NLM OQIBMDTM NLM001340944 THERAPEUTICS OF TUBERCULOSIS OR PULMONARY CONSUMPTION. BY WM. H. BURT, M.D. ; mm OF CHICAGO, ILLINOIS, AUTHOR OF "CHARACTERISTIC MATERIA MEDICA," A MONOGRAPH ON " POLYPORUS OFFICINALIS, POLYPORUS PINICOLA, USTILAGO MAD1S, AND CHINCHONA OFFICINALIS." BOERICKE & TAFEL, NEW YORK and PHILADELPHIA ; Henry Turner & Co., of London, 77 Fleet Street. 1876. WFA Copyright, BOERICKE & TAFEL, 1876. LAKE SHORE PRESS, Bouses Point, N. Y. to JOHN MEYHOFFER, M.D., OF NICE, IN CONSIDERATION OF THE GREAT BENEFIT DERIVED FROM YOUR LABORS FOUND IN YOUR TREATISE ON CHRONIC DISEASES OF THE ORGANS OF RESPIRATION, I WOULD MOST RESPECTFULLY DEDICATE TO YOU THIS MY HUMBLE EFFORT, WITH GRATITUDE. THE AUTHOR. INTRODUCTORY. TUBERCULOSIS OR PULMONARY CONSUMPTION. It is estimated that more than one-eighth of the entire mortality of the human family is due to the fatal ravages of tuberculosis. It is, therefore, not only the most frequent of constitutional, but also the most common of all diseases. With these facts before the physician, it behoves him to make its treatment a life study. Tuberculous matter is an unorganized material, character- ized by a soft, cheesy, pale or yellowish gray colored substance deposited into all the organs and tissues of the body, especially the lungs, accompanied by persistent cough, expectoration of mucus, blood and pus, dyspnoea, asthma, hectic fever, emacia- tion, night-sweats, aphthae, diarrhoea, pain, bed-sores, general atonic condition of the body and debility. In perusing the works of various authors who have written elaborately upon the pathology and treatment of this dreaded disease, the writer's attention was directed to the catalogue of distinct characteristic symptoms of pulmonary tuberculosis, each of which presented itself as a subject for profitable study. Impressed with this idea, we have divided pulmonary tuberous losis into twelve of its most prominent characteristic sympr toms, and given a plenary treatment of each symptom by it- 8 INTRODUCTORY. self, believing that in so doing it would greatly aid the practi- tioner in successfully combating its fatal ravages. They are the following,— 1. General atonic condition of the body. 2. Emaciation. 3. Debility. 4. Haemoptysis. 5. Cough. 6. Asthma. 7. Hectic fever. 8. Night Sweats. 9. Aphthae. 10. Diarrhoea. 11. Pain. 12. Bed-sores. The pathology of the disease has been entirely omitted, it being so fully written up in our works on pathology, which are in the hands of every practitioner. In writing the treatment of each symptom, we have collected together from our text books and journals all that has been written on this disease, and put in such shape that the busy physician and student can grasp and utilize it at once, with- out having to search over his whole library whenever a case presents itself for treatment. The remedies have been so fully written, that not only the general indications are complete, but a Characteristic Materia Medica has been produced that forms a marked feature of the work, and we believe will be prized by the profession as inval- uable ; in it, the heart and soul of each remedy is put in such a concise shape that the labor of applying it to disease is made easy. We have aimed to put nothing in this work but actual prac- tical, clinical experience, something that can be turned to by the student with the feeling that what he is wielding has been thoroughly tested and found reliable. MEDICAL TREATMENT. 9 Medical Treatment-—Before giving the indications for our remedies, it will not only be interesting, but practical, to note down the remedies used in our standard works for this for- midable disease. Dr. B. Baehr, in his science of Therapeutics uses forty reme- dies, namely : Aconite, Cannabis, Kali carb., Pulsatilla, Alumina, China, Kali nit., Plumbum, Arnica, Cuprum, Kreosote, Phos. acid, Belladonna, Causticum, Ledum, Spongia, Bryonia, Cod liver oil, Lycopodium, Stannum, Bromine, Digitalis, Manganum. Silicea, Baryta carb., Ferrum, Millefolium, Sulphur, Calc. carb., Hepar sulph., Morphine, Tartar emetic, Calc. phos., Ipecac, Natrum m., Veratrum alb. Carbo veg., Iodine, Phosphorus, Dr. W. Hitchman, in his work on consumption gives us forty eight remedies, namely: Aconite, Cantharis, Gamboge, Oleum Ricini, Arsenicum, Conium, Hepar sulph.. , Pulsatilla, Arnica, Chelidonium, Ipecac, Plumbum, Antimonium Chininum sulph. , Iodine, Phosphorus, crud. Coffea, Kali hyd., Phos. acid, Acid, sulph., Cocculus, Kali b., Rheum, Argentum, Chamomilla, Lacl^esis, Sulphur, Acid Nit., Camphor, Laurocerasus, Petroleum, Belladonna Cuprum, Lamium, Terebinth., Bryonia, Digitalis Merc, cor., Tartar emetic, China, Elaps, Nux vom., Veratrum alb., Cannabis, Ferrum, Opium, Zincum. 2 10 PULMONARY CONSUMPTION. • Dr. C. H. G. Jahr, in his " Forty Years Practice," gives thirty-three remedies, but he doubts the virtues of the last ten, as indicated in his work : Aconite, Bromine, Belladonna, Bryonia, Calc carb., Carbo veg., China, Drosera, Dulcamara, Ferrum, Hepar sulph., Iodine, Ipecac, Kali carb., Kali hyd., Kreosote, Ledum, Lycopodium, Lachesis, Mercury, Nux vom., Nitric acid, Phosphoric acid Phosphorus, Plumbum, Psorinum, Pulsatilla, Rhus tox., Sulphur, Spongia, Silicea, Stannum, Sambucus. Dr. C. G. Raue,—In his " Practice," gives twenty-six reme- dies. Aconite, Apis mel., Arsenicum, Carbo veg., Calc. carb., China, Dulcamara, Lycopodium, Ferrum, Myrtus communis, Gelseminum, Nitric acid, Hepar sulph., Opium, Iodine, Phosphorus, Kali carb., Sanguinaria, Spongia, Stannum, Sulphur, Tartar emetic, Veratrum alb. Cimicifuga, Lachesis, Silicea, Drs. Marcy and Hunt, in their work on " Practice," give thirty-five remedies, viz : Aconite, Arnica, Alcohol, Ammonium carb., Acaliphaindi- ca, Belladonna, Bryonia, Bromine, Calc. carb., Cod-liver oil, Cuprum, China, Digitalis, Drosera, Ferrum, Ipecac, Iodium, Kali hyd., Kreosote, Lobelia, Lycopodium Lachesis, Hepar sulph., Mercurius, Hamamelis, Nitric acid, Hypophosphite of Lime, Phos. acid., Phosphorus, Sambucus, Silicea, Stannum, Sanguinaria, Sepia, Sulphur. MEDICAL TREATMENT. 11 Dr. Epps, in his work on " Consumption," 'gives thirty- seven remedies, viz : Aconite, Arnica, Arsenicum, Asafcetida, Belladonna, Bryonia, Baryta carb., Calc. carb., China, Causticum, Cantharis, Clematis, Cinnamon, Cod-liver oil, Graphites, Hepar sulph., Helleborus, Ipecac, Ignatia, Kali carb., Lycopodium, Lachesis, Ledum, Mercurius sol. Nux vomica, Nitric acid, Opium, Phosphorus, Pulsatilla, Quinine, Rhus tox., Sulphur, Spongia, Sepia, Veratrum alb. Dr. Hugh Hastings, in his " Consumption, its prevention and cure," gives nineteen remedies, viz : Aconite, Belladonna, Cod-liver oil, Kali carb., Ammonium Bryonia, Carbo veg., Lycopodium, carb., Calc. carb., Digitalis, Nitric acid, Arnica, Causticum, Dulcamara, Phosphorus, Arsenicum, China, Ferrum, Sulphur. Dr. E. PI. Ruddock, in his work on " Consumption," gives twenty-eight remedies, viz : Aconite, Arsenicum, Arsenate of Soda, Belladonna, Bryonia, Calc. carb., China, Calc. phos., Cod-liver oil, Drosera, Ferrum, Hepar sulph., Hyoscyamus, Ignatia, Ipecac, Iodine, Kreosote, Kali b., Laurocerasus, Lycopodium, Mercurius sol., Pulsatilla. Mercurius iod., Millefolium, Nux Vomica, Phosphorus, Phos. acid, Podophyllum, 12 PULMONARY CONSUMPTION. * Dr. Richard Hughes, in his " Therapeutics," gives seven- teen remedies, viz : Arsenicum, Hyoscyamus, Kreosote, Phosphorus, Calc. carb., Iodine, Lycopodium, Stannum, China, Ipecac, Pulsatilla, Spongia, Drosera, Kali carb., Phos. acid, Sulphur. Dr. A. Charge, in his " Traitement Homceopathique, des Maladies des organes de la Respiration," in the section " Phthisic Pulmonaire, " gives forty-two remedies, and fifteen " Medicaments intercurrents," viz : Ammon. carb., , China, Lachesis, Plumb, acet., Ammon. mur.. , Con. mac, Lycop., Sang, can., Ars. alb., Drosera, Lysimach. Sepia, Ars. iod., Eryth. coca, numm., Silicea, Ars. nat., Ferrum, Merc, sol., Silphion, Bov. lycop., Hepar sulph., Natrum mur., Spong., Calc. carb., Iodium, Nitric acid, Stannum, Calc. phos., Kali carb., Pheli aq., Sticta pulm., Calc. sulph., Kali hydr., Phosph., Sulphur, Carbo veg., Kali nit., Plumb. Met., Thuya. Caustic, Kreosote, " MEDICAMENTS INTERCURRENTS " Aeon, nap., Bellad., Hyoscy. nig., Puis- nig., Actsea racem., Bryon., Lact., Sambucus. nig., Allium cepa., Digit., Laurocer., Tart. Emetic. Allium sativ., Hydroc acid, Myrt. comm., Dr. J. Kafka, in his work on Therapeutics gives fifty-four remedies for tuberculosis of the lungs, twelve of which he has MEDICAL TREATMENT. 13 great confidence in, the balance has given him but little satis- faction ; they are the following. The truly reliable remedies are : Calcaria carb., China sulph., Kali carb., Natrum m., China, Hepar sulph., Mercury, Silicea, Cod-liver oil, Iodine, Phosphorus, Sulphur. MINOR REMEDIES. Aconite, Apis m., Arsenicum, Conium, Hyoscyamus, Ignatia, Lachesis, Lycopodium, Nux vomica, Sepia, Stramonium, Thuya, Belladonna, Kali hyd., Pulsatilla, Veratrum alb. INCIDENTAL REMEDIES. Atropine, Arnica, Ammonium carb., Bryonia, Cannabis, Chamomilla, Colocynth, Lactucarium, Rheum, Colchicum, Carbo veg., Digitalis, Ergot ine, Ferrum, Ipecacuanha, Morphine, Nitric acid, Opium, Phosphoric acid, Rhus tox., Sulphuric acid, Secale cor., Sambucus, Sabadilla, Tartar emetic, The mineral springs. A careful study of the above remedies used by the Homoeo- pathic school, reveals the fact, that the real curative agents in consumption have for their starting point, or centre of action, the ganglionic nervous system, the cerebro-spinal remedies be- ing only given for incidental symptoms, and not depended upon as the true curative agents by any of our school. This is strong evidence that the great sympathetic, or vegetative nervous system, is the great receptacle for that fearful destroy- er, tuberculosis. Now if this disease has for its grand centre of action and starting point, the ganglionic nervous system, we 14 PULMONARY CONSUMPTION. at once get a true idea of the class of remedies that should be given to arrest it, their grand centre of action must be on the same tissues. This gives us a large number of well tried reme- dies that will really cure this frightful destroyer. Of course, every remedy in the materia medica will be more or less use- ful for incidental symptoms, but the grand curative ones must be those having a specific action upon the great vegetative ner- vous system. Dr. Frost, of Bangor, Maine, published in the sixth volume of the American Homoeopathic Review, page 145, an article entitled " The Sympathetic and Spinal Systems in relation to Psora," wherein he "advocates the ganglionic system as the fundamen- tal form of life, common alike to the lowest and to the highest species, and this vital principle, peculiar to the ganglionic sys- tem, is originally constructive and constantly sustaining all the rest. Hence all that is meant by constitution must belong to the ganglionic system, which, in immediate relation to the sem- inal embryo, precedes both spinal and cerebral organization- In those obscure recesses of nature, the minute, individual and collective ganglia of the sympathetic system, lie concealed the subtle but persistent germs of health and longevity on the one hand, and of disease and premature decay on the other. Here, amid the primary and most secret springs of life, ready to flow with them into all the vital organization and into the spinal and cerebral systems, and to perpetuate itself in procreation and conception, lurks the latent miasm, the aqua tophana of scrofula, or of that hereditary psora, which since Hahnemann's time has remained a questio vexata to the physicians." And again, page 151: " Instead of being limited to an u itch," suppressed in the person of the sufferer himself or in some of his ancestors, psora may be regarded as an hereditary taint of constitution. Doubtless the skin is the primary and preferred form of developement of all chronic as well as all acute diseases. The relation between the sympathetic ganglia and the spinal cord is still but imperfectly understood. Disease in the great sympathetic occasions tenderness of the spinous processes, MEDICAL TREATMENT. 15 which is sometimes mistaken and unavailingly treated for spi- nal disease. The ganglionic system contains all the hereditary elements of health and disease, which latter may be considered as latent till they begin to be transmitted to some of the organizations which this system supplies. It is believed that the germs of the hereditary dyscrasia, latent in the sympathetic ganglia, may be discovered in the form of minute tubercles in the involuntary organs, in the spinal marrow, and in the brain." With these few remarks, we will commence first with GENERAL ATONIC CONDITION OF THE BODY. This symptom may exist from infancy up to manhood, and arises from an undeveloped physical organization; the subject inherits a scrofulous constitution ; the thorax is ill-formed and flattened and inclined to become contracted ; respiration is above the normal standard, and greatly accelerated on slight exertion. The germ of tuberculosis lies dormant in the organic ner- vous system, and the most trivial event may kindle the spark into a flame that will not end until death claims the victory. The treatment of this condition is to strive to get a better development of the body, by insisting upon obedience of all the laws of health, advising a proper selection of food, and the use of gymnastics. During the period of development, gym- nastics are invaluable, and their effects are sometimes most miraculous, in developing the muscular system. " xV systema- tic course of exercises which shall especially bring into play the muscles of the chest and keep the body erect, will greatly enlarge the capacity of the chest; the lungs may be made to receivfc ft much larger quantity of air; but it is necessary that this' course of health-giving exercises should be commenced before hopeless structural disease already exists, and that it be so directed as not to ' give fatigue and exhaustion in the ner- vous system out of all proportion to the effect upon the mus- cles.' The general indication " says Dr. C. F. Taylor u will be 16 PULMONARY CONSUMPTION. met by employing the muscles in such a manner that while they are made to act with more or less force, no greater de- mand shall be made upon the nervous system than can be easi- ly and healthfully responded to." " The first thing to be attended to and never to be lost sight of for a moment, is the circulation of the blood. Feebleness of the heart's action, imperfect respiration, poor quality and small quantity of blood, and especially want of affinity between the blood and the tissues, all conspire to produce the livid coun- tenance, cold extremities, and consequent pectoral congestion and oppression so characteristic of pulmonary consumption. It is advised to act almost wholly and very perseveringly on the extremities, by rotations of the feet, hands, arms, and legs, and by flexions and extensions of the same, but there should never be any attempts to expand the chest, till after the peripheric circulation has been improved. After a proper distribution of the fluid has been secured and maintained, improved health is sure to follow." For full and minute directions how to use these physical movements the reader is referred to works treating particularly upon gymnastic exercises. Breathing Tubes.—The use of breathing as a phy- sical exercise for the lungs cannot be urged upon the patient too strongly. It is a good means of developing the muscles of the chest, and nothing is so beneficial as an habitual custom of taking deep and free inspirations. The use of breathing tubes will soon get the patient into the habit of deep and full inspirations. Health-Lift.—The use of the health-lift is, without doubt, the most important remedial agent that has been devised by man for the cure of a general atonic condition of the body. It is the most thorough, the most expeditious, the safest and easiest method of developing the whole muscular system that can be thought of, for it exercises almost all the muscles in the body simultaneously, at a minimum expense of mental effort. The chief recommendation of this means is, that the MEDICAL TREATMENT. 17 apparatus is so simple that the most fragile woman, if she can but stand up, can use it with perfect safety. From six weeks to two months exercise, spending each day, ten or twelve minutes in Health-lift exercise, will give her not only a strong muscular system, but health. Consumptives who have been treated by the health-lift have uniformly found their health and strength daily improved, cough and expectoration diminished, appetite improved, pulse slower and stronger, the capacity of the lungs greater, the mobility of the chest frequently doubled, and the circumference greatly enlarged, increase of weight, and all the appearance of returning health. The health-lift apparatus consists substantially of a table or platform, upon which the individual stands between two vertical iron rods, attached to a cross-bar below the table; from which cross-bar is suspended by a slogger joint, a notched shaft to which any number of fifty pound iron plates may be keyed. Each vertical rod hoi is, in a suitable socket, an inclined handle, so shaped to the hand as to give the greatest possible friction-surface, whilst its inclination is such as to throw most weight upon the fleshy cushion of the palm of the hand, rather , than upon the more bony fingers. Standing thus between the vertical rods, directly over the centre ot the weight to be lifted, the heels are separated three or four inches, the toes turned well out, the hands adjusted to the handles, and the knees bent to such an angle as that when th'e trunk and shoulders are perfectly erect, with the shoulders slightly thrown back, arms extended to their fullest limit, and chest expanded, the stature shall be from three to four inches below the usual height. In this position, the knees are slowly and gradually straightened, until the body is perfectly erect, when a line describing the centre of gravity would fall from the point of the shoulder through the hip, knee and ankle-joint. In this way the greatest possible amount of muscular tissue is brought into use in its natural and symmetrical relation; no one muscle, or set of muscles, is unduly exerted, nor are any muscles re- 18 PULMONARY CONSUMPTION. laxed. It will be seen that in this way the spinal column is kept perfectly straight, there being no lateral twist or contor- tion, as in lifting with a cross-bar between the legs, which is the usual mode as practiced in the gymnasium. RULES FOR THE USE OF THE HEALTH-LIFT. Jm—Exercise should be taken usually in the forenoon, about three hours after breakfast.—The reason for this involves the physiological law that exercise of function increases the supply of blood in the organs or tissues which is acting—perfect functional activity is impossible, indeed, without a free supply of blood, and, as during this exercise, the muscles "" suck up blood like so many sponges," drawing it away from brain, stomach, liver, and every other organ, it is clear digestion would be interfered with by lifting too soon after eating. II—Lift slowly.—This rule is formed on the fact that the muscles do not contract simultaneously, but some much more promptly than others—depending upon the amount of use; and as the object is to get the greatest possible bulk of mus- cular tissue into contraction, it is obvious that this can only be done by giving the more slowly acting muscles time to come into play. This also prevents any undue expenditure of nerve-force,—economy of which, results in an increase of general vitality. III.—Lift regularly, and as nearly at the same time each day as practicable.—By lifting as nearly as possible at the same hour each day—or every other day—the system reaps the benefit of that compliance with habit which is of so much importance in the economy, and which obtains so largely in our daily life— getting hungry, or sleepy, or waking at given hours, with an al- most sentient regularity, and on which the hours of meals and sleep, etc, in health, are based. Hence it is of first importance that this stimulus to the tissue-changes, which only lasts a certain time, growing less with varying regularity until its effect is entirely lost, be renewed at regular periods. MEDICAL TREATMENT. 19 1V.