do not deceive. For abstinence from 
food has often no other effect than to suspend for a while 
the power of the organism to react on the virus, but which 
it resumes when the patient returns to a good diet, and with 
it has a return of the symptoms. 
The contrary may also take place and assist the cure. 
By a long duration of the disease, and by a debilitating 
treatment, the system is brought into so great a degree of 
weakness and torpor, that though the specific character of 
the disease has been annihilated, it may continue as a sim- 
ple dyscrasyj this explains the use of roborants, as arnica, 
cinchona, iron, which is the best for removing these rel- 
ics. 
This is the very case in which a decoction of sarsaparilla 
orguaiacum (in whose stead carex arenaria may be. substi- 
tuted), with an addition of senna leaves, or Pollings potion, 
(No. 203) removes the remnants of the disease. In the 
excruciating nightly pains of the bones, mezereum, used 
internally (cortex mezerei two drachms daily, made to a 478 
VENEREAL DISEASE. 
decoction), but better if combined with sarsaparilla, proves 
a true specific. 
Zittmann’s decoction is of great service in obstinate ve- 
nereal disorders; such as have been unsuccessfully com- 
batted by other methods. It has frequently effected a 
perfect cure, as I can assure from my own experience. 
Aurum muriaticum, in small doses, rubbed under the 
tongue, has been applied with benefit. 
lodine has proved exceedingly efficacious for the final 
extirpation of inveterate venereal disorders ; especially the 
alkaline solution of it (No. 233). 
* It may happen, after the specific character has been ex- 
tinguished, that the local disorders, especially the corrupt 
secretions, eruptions and ulcers, which were the conse- 
quence of a former syphilitic disturbance, now continue 
merely as the effects of a general dyscrasy. In such cases 
mercury is no longer of any use ; but the general antidys- 
crasic remedies must be resorted to. Here mineral acids 
are of excellent service, especially nitric acid, one to two 
drachms daily, diluted in two pounds of mucilaginous water. 
It is not uncommon for a particular morbid state to set 
in towards the end, which deserves the greatest attention, 
and may seriously embarrass both patient and physician. 
It is a mercurial disease, or a peculiar dyscrasy, created by 
the non-expelled mercury and an imperfectly extinguished 
syphilitic matter (dyscrasia mixia). It is the consequence 
of an immoderate or disorderly use of mercury without 
proper care, and a disregard of taking cold. The distinc- 
tive sign is, that the symptoms, which are often nothing 
but mercurial symptoms, effects of the mercurial poison- 
ing, do not yield to the continued use of mercury, but be- 
come aggravated. For such a case, the principal remedy 
is sulphur in its most volatile form, the artificial or natural 
sulphur water, taken internally, but especially in baths 
(Neundorf, Weilbach) ; the most efficacious are the ther- 
mal baths of Warrnbrunn, Landeck, the strongest of all 
those, Aachen (Aix la Chapelle). 
IV. Larved or Latent Syphilis. 
The diagnosis is most difficult. The most dissimilar and 
opposite chronic diseases may be nothing else than the ef- 
fects and forms of a lurking syphilis. Paralysis, spasms, 
hypochondriasis, profluvia and obstructions, hectic and 
dropsy, may be of a syphilitic nature and not curable but 
by mercury. We cannot be too much on our guard against VENEREAL DISEASE. 
479 
latent syphilis, especially in certain ranks of society, and 
in large cities, where syphilis has become very prevalent. 
This often throws light on obstinate chronic diseases. On 
inquiry whether the patient has ever been infected, we 
shall often find that to have been the case, and from that 
period up to the time of inquiry there has existed a conti- 
nuous chain of phenomena, hitherto unsuspected of a vene- 
real origin. Now try mercury, and the promptly beneficial 
result will surprise and immediately convince us of the true 
syphilitic nature of the evil; and then the antisyphilitic 
treatment is regularly to be pursued. 
(Even lately I have again had such a case. A modest 
woman, already advanced in age, labored for a year under 
an extremely troublesome feeling of crawling and painful 
boring near the anus; without the slightest discoverable 
trace of swelling or altered color. She had used many re- 
medies without relief. It was most natural to consider it 
a hsernorrhoidal anomaly ; but neither leeches nor other 
antihaemorrhoidal remedies had the least beneficial effect. 
Finally, on accurate inquiry, it was ascertained, that the 
woman had had a venereal infection 12 years before, and 
as usual had been treated in a very superficial manner. 
Since that time she had been subject to various complaints 
of one kind or another, with occasional intervals of entire 
freedom from the complaint. I first made trial of an ex- 
ternal application of corrosive sublimate in water to the 
part, and I was astonished at the rapid amelioration, which 
no other external means, either opium or other narcotics, 
had been able to effect. I then prescribed pills of submu- 
riate of mercury in doses increasing up to f of a grain a 
day, which perfectly cured her. But some time after she 
had eruptions, and once even glandular tumors formed; 
which were likewise cured by corrosive sublimate or the 
red precipitate of mercury; but more than a year elapsed, 
before the struggle with the inveterate enemy was entirely 
terminated and The patient perfectly cured.) 
Finally, one word may be said in regard to prophylaxis. 
Various embrocations and lotions have been recommended 
and applied previous to and after coition; but none of them 
has hitherto stood the ordeal; and the old adage, Unicum 
prophylacticum Mali venerei est abstmentia a Bono venereo, 
is still true. 480 
POLYSARCA. 
POLYSARCA. 
Adiposis. 
Diagnosis. Excessive accumulation of fat either in the 
whole system or in single parts; forming externally adi- 
pose tumors (steatoma) ; internally, accumulating around 
the heart, in the omentum, and about the kidneys.—Its ef- 
fects are: to impede the functions of the part concerned; 
and when it is universal, to embarrass motion, to overload 
the individual, to molest the whole economy, to oppress 
the circulation, to obstruct secretion and excretion ; to dis- 
pose to external erysipelatous inflammations and abscesses; 
finally, transition into cachexy and dropsy. 
Pathogenesis. Immoderate use of nutritive, especialljr 
animal food, while exercise and elimination is wanting; a 
phlegmatic temperament, lax fibre and constitution, ces- 
sation of habitual hasmorrhages, therefore occurring in 
women after the cessation of the menses. In general a 
congenital disposition has a great influence ; hence some 
men continue lean though supplied with the richest food, 
and others grow fat though subject to restriction. 
Therapeutics. The leading idea of cure is to diminish 
the accession, and to increase the elimination of the ali- 
ments. The principal remedies are, consequently, scanty, 
unnutritive, vegetable, watery food ; strong corporeal ex- 
ercise ; little sleep, excitement of mental affections, pro- 
motion of all the secretions, especially that of perspiration 
and the discharge from the bowels; fasting, mercurial 
treatment, in extreme cases iodine. DISORGANIZATIONS, ETC. 
481 
THIRTEENTH CLASS. 
DISORGANIZATIONS. PSEUDO-ORGANIZATIONS. 
PARASITES. 
We comprise under these terms all deviations from the 
normal state of structure and internal organization of an 
organ. In external disorders of this kind the diagnosis 
is easy, and falls more within the department of surgery. 
Those disorders of the internal viscera which come under 
this head more particularly concern the physician. They 
are, in regard to diagnosis as well as to treatment, the most 
difficult tasks in practice. 
They were formerly comprised under the general name of 
obstructiones viscerum, or when in a higher degree, of excre- 
scences, indurations, etc. Modern, pathological anatomy 
has distinguished them with more accuracy and care, and 
has enriched nosology with a multitude of such abnormali- 
ties and metamorphoses. But they are of value only as 
regards the natural history of the human body, nosology 
and surgery, and much less as regards internal treatment. 
For, in the first place, the diagnosis is deficient, it is im- 
possible to recognise and accurately distinguish the various 
species of disorganization in the internal viscera; in the 
second place, special therapeutics are also deficient, and, in 
general, we must be satisfied with general principles of 
treatment, which are most likely to effect a cure. 
Therefore, for practical purposes, it will be sufficient to 
classify them according to the various cavities of the body 
in which they are found, and to describe the symptoms 
which authorize us to suppose, that organic disorders are 
located in them. 
In the abdomen: Examine the abdomen by feeling, whe- 
ther in one or several parts a distention, tumor, hardness, 
with or without pain is discoverable by pressure. This ex- 
amination is best performed on the patient in a fasting 
state, lying in bed, standing, bent forwards, and towards 
the sides, since the deep seated and smaller nodes appear 
only in different positions. Ascertain farther, whether the 
41 482 
DISORGANIZATIONS, ETC. 
patient finds trouble or impossibility to lie on either side or 
on the back ; if so, the seat of ihe evil may always be pre- 
sumed to be on that side, on which he can lie best, with 
the exception of painful disorders. Observe also the con- 
tinued disturbance or stoppage of the functions of that or- 
gan, in which the evil is situated ; likewise the faulty con- 
dition of its secretions, hsemorrhoidal complaints. Finally, 
a peculiar cachectic complexion, pale, light-yellow j in dis- 
orders of the liver, yellow, particularly in the eyes, deserves 
attention. 
In the 'pectoral cavity: Difficulty of respiration, inability 
to lie on either side, or on the back, disordered motion of 
the heart and the pulse (vide asthma, phthisis), come here 
into consideration. 
In the cephalic cavity: Constant, irremovable pains in 
one part of the head, most felt in certain positions, dizzi- 
ness, stunning, disturbance or obtusion of mental action or 
of single senses,- spasms and paralysis are here observed. 
The proximate cause of all malformations, as well as of the 
parasitic products, is a faulty plastic process. 
This can be caused in a quadruple manner. By immode- 
rately increased plasticity, as inflammation, congestion, in- 
fantile age, excess of nutrition ; by diminished, obstructed 
plasticity (likewise as the monstrosities of the first forma- 
tion), as old age, debilitation; by qualitative change of 
plasticity, as dyscrasy, metastasis; by mechanical pressure 
and chemical operation. 
The exciting causes may be the following : inflammation, 
acute as well as chronic ; and congestion. Inflammation is 
the most frequent cause, but not the constant one. It par- 
ticularly engenders hypertrophy, physconies, thickenings, 
indurations, adhesions, pseudo-organizations;—mechanical 
pressure obstructing the afflux and reflux of humors, and 
the normal action of the vessels, as by lacing, ligatures, 
permanent silting, contraction of the abdomen ;—nervous 
affections, the disturbed or faulty influence of the nerves of a 
part is capable of producing a disturbance and degeneration 
of its normal reproductive action ; such as the frequently 
observed influence of fright, grief, sorrow, tending to create 
such products, especially in the glandular system (which 
is evidently proved in the milk tumors that form in the 
breast of nursing women immediately after fright) ; meta- 
Stases, when the normal nutrition is deranged by the deposi- 
tion of a morbid matter, as after suddenly suppressed in- 
termittent fevers, cutaneous eruptions, syphilis, scrofula, 
arthritic matters (such organic disorders are nothing but DISORGANIZATIONS, ETC. 
483 
symptoms of these diseases) ;—finally, a vitiated condition 
of the humors ; thus it is certain, that a too thick, viscid, 
atrabilious blood may contribute a great deal to produce 
obstructions in the abdominal viscera ; a too viscid bile to 
obstructions in the liver and the formation of gall-con- 
cretions. 
Of great importance for the practice is the circum- 
stance, that an organic disorder may become a depository 
or derivative organ for other maladies and morbid matters. 
This is especially true of internal congestive diseases and 
dyscrasies; even nervous and mental diseases arise from 
that cause. As soon as an external pseudo-organization 
forms, these general or internal evils abate, they become, 
so to say, concentrated in one point, corporified and deri- 
vated. 
In regard to their different nature we distinguish for prac- 
tical use: 
1. Obstruction, the slighter degree. Accumulation, stag- 
nation, thickening of the humors contained in the vessels 
(particularly the venous), thereby stoppage, impermeabi- 
lity, distention (hypertrophy, physcony, infarcts), disturb- 
ed function of a viscus, most frequently in the abdomen 
and in the plurality of cases occurring in the liver. 
2. The higher degree, veal disorganization. Here scir- 
rhus, tubercles, polypus, fungi, tumors, steatomata and 
osteosteatomata, mollifications and ossifications, genera- 
tion of calculus are to be classed. 
3. Parasits, newly generated animated organisms, ento- 
zoa; to which not only worms, but also several organic 
diseases, as hydatides, encysted tumors, even scirrhus and 
cancer are to be counted, inasmuch as they possess a pe- 
culiar life and vegetation. 
Therapeutics. Above all, two rules must be adverted to 
and strictly complied with. In the first place, avoid as 
long as possible to presume that an organic disorder is the 
cause of disease; for to do so, usually precludes all kinds 
of treatment, and discourages us from searching for other, 
curable causes, that perhaps exist, and seeking for new 
ways and methods of cure. In the second place, though, 
organic disorders decidedly exist, they must not be judged 
of precipitately, and pronounced to be incurable; but all 
possible curative means must be tried, since experience has 
taught, that even in such cases complete cures have unex- 
pectedly been effected, or at least that the evil may be ar- 
rested and life preserved. 
The external (surgical) part of the healing art has in this 484 
DISORGANIZATIONS, ETC. 
regard the advantage over the internal; for the surgeon 
may easily recognise and discriminate the various species 
of degeneration, but it is not so with internal diseases, 
which fall to the lot of the physician. In general, he only 
perceives a derangement in the functions of an internal 
part, but is rarely capable of discerning of what special kind 
it is. Me is, therefore, guided in his treatment by general 
principles. These are: to promote the internal, especially 
the venous action of the organ by discutienls (motion and 
friction) ; to promote its absorbent action by absorbents 
(among which mercury and soda rank first) ; to excite the 
nervous action of the part by remedies which have a spe- 
cific influence ; to derivate the nutrition of the part by di- 
minishing or withholding the nutritive matter; to remove 
the inflammatory state, if such a one exist; to dissolve and 
discuss the stagnant matter by chemically decomposing 
means (of which water, soda, and iodine are the principal 
ones) ; and finally to respect the specific character of the 
obstruction or degeneration, as the syphilitic, when re- 
course is to be had to the specific antidote, mercury. 
It is also useful to establish an artificial ulcer near the 
disorganization, in order to derivate and to withhold its 
support; which, if used at an early stage of the disorder, 
will do away with it entirely, if at an advanced stage, will 
stop and prevent it from increasing. 
The seat of the disorder makes a difference, and requires 
a modification in the treatment. We distinguish: 
1. Obstructions and disorganizations in the abdomen, 
which are the most frequent. They are most commonly 
seated in the liver, the spleen, the pancreas, the mesentery, 
and in the female, in the ovaries. For the diagnosis see 
above. The treatment consists in the employment of dis- 
solvent vegetables, especially of dandelion, solvent salts, 
the gums of ferulaceous plants, soda, similar mineral wa- 
ters, antimonials and mercurials, clysters, baths; in obsti- 
nate cases, great insensibility and atony, aloes, scammony, 
and similar drastics (see visceral treatment of hypochon- 
driasis), When the liver is obstructed, mercury, internally 
as well as by inunction, is chiefly to be relied upon. But 
in general, we cannot too strongly recommend in abdomi- 
nal obstructions, soda, especially Carlsbad spring; when 
that cannot be procured, it may be replaced by the arti- 
ficial water. I have seen cases of the worst kind, in which 
the w'hole abdomen greatly distended, perfectly re- 
lieved by this agent, after the most vigorous dissolvents, 
even mercury, had proved abortive.—lodine is also one of DISORGANIZATIONS, ETC. 
485 
the most efficient dissolvents; but it is always an unsafe 
remedy, apt to operate destructively on the whole animal 
economy and to leave bad consequences ; therefore it ought 
to be used only in extreme cases and with caution, cor- 
rected by alkalines (vide No. 233). If pains are present, 
do not omit to apply leeches from time to time. 
Also external embrocations of dissolvent ointments and 
cataplasms, for which all kinds of dissolvent herbs, parti- 
cularly cicuta, may be used, are of great service. Even 
gentle rubbing, repeated several times a day, continued for 
a length of time, is beneficial. Of unguents the following 
have proved most efficacious : ammoniac, mercurial, digi- 
talis, and iodine ointments; I can particularly recommend 
a mixture of castor oil and tincture of colocynth (vide No. 
255), which is also very serviceable in external indurations. 
A resolvent soap plaster, worn constantly on the part, 
has also a very good effect. 
2. When such disorders are located in the chest, and 
especially in the lungs, great caution must be observed in 
the use of dissolvents, lest they create too much irritation, 
haemoptysis, inflammation, increase of tubercles or suppu- 
ration, terminating in phthisis (vide phthisis tuberculosa. 
As regards the treatment of organic disorders of the heart, 
see asthma syncopticum). 
3. Organic disorders in the head can rarely be distin- 
guished with such certainty as will justify a direct spe- 
cial treatment. We must therefore be guided by the ge- 
neral rules just stated ; treat the dyscrasies which may ex- 
ist, and promote absorption. The principal remedies for 
these are derivatives, especially by the intestinal canal and 
the skin ; issues on the neck and arms are to be kept open 
for a long time, and abstractions of blood repeatedly made. 
In treating these external disorders, we must never for- 
get that they may be the depositories or secretory organs, 
as it were the vicars or substitutes of internal diseases, and 
that their retrocession, like the suppression of a cutaneous 
eruption, create an internal disease. Derivatives therefore 
are to be resorted to only after the internal cause, the dys- 
crasy, has been removed. In general, we ought carefully 
to weigh the difference between enduring the external dis- 
order, and the danger of giving rise to a worse internal 
one.—This precept is particularly to be observed by the 
surgeon before extirpating such evils. 
Finally, cases may occur, in which a cure can be effect- 
ed only by destroying the parasitic being, the pathological 
animal, as the scirrhus or cancer, by arsenic. 486 
WORMS, 
Two diseases of this class merit our particular atten- 
tion, and must be here specially treated of, lithiasis and 
helminthiasis. 
WORMS. 
Helminthiasis. 
There is no part in the human body, in which worms 
or other imperfectly organized beings cannot be developed 
or received. 
They are most frequently found in the intestinal canal, 
but also in all the other viscera, in the liver, lungs, kidneys, 
bladder, uterus, ovaries, even in the brain and eyes, espe- 
cially the encysted tapeworms, teenies hydatigence (viscerales), 
or in the external parts and cavities (externi, superjiciales). 
1. Intestinal Worms, Vermes Intestinales. 
The most common are mawworms (ascarides lumbricoi- 
des)‘, the small white worm (ascarides vermiculares); the 
tapeworm, of which there are two species, the broad one 
(tcenia lata), and the catenated, or the pumpkin-seed-like 
solitary worm (tcenia solium)’, the hairworm (trichuris, 
trichocephalus). 
Besides, larvse of various insects are frequently met 
with. 
Diagnosis. General signs are : pale and changeable com- 
plexion with livid circles around the eyes; saliva accumu- 
lates in the mouth in the morning and in a fasting state ; 
nausea, fetid breath, irregular appetite, great hunger, fre- 
quent itching in and on the dorsum of the nose, sneezing, 
distended, but not hard abdomen, pain in the umbilical re- 
gion, dilated pupils, bleeding at the nose, frequent starts 
and fright during sleep, grinding of the teeth, lying on the 
belly, somnambulism, unusual emaciation, disposition to 
spasms ; but the most important and only sure sign is the 
discharge of worms or parts of worms. 
Special signs of ascarides: troublesome itching in the 
anus, particularly in the evenmg, dysury, strangury, tenes- 
mus, apparent hfemorrhoidal complaints, discharge of mu- 
cus from the rectum, bladder, vagina, extraordinary dispo- 
sition of the mind and periodical sadness. 
Of the mawworm; besides the general signs, frequent 487 
bellyache, and a vermicular sensation in the umbilical 
region. 
Of the tapeworm : a sensation, as of something suddenly 
rising from the left side into the throat and falling back, 
a feeling of a lump in one or the other side making an un- 
dulatory motion, feeling of sugillation in the abdomen, 
dizziness, creeping, surdity, numbness of the fingers and 
toes, sudden cessation of the abdominal troubles suddenly 
after a swallow of brandy or of essence of absinth. 
Effects: The worms may, by the irritation they cause, 
and the influence they exercise on digestion and assimila- 
tion, have a very important influence on the human econo- 
my, and on all the vital functions, even on the psychical; 
hence they may produce great disturbances and conse- 
quently manifold and dangerous maladies, especially most 
strange nervous diseases (see pathogeny) ; therefrom re- 
sults a momentous rule, to suppose the presence of worms, 
and to act accordingly in all such diseases, especially at 
the infantile age, where no other sure cause can be ascer- 
tained ; for experience has shown that an anthelminthic 
treatment has procured complete relief in very serious dis- 
eases, after all other methods had proved abortive. This 
applies not only to cases, in which signs of worms are pre- 
sent, but also when there are none ; for worms may exist 
without any symptoms of them being perceptible. 
Pathogenesis. We must view two things: the origin and 
formation of worms, and that of verminous diseases. 
The generation of intestinal worms occurs in two ways. 
Some are evidently brought in from without, as the larvae 
of insects and other imperfectly organized animals (snails), 
which can live for some time in the intestinal canal. Others, 
on the contrary, are evidently products of the human eco- 
nomy itself. 
The causes, which favor this creation (causes remotce\ 
are : particularly the age of infancy on account of the gene- 
ral predominance of nutrition (whence the intestinal canal, 
being the receptacle of nutriment, is most disposed this 
way), laxity and weakness of the intestines, accumulation 
of mucus, animal and farinaceous food, moist habitation 
and a like epidemial constitution of the atmosphere, hence 
verminous maladies may become endemial and epidemical. 
Origin of verminous maladies, or of worms as cause of 
disease. These parasites do not always cause disease, 
when they are not too numerous and remain in repose, but 
they must always be considered as something hetero- 
geneous, as a morbid disposition; they may even become 
WORMS, 488 
WORMS, 
causes of the most dangerous maladies, or at least impart 
the most dangerous complication to all diseases which af- 
flict the patient. 
The manner and way, in which worms create diseases 
is: they withhold the nutritive substance of the food (they 
are co-eaters, parasites ; hence, where they exist in great 
number, emaciation, and finally fatal atrophy ensue); they 
create putrid and mucous impurities in the intestinal ca- 
nal, by their excrements and dead bodies; hence gastric 
putrescency in verminous fevers, and acrimony even in the 
humors; they excite irritation, when they are hungry or 
stirred up by other causes, or gather on a particularly sen- 
sible part of the intestinal canal, or when the sensibility of 
the intestinal canal becomes suddenly increased, as by 
fever. The irritation is partly local, partly consensual. It 
produces, locally: pains, spasms, increased secretion, and 
action of the intestinal canal, diarrhoea, dysentery, spasmo- 
dic incarceration, ileus, abscesses, through which worms 
are discharged. It affects the nerves by sympathy, causing 
convulsions, all kinds of spasms, particularly chorea, epi- 
lepsy, somnambulism, periodical paralysis, insanity, fury; 
and operates on the vascular system, giving rise to vermi- 
nous fevers, sanguineous congestions, haemorrhages, blen- 
norrhoeas, exanthemata. 
The effects of verminous irritation are not always appa- 
rent: individuals may have worms and nevertheless feel 
very well for a long time ; but suddenly verminous attacks 
may set in. This happens by accessory causes, which ex- 
cite them, as by ingesta disagreeable to them, by hunger, 
by accumulation and sucking from a sensitive part of the 
intestinal canal, or by increased sensibility of this gut, 
which is the case in every fever; hence every fever is 
likely to give trouble to the worms. 
The treatment is double : 'palliative, soothing the worms; 
and radical, annihilating the verminous disease itself. 
Palliative treatment, 
Is of great importance, partly to remove the frequently 
violent and dangerous symptoms of worms ; partly in fevers 
associated with verminous attacks, producing local pains 
in the abdomen, which may even cause inflammation, ab- 
scess and perforation ; partly in the treatment for worms, 
when they become too much agitated. 
The indication is double : to appease the worms and to 
soothe the spasm created by them. The principal remedy 
answering both ends, is milk, in all forms used, as beverage, 
injection, fomentation on the belly. Next to it is oil, oily WORMS, 
489 
emulsions (oil at once weakens, kills and prevents the 
worms from sucking), Acres zinci, extract of hyoscya- 
mus, mercurial water (vide No. 234) as a drink and in 
clysters; in obstinate cases, emetics, asa foetida, valerian. 
In violent attacks of ttenia, a tablespoonful of the tincture 
of absinth is the best suppressive remedy. 
The radical treatment must tend to dislodge the existing 
worms, and to prevent their reproduction. 
The Expulsion of Worms, 
Can be effected in three ways ; by remedies which annoy 
the worms, drive them downwards, debilitate and kill them 
(anthelminthics, of which semen Santonici or cinse is the 
most common, efficacious, and appropriate to all sorts of 
worms), followed by cathartics to purge out the dead 
worms; or the simultaneous use of anthelminthics and 
purgatives; or by strong drastics, which forcibly expel the 
worms living or dead, by increasing the peristaltic motion 
of the intestines.—In all attempts to cure worms it will be 
well to take advantage of the declining of the moon ; for at 
that time the worms are weaker and less capable of sucking ; 
and it will also be proper to combine the anthelminthics 
with such remedies, as dissolve mucus (neutral salts, oxy- 
mel scilliticum, and the like), since mucous accumulation is 
always present, forms the lurking place for the worms, and 
blunts the power of the anthelminthics. Finally, I must ob- 
serve, that a patient may be perfectly cured of worms, 
though none may have appeared to be discharged; for when 
killed by the anthelminthics, like all dead matter they may 
be digested and evacuated as excrements. 
Every species of worms has its peculiar vermifuges. 
Are efficiently destroyed by injections of a decoction of 
tobacco, oil, culinary salt, mercurial water, or water with 
a small admixture of a weak solution of corrosive subli- 
mate, pills of extract of quassia and tansy (vide No. 235) 
continued for several months. 
Ascarides, 
Lumbrici. 
The most efficacious remedy is semen Santonici (vide 
No. 237), which we may administer in the form of elec- 
tuary (vide No. 236), or in substance with honey to chil- 490 
WORMS 
dren who dislike medicine. Let a teaspoonful be taken for 
a fortnight every morning fasting during the decline of the 
moon, and be followed by a purgative of jalap and calomel. 
The following remedies may also be used ; tanacetum, ab- 
sinth., rad. spigel. anthelminth. (vide No. 239), extract, 
nucis juglandum, all mercurial and ferruginous prepara- 
tions (vide No. 24-0), aloes, fucus heirnintochortos (vide 
No. 238), valerian root, pulp of carrots mixed with sugar, 
taken fasting ; also mechanical stimuli, as iron filings, doli- 
chos pruriens. One ought to be acquainted with several 
kinds of anthelminlhics, for that which is efficacious in one 
case is not so in another. External means also aid in dis- 
lodging worms; as embrocations of oil of tansy, or petro- 
le ura on the abdomen, cataplasms of tansy and absinth. 
At the same time a proper diet must be enjoined. Fari- 
naceous and glutinous food, as well as warm drinks must 
be avoided ; a little culinary salt, occasionally a little wine 
and much exercise are to be taken. 
Tapeworm. 
There are two methods of dislodging the tapeworm. One 
is to weaken it gradually, to destroy it, and remove it gra- 
dually without any violent commotion ; the other, to expel 
it at once, as if it were by storm. 
The first, gentle method, is the safest, and ought to be 
tried before the other. It is the only one, applicable to 
delicate and sensitive patients. It consists in the perse- 
vering use of such remedies as are troublesome, debilitating 
and fatal to the worm. Of this number are : Glauber’s salt 
and Sedlitz salt taken every morning; and several times 
during the day elixir acid. Halleri, or pewter filings, 3 or 4 
drachms a day, mixed in conserves of roses ; garlic stewed 
in milk, taken every morning fasting ; also the bark of 
pomegranate root (vide No. 241) has proved very efficient 
in my experience. I have succeeded without any trouble 
to expel the taenia in a nervous woman within eight days, 
by the following combination : Tinct. absinth, asa foetid, 
aa M. S. 60 drops 3 times a day. Limatur. stanni 1 ounce, 
pulv. rad. filicis maris 2 drachms, conserv. rosar., as much 
as will make an electuary, 1 teaspoonful 3 times a day and 
a tablespoonful of castor oil after every dose; meagre food 
and more salted than usual. 
The second, the forcible method, is of course more 
prompt and efficacious, but also more dangerous ; is capable 
of producing all the consequences of poisoning, and may WORMS, 
491 
impair the digestive organs to such a degree, that the pa- 
tient for ever after feels its effects, suffering more from 
the consequence of the treatment than he did by the tape- 
worm ;it is, therefore, not applicable in feeble individuals. 
When, however, the worm produces very obstinate and 
malignant disorders, as epilepsy, and the gentle method is 
unavailing, no other expedient is left. 
The principles of this method, which may be styled a 
kind of military expedition against the enemy, are: to 
commence by weakening the foe, in order to deprive it of 
the power of assugilating and creating spasms ; this is at- 
tained by cold, oil, hunger ; to drive it down to the lower 
part of the intestinal canal, by remedies offensive to the 
animal (of which the root of the genuine malefern is the 
most efficacious of all) ; to prevent spasms during the ope- 
ration, by which the discharge might be stopped and bad 
symptoms excited (which is accomplished by asa fostida, 
hyoscyamus); and finally to enforce its discharge by dras- 
tic purgatives. In obstinate cases the powdered seed of 
Indian caustic barley is a very efficient remedy ; from 10 
grains to one scruple may be taken every morning mixed 
in honey. 
The most efficient method, according to my experience, 
is: in order to ascertain the existence of the tapeworm, 
when it is not positively known, is to give a few days pre- 
vious to the above course, resina guaiaci with bitter almond 
water daily, when pieces of the worm will be discharged 
by stool. 
After this the patient is to live for a few days on her- 
rings, sardines, and similar aliments, and for supper only 
panado, and before retiring, according to his capacity 1 or 
2 drachms of malefern root in powder, or 30 drops of the 
very efficacious ethereal oil of the same in pills. On the 
following morning he is to commence by taking a glass of 
cold water, then a powder of 6 grains gamboge, 1 grain of 
calomel, 10 grains of magnesia, 1 grain of extract of hyos- 
cyamus 5 half an hour afterwards he must swallow ounce 
of castor oil and receive an injection of milk, and the ab- 
domen may be embrocated with petroleum. If the worm 
is not discharged, the same remedies are to be repeated 
two hours afterwards, and if they again fail, the purging 
not being too strong, let them be repeated once more. 
When the worm is not completely discharged, but hangs 
out of the rectum, caution must be used not to break Tt, 
but wind it around a little piece of wood, to prevent it from 
returning; the patient must sit in a vessel filled with warm 492 
LITHIASIS. 
milk, and the worm is to be gradually extracted by wind- 
ing it up. It is only when the pointed end or head has 
been evacuated, that we are sure the whole is really ex- 
pelled. 
To Prevent the Formation of Worms, 
Requires fortification of the intestinal canal by a nou- 
rishing diet, more animal than vegetable ; a moderate use 
of wine, much and vigorous exercise of the body, ferrugi- 
nous remedies, as a small quantity of Pyrmont water, taken 
every morning for a length of time, or ferrum alcoholisa- 
tum. In children it is very salutary to give every month, 
at the decline of the moon, wormseed (semen Santon.) and 
a dose of jalap after it. 
2. Vermes Superficiales. 
Mercury, and particularly the red precipitate ointment, 
is the most sure remedy against body and head lice and 
other insects burrowed into the skin. In phthiriasis, baths 
of corrosive sublimate, and in an extreme case a solution 
of arsenic may be used against this formidable evil. When 
worms are engendered in ulcers, the application of tar is 
the surest remedy. 
LITHIASIS. 
The formation of stone, under which head ossification is 
also to be classed, can take place in any part of the eco- 
nomy; they occur most frequently in the urinary passages 
and gall ducts; they are also found in the intestinal canal, 
lungs, brain, salivary glands, blood vessels, especially in 
the heart and the large vessels. Their formation is either 
due to a tendency to decomposition of the substance in 
which they are found (as urine, bile, saliva) ; or to a vitiat- 
ed secretion and reproduction. In the latter respect old 
age always favors ossification, by a defect in nutrition and 
a prevalence of the earthy matter.—“ Fulvis es, et in pulve- 
rem reverterisP URINARY CALCULUS. 
493 
URINARY CALCULUS. 
Calculus Vrinarius. 
Stone in the Bladder, Stone in the Kidneys. 
Diagnosis. Stone in the bladder. Constant urgency to urin- 
ate, accompanied by the most violent pains, especially,in the 
glans ; sudden stoppage of the stream (all these accidents 
are less in the recumbent than in the standing position); 
strangury, dysury, a constant troublesome itching and 
tickling in the orifice of the urethra; slimy sediment in the 
urine, frequently mixed with gravel or little stones, some- 
times with blood, especially after rough exercise ; sensa- 
tion of pressure and heaviness deep in the pelvis, alleviated 
by lying down, aggravated by standing ; exploration, either 
by the finger in the rectum and vagina, or by a catheter. 
The detection is often very difficult, even by the catheter, 
when the stones are encysted,—calculi cystici. The dis- 
ease is apt to be confounded with vesical gout and vesical 
haemorrhoids. 
Course. Frequently returning spasms and inflammatory 
attacks in the bladder, which terminate in disorganizations, 
thickening and callosity, spongy excrescences and suppu- 
ration of the bladder, lingering fever, phthisis vesicalis, 
and death by emaciation. 
Nephritic Stone is recognized by the permanent or pe- 
riodically returning pains, or a sensation of heaviness and 
pressure in the region of the kidneys; by colic occurring 
from time to time (colica nephritica), which is generally 
followed by a discharge of gravel, by the red color of the 
discharged gravel, a dull pressure felt in the leg of the side 
affected, even weakness and lameness of it. It is frequently 
attended with nausea and vomiting in a fasting state, even 
with vertigo. 
The calculary paroxysms or calculary colics are vio- 
lent, sudden, acute, extremely painful attacks, particularly 
in nephritic calculus. They are distinguished by the vio- 
lence and the sudden occurrence of the pains in the region 
of the kidneys or bladder, spreading over the whole abdo- 
men ; by the vomiting and crying, which is always con- 
nected with it, by spasmodic sympathetic sensations in the 
cremaster, testicle, leg of the same side, in the urethra ; 
and especially by a previously existing lithiasis being 
known and by the exciting causes. These causes are: 494 
URINARY CALCULUS. 
either increased irritation of the calculus (when it tends to 
a new position, or to pass through the ureter into the 
bladder), or increased irritability of the kidneys. The first 
may be brought on by rude motions, as riding; the latter 
by excessive use of ardent or diuretic beverages, violent 
passions, overheating of the body and taking cold, me- 
tastaees. 
The effects of a nephritic stone, when it remains in the 
kidney, are : besides the pains it creates, disturbances of 
urinary secretion, nephritic colics, inflammations, disorga- 
nizations, induration, suppuration of the kidneys ; and when 
it is dislodged, passing through the ureter, pains, spasms, 
inflammation, colic, frequently also incarceration and 
stoppage in the ureter, followed by adhesion. It can be- 
come fatal by inflammation and suppuration. 
Pathogenesis. The formation of stone is a chemical pro- 
cess, which can form under favoring circumstances in all 
parts of the body (even in the brain), and from all the hu- 
mors (even from saliva). The favoring circumstances are : 
stagnation, disorders of nutrition, and a condition of the 
humor chemically inclined to concretion. 
In the urinary ducts this process is very apt to take 
place, for this fluid, by its very nature, contains more che- 
mical affinities and materials for calculary formations, as is 
seen in every urinal. 
The remote causes are : either chemical (lithiasis acci- 
dentalis), stoppage of the urine (in cavities, diverticles of 
the bladder, chronic pressure on the kidneys, etc.), by 
which decomposition of the urine is made possible, the pre- 
sence of a foreign body, which serves as centre of aggre- 
gation (shot, ears of wheat, coagulated blood and mucus); 
certain kinds of food, which particularly favor the genera- 
tion of calculus, especially the use of sour, acerb wines. 
Beer drinkers are less subject to stone ; it is also evi- 
dently more rare since the introduction of tea, coffee, and 
diuretic drinks, and it is more seldom met with in beer 
than in wine-drinking countries.—Or organic (lithiasis 
constitutional), a disorder of the secretion of the kidneys, 
which yields this product. It is either congenital (lithiasis 
congenita, hereditaria), or acquired, in which case a meta- 
schematismus of other diseases, especially of gout, may be 
the cause (being very similar in both, stone in the kidneys, 
in arthritis, concretion in the joints). Hence, both alternate, 
and gravel is often nothing but a metastasis arthritica ad 
renes. Calculus and diabetes have also some analogy: in 
the first, stone 5 in the latter, saccharine matter is gene- URINARY CALCULUS. 
495 
rated ; in both a predominance of acidity is the base, en- 
gendered perhaps by the same process differently mo- 
dified. 
The chemical ingredients of urinary calculus are : phos- 
phoric acid, benzoid, oxalic acid, calcareous earth, mucus, 
but varying in proportion ; sometimes ammoniacal calcu- 
lary ingredients, but in by far the greater number of cases 
acidity predominates. 
Therapeutics. The treatment is palliative or radical. 
The palliative treatment has for its end to soothe the ne- 
phritic attacks and complaints, the cure of the nephritic 
colic. 
Inquire whether the attack be inflammatory or spasmo- 
dic. The first is recognized by its violence, pain, and du- 
ration (inflammation may associate as an accessory to the 
spasmodic) ; by pain on pressure over the vesical region, 
by a febrile pulse, and heat in passing urine.—Such a case 
requires the treatment for cystitis : a venesection is to be 
made immediately, leeches, cataplasms of linseed and hy- 
oscyamus are to be applied; and oily emulsions containing 
extract of hyoscyamus, cooling purgatives must be admi- 
nistered internally. 
The spasmodic state is recognized by the absence of in- 
flammatory, and presence of the spasmodic symptoms.— 
Such a case calls for the most vigorous anodynes, oily 
emulsions with opium, decoction of linseed as beverage, 
also clubmoss seed made into an emulsion, embrocations 
of volatile liniment, of camphor with laudanum, oily injec- 
tions of £ of drachm of hyoscyamus herb or opium, narco- 
tic cataplasms, tepid hip-baths. It frequently happens that 
the pains are so constant, as to require the daily recourse 
to the use of opium. 
The radical treatment has two indications: to annihilate 
the formation of stone, and to dissolve the existing one. 
The first intention is to bring the secretion of the kid- 
neys to its normal condition, and to take away the disposi- 
tion to that specific decomposition and combination of 
those materials which originate stone. In this respect the 
cure is very similar to that of diabetes mellitus. That 
which produces a saccharine state of the urine in diabetes, 
in the latter produces stone. 
A remedy, answering both indications, and which is 
therefore rightly styled the principal lithotripticum, is 
soda or alkali in general; and among all preparations known 
to me, Carlsbad is the best; when the natural cannot be 
procured, the artificial must be used. In lack of this, soda 496 
GALL-STONE. 
dissolved in carbonic acid water (the soda water of the 
English), Next to it is the kali causticum vel purum (10 
drops twice a day in broth) ; soap, or limewater, taken by 
the pint daily ; Harlem oil, and Loot’s remedy. It is proved 
by experience, that stone may be dissolved by these alka- 
lies, and may be prevented from forming. It is a fact, that 
alkali passes really into the blood and urine, and maybe 
there made to effervesce by acids; the urine thus is made 
to receive a chemical dissolving property, as alkaline wa- 
ter possesses out of the body. I have seen myself stone 
transformed into gravel, which alone is a great advantage. 
Carbonate of magnesia, £ drachm three times a day, the 
pulvis aerophorus natronatus (vide No. 243), 20 to 30 
grains three times a day, the carbonic acid soda water 
(which may be easily made by dissolving % drachm of 
bi-carbonate of soda, in a bottle of Selters’ water), the Fa- 
chingen, Geilnau, and Wildungen water, are all useful. 
Some vegetables also have proved serviceable, as ra- 
dishes, strawberries, red bilberries (vaccinium vitis idaea), 
honey, a powder composed of quince-seed, acin. cynosbat., 
juniper-berries, a teaspoonful three times a day ; especially 
bear-berry leaves, which possess also the advantage of al- 
laying pain, F drachm 3 or 4 times a day. 
A chemical examination of the discharged calculi may 
be profited of, in order to distinguish whether the stones 
have more of an acid or alkaline base, and to determine on 
the remedies accordingly. 
If all prove abortive, nothing is left for the relief of the 
poor sufferer, but the operation of lithotrity, or of cutting 
out the stone. The first may always be performed, but 
the latlen requires great precaution, and must never be per- 
mitted, when suppuration in the bladder or kidneys is ma- 
nifest; nor when gravel is simultaneously present. 
GALL-STONE. 
Calculus Biliarius s. Felleus. 
Diagnosis. Frequent pressure and complaints in the he- 
patic and epigastric region, especially spasms of the sto- 
mach with vomiting. The principal signs are : colics, re- 
markable for this, that the patient is from time to time af- 
fected with most violent pains in the hepatic and epigas- 
tric region, accompanied with violent vomiturition and 
vomiting, followed by a yellow color of the skin, lasting GALL-STONE. 
497 
for a few days; after which gall-stones are found discharg- 
ed in the stool. 
Pathogenesis. Gall-stone is not stone, but a resinous- 
earthy combustible mass, a concretion of bile. The exciting 
causes are such as have a tendency to create a profuse and 
viscid secretion of bile and stagnations in the liver, as a 
choleric temperament, much heavy, fat, animal food, omit- 
ting fluids, sedentary life, lacing of the abdomen, long con- 
tinued grief and sorrow, especially suppressed anger dur- 
ing eating (therefore of frequent occurrence in unhappy 
marriages). 
Therapeutics. The cure consists in that of the colic of 
biliary calculus. It is the same as that of nephritic colic. 
Oleosa, narcotica, clysmala, semicupia, and where there is 
an inflammatory disposition, venesection, are chiefly to be 
relied upon. 
The radical treatment tends to dissolve and remove the 
calculus and to prevent its regeneration. For this alkalies 
are also the principal remedy, especially soda, the Carlsbad 
well, and when the natural cannot be had the artificial one, 
or other preparations of soda, also soap pills with bitter 
extracts (vide No. 242), continued for a long time, and 
purgatives given intermediately. In great inclination to 
vomit I have found the combination of soda with pulvis 
aerophorus (vide No. 243) excellent. Of a similar effect 
is bi-carbonate of soda, 1 drachm dissolved in a bottle of 
Sellers water drank daily, or the English soda water. The 
turpentine in Durand’s remedy (vide No. 244), vegetable 
diet, much drinking, exercise, in general the whole treat* 
ment of visceral abdominal obstruction. 498 
DISEASES OF FEMALES. 
DISEASES OF FEMALES. 
SEXUAL DISEASES OF FEMALES, 
Do not comprise the general maladies to which a female 
may be liable, bat such as are peculiar to the female sex, 
or what is the same, diseases of the sexual system, of the 
conceptive and productive functions. It cannot, however, 
be denied that this destination of the female imparts a par- 
ticular character to the whole economy, and modifies all 
her diseases, giving them, as well as the treatment, a fe- 
male character. 
Physical Characteristics of the Female. 
To give birth to children is the destination of the female ; 
therefore pregnancy, parturition, and nursing is her natural 
state ; while menstruation is a vicarious or surrogate con- 
dition—a malady. 
The whole economy of the female is arranged and cal- 
culated for reproduction and a double life. The sexual func- 
tion is in her a prevailing tendency, in man it is subordinate. 
(This is made evident even by the position of the genital 
organs ; in the former they are placed internally, and are 
intimately interwoven with the organism ; in the latter they 
are external, and as it were, only an addition.) The char- 
acter of the female sex is to receive, that of the male is to 
give ; hence in the former, passive life, susceptibility, flex- 
ibility predominate ; in the latter, activity. 
The essential differences are as follows : 
1. Greater laxity of the fibre—hence a disposition more 
to diseases of atony and relaxation. 
2. Greater irritability and sensibility of the nervous sys- 
tem ; hence sensibility is very apt to become morbidly 
increased ; disposition to nervous diseases ; little irritation 
produces intense reaction, unusual sympathies. MENSTRUATION. 
499 
3. Quicker and richer chylification and sanguification ; 
sanguification calculated to the nutrition of a second being, 
hence a plethoric state, a disposition to congestions, hem- 
orrhages. 
4. Greater productivity and plasticity ; hence more in- 
clination to abnormal productions, especially when the 
sexuat production is interrupted or ceases. 
5. Great influence of the uterine and gangliary system 
on the organism ; hence the hysterical state and character 
frequently attendant on all the affections of females. 
6. Easy excitability, but less endurance of energy, more 
suffering than active power ; hence diseases are apt to pass 
from the active into a passive slate. 
7. On the whole, much resemblance to the character of 
children. 
MENSTRUATION. 
Menstruatio, Catamenia, Menses. 
It is the blossom of sexual life, the sign of aptness for 
procreation, and at the same time a sign and a genera! pre- 
servative of the health of the female economy (signum 
et presidium sanitatis). Therefore it is, that this function 
is so important to the health and life of females. The more 
regular the menses are, the healthier is the female. These 
monthly turns render females even less liable to some dis- 
eases, and enable them to resist them longer than males, as 
in consumption. 
Menstruation is owing to the double sanguification of 
the female, and to the necessity of evacuating from lime 
to time the abundance of blood, which is destined to the 
formation and nutrition of the foetus. Menstruation, there- 
fore, is only a surrogate of pregnancy, a temporary, a vica- 
rious secretion, to prevent the danger of sanguineous 
accumulation, but at the same lime an expedient, dispen- 
sing woman of the physical necessity of sexual gratifica- 
tion, and securing her moral freedom. 
The circumstance of this secretion being performed by 
the uterus, is accounted for by the irritability being in- 
creased by the awakening of sexual instinct. 
Menstruation, therefore, must not be regarded as a mere 
passive flowing, but as an active critical periodical secre- 
tion, not only to discharge the blood, but also as regards the 
productivity connected with it. Therefore its signal influ- 500 
MENSTRUATION. 
ence on the whole organism is not only an excitement and 
purification of the uterus, but arouses and purifies the whole 
economy, as is sufficiently manifest in many persons by 
the altered smell of their breath, their dim eyes, slight cu- 
taneous eruptions, excitement, abnormal tone of the ner- 
vous system and mind, even by actual nervous attacks, in 
short, it is a perfect monthly crisis. 
The conditions of it are : a proper quantity of blood dis- 
charged, properly irritating in its quality (cruor, warmth), 
a proper degree of irritability and tone of the uterine sys- 
tem (middle degree). 
Diseases of Menstruation, 
May be divided into disorders previous to the first de- 
velopment, during its course, and at its cessation. 
1. The First Development. Puberty, Morbid Obstruction 
of it. 
It is the awakening of sexual life, of a new (a parasitic) 
life, even of a system of the economy, developing new ir- 
ritations, new sympathies, new relations, impressing a new 
character to the physical as well as to the mental life ; 
consequently one of the most important revolutions in or- 
ganic life. 
It sets in, in our climate, between the fourteenth and 
eighteenth year of age, earlier in the south ; later in an 
active, industrious mode of living, earlier in idle life ;in 
rare cases only in the twentieth, even only after marriage. 
A premature appearance is always significative of a weak 
constitution and strong sexual instinct. It is better that 
it appear too late than too early. It is therefore of the 
greatest importance not to accelerate this period, nor to 
attribute all the affections of disease and sickliness, which 
may occur in a young girl at this period, to that source, and 
try to remove them by promoting menstruation. But it is 
equally important to assist nature where there is a morbid 
obstruction, to promote menstruation; for the consequen- 
ces are: sanguineous congestions to noble parts, as the 
head, lungs, stomach, which often degenerate in hemor- 
rhages of these organs ; nervous fits, hysteria, spasms of 
all kinds, cachexy, particularly chlorosis, phthisis, tabes, 
hydrops. 
The first and most momentous point of treatment conse- 
quently consists in discriminating the morbid retention MENSTRUATION. 
501 
from the natural retardment; and the rule must be this: 
to presume a morbid obstruction, a retention, only when 
molimina menstrua and signs of puberty have already 
really set in. These are : pains in the small of the back 
and in the abdomen appearing from time to time, periodi- 
cal distention of the belly, development or painful tension 
of the breasts. 
If these are wanting, abstain from medical acting, but 
wait patiently. There are cases when they never appear 
(viragines). When molimina are present, but nothing mor- 
bid, it will be sufficient to assist nature occasionally. This 
is done by foot baths, taken in the evening at the time of 
the molimina, and a few grains of the pilulae balsamicse 
Hofmanni (No. 171), along with chamomile tea. The 
same maxim is applicable to menstruation when it appears 
once and then ceases, or when it is more watery than san- 
guineous. 
It is only when the molimina menstrua are attended with 
morbid troubles, that morbid retention is supposed to exist 
and is an object of cure. 
It is then proper not to immediately attack with emmen- 
agogues, but to investigate into the cause, which may vary 
very much. ' 
1. Plethora, over-filling of the vessels, and a strong, 
firm fibre may be the cause of obstruction, as this is often 
the case with vigorous country women, also in the well- 
fed inhabitants of towns. Full pulse, strong development 
of the body, a vigorous habit, are the discriminative signs. 
In such a case, which borders often on inflammation, the 
intention is to diminish and attenuate the quantity of blood, 
to relax the fibre ; for which the principal means are a ve- 
nesection in the foot at the time of the molimina, foot and 
steam baths, effervescent powder. Besides, vegetable diet, 
borate of soda, decoction or extract of grass, powdered 
madder, half a drachm three times a day, tepid baths. If 
this do not succeed, apply leeches at the genitals, cups to 
the internal side of the thighs at the time of the molimina. 
2. Ora reverse state exists. The patient is pale, tveakly, 
more inclined to cold than to warmth, lazy, inactive, her 
pulse weak, and disposition to chlorosis is visible. In such 
a case, blood is defective of irritative power, and the ves- 
sels, especially those of the uterus, lack irritability. Fer- 
ruginous and bitter remedies, best combined with oxygen 
(chalybeate waters), or flor. sails ammoniac! rnartiales 
along with arnica (No. 127), sulphate of iron and the like, 
are chiefly to be relied upon ; also the red cheek pills (No. 502 
MENSTRUATION. 
128), so called since they change very soon the pale coun- 
tenance into a florid complexion. At the same time, ani- 
mal nutritive food, a motory life, exciting corporeal and 
mental activity, walking, riding in a carriage, still better 
on horseback, and the balsamic pills at the time of the moli- 
mina may be used. In this case, onanism and irritated 
sexual instinct must be well attended to and counteracted. 
3. It is a middle state. Weakness combined with in- 
creased sensibility, erethismus. Here spasm prevents 
menstruation, and the antispasmodic treatment is best, 
especially by valerian, asa foetida, castoreum, galbanum, 
warm baths, steam baths to the genitals. Here also ple- 
thora of the vessels may be combined with irritable weak- 
ness, and besides the use of the above mentioned reme- 
dies, topical, sometimes also general abstractions of blood 
are called for. 
4. Finally, material local stimuli and substances may 
exist in the body, which, by their operation, obstruct the 
uterine function. Of this number are worms, scrofulous 
diathesis, and glandular obstruction in the abdomen, espe- 
cially of a mucous character, dyscrasies, especially psoric 
and syphilitic. In such a case the treatment must tend to 
remove those irritatives, as worms, and the obstruction by 
the continued use of resolvents, the dyscrasies, etc. 
If all prove abortive, the patient must be examined, 
whether it be due to a mechanical obstruction, an atresia 
vaginse. This may be suspected already at the commence- 
ment, especially in otherwise healthy persons, when very 
urgent molimina menstrua appear every four weeks, the 
abdomen swells very much, a sensation of fulness and pres- 
sure in the depth is felt, and all other signs of puberty are 
present. I beg, never to forget this intimation. In this 
case, the mechanical surgical process, the cutting of the 
hymen only affords relief. 
Only after being convinced that no remote causes of re- 
tention exist, or the same are removed, the menses never- 
theless not appearing, have recourse to the methodus 
emmenagoga (vide obstructio menstr.). 
In the first appearance of menstruation, it is most impor- 
tant that it be not disturbed nor interrupted. It is of mo- 
ment for the whole life, for when it once has assumed a 
proper typical order, it is not easily interrupted after- 
wards ; bear in mind, that the menses are a monthly crisis, 
protective and conservative of the female health. 
Therefore the following MENSTRUATION. 
503 
Regimen Menstruale 
must be observed, not alone at the commencement of the 
menstruation, but through the whole life. 
Avoid, during the menstruation, any kind of over-heat- 
ing (especially dancing), and taking cold, heavy meal- 
meats, particularly fresh baked bread, violent mental 
affections, coition, medicines, especially emetics and pur- 
gatives, and baths. 
This must be adhered to even in diseases, medical 
treatment, water-cure; and menstruation is to be respected, 
except in cases of diseases endangering life, when imminent 
danger of life requires the use of remedies. 
2. Suppression of Menstruation (Ohstructio Menstruorum). 
Suppression of menstruation is either a sudden stoppage 
of its course (suppression properly so called), or a cessa- 
tion of it (obstruction of the catamenia). 
The sudden stoppage during its course, which may hap- 
pen by taking cold (particularly on the feet), or over-heat- 
ing, or mental affections, or faults of diet, is an acute case, 
often rapidly dangerous, sometimes, however, only detri- 
mental in its consequences. 
The treatment depends solely on the circumstances, 
causes, and phenomena. 
When violent abdominal pain or congestions to other 
noble parts set in from the beginning, attended with a full 
pulse, fever: there is an inflammatory state, and w'e must 
guard to use emmenagogues. A venesection on the foot, or 
when the state is not sufficiently plethoric for that, leeches 
at the genitals and antiphlogistic medicines (internally), 
foot and steam baths, warm, emollient narcotic cataplasms 
on the genitals and uterine region, emollient injections re- 
store best the flux and prevent danger. Should these 
means prove unsuccessful, administer borax, pulvis aero- 
phorus. When the phlogistic state has passed by, or 
no sign of inflammation was present from the beginning, 
but all point to a spasmodic state, foot and steam baths, 
cataplasms, injections, and internally pulvis aerophorus 
along with extract, hyoscyami and crocus, or extract, taxi, 
one grain as a dose, also castoreum and chamomile tea are 
serviceable. 
If this be too weak, add a few drops of laudanum; the 
same also to the injection. 
But it is otherwise when the menses fail to appear {oh- 504 
MENSTRUATION. 
structio). In this case the principal thing is to ascertain 
the cause. 1 cannot sufficiently impress upon the mind 
of the young practitioner, that his first suspicion must 
be the most natural one—pregnancy. This is often disbe- 
lieved, even by married women, and is often purposely 
concealed, especially by unmarried persons. If the physi- 
cian is heedless of such a state and uses emmenagogues, 
he will likely produce abortus, and may lose not only his 
professional reputation, but cause—what is still worse— 
bitter remorse. 
The physician is, assuredly, in a bad dilemma, for it is 
known that even exploration does not afford certain know- 
ledge in the early months of pregnancy. My advice, which 
is that with which 1 have always complied, is therefore as 
follows : Never use in married or in unmarried persons, 
unless the suppression is due to a sudden interruption in the 
first months, remedies which directly promote its flow j but 
temporize, and be content with means directed against the 
general causes or the actual urgent exigencies (as in violent 
sanguineous congestions a venesection in the arm and cool- 
ing remedies). If nothing is indicated, and notwithstanding 
the person asks for remedies (in order to obtain something 
which may bring on abortion), give something trifling, as 
pills of bread and the like, in order to prevent her from 
procuring abortives from a quack. Thus delay, until the 
three or four first months are passed by, when, if pregnan- 
cy exists, more evident vestiges appear, and at the half 
of the term the motion of the child will remove all doubt. 
In this way reputation and conscience are best secured. 
After being satisfied that it is not pregnancy but a mor- 
bid retention, relief is necessary ; for the consequences are 
very serious, as hysterics, epilepsy, vomitus cruentus, 
spitting of blood, consumption, dropsy. First, try to re- 
move the causes, Avhich have produced and sustain sup- 
pression : this alone is often sufficient to restore the cata- 
menia. They are : debility, paucity of blood (brought on 
by grief, want of nutrition, severe diseases, too many ab- 
stractions of blood, and other evacuants, hard labor, as that 
of harvest in country women, and fluor albus). Here the ma- 
terial for menstruation is wanting, and to provoke the 
latter would be foolish. Nourish and well strengthen the 
patient, after which the catamenia will come by itself. If 
it is due to obstructions in the abdominal viscera, and ute- 
rine system (especially after a sedentary life) ; vigorous 
resolventia visceralia and uterina must be used ; if due to 
a spasmodic state, antispasmodics; if to worms, dyscra- 505 
sles, metastatic, frequently specific irritatives, amongst 
which lurking syphilis is particularly important, those 
disorders must be attended to according to their respect- 
ive character. Should the causal treatment not suffice, or 
when there is no indication for it, recourse must be had to 
the direct emmenagogue method. It comprises two kinds 
of remedies: pellentia, such as produce from within a 
stronger rush of blood to the uterus; and attrahentia, such 
as attract it from without. The latter are more safe and 
preferable in all cases, where congestions to noble parts 
are to be dreaded. 
MENSTRUATION. 
The pellentia are : aloes, myrrh, the balsamic pills, oxy- 
gen, mineral water, borax, iron, sulphur, tinct. fuiig., mer- 
cury, colocynthides, crocus, guaiac, hellebore, galbanum, 
the strongest is savin (No. 129, 130, 131, 132). 
The attrahentia are : foot baths and steam baths to the 
genitals, rubbing of the thighs, injections, cups on the inter- 
nal parts of the thighs, leeches to the genitals, fontanels on 
the internal parts of the thighs, kept open for a length of 
time, especially electricity (sparks to the genitals and ute- 
rine region, shocks across the pelvis and directed from the 
sacrum to the os pubis), and the strongest of all, acupunc- 
ture in the inguinal region. 
When molirnina exist, it is a good period for the appli- 
cation of these remedies. 
3. Immoderate Flow of the Menses, Hemorrhages from the 
Uterus. (Menstrua Nimia, Metrorrhagia,) 
It is difficult to say what is profuse menstruation ; for 
quantity proves nothing; some need much, some only a 
little. It is the effect that furnishes the measure. When 
there is a weak or even intermitting pulse, a general pros- 
tration, cool extremities, feeble respiration, palpitation of 
the heart on exercise, want of appetite, and melancholy, 
perhaps also oedema of the feet in the evening, menstrua- 
tion is too profuse. Likewise, when the catamenia last too 
long (eight or more days) ; when they return too often. 
The case is called hcenorrhagia uteri, when feebleness in- 
creases to fainting. Hcemorrhagii uteri chronica (stillici- 
dium uteri) is a constant discharge of blood, confined to no 
periods. 
The consequences of too profuse menstruation are : gen- 
eral debility, especially of the nerves, and all its effects, 
hysterics, spasms of all kinds—never forget in these dis- 506 
MENSTRUATION. 
eases to inquire after this cause—cachexy, a disposition to 
dropsy. 
The causes are : general laxity and weakness of the 
fibre, sedentary life, especially high living, increased sen- 
sibility, particularly of the uterine system, morbidly in- 
creased sexual instinct, too frequent coition, masturbation, 
frequent childbeds, local weakness of the uterine system, 
dissolved scorbutic blood, abdominal irritatives, especially 
bile, local irritatives of the uterus, melastases, polypus. 
The treatment is double : radical and palliative. The 
radical treatment is guided by the causes. The most fre- 
quent of all is weakness and laxity of the uterus recogni- 
zable by the general habit of the patient, frequent parturi- 
tion, sedentary life. In such a case, the use of bitter, 
astringent, aromatic remedies gives the surest relief; such 
as cinchona (No. 133, 134), cort. salicis, terra japonica, 
kino, cort. aurantiorum, cinnamon, sulphuric acid, espe- 
cially alum, given as alum whey (No. 135); cinnamon tea, 
made by infusing one drachm of cinnamon in two cups of 
water, drank daily, is a very approved remedy. In great 
debility, ferruginous remedies, combined with acids ; the 
best preparation is sulphate of iron (No. 136). At the 
same time, all debilitating causes must be avoided, and a 
cold diet observed. When increased sensibility exists, an- 
tispasmodics, particularly ipecacuanha in small doses ; if in 
a higher degree, opium may be prescribed. In case of 
plethora (which is very rare and only found in combination 
with local uterine weakness), a venesection on the arm is 
to be made, and tartaric acid, cooling purgatives and min- 
eral acids must be given. In a scorbutic dissolution, scurvy 
is to be attended to. Look particularly for morbid stimuli, 
as bilious matter, abdominal obstructions, worms, dyscra- 
sies, especially the syphilitic, and remove them. (I have 
once seen the flux of menstrual blood stopped by the use 
of guaiacum when arthritis was the remote cause of the 
disorder.) If these means prove unsuccessful, it is pro- 
bable that a polypus of the uterus exists, when exploration 
and operation are called for. 