—Avoid competition, and do not strive to see how much you can lift. Usual effects produced by the health-lift. Following the exercise most commonly, is a tingling glow over the whole surface of the body, with a sense of buoyancy and vigor which prompts one to want to do something—the exercise seems to have been entirely insufficient—there is a temptation to strike out from the shoulder, to seize the heavy dumb-bells, or " skin the cat " on the suspended rings. Instead of spending this increased vitality, however, you are cautioned against doing any of these things : you take it away with you to put it into your daily life and work: the pulse has fallen from five to eight beats per minute-you breath more deeply and fully, —the headache is gone,—rif the feet were cold before, they are now warm. As the exercise is continued the weak spots de- velop themselves ; the results of former illness or injuries re- mind you of their existence ; probably you find it impossible to-day to raise the weight of yesterday, or even of a week or more previous, you have action where before was stagnation, you may have to go back in your weight, 50, 100, or even 200 lbs, whatever may be the limit of what is now your weakest spot, which is the measure of your strength. Grad- ually increasing again from this, usually at the rate of ten pounds a day, as you did at first, you reach your old limit and pass it with ease, and have demonstrated that jon are a healthier man by so much as you have eliminated that ele- ment of weakness. Sometimes it is attended by pain or discomfort; the more thoroughly circulated blood—in itself healthier and more highly stimulating—arouses sensation in nerve-tissue hither- to dormant. Each one must be a law unto himself in this matter of weight; some men, and many women lift with benefit only every other day, or lift light and heavy weights on alternate 20 PULMONARY CONSUMPTION. days, and some absolutely need to lift heavy every day. Tem- perament, occupation, inherent vitality, etc., etc., all must be taken into consideration. No rule can be laid down for any given case, even by the most experienced. From fifty to eighty pounds will frequently tax the strength of the patient at first, but in the course of three or six weeks, three or four hundred pounds can be lifted with ease. From ten to twelve minutes Health-lift exercise once a day has been found, after years of experience, to be all that should be taken to get the full benefit of the exercise. For this atonic condition of the body, change of climate will often be of much value, especially if the patient will go to a place where the atmosphere is very much rarified, such as found in Colorado, New Mexico, and the mountainous por- tion of North Carolina and Virginia. Bathing.—Frequent bathing, followed by brisk friction with the flesh-brush, will be of much service. Cod-liver oil once a day will also be of great value at this early stage of the disease, if persevered in for a long time, especially if the patient is under the influence of such remedies as Calcaria carb., Lycopodium, Phosphorus, Iodium, Silicea and Sulphur. EMACIATION AND DEBILITY—These two symp- toms are so closely united to each other that their treatment will be given together. The most useful remedies for this condition are Calc carb., Arsenicum, Iodium, Iodide of Potash, Phosphorus, Silicea, China, Ferrum, Stannum, Sulphur, Kali Carb., Lycopodium, Zinc, Cod-Liver Oil, the Health-Lift, and a nutritious diet. CALC CARB.—Leucophleg- matic temperaments, prone to affections of the mucous mem- branes ; dry flabby skin, and in children large,open f ontanelles, with large drops of perspiration on the head during sleep. Pale and fair children, with soft No remedy in the Materia Medica acts more profoundly upon the gang- lionic vegetative nervous system than Calc. carb., and none is more useful in this destructive disease. In cases of emaciation and debility, where the secondary assimilation of EMACIATION AND DEBILITY. 21 flabby muscles, hair dry and looking like tow. Exceedingly sensitive to the least cold air, which seems to go through and through him. Feet cold and damp continually, as if he had on cold, damp stockings. Walking produces great fa- tigue, especially walking up stairs; is all out of breath and has to sit down. In women, the menses are too soon, too profuse, and last too long, verti- go on going up stairs. Pains are aggravated by the slightest touch, as from a current of air, noise, excitement, etc. the digested food to blood and tissue does not proceed as it should, we have obstructions " intumescence in the lymphatic and glandular sys- tems, dyscrasial affections of mem- branous structures, of all the white structures which have but little vitality or blood, and are nourished chiefly by lymph." Development is also imperfect or arrested in the tendons,cartilages, bones,and serous membranes. Emaciation and debility, are the most marked symptoms of Calc. carb., and will always be found one of the most marked symp- toms, when this remedy is indicated. Also another marked symptom, if the patient is a child, it has profuse perspiration on the head during sleep. Phosphate of lime, in many cases will be the best form to use. ARSENICUM.—Rapid and great prostration, with sinking of the vital forces. Extreme emaciation, with great debili- ty, great restlessness, anguish and fear of death. Very weak and prostrated, has a clear countenance, frail look, with great desire for acids. White, waxy, pale face, with great de- bility, craves cold water, but the stomach cannot assimilate it ; drinks often, but little at a time. Diarrhoea of a cadaver- ous smell, with great enerva- tion after stool. General em- aciation with great debility. Symptoms all worse at night, particularly after midnight. This remedy is adapted to lym- phatic, nervous temperaments, the patient being very sad and irritable. Through the ganglionic system, es- pecially the solar plexus, it acts particularly upon the alimentary canal. " The organic functions of the whole symphathetic nervous system are stricken down and de- stroyed from the inmost recesses of vitality. The blood-making power of the ganglionic nervous system is completely annihilated by the action of Arsenicum. The poison acts directly on the red corpuscles, diminishing their power of taking 22 PULMONARY CONSUMPTION. up the oxygen supplied to them in the lungs; and the carbonaceous compounds thus unconsumed, deposit them- selves in the form of fat. If this direct action on the corpuscles be granted, many of the phenomena of arsen- ical poisoning become explicable. No wonder that the blood is black and non-coagulable, resembling that of malig- nant fever and cholera. Petechial effusions frequently occur, and the chronic poisoning takes the form of a profound This remedy will often be called for in the second and last cachexia." stages of consumption, when we have cold, clammy sweats, great emaciation and debility accompanied with more or less dyspnoea, and general emaciation, and anasarca. IODIUM.—Remarkable and unaccountable weakness and loss of breath when going up stairs. Cachectic, scrofulous people, especially women, with dwindling away of the mam- mae; they hang down heavily and lose their fatness. Dark brown color of the face, exces- sive debility during the menses. Greatly aggravated by motion. This is one c f our most important remedies in confirmed phthisis. Its main action through the ganglionic system is spent upon the lymphatic glandular system. Dr. Hughes says: " Its true action is one of a depressant character, ex- erted upon the lacteal vessels and mesenteric glands, giving a sluggish taking up of the fatty elements of the food by the lacteals, and an insufficient elaboration of their contents by the mesenteric glands, and we have at once a most important channel of nutrition choked up and rendered useless. The fatty aliments being those taken up by the lacteals, the emaciation becomes more rapidly apparent than if it had been the albuminous constituents of the diet whose supply was cut off. The action on the glands of which the emaciation of Iodine is thus a prominent instance, displays itself also in the salivary glands, the liver, the glands of the generative system, and the thyroid. Upon the glands of the generative system it exerts a depressing and atonizing influence. The mammas and testes have more than once wasted away and EMACIATION AND DEBILITY. 23 disappeared under its use ; and a diminution of the functional energy of the ovaries makes it probable that those are simi- larly affected." The most marked effects of Iodine are: " Over-excitement of the whole nervous system; ebullition of the blood and pulsations over the whole body, increased by every effort; trembling, tottering gait; great debility, atrophy; extreme emaciation; general oedema; pulse accelerated, hard and small; hectic fever; variable appetite, either excessive or absent; digestion very feeble; dyspepsia ; suffocation; out of breath on going up stairs, with violent palpitations and cramp-like pains about the heart on the least effort." Symp- toms all greatly aggravated by motion. IODIDE OF POTASSIUM.—This remedy is so closely related to Iodine, that we will not in this place give separate indications, but simply state where we find the symptoms strongly pointing to Iodine, and the patient has been sat- urated with mercury, and has had syphilis, has many rheumatic symptoms, with much derangement of the mucous membranes, we would give the Iodide of Potassium the pre- ference. PHOSPHORUS. — People with meagre,slender form, fair complexion and strong sexual feelings. Sensation of weak- ness in the abdomen, that ag- gravates all the other symp- toms. Stools long,, narrow, hard and very difficult to void, or profuse, watery, exhaustive diarrhoea pouring away as from a hydrant. Profuse haemorrha- ges, anaemia, with profuse per- spiration and great emaciation. When the disease is deeply seat- ed, much emaciation accompanied with great nervous prostration, and more or less complicated, with gas- tric and intestinal disease, Phos- phorus will be found of much value. There is much anasmia and deliquescence of the blood, with frequent haemorrhages of dark, fluid blood. The emaciation is ac- companied with a dry, hard cough: the expectoration is frequently mixed with blood ; the lungs more or less hepatized and much sanguineous infiltration of the parenchyma of the lungs. There is a great tendency to 24 PULMONARY CONSUMPTION. a watery, exhaustive diarrhoea, or much gastric irritability: the tongue is red at the tip and sides; nausea and more or less vomiting. SILICEA.—Emaciation ac companied with more or less suppuration going on in the lungs. Profuse night-sweats. Much perspiration about the head and chest, especially in little children. Terribly offen- sive sweating of the feet. Hun- gry, but cannot get down food, it is so nauseous. Great con- stipation, the rectum has not power to expel the stools, the stool recedes after having been partly voided. Great want of vitality, always cold, takes cold at every change of the weather. Greatly constipated before menstruation. In emaciation and debility where there are organic changes taking place, especially suppuration, it has an extraordinary control over the suppurative process, seeming to ma- ture abcesses when desired, and certainly reducing excessive sup- puration to moderate limits. This remedy is especially adapt- ed to children that are inclined to rachitis, with large bellies and weak ankles ; great difficulty in learning to walk. Emaciation, with ulcera- tion of the lymphatic glandular system. The emaciation that calls for Silicea has been brought on by a long lasting organic disease of lungs, or some other organ undergoing suppura- tion. CHINA—In emaciation where the system has been debilita- ted by the loss of vital fluids, especially blood, semen, over- lactation, leucorrhcea, diar- rhoea, or profuse night-sweats. Great distention of the abdo- men, not relieved by eructa- tion or dejections. Debilita- ting diarrhoea of undigested food. Emaciation, where de- bility is the most prominent symptom, from loss of blood. Anaemic people with frequent In emaciation and debility from profuse hemorrhages from the lungs, or excessive suppuration, accom- panied with night-sweats, China will be found of great value. The cases that especially call for China have many gastric symptoms, one of the most prominent of which is immense distention of the abdo- men, it seems packed full of gas, not relieved by eructation or dejection, IODIDE OF POTASSIUM. 25 exhaustive haemorrhages, long with much acidity of the stomach. lasting, congestive headaches. Anaemia with excessive debility Excessive sensitiveness of the r ■■ <• •, i n • i ,, ,. , . ... ,..,.! .,., trom loss ot vital fluids. Most of skin, with much irritability and sadness. The least draft the symptoms of China are aggra- of air causes great suffering, vated in the evening and at night. Its great action is to cause debility of the trophic nervous sys- tem. Debility is to the nervous system what anaemia is to the blood, and this is the great field for the action of China, or its alkaloid, the Sulphate of Quinine. Its medicinal effect is to build up and prevent the destruction of nerve tissue. In emaciation and debility from the loss of vital fluids there is great disintegration of nervous tissue; in such states China, and especially the Sulphate of Quinine, contributes wonderfully to the reparative process, in fact, may be called the great conservator and builder of the cerebro-spinal nervous system. Iron especially affects the blood- plasma, decreasing the albumen and red corpuscles, increasing the water in the serum sanguinis, producing anaemia and chlorosis. Diarrhoea with stools of mucus and undigested food; the stools are painless, excoria- ting and exhaustive. Mensc. s inter- mit two or three days, and then re- turn again; blood pale and watery. General haemorrhagic tendency. Emaciation, with cedem- atous swelling of the body ; cool skin, constant chilliness and evening fever. Symptoms aggravated towards and in the morn- ing, while at rest, especially when sitting still. Amelioration from slow exercise. Emaciation and debility brought on by the abuse of Quinine, and alcoholic drinks where there is much enlargement of the spleen, and anaemia. 2 FERRUM.—Anaemia, with pale face., emaciation and great debility. Weakly persons, the least exertion or motion pro- duces a red, flushed face. Bel- lows-sound of the heart, with anaemic murmur of the arte- ries, and veins, muscles fee- ble, and easily exhausted from slight exertion. Lienteria, the food is undigested and painless. PULMONARY CONSUMPTION. The cases that will be cured by this remedy, will have great prostra- tion of the whole cerebro-spinal nervous system, the most of which seems to centre in the chest. With the emaciation and debility the patient is apt to have a cough, with profuse, greenish expectora- tion. Goes up stairs easily, but becomes very faint on coming down. " The pains commence lightly, in- crease gradually to a very high de- gree, decrease again as slowly."— Hahnemann. Debilitating night-sweats, in the morning, affecting more particularly the neck and chest. The symptoms are all relieved by walking (except the de- bility) but return at once during rest. STANNUM,—Great weak. nessof the chest, the least exer- tion puts him all out of breath, an not answer questions, there is such debility all centering in the chest ; reading aloud, coughing, or the effort to ex- pectorate produces great weak- ness in the lungs. Feels so weak can hardly sit down, must drop down suddenly, but can get up very well. Great weakness of the legs, they can- not support the body. SULPHUR.—Sensation of constant heat in the top of the head. Feels ver weak and faint from 11 to 12 m. she must have her dinner. Early morning diarrhoea, driving the patient out of bed, has hardly time to keep from soiling herself. Ex- coriating discharge from the bowels or urinary organs, es- pecially in children. Feeling of suffocation ; must have the doors and windows open. Sud- den flashes of heat, which soon pass off with moisture and de- bility. Great heat in the palms of the hands and espe- cially in the soles of the feet. wishes to find a cool place for them or puts them out of bed. Long lingering cases that seem to get almost well, when they relapse again and again. Great emaciation and debility, with much rattling of mucus in the lungs, and the catarrhal symptoms become worse and worse. Chronic constipation, the stools are hard, dark and dry, expelled with great difficulty frequently accompanied with bleeding piles, or the patient has chronic diarrhoea driving him out of bed early in the morning, with many weak,faint spells through the day. The skin is full of pim- ples and eruptions, with a great disposition to excoriation. Offen- sive, corrosive, ichorous leucorrhcea. IODIDE OF POTASSIUM. 27 Chronic uterine haemorrhages, that seem to get almost well, and then return again and again. Menses thick and black, and so acrid as to make the vulva and legs sore. The child has great voracity, watches eagerly for everything it sees. Emaciation and debility, with hoarseness and roughness in the throat, and much mucus in the chest. Great dyspnoea, shortness of breath and oppression of breathing, Asthma at night. Tearing pains in the outer parts of the limbs, in the muscles and joints commencing above and running downwards. Sj-mptoms worse in the evenings, or after midnight. It will often rouse the slumbering vitality, if the proper medicines have failed to produce a favorable effect, especially in acute cases. In emaciation and debility where there is a dry cough, invariably aggravated about 3 A. m., hectic fever and night sweats, with many stitching, darting, shooting, cutting pains, this remedy is invaluable. It seems to act on the system so as to produce dryness of the serous membranes, which give rise to the stitching pains, the great leading characteristic of the remedy. Suppuration of the lungs, with great emaciation and debility, accompanied by profuse night-sweats, affecting more especially, the head and chest. Excessive dryness of the scalp, with falling off of the hair. Great liability to take cold at every change of the weather. Very irritable, with much anxiety, fear and tendency to start from the least noise. Rheumatic subjects. KALI CARBONICUM.— The characteristic of this reme- dy in long diseases is stitching pains, and the symptoms are all worse in the morning, at 2 or 3 a. m. when at rest, better in the open air. Great liabili- ty to take cold at every change in the weather. Swelling over the upper eyelids in the morn- ing, looking like little sacks. 28 PUMONARY CONSUMPTION. In emaciation and debility, where Lycopodium is indicated there will be found many dyspeptic symptoms present with an immense accumula- tion of gas in the stomach and bow- els, the stomach is often acid, and the least quantity of food will seem to fill the patient full up to the throat. Great emaciation of the upper part of the body, while the lower portion is enormously dis- tended. Cough day and night, with ex- pectoration of large quantities of muco-purulent matter. Night sweats, perspiration cold, clammy, sour, fetid, bloody and sometimes smelling like onions. The patient is very low-spirited, and melancholic ; grieves constantly and is excessively irritable, Dr. Pope thinks there are but few medicines so valuable in consumption as this, when persistently used. The cough, gastric irritation, emaciation and debility are wonderfully mitigated by it. The symptoms are aggravated at 4 P. m., and night, or at 9 in the morning:. LYCOPODIUM. — Great quantities of red sand in the urine. Much pain in the back previous to urinating, relieved as soon as the urine begins to flow. Constant sense of satiety. Great accumulation of flatus in the stomach and abdomen, much fermentation with sour vomiting. Chronic constipa- tion, stools passed with great difficulty. Loose rattling cough with much emaciation and de- bility. Constantly taking cold at every change of the weather. ZINCUM. — Cerebral ex- haustion with mental and phys- ical depression, from anaemia of the brain. Incessant and con- stant fidgety feeling of the feet; must move them constantly. In emaciation and debility, where there is great debility of the cere- brospinal nervous system, this remedy is often of great value; it seems to be to the animal nervous system, what Iron is to the blood. Many gastric symptoms, with distended abdomen, and dry, hard, small stools. Strong sexual desires. Much weakness and trembling of the hands. Profuse perspiration all night, with inclination to uncover one's self. OLEUM JECORIS ASELLI. 29 Most of the symptoms are aggravated after dinner. I now use the hypophosphorous zincum, with better re- sults than in the metallic form. Oleum Jecoris Aselli.