The palliative treatment, during a dangerous hemor- 
rhage, calls for the most vigorous astringents, of which 
alum ranks first (ten grains in powder or half a cup of 
serum lactis alurainat. every two hours), besides too, sul- 
phate of iron (No. 137), tincture of cinnamon, thirty or 
forty drops at a dose, cold fomentations on the uterine 
region and genitals, cold injections, also injections of red 
wine, or alum, dossils impregnated with the same inserted, 507 
horizontal position, and extreme quietude, ligatures round 
the thighs. 
MENSTRUATION. 
4. Difficult, Painful Menstruation, Menstrual Spasms. 
(Menstrua Dolorifica, Difficilia.) 
Diagnosis. At every menstruation, violent colic, throe- 
like pains, headache, vomiting, toothache, or still more 
violent and general accidents, cholera, fits of fainting, con- 
vulsions, epilepsy, delirium, melancholy, mania are ob- 
served ; they occur only during the flux, or several days 
before or after it. 
The consequences are : half a life spent in sickness 
(every month for eight or fourteen days), and sterility. 
Pathogenesis. The proximate cause is excessively in- 
creased morbid sensibility of the uterine system, or of the 
whole nervous system, by which it happens that the local 
irritation of the uterus appertaining to the menstrual pe- 
riod degenerates into spasm, and which is communicated 
to remote systems. 
The remote causes are : local irritation and debilitation 
of the uterine system by onanism (physical and mental), 
excesses in venery, especially without satisfaction, general 
hysteria, obstructions of the abdominal viscera and infarcts 
of the uterus itself, worms, specific, frequently concealed 
irritatives, especially latent syphilis, rarely plethora and 
rigidity of fibre. 
Therapeutics. The cure is most difficult. First, the re- 
mote causes must be ascertained and removed, and if the 
evil do not yield to such treatment, the general spasmodic 
disposition, and the weakness of the uterine system must 
be attended to. The most appropriate remedies are : a 
loncr continued use of asa foetida, camphor, quassia, elixir 
acidum, and of baths, tepid at first, and lastly cold, espe- 
cially those containing iron (Pyrmont and Dryburg at the 
well) ; however, attention must always be paid to obstruc- 
tions in the abdominal viscera, and even in the uterine 
vessels, as probable causes of this troublesome evil, and 
remedy them. I have several times seen the Carlsbad water 
effect a perfect cure, after all the foregoing remedies had 
been administered without success. 
If all these means fail, resort to magnetism, which may 
prove very beneficial in this case as well as in all other 
nervous diseases, which are in causal connection with the 
menstrual function. 
The palliative treatment consists merely in the mitigating 508 
MENSTRUATION. 
and antispasmodic method. The most reliance is to be 
placed on the internal use of opium, but in an oily emul- 
sion, combined with warm narcotic cataplasms on the gen- 
itals and uterine region, antispasmodic ointments, emollient 
injections, tepid hip-baths, in plethoric individuals, and 
where gastric impurities are present, instead of the opium, 
extract of hyoscyamus must be given. 
5. Cessation of Menstruation, the Dying of Sexual Life. 
(Cessatio Mensium.') 
Takes place, in our climate, between the forty-fifth and 
fiftieth year of age. This, however, varies as well as does 
the first appearance of the catamenia, according to consti- 
tution, climate, and mode of living. The earlier they ap- 
pear, the more laborious and toilsome life has been, the 
colder the temperament, the sooner does menstruation 
usually cease. The contrary conditions retard it. 
The cessation happens in the following manner. It 
ceases either suddenly and all at once, which is always 
hazardous; or decreases gradually, failing once or twice, 
then reappearing again, sets in at greater intervals, and 
finally disappears entirely. This is the best and most harm- 
less way. In some females the menses terminate with con- 
siderable hemorrhages. In rare cases the menstrua con- 
tinue alternating with interruptions up to the sixtieth year 
and longer. We farther perceive an essential difference. 
In some, momentary flushes with passing sweats, cutaneous 
eruptions also appear; the impulse of the humors tends to 
the periphery. This is salutary, and guards against bad 
consequences. In others, cold and chills occur, premoni- 
tors of internal affections and congestions. 
This period is important, is even decisive of female life. 
This period is therefore rightly styled the critical time of 
female life, for mortality is then greatest. 
The effects are double. In some the change is for the 
better ; they become healthy, robust, even blooming and 
vigorous,—it is to them a kind of regeneration. In others 
it is for the worse : sanguineous congestions to the head, 
lungs, stomach, hemorrhages, particularly vomitus cruen- 
tus, serous and mucous profiuvia supervene. 
Nervous diseases, hysteria, spasms, especially cardial- 
gia. Dyscrasies, acrimonies, especially cutaneous diseases 
and arthritis. Scrofula, which existed in infancy, reap-' 
pear. 
New formations, pseudo-organizations, scirrhus, cancer. polypi uteri. This is the period when long dormant indu- 
rations begin to revive, become painful, larger, inflame, and 
scirrhus passes into cancer. 
Therapeutics. A correct idea of this state is of the 
greatest importance. Three circumstances belong to it, 
and which also point out objects or leading principles of 
cure. 
MENSTRUATION. 
509 
]. Continuation of the double sanguification, and im- 
peded excretion—plethora. 
2. Productivity still existing, but retiring inwardly, on 
account of the dwindling away of the uterus—hence the 
disposition to pseudo-organizations. 
3. Acrimony, dyscrasy, owing partly to the monthly 
crisis now absent, which in many serves to discharge not 
only blood, but also other morbid matters; partly to the 
abundance of humors now suddenly arising. 
The chief indication is therefore : 
To derivate the congestion, to restore the balance, and 
to compensate the menses. 
Special Treatment. 
Such persons as feel well, even belter than they nsed to 
do ; such as are poor of blood, or who labored under too co- 
pious catamenia—must be left alone ; exercise and regular 
diet are to be enjoined, this is all that is needed. 
But when congestions and other morbid accidents set in, 
a venesection is called for, and must be repeated, accord- 
ing to the varying plethora, every six or twelve months ; 
intermediately once in a while scarification may be useful 
as a means of derivation. Simultaneously cream of tartar 
(one teaspoonful in a glass of sweetened water), serves best 
against phlogoses; and use every two or three weeks 
Saidchutz water or a solution of Glauber’s salt. In very 
plethoric persons, or in great danger of congest'oas, me- 
tastases, especially seirrhus, a fontanel on the arm or foot 
may be made ; to nervous individuals, give the elixir aci- 
dum. At the same time, corporeal exercise, regular diet of 
an antiphlogistic character. Abstractions of blood must 
be continued as long as indications of congestions exist j 
but increase the intervals, as time advances. This course 
must sometimes be pursued for several years before the vas- 
cular system becomes settled. It is advisable in most cases 
to bleed in the first year three times, in the following, 
twice, and in the third, once. 510 
PREGNANCY. 
PREGNANCY. 
To be pregnant, to breed and to nurse, is a natural state, 
and is therefore the healthiest one of woman. Woman is 
to be blessed by giving birth to children, says the holy 
writ. The healthiest women are those in whom these 
functions are regularly performed. Menstruation is only 
a surrogate, a poor compensation of pregnancy, impor- 
tant and necessary to woman, whereby she maintains her 
moral dignity, and ceases to be the slave of brute instinct; 
but it is still an abnormal morbid state. In well organized 
constitutions, and when the mode of living accords with 
nature, pregnancy produces no morbid symptoms. 
The usual complaints which trouble pregnant women are 
the following : nausea, vomiting, headache and toothache, 
spots on the skin, and eruptions, nervous attacks of all 
kinds, hysterism, sometimes a peculiar change of mind and 
temper, even delirium, mental derangement, melancholy, 
and mania, which cease when pregnancy terminates. The 
most dangerous of all its accidents is abortion. 
The prompt diagnosis of pregnancy is very important, 
though very difficult in the first months, lest we mistake 
for disease that which is only a symptom of this state, and 
make use of remedies productive of the greatest injury, 
which might even disturb pregnancy by producing abor- 
tus. The most common and surest signs are : absence of 
the menses and swelling of the. breasts; in the plurality, 
but not universally, also nausea, vomiting, and some have 
their peculiar sensations and phenomena. But sometimes 
all these symptoms are wanting, even the catamenia con- 
tinue. The discrimination by the stethoscope (hearing the 
foetus) does not apply to the first'periods of pregnancy, it 
is of use only in the second period. But, on the reverse, 
menstruation may stop, and nevertheless no pregnancy ex- 
ist, but a morbid suppression which sometimes affects and 
increases the breast. It is still worse in those who con- 
ceal pregnancy. 
In all such cases 1 cannot too urgently enjoin on the 
young practitioner the following as a golden rule : rather 
to suppose the existence of pregnancy, and to act accord- 
ingly ; that is, to temporize rather than act the contrary, 
until the fourth month arrives, when the motion of the 
child will remove all doubt. The physician will thereby 
avoid much mischief, and preserve his conscience as well 
as his reputation. PREGNANCY. 
511 
Pregnancy is certainly not a disease by itself, bnt a nat- 
ural stale. It can, however, give rise to many morbid at- 
tacks, especially where great sensibility, or a relatively 
weaker part, or an idle life predispose to tfwem ; therefore, 
accidents are met with more frequently in the higher refin- 
ed and effeminate classes, than in the lower and laborious. 
The essentia] idea of the pregnant state is: a living 
being within a living being, a double life, increased pro- 
ductivity and sanguification. 
All accidents of pregnancy spring from four sources: 
1, from plethora, from the suppressed menstrual blood, 
which in the beginning is not sufficiently consumed by the 
foetus ; hence this class of accidents occur most frequently 
in the first three or four months ; hence persons poor in 
blood feel better at this period of pregnancy ; 2, from ner- 
vous, spasmodic affections, from the irritation of a foreign 
body, and the nervous sympathy of the revived and newly 
excited uterus (similar to the verminous irritation) ; 3, or 
from gastrosis, accumulation of gastric impurities in the 
stomach and intestinal canal, by the perturbated secretions 
and excretions of the intestinal canal, the liver, and other 
abdominal viscera ; or finally, 4-, from mechanical pressure 
effected by the distended uterus on the blood and lympha- 
tic vessels, and on all the abdominal viscera ; hence in the 
last half, especially in the last months of pregnancy, there 
is retention of stool and urine, heemorrhoidal complaints, 
obstruction to the lymphatic absorption, oedema pedum et 
labiorum vulvee, varices on the lower extremities. 
General Rules for Pregnant Women. 
1. In all cases, the principal and promptest means of 
relief is horizontal position, persevered in for a few hours. 
2* Avoid tight lacing and tight dressing. 
3. Moderate exercise, and the enjoyment of free air. 
All laboring women have an easier parturition than idle 
ones. 
4. Mental discipline; avoiding all violent and injurious 
affections, on account of their operation on the fruit; even 
good morals, tranquillity, and purity of mind are influential 
in this regard. 
5. Avoid exertion and forced motions, especially lifting 
and carrying heavy loads. 
6. Constant respect in selection of remedies, to avoid 
such as might operate injuriously on the foetus and its pre- 
servation and tend to abortus. Drastic aloetic remedies 512 
PREGNANCY. 
and oxygenated, especially chalybeate mineral waters and 
warm baths are to be avoided, especially during the first 
half of pregnancy. 
7. Regular stools, especially in the last months. It is 
best to give for that purpose, a purgative every four 
weeks. 
The Special Treatment, 
Depends entirely upon the various causes. 
If plethora is the cause, which may be recognized by a 
full pulse, the constitution and the previous habitually co- 
pious menstruation, a venesection in the arm, antiphlogis- 
tic diet, and the use of cooling remedies, especially No. 
138 are indicated, and best cure headache and toothache, 
spasms and other nervous attacks, arising from that source. 
I would here enjoin one rule, which applies to every vene- 
section, but especially to that made in pregnant women : 
perform the venesection while the patient is lying and her 
legs extended. This is the best means to prevent fainting 
(on account of the blood having an easier reflux), which is 
of great importance in pregnant women, for a stagnation of 
the circulation is always dangerous, as regards mother and 
foetus. 
But if it be owing to nervousness, which is recognized 
hy the absence of plethoric signs, by the sensitive consti- 
tution, pale urine, etc., antispasmodics are proper ; among 
which, however, the hot ones, particularly opium, are to 
be avoided, or at least not resorted to, except in extreme 
necessity. 
The cause is often only gastric, and then remedies to 
cleanse the intestinal canal are needed, carefully avoiding, 
however, all hot drastics, aloetics, since they are apt to 
produce abortion ; and cooling neutral salts, tamarinds, 
sharpened by senna, are preferable. 
Finally, the effects of mechanical pressure can be pre- 
vented by a mechanical expedient—horizontal position. 
It is the principal means to diminish all these troubles in 
the last months of pregnancy. Apply also remedies to 
soothe or remove the effects, injections, purgatives in con- 
stipation, abstractions of blood in haemorrhoidal and vari- 
cous complaints. 
In obstinate constipation or retention of urine during 
the second half, we must be attentive to examine whether 
or not an inversion of the uterus is the cause, which case 
require the assistance of the obstetrician. HEADACHE, TOOTHACHE, VOMITING. 
513 
HEADACHE AND TOOTHACHE, 
Particularly the latter, torment most in the first months. 
There is most commonly congestion of blood ; therefore 
a venesection in the arm, the powder No. 138, a sinapism 
on the arm, and cooling purgatives afford the most sure 
relief. When the pains are violent, or a nervous state ex- 
ists, give one dose of the powder every two hours, to 
which add half or a whole grain of hyoscyamus. As an 
external remedy cold water, taken into the mouth, also 
leeches on the gums are serviceable ; and also the remedy 
No. 139, 
VOMITING OF PREGNANT WOMEN. 
It is one of the most common and troublesome concom- 
itant complaints of pregnancy, especially in the first 
months, and sometimes through the whole period. It ffen- 
erally takes place in the morning and forenoon, some- 
times, however, at all hours of the day. It sets in soon 
after conception, and is one of the most common signs of 
pregnancy ; is insignificant and innoxious when it is not 
too violent. But when it becomes very violent and con- 
tinues, then it may not only weaken and impair nutrition, 
but even give rise to hernia and abortion. 
It is impossible to cure vomiting perfectly ; for it origin- 
ates from pregnancy itself. It is owing first to a sympa- 
thetic irritation, communicating by the fetus to the uterus 
and the new life of this organ to the stomach ; next, to local 
plethora of the stomach, caused by suppression of menstru- 
ation and the too little consumption of blood by the fetus; 
and finally by the secretions of the stomach and the biliary 
system becoming frequently disordered by the new abdo- 
minal affections. 
The treatment, therefore, must be confined to moderating 
its violence and duration, and art can indeed do much to- 
wards that end. First, a young plethoric person, who has 
always had copious menses, who now has a full pulse, 
must have the plenitude of blood diminished by a venesec- 
tion in the arm, which alone will often procure relief and 
prevent dangerous consequences. When indications of 
impurities, tardy stool exist, use gentle purgatives and 
antiphlogistic remedies, and if all this be unavailing, and 
the person is nervous and sensitive, antispasmodics, par- 514 
PREVENTION OF ABORTION. 
ticularly such as counteract the inclination to vomit. Ex- 
perience has recommended the following as very suitable 
for that purpose : the most efficacious is River’s potion, 
with a little hyoscyamus (No. MO), (it is better than the 
effervescent powder, since the effervescence of the carbo- 
nic acid gas might operate as a pellens on the uterus), 
drinking of a decoction of cream of tartar, elixir'acidum aro- 
maticum c. tinctura. ambree (No. 141), embrocation on the 
epigastric region with spirit, matrical., bals, vitse Hofman- 
ni, laudanum, epigastric plasters of emplastr. arom. c. oleo 
cajeputi and opium, cataplasms of mint steeped in wine, 
emollient clysters. The latter are very important, partic- 
ularly during the second half, when fseces enormously ac- 
cumulate by the pressure of the uterus on the colon. This 
accumulation keeps up the vomiting and cannot be dis- 
lodged by a purgative. In such a case, order three or four 
emollient injections to be given every day for a continuance 
of several days. In obstinate cases of vomiting I have ob- 
served good effects from animal magnetism. 
PREVENTION OF ABORTION AND PREMATURE BIRTH. 
Abortus is most apt to take place in the third month. 
The precursors are : pain in the loins and in the abdomen, 
softening of the breasts, chills, cold in the back, sensation 
of pressure in the pudendum, urgency to urinate, discharge 
of mucus by the vagina—finally, when the abortion is near 
at hand, and can scarcely be prevented—slight sanguine- 
ous discharge from the womb. To these signs are added 
dessation of the motion of the foetus after the fourth 
month. 
The usual causes are : violent fright or anger, a fall, a 
push, over-heating, and taking cold, violent exercise, too 
frequent or forced coitus, fever. 
The consequences are, besides the loss of the child, the 
risk of hemorrhages from the womb, sometimes also in- 
flammatory affections, but particularly a remaining weak- 
ness of the uterus and a disposition to a repetition of abor- 
tion at the same time in a future pregnancy. 
All must, therefore, be done to prevent abortion, and it 
can be prevented, if seasonable and sufficient attention is 
paid to the emergency. 
The means for attaining this end are: the first and most 
important, without which all the rest are unsuccessful— 
horizontal position and complete rest of the body, contin- CONVULSIONS. 
515 
vied for several days, immediately after the first precursor, 
until the signs have disappeared. The second is a vene- 
section in the arm; and when too great debility forbids 
this (which, however, rarely happens), the application of 
eight to twelve leeches to the breasts, being a locality to 
which the most efficient derivation from the uterus may be 
made. Give at the same time the powder No. 138, and or- 
der the belly and sacrum to be washed with warm spiritus 
matricalis. In the spasmodic state of nervous persons, and 
when the pains,are violent, an oily emulsion containing 
extract of hyoscyamus, one grain every hour, and exter- 
nally embrocations of oil of hyoscyamus one ounce, tinct. 
of opium one drachm, curled mint half a scruple, are best. 
Should gastric crudities exist, gentle cooling cathartics 
are of use. 
The disposition to abortion may become a real disease, 
so that abortion takes place in every pregnancy at the 
same period. I know of no better remedy to counteract 
such a state, than Pyrmont water, used as a drink and 
bath, or similar martial waters ; in short, iron, internally as 
well as in baths, which of course is to be used during the 
absence of pregnancy. During pregnancy such persons 
have to observe for the three or four first months the 
greatest repose, horizontal posture, light antiphlogistic 
diet ; constipation of the bowels must be removed by in- 
jections, plethora by venesection in the arm ; the belly 
and sacrum are to be washed daily with spiritus matrica- 
lis. Also zinc has been found particularly useful to pre- 
vent abortion, likewise a mixture of Haller’s acid elixir, 
one drachm, essence of ambergris two drachms, thirty 
drops of which in a cup of water, to be taken three times 
a day. 
CONVULSIONS OF PREGNANT WOMEN. 
They break out either in the last months of pregnancy, 
or at the commencement of the pains and during labor. 
They are generally accompanied with loss of conscious- 
ness and a soporous state, and are apt to pass into com- 
plete apoplexy. 
In the majority of cases, they arise from a sanguine- 
ous congestion of the brain, a general plethora, or are 
owing to an omission of venesection. The exciting cause 
is a violent excitement of the body or mind, a difficult par- 
turition, or a faulty position of the child. 516 
PARTURITION. 
The treatment consists in a prompt derivation of the 
blood from the head by venesection, leeches, purgatives, 
cold fomentations on the head, sinapisms on the extremi- 
ties, and when the accidents do not abate after the proper 
abstractions of blood and diminution of the pulse, the use 
of opium with calomel and a warm bath, must be resorted 
to. A n examination must be made, to ascertain whether 
or not a mechanical impediment to labor exists, which must 
be removed ; and in an extreme case, the birth must be 
accelerated by artificial assistance. 
PARTURITION AND CHILDBED. 
Parturition is the object and concluding act to which all 
the organic functions and efforts of the female tend. It 
must be regarded as the most important moment of a wo- 
man’s life, not only as an act productive of a new being, 
but also as the most momentous crisis of the female econ- 
omy itself. It possesses all qualities of crisis ; as the 
restoration of equilibrium, secretion and excretion. The 
more complete it is, and the better attended to, the more 
perfect will be the health of the woman. 
Characteristics of this State. 
It is the most sublime act, and at the same time the most 
extraordinary catastrophe and revolution of organic nature. 
An operation in which the self-preservative and restoring 
principle, the sanative power of nature is most perfectly 
exemplified ; and that which will render it ever wonderful 
is, how an act which is connected with the most dangerous 
accidents, the most extraordinary metamorphoses and the 
greatest peril to life is generally performed, even in millions 
of cases, without injurious consequences, still more, fol- 
lowed by a complete restoration to health. 
The subject is worthy of our highest attention. The 
investigation of the pathogenetic state previous to birth, 
as well as of the pathogenetic state created by the very act 
of parturition, and of the institutions and crises devised by 
nature herself to guard against accidents, merit our best 
regard, in order that we may form a correct idea of the 
deviations and diseases which are likely to occur, and to 
appreciate them the better. 
The following are the particular characteristics of partu- 
rition : PARTURITION AND CHILDBED. 
517 
1. Plethora abdominalis, a natural effect of sanguineous 
plenitude, attracted hither by the formative process, a 
quantity which is no longer consumed, but is still in- 
creased by the sudden removal of the uterine pressure. 
2. Abundance of plasticity and plastic lymph, which are 
now deprived at once of an organ and an object to act on. 
3. Altered circulation and retrograde motion of the blood 
from below to above. 
4. Gastric accumulations, especially of impurities which 
have been retained by the pressure of the last months, now 
suddenly become free, giving rise to a true “ turgescentia 
sordium.” 
5. Vulneration, irritation, and debilitation (by hemor- 
rhage). The act of parturition unites all the properties of 
vulneration, irritation, and bleeding; and every puerperal 
woman is to be regarded as a wounded one. Consequently 
there is a disposition to inflammation, but which is of an 
exsudatory kind, and likely to become asthenic. 
The sole means by which provident nature effects this 
crisis, and causes this perilous state in millions of women 
to pass imperceptibly and easily into health, are two 
crises : the Jochial flux and lacteal secretion, both deriva- 
tives of the abundance and plasticity of the blood and re- 
storatives of the balance of organic action. 
Treatment after Delivery. 
Above all things, hold to the idea, that parturition and 
confinement are not diseases, but are natural acts, the most 
normal and necessary, for the happy termination of which 
nature has taken wise and wonderful care—a natural cri- 
sis. As a rule, therefore, nothing is wanted, but to abstain 
from disturbing the crises ordained by nature (lochia and 
lacteal secretion), and to guard against all injurious influ- 
ences (taking cold, over-feeding, mental affection). 
The following are the general rules for the treatment of 
the childbed state. 
1. The whole term of confinement must be reckoned 
six weeks. Before that time, the organism, especially the 
uterine system is not entirely what it has been and ought 
to be. 
2. The lying-in woman must constantly be observed and 
carefully attended to during the first twenty-four hours, lest 
she die by bleeding during sleep. 
3. The first fortnight must be carefully attended to ; that 
is to say, she must lie in bed, avoid taking cold, mental af- 518 
PARTURITION AND CHILDBED. 
factions, and dietetic disorders. 'Decubitus is required, 
in order to prevent prolapsus uteri and hemorrhages. It 
is also the period when puerperal fever is apt to set in; 
4. Diet and treatment must be antiphlogistic during this 
period. Water gruel and barley-water, and panado are suf- 
ficient. To very weakly persons broth may be allowed a 
little earlier ; but the days of lacteal fever, the first week, 
must always be respected. 
5. Moderate temperature of the room, not too much bed 
clothing, and the greatest possible cleanliness are also prin- 
cipal conditions. 
6. Cleansing of the primse vise is necessary to every 
lying-in woman, and best prevents puerperal fever. But 
be careful not to purge strongly within the first three days, 
for it might disturb the lacteal crisis. Give, therefore, in 
in the first days, only a light saturation (No. 1), and an 
emollient injection every evening, in order to free the large 
intestines ; but after the fourth or fifth day, a cooling lax- 
ative continued for some days. A spoonful of castor oil, 
or the mixture No. 6, answers this purpose best, 
7. The child must be applied to the breast twelve hours 
after birth, and so continually applied for a fortnight, whe- 
ther the mother will nurse it or not. Her own preservation 
requires this, in order to prevent puerperal fever and stag- 
nations of the milk. 
8. Proper attention must be paid to the lochial flux, as 
being the second principal crisis, designed for the diminu- 
tion of local plethora. A cup of chamomile tea occasion- 
ally taken,' best subserves this end in common cases, and it 
most effectually mitigates at the same time, the after- 
pains. 
9. In violent and very painful after-pains, an oily emul- 
sion, which may be strengthened by a few grains of extract 
of hyoscyamus (No. 142 a.), is the best and safest*remedy. 
Some recommend opium, which is, however, not to be ap- 
proved of, is even dangerous, as it creates constipation, a 
state much to be guarded against, and increases the in- 
flammatory disposition, always existing, and most to be 
dreaded. 519 
PUERPERAL FEVER. 
PUERPERAL FEVER. 
Phlegmasia exsudatoria abdominalis, puerperalis, Peritonitis 
puerperalis. 
A lying-in woman may, like any other person, be affected 
with any kind of fever and inflammation ; such a one is dur- 
ing childbed, but not a childbed (puerperal) fever. Puerpe- 
ral fever is a peculiar disease, distinguished from any other 
by particular symptoms, and by characteristics of its own. 
Its distinctive symptoms are : immediately from the be- 
ginning, a violent pain in the abdomen, attended with a 
considerable distention of it, which is very-apt to increase 
to a tympanitic tension ; and there is such sensitiveness, 
that the patient cannot bear the slightest touch, not even 
covering; the pulse is very quick from the commence- 
ment ; there is great prostration and low spirits, suppression 
of the lacteal and lochial secretion, violent thirst, usually 
diarrhoea, with frequent urgency to stool, also vomiting. 
It is rapid in its course, terminating fatally in three or 
four days. The favorable issue is either a perfect resto- 
ration ; or, what is more frequent, a metastasis, as a mili- 
ary eruption, a cerebral affection, milk abscess, leucophleg- 
masia. Dissection shows gangrenous inflammation of the 
peritoneum, sometimes also of the intestines or the womb, 
with an unusually large quantity of coagulable or perfectly 
milk-like lymph effuded. 
Genuine puerperal fever may prevail epidemically, be- 
come even contagious in houses where many lying-in wo- 
men are gathered together. In some years it is rarely met 
with, in others a great many women are affected by it. 
This fever occurs only in lying-in women ; its existence 
depends on the peculiar state of the human economy previ- 
ous to, and after parturition. 
Pathogetiesis. The proximate cause is an inflammatory 
state in the abdomen, sometimes located more in the perito- 
neum, in other cases more in the intestines; sometimes 
affecting all these parts together; attended with a great 
disposition to a quick and large lymphatic exsudation into 
the abdominal cavity {inflammatio exsudatoria). But this 
local inflammatory state is of a particular kind, and is possi- 
ble only to recently delivered women, in the first week of 
childbed, and therefore dependent on the peculiar state of 
the organism previous to, and after parturition. In the last 
months previous to parturition, the distended uterus presses 5 20 
PUERPERAL FEVER. 
on all the systems of the abdomen, thereby impairing them 
and disturbing their action ; to this is added a double san- 
guification. The consequence is an atony of the gastric, 
sanguineous, and lymphatic systems of the abdomen, accu- 
mulation of bilious matters and impurities in the gastric 
system, frequently even hardened excrements in the colon, 
sanguineous and lymphatic plethora of the abdomen. 
While the female economy is in this state and disposi- 
tion, the violent commotion of parturition, an act very sim- 
ilar to vulneration takes place, exciting more or less an 
inflammatory state of the uterine and abdominal systems, 
but which, by two crises—the lacteal secretion and the 
lochial flux, is brought back to the normal state and has its 
balance restor.ed. However, the following accidents may 
occur : suppression of the lacteal secretion, suppression of 
the lochia, taking cold, or over-heating by stimulant food, 
too hot regimen, overloading of the stomach, mental affec- 
tion, laborious parturition with lesion. Under such cir- 
cumstances the inflammatory disposition increases unto 
real inflammation, which, however, has a peculiar charac- 
ter, namely: it is located, 1, in an extremely impaired 
part (like an inflammation “p°st commotionern”), of a ty- 
phoid type, very liable to pass rapidly into a nervous or 
gangrenous state ; 2, it is attended with lymphatic pletho- 
ra of the abdominal system, and consequently is much 
inclined to lymphatic effusion ; 3, it is accompanied with 
great accumulation of gastric impurities. This is the es- 
sential character of puerperal fever. 
Therapeutics. The treatment may be prophylactic or 
curative. Reliance must principally be placed on prophy- 
lactic treatment. It consists in this: during the last 
months the patient must take daily exercise and procure 
regular stools (for the latter, electuariurn lenitivurn is 
best), and if she be young, and to a certain degree pletho- 
ric, she must be bled shortly before delivery. After deliv- 
ery the infant must be applied to the mother’s breast, and 
she must herself nurse it for a few weeks, even when it is 
the intention not to continue nursing. She must spend 
the first nine days in her bed, and not leave her room be- 
fore a fortnight has elapsed ; observe an antiphlogistic 
vegetable diet, avoid external cold and over-heating, and 
when she nurses her child, use gentle cooling evacuants, 
the best is citrate of potassa ; but when she does not nurse 
the child, after the third day, stronger cathartics, as sul- 
phate of potassa (No. 142 b.), are to be taken, so as to pro- 
duce several fluid stools every day. TREATMENT IN REGARD TO LACTATION. 
521 
The Curative Treatment. 
At the first appearance of the disease, announced by 
bellyache with febrile motions, use cooling- laxatives, injec- 
tions, frequently applying the child to the breast, in order 
to keep up and increase the lacteal secretion ; when the 
lacteal secretion has been suppressed, the same remedies 
must be used and dry cups applied on the breast, emollient 
cataplasms. In case the lochia should stop, administer 
borax, and inject emollients into the womb j if this does 
not suffice, apply leeches to the genitals ; in evident gas- 
tric turgescence, an emetic of ipecac. When the disease 
increases, and the inflammatory state is more pronounced, 
a venesection must be made \ should the pains continue 
notwithstanding, leeches are to be applied, or what is more 
efficacious, eight to twelve cuppings on the abdomen, an 
oily emulsion with aqua laurocerasi, and cooling purga- 
tives, calomel, embrocations of camphorated oil and mer- 
curial ointment with opium, emollient narcotic cataplasms, 
in short, the whole treatment of enteritis, having constant 
regard to the liability the disease has of passing into a 
nervous or putrid state. Should the first (nervous state) 
take place, valerian, musk, and opium ; in the latter, Peru- 
vian bark, camphor, and arnica must be resorted to. Gan- 
grene of the uterus, indicated by putridity of the lochia, 
may set in, must not be lost sight of, and is to be counter- 
acted principally by injections of arnica and cinchona into 
the womb. Every indication of a lacteal translation to 
the surface must carefully be promoted. 
LACTEAL SECRETION AND ITS TREATMENT, IN CASES OF SUCK- 
LING AND NOT SUCKLING. 
I would enjoin the following rules in regard to this im- 
portant function. 
1. Before the time of lying in, the nipples ought to be 
prepared, and made fit for their office, which is done by 
placing over them little hollow shields, made out of an ex- 
cavated nutmeg, or a thimble of wax or elastic gum. Du- 
ring the last months, they ought to be washed every day 
with' French brandy (the best preservative against excori- 
ation). If they are very much sunk in, the milk-pump may 
be used for drawing them out. 
2. The child must be applied to the breast twelve hours 
after delivery, partly to promote the secretion of milk and 522 
FLUX OF MILK. 
prevent metastases ; partly to accustom the infant to suck 
before the breasts grow too hard and large. I advise 
suckling of the child for the first fortnight, even when the 
mother is not to be the nurse. To do so is advantageous 
both for mother and child ; for the mother, because it is 
the best mode of relieving the breast; for the child, be- 
cause the mother’s milk is the most appropriate nutriment 
of the first days. 
3. Now, two cases may present themselves : the mother 
intends to suckle the infant herself. In such a case, the 
principal thing to be done, is, to apply the child frequently, 
and in order to promote and increase subsequent secre- 
tion, she may drink largely of fennel-tea, beer, and soups ; 
and she may be permitted to take substantial food earlier 
than one who is not to nurse. Or she is not able, oris not 
willing to suckle the child. In this case, three things must 
be done ; the lacteal secretion must be prevented, the milk 
already in the breasts discussed and removed by discharge 
and derivation. The rheans for accomplishing these ends, 
are: the application of cotton fumigated with burning 
sugar and ambergris, gentle support of the breasts; when 
the milk accumulates, it must be evacuated by drawing; 
the diet must be meagre and watery, cathartics adminis- 
tered, and perspiration favored. A remedy particularly 
suitable for consuming and removing the milk is sulphate of 
potassae (formerly termed arcanum duplicatum,No. 142, b.), 
one or two drachms daily, so that it produce several 
stools. 
4. When swellings, pains, indurations of the chest 
follow, use warm emollient cataplasms ; to make milk flow, 
embrocations, and application of spermaceti and almond- 
oil, frequent sucking and pumping out, warm fomentations, 
and low diet. 
In soreness of the nipples, a most tormenting evil, 
French brandy, cacao-butter, lime-ointment (No. 143), 
cacao-butter with zinc, powder of gum-arabic, 1 ounce, 
and flores cassise, 1 scruple, spread on the part may be 
used. 
FLUX OF MILK. 
Galactorrhosa. 
Sometimes the lacteal secretion does not stop with the 
cessation of suckling, but continues to an inordinate WHITE SWELLING OF LYING-IN WOMEN. 
523 
degree. This creates, besides its inconvenience, great 
weakness, even tabes. 
The cause is either a too protracted lactation, or a non- 
return of menstruation. 
The remedies are : to restore the catamenia, and to 
apply externally aromatic herbs, especially camphor, to the 
chest and in the axillte j also carrot herb in the axillse. 
WHITE SWELLING OF LYING-IN WOMEN. 
Phlegmasia alha dolens puerperalis. 
Diagnosis. A white, rapidly formed, large leuco-phleg- 
matic, very painful swelling of the thigh, which sometimes 
extends to the whole regions of the pelvis and genitals, at- 
tended with febrile motions. It happens within the first 
fortnight after delivery, and lasts eight to fourteen days, 
and when relief is tardy, terminates in death by gangrene 
or lacteal abscesses. 
It is an analogous disease to the puerperal fever. It 
consists in a lymphatic infiltration into the cellular tissue 
of the pelvis and thighs, the effect of an inflammatory state 
of the venous and lymphatic vessels of the pelvis dependent 
on pressure during pregnancy. It is puerperal fever with- 
out the peritoneum, as this one is phlegmasia alba within 
the peritoneum. The exciting causes may be the same as 
those which create puerperal fever ; a suppressed lacteal 
and lochial secretion, taking cold, mental affections, gas- 
tric accumulation. Death is owing to lymphatic inflam- 
mation extending to the abdomen. 
The treatment consists in removing inflammation as 
quickly as possible, and promoting absorption. The prin- 
cipal remedies are, first : the application of leeches to the 
thighs and groins, embrocations of mercurial ointment, 
vesicatories to the thighs kept in suppuration, cooling pur- 
gatives (sulphate of potassa), calomel, digitalis; externally 
dry cataplasms of discutient herbs; in violent pains, fomen- 
tations made of a decoction of hyoscyamus with a little 
saturnine water. In some cases, emetics repeated for a 
few days, are an efficacious remedy. 524 
WHITES. 
WHITES. 
Leucorrhcea, Fluor Albus. 
Diagnosis. Discharge of mucus from the vagina, of a 
white yellowish, or greenish color; puslike, thin and 
watery, or thick, gelatinous; mild {fluor albus benignus), 
or acrid and corrosive {fluor alb. malignus, acris). It may 
he permanent, or only periodical before and after the men- 
struation. 
When this discharge is protracted or copious, but espe- 
cially when it is acrid, it is injurious to the whole economy, 
and causes a pale color, a hysteric state, and bad digestion. 
When we meet with the latter symptoms, we must suspect 
the existence of leucorrhcea, and discover whether such is 
the concealed cause. It may end in a lingering fever or 
tabes. Particular attention must be paid to the possibility 
of a scirrhus of the womb being the cause as well as conse- 
quence of fluor albus. This is to be feared, when the pa- 
tient feels pungent pains shoot through the pelvis, or boring 
violent pains and a fetid, sometimes a blood-colored dis- 
charge, already exist or subsequently appear. In such a 
case, or even when there is only a suspicion of scirrhus, 
exploration is indispensable. 
(Syphilitic fluor albus is a symptom of syphilitic infec- 
tion, and belongs to the head of syphilis.) 
Whites is one of the most protracted diseases, and hardly 
admits of a cure. It is most curable when it is a precursor 
of the first catamenia (of puberty), or a consequence of 
suppressed menstruation, when it is removed by the ap- 
pearance of the catamenia. When it is hereditary, consti- 
tutional, or the effect of an unalterable mode of living, or 
a symptom of every menstruation, it is least curable. 
Pathogenesis. The proximate cause is, as in all profluvia : 
either local irritation, or a local weakness, frequently both 
act simultaneously. 
The remote causes are: most frequently a sedentary 
life, and eating largely of rich food, excess in warm drinks, 
especially of tea, fat, and rich milk 5 therefore it is more 
rarely met with in an active, industrious mode of living, 
in poor, than in an idle state of life. Farther, moist cli- 
mate, damp dwelling (hence more frequent on the sea- 
coast) ; chronic suppression of perspiration, hence, may be 
due to too light dress; local debility from too frequent 
coition, parturition; also the bad habit of sitting over WHITES 
525 
warming-pans ; increased and unsatisfied sexual instinct, 
excited imagination, sentimental erotic readings, mastur- 
bation, young widowship, syphilitic infection, rnetastases 
of all kinds, especially catarrhal, rheumatic, psoric, scrofu- 
lous, anomalous heemorrhoids, mucous haemorrhoids of the 
vagina, a vicarious secretion in suppression of menstrua- 
tion, accumulations and obstructions in the abdominal 
viscera, worms, local stimuli, infarcts, polypus, scirrhus of 
the uterus, even ascarides. A lax, leucophlegmatic, lym- 
phatic constitution, and watery blood, predispose to the 
disorder. 
Therapeutics. The leading idea in the treatment must 
be to consider the disease as a catarrhus vaginaj vel uteri, 
and to act accordingly. Hence, it is evident, how absurd 
and injurious the usual routine is: to view the evil as 
merely local, and try to suppress the flux by merely topi- 
cal means, such as injections and the like. What would 
be thought of a physician, who would treat coryza by mere 
topical means, cold water and astringents 1 And what 
would be the consequence 'I Remove therefore, above all, 
the causes. Too light dressing and sedentary life come 
first into consideration ; in such a case, warm clothing and 
daily strong exercise are the principal remedies, and often 
perform a cure. Farther, gastric impurities, worms, abdo- 
minal obstruction, scrofulous and other dyscrasies must be 
attended to ; physical and mental sexual stimuli must be 
shunned, tonics must be taken when general debility exists, 
and the menstruation be promoted. Of particular value 
are purgative, strengthening visceral remedies, especially 
rhubarb in small doses, aloes, bitter extracts, balsamic 
pills, guaiac with calomel and sulphuret of antimony. 
They are alone sufficient to effect a cure in many cases. 
When the discharge continues after the causes have been 
removed, or when none can be found, and the disorder is 
merely owing to a local weakness, the direct, that is, the 
local treatment, may be commenced, beginning with internal 
specifics first, remedies which, by their particular affinity 
to the uterus, operate directly on it and on this anomaly 
of its action. Of that number are: balsam of copaiva, 
30 drops three times a day on sugar, savin, rhubarb (one 
grain morning and evening), with prepared oyster-shells, 
mastic, terra catechu, alum (No. 144), cinchona, ratanhy, 
elm-bark, herba lamii purp. (both in decoction, one ounce 
daily), sulphate of iron, muriate of barytes, a long continued 
use of ferruginous water in small doses (a glass every 
morning), especially Pyrmont, Driburg, and Spa water. 5 26 
BARRENNESS. 
Combine with the use of these medicines, external ablu- 
tions of cold water and lime-water, also tepid baths. This 
is sufficient in the majority of cases. It is only when this 
treatment proves abortive, (hat there is reason to suspect 
a high degree of local weakness, or organic disorder of the 
uterus, and then it is time to have recourse to more vigo- 
rous local applications in the way of injections. However, 
even here a graduation must be observed. Commence by 
cleansing, alterative, gently strengthening remedies, as 
lime-water, decoction of elm-bark, cicuta with laurel-water, 
calomel; after these, sulphate of zinc, corrosive sublimate 
in solution ; finally, Peruvian-bark, oak-bark, glum, sul- 
phate of iron, nitrate of silver. Farther, fumigations of 
balsamic substances, as mastic, benzoin, storax, baths of 
oak-bark, sulphate of iron, or chalybeate balls j also sul- 
phur, sea and ferruginous baths. 
BARRENNESS. 
Sterilitas. 
Pathogenesis. As little as we know, and ever shall learn 
of the mystery of procreation, so much is certain, that a 
sufficient degree of vitality, of excitability, irritability and 
productivity of the female organs of generation is requi- 
site. 
Besides the foregoing causes of sterility, there are the 
following : 
1. Mechanical obstructions, which prevent the sperm 
from penetrating in the womb, atresia, callosities and a 
spasmodic contraction of the vagina. 
2. Disorders of menstruation ; absence of it prevents 
conception (sine menstruis nulla conceptio) / therefore the 
viragines (manly women), who never have catamenia, are 
barren. Profuse menstruation annihilates and washes the 
germ away (of that class are the imperceptible abortions 
which ,are renewed every four weeks). 
3. Fluor albus, and concretions in the uterus. 
4. What is called “ cold temperament j” that is, a defi- 
ciency of irritability, plasticity, animal warmth, watery 
blood, phlegmatic temperament, lack of susceptibility. 
5. Want of nourishment and grief may have the same 
effect; as also will the reverse, a too ardent temperament, 
excess of excitability and sensibility may prevent concep- 
tion ; the same is true of the erethic spasmodic state, which BARRENNESS. 
527 
makes the excitement daring coition degenerate into 
spasm, even into violent pains (though productiveness 
may be so great in some, that neither insensibility, nor 
aversion, nor pain during coition, can hinder conception •, 
of which I have seen instances). 
6. Too frequent or forced coition, which makes concep- 
tion so rare in prostitutes. 
7. Finally, organic disorders of the uterus, scirrhosities, 
polypus, and dyscrasies, particularly affecting this part, as 
the scrofulous and syphilitic, though conception is fre- 
quently possible even in these states. Barrenness may 
therefore be absolute, relative, and temporary. A woman 
may be barren during a prevailing sickness, mental dispo- 
sition, distress; not so at other times; she may be barren 
with the same man when the temperaments differ, at one 
time, not so at a later period. This is owing to the ac- 
commodation of temperaments by time, when one part is 
too ardent in proportion to the other, which decreases by 
years and is equalized. We have observed marriages 
barren for ten years, and longer, become prolific later in 
life.—Even change of climate, travels can contribute very 
much towards fruitfulness. Thus, women who are barren 
in the north, become mothers in the south. 
Therapeutics. It is very important, though very difficult, 
to examine and discriminate, whether the fault of barren- 
ness lies with man or with woman. 
The treatment of barrenness itself, must first begin by 
removing the remote causes, the mechanical impediments, 
the amenorrhoea, fluor albus, dyscrasies, constitutional 
disorders ; the cold atonic weakened state must be reme- 
died by strong nutriments, tonics, excitants ; the nervous 
spasmodic state by antispasmodics ; the plethoric, phlogis- 
tic, by a moderate diminution of the blood, by limiting the 
frequency of coition, and doing away with unnatural 
stimuli. After this, the uterine system must be attended 
to, by respecting the indication, to impart to the genital 
organs that degree of excitability and plasticity which is re- 
quisite for the procreation oj a new being ; in short, to clear 
the ground and render it apt for fructification. When 
stagnations and infarcts of the uterus exist, which is recog- 
nized by the menstrua, before and after they appear, being 
attended with pains and spasms, by the discharged matter 
being mucous, or mixed with membranous and other con- 
crements, and the lower abdominal region being distended, 
the uterus must be freed and cleared from those foreign 
substances, for which resolvents, bitter extracts, asafoetida, 528 
BARRENNESS. 
galbanum, aloes, soda (Carlsbad), even calomel and 
visceral clysters, and warm soap and sulphur baths are 
recomrnendable; most efficient are Eras and Wiesbaden 
springs. 
The second indication is to arouse the specific sexual ac- 
tion in the uterus. This end is best attained by iron and 
baths, still more by thermal baths. Iron is undoubtedly 
the greatest remedy to create productiveness, and to in- 
crease the plasticity of the blood. Among the springs, I 
can praise most Ems (renowned for his boy-well already 
since ancient times), and Pyrmont. I have undeniable 
proofs of their efficacy. The former is more suitable to 
delicate nervous persons, and who labor under infarcts ; the 
latter more to very debilitated, atonic persons. 
Also, some secondary considerations may have an essen- 
tial influence in this matter; the time when coition is per- 
formed, immediately after menstruation has terminated, 
during a joyful excitement, in the morning; position du- 
ring coition in case of a faulty position of the uterus. DISEASES OF CHILDREN. 
529 
DISEASES OF CHILDREN. 
This is a very important part of the practice of medi- 
cine; for one third of all diseases belong to the age of in- 
fancy, and they constitute a particular branch of the heal- 
ing art, that requires a special study. One may be a very 
good physician for adults, but a very unsuccessful one in 
the treatment of children; for the difference does not lie 
in a diminution of the strength of the doses, but in a dif- 
ferent semiology, a modified pathology requiring corres- 
ponding therapeutics ; the character is quite different, and 
ought to be understood. 
We, therefore, shall here treat of the diseases which oc- 
cur in infantile age, and of the peculiar character which 
this age imparts to all diseases and to the whole practice 
of this period. 
Characteristics of Infancy and its Diseases. 
1. The essential character of this period of life is: an 
unfinished state of existence, a continual development of 
the yet incomplete economy. The first months after birth, 
the first year of life, may especially be considered as a con- 
tinuation of generation, one half of which has taken place 
within, the other without the womb. New organs form, 
those already existing progress, are perfected, or altered j 
others disappear, entirely new spheres of existence are 
opened, first the sphere of atmospheric life, then that of the 
senses, and finally the intellectual world.—The life of a 
child is therefore not yet a normal state, but an effort to 
become so, a morbid state, a crisis, and must be considered 
and treated as such by the physician. Many a phenomenon, 
which we might consider a disease under other circum- 
stances, is the effect and symptom of a continued critical 
operation of nature. 
2. The first great step of infantile life is a transition from 
a dependent parasitic existence into an independent one. 
We cannot sufficiently admire the wisdom of nature, which, 
has ordained this gradual transition, requiring the child to 530 
DISEASES OF CHILDREN. 
remain, by suckling-, an integral part of the mother for six 
months or a year, receiving from her vitality and nutri- 
tion. This period of transition, founded on the laws of na- 
ture, is of the highest importance, and exerts a decisive in- 
fluence on the whole terra of future life. Want of it is 
most unnatural, and cannot be made good by any thing. 
3. The vital operations of infancy are more active than 
those of the adult. The circulation is more rapid, inter- 
stitial exchange of material takes place quicker, consump- 
tion and restoration are greater; hence diseases run 
sooner into danger; but their crisis and convalescence are 
also sooner attained. Hence also a great need of restora- 
tion by sleep, and the more so the younger the child, 
4. Irritability and sensitiveness are greater. There is 
an especial preponderance of sanguineous life and produc- 
tiveness j hence a great inclination to nervous affections, 
spasms and inflammations. 
5. Predominance of vegetative life and nutrition, growth, 
increase, and formation. Hence the great importance of 
the digestive and assimilative functions, but particularly of 
the lymphatic and glandular system ; hence the great dis- 
position to diseases affecting these systems. 
6. Unequal and disproportioned size and development 
of the organs, hence unequal distribution of the blood and 
humors. Brain, liver, and intestinal canal are particularly 
pathogenetic parts. 
7. Importance of the periods of development. They 
may create diseases (often in appearance only) and remove 
them ; especially the period of dentition, growth, and the 
7th year. 
8. The sympathies are numerous and strong, especially 
that of the stomach and intestinal canal with the brain, to 
which alone often the existence of various disturbances 
and maladies, even their fatal issue, are owing. 
9. Infantile age may be divided into three essentially dif- 
ferent periods: 
The first, from birth to the end of dentition. It is a real 
continuation of generation, the time of development, the 
most imperfect, but at the same time the most creative, 
hence it is the most mortal. (The third part of all born die 
in this period.) However, it is a wonderfully restorative 
period, and terminates at the great crisis of dentition, which 
brings with it a new mental life. 
The second, extends from the commencement of denti- 
tion to the seventh year ; it is the termination of genera- 
tion, the equilibrium is more perfect, there is less suscep- 531 
tibility of diseases and less mortality, but a great tendency 
to inflammation, especially to croup and exsudatory inflam- 
mation of the brain. The seventh year commences a re- 
markable section. Croup, asthma acutum, and hydroce- 
phalus rarely occur after this age. In this period gene- 
rally the 6th part of all born die, so that the half of man- 
kind die before attaining the 14th year. 
The third, from the 7th to the 14th year, is one of the 
healthiest and least fatal periods of life. 
DISEASES OF CHILDREN. 
Diagnostics in Children. 
Diagnosis, on the whole, is difficult and is quite pecu- 
liar. For on one hand, we have not the aid of language or 
reason; a child is unable to describe its sensations; even 
the pulse is an unsure sign, on account of the great pre- 
valence of irritability. On the other hand, the diseases, 
like the organism itself, are less distinctly characterized 
and defined. 
The principal signs are : 
The pulse. In the first year it generally beats 90 times 
in a minute ; so that it is only when the frequency is higher 
we may presume fever. 
Temperature. Increased warmth of the head and fore- 
head, is a chief sign of fever. The same is true 
Of thirst, heat in the mouth. 
Want of appetite, is indicative of impurities in the first 
ways, or of fever. 
The excretions, especially by stool, their color, consist- 
ence, frequency or deficiency; eructation, discharge of 
winds, vomiting, odor of the breath ; state of the tongue ; 
of the urine, its color in the first periods of infancy ; open 
or dry skin, eruptions. 
Condition of the abdomen, especially of the prsecordia and 
hepatic region. 
Respiration, coughing, rattling in the throat, hot breath, a 
chief sign of internal inflammation. 
Crying. The only expression of the sensations, which 
a child is capable of uttering; we must, however, under- 
stand it and know how to interpret it. Much crying and 
restlessness indicate disagreable sensations; crying and 
drawing the legs towards the belly, pains in the abdomen ; 
crying and carrying the hands to the mouth, pains of den- 
tition ; crying in coughing, pains in the chest. 
Altered voice, hoarseness. 
Impediment in suckling and swallowing. 532 
DISEASES OF CHILDREN. 
Sleep, too little or too much, quiet or restless, with con- 
vulsions and starting up, are in general indicative of ner- 
vous affections. 
Therapeutics for Children, 
Must he founded on the foregoing characteristics of in- 
fantile age. The leading principles areas follows: 
As the diseases of children in the first periods of life 
have generally an indefinite and undefined character, the 
best course is to treat them according to the principles of 
general pathology and therapeutics. The most simple 
treatment is the best. 
In treating diseases of children, we must be all fear and 
all hope : this is to say, we must always be prepared to 
meet with the occurrence of sudden and dangerous acci- 
dents ; but we must not despair even in the greatest dan- 
ger, since the creative power of the organism is so power- 
ful at this age, and can do wonders at restoration. 
A chief rule with us must be, not to do too much, not to 
be too active, for fear of the extreme irritability and sensi- 
tiveness. The practical rule : “Not to do harm in attempt- 
ing to do good,” is nowhere of greater importance. The 
greatest caution is particularly due to the doses ; the small- 
est being the best. “ Little, very little can do very much.” 
This applies to diagnosis as well as to therapeutics. Very 
trifling causes may produce the most violent effects; as 
something acid in the stomach, or winds may produce con- 
vulsions. Hence it is that the weakest remedies, seem- 
ingly insignificant, may produce great effects; as magne- 
sia, and phosphate of lime, which soothe convulsions. In 
short, nothing must be regarded as trifling in children. 
In the first period of life the attention of the physician 
must always be directed, first, to the prirnse vise. Acidity, 
mucosity, overloading of the stomach, winds, accumula- 
tion of fseces in the bowels are the most frequent causes of 
morbid attacks in the first years. Iherefore we must be- 
gin with magnesia, rhubarb, fennel seed (vide No. 256), 
and injections, as they give prompt relief in all accidents. 
By using these remedies at the onset of a disorder, we may 
prevent a most severe disease, which will often form if this 
timely assistance be neglected. Khubarb is the chief reme- 
dy for infants. It does not only cleanse the first ways, but 
promotes also, what is so important here, the secretions of 
the liver and kidneys, and is not weakening as other pur- 
gatives are, but, on the contrary, it is possessed of a tonic 
virtue. DISEASES OF CHILDREN. 
533 
Next, the nervous system must be appeased and spasms 
prevented ; for which purpose nothing is needed but mag- 
nesia, prepared chalk, rad. pseonise, small doses of vale- 
rian, and emollient injections (vide No. 257). 
Constant attention is to be paid to congestions to the 
head, which are likely to happen. They are recognized 
by heat of the head, redness of the face, a soporous or con- 
vulsive state. Derivations by the intestinal canal, injec- 
tions, and in an obstinate case one or two leeches behind 
the ears (in the first year) are the best remedies. 
Be very cautious in the use of debilitating remedies, 
especially of evacuants ; for a fatal exhaustion is apt to fol- 
low them in the first periods of life. This is especially true 
of the administration of strong emetics and cathartics. 
Even nitre is too debilitating for the stomach of little 
children. The same applies to the treatment of profuse 
morbid evacuations ; try to moderate them promptly. 
Equally great precaution is needed in regard of excitant 
and all volatile remedies, which deeply affect the organ- 
ism ; they are very apt to create dangerous congestions 
to the head. This is especially true of the use of opium, 
which, as a rule, never ought to be given in the first periods 
of life, for it may readily bring on apoplexy. This drug 
ought not to be used even subsequently, except in extreme 
danger of life ; as in diarrhoeas, which cannot be stopped 
by any thing else, and also then only in the most minute 
doses, i of a drop of the tincture of opium (1 drop tritu- 
rated with a drachm and a half of sugar, and divided into 
6 parts) ; -6XO- grain is sufficient; or what is better, let it be 
applied only externally, or by injections.—In general it is 
better to abstain from all kinds of narcotics, or when given 
let it be with the greatest caution ; for there is always rea- 
son to fear, that, while the formative process is active, they 
affect and disturb this important act (especially the orga- 
nization of the nervous system), and become as it were in- 
corporated with it, leaving consequences pernicious to life 
ever after. 
The application of medicinal agents through the skin is 
of great importance in children, for in infancy the skin has 
a high nervous susceptibility as well as absorptive power, 
and many an injurious influence, as that of opium on the 
stomach and intestinal canal, can thus be avoided. 
A child has less power to live on itself than an adult has. 
It consumes quicker and requires a constant supply. There- 
fore children require more sleep, more frequent nutrition; 
to withhold food for a long time, even in diseases, is there- 534 
DISEASES OF CHILDREN. 
fore not advisable. Air is particularly wanted, and the 
greatest care must be taken to provide it pure. 
Great consideration is due to sympathetic connections 
and their effects in the economy ; for, at no time is nervous 
sympathy as great as in infantile age. I his is important, 
partly, because it interprets the phenomena and morbid 
accidents, especially as the cause must often be sought for 
in quite a different location, than that in which the disease 
is seated, as when the cause of the most violent cerebral 
affections may reside in the stomach ; partly, for the 
treatment, since the great use of antistimuli and of the de- 
rivative method in the diseases of children rest on this ob- 
servation, as when antistimuli are used by the skin and the 
intestinal canal. A merely emollient injection, an emol- 
lient poultice, and fomentations of milk on the abdomen or 
feet often work wonders. In this respect, we cannot suffi- 
ciently recommend emetics, not only as evacuants, but as 
the best antispasmodics, and as efficient to remove morbid 
sympathies between the stomach, the brain, and the lungs. 
There is little danger in their administration ; for children 
throw up easily, especially when we use the linctus eraeti- 
cus (vide No. 258). 
Be always attentive to respiration and the voice, in or- 
der to discover in time the commencement of croup. 
Finally, I add a general admonition. Do not believe 
every affection to be a malady. Many complaints are only 
symptoms of development, and are peculiar to this import- 
ant process, which is not to be interrupted but only rightly 
guided. In children of more than 2 years of age, who are 
plethoric, well fed, and are good eaters, but especially in 
such as have a scrofulous disposition, the old maxim of our 
predecessors is highly important, and I can bear testimony 
to its utility : purge every 4 weeks by a dose of rhubarb or 
infusion of senna. In such children an abundance of un- 
digested, unassimilated, excrementitious matter is formed, 
and if not evacuated, gives rise to many diseases, or at 
least obliges nature to throw it offby cutaneous eruptions, 
boils, etc. These evils, and even inflammations and con- 
gestions to the head, are prevented by such purgation, to 
say nothing of worms, which are readily generated, and 
require to be discharged. Even moral education is thereby 
facilitated, for I have found children become more gentle 
and flexible after such purifications. The great influence 
of abdominal accumulations on the character is a well- 
known truth. DISEASES OF CHILDREN. 
535 
Regimen for Children. 
Physical Education. 
The fundamental principles must be: As the life of the 
child in the first period is a continued generation and de- 
velopment, it is most important that these acts should not 
be disturbed. Regard the child therefore in the first six 
months as a vegetative being, which prospers best in a state 
of rest and sleep. 
Try to effect the development of all the systems and fa- 
culties as uniformly and successively as possible. No im- 
pediment, no disturbance must be caused, nor premature 
activity and development: especially the premature excite- 
ment and development of the sensual and mental faculties 
is to be avoided. 
Try to accustom the child gradually to the external in- 
fluences, even to the injurious ones, to which it will be ex- 
posed during life. This is the system of a reasonable har- 
dening. This purpose is answered by daily washing the 
whole body with cold water, which may be commenced as 
early as the sixth week after birth, gradually changing the 
water from tepid to cold. It is the most effectual remedy 
to invigorate'the nervous and cutaneous system, and to 
guard against nervous as well as catarrhal and rheumatic 
complaints. The same applies to the daily enjoyment of 
free air. 
In general, air and water, as they are the fundamental 
elements of organic life, are also the principal elements of 
a reasonable physical education. Daily washing of the 
a tepid bath a few times a week, daily expo- 
sure to free and pure air, and its admission into the dwell- 
ing, especially into the sleeping room, are chief requisites. 
"Cleanliness is a main condition of a good education. 
Pure air, removing all pernicious exhalations from the nur- 
sery, cleansing the body by washing and bathing, frequent 
change of linen and bedclothes must therefore be observed. 
Sleep during the first 6 months is a sacred sleep. It is 
the laboratory of ever creative and formative nature. The 
infant must sleep that the plant may prosper, and must in 
no way be disturbed. The younger the infant, the more 
sleep it requires, and it must be left to the instinct of the 
child itself to shorten sleep. 
Food must be digestible, assimilative, nourishing, and ap- 
propriate to the constitution of the child, and according 536 
with its various periods. It is, therefore, most proper in 
the first periods of life, the period of transition from the 
parasite to solitary existence, that it be prepared by an- 
other being, and full of her vital power, a mother’s or a 
nurse’s milk drawn from the breast (the vital fountain) ; 
when this cannot be had, use boiled milk diluted with half 
the quantity of water. It is best to give nothing but milk 
during the first year ; after the first 6 weeks it may occa- 
sionally be thickened with meal or biscuit, administered 
first once, then twice, and finally three times a day. To 
feeble children weak broth may be given after the first six 
months ; animal food must not, however, be much used be- 
fore the dentition, since it is apt to inflame the blood and 
to give rise to inflammatory accidents. No solid food pre- 
vious to completed dentition. After this period up to the 
seventh year, milk every morning and evening, for dinner 
a little meat, with easily digestible greens, carrots, scorzo- 
nera-roots, spinage, mashed potatoes, fruit; no fat, no 
cakes, no confectionary, no spices, no coffee; water and 
milk as beverages, wine is not allowed. It is incredible, 
what advantage it is, to be accustomed to water-drinking. 
It is the surest means to preserve a good stomach, which 
can bear and digest every kind of aliments, and an unim- 
paired digestive power ; whereas on the contrary, prema- 
ture drinking of wine deprives us of this advantage by over- 
irritation, and weakens instead of strengthening. 
Finally, premature exertion of the mental faculties must 
be avoided. The body must first have acquired its energy 
and development, lest we disturb them and predispose to 
nervous diseases, even to stupidity. 
It is also an important rule to lead the attention of the 
children not too much to their physical condition, nor to 
make them anxious or careful of it; but rather to accustom 
them to disregard little evils,.indisposition, and pains. 
DISEASES OF THE NEW-BORN, ETC. 
DISEASES OF THE NEW-BORN AND INFANTS. 
Transition from the womb into the world of light and 
air, from a parasitic existence into a solitary one, is so 
important and extraordinary a step, that we are rather as- 
tonished at, and admire the wisdom of nature, seeing that 
so many children perform it without suffering, than that 
some become affected with disease and die in the attempt. 
Form a correct idea of this transition and the state of a 
new-born child. Transition into an entirely new world j 537 
exposure to influences entirely novel ; unusual stimuli and 
potences, light, air, change of temperature, irritation of the 
senses, clothing; further, instead of the hitherto dependent 
existence, a solitary one takes place, living on and con- 
suming itself, digestion, the preparation of the food, san- 
guification, generation of its own warmth. Finally, an en- 
tirely new circulation, new functions, as that of respira- 
tion, the most important of all vital operations ; secretions, 
and excretions. 
ASPHYXIA OF INFANTS. 
Generally, nature alone conquers and succeeds in equal- 
izing this first step into life ; and wants nothing but a uni- 
form support of warmth, a mother’s or a nurse’s milk ; and 
rhubarb, mixed with a carminative (vide No. 259), in order 
to evacuate in the first days the mecony, continued until 
the discharged matter ceases to be black. By this practice 
jaundice, bellyache, acrimonies, even more dangerous evils 
are prevented. When infants cry and draw their legs to 
the belly, indicative of abdominal pain, the infantile pow- 
der and an injection of a decoction of chamomile and gruel 
with a little oil gives the surest relief. 
The diseases which occur in the first days after birth, 
some of which, as trismus and erysipelas, are highly apt to 
endanger life; others, as ophthalmia, threaten blindness; 
are the following; 
ASPHYXIA. 
The first accident which endangers life on its very en- 
trance is asphyxia. 
jDiagnosis. Cessation of circulation and respiration, and 
motion. It is often a continuance of the foetal slate (hy- 
datic life), a failure of the commencement of atmospheri- 
cal, independent existence. 
General causes : congenital debility, difficult parturition, 
violence committed during labor (by the forceps), the um- 
bilical cord wound round the neck, accumulation of mucus 
in the throat, too rapid separation from the mother (by 
tying the navel string), too hot or too cool surrounding 
temperature. The state may differ according to the causes 
and so will the treatment. 
1. Real debility, vital debility. Pallor, absence of any 
sign of life. 
In such a case excitants; as a warm bath, insufflation of 
air into the mouth and anus, injections, cold water or wine 
dropped on the pit of the stomach and chest. 538 
ICTERUS. EXCORATIONS. 
2. Plenitude of blood in the heart and brain ;—recog- 
nized by a red bloated face ;—causes : lengthened parturi- 
tion, coiling of the navel string round the neck, tying it 
too soon. 
In such a case blood (one or two spoonfuls) must be ab- 
stracted from the umbilical cord. 
3. Suffocation, mechanical impediment to breathing 
made by mucus. The child endeavors, but cannot cry, 
there is hoarseness, and rattling is often heard in the throat. 
The only salvative is an emetic, after which come exci- 
tants. 
The chief remedies in every asphyxia neonatorum are : 
animal bath, which consists in the close application of the 
child to its mother, warming it on her bosom, and a proper 
covering. 
ICTERUS, 
Arises from retention of the meconium in the intestines, 
and of bile in the liver; the meconium having been ab- 
sorbed into the blood, and from the unaccustomed impres- 
sion of air on the skin. 
It is without danger, and generally passes away in a few 
days. 
The best medicine for it is the linctus of rhubarb (vide 
No. 259). 
EXCORATIONS. 
Chafing between the legs and arms is a very common 
accident to infants during the first weeks of their life. It 
usually yields to cleanliness, to frequent washing with fresh 
water, and the use of some drying powder continued for a 
few days. Salves and greasy substances must be avoided ; 
they are apt to cause ulceration; topical repellent reme- 
dies, as lead, which may produce fatal spasms, are also ob- 
jectionable. In order to prevent adhesions, order the parts 
to be strewed with lycopodium. Should this simple treat- 
ment be of no avail, and the excoriations pass into ulcers, 
becoming deeper and phagedsenic, an internal dyscrasy, 
scrofulous or syphilitic, is to be supposed, the latter either 
in the child itself or in the nurse ; and cautious use of mer- 
cury is the only and the surest remedy ; commence with 
eethiops mineralis, and if this do not take effect, give mer- THRUSH. OPHTHALMIA, BLEPHAROPHTHALMIA. 
539 
curius solubilis Hahnemanni, -fV grain a day, along with 
magnesia. In obstinate ulceration zinc-ointment is the best 
external application. Sometimes the excoriation of the 
anus is of an aphthous character, and attends thrush in the 
mouth. This requires the treatment of aphthse. 
THRUSH. 
JLphthai Infantum. 
DiagJiosis. Spongy little ulcers in the mouth, throat, 
and anus (vide aphthae). 
They often appear daring the suckling of infants, and ge- 
nerally in consequence of a neglect of cleanliness. Fre- 
quent washing of the mouth, and on the least appearance 
of them, rubbing them with fine pulverized sugar prevents 
and heals them best in the commencement; Jet also laxa- 
tives be given. When they increase, borax (vide No. 260) 
will cure them. 
OPHTHALMIA, BLEPHAROPHTHALMIA. 
A redness of the eyelids with discharge, appearing im- 
mediately after birth, or a few days later, but always with- 
in the first eight days. The phenomena increase in a few 
days, especially the discharge of a yellowish-white puslike 
matter. The eyelids swell and are glued together by the 
matter. The duration varies from 8 days to 3 weeks. The 
issue, if proper assistance is not procured in time, is opa- 
city of the cornea, suppuration, adhesion, and destruction 
of the eye. 
Causes: Too bright light in the first days afterbirth; 
fluor albus of the mother, neglect of cleansing the eyes and 
the whole body, dust, impure air, too warm covering of the 
face, meconium, congenital dyscrasy, scrofulous or syphi- 
litic. 
Therapeutics. Preservative treatment. Keep the infants 
away from too bright a light during the first days ; the eyes 
must be carefully and frequently washed. General clean- 
liness and pure air; the meconium must be purged off. 
Curative treatment. The principal things to be done are: 
constant and frequently repeated fomentation and washing 
of the eyes with tepid water and milk, or elder tea, by 
means of a sponge or rag, to prevent the accumulation of 540 
ERYSIPELAS, TRISMUS, ETC. 
acrimony under the eyelids. In the same way a weak 
solution of vitriol or lead may be frequently used ; in ob- 
stinate cases a very weak solution of corrosive sublimate, a 
collyriurn of zinc and mercury on the eyelids. Give at the 
same time internally pulvis puerorum as a laxative ; and 
should the complaint not yield, add yV grain of calomel to 
it, twice a day. Tepid baths. 
ERYSIPELAS. 
Induratio Telce Celluloses. 
Diagnosis. Within the first 6or 8 weeks, fever, thirst, 
red spots appearing, first on the extremities, then on the 
abdomen and genitals, with induration of the skin. Some- 
times the induration is unaccompanied with fever, heat, 
redness, but rather with increased cold. The infant is un- 
able to cry ; utters only dull sounds, on account of the in- 
duration of the maxillary muscles. Finally, the skin be- 
comes as dry as wood. 
The duration of the disease is 4, 7, or 14 days. Death 
ensues by gangrene or by suffocation. Dissection shows 
an effusion of yellowish lymphatic fluid in the cellular tis- 
sue, swelling of the glands, of the lymphatic vessels, and 
of the liver. 
Pathogenesis. Taking cold, neglected cleansing of the 
intestinal canal, impurity, dyscrasy of the mother. 
Therapeutics. Cleansing of the primse vise by evacuants 
and injections, warm baths, small doses of calomel; exter- 
nally powder of bean-meal, elder flowers, and roses.—As 
soon as the redness changes to livid, or spasm sets in, an 
infusion of valerian, flores zinci, and musk, are to be ad- 
ministered ; externally fomentations of cinchona and arni- 
ca are to be applied. 
TRISMUS ET TETANUS. 
Diagnosis. These affections happen only in the first 
days of life. The child cries, wants to suck, and is not 
able ; the milk chokes it, and it is returned. On examina- 
tion, the masticator muscles are found stiff, the lower 
maxilla cannot be depressed; the jaws gradually close, 
the abdomen swells, the whole body stiffens, and an apo- 
plectic death follows. ASTHMA THYMICUM. SYPHILIS. 
Duration is from two to four days. The disease is, in 
most cases, incurable; mortality is in proportion of one to 
fifty. 
Pathogenesis. Vitiated milk, accumulation of meconium, 
confined vitiated air, local irritation, especially from the 
navel-string- being too closely tied, taking cold. 
Therapeutics. An emetic and change of milk, injections 
and warm baths must immediately be resorted to; inter- 
nally, zinc (No. 261), and linctus (No. 262), is to be given. 
I once succeeded in saving a child by these united means. 
The ointment, No. 263, is to be rubbed into the gums, 
spine, and abdomen. If this is unavailing, try injections, 
with six drops of laudanum, every four hours, and frictions 
of ointment of cantharides on the back and chest. 
ASTHMA THYMICUM. 
Diagnosis. Attacks of short whistling, imperfect in- 
spiration ; sometimes a complete stoppage of respiration ; 
spasmodic motions of the limbs, cold extremities, red 
face ; these symptoms last for some minutes and then pass 
off, leaving the patient perfectly well and breathing freely. 
Children are liable to this complaint from the first weeks 
to the second year. The attacks most commonly happen 
at the time of awakening in the morning, or after excite- 
ment and anger. They may, though rarely, terminate in 
fatal suffocation, but more frequently they are free from 
danger, gradually decrease, and finally cease entirely. 
The cause seems to be a too large and firm thymus, and 
its tardy absorption, connected with great irritability and 
sensibility of the pectoral nerves. 
A cure, therefore, can only take place by a gradual 
diminution of this gland, an operation which is the work 
of nature. Art can do nothing more than promote this 
process by low diet and frequent purgatives; and, as a 
palliative, diminish the spasmodic action of the pectoral 
nerves and fits of spasm. This is best effected by phos- 
phate of lime, valerian (pulvis antispasmodicus, No. 257), 
small doses of zinc, and, in more violent degrees, musk 
and warm baths. 
SYPHILIS. 
Diagnosis. Ulcers or eruptions which exist at the time 
of birth, or come on a few days after, the parents being 
evidently infected with syphilis. 542 
DIARRHOEA. 
Therapeutics. The treatment must be mercurial, but in 
the mildest forms and doses. Aethiops mineralis, half or 
one grain a day, along with pulvis puerorum and baths, are 
generally sufficient; in obstinate cases, mercurius solubilis 
Hahnemanni or calomel is to be administered. If a syphi- 
litic mother nurses the child, she is to undergo the same 
treatment. Syphilitic ulcers in the mouth of the child may 
be moistened with a diluted solution of corrosive sublimate 
and lime water (d grain of corrosive sublimate to three 
ounces of aqua calcis). 
DIARRHOEA, 
Is one of the most common accidents of this period. It 
may be attended with or without pains, which are recog- 
nized by the child drawing its legs up to the abdomen. It 
is generally without any danger, is even salutary, and must 
not be stopped. It becomes dangerous only when it causes 
exhaustion by its copiousness and long continuance, or 
when it is suddenly stopped. 
The most common cause in suckling infants is acidity in 
the first ways, or taking cold; when older, irritation by 
dentition, overloading of the stomach, also worms. Fre- 
quently returning diarrhoea creates weakness of the diges- 
tive organs, and thereby a disposition to its return. The 
worst cause is obstruction of the pancreatic and intestinal 
glands (vide Atrophia). 
The treatment depends altogether on the causes, which 
are: 
1. Acidity. Is recognized by green stools, having the ap- 
pearance of chopped eggs, and the sour breath of the child. 
Such a case is promptly remedied by magnesia, with rhu- 
barb (pulvis puerorum), and, if this is ineffectual, by lapides 
cancrorum (No 264). When the bellyache is violent, an 
injection of chamomile tea, with gruel, and a teaspoonful 
of oil gives relief. When the diarrhoea ever and anon re- 
turns, the cause lies in the food, which inclines too much 
to acidity. If the child is at the breast, the nurse must 
take more exercise, eat animal food, and take the milk- 
powder (No. 265). When this course will not do, change 
the nurse. Diarrhoea is more frequent in dry nursing, when 
faulty diet, acescency of,the aliments, and using milk or 
gruel kept too long are the causes. This must be carefully 
attended to. 
2. Irritation caused by dentition. It is recognized by the DIARRHOEA. 
543 
respective signs (vide dentition), and the stools generally 
being watery. If the diarrhoea be moderate, do not inter- 
fere. It is the best derivative from the head and preserva- 
tive against dangerous accidents, as spasms, fever, &c., 
and saves the use of purgatives. But when it becomes 
violent, nothing else can be done than to moderate the 
irritation ; for we cannot do away with the stimulus itself. 
This end is usually attained by absorbents and mucilages, 
as prepared chalk, or pulvis puerorum, in small doses; or 
the antispasmodic infantile powder (No. 257), salep, muci- 
laginous injections. But if it becomes so violent that 
spasms set in, then strong astringents are needed, the 
surest of which is opium. The greatest caution, however, 
must be observed in its use ; and I cannot sufficiently in- 
culcate prudence ; for if the dose is only a little too strong 
or improperly prescribed, it will create a sudden stoppage, 
which may be followed by instantaneous death, in conse- 
quence of apoplexy. For, in the first place, this immoder- 
ate diarrhoea may be the effect of the dental irritation, ac- 
companied by too great a sanguineous congestion to the 
brain, to which are also due the concomitant nervous 
attacks. It is, therefore, not owing to weakness. It may 
easily be conceived, that opium, given in such a state, must 
produce apoplexy. This must be presumed to be the case 
in a plethoric well-fed child, or when the head is hot and 
the face flushed. The first thing to be done is to apply two 
leeches behind the ears, after which the diarrhoea will often 
cease of itself; or, if that does not suffice, we may have 
recourse, with safety, to laudanum. 
The second case is when no signs of congestion are 
present. The child is not plethoric, but rather weakly and 
ill-fed, and nervous fits set in. It allows opium to be ad- 
ministered immediately, but only in the most minute doses, 
for a small dose is sufficient to attain the end sought, and 
avoids the injurious influence on the brain. It is to be 
given as directed in No. 266. Commence by giving one of 
these powders (containing i drop or grain of opium), and 
wait for the effect, which often suffices to moderate 
the discharges; repeat it only when they again become 
frequent. But if the first dose takes no effect, give a 
second powder four hours after, and continue so until the 
violence of the diarrhoea is diminished, when the use of it 
is to be stopped, or longer intervals made. Give, at the 
same time, an injection of starch, of salep, rice, or egg- 
water ; and make an embrocation of the ointment, No. 267, 
on the abdomen. In great weakness and continual diarrhoea 544 
VOMITING. 
the simultaneous use of extract of cascarilla (No. 268) is 
an excellent and really a specific remedy. Also warm 
baths are of great use. 
3. Finally, merely a cold can be the cause, owing to 
too light clothing, lying exposed during the night, leaving 
the infant wet; causes into which the physician must par- 
ticularly inquire, since they are often totally disregarded. 
In such cases, wrapping the belly in flannel, a warm 
regimen, elder tea, and injections of starch generally are 
sufficient for a cure. 
Does diarrhoea become chronic with children, or does it 
return on the least occasion, the continued use of extract 
of cascarilla is the best remedy; besides warm baths, 
covering the abdomen and back with flannel, embrocations 
of the strengthening ointment, in both regions, warm baths 
with chamomile, strict animal diet. In children of more 
advanced age, acorn coffee is also recommendable. 
One cause more of diarrhoea remains to be mentioned, 
which sometimes occurs in children, and calls for our at- 
tention. Softening of the membrane of the stomach, 
which may increase to perforation. Its signs are : sudden 
appearance, rapid decay of the countenance, and quick 
emaciation, discharge of mucous water, sometimes also 
vomiting of acid-smelling matters, of food, frequent whim- 
pering, inflation of the epigastric region, coma ; pulse ex- 
tremely quick and small, much thirst. The best treatment 
is, application of two or three leeches to the epigastric 
region, warm fomentations of a decoction of balm-mint, 
elder-flowers on it, tepid baths twice every day: internally 
a teaspoonful of a mixture of aqua chlorin. in six ounce's 
of water, with mucilage of gum arabic, to be talfen every 
two hours, mucilaginous injections, milk as a beverage; 
cold fomentations on the head. 
VOMITING. 
Vomitus. 
The principal rule here is also: Vomitus vomitu curatur. 
In most cases the vomiting of children is nothing but a 
salutary attempt of Nature, to rid herself of injurious mat- 
ters contained in the stomach. It is, therefore, best to 
promote vomiting, so as to attain that end. In little deli- 
cate infants, frequent drinking of chamomile tea, and a 
teaspoonful of oxymel scilliticum is sufficient. In more 545 
NERVOUS ATTACKS, SPASMS, CONVULSIONS. 
grown infants, a teaspoonful of the linctus emeticus. 
After vomiting a few times, follow up the treatment with 
rhubarb or pulvis puerorum, which will appease the throw- 
ing up and evacuate the remaining impurities by the intes- 
tinal canal; at the same time give mucilaginous beverages, 
and when the vomiting is violent and the bowels consti- 
pated, a mucilaginous injection. 
But never forget that vomiting may have important and 
remote causes. The following cases deserve attention. 
If vomiting is attended with fever, the epigastric region 
distended, and painful on the pressure, causing the child to 
cry, an inflammatory state of the stomach is to be feared 5 
for which the application of some leeches to that region, 
and the use of mucilaginous beverages and gentle purga- 
tives are required. When fever is present with sopor and 
costiveness, vomiting is sympathetic of an inflammatory 
state of the brain, which must be removed. Does it return 
chronically, it may point to a chronic affection of the head, 
or softening of the stomach, also to worms. 
NERVOUS ATTACKS, SPASMS, CONVULSIONS. 
Eclampsia. 
In all spasms and convulsions of infants we are to look 
particularly to the cause. It lies most frequently in the 
stomach and intestinal canal. Acidity in sucklings, over- 
loading, sordes, worms, constipation of the bowels, even 
mere accumulation of winds may produce them. In such 
cases, cathartics, injections, absorbents (magnesia, lapid. 
cancror.), also the very efficacious antispasmodic infantile 
powder (No. 257), and carminatives are the best means 
of relief; vomits, when they are indicated. I have seen in 
the most violent and continuous convulsions, with sopor ap- 
parently apoplectic, after all antispasmodics had been used, 
and when it was ascertained that an overloading of the 
stomach had preceded, one single emetic immediately and 
completely remove spasm and sopor, and restore perfect 
health.—At a later period, the irritation of dentition may 
be the cause (vide dentition). In this and also in other 
cases, not seldom occurring, spasms are owing to sanguine- 
ous congestion or inflammatory affections of the brain, 
which are recognized by the redness of the face, heat of 
the head and forehead, and a soporous state (vide hy- 
drencephalon acutum). Such a case calls for the applica- 546 
tion of ,a few leeches on the temples and behind the ears, 
and for purgatives and injections. When signs of conges- 
tion are absent, in weakly, nervous subjects, when the 
spasms continue, after the removal of the gastric causes, 
the use of direct antispasmodics is needed, of which the 
animal earths, flor. zinci, valerian, clysters, antispasmodic 
embrocations, and tepid baths are the principal ones to be 
mentioned. 
FEVERS. 
Be cautious in using stronger excitants, for they are 
likely to create over-irritation and apoplexy. Only in ex- 
treme cases resort to musk and opium; the latter is best 
used in injections, and in minute doses. 
FEVERS. 
Febres, 
Diagnosis. Thirst, heat in the mouth, hot breath, hot 
forehead, accelerated pulse. These signs suffice ; for the 
pulse is fallacious in children. 
Pathogenesis. The causes are usually a gastric, a catar- 
rhal, or a dental irritation ; therefore, in slight cases, no- 
thing more need be done than to give a few doses of the 
infantile powder, and to confine the child to the room. 
Should this treatment fail, distinguish the different species 
of fever. 
1. Gastric Fever, the most common in children. 
Diagnosis. Want of appetite, nausea, eructations, bad 
breath, furred tongue ; also spontaneous vomiting ; fre- 
quently there is rattling in the throat, and oppression of 
the chest. Sometimes slight convulsions, particularly, 
starting up during sleep. 
Therapeutics. Commence by giving the linctus eme- 
ticus, until three rejections have been effected (in case of 
constipation an injection must be previously administered), 
then injections and a purgative, antiphlogistic linctus, No. 
269. No broth, no eggs. 
In all fevers of children, when they are accompanied 
with an aversion of food, I advise the linctus emeticus, at 
the commencement. It will frequently annihilate the fever 
at its very origin ; it will give to the disease and subse- 
quent treatment a more favorable turn, even if the fever be 
premonitory of an exanthema. FEVERS. 
547 
2. Cold in the head, Catarrhal Fever. 
Sneezing, discharge from the nose and eyes, cough, 
hoarseness,’ in infants there is commonly a rattling in the 
throat, because they cannot throw up the phlegm. 
In this fever also it is best to commence the treatment by 
the linctus emeticus, partly in order to evacuate the gastric 
irritants which are generally present, partly to free the 
lungs from phlegm, partly to prevent croup. After this, 
an antiphlogistic diaphoretic linctus (No. 270), gruel with 
sugar-candy, and occasionally light elder-tea. 
3. Fever from Teething. 
Fever with all the signs of dentition (vide below). 
4. Worm Fever (in children of more advanced age). 
Fever with verminous symptoms, especially bellyache ; 
a distended but not hard abdomen. 
Antiphlogistic treatment, joined to the palliative method 
of cure of worms, especially milk taken internally, and by 
injections ; oily remedies, mercurial water ; calomel (vide 
helminthiasis). 
5. Inflammatory Fever, Pectoral Fever, Brain Fever. 
An inflammatory local affection of a noble viscus, espe- 
cially of the lungs (pectoral fever), and of the head (brain 
fever). The first is recognized by a short rattling respira- 
tion, with a constant irritation, producing coughing; and 
constant crying (evidently caused by pains) : the latter by 
a soporous state, and occasional convulsions. Local in- 
flammation may also be generated in the abdominal viscera, 
especially in the liver, which is recognized by distention 
of the abdomen, heat at the part affected, and the expres- 
sion of pain or pressure. The before-mentioned linctus, 
mixed with half a drachm of nitre ; the application of some 
leeches on the chest, head, or abdomen ; small doses of 
calomel; when sopor continues {hydrocepha- 
lus acutus), cold fomentations on the head are of use. In 
pulmonary inflammation, when the above-named remedies 
are unavailing, and the rattling threatens to suffocate the 
child, the linctus emeticus, sulphur antimonii aurat. in 
small doses, triturated with sugar, may be resorted to. 
In abdominal inflammations apply, besides leeches and 
general antiphlogistics, fomentations of warm milk and 
tepid baths. 548 
DIFFICULT TEETHING. 
But even in the apparently cerebral and pectoral affec- 
tions of children, I cannot too strongly recommend atten- 
tion to the probable existence of a gastric source. I have 
seen children lay for days in a soporous state, and all anti- 
phlogistic remedies proving useless, when, finally, a single 
emetic has removed the whole disease. It was ascertained 
that a mere surcharge of the stomach with indigestible food 
was the sole cause of sopor and cerebral affections. 
6. Exanthematic Fevers (see Variolce, Morbilli, Scarlatina). 
They hardly admit of recognition in the first stage ; and 
it is best to treat them according to general rules, and, 
particularly, not to neglect cleansing of the intestinal 
canal and the stomach by emetics. 
DIFFICULT TEETHING. 
Dentitio difficilis. 
Dentition, by itself, is not a disease, but belongs to the 
natural developments, as birth does. But, as parturition 
by accidental and accessory causes may bring on maladies 
and danger to life, so may dentition. Thus it becomes one 
of the most frequent causes of the diseases of children, to 
which the physician cannot too earnestly direct his atten- 
tion. 
Diagnosis. The period of life (from the fifth to the 
twelfth or fourteenth month), the infant salivates much ; 
constantly carries things to its mouth, on which it may 
bite ; the mouth is hot, likes to have it touched ; frequently 
laments and cries ; the gums are swollen.' 
At the same time the following concomitant symptoms 
appear: most frequently there is diarrhoea ; in some there 
is costiveness ; fever, cutaneous eruption, heat of the head, 
coughing, rattling in the throat, difficulty of breathing, 
spasms, convulsions, local inflammations, especially of the 
brain and of the lungs. The accidents cease and return 
periodically ; cease entirely when the tooth has pierced the 
gum, but when the tooth has not pierced, they become 
more violent, and end fatally by convulsions, apoplexy, and 
suffocation. 
The most favorable symptom is diarrhoea. It serves as 
a natural derivative, and prevents fever, spasm, cerebral 
affections, and all other dangerous accidents. DIFFICULT TEETHING. 
549 
Course. Dentition commences about the fifth month, by 
an internal development at first, which is imperceptible 
externally. The tooth grows in all its dimensions, creating 
irritation by its pressure within the maxilla. This is 
generally made known only by increase of the salivary se- 
cretion f but it also frequently excites very violent con- 
sensual accidents. Next comes the cutting through of the 
teeth; the incisors appear first, then the first grinders, 
afterwards the eye-teeth (dentes canini). This process 
generally commences at the seventh up to the twelfth 
month, in rare cases earlier, even before birth. Tardy den- 
tition is always better than too early. 
Pathogenesis. It is not only the cutting of the teeth, but 
the acquisition of language, and its associate reason, the 
first appearance of mental existence,—the greatest revolu- 
tion in life,—which are the causes that render this period 
so important and dangerous, and give particularly rise to 
great congestion to the brain. 
The effects of dental irritation are double,—local and 
consensual. The local effects are: inflammation, swel- 
ling, pains, salivation, trismus, even sometimes suppuration 
and gangrene. The sympathetic effects are: first and 
most frequently, irritation of the intestinal canal; diarrhoea, 
even discharge of blood (teething dysentry), sometimes 
obstruction,—ileus; irritation of the vascular system,— 
fever; irritation of the skin,—eruptions; irritation of the 
chest,—cough, accumulation of phlegm, rattling; of the 
mucous membranes,—ophthalmia, otorrhoea ; of the nerv- 
ous system,—spasms, affections of the brain. 
The accessory causes, which render this development 
difficult and make dentition a disease, are : the form of the 
piercing tooth ; the eye-teeth, therefore, give most trouble, 
since they are pointed and increase conically in thickness, 
first break and then keep continually stretching ; too large 
a number of teeth cutting at once, which may be particu- 
larly accelerated by fevers, as by exanthematic fevers 
(measles and small-pox may thereby terminate fatally) ; the 
complication of other diseases; and, finally, the constitu- 
tion, the individual as well as the general (scrofulous, 
rachitic nervous constitution renders dentition difficult). 
Difficult dentition may, therefore, prevail even epidemic- 
ally. 
Therapeutics. The irritative, the exciting cause, the cut- 
ting tooth, cannot of course be done away with. Therefore, 
nothing can be done but appease the effects of the irrita- 
tion,—the spasms, congestion, and thereby prevent danger. 550 
CUTANEOUS ACRIMONY, ETC. 
The principal means for accomplishing this end is deriva- 
tion by the intestinal canal (a remedy which Nature herself 
indicates by diarrhoea) by gentle laxatives and injections. 
In congestions to the head, one or two leeches on the head ; 
in nervous irritation, spasms—flores zinci, valerian ; when 
they appear very intense—musk, tepid baths, antrspasrno- 
dic injections j locally, means which soften and wear away 
the gums, as by chewing marshmallow root and similar 
substances. In an extreme case, when the point of the 
tooth is still retained by a tender skin, cutting of the gum 
may be resorted to, but not too early, since this might 
rather prevent than promote its breaking through. 
CUTANEOUS ACRIMONY, BILES, CRUSTA LACTEA, SCALDHEAD. 
These disorders occur frequently in children. Often they 
are owing merely to abundant, especially too nutritious 
(animal) food, to plethora, or to injurious acrid and irrita- 
tive aliments. They may also be caused by neglect of 
cleanliness, by corrupt, moist air, too warm regimen. 
They may, however, also be a symptom of a scrofulous 
diathesis. 
In common cases nothing is wanted for a cure but regu- 
lation of diet, diminution of food, avoiding all fat, acrid, 
salted, heating meals, living on vegetables; cleanliness, 
frequent change of linen and air ; tepid bran baths, the use 
of rhubarb and magnesia, or pulvis puerorum, along with 
infusion of pansy, continued for some time. If the 
complaint does not yield, add a few grains of aethiops 
mineralis (£■ grain for each year of the child’s age); it 
generally suffices. The doses of the powder must be made 
so as to purge several times a day. In very obstinate 
cases add (instead of aethiops) Plummer’s powder (calo- 
mel, sulph. antim. aurat. \ or f grain of each every twenty- 
four hours), and sassafras-tea (No 271). When the dis- 
order is of a scrofulous nature, which is recognized by the 
symptoms of scrofula, especially by glandular swellings on 
the neck co-existing, the treatment of scrofula must be 
pursued (vide Scrophulosis). 
The same treatment is the best for crusta lactea and 
scaldhead. In the first case, when it is obstinate, the nurse 
must be changed. In tinea capitis the hair must be cut, 
but not too short, and frequently combed and washed with 
tepid soapwater. 
The use of external topical remedies is in general wrong, CROUP 
551 
for they are apt to produce a retrocession and metastasis 
of the acrimony to noble parts; while the use of the above 
remedies is sufficient in most cases (vide Tinea). 
In obstinate cutaneous diseases of children at the breast, 
the case must always be investigated, to know whether it 
be not owing to a concealed syphilitic dyscrasy of the 
nurse. 
CROUP. 
Angina polyposa, membranacea, Laryngitis exsudatoria. 
Diagnosis. Hoarseness, short, difficult respiration, ac- 
companied by a whizzing, or whistling, or rattling sound, 
cough with hoarse, whistling, croaking, barking tone; when 
the oppression of the chest increases, the child makes at- 
tempt to stretch the throat and extend it upwards (not to 
shorten it by bowing forwards, as in pulmonary inflamma- 
tion) ; violent fever ,• in bad cases—sopor. 
A prompt diagnosis is momentous on account of the 
great danger and rapid fatality of this disease. There are 
two diseases, with which it may be confounded:—the first 
is a violent catarrh of the throat. There are some kinds 
of this catarrh, in which hoarseness and a barking cough 
(the so called sheep cough) are present.—The second is 
the asthma acutum Millari. To confound croup with this 
affection is the more dangerous, since it calls for quite a 
different treatment, antispasmodic remedies, musk, asa foe- 
tida; croup on the contrary for antiphlogistics and ab- 
stractions of blood. They are distinguished by this: that 
asthma sets in all of a sudden, croup appears always after 
catarrhal symptoms have preceded; the croup is always 
attended with fever, and usually a very violent one ; the at- 
tacks of asthma, as of a spasmodic disease, are periodically 
violent or weak, even cease entirely for hours; the symp- 
toms of croup are always present with equal intensity, and 
in croup the urine is feverish, inflammatory, red; in asthma 
spasmodic and pale. 
Its course is very rapid. The disease terminates within 
two, three, at most six days. Death ensues by suffocation 
or by apoplexy, sometimes even after respiration has be- 
come free, in consequence of congestion and paralysis of 
the brain thereby created. 
Pathogenesis. The proximate cause is inflammation of 
the mucous membrane of the larynx, with the peculiarity 552 
of coagulable lymph being extremely rapidly effused, thick- 
ening the membranes, and forming polypous concretions, 
which straiten, even mechanically close up the trachea. 
The predisposing causes are: the infantile age up to the 
7th year, on account of the great plasticity at that time of 
life; farther, a too nutritious and heating diet, animal food 
and wine, therefore it occurs now-a-days more frequently, 
on account of this unreasonable but fashionable change. 
Exciting causes : Influence of cold, east and north-east 
air blowing into the open mouth, catarrh. 
Therapeutics. The inflammation must be resolved as 
promptly as possible, and the thickened lymph or new- 
formed tissue be discussed and dislodged. Assistance 
must be prompt, and remedies administered with all haste. 
The treatment, therefore, consists in using the linctus 
emeticus and warm vapors, as soon as the characteristic 
symptoms of the disease appear; and, if this be of no avail, 
in applying leeches to the throat, 1 to 3 for children of 
less than one year of age, 4 for those of two years, increas- 
ing the number in proportion to the years (12 leeches 
kill a child of six months ; of this I have seen an instance) ; 
and administering a dose of calomel, in infants grain, in 
more grown children up to 2 grains ; intermediately a linc- 
tus containing nitre, and inhalations of warm vapors (of 
elder flowers steeped in water) and injections with a table- 
spoonful of vinegar, in order to effect a proper discharge 
from the intestines, which is here highly useful, even in- 
dispensable to salvation. If no improvement follows with- 
in 24 hours, give sulphurate of copper, a most efficacious 
remedy for removing the spasmodic state, which keeps up 
the disorder. It may be triturated with sugar and admin- 
istered with water or in a linctus, first in such doses as 
to create vomiting (1 to 4 grains according to the age), then 
■b of a grain every 2 hours; when the suffocative fits re- 
turn, resort again to the former dose, which creates vom- 
iting, and cause mercurial ointment to be rubbed on the 
neck, and sinapisms and vesicatories on the throat. When 
rattling continues, a vomit is the best remedy to clear the 
larynx from the formed concretions. Sulphurous remedies 
are likewise serviceable. Give musk when weakness and 
spasm increase. If, as sometimes happens, sopor and con- 
gestion to the head remain, in consequence of the long 
strangulation, leeches must again be applied to the neck 
and the temples. If all these remedies fail, a paralytic 
state must be supposed, then cold lotions to the head, and 
even affusions have yet proved useful. 
CROUP millar’s asthma. 
553 
Be, however, careful not to take every hoarseness, at- 
tended with a barking cough, for an incipient croup, as 
is now too frequently the case, and to proceed immediately 
to this harsh treatment. Administer the linctus emeticus. 
I have often seen all the symptoms of apparent or begin- 
ning croup entirely disappear after a strong vomit. Such 
a catarrhal state may be the beginning of croup, which I 
have often removed by an emetic seasonably administered. 
The same applies to the uncertainty, whether we have to 
do with croup or a spasmodic asthma. Also here an eme- 
tic is the best means, and is suitable to all cases. 
millar’s asthma. 
Asthma acutum infantile. 
Diagnosis. Sudden attack of short breath, usually at 
night; the respiration is gasping, whistling, approaching to 
suffocation; attended with great anxiety ; barking cough, 
in the tone of a large dog; no fever; after 6 or 8 hours 
the symptoms entirely cease; the child feels well during 
the day ; in the next night the same accidents return with 
still more violence, again entirely cease, and so on. Death 
generally ensues by suffocation on the third day. Some- 
times it finally becomes permanent. It may be easily con- 
founded with angina membranacea; which is a dangerous 
mistake, for this is an inflammatory, the asthma a spasmo- 
dic disease, and each must be treated differently. 
The discriminative signs are : In asthma there is a re- 
mission, even intermission of the dyspnoea; in angina it 
continues permanently ; in asthma there is no fever, in 
croup inflammatory fever; in asthma pale, in croup red 
urine ; it attacks only children from 2 up to 8 years of age. 
Pathogenesis. Causes: Taking cold, damp air, and 
moist dwelling. 
Therapeutics. The only indication is to remove most vi- 
gorously and promptly the spasm. Commence Wh an 
emetic, then give asa fffitida internally (vide No. 272) and 
in injections, musk in large doses, antispasmodic embroca- 
tions to the chest, abdomen and spine, sinapisms and can- 
tharides on the chest. 554 
HYDROCEPHALUS. 
HYDROCEPHALUS ACUTUS. ENCEPHALITIS EXSUDATORIA. 
HYDROCEPHALUS CHRONICUS. HYDROCEPHALUS EXTERNUS. 
Acute and Chronic Hydrocephalus. 
SPINA BIFIDA. 
Hydrocephalus Acutus. 
Diagnosis. The precursors are the most important. They 
are : the fontanel remaining too long open, a head of dis- 
proportioned size (too large), especially the forehead; un- 
usual vivacity and prematurity of mind ; or stupidity, dul- 
ness of the mental faculties, great drowsiness; or falling 
asleep amid play, dilated pupil, squinting, very frequent 
falling down, want of strength of the feet, frequent head- 
ache, lying on the belly and forehead during sleep. 
Signs of the formed disease :—lt may be divided into 
two stages, stadium irritativum and paralyticum. In the 
first stage sopor and convulsions occasionally, sometimes 
even violent epileptic spasms, vomiting, especially in an 
upright position of the head, obstructio alvi, inclination to 
lean the head, falling of the head forward or sideways, a 
peculiar staring and at the same time squinting look of the 
eye, with trembling of the pupil. The pulse is very une- 
qual, sometimes frequent, at other times slow. 
In the second paralytic stage: deep sopor, not to be 
awakened, paralysis of single limbs, finally apoplectic 
death. 
The diagnosis is sometimes difficult at the commence- 
ment. The disease admits a possibility of being confound- 
ed with worm fever and dental affections. The most im- 
portant distinctive sign is vomiting and constipation of the 
bowels, which are not present in other affections of the 
head. 
The disease lasts Bto 21 days. It is met with most fre- 
quently from the Ist to the 7th year, more frequently since 
thirty years past than formerly. 
It may be primary or secondary, as a consequence of 
another disease, especially of a febris acuta or of another 
internal inflammation. 
Dissection shows accumulation of blood in the cerebral 
vessels and serous effusion in the cavities of the brain and 
spinal marrow. 555 
HYDROCEPHALUS. 
Pnthoge?iesis. The causes are: Congenital disposition, 
children with an unusual large head, with congenital weak- 
ness of the brain ; there are families, in which all the chil- 
dren become affected with hydrocephalus (sometimes only 
those of one sex, sometimes at a certain period of life), 
scrofulous disposition, all that can keep up a permanent 
congestion to the brain or exaltation of imagination, wine, 
spiced diet for children, dentition. Thus every acute fever, 
every cerebral inflammation may pass into this disease ; a 
stroke, a fall on the head (also the influence of the sun- 
beams on the bare head during the summer, the influence 
of rigid cold in the winter, particularly the sudden omis- 
sion of warm covering of the head ; likewise cutting the 
hair short in winter can give rise to the malady). Metas- 
tases to the brain, especially scrofulous and psoric (a ra- 
pidly suppressed scaldhead or otorrhoea, and the like). 
Thus the modern fashion of leaving the head bare and 
wearing the hair short in children, which, no doubt, has 
diminished the frequency of scaldhead, may have given 
occasion to the more frequent formation of this di SGaScj 
even by preventing the scrofulous acrimony, formerly 
created by warm caps, to deposite on the skin as tinea 
capitis. 
Therapeutics. In acute hydrocephalus an inflammatory, 
at least a congestive state of the brain must generally be 
suspected, the speedy removal of which best prevents ex- 
sudation. Therefore, leeches are to be applied behind the 
ears and on the temples, and calomel, £ to 1 grain, accord- 
ing to the difference of age, is to be administered every 2 
or 3 hours, irritant injections, particularly with an addi- 
tion of vinegar, are to be given, so that three or four dis- 
charges from the bowels be produced. This discharge is 
indispensable, and if calomel alone is insufficient, jalap must 
be added; the hair must be shaved off, and cold fomenta- 
tions or bladders filled with ice applied to the head; small 
doses of digitalis to be given, and sinapisms to the soles of 
the feet; in infants, the feet are to be enveloped in a cloth 
wetted with decoction of mustard. This often suffices for a 
cure, which is recognised by cessation of the sopor and con- 
vulsions.—But, should the sopor continue, as well as the 
redness of the face and the heat of the forehead, applica- 
tion of leeches and affusions of the head with cold water 
are the only salvatives. The leeches are to be repeated 
every 2 hours, the intervals shortened and the water poured 
down from a greater height, until the child manifests a re- 
turn of sensation by crying. Then the frequency of the 556 
HYDROCEPHALUS. 
applications may be gradually decreased. In obstinate 
sopor a vesicatory applied to the neck is of extraordinary 
efficacy, likewise the concomitant use of diuretics, as di- 
gitalis, oxymel scilliticum, decoction of rad. levistic., ni- 
trous ether. 
The disease is apt, especially in scrofulous individuals, 
to leave a disposition to recidives, for which the best pre- 
servative is a fontanel on the arms, cold washing and affu- 
sion of the head every morning and evening, and a cathar- 
tic of calomel and jalap every fortnight ; the efficiency of 
which experience has confirmed to me in several cases. 
In chronic hydrocephalus the same treatment, only less 
active, but continued for a longer time, must be followed. 
Also fomentations of the head with acetum scillss, mercu- 
rial inunctions in the neck, artificial ulcers on the neck 
kept in copious suppuration, may here be of use ; but above 
all, the remote cause, as scrofula or psora, is to be attend- 
ed to. 
Other organic diseases of the brain, as hypertrophia, 
hydatidcs, tubercles, indurations, suppurations, softenings, 
hardly admit of diagnosis, and still less of a cure. The signs 
distinguishing them from hydrocephalus are, that sopor 
is absent, or at least happens only periodically in those dis- 
eases, whilst the other symptoms resemble those of dropsy. 
The treatment is the same as that stated under hydrops, 
which is frequently associated here. Softening of the brain 
is remarkable for this, that the children are able to walk 
about until the last moment; it is only indicated by weak- 
ness of the extremities, weakness of memory and other in- 
tellectual faculties, sudden attacks of violent headache, 
sometimes also transient spasms, and a nervous apoplectic 
fit suddenly terminates life. 
Hydrocephalus Externus. 
Accumulation of water between the brain and the cere- 
bral membranes—is generally a congenital disease. The 
fontanels will not close at all, but rather dilate more and 
more with the increasing distention and attenuation of the 
cranial bones and enlargement of the whole head, which 
may become enormous; in the fontanels an elastic disten- 
tion with fluctuation is perceived. A child may live in 
this state to its 14th or 18th year, whilst its organic life 
is otherwise progressing, even growth and development are 
undisturbed. A cure is rarely possible, and may only suc- 
ceed in the first years of life. The treatment consists in a DECAY OF CHILDREN. 
557 
vigorous application of mercurials, drastic purgatives, diu- 
retics, artificial ulcers, daily cold affusions of the head, fo- 
mentations of the head with acetum scilliticum, also a gra- 
dual and moderate compression by agglutinative plasters. 
Even a cautious puncture with needles occasionally per- 
formed, followed by immediate compression has sometimes 
proved useful. 
Spina bifida, hydror-rhachitis is the same disease oc- 
cupying the lower part of the spine, and exhibits an elastic 
tumor appearing through a cleft of the vertebral column. 
It is incurable ; cautious acupuncture repeated from time to 
time combined with compression, may be tried; the issue 
has hitherto been fatal in most cases. 
DECAY OF CHILDREN. 
Atrophia mesenterica Infantum. 
Diagnosis. Distended, hard abdomen, on which hard 
nodes are frequently perceived, and total emaciation of the 
extremities. It is attended with the greatest, often insa- 
tiable appetite (which gave rise to the superstition of witch- 
craft, in order to account for the constant eating and be- 
coming more and more meagre), usually there is costive- 
ness, intermediately also diarrhoea, pain in the belly ; old, 
wrinkled, disfigured countenance; the skin is in general 
inactive, flaccid, and often exhibiting comedones. 
Pathogenesis. The proximate cause is obstructed chyli- 
fication and impeded passage of the chyle into the blood 
by obstruction in the mesenteric glands. Remote causes: 
sickliness, weakness, old age, syphilis, scrofula of the pro- 
genitors. Want of mother’s milk or unhealthy nurse’s 
milk, most of all artificial nutrition by heavy pastry or sour 
aliments, heavy farinaceous meals, potatoes in infancy; 
overfeeding in general, worms, neglect of cleanliness and 
cultivation of the skin; closed, corrupt, damp air, tight 
lacing of the abdomen, spirits, opiates. 
The disease is most frequent from the first to the third 
year ; it may however befall adults as a symptom of scro- 
phulosis. 
The disease admits easily of a cure, when the necessary 
remedies are used in time. But, if neglected, it becomes 
fatal, either by total induration of all the mesenteric glands, 
which withholds from the system access to nutrition, or 558 
LIMPING. 
by chronic inflammation and a gradual suppuration of the 
mesenteric glands. 
The indication of cure is to restore the obstructed 
glands, to restore and strengthen the digestive system as 
well as the whole body. In the first year, and where want 
of mother’s milk and bad food are the cause, usually no- 
thing else is needed but a good wetnurse, or, when this 
cannot be had, fresh goat’s milk or egg-water as a bever- 
age, and tepid baths of malt, intermediately the powder for 
children. 
In great intensity of the disease and in more advanced 
age, likewise egg-water, especially acorn coffee (a true 
specific for discussing the .hard, distended belly, malt- 
baths, cleanliness, daily new linen, which contributes 
essentially towards the cure, and may be made still more 
effectual by fumigating it with ambergris or other bal- 
samics), dry dwelling, residence in free salubrious air. 
At the same time use first magnesia, rhubarb with calo- 
mel, or sethiops mineralis, by which also worms, which 
frequently exist, simultaneously are removed; extract, of 
dandelion with Peruvian bark (vide No. 273); afterwards, 
ferruginous medicines, in which most reliance must be 
placed, since also the glandular obstructions are dependent 
on weakness, best alcoholized iron (sethiops martialis, flor. 
sal. ammon. martial.), or mild chalybeate waters, as those 
of Fachingen, Geilnau. Do not neglect to make at the same 
time inunctions into the abdomen of roborant dissolvent 
ointments, this promotes exceedingly the resolution. Malt 
baths are a principal remedy, even when a lingering fever 
is present, which they most efficiently remove. 
Of great importance is the consideration, whether chro- 
nic inflammation of the mesenteric glands exists, and if so, 
to remove it promptly that it may not pass into suppura- 
tion, which renders the disease incurable. As soon as 
pains in the abdomen supervene, the application of 3 or 4 
leeches is indispensable, and produces the most salutary 
effect. 
Clnudicatio spontanea, Coxalgia infantilis. 
LIMPING. 
Diagnosis. Limping, which comes on gradually, and 
sometimes suddenly, without an external cause ; no pain is 
felt while lying or at rest, but it is attended with pain on limping. 
559 
stepping, walking, or moving the foot, also by pressure on 
the hip-joint. It generally appears between the third and 
seventh year. After longer or shorter time, sometimes 
after a few days, an elongation of the affected leg and pro- 
minence of the trochanter is manifest. 
Pathogenesis. The proximate cause is an inflammatory 
affection of the hip-joint. The most usual remote causes 
in children are : a scrofulous or rheumatic metastasis; and 
this cause may associate with an external lesion, as a fall. 
Therapeutics. The best and generally successful treat- 
ment is the application of leeches to the joint, a warm bath 
with soap daily, mercurial ointment rubbed morning and 
evening on the hip-joint, and calomel (1 or 2 grains, ac- 
cording to the age) taken three times a day; intermediately 
a cooling purgative, so that a few fluid stools are daily 
evacuated. If improvement succeeds, which is perceived 
by the diminution of pain and gradual shortening of the 
foot, this method is to be persevered in, and nothing else 
need be done. If the disease does not abate after 8 days, 
a vesicatory is to be applied to the hip-joint. 
This gentle method is often of service, even when the 
disease is advanced ; and it is with it, that we are always 
to commence. When it is abortive, and only then, re- 
course may be had to the cauterium, either the actuate or 
potentiate. FORMULAS OF PRESCRIPTIONS. 
No. 1. 
Potio Riveri. 
R Potass® carbonatis 3 ij. 
Succi citr. rec. expressi q. 
s. ad perfect, saturat. 
Aqu® distillat® giij. 
Syrupi rubi id®i §i. M. 
Take of carbon, of potassa 
two drachms. 
Recently expressed lemon 
juice, as much as will sa- 
turate the potassa. 
Distilled water three ounces. 
Raspberry syrup one ounce. 
Mix. 
Two tablespoonfuls every two hours. 
No. 2. 
Aerated Powder. 
R Magnesi® carbonatis 3i. 
* (Velbicarbonatis gr.xv.) 
Acidi tartari, sacchari, aa 
3i. M. 
Take of magnesia one scru- 
ple. 
(Or of bicarbonate of mag- 
nesia fifteen grains.) 
Tartaric acid and loaf sugar 
of each one scruple. 
* When a brisk effervescence is wanted.—Made into a powder, and 
mixed in a glass of water ; the whole taken at once in a state of effer- 
vescence. 
No. 3. 
R Potass® bitartrat. ifss. 
Coque in vase terreo cum 
aquse fontan® ftv. 
Adde pomum citron, con- 
cis. No. i. 
Sacchari albi fvi. 
Take of cream of tartar half 
an ounce. 
Spring water 5 pints. 
Boil together in an earth- 
en vessel, and add one le- 
mon bruised. 
White sugar six ounces. 
Mix and strain for a drink. 
Beside one"or two misprints of spirit! for spiritus, and a few ablatives in 
a in place of genitives in as, the following corrections must be made : 
Recipe No. 88, add, Three powders, daily. 
“ “ 90, for every two hours, read every hour. 
“ “ 110, for Tincture of cinnamon 1 oz. read 1 drachm. 
47** 
ERRATA. 562 
RECEIPTS. 
R Nitratis potassse sij-iij. 
Antimonii tart. gr. i. 
Aquae fontanse §vij. 
Syrupi hordeati s. amyg 
dal. gi. 
No. 4. 
Take of nitre 2 to 3 drachms. 
Emetic tartar 1 grain. 
Spring water 7 ounces. 
Barley-sugar or almond sy- 
rup 1 ounce. 
Two tablespoonfuls every two hours. In irritable pa- 
tients substitute a decoction of mallows for the water. 
No. 5. 
R Potassse nitratis 3 ij. 
Sodse sulphatis gi. 
Antimonii tartarisati gr. i 
Aqu se fontanse gvij. 
Syrupi rubi idsei gi. M. 
Take of nitre 2 drachms. 
Sulphate of soda 1 ounce. 
Emetic tartar 1 grain. 
Spring water 7 ounces. 
Raspberry syrup 1 ounce. 
Two tablespoonfuls every two hours. 
R Fruct. tamarindorum, 
Mannse elect.5 aa §ss. 
Sodse sulphatis §i. 
Coque cum aquae fontanse 
ixij.-viij. 
Colat. adde 
Syrupi rubi idsei gi. M. 
No. 6 
Take of tamarinds and of 
flake manna each jounce. 
Sulphate of soda 1 ounce. 
Spring water 12 to 8 ounces. 
Boil and add to the strained 
liquor 
Raspberry syrup 1 ounce. 
Two tablespoonfuls every two hours, until it produces 
effect. 
No. 7 
R Aquae chlorin. sss.-i. 
“ distillatse ivij. 
Syrupi rubi idsei §i. M. 
Take of liquid chlorine £ to 
1 ounce. 
Distilled water 7 ounces. 
Syrup of raspberries 1 oz. 
Two tablespoonfuls every two hours. 
R Radicis valerianse con- 
tuses gss. 
digere cum 
Aqua fervida per hor. di- 
mid. in vase clause. Co- 
lat. gviij. Adde 
Liquoris ammonii acet. 
3 vi. 
Spirit! sulphur, setheri. 3i. 
Syrupi communis gss. 
No. 8. 
Take of valerian in coarse 
powder half an ounce. 
Boiling water, a sufficient 
quantity to leave 8 ounces 
of clear liquor after half 
an hour’s digestion. To 
which add 
Liquid acetate of ammonia 
6 drachms. 
Sulphuric ether f of a dr. 
Common syrup \ ounce. 
One tablespoonful every two hours. RECEIPTS. 
R Radicis Valerianae con- 
tuses |ss. 
“ angelicas 
Flor. arnicas aa 3 ij. 
digere cum 
Aqua fervida per hor. di- 
mid. in vase clauso. Co- 
lat. gviij. adde 
Liquoris ammonii anisat. 
Spiriti aetheris sulph. aa 
3i. 
Syrupi communis §ss. M. 
No. 9. 
Take of valerian, in coarse 
powder, £ an ounce, 
angelica 
Arnica flowers of each 2 
drachms. 
A sufficient quantity of boil- 
ing water to leave 8 oz. 
after boiling half an hour 
in a closed vessel. To 
which add 
Aromatic spirit of ammonia, 
Sulphuric aether, of each 1 
drachm. 
Common syrup f an ounce. 
Two table spoonfuls every two hours. 
R Pulver. rad. arnicas gss. 
Coque cum aqua font. %x. 
ad sviij. Adde 
Pulver. rad. serpentariae 
3ij. 
digere. Colat. adde 
Liquoris anodyn Hofman- 
ni. 3i. M. 
Syrupi cort. aurant. jfi. 
No. 10. 
Take of the powdered root 
of arnica an ounce. 
Boil in 10 ounces of water to 
8. Add to the clear liquor 
Powdered root of serpenta- 
ria 2 drachms. 
Digest and add to the strain- 
ed liquor 
Anodyne liquor of Hofmann 
1 drachm. 
Syrup of orange-peel 1 oz. 
Two tablespoonfuls every two hours. 
R Olei cinnamomi gutt x. 
Essen, ambrae s. moschi 
3ss. 
Balsam! vitae Hofrn. 3i. 
JEtheris sulphurici 3iss. 
Laudan. liquid! Sydenh. 
3i. 
No. 11. 
Take of oil of cinnamon 10 
drops. 
Essence of amber or musk 
\ a drachm. 
Hofmann’s balsam of life 1 
drachm. 
Sulphuric ether drachm. 
Liquid laudanum of Syden- 
ham \ of a drachm. 
Thirty drops to be taken every two or three hours. 
No. 12. 
r Pulver. cort. cinchonas §i. 
Coque cum aqua fontana 
fxvi. ad viij. 
Take of Peruvian bark 1 oz. 
Spring water 16 ounces. 
Reduce by boiling to 8 oz. 564 
RECEIPTS. 
adde 
Pulver. radicis serpentari®. 
“ “ Arnic®, aa 3ij. 
digere. Colat. adde 
Tinct. cinch. Whyttii 3iij. 
Aluminis crudi 3ij. 
Liquid! anody. Hofm. 3i. 
Syrupi cinnamomi gi. M. 
Add serpentaria 
Arnica root, in powder, 
of each 2 drachms. 
Digest, and add to the strain- 
ed liquor 
Whytt’s tincture of bark 3 
drachms. 
Crude alum 2 drachms. 
Liquid laudanum of Hof- 
mann 1 drachm. 
Syrup of cinnamon 1 ounce. 
Two tablespoonfuls every two hours. 
No. 13. 
R Antimonii tartarisati gr. 
Pulver. rad. ipecacuanhas 
3i. 
Oxymellis scill® gss. 
Aqu® fontan® gij. M. 
Take of tartrate of antimony 
2 grains. 
Powdered ipecacuanha one 
scruple. 
Oxymel of squills F ounce. 
Spring water 2 ounces. 
One tablespoonful every quarter of an hour, until vomit- 
ing be produced. 
No. 14. 
R Sulphate of soda gi. 
Mrnn® elect® 
Fruct. tamarindorum aa 
5 SS. 
Foliorum senn® 3ij. 
Ebull. cum aqua font. q. s. 
Colat. unc. gvij. Adde 
Syrupi rubi id®i gi. M. 
Take of sulphate of soda 1 
ounce. 
Best manna, and 
Tamarinds, of each \ ounce. 
Senna leaves 2 drachms. 
As much spring water as will 
leave after boiling 7 oz. of 
strained liquor, to which 
Add raspberry syrup 1 oz. 
Two tablespoonfuls every two hours, until it produce 
sufficient effect. 
R Extract! taraxaci 
“ Trifol. fibrin, aa 3ij. 
Elixirii visceral. Hofm. 
Tinct. rhei vinosse aa 3iij. 
Aquse menthse piper. giv. 
M. 
No. 15. 
Take of extract of dandelion, 
Tincture of trefoil, of each 
2 drachms. 
Visceral elixir of Hoffmann. 
Vinous tinct. of rhubarb, of 
each 3 drachms. 
Peppermint water 4 ounces. 
A tablespoonful four times a day. RECEIPTS. 
565 
R Rasuri ligni quassi® gss. 
Ebulli cum aqu® font. q. s. 
digere per \ horam, co- 
lat. gviij. 
adde 
Tinctur® rhei vinos 3iij. 
“ anodyni Hofm. 
5 ss. 
Syrupi corticis aurant. gi. 
M. 
No. 16. 
lake of rasped quassia £ oz. 
Boil it for a quarter of an 
hour in as much spring 
water as will leave 8 oun- 
ces of strained liquor ; add 
Vinous tincture of rhubarb 3 
drachms. 
Hofmann’s andoyne tincture 
half a drachm. 
Syrup of orange-peel 1 oz. 
Two tablespoonfuls four times a day. 
R Spiritus Mindereri gi. 
Yini antimonii si. 
Aquae florun? sambuci, 
“ distillatse, aa giv. 
Syrupi flor. aurantii gi. 
No. 17. 
Take of spirit of Mindererus 
1 ounce. 
Antimonial wine 1 drachm. 
Elder-flower water, 
Distilled water, of each 4 oz. 
Syrup of orange-flowers 1 
ounce. 
Two tablespoonfuls every two hours.—When fever is 
high, add 2 drachms of nitre. 
No. 18. 
R Camphor® gr. vi. 
Potass® nitratis si. 
Sacchari albi 3 ij- M. 
Fiat pulvis dividendus in 
vi. partes scquales. 
Take of camphor 6 grains. 
Nitre 1 drachm. 
White sugar 2 drachms. 
Mix, make a powder to be di- 
vided into 6 equal parts. 
One portion to be taken every two or three hours. 
No. 19. 
R Extract! aconlti gr. viij. 
Vini antimonli 3ij. M, 
Take of extract of aconite 
8 grains. 
Antimonial wine 2 drachms. 
From ten to twenty drops to be taken every three hours. 
Pill vis Pectoralls. 
R Flor. sulphuris giss. 
Seminis foeniculi, 
Rad. iridis Florent., 
“ 1 iquiritise, aa gi. 
Foliorurn senncs 3vi. M. 
Fiat pulvis. 
No. 20. 
Pectora! Powder. 
Take of flowers of sulphur 
ounce. 
Fennel seed, 
Florentine iris, 
Liquorice root, of each 1 oz. 
Senna leaves 6 drachms. 
Mix and make a powder. 
A teaspoonful to be taken every three or four hours. 566 
RECEIPTS, 
Tliea Pectoralis. 
B Florum verbasci, 
Herbse tussilaginis, 
Florum sambuci, 
Radicis glycyrrhizse, 
“ allhsese, aa gi. 
Iridis Florentinee, 
Semin, foeniculi, aa 3vi. 
Conseca, contere, raisce. 
No. 21. 
Pectoral Tea. 
Take of mullen flowers, 
Tussilage, 
Elder flowers, 
Liquorice root, 
Mallow root, of each 1 oz. 
Florentine iris, 
Fennel seed, of each 6 dr. 
Cut up, bruise, mix. 
No. 22. 
B Emplastri hyoscyami gi. 
Opii 3ss. 
Malax. 
Take of hyoscyamus plaster 
1 ounce. 
Opium drachm. 
Knead them together. 
No. 23. 
B Corticis cinchonse pulv. §i. 
Dividendus in viij. partes 
sequales. 
Take of Peruvian bark pow- 
der 1 ounce. 
Let it be divided into 8 
equal parts. 
The half of one of these parts to be taken every two 
hours. 
No. 24. 