—Cod-liver oil. This is obtained from the liver of the common cod; the process is thus described by Dr. Garrod : " The livers are collected daily, so that no trace of decomposition may have occurred ; carefully examined, so as to remove all traces of blood and impurity, and to sepa- rate any inferior livers ; they are then sliced, and exposed to a temperature not exceeding 180° Fahr. till all the oil is drained from them. This is filtered, afterwards exposed to a temper- ature of about 50° Fahr.. in order to congeal the bulk of the margarine ,and again filtered, and put into bottles well se- cured from the action of the air." Cod-liver oil, being the only agent in which the old school have any confidence as a curative agent in tuberculosis, let us first see what the oil really contains. Dr. Jongh, found the principal constituents of these oils to be oleate and margarate of glycerine possessing the usual properties, but they also contained butyric and acetic acid, the principal constituents of the bile as fellenic, cholic and bilifellinic acids, and bilifulvin, a peculiar substance soluble in alcohol, a pecxdiar substance soluble in water, alcohol, or ether; iodine, chlorine, and traces of bromine ; phosphoric, and sulphuric acids ; phos- phorus ; lime ; magnesia, soda, and iron. These were found in all the varieties, though not in equal proportions in all, yet it is quite uncertain whether the differ- ence had any relation to their degree of efficacy. This analysis gives us a compound of twenty different rem- edies, all of which, it will be seen, act especially upon the great sympathetic or vegetable nervous system, the grand centre for the action of the tubercular poison, and, it will be seen, are the principal remedies used by our school for the cure of tubercu- lar consumption. This analysis also gives us an explanation how cod-liver oil cures consumption. First it holds in solution a fine attenuation of lime, iodine, phosphorus, bromine, and 30 PULMONARY CONSUMPTION. a large number of other valuable remedies, and it is nonsensi- cal to think they do not act medicinally. Our preparations of the same remedies in which we all have such unbounded confidence, contain far less medicine of each one of the ingredients, at the 30th and 200th attenuation, than the oil. We would like to see the chemist who could give the amount of iodine, the 30th or 200th centesimal attenuation con- tain to the grain or ounce. We are certain that they do act med- icinally in those attenuations. A chemist can tell us the quan- tity of iodine contained in an ounce of oil, but he cannot in an ounce of the 200th attenuation of iodine. Consequently, we must conclude from this, that the beneficial influence exerted by cod-liver oil in Phthisis, is to a large extent medicinal. Secondly, it is* also a highly nutritious and easily assimilable food. In all ages oleaginous substances have been esteemed highly as curative agents in consumption, whether their action was to be attributed to their medicinal, or to their nutritious properties. We now see that it supplies nutriment in a con- centrated form, and at the same time holds in solution medi- cines that are homoeopathic to the tubercular diathesis. Dr. C. J. B. Williams, in his late work on Pulmonary Con- sumption says: "A fter a quarter of a century's experience, it is the only agent in any degree deserving the title of a remedy in this disease : Its mode of action is still a matter of uncer- tainty, but we can at least offer some reasonable conjectures. That it is in itself a nutriment cannot be doubted, and that its nutritious properties go farther than to augment the fat in the body is proved by the well-ascertained fact that the muscles and strength also increase under its use. In fact, it has been proved to increase the proteinaceous constituents of the blood except the fibrin which is diminished; in truth, the beneficial operation of cod-liver oil extends to every function and struc- ture of the body. In cases most suitable for its use, there is a progressive improvement in digestion, appetite, strength, and complexion; and various morbid conditions perceptibly di- minish. Thus purulent discharges are lessened, ulcers assume OLEUM JECOPIS ASELLI. 31 a healthier aspect, colliquative diarrhoea and sweats cease; the natural secretions become more copious, the pulse less fre- quent. It is difficult to comprehend how it can produce such marvellous manifold salutary effects." (Through the vegetative nervous system it produces these marvellous effects). "When we remember that in a teaspoonful of oil we are administering a dose of Iodine equal to a drop and a half of its 3d decimal dilution, and that we are generally giving it in cases to which the drug is thoroughly homoeopathic, can we doubt that it exerts a curative action ; if we disbelieve this, we have no rea- son for believing in the action of infinitesimals anj^where. Moreover were it the oleaginous matter per se which cures, why should all attempts to find a substitute for the oil of fishes be so unsuccessful ? " In cases that are benefited by the use of cod-liver oil, the nutrition of the body is at fault, and we find the loss of flesh, or emaciation a prominent symptom, with marked debility, or we may have enlargement of the lymphatic glandular system, and swelling of the cervical, or sub-maxillary glands. Such cases are sure to be benefited by the oil, especially if in little children. There are three varieties of oil in use ; the dark-brown; a brown, and a pure, pale oil. The latter is the only kind that ought to be used for medicinal purposes. The strong smelling and dark-colored oils owe their offensive properties to the partial decomposition and putrefaction that has taken place before the oil is taken from the livers. Speaking about the various kinds of oil Dr. Williams says in his work on con- sumption : " It was- not until the pure, pale oil was brought under my notice that the difficulties in administering it gave way ; and during the last twenty-five years, I have prescribed it (the pale oil) for between twenty and thirty thousand pa- tients, and with such success that it was taken without material difficulty by about 95 per cent, of the whole number, and of those who thus took it, full 90 per cent, derived more or less benefit from its use. This experience, which is in accordance 32 PULMONARY CONSUMPTION. with that of many of my professional friends, is at least quite as strong as any that can be adduced in favor of the brown or impure kind of oil, and it does seem absurd to recommend the exhibition of the remedy in its offensive form, when the pure, fresh oil has been proved to be at least equally effica- cious." To get the full benefit of the oil, its use must be persevered in for at least several months, and some patients will find it their staff of life, and will have to continue it their whole life- time. To preserve the oil, the bottle should be well corked and kept in a cool place; the oil should not be exposed to the air any longer than it is necessary to take it. Dr. Mayhofer says: " Cod-liver oil justly merits the high reputation which it has acquired in correcting those deficien- cies of nutrition commonly comprehended in the terms of scrofulosis and tuberculosis. In patients exhibiting a stru- mous diathesis, of a slender and lean figure and thin, trans- parent skin, we generally find combined a frequent weak pulse, great excitability of the nervous system, with high specific gravity of the urine—all signs of an accelerated me- tamorphosis. It is in this condition that the action of Cod- liver oil has obtained its anti-scrofulous fame. In a short time after its use the angular forms acquire more roundness, and the general susceptibility, as well as the morbid phen- omena, gives way to its influence. Scrofulous individuals however, who exhibit a fatty, puffy, leuco-phlegmatic body, swollen nose and upper lip, slowness of the cardiac contrac- tions, defective irritability of the nervous system, and low specific gravity of the urine, far from being benefited by Cod oil are the very victims who have been made to swallow it by quarts, and to no purpose. The reason of this is obvious : fat requires nearly double the amount of oxj-gen for its combus- tion (100 : 292.14) to that. demanded by albumen (100 : 153. 31) and as it evinces a greater tendency to generation of acid than the latter, acts, when introduced into the organism, the OLEUM JECORIS ASELLI. 33 part of a moderator to the metamorphosis of nitrogenous substances. On the other hand, that part of the oleagenous matter which has not furnished its share towards the pro- duction of animal heat by combustion, does so by its ac- cumulation under the cutaneous surface, or enters as a neces- sary element into the formation of cells. It is thus evident that Cod-liver oil can only be of service when the destructive nutritive process prevails over the constructive one, and that otherwise its agency must rather increase than diminish a lymphatic tendency of constitution. But the virtues of this animal product are, by a great num- ber of physicians, attributed in a measure to the Iodine con- tained in it. There can be no doubt as to the salutary in- fluence exercised by this metalloid over some special scrofu- lous affections ; but this does not destroy the fact that Cod oil, like any other fatty substances (the fat of dogs is a popu- lar remedy in Germany for scrofula and phthisis), produces its best effects on lean persons, who as physiology teaches consume more oxygen and excrete Carbonic acid and bile than fat ones, while on those who show a disposition to the forma- tion of adipose tissue, it effects a contrary result to that which is desired, in spite of the Iodine which it contains. Cod oil is a specific only in a limited number of morbid conditions : in the majority of instances it derives its importance from its value as a nutritive* agent arresting a preternatural waste." Dr. Walshe, an allceopathic physician, whose authority on this subject, no physician can out-rank in any school draws the following conclusions. (1.) That Cod-liver oil more rapidly and more effectually induces improvement in the general and local symptoms than any other known substance. (2.) That its power of curing disease is undetermined. (3.) That the mean amount of permanency of the good effects of the oil is undetermined. (4.) That it relatively produces more marked effects in the third, than in the previous stages. 34 PULMONARY CONSUMPTION. (5.) That it increases weight in favorable cases with singular speed, and out of all proportion to the actual quantity taken ; that hence it must in some unknown way save waste, and render food more readily assimilable. (6.) That it sometimes fails to increase weight. (7.) That in the great majority of cases where it fails to increase weight, it does little good in other ways. (8.) That it does not relieve dyspnoea out of proportion with other symptoms. (9.) That the effects traceable to the oil in the most favor- able cases are : increase of weight, suspension of colliquative sweats, improved appetites, diminished cough and expectora- tion, cessation of sickness with cough, and gradual disappear- ance of physical signs. (10.) That in some cases it cannot be taken either, because it disagrees with the stomach, impairing the appetite (without being itself absolutely nourishing) and causing nausea; or because it produces diarrhoea. (11.) That in the former case it may be made palatable by associating with a mineral acid; and in the latter prevented from affecting the bowels by combination with astringents. (12.) That intrathoracic inflammations and haemoptysis are contra-indications to its use, but only temporarily so. (13.) Diarrhoea if depending on chronic peritonitis, or secre- tive change, or small ulcerations in the ilium is no contra- indication to the use of the oil; even profuse diarrhoea caused by extensive ulceration of the large bowel, is not made worse by it. (14.) That the beneficial operation of the oil diminishes, caeteris paribus, directly as the age of those using it increases. (15.) That the effects of the oil are more strikingly beneficial when only a small extent of the lung is implicated in an ad- vanced stage, than where a relatively large area is diseased in an incipient stage. (16.) That where chronic pleurisy, or chronic pneumonia exists on a large scale, the oil often fails to relieve the pectoral symptoms. CAUTION—EXHIBITION. 35 (17) That it often disagrees, when the liver is enlarged and probably fatty. (1H.) That weight may be increased by it, the cough and expectoration diminish, night sweating cease, the strength which has been failing remain stationary under the use of the oil, and yet the local disease be all the while advancing. " Singular proof," says Dr. Walshe, " of the nutritive power of the agent," and, we may add, of its inefficiency as a medicine. "This admirable exhaustive summary of the knowledge which is possessed of the subject to which it relates, confirmed, as it has been, by the conclusions of competent observers, shows a wide difference between the anticipations which were indulged respecting the virtues of Cod-liver oil and the sober realities of experience. But enough remains to prove that among the remedies that have been proposed for pulmonary consumption, none can be compared with this in efficacy. More than any other, it mitigates the symptoms of the disease, and delays its march; while in some cases it appears permanently to arrest the degeneration of tubercles already deposited, and so to im- prove the nutrition as to prevent the formation of new ones." —Stille. Dr. H. C. Wood says : "There can be no doubt that con- sumption often commences with catarrh, and is often developed slowly, as the result of frequently " catching cold." When- ever a patient is feeble, pale, somewhat anaemic, complains of his liability to catch cold on the slightest exposure, even though no local disease exists anywhere, or rather because no local disease exists anywhere, there is cause for alarm; and it is of the most vital importance that the patient be put upon a tonic treatment whose basis is Cod-liver oil." Caution.—Cod-liver oil "should not be administered in- discriminately during the persistence of acute febrile symptoms, congestion, haemorrhages, or any active form of disease; digestion being then impaired, and the mucous membrane irritable, the oil is only likely to increase the disorder. The sphere of Cod-liver oil is to remove exhaustion and impart 36 PULMONARY CONSUMPTION. general tone; this is best accomplished when active morbid processes and local irritation have subsided, for then the system is in a condition to appropriate a larger amount qf nourish- ment."—Dr. Ruddock. Exhibition.—Many people and even children have no trouble in taking Cod-oil, in fact Cod-liver oil is taken better by children than by grown people ; but, with some the sweetest oil is taken with great difficulty ; those who are so sensitive, should take it in the form of capsules, or by inunction. One of the best methods I have ever found to administer it is for the patient to suck the juice of a lemon, or chew a little of the lemon skin before taking the oil, and the same after, the taste of the oil is generally all gone in one minute after. Another good way is to take it floating on a weak solution of phosphoric acid, or an infusion of orange peel, the quantity of the vehicle should not exceed a tablespoonful, with a teaspoon- ful of the oil, which should be gradually increased to a table- spoonful for adults, and half the quantity for children. The oil should be taken morning and night, directly after eating. Experience has taught us that if taken directly alter eating it is not so apt to disagree, and rises much less, leaving the appetite free for the next meal. If taken on an empty stomach it leaves for hours a rancid, unpleasant taste, with frequent eructations, tasting of the oil. Children generally take it very readily; if they should not like it, the best way is to form an emulsion with the yolk of an egg, or mucilage, and flavor it with some syrup, or if the child is very young, the first three decimal triturations can be given in many cases with excellent results, at the same time it can be used on the child by inunction. Dr. Hempel says: " If the stomach should not be able to retain the oil, a minute portion of common salt, taken both before and after the dose of oil, will sometimes enable the stomach to bear this remedy when all other devices fail." Dr. Ruddock says: " Probably the best method of rendering the oil palatable is to have it made up into bread, as it is then EXHIBITION. 37 scarcely tasted. The proper proportion is two to four table- spoonfuls of the oil to one pound of dough. Patients to whom we have recommended this method of taking the oil assure us that while pleasant and digestible, it is as efficacious taken in this as in any other way.' " Small pieces of ice in each dose of oil also render it almost tasteless." " Its assimilation is promoted, and its beneficial action greatly enhanced, by the addition of ten drops of the first dilution of Iodium to each pint of oil. This addition is especially recom- mended in Phthisis Pulmonalis, and Atrophy." " Claret is another vehicle for Cod-liver oil. The oil should be poured upon the wine, so that it does not touch the glass, but floats as a large globule ; in this way it may be swallowed untastecl." A correspondent of the Lancet suggests the following method of taking Cod-liver oil. " Take one orange and divide it into two equal parts; squeeze the juice of one half into a cup ; pour the oil upon it, then squeeze the juice of the other half very gently on the oil. By swallowing the whole cautiou-Jy, not the least taste of the oil is experienced." Dr. Buchner, in'his essay on " Air and Lungs," adverts to the fact that, in England they burn Cod-liver oil in several light-houses; and that a number of lighthouse-keepers, who had been threatened with phthisis pulmonalis, before entering upon the duty above-mentioned, and who inhaled day after day, the air of the lantern impregnated with the volatile parts of the oil, became fleshy and robust. I have acted on the above hint for five or six years past. In all my prescriptions of Cod-liver oil I have directed the inhalations of the vapors arising from gently heated (not burned or scorched), crude Cod-liver oil and have in more than one case, seen happy re- sults. I direct my patient to fill a saucer with the crude oil, place the saucer over a tin dish, filled with sand, and heat the bottom of this either by a stone, or other convenient means. To some the effect is very soothing and grateful. I remember only one instance in which the inhalation of the fumes was at 38 PULMONARY CONSUMPTION. once very distasteful and nauseating, that of a young lady whose health faih.d repeatedly whenever she lived in New Bedford (near salt water), and gained on her going west to Illinois." G. F. Matthes. New England Medical Gazette, vol. 6, p. 6. I have tested the fumes of 1 he oil as given above, and am pleased with its action. Inhaling the fumes all night during sleep, will be found of much value in the first stages of phthisis. Latest Modification of the Cod-Liver Oil Emulsion.—We have several times called attention to an emulsion of Cocl-liver oil and phosphoric acid. The last report of the Utica Insane Asylum contains a formula for an emulsion that has long been in use in that institution, and to which our attention was first called by Dr. Andrews. We have experimented consider- ably with various modifications of the original prescription. The latest formula, and one that suits us better than any other, is the following : B Cod-Liver Oil...................iv. oz. Glyconin.......................ix. dr. Glyconin is made by thoroughly triturating glycerine and yolk of egg, equal parts. Add to the glyconin thirty drops of the essential oil of bitter almonds; then add the oil to the glyconin very slowly, drop by drop, stirring vigorously all the time. The success of the emulsion depends on the thorough- ness with which this task is performed. Then add— Jamaica Rum........................ii. ozs. (Jamaica rum seems to cover the taste better than sherry wine, which has usually been employed.) Dilute Phosphoric Acid..........oz. ss. to oz. i. The average dose is one tablespoonful after meals, being- regulated mainly by the phosphoric acid. The above combination is a most excellent brain and nerve food. If properly prepared it does not separate, keeps for a KOUMISS OR MILK WINE. 39 long time, and is rather agreeable to the taste. If need be, pyrophosphate of iron can be added, or strychnine, or Fowler's Solution. We have used it especially in hysteria and allied affections, and in organic diseases of the nervous system it is also valuable. Consumptives frequently take it in preference to Cod-liver oil. As Cod-liver oil has a somewhat unpalatable name, it is sometimes better, in prescribing for nervous patients, to call this the phosphoric emulsion. The fishy odor cannot be entirely neutralized; but for those who are not familiar with Cod-liver oil, neither the odor nor taste of this emulsion, when well made, suggests the presence of the oil.