B Corticis cinchonse pulv. 
gi. 
Syrupi cinnamomi q. s. ut 
f. electuarium. 
Take of Peruvian bark pow- 
der 1 oz. 
Syrup of cinnamon, as much 
as will make an electuary. 
A teaspoonful every two hours. 
No. 25. 
B Quinini sulphatis 3i. 
Succi glycyrrhizse q. s. ut 
fiant pilulse. No. xx. 
Take of sulphate quinine 20 
grains. 
Extract of liquorice, a suffi- 
cent quantity, and let 20 
pills be made. 
One to be taken every two or three hours. 
No. 26. 
B Phosphori gr. i. 
Solve in 
Olei terebinthinse 3i. 
Take of phosphorus 1 grain, 
and dissolve it in spirits of 
turpentine 1 drachm. 
Ten drops to be taken four times a day. RECEIPTS. 
567 
ft Resinae guaiaci 3ij - 
Mucil. gum. acaciae q. s. 
ut f. c. aquae distillatae 
§v. emulsio, cui adde 
Syrupi amygdalarum |i. 
No. 27. 
Take of resin of guaiac 2 dr. 
Mucilage of gum arabic, as 
much as will make an 
emulsion with five ounces 
of distilled water, to which 
add almond syrup 1 oz. 
A tablespoonful four times a day. 
No. 28. 
ft Resinae guaiaci 3ss. 
Extract! aconiti gr. ij. 
Elaeosacchari citri 3i. 
Potassae bitartrat. 3ij. 
M. fiat pulvis. dispens. dos. 
Take of resin of guaiac £ dr. 
Extract of aconite 2 grains. 
Lemon syrup 20 grains. 
Cream of tartar 40 grains. 
Mix, make into a powder. 
Take one third in the morning, one other at noon, the 
rest at night. 
No. 29 a. 
ft Resinae guaiaci siij. 
Lactis sulphuris, 
Saponis medicati aa 3i. 
Extract! dulcamaras q. s. ut 
fiant pil. gr. ij. 
Take of resin of guaiac 3 drs. 
Milk of sulphur, 
Medicinal soap, of each 1 dr. 
Ext. of bittersweet a suffi- 
cient quantity. Let it be 
made into pills of two gr.» 
No. 29 b. 
ft Calcis antim. sulphureti 
sij. 
Coque cum aquae fontanae 
ft v. ad iv. 
Serva in lagenis bene ob- 
turatis. 
Take of antimoniated sul- 
phuret of lime 2 drachms. 
Spring water 5 pints. 
Boil down to 4 pints, and 
preserve in well stopped 
bottles. 
ft Ligni guaic rasi §ij, 
Stipitum dulcamarse fss. 
Coque cum aquae font, ifeij. 
ad ftiss. 
Colaturae adde mercurii 
sublimat. corros. gr.ss, 
Syrupi althaeae, gij. M. 
No. 30. 
Take of rasped guaiac. 2 oz. 
Tops of bittersweet ■%- ounce. 
Spring water, 2 pints. 
Boil down to one pint and a 
half; add corrosive subli- 
mate \ grain, 
Syrup of mallows, 2 ounces. 
Take half a cupful every two hours, so as to drink half 
in one day. 
No. 31. 
ft Mercurii sublim, corros. 
Take of corrosive sublimate 
2 grains. 568 
RECEIPTS. 
Solve in aquse distillatse, 
q. s. adde 
Opii gr.ij. 
Micae panis albi, mellis pu- 
rificati aa q. s. ut fiant 
pilulse No. lx. 
Distilled water, a sufficient 
quantity to dissolve the 
salt; add opium 2 grains. 
Crumb of white bread, clari- 
fied honey,of each enough. 
Let 60 pills be made. 
From three to five to be taken twice a day. 
No. 32. 
B Resinse guaiaci 3ss. 
Lactis sulphuris 3ss. 
Potassae bitartratis 3i. 
Elaosacchari citri 3i. 
Misce, fiat pulvis. 
Take of resin of guaiac dr. 
Milk of sulphur 10 grains. 
Cream of tartar 1 drachm. 
Lemon syrup 20 grains. 
Mix and make a powder. 
Take half in the morning, and the rest at night. 
No. 33. 
B Florum sulphuris 
Potassae bitartratis aa gss. 
Radicis glycyrrhizae 3ij. 
Elseosacchari anisi 3i. 
Foliorum sennae 3ij. 
Antimonii sulphureti (au- 
ral.) gr.vi. 
• Misce, fiat pulvis. 
Take of flowers of sulphur, 
Cream of tartar, of each }oz. 
Liquorice root 2 drachms. 
Syrup of anis 1 drachm. 
Senna leaves 2 scruples. 
Golden sulphuret ol antimo- 
ny 6 grains. 
Mix. make a powder. 
7 r / r 
A teaspoonful three limes a day. 
B Stipitum dulcamaras gss. 
Coque cum aquae font. gx. 
ad vij. adde 
Potassae tartratis 3 ij. 
Vini antimonii guttas lx. 
Syrupi glycyrrhizae gi. M. 
No. 34. 
Take of twigs of bittersweet 
ounce. 
Spring water 10 ounces, boil 
down to 7 ounces; and 
add tartrate of potassa 2 
drachms. 
Antimonial wine 60 drops. 
Syrup of liquorice 1 ounce.' 
Two teaspoonfuls four times a day. 
No. 35. 
B Spec, pectoral gij. 
Maruhii gi. 
C. M. S. pro thea eras 
mane sumenda. 
Take of pectoral species* 2 
ounces. 
Hoarhound 1 ounce. 
For a tea in the morning. 
* Ingredients that vary in different countries, and generally are 
very numerous. 
No. 36. 
a Extract! graminis gss. 
Take of extract of dog grass 
i ounce. 569 
Extractl marubii. 
Potassse acetalis aa 5 ij. 
Vini antimonii, 
Aqure laurocerasi aa si. 
Aquse foeniculi gvi. M. 
RECEIPTS. 
Extract of hoarhound. 
Acetate of potassa, of each 
2 drachms. 
Antimonial wine, 
Laurel water, of each 1 dr. 
Fennel water 6 ounces. 
A tablespoonful every three hours. 
R Lichenis Islandici 3vi. 
Stipitum dulcamarse 3iij. 
Coque cum aqute font. 
gxvi. ad viij. 
Coletur. Adde 
Syrupi balsarnici gi. M. 
No. 37. 
Take of Iceland moss 6 drs. 
Twigs of bittersweet 3 dr. 
Spring water, 16 ounces, 
boil down to 8 ounces, 
and add 
Syrup of balsam 1 ounce. 
Two tablespoonfuls four times a day. 
No. 38. 
R Hydrargyrii submuriatis 
gr-ii- ... 
Foliorum digitalis purpur. 
gr.ss. 
Sacchari albi 3i. 
Misce, fiat pulvis. Divi- 
dendus in iv. partes 
sequales. 
Take of calomel 2 grains. 
Digitalis F grain. 
White sugar 1 drachm. 
Mix. Let a powder be made, 
to be divided into four 
equal parts. 
One to be taken every three or four hours,—for a child 
of two years of age. 
No. 39. 
R Infusionis flor. sambuci 
g*. 
Potassre nit. vel ammon. 
muriat. 3iss. 
Oxymellis simplicis gij.M. 
Take of infusion of elder- 
blossoms 10 ounces. 
Nitre or sal ammoniac 
drachm. 
Oxymel 2 ounces. 
Mix for a gargle and injection. 
No. 40. 
R Oxymellis simplicis gi. 
Syrupi mororum §ij- M. 
Take of oxymel 1 ounce 
Syrup of blackberries 2 oz. 
A teaspoonful frequently repeated. 
R Herbse salvise 
FJorum sambuci aa gss. 
ebulli cum aqure font, 
ftij. coletur. Adde 
No, 41. 
Take of sage, 
Elder blossoms, of each $ oz. 
boil in 2 pints of spring 
water ; add to the strained 
liquor, 570 
RECEIPTS. 
Essentiae pimpinellae gi. 
Aluminis crudi 3iij. M. 
Essence of pimpinel 1 oz. 
Crude alum 3 drachms. 
To be used as a gargle and injection. 
R Essentia? pimpinella? 3iss. 
Syrupi althaeas giij. M. 
No. 42. 
Take of essence of pimpinel 
Ij- drachm. 
Syrup of mallows 3 ounces. 
A tablespoonful every half hour. 
No. 43. 
R Essentiae pimpinellse 3 ij. 
Fifteen drops on sugar: suffered to dissolve in the mouth. 
Essence of pimpinel 2 drs. 
No. 44. 
a Antimonii tartarisati gr. 
iij- 
PotassEß nitratis sij. 
Aquae fontanae giv. 
Syrupi althaese, 
u glycyrrhizse aa gi. M. 
Take of emetic tartar 3 grs. 
Nitre 2 drachms. 
Spring water 4 ounces. 
Syrup of mallows, 
“ liquorice, each 1 oz. 
Two tablespoonfuls every two hours. 
No. 45. 
& Hydrargyrii submuriatis 
gr.vi. 
Opii gr.ij. 
Sacchari albi 3ij. 
Misce fiat pulvis. Divi- 
dendus in vi. partes 
aequales. 
Take of calomel 6 grains. 
Opium 2 grains. 
White sugar 2 drachms. 
Mix. Let a powder be made, 
and divided into six equal 
parts. 
One every two hours. 
No. 46. 
R Radicis senega? 3ij. 
Coque cum aquae fontanse 
gxiv. ad viij. 
Colaturae adde 
Ammonias muriatis, 
Vini antimonii, 
Aquae laurocerasi aa si. 
Syrupi althaeae, 
Mellis puri aa gi. M. 
Take of senega 2 drachms. 
Spring water 14 ounces. 
Boil down to 8 ounces ; let 
it be strained, add 
Muriate of ammonia, 
Antimonial wine, 
Laurel water, of each 1 dr. 
Syrup of mallows, 
Clarified honey, of each 1 oz. 
Two tablespoonfuls every two hours. RECEIPTS. 
571 
No. 47. 
R Olei amygdala, dulc. s. pa- 
paver. rec. express, gi. 
Aquae fontana) gviij. 
Mucilaginis gum. acacise 
q. s. ut fiat emulsio, adde 
Extracti hyoscyami gr. vi. 
Syrupi gss. M. 
Take of sweet oil of almonds 
or fresh poppy 1 ounce. 
Spring water 8 ounces. 
Mucilage of gum arabic, as 
much as will make an 
emulsion ; add 
Extract of henbane 6 grains. 
Syrup £ ounce. 
A tablespoonful every hour. 
No. 48. 
R Magnesise carbonalis, 
Potassa; sulphatis, 
Radicis rhei, 
Elaeosacchari menthae aa 
partes aequales ; rnisce 
fiat pulvis. 
Take equal parts of magne- 
sia, 
Sulphate of potassa, 
Rhubarb, 
Syrup of mint; mix and 
make a powder. 
A teaspoonful for a dose. 
R Radicis taraxaci, 
“ saponarise, 
Florum verbasci, 
“ chamoraill. aa 
C. M. S. 
No. 49. 
Take of roots of dandelion, 
“ saponaria, 
flowers of mullen, 
“ chamo- 
mile, of each equal parts. 
Mix for an enema in the 
morning. 
Make a decoction by boiling 2 spoonfuls with a little bran. 
No. 50. 
Liquor JSeliladosiiisc 
cyanic ns. 
R Extracti belladonna) gr.iv. 
solve in 
Aquae laurocerasi gss. 
Cyamirctcd Liqnor 
of ISeSiJußoaiaia, 
Take of extract of belladon- 
na 4 grains, dissolve in 
Laurel water ounce. 
Twenty to thirty drops four times a day. 
R Herbse digitalis 3ss. 
digere cum aquae font, 
per -J- horam, usque gvi. 
coletur adde 
No. 51. 
Take of digitalis ± drachm, 
digest in as much spring 
water for -J- of an hour, as 
will leave 6 ounces of clear 
liquor; add 572 
Aquse laurocerasi 3ij. 
Potassae nitratis 3iij. M. 
RECEIPTS. 
Laurel water 2 drachms, 
Nitre 3 drachms. 
A tablespoonful every two hours. 
R Ext. taraxaci, 
“ graminis, aa fss. 
Potassce tartratis siij. 
(vel potassse carbonatis 
3iij.) solve in 
Aquse menth. piperitas, 
“ distillatse, aa giij.M. 
No. 52. 
Take of extract of dandelion, 
“ dog grass, 
each 4 ounce. 
Tartrate of potassa 3 drs. 
(oncarbon. of potassa3dr.) 
dissolve in 
Peppermint water, 
Distilled water, of each 3 oz. 
A tablespoonful four times a day. 
R Gummi ammoniaci siij. 
Saponis med. 3ij. 
Lactis sulphuris, 
Pulveris radicis rhei, 
(vel foliorum sennse,) 
aa 3i. 
Extracti tafaxici q. s. ut 
fiant pilulee gr.ij. 
No. 53. 
Take of gum ammoniac 3 
drachms. 
Soap 2 drachms. 
Milk of sulphur, 
Rhubarb powder, 
(or senna,) of each 1 dr. 
Extr. of dandelion, as much 
as will suffice. Let pills 
be made of 2 grains. 
Ten pills, three times a day. 
No. 54. 
R Potasssß carbonatis, 
Ammonii muriatis, aa 3i. 
Solve in aquee menthse pip. 
§iij. adde 
Aloes, 
Myrrhss, 
Resinas guaiaci, 
Radicis rhei aa sss. 
Croci 9i. 
Digere, 1. a. ut. f. E. 
Take of carbonate of potassa, 
Muriate of ammonia ea. 1 dr. 
Peppermint water, 3 ounces. 
dissolve and add 
Aloes, 
Myrrh, 
Resin of guaiacum, 
Rhubarb, each drachm. 
Saffron 1 scruple, 
Let it digest to make an elixir. 
Forty to sixty drops three times a day. 
No. 55. 
R Elixirii acidi Halleri 3ij. 
Take of acid elixir of Haller 
2 drachms. RECEIPTS. 
573 
Tincturse cinchonse Whyt- 
tii 3vi. M. 
Whytt’s tincture of bark 6 
drachms. 
Sixty to eighty drops three times a day in a cup of water. 
No. 56. 
R Aluminis crudi, 
Terra; catechu, 
Extracti cinchonas, aa 
paries sequales. Misce 
f. pil gr. ij. Consperge 
pulvere cinnamomi. 
Take of crude alum, 
Terra catechu, 
Extract of bark, of each equal 
parts. Mix. Let pills of 2 
grains be made, sprinkled 
with cinnamon powder. 
Ten night and morning. 
No. 57. 
R Foliorum aurantii viridis, 
Radicis Valerianae, 
Caryophillatae, 
Herbae melissae, aa partes 
sequales. 
Take equal parts of green 
leaves of orange, 
Valerian root, 
Cloves, 
Melissa. 
Infuse over night, 1 to 2 spoonfuls in 2 cups of water ; 
which is to be taken cold, half every morning, the rest in 
the evening. 
No. 58. 
r Radicis columbo jfss. 
Coque cum aquae font. 
gxij. ad gviij. 
Coletur. Adde 
Tincturse ferri setheris, 
“ valerianse, 
“ cort. aurantii, 
aa si. M. 
Take of columbo root £ oz. 
Boil in 12 ounces down to 
8, let it be strained, and 
add 
Ethereal tincture of iron, 
Tincture of valerian, 
“ orange peel, 
each 1 drachm. 
Two tablespoonfuls four times a day. 
No. 59. 
R Zinci oxidi 3ss. 
Succi glycyrrhizse q. s. ut 
fiant pilulse No. lx. 
Take of flowers of zinc £ dr. 
Liquorice, a sufficient quan- 
tity ; let it he made into 
60 pills. 
Take 2 morning and evening j adding one every two days. 
Pulvis Antipilepti- 
cus. 
R Zinci oxidi, 
Extract! hyoscyami, aa 
or, i. 
D 
No. 60. 
Powder against Ep- 
ilepsy. 
Take of flower of zinc, 
Extract of henbane, each 1 
grain, 574 
RECEIPTS. 
Olei valerianse setherei, 
guttara i. 
Radicis valerianse 3ss. 
Misce, fiat pulvis. 
Oil of valerian 1 drop. 
Root of valerian £ drachm. 
Mix. Make a powder. 
Morning and evening. In obstinate cases grain of 
ammonia of copper. 
No. 61. 
R Radicis valerianse sss. 
Olei valerianse seth. guttas 
ij- 
M. fiat pulvis. 
Take of valerian root dr. 
Ethereal oil of valerian 2 
drops. 
Make a powder. 
Take one three times a day. 
& Argenti nitratis gr. x. 
Extract! cicutse 3ij. 
Opii gr. v. 
Sued glycyrrhizse 3i. 
Misce, fiant pilulse gr. ij. 
No. 62. 
Take of nitrate of silver 10 
grains. 
Extract of cicuta 2 drachms. 
Opium 5 grains. 
Liquorice 1 drachm. 
Mix. Let pills of 2 grains 
be made. 
Two morning and evening, at first, afterwards three, 
gradually increasing to five. 
No. 63. 
R Essentiae castorei, 
Liquoris anodyni Hofm. 
aa 3i. 
Olei menthaepip. guttas vi. 
Laudani liquid! Syden- 
hami gr. xx. 
Take of essence of casto- 
reum, 
Anodyne liquor of Hofm. 
each 1 drachm. 
Oil of peppermint 6 drops. 
Liquid laudanum of Syden- 
ham 20 grains. 
Forty drops every two hours. 
R Gummi ammoniaci 3ij. 
mucilaginis acacias q. s. 
ut fiat cum aquae fosni- 
culi §vi. emulsio. Adde 
Aquae ammonii anisatae 
3 ss, 
Oxymelis scillse, 
Syrupi glycyrrhizse aa gi. 
M. 
No, 64. 
Take of gum ammoniac 2 
drachms, as much muci- 
lage of gum arable, with, 
fennel water as will make 
6 ounces of emulsion, add 
Aromatic spirit of ammonia 
half a drachm. 
Oxymel of squills, 
Liquorice, each I ounce. 
A tablespoonful every hour. RECEIPTS. 
575 
R Asa foetidse, 
Gummi arnmoniaci, 
Saponis med., 
Extract! taraxaci, aa sij. 
Antimonii sulphureti (au- 
rat.) gr. xx. 
Misce, fiant pilulse gr. ij. 
Consperge semine lyco- 
podii. 
No. 65. 
Take of asa foetida, 
Gum ammoniac, 
Soap, 
Extract of dandelion, each 
2 drachms. 
Golden sulphuret of antimo- 
ny 20 grains. 
Mix. Let pills of 2 grains 
be made. 
Sprinkle it with club moss 
seed. 
Ten three times a day. 
No. 66. 
R Extract! qualse 3ij. 
Aquae ammonii anisatse 
3iss. 
Aquae foeniculi gij. M. 
Take of extract of elecam- 
pane 2 drachms. 
Aromatic spirit of ammonia 
1 drachm. 
Fennel water 2 ounces. 
Eighty drops every two hours. 
R Gummi ammonii, 
Extract! arnicse, 
“ polygalse, 
“ qualse, aa 3ij. 
Pulveris rad. scilla?, 
Antimonii sulphureti (aur.) 
aa gr. xx. 
Misce, fiant pilulse gr. ij. 
No. 67. 
Take of gum ammoniac, 
Extract of leopard’s bane, 
Rattlesnake herb, 
Elecampane, each 2 drs. 
Powder of squills, 
Golden sulphuret of antimo- 
ny, each 20 grains. 
Mix, make pills of 2 grains. 
Eight to ten three times a day. 
No. 68. 
r Specierum pectoralium §ij. 
Herbse chenopodii, 
“ marubii, aa fss. 
C. M. S. thea. 
Take of pectoral species 2oz. 
Worm seed, 
Hoarhound, each £ ounce. 
Infuse for a tea. 
No. 69. 
R Radlcis qualse, 
“ iridis, 
“ scillse, a&, gi. 
Benzoes, 
Take of elecampane, 
Florentine iris root, 
Squills, each 1 ounce. 
Benjamin, 576 
RECEIPTS. 
Myrrhse, 
Seminum anisi, 
Succi glycyrrhizse, 
Gummi ammoniaci aa gss. 
Croci 3 iij. M. 
f. c.spiritus vini rectificat. 
libra una. 
L. a. elixir. 
Myrrh, 
Anis, 
Liquorice, 
Gum ammoniac, each oz. 
Saffron 3 drachms. 
Rectified spirits of wine, 1 
pint. 
Make an elixir. 
Sixty to eighty drops several times a day. 
No. 70. 
R Extract! digitalis, 
“ hyoscyami, 
Pulv. digitalis, aa partes 
aequales. 
Misce, fiant pilulse gr. i. 
Take of extract of digitalis, 
Henbane, 
Powder of digitalis, equal 
parts. 
Mix, make pills of 1 grain. 
One morning and evening.—In obstinate cases, three or 
four times a day. 
No. 71. 
R Ammonii muriatis 3ij. 
Succi glycyrrhizse §ss. 
Aquse foeniculi, 
“ fontanse, aa |iv. 
Syrupi althaeas §i. 
Vini antimonii, gut. xl. M. 
Take of sal ammoniac 2 dr. 
Liquorice half an ounce. 
Fennel water, 
Spring water, each 4 ounces. 
Syrup of mallows 1 ounce. 
Anfimonial wine 40 drops. 
A tablespoonful every hour. 
No. 72, a. 
R Extract! dulcamaras 3i. 
Florum sulphuris 3ss. 
Misce, fiant pilules gr. i. 
Take of extract of bitter- 
sweet 1 drachm. 
Flowers of sulphur £ dr. 
Mix, and make pills of 1 gr. 
Four, five to eight pills four times a day. 
No. 72, b. 
Elixir Anticatarr- 
hale. 
R Extr. card, benedicti 3i. 
“ dulcamara} gr. xx. 
Aquse foeniculi §i. 
“ laurocerasi 3i. 
Aiaticatara’lial 
Elixir. 
Take of extract of blessed 
thistle 1 drachm. 
Bittersweet 20 grains. 
Fennel water 1 ounce. 
Laurel water 1 drachm. 
Sixty drops four times a day. receipts. 
577 
No. 73. 
R Lichenis Islandici, 
Stipitum dulcamarse, aa 
gss. 
Coque cum aquse fontanse 
gxiv. ad viij. 
Colaturse adde 
Liquoris ammonii anisati 
gutt. LX. 
Syrupi glycyrrhizEe gi. M. 
Take of Iceland moss, 
Twigs of bitter-sweet, each 
■£- ounce. 
Boil in 14 ounces of spring 
water down to 8. Let it 
be strained. Add 
Aromatic spirit of ammonia 
60 drops. 
Syrup of liquorice 1 ounce. 
Two tablespoonfuls four times a day. 
R Potassse tartratis 3i. 
Aquae foeniculi fss. 
Syrupi mannse gi. 
Oxymellis scillse 3ij. 
Vini antimonii guttas xx. 
Extracti hyoscyami gr. ij. 
M. 
No. 74. 
Take of tartrate of potassae 
1 drachm. 
Fennel water ounce. 
Syrup of manna 1 ounce. 
Oxymel of squills 2 drachms. 
Antimonial wine 20 drops. 
Extract of henbane 2 grains. 
A teaspoonful every two hours (for children of two to 
four years of age). 
No. 75. 
R Radicis belladonnas gr. i. 
Sacchari albi 3i. 
Misce, fiat pulvis dividendus 
in viij. partes aequales. 
Take of nightshade root 1 gr. 
White sugar 1 drachm. 
Mix. Let a powder be made, 
to be divided into 8 equal 
parts. 
One morning and evening (for children from 2 to 4 years 
of age). 
R Magnesise carbonatis 
Florum sulphuris aa gr. iv. 
Laudani liquid! Sydenha- 
mi guttam 1. 
Sacchari albi 31. 
Misce, fiat pulvis. Dis- 
pens. dos. iv. 
No. 76. 
Take of magnesia 
Flowers of sulphur each 4 
grains. 
Liquid laudanum of Syden- 
ham 1 drop. 
White sugar 20 grains. 
Mix. Make a powder, and 
divide it in 4 doses. 
One to be taken morning and evening. 
& Antimonii tartarisati 3i. 
Axungite pore. gss. M. 
No. 77. 
Take of emetic tartar 1 dr. 
Lard f ounce. 
Used in friction. The size of a bean at a time. RECEIPTS. 
No. 78. 
B Gelatinse lichen. Island. 
f ss. 
Syrupi glycyrrhizse §i. 
Take of Iceland moss jelly 
£ ounce. 
Syrup of liquorice 1 ounce. 
A teaspoonful every two hours. 
B Tincturse cort. aurantii 3 ij. 
“ castorei, 
“ aloes, aa 3i. M. 
No. 79. 
Take of tincture of orange- 
peel 2 drachms. 
Castoreum, 
Aloes, each 1 drachm. 
Sixty drops twice a day. 
No. 80. 
B Potassse carbonatis 3 ij. 
Succi citri rec. expr. q. s. 
ad saturationem, 
Aquse melissse §iij. 
Extract! hyoscyami gr. vi. 
M. 
Take of carbonate of potas- 
sa 2 drachms. 
Lemon juice as much as will 
saturate. 
Melissa water 3 ounces. 
Extract of henbane 6 grains. 
A tablespoonful every hour. (If it produce no effect, 
add 8 drops of laudanum to each dose.) 
No. 81. 
B Spiritus matricalis fvi. 
Bals. vitee Hofmanni §ss. 
Tincturse opii 3ij. M. 
Take of compound spirit of 
mastic 6 ounces. 
Hoffmann’s balsam of life £• 
ounce. 
Tincture of opium 2 dr. 
To be used in friction. 
No. 82. 
Spiritus carminativus, in flatulency. 
B Spiritus matricalis, 
“ serpylli, 
“ ror. marini, 
“ menth. pip. aa pp. 
se. 
Take of spirit of mastic, 
Thyme, 
Rosemary, 
Peppermint, each alike. 
To wash the hypogastrium morning and evening. 
No. 83. 
B Magnesise carbonatis, 
Potassse sulphatis, 
Radicis rhei, 
Take equal parts of magne- 
sia, 
Sulphate of potassa, 
Rhubarb, RECEIPTS. 
579 
Pulveris aromatici aa pp. 
M. 
Aromatic powder, mix. 
A teaspoonful three or four times a day. 
No. 84. 
R Emplastri de galbano croc, 
gi. 
Camphor®, 
Ammoni® carbonatis, 
Opii, aa 3ss. 
Olei cajeputi, 
“ menth® pip- aa guttas 
xx. 
Malax. 
Take of compound galbau- 
um plaster 1 ounce. 
Camphor, 
Carbonate of ammonia, 
Opium, each F drachm. 
Oil of cajeput, 
Peppermint each 20 drops. 
Knead together. 
R Pulveris cort. cinchon® 
regalis 3ss. 
Ferri sulphatis gr. i. 
Cinnamomi gr. ij. 
Misce, fiat pulvis. 
No. 85. 
Take of powdered bark £ dr. 
Green vitriol 1 grain. 
Cinnamon 2 grains. 
Mix, make a powder. 
Take one morning and evening. 
R Resin® guaiaci 3ss. 
Antiraonii sulphureti(aur.) 
Hydrargyri submuriatis, 
Extracti aconiti, aa gr. ij. 
Olei valerian® ®ther. gutt. 
ij- 
Sacchari alb. gr. xx. 
Misce, fiat pulvis. 
No. 86. 
Take of resin of guaiacum £ 
drachm. 
Golden sulphuret of anti- 
mony, 
Calomel, 
Extract of aconite, each 2 
grains. 
Essential oil of valerian 2 
drops. 
White sugar 20 grains. 
Mix, make a powder. 
Half to be taken in the morning, the rest at night. 
No. 87. 
Pulvis errhinus. 
r Florum lavendulse, 
Herb® majoran® aa 3iss. 
Sacchari albi 3i. 
Saponis, 
Flor. convallari® majalis, 
aa 3ss. 
Olei caryophyllat® guttas 
iv. 
Misce, fiat pulvis. 
Take lavender flowers, 
Marjoram, each drachm. 
White sugar 1 drachm. 
Soap, 
Flowers of lily of the valley, 
each F drachm. 
Oil of cloves 4 drops. 
Mix, make a powder. 580 
RECEIPTS. 
R Bismuthi subnitratis gr. ij. 
Extracti hyoscyami gr. i. 
Magnesia carbonatis gr. x. 
Olei cajeputi guttam i. 
Sacchari albi gr. xx. 
M. f. pulvis. 
No. 88. 
Take flowers of bismuth 2 
grains. 
Extract of henbane 1 grain. 
Magnesia 10 grains. 
Oil of cajeput 1 drop. 
White sugar 20 grains. 
Mix, make a powder. 
lilnlmeiitum Anti- 
spasmodicum. 
R Linim. volat. camphor. §i. 
Olei cajeputi, 
“ mentha crisp, aa gr. 
x. 
Tinct. Thebaica si. M. 
No. 89. 
Antispasaiiodic Un- 
iment. 
Take of camphorated vola- 
tile liniment 1 ounce. 
Oil of cajeput, 
Crisp, mint, each 10 grains. 
Tincture of opium 1 drachm . 
No. 90. 
R Olei amygdal. dulc. gi. 
Aqua fontana gvii. 
Mucilaginis g. acacia q. s. 
f. emulsio, adde 
Manna electa gi. 
Potassa tartratis 3iij-iv. 
Syrupi emulsivi gss. 
Extracti hyoscyami gr. vi. 
M. 
Take of sweet oil of almonds 
1 ounce. 
Spring water 7 ounces. 
Mucilage of gum arabic, 
enough to make an emul- 
sion, add 
Chosen manna 1 ounce. 
Tartrate of potassa 3 to 4 
drachms. 
Syrup £ ounce. 
Extract of henbane 6 grains. 
Two tahlespoonfuls every two hours. 
R Florum sulphuris, 
Magnesia carbonatis aa 
3ij. 
Opl** . , .. 
Rad. ipecacuanha aa gr. 
iij. 
Misce, fiat pulvis dividend- 
us in xij, partes aquales. 
No. 91. 
Take of flowers of sulphur, 
Magnesia, each 2 drachms. 
Opium, 
Ipecacuanha, each 3 grains. 
Mix. Let a powder be made 
and divided into 12 equal 
parts. RECEIPTS. 
581 
Pllulae Resolventes. 
B Gumtni ammoniaci 3iij. 
Saponis 3ij. 
Pulv. radicis rhei si. 
Extract! taraxaci q. s. ut. 
fiant pilulse gr. ij. 
No. 92. 
IMscutient Fills. 
Take of gum ammoniac 3 
drachms. 
Soap 2 drachms. 
Rhubarb 1 drachm. 
Extr. of dandelion, enough. 
Let pills of 2 grains be made. 
Ten to fifteen, take three times a day. 
No. 93. 
B Fellis tauri inspissati, 
• Extract! rutse, 
Saponis, 
Lactis sulphuris, aa 3ij, 
Misce, fiant pilulse gr. ij. 
Take of dry ox gall, 
Extract of rue, 
Soap, 
Milk of sulphur, each 2 dr. 
Mix. Let pills of 2 grains 
be made. 
Ten morning and evening, with infusion of melissa, 
chamomile, millefoil, arnica. 
B Foliorum sennse 5 ij. 
Soda sulphatis |i. 
Coque cum aquse fontanae 
q. s. colat. 
Adde 
Antlmonii tartarisata gr. ij. 
Syrupi mannae gi. M. 
No. 94. 
Take of senna leaves 2 dr. 
Sulphate of soda I ounce. 
Boil in as much water as will 
leave 7 ounces of strained 
liquor. Add 
Emetic tartar 2 grains. 
Syrup of manna 1 ounce. 
One or two tablespoonfuls every hour. 
No. 95. 
B Pulv. rad. valerianse gss. 
Florum arnicse ij. 
Digere cum aquae fervente 
q, s. per horam \, colen- 
tur. §vij. Adde 
Sodae sulphatis gss. 
Liquoris cornu cervi suc- 
cinati, 
“ anody. Hoffm. aa 
guttas xl. 
Syrupi cort. aurantii §ss. 
Take of pqwdered valerian 
root F oiAce. 
Flowers of arnica 2 drachms. 
Digest F of an hour in as 
much boiling water as will 
leave 7 ounces of clear li- 
quor. Add 
Glauber salts F ounce, 
Succinated spirits of harts- 
horn, 
Anodyne liquor of Hoffman, 
each 40 drops. 
Syrup of orange bark F oz. 
A tablespoonful every hour. 582 
RECEIPTS. 
R Resinas guaiaci 3ss. 
Potassae bitartratis 3i. 
Sacchari albi 3ss. 
M. f. pulv. 
No. 96. 
Take of resin of guaiacum 
a. drachm. 
Cream of tartar 1 drachm. 
White sugar £ drachm. 
Mix, make a powder. 
Half in the morning, the rest in the evening. (To be 
continued several days.) 
No. 97. 
R Antimonil tart. gr. xv. in 
aqua solut. 
Galbani, 
Gummi ammoniaci, 
Extracti arnicse, aa 3i. 
Castor. 3ss. 
M. f. pil. gr. i. 
Take of emetic tartar 15 gr. 
dissolved in water. 
Galbanum, 
Gum ammonia, 
Extract of arnica, each 1 dr. 
Castor oil dr. 
Mix, make pills of 1 grain. 
Eight 4 times a day, continually augmenting the number 
until nausea supervene. 
No. 98. 
R Olei cajeputi gr. xx. 
Liquoris anod. Hofm. 
“ cornu cervi suc- 
cinati aa 3i. M. 
Take of oil of cajeput 20 grs. 
Anodyne liquor of Hofm., 
Succinated spt. of hartshorn, 
each 1 drachm. 
Thirty drops every three hours. 
R Florum arnicse gr. xx. 
Olei Valerianae setheris gut- 
tam i. 
Sacchari albi gr. x. 
M. f. pulvis. 
No. 99. 
Take of flowers of arnica 20 
grains. 
Essential oil of valerian 1 
drop. 
White sugar ten grains, 
Mix, make a powder. 
One to be taken every three hours. 
No. 100. 
R Extract! nucis vomicae 
spirituosi. 
f. pilulae gr. i. 
Alcoholic extract of nux vo- 
mica. 
Made into 1 grain pills. 
One three times a day ; gradually augmenting to two or 
three. RECEIPTS. 
583 
B Spiritus matricalis, 
“ serpylli, 
“ formicarum, aa 
Sij- 
“ camphorati |i. 
Balsam vitse Hofm., 
Linimenti volat. aa gss. 
Olei cajeputi 3i. M. 
No. 101. 
Take of compound spirit of 
mastic, 
Thyme, 
Ants, each 2 ounces. 
Camphorated spirit 1 ounce.’ 
Hofmann’s balsam of life, 
Volatile liniment, each half 
an ounce. 
Oil of cajeput 1 drachm. 
Used as a lotion. 
No. 102. 
B Olei cajeputi 3i. 
Linim. voJat. cum oleo 
camph. |i. 
Bals. vitae Hofm. gss. M. 
Take of oil of cajeput 1 dr. 
Camphorated volatile lini- 
ment 1 ounce. 
Hofmann’s balsam of life 
half an ounce. 
To be used in friction. 
No. 103. 
R Phosphori gr. v. 
Olei animalis Dippelii 3ij. 
“ papaveris gss. 
Take of phosphorus 5 gr. 
Animal oil of Dippel 2 dr. 
Oil of poppies half an ounce. 
To be used in frictions. 
No. 104. 
iEther Merciirialls. 
B Hydrargyri chloridi cor- 
ros. gr. ij. 
iEtheris sulphuric! 3ij. 
Solve. 
Mercurial iEllier. 
Take of corrosive sublimate 
2 grains. 
Sulphuric ether 2 drachms. 
Dissolve. 
Ten to thirty drops, three times a day. 
R Barytes muriatis 3i. 
Aquas distillates gij. 
Extract! cicutes si. M. 
No. 105. 
Take of muriate of baryta 1 
drachm. 
Distilled water 2 ounces. 
Extract of cicuta 1 drachm. 
M. 
Thirty to forty drops four times a day, with decoction 
of bittersweet. 584 
RECEIPTS. 
No. 106. 
Chalybeate Wine. 
ft Ligni quassias, 
Trifolii, aa Svi. 
Radicis zedoarias, 
“ galangae, aa 3ij. 
“ gentianae, 
Corticis aurantii, aa gss. 
“ cinchonas gij - 
Liraat. ferri Svi. 
Infunde vini Rhen. opt. s. 
Tokay. Ibviij. 
Stent in digestione in loco 
calido. 
Take of quassia, 
Trifoliura, each 6 drachms. 
Zedoary, 
Galanga, each 2 drachms. 
Gentian, 
Orange bark, each £ ounce. 
Peruvian bark 2 ounces. 
Iron filings 6 drachms. 
Rhenish or Tokay wine 8 
pints. 
Digest in a warm place. 
A wine glass full three or four times a day. 
No. 107. 
ft Elixir, visceral. Hofm. gi. 
Tincturse cort. aurantii si. 
Extracti columbo gr. xx. 
Take of Hofmann’s visceral 
elixir 1 ounce. 
Tincture of orange peel 1 
drachm. 
Extract of columbo 20 grs. 
Eighty drops morning and evening. 
No. 108. 
ft Tinctures absinthii, 
Elixir, aurantii comp. (Ph. 
Borus.) aa pp. sequales. 
Take of tincture of worm- 
wood, 
Compound elixir of orange 
(Prussian pharmacopoeia), 
of each equal parts. 
Eighty drops morning and evening. 
ft Extracti lupuli si. 
Aquas menth. pip. gi. 
“ cinnamomi gss. M. 
No. 109. 
Take of extract of hops 1 
drachm. 
Peppermint water 1 ounce. 
Cinnamon half an ounce. 
Sixty drops three times a day. 
No. 110. 
ft Pulver. rad. columbo gss. 
Coque cum aquas font. gx. 
ad vi. 
Coletur, adde 
Spiritus sulph. esth. marti- 
alis 3 ij. 
rl'ake of powdered root of 
columbo half an ounce. 
Boil in 10 ounces of spring 
water to 6. 
Let it be strained, add 
Martial sulphuric ether 2 
drachms. RECEIPTS. 
585 
Tinctures cinnamomi 3i. 
Syrupi port, aurantii §i. 
Tincture of cinnamon 1 oz. 
Syrup of orange peel 1 oz. 
A tablespoonful every three hours. 
No. 111. 
R Extract! quassiee 3ss. 
Elix. viscer. Hoffm., 
Tinct. cinchonas Whyttii, 
aa gss. 
Spiritus seth. sulph. mart. 
3 ij. M. 
Take of extract of quassia 
half a drachm. 
Hoffmann’s viscer. elixir, 
Whytt’s tincture of bark, 
each half an ounce. 
Martial sulph. ether 2 dr. 
Eighty drops three times a day. 
R Extract! quassiee fss. 
Ferri sulphatis gr. xx. 
Pulver. cinnamomi 3ss. 
Misce, fiant pilulee gr. ij. 
No. 112. 
Take of extract of quassia 
half an ounce. 
Green vitriol 20 grains. 
Cinnamon powder £ drachm. 
Mix. Let two grain pills be 
made. 
Ten pills two or three times a day. 
No. 113. 
R Spiritus Formicarum gij. 
Liquoris anodyn. Hoffm., 
Bals. vitse Hoffm. aa f ss. 
Aquee menthee pip., 
“ serpylli, aa giij. M. 
Take of spirit of ants 2 oz. 
Hoffmann’s liquid anodyne, 
“ balsam of life, 
each ounce. 
Peppermint water, 
Thyme, each 3 ounces. 
As a lotion to the sacrum and genitals. 
No. 114. 
jj Hesinse guaiaci sss. 
Hydrargyri submuriatis, 
Antimonii sulph. (aur.) aa 
gr. ij. 
Sacchari albi gr. xx. 
M. f. pulvis. 
Take of resin of guaiacum £• 
drachm. 
Calomel, 
Golden sulphur, ant. each 2 
grains. 
White sugar 20 grains. 
Mix, make a powder. 
Half, evening and morning. 
r Olei amygdal. dale. 3i. 
“ camphorati gr. x. 
No. 115. 
Take of sweet oil of almonds 
1 drachm. 
Camphorated oil 10 grains. 586 
RECEIPTS. 
Fellis tauri 3ss. 
Olei cajeputi guttas ij. M. 
Ox gall \ drachm. 
Oil of cajeput 2 drops. 
To put into the ears; applied on cotton wool. 
B Fol. digitalis purp. gr. i. 
Potassae nitratis, 
Pulveris gummosi, aa gr. 
xx. 
Misce, f. pulvis. 
No. 116. 
Take of red foxglove 1 gr. 
Nitre, 
Gum powder, each 20 gr. 
Mix, make a powder. 
To be taken morning and evening. 
No. 117. 
B Calcii chloridi si. 
Aquse laurocerasi 3ij. 
“ distillates gss. M. 
Take of chloride of lime I 
drachm. 
Laurel water 2 drachms. 
Distilled water 4 drachms. 
Forty or fifty drops four times a day. 
B Plumbi acetatis gr. i. 
Extr. opii. aquosi gr. ss. 
Sacchari albi gr. xx. 
M. f. pulv. 
No. 118. 
Take of acetate of lead 1 gr. 
Watery extract of opium a. 
grain. 
White sugar 20 grains. 
Mix, make a powder. 
Take one morning and evening. 
No. 119. 
B Myrrhae 3ss. 
Sacchari albi gi. 
M. f. pulv. 
Take of myrrh drachm. 
White sugar 1 ounce. 
Mix, make a powder. 
A teaspoonful several times a day. 
No. 120. 
B Cretse prseparatee 3 ij. 
Succi citri q. s. ad satu- 
randum. Adde 
Aqua florum tilise gvi. 
Syrupi glycyrrhizse gi. 
Misce. 
Take of prepared chalk 2 
drachms. 
Lemon juice, enough to sa- 
turate. Add 
Linden blossom water 6 oz. 
Syrup of liquorice 1 ounce. 
Mix. 
Two tablespoonfuls every two hours. RECEIPTS. 
587 
No. 121. 
R Zinci sulphatis gr. x. 
Extracti catechu -sss. 
Syrupi althsese §i. M. 
Take of white vitriol 10 grs. 
Extract of catechu dr. 
Syrup of mallows 1 ounce. 
R Gelatin, lichenis Isl. |i. 
Extract! dulcamarse gr. x. 
Syrupi glycyrrhizse gi. 
Liquor, ammon. anisati 
guttas xx. M. 
No. 122. 
Take Iceland moss jelly 1 
ounce. 
Extract of bittersweet 10 
grains. 
Syrup of liquorice 1 ounce. 
Aromatic spirit of amm. 20 
drops. 
Take it daily by teaspoonfuls. 
No. 123. 
R Extract! myrrhee aquosi 
. 3J- 
Liquoris potassse tartaris- 
ati gij. M. 
Take of watery extract of 
myrrh 1 drachm. 
Solution of tartrate of potas- 
sa 2 ounces. 
Forty drops every three hours. 
No. 124. 
R Pulveris corticis cinchonse 
Bad. ratanh. aa §ss. 
Coque cum aquee fontante 
gxij. ad viij. 
Coletur. Adde 
Aluminis crudi 3ss. 
Syrup! althsese |iss. M. 
Take of Peruvian bark, 
Ratanhy root, each £ ounce. 
Boil in 12 ounces of water 
down to 8. 
Let it be strained; and add 
Crude alum drachm. 
Syrup of mallows ounce. 
Two spoonfuls every two hours. 
R Calcii chloridi sss. 
Extract! hyoscyami gr. 
viij. . . __ 
Aquae laurocerasi gi. M. 
No. 125. 
Take chloride of lime \ dr. 
Extract of henbane 8 grains. 
Laurel water 1 ounce. 
Twenty drops three times a day. 
No. 126. 
R Sacchari lactis §i. 
Extract! myrrhseaquosi 3i. 
Florum sulphuris 3iss. 
Extract! hyoscyami gr. 
xx. 
Misce, f. pulvis. 
Take of sugar of milk 1 oz. 
Watery extract of myrrh 1 
drachm. 
Flowers of sulphur dr. 
Extract of henbane 20 grs. 
Mix, make a powder. 
A teaspoonful morning and evening. 588 
RECEIPTS. 
R Radicis arnicse 3 iij. 
Coque cum aquse font. §x. 
ad vi. 
Coletur. Adde 
Extracti chamomillse, 
“ rutse, aa 3iss. 
Ferri tartaris. 3i. 
Aquse menthse pip. |ij. 
Syrupi cort. aurantii §i. 
M. 
No. 127. 
Take of arnica root 3 drs. 
Boil in,lo ounces of spring 
water to 6. 
Strain, and add 
Extract of chamomile, 
Rue, each 1£ drachm. 
Tartrate of iron 1 drachm. 
Peppermint water 2 ounces. 
Syrup of orange peel 1 oz. 
Two tablespoonfuls three or four times a day. 
No. 128. 
R Gummi galbani, 
Extract! arnicse, 
“ chamomillse, 
Florum salis ammoniaci 
mart, aa pp. seq., fac pil- 
ulas gr. ij. 
Take galbanum, 
Extract of arnica, 
“ chamomile, 
Flowers of sal ammoniac, of 
each equal parts. Make 
pills of 2 grains. 
Ten, three times a day. 
R Sodse boracis 3ss. 
Croci gr. viij. 
Flor. sulphuris, 
Elseosacchari menth. aa 
gr. xx. 
M. f. pulvis. 
No. 129. 
Take of borate of soda half 
a drachm. 
Saffron 8 grains. 
Flowers of sulphur, 
Mint-sugar, each 20 grains. 
Mix, make a powder. 
One-third, morning, noon, and evening. 
No. 130. 
R Myrrhse, 
Galbani, 
Extract! hellebori nigri, 
aa 3i. 
A 1 oes gr. x. 
Castorei gr. xx. 
Misce, f. pil. gr. ij. 
Take of myrrh, 
Galbanum, 
Extract of black hellebore, 
each 1 drachm. 
Aloes 10 grains. 
Castoreum 20 grains. 
Mix, make two grain pills. 
Ten, two or three times a day. RECEIPTS. 
589 
B Florum chamomillse, 
Herbse melissse, 
“ menthse crispse, aa 
3]J- 
“ sabinse si. 
No. 131. 
Take of chamomile, 
Melissa, 
Crisp mint, each 2 drachms. 
Savin 1 drachm. 
C. M. S. Infused in two cups of boiling water. Half 
to be taken morning and evening. 
B Magnesise carbonatis gr. 
xx. 
Acidi tartarici gr. xvi. 
Herbse sabinse, 
Sacchari albi, aa gr. xx. 
Misce, fiat pulvis. 
No. 132. 
Take of magnesia 20 grains. 
Tartaric acid 16 grains. 
Savin, 
White sugar, each 20 grains. 
Mix, let a powder be made. 
To be taken three times during the day, in a cup of 
water. 
No. 133. 
B Elix. acidi Halleri 3ij. 
Tr. cinchonse Whyttii |i. 
“ cort. aurantii 3i. M. 
Take of acid elixir of Haller 
2 drachms. 
Whytt’s tincture of bark 1 
ounce. 
Tincture of orange peel 1 
drachm. 
Eighty drops three times a day in a cup of water. 
No. 134. 
B Pulveris cort. cinchonse 
fi. 
“ aurantii 3 ij. 
Coque in aqua font. |xij. 
ad viij. 
Coletur. Adde 
Elix. acidi Halleri 3ss. 
Tincturse cinnamomi sij. 
Syrupi cort. aurantii ii. 
Take of powdered bark 1 
ounce. 
Orange peel 2 drachms. 
Boil in 12 ounces of water 
down to 8. 
Let it be strained ; add 
Haller’s acid elixir \ dr. 
Tincture of cinnamon 2 dr. 
Syrup of orange peel 1 oz. 
Mix two tablespoonfuls every three hours. 
B Lactis vaccini ftiss. 
Coque cum aluminis 3ij. 
No. 135. 
Take of cow’s milk pint. 
Boil with two drachms of 
alum. 590 
RECEIPTS. 
Fiat serum. Adde 
Syrupi cinnamomi §i. 
Make whey. Add 
Syrup of cinnamon 1 ounce 
Half a cup full every hour or two hours. 
No. 136. 
Take of extract of bark, 
Ratany, 
Sage, 
Catechu, each 2 drachms. 
Green vitriol 40 grains. 
Mix. Let pills of 2 grains 
be made. 
R Extract! cinchonse, 
“ ratanhse, 
“ salviae, 
“ catechu, aa 3 ij. 
Ferri sulphatis gij. 
Misce. Fiant pilulse gr. ij. 
Ten to fifteen, three times a day. 
No. 137. 
Sc Cinnamomi gr. x. 
Ferri suiphatis gr. i. 
Sacchari albi gr. xx. 
M. f. pulvis. 
Take of cinnamon 10 grains. 
Sulphate of iron 1 grain. 
White sugar 20 grains. 
Mix. Make a powder. 
One powder to be taken every two hours, or oftener. 
No. 138. 
B Potassse bitartratis §i, 
“ nitratis, 
Sacchari albi, aa 3ij. 
M. f. pulvis. 
Take of cream of tartar 1 oz. 
Nitre, 
White sugar, each 2 dr. 
Mix. Make a powder. 
A teaspoonful two to three times a day, in a glass of 
sweetened water. 
No. 139. 
ft Aquae fontanae ifvij. 
Spiritus cochleariae f iss. 
Aquae laurocerasi, 
Potassae nitratis, aa 3i. 
Extract! hyoscyami gr. x. 
M. 
Take of spring- water 7 oz. 
Spirit of cochlearia oz. 
Laurel water, 
Nitre, each 1 drachm. 
Extract of henbane 10 grs. 
As a gargle. 
No. 140. 
# Potassse carbonatis 3 ij. 
Succi citri q. s. ad satur- 
andum 
Aq use melissse giij. 
Extr. hyoscyami gr. iv. M. 
Take of carbonate of potassa 
2 drachms. 
Lemon juice as much as will 
saturate. 
Melissa water 3 ounces. 
Extract of henbane 4 grains. 
Two tablespoonfuls every two or three hours. 591 
RECEIPTS. 
R Elixir acidi sulphur, ar., 
Tinctures ambree, aa pp. 
Esq. 
No. 141. 
Take equal parts of elixir of 
vitriol, 
Tincture of amber. Mix 
Forty drops three times a day. 
No. 142, a. 
R Olei amygdal. dulc. gi. 
Aquas fontanae gvij. 
Mucilaginis g. acacias q. s. 
ut fiat emulsio. Adde 
Extracti hyoscyami gr. vi. 
Syrupi gi. M. 
Take of oil of almonds 1 oz. 
Spring water 7 ounces. 
As much mucilage of gum 
arabic as will make emul- 
sion. Add 
Extract of henbane 6 grains. 
Syrup 1 ounce. 
Two tablespoonfuls every hour. 
No. 142, b. 
R Potasses sulphatis gss. 
Aquas distillates gvj. 
Syrupi rubi ideei giss. M. 
Take of sulphate of potassa 
2 ounce. 
Distilled water 6 ounces. 
Raspberry syrup 1£ ounce. 
Two tablespoonfuls four times a day. 
Lngucntum Calcis. 
R Aquas calcis vivas, 
Olei papaveris aa pp. asq. 
No; 143. 
Lime Liniment. 
Take equal parts of lime wa- 
ter and poppy oil. 
Pilulae Adstringcntes 
s. Styptics®. 
No. 144. 
Astringent or Styp- 
tic Pills. 
r Extract! catechu, 
Aluminis crudi, 
Extract! cinchonas, aa pp. 
aeq. 
Misce f. pilulae gr. ij. 
Take of extract of catechu, 
Crude alum, 
Extract of bark, equal parts. 
Mix. Let pills of two grains 
be made. 
Ten, three times a day. 
No. 145. 
r Potasses nitratis 3 iij. 
“ bitartratis 3 ij. 
Aquae fontanae gvi. 
Take of nitre 3 drachms. 
Cream of tartar 2 drachms. 
Spring water 6 ounces. 592 
RECEIPTS. 
Extract! digitalis gr. i.-ij. 
Syrupi althsese giss. M. 
Extract of digitalis 1 to 2 gr. 
Syrup of mallows 1£ ounce. 
Two tablespoonfuls, at first every half hour, afterwards 
every hour, at last every two hours. 
No. 146. 
R Radicis ipecacuanhse gr. i. 
Sacchari albi 3 ij. 
Misce. Fiat pulvis divi- 
dendus in viij. partes 
sequales. 
Take ipecacuanha 1 grain. 
White sugar two drachms. 
Make a powder, to be di- 
vided into 8 equal parts. 
One every quarter of an hour. 
No. 147. 
R Acidi tartari. gr. xx. 
Extract! hyoscyami gr. 
viij. 
Aquae fontanse giv. 
Syrupi althsese giss. M. 
Take of tartaric acid 20 grs. 
-Extract of henbane 8 grains. 
Spring water 4 ounces. 
Syrup of mallows ounce. 
A tablespoonful every half hour. 
No. 148. 
R Elix. acidi Halleri gutt. 
lx. 
Laudani liquidi Sydenh. 
gutt. xx. 
Aquse fontanse giv. 
Syrupi papaveris rhoead. 
gij.M. 
Take of Haller’s acid elixir 
40 drops. 
Laudanum of Sydenham 20 
drops. 
Spring water 4 ounces. 
Red poppy syrup 2 ounces. 
Two table spoonfuls every half hour. 
No. 149. 
R Foliorum digitalis purp. 
3 SS. 
Ebulli cum aqua font. q. 
s. Colat. gvij. adde 
Acidi muriatic, oxygenat. 
3iJ- 
Aquse laurocerasi 3i. M. 
Take of leaves of digitalis £ 
drachm. 
Boil in enough spring water 
to leave strained 7 ounces. 
Add strong muriatic acid 2 
drachms. 
Laurel water 1 drachm. M. 
A tablespoonful every two hours. 
No. 150. 
R Olei araygdalar. dulc. §i. 
Aquce fontanse gxvi. 
Gutnmi acacise iiss. 
F. emulsio. Adde 
Syrupi fi. M, 
Take of almond oil 1 ounce. 
Spring water 16 ounces. 
Gum arabic 1£ ounce. 
Let an emulsion be made. 
Add syrup 1 ounce. 
Half a cup full every hour. 593 
Diuretic Infusion. 
RECEIPTS. 
No. 151. 
B Radicis levistici, 
“ ononis spinosae, 
aa gss. 
Baccarum juniperi |ij. 
Rad. glycyrrhizae §ss. 
Take of lovage root, 
Rest-harrow,— each £ oz. 
Juniper berries 2 ounces. 
Liquorice root £ ounce. 
B Pulveris rad. scillae, 
“ herbae digitalis, 
aa gr. xx. 
Corticis cinnamomi 3iss. 
Extract! qualae q. s. ut f. 
pil. No. lx. 
No. 152. 
Take powder of squills, 
Digitalis, each 20 grains. 
Cinnamon 1£ drachm. 
Extract of elecampane as 
much as is sufficient. Let 
60 pills be made. 
Two or three, three times a day, increasing to six and 
more, with diuretic infusion. 
B Olei juniperi 3ss. 
Tincturae digitalis 3i. 
lEtheris nitrosi 3ij. 
No. 153. 
Take of oil of juniper £ dr. 
Tincture of digitalis 1 dr. 
Nitrous ether 2 drachms. 
Thirty to sixty drops three times a day. 
B Succi spissati juniperi |iss. 
Potassse tartratis 3 ij. 
Aquae petroselini f vij. 
iEtheris nitrosi 3ij. 
Oxymellis scillae gi. M. 
No. 154. 
Take of inspissated juice of 
juniper 1£ ounce. 
Tartrate of potassa 2 dr. 
Water of petroselinum 7 oz. 
Nitrous ether 2 drachms. 
Oxymel of squills 1 ounce. 
Two tablespoonfuls every two hours. 
No. 155. 
B Olei terebinthinae, 
Aceti scillae, aa gij. 
Spiritus serpylli giij. M. 
Spirit of turpentine, 
Vinegar of squills, each 2 oz. 
Spirit of thyme 3 ounces. M 
Lotion for the abdomen. 
& Garnbogiae, 
Pulver. scillae, 
Digitalis, 
Antirnonii sulphuret (aur.) 
No. 156. 
Take of gamboge, 
Squills, 
Digitalis, 
Golden sulphuret of anti- 
mony. 594 
RECEIPTS. 
Extr. pimpinelles, aa pp. 
Esq. 
Misce. Fiant pilules gr. ij. 
Extract of pimpinella equal 
parts. Let pills of 2 
grains be made. 
One every two or three hours, gradually increasing the 
number until effect be produced. 
No. 157. 
R. Radicis bryonies albes gi. 
Infunde vino Rhenan. ftij. 
Digere leni calore per 
duos dies. Colentur. 
Take of white bryony root 
1 ounce. 
Rhenish wine 2 pints. 
Digest for two days, at a 
moderate temperature. 
One or two spoonfuls every morning ; increasing to half, 
even to a whole cup full, according to the effect. 
No. 158. 
R Potasses carbonatis gi. 
Aceti scilles q. s. ad sa- 
turand. 
Extract! fumariee, 
“ centaurii min., 
“ gentianes, 
“ trifolii, aa gss. 
Infus. baccarum juniperi 
ftiv. 
Tincturee martialis aperit. 
“ antirnonii Jacobi 
aa gi. M. 
Take of carbonate of potassa 
1 ounce. 
As much vinegar of squills 
as will saturate. 
Extract of fumitory, 
Centaury, 
Gentian, 
Trefoil, each £ ounce. 
Infusion of juniper berries 
4 pints. 
Laxative tincture of mars., 
Antimonial tinct. of James, 
each 1 ounce. 
A tablespoonful every two hours. 
R Elaterii gr. i. 
Aques petroselini gvi. 
JEtheris nitrosisi 3 ij. 
Oxymellis scilles, 
Syrupi de spina cervina, 
aa gi. 
Tinctures aromaticee 3ij - 
M. 
No. 159. 
Take of elaterium 1 grain. 
Water of petroselinum 6 oz. 
Nitrous ether 2 drachms. 
Oxymel of squills, 
Syrup of cathartic buck- 
thorn, each 1 ounce. 
Aromatic tincture 2 drs. 
A tablespoonful every two or three hours, according to 
the effect. RECEIPTS. 
595 
No. 160. 
R Syrupi de spina cervi, 
< Succi spissati juniperi, 
“ sambuci, aa 
pp. teq. 
Take equal parts of syrup of 
buckthorn, 
Inspissated juice of juniper, 
Elder flowers. 
A spoonful every three hours. 
R Scammonii 3i. 
Antimonii crudi, 
Croci martial, aperit. aa. 
3ss. M. 
No. 161. 
Take of scammony 1 dr. 
Crude antimony, 
Aperitive martial crocus, 
each \ drachm. 
Twenty grains in pills for a dose. 
No. 162. 
R Resinas guaiaci 3i. 
Gambogise gr. xx. 
Rad. scillse gr. xij. 
Hydrargyri nitratis gr. ij. 
Extr. levistici 3i. 
Misce. Fiant pilulte No. 
LX. 
Take of resin of guaiacum 1 
drachm. 
Gamboge 20 grains. 
Squills 12 grains. 
Nitrate of mercury 2 grains. 
Extract of levisticum 1 dr. 
Mix. Let 60 pills be made. 
Five, three times a day, taken in diuretic infusion. 
No. 163. 
R Hydrargyrii nitratis gr. vi. 
in aquse q. s. solutus. 
Extracti levistici, 
“ pimpinellee, aa si. 
Olei juniperi guttas xxx. 
Pulv. rad. althsea3 q. s. ut 
Fiant pilulee No. lx. 
Take nitrate of mercury 6 
grains. Dissolved in a suf- 
ficiency of water. 
Extract of levisticum, 
Pimpinella, each 1 drachm. 
Oil of juniper 30 drops. 
Powdered mallow root, 
enough. 
Let sixty pills be made. 
One every two hours. 
No. 164. 
R Olei menthse pip. guttas x. 
Solve in 
Liquoris anodyni Hof. 3i. 
“ ammonise anisati, 
Take of oil of peppermint 10 
drops. 
Dissolve in 
Anodyne liquor of Hofmann 
1 drachm. 
Aromatic spirit of ammonia, 596 
Tincturse valerianee aa 
3iss. M. 
RECEIPTS. 
Tincture of valerian, each 
Ij■ drachm. 
Thirty to forty drops in infusion of cumin. 
B Essentise menthse pip., 
“ castorei, 
Liquoris anodyni Hof. aa 
3i. 