—Arch. Electrology and Neurology. As to the kind of diet the patient should use while taking the oil Dr. AVilliams says : " With some individuals the oil agrees so well and so much improves their digestion, that they require little or no restriction in diet, but this is not the case with the majority. The richness of the oil does prove more or less a trial, sooner or later, to most persons, and to diminish this trial as much as possible, it obviously becomes proper to omit, or reduce all other rich and greasy articles of diet. All pastry, fat meat, rich stuffing, and the like should be avoided, and great moderation observed in the use of butter, cream and very sweet things. Even milk in any quantity is not generally borne well during a course of oil, and many find malt liquor too heavy, increasing the tendency to bilious attacks. A plain nutritious diet of bread, fresh meat, poultry or game, with a fair proportion of vegetables, and a little fruit, and a moderate quantity of liquid at the earlier meals, common- ly agrees best, and facilitates the exhibition of the oil in doses sufficient to produce its salutary influence in the system." KOUMISS OR MILK WINE. Fermenting Milk. This natural dietetic remedy has been used extensively by the inhabitants of Tartary, in Consumption, and diseases where V 40 PULMONARY CONSUMPTION. emaciation is a marked feature, with most marvelous effects ; in fact with such success, that scrofula, and consumption are almost unknown to them, and travellers from all parts of Eu- rope, suffering with phthisis, go into their country to submit themselves to a course of Koumiss, many of whom have returned in perfect health. The success in phthisis has been so great that the imperial government of Russia has established, and supports institutions devoted to the manufacture of Koumiss, and yet here, in progressive America, Koumiss, with all its vir- tues, is nearly unknown to the profession; but few things in nature have eluded the keen-eyed American, and why has this ? Fermenting milk is the most easily digested food known to the physician, and containing all the elements of pure milk, consequently contains about all the elements of the human body, it becomes us as physicians to thoroughly investigate all its properties, especially if it is of such value in arresting tu- berculosis. Dr. Jarotzki, gives the following receipt to make Koumiss (Kumiss). " Take one tablespoonful of pure honey or golden syrup; eight ounces of brewer's yeast; four ounces of wheaten flour ; mix thoroughly and add a cup of fresh, tepid milk; make a dough of it, and put it in a warm place, to remain over night. In the morning wrap it in a clean cloth, and place it in an earthen, or china vessel; add to it eight pints of tepid, fresh milk; cover the vessel with a woollen cloth and put it in a warm place, stir it thoroughly several times during the day with a wooden spoon, and in two or three days the fermenta- tion will take place, and fresh Koumiss be produced. Take off for the first day's use two or three pints, and at the same time add the same quantity of fresh, tepid milk. Stir it thoroughly and let it ferment again. Repeat this process from day to day, until the taste becomes more acidulous and the fermentation ceases, when new yeast has to be made again. Koumiss is therefore a fermenting, and not a completely fermented milk." Since writing the above, I have succeeded in getting from KOUMISS OR MILK WINE. 41 my friend, A. Arend, Esq., of 521 W. Madison street, Chicago, the following method to prepare new Koumiss from the old. Mr. Arend is the only chemist, I believe, in the United States, that has really succeeded in making good Koumiss, and he ex- perimented one year before he considered himself qualified to make a good article of the Milk-wine. It is made with such difficulty that it requires the nicest manipulation and most careful attention to all the minor details to succeed. " The only mode of preparing good Koumiss is that followed in every Tartar household. The manipulation is the same for both mare's milk and cow's milk Koumiss. Mix one part of the old Koumiss, with five parts of fresh milk, warmed to a temperature of 70° Fahr.; put into a churn and agitate with a churn stick lively at short intervals for the space of three hours ; by this time the fermentation is en- gendered and the fresh Koumiss is ready for bottling ; after bottling put into a cool place for twenty-four, or forty-eight hours, when it is ready for use." To prepare new Koumiss, he uses Dr. Jarotzki's receipt, as noted above, with some few exceptions. This, the most assimilable of nutriments, contains 980 grains of solid respiratory and plastic food to the quart. An analysis by Wanklyn, a London Chemist, gives the fol- lowing result from a quart of Koumiss. "Water........... 10,662 grains Alcohol............192 „ Casein and Albumen . . . 128 „ . Lactose............ 582 „ Lactic acid..........130 „ Fat................36 „ Ash..............•. . 90 „ Carbonic acid........180 „ 12,00 "The ninety grains of ash contains approximately 60 grains of 4 42 PULMONARY CONSUMPTION. phosphate of lime and 30 grains of mixed chlorides of sodium and potassium. The physical and chemical characteristics of Koumiss render it an aid upon which the physician can rely with great confi- dence, for the treatment of extreme debility, and all the phases of impending marasmus." Koumiss not only contains a large proportion of lactic acid, which is a prime constituent of the gastric juice, but holds the casein in that state of vitality which gives it the property of metamorphosing itself and the other constituents of the milk into healthy lymph and blood. " The process of double fermentation in the preparation of Koumiss does nearly all the preliminary work of digestion, that otherwise must be performed by the stomach. There is no other derivative of milk, or any other substance, that pos- sesses the same advantages; for, containing all the elements of nutrition, and just in that proportion necessary to maintain healthy life, it may constitute a sole diet in cases of disease." Its great sphere of usefulness is in emaciation, similar to Cod-liver oil. Koumiss gives the best results in the first stages of consump- tion, with emaciation, shortness of breath, tiresome, loose cough, haemoptysis, night sweats, diarrhoea and great debility. " The original Koumiss of the Tartars is made from mare's milk, but chemical research, and the experience of the last ten years proved that cow's milk is an equally good raw material, if not better, and there is no doubt that cow's milk Koumiss gives highly successful results in proper cases, as shown in the Koumiss cures of Odessa, Warsaw, Cracow, St. Petersburgh, Berlin, Dresden, London, &c." This sparkling and nourishing beverage should be taken like any other food, when the desire for it is felt, and in suf- ficient quantities to nourish the body. " The quantity to be taken at a time should be suited to the individual, age and condition of the partaker; if the stomach be irritable, as is generally the case in debilitated constitutions, EXTRACT OF MALT. 43 but a small quantity, for instance a wine glass full, should be taken at once, and this quantity frequently repeated, until as much as one-half or one quart bottle is consumed in a day. As the patient grows stronger and accustomed to this new diet, he will learn to relish the Koumiss and he will be able to take one-half, or one gobletful, or more at a time, and as much as two or three quarts in a day." Infants may be fed on Koumiss exclusively, and they soon learn to like it. How to keep Koumiss.----It has a sweetish sour taste: when at rest, sometimes it will separate in several layers.. It then requires to be shaken before using, in order to mix all particles uniformly. If kept in a cool place, between 40°Fahr. and 50°Fahr., Koumiss will remain good for months. In a temperature exceeding 60°Fahr. it will soon become unpalatable, and unfit for use. In winter, spring or fall when the temperature of the atmosphere does not exceed 60°Fahr. it may be kept in a cool cellar, protected against frost; in sum- mer, when the temperature is above 60°Fahr., Koumiss must be kept on ice. How to open A bottle of Koumiss.—Koumiss being very effervescing, it requires careful handling in order to prevent waste or damage to surrounding objects. Shake it up well, then allow it to rest five minutes, the bottle standing; place a pitcher by the side of the bottle, cut the string, remove the cork quickly, and immediately hold the mouth of the bottle, the bottle itself being slightly inclined upward, over the pitch- er, and let the liquid work out by its own force. When all the force is expended, set the bottle down, take from the pitcher what is needed for immediate use, and pour the balance back into the bottle. A more convenient way is to draw the Koumiss by means of a champagne tap. By using the tap, waste is obviated, and any desired quantity may be drawn at a time, and the full spark- ling liquid is retained to the last drop. Hoping that this short notice of milk wine will be the means 44 pulmonary consumption. of causing many to use the nourishing beverage to the great benefit of many suffering invalids, I will refer the reader to larger works devoted wholly to Koumiss. Having seen its salutary effects in my practice, I am anxious that every physi- cian should give his patients the benefit of this fermenting milk. extract of malt. The extract of Malt is a most valuable auxiliary in the treatment of phthisis, bronchitis, scrofula, dyspepsia and gen- eral debility. Prof. Niemeyer, and Dr. Aiken recommend it very highly as a nutritious tonic, in fact many physicians use it instead of Cod-liver oil. "A single dose of Trommer's Extract contains a larger quan- tity of the soluble constituents of malt than is found in a pint of the best ale, and as it is prepared without being allowed to ferment it is absolutely free from alcohol and other products of that process. " In Germany, Extract of Malt is extensively employed as a substitute for Cod-liver oil in pulmonary consumption. The combined experience of the medical world has nevertheless placed the oil on a basis of unrivalled excellence. Where, how- ever, patients have taken the oil for a long time and become tired of it, or it is no longer well borne, and also in the case of those who cannot take the oil, the malt may be employed as a most efficient remedy. Dose.—It should be taken three times a day, about one tablespoonful for an adult, and half the quantity for a child. HEMOPTYSIS. Pneumorrhagia, or pulmonary haemorrhage, generally is a source of great alarm to the patient; but usually, we might say, in the great majority of cases, the haemorrhage is a sanguineous exhalation from the mucous membrane of the lungs, and in it- self is not a dangerous symptom, but rather an indication that t haemoptysis. 45 changes are going on in the lungs that will eventually result in fatal tuberculosis. Passive haemoptysis is more intractable than active haemorrhage. When the haemorrhage comes from the lung tissue itself, the symptoms are more violent, and may prove suddenly fatal. The principal remedies for haemoptysis and pneumorrhagia are Aconite, Veratrum viride, Hamamelis, Millefolium, Ipecac- uanha, Phosphorus, Ferrum, Arnica, China, Belladonna, Pulsa- tilla, Crocus, Trillium, Sanguinaria and Sulphur. ACONITE.—Great restless- ness, agitation and fear of death, much congestion of blood to the lungs, with great anxiety. Symptoms aggra- vated at night ; sleeplessness and constant tossing about ; especially if brought on in dry; cold air; short, dry, titillating, croupy cough. Active and sudden cases of haem- optysis or pneumorrhagia, when there is much hyperaemia of the lungs, after a violent fit of passion, or severe exertion of the lungs. Animated people, with a plethoric habit of body, bright complexion, and disposition to palpitation of the heart. The blood is expectorated with a hacking, dry cough, which torments the patient contin- ually ; burning, stinging pains in the chest, the cheeks are flush- ed ; pulse much excited, with great anguish and restlessness; co- pious discharge of bright red blood, sometimes without much coughing ; the face is pale, with an expression of agony in the countenance. The disturbed condition of the mind, with great mental anguish, is the predominating symptom when Aconite is indicated. VERATRUM VIRIDE.—In- tense hyperaemia of the lungs, with a hard, full, quick, bound- ing pulse ; short rapid respira- tions, accompanied by more or less gastric symptoms, sudden haemoptysis. In sudden cases of haemorrhage from the lungs, where the pneumo- gastric nerve is more or less impli- cated. No remedy has such abso- lute control over the circulation, by the use of large enough doses of Squibb's Fluid Extract, to produce slight nausea. Active haem- orrhages can be controlled at will, but in passive haemorrhages 46 PULMONARY CONSUMPTION. it is not so useful. In active haemorrhages from the lungs, this remedy only has to be given to be appreciated. In haemoptysis this is well nigh a specific. No remedy has given us such prompt and satisfactory re- sults, in active or passive venous haemorrhages from the pulmonary mucous membrane. HAMAMELIS.—Especially called for in nervous, passive haemorrhages, the blood is dark and comes into the mouth without any effort, like a warm current out of the chest. Tick- ling cough, with a taste of blood on waking. For passive haemorrhages from the lungs, or any other or- gan, no remedy has given the profession at large such unvary- ing and brilliant cures. Dr. Hughes thinks " the haemorrhages it cures depend rather upon the state of the bloodvessels, than that of the blood." We believe it cures haemorrhages by its specific ac- tion upon the muscles of the capillary blood-vessels, causing them to contract. When the blood comes from the pulmonary mucous mem- brane, this is well nigh a specific, but if the haemorrhage is due to a rupture of one or more blood-vessels from deep ulcer- ation, Aconite, Veratrum viride or Millefolium will be more appropriate. MILLEFOLIUM. — Haemo- ptysis in tuberculosis, brought on by violent exertions, either active or passive. This remedy has a special action upon the vascular capillary circu- lation, controlling active or passive haemorrhages to a marvellous extent. Hartmann says : " In almost every variety of haemorrhage, and likewise in pulmonary haemorrhage, Millefolium is a splendid and indispensible remedy. More especially in the case of robust and fleshy persons ; the spitting of blood is un- attended with cough, or the cough is very slight and is caused by the newly accumulating blood ; at the same time there is bubbling up in the chest, with a sensation as if warm blood HAEMOPTYSIS. 47 were ascending in the throat, gradually increasing in intensity until blood is raised." Jr Spitting of blood, with violent palpitation of the heart and much excitement, accompanied with a feeling of great oppres- sion of the chest, active haemorrhages from deep ulcerations in the lungs. IPECACUANHA.— Haemor- rhages from all the orifices of the body, with great and long continued nausea, accompani- ed by great weakness and aversion to food. Haemopty- sis from the slightest exer- tion. Much rattling and bub- bling of blood and mucus in the bronchial tubes. For acute haemorrhages, no rem- edy is used more frequently than Ipecac, and thousands of patients have been cured by this remedy alone. And the great key for its selection is great and long continued nausea. Spasmodic, suffocative cough; asthmatic breathing; blood very dark, and mixed with mucus. Much rattling of mucus and blood in the bronchi. Constant taste of blood in the mouth. The action of Ipecac in controlling haemorrhages, closely re- sembles Digitalis; they both arrest the haemorrhage through their action upon the par vagum. If there is any organic dis- ease of the heart so as to cause obstructions to the circulation, Digitalis and especially its active principle Digitaline, should be preferred. Digitaline is a remedy of untold value in many pulmonary affections, especially if accompanied with a loose, rattling cough, and intermittent pulse. It should be given in the 3d. dec. or centesimal trituration. PHOSPHORUS.— Sensation of weakness and emptiness in the abdomen, it is so distress- ing that it aggravates all the other symptoms. Stools long, narrow and expelled with great This is one of the most valuable remedies we have in haemorrhages. Dr. W. Arnold, of Heidelberg says: " The changes occasioned by it in the blood, and through the blood in the 48 PULMONARY CONSUMPTION. whole organism, have been over- looked for a long time. In numerous cases of poisoning by means of Phos- phorus-matches, and by Phos- phorus-paste, the changes in the blood are too conspicuous to remain unnoticed any longer. The facts gained in this way were so often confirmed by numerous and oft- repeated experiments upon animals that now they are generally accepted. Almost all ob- servers speaking on this subject, describe the blood as being dark, even black, and of fluid consistence. As a rule it is thin, flowing, more rarely of molasses-like, or of more thick- flowing appearance. In a coagulated state it has been observed so rarely and exceptionally, and then only in a few single parts of the body that we are justified in assuming that the coagu- lation cannot be taken as an effect of the Phosphorus, but is dependent upon other conditions. Upon the whole the blood is more fluid if Phosphorus does not kill quickly, but has a chance to effect changes in the blood in consequence of a more lasting action for several days. These changes, however, fre- quently set in very rapidly, if Phosphorus has been taken in the form of a solution, as, for instance, in butter, fatty oils, or ether. " The results of microscopic investigations of the blood offer important disclosures. Phosphorus occasions an important change in the blood discs, their decrease in consistency and circumference is very conspicuous. They become smaller, more extensible, and consequently can assume different forms ; they change their form in many ways, especially in their pas- sage through narrow vessels, and in their proportion to each other. One might say, almost, that Phosphorus acts as a dis- solvent upon the blood discs. This action touches the blood cell-membrane more than the nucleus. Greater luster, a less granular appearance, irregular and less distinctly defined out- lines, these are the most conspicuous changes of thu blood difficulty. Fatty degeneration of the liver, with much jaun- dice. Strong sexual desire, or impotence from sexual abuse. Tightness across the chest, with dry cough, or rusty spots raised with great difficul- ty. Hard, teasing, dry cough with a sensation as if cotton was in the throat. Slight wounds bleed much. Tall, slim, nervous temperaments. HAEMOPTYSIS. 49 discs which can undoubtedly be ascribed to the direct action of Phosphorus. That these changes take place on account of •immediate action, I have proved in this way : I let Phosphorus oil act upon the blood under the microscope, and thus I wit- nessed changes of the blood-discs, slighter in degree, it is true, yet entirely similar to those observed from the application of Phosphorus during life. In this way I was able to follow up the successive dissolution of the blood-discs. This dissolution was not as great as under continued action of the Phosphorus in the living organism, and undoubtedly, for the reason that not so intimate and lasting a contact with the blood took place. " Besides several other observers, Pummel testifies to a change of the blood, perceptible under the microscope. He could not find a single colored corpuscle, but only colorless discs in the blood of a hen, poisoned by Phosphorus, and Voit made the same observations on a dog, into whose vena cruralis he had injected Phosphorus. According to Pummel, the destruction of blood-discs is the most essential phenom- enon when Phosphorus has been introduced into the stomach, as well as when directly mixed with the blood by means of in jections. The blood-discs separate into haematine and globu- line. The former floats as a purple coagulum in the plasma, or may according to the conditions present, even be dissolved therein, while the form of the latter is still preserved. Another observation of Pummel is very worthy of notice for the ex- planation of haemorrhages after Phosphorus poisoning. If a rabbit, into whose vena cruralis Phosphorus oil had been in- jected, was held head downwards, he soon saw red colored plasma, which under the microscope was free from any blood- discs, flow from the nose. The blood in this dissolved state had passed through the walls of the vessels. On opening a vessel, numerous well-preserved blood-discs could still be found. " To judge from the haemorrhages and ecchymosis, so fre- quently, and, we may say, almost constantly observed in Phos- phorus-poisoning, and from the often confirmed curative action 50 PULMONARY CONSUMPTION. of small doses of Phosphorus in morbus maculosus, and many haemorrhagic changes in the blood, must exist and what are they ? This question is partly answered by the observations of Friedreich. He noticed in a young man afflicted with haema- turia, on whose lower extremities oedema, petechia, in short, an exanthema of an exquisitely haemorrhagic character, had made their appearance, that the blood-discs, passing with the urine, were essentially changed. They were normal as to form and size only in small numbers, but frequently very abundantly formed. Many of them were oblong-oval and presented com- pressions as from ligatures, and so much so, as even to assume the shape of baker-rolls. With others, a division into two un- even halves seemed to be taking place. Not a few had already separated themselves completely and were divided, and this went on until finally blood-discs of the most minute form—mole- cular blood-discs, so to say—were formed. This process of divis- ion could not only be understood from the results of microscopic examinations, but also be observed directly. The whole left the impression, as if the blood-discs consisted in a semi-solid, almost oil-like substance, without any external membrane. Even in a case of sarcoma of the kidneys, Friedreich has re- peatedly seen the above described division of the red blood- discs into molecular forms. The red blood-discs of anaemic, hydrsemic, leucaemic, marasmic and strumous individuals, drawn by Daman, completely resemble a number of the forms presented by Friedreich^ This striking resemblance in the change of the blood, and especially of the blood-discs, after poisoning with Phosphorus shows us why it is of such wonderful efficacy in the eure of haemorrhages. We once cured a case of haemorrhage from the lungs in a tuberculous subject with Phosphorus, when the patient had well-nigh bled to death. Without any effort on the part of the patient the blood would rise into his mouth, so that a quart-dish would be filled in half an hour, faintness would come on, and the haemorrhage would cease for twenty-four HAEMOPTYSIS. 