Laudani liquidi Sydenh. 
3ss. M. 
No, 165. 
Take of essence of pepper- 
mint, 
Castoreum, 
Anodyne liquor of Hof. each 
1 drachm. 
Liquid laudanum of Sydenh. 
half a drachm. 
Thirty drops for a dose. 
No. 166. 
B Tincturse absinthii, 
Elixir aurantii co. aa §ss. 
Essentise menthse pip. ij. 
drachms. M. 
Take tincture of absinth, 
Compound elixir of orange- 
peel, each half an ounce. 
Essence of peppermint 2 
drachms. 
Sixty drops three times a day. 
No. 167. 
B Asse foetidse, 
Fellis tauri inspissati, 
Extracti absinthii, 
“ quassise, 
“ cort. aurantii aa 
3i. 
Olei cajeputi gr. x. 
Misce. Fiant pilulee gr. ii. 
Take of asa foetida, 
Dry ox-gall, 
Extract of absinth, 
Quassia, 
Orange-peel, each 1 drachm. 
Oil cajeput 10 gr. 
Mix. Let pills of 2 grains 
be made. 
Ten to fifteen morning and evening. 
No. 168. 
B Extracti graminis, 
“ taraxaci, 
Potassse tartratis, aa |ss. 
Aquse distillatse, 
“ menthsepip. aa §iij. 
M. 
Take of extract of dog-grass, 
Dandelion, 
Tartrate of potassa, each 4 
ounce. 
Distilled water, 
Peppermint, each 3 ounces. 
A tablespoonful four times a day. RECEIPTS. 
597 
R Potassae bitartratis §i. 
Florum sulphuris §ss. 
Misce. Fiat pulvis. 
No. 169. 
Take of cream of tartar 1 oz. 
Flowers of sulphur £ ounce. 
Mix. Let a powder be made. 
A teaspoonful once or twice a day, for a few days, so as 
to produce one or two loose stools. 
R Lactis sulphuris, 
Magnesias carbonatis, 
Acidi tartari, 
Eloeosacchari citri, aa gr. 
xx. 
Misce. Fiat pulvis. 
No. 170. 
Take of milk of sulphur, 
Magnesia, 
Tartaric acid, 
Citron sugar, each 20 grains. 
Mix. Let a powder be made. 
A powder in a cup of water every evening. 
PiluSie Balsamlcae 
Hofmaimi. 
R G. Myrrhae, 
Aloes, 
Ext. hellebori nigri aa 
sv. 
“ cardi benedicti, 
“ absinthii, 
“ fumariae, 
“ centaurii, 
“ millefolii, aa |i. 
Terebinthinse, 
Benzoes, 
Resinae juniperi, 
“ hederas, aa §ss. 
Croci orientalis, 3i. 
Misce. Coque in balnea 
mar. ad consistatem 
massulae pilulse. Dosis 
gr. iv. ad xij. 
No. 171/ 
Balsamic Pills of 
Hofmann. 
Take of myrrh, 
Aloes, 
Extract of black hellebore, 
each 5 drachms. 
Cardus benedictus, 
Absinth, 
Fumitory, 
Centaury, 
Millefoil, each 1 ounce. 
Turpentine, 
Gum benjamin, 
Kesin of juniper, 
Ivy, each ounce. 
Saffron 1 drachm. 
Mix. Boil in a water bath 
to the consistence of pill- 
mass. Dose from 4to 12 
grains. 
Pulvis Aeroplior«t§. 
$ Sodse bicarbonatis 3i. 
Acidi tartari gr. vi. M. 
No. 172. 
Aerated Powder. 
Take of carbonate of soda 
20 grains. 
Tartaric acid 6 grains. 
To be taken two or three times a day. 598 
RECEIPTS. 
a Elix. acid Halleri gss. 
Tincturse cinchonse Whyt- 
tii giss. 
No. 173. 
Take of Haller’s acid elixir 
a- ounce. 
Whytt’s tincture of bark 1 * 
ounce. 
Fifty to eighty drops in a cup of water three times a day. 
No. 174. 
a Pulv. radicis columbo gss. 
Coque in aqua fontana gx. 
ad vi. 
Colaturae adde 
Tincturse cort. aurantii 3 ij 
Syrupi “ §i. M. 
Take of columbo £ ounce. 
Boil in 10 ounces of water 
to 6. 
To the strained liquor add 
Tincture of orange peel 2 dr. 
Syrup of “ “ 1 oz. 
A tablespoonful every three hours. 
a Extracti catechu, 
Aluminis crudi, 
Corticis cinchonae, 
Extracti quassiae, aa 3i. 
Ferri sulphatis gr. x. 
Misce. Fiant piiulse gr. ij. 
No. 175. 
Take of extract of catechu, 
Crude alum, 
Bark, 
Ext. quassiae, each 1 dr. 
Green vitriol 10 grains. 
Mix. Let pills of 2 grains 
be made. 
Ten every morning and evening, increasing. 
No. 176. 
Liquor Aiilcrclhi* 
etas. 
a Aquae laurocerasi, 
Liquoris plumbi subace- 
tatis aa gij. 
Aquae rosarum giv. M. 
Antcrethic Liquor. 
Take of laurel water, 
Goulard’s water, each 2 oz. 
Rose water 4 ounces. 
For an external application. 
a Furfurse triticse gij. 
Camphorse 3ij. M. 
No. 177. 
Take wheaten bran 2 ounces. 
Camphor 2 drachms. 
R Tincturse rhei aquosse gi. 
Aquse menthse pip. §ij. 
“ distillatse giv. 
AmmonifE muriatis 3i. 
Syrupi althsese gi. M. 
No. 178. 
Take of aqueous tincture of 
rhubarb 1 ounce. 
Peppermint water 2 ounces. 
Distilled “ 4 ounces. 
Muriate of ammonia 1 dr. 
Syrup of mallows 1 ounce. 
Two tablespoonfuls every three hours. receipts. 
599 
R Olei amygdal. dulc. §i. 
Ammonii muriatis sij. 
Mucilaginis gum. acacise 
§ss. 
Aquae fontanae §vi. 
Extract! hyoscyami gr. vi. 
Syrupi amygdal. §i. M. 
No. 179. 
Take of oil of almonds 1 oz. 
Sal ammoniac 2 drachms. 
Mucilage of gum arable £ oz. 
Spring water 6 ounces, 
Extract of henbane 6 grains. 
Syrup 1 ounce. 
Two tablespoonfuls every two hours. 
No. 180. 
B Radicis rhei gr. ij. 
“ ipecacuanhas gr. 
Cretse prseparatae gr. 10. 
Misce fiant pulv. Dispens. 
viij. doses. 
Take of rhubarb 2 grains. 
Ipecacuanha \ grain. 
Prepared chalk 10 grains. 
Make a powder of it. Give 
8 doses. 
One dose every half hour. 
No. 181. 
B 801. Armenian, gr. x. 
Nucis moschat. gr. iij. M. 
Misce fiant pulveris dis- 
pens. dos. vi. 
Take of Armenian bole 10 
grains. 
Nutmeg 3 grains, mix it into 
powder. Give 6 doses. 
One dose to he taken every three hours. 
B Extract! cascarillse si. 
Aquas menthae, 
“ chamomillae aa 3ij. 
Mucilaginis gum. acaciae 
f ss. M. 
No. 182. 
Take of extract of casca- 
rilla 1 drachm. 
Peppermint water, 
Chamomile water each 2 oz. 
Mucilage of gum-arabic £ oz. 
A tablespoonful every two hours. 
No. 183. 
B Radicis rhei gr. ij. 
Greta} prseparatae, 
Pulveris gummosi aa. gr. 
xx. 
Laudani liquidi Syd. gtt. 
Ip 
Nucis raoschatae gr. uj. 
Misce, fiat pulvis. 
Take of rhubarb 2 grains. 
Prepared chalk, 
Gum-powder, each 20 grs. 
Liquid laudanum of Sydenh. 
2 drops. 
Nutmeg 3 grains. 
Mix. Let a powder be made. 
To be taken two or three times a day. 600 
RECEIPTS. 
R Pul. rad. columbo gss. 
Coque cum aq. §xij. ad vi. 
Colaturas adde 
Syrupi corticis aurantii 
ij- 
Laudani liquidi Sydenh. 
guttas x. M. 
No. 184. 
Take of powdered columbo 
£ oz. 
Boil in 12 oz. of water to 6. 
Add to the strained liquor 
Syrup of orange peel 1 oz. 
Liquid laudanum of Syd. 10 
drops. 
One tablespoonful every two hours. 
No. 185. 
R Pulveris ligni Campech. 
gss. 
Cort. aurantii 3iss. 
Coque cum aqua font. fxii. 
ad viij. 
Colaturas adde 
Syrupi cort. aurantii. §i. 
M. 
Take of powder of Cam- 
peachy wood oz. 
Orange peel 1£ drachm. 
Boil in 12 ounces of water 
to 8. 
To the strained liquor add 
Syrup of orange peel, 1 oz. 
Two tablespoonfuls every two hours. 
R Tinctures macis §ss. 
Laudani liquidi Sydenh. 
3ss. M. 
No. 186. 
Take of tincture of mace 
f oz- 
Liquid laudanum of Sydenh. 
drachm. 
Thirty drops, three or four times a day. 
No. 187. 
R Nucis vomicae gr. iij. 
Gretas praeparatae gr. x. 
Nucis moschatae gr. iv. 
Misce. Fiant pulvis. 
Takenux vomica 3 grains. 
Prepared chalk 10 grains. 
Nutmeg 4 grains. 
To be taken two or three times a day. 
No. 188. 
R Radicis arnicas 3iij. 
Corticis cascarillas 3ij. 
Coque cum aqua font. fx. 
ad vi. 
Colaturss adde 
Tinctures catechu 3ij. 
Laudani liquidi Sydenh. 
gutt. xij. 
Syrupi althaeas §j. M. 
Take of arnica root, 3 dr. 
Cascarilla bark 2 drachm. 
Boil in 10 ounces of water 
to 6. 
Add to the strained liquor. 
Tincture of catechu 2 dr. 
Liquid laudanum of Syd. 12 
drops. 
Syrup of mallows 1 oz. 
Two tablespoonfuls four times a day. RECEIPTS. 
601 
No. 189. 
Take equal parts of 
Extract of arnica, 
“ columbo, 
Extract of millefoil, 
Flowers of sulphur. 
Mix. Let 2 gr. pills be made. 
R Extracti arnicas 
“ columbo 
“ millefolii 
Florum sulphuris aa pp. 
aq- 
Misce. Fiant pilulse gr. ij. 
Ten three times a day. 
No. 190. 
r Mucilaginis g. acaciae fi. 
Aquae fontanae gvij. 
Laudani liquid! Syden. 
guttas xvi. 
Syrupi althaeae §i. M. 
Take of mucilage of g. ara- 
ble 1 oz. 
Spring water 7 oz. 
Liquid laudanum of Syd. 16 
drops. 
Syrup of mallows 1 oz. 
A tablespoonful every two hours, and in urgent cases 
every hour. 
No. 191. 
r Tinctures rhei aquosae 3vi. 
Ammonias muriatis 3ij. 
Aquae cerasorum |vij. 
Laudani liquid! Sydenh. 
guttas xx. 
Syrupi althseae fj. M. 
Take watery tincture of rhu- 
barb 6 drachms. 
Sal ammoniac 2 drachms. 
Cherry water 7 ounces. 
Liquid laudanum of Syden. 
20 drops. 
Syrup of mallows 1 ounce. 
Two tablespoonfuls every two hours. 
No. 192. 
g, Fellis tauri inspissati 
Saponis 
PuW. rhei aa 3j. 
Extract! taraxici q. s. ut 
fiant pilulse gr. ij. 
Take of dry ox gall, 
Soap, 
Rhubarb each 1 drachm. 
Enough extract of dandelion. 
Let pills of 2 grs. be made- 
Ten night and morning. 
No. 193, a. 
R Aloes vel scammonii. 
Ferri alcoholisati aa pp. aeq. 
Misce. Fiat pilulee gr. i. 
Take of aloes or scatnmouy, 
Iron filings equal parts. 
Mix. Make into pills of 1 
grain each. 
One at bed-time. 602 
RECEIPTS. 
R Colocynthidis pulp® fvi. 
Aloes spicat® extracti 
§xii. 
Scammonii giv. 
Cardamomi seminum §i. 
Saponis giij. 
Spirit, tenuioris congium. 
Macera colocynthidis pul- 
pam in spiritu, leni ca- 
lore, per quadriduum. 
Liquorem cola, eique 
adjice aloen, scammo- 
nium et saponem ; dein 
spiritum consume, do- 
nee idoneam cessitudi- 
nem habeat et, sub fi- 
nera, cardamomi semina 
admisce. 
No. 193, b. 
Take of pulp of colocynth 
6 ounces. 
Extract of aloes 12 ounces. 
Scammony 4 ounces. 
Cardamom seed 1 ounce. 
Hard soap 3 ounces. 
Weak spirits 1 gallon. 
Digest the colocynth in the 
spirit, for four days, at a 
moderate heat, add to it 
the aloes, scammony, and 
soap, evaporate to a pro- 
per consistence, and add 
the cardamoms. 
No. 194. 
r Pulv. foliorum sennse 3ij. 
Extracti taraxici q. s. ut 
fxant pilulse No. lx. 
Take of powder of senna 2 
drachms. 
Extract of dandelion a suffi- 
ciency. Let sixty pills be 
made. 
Five to ten a day. 
No. 195. 
Species Thea St. 
Oermani. 
r Foliorum sennse §lv. 
Digere cum spiritu vini 
rectif. per horas xxiv. 
Post digestionem ex- 
sicca sine calore. Adde 
Florum sambuci giiss. 
Seminum foeniculi, 
anisi, aa §i. 
Potassse bitartratis 3vi. 
M. C. M. 
Ingredients tor the 
Tea of St. Germain. 
Take of senna leaves 4 
ounces. 
Digest in proof spirits for 
24 hours. After the di- 
gestion, dry without heat. 
Add 
Flowers of elder 2£ ounces. 
Fennel seed, 
Anis seed, each 1 ounce. 
Cream of tartar 6 drachms. 
Mix. RECEIPTS. 
603 
ft Mann® el ect®, 
Fructus tamarindorum, 
Magnesi® sulphatis, aa gi. 
Coque cum aqua font, 
gxij. ad viij. sub finem 
coctionis, adde 
Foliorum senn® 5 ij. 
Liquori colato. adde 
Extract! hyoscyami gr. 
viij. 
Syrupi papaveris gi. M. 
No. 196. 
Take of best manna, 
Tamarinds, 
Epsom salt, each 1 ounce. 
Boil in 12 ounces of water 
to 8. At the end of the 
boiling add 
Senna leaves 2 drachms. 
To the strained liquor add 
Extract of henbane 8 grains. 
Poppy syrup 1 ounce. 
Two tablespoonfuls every hour. 
No. 197. 
ft Old amygdalarum, 
Magnesi® sulphatis, aa gi. 
Extr. aloes aquosi gr. x. 
“ hyoscyami gr. xx. 
Aqu® fontan® gviij. M. 
Take of almond oil, 
Epsom salt, each 1 ounce. 
Aqueous extract of aloes 10 
grains. 
Henbane 20 grains. 
Water 8 ounces. 
Two tablespoonfuls every two hours. Shake the mixture 
each time. 
No. 198. 
ft Nicotian® siij. 
Coque cum aqua gix. ad 
vij- 
Colentur. 
Take of tobacco 3 drachms. 
Boil in 9 ounces of water to 
7. 
Let it be strained. 
Half a cup full every hour. 
ft Sued spissati juniper! gi. 
Aqu® petroselini giv. 
Acidi muriatici diluti 3 ij, 
M. 
No. 199. 
Take of Inspissated juice of 
juniper 1 ounce. 
Water of petroselinum 4 
ounces. 
Dilute muriatic acid 2 drs. 
A tablespoonful every two hours. 
No. 200. 
$ Pulv. cantharidum gr. i. 
Camphorse gr. vi. 
Mucilaginis g. acaci® q. 
s. ut. 
F. pilulse No. iv. 
Take of cantharides 1 gr. 
Camphor 6 grains. 
Mucilage as much as neces- 
sary. 
Make 4 pills. 
One, morning, noon, and night with gruel. 604 
RECEIPTS. 
Poliis A ntidyscrasi- 
ciis 8. Puriiicans. 
R Resinse guaiaci gr. xx. ad 
XXX. 
Sulphureti antim. (aur), 
Hydrargyrii submuriatis, 
5a gr. ij. 
Magnesise carbonatis, 
Eloeosacchari foeniculi, aa 
gr. xx. M. 
No. 201. 
Purifying or Anti- 
dyscrasic Powder. 
Take of resin of guaiacum 
20 to 30 grains. 
Golden sulphuret of anti- 
mony, 
Calomel, each 2 grains. 
Magnesia, 
Fennel candy, each 20 grs. 
M. 
For infants and delicate persons, let black sulphuret of 
mercury or antimony be substituted for the calomel, in the 
proportion of one grain for each year of age, and of a scru- 
ple for adults. Make a powder, half night and morning. 
No. 202. 
R Radicis sarsaparillse, 
“ bardanse, 
“ saponarise, 
Ligni guaiaci, 
Rad. glycyrrhizse, 
Stipitum dulcamarse aa 
pp. seq. 
C. M. 
Take of sarsaparilla, 
Burdock, 
Soapwort, 
Guaiacum, 
Liquorice roots, 
Tops of bittersweet, equal 
parts. 
An ounce or an ounce and a half every day, in decoction. 
No. 203. 
Dccoctum Foil Ini. 
R Rad. sarsaparillse gi. 
Stipit. dulcamarse gss. 
Pulver. antimonii crud. 3 i. 
C. coque cum aqua font. 
Ibij, ad Ifeiss. Adde 
Foliorum sennse sss 
Colaturee adde 
Syrupi fumarise |i. M. 
Decoction of Pol- 
lini. 
Take of sarsaparilla 1 ounce. 
Twigs of bittersweet £ oz. 
Crude antimony in powder 
1 drachm. 
Boil in 2 pints of water to 
IF pint. Add 
Senna F to 1 drachm. 
To the strained liquor add 
Syrup of fumitory 1 ounce. 
All to be taken in one day. RECEIPTS. 
605 
No. 204, (1.) 
Decoctum Zitt- 
manni Fortius. 
B Rad. sarsaparilla fxij- 
Infunde 
Aquae communis mensuras 
xxiv. 
Et digere per horas xxiv. 
Turn additis 
Sacchari aluminati |iss. 
Hydrarg. submuriatis §ss. 
Cinnabaris 3i. 
Sacculolinteo inclusis, co- 
que ad reraanentiam 
mensurarum octo, sub 
finem coctionis addendo 
Seminum anisi, 
“ foeniculi singu- 
lorum contusorum §ss. 
Foliorum sennee §iij. 
Radicis glycyrrhizae §iss. 
Cola et exprime. Liquor- 
em obtentum decantha. 
Zi II in aim's Strong’ 
Decoction. 
Take of sarsaparilla 12 oz. 
Pour over it 
Common water 24 pints, 
And digest for 24 hours. 
Then add 
Alumniated sugar ounce. 
Calomel j- ounce. 
Vermilion 1 drachm. 
Enclosed in a linen bag, and 
boil down to 8 pintsj to- 
wards the last of the boil- 
ing there being added of 
separately bruised 
Anis seed, 
Fennel seed, each £ ounce. 
Senna 3 ounces. 
Liquorice root ounce. 
Strain and press the liquor 
out. 
No. 205, (2.) 
Decoct. Zittman. 
Mitius. 
B Rad. sarsaparillse gvi. 
Cum speciebus a decocto 
fortiori mensurarum, 
octo residuis mixtas 
coque cum aqua com. 
mensuris xxiv. ad re- 
manentiam mensura- 
rum octo, sub finera coc- 
tionis addendo 
Corticis citri, 
Cassiae cinnamomi, 
Cardamomi minoris, 
Rad. glycyrrhizae singulo- 
rum contusorum et con- 
cisorum 3iij- 
Cola et exprime liquorem, 
obtentum decantha. 
Weaker Decoct. of 
Zlttmaim. 
Take of sarsaparilla 6 oz. 
Boil with the residue of the 
preceding decoction, and 
reduce to 8 pints, adding 
towards the end 
Citron peel, 
Cassia cinnamon 
Lesser cardamoms 
Liquorice root, each bruised 
and cut up. 
Strain and express. 606 
RECEIPTS. 
Take a gill of the strong decoction (1.) while yet in bed, 
quite early in the morning. Remain there until the perspi- 
ration be over, change linen, after this take two cups of 
coffee. In the course of the forenoon take a cup of broth ; 
at noon a dish of soup, roast meat (fowl is preferable), and 
vegetables, abstaining from fruit, wine, beer and pastry j 
from all kinds of ices; acids, salted or fat meats. After 
dinner, take again coffee, and half a pint of the strong de- 
coction, cold. In the evening gruel. Before going to bed 
take half a pint of the weak decoction (2). 
The medicine ought to be kept in the cellar ; keeping 
only two bottles for immediate use, which must be well 
shaken before using. 
B Limat. ferri gr. x. 
Radicis rhei, 
Cinnamomi aa gr. ij. 
Sacchari albi gr. xx. 
Misce. F. pulvis. 
No. 205. 
Take of iron filings 10 grs. 
Rhubarb; 
Cinnamon, each 2 grains. 
White sugar 20 grains. 
Mix. Let a powder be made. 
To be taken morning and evening. 
• No. 206. 
B Florum ammoniacal. mar- 
tial. vel ferri tartaris 3i. 
Extract! gentianse 3 ij. 
Corticis aurantii 3i. 
Aquse melissas giij. 
“ cinnamomi §ij. 
Syrupi cort. aurantii §i. M. 
Take of martial flowers of 
sal ammoniac or tartrate 
of iron 1 drachm. 
Extract of gentian 2 dr. 
Orange peel 1 drachm. 
Melissa water 3 oz. 
Cinnamon water 2 oz. 
Syrup of orange peel 1 oz. 
Mix. 
A tablespoonful four times a day. 
B Extract! taraxici 
“ chelidonii aa 5 iij. 
Acidi tartaris |ss. 
Tincturee rhei aquosse |i. 
Aquae menthae pip. gij. 
“ distillatae §iv. 
Syrupi menthae §i. M. 
No. 207. 
Take of extract of dandelion, 
“ chelidonium, 
each 3 drachms. 
Tartaric acid, £ oz. 
Watery tincture of rhubarb 
1 oz. 
Peppermint water 2 oz. 
Distilled water 4 oz. 
Syrup of mint 1 oz. 
A spoonful every two hours. RECEIPTS. 
607 
No. 208. 
R Pulveris rad. rhei, 
Extract! taraxici, 
“ chelidonii, 
Saponis, 
Gummii ammoniac! aa 3i. 
Aloes gr. xx. 
Misce. Fiant pilulse gr. ii. 
consperge seminibusly- 
copodii. 
Take of rhubarb, 
Extract of dandelion, 
“ chelidonium, 
Soap, 
Gum ammoniac, each 1 dr. 
Aloes 20 gr. 
Mix. Let 2 grain pills be 
made, sprinkled with ly- 
copodium. 
Twelve morning, noon and night. 
No. 209. 
R Radicis belladonnse gr. i. 
“ rhei gr. v. 
Sacchari albi g. xx. 
M. F. pulvis. 
Take of nightshade root 1 
grain. 
Rhubarb 5 gr- 
White sugar 20 gr. 
Mix. Make a powder. 
To be taken morning and evening. 
No. 210. 
R mineralis gr. i. 
ad iij. 
Pulveris puerorum gr. xx. 
ad xxx. 
Misce. F. pulvis. 
Take of JEthiops mineral 1 
to 3 grains. 
Pulvis puerorum 20 to 30 
grains.* 
Mix. Let a powder be made. 
Half in the morning and the rest at bed-time. 
R Antimonii sulphuret. (aur.) 
Hydrargyrii submuriatis, 
aagr. i. 
Pulveris puerorum 3ss. 
M. F. pulvis. 
No. 211. 
Take of golden sulphuret of 
antimony, 
Calomel, each 1 gr. 
Pulvis puerorum £ drachm. 
Mix. Let a powder be made. 
Half in the morning and the rest in the evening (for 
children of five years and upwards.) 
No. 212. 
R Antimohii sulphur, (aur.) 
Hydrargyrii submuriatis, 
Ext. cicutse aa gr. i. 
Resinse guaiaci gr. x. 
Take of golden sulphuret of 
antimony, 
Calomel, 
Extract of cicutee, each 1 gr. 
Resin of guaiacum 10 gr. 608 
RECEIPTS. 
Eloeosacchari fasniculi gr. 
xx. 
Misce. Fiat pulvis. 
Fennel candy 20 gr. 
Mix. Let a powder be made. 
Half in the morning the rest in the evening. 
No. 213. 
R Barytas muriatis 3ss. 
Aquae distillatae §i. 
Take of muriate of barytes 
$ drachm. 
Distilled water 1 oz. 
Ten to thirty drops, three times a day. 
No. 214. 
R Ligni sassafragae §iv. 
Radicis rubiae tincturi 
“ glycyrrhizae aa §i, 
C. M. 
Take of sassafras 4 oz. 
Madder, 
Liquorice root, each 1 oz. 
A tablespoonful in infusion, as a tea, daily. 
R Resinas guaiaci 
Extract! dulcamaras aa sij. 
“ cicutae gr. xx. 
Florum sulphuris 
Hydrargyrii submuriat. aa 
gr. x. 
Misce. Fiant pilulse gr. ij. 
No. 215. 
Take of resin of guaiacum, 
Extract of bittersweet, each 
2 drachms. 
Extract of cicutse 20 gr. 
Flowers of sulphur, 
Calomel, each 10 gr. 
Mix. Let 2 grain pills be 
made. 
Ten, twice a day. 
No. 216. 
R Radicis saponariae 
“ taraxici 
“ bardanae 
“ sassafragae aa §ij. 
<c rubiae tinctori giij. 
“ glycyrrhizae gi.M. 
Take of root of saponaria 
“ dandelion 
“ bardana 
“ sassafras, each 
2 oz. 
“ madder 3 oz. 
“ liquorice 1 oz. 
C. M. Boil one ounce in a quart of water, and reduce 
to two-thirds. The whole to be taken in one day. 
No. 217. 
R Calcii chloridi gss. 
Take of chloride of lime, 
i oz. 
Solve in aqua distillata Distilled water 1 pint. 
S’l, Externally. 609 
RECEIPTS. 
No. 218. 
R Potassse hydriodatis 3ss. 
Adeps suillse gi. M. 
Take of hydriodate of po- 
tassa f drachm. 
Hog’s lard 1 oz. 
No. 219. 
Fngiientum Oph- 
thalmicHm. 
R Hydrargyrii oxidi .rubri 
gr- y- . 
Tuttse gr. vi 
TJnguenti simplicis 3i. 
Extract! opii aquos. gr. ss. 
M. 
Ophthalmic Oint- 
ment. 
Take of red precipitate 2 gr. 
Tutty 6 gr. 
Simple ointment 1 drachm. 
Aqueous extract of opium, 
i gr- 
No. 220. 
R Boracis sodse 3iss. 
Solve in aqua giv. 
Aquse laurocerasi 3 iij. M. 
Take of borax drachm. 
Dissolve in water 4 oz. 
Laurel water 3 drachms. 
R Spongise tostse 3ss. 
Cretae prseparatse 
Elseosacchari citri aa g. xx. 
JEthiopis mineralis gr. x. 
Misce. F. pulvis. 
No. 221. 
Take of burnt sponge dr. 
Prepared chalk, 
Citron candy, each 20 gr. 
JEthiops mineral 10 gr. 
Mix. Let a powder befnade. 
Half in the morning the rest at night. 
No. 222. 
R Spongise tostse gss. 
Coque cum aqua gxij. ad v. 
Colaturse adde 
Aquse cinnamomi, 
Syrupi corticis aurantii aa 
ih 
Take of burnt sponge \ oz. 
Boil in 12 oz. of water to 5. 
To the strained liquor add 
Cinnamon water, 
Syrup of orange peel, each 
1 oz. 
A tablespoonful four times a day. 
No. 223. 
R Potassse bi-carbonatis 3i. 
Aquse citmamomi 
Syrupi althsese aa gi. 
Aqua fontana gvi. M. 
Take of bi-carbonate of soda 
1 drachm. 
Cinnamon water 
Syrup of mallows, each 1 oz. 
Spring water 6 oz. 
Two tablespoonfuls four times a day. 610 
RECEIPTS. 
R Sacchari albi gr. xx, 
Greta praparata gr. x. 
Ferri alcoholisati gr. i—ij. 
Cinnamomi gr. i. M. 
M. pulvis. 
No. 224. 
Take of white sugar 20 gr. 
Prepared chalk 10 gr. 
Iron filings 1 to 2 gr. 
Cinnamon 1 gr. 
Mix, Make a powder. 
Take morning and evening. 
No. 225, a. 
Take of guaiacum 
Gum arabic, each 2 dr. 
Distilled water 6 oz. 
Let an emulsion be made ; 
add 
Nitre 1 drachm. 
Syrup 1 oz. 
Antimonial wine 1 drachm. 
R Resin® guaiaci, 
Gummi acacia aa sij. 
Aqua distillata gvi. 
Fiat emulsio; adde 
Potassa nitratis si. 
Syrupi gi. 
Vini antimonii 3i. M. 
A tablespoonful every two hours. 
No. 225, b. 
R Tinctura guaiaci volatil. 
gi. 
Mucilaginis gum. acacia 
3ij. 
Syrupi amygdalarum, 
‘W cort. aurantii, aa 
giss. M. 
Take of volatile tincture of 
guaiacum 1 oz. 
Mucilage of gum arabic 2 
drachms. 
Syrup of almonds, 
“ orange peel If oz. 
Half a spoonful three times a day. 
No. 226. 
R Soda carbonatis si. 
Extracti absynthii 3ij. 
Aqua menthii pip. giv. 
Syrupi corticis aurant. gi. 
Tinctura “ “ siss. 
M. 
Take of carbonate of soda 
1 drachm. 
Extract of absinth 2 dr. 
Peppermint water 4 ounces. 
Syrup of orange peel 1 oz. 
Tincture of “ “1£ dr. 
A tablespoonful four times a day. 
R Calcis antimonii sulphu- 
rati 3ij. 
Coque cum aqua fontana 
fcv. ad iv. 
No. 227. 
Take of calx of antimony 2 
drachms. 
Boil in 5 pints of water to 4. 
Half, or a whole cup, every two hours. RECEIPTS. 
611 
No. 228. 
R Olei sabinse guttas ij. 
Extracti aconiti gr. i. 
Sacchari albi gr. xx. 
Misce, f- pulvis. 
Take of oil of savin 2 drops. 
Extract of aconite 1 grain. 
White sugar 20 grains. 
Mix, make a powder. 
To be taken morning and evening. 
No. 225. 
$ Olei sabinse guttas iv. 
Calcis sulphureti gr. vi. 
Extracti aconiti gr. ii. 
Sacchari albi si. 
M. f. pulvis. 
Take of oil of savin 4 drops, 
Sulphuret of lime 6 grains. 
Extract of aconite 2 grains. 
White sugar 1 drachm. 
Mix, make a powder. 
To be taken in three times during the day. 
R Resinse guaiaci 3ss. 
Lactis sulphurisgr. x. 
Antimonii sulphureti 
(aur.) gr. ij. 
Elseosacchari citri 3ss. 
Misce. Fiat pulvis. 
No. 230. 
Take of guaicum £ drachm. 
Milk of sulphur 10 grains. 
Golden sulphuret of antim. 
2 grains. 
Citron candy £ drachm. 
Mix. Let a powder be made. 
To be taken in three times. 
No. 231. 
R Hydrargyrii bi-chloridi 
gr. ij* 
Solve in aqua distillata q.s. 
Opii gr. ij. 
Mellis gr. xx. 
Micse panis, q. s. ut fiant 
pilulse No. xl. 
Take of corrosive sublimate 
2 gr. 
Dissolve in distilled water 
Opium 2 gr. 
Honey 20 gr. 
Crumb of bread as much as 
will do. Make 40 pills. 
Six, ten, even twelve morning and evening. 
R Hydrargyrii oxidi rubri 
gr. i. 
Antimonii crud. gr. xl. 
Extracti glycyrrhizse q. s. 
ut fiantpilulae No.lxxx. 
No. 232. 
Take of red precipitate 1 gr. 
Crude antimony 40 gr. 
Extract of liquorice enough. 
Let 80 pills be made. 
Ten at bed-time, and in the course of time that number 
twice in obstinate cases. 
No. 233. 
R Potassse hydriodatis 3i. 
Take of hydriodate of potass 
1 drachm. 612 
RECEIPTS. 
lodini gr. i. 
Aquae distillates gv. 
Syrupi papaveris gi. M. 
lodine 1 drachm. 
Distilled water 5 ounces. 
Syrup of poppies 1 ounces. 
A spoonful three times a day. 
R Hydrargyrii vivi fti. 
Coque in vase terreo saepe 
agitando cum spatula 
lignea cum aqua fonta- 
na ftiv. per aliquot bo- 
ras. 
No. 234. 
Take of quicksilver 1 pound. 
Water 4 pints. 
Boil in an earthen vessel, 
stirring often with a wood- 
en spatula for a few hours. 
Used as a drink. 
No. 235. 
R Extracti tanaceli, 
“ quassias, aa 3ii. 
Olei tanaceti guttas x. 
Misce, fiant pilulaj pon- 
derse gr. ij. 
Take of extract of tansy, 
Quassia, each 2 drachms. 
Oil of tansy 10 drops. 
Mix. Make pills of 2 grs. 
Ten morning and evening. 
R Pulvis seminum santonici 
gss. 
Ead. valerianse 3iss: 
“ jalapa 3i. 
Acid tar tar i 3 ij. 
Oxymel scillae 3iij. 
Syrupi rubi idsei q. s. ut 
fiat electuaria. 
No. 236. 
Take of santonicum seed 1£ 
oz. 
Powder of valerian 11 dr. 
Jalap 1 drachm. 
Tartaric acid 2 drachms. 
Oxymel of squills 3 drachms. 
Easpberry syrup, as much as 
will make an electuary. 
Three or four teaspoonfuls a day. 
No. 237. 
R Seminum santonici 3i. 
Eadicis jalapa gr. x. 
Hydrargyrii submur.gr.ij. 
Misce, f. pulvis. 
Take of santonicum seed 1 
drachm. 
Powdered jalap 10 grains. 
Calomel 2 grains. 
Mix, make a powder. 
Half morning and night (for a child 6 years old, conti- 
nued for three days). 
No. 238. 
R Fuci helmintochortonis 
3 iij. 
Coque cum aqua gviij. ad 
iv. 
Colentur. 
Take of Corsican worm seed 
3 drachms. 
Boil in 8 ounces down to 4?. 
Let it be strained. 
A tablespoonful every two hours. RECEIPTS. 
613 
R Radicis spigelise 3ij. 
Ebullitor cum aqua fonta- 
na fti. Colentur. 
No. 239. 
Take of pink root 2 drachms. 
Let it be boiled in 1 pint of 
water, and strained. 
Half a cupful every two hours. 
R Ferri sulphatis gr. ij. 
Pulv. jalapse, 
Semin, santonici aa gr. xx. 
Misce, fiat pulvis. 
No. 240. 
Take of green vitriol 2 grs. 
Jalap, 
Santonicum, each 20 grains. 
Mix, make a powder. 
One morning and evening. 
No. 241. 
R Pulv. corticis granati §iss. 
Coque cum aquee §xij. ad 
viij. 
Colentur. 
Take of pomegranate li oz. 
Boil in 12 ounces of water 
to 8. 
Let it be strained. 
Two tablespoonfuls every half hour, in the morning, 
fasting. 
R Saponis gss. 
Gutnmi ammoniaci, 
Extracti absinthii, aa §ij. 
Misce, f. pil. gr. ij. 
No. 242. 
Take of soap half an ounce. 
Gum ammoniac, 
Extract of absinth, each 2 oz. 
Mix, make pills of two grs. 
Ten, three times a day. 
No. 243. 
R Sodse carbonatis 3ss. 
Acidi tartari, 
Sacchari albi, aa gr. xx. 
M. f. pulvis. 
Take of carbonate of soda f 
drachm. 
Tartaric acid, 
White sugar, each 20 grains. 
Mix, make a powder. 
Three times a day 
No. 244. 
R Olei terebinthinse |ss. 
JEtheris sulphuric! 3ii. 
Take of spirit of turpentine 
half an ounce. 
Sulphuric ether 2 drachms. 
Thirty to sixty drops three times a day. 
No. 245, a. • * 
RPotassae tartarisati 3iss-iij. 
(according to the age). 
Aquae distillatoe gij. 
Syrupi mannse §i. 
Vini antimonii gut. xx. M. 
Take of tartrate of potassa 
If to 3 drachms, 
(according to the age). 
Distilled water 2 ounces. 
Syrup of manna 1 ounce. 
Antimonial wine 20 drops. 
A teaspoonful every two hours. 614 
RECEIPTS. 
R Vini antimonii guttas xxx; 
Potassse tartarisati 3iss. 
Aquse flor. sambuci gij. 
Syrupi althaeas gi. M. 
No. 245, b. 
Take of antimonial wine 30 
drops. 
Tartrate of potassa dr. 
Elder-flower water 2 oz. 
Syrup of mallows 1 ounce. 
A teaspoonful every two hours (for a child of 3 years 
of age). 
R Olei amygdalarum 3i. 
Aquse fontanse gij. 
Mucilaginis g. arabici q. s. 
ut. f. emulsio, adde 
Extract! hyoscyami gr. ij. 
Syrupi amygdal. gi. 
No. 246, 
Take of olive oil 1 drachm. 
Spring water 2 ounces. 
Mucilage of gum arable, 
enough to make an emul- 
sion, add 
Extract of henbane 2 grs. 
Syrup 1 ounce. 
A teaspoonful, frequently repeated in violent coughs. 
R Acidi sulphurici diluti gt. 
x. 
Syrupi mororum gij. 
No. 247, a. 
Take of dilute sulphuric acid 
10 drops. 
Syrup of black berries 2 oz. 
Swallow a spoonful slowly and often. 
R Radicis levistici, 
Baccar. juniper!, aa gi. 
Specieri pecloralis gij. 
C. M. 
No. 247, b. 
Take of levisticum, 
Juniper berries, each 1 oz. 
Pectoral ingredients 2 oz. 
Cut up and mix. 
No. 248. 
R Extract! dulcarnarse, 
Pulvis antimonii crud. aa 
pp. seq. 
Misce, f. nil. gr. ij. 
Take equal parts of 
Extract of dulcamara, and 
Crude antimony. 
Mix. Make 2 grain pills. 
Five to ten three limes a day. 
No. 249. 
R Furfurisamygdalarum 3ij. 
Aquse rosarum, 
“ florum naphse* aa gvij. 
Ut fiat eraulsio, adde 
Tincturse Benzoes, 
Boracis sodse aa 3i. 
As a lotion at bed time, 
borax must be omitted. 
Take of bran of almonds, 2 
drachms. 
Rose water, 
Orange water, eaeh 7 oz. 
Let an emulsion be made 
adde 
Tincture of Benjamin, 
Borax, each 1 drachm. 
When the skin is irritable, the 615 
RECEIPTS. 
R Aquae fontanae ftiss. 
Lactis sulphuris 3v. 
Carnphorse 3 ij. 
No. 250. 
Take of spring water pt. 
Milk of sulphur 5 drachms. 
Camphor 2 drachms. 
To moisten the exanthemas every night, and to wash 
them in the morning. 
R Sodse boracis 3i, 
Syrupi mororum gij. M. 
No. 251. 
Take of borax 1 drachm; 
Syrup of blackberries 2 oz. 
A teaspoonful frequently. 
No. 252. 
R Hydrargyrii submuriatis 
3 i. 
Adipis suillse gi. M. 
Take of calomel 1 drachm. 
Hog’s lard 1 ounce. 
No. 253. 
R Florum chamomillse, 
“ 1 lavendula;, 
Herbse rosmarini, 
“ serpylli, 
“ thy mi, 
“ marjoranse, aa gij. 
Conciss. M. 
Take of chamomile flowers, 
Lavender, 
Rosemary, 
Serpyle, 
Thyme, 
Marjorum, each 2 ounces. 
Boil for a bath. 
No. 254. 
R Hydrargyrii bichloridi, 
Ammonise muriatici, aa si. 
Axungise porcinse gi. 
Tere exactissime perhor. 
Take of corrosive sublimate, 
Muriate of ammonise, each 
1 drachm. 
Hog’s lard 1 ounce. 
Triturate them well together. 
A teaspoonful to be rubbed into the soles of the feet, at 
night. 
R Olei ricini gi. 
Tincturse colocynthidis 
gss. M. 
No. 255. 
Take of castor oil 1 ounce. 
Tincture of colocynth half 
an ounce. 
To be used in frictions. 
No. 256. 
R Magnesise carbonatis gi. 
Radicis rhei 3 ij. 
“ valerianae 3ss. 
Elseosacchari foeniculi gss. 
Misce. Fiat pulvis. 
Take of carbonate of mag- 
nesia 1 ounce. 
Rhubarb 2 drachms. 
Valerian drachm. 
Fennel candy £ ounce. 
Mix. Let a powder be made. 
Once or twice as pinch as can be taken upon the point of 
a knife. RECEIPTS. 
No. 257. 
B Magnesise carbonatis, 
Cretse ppt., 
Cornu cervi rasuri, 
Visci quircini, 
Radix valerian®, aa pp. 
sequales. 
Misce. Fiat pulvis. 
Take of magnesia, 
Prepared chalk, 
Rasped hartshorn, 
Misletoe, 
Valerian, of each equal parts- 
Mix. Make a powder. 
Like the preceding. 
No. 258. 
R Antimonii tartarisati gr. i. 
Solve in aqua gi. 
Oxymellis scillse, 
Syrupi simplicis, aa gss. 
Pulv. rad. ipecacuanhse gr. 
xx. 
Misce. Fiat pulvis. 
Take of emetic tartar 1 gr. 
Dissolve in tvater 1 ounce. 
Oxymel of squills, 
Simple syrup, each ± ounce. 
Powdered ipecacuanha 20 
grains. 
Mix. Make a powder. 
A teaspoonful every quarter of an hour until vomiting 
occur. 
R Syrupi de cichorico cum 
rheo, 
Aquae foeniculi, aa gss. 
No. 259. 
Take equal parts of syrup of 
chicory, 
Fennel water, each , ounce. 
A teaspoonful three or four times a day. 
R Syrupi mororum gi. 
Mellis rosarum gss. 
Sodse boracis gr. xx. M. 
No. 260. 
Take of syrup of blackber- 
ries 1 ounce. 
Honey of roses % ounce. 
Borax 20 grains. 
No, 261. 
R Oxidi zinci gr. viij. 
Moschi orientals gr. iv. 
Laudani liquid! Sydenh. 
guttas vi. 
Sacchari albi 3 ij. 
Misce, f. pulvis in viij. pp. 
seq. 
Take of flowers of zinc 8 gr. 
Oriental musk 4 grains. 
Liquid laudanum of Syden- 
ham 6 drops. 
White sugar 2 drachms. 
Mix. Let a powder be made 
and divided into 8 equal 
parts. 
One every hour. 
No. 262. 
R Spiritus cornu® cervi suc- 
cin. gutt. xl. 
Aqua; foeniculi, 
Syrupi rhei, aa gi. 
Cretse ppt. gr. xx. 
Take of succinated spirit of 
hartshorn 40 drops. 
Fennel water, 
Syrup of rhubarb, each 1 oz. 
Prepared chalk 20 grains. RECEIPTS. 
617 
Extract! hyoscyami gr. ij. 
Moschi orientalis gr. iv. 
Cum saccharo triturat. 
Croci orientalis gr. iij. M. 
Extract of henbane 2 grains. 
Oriental musk 4 grains. 
Triturated with sugar. 
Saffron 3 grains. 
A teaspoonful every two hours. 
No. 263. 
R Olei hyoscyami, 
“ camphorse, aa fss, 
Tincturse thebaici 3i. M. 
Take of oil of henbane, 
Camphor, each £ ounce. 
Tincture of opium 1 dr. M. 
Applied in frictions every two hours. 
R Cretse ppt. 3ss. 
Aquee foeniculi, 
Syrupi rhei, aa §i. 
No. 264. 
Take of prepared chalky dr. 
Fennel water, 
Syrup of rhubarb, each 1 oz. 
A teaspoonful every hour;—shake up the medicine first. 
No. 265. 
R Magnesise carbonatis 3 iij. 
Sememim foeniculi, 
Corticis aurantii, 
Sacchari albi, aa sss. 
M. f. pulvis. 
Take of magnesia 3 dr. 
Fennel seed, 
Orange peel, 
White sugar, each drachm. 
Mix. Let a powder be made. 
A teaspoonful morning and evening. 
R Cretse ppt,, 
Elseosacchari foeniculi, 
Radicis althsese, aa gr. xx. 
Laudani liquidi Sydenh. 
gutt. i. 
M. f. pulvis. Divid. in 
quaturse partes. 
No. 266. 
Take prepared chalk, 
Fennel candy, 
Mallow root, each 20 grains. 
Liquid laudanum 1 drop. 
Mix. Divide into four equal 
powders. 
No. 267. 
R Unguenti de althsese, 
Balsami nucistse aa §ss. 
Olei menthse crisp, gut. vi. 
Laudani liquidi Sydenh. 
gutt. xx. M. 
Take of mallow ointment, 
Balsam of nutmeg, each \ oz. 
Oil of mint 6 drops. 
Liquid laudanum of Syd. 20 
drops. 
R Extract icascarillse gr. xv. 
Aquee fmniculi gij. 
Mucilaginis rad. salep, 
Syrupi althseee, aa gss, M. 
No. 268. 
Take of extract of cascarilla 
15 grains. 
Fennel water 2 ounces. 
Mucilage of salep, 
Syrup of mallows, each half 
an ounce. 
A spoonful every two hours. 618 
RECEIPTS. 
No. 269, 
R Potassae tartarisati 3ss. 
Aquae fceniculi giss. 
Syrupi mannae & rhei, aa 
gss. M. 
Take of tartrate of potassa 
half a drachm. 
Fennel water 1\ ounce. 
Syrup of manna and rhubarb 
each half an ounce. 
A teaspoonful every two hours. 
R Potassse tartarisati 3ss. 
Vini antimonii guttas xx. 
Aquae flor. sambuci giss. 
Syrupi mannse, 
“ althsese, aa gss. 
No. 270. 
Take of tartrate of potassa 
£ drachm. 
Antimonial wine 20 drops. 
Elder-flower water oz. 
Syrup of manna, 
Mallows, each £ ounce. 
A teaspoonful every two hours. Strong and robust chil- 
dren will require the addition of 20 grains of nitre. • 
No. 271. 
R Ligni sassafragas gij. 
Rad. glycyrrhizse gss. 
C. M. 
Take of sassafras 2 ounces. 
Liquorice root £ ounce. 
A teaspoonful every day. 
No. 272. 
fi Asa foetidse 3ij. 
Spirilus Mindereri 3iij. 
Mucilaginis g. acacise q. s. 
ut f. cum aqua melissa 
giij. emulsio. 
Take of asa foetida 2 drs. 
Spirit of Mindererus 3 drs. 
Mucilage of g. Arabic as 
much as will make an 
emulsion with 3 ounces of 
melissa water. 
A teaspoonful every hour. 
No. 273. 
R Extract! cinchonse gr. xx. 
“ taraxici 3i. 
Potassse acetatis 3ss. 
Aqu SB fceniculi, 
Syrupi rhei, aa gi, M. 
Take of extract of Peruvian 
bark 20 grains. 
Dandelion 1 drachm. 
Acetate of potassa ■*- drachm. 
Fennel water and rhubarb, 
each 1 ounce. 
A teaspoonful four times a day. INDEX. 
A. 
Abdominal cough, 230. 
Abdominal dropsy, 312. 
Abortus, how to be prevented, 
514. 
Abscessuslumbaris, 167,181,300 
“ renalis, 165. 
Achores, 425. 
Acidity of the stomach, 188. 
Acrimony of the stomach, 188. 
Acrimoniahsemorrhoidalis, 335. 
Acrimony, cutaneous, 550. 
Acute fevers, see Febres acutse. 
Adiposis, 4SO. 
Affections of the mind and 
nerves, 61. 
Age, 27. 
Agrypnia, 62, 218. 
Ague-cakes, 123. 
Agustia, 278. 
Air, accumulations of, 318. 
“ and water, 310. 
Alopecia, 433. 
Amaurosis, 276. 
Amblyopia, 276. 
Amentia, 195. 
Amnesia of language, 272. 
Anaesthesia, 278. 
Anaphrodisia, 279. 
Anasarca, 317. 
Angina, 143. 
biliosa, 144. 
catarrhalis, 144. 
chronica, 146. 
gangraenosa, 145. 
gastrica, 144. 
habitualis, 146. 
laryngea, 143. 
membranacea, 551. 
parotidea 145. 
pectoris, 146, 225. 
pharyngea, 143. 
polyposa, 551. 
putrida, 145. 
rheumatica, 144. 
serosa, 144. 
Angina tonsillaris, 144. 
uvuiaris, 144. 
Anxiety, 65. 
Anidrosis, 378. 
Anomalies ofmotion and sensa- 
tion, 210. 
Anorexia, 279. 
Anosmia, 278. 
Anthrax, 111, 115. 
Anuria, 375. 
Apepsia, 273. 
Aphonia, 51, 250, 271. 
completa, 271. 
paralytica, 272. 
Aphthae, 296, 415. 
infantum, 417, 539. 
Apoplexia, 67, 253. 
adynamica, 255. 
biliosa, 257. 
completa, 253. 
metastatica, 258. 
nervosa, 257. 
pulmonum, 259. 
sanguinea, 255. 
serosa, 255. 
spastica, 255. 
Appetite, excessive (bulimia) 
or (polyphagia) 250. 
for unusual food (pica) 
274. 
want of (apepsia) 273. 
Apyrexia, 117. 
Arachnoids, 138. 
Architectura apoplectica, 255. 
phthisica. 285. 
Arthritis, 453. 
acuta, 453. 
anomala, 454. 
atonica, 455, 461. 
chronica, 454, 459. 
disorganisans, 454. 
destructoria, 454. 
fixa, 454. 
interna, 454. 
irregularis, 454. 620 
INDEX 
Arthritis larvata, 454, 
manifesta, 453. 
nodosa, 454, 459. 
occulta, 454. 
regularis, 453. 
retrograda, 455. 
spuria, 457. 
vaga, 454. 
Ascarides, 489. 
lumbricoides, 486, 
489. 
vermiculares, 486. 
Ascites, 312. 
urinosus, 375. 
Asphyxia, 259, 261. 
neonatorum, 537. 
Asthma, 222. 
abdominale, 223, 224. 
acutum infantile, 222, 
227, 553. 
adynamicurn, 223,224 
aereum, 223, 227. 
arsenicale, 223, 225. 
arthriticum, 223. 
atonicum, 223. 
calculosum, 223, 225. 
cardiacum, 223. 
consensuale, 222. 
continuum, 222. 
convulsivum, 222. 
emphysematicum, 
223, 227. 
flatulentum, 223, 319. 
gibbosum, 223. 225. 
humidum,222,223,226 
hydropicum, 223. 
hypochondriacum, 
222. 
hystericum, 222, 224. 
idiopathicum, 222, 
223, 225. 
mechanicum, 223, 
225. 
mercuriale, 223, 225. 
rnetallicum, 222, 223. 
metastaticum,222,224 
millari, 227, 553. 
rnucosum, 222, 226. 
nervosum, 222, 224. 
nocturnum, 224. 
organicum, 223. 
pannificum, 223, 225. 
periodicum, 222, 224. 
Asthma, pneumaticum, 227. 
psoricum, 223. 
pulmonale, 223, 225. 
pulverulentum, 223, 
225. 
rheumaticum, 223. 
saburrale, 223. 
sanguineum, 222,224, 
225. 
saturninum, 223, 225. 
scrophulosum, 223. 
scorbuticum, 224, 
senile, 223, 227. 
serosum, 223. 
siccum, 222. 
spasticum, 222, 224. 
strumosum, 223, 225. 
syncopti cum, 223,225, 
thymicum, 227, 541. 
tuberculosum, 225. 
urinosum, 223, 
venereum, 223. 
Atony of the lungs, 282. 
Atrophia, 280, 306. 
abdominalis, 306. 
hepatica, 306. 
lienalis, 306. 
localis externa, 307. 
mesenterica infan- 
tum, 306, 557. 
pancreatica 307. 
pulmonalis, 307. 
stomachica, 307. 
verminosa, 306. 
B. 
Balbuties, 272. 
Bald head, 433. 
Barrenness of women, 526. 
Bile or boil, 427. 
in infants, 550. 
Bilious accumulation, 187, 251. 
Bladder, inflammation of the, 165 
Bleeder families, 345. 
Blennorrhcea, 346, 470. 
Blennorrhoeu intestini recti. 358. 
pulmonum, 183, 
301, 347. 
syphilitica, 470. 
vaginae uteri, 347. 
Blepharophthalmia neonato- 
rum, 539. 
Blindness, nervous, 276. INDEX, 
621 
Blood, 52, evacuations—spit- 
ting of, 61. 
micturation of, 343. 
vomiting of, 331. 
Brain, droosy of the, 317. 
fever of the, 138, 547. 
inflammation, 138. 
fever of children, 547. 
Bronchitis, 148 
Bronchocele, 452. 
Bubones, pestilential. 111. 
venereal, 473. 
Bulimia, see polyphagia, (ex- 
cessive appetite), 250. 
C. 
Calculus biliary, 496. 
cysticus, 493. 
urinarius, 493. 
Callositas cutis, 430. 
inteslinorura, 160. 
Calor ad sensum, 64. 
ad thermometrum, 64. 
chemicus, 65. 
mordax, 65. 
vivus, 65. 
Cancer scrophulosus, 445. 
Carbunculus coniagiosus, 115. 
malignus, 427. 
Cardialgia, 244. 
Carditis, 157. 
Caries 434. 
Carriage, 67. 
Catalepsy, 215. 
Catamenia, 499. 
Catarrhosis, 184. 
Catarrhal lever of children, 547. 
Calarrhus, 181,—auriym, 182. 
imestinorum, 182. 
intestini crassi, 182. 
malignus, 93. 
oculorum, 182. 
pulmonum, 182. 
suffocativus, 259. 
vaginae et uteri, 182. 
vesicse, 182, 352. 
Causae occasionales, 32, 71. 
Causes of disease exciting, 71. 
predisposing, 711 
remote, 71. 
proximate, 71. 
Cephalalgia, 241. 
Cephalaea, 241. 
Cephalsea gastrica, 242. 
hypochondriaca, 242. 
hysterica, 242. 
metastatica, 242. 
nervosa, 242. 
organica, 242. 
sanguinea, 242. 
vomitoria hysterica, 
237. 
Cessation of the menses, 508. 
Chancres, 465, 472. 
Chest, dropsy of the, 315. 
pressure, straining, sounds 
in the, 49. 
Childbed, 516. 
Children, diseases of, 529. 
Chills, 64. 
Chiragra, 454. 
Chlorosis, 438. 
Cholera, 367. 
biliosa, 368. 
orienfalis, 112. 
sicca, 368. 
Chordee, 471. 
Chorea, 214. 
Chronic fevers, 116. 
Clap, 353, 465. 
Claudicatio spontanea, 180,453, 
558, 
Clavus, 241, 430. 
Climate, 30, 31. 
Cognition of the object of cure, 
[24. 
disease, 30. 
patient, 25. 
Colic, inflammatory, 159. 
varieties of, 245, etc. 
Collapsus vasorum, 88. 
Coma somnolentum, 62. 
vigil, 62. 
Comedones, 429. 
Complexion, 67, 68. 
Condylomata, 473. 
Congestions, sanguineous, 125, 
135, etc. 
Constipation, 371. 
Consumption, see Phthisis. 
Contaginm, 108. 
Contagious fevers, see Febres 
contag. 
Constitution of the patient, 25. 
diseases, 31. 
Convulsions of infants, 545. 622 
INDEX, 
pregnant women, 
515. 
Cophosis, 277. 
Coriurn, 52. 
Coryza, 105. 
Costiveness, 371. 
Cough 49, 228, 230. See Tussis. 
Cow pox, 396. 
Coxagra, 180, 460. 
Coxalgia, 244, 558. 
Crisis, 21, 30. 
Croup, 551. 
Crusta lactea, 423, 550. 
Crusla pleuritica, 52. 
Crusta serpiginosa, 423. 
Cure causal, 72. 
radical, 72. 
palliative, 72. 
Cutaneous diseases, 380. 
Cyanosis, 439. 
Cystitis, 165. 
Cystorrhoea, 182, 352. 
D. 
Deafness, 277. 
Debility of the nerves, 204. 
Decay of children, 557. 
Dentitio difficilis, 548. 
Delirium activum s. furibund. 
61. 
blandura, 62. 
somnolenturn, 62. 
tremens, 140, 141, 199. 
typhosum, 62. 
Diabetes, 60, 350. 
insipidus, 350. 
mellitus, 350. 
spurius, 350. 
verus, 350. 
Diagnostics, 24. 
for children, 531. 
Diaphragmitis, 163. 
Digestion, 53. 
Diarrhoea, 182, 359, 542. 
adynamic, 362. 
chronic, 361. 
colliquative, 363. 
infantilis, 363, 542. 
purulenta, 363. 
putrida, 363. 
rheumatica, 361. 
torminosa, 359. 
Diplopia, 63, 250, 319. 
Disorganizations, 481. 
Disposition, 32. 
Dropsy, vide Hydrops. 
Dumbness, 271. 
Dyscrasies, 434. 
Dyscropia. 371. 
Dysenteria, 182, 363, 367. 
Dyslogia, 271. 
Dyspepsia, 250, 273. 
Dysphagia, 270. 
Dysphonia, 271. 
Dysuria, 375. 
E. 
Ears, inflammation of the, 168 
Ear-ache, 244. 
Ecchymoses, 413. 
Eclampsia, 545. 
Elephantiasis, 423. 
Emaciations, 280. 
Emphysema, 322. 
pulmonale, 223. 
Emprosthotonus, 219. 
Enteorema, 59. 
Encephalitis, 138. 
adynamica, 141. 
biliosa, 141. 
exsudatoriainfan- 
turn, 554. 
gastrica, 141. 
inflammatoria, 140, 
nervosa, 141. 
verminosa, 141. 
Endurcissement du tissu cellu- 
laire, 430. 
Enteritis, 159. 
Enuresis, 348. 
Ephelis, 429. 
Ephemera, 84. 
Ephialtes, 217. 
Epidrosis, 347. 
localis, 348. 
Epilepsy, 210. 
Epistaxis, 326. 
Erethismus nervosus, 128, 190. 
Erotomia, 251. 
Eruptions, see Zona, 
Erysipelas, 169. 
* bullosum, 169, 170. 
chronic or habitual, 
171. 
neonatorum, 540. 
phlegmonodes, 169, 623 
INDEX. 
Erysipelas pustulosum, 170. 
Erysipelas of children, 540. 
Erythema, 424. 
Essera, 409. 
Evacuations ofblood, 61. 
from the intestines, 55. 
Exacerbation, 80. 
Exanthemata, 380. 
accidentalia, 381. 
acuta, 381. 
chronica, 382. 
essentialia, 381. 
Exanthemata primaria, 381. 
secundaria, 381. 
Exanthematic fevers, 548. 
Excoriationes neonatorum, 533. 
Excrescent!®, 430. 
Excretions, 56. 
Expectoration, 60. 
Extravasata, 324. 
Eyes, 63, inflammation of the, 
168. 
F. 
Fainting, 137, 259. 
Falling sickness, 210. 
Fatuitas, 195. 
Favus, 425. 
Febres acriticse, 91. 
acutffi, 79. 
contagiosse, 107. 
atactae, 91. 
Febris biliosa, 100. 
bullosa, 414. 
catarrhalis, 105, 547. 
maligna, 107. 
Febres chronic®, 116, 123. 
Febris continens, 80. 
Febres continuae, 79. 
Febris duplicata, 117. 
gastrica, 100, 546. 
saburralis, 101. 
hectica, 124. 
inflammatoria, 85, 547. 
Febres intermiitentes, 116. 
intermittens maligna s. 
perniciosa, 122. 
intestinales. 100. 
lenta, 116, 123, 302. 
nervosa, 124,302. 
symptomatica, 125 
mesenterica, 100. 
mucosa, 100. 