51 hours, and then suddenly come on again. The man was so weak at the end of two weeks that he could not speak above a whisper. Aconite, Hamamelis, Millefolium, Belladonna and Ipecac, all had been tried faithfully and failed. After com- mencing the use of Phosphorus he had no more haemorrhage, and made a quick convalescence. He remained well one year, and then died with pulmonary tuberculosis, without any return of the haemorrhage. This confirms Pane's observation, " Profuse haemorrhage, pouring out freely, then ceasing for some time." It is particularly adapted to tall, slender people, with lively perceptions, and inclined to stoop over forward. In those cases where the blood- plasma is impoverished the albumen and red-corpuscles are decreased and water in the serum sanguinis. Great paleness of the increased membranes, especially that of the mouth. The least mental emotion pro- duces red-flushed face. Haemorrhagic tendency, with fly- ing pains in the chest. " Always better from walking slowly about, notwithstanding weakness obliges the patient to lie down. Quick motion and talking brings on cough, with pain between the shoulders; the face has a yellowish tint; sleep is poor at night, and there is frequent palpitation of the heart." Bellows-sound of the heart, and anaemic murmur of the ar- teries and veins. Especially adapted to cachectic and leucophlegmatic indi- viduals, and to diseases where the vegetative system is in- volved. " (Edematous swelling of the body; cool skin; constant with fiery-red face ; the least emotion produces a fiery-red face, anaemia with great debili- ty,pale face and lips. Haemop ysis better when walking slow- ly. Lienteria, undigested stools, without pain. Chlorosis ; watery leucorrhcea. Great variability of the mind. (Ed- ema of the feet and legs, with bloated face, and great debil- 52 PULMONARY CONSUMPTION. chilliness, and evening fever, likening hectic fever."—Hempel. The slightest exertion exhausts the patient. ARNICA.—Traumatic hae- moptysis. The patient feels sore as if bruised. The bed on which he lies feels too hard; keeps continually changing from place to place. Face hot, while the body and limbs feel cool. Myalgic pains of the in- tercostal muscles. Haemoptysis in weakly people greatly troubled with many muscu- lar pains; the pains occur in all the voluntary muscles or their ten- dinous prolongations. Haemoptysis in people that are subject to boils, and extravasations of blood into the cellular tissue, especially if from some me- chanical cause. The extravasations are quickly taken up by the venous cap- illaries. Eructations of putrid gases, as if from rotten eggs. Haemoptysis from slight bodily exertions, with constant tickling cough starting from the sternum. "Particularly useful in venous, plethoric, not very robust individuals; the respirations are very much oppressed during the bleeding; the patient is very much disposed to vomit; the attack is caused from every slight exertion, especially in young people." Hartmann. The expectoration is generally dark red, and raised without much effort. CHINA.—Patient has lost a large quantity of blood, and is worse every other day. Sensation of great distention of the abdomen, not relieved by eructations or dejections. Sour stomach, with debilita- ting, watery diarrhoea, aggra- vations at night, copious night sweats. symptom. Haemoptysis in people who have lost much blood, with singing in the ears, and fainting. Long - lasting, congestive head- aches, worse at a certain time every day. Great anaemia from loss of blood, where debility is the prominent HAEMOPTYSIS. 53 BELLADONNA.—Haemop- tysis with a dry, teasing, spasmodic cough. Haemorrhage comes on sud- denly, and is worse evenings. In robust, plethoric people, catarrhal haemoptysis, in pleth- oric people. " This remedy is " particularly ap- plicable in robust, plethoric individ- uals, and for congestions towards the head, without any cardiac irregularities being complained of; also more particularly if the haemorrhage was the result of an incipient catarrh." Baehr. In tubercular haemorrhage Baehr has no confidence in Bel- ladonna, but if it is vicarious, or at the critical age, he has great confidence in its medicinal virtues. Expectoration of bright-red blood, with great congestion of blood to the chest, aggravated by motion, with throbbing head- ache. PULSATILLA. — M u c h chilliness with expectoration of dark, coagulated blood, vi- carious menstruation. Menses suppressed. Inclined to diar- rhoea. Symptoms aggravated in the evenings. Great crav- ing for fresh air, must have the doors and windows open; feels like suffocating in a warm room. Patients that are very tearful; weeps at everything, whether joy- ful or sorrowful. Haemoptysis, with a loose, rattling cough, the bronchi seem loaded with mucus and blood. Haemoptysis in women that have suppression of the men- ses. Sub-acute haemoptysis with dark, venous blood, especially in females who are constantly chilly. More especially adapted to females, but acts well on both sexes. CROCUS. — Haemoptysis where the blood is dark and stringy, with much mental de- jection. On raising a clot of blood long strings drop from it. Great debility and palpitation of the heart. Passive haemoptysis is worse evenings. Acts better in women, subject to uterine haemorrhage of dark coagulated blood ; as it is dis- charged it forms into long strings. 54 PULMONARY CONSUMPTION. SULPHUR. — Frequent flashes of heat, which pass off with moisture and debility. The top of the head is contin- ually hot. Early morning diarrhoea, or obstinate consti- pation. Stools acrid produc- ing excoriation. Ichorous discharges from the nose, va- gina or anus. Chronic haem- optysis seems to get almost well, when it returns again and again for weeks. Has many weak faint spells. Heat in the chest with bloody ex- pectoration . Mental symp- toms, everything looks beau- tiful which the patient takes a fancy to, with happy dreams constant heat in the soles of the feet, puts them out of bed to find a cool place for them, weak faint spells, cannot wait for dinner. chronic morning diarrhoea. This remedy will be found of great value in those cases that of- ten seem to get about well, when relapses occur again and again, day after day for a long time. The cough is loose and rattling, with a suffocating feeling, wants the doors and windows open, craves fresh air so much. Often has weak faint spells about 11 A. M.; cannot wait for dinner. Bends forward when walking, does not walk erect. Great disinclination to being bathed. Diseases caused by suppressed eruptions, especially the itch. Adapted to lymphatic constitu- tions, disposed to constipation and haemorrhoids, or to people with there are many more remedies that may be useful in haemoptysis, such as Trillium, Erigeron, Gallic Acid, Ergot, Ustilago Mades, Sen- ecio, Aurnens, Carbo veg., Terebinth, Conium, Opium, Tartar emetic, Hyospyamus, Drosera, Nitric Acid, Sulphuric Acid, Collinsonia, Apocynum, Sanguinaria, Cactus, Rhus tox., Lyco- podium, Lycopus, Stannum, Calc. carb. and phos., Sepia, Lachesis, Ledum, Arsenicum, &c, &c. For the special indications of the above remedies, the read- er is refered to the Materia Medica. Usually, however, one or two of the mentioned remedies will be all that is required. PRACTICAL EXPEDIENTS. —Dr. Ruddock says:— " The subcutaneous injection of Morphia will control the haemorrhage almost instantly in a majority of cases." HAEMOPTYSIS. 55 The cautious use of cold water, or ice, in severe cases, we believe to be of much service. The ice should be put into a bladder so as to keep the patient from getting wet, and there should be a towel folded several thicknesses and laid upon the chest, and the bladder of ice placed upon the towel, and not on the chest. We have seen great benefit from the use of ice applied in this manner. Ice may be sucked freely, but the better way is for the pa- tient to swallow small pieces of ice and let it dissolve in the stomach, in close contact with the lungs. Dry cupping has been found of signal service in profuse haemoptysis. Its action is immediate and decisive. The cups should be applied over the chest, and in the inter-scapular and scapular region. STYPTICS.—Such as Gailic Acid, Acetate of Lead, Tan- nic Acid, Sulphuric Acid, Alum, Perchloride of Iron, and Ergot of Rye, are the principal styptics depended upon in the old school practice. I have never used them and cannot judge as to their merits. The Hydrate of Chloral might be of much value as a palliative. The patient must be kept quiet in bed if pos- sible, and his mind free from all excitement. The room should be cool, and his beverages should also be cool, and free from alcoholic stimulants. The diet should consist of cold beef tea, chicken broth, milk, cold tea, coffee, &c, &c. DIET.—A very important item in the treatment of phthi- sis is the diet of the patient. It should be very nutritious and of a non-stimulating nature. We believe that stimulating food, such as all kinds of liq- uors, are instead of a benefit, an actual injury to the patient. Stimulating drinks lash the digestive organs into an excited feverish state, when there is fever in the system already free from disease. A small quantity of nutritious, easily digested food, should be taken at a time, on account of the little gastric juice secreted, from the feverish condition of the system. 56 PULMONARY CONSUMPTION. " Dr. Beaumont observed that there is always disturbance of the stomach when more food has been received than there is gastric juice to act upon it; i. e., a condition induced sim- ilar to that which is present in fever, namely, that the gastric juice' not being able to act on the undigested food, the stom- ach is irritated just as if the food had been introduced into the stomach when the system was in a febrile state. " If to these facts is added the fact already referred to, that the gastric juice combines with only a given quantity of ali- ment, it becomes apparent that in weak stomachs, and in per- sons laboring under disease, the supply of gastric juice being diminished by the state of disease, the evils of taking a large quantity of food must be indeed great." (Constipation, by J. Epps, M. D.) The patient cannot be too cautious with his diet. Hunger being dependent upon a state of the brain, it may be so irri- tated as to cause a false hunger, and whatever is fancied can- not be indulged in, for serious results may follow, especially if the digestive organs are implicated. MILK is an article of diet we greatly prize in phthisis, and all writers on consumption esteem it highly, especially the milk of asses. Goats' milk has also gained considerable repu- tation. Many physicians recommend the use of lime water and milk. We believe the reason that milk has given such satisfaction in phthisis is because it is so easily digested. The intestinal canal cannot tolerate solid food, but the milk is assimilated into tissue with the greatest ease. Soups made from beef, mutton, veal, oysters, &c, &c, will also be found of great value. When milk disagrees the Koumiss will frequently be a lux- ury to the patient (see Koumiss'). fish is another article of diet of great value in this dis- ease, and often ought to be indulged in, for we believe it builds up the nervous tissues, especially the ganglionic nerve HAEMOPTYSIS. 57 globules, which we believe is the starting point of this fatal disease. Fish eaters are " especially strong, healthy, and pro- lific. In no other class than that of fishers do we see larger families, handsomer women, and more robust and active men." Probably the most suitable fish for the consumptive to use are the white fish and trout, they contain but little fat, and are easily digested. To those who are called upon to put forth great nervous energy we would recommend fish once a day for supper. Especially would we recommend the smoked halibut. " Salmon stands pre-eminent as a delicacy, and more nearly resembles meat than other fish; fat is intermixed with the muscular fibre and underlies the skin, particularly of the abdomen; it is, therefore, rich, too rich for most invalids. Mackerel, Herring, Pilchard, Sprat and Eel are also fatty in their composition. These are less suitable than the white fish, for those whose powers of digestion are feeble. These are Whiting, Sole, Haddock, Flounder, Cod, Turbot, Brill, etc. Their flesh contains but little fat, except in the liver. Whit- ing, the chicken of fish, is the most delicate and easy of di- gestion. Sole possesses the same excellencies and deserves its popularity in the sick room. Haddock is firm, not so delicate, nor so digestible. Flounder is tasteless, but otherwise suit- able. Cod is close, firm, tough, and indigestible by a weak stomach. Turbot has richer flavor, but does not stand high as food for invalids." " The quality of all fish is superior before the spawning, when it is ' in season.' " " Fish caught from deep seas are bet- ter than those from shallow bays. Freshwater fish from deep clear water, with stony bottom, are better than those from muddy shallows." " For the invalid it should always be boiled or broiled, the fat added in frying renders the fish less digestible. Dried, salted, smoked, or pickled fish should not be seen in the sick- room."—Dr. Ruddock. As a rule, Shell-fish are unsuitable for the invalid, such as the Lobster, Crab, Prawn and Shrimp. They produce gastric irritation, etc., but the 5 58 PULMONARY CONSUMPTION. OYSTERS form an exception, they are not only nutritious, but easily digested, excepting the hard portion that was at- tached to the shell; that should not be eaten. They should be eaten raw and well masticated before swallowing. MEAT, as an article of diet, will be of great value in this disease, such as beef, mutton, and all kinds of game, including the various kinds of Poultry. These should be fresh and plainly cooked. All rich sauces, gravy, or stuffing, should be excluded. The diet should be often varied, by the introduc- tion of fish, game and poultry, but butcher's meat, not over- loaded with fat, should preponderate. The use of raw meat, where there is great emaciation, has often been invaluable. The French mix the raw meat with sugar, and it forms a palatable sweetmeat much liked by chil- dren. The French also practice drinking fresh lambs' blood. We have no doubt but the blood is really valuable, it being so easily assimilated, but it seems so disgusting we believe but few patients could be induced to use it. Fresh vegetables, and especially ripe fruits, should be used in abundance. CLOTHING.—Consumptive people are very susceptible to the process called " catching cold," consequently, should be warmly clothed, though not to such an extent as to produce much perspiration, or diseased fat. The extremities, especially, should be kept warm, to prevent congestion of blood to the lungs. The under-clothing is the most important point to be attended to, which should be of flannel, lambs-wool or silk, and should be worn the year round. In summer it neutralizes any variation of temperature, and prevents sudden cooling by / evaporation. In the winter it prevents the loss of the vital warmth of the body. In the winter an addition of a chamois leather vest may be worn over the flannel. In the summer, during the warmest weather, a cautious change to thinner flannel of fine merino may be advisable. The circulation seems so easily chilled, he cannot be too cautious in cold weather, by wrapping up warmly in furs and rugs, and if these do not keep his feet warm, extra heat should be used by means CLOTHING.—COUGH. 59 of a warm brick or flask of hot water to the feet. To prevent injury from the exposure of the chest to cold, every consump- tive person should have a waistcoat buttoned to the chin, and should wear the beard long, and women should avoid low dresses, and have a shawl ready for protection at all times. COUGH. This being one of the most prominent symptoms of pul- monary phthisis, requires the most careful and critical atten- tion of the physician. No one symptom causes the pa- tient more anxiety of mind than cough, and it makes no dif- ference whether it is due to organic lesions of the respiratory organs, or nervous irritation, caused by reflex action from some distant organ ; the cough must be cured, or the patient will seek some other physician. We are, therefore, compelled to include under this symptom all kinds of cough, and in doing so we most gladly and gratefully avail ourselves of the practical, clinical hints given us by Dr. B. Hirschel. He says: tk A cough is a short, resonant, more or less forcible impul- sive expiration, with a more or less narrowed glottis, occur- ring generally after a deeper and more powerful inspira- tion. The cause of the different tones usually depends on the vocal formation. Expirations and inspirations often alternate. A cough can be produced voluntarily and also directly from the spinal cord; generally it is a reflex action depending on conditions of the mucous membrane (inflammation, catarrh, collection of mucus, nervous excitement, foreign bodies, such as dust and the like) of the superior parts of the air-passages, especially of the larynx, and very often of the thoracic organs (bronchi, lungs). " Formerly a cough was looked upon as the most positive sign of a lung affection, but experience has taught us that it may be totally absent in such cases, even in pneumonia, and tuberculosis. On the other hand^a cough may be present in conditions that have no connection with the thoracic organs, viz., in many cerebral and spinal diseases, from an elongated 60 PULMONARY CONSUMPTION. uvula, from diseases of the heart, pharynx, oesophagus, stomach, uterus and intestinal canal, so that it may even simulate phthisis. " Likewise mechanical influences, such as tumors, may pro- duce a cough by pressing on the vagus, but as soon as there is a spot in the respiratory organs where the tissue has become destroyed, greatly compressed, paralyzed by exudations, or be- come callous, or the susceptibility has become deadened (Wunderlich) then the irritation which caused the cough van- ishes. " The individual kinds of cough accord pretty definitely with certain forms of disease, so that from its tone, or kind, we can draw conclusions as to the seat and form of the disease. But we must be very prudent in thus drawing conclusions, so as not to be led into manifold and great mistakes. Thus we like to differentiate laryngeal, tracheal, bronchial, pulmonary coughs from their tone and depth, yet we cannot do this with icertainty. From its degree, from the periodicity of the at- tacks, some pretend to recognize, now a beginning tubercu- losis, then a simple catarrh, or a pneumonia, or emphysema, or spasmodic cough, yet there is no certain criterion for all this. The most insignificant morbid process may cause a severe and exhausting kind of cough, such as is often the case in neuroses. " Our judgment must depend on the repetition of the cough, as also on the fact of its being by day, by night, and on its in- termissions, which sometimes last for weeks, and on its being paroxysmal; inasmuch as the tone depends more on the con- dition of the larynx than on that of the more deeply lying thoracic organs, so it will be evident that it cannot be made use of for diagnostic purposes. " The kind of secretion is of very great importance. Dry, chronic coughs are always suspicious, unless they are purely nervous. " The cough is dry at the commencement of the organic disease, and only gets moist when the secretions become move- able. If the secretion comes from far down, the condition is always more dangerous than when the cough is superficial, CLOTHING.—COUGH. 