Febris nervosa, 90. 
gravis, 95. 
mitis, 94. 
nullius generis, 84. 
petechialis, 413. 
phthisica, 124. 
puerperalis, 519. 
putrida, 99. 
remittens, 80. 
rheumatica, 105. 
simplex, 84. 
from teethings, 547. 
verminosa, 101. 
Feeling, activity of the, 61. 
Fevers, see Febres and Typhus. 
Flatulence, 55. 
Flatulency, 319. 
Fluxus coeliacus, 358. 
hepaticus, 358. 
Flux of milk, 522. 
Fluor albus, 182, 465, 524. 
Freckles, 429. 
Furor uterinus, 251. 
Furunculus, 427. 
G. 
Galactorrhoea, 522, 
Gall stone, 496. 
Gangrtena critica, 91. 
Gastric disease, 184. 
Gastric fever, 100. 
in children, 546. 
Gastritis, 158. 
Gastroses, 184. 
Gastrosis chronica, 185. 
Gastrodynia, 244. 
Genius loci, 31. 
Giddiness, 62, 263. 
Glands, inflammations of, 145. 
scrofulous, 444. 
Gleet, 471. 
Glossitis, 147. 
Goitre, 452. 
Gonagra, 454. 
Gonorrhoea, 353. 
chronica, 462. 
secundaria, 353,462. 
syphilitica, 470. 
Gout, 453. see Arthritis, 
atonic, 461. 
chronic, 459. 
retroceded, 460. 
Gravedo, 181. 624 
INDEX 
Groaning, 51. 
Gutta rosacea, 426. 
H. 
Habit, 29. 
Habitual crises and diseases, 30. 
Hfematemesis, 331. 
Hsematosis, 345. 
hereditaria, 345, 
Hrematuria, 340. 
renalis, 343. 
vesicalis, 343. 
Haemoptysis, 327, 
Hsemorrhagi®, 324. 
pulmonum, 327. 
Haemorrhoids, 332. 
ani coecse, 338. 
anomalse, 340. 
dolentes, 338. 
external, 338. 
fluentes, 339. 
furentes, 338. 
incongru®, 333. 
internee, 338. 
mucosae, 341. 
pulmonum, 340. 
retrogress®, 333. 
saccaiee, 339. 
scirrhosee, 338. 
urethras, 344. 
ventriculi, 340. 
vesicas, 340. 
Hair plaited, 430. 
Head, dropsy of the, 317. 
Headache, 65, 241. 
of pregnant women, 
513. 
Hearing, 63. 
Heart, inflammation of the 157. 
palpitation of the. 43, 319 
Heat, 64. 
Hectic fevers, 123. 
Hectica, 280, 309. 
Helminthiasis, 486. 
Hemicrania, 240. 
Hemiphlegia, 253. 
Hemitritaeus, 121. 
Hemorrhages, 324. 
Hepatitis, 161. 
Hereditariness, 26. 
Herpes, 172, 420. 
Heuristic, 73. 
Hiccough, 53, 239. 
Hips, 180. 
Hoarseness, 50, 272. 
Hooping cough, 232. 
Horripilatio, 64. 
Hunger, 54. 
Hydrencephalon, 317. 
Hydrocephalus, 317. 
acutus, 554. , 
chronic, infant. 
556. 
externus, 317, 
556. 
internus, 317. 
Hydropes, 310. 
Hydrops ascites, 312. 
cerebri acutus infan- 
tum, 554. 
pericardii, 316. 
saccatus, 312. 
Hydrophobia, 113, 249. 
Hydrorrhachitis, 557. 
Hydrothorax, 315. 
Hypochondria, 203. 
Hysteria, 203. 
Hysterismus of the stomach, 
186, 236. 
I, 
latrognomic, 24. 
Jaundice, 441. 
Icterus, 441. 
neonatorum, 538. 
Niger, 443. 
Idiosyncrasy, 29. 
Ileus, 372. 
chronicus, 374. 
inflammatorius, 159. 
Impotency, 274. 
Impotentia imperfecta, 275. 
perfecta, 275. 
Incontinentia urinae, 348. 
Incubus, 217. 
Indigestion, 187. 
Indurauo telae cellulosae neo- 
natorum, 540. 
Infancy, characteristics of, 529. 
Infarctus, 184, 189. 
Infection, venereal, 465. 
primary, 465, 468. 
secondary, 465, 473. 
ulcerous, 465, 472. 
Inflammationes, 125. 
activa, 130. INDEX, 
625 
Inflammat. antagonistica,l29. 
atonica, 130, 134. 
catarrhalis, 133. 
chronica, 130,134. 
consensualis, 129, 
136, 138. 
erethica, 129. 
erysipelatosa, 134. 
exsudatoria, 127, 
133. 
gangraenosa, 130, 
133. 
idiopathica, 129, 
138. 
maligna, 130. 
metastatica, 134. 
nervosa, 129. 
occulta, 125. 
passiva, 130. 
periodical, 130,134 
phlegmonous, 133. 
phlogistic, 133. 
putrida, 130, 133. 
rheumatic, 133. 
specific, 134. 
sicca, 129. 
sympathica, 129. 
topic®, 125. 
Inflammation, of abdomen, 158. 
brain, 138. 
bladder, 165. 
bronchitis, 148. 
caul, 164. 
chest and lungs, 147. 
dorsal vertebrae, 142. 
ears, 168. 
eyes, 168. 
heart, 157. 
intestines, 159. 
kidneys, 164. 
liver, 161. 
mesentery, 163. 
midriff, 163. 
mouth, 146. 
ovaria, 166. 
pancreas, 164. 
peritoneum, 164. 
psoas muscle, 167. 
spinal marrow, 142. 
spleen, 163. 
stomach, 158. 
throat, 143. see Ang. 
womb, 166. 
Insania, or Insanity, 195. 
Inunction, mercurial, 476. 
Intermittent fever, 116. 
Interpretatio Naturae, 32. 
Intertrigo, 429. 
Intestines, evacuations from the, 
55. 
accumulations of, 189. 
Intonatio intestinalis, 319. 
Irascibility, 198. 
Irritatio cerebralis inflammato- 
ria, 139. 
Ischias 180, 240, 460. 
nervosa cotunni, 180. 
Ischidrosis, 378. 
Ischuria, 375. 
Itch, 417. 
Itching of the genitals, 241. 
K. 
Kidneys, inflammation of the, 
164. 
stone in the, 493. 
L. 
Lactation, 521. 
Land-scurvy, 440. 
Laryngitis, 143. 
exsudatoria, 551. 
Laughing, 51. 
Lentigo, 429. 
Leprosy, 423. 
Lethargy, 263. 
Leucorrhoea, 352, 524, 
Lientery, 357. 
Limping, 558. 
Lipothymia, 67, 259. 
Lithiasis, 492. 
Liver, inflammation of the, 161. 
Lues venerea, 462. 
inveterata, 476. 
universalis, 473, 
Lumbago, 181, 240. 
Lumbrici, 486, 489. 
Lungs, consumption of the, see 
Phthisis, 280, 303. 
Lupus, 420. 
M. 
Malacia, 274. 
Madness, or Mania, 195. 
Marasmus senilis, 300, 305. 
Materia rheumatica, 177. 626 
INDEX 
Measles, 400, 
Melaena 341. 
Melancholia, 195. 
Meningitis, 138. 
Menostasia, 379, 503. 
Menstruation, 345, 499. 
difficult. 507. 
obstructed, 500. 
profuse, 505. 
suppressed, 503. 
cessation of, 508. 
regimen during, 
503. 
Mental diseases, 195. 
Mesenteritis, 163. 
Meteorismus, 55. 
Metritis, 166. 
Metrorrhagia, 345, 505. 
Miasma, 108. 
Mictus emeritus, 343. 
Middriff, inflammation of the, 163 
Miliaria alba et rubra, 410. 
chronica, 412. 
Mind, action of the, 61. 
Miscarriage, how to prevent,sl4 
M iserere, 372. 
Mode of living, 29. 
Mole, 432. 
Molimina hsemorrhoidalia, 333. 
menstrua, 501. 
Morbilli, 400. 
Morbus hmmorrhag. mac. Werl- 
hofii, 345. 
Morbus niger, 341. 
Morbus verrucosus universalis, 
431. 
Moria, 195. 
Motion, musculosis, 66. 
Mouth, inflammation of, 146. 
Mucosity of the stomach, 188. 
Murmuratio intestinalis, 319. 
Muscular motion, 66. 
Myelitis, 142, 305. 
chronica, 305. 
N. 
Ngevus, 432. 
Nature and Art, 19. 
Nausea, 54. 
Nephritis, 164. 
Nephritic stone, 493. 
Neuralgia, 240. 
Neuroses, 190. 
Nervous fever, 90. 
blindness, 276, 526. 
consumption, 302. 
diseases, 190, 545. 
Nightmare, 217. 
Noma, 434. 
Nostalgia, 303. 
Notalgia. 240. 
Nubecula (in the urine) 59. 
Nymphomania, 251. 
O. 
Obstructio alvi, 371. 
Occupation, 29. 
Odontalgia, 243. 
Oedema, capitis, 317. 
pulmonum, 223 
Omentitis, 164. 
Onania, 354. 
Onanismus, 251. 
Oophoritis, 166. 
Ophthalmia humida, 182. 
scrophulosa, 451. 
neonatorum, 539, 
Ophthalmitis, 168. 
Opisthotonus, 219. 
Orchitis, 473. 
Order of rational mode of treat- 
ment, 73. 
Otalgia, 169, 244. 
Otitis, 168. 
Otorrhcea, 169, 182, 356. 
P. 
Psedarthrocace, 445. 
Pain, 65. 
Palpitation of the heart, 43, 227, 
Pancreatitis, 164. 
Paracusis, 250. 
Paralysis, 66, 481, atrabilaria 
269. 
of the brain, 253. 
dorsalis, 269. 
localis, 264. 
medullaris, 269. 
metastatica, 267. 
of the lungs, 259. 
rheumatica, 173. 
sanguinea, 265. 
syphilitica, 267- 
Paralytic diseases, 252, 272. 
Paraphimosis, 471. 
Paraplegia, 253. INDEX 
627 
Parasites, 481. 
Parotitis, 145. 
Paroxysmus, 117. 
Parturition, 516. 
Pathogenesis, 31. 
Pellagra, 424. 
Pemphigus, 414. 
Period of life, 27. 
Peripneumonia, 147. 
Peritonitis, 164. 
puerperalis, 519. 
Perspiration, 56. 
Perspirabile retentum, 172. 
Pestis bubonica, 111. 
Petechias, 413. 
Petechianosis, 345. 
Pharyngitis, 143. 
Phenomena of disease, 30. 
Phimosis, 471. 
Phlebitis universalis, 85. 
Phlegmasia exsudatoria abdo- 
minalis, 519. 
alba dolens puerpe- 
ralis, 523. 
Phlyctsenae, 424. 
Phrenitis, 138, 141. 
Phthisiosis, 258. 
Phthisis, 280, 303. 
abdominalis, 300. 
accidentalis, 288. 
constitutionalis, 288. 
consumata, 284. 
liens, 282. 
fiorida, 288, 298. 
formata, 290. 
hectica, 309. 
hepatiea, 299. 
incipiens, 282. 
inlestinalis, 300. 
laryngea, 298. 
manifesta, 284, 290. 
mesenterica, 299, 300. 
pituitosa, 281, 301. 
pulmonalis, 281. 
purulenta, 
281, 291. 
purulenta, 297. 
renalis, 299. 
scrophulosa 307- 
sicca, 307. 
tabes pulmonalis, 301. 
Irachealis, 298. 
tuberculosa, 281, 307. 
Phthisis uterina, 300. 
vesicalis, 299, 300. 
vomica clausa, 297,300 
Physiatric, 19. 
Physometra, 323. 
Pica, 250, 274. 
Piles, see Haemorrhoids, 332. 
Plague, Levantine, 111. 
cold, 112. 
Plaited hair, 431. 
Pleuritis, 147. 
chronica, 154. 
rheumatica, 153. 
Pleuro-peripneumonia, 147. 
Plica polonica, 431. 
Pneumatoses, 310. 
Pneumonia, 147. 
gangnenosa, 154. 
notha, 154. 
putrida, 154. 
rheumatica, 153. 
Pneuraonites, 147. 
Podagra, 454. 
retropulsa, 455. 
Pollutio, 305, 354. 
Polydipsia, 249. 
Polyphagia, 250. 
Polysarca, 480. 
Porcupine skin, 431. 
Priapisrnus, 219, 251. 
Profluvia, 323. 
Pregnancy, 510. 
Prophylaxis phthisica, 289. 
Prosopalgia, 242. 
Pruritus, 240. 
vulvse, 241. 
Pseudacusis, 250. 
Pseudaesthesiae, 210. 
Pseudo-erysipelas, 169. 
Pseudopia, 250. 
Pseudo-organisations, 481. 
Psoitis, 167. 
Psychical treatment of insane, 
201. 
Plyalismus, 347. 
Puberty, 500. 
Pulse, 33. 
art of feeling the, 44. 
varieties of it, 39. 
Pulsatio abdominalis, 227. 
Purpura, 410. 
Pustula nigra, 427. 
Pyrosis, 245, 628 
INDEX. 
a. 
Quartan fever, 117, 121. 
Quinsy, 143. 
Quotidian fever, 117. 
R. 
Rabies, 113. 
Rachitis, 452. 
Raphania, 218. 
Rational method of curing, 72. 
Raucitas vocis, 272. 
Recidives, 121. 
Regimen menstruale, 503. 
for infants, 535. 
Remissio, 80. 
Respiration, 45. 
varieties of anoma- 
lous, 46. 
Restlessness, 62, 218. 
Rhagades, 428. 
ani, perintei, genital. 
339. 
Rheumatalgia, 173. 
Rheumatic affection of the rau- 
cous membrane, 181. 
fever, 105. 
Rheumatismus, 173. 
acutus, 174. 
arthriticus, 174. 
chronicus, 174,177 
fixus, 174. 
frigidus, 173. 
intestinorum, 366. 
intestini crassi,364 
vagus, 174. 
verus, 174. 
universalis, 106. 
Rheumatoses, 172, 179. 
Rickets, 452. 
Rigor, 64. 
Risus sardnnicus, 52. 
Rubeolse, 409, 
Ructuositas, 319. 
Ruminatio humana, 238, 270. 
S. 
Saburra, 185. 
Saburral accumulation, 187,189 
Salivation, 347. 
Satyriasis, 251. 
Scabies, 417. 
Scald-head, 425. 
Scald-head of infants, 550. 
Scarlat fever, 405, 548. 
Sciatica, 180. 
Scorbutus, 440. 
Scotomia, 250. 
Scrofula, 444. 
Scurvy, 440. 
Sediment in the urine, 59. 
Secretions, 56. 
of urine, 57. 
salivary, 60. 
Sea-sickness, 239. 
Sea-scurvy, 140. 
Selection of remedies, 73. 
Seminal weakness, 354. 
Senses, action of the, 61. 
Serpigo, 339. 
Sex, 27. 
Sexual diseases of females, 498 
Sexual instinct,disorders 0f,251. 
Sight, 63, 250. 
Singultus, 66,239. 
Skin, dropsy in the, 317. 
Sleep, 62. 
Sleeplessness, 62, 218. 
Small pox, 386. 
Smelling, 63. 
Sneezing, 51. 
Soda, see Pyrosis, 
Sopor, 62. 
Somnambulism, 195, 216. 
Sordes primarum viarum, 184. 
Softening of the brain, 556. 
stomach, 544. 
Specific method, 72. 
Specifics, 73. 
Speech, 50. 
faults of, 271. 
loss of, 51. 
Spasmodic diseases, 210. 
Spasms, 66. 
of children, 545. 
of the stomach, 244. 
menstrual, 507. 
clonici, 210. 
tonici. 210. 
Spina bifida 554- 
ventosa, 434, 445. 
Splenitis, 163. 
Spondilitis, 142. 
Sputa, 61. 
cocta, 61. 
Sputa subacta, 61. 
Sputum cruentum, 327, 330. INDEX, 
629 
Sputum sanguineura, 61. 
Squinting, 63. 
St. Anthony’s fire, 169. 
St. Vitus’ dance, 214. 
Stammering, 272. 
Steatoma, 480. 
Stenocardia, 223. 
Sterilitas, 276, 526. 
Stillicidium uteri, 
Stomach, acidity of the, 188. 
ache, 244. 
acrimony of the, 188. 
inflammation of the, 
158, 188. 
Stomacace, } •. ,p 
Stomaitis, $ 
Stone of the bladder, 493. 
kidneys, 493, 
Strabismus, 63. 
Stranguria, 375. 
Strangulatio hysterica, 224. 
Structure, 67. 
apoplectic, 26, 255. 
phthisical, 26, 285. 
Struma, 452. 
Stuttering, 272. 
Stymatosis, 344. 
Suckling, 521. 
Sudor anglicus, 348. 
ani, perinaji et genita- 
lium, 339. 
Suffocatio hysterica, 224. 
Suffocative catarrh, 259. 
Suggilationes, 324. 
Suppressiones, 369. 
Suppression of the itch, 419, 
piles, 340, 379. 
menses, 503. 
syphilis, 467. 
Susurrus aurium, 25‘0. 
Sweat, 56, 347. 
Sycosis menti, 422. 
Symptomatology, 32. 
Symptomata, 71. 
Symptomatic method, 72. 
fevers, 123. 
Synocha, 85. 
Syncope, 67, 259. 
Syphilis, 462. 
localis s. primaria,462. 
secundaria s. universa- 
lis, 463, 473. 
inveterata, 476. 
Syphilis larvata, 478. 
of infants, 541, 
T. 
Tabes, 280, 300. 
dorsalis, 304. 
medullaris, 304. 
nervosa, 302. 
pulmonalis, 301. 
Taenia, 486, 490. 
Tapeworm, 490. 
Taste, 63. 
Teething, difficult, 548. 
fever from, 547. 
Temperaments, 28. 
Tenesmus, 56. 
Tenuitas serosa sanguinis, 52. 
Tertian fever, 117. 
Tetanus, 219. 
of children, 540. 
linguae, 219. 
localis, 219. 
neonatorum, 220. 
penis, 219. 
traumaticus, 221. 
universalis, 219. 
Therapeutics, 70. 
for children, 532. 
Thirst, 54, 249. 
Throat, 143, see Angina. 
Thrush, 415, 539. 
Tic douloureux, 242. 
Tinea capitis, 425. 
Tongue, inflammation of the,l47 
Toothache, 243. 
of pregnant women, 
613. 
Tracheitis, 143. 
Transpiratio insensibilis, 56. 
Trembling, 66, 219. 
Tremor, 66, 219. 
Trichocephalus, 486. 
Trichoma, 431. 
Trichuris, 486. 
Trismus, 219, 221. 
of children, 540. 
Tussis, 228. 
varieties of, 229-234. 
Tympanites, 321. 
abdominalis, 321, 
intestinalis, 321. 
thoracis, 223. 
of the uterus, 323. 630 
INDEX. 
Typhus, 81, 90, 95. 
Typhus abdominalis, 98. 
contagiosus, 110. 
enteriticus, 98. 
erethicus, 96. 
gastricus, 98. 
gravior, 90. 
icterodes, 112. 
irritativus, 96. 
mitior, 94. 
nervosus, 90. 
putridus, 99 
versatilis, 96. 
U. 
Ulcers, 434. 
Ulcus syphiliticum, 472. 
Uterus crepitans, 323. 
Urethritis exsudatoria, 462. 
Urine, 57. 
varieties of, 58-60. 
Urinary calculus, 493. 
Urticaria, 410. 
Y. 
Vaccination, 396. 
Yaccinella, 396, 
Vari, 426. 
Varicella, 395. 
Variolse, 386. 
varieties of, 388. 
Variola spuria, 395. 
Varioloides, 398. 
Venereal disease, 462-479. 
Vermes, 486. 
intestinales 486. 
superficiales, 486, 492 
Verrucce, 430. 
Vertigo, 62, 263. 
caduca, 263. 
tenebricosa, 263. 
Vesania, varieties of, 199. 
Vibices, 413. 
Vision, double, 250, 319. 
Vitiligo, 423. 
Voice, 50. 
Vomica, 296. 
closed, 297, 300. 
Vomit, black, 112. 
Vomiting, 54. 
chronic, 235. 
varieties, 236. 
of blood, 331. 
of children, 544. 
Vomiting, of pregnant women, 
513. 
Vox balbutiens, 51. 
rauca, 50. 
W. 
Warts, 430. 
Weak part, 29. 
Weeping, 51. 
Whites, 524. 
Whooping cough, 232. 
Womb, inflammation of the, 166. 
Worms, 486. 
Worm-fever, 547, in children. 
Y. 
Yawning, 51. 
Yellows, 441. 
Yellow fever, 112. 
Z. 
Zona, zoster, 172, 
Besides a few bad spellings of Latin words and a few errors of punctuation, the fol- 
lowing corrections are to be mentioned. 
Wherever “ sublimate” is used in the translation, mercurius sublimates cor- 
rosives is meant by this term. 
ERRATA. 
In the article “ Diabetes mellitus” not 50-100 pounds (as in the original) of urine, 
but as many fluid ounces are understood to be discharged. 
Instead of vagina crepitans (page 323) read uterus crepitans. THE 
THREE CARDINAL MEANS 
OF THE 
ART OF HEALING. 
BY 
C.V. HUFELAND, 
ir~' 5 
ONE OF THE PHYSICIANS IN ORDINARY TO THE DATE KING OF PRUSSIA, 
AND PROFESSOR TO THE UNIVERSITY OF BERLIN, KNIGHT OF THE 
RED EAGLE ORDER, ETC., ETC. 
WEW-YOBK! 
WILLIAM RADDE, 322 BROADWAY. THE THREE CARDINAL MEANS OF 
THE ART OF HEALING. 
The art of medicine possesses three great means, which 
are pre-eminent over all others : they are bleeding, emetics, 
and opium. 
They represent, as it were, the three fundamental me- 
thods of the healing art: the antiphlogistic, the gastric, 
and the exciting; and at the same time the three funda- 
mental systems of the human economy:—that is to say, 
venesection for the irritable; emetics for the nutritive ; 
and opium for the sensitive systems. They have a direct 
influence over life, and are the most decisive and prompt 
remedial agents known, true heroes, capable of giving 
either life or death; they decide the struggle at the criti- 
cal moment; on their judicious use particularly depends 
the success and reputation of the practitioner. They are 
unique, each is one by itself, and cannot be replaced by 
any thing else. 
He who knows how to use them rightly, is a master in 
our art, and may be recognized as such by the ability with 
which he wields them. But often, like a virtuoso, it is 
only to one instrument he is attached. Many a physician 
has paid particular attention to the emetic, and performs 
admirably on this instrument ; but does not understand 
bloodletting, and is ignorant of its appropriate application. 
Another is skilled in bleeding, but is incompetent in the 
use of emetics and opium. 
Even whole periods have occurred in which this was the 
case, and where one or the other of these remedies has 
prevailed. Strictly speaking, one or the other of them has 
always had supremacy in medicine ; one alone has always 
reigned, and we can in the annals of medicine as in politi- 
cal history, clearly see the successions of these monar- 
chies alternately ruling the profession.* 
* In this remark I do not mean to accuse the physician of a fond- 
ness of fashion. The reason for these changes is undoubtedly foimd- 
pd on the changes which take place in nature, in the change of the 
prevailing constitution. But there is also joined to this a predilection 4 
VENESECTION. 
Fifty years ago venesection governed almost absolutely. 
It was succeeded by the reign of emetics for a long space 
of time; then opium took its turn as sovereign. Now vene- 
section begins again to predominate. 
These three remedies, however, differ totally in nature. 
Each is fitted to its own peculiar cases. One cannot be 
substituted for another, without endangering the life of the 
patient. 
It seems to me, therefore, worthy of the labor, to sub- 
mit these heroes of our art to an accurate examination, to 
define their power as well as their limits, and to assign to 
each its place, but particularly to point out the cases 
wherein they are likely to be misapplied, abused, or ne- 
glected ; and the cases wherein their use is not yet so ge- 
nerally acknowledged. 
I. 
Venesection. 
“ The life of man is in his flood.” 
Moses. 
Venesection undoubtedly ranks first among all remedies, 
being the only one, by which we abstract a part of life it- 
self, and may diminish the amount of vitality in its very 
source. For, nobody now doubts the truth of what I pro- 
nounced 25 years ago, and what so many then contradict- 
ed : that blood itself imparts life to the body, not only as a 
stimulant, but a constituent part of life itself, a vital fluid 
organ. 
Yes, I believe what the holy writ says : “ The life of man 
is in his blood.” Blood is the mother, from which every 
living thing proceeds—the seat of the ever active creative 
power. Without fluid there is no life; every living thing 
proceeds from fluid, is maintained by fluid. Life is nothing 
else than a ceaseless repetition of the act of creation. 
for certain remedies, amounting to an abuse, which arises from want 
of observation and reflection, and from want of an independent exer- 
cise of the practitioner’s own judgment. I may here refer to what I 
have already said in my work on “Military Plague;” and to the ex- 
cellent treatise of Sydenham, “De novae febris ingressu in which 
this great man describes how he himself was compelled by nature, 
and by the altered character of disease, to abandon the method of 
treatment he had hitherto followed, and to adopt a new one. Venesection. 
5 
Without blood the nerves and the brain are lifeless; but 
the heart and the blood live without nerves. 
Weakening of life is, consequently, the primary and prin- 
cipal effect of the abstraction of blood. On that account 
venesection is the greatest remedy in all disorders marked 
by an abundant development of life in the blood; such are 
the inflammatory diseases. This disposition may, in the 
commencement of a febrile malady, be completely van- 
quished by a venesection made in season; and general or 
local inflammation already existing, may be removed by 
one or repeated venesections, and life saved. 
Venesection produces a no less important secondary ef- 
fect: relaxation of the fibre ; and resolution of spasm and 
contractility. By this property it is also a great remedy in 
those diseases which are not properly inflammations, but 
in which there exists only an inflammatory disposition: in 
nervous diseases, spasms and convulsions, nervous fevers, 
in cases of suppressed evacuations of spasmodic reaction; 
it is useful even for promoting the crisis, as the eruption in 
cutaneous diseases.—The depression of life, and relaxation 
of fibre is altogether dependent on the proper quantity dis- 
charged, and the velocity with which it is effected. 
The third effect of bleeding is, the diminution of the 
quantity of blood. This must be considered separately from 
the former. As plethora is not an imaginary but a really 
morbid state, and as a mere abundance of blood may be the 
cause of numerous diseases, the mere diminution of the 
quantity may prove a great curative, even when no inflam- 
mation is present. In this case neither the part of the body 
whence the evacuation is made, nor the time of doing so 
is so much to be considered as the proper quantity. 
Finally, there is a fourth effect, it is derivation. This is 
most important in local congestions and affections. Here 
the place of abstraction deserves particular attention. This 
opinion, it is known, has recently been doubted. But the in- 
credulous need only to be reminded of the effect of vene- 
section in pleuritis. Why is a venesection on the foot 
without avail, why one on the opposite arm of little bene- 
fit or even of detriment, and why does a discharge from the 
arm of the affected side only give immediate reliefl— 
Farther, it is an observation which I have found repeatedly 
confirmed, that a venesection on the arm may remove the 
menstrual flux and disposition to abortion, whereas a vene- 
section on the foot may increase and promote both. 
Every one will again comprehend that bleeding is the 
principal remedy in inflammations and other diseases of an 6 
VENESECTION. 
inflammatory tendency, and there is no need to dwell fur- 
ther on the subject. But that which is less understood is, 
that where no inflammation exists, in plethora and in chro- 
nic diseases, that it acts as a derivative and particularly as 
a great preventive of some diseases. To demonstrate and 
lead the attention to this is the chief object of this paper. 
We have omitted bleeding in a great many cases, in 
which our predecessors used it regularly, and with signal 
benefit, founded on experience ;—we now omit it, certainly 
to the prejudice of mankind. 
If only as an assertion, I may be permitted to hazard an 
hypothesis. It strikes me as very probable that the dis- 
eases of the heart, which have become so very frequent 
within these last 20 years, are chiefly due, exclusive of po- 
litical events affecting the heart, to the omission of vene- 
section, the result of a false system predominant in these 
times. All the other physical and moral causes also existed 
formerly, and with equal violence and continuance, as dur- 
ing the thirty years and the seven years war ; nevertheless, 
diseases of the heart did not prevail to an equal extent 
then. The cause adduced by me is novel, and is well cal- 
culated to produce the effects assigned. Formerly it was 
a fashion and a rule, to perform a prophylactic venesection 
after every violent commotion of the body as well as of 
the mind; such as violent passions, overheating, plethora, 
general and local, in short whenever an excitement of the 
blood and a rush to the heart happened, in order to avert 
the evil consequences likely to follow, and to derivate the 
blood from the heart. In the last twenty years this has 
been neglected. Seduced by a false theory, physicians 
did not bleed in all these cases; they in general rejected 
preservative bleeding, and, led by a false notion of debility, 
they substituted wine, rum, and stimulant medicines, after 
violent mental and corp'oreal emotions. Must it not follow 
as a consequence of this sin of omission, that the rush of 
blood being neither diminished in its quantity nor in its 
force, but suffered for a length of time, that it would 
finally produce distention and enlargement and other dis- 
organizations of the heart 1 
I will especially advert to the following cases in which 
many years’ experience have taught me. how beneficial and 
indispensable it is to make a venesection; and on the con- 
trary how dangerous it is to omit it, many sad instances of 
which I have learned, and of which practitioners do not yet 
seem to be convinced. VENESECTION. 
7 
1. Pregnancy. 
It was an inviolable rule with our predecessors, when 
pregnant women suffered accidents during the first months, 
to open a vein in the arm, and during the last months pre- 
vious to confinement in the foot; and by this practice fe- 
males were benefited. The nervous, and after it the 
asthenic period of science appeared, obedient to which 
physicians dared not bleed; the good old habit ceased to 
be in fashion and at last was forgotten ; even this principle 
was brought forth: every pregnant woman was to be re- 
garded as inclined to astheny, under this state abstraction 
of blood was hazardous, both for her and the fostus. I, on 
the contrary, sustain the very opposite principle. It has 
always guided me, and afforded me success in ray practice : 
Every 'pregnant woman must he regarded as a bivivid being, 
with increased sanguification and nutrition, and her habitual 
discharge of blood suppressed; therefore, she is rather more 
inclined to a plethoric and sihenitic state than to one of de- 
bility. 
There are two periods of pregnancy, when venesection 
is the only means, and is indispensable for preventing great 
danger. 
The first, is in the second, third, and fourth month, when 
violent accidents set in ; such as violent toothache and 
headache, vomiting, vertigo, fits of fainting, cough, oppres- 
sion of the chest, precursors of abortion, bellyache, pain 
in the back, weakness of the lower extremities, pressure 
on the uterus and vesical region. Here the habitual men- 
strual discharge is impeded, while the consumption of the 
foetus is still trifling ; these causes always produce a cer- 
tain degree of plethora. In all these cases, unless a signal 
and decided weakness and exhaustion is present, I ahvays 
bleed in the arm, for a venesection on the foot might be 
promotive of abortion. All those complaints are surest re- 
moved and abortion prevented by it. How often have I 
not removed by this means alone the most violent vomit- 
ing—vomitings which had resisted all other remedies. 
The second period for bleeding is in the last month, 
shortly before confinement; at which time every pregnant 
woman shows a plethoric constitution ; or abetter rule is : 
when there are no evident proofs of weakness and want of 
blood. A double advantage is obtained by this venesec- 
tion, which must be made on the foot previous to delivery. 
In the first place it will be rendered easier. How krilen, 8 
VENESECTION. 
even daring labor, when the throes had vainly tortured the 
laboring woman for a length of time, have I not effected 
an abatement of the cramplike pains and an easy delivery ! 
In the second place a multitude of bad consequences and 
dangerous accidents after delivery are thus avoided. I 
particularly allude to the sudden apoplectic death during 
or immediately after labor ; to immoderate haemorrhages ; 
and to puerperal fever. Nobody will deny that parturition 
has a great resemblance to a violent lesion. Pain, separa- 
tion of organic parts, loss of blood, mental emotion, occur 
united here as there 5 also the result is the same—fever. 
Now it is a rule with all good surgeons, to institute a vene- 
section previous to every operation, when the condition of 
the individual will admit of it, since it guards greatly 
against violent inflammation and other bad consequences. 
Even in the operation of amaurosis this truth has been 
recently strikingly confirmed.—Why should we not apply 
the same principle to labor—a perfectly analogous state 1 
It is one of the most fearful and affecting events, when 
healthy and blooming parturient women, suddenly die by 
an apoplectic fit with or without convulsions, sometimes 
without any haemorrhage, at other times with and after 
haemorrhage, in the very act of delivery or shortly after it 
terminated. I have observed this accident much more in 
young plethoric, than in aged and feeble persons; also in 
cases wherein venesection had been omitted previous to 
confinement. All this tends to prove that such‘an apoplec- 
tic fit is produced not by a deficiency of strength, but by 
the sanguineous congestion to the brain, brought on in the 
full vessels by the forced exertions of labor. I consider 
venesection, shortly before delivery, as the only preser- 
vative against such an emergency, and never have I obser- 
ved these accidents to happen, when it had been previously 
performed. 
2. Cessation of the Catasnenia. 
This is another period in which great evils may be pre- 
vented by venesection, but in which it is frequently neg- 
lected. This cessation is by no means, as some believe, 
always a consequence of weakness brought on by advanced 
age and a decrease of sanguification ; it is simply due to a 
cessation of sexual life and the functions of the genital or- 
gans ; while the rest of the organism and sanguification 
may remain active and vigorous; so much so, ihat at this VENESECTION. 
9 
time the body increases in size and strength by the very 
cessation of the monthly flux ; and many women are seen 
to become strong, full, and blooming at this period. How- 
ever, this very vigor which follows the monthly suppression 
frequently produces the worst accidents, and the time which 
intervenes between the restoration of the balance is rightly 
styled the critical period of female life. This equilibrium 
does not consist in the mere restoration of a proper pro- 
portion between nutrition and secretion, nor in a new dis- 
tribution of humors ; but also in a new distribution of the 
powers even of productivity, which, being now deprived of 
its normal formative organ, is thrown into a false—a patho- 
logical direction. Hence arise the many accidents which 
endanger life, and which can be traced to two sources. 
They are either sanguineous congestions to the head, the 
chest, the stomach, and other abdominal viscera, extrava- 
sations of blood, metrorrhagia, hsematemesis, haemoptysis, 
hsemorrhoidal complaints and nervous attacks ; or they 
are disorders of secretion and consequences of a degener- 
ating productivity, as the formation of scirrhi, or their 
transition into cancer, cutaneous diseases, ulcers, gout, 
dropsy. 
The treatment solely applicable to this period, and which 
may prevent all these accidents, consists in a restoration of 
the balance, in diminishing plethora, derivating the blood 
from noble parts, and supplying new secretions for those 
which have ceased to exist. 
The safest means to fulfil these indications, unless for- 
bid by great debility, is a moderate venesection performed 
every six months, even every three months in the case of 
plethoric women, and such as were subject to copious 
menstruation. 
When there are local congestions and affections, let ten 
to sixteen cups be applied every two months, a kind of de- 
rivation which I have found very useful in this period, in 
order to free the capillary system, which is so frequently 
the seat of disease. The diet must not be too nutritive ; 
daily exercise and a cooling cathartic must be taken for 
four or six days every month. The best kind of laxative 
is a glass of six or ten ounces of Seidlitz water every morn- 
ing. When important and obstinate affections and conges- 
tions, as vertigo, an apoplectic disposition, oppression of 
the chest, cutaneous diseases, arthritic affections set in, 
fontanels are required. 
These abstractions of blood are to be performed more 
and more seldom, as the period of cessation advances and 10 
VENESECTION- 
plenitude decreases, so that no more be made after one, in 
others after two or three years. There are persons, how- 
ever, of so plethoric a constitution, that one abstraction 
yearly must be persevered in from this period onward to 
advanced age. 
I do not hesitate to assert, that following these pre- 
cepts, and especially the occasional venesection, will often 
prevent the worst accidents of this period, even cancer, at 
least scirrhus from passing into cancer, which is then so 
frequent. 
3. Phthisical Disposition. 
There are two modifications of the phthisical disposition, 
the atonic and the florid or inflammatory. In the first, re- 
laxation of the lungs and atony of the whole system is per- 
ceived ; it is distinguished by cough and a mucous expec- 
toration becoming more frequent and copious. To prevent 
it from passing into real consumption, strengthening is re- 
quired, which may be effected by a continuous use of Ice- 
land moss, Peruvian bark, and similar tonics. Abstraction 
of blood would be injurious in such a case, and accelerate 
that transition which we desire to prevent. In the florid 
phthisical disposition, on the contrary, a phlogistic state of 
the lungs inclined to inflammation, irritated, frequently 
tuberculous, exists, with an augmented irritability of the 
whole vascular system. The cheeks are red, as if painted ; 
they and the hands are often hot, a constantly irritated 
pulse, frequent stitches or pains in the chest, with short dry 
cough and oppression, disposition to haemoptysis and febrile 
motions, are characteristic of it. Here the only means to 
save life and to prevent the transition into real consump- 
tion, consist in an antiphlogistic diet and small venesec- 
tions repeated from time to time. 1 have enabled persons 
so constituted to pass safely through that perilous period, 
the age from the sixteenth to the twenty-fifth year, by the 
following treatment: a moderate venesection of six or 
eight ounces every two, three, or four months, fontanels, 
or, still better, mezereura on the arms, internally nothing 
but whey and milk diet, the expressed juices of mellagines, 
of tussilage, carvil, borrage, grass-root, cucumber-juice, 
small doses of digitalis. The best proof of the importance 
of abstractions of blood in these cases is exhibited by Na- 
ture herself in the female sex ; for every one knows that 
the continuance of menstruation is the surest remedy to VENESECTION. 
prevent phthisis for a long time, even where there is a great 
disposition to it. It is only when the menstrual flux ceases 
that phthisis manifests itself to its full extent, and then the 
patient is lost. 
4. The Apoplectic Disposition. 
In men, who have a short stout body, short thick neck, 
and unusually large head (which is therefore called archi- 
tectura apoplectica) a natural disposition to apoplexy exists, 
and when such individuals get farther advanced in age, up 
to forty or fifty years, the precursors of it, vertigo, feeling 
of fulness in the head, tingling and buzzing at the ears, un- 
usual sleepiness and forgetfulness set in. In the absence 
of such a structure this disposition is produced at a certain 
age by other diseases, especially by gout and hsemorrhoidal 
complaints. Even old age alone may generate it in pletho- 
ric persons, by straitening or even ossification of the ex- 
ternal vessels, by which a stronger rush of blood inwardly 
and to the brain (plethora ad spatium) is brought on. In all 
these cases, when the above-mentioned forerunners set in, 
and indications of plethora associate with it, I know of no 
greater remedy to prevent apoplexy and preserve life, than 
a frequent use of cooling cathartics,* fontanels, and oc- 
casionally a venesection alternately on the arm or foot. 
The most appropriate seasons, indicated by Nature, for 
such prophylactic venesections are the time of the first 
snow in November, when the contraction of the peripheric 
vessels, combined with the pressure of the atmosphere, is 
likely to produce congestions to the head, and the time of 
the first summer heat, in May or June (the season of bloom- 
ing, as the ancients called it), when the first influence of 
* I cannot too strongly recommend a remedy against vertigo, first 
brought into notice by Ksempf, which innumerable cases have con- 
firmed to me. It is the following : 
R. Gum guaiac, 
Cremor tartar. 
of each half a drachm. 
S. To be taken, for several days, in the evening, before retiring. 
M. F. P. 
I have found this remedy of excellent use, not only against vertigo, 
but in general as a preservative against apoplectic tits in persons of 
advanced age, when atonic gout is likely to be mixed with it. 
It may be repeated every month, for several days. When hemor- 
rhoidal congestions are connected with it, I add ten to fifteen grains 
of lac sulphuris. 12 
VENESECTION. 
warmth creates an unusual distention of the blood (plethora 
ad volumen), and thereby congestion to the brain. 
I know a number of persons, who have prolonged their 
life up to eighty years by such annual venesections. That 
very old age is often the sole indication for bleeding, even 
in individuals who were not in need of it formerly; and I 
cannot omit to recommend this point to particular atten- 
tion. Old age ought not to lead us to suppose weakness 
alone, as many practitioners do, and suggest the use of 
tonics. In persons of a sanguine constitution and good 
digestion, very active sanguification persists up to great 
age, and the plenitude of blood now becomes dangerous, 
since its equal distribution is impeded by the straitening of 
the vessels and the decreased motive power in the smaller 
and capillary ones, and local congestion of blood, especially 
to the brain, is caused. Therefore, there are persons who 
attain their fiftieth or sixtieth year of age without need of 
bleeding, but who, from this period onward require annual 
venesection. Be careful in this, as in the fit of apoplexy 
itself, not to be deceived by the external appearance of 
weakness and deficiency of blood, pale countenance and 
leanness. Such individuals are often internally most rich 
in blood; of which a full, strong, and hard pulse is a sure 
indication. I have abstracted from a man of seventy-two 
years of age, of pale, meagre constitution, who had had a 
fit of apoplexy, and laid speechless and consciousless, with 
pale face, but with a full, hard pulse, first one pound of 
blood, and this being of no use, and the vein yielding no 
more, immediately fourteen ounces of blood from a second 
vein of the other arm, and it was not until he had lost 
twenty-six ounces of blood, that speech, consciousness, and 
ability to swallow returned, and the attack of apoplexy 
passed by happily. 
5. Haemorrhages. 
Here also venesection has been too much forgotten and 
neglected, owing to the erroneous idea that haemorrhage 
is always caused by debility, and is a substitute for abstrac- 
tion of blood. Practitioners seem to have forgotten that 
haemorrhages might arise from plethora and from increased 
vascular action ; that loss of blood by venesection has a 
quite different effect from that by haemorrhage ; and finally, 
that it js better that a superabundance of blood be dis- 
charged from a vein of the arm, than from the lungs. VENESECTION. 
13 
Bleeding from the lungs deserves particular attention. 
This most plethoric organ of our body, one so apt to lesions 
which are so irremediable, requires venesection, according 
to my opinion, at every eruption of blood, though it be 
trifling, except the single case, where a putrid dissolution 
or an ulcer in the lungs is evidently the cause. In all 
other cases it will be prudent to commence by a moderate 
venesection, which often is alone sufficient to stop bleed- 
ing, at least prepares the system for the application of other 
remedies ; and which is essential for preventing dangerous 
consequences,—inflammation of the bleeding part. 
It is likewise often the only remedy, or, at least, an indis- 
pensable accessory in metrorrhagia, particularly those cases 
which happen in plethoric subjects, and at the period of the 
menstrual cessation, when a venesection in the arm occa- 
sionally repeated is often the only means of relief. 
Bleeding is less necessary in heemorrhoidal haemorrhages, 
hsematuria, and hsematemesis. But even in these cases it 
may be salutary when plethora exists, or a previous haemor- 
rhage has been suppressed. 
6. Commotion. 
I must now mention the important case of a violent 
mechanical concussion, a fall or a blow. The consequence 
is always a local debilitation of one or several internal vis- 
cera, distention of the vessels injured, and a congestion or 
a real extravasation of blood, either into the cellular tissue 
or poured out externally (haemoptysis, hsematuria, metror- 
rhagia). Thus violent concussions are apt to give rise to 
inflammation of the brain, of the lungs, of the kidneys, &c., 
which have the further peculiarity of being of a compound 
character, active and passive; that is to say, consisting in 
a considerable accumulation and stagnation of blood in a 
debilitated vascular system, in which irritation, develop- 
ment of warmth and inflammation is increased by the exist- 
ing local plethora. This state is liable to be mistaken in 
its intrinsic character, and has indeed been frequently mis- 
taken. When the asthenic theory reigned, the conse- 
quences of all commotion, even inflammatory phenomena 
were regarded as mere weaknesses, treated with stimulants, 
and abstraction of blood was abstained from ; in conse- 
quence of which, if the patient did not immediately die, he 
fell into a chronic disease of the viscera, frequently ter- 
minating in consumption. 
The only correct treatment of such inflammations (a com- 14 
VENESECTION. 
motione) is to unite both methods, for both states of dis- 
ease are united here,—that is to say, the evacuant and tonic 
method. 
The first thing to be done is a venesection, in order to 
promptly remove the local accumulation of blood. As 
soon as this has been sufficiently done, have recourse to 
the topical application of cold, and internally to antiphlo- 
gistics, as long as inflammability is evident; if these means 
be not at hand, an infusion of arnica montana (leopard’s 
bane) is the specific, to effect a prompt absorption of the 
stagnations and extravasations which follow commotions ; 
a property which is implied in the (German) popular name 
of this plant, which is Fall-Kraut, falling herb. 
The commotion may not be followed by inflammation, 
but by a chronic affection of the part injured. In such a 
case, a stagnation of the humors within or without the ca- 
pillary vessels (an extravasation into the cellular tissue, 
parenchyma of the part) must be suspected. The doctrine 
of extravasations and stagnations of blood in the substance 
of the viscera merits attention, and needs farther investi- 
gation. We see externally, after violent contusions, 
ecchymoses, which last for weeks, months, even for a long- 
er time, spreading from one part to another, as from the 
shoulder to the ends of the fingers, and which are often 
followed by disorganizations, indurations, suppurations: 
the same also happens to the internal viscera. A protracted 
pressing or pains in single viscera, as in the lungs, liver, 
spleen have often been observed, have lasted many months 
without yielding to any remedy, and finally have disap- 
peared by spontaneous discharges of blood from the lungs, 
stomach, or intestinal canal. But it more frequently hap- 
pens, that such local accumulations and stagnations gra- 
dually form into incurable obstructions, indurations, sup- 
purations, or other pathological metamorphoses. 
All these evils, acute as well as chronic, are most surely 
prevented by a venesection made in season; that is, imme- 
diately after the accident. 
7. Plethora at Spatium, by faults of structure or 
proportion. 
By this, I understand a state of the body, in which, while 
sanguification continues perfect, there exist mechanical 
obstructions, which impede and deprive the blood of room 
to circulate. 15 
This is the case in all humpbacked persons ; for the 
spinal distortion diminishes the space between the pelvis 
and the chest, and gives a new curvature to the aorta, by 
which the circulation of the blood will be necessarily ob- 
structed, and forced to accumulate in the large vessels 
near the heart. When these deformities are great, we al- 
ways find the subject of them troubled with ha3morrhoidal 
congestions, or congestions in the chest and head; for which 
there is no other cause than this. The only means of alle- 
viating the complaints of such deformed persons, and to 
prevent the dangers of congestion, is to practise moderate 
venesections occasionally. 
We meet with something of the same kind also in those 
cases where there is considerable congenital disproportion 
between the limbs and the body. A person who has very 
short legs will always be more subject to sanguineous con- 
gestions to the head and chest, than a long legged one. 
In general the apoplectic disposition is owing to the short- 
ness of the neck, the large size of the head, and the com- 
pressed form of the rest of the body. In little children 
it is likewise the proportional size of the head which ren- 
ders them particularly so liable to sanguineous congestions. 
There may be a disproportion even in the vessels ; the con- 
stant disposition to internal sanguineous accumulations is 
often due to disproportional smallness of the external ve- 
nous vessels. 
OPIUM. 
We must also mention those cases, where a great part 
of the room designed for the motion of the blood has been 
taken away by amputations of large limbs, or the tying and 
adhesion of large blood vessels (in aneurisms). In all these 
cases the faulty structure is an indication for the abstrac- 
tion of blood when cases require it; venesections in these 
cases are important preservatives. 
11. 
Opium 
Sacra vitae anchora, circumspecte agentibus, est opium ; cymba 
Charontis in manu imperiti. Wedee, 
We will now speak of the second heroic remedy—« 
opium. A great, a mysterious, an extraordinary remedy, 
still incomprehensible in its effects ; and on which Nature 
has appropriately placed a crown at the completion of its 16 
OPIUM. 
vegetative life (in the capsules). We are perfectly right 
to style it a hero ; for it unites all the virtues of one. It 
is a remedy whose power affects the very source of life, 
whose effect is decisive of life or death ; and used in the 
critical moment may save, as surely as it will destroy if 
wrongly applied; which is unique in its operations, and 
cannot be replaced by any other one ; finally, it has often 
reigned king, even despot over the whole medical world, 
and spread benefits as well as ruin over humanity. 
What Wolfgang Wedel has said of k in his Opiologia, 
will remain for ever true : “ Sacra vitce anchor a, circum- 
specie agentibus, est opium ; cymba vero Charontis in manu 
imperitiy—lt is a double edged sword, a divine gift from 
heaven in the hand of the master ; the most deadly poison 
in the hand of the ignoramus. O that it were possible to 
commit it only into the hands of a master, and to withdraw 
it from the profane hands of the demi-physician. 
The history of opium is the history of medicine. It has in- 
separably accompanied the art of healing through all its va- 
rious phases ; alternately been raised up to the skies, and, 
as it were, revered ; again dreaded and banished ; but always 
again sought for as indispensable. The greatest masters 
of the art,—Galen, Sydenham, Hoffmann, Werlhof, paid re- 
spect and veneration to it, and believed that one could not 
be a physician without it. And how far back is the date 
when every disease was thought to be curable by opium, 
and that almost every physician carried the opium-vial in 
his pocket 1 Did it not defeat all other medicines, and 
maintain the battle-field alone 1 Can we deny that at that 
time, opium really controlled medicine, even that it had 
the most decisive influence on the theory of medicine I 
It was its frequent use and its extraordinary effect that 
most contributed to start the opinion, which considered the 
original character of all diseases to be astheny. 
But as it is in general the lot of men to pass from one 
extreme to the other, so has it also happened with opium. 
To a predilection for this remedy, and its abuse, which 
only a few lustres ago perpetrated so much mischief, and 
to an ignorance of its real merit, succeeded an exaggerated 
horror of its use among physicians, and thereby was medi- 
cine deprived of one of its most excellent remedies, and 
many a patient of the relief which it alone could afford. 
It is time to seek a reasonable medium, and to instate 
this venerable drug in its true rights. This is the object of 
the present treatise: to appreciate the virtues of opium, 
to reduce them to fixed principles, and to give a proper 17 
rule to physicians, especially to young practitioners; 
whereby to avoid abuse, and to apply it in its proper place. 
All—even life and death—depends on a correct knowledge 
of its primitive effects, on a right appreciation of the indi- 
cations, and an accurate discrimination of the case. The 
first and most important thing is undoubtedly a knowledge 
of the primitive effect, the essential character of a remedy. 
As every disease has its peculiar character developed in 
the organism, so is the effect of every remedy nothing less 
than a disease created by art, and possessed of a character 
of its own. In order to understand the primary effect of 
a remedy, we must have a knowledge of the alteration 
which it produces in general in the living economy, what 
are the alterations it produces in the various systems, what 
is the system it attacks in preference, carefully discrimi- 
nating the proximate from the remote effects. For this 
purpose it is not sufficient to know the names of the dis- 
eases in which opium has proved beneficial. This can at 
most impart an empirical knowledge. Nor is a chemical 
analysis sufficient, however accurate it be; it will always 
remain subordinate to autonomy and autocrasy of life. 
But least of all are we to respect a deductio a priori, which 
will ever change obedient to the wind of every system. 
The primitive effect can only be determined on by observ- 
ing the effects of its operation on the living organism, as far 
as they strike the senses. It is only the proximate, essen- 
tial, constant effects that come into consideration,—not 
every phenomenon which follows its use, as Homoeopathy 
pretends to; for a multitude of accidental causes, depend- 
ent on individuality, and on temporary external and inter- 
nal conditions, co-operate and modify those effects. The 
task therefore is to inquire from experience, and to sepa- 
rate the proximate, essential, and constant effects of opium 
from the secondary and accidental ones. 
Large is the field and difficult the task. One might feel 
inclined to believe, from the immense crowd of observa- 
tions and trials, which have been accumulated, and are before 
us since more than ten centuries, it might be easily done. 
But this is not so. For now we have to distinguish which 
of its effects belong to the individual’s constitution, to the 
idiosyncrasy of the person ; what is to be attributed to the 
reaction which is altered by disease, what must be ascribed 
to the various epidemical and endemical constitutions 
which so greatly modify all living beings; how much is 
owing to habit, as in the east; finally, how much is attri- 
butable to the observer, and the spectacles through which 
OPIUM 18 
OPIUM 
he sees the subject, and by which even facts may present 
quite a different appearance, and by which so many false 
and single-eyed observations have been brought before the 
public. I shall endeavor, according to these considera- 
tions, to lay down and fix the most essential out of this 
vast mass of observations and trials, and my own longse- 
val experience. In this respect Brownianisrn was particu- 
larly prolific. It may very properly be considered the 
greatest and most universal experiment, which has ever 
been instituted on mankind. 
Constant Phenomena 
When we bring opium in conflict with the living organ- 
ism, be it by the internal or external surface, the following 
symptoms appear as constant: 
1. The pulse is raised, becomes full and vigorous. This 
effect is immediate and constant. Acceleration is only re- 
lative, and depends on the variability of the vital state. In 
a healthy state, a moderate acceleration is observed, even 
when the vital power is increased. If, on the contrary, a 
frequency of pulse exists, excited by weakness, opium 
moderates it and makes the pulse slower and more regular. 
Large doses also render the pulse slow and like that of an 
apoplectic person. 
2. Turgor (expansion) of blood. It is manifest in the ful- 
ness of the pulse, in the swelling of all the vessels, in the 
sanguineous congestions that happen. It tends first to the 
head, the lungs, or to any other predisposed organ, and is 
apt to create haemorrhages, even inflammations. 
This vital turgescence, exhibited in the expansion of 
blood, must be considered as a peculiar effect of opium, 
and deserves particular attention. It was known under 
the name of rarefaciio sanguinis by gray antiquity, and re- 
garded as the primitive effect of opium. And it is indeed 
one of the most constant phenomena, and is perceptible at 
all times. The pulse becomes full and large even in debil- 
itated persons, and such as are poor in blood ; an artificial 
plenitude, a true plethora ad volumen is the consequence. 
Therein particularly, resides the danger of sanguineous 
congestion to the head after the use of opium ; and on 
this circumstance depends the dissolution of the blood, the 
decomposition of the living mixture which sometimes hap- 
pens. 
3. Increase of vital warmth. It is an inseparable com- 
panion, a co-effect of the augmented vital turgescence, 19 
and of the increased circulation, and is one of the most 
constant effects of opium. 
OPIUM 
4. The nervous system, especially the sensoriutn, is di- 
rectly and mightily affected / sensibility is diminished, for 
it produces stupefaction, sleepiness, coma; when applied 
locally, numbness, insensibility of the part, cessation of 
pains and spasms. Sometimes, it is true, its internal use 
produces increased gaiety, exaltation of the sensorium, of 
psychical life, even delirium, which may reach unto fury. 
But these are excitements which very soon pass away, and 
are followed by a contrary state. They are relative, and 
depend partly on the dose, partly on individual varieties. 
They belong in part to the affection of the nervous system, 
which, before yielding to the narcotic power of the 
remedy, resists the attacking agent for a while ; partly also 
to an afflux of blood to the brain, on which opium acts as 
a powerful stimulant, and exalts its action, as is seen in any 
Other sanguineous or inflammatory state of the brain.* 
The immediate operation of an agent on the human eco- 
nomy is most accurately and best ascertained by its local 
effect, and this in opium is always a diminution of sensi- 
bility. When applied to the intestinal canal, the action of 
the latter ceases; applied on an external part, it removes 
pain and spasm, provided that the epidermis is whole ; for 
otherwise the soreness of the part would of course render 
that, as every other application of a foreign substance, es- 
pecially of a resinous one, painful. 
5. Constipation of the bowels, and dryness of the throat, 
owing to a local paralysis of the intestinal canal and its ab- 
sorbent vessels, created by its internal application. This 
is a stupor, a sleep of the intestines. 
6. Increased secretion of the skin, sweat. The product of 
the exciting power, of the augmented arterial action, the 
* The pure effect of opium can be known only in persons unaccus- 
tomed to its use. Therefore, the effect of it amongst the Turks and 
other oriental nations, as well as amongst us in persons accustomed to 
it, does not prove any thing to the contrary. Habit produces a per- 
fectly new relation between the opium and an organism already ac- 
customed to its excess, blunted and pathologically altered. The mad 
courage of the Turks, created by opium, is a double product, created 
by the double, positive and negative effect of opium ; on one part it is 
negative : disregard, forgetfulness of danger and of themselves, by the 
depotentiating power of opium ; on the other part exaltation of en- 
ergy and courage, by the increased tendency of blood to the brain and 
heart.—We also see persons in our own climate, by long and abundant 
use of this remedy in large doses, suffer no other perceptible effect than 
a forgelfulnes of themselves, of their pains, of their whole morbid 
condition, whence results their mirth and contentment. 20 
OPIUM. 
motus periphericus, combined with the sedative, the solu- 
tion of the cutaneous spasm, the relaxation of the orifices 
of the vessels. Hence it promotes suppuration, and is apt 
to create pimples, petechise and aphthse in fever. 
7. Besides these, the effect on the genitals and urinary 
organs may be adduced as almost a constant effect; it ex- 
cites their action. The first are most excited ; amorous 
dreams, erections and emissions generally follow its use. 
As to the urinary apparatus, the discharge of urine is in- 
creased in quantity and in frequency; but this depends on, 
circumstances, and is yet a question to be settled, whether 
it be a real increase of the urinary secretion, or only in- 
creased urgency to make water. 
8. Too abundant and too long continued use brings on 
dissolution of the blood, decomposition of the vital combina- 
tion and mixture, putrescency, gangrene, rapid transition into 
complete putrescency after death. Although this is a secon- 
dary, it is still one of the most constant effects of opium, 
after a concentrated use of it (opium poisoning), or after 
a protracted use. All acute fevers may be changed by the 
abuse of opium into putrid typhus ; all inflammations into 
gangrene. Also in chronic diseases this inclination to dis- 
solution and heemorrhages is manifest after its long con- 
tinued use. Even among the Turks its abundant use brings 
on a gradual mortification, and the most profuse haemor- 
rhages. Equally constant is the rapid transition of such 
dead bodies into putrescency, and the effect of opium is 
perfectly similar to the effect of lightning. 
Primitive Effect. 
We see thus in opium a most wonderful and unique com- 
bination of excitement with stupefaction ; of an animating 
with a destructive power ; and it is these effects which are 
distinctive of the remedy, and which give to it so high and 
exclusive a value for practice. Depression, even complete 
annihilation of sensibility, of nervous life, and awakening 
and raising of the irritability of the heart and the whole vas- 
cular system ; that is to say, of the organic, vegetative, prim- 
itive life, along with augmentation and acceleration of the 
vital process unto fatal hyperanimalization, destruction of all 
plasticity and incipient chemical dissolution,—this is the 
essential character, the primitive effect of this extraordi- 
nary remedy. Hence the instantaneous excitement and 
filling of the pulse, which was reduced by weakness; mo- OPIUM, 
21 
deration of the pulse accelerated by weakness ; the conver- 
sion of violent, sanguineous congestions into inflammation ; 
hence the rapid transition into gangrene, collicjuation, 
hypercarbonization, putrescency and putrefaction. 
Opium is therefore a great, even the greatest excitant 
and cardiacum, in the strictest sense, which we possess. 
And this is, indeed, a positive primary effect, not a medi- 
ated one, the effect of secondary or antagonistic reaction. 
The best evidence of this is furnished by trials on persons 
who are almost in an exhausted state. I must remark here, 
as a general observation, that in order to ascertain its 
effects on the living body, it is most necessary to consult 
pathology, and its pathological effects ; not only the trials 
on healthy persons. One ought to have seen himself the 
wonderful momentaneous effects which a dose of opium 
produces in the most prostrated and exhausted state of the 
vital power, as in typhus fevers and in malignant small- 
pox ; how the scarcely perceptible, quick, trembling, inter- 
mittent pulse changes into a full, equal, vigorous one, how 
the skin acquires an uniform warmth, an universal, vital 
turgescence spreads a new sensation of life; vigor, cour- 
age, and comfort pervade the patient, and the internal 
curative process, the crisis, which hitherto could not oe 
effected, all of a sudden receives the most vigorous im- 
pulse, and from that moment all the salutary productions 
and secretions of Nature go into operation. 
In this Brown was perfectly right, though it was known 
and in usage a long time before. He only forgot the other 
side ;—that this remedy acted also as a sedative on the 
nervous system, and that even its exciting impulse is so 
powerful, and affects life so deeply, that the excitement 
passes rapidly into the greatest prostration and paralysis ; 
hence, we cannot attribute to it a really and lastingly 
roborative virtue. 
But the idea of irritation and excitement does by no 
means exhaust the effect of opium, no more than the idea 
of over-irritation does that of its secondary effect. For its 
operation extends deeper; the excitation attacks the primi- 
tive process of life, the chemico-vital mixture, and the 
over-irritation becomes an over-living, a vital process in- 
creased above the normal measure. This is made evident 
by the rapid transition of the bodies of those who have suf- 
fered from it, into putrefaction, gangrene and dissolution. 
Therefore, the sedative effect ought no less than the ex- 22 
OPIUM. 
citement to be considered a fundamental operation of 
opium. 
Nor is this sedative effect, as is generally supposed, a 
secondary one, created by over-irritation ; but, like excite- 
ment, it is a primitive action, exerted immediately on the 
nerves, and which strikingly shows the power of opium, 
locally applied, in arresting pain, spasm, and even every 
species of activity. 
It is, therefore, with a full conviction that I maintain: 
There is no remedy, in our whole stock of medicines, which 
operates so directly and powerfully, and at the same time so 
variously on life, on the fundamental principle of vitality, as 
opium. He who uses it, has life and death in his hands, 
bordering very near on each other. So true is what the 
great Sydenham says : “Without opium all medicine would 
be imperfect and insufficient.” 
Mode of Operation. 
Every inquirer will naturally ask: How are we to explain 
the surprising and, to a certain degree, contrary effects, 
and such as no other remedy produces I This task has 
occupied and exercised the sagacity of the physicians since 
thousands of years. It is one of the most difficult riddles 
put by Nature to the inquiring mind ; and nothing is more 
instructive, and at the same time more discouraging, than 
an exposition of the various opinions put forward on this 
account. It is, so to say, a history of the human mind and 
the variable states of science ; and as this mysterious re- 
medy affects the innermost relations of organic life, its 
history furnishes an exhibition of the fundamental ideas 
which prevailed from time to time of Nature, and of the 
actions of life. The first we meet with is the theory of 
vital spirits, which, according to the opinions of the an- 
cient physicians, are fascinated and enchanted by opium in 
some wonderful way.* After this came the Galenian view 
of temperature, according to which opium was of a cold 
nature, and therefore required the assistance of aromatics. 
Afterwards the opinion of Sylvius, who endeavored to 
explain all in a chemical way ; supposed that opium was 
possessed of a peculiar principium sulphureo-volatile, 
which was productive of all its effects. Helmont asserted, 
that opium operates on his “ archeeus,” and by this he 
* The great Bacon thought that the effect of opium was to drive the 
spirits from the surface, and to concentrate them at the centre. Hist. 
Vitse et Mortis. Art. xii. 23 
OPIUM. 
accounted for the phenomena. The more mechanical 
school supposed the effect of opium to be due to an ob- 
struction of the finest vessels. Then the opinion, that 
opium operated merely by expanding the blood, spread 
universally and prevailed for a long time ; an opinion to 
which even the great F. Hoffmann assented to a great ex- 
tent.—-Then appeared the more accurate knowledge of the 
nervous system, and its influence on the organic functions, 
the great discovery of Haller, that of the difference between 
sensibility and irritability, which altered the views in physi- 
ology and pathology, and thereby also the view heretofore 
entertained of the operation of opium. It was now par- 
ticularly referred to the nerves, exclusively so by Cullen. 
In more recent times, two other remarkable explanations 
were given. The one most ingeniously excogitated by 
the subtle Lewis Hoffmann.* He founds it on the prin- 
ciple, that the small vessels and their terminations, having 
a weaker degree of irritability than the large ones, and the 
heart, consequently lose it before the latter under the irri- 
tating operation of opium. Hence results a state of rela- 
tive weakness, a want of action and obstructed circulation 
of the humors in the smaller vessels, and by this resistance, 
by this disturbed equilibrium, an increased and strengthen- 
ed reaction of the heart.—The second explanation comes 
from the famous Brown. According to him, opium is the 
strongest and most diffusible stimulant for the whole system. 
It consequently arouses a violent reaction in the whole 
economy, but by the very same cause is consequently fol- 
lowed by the greatest exhaustion; which is indirect debi- 
lity. The most recent opinion is that appertaining to the 
system of polarity prevailing in natural philosophy, and 
which approaches to the chemical view. 
The plurality of physicians hold now to the opinion, that 
opium operates by irritating the whole system ; and that 
the narcotic effect is a consequence of over-irritation, of 
indirect debility. I oppose to this two questions : In the 
first place,—why do not other equally volatile remedies, 
which excessively irritate the vascular system, such as 
musk, ammonia, castoreum, likewise create narcotic ef- 
* Who lived half a century later than Frederick Hoffmann for 
whom young physicians often mistake him. 
| Even such was the opinion of Bracket in his Traite sur I’Opium ; 
Paris, 1828. OPIUM. 
fects 1 And in the second place,—do we not see narcotics 
which produce most violent narcotic effects without the 
least irritation of the vascular system, without alteration 
of the pulse and warmth, even by retardation of the pulse, 
and consequently diminished action of the heart 1 Hence, 
I deem it clearly evident, that the narcotic matter is some- 
thing peculiar, which, independently of the irritative power 
of the heart and vascular system, operates directly and 
specifically to the brain and nervous system, and is capa- 
ble of depressing and affecting it directly, and without the 
medium of an over-irritation. This narcotic principle is 
manifestly present in opium. The proofs are as follows: 
the peculiar smell of opium, which is very similar to that 
which we perceive in hyoscyamus, stramonium, and other 
narcotic plants, and which always betrays the existence of 
narcotic matter. Farther, the local sedative effect of 
opium; it operates also when externally applied, relieving 
spasm, and soothing, without any affection or excitation of 
the vascular system ; it may even (as I have experienced 
myself, when on a hot day I held a large piece of opium in 
my hand for a length of time) by a strong and long con- 
tinued external application, affect the sensorium and create 
narcotic accidents* without any excitement of the blood, 
merely through a nervous consensus. The mere applica- 
tion to the temples causes sleep.t The topical application 
to the stomach, when taking it as a medicine, immediately 
stops the local sensibility and nervous action of this organ 
(appetite, digestive power, and peristaltic motion) ; its ap- 
plication to the intestinal canal by injections arrests the 
peristaltic action of the intestinal canal. Farther, we see 
that the mere vapor, which is the purest element of narco- 
tic matter, produces stupor. The aqua opiatica, which 
does not contain any thing chemically recognizable, conse- 
quently only the exhalation, the most volatile part, has also 
a sedative effect in ophthalmias. Finally, experience 
teaches that the watery extract operates antispasmodically 
and soothingly, without exciting the vascular system (simi- 
lar to other pure narcotics, as hyoscyamus, stramonium), 
* Has the strongest alcohol ever done so ? I ask of those who con- 
sider the effect of opium identical to that of wine. 
t It is one of my usual remedies in sleeplessness of nervous patients, 
this so frequently tedious complaint, to apply on both temples every 
evening the following plaster : 
R. Empl. de hyoscyamo half an ounce. 
Opii 20 grains. 
Malax. 25 
but which the resinous preparation would produce,—evi- 
dently proving the existence of narcotine, which is active, 
without any excitement of blood and vessels intervening. 
We may, by the admixture of nitre and other antiphlogis- 
tics, deprive opium of its heating property, and still the 
sedative remains. 
OPIUM, 
We must, therefore, distinguish the sedative from the 
exciting operation of opium. The only true and satisfac- 
tory explanation of its mode of operation is, according to 
my opinion, the following: a peculiar and intricate union 
of a narcotic with an excitant principle ; the first tending to 
the nervous system, the other to the vascular. The mere 
aspect of one of the important narcotics shows that this 
difference exists, and that the narcotic effect is by no means 
in equal proportion to the exciting, which, however, would 
be the case if both were one and the same, or the effect of 
one and the same stimulus. Stramonium is perhaps the 
strongest narcotic we are acquainted with after opium ; it 
does not in the least excite the pulse nor the vascular sys- 
tem, according to experiments made on animals; digitalis, 
on the contrary, operates depressingly, belladonna, on the 
other hand, excitingly. Prussic acid is capable of totally 
annihilating sensibility, without producing the least excite- 
ment of the heart and vascular system. These remarkable 
varieties in the effects of narcotic remedies, seem to me to 
furnish the strongest proofs of difference between sensi- 
bility and irritability as primitive organic powers. 
Let us now resort to chemistry, that art which resolves 
all things, and ask: To what principles can opium be redu- 
ced 1 Perhaps it will throw some light on the various 
powers which this drug possesses, and it may give to us the 
key of the mystery. 
Ancient chemistry was contented with dissolving it in 
water, wine and alcohol, to separate the parts which were 
soluble in water from those not soluble, and it was found, 
that the watery solution (extractum aquosum s. gummo- 
sum) possessed the narcotic virtues, though in a lower de- 
gree, but not the hot properties, and that the latter per- 
tained, consequently, to the resinous part ; wherefore this 
was prescribed by the physicians, when sanguineous ex- 
citement and phlogosis rendered the use of opium hazard- 
ous. 
Modern chemistry, which has made such great discove- 
ries, and has discovered entirely new modes of penetrating 26 
OPIUM 
into the interior of nature, has directed her attention also 
to this important object, and submitted opium to the most 
accurate and manifold examinations. It has discovered as 
primitive substances, oxygen, carbon and hydrogen. The 
result is, that opium may be divided into four ingredients, 
morphium, meconium, and narcotine, to which the extrac- 
tive matter* must be added. But opinions differ very much 
regarding the properties and effects. Thus much is cer- 
tain, that morphium alone is of little efficacy. It must be 
combined with an acid in order to operate, and then it has ef- 
fects pretty much resembling those of opium unto fatal poi- 
soning. But narcotine (Derosne’s principle) remains, which 
is very efficacious according to some, indifferent according 
to others. Equally wanting of confirmation is the opinion, 
that the latter produces the exciting, the first the sedative 
effects. Besides, we have yet to consider the extractive 
matter, which the Swedish chemist Lindbergson maintains 
is the most efficacious one in opium. 
What results from all these investigations for the physi- 
cian I Neither morphium alone is opium, nor meconium, 
nor the narcotine, nor the extractive matter ; but, what 
even the great chemist Orfilaowns: the effect of opium pro- 
ceeds from the combination of all these ingredients, and I add, 
from the peculiar mode of combination and existence, whichs 
however, is destroyed by chemical analysis. The lesson for 
practice is: he who wants to use opium, let opium be the article. 
In this he is sure to have all the ingredients that it con- 
tains, and in that very peculiar organic combination, which 
probably in all bodies is the principle and foundation of 
their essence. 
Of far greater importance to the physician is a know- 
ledge of the spirituous and the watery solution of opium, 
tinctura opii, and extractum opii aquosum. The first produ- 
ces narcosis, with sanguineous congestion and increased 
action of the heart; the latter narcosis with less, or at least 
with much less heating power. This is confirmed by ex- 
perience, and is of great practical importance for the 
various cases of its application when we wish to have the 
sedative united with the exciting power, or the sedative 
alone. 
* But that very extractive matter seems to me by no means unim- 
portant, and chemistry may allow me the question, whether it did 
not treat the same too much as a trifle in general as well as in partic- 
ular. For what is it but an ingredient, which we do not yet know? 
And would it not be better to call it, instead of using the non-signifi- 
cant word extractive, rather problematic matter, as an incentive for 
future investigations ? OPIUM, 
But this distinction is also important in a chemical point 
of view, for it shows in its most simple form that the in- 
gredients of opium which are soluble in water possess a 
more purely narcotic power than those soluble in spirit, the 
resinous; it also shows that the narcotic and exciting pro- 
perties are also contained in the alcoholic extract, which 
must be distinguished from the former. The first are the 
meconic-acid, morphium and the extractive matter; the 
latter the pure opium and the narcotine. 
I may here be permitted to subjoin my own opinion on 
the examination. 
Irritability is different from sensibility not only in name 
but in reality ; it is independent, and its action resides in 
itself, is not secondarily dependent on the nerves, though 
influenced and modified by them. In this respect Haller 
was perfectly right ; and it needs nothing but a look to the 
heart and its nerves, so insignificant when compared to its 
power, and to the first “ punctum saliens,” which distends 
and contracts without nerves, in order to become convin- 
ced of this truth.* Now to conceive the idea of irritability 
and an irritable system, the subject must be taken in its 
totality ; I therefore prefer to call it the sanguineous life, 
the sanguineous system. For the blood is its element, and 
the heart and circulation exists for the blood’s sake, not 
the blood for the heart’s sake (one of the usual views), in 
order to put it in motion. The blood, not the nerve, is 
the source and supporter of life; the nerve needs the blood. 
Fluids exist before the solids ; all life springs from fluid, 
not alone in its origin and formation, but continually during 
its whole existence. The blood and the vascular system 
are consequently the base of the proper organic, the vege- 
tative plastic life ; the blood is the factor, the nerve the 
regulator of life. 
Susceptibility to external impressions, therefore, by no 
means relates solely to the nervous system, nor is it de- 
* I will recall to mind only two additional proofs of the peculiarity 
and independence of irritability, as a peculiar original organic power. 
In the first place, the contraction and oscillation of the muscular fibre, 
even after the nerves have been cut ; when not only chemical, but 
even mechanical irritation is applied. In the second place, the ab- 
sence of fatigue in incessant labor and contraction, as we perceive in 
the heart ; whereas all action dependent on the nerves is subject to 
the law of fatigue. This shows, 1 believe, absolutely, a self-acting 
power, innate in the organ, not replaceable by any thing, in short, a 
peculiar power. 28 
OPIUM 
pendent and solely due to it and. only secondarily to san- 
guineous life, but external influences operate as well im- 
mediately and directly on the blood (its mixture and life) 
as on the nerves. I will only call in mind the effect of 
venesection. It evidently operates directly on the mixture 
of the blood. The same is true in regard to warmth (the 
life) ; it directly creates an increased turgescence of the 
blood, and increases sanguineous life without a previous 
assistance of the nervous system. 
In like manner opium operates simultaneously and di- 
rectly on the nerves and blood, and produces in the latter 
a momentary increase of its vitality, which is clear and 
manifest by the temporary and apparent distention (tur- 
gescence), by the augmented action of the heart, and by the 
increased vitality of the products directly dependent on 
the blood, as suppuration ; and finally by the acceleration 
of the whole vital process, and the aptness to decomposi- 
tion and putrescency which follows. We must attribute 
to the idea of vitality a higher and more extended sense 
than is generally admitted. Do we not perceive in the 
plants, which are likewise living organic beings, clear 
proofs of vitality, and even a certain degree of irritability, 
though they are destitute of nerves I Do we not see some 
substances increase, others lower, even destroy their vital- 
ity, though they have no nerves, as frequently repeated 
experiments sufficiently prove 1 And can we deny that 
the internal animal life has such a vegetative life for its 
foundation I 
In order to say all in one word, opium is one of those 
remedies, whose mode of acting cannot be confined, like 
that of others, to the ideas of stimulus, irritation, excite- 
ment, but which, like the superior agents of Nature, 
warmth, light, electricity, operates directly on vitality it- 
self, and on all points causes modifications and phenomena, 
penetrates and fills this vitality, with this peculiarity, that 
it increases the organic vegetative sphere of life, the fun- 
damental, plastic, vital process, but on the contrary, de- 
presses the sensitive sphere. 
Indication. 
The principal indication for the use of opium may right- 
ly be derived from its primitive effect, as before stated. 
It is as follows. 
Spasm, nervousness, i. e. anomalous or increased sensibili- OPIUM 
29 
ty, but (which is well worthy of notice) in depressed vital 
energy of the vascular system and the whole sanguineous life. 
This applies to the whole system as well as to parts, and 
to the acute as well as to the chronic state of disease. 
The more the erethismus of the nervous system in- 
creases, the more the energy of the heart and vascular 
system, consequently that of the fundamental system is 
prostrated; that is to say, the more that real vital debility 
is present: the more proper and greater is the indication 
for opium ; and this is, indeed, its highest merit, when the 
most imminent danger of life is brought about by this dis- 
proportion, as is the case in malignant small pox, gangrene 
and typhus. 
On that account opium is the more beneficial, the more 
the economy is debilitated by previous losses of humours 
or artificial abstractions of blood and gastric evacuations. 
Therefore, soothing the excited nervous system, norma- 
lization of its anomalous action (where also the disorders 
of secretion are to be classed), resolution of the spasm, 
especially of the painful spasms, and increasing the energy 
of the heart and the whole organic life—must be the prin- 
cipal ideas, which determine its use and guide us in its 
application. 
It is especially and particularly indicated in pain, in a 
necessity to create perspiration generally, when it is requi- 
site to produce a strong impulse from the centre to the 
periphery, in debilitating stools. 
Hence naturally result the counter-indications. The 
first \s plethora and an inflammatory diathesis. As long as 
an abstraction of blood is indicated, opium will be a most 
dreadful poison, since it forcibly augments sanguineous 
congestions, especially to the brain, and increases local 
irritation. This observation applies also to every incipient 
fever, which is known to be always inflammatory in its 
onset (genesis). By such an unseasonable use of opium, 
every fever may be converted into a typhus, as we have 
often enough had occasion to see at the time of the Browno- 
nian period, as I have shown in my treatise on artificially 
made nervous fevers. 
The second contra-indications are, gastric accumulations 
in the stomach, in which opium never does good, but even 
proves injurious by retaining them. 
The third is, a state of blood inclined to dissolution and 
putrescency, which is likewise increased by opium. 30 
OPIUM, 
Application. 
It is beyond my task, to show the use of this great 
remedy in all special cases and diseases. To accomplish 
this end, I would have to go through the whole of patho- 
logy. For there is indeed no disease, in which opium has 
not been used, and with good reason, under certain condi- 
tions. I shall only here state the cases in which it is most 
valuable, in which no other can replace it ; and such where 
its use is doubtful, and needs accurate discrimination, and 
those, in which it is yet too little known and used. 
Local Infiaminations. 
I commence with its virtue in local inflammations. This 
will make many a phlegmonist of now-a-days shake his 
head. But so it is, and I consider the proper use of opium 
in inflammation as a superiority of modern practice and the 
master stroke of a practitioner. The case is this : it hap- 
pens sometimes, and not unfrequently, that the symptoms 
of local inflajnmation, after a proper application of general 
and topical bleeding, do not entirely cease ; or, after they 
have abated, return with increased violence; as in pleuritic 
affection, pain in the side, cough, short respiration, the 
pulse is quick and feverish, but so small, that we dare not 
venture on another venesection. In such a case, antiphlo- 
gistics have, it is true, removed the share which the blood 
and vascular system had in the inflammation ; but the irri- 
tation of the nervous system of the inflamed part, the in- 
creased sensibility, or spasm, as it is called, in the inflamed 
part is left, is even increased by the debility which follows 
too copious venesections ; if more blood be now abstracted, 
the more will pain and the local symptoms increase, and 
must increase. Here opium is the only, a most divine 
remedy ; it can, as by a charm, remove the remainder of 
the inflammation within 24 hours ; for it unites both powers 
which are needed here, in a degree nowhere else to be 
found ; partly to remove the abundance of increased sensi- 
bility, the spasmodic state from the inflamed part, partly to 
arouse the too much debilitated and inactive vessels, and 
to give them that degree of activity which is requisite for 
the absorption of the stagnant or effused blood, and for 
completing the necessary local as well as general crisis, 
both of which must be aggravated by continuing the anti* 
phlogistics. OPIUM 
31 
This applies particularly to pleurisies or painful pneu- 
monies. The judicious use of opium may in such cases 
save much blood, even the life of the patient. Here, how- 
ever, the glance of a master is needed. For, alas ! used 
unseasonably, it may cause the greatest injury ; we have 
seen too much of this during the Brownonian period, when 
the practitioner administered opium immediately from the 
commencement, and without having previously made an 
abstraction of blood. The pain abated, but oppression re- 
mained, the inflammation was not discussed, and the conse- 
quence was a transition into gangrene, and a fatal issue, or 
induration and suppuration ; the patient had his life saved, 
and apparently recovered ; the salutary power of opium 
was praised, but he had the germ of future death lingering 
in him, which sooner or later would be developed, and 
manifested in phthisis. This is the dangerous side of 
opium ;—it is capable of temporarily assuaging pains and 
morbid sensation, and bring the physician as well as the 
patient into the most hazardous illusion ; by which the fa- 
vorable days for using effectual curatives are neglected. 
Opium has its place only when the lancinating pains in 
the chest do not yield to bleeding and antiphlogistics ] or 
when having ceased they return, even with more force, 
and that even a vesicatory proves unavailing, the pulse con- 
tinuing small and tender, and does not admit of any fur- 
ther abstraction of blood, then—usually the sth or 6th day 
—is the seasonable time for the use of opium ; one grain, 
in the form of Dover’s powder, taken in the evening, works 
wonders, takes away, as it were by charm, the remains of 
inflammation within one night, and completes the general 
as well as local crisis. But use the combination with mer- 
cury,* which I have used in numerous such qualified cases 
wdth the best success, for mercury operates simultaneously 
on the lymphatic portion of the inflammation, dissolving 
and absorbing the lymphatic coagulum or extravasation 
which perchance may have remained. 
Frequently, nothing more will be needed for completing 
the cure but this remedy continued for 24 or 48 hours, 
with warm expectorative beverage. The pain disappears, 
perspiration becomes free, expectoration comes on, a criti- 
cal sweat appears, and the feverish pulse is soothed. 
♦ R Calomel gr.vj. 
Opii gr.ij. 
Sacchari albi dr.ii. 
M. f. P. Divide it in six equal parts. 
D. S, One powder every 2or three hours. 32 
OPIUM 
At the commencement of inflammatory rheumatic pleu- 
risies it is often sufficient for the whole cure, to make a 
copious venesection in the arm, and to give immediately 
after a Dover’s powder. 
I know even of a case of carditis, where, after bleeding 
as copiously as could be, the most fearful palpitation with 
the most violent anguish of death persisted ; it was in vain 
to give aqua laurocerasi. Opium removed these remains 
promptly and perfectly. 
In all inflammatory maladies, careful attention must be 
paid to the pulse, which is the chief criterion, by which we 
judge whether this remedy is proper or not. The use of 
opium is not only inadmissible while the pulse is strong 
and hard ; but even during its use we must accurately ob- 
serve its effect ; for if the pulse becomes again hard and 
accelerated, it is a proof, that a remnant of inflammation 
is still in the blood, and which the opium has roused, that 
it is still too early to resort to it. Set it aside and have re- 
course to other narcotics, as hyoscyamus, aqua laurocerasi, 
digitalis. 
The same thing happens in all other local inflammations, 
we must therefore proceed according to the same princi- 
ples. It applies to inflammations of all the abdominal visce- 
ra, of the spleen, the stomach ; especially to that of the 
stomach, which, on account of the great sensibility and 
nervous sympathy of this part, may be so intense that the 
patient may be said to die not by the inflammation, but of the 
nervous spasm which it has created : in such a case opium 
is the only salvative. 
The same holds good in regard to cholera acutissima, 
the true treatment of which ought in general to be the 
same as for the most intense gastritis, which is after due 
abstraction of blood, to give opium with calomel and mu- 
cilaginous beverages as the only curative means. In en- 
teritis, in ileus inflammatorius, when the spasmodic con- 
striction of the intestines, the constipation persists, as an ef- 
fect of the nervous state which follows the inflammation 
which venesection has not been able to cure, there is nothing 
so capable of affording alvine evacuations as calomel and 
opium combined, and warm baths. 
This applies even to purgatives, to which we are often 
obliged to recur. They operate only when combined with 
opium. Lately in an obstinate case of ileus even the strong- 
est drastic, oleum crotonis, was inefficacious, until opium 
was added. The same is true in respect to ischuria in- 
flammatoria. When abstractions of blood have been made OPIUM 
33 
in vain, when the catheter and diuretics refuse their ser- 
vice, opium enables the urine to flow. 
Particular regard is due to inflammation of the throat, 
and especially to croup. It is .one of the most important 
rules of practice in all these diseases, especially in the lat- 
ter, that a period may arrive when, by a proper antiphlo- 
gistic treatment the irritation has been removed, a ner- 
vous inflammation, i. e. a spasmodic state in the organs of 
deglutition or respiration still remains, keeping up the 
difficulty of swallowing in the first case, and in the latter 
that of breathing ; as strong as if inflammation still existed, 
and which may even terminate in death. Here the anti- 
phlogistic method is of no farther use, for the case is now 
one of spasm left by inflammation ; opium or a similar active 
antispasmodic remedy, a vesicatory to the neck and anti- 
spasmodic emollient cataplasms are alone able to bring 
relief. 
I consider myself obliged to insist upon this point, in 
the case of croup, for I have observed, that practitioners 
often have only the idea of the presence of inflammation 
and antiphlogosis ; so that on this account the patient is 
not cured, whereas the use of opium or musk at this period 
takes away the complaint as it were by charm, and proves 
a salvative of life in the strictest sense. In this way we 
can explain the contradiction among physicians, some of 
whom look upon the disease as inflammatory, others as 
spasmodic ; both supported in their views by the effect of 
their remedies. Both are right to a certain extent. For 
although the disease is naturally and originally inflamma- 
tory, and often may be cured by antiphlogistics alone, yet 
the inflammatory stage may rapidly pass into a spasmodic, 
a nervous one, in which change spasmodics alone are of 
avail. 
Cerebral inflammation must be treated according to 
same principles. Opium here finds its place as a specific 
sensorial remedy, in a double point of view, as soon as, af- 
ter due bleeding, application of cold and antiphlogistic 
purgatives, stupefaction and delirium will not yield, and 
the pulse no more admits of abstractions of blood. In this 
case inflammation has passed into a nervous state of the 
brain, or a serous effusion is already present; opium will 
often suffice alone to take away the whole remainder of 
the disease, to which, however, on account of the extrav- 
asation, calomel may be added. I saw the good effects of 
opium against delirium tremens with pleasure ; it brought 
back many physicians to the use of this remedy which 34 
OPIUM, 
had been entirely laid aside, obedient to notions of antipblo- 
gosis : but my surprise was not slight when I saw these 
effects looked upon as a new phenomenon ; for the best 
practitioners since a long time have appreciated opium in 
cerebral affections, or in such as put on a nervous charac- 
ter at the end of inflammation. 
Nervous Fever and Typhus. 
This leads me to speak of the use of opium in nervous 
fever or typhus. 
I am far from believing that these fevers are always due 
to cerebral inflammation ; but thus muchis certain, there 
always exists a morbid affection of the brain and nervous 
system ; and the brain is here the centre of action, as the 
heart is in inflammatory fevers.—A sanguineous congestion 
is very apt to associate with it, as with every local irrita- 
tion ; but there is a vast difference between congestion 
and inflammation, and the share performed by the vascu- 
lar system is always accessory, not essential. This state 
however makes a great, a decisive difference regarding 
the use of opium. However much opium may seem indi- 
cated for the nervous affection of the brain and nervous 
system, it will nevertheless operate very injuriously when 
sanguineous congestion or inflammation of the brain is 
connected with it. Here opium will surely serve to accel- 
erate the transition into stupor and apoplexy. This sub- 
ject needs no farther discussion, since the sad experience 
of opium afforded by the Brownonians. 
But it is therefore the more necessary to look again on the 
other side, which had been lost sight of, and to do justice 
to opium also in this respect. 
There are four cases, in which the use of opium in ner- 
vous fevers is exceedingly beneficial, even indispensable. 
1. When the nervous fever is from its very onset purely 
nervous, that is a fever of debility, created by excessive 
exertion, excesses in venery and masturbation, liquor and 
the like ; or has attacked a nervous individual; when no 
sign of inflammation is perceptible. Here, after a few 
evacuants, we may at once proceed to the use of opium ; 
and often, nothing else is wanted to accomplish the cure. 
—Here also must be mentioned, the lately so much praised 
use of opium in the delirium potatorum. Besides these, 
there is a kind of nervous fever, which chiefly occurs in 
delicate, nervous, and young persons. The pulse is irrita- 
ted, there is great prostration, on local symptoms, but only a opium- 
35 
slight delirium, the pulse exhibits no signs of inflamma- 
tion ; or sanguineous congestion to the head j antiphlogis- 
tics alleviate, but the fevers and delirium continue for 8 
to 14 days. In such cases, both the fever and delirium 
will cease by a small addition of tinctura opii to the an- 
tiphlogistic potion. 
2. When after the accessory abstractions of blood and 
the application of cold and cathartics, though the signs of 
congestion cease, yet the delirium persists, even passes 
into fury. In this case the fever is of a purely nervous 
nature, and opium, to which it is better to add calomel, ac- 
cording to the mixture before mentioned, is all that need 
O ' 
be employed. 
I shall never forget the joy which opium gave me in the 
treatment of one of my most worthy colleagues. He lay 
in the seventh day of a very intense typhus ; with small, 
scarcely perceptible pulse, sopor, delirium, subsultus ten- 
dinum ; abstractions of blood, cold, cathartics and calomel 
had been profusely used. The above mentioned powders 
(of calomel and opium) were administered to him, and after 
6 doses the pulse became slow and raised ; the spasmodic 
symptoms disappeared, the head became free and the cri- 
sis was effected ; amelioration followed from that day, 
and was completed. How many similar cases could I 
not cite. 
3. When typhus is accompanied from the commence- 
ment with diarrhoea, dysentery or cholera, a derivation 
from the brain is effected ; but great danger of exhaustion 
ah exinanitione is brought on. In such a case opium is the 
only remedy that will arrest this profusion, soothe the over- 
irritation of the intestinal canal, and thereby save life. We 
must however be sure that the first ways have been cleans- 
ed. Thus, opium was the only remedy in the years 180G 
and 1807, at the time of the army plague in Prussia, when 
diarrhoea was essentially connected with the typhus. 
4. When the period of complete prostration, when the 
indicatio vitalis appears, and the most vigorous nervines 
and excitants are incapable of raising the small quick pulse. 
Here I know of no greater remedy than an addition of 
laudanum to the other excitants, given in frequently re- 
peated small doses. 
To be able to give due praise to this beneficent gift of 
heaven, one must have witnessed in these cases how opium 
is able to change in one night the small quick pulse into 
a quiet, full and vigorous one ; to appease the delirium, to 
restore consciousness, to stop the debilitating evacuations, 36 
OPIUM 
and to produce a really wonderful transmutation. But we 
must not forget the warning in nervous fevers, to resort to 
opium only, after purgatives and remedies derivative from 
the head have been properly used ; and not to use it too 
early. 
Intermittent Fever. 
The effect of opium is most apparent in fever and ague ; 
most so in pernicious intermittent fever. It is evidently the 
only remedy to save life in these cases, and it is only since 
we learned this virtue from L. Hofmann that we can boast 
of being masters of this disease. Pernicious intermittent 
fever is one in which every paroxysm is combined with a 
symptom that endangers life : as apoplexy, sopor and the 
like ; and in general the second or third paroxysm proves 
fatal. In such cases opium may save life in a double way. 
In the first place, during the attack of such an apoplexy, 
he who believes that venesection will do good is greatly 
mistaken ; for the fit is nothing but spasm, and it is only 
opium that can solve it and remove the apoplectic state. 
The apoplectic state is a paroxysm of intermittent fever, 
and all depends on preventing or suppressing the paroxysm 
as quickly as possible. This cannot be done in a surer 
way than by administering to the patient during the apy- 
rexia one ounce of fresh and finely alcoholized Peruvian 
bark, and adding to the last dose immediately previous to 
the paroxysm, 1 grain of opium. In general we may con- 
sider this as the surest method of suppressing the inter- 
mittent fevers. 
Spasms. 
It is generally known that opium is the surest remedy in 
spasmodic diseases. Even every quack is reminded by 
the word spasm of the word—but only of the word—opium ; 
and this very circumstance is ominous; for what a vast 
difference is there not between those spasms where opium 
is serviceable, and those in which it is injurious, causes 
even irreparable, fatal injury! And how few know what 
this difference is, and observe it! I shall now endeavor to 
designate those cases. 
Three points are carefully to be distinguished before we 
resort to opium. We must find out, whether spasm is 
combined with plethora, congestion to the head, or even 
With an inflammatory diathesis, or engendered by one of 
these ; or whether it is exempt from that complication, OPIUM, 
37 
and is of a purely nervous nature. In the first case, 
especially in youthful persons and in infants during 
dentition, opium will augment the spasm, and likely in- 
crease it unto fatal apoplexy. Here it is absolutely ne- 
cessary to previously remove the congestion by abstractions 
of blood, antiphlogistics and derivatives ; and this often 
suffices to banish the spasms. It is only when the spasms 
persist that opium is allowed and serviceable. It will, how- 
ever, be better to use antispasmodics at first, such as 
hyoscyamus, aqua laurocerasi, zinc ; and if these fail, opium. 
In the second case likewise opium will be not only not use- 
ful, but obnoxious. The stomach and intestinal canal must 
previously be cleansed by emetics and cathartics, which 
alone often suffice for removing the spasms ; should spasms 
continue after their application, give opium. 
The third is the only case in which opium is proper 
and serviceable, and it will be more useful in proportion 
as the spasmodic state is founded oh real debility ; or 
that the debility has been caused by abstractions of blood 
and by purgatives ; in short, as the pulse is smaller, softer 
and emptier. I must, however, here remark, that hys- 
terical persons commonly have a peculiar idiosyncracy 
against opium ; therefore it will always be advisable in the 
case of such individuals, to combine it with a corrector, 
as hyoscyamus, castoreum. Sydenham’s composition is 
applicable to such cases, as also are the various combina- 
tions of opium with aromatic and balsamic substances, in 
the form of theriac and mithridate, as formerly found ne- 
cessary by medical practitioners. An important observa- 
tion, and one which has been confirmed to me in many in- 
stances, is, that opium used in injections is by far more 
generally efficacious in violent spasms of a nervous cha- 
racter, especially those of the abdomen, and in such as are 
located in the spinal marrow and intercostal nerves, than 
when taken by the mouth. 
Traumatic Nervous Affections. 
Traumatic irritation deserves particular notice. When 
after severe wounds and great loss of blood the patient lies 
spasmodic, stiff, half lifeless, or when in such cases the 
pains become exceedingly violent, as generally happens on 
the second or third day, when the pulse and the whole as- 
pect announce spasm, the inflammation has lost its lively 
color, the suppuration becomes more ichorous than puru- 
lent, then opium is the only remedy that can save the pa- 38 
OPIUM 
tient, and rapidly change the scene into a more favorable 
aspect; for it simultaneously appeases the pain, resolves 
the spasm, raises the vital power, and is capable of ameli- 
orating the inflammatory and suppurative process by its 
peculiar influence on the vascular system and the plasticity 
of the blood. 
It is only recently that I was again convinced of this, in 
a case of a Cesarean section. The operation had been 
performed five days before by the master hand of Graefe, 
thirty-six hours after rupture of the membranes, and was 
completed in five minutes. She was a weakly woman, and 
had been bled twice previously and once after the opera- 
tion. She had hitherto taken potio Riveri alternately with 
extract of hyoscyarnus and aqua laurocerasi, which miti- 
gated the pains. On the fifth day the pains became ex- 
tremely violent and resembled labor pains, forcing the pa- 
tient to cry out. The pulse increased to 135 beats, was 
small ; the hands grew cold, viscous sweat set in, and the 
inflammation of the wound was languid. One drop of lau- 
danum and two drops of liquor anodyn. were given to her 
every hour. After a few hours the pains abated, the pulse 
rose, decreased 20 beats ; the edges of the wounds became 
more vividly inflamed, the suppuration less ichorous, and 
from this moment the curative process went on normally 
and terminated favorably. 
That opium is the only salvative remaining in trismus 
and tetanus traumaticus, I need scarcely mention. The 
whole medical world is persuaded of it. Its virtue as a 
resolvent of the nervous spasm is here strikingly illustrat- 
ed. In this disease the sensibility of the nerves is so ob- 
structed that even the narcotic effect of opium is not felt. 
We may give it unto the most enormous dose without de- 
triment. But as soon as it has resolved the spasm, the 
normal perception and reaction of the system against it 
takes place. Given also by injections in large doses, from 
half an ounce to even an ounce of laudanum at a single 
dose is often of far greater efficacy, even frequently the 
only mode of application possible when the mouth is en- 
tirely shut up. 
Insanity. 
The effect of opium in mental diseases depends on many 
circumstances : it is sometimes extremely rapid and deci- 
sively beneficial, in other and more numerous cases it is 
inefficacious, and not rarely is very pernicious. It is there- 39 
fore most necessary to distinguish the cases with the ut- 
most care. The principal rule is this : The more the men- 
tal derangement is of a purely nervous nature, the more it 
is combined with or derived from real weakness, so will 
opium prove more beneficial ; as this is seen in the insan- 
ity owing to excesses in drinking and venery {delirium tre- 
mens, nervosum), in the cases of hysterical persons, that 
which remains after inflammatory affections, and those 
cases which are purely psychical. But where a plethoric 
state, or a disposition to an active phlogistic excitement of 
the brain exists, or where the evil does not originate in the 
brain or nervous system but in the abdomen ; in accumula- 
tions, obstructions in the prsecordial viscera, which is es- 
pecially the case in the melancholic, opium will be injurious. 
It may, however, be useful at the end of the disease after 
the material cause has been removed ; when nothing but a 
nervous state continues. Here, also, it is important to 
remark that opium given by injections produces by far 
more effect in delirium nervosum, than when taken by the 
mouth. 
OPIUM. 
Cough and Complaints of the Chest. 
Cough and pectoral complaints are likewise important 
objects for the use of opium. It cannot be denied, that 
some kinds of cough, even of consumption, may be cured 
by opium. But it is equally certain, that by far a greater 
number are aggravated, even true inflammation of the 
lungs and its transition into true phthisis may be brought 
on thereby. All depends upon the different nature of the 
pectoral complaints, which the art of the physician must 
discriminate. When the cough is of an inflammatory char- 
acter, the effect of an inflammation or sanguineous con- 
gestion of the lungs, or at least complicated with it, opium 
will always injure. The same applies to the catarrhal 
cough as long as it remains complicated with inflammatory 
irritation; likewise to gastric cough, which nothing but an 
emetic can remove, but which will be rendered worse by 
opium. When the cough is purely nervous or spasmodic, 
then opium is superlative. A single dose of Dover’s pow- 
der, taken in the evening, is capable of removing it entire- 
ly. Also in convulsive cough it is one of the principal 
remedies in the second nervous stage. There is even a 
kind of phthisis, which is purely nervous in its origin, and 
in its first stage is the product of the increased sensitive- OPIUM. 
ness of the lungs and the whole nervous system. Here it is 
most important, to diminish the increased nervous irrita- 
bility of the lungs as well as of the whole system ; and in 
such a case, besides the use of asses milk, of jellies of Ice- 
land moss and salep, of tepid baths, of woollen clothing-, the 
intermediate use of opium may be of excellent service for 
diminishing the cough and curing the morbid condition.* 
Dysentery, 
The use of opium in dysentery merits our particular at- 
tention.—Here also the cases must be well distinguished. 
He, who would give opium in a bilious or inflammatory 
dysentery, would kill his patient. On the contrary it is 
the only salvative in a purely rheumatic dysentery. That 
dreadful rheumatic dysentery engendered by damp and 
cold, which killed so many thousands of the Prussian army 
in the campaign of 1792, as long as it was treated with rhu- 
barb, at that time in usage, only became controllable, 
and was annihilated, when opium was universally 
used against it. But I advise an emetic of ipecac to be 
given before resorting to the use of opium ; and to use it 
not in a full dose at once, but in small frequently repeated 
doses mixed with a mucilage or an emulsion ; since a sup- 
pression of dysentery may be caused which is always 
injurious ; while the intention must be only to gradually 
diminish the increased secretion of mucus, the escape of 
blood, and to resolve the spasm, which locks up the foecal 
matter, all which is best attained by the latter method. 
Diabetes. 
A similar state takes place in diabetes.f For the prox- 
imate cause lies in a morbid erethism of the kidneys, which 
may increase to convulsiveness, and is complicated in the 
diabetes* “ mellitus” with a peculiar alienation of produc- 
tivity (chemico-organic secretive process), so that, instead 
of the usual urinary salts, saccharine matter is generated. 
Against this proximate cause opium is surely the chief 
remedy, though the multifarious, even entirely opposite 
* Se emy treatise on prevention and cure of pulmonary consumption, 
in the collection of my minor writings, Yol. IV., I. of the new series. 
fAn analogy implied by the very German name ; Harn-Ruhr 
(Dysentery, Ruhr). 41 
OPIUM. 
remote causes may sometimes require very different pre- 
vious remedies and methods which may be sufficient for a 
cure. But when we cannot discover any of these remote 
causes, such as plethora, congestion, metastases, abdominal 
obstructions, or when the disease continues after their re- 
moval, and we have to do only with diabetes as diabetes, 
with that specific nephritic erethismus and secretive dis- 
order, then opium most completely fulfills the only remain- 
ing indications, which are to remove the local nervous 
erethismus and to create a vigorous peripheric impulsion ; 
to promote diaphoresis as a derivative and anti-stimulant; 
and opium in large doses and continued for a long time, 
together with animal food, are the principal means to at- 
tain this end ; and of this I have been convinced by my 
own experience, conformable to the statements of Warren 
and Rollo, and lately to that the worthy Blane, who in 
the Repository gives us two remarkable instances. Also 
Baron de Stosch in his recent valuable essay on diabetes, 
gives opium the praise it deserves. 
Poisons. Miasmata. 
The most remarkable effects of opium are its anti-mias- 
matic and anti-venomous powers. 
It was a fact universally admitted in antiquity, that 
opium resisted poisons and infection. It is known, that 
the mithridate, a mixture of opium and spices similar to 
theriaca, received its name from Mithridates, king of Pon- 
tus, who took it daily, in order to resist the influence of 
poisons. The emperor Marcus Aurelius used theriaca for 
a like purpose. 
It is undeniable, that a certain degree of insensibility 
and blunting of the nerves may also diminish the operation 
of poisons and miasmata on the organism, since this oper- 
ation depends on the susceptibility derived from the nerves. 
This is also confirmed by the curious fact, that hypochon- 
driacal and hysterical individuals, in whom the susceptibil- 
ity of external impressions is impaired by the peculiar 
direction and concentration of their sensibility to the 
interior—to their physical part,—are less liable to conta- 
gious and epidemical maladies. 
But we must here carefully distinguish the animate from 
the inanimate miasmata. 
As regards the first, opium may be useful in a double 
manner ; in the first place by blunting the nerves against 42 
OPIUM, 
the influence of the poison and impairing the nervous re- 
action ; in the second place by its diaphoretic influence, 
volatilizing and expelling the power of the poison. But 
the ancients did not sufficiently regard the property which 
opium has of increasing the circulation, heating and infla- 
ming ; hence arose the sad abuse made of it in acute fevers ; 
for physicians thought that there was always a miasma at 
the bottom which required to be expelled ; they transmit- 
ted nearly all fevers into malignant putrid ones, complica- 
ted with pimples and petechise. 
In acute miasmata, therefore, its use will be always per- 
nicious, except in the first moment of infection, when a 
dose of Dover’s powder, attended with subsequent sweat- 
ing, has often removed within 24 hours the first vestiges of 
the disease. 
It is of greater importance in chronic miasmata, in 
which its great power of exciting the blood, of volatilizing 
and throwing to the periphery, can be highly beneficial and 
make up what the organism is wanting of in reaction. 
Let us first of all take the example of syphilitic infection. 
It is confirmed by numerous facts that opium is the best 
remedy against some remnants of syphilis, which are 
beyond the reach of mercury. There was even a time (in 
the years 1780-85) when in England they believed they 
were able to cure syphilis by opium alone, without the aid 
of mercury, and a multitude of instances to prove this 
were laid before the public. Nor could it be denied, that 
the symptoms of syphilitic infection were removed by 
opium alone ; also Bennard’s Arcanum anti-syphiliticum, 
composed of opium and alkali possessed the same virtues. 
My experience and that of others have convinced me, that 
the specific virtue which mercury has of annihilating the 
syphilitic virus cannot be replaced by opium, but the dis- 
ease created by this virus in the organism—its reaction, 
the critical elaboration and secretion of the virus—may 
be highly promoted and regulated by this remedy. In the 
second stage of infection, after the inflammatory state had 
been passed away, I saw the effect of mercury evidently 
increased and accelerated by an addition of opium. In in- 
veterate syphilis, particularly when it has degenerated by 
an improper use of mercury, opium combined with corro- 
sive sublimate has done better than when I gave corrosive 
sublimate alone. I consider it as indispensable to the use 
of corrosive sublimate. It is not alone a “ corrigens,” as 
it is commonly supposed, but a mighty “ adjuvans” of 
mercury. Not only the troublesome, often dangerous ac- 43 
OPIUM 
cessory effects of this corrosive metal, as burning in the 
stomach, spasm of the stomach, nausea, colicky pains and 
diarrhoea are prevented, but even the mercurial power and 
effect on the virus, its volatilization and evacuation, are 
exceedingly augmented ; and the reproductiveness of the 
virus, which is the principal object of cure, is thereby anni- 
hilated. We cannot too much prize an impulsion towards 
the skin and whole periphery, which opium imparts and 
mercury is destitute of. It may produce salutary sw'eats 
and critical secretions, especially in weak torpid subjects. 
In order to give an explanation and a correct knowledge 
of the effect and application of opium, I am obliged to say 
one word on the innermost peculiarity of this obscure and 
complicated morbid state, which is comprised under the 
name of inveterate, modified, degenerated or larved syphi- 
lis, also called “morbus secundarius syphiliticus,” or “ se- 
quela” now, alas ! of so frequent occurrence, and embittering 
the life of so many men. It is however not always the 
same condition, but varies very much. 
In the first we have to distinguish the virus, and the 
productiveness of the virus. The virus may be des- 
troyed, but not the reproductiveness of it in the organ- 
ism. This is the most common case in the imperfect and 
insufficiently long continued mercurial cures, when the 
physician or patient is content with the disappearance of 
the symptoms. 
This reproductiveness is peculiar to the nerves, as is all 
that is specific, even in the normal, the secretive and the 
individual states. It is evident, that the greatest nervine, 
opium, must be particularly efficacious, and the most proper 
adjuvant to quicksilver. 
Now, the virus may be in a latent, dormant state ; expe- 
rience has sufficiently shown that its action may be suspend- 
ed though not cease to exist ; and the analogy afforded by 
other agents, as caloric, which may lie concealed in a body 
in its free as well as in its latent condition, even the analogy 
of other miasmata as the hydrophobic, which may exist for 
months even for years in a latent state, is confirmatory of 
the latent possibility of syphilis. What remedy could be 
more apt than opium, to revive and arouse the dormant 
germ, by its volatile, all penetrative, irritative power, and 
to make it an object of critical elaboration ; or when it is 
fixed by a chronic spasmodic incarceration, as sometimes 
really appears, to dissipate the spasm and set the poison at 
liberty. 
Farther, the virus by length of time may have penetrated 44 
OPIUM. 
deeply into the economy, and become assimilated with it. 
What remedy is more capable of penetrating deep into the 
system, and of exciting a new and general reaction in the 
most remote and subtile folds of the system than opium'? 
And finally, the case, now of frequent occurrence, in 
which the virus ceases to be venereal, but by its long con- 
tinuance in the system, and the frequent but imperfect use 
of mercury, which has divested it of its specificity, but has 
not destroyed it, a new pathological product, an entirely 
peculiar dyscrasy, for which we have no name—it might 
perhaps be called deutero-syphilitic—has been generated, 
not extinguishable by mercury alone, or when the patient 
is really infected with a mercurial poisoning by excessive 
or irregular use of mercury. In all these cases opium, by 
its excitative, penetrative power, creating critical motions, 
especially cutaneous crises perfectly answers the indication. 
I avow that it is often difficult, even impossible, to dis- 
tinguish these different states from one another; hence 
they are usually confounded under the general name of 
“ sequela luis venereas” or “ lues degenerata.” But I can 
declare, that I have seen perfect cures effected by corro- 
sive sublimate combined with opium, even after inunction 
and salivation had failed. 
When it is a genuine mercurial disease, mercury of course 
will not cure it, and it may be recognized by this very cir- 
cumstance. Sulphur is the only remedy in this state; 
opium however is the best adjuvant. 
This leads me to the second point of this subject, the 
antidotal power of opium in physical poisoning, especially 
the metallic, such as the mercurial, saturnine, and arseni- 
cal. Opium acts a principal part in the cure of all secon- 
dary poisoning, that is to say, when the virus has passed 
into the second ways, or penetrated the whole system. It 
is a known fact, that in poisoning with lead, after the first 
ways have been properly evacuated, opium is the principal 
remedy. The same is true of chronic mercurial and arse- 
nical poisonings, when it is to be combined with sulphur, 
the great chemical neutralizer of metallic poisons. It is 
undoubtedly in a great measure on this that the remarkable 
antisialagogic virtue of opium depends, and which renders 
it one of the most efficacious remedies against salivation 
during the use of mercury, even to cure salivation ; though 
this effect of opium may partly be attributed to its periphe- 
ric and diaphoretic virtue, which is consequently a deriva- 
tive and sedative effect, of which we are now going to 
speak. OPIUM, 
45 
In the bite of the viper and similar animal poisonings, 
the virtue of opium is chiefly owing to its salutary and 
prompt excitation of perspirative crisis. 
Crisis, VivificatioJi of the Skin. 
I am now going to treat of the extraordinary and pecu- 
liar power which opium has of operating on and vivifying 
the cutaneous system, and altering its pathological secre- 
tions. This is strikingly manifested in two cases. 
The first is that of small pox. When in malignant small 
pox the suppuration ceases about the sth or 6th day after 
the eruption, and degenerates into an ichory secretion, 
when the pustules do not fill, or when they assume a livid 
appearance, approaching gangrene, with great prostration 
and violent typhus fever, then I know of no remedy, which 
so vigorously promotes the suppuration of the pox, brings 
about the perfect crisis, and thereby salvation to the pa- 
tient, as opium. This 1 have often had occasion to see in 
my early practice, especially in the malignant variolous 
epidemy at Weimar, in 1786. Here its double virtue af- 
fords relief; the soothing virtue removes the horribly pain- 
ful cutaneous irritation, to which the patient is subject; 
and its exciting property arouses a vigorous critical impul- 
sion in the half dead surface. 
The second case is gangrene, especially that kind of 
mortification, which appears in old people locally on ex- 
ternal parts, without previous inflammation. The cause of 
this is a deficiency of plastic vitality ; for which opium is, 
according to all experience, the only remedy. 
Opium has a particular power to promote the suppurative 
process, and to make good pus, of which an advantageous 
use may be made in all cases, where this is of importance. 
It is known that opium has not only the power to excite 
perspiration, but also frequently to produce eruptions of 
no determined character, more like miliaria than any other. 
I have seen these eruptions, especially in persons tainted 
with arthritis,—and in many cases it has a critical effect. 
This is of great importance and value, in a multitude of 
chronic diseases, especially in nervous maladies, which are 
more frequently material than is commonly believed ; that 
is, that they are the product of a morbid matter thrown on 
the nerves, and disturbing their normal action. One in- 
stance may serve for all. A middle-aged man labored for 
years under coxalgia, which caused him to go lame. He 
had an attack of dysentery, which obliged him to use 46 
OPIUM, 
opium. The consequence was a very profuse sweat and a 
general cutaneous eruption ; after which his hip was cured, 
and he has since had the full and free use of limbs. Here 
the hip complaint was probably nothing but a metastasis 
of rheumatic matter to the part. This was made mobile 
by the opium, and secreted by the cutaneous crisis in the 
shape of an exanthema. 
Pseudo-organizations. 
Opium exerts a very remarkable and salutary effect on 
some external morbid productions, especially on some 
kinds of polypus of the vagina, the nose, the meatus audi- 
torius, etc., where its long continued use produced a gra- 
dual wasting, and finally a perfect cure. This local sana- 
tive virtue certainly deserves to be profited of more fre- 
quently, and in more species of organic disorders. 
Palliation. 
I will speak, in conclusion, of the palliative virtue and 
effect of opium, which is generally considered insignificant, 
but is often most important and surpasses every other nar- 
cotic. It consists in alleviating sufferings and pains, sooth- 
ing, raising the mind and easing the act of dying. Is it 
not a great deal in this poor terrestrial life, which is so 
often filled with misery, and which it is too frequently dif- 
ficult to leave without more suffering before reposing in 
death I And what remedy is there able of imparting this 
consolation to life in an equal degree with opium I If it 
had no other power, it would on that account alone be con- 
sidered, like its brother sleep, the highest gift of God. 
No other remedy can alleviate pain and anxiety equally 
with opium, even act like a charm, removing it for a time. 
Not a hundred, but a thousand times I have seen my pa- 
tients quite changed in physiognomy, speech, and whole 
external expression in the morning, after taking opium the 
preceding evening. The effect lasts usually for 24 hours. 
I will only mention the disconsolate situation of the in- 
curable consumptive, who gradually fades away under an- 
guish and loss of breath ; of the cancrenous patient, who, 
without any prospect of cure is tortured by most violent 
pains ; and of the protracted agony of one, who labors 
under pectoral dropsy.—Who would be physician without 
opium 1 How many sick has it not saved from despair! 
For one of the great properties of this great drug is, that OPIUM, 
47 
it soothes not only corporeal pains and complaints, hut af- 
fords also to the mind a peculiar energy, elevation and 
tranquillity. 
This soothing virtue manifests itself in the most splendid 
manner, in relieving death in severe cases, to effect the 
“ euthanasia, ” which is a sacred duty and the highest 
triumph of the physician, when it is not in his power to re- 
tain the ties of life. Here, it is not only capable of taking 
away the pangs of death, but it imparts even courage and 
energy for dying ; it promotes in a physical way even that 
disposition of mind, which elevates it to heavenly regions. 
An instance, which I but lately witnessed, may find a place 
here instead of many others which I could relate. A man, 
who had labored for a long time under complaints of the 
chest and vomicas, finally approached death. The most 
dreadful anguish of death, with a constant danger of suffo- 
cation, seized him; he got in real despair, and his state was 
an insupportable torment even for the persons around him. 
He now took grain of opium every hour ; after 3 hours, 
he became quiet, and after he had taken 2 grains, he fell 
asleep ; slept quietly for several hours, awoke quite cheer- 
ful, free from pain and anxiety, and at the same time so 
much strengthened and appeased in his mind, that he bade 
farewell with the greatest composure and satisfaction to 
his relatives ; and after he had given to them his blessings 
and many a good admonition, fell again asleep and ceased 
to live while sleeping. 
Detriments and Dangers. 
One word more on the injuries and dangers, to which 
opium may give rise. They are, alas! very great, and it 
might be difficult to decide, whether opium has not done 
as much injury as good. The same, however, applies to 
venesection, gun-powder, and all the grand powers and 
agents of nature, not excepted fire. The greater the 
power of doing good, the greater also the power of doing 
mischief, and who would dispense with such an instrument 
on account of its being able to do injury by abuse 1 
The first, and certainly the greatest danger lies not in its 
fatal but in its illusory effect. It appeases, it soothes pains, 
inquietude, spasms, and other tormenting sensations, which 
are but the cries of suffering nature calling for relief; it 
influences even the mental disposition and imagination, 
and is capable of inspiring so much courage and hope, that 
the patient as well as the physician may be deceived re- 48 
OPIUM, 
garding the real condition of things ; the concealed danger 
which induced both to indulge in dreams of carelessness 
and hope, at a time when the most active assistance is re- 
quired and may possibly be still attended with success. 
The second danger is that of an apoplectic cerebral af- 
fection. It is greatest in infants in the first year, at a time 
I cannot too earnestly warn against the use of opium, and 
when one single drop of laudanum may be a large, a too 
large dose. Resort to it only in imminent necessity and 
danger, as in an exhausting diarrhoea which endangers life, 
and in this case in the form of injections one drop tritu- 
rated with sugar, divided into four parts (| of a drop for 
one dose) is to be given internally. 
The third, in active inflammations : increasing inflamma- 
tion and accelerating it to pass into suppuration and gan- 
grene. 
The fourth: incarceration of gastric impurities and ab- 
dominal obstructions, increase of sanguineous congestion 
in the portal system. 
The fifth: increase of colliquation and putrescency in 
the blood, of colliquative sweats, generation of pimples, 
petechisß, aphthae. It is to be dreaded in all fevers when 
given unseasonably or in copious doses or a too protracted 
use, most so in gastric fevers. 
Finally, the last: bad habit. One may get into the ha- 
bit of taking opium, so much so that it becomes a daily 
want, even after the malady has ceased. The patient now 
takes it to raise himself to that point of comfort, vivacity 
of physical and mental usefulness, just as the drinker of 
brandy gets accustomed to brandy, and it becomes to him at 
last as indispensable as an article of use. The same result 
follows, a need of larger doses, analogous to drunkenness 
and its effects, which are to increase nervous debility, 
trembling, destruction of the digestive and reproductive 
powers, finally delirium tremens, blunting of the senses and 
mind, heemorrhages, dissolution of the blood, tabes. VOMITS. 
49 
111. 
Tom Its. 
Si quid movendum est, move. 
Hippocrates. 
In speaking of vomits, I speak of one of the curative 
means employed by nature herself. Vomiting is one of 
the most common phenomena, by which nature announces 
the existence of an internal morbid state. It is one of the 
most important operations of nature, an act by which she 
often rids herself of disease at its birth or in its course. 
Vomiting is, however, one of the most tumultuous acts 
of the organism, even one of the most contrary to nature, 
a complete inversion of the order of things, an evacuation 
by that passage whose office is the reverse, a sort of orga- 
nic convulsion, comparable to the volcanic explosions of 
inorganic nature. 
In the secret depths of the organism, at the centre of all 
the sympathies, at the focus of nutrition, in the first and 
most important organ through which foreign matter is in- 
troduced into the economy, in that one where all that is to 
form part of our future existence receives the first imprint 
of our nature, a revolution bursts out, agitating the dia- 
phragm and the respiratory organs with violent convul- 
sions, shaking even the heart—the centre of organic life, 
penetrating through the nervous system to its extremities, 
filling the soul with a new sensation—unique and painful 
but more oppressive than painful, that feeling which is 
comparable to hunger in an inverse order, and to which we 
give the name of disgust or nausea; provoking in irritable 
persons intense nervous symptoms—syncopy, cold sweats, 
spasms, convulsions; finally, not only expelling the con- 
tents of the stomach and of matters seated farther in the 
interior, but also producing an activity in all the secretions 
—that of the liver, the skin, the intestinal canal, the bron- 
chia, and the kidnies. 
It is no wonder that such an act has attracted the atten- 
tion of physicians from the earliest times. From the re- 
motest ages vomiting, whether natural or provoked by art, 
has been regarded as one of the most important means 
of art. VOMITS. 
The ancients were content to base the curative opera- 
tion of vomits on the idea of humorism and mechanism. 
Towards the middle of the last century, physicians (Cullen, 
Tissot, Schaeffer, Stoll) began to see the utility of vomits 
in a dynamic light, and to employ them as a means of ap- 
peasing spasm, of modifying sensibility, of arresting febrile 
irritability, and of correcting the biliary secretion. These 
views have unfortunately been carried too far—to an abuse 
of emetics. This was during the reign of gastricism. 
Brown and his disciples appeared next. The use of vo- 
mits was stamped with the seal of proscription ; or at most, 
was permitted in cases of gastric accumulation of crudi- 
ties. Vomits they considered as pure debilitants. 
Is there not reason to deplore the unhappy blindness of 
a theory, which robs art of one of its most precious instru- 
ments ; of the spirit of sectarianism, and especially the con- 
tempt of experience ! Is it not wonderful that a school 
which declared war against the idea of material humorism, 
was precisely that school which placed vomits in a class of 
means, which belonged to a purely humoral theory; that 
is to say—among evacuants ; so that, while attempting to 
elevate its views it limited the extent of its horizon I 
Under the expression—gastricism, the very idea of an 
emetic was considered as one of disgrace and unworthy of 
a philosophical physician, regardless that Stoll did not con- 
sider the gastric method of treatment as one of mere eva- 
cuation, and that all his reasonable partisans thought more 
of the dynamic power of the remedy than of the evacuation 
it produced, and certainly they gave a wider and a better 
interpretation to nature than the disciples of excitability, 
who, nevertheless, looked upon them with an eye of piti- 
able contempt. 
Truth at last triumphed. Physicians returned to the use 
of vomits and bleeding. But, now they fall into another 
extreme : it is the dynamic virtue of the remedy, and the 
discharge of noxious matter that is seen ; in one word, the 
effects are looked upon as purely nervous, and under this 
impression a new abuse springs up. 
To-day, we stand between two schools; that of Brous- 
sais, which sees inflammation everywhere and thirsts for 
blood ; that of Hahnemann, which is content with tempo- 
rization and rejects all heroic means. Both are hostile to 
vomits, which they consider as incapable of aught but 
trouble and danger. 
The practice of medicine is at present in a strange posi- 
tion. Some employ vomits only empirically and too often VOMITS. 
51 
in excess ; others totally abstain from them, believing them 
to be useless as a remedy and otherwise dangerous.* 
O, holy nature! show us the true path; with your own 
hand unfold to us our art; and preserve us against the er- 
rors of schools! 
The fault was, as it yet is, to look upon the action of 
vomits in a partial light. Even now, some see no other 
effect from them than evacuation ; others nothing but ex- 
citement or irritation; in one case nothing but a material 
discharge, in another nothing but a dynamic power. But 
here, as elsewhere, if we would explain the nature of dis- 
eases or the action of medicines, both theories must be 
united. This is a law which I ever imposed upon myself 
and proclaimed to others. It is only by this union that a 
complete and a satisfactory explanation can be had. 
We shall now declare what is the mode in which vomits 
act, not according to speculative notions, but under the 
dictation of experience ; next point out the indications for 
their use, again without the assistance of theory but obe- 
dient to practice ; that is to say, relating the symptoms 
which call for them; after this, pass in review those cases 
in which they are useful, necessary, sometimes the only 
thing which can save the patient, and also those cases in 
which they are hurtful and are even a mortal poison ; 
finally, we shall give rules whereby their complete effect 
may be attained, and the art of exciting emesis, the import- 
ance of which is great. 
Mode of Action. 
Vomits have two effects, general and local 
1. Local Effects. 
These are generally two, accordingly as evacuation or 
stimulation ensues, a modification of nervous activity. 
As regards evacuation, vomits not only discharge the 
contents of the stomach, but those of contiguous viscera 
—the duodenum. The evacuation reaches even to the 
* Even not long ago an estimable writer said that vomits should 
never be given, except when poisons have been taken into the sto- 
mach. I cannot help reproducing here a passage that I wrote thirty- 
five years ago, and which unfortunately is still applicable, “It is 
painful to see young and unexperienced practitioners expunge with 
a dash of the pen, the best established results of the experience of 
past ages, and thus deprive mankind of a powerful remedy, at least 52 
VOMITS. 
gall-bladder, the biliary ducts, the whole liver, whenever 
the bile is driven into the stomach, both by the irritation 
excited and by the mechanical pressure exerted. Here, 
then, occurs a phenomenon which a purgative can never 
produce, and to which the great utility of vomits in bilious 
fevers is specially due. This evacuative power acts even 
on the lungs and air passages ; and it cannot be denied that 
the shock given to the whole economy—the contraction 
of the diaphragm and of the intercostal muscles which ac- 
companies vomiting—is not capable of mechanically expel- 
ling the mucus, pus, concretions, and lymphatic accumu- 
lations contained in the air passages ; of freeing the lungs 
from them, giving great relief to the patient, whose life 
often depends on clearing the bronchia from engorgement 
of mucus, as in the cases of children—pertussis and 
croup. It is not only gross matters, crudities, bile, muco- 
sities that are thus expelled ; for vomiting appears to carry 
along with it more subtile bodies; for example, contagious 
principles, as is proved by the efficacy of vomits in the 
commencement of infectious diseases. 
The local nervous affection is as important as is the 
evacuation. By this, vomits can totally change the ener- 
vation of the stomach, of the liver and neighboring parts, 
in a word of the whole solar plexus, of which we have the 
proof as much by a cessation of the spasmodic state of 
these organs, as by a modification in their secretion, which 
recovers its normal character. It is this nervous effect 
which, at the same time that mucosities, bile, and sabura 
are expelled, destroys that morbid state, whose presence 
caused the production of the saburas, and consequently it 
drys up the source. 
2. General Effects. 
These are due to sympathies dependent on the gastric 
nerves. The connexion of these nerves with all other parts 
of the body gives great importance to these general effects, 
and is the medium through which vomits affect every sys- 
for a time, by their influence on some persons ; it is therefore the duty 
of one who loves truth not to remain silent, but to proclaim with a 
loud voice and regardless of theory, that which nature has taught us 
during a long series of years. Though we may allow, in science as 
in politics, that revolutions are sometimes necessary to change the 
current of ideas, even when a slow course seems more sure and con- 
formable to reason, we ought no less to save from wreck those truths 
which have become the legitimate property of mankind, that they be 
not lost and require to be again discovered.” VOMITS. 
53 
tern of the economy. They are distinguished into those 
which excite or stimulate, those which translate by anta- 
gonism (antispasmodics), and those which excite secre- 
tion and absorption. 
The excitant effect is made apparent, principally by in- 
creased activity of the lungs and heart, organs which first 
feel the influence. Hence it is, that emetics are employed 
with advantage to recall life to the asphyxiated, the para- 
lytic, the apoplectic, and in cases of hooping cough (cere- 
bral and pulmonary paralysis). 
Revulsive and antispasmodic effects are often called 
forth, and play a great part; for in this case the counter- 
irritation acts on the most essential part next to the brain, 
that is, on the ganglionary system, which sympathizes 
with all parts of the economy. Therefore, this effect may 
reach to the remotest points. It is in this way that vomits 
become a most powerful means for calming all kinds of 
spasms. They have even been successfully employed 
against epilepsy, intermittent fevers, spasms, asthma, and 
convulsive cough. They are particularly useful in moral 
affections of the brain—in mental alienation. Even when 
employed in small doses, they produce great effects by 
their counter-irritating and calming power. 
The secretive effects of vomits are seen most strongly 
marked on the skin. On this account they are salutary in 
rheumatism and in the exanthemata. They also augment 
that by the kidnies, the intestinal canal, and the salivary 
glands. They equally activate absorption by the lymphatic 
system, as is seen when administered in dropsies, even that 
of the joints and scrotum, and the resolution of stagna- 
tions and local tumefactions. 
Indications, and Counter-Indications. 
This is the principal indication : Vomitus vomitu sanatur. 
Hippocrates gives it thus: Si quid movendum est, move. In 
other words,—when nature herself calls for the evacuation 
of something noxious, tends to or has attempted vomiting, 
it becomes an imperious duty to favor the discharge, which 
injunction is never disobeyed with impunity. 
However, we must be sure that this effort of nature is 
due to a gastric accumulation, that is to say, to gastric 
turgescence. Its existence is known by symptoms of gas- 
tric sabura. And it is from this that the rule comes, to 54 
give no vomit unless there be signs of sabura in the sto- 
mach. 
VOMITS. 
For vomiting may depend on a multitude of other causes. 
It may be due to inflammation of the stomach, which ex- 
asperates the irritability of this organ to a term which 
causes its contraction. It may result from exalted sensi- 
bility of the viscus. And, what is more common, may be 
due simply to a sympathetic affection of the stomach, de- 
pendent on some distant irritation; such is the vomiting 
proceeding from the liver, from the spleen, pancreas, kid- 
nies (especially in calculary cases), from the brain (in hy- 
drocephalus, and concussion of the brain). 
In all these cases, a vomit would be useless, injurious, 
sometimes even fatal; for example, in gastritis. 
But independently of this general indication, vomits may 
be prescribed on account of their energetic influence on 
the nerves ; to excite, translate, and activate secretion and 
absorption. This is what happens in mania, spasms, rheu- 
matisms, etc., when not counter-indicated. 
The counter-indications for vomits are : 
1. Inflammation, and that of the stomach before all 
others 5 for in such a case an emetic might act as a real 
poison, and cause immediate death. They are equally 
counter-indicated in all other internal inflammations, for 
they would exasperate the phlegmasia and render it more 
dangerous. But, I wish it to be particularly observed that 
I mean a real inflammation ; for an irritation resembling an 
inflammation, is not subject to the same interdiction. I 
must, here, raise my voice against a modern error, and 
take the part of vomits, of which this error has pronounced 
the exclusion. Every spasm has been called inflammation ; 
while I assert that a host of spasms, even the most painful 
ones, have instantly yielded to a vomit in my practice, 
when they depended on the presence of a gastric matter. 
Nor should erysipelatous inflammations be considered as 
counter-indications; far from it, for vomits are the best 
means to combat them. 
The empirical rule is then : to abstain from vomits when- 
ever there is violent fever, red and dry tongue, intense 
thirst, violent burning pain in the stomach, and impossibi- 
lity to retain in it any thing, for these are the symptoms of 
inflammation of this viscus. 
2. Vomits are also forbid in constipation; for they not 
only act more violently at such a time, excite spasms, and 
may determine dangerous congestions to the brain and 
chest; but they may also render the constipation itself „ VOMITS. 
55 
more obstinate, give rise to a permanent antiperistaltic mo- 
tion, and produce ileus. In such cases, the bowels ought 
first to be emptied before the administration of a vomit. 
It is also customary to consider hernias, pregnancy, and 
the presence of the catamenia as counter-indications to 
vomits. I admit that in these cases it is preferable to ab- 
stain from vomits, and to seek the same relief by purga- 
tives ; but when life is at stake, the imminence of danger 
silences the lesser fears, and removes every hesitation. 
Persons affected with hernia may guard against the proce- 
dentia of the intestines by a proper bandage, and by sup- 
porting the tumor at each rejection. 
Finally, I must add, that emetics ought never to be given 
immediately after a fit of passion (colere), whatever be 
their efficacy to provoke a biliary discharge ; for they 
might cause dangerous accidents. In such case, let ano- 
dynes be first administered, and when the lively nervous 
excitement is appeased, a vomit may be given. 
Tlie Art of Exciting- Vomiting. 
No remedy requires so much art as an emetic to produce 
the desired effect. It is from not knowing this, that eme- 
tics are accused of inefficacy, of too great violence, and 
that they have lost credit with a great many practitioners. 
One of the principal causes of the unfavorable operation 
of vomits, formerly was, and is still, the usage of giving 
them at a single dose. No physician is capable of deciding 
beforehand, what is the extent of the gastric irritability 
and of its turgescence, on which the effect of the remedy 
depends ; so that the same dose, which is enormously great 
under one circumstance, will be inefficacious in another. 
The first rule then is : npver to give a vomit at a single 
dose, but always in divided doses. This method affords 
two advantages: first, the first doses act as digestives, and 
dispose the contents of the stomach to be more easily dis- 
charged ; by the next, we are capable of exactly calculat- 
ing The effect, that it may be neither too strong nor too 
weak. Therefore, let a fourth of the whole dose be given 
every fifteen minutes until vomiting occurs; and then wait 
half an hour, during which period should the patient not 
have vomited three times, we give half as much as the 
whole quantity of the medicine already taken. Nor are 
the liquids which the patient takes without importance. 
Too much drinking may dilute the remedy and weaken its 56 
VOMITS. 
action; or by distending the stomach render the evacua- 
tion difficult and increase the distress. It is better then, 
not to drink after the first doses, and not until nausea has 
commenced ; now a cup full of chamomile tea may be taken, 
and repeated after each discharge from the stomach. When 
vomiting becomes painful, we may employ warm water 
containing a little butter with success. 
Vomiting ought to be repeated at least three times, in 
order to clear the stomach effectually; in a word, it ought 
to be continued until bile comes up ; the only sign that the 
stomach is completely cleansed. 
There are only three cases in which we ought to prefer 
administering the vomit in a single dose : in extreme in- 
sensibility of the stomach (as in certain typhus fevers) ; in 
mental alienation, mucous sabura; in cases of poisoning 
which require prompt action ; and finally in diarrhoea, for 
here, small doses might pass the pylorus and aggravate the 
intestinal irritation. 
After settling what is the dose, the next thing is the se- 
lection of the kind of vomit, each substance being pos- 
sessed of accessory properties which deserve respect. 
Emetic tartar enjoys very energetic powers, and like all 
other vomits it shakes the whole frame, and acts on the 
bowels. It consequently is applicable in slug'gish patients, 
when there are tenacious mucosities in the stomach, and 
a tendency to costiveness. But it ought to be avoided in 
the case of delicate and irritable persons, or when diar- 
rhoea is present. Ipecacuanha is more antispasmodic, less 
acrid, and more constipative ; hence it is fitter for irritable 
persons, inclined to spasms, and affected with diarrhoea. 
Oxymel of squills is excellent in mucosities, it acts gently, 
and is particularly indicated in cases of mucous accumula- 
tions in the primse via?. I have, therefore, found that it is 
best to unite all these three substances, when an antispas- 
modic &nd an incisive effect are needed, in this way cor- 
recting one by the other. I generally make use of the for- 
mula No. 258. 
One more point remains to be examined, which is the 
preparation of the patient, and the precautions which con- 
comitant circumstances call for. This is the most import- 
ant of all, for by its neglect the remedy may not act, or 
acting, produce injurious even dangerous effects. The 
following cases must be distinguished : 
1. Immobility of sabura. It may be too viscous, too 
fixed, too enveloped in adhesive mucosities. Such a state 
of things is known by a foul tongue, the coating of which VOMITS. 
57 
is dry and firm, by the absence of nausea while there is a 
desire to vomit. If we hurry a vomit in such a case we 
fatigue the patient uselessly, produce violent retching with- 
out effect, for the vitiated matter remains behind. Diges- 
tives, then, must first be given, either sal ammoniac (when 
there is a tendency to diarrhoea, or one already exists), or 
tartrate of potassa (when there is a tendency to costive- 
ness). The result will be that the gastric symptoms will 
disappear spontaneously along with mild alvine evacua- 
tions, dispensing with the vomit; or, when symptoms of 
gastric turgescency appear more and more, and the accu- 
mulation becomes more mobile, we give a gentle vomit 
which will now operate with ease and efficacity. 
2. Mobility of Sahara. In this case there is strong tur- 
gescency, made evident by a thick fur, humid and soft 
tongue, tendency to vomit, or vomiting already com- 
menced. In such a case an emetic ought to be given forth- 
with, but with care lest it act excessively. Consequently 
emetic tartar is to be avoided, and ipecacuanha given, of 
which 5 grains with oxymel of squills repeated every 15 
minutes, until a sufficient effect be produced. 
3. Plethora—known by a full strong pulse, acute fever, 
inflammatory disposition. An emetic given in such a case 
without preparation, might occasion much mischief, pro- 
duce violent congestion to the head and chest, bring on 
rupture of vessels and haemorrhages. We ought then first 
to combat the plethora by moderate venesections, which 
will prevent the anticipated accidents. 
4. A spasmodic state. The patient is excessively irri- 
table, and is subject to spasms, syncope, feels much pain 
at the prsecordia and anxiety. In this case, a vomit might 
provoke violent spasms, even undue vomiting, if the ano- 
malous state of the nervous system is not previously or 
simultaneously removed. To do this we commence by 
making antispasmodic frictions, and applying narcotic 
cataplasms on the epigastric region ; and internally admi- 
nister anodynes, and to the emetic we add a few grains of 
hyoscyamus or castoreum. 
5. The patient has diarrhoeq, and at the same time all the 
symptoms of gastric turgescence are present. In this case 
it is to be feared that a vomit, especially emetic tartar, 
may escape downward, and augment the diarrhoea. There- 
fore, we first give sal ammoniac in mucilage, after which 
a full dose of ipecacuanha. 
This occurrence is common enough in typhus gravior, 
complicated with inertness of the stomach; life is in great VOMITS. 
danger ; and this is one of the most difficult problems in 
practice. The patient, overcome with weakness, in the 
eighth or ninth day of fever, is affected with stupor and 
other nervous symptoms; his tongue is highly charged 
(evacuations have most likely been neglected) ; there is 
retching and attempts to vomit, anxiety, a continual aqueous 
diarrhoea, which is often colliquative. Here, a vomit is in- 
dispensable ; it is even the only remedy to save life ; but 
we have to fear that it may pass the pylorus, increase the 
colliquative diarrhoea, which would place the life of the 
patient in great danger. It is important first to arrest the 
diarrhoea, and to rouse the natural excitability of the sto- 
mach. This is attained by giving first a dose of opium 
with ipecacuanha, applying vinous and aromatic fomenta- 
tions on the epigastrium, giving enemas of starch contain- 
ing opium, after which a scruple of ipecacuanha at one 
dose. More than once by this means 1 have attained the 
object I sought, and brought about the commencement of 
convalescence. A vesicatory on the epigastrium will also 
contribute to rouse the languishing excitability of the sto- 
mach. I saw a patient who had taken a vomit, and four 
hours had elapsed without effect, spontaneously vomit after 
a vesicatory had commenced to draw. 
I have here one more remark to add. Many imagine that 
nothing more is needed after the emetic. But it is not so ; 
in order that the effect of the vomit be complete, the pa- 
tient ought to have several stools; for the vomit always 
drives a part of the sabura into the duodenum, or the liver 
pours out a larger quantity of bile, and these substances 
must be evacuated downwards; without this the relief and 
use of a vomit is incomplete. Therefore, if dejections do 
not spontaneously take place, we must never neglect to 
prescribe a gentle laxative after every vomit. 
I shall terminate by making a few remarks on excessive 
vomiting. It is generally due to a neglect of properly pre- 
paring the patient, or to too strong a dose of the emetic. 
The vomiting continues, either because inflammation or 
hasmatemesis has been produced, or because the forces 
have been excessively reduced. Happily, we possess cer- 
tain means for the relief of such a case. The first is to give 
abundantly of mucilaginous drinks, after which the potio 
Riveri (but not effervescing, which almost always adds to 
the existing irritation), under the following form : 
R. Carbonatis potassse 3ij. 
Syrupi citri q. s. 
Aquse melissse |iij. VOMITS. 
59 
Syrupi florum aurantii §i. 
A tablespoonful to be taken every half hour. 
At the same time we apply a vesicatory to the epigas- 
trium, and mint boiled in wine. 
Use of Vomits isi Particular Cases. 
Let us now examine, in conformity with the principles 
which we have just established, those diseases in which 
vomits are particularly appropriate ; also those in which 
they are too often neglected, or not justly appreciated, and 
let us add to this review such remarks as are afforded by 
our own experience. 
Acute Fevers 
In all fevers, the prsecordial ganglia and the great sym- 
pathetic appear to be the point first irritated, as it were the 
focus whence proceeds the febrile irritation. Proof is fur- 
nished by the sensations, which the first appearance of a 
fever produces, the loss of appetite and digestive powers, 
which take place at once, the chills which emanate from 
this region. This particular nervous affection has not yet 
met with an explanation. There is no means so powerful 
as emetics to combat it, and to act on that part of the ner- 
vous system in which it is seated. Hence it is, that vomits 
are looked upon as the most general antifebriles, as well as 
the best means for conquering fever itself, to destroy fe- 
brile irritation in the bud, even when given in such small 
doses as are insufficient to excite vomiting; and expe- 
rience has established the efficacy of James’s powder, 
which, as is well known, is an oxide of antimony. 
But there are cases of fever in which this affection of the 
stomach and intestinal canal attain a high degree, not only 
of morbid irritation, but also of alteration in the secretions 
and humors, and continues to be the source of the disease 
while it lasts. It imparts its own character to the disease, 
hence the latter are called gastric. The fact is that there 
are fevers in which gastric symptoms and a perversion of 
the humors are the salient points; and in which there are 
no other means of relief, or when very intense, of saving 
life, than the use of vomits and purgatives. 
The fundamental indication in such cases is to listen to 
the voice of nature, and to favor the tendency she mani- 
fests. Vomitus vomitu curatur. Called to a patient labor- 60 
VOMITS. 
ing under fever, from the commencement of which nausea 
and vomiting, bad taste, foul tongue with a yellow or brown 
crust exist, the physician who hesitates to prescribe a vomit 
commits a grave fault, and the patient will cruelly expiate 
the error ; for it is important to seize the moment in which 
nature calls for an evacuation, or is disposed for one, and 
it is particularly here that Hippocrates had reason to say : 
Quid movendum est, move. It is even often impossible to 
repair the evils following the omission of a vomit. Given 
in time, it may stifle the disease at its birth ; as its omis- 
sion may leave it of long duration, hard to cure, incurable. 
With this truth young practitioners cannot be too deeply 
imbued. Let it not be thought that a purgative can supply 
the place of a vomit. A purgative can never expel what a 
vomit draws forth. I have seen the remains of indigested 
food remain in the stomach fifteen days in spite of conti- 
nual purgation, and finally come away by force of a vomit. 
It must also be borne in mind, that the shortest road of dis- 
charge is the best one, through which putrid sabura can 
be discharged in cases of fever ; for, by following the whole 
course of the intestinal canal, and consequently making a 
longer sojourn in the body, the offensive matter would in- 
jure the body more by irritation, debility, and absorption. 
But, what is still more important, purgatives never provoke 
that salutary revolution in the whole nervous and secretory 
systems, the stomach and liver; that which overcomes the 
faulty action, and dries up the source of sabura. 
A single vomiting is often insufficient. It needs to be 
repeated two or three times. In a word, it must be admi- 
nistered as often as nature calls for it by a gastric tur- 
gescence. 
The various forms and complications of gastric fevers 
are to be respected. As regards matter, fevers are distin- 
guished into sabural, bilious, mucous, verminous ; and as re- 
gards form, into inflammatory, nervous, and putrid-gastric. 
Local as well as general inflammation may accompany 
every kind of gastric fever, and requires to be taken into 
consideration before any thing else. It must be checked by 
adequate sanguineous evacuations before proceeding to 
the vomit. 
In the nervous or putrid complication, the vital forces 
must be supported by a simultaneous administration of 
nervines, excitants, |onics and antiseptics. 
Simple sabural fever, that which is caused by indigestible 
matter, requires, in general, nothing but vomits and pur- 
gatives. VOMITS. 
61 
Bilious fever requires prudence, on account of the in- 
flammation which often complicates it, especially in the 
hepatic system; and on account of the acrimony which 
the bile sometimes acquires ; on this last account we must 
abstain from violent emetics, especially full doses, and 
order abundance of dilution. 
Mucose fever is always accompanied with great slug- 
gishness of the digestive organs. It is, therefore, the spe- 
cies of fever in which vomits are particularly indicated; 
but requires at the same times energetic incisives and 
solvents. 
Vomits may also be useful in worm fevers, as much to 
dislodge worms that sometimes nestle in the stomach, as 
to get rid of certain sympathetic symptoms. Thus, a vomit 
will instantly relieve the violent pain in the side, apparently 
pleuritic, which is so commonly met with in this fever. 
Generally, all those sympathies which are seated above 
the diaphragm (chest, neck, and head), in cases of gastric 
fever, announce a turgescence upward, and indicate the 
use of vomits. 
Intermittent Fever. 
I feel persuaded by all the essential symptoms of the dis- 
ease, that its seat is in the prascordial ganglia and great 
sympathetic nerve ; and my conviction is fortified by the 
excellent effects of vomits. Often have we seen a vomit 
taken before the access prevent it. Ordinary intermittents, 
especially those of the spring, are frequently curable by 
vomits alone, in the intervals of which sal ammoniac is 
given. In those which are more severe, which even re- 
quire bark, we must commence by a vomit; it will render 
the action of cinchona more supportable, and the fever of 
more easy cure. I have often seen cinchona, or quinine, 
which sits easier, ineffectual, even augment the disease, 
and even disturbing the period of apyrexia: if it be sus- 
pended, and an emetic given, the case suddenly changes, 
bark will operate well, the fever cease, and cure speedily 
follow. 
I have again lately had occasion to be convinced of the 
extraordinary powers of vomits. A man of a certain age 
who was attacked the preceding year with jaundice again 
took ill; the chief symptoms were sleeplessness, loss of 
appetite, anxiety, oppressed respiration, intermittent pulse 
irregular stools, frequent febrile flushes, but without regu- 
lar type, and a yellow tint of the eyes. This state lasted 62 
VOMITS. 
three weeks, followed by alarming emaciation and great 
prostration. Until now the patient had taken solvents, 
sal ammoniac. As the fever grew more marked every night, 
growing more regular, and as intermittent fever then pre- 
vailed epidemically, he took quinine, at first in 6 grain, 
then in 8 grain doses every day. But as the fever increas- 
ed in intensity with each dose of this medicine, it could 
no longer be used. This circumstance suggested the pro- 
priety of a vomit. Two grains of emetic tartar afforded 
four evacuations and several stools, which brought away a 
great quantity of bile and mucosities. From this moment 
every trace of fever disappeared, the anxiety ceased, as 
well as the dyspnosa and cough ; appetite and sleep return- 
ed, and the complexion brightened ; in a word the patient 
became convalescent, and this regularly progressed to a 
cure. It is evident that the mere discharge of the bile was 
sufficient, with the regulation of the hepatic action. 
I must mention a fact regarding emetics of which I have 
often profited. It is not uncommon for intermittent fever 
to be irregular, without decided intermissions, destitute of 
type, and resembling a continued fever. Let a vomit be 
given now, and the disease will become a regular intermit- 
tent fever with well marked apyrexia, which bark will 
quickly cure. 
Contagious Fevers. 
The prsecordial and great sympathetic nerves are no 
doubt the point on which the action of febrile miasms first 
settle ; often the road through which they enter the eco- 
nomy. Vomiting and other gastric symptoms are ordina- 
rily the first symptoms. This is seen in small pox, in 
measles, and particularly in contagious typhus. We have 
no other indications for the use of vomits in this stage. By 
this means we may expect to expel a part of the contagious 
principle, to destroy its action, and prevent its regenera- 
tion. I have, indeed, often seen these remedies when ad- 
ministered in the commencement offerer diminish its vio- 
lence. They are capable of preventing the influence of 
contagious typhus. 
On the contrary, later in the disease, when the contagious 
principle has penetrated into the system and commenced 
to act, when nature already makes critical efforts to throw 
it off by the skin, in a word, it is an exanthematic fever, I 
advise great circumspection. If the eruptive period has 
commenced, if the exanthema appears, the revolution and VOMITS. 
63 
counter-irritation producible by a vomit is not only in- 
jurious but dangerous to the cutaneous crisis, as I have 
sometimes seen. It is, therefore, only in a pressing neces- 
sity, and when the gastric symptoms render its use indis- 
pensable, that a vomit may be employed. 
But, in the diseases which follow these contagious erup- 
tive fevers, an epoch arrives when vomits can be employed 
with advantage. This is a point to which lam bound to 
call attention, because it is precisely that one which is the 
least thought of. Measles in particular, and the cough 
which it so commonly leaves behind,—a cough which is 
only the sign of a remnant of a psoric irritation in the 
lungs, and which, as we know, is so apt to degenerate into 
tubercles, are particularly benefited by an emetic. Of this 
I had a striking example in the following case. A little 
girl, twelve years of age, went well through the measles; 
had reached the fourteenth day of the disease, her state was 
satisfactory ; since several days the fever had ceased, and 
even appetite commenced to return: but of a sudden this 
last ceased, the cough became violent, respiration embar- 
rassed, debility increased, sleep was disturbed, she had 
headache and constipation, and purgatives had only little 
effect: I gave a vomit; it operated six times, and brought 
away much mucosity and bile; from this moment a spon- 
taneous diarrhoea came on, a true crisis, affording five or 
six stools a day ; the cough disappeared, appetite returned, 
and health was soon re-established. 
Angina, Croup. 
In every inflammation of the throat, according to my ex- 
perience, emetics are one of the most active and generally 
useful means. The irritation which they excite on the 
nerves of the mucous membrane of the pharynx appears to 
have a salutary'' influence, often a decisive one, over the 
inflammatory stasis, and are productive of prompt relief. 
Difficulty of swallowing is no objection to their use, for the 
patient vomits easier than he swallows. The only excep- 
tion is pure inflammatory angina of a high degree, that 
state which calls for sanguineous evacuations. 
Vomits are particularly useful in the following cases, in 
which we cannot too strongly recommend them. 
1, In true gastric angina; that is to say, when symp- 
toms of a gastric state accompany the inflammation from 
its commencement; they are: loaded tongue, bad taste, 
nausea, attempts to vomit, In this case angina is onlya 64 
VOMITS. 
sympathy of gastrosis, with turgescency upward, for the 
cure of which a vomit will suffice, often banishing at once 
all symptoms of inflammation in the throat. 
2. In croup. Vomits have a powerful action over this 
disease, and particularly at two epochs. 
They are proper at the commencement. If there be a 
means to arrest the development of croup, to arrest it when 
developed, it is surely an emetic. Of this I have had proof 
in numerous instances ; among which I shall cite only one. 
A child three years of age, vigorous, plethoric, and in 
health, was chilled by a north-east wind ; felt feverish for 
three days, and had cough \ every night about 'S o’clock a 
spasmodic cough supervened with such violent symptoms 
of suffocation, and barking cough, that it was taken for the 
asthma of Millar, and for which musk was prescribed with 
calomel in the intervals. I saw this patient for the first 
time on the fourth day: the pulse was full and frequent; a 
constant cough; respiration alternately oppressed ; the 
head was free from trouble, in other respects the child was 
gay and had some appetite, but the tongue was charged. 
Here I saw the commencement of croup, which, as is some- 
times seen, was accompanied with periodical spasms in the 
respiratory organs; forthwith I prescribed the following 
emetic : 1 grain of emetic tartar, 20 of ipecacuanha, oxy- 
mel of squills, and raspberry syrup each half an ounce, and 
one ounce of water: to be taken by teaspoonfuls every 
quarter hour until vomiting occur. When the patient had 
vomited three times a great quantity of mucosity, the cough 
ceased, and the child slept for fourteen hours calmly in an 
abundant perspiration. The next morning, both cough and 
dyspnoea having completely disappeared, the crisis was 
finished, and the birth of croup aborted. 
Vomits are also useful at the last of the disease, when 
the false membranes detach but cannot escape, whence is 
heard a rattling respiration and augmentation of suffoca- 
tion. A vomit aids the expulsion of the gluey mass of 
membrane and clears the trachea. Here is an example : 
A child two years of age, of good health, with the ex- 
ception of frequent coryzas, was attacked with violent 
croup. Called in on the evening of the second day, I found 
it laboring under attacks of imminent suffocation, with 
barking cough and wheezing respiration ; a continual ten- 
dency to raise the head and stretch forth the neck, pulse 
120. Eight leeches were applied to the neck, calomel every 
hour, and injections of vinegar. After the operation of the 
leeches, and the taking of eight grains of calomel, which VOMITS. 
65 
procured several stools, it was evidently relieved. At 12 
o’clock the pulse was reduced to 90: but the voice was 
rough and the respiration still rattling. I applied two more 
leeches, and prescribed every quarter hour the emetic al- 
ready mentioned. It was followed by immediate amelio- 
ration. The treatment was terminated by a potion, con- 
taining 1 scruple of carbonate of potassa, 1 ounce of water, 
f ounce of syrup of manna, and 20 drops of antimonial 
wine, of which the patient took a teaspoonful every two 
hours. 
3. In parotitis, a disease which is generally epidemical. 
At first it is seated in the parotid and sublingual glands ; but 
as it increases it also attacks the internal glands of the 
mucous membrane of the throat; hence it may cause im- 
minent suffocation, and even cause complete trismus. In 
such a case, and at the last extremity, the principal remedy 
is a vomit, it is even the only one that can save life. When 
the disease is light and without danger, and belongs more 
particularly to the class of inflammations, which attack the 
mucous membranes, it requires nothing more than diapho- 
retic and antiphlogistic remedies. But this is no more the 
case -when the disease has acquired intensity ; even emis- 
sions of blood, calomel and vesicatories fail, and nothing 
but emetics can place the patient out of danger. This 
may be judged of by the following fact; 
A woman, 26 years of age, was attacked with parotitis 
of a most severe character, affecting not only the parotid 
glands, but also the subrnaxillary and sublingual glands ; 
the tonsils were so swollen that the patient could swallow 
only with great difficulty, and was scarcely able to breathe; 
the jaws were so fixed as almost to close the teeth ; real 
trismus existed ; the case had reached the ninth day. 
Venesections, leeches, vesicatories, mercurials, cataplasms, 
and frictions had all failed. A vomit wras the only remain- 
ing resource, but there hesitation on account of the 
closure of the pharynx and jaws through which the con- 
tents of the stomach might be arrested, and cause suffoca- 
tion. However, no alternative was left, and the effect was 
surprising. Those organs which refused passage to the 
entry of substances, readily permitted their exit; imme- 
diately after the trismus ceased, the glandular swelling di- 
minished, deglutition became possible, and in a few days re- 
covery was complete. 
I cannot too strongly recommend vomits in this disease. 
At a time when it prevailed epidemically, and did not spare 
even children at the breast, a vomit given at the onset, 66 
VOMITS. 
promptly arrested the disease and brought about a rapid 
cure. 
4. In angina gangrsenosa. In this dangerous disease, 
but fortunately a rare one, being met with in this country 
only as an accompaniment to scarlatina maligna, in which 
a gangrenous disposition is seen from the commencement 
of the inflammatory symptoms, vomits are the means most 
to be relied upon, especially at the outset. 
5. In the stomatitis. I regard vomits as a great specific 
against this affection, and as one which acts with the great- 
est promptitude. In cases where every means had been 
exhausted, I have seen a single vomit cure this painful and 
disgusting malady. 
In a word, I repeat it—a vomit is the only hope in all in- 
flammations of the throat, in which antiphlogistics and 
antispasmodics have failed, and in which there is a threat- 
ening suffocation. 
Pneumonia. 
There is a species of pneumonia in which venesections, 
nitre, opium, and vesicatories, indeed, in which every 
means fail excepting a vomit. This is one of the great 
triumphs of this remedy. I remember the time when the 
only treatment in pneumonias was bleeding; again when 
we had recourse only to opium and stimulants ; lastly when 
nothing but leeches and calomel were in vogue ; but at all 
these periods I have repeatedly seen this great truth made 
evident—that there are cases wherein every treatment fails 
except that by vomits. What is even the method of 
Peschier, of late celebrity, if it is not the same as that 
which Schroeder, Tissot, Stoll, and Richter recommended 
forty years ago, and which consisted in the employment of 
tartar emetic in pneumonia, to produce at first vomiting, 
after which gentle purgation 1 
These pneumonias are called gastric, or false. They 
depend immediately on the gastric system, and are pure 
consensual irritations, or pulmonary inflammations provok- 
ed by such an irritation, and are consequently analogous to 
erysipelas of the surface, which have the same origin, and 
which vomits cure. 
They are distinguished from purely inflammatory pneu- 
monias by the absence of hardness in the pulse, that it is 
not so strong, nor so difficult to compress, and is some- 
times even soft and small; by gastric symptoms from the 
beginning, such as furred tongue, yellow or brown, bad VOMITS. 
67 
taste, particularly a bitter one, repugnance for food, nausea, 
and even vomiting, weight in the region of the stomach, 
cephalalgia in the forehead, sometimes even delirium, yellow 
tint about the mouth, in the wrinkles of the face and the 
white of the eyes ; finally, by extraordinary prostration 
and curving up of the body at the very onset. The stitch 
in the side which is a chief symptom in these maladies is 
often so painful as to cause a short breathing, as happens 
in the most inflammatory and intense pleurisies. 
When, on approaching the patient, we find him laboring 
under such a violent state of the chest, with all the signs 
of gastric turgescence, there is no other course than to ad- 
minister an emetic forthwith ; for the violence of the affec- 
tion in the thorax is due to the extreme mobility of the 
gastric sabura, A bilious or sabural vomiting will soon 
follow, and we shall be surprised to find the pain in the 
side, the oppression and anxiety disappear suddenly, as if 
by enchantment. 
But sometimes this gastric character is associated with 
true inflammation ; that is to say, there is a gastric pneu- 
monia. The pulse is full and hard; great thirst, high co- 
lored urine, considerable heat. In such a case, the inflam- 
matory character is to be first subdued by bleeding and an 
antiphlogistic regimen; after which we have recourse to 
the antigastric method. 
Thus, when we meet with a hard and full pulse, with 
signs of gastric turgescence ; that the patient is young, 
and of a plethoric constitution, we ought to bleed from the 
arm, after this give a vomit. Sometimes the real character 
of the disease does not present the usual appearance ; in 
this case the vomit must be given first. 
As an example I shall now cite a case taken from my 
practice. A woman, 35 years of age, attacked with vio- 
lent fever and painful stitches in the side. Besides she 
had a short dry cough, short and oppressed respiration, 
violent headache, gastric symptoms, hard and full pulse. I 
ordered a large bleeding from the right arm ; and as she 
was costive, a mixture of Glauber’s salt, antimonial wine 
and electuary of senna. The pain lessened for a few hours 
after the bleeding, but again reappeared with increased 
violence; the next day the pulse was fuller and more fre- 
quent, but had lost its hardness; the headache was violent, 
the dry cough had augmented; the seat of the pain, about 
the edge of the ribs and the hepatic region was tumid and 
painful to touch, proving that the liver participated in the 
inflammation; besides there was nausea, and the tongue 68 
VOMITS. 
was covered with a moist brown coat. On account of these 
manifest signs of inflammation as well as of the gastric af- 
fection, I again ordered the patient to lose blood to the ex- 
tent of 16 ounces ; which, on coagulating presented no buff. 
The pains did not diminish much and the nausea increased. 
I now gave emetic tartar and ipecacuanha in divided doses. 
The patient vomited three times a great deal of bile and 
mucosities; followed by an immediate diminution of the 
pain and fever; the pulse fell from 110 to 90 pulsations. 
From this moment convalescence progressed each day 
under the use of purgatives, which were persisted in for 
some time. 
However, the signs of a gastric character are not always 
so strongly marked ; and there are latent pneumonies 
which require great attention on the part of the practi- 
tioner; for, though the state of the patient is the same, the 
symptoms are not so clearly marked. The diagnosis is 
doubtful, and in the beginning we are guided by negative 
indications. There is violent pain in the side and great 
oppression, but the pulse is not inflammatory, and the other 
signs of synochus are absent. Bearing now in mind the 
antecedents of the case, such as grief, contradictions, dis- 
turbed digestion, and taking into consideration the feeling 
of weight and tension in the prsccordial region, the aspect 
of the tongue, or even the yellow tint of the face, there is 
no longer cause for hesitation. I particularly name anxiety 
as a symptom of a hidden gastric state. In this case it may 
attain great height, and we must be careful not to confound 
it with inflammation. It is a pressing indication for a 
vomit, which is the only remedy capable of removing it. 
Finally, in very doubtful cases, we may try a small bleed- 
ing; and if the case is really an inflammatory one, a few 
ounces of blood lost will give some relief; if the case is 
purely a gastric one, the pains will increase rather than 
diminish, and now we will close the vein at once, for we 
have to deal with a gastric not with an inflammatory dis- 
ease. It sometimes happens during the bleeding, or imme- 
diately after, that a gastric turgescence becomes apparent, 
and a spontaneous vomiting occurs. If a vomit be now 
given it will produce the best effects. We must here no- 
tice the circumstances under which the true nature of the 
case has been mistaken from the commencement, where 
we have already had recourse to bleeding several times, 
always without benefit, without diminishing the pain in the 
side ; finally, where the patient still has fever, pains in the 
chest, difficult respiration, a gastric state, the pulse inter- VOMITS. 
69 
diets further bleeding; here a vomit may, even late in the 
disease, procure complete relief, and is the only means to 
banish danger. 
These cases in which emetics have been neglected, and 
are required at a later period in pneumonies, are very re- 
markable, and prove how powerful even indispensable they 
are. They have often occurred in my practice, and are 
again becoming frequent now that an exaggerated view of 
inflammation exists, and that bleeding method leads to a 
negligence of the gastric character.—Out of a vast number 
of cases, I shall relate only one for instruction. 
A woman of 30 years was seized with all symptoms of 
pneumonia. Her physician used venesection, leeches, pur- 
gatives, and the whole internal antiphlogistic method; the 
most violent symptoms were diminished, it is true, but the 
chief affection continued. I found her in the Bth day of 
disease, in a violent fever, having a constant irritative 
cough, difficult breathing, and particularly a constant tor- 
menting anxiety, alternating with fits of fainting, the utmost 
weakness, dizziness, delirium, quick pulse, small and soft, 
urine jurnentous, tongue covered with a yellow-brown coat- 
ing, and suffering at the same time from an extremely pros- 
trating watery diarrhoea. Resolution and decisive action 
were here necessary, no time was to be lost, life was at 
stake. That anxiety, cough, and difficulties of respiration 
did not arise from genuine pneumony, was made evident 
by the pulse, the jurnentous urine, and especially by the 
possibility of inspiration without coughing. The most ur- 
gent symptoms to be attended were the prostration of the 
vital powers (menstruation had moreover set in), and the 
profuse exhausting diarrhoea. Therefore small doses of 
Dover’s powder and mucilaginous injections were ordered. 
A repose of 6 hours ensued, after which appeared anxiet)'-, 
stitches in the side, nausea, pulse extremely small, quick 
and intermittent, fits of fainting, vertigo, unconscious dis- 
charge from the intestines. The unavailing use of seda- 
tives, the continuing even increasing difficulties of the 
chest, above all the anxiety and nausea, showed that a ma- 
terial irritative was still present in the prsecordia, and 
ought to be considered as the principal cause of the per- 
sistence of the pectoral and nervous affections and of the 
fever; and that an emetic was here indicated, and this 
alone could procure relief and salvation in this state really 
endangering life. It was, however, very hazardous and 
uncertain in this extreme prostration and the continuance 
of the diarrhoea. Should the emetic act on the bowels it 70 
VOMITS. 
might carry the debility to a fatal extent. A small dose of 
Dover’s powder was therefore given a few hours before, 
in order to guard against this downward tendency, and 
then 6 grains of ipecacuanha administered every 10 mi- 
nutes; after 4 doses three copious discharges of bilious 
phlegm ensued. After this the patient enjoyed a quiet 
sleep of a few hours, and when she awoke her respiration 
was natural, and the anxiety and stitches had disappeared. 
The following day the fever was but trifling, the chest and 
head entirely free, and there remained only weakness and 
a disposition to diarrhoea. In short, she was cured, her 
dangerous state was removed within a few hours by a 
single emetic, and convalescency followed in a short time 
and without any further difficulty. 
I shall yet mention two cases of this kind, if only to di- 
rect the attention of young practitioners to this subject 
and to the value of emetics; for, in either case a single 
emetic not only saved the life of the patient—the principal 
object of course—but also laid the foundation of the physi- 
cian’s future reputation and his subsequent prosperity. 
One of my academical friends left the university for the 
great capital of a foreign country, in order to make his for- 
tune. Not long after his arrival, he was sent for by one of 
the principal men of the city, who had already labored for 
10 days under an acute pectoral fever. He was attended 
by the first physicians of the place, and was despaired of 
by them. Another trial yet remained to be made, and that 
by the recently arrived foreign physician. Venesections, 
vesicatories, antiphlogistics, pectoral remedies, ajl had been 
tried in vain. The patient lay in a soporous state, rattling 
in the throat with great oppression of the chest, violent 
fever, in short he seemed to be in agony. The young phy- 
sician came from Goettingen, out of Richter’s school, and 
had there been made acquainted with gastric pneumonias. 
Finding amid all the bad symptoms that there were also 
frequent eructations and nausea, that the tongue was cover- 
ed with a thick loose brown coat, the prajcordia distended, 
and the patient carrying his hands often.to this part: all 
signs of the existence of a gastric accumulation. Deter- 
mined by this, he prescribed an emetic. The patient threw 
up an enormous quantity of bilious impurities and was 
saved. The natural consequence was to give him the repu- 
tation of a great adept; his fame resounded through the 
city, and he became within a short time the most popular 
and most noted practitioner. 
The second case was that of a distinguished universally VOMITS. 
71 
venerated princess. She lay in the 11th day of a pulmo- 
nary inflammation, accompanied with a miliary eruption. 
Her physicians had used all the remedies that were proper 
to the case, without success. Danger had reached the 
highest pitch, and her recovery was doubted. A foreign 
physician, who had been sent for, ventured, in spite of the 
apparently fatal weakness, to order an emetic. She vomit- 
ed, and this was the signal of her recovery. This single 
emetic made him her physician in ordinary. 
But I go farther, maintaining, as I have been convinced 
by many facts, that in all pneumonies, with or without 
pains in the chest, when the degree of inflammation is not 
so violent as to require a venesection, there is no more se- 
cure, prompt, and more effectual remedy than tartar emetic 
—(for here the virtue of antimony seems to be essential), 
\ a grain given every hour. The first doses produce vo- 
miting, the following gentle purging, sweat and expectora- 
tion—all do what is necessary—and perform in this way a 
cure. 
This applies not alone to the gastric, but also to that 
which is not less frequent—catarrhal and rheumatic pneu- 
mony; in which it is not the matter discharged, but the 
antistiraulus at the prsecordia, which here has specific ten- 
dency to the pectoral organs and creates the good effect. 
How much is gained for the integrity and safety of the 
organic fabric if the use of calomel, now too much in vogue, 
be superseded. 
Erysipelas 'of the Face. 
In all kinds of erysipelas emetics and cathartics are the 
principal means of cure ; but especially in erysipelas faciei, 
in which they really deserve the name of a specific. It is 
known to what an alarming height, even endangering life, 
this disease may attain in the third stage. Violent fever, 
anxiety, delirium, even furor torment the patient; every 
thing announces a translation to the brain. Even in this 
case an emetic is the only salvative. I have several times 
seen, when abstractions of blood, as usual, had been made 
to no purpose, the promptest and most decisive relief pro- 
cured by an emetic. Do not hesitate to give it, and be not 
deterred even by apparent congestion j and if one is not 
sufficient, give boldly a second. 
Thrush is particularly one of those diseases, in which 
emetics are indicated. It is an anomalous production of 
Aphthai. 72 
VOMITS. 
the mucous membrane, always connected with an abnormal 
secretion of the stomach, and therefore likely to be propa- 
gated to this organ. In infants gentle gastric remedies are 
generally sufficient, but, as soon as the malady becomes 
obstinate, the best and promptest remedy is an emetic. 
The same is true of the aphthous affections of adults. 
Cough. 
There is a species of cough, which we rightly call gastric 
cough, distinguished by signs of a gastric disorder and ac- 
cumulation, a furred tongue, loss of appetite, nausea, etc. 
In such cases gastric remedies, dissolvents, purgatives, but 
chiefly emetics are most curative of the cough. Such a 
cough may have been treated for months with the usual 
catarrhal remedies without success; a single emetic re- 
moves it. 
Tussis Convulsiva. 
Hooping cough is not an inflammatory nor therefore a 
gastric disease ; but as I have already proved 40 years ago,* 
that a contagious convulsive nervous disease of the pra> 
cordial and pulmonary nerves existed, which, it is true, 
may in the beginning be combined with a febrile inflamma- 
tory affection, but then it always passes into its true cha- 
racter, the spasmodic nervous, and which is always con- 
nected with a peculiar influence over secretion of these 
organs, which it increases and thickens. Here an emetic 
is still the principal remedy on two accounts; in the first 
place, as the most active contrastimulus, capable of sooth- 
ing a spasmodic state ; in the second place, as a most be- 
neficial evacuation of the accumulated viscous phlegm and 
alterative of the mucous secretion. This is fully confirm- 
ed by experience. An emetic always procures alleviation 
and amelioration of the attacks for a few days. And I 
have always found it exceedingly easy in its operation and 
accelerative of the cure of the disease. Besides, along with 
the use of proper anti-spasmodics and anti-irritatives of the 
skin, an emetic ought to be administered intermediately. 
Pulmonary Consumption. 
Emetics are in general not curatives of pulmonary con- 
sumption, though the Englishman Reid extols their use. 
* Hnfeland’s remarks on small pox and diseases of children, Jena 
1797. VOMITS, 
73 
In the inflammatory kind and stage of consumption, where 
there is a disposition to haemoptysis, they can become very 
injurious. But they may be of use in two cases. The first 
is the purulent; when, whilst inflammatory signs are ab- 
sent, expectoration is difficult, and fever and anxiety is 
thereby increased; here an emetic occasionally adminis- 
tered, can procure great relief. The second is the pitui- 
tous, which originates in the abdomen, in disorders and 
accumulations of the digestive system; as well as the gas- 
tric cough, mentioned before, which may even change into 
a pituitous consumption. In such cases I have seen the 
most striking curative effects produced by emetics fre- 
quently repeated; and I refer to my treatise* on this sub- 
ject. 
Dyspnoea, Choking Rheum. 
Asthma is known to belong to the most difficult and 
often most dangerous diseases. Also here emetics main- 
tain a high rank among palliatives. In the moist or pitui- 
tous (asthma humidum) the same, occasionally given, bring 
if not a perfect cure, at least a great relief. In the dry 
spasmodic (asthma spasmodicum, asthma convulsivum) it is 
the greatest of all known alleviating means : even in that 
kind which sets in periodically, as a real paroxysm, and 
puts the patient in danger of life, it is often the only means 
of salvation. Here experience has taught, that an emetic 
has effected a perfect resolution of the spasm and restora- 
tion, after musk and opium had been used in vain. 
The same applies to choking rheum (catarrhus sujfocati. 
vus) or paralysis of the lungs, that fit which is so like apo- 
plexy, with only this difference, that in the first case the 
cerebral nerves, in the latter the pulmonary nerves are in 
a paralytic state. When the patient is in the most immi- 
nent danger of suffocation, has a rattling breath, the brain 
and consciousness being generally free. Also here, after 
a venesection has been previously made, the emetic is the 
greatest, even the only salvative left. 
Dysentery and Cholera. 
In dysentery an emetic of ipecacuanha given in the onset 
is a chief means of cure. In numerous cases I did not want 
any thing else to cure this disease but an emetic given at 
* Prevention and cure of consumption, founded on experience. 
Hufeland’s miscellaneous writings, vol. 4. 74 
VOMITS, 
the commencement, and then emulsions of gum arabic with 
small doses of opium. I have always observed, that the 
emetic first administered had a most favorable influence on 
the whole cure, and shortened it; for when it had been ne- 
glected, the best remedies had by far a less sure and prompt 
effect. Ipecacuanha is always preferable to tartar emetic 
in this disease 5 for, the first, by its very nature operates 
more permanently, even in small doses. 
In cholera morbus, cases may occur, where an emetic is 
indispensable. The immoderate discharges are, as it is 
known, generally acted on by soothing remedies, but then 
sometimes a state of nausea, dyspepsy, and bilious-gastric 
indication remains, a proof, that there is left a remnant of 
bilious accumulation which acts anew, and here I have 
several times observed, that nothing removed this state so 
quickly and perfectly as a moderate emetic. 
Rheumatisms. 
I have myself had but little experience regarding the ef- 
fect of emetics in rheumatisms, because other remedies 
proved sufficient in my hands, so that I have spared this 
exertion and debilitation to the stomach and digestive func- 
tion. But I have been persuaded by the experience of 
others, that an emetic is indeed a very efficacious remedy 
in rheumatism, though I still hold to the opinion, that it is 
preferable to try first other remedies, and only when they 
prove abortive, to have recourse to this method of treat- 
ment, which, at any rate, affects the important digestive 
system. 
hisanity. 
Among all physical means against insanity I consider, 
besides the cold affusions, emetics the most efficacious. 
An emetic is a most powerful antistimulant against the 
morbid action of the brain ; and the more decided this is, 
that extreme inactivity and insensibility of the prsecordial 
and abdominal nerves (connected with all these psychical 
cerebral affections, especially the melancholic), the more 
certain it is that this disturbed equilibrium is one of the 
most important causes in these diseases; therefore, a for- 
cible excitation and arousing of these organs is here more 
proper and of greater efficacy, to restore the balance and 
to regulate the cerebral action. To this one circumstance 
may be added, one to which too little attention seems to VOMITS. 
be paid, the importance of the stomachical sense, the pecu- 
liar property of the stomach, exhibited in hunger, still more 
in appetite, most in nausea. This feeling of hunger is one 
of the strongest and most forcible, pervading the whole 
organism, affecting even the mind unto insanity and des- 
pair, as the effect of hunger sufficiently proves, and so it 
must be, since the preservation of mankind, all life and the 
working of the world, depends on this sense and the sexual 
instinct. For that very reason it is one of the most effica- 
cious means, to bring man, when he is lost in insanity, to 
consciousness, and to set him again in a normal relation 
with himself and with the world. It is undoubtedly in this 
that resides the great benefit of fasting cures. Nausea and 
inclination to vomit operates on the same sense, only in a 
reverse way; and how many unfortunate persons have 
there not been restored in this way since Mutzel’s time I 
My experience has fully confirmed it. Emetics proved 
exceedingly efficacious not only in melancholics, but even 
in cases of most violent rage, and in the delirium potato- 
rum. I have still particularly to notice melancholia suicida, 
in which I have several times observed, that the thought of 
self-destruction disappeared after the administration of an 
emetic, and the cure perfectly succeeded after gratiola and 
neutral salts had bpen used intermediately. 
Apoplexy, Paralysis. 
As much as emetics must be avoided in an apoplectic 
state, while a full pulse, red face, in short, while indication 
of venesection is present, they are equally recommendable, 
where this is not the case, and now they are certainly the 
most vigorous irritatives and excitants; and frequently 
they are the only ones, which procure relief. 
But as the unseasonable use of them will produce the 
greatest injury and accelerate death, I shall point out those 
cases of apoplexy, in which they are proper. 
1. When apoplexy is of a purely gastric origin, as after 
a meal, overloading of the stomach, or is attended with 
nausea, spontaneous vomiting, furred tongue; an emetic is 
the real radical and causal remedy; in plethoric persons, 
however, and where the pulse is full, a venesection is to be 
made previously to its administration. 
2. In sanguine apoplexy, when after proper abstraction 
of blood and diminished pulse, the sopor and an apoplectic 
state will not cease. 
3. In nervous or serous apoplexy, when the pulse is in 76 
VOMITS. 
the beginning small and weak, the face not red and bloated, 
but pale and shrivelled, the treatment must commence with 
an emetic. 
What has just been said of apoplexy, is true of all kinds 
of paralysis. Emetics have often been the most vigorous 
animatives. 
Asphyxia, 
Especially of Newborn Infants. 
The emetic is, in my opinion and experience, one of the 
most important remedies to arouse the life of a newborn 
child, or to bring the weak and suppressed life into opera- 
tion. Here it is a most momentous means to move for the 
first time the action of the respiratory function and the 
smaller circulation. Which irritative tends so directly, 
even mechanically to arouse the midriff, the pectoral 
muscles, the heart and lungs, as the stimulus and action of 
vomiting % Besides, in many cases, the inactivity of these 
organs and of the suffocation resulting therefrom is prin- 
cipally owing to overfilling with phlegm, which the weak 
newborn child is not able to throw off’. The so called as- 
phyxia is often nothing else than a true suffocation. And 
here, indeed, no other means is left to.us, but the removal 
and expulsion of the phlegm, which fills the air-passages 
possibly effectuated by vomiting. lam really astonished, 
to see this great auxiliary disregarded among the resusci- 
tatives; and I take this occasion to recommend it most 
earnestly to general attention. 
In confirmation of it, I will communicate a case, which 
has strikingly convinced me of it. A lady had the mis- 
fortune, twice to give birth to children, which in other re- 
spects were strong and well built, but came to light almost 
lifeless. They did not utter a sound, at best a very hoarse 
tone, and no respiration could be perceived ; after a short 
time they died away. The skilful practitioner had used 
all imaginable animatives; baths, inhalation of air, frictions, 
aspersions, injections, etc., without success. At the third 
confinement my assistance was called for. I here recog- 
nized that the case proceeded from a stoppage of respira- 
tion, and resolved to administer an emetic, which I kept 
ready for the purpose. The child was easily and happily 
delivered, but the former phenomena presented themselves. 
No crying, no respiration, only a weak, hoarse sound at its 
first appearance. I ordered the child to be placed imme- 
diately in a warm bath, and made it swallow a teaspoonful VOMITS 
77 
of oxymel scilliticum with 1 grain of ipecacuanha and a 
little chamomile tea; after 6 minutes a second dose, and 
then an active vomiting ensued and much evacuation of 
phlegm, immediately afterwards it cried lustily; respira- 
tion went into operation, and the child was saved. All went 
on excellently, and this child is now a healthy, robust man. 
Also in the asphyxia of adults, this great remedy ought 
to be more used, than is done at the present time. Led 
by the reasons just adduced, in order to arouse the heart 
and the respiratory organs by a mighty stimulus in their 
neighborhood, and to rid the lungs of material accumula- 
tions, an emetic of emetic tartar ought to be infused, as 
soon as there is a possibility of swallowing, or when swal- 
lowing is not practicable, be injected into the veins. 
Diseases of Children. 
Emetics, according to my opinion, take the lead of all 
other remedies in the treatment of children. The morbid 
matter in infants is most frequently located in the prsecor- 
dia. In children the system of the prsecordial nerves is of 
particular pathogenetic and sympathetic and therefore of 
therapeutic influence ; and every operation on it has a by 
far more general and decisive effect on the whole economy. 
Finally, in children the operation of vomiting proceeds 
much easier than in adults. All this has been proved to 
me by experience in numerous cases, so that I could fill 
whole volumes on this subject. I have removed in innu- 
merable cases immediately and perfectly the most violent 
fevers of children by an emetic, given at the onset of the 
disease; so I have done away with pectoral and tracheal 
affections, appeased the most violent cough, which would 
not yield to any remedy, cured vomiting, diarrhoeas, dysen- 
teric attacks, even spasms, when they originated in the 
preecordial nerves. The result of my experience at the 
end of my long practical career is this : “When a child— 
especially in the first years of life—is attacked by fever, 
attended with want of appetite and furred tongue, still 
more, when it vomits spontaneously, or has eructations 
and an inclination to vomit, never neglect to administer an 
emetic.” It is of indefinable use, frequently alone performs 
a cure, and its omission is hardly compensated subse- 
quently by other remedies, even by emetics. Nor ought 
we to avoid using emetics, when the cough and difficulty 
of respiration are present at the same time ; it often per- 
fectly removes them. 78 
VOMITS. 
I except only one case ; when a child is attacked by a 
fever with soporous symptoms. Here congestion in the 
brain, even perhaps incipient inflammatory hydrocephalus 
is always to be presumed, and an emetic might do mischief. 
We need not fear the violence of the exertions in vomit- 
ing, or the congestion to the head likely to appear—which 
may perchance be a contra-indication in adults, but cannot 
deter us from prescribing emetics to children. Children 
vomit much easier than adults, the younger they are the 
easier they throw up. 
Vomiting, however, must not be excited more than three 
or four times; and an easy, simultaneously phlegm-dissol- 
vent, rather antispasmodic emetic ought to be selected. A 
great deal depends on the selection of the substances which 
are used. In infants, and where there is a spontaneous dis- 
position to vomit, oxymel of squills, 1 teaspoonful every 
quarter of an hour, along with chamomile tea is perfectly 
sufficient; in more grown persons a mixture of oxymel 
scillse (which is a dissolvent of phlegm and always ex- 
ceedingly facilitates vomiting) and ipecacuanha; in still 
more advanced in age, a small addition of tartar emetic 
solely to sharpen the irritation a little, except in those 
cases, where there is a great disposition to diarrhoea, which 
the emetic tartar would likely increase. I would advise 
the following formula for children : 
R. Pulv. rad. ipecac. 3i. 
Oxymel. scillse 
Syrup, rubi idsei 
Aquse fontanse aa |ss. 
One teaspoonfull to be taken every \ hour, until vomiting 
commences, and then wait for the effect which may be re- 
peated in half an hour, if no further vomiting occur. This 
mixture is the best in children in their first year ; for older 
ones | of a grain of emetic tartar may be added. 
Poisons. 
The most natural thought, which strikes us first, is to 
discharge the poison from the stomach, by the same road 
it was introduced, as the shortest, even in imitation of na- 
ture. It is a rule without exception to excite vomiting 
when we are called for in time. We do so, presuming that 
the poison is still in the stomach. We must, however, be 
careful to distinguish these two cases. Sometimes after 
taking acrid and caustic poisons, they cause such violent 
and forced vomiting, that we need do nothing more, but to VOMITS. 
79 
promote and sustain it by copious drinks of milk and oil. 
But sometimes vomiting does not take place; or it is only 
an imperfect vomiturition ; this is particularly the case after 
narcotic poisons having been swallowed. Here an emetic, 
the best is tartar emetic, is to be given. Sometimes the 
insensibility of the stomach caused by the narcotic is so 
great, that this does not take effect, and recourse must be 
had to stronger emetics, as sulphate of zinc.—How far 
the stomach pump may be able to replace the emetic, time 
and continued use will teach. It seems to me, that poisons, 
which stick to the membranes and folds of the stomach, 
are more perfectly evacuated by the self-active contraction 
of the stomach, than by mere mechanical pumping. 
University Press, 
JOHN P. TROW, PRINTER, 
114 Nassau-street, 
New-York,