61 and if the secretion becomes continuous and yet affords no re- lief, and the strength begins to fail, then the prognosis is un-. favorable. Such is the case in chronic bronchitis, in tuber- cular suffering, and pulmonary abscesses. " For the physician treating a cough, no matter what school he may belong to, it is important that he distinguish— " a. The seat and point of origin of the cough. " Here we must see whether the cough has its origin in the larynx, in the trachea, in the bronchi and its ramifications, or in the lung itself; in the pleura, in the heart, in the vagus, in the spinal chord — whether the mucous membrane or the parenchyma itself, the blood-vessels or the nerves (primarily or secondarily) are affected. " b. Its character, as regards the casual morbid process. " It is especially important to know whether the process be catarrhal, simple, or complicated with fever, acute or chronic catarrhal; whether it be inflammatory (acute or chronic, sim- ple or croupous) ; or whether it be organic (with textural changes or not); or whether it be nervous (origin peripheral or central.) " Arranged in this manner, we find a cough is a most im- portant symptom in the folio wing forms of disease : " I. In simple catarrh, acute or chronic, and with or without fever, to wit: " (a.) Laryngeal catarrh. " (b.) Tracheal catarrh. " (c.) Bronchial catarrh. " (d.) Pulmonary catarrh. " (e.) A peculiar form of epidemic catarrh, such as influ- enza. II. In inflammations of the vocal and respiratory organs, acute or chronic in form, to wit: "a. Laryngitis, simple or croupous (angina membranacea,) diphtheritic, aphthous, pustular, submucous inflammations, oedema glottidis, perichondritis, epiglottidis. " b. Tracheitis. " c. Bronchitis—simple, croupous, diphtheritic. 62 PULMONARY CONSUMPTION. " d. Pneumonia—simple, croupous, intestinal, or hypostatic. III. With organic metamorphosis of the vocal and respiratory organs. "a.b. Laryngeal deformities and neoplasmata, helcosis laryngis, tuberculosis, polypi, carcinoma, stricture, stenosis, formation of diverticula, fistula of the larynx and of the trachea. " c.d. Tuberculosis (infiltrated and miliary), haemorrhage from bronchi and lungs, bronchiectasis, pulmonary emphy- sema, insufficiency and atrophy, cirrhosis, carcinoma, and other neoplasmata, ossifications, apostemata, gangrene of bronchi and lungs, pneumothorax. " Here we must further enumerate : u e. Affections of the pleura which excite pulmonary cough, either sympathetically or mechanically, as haemor- rhages, serous and inflammatory exudations, tuberculosis pleurae ; and, finally, " f. Cardiac affections which, by obstructing the reflux, produce pulmonary hyperaemia, and thus excite cough. IV. In neuroses. These arise either as primary forms from irritation of the vocal and respiratory nerves, or secondarily from central irritation, to wit: " a. Spastic, tickling, spasmodic coughs. " b. Pertussis (according to some a neurosis of the bronchi, according to others an affection of the vagus.) " c. As symptom of a nervous stenosis of the glottis in children and adults. " d. As symptoms of bronchial asthma of the nervous kind, or " e. Angina pectoris, cardiac spasm. Finally " f. As collateral phenomena of a central affection of the spinal cord, spinal irritation (hysteria.) " The physician has also the essential peculiarities of the cough itself to bring within his ken, if he intends to make a good choice of remedies. " 1. The tone of the cough. " 2. The subjective sensation, the kind of pain. CLOTHING.—COUGH. 63 " 3. The seat, the origin as far as the patient can define it, or the tone and depth which it gives. " 4. The repetition, time of occurrence. " 5. The dryness, or the sputum, and its nature. " 6. The exacerbation or amelioration by certain conditions, such as eating, drinking, lying down, moving about, rest, air, cold, warm, etc. " 7. The concomitant phenomena, as fever, pains in other parts, complications. " Under these forms we believe we have exhausted all the kinds of cough which present themselves for clinical treat- ment. A more elaborate description, which may be found in all the hand-books of pathology, our readers will willingly spare us,*as such is not the object of this treatise which has more especially to deal with therapeutics." Every case of cough we are called upon to attend, may vary at different hours, being sometimes dry and sometimes moist, but each one as a whole is either predominantly dry or pre- dominantly moist. 1. Predominantly Dry. Aconite, Dry, Aggravated at night and by warmth. Ambra, u u evening, relieved by open air. Arnica, ti u day and night. Arsenicum, 11 u by cold air and at night. Argentum, a u daytime. Atropine, a a day and night. Bromine, a i< daytime. Bryonia, a ' a night, cold air and motion. Causticum, a a evening and by getting warm. Chamomilla, a a night and by cold air. Conium a a night, when lying down, and by deep inspirations. Coffea, a u night. Cuprum, a u day and night, and by cold, damp air. 64 PULMONARY CONSUMPTION. Drosera, Dry, Aggravated in the evening, after lying down, especially after mid- night. " by damp cold air and getting wet. ■' by cold air, and in the evening in bed. " at night. " at night, especially by lying down. " by cold air, mental affections, motion and contact. " by going up stairs, and warm air. " by cold, damp air, and at night. " by rest and damp weather. " by sleep, at night; cold, damp weather, and touching the larynx. " at night; by heat and damp, cool air. " at night; by damp, cool air and getting wet. " 3, A. M., early in the morn- ing ; by getting cold and mo- tion. " especially at night, and by stimulants. " day and night; by change of weather, and cold air. " by cold damp atmosphere, getting wet, and at night. " by inhaling cold air, and lying down at night. " all day, until midnight; by cold, damp east winds. Dulcamara, " Ferrum, " Gelseminum, " Hyoscyamus, " Ignatia, " Iodium, " Kali carb., " Kali hyd., " Lachesis, " Merc, sol., " Nitric acid, " Nux v., " Opium, " Phosphorus, " Rhus tox., " Rumex Crispus, Sepia, " CLOTHING.—COUGH. 65 Spongia, Dry, Aggravated at night; by cold, damp east winds, and with the head low. 2. Predominantly Moist. Ammonium mur., Moist, Aggravations, mornings, and by cold, damp weather. Arsenate of Soda, " Antimonium crud., " Aurum mur., " Calc. carb., " Carbo veg., " Carbo an., " China, Chelidonium, " Digitalis, " Hepar sulph., " Ipecacuanha, " Kali bi., Kali brom., " Kreosote, " Lycopodium, " Mercurius iod., " Pulsatilla, Sanguinaria, " Senega, " day. mornings, and by warm atmos- phere. morning and by cold air. by damp cold weather. by damp cold weather and evenings. evenings and night, and by damp cold weather. intermittent and at night. morning. from warmth. night, by cold, or cold north- east wind. by warm air, night and morn- ing. after eating; by awaking and deep inspirations. night. by cold air, morning and even- ing. by cold, high winds, evening and midnight. at night, in a warm room; relieved by cold air. in warm close room; evenings, relieved by cool fresh air. evening and night, especially when lying down. by warm air; evenings and night, better in cool air. 66 PULMONARY CONSUMPTION. Silicea, Moist, Aggravations, by cold air, even the slightest draft, and at night. Stannum, " " by rapid motion, and at night. Sulphur, " " by cold, or cold damp weath- er, afternoon till midnight. Tartar emetic, " " in damp cold weather, and evenings. Veratrum alb., " " from cold to warm air, by damp cold weather; by eat- ing ice cream. 3. According to the Seat of the Cough, Affections of the Larynx and Trachea. Aeon., Chelid., Kali bich., Nux v., Bell., Coffea, Kali hyd., Opium, Brom., Dig., Kali brom., Phos., Bry., Dros., Lach., Puis., Conium, Gelsem., Lauroc, Rumex, Cham., Hepar s., Merc, iod., Sang., Calc. iod., Hyos., Merc. c„ Silicea, Carbolic acid, Ipecac, Merc, s., Sulph. and Carb. veg., Iodine, Morphine, Tartar emetic, Caust., Ignatia, Nitric acid, 4. Affections of the Bronchi and Lungs. Aeon., Coral, rub., Kali carb., Sulphur, Ant. tart., Dig., Kali brom., Sang., Ars., Dros., Kreosote, Sarsap., Bell., Elaps, Lycopod., Silicea, Bryonia, Ferrum, Merc, Stannum, Calc. c, Hepar sulph., Phos., Tart, em., Calc. phos., Ipecac, Puis., Veratrum alb. Carbo veg., Iodine, Rhus tox., and Carbo an., Kali bich., Senega, Veratrum viride Cuprum, Kali hyd., Sepia, CLOTHING.—COUGH. 67 5. Stomach and Intestinal Canal. Sympathetic or reflex coughs usually call for a cerebro- spinal remedy, such as Antimonium Carbo veg., Kreosote, Pod., crud. and Chamomilla, Lachesis, Quinine, tart., Digitaline, Lycopod., Robinia, Ars., Eupatorium, Mercury, Sang., Chelid., Hepar sulph., Nux v., Sulphur, and Cinchona, Ipecac, Puis., Veratrum alb. Kali bich., Phos., 6. Coughs from Cerebral Irritation especially call for the cerebral-centrics, type Bell. 7. Reflex Cough from Ovario-Uterine irritation most always demands cerebro-spinal remedies. 8. Heart and large Blood-vessels, (reflex-cough) call for such remedies as Aeon., Collinsonia, Opium, Spigelia, Ars., Dig., Iodine, Secale, Bell., Digitaline, Phos., Sulph., and Cactus, Lauroc, Spongia, Veratrum vir. 9. Cough from Acute Inflammation. First stages must be combated with a Cerebro-spinal remedy ; second and third stage with organics, 10. Coughs from Influenza or Whooping Cough, are mostly always cured with Cerebro-spinal remedies, 11. Croupy Cough, demands at first such remedies as Aeon., Rhus ver.; second stage, Spongia, Hepar, Iodine, Kali bich., &c. 12. Croup.—The acute stage demands a cerebro-spinal, the sub-acute and membranous forms are more successfully treated with the organic remedies. Ulcerations, Disorganizations, Pseudoplasmata de- mand the organic remedies. 13. Asthmatic, Suffocative Cough. Ars., Drosera, Kreosotum, Sulph., 68 PULMONARY CONSUMPTION. Asaf., Dig., Lachesis, Spongia, Bell., Gels., Lye, Sepia, Cham., Hyos., Nux v., Tartar em., Caust., Ipecac, Opium, Veratrum alb., Carbo veg., Iodium, Morphine, and Veratrum Cuprum, Kali hyd., Puis., viride. China, Kali bichro., Phos., 14. Morning Cough. Aeon., China, Kreos., Staph., Alum, Cina, Nat. m., Stram., Atropine, Dig., Nux v., Veratrum alb. Caust., Iod., Phos. acid, Chel., Ipecac, Squill., 15. Evening Cough. Amb., China, Mezer., Sang., Ars., Cina, Mosch., Seneg., Atropine, Dros., Morphine, Sep., Baryta, Eupat. perf., Mur. Acid, Sil., Bell., Ferr., Nat. m., Spong., Bry., Hepar, Nit. Acid, Stann., Calc. c, Ignat., Phos., Sticta, Carb. an., Lach., Phos. Acid, Sulph., Carbo veg., Lye, Puis., Sulph. Acid, Caust., Magn. m., Rhus tox., Verat. alb., and Cepa, Merc, Rumex. e, Zinc 16. Night Cough. Aeon., Bry., Coral., Merc, Alum, Calc. c, Dulc, Phos., Amb., Carb. an., Hyose, Rumex c, Anac, Cham., Ipecac, Sang., Ant. tart., Cocc, Kali c, Seneg., Ars., Cact., Kali b., Sil., and Bell., Con., Magn., Veratrum alb. CLOTHING.—COUGH. 69 17. After Midnight. Aeon., Bell., Chin., Dros., Hyosc, Kali, Nux. v., Sambucus. We will now endeavor to give the special indications of each remedy in alphabetical order. My best guide to the selection of a remedy is the nature of the cough, for you are all well aware that every cough is either predominantly loose or predominantly dry. This is my first inquiry; and my sec- ond is to know the nature of the expectoration; the third, the time of day, or night, and the fourth the concomitant symptoms. DRY. ACONITE. — Dry croupy i cough, resulting from an ex- posure to dry cold air, short, dry, titillating cough, and every inspiration seems to in- crease the cough. The patient is greatly disturbed in his sleep by the cough, and as soon as he is fairly settled down to sleep again, the cough recom- mences, and so continually re- peats itself. Uncontrollable anguish with great fear of death. Sudden inflammation with high fever, great restless- ness from exposure, whereby the perspiration is suddenly suppressed. Di-y, tickling, night cough,, in a restless, e feverish patient; cough with active hsemorrhages, and great fear of death. This remedy is especially adapted to people of sanguine temperament and a full, plethoric habit, where the primary or inflammatory stage has not passed. If there is high fever present it suits a loose, as well as a dry cough; but as a rule will be found to act best where there is a dry cough, and aggrava- ted at night. " There is most always a tingling sensation in the chest after cough- ing. There may be stitches in the chest and side, which are often so severe as to interfere considerably with respiration, can only get half- inch respirations; sometimes there is an oppression of the chest, with- out pain, which keeps one from taking a deep breath, palpita- tion of the heart, with great anguish." In dry bronchial catarrh, in its most obstinate form, it is the most reliable agent we have. It is also of great value in these long fits of dry 70 PULMONARY CONSUMPTION. morning and evening coughs, so trying to the patient from their every-day recurrence. " Where the left lung is most involved, and the pleura is at the same time implicated, manifested by a sharp stitching pain on breathing, the cough which would be very hard were it not suppressed on account of the pain, is almost dry, it being extremely difficult to raise anything. The little that is brought up is tenacious, falling in a round lump, and of a dark cherry-red color. " Aconite 30th is assuredly the remedy." C. Pearson, M. D. Aconite cough is aggravated in the evening, and more par- ticularly in the night, and in a warm room. Amelioration in the open air, and when still. DRY. AMBRA. — Ambra-cough has its seat in the spinal mar- row or indirectly in the uterine system, and is purely nervous, originating in the nervous spi- nal centre. Hysterical women, with constant hacking cough, scraping and copious expec- toration. Lean, delicate, sick- ly-looking people. Highly hysterical women, cough with expectoration of grayish mu- cus, and abundant eructations. Reflex cough, from spinal or ovario-uterine irritation, and not from any organic lesions of the respiratory organs. Worse even- ings and better in the open air. MOIST. AMMONIUM MUR. — CI ironic catarrh of old people, with bronchiectasis, emphyse- ma of the lungs with profuse, thick, whitish expectoration, ..the cough sounds much looser than it is; much mucous rat- tling without expectoration. Fat bloated and lax individuals who are indolent and sluggish. The ammonia cough is aggrava- ted in the mornimg and frequently accompanied with sobbing and hiccough. Speaking of Amm. carb., Dr. Meyhoffer says: u We have found it of great use in very chronic cases of copious bronchial secretions, great difficulty of expec- toration, and bronchial dilation. Low vitality and atony of CLOTHING.—COUGH. 71 the bronchial surface are leading indications. The hand and the ear will detect numerous coarse rattles, and yet the patient experiences no necessity to clear his chest of its mor- bid production, cachectic conditions and old age are its great indices. The second and third dilutions act unexceptionally." The cough is worse in cold, wet weather. Arnica — Cough resulting from the bad effects of mechanical injuries ; bruised sensation in any part of the body ; inflammation of the skin and cellular tissue, with extreme tenderness on pressure. The bed on which he lies feels too hard, keeps changing from place to place. DRY. For some unknown reason to me, our school hardly, if ever, prescribe Arnica for coughs,although it ought to be very valuable in a cough that is predominantly dry, and worse nights, especially if brought on from mechanical injuries, accom- panied with much myalgia of the intercostal muscles. In organic cough, where seriousjexudation has taken place; dry cough and hoarseness from over-exertion ; dry concussive cough, with difficult or bloody expectoration, etc., etc. MOIST. This is a splendid cough remedy, where the cough is predominantly loose, and seems to have its start- ing point from irritation of the mucous membrane of the stomach with much vomiting, diarrhoea and heavily coated tongue. Its great centre of action is upon the fila- ments of the vagi that are distri- buted to the mucous membranes of the lungs and digestive organs, especially the stomach. Like Antimonium Crudum — Thick, milky white coating on the tongue ; mucous mem- branes are loaded with mucus, with slow digestion ; nausea and vomiting ; reflex cough from the stomach or abdomen; great emaciation, with exces- sive grief ; eating, ever so lit- tle, produces obstinate vomit- ing ; aged people, with corns, horny excrescences, and in- flammation of the skin; aver- sion to washing. Tartar emetic its action hardly ever goes on to inflammation. 72 PULMONARY CONSUMPTION. A tubercular cough will not be much benefitted by it; for sim- ple bronchitis, after the second stage has commenced, with a loose cough, this is a first class remedy. Arsenicum Album—Cough that is predominantly dry, in organic diseases of an incura- ble and destructive nature; cough excited by a sensation as if the fumes of sulphur were inhaled; cough followed by in- creased difficulty in breathing, great exhaustion, with severe dyspnoea, aud nightly aggrava- tions, rapid and great prostra- tion, with sinking of the vital forces ; burning pains, the parts burn like fire ; pains greatly aggravated by rest, re- lieved by motion ; extreme anguish and fear of death ; cannot lie down for fear of suf- focation ; great thirst, drinks often, but little at a time. Lymphatic people that are sad and irritable. DRY. Dr. Hirschel's description of the arsenicum cough is most graphic, and to the point. He says it "ap- plies in all kinds of coughs; pre- dominantly, however, in dry cough. In spasmodic cough it is indicated only in its typical form. Whooping cough does not lie in its range. It is indicated in chronic affections of a torpid or dangerous nature, and in acute cases of the same nature, especially indicated for cough in or- ganic diseases of an incurable or de- structive nature, either in the larynx bronchi, lungs, pleura or heart; its choice depends upon others than cough symptoms. These func- tional symptoms are: dyspnoea, asthma, suffocating spells, cyanosis, heart symptoms of all kinds, disturbed circulation, decomposi- tion of the blood, exudations, decay and gangrene of organic substance, disorganizations, excessive pains. Constitutional indications are: exhaustion of life-power, collapse, high de- gree of weakness, syncope, anaemia, nervous irritability, dis- position to ulceration, hydrsemia and the like. Conditions are: typical forms, nightly aggravations, worse from lying down, drinking and change of weather." I cannot state any- thing more practical and to the point, in the use of this remedy in cough than is given by J. Meyhoffer, M.D., in his work on " Chronic Diseases of the Organs of Respiration." He says : " Arsenicum is, after aconite, one of the most im- CLOTHING.—COUGH. 73 portant medicines in dry catarrh not of recent date. It oper- ates its most striking effects in the form of dyspnoea, which results from a more or less extensive emphysema and consecu- tive pulmonary congestion. Thus the difficulty of breathing which is relieved by arsenic does not entirely cease in the in- tervals of coughing, and also returns in periodical, severe par- oxysms, especially during the night. None the less remark- able is its action when the obstruction in the pulmonary cir- culation is caused by regurgitation of the blood from the ven- tricles into the auricles. There may be oedema of the lungs, but the bronchia] secretion is scanty, and a sensation of dry- ness in the respiratory lining prevails. The patients complain of an exasperating titillation in the windpipe or under the sternum, chiefly in the night, that provokes a dry, wheezing, often very violent cough; this is attended, after a time, by a white, frothy, sometimes sticky mucous. Its action is prompt and intense, numberless invalids, who without its aid, would have passed agonizing nights, are, by its use, enabled to rest tranquilly. This vitalizing action of the mineral on the nerv- ous system has often been the means of saving the lives of children arrived at the last stage of suffocative catarrh. No remedy will be found more powerful or more sure to raise the vitality when asphyxia is too far advanced for the exhibition of Tart, emetic and the tumultuous agitation of the heart foretells its fast approaching paralysis. Though rarely of much service in simple catarrh, arsenicum is invaluable in the treatment of bronchitis connected with deficient assimilation and arrested organic metamorphosis. As a haematic and ganglionary neurotic it displays remarkable re- gulating effects on nutrition in great emaciation or tendency to fatty deposits ; in anaemia, malaria, cachexia and fatty de- generation of the kidneys. No less valuable is this mineral in all forms of bronchitis dating from a herpetic taint." In anaemic subjects, with dry asthmatic nightly cough, or if there is a disturbed circulation from atheromatous disease of the valves of the heart, arsenicum will be found of much 6 74 PULMONARY CONSUMPTION. value. Anguish and despondency are prominent in cases that call for the use of arsenicum. ARSENATE OF SODA.- [ Dr. Ruddock gives the following Organic cases where the second .-..,. n ,, . -. r, . , , . .,, t indications lor this remedy: " Se- stao-e has set m with a loose J cough, night sweats and diar- vere cough and profuse expectora- rhcBa. tion ; hectic fever ; night sweats; diarrhoea. Even when auscultation detects abscesses in the lungs, the disease may sometimes be controlled by this remedy." Aggravations, in the night, after midnight, in cold air, or getting cold; after drinking; from exertion; while lyino- down with the head low ; from cold drinks ; always wants to be wrapped up warm, and on going up stairs; relieved on ly- ing with the head high; going down; from warm food or drinks, and near a stove. DRY. This remedy has a special and specific action upon the cartilagin- ous system ; in tuberculosis, with ulceration of the larynx and trachea, with dry, racking cough, this remedy will be of great service, especially if there is a syphilitic taint in the s}rstem. Dr. J. Meyhoffer says : " Nitrate of silver proves a highly beneficial agent in all the stages of tubercul- ous laryngitis. In the beginning of the disease, when the throat and larynx are much inflamed, and with titillation in the latter, much hawking or spasmodic cough, and accumulation of phlegm in the throat. At a later period, when the edges of the ulcers are the seat of luxuriant granulations, the inhala- ARGENTUM NITRICUM. —A withered and dried-up per- son from disease, Patient can't think, can't talk, can't walk, very dizzy; minutes seem hours to the patient; time seems so long that the patient worries about everything. Is in a great hurry to do things. Great distention of the stomach with gas. Fluids seem to run straight through the intestinal canal without stopping. Ul- ceration of the bowels with diarrhoea. CLOTHING.—COUGH. 75 tions of the stronger solutions of this salt produce excellent effects, as they reduce the morbid growths. In several in- stances we have ascertained incipient serous infiltration of the sub-mucous tissue in the last stage of laryngeal phthisis, and seen it give way to these solutions. They have, however, the drawback of blackening the skin or • linen with which they come in contact; that can be only partly avoided by inhaling the steam through a glass tube, or by otherwise protecting the exposed parts. Sometimes, therefore, when wishing to act with more energy, without employing the caustic in substance, we use insufflation into the larynx by a slightly curved glass tube, of one or two grains of the first decimal trituration of nitrate of silver. The frequent effect is a violent fit of cough- ing, but the growth is thoroughly acted upon, and the opera tion need not be repeated more than three or four times. Should the vegetations be extensive, however, or in cauli- flower form, or if by their situation they should cause dysp- noea, they must either be destroyed by the porte-caustique, or removed with the laryngeal scissors. The same operation is to be performed on the detached flaps of the mucous membrane; difficult and painful deglutition, with extensive ulceration of the epiglottis, is often only relieved by the direct application of the caustic. " We use Argent, nitric, in all its preparations ; from the second and third potency, to the local application of the lunar caustic, and from one to six grains to an ounce of water for inhalations. " We have seen this mineral master inflammation and swel- ling of the posterior wall and lining of the larynx, attended by a sensation of a clog in the vocal organs, with hoarseness or loss of voice, continued and vain efforts to swallow, with pain and soreness in deglutition, and hawking, considerable muco- purulent expectoration, or titillation in the larynx, with dry spasmodic cough. The third to the twelfth attenuations." 76 PULMONARY CONSUMPTION. MOIST. AURUM MURIATICUM. —Suicidal monomania, accom- panied with extreme depression of spirits ; dread of some im- pending calamity, unrefresh- ing sleep, loss of ambition and energy ; disposition to dwell upon some imaginary ailments diminution of verile strength, great difficulty of breathing during the night, violent pal- pitation of the heart ; nightly bone pains ; Ozaena. Acts decidedly upon the lymphatic glandular system, much like merc- ury, and is adapted to suffocative coughs that are inclined to be loose, in scrofulous subjects, especially if they have chronic nasal catarrh, with ulceration of the nasal bones ; so if the patient has been abused with mercury, or has the effects of syphilis grafted upon him, with nightly bone pains, Aurum greatly resembles Arsenicum and Silicea. Suffocative cough with pal- pitation of the heart, and extreme despondency. " I have had cases of a dry spasmodic (or what I should call nervous) cough, peculiar to females, generally periodical, every night, commencing at sunset, and continuing through the night, going off with the rising of the sun, and freedom from it during, the day. Aurum 200 cures every time. In the plain text, cough for want of breath at night." L. B. Wells, M. D. Aggravation in the morning, in the cold air , on getting cold; better from moving, and in the warm air. Its action is simi- lar to that of Iodide of Potash. As an inter-current, where the Iodide has ceased to act, Aurum Mur. will be of great value. BELLADONNA—Pains come and go with great celerity. Fu- rious delirium, wild look,wishes to strike, bite or quarrel. Face flushed, eyes red, rage, tears, bites, and shrieks ; violent con- gestion of blood to the head. with strong throbbing of the carotids. Throbbing headache worse from motion and noise DRY. The primary or starting point of the affection is in the brain. A hard, dry, teasing, spasmodic cough pre- dominates, generally accompanied with inflammation of the throat, and difficult, painful deglutition. Dr. Hirschel says that Bell, has " great sensitiveness, in contradis- tinction to the irritable Aconite. CLOTHING.—COUGH. 77 is intolerable. Eyes red and glistening; photophobia ; great dryness of the mouth and fauces ; tonsils bright red and swollen, spasms of the throat ; symptoms worse evenings and at nicrht. Vasomotory stimulation with in- creased nervosity. The chief remedy, therefore, for sensitive persons, women and children : for erethic inflammatory forms, not for croupy, plastic ones, for spastic states, cough dry, barking, spasmodic, in paroxysms, with titillation in the trachea or bronchi; aggravation at night, and when continuous, sensation as of having swallowed dust; amelioration from any- thing cold, sensation of constriction in throat, difficulty of swallowing ; congestion to the head ; stitches in the chest. In simple catarrhs, in inflammatory forms with catarrhal character (larjmx, trachea down to the lungs), specially in the first stage, more in bronchitis, especially capillary than in pneumonia in the beginning of whooping cough ; influenza ; in affections of the brain, spinal cord or heart; inflammation of parts adjacent to the respiratory organs. In stenosis of the glottis, in bronchial asthma, as an intercurrent remedy in chronic cases. Examination of the affected parts shows a pinkish, smooth redness in the pharynx, uvula, and fauces." Baehr says : " A disposition to perspire while the skin is very hot, with a dry, continual, distressing, spasmodic cough; short paroxysms of cough but very violent, especially towards eve- ning, no expectoration, or else a yellowish, tenacious, blood- streaked, scanty expectoration. Sensation of great fulness in the lungs without pain." Larynx exceedingly painful, with constriction of the trachea, hoarseness, paralytic aphonia, of a cerebro-spinal origin, that has come on very suddenly. As soon as the cough commences to loosen up the usefulness of Bella- donna has passed and another remedy must be selected. Aggravation in the afternoon and at night, and by moving or touching the parts. Ameliorated, while reposing. 78 PULMONARY CONSUMPTION. DRY. Atropine.—This is a precious remedy for cough, but its true characteristics are not yet known with precision enough to separate them from those of Belladonna. All the symptoms are the same, excepting the vascular symptoms, the congestions and inflammation of Belladonna do not appear so prominently in the Atropine cough, but the neurotic elements predominate. This neurotic element seems to predominate in all diseases where Atropine acts better than Belladonna, the parts seem to be in a nervous, irritable state instead of a congested inflam- matory condition. Many cases of cough have yielded most beautifully and rapidly under the influence of Atropine after Belladonna, which was indicated, had failed to entirely cure. In my opinion Atropine is of much more service to us in a dry hard, tearing cough than Belladonna, and ought to be employed much more frequently. I use the third decimal dissolved in water. DRY. This remedy has not been given very often in cough, and its true sphere is not yet fully known. Dry cough, with suffocation, seems to be its indication ; but Prof. Guern- sey says, "• with the croupy sound there is a good deal of loose rat- tling in the larynx with the breath- ing and coughing, but no choking in the cough as there is in Hepar." In my opinion, Dr. Hirs- chel is about correct when he says •Bromine is indicated. " for swelling and hypertrophy of the mucous membrane (Iodine for the exudation), of the upper parts of the respiratory organs, of a catarrhal, inflammatory or organic origin; dry, croupy cough, with scraping titillation and hoarseness, small follicles are found on the posterior mucous membrane of the pharynx, extending from there to the larynx and producing continued BROMIUM.—Croupy, dry, rough, barking or whistling cough. Tickling in the throat as if from sulphur vapor; sensa- tion of coldness in the larynx ; for blondes rather than for persons of white, delicate skin. Has a remarkable action upon the glandular system, and res- piratory organs. CLOTHING.—COUGH. 79 titillating cough. The larynx painful to the touch. Anatom- ically, we might say Spongia is more suitable for stasis, simple inflammation ; Bromine for swelling and hypertrophy of the mucuous membranes; Iodine for exudation. Aggravation of the cough in the day time. DRY. Bryonia's great sphere of useful- ness is found in inflammatory affec- tions of the respiratory organs, the lungs and their enveloping mem- branes, that have advanced to the stage of effusion, Dr. Hirschel says : " Bryonia stands in close relation to the chest. It frequently follows Aconite, to remove the debris, and is therefore in a certain way more powerful than Aconite, which acts more on the general state and less on the local, and vice versa in comparison to Mercurius, the latter acting more on the local state, whereas Bryonia affects the general state, Bryonia brings on resolution in catarrhs, resorption in inflammation, chiefly indicated in the second stage for slightly plastic but not highly graded inflammatory forms in croup. It is the chief remedy in bronchial affections (there- fore in influenza) ; in catarrhal pneumonia only applicable where hepatization passes over in resolution, or where the pleura is at the same time affected, perhaps also in chronic pneumonia. The Bryonia cough is concussive by coming dry from the sternal region, as if the chest would burst, with scanty yellow, or blood-streaked thin mucus, frequently with vomi- turition and vomiting, especially after eating, with status gastricus, difficulty of breathing, pleuritic stitches, muscular pains, sensation of soreness in the throat and below it." Dr. W. H. Holcomb says : " Bryonia for a dry, concussive cough, producing pain both in the head and chest, Avith characteristic stitching pains." Dr. Guernsey says : " Bryonia cough at night BRYONIA ALBA.—Symp- toms greatly aggravated by motion. Patient cannot sit up; lips dry and cracked ; cannot sit up from nausea and faint- ness ; everything tastes bitter. Diarrhoea from hot weather, or constipation, stools hard and dry as if burnt; irritable head- ache as if it would burst open. 80 PULMONARY CONSUMPTION. in bed, compelling one to spring up and assume an erect posture at once. This seems an involuntary motion." A prominent indication for this remedy is rheumatic and braising pains in the muscles of the chest and back. Dr. Baehr says ; " We wish to state, as an evidence of the healing powers of this drug that we scarcely ever notice under its administration a copious secretion of the so-called sputa cocta, and that the resorption of the infiltration takes place Avith very little, or perhaps without any expectoration, or, judging from the stand-point of pathology, taking place in its most perfect form." This is practical knowledge. " Where the cough and fever are very similar to those of Aconite, except that there being much less inflammation in the pleura and consequently less pain, the patient is enabled to cough much harder, raising, however, but little, which is tough, falling in a round jelly-like lump, but in color, much lighter, almost a yellow or soft brick shade, Bryonia 30th or 200th will scarcely fail to cure nine cases out of every ten." C. Pearson, M. D. Aggravation, in the evening and night ; from cold air and motion. MOIST. CALC ARIA CARBONIC A. —Constitutional diseases of scrofulous people, with leuco- phlegmatic temperament ; prone to affections of the muc- ous membranes imperfect assi- milation of food to tissue. Dry and flabby skin; children with large open fontanelles, and much perspiration in drops on the head, which wets the pillow far around, during sleep. Ex- cessive debility; walking pro- duces great fatigue ; going up stairs, is out of breath and has to sit down;feet feel as if they had on cold, damp stockings ; This is one of the best and most useful remedies in the Materia Medica for consumption. It acts with great power, through the ganglionic system upon the lympha- tics, mucous membranes, skin and osseous tissue, and Ave find it espe- cially useful in diseases and indi- vidualities in whom the process of formation and reformation is im- perfectly performed, as in childhood during dentition, rachitis and in lymphatic constitutions. It is one of the most useful cough remedies CLOTHING.—COUGH. 81 cold continually ; women who we have, and it is adapted more menstruate profusely and too especially to a loose COUgh, acts often ; great emaciation, with weU in eitheJ. a d Qr looge ^ constant disposition to take , . . , . ,, n ,, many physicians claim that a dry cough is its forte, but with me, after a cough has lasted a Avhile and has passed, or is passing, into a loose, moist cough, Calcaria is one of the remedies par excel- lence. Dr. Hirschel says: "Calcaria is our chief remedy in scrofulosis and tuberculosis, and therefore beneficial in many chronic coughs, especially in ulcerative processes of the larynx or in other kinds of cough resting on an organic base." Marcy and Hunt say : " Persons curable by it are of lymphatic temperament, scrofulous, or rickety; show plethora of the veins, easily take cold, are frail, poorly fed, but tend to grow fat. Its application in consumption is chiefly restricted to cases in which these features predominate. The patient is feeble in body and mind, though in some cases mentally precocious, and often regarded as a genius ; he is subject to depression of spirits, Aveeping mood; restless and anxious ; has no hope of recovery, is hypochondriacal ; the hair falls off, the eyes are feeble, cannot bear gas-light ; and he suffers from all possible derangements of digestion ; the nervous system becomes ex- cessively irritable, especially in females, hysteria, fault-finding, nervous exhaustion, especially menorrhagia; in males sperma- torrhoea or exhausting emissions. It is proper in the stage of purulent expectoration, especially after sulphur or nitric acid." Dr. Meyhoffer says: "We fully agree with Baehr, who indicates emphysematous catarrh as being especially Avithin its sphere of action, no less commendable is this mineral in bron- chial dilatation and putrid expectoration." Dr. Holcomb says, " calcaria carb. frequently softens and mitigates a harsh, dry, recent cough, but has quite a different indication in serious chronic and organic bronchial disease." This is one of our most poAverful constitutional drugs, " Avhich frequently finds its indications in the general symptoms or constitution of the patient, quite as prominently as in the specific symptoms of an individual case, and yet characteristic 82 PULMONARY CONSUMPTION. symptoms are not by any means Avanting ; the cough is almost always accompanied with a more or less profuse expectora- tion, early putting on a purulent character. Amelioration from lying upon the back ; aggravation from lying upon the sides. Calcaria, with us has shown a more marked control over the upper half of the right lung than over any other portion of either lung." Dr. C. Dunham says : " short, spasmodic cough, in brief, but frequently repeated paroxysms; excited by a tickling as if from feathers or down in the throat and trachea, in the evening and at night, without expectoration, but in the morning and during the day attended by copious mucous or purulent, yelloAV expectoration and is sometimes bloody, having gene- rally a sour taste and an offensive odor." Aggravation, In damp, cold atmosphere, from getting wet; from drinking, talking, lying doAvn and during sleep; relieved in dry, warm weather. MOIST. CARBO VE&ETABILIS, great foulness of the secretions, patient wants more air, wants to be fanned all the time. The most innocent food disagrees. Excessive accumulation of gas in the stomach and bowels, the gas is generated by the walls of the viscera, rather than from the fermentation of food, much bleeding of the gums ; when eating or drinking, sen- sation as if the stomach or abdomen would burst. Icy coldness of the parts with a livid, purple look; Hippocratic face with cold breath, and general coldness of the whole body. Long lasting hoarseness. •Diseases of the lungs, where there is a great tendency of the chest to perspire and the patient takes cold with the least change of temperature. The Carbo veg. cough is moist and loose in patients that have become greatly enfeebled by long lasting disease; the expectora- tion is copious, yelloAV, greenish, and very fetid, accompanied Avith an extremely fetid breath. Baehr says: " Cough in old people, with emphysema and hypertrophy of the lungs, heart and abdominal viscera are very much impeded, very sensi- tive to cold, worse af night, ex- pectoration profuse, especially if the larynx is invaded. Dr. CLOTHING.—COUGH. 83 Reis says: " Chronic catarrh of the bronchi and stomach. Cough Avith copious expectoration at night and in the morning; tightness of the chest; sickly appearance, great sleeplessness at night, through the clay pyrosis, Avith a great floAv of Avater from the mouth."' Dr. (luernsey says: "Respiration oppressed; having some kind of bad smell; quick cough with expectoration in the morning, and no expectoration in the evening; neglected pneumonia, Avith expectoration of a dirty yellow color, and smelling badly." Dr. Meyhoffer says " Carbo veg. is the panacea for poor exhausted constitutions and aged people with great torpor of the bronchial lining, profuse muco-purulent sputa, or deficient power of expectoration with symptoms of imperfect oxidation of the blood; lips, and nails blue, extremi- ties cold. The Aveaker the invalids the better the higher dilutions Avork." Dr. C. C. Smith says : " Frequent and easy epistaxis, generally Avorse at night, or in the forenoon, folloAved by pain OA'er the chest, and pale face; sensitiveness to sudden changes of temperature : hoarsness towards evening, about 5 o'clock; pains in the chest burning." Carbo veg. is more strongly indicated if the larynx is invoh'ed.. The patient is so greatly reduced, and the lungs so much involved, the remedy must not be expected to act immediately. Aggravations—Evening till midnight; by Avalking in.the open air, especially in damp, cold air, by passing from a warm into a cold atmosphere ; by becoming cold, and by eating or drink- ing cold food or liquids, by butter or fat food and in the morning. CARBO ANIMALIS.— Scrofulous venous constitu- tions, with enlarged g-lands, great debility, with great dispo- sition to perspire about the thorax. Great disposition to take cold, patient feels com- MOIST. Cirrhotic dyscrasia Avith swelling and ulcerations of the glands. This remedy is adapted to chronic coughs after they have reached the second or suppurative stage, the cough is loose and rattling, expectoration 84 PULMONARY CONSUMPTION. pletely exhausted, can hardly stand, if it is a woman, men- struation exhausts her, so that she can hardly speak. Earthy- colored face, copper - colored spots on the face and body, secretions acrid. profuse of thick, yellow, greenish, fetid sputa, Avith much fetor of the breath, accompanied Avith debilitat- ing, profuse, night SAveats. The constitution of the patient will have much to do in the selection of this remedy, if the patient has inveterate and obstinate indurations of the glands, and the complexion is of a coppery color, and the disease is Avell advanced, the remedy Avill be found of great utility. Its indications greatly resemble those of Carbo veg. Aggravation of the cough in damp, cold air and at night. DRY. CAUSTICUM.—Scrofulous people with yellow complexions Cannot keep the upper eyelids up, they are nearly paralyzed, and will fall down over the eyes, great melancholy, looks on the dark side of everything. Constant sensation as if lime was being burned in the stomach, with flatulence and waterbrash. Catarrhal aphonia. Dry hard cough with involun- tary emissions of urine. This is the clergymen's remedy for hoarsness, and loss of voice from over-exertion. Inability to expectorate. This is a remedy of great value in the treatment of diseases of the respiratory organs. The great pre- dominating symptom is a dry hoarse cough, with aphonia; for complete aphonia no remedy can equal it. If the cough is loose, the patient is obliged to swalloAv what is raised, cannot spit it out. Involuntary passing of urine during the fit of coughing is a Araluable indication, especially if there is an excessive amount of uric acid in the urine. Chronic morning hoarseness, Avith dry cough and much congestion of the fauces, catarrhal aphonia, weakness of the voice from over-exertion, phlegm in the throat that cannot be hawked up which produces nausea. Hard, dry, racking, hoarse, morning cough, with involuntary emissions of urine. " Dry hollow cough, with soreness in the chest, caused by tickling and mucus in the throat, with expectoration only at night, of acrid tasting mucus, which he cannot raise b,ut has to SAvallow again." Jahr. Dr. Guernsey CLOTHING.—COUGH. 85 says : " Cough, after getting warm in bed, or after recovering the natur Sepia may claim our attention in a similar cough as Spongia, but we must confess that Ave have never derived very striking results from its use. The numerous symptoms in the pathogenesis of Sepia, which point to bronchial catarrh, give evidence that Sepia must be a remedy for this disease. Only it is difficult, 136 PULMONARY CONSUMPTION. owing to the multitude of symptoms, to present a character- istic group."-—Baehr. " The cough of Sepia is sometimes dry and spasmodic, at- tended with nausea, and resulting in bilious vomiting, but is generally accompanied with abundant expectoration of green- ish or yellowish matter, purulent or even bloody, and of a putrid or saltish taste. The cough exacerbates in the even- ing, and also in the late evening hours, accompanied by sore- ness and Aveakness of the chest, and a marked degree of dysp- noea is present. Baehr points out that Sepia is not adapted to bronchial catarrhs, accompanied Avith bronchiectasis, emphy- sema, etc. Sepia acts best in the 30th dilution, and I have had fine results from the 12th trit."—Dr. T. Nichol. Aggravations, forenoon and evening until midnight, from cold damp north-east winds, and from repose. Relieved in warm, dry air. In chronic cough, sepia folloAvs well after Pulsatilla. MOIST. SILICEA.—Deep-seated or- ganic coughs ; where the nu- trition of the tissue is assail- ed ; great lack of vitality, can- not keep warm even when walking ; great disposition to take cold, even from the slightest draft of air ; ten- dency to suppuration, has won- derful power over suppuration, much perspiration upon the head and chest ; children with large open f ontanelles and who wish the head covered up ; rachitis, with slow dentition. In women, great coldness dur- ing menstruation ; constipa- tion ; stools difficult; as the rectum had not power to expel them ; the stool recedes after JNo remedy m the materia- medica controls the suppurative process equal to Silicea. In organic diseases of the air-passages, where suppuration has taken place, with a suffocative, racking, loose cough, with copious expectoration of thick, yellow, greenish pus, accom- panied with hectic fever, great de- bility and profuse night sweats. this remedy Avill be our sheet anchor. Dr. T. Nichol says: " Silicea is particularly suitable for lymphatic or sanguine individuals, and as a remedy for chronic bronchitis, it is only second to Sulphur." COUGH. 137 having been partially expelled; profuse, very fetid foot-sweat; debilitating night-sweats etc. ; caries of bones; fistulous ulcer- ations; excessive debility. Meyhoffer says: "I think it hardly possible to overcome radi- cally the catarrh pituiteux of Laennec without the intervention of Silicea. In this form of bronchial disease no other agent contributes so largely towards recovery. Not less beneficial are the effects of Silicea in bronchial affections of rachitic children." Hughes? thinks that Silicea may find its place in chronic bronchitis with puriform expectoration, while Teste coldly says : " Silicea is recommended in chronic bronchitis." Silicea is one of the principal remedies in obstinate or severe cases, characterized by racking cough, with copious expecto- ration of transparent purulent matter. The cough is suffoca- tive, with oppression at the chest, and aggravated at night, and is sometimes accompanied by sore throat, with loss of breath when lying on the back and when stooping. All unite in prescribing the higher dilutions, and Baehr says that " we have never derived any advantage from alcoholic attenu- ations, but always from the higher triturations." Marcy and Hunt say : " This remedy embraces most of the symptoms that belong to the phthisical dyscrasia, consequently it is a remedy of value for the constitutional condition in con- genital or hereditary cases. The dyspeptic symptoms pecu- liar to consumption are also nearly the same as under Hepar. The symptoms that show themselves in the respiratory sys- tem are: roughness and sore feeling in the larynx, with dry hacking cough, causing soreness in the chest; hoarseness with cough, suffocative night cough; excessive, continual cough, with discharge of translucent or bloody mucus ; vomiting of purulent matter when coughing, ulceration of the lungs, dis- charge of clear, pure blood, with deep, hollow cough; the chest painful as if bruised; shortness of breath felt on walk- ing or exercising; weakness and oppression of the chest, with chilliness of the surface; oppressive heaviness in the region of the heart and palpitation when sitting still." Aggravations, in the evening and at night; from cold air, from any single part of the body becoming cold; getting 138 PULMONARY CONSUMPTION. cold after sweating ; change of temperature before a thunder storm. Relieved in warm air or a warm room. DRY. SPONGIA TOSTA.—Es- pecially affects the larynx and trachea: dry,hard,tight,hollow, croupy cough; great hoarseness; loss of voice ; great dryness of the larynx; with hoarse, hollow wheezing cough ; symptoms aggravated by lying down with the head low ; goitre. Spongia corresponds to affections of the upper part of the respira- tory organs, especially the larynx and trachea. The cough is croupy, dry, sibilant, sounding like a saw driven through a pine board, each cough corresponding to a thrust of the saw. Baehr says: " Spongia is characterized by a hollow, bark- ing, dry, seldom moist cough, continuing all day, and likewise all night, in long-lasting distressing paroxysms; at the same time labored, crowing, wheezing inspirations, sometimes ac- companied by rales. The remedy is most appropriate for children, more particularly if the disease set in as laryngitis and gradually extended to the lungs. It is an excellent remedy in croupous bronchitis." " Often the patient is quite convalescent, when on very slight exposure the cough returns with redoubled violence—the most pressing dyspnoea, sibilant ronchi and violent convulsive cough. When this relapse occurs, Spongia is pre-eminently the remedy, even though it had not been previously indicated." Dr. Nichol. The first inflammatory symptoms should be subdued by Aconite. This remedy is not used as much as it ought to be in those hard, tough cases of what might' be called dry bronchitis. There is an absence of inflammatory symptoms, but the pa- tient has a terrible hard, dry, racking cough, slight expectora- tion and much dyspnoea. The triturations will give the best satisfaction. COUGH. 139 Aggravations at night from cold air, especially northeast wind ; and lying with the head low. Relieved by warm air. MOIST. STANNUM. — Profound prostration of the cerebro-spi- nal nervous system ; patient must drop down, but can get up very well; can go up stairs nicely, but coming down stairs produces great faintness ; reading aloud or talking pro- duces great exhaustion ; great weakness of the legs, they are not able to support the body; pains commence lightly, in- crease gradually to a very high degree, and then decrease again as slowly; profuse greenish expectoration; bron- chial dilatation, with profuse purulent expectoration. Ex- hausting night sweats. In chronic bronchitis, where the mucous secretion is very copious, of greenish, yellow or purulent mat- ter, with a loose, rattling cough, accompanied with excessive pros- tration, especially centering in the chest, Stannum will be found of great utility. " Rough throat, hoarseness, weakness and emptiness in the chest; the hoarseness was sometimes momentarily relieved by a fit of cough; mucus in the trachea, in the forenoon, easily thrown off' by a slight cough, the chest feeling very weak as if deadened all over, with faintness of the whole body and limbs, in which a weak feeling is moving up and down, many mornings in succession. Accumulation of mucus in the chest, with rattling breathing which can be felt internally, and heard by others; titillating creeping in the throat (lar- ynx), with a feeling of dryness, obliging one to cough; irri- tation in the trachea during an inspiration, as if from mucus, there being neither mucous nor dry cough; it is more violent- ly felt when sitting crooked than when walking; short coughi from time to time, as if from weakness of the chest, with; hoarse, weak sound; short and hacking cough; constant desire to cough, as if owing to too much mucus in the chest, with an internal feeling of panting and slight rattling; con- stant desire to cough, from a continual constriction of the trachea; titillating cough, as if from soreness deep in the 140 PULMONARY CONSUMPTION. trachea, with scratching rising up into the throat; exhausting fits of cough, which produce a bruised sort of pain in the pit of the stomach; oppression of the chest when coughing ; scraping in the throat, with greenish expectoration of a dis- agreeably sweetish taste, more violent in the evening before going to bed; hoarse speech; after every cough (with irrita- tion in the lower part of the trachea) sore feeling in the chest and trachea; horrid cough, with expectoration and spitting of blood; yellow discharge from the trachea, having a putrid taste; salty expectoration; fit of asthma, short breathing and anguish in the evening, obliged to breathe hurriedly for a long time, until he succeeds in drawing a deep breath, when the shortness disappears."—Hahnemann. Aggravations by rapid motion, reading aloud, and at night. MOIST. SULPHUR.—Constant heat .on the top of the head; has ,happy dreams ; everything looks pretty which the patient takes a fancy to; excoriation about the anus and vagina; morning diarrhoea that drives the patient out of bed in great haste, can't wait, must go to stool as soon as the desire is felt; obstinate, chronic con- stipation, stools dark, hard and dry, expelled with great strain- ing, accompanied with piles that bleed much; all the se- cretions are exceedingly acrid, and excoriating; very faint and weak at 11 a. m., cannot wait for dinner; chronic haemor- rhages ; patient gets almost well when it returns again and again; great deal of burning in the palms of the hands and This remedy is the back-bone of our School, and but few diseases can be treated without its aid, and about all kinds of cough yield to its power, but particularly chronic bronchial catarrh,with excessive col- lection of mucus or muco-purulent matter, with loose, rattling cough, and easy expectoration, especially in the day-time. At night the mu- cus is more tenacious and raised with difficulty, but becomes easy in the morning. Baehr says : " Sul- phur is utterly useless in phthisis, and cases where it has done good have been cases of chronic pneu- monia." In chronic bronchitis, he says: " Sulphur is undoubtedly the most COUGH. 141 soles of the feet ; hot flushes with faintness ; patient feels suffocated, wants the doors and windows open ; much rattling of mucus in the lungs; ex- cessive sensitiveness of the skin, every trifling change in the temperature causes an ex- acerbation, even if the patient remains in his room; he is powerfully affected by changes in the weather. important remedy we have in this disease, because it corresponds to the worst and most inveterate cases. If emphysema is present, this rem- edy may never yield any marked results ; even its palliative effect is questionable. Brilliant results may, however, be obtained in cases of chronic catarrh of long stand- ing, if the mucus is secreted in large quantities, or is very tenacious, and the symptoms point to a decided thickening of the mucous membrane. An emi- nent indication for Sulphur is the excessive sensitiveness of the skin, so that every trifling change of temperature causes an exacerbation, and that even if the patient remains in his room he is still powerfully affected by changes in the weather. Only this hypersesthesia must not be caused by pulmonary tuberculosis; the tubercles at least must not be in a state of suppuration. What we have said shows that the symptoms may be distinguished in two series. The cough is either loose, the mucus easily detached, but only at times, so that at night, for instance, there is a good deal of dry cough, whereas in the morning and during the day the cough is moist. The expectoration is mostly white, compact, but mixed with a number of yellowish or green lumps, showing that the mucus had been secreted in the bronchia for some time before being coughed up ; it has a foul taste and even a bad odor, and the accompanying hoarseness and sensation of rawness, show that the larynx and trachea have become in- volved in the pathological process. Or else the cough sets in in more violent paroxysms with considerable dyspnoea, is dry and spasmodic, with wheezing in the chest; it occurs most generally late in the evening and in the night, and it is only towards morning or after rising that a tenacious glassy mu- cus is brought up after a slight coughing spell. The diges- tive symptoms and the condition of the liver, which generally appears very much enlarged in chronic catarrh, confirm the 142 PULMONARY CONSUMPTION. selection of Sulphur. It has always seemed to us that the trit- urations of Sulphur did not act as well in this disease as the attenuations prepared from the alcoholic tincture, and that, as a rule, higher potencies act better than the lower. Finally, we have to observe that in the case of decrepit, and more es- pecially old individuals, Sulphur seldom does any good." Dr. Hirschel says: " Sulphur allows a far more extensive application in chronic forms; less, perhaps, by its specific re- lations to cough than by its vasomotory effect, and by its power of causing a reaction in the metamorphosis. It acts favorably where the course of the disease is slow, without coming to any decision in acute cases, as in catarrh or inflam- mation (Sulphur effectually developes hepatizations), as well as in chronic diseases of the respiratory organs and of the heart. Sulphur shows in the proving all sorts of coughs and different expectorations, but the constitution of the patient and the adjectiva of the disease give us hints for its selection. Wherever a dyscrasia is on hand, the physician remembers Sulphur." " Burning of the feet at night, with desire to uncover them; flushes of heat to the face; early morning diarrhoea ; cramps in calves of legs at night, or in feet while walking; sudden arrest of breathing while turning over in bed; better while sitting up ; sense as if the lungs touched the back while coughing; throat rough and dry, with burning ; hoarseness in the morning."—Dr. C. C. Smith. " Great desire to cough, but is partially suppressed; does not amount to a full, free cough ; in whooping cough."—Dr. W. H. Guernsey. " Complete aphonia, with hoarse, suffocating cough, and smarting in the chest. Sulphur 10m. cured in two days."— Wm. H. Holcomb, M.D. " Sulphur.—Dry cough with retching, vomiting and spas- modic constriction in the chest, chiefly in the evening, or at night Avhen the patient is lying down ; loose cough, with ex- pectoration of much thick whitish or yellowish mucus, some- times only during the day, with dry cough at night; obstinate COUGH. 143 dry cough, excited by tickling in the throat; lancinating pains in the chest and head; giddiness of sight when coughing; sen- sation of fulness in the chest, with oppression; rattling of mucus ; palpitation of the heart."—F. W. Ingalls, M.D. " Sulphur.—This is perhaps the most perfect specific for phthisis in its unmixed psoric form, not only when it follows pneumonia, but also when the disease is hereditary, and in the period of purulent expectoration." In cases of incipient phthisis it should only be given at long intervals, a single dose should be allowed to operate for sev- eral weeks undisturbed. Dr. Nuiies, of Madrid, says " he has cured some cases of confirmed phthisis by this remedy." Teste says, " if it has not cured phthisis, it has at least retarded it for several years." Hahnemann regarded phthisis as a psoric disease, and sul- phur as the first of antipsoric remedies. He refers to six cases in which consumption was caused by the repulsion of psora from the skin; later writers have admitted that Sulphur is a specific for itch, and also for the diseases caused by its reces- sion. Sulphur is specifically suited for phthisis in psoric constitu- tions, of lymphatic temperament, subject to venous plethora and haemorrhoids. There is predisposition to take cold from slight exposure, running into chronic catarrh; eruptions re- sembling those of scrofula appear on the skin; rheumatic pains without SAvelling ; drawing pains in the limbs; unsteady gait and tremor of the hands; great general prostration; ner- vous exhaustion folloAving debilitating losses; numbness of different parts, paralysis and emaciation ; pains worse at night, relieved by external warmth ; drowsiness and disturbed sleep; disturbing dreams; hallucinations and timidity. The patient curable by Sulphur has generally some eruptive disease of the skin, or has had such affection (not necessarily the itch) repelled from the surface at some former time; he is subject to abscesses, boils, or swelling of the glands; hectic fever, folloAved by night sweats, or profuse sweat from slight heat or exercise. There is hypochondriac sadness, disposition 144 PULMONARY CONSUMPTION. to weep ; irritated, taciturn disposition ; the head is dizzy; in- tolerance of light. The face is pale, wan, blanched, sickly, bloated, with Avrinkled countenance ; blue margins around the eyes ; hepatic spots in the skin ; swelling of the gums; dry- ness of the tongue; favus on the skin. The throat is dry; mucous expectoration ; sore throat, vesicles on the surface ; pressure in the throat as if from a lump ; tonsils red, swelled; uvula enlarged; putrid taste in the morning, ravenous appe- tite or loss of appetite; acidity of stomach and sour eructa- tions ; heartburn, morning nausea, waterbrash, acid vomiting. The stomach is painful on pressure; swelling, burning and cramplike contraction or spasm of the stomach; malaise be- fore a meal, nausea after eating. Pain in the abdomen, with sensitiveness of the surface; spasmodic contractive colic, cutting pain and nausea, followed by diarrhoea and tenesmus ; haemorrhoids, constipation with pain on the rectum as if it would protrude; mucous stools streaked with blood, passed with ascarides or lumbrici; strangury, fetid urine. The throat feels rough, the larynx dry, sore, its sides swollen and feeling as if something lodged there. Hoarseness or loss of voice; catarrh, fluent coryza, rawness or spasmodic contraction of the chest; cough dry, short and hacking, and after a meal excit- ing retching or vomiting. At a later stage the cough is looser, raising thick mucous, then greenish masses ; the cough excites violent headache, which in the occiput is pulsative; spitting of blood. The breathing is spasmodically arrested; asthma excited by a long or rapid walk, or ascending the stairs ; suffocative paroxysms, especially coming on at night; talking causes weak feeling in the chest; oppression, or con- tractive pain there ; neuralgic stitches of the chest, extending to the sternum or back ; palpitation of the heart, anxious throbbing with flush of the face, or rush of blood to the head ; leucorrhoea, irregular menstruation, cold hands and feet. It may not be proved that Sulphur has cured confirmed phthisis in advanced stages; but, says Teste: " There is no doubt, however, that serious affections of the air passages have fre- quently been arrested by its use; affections which, without COUGH. 145 being tuberculous phthisis, would nevertheless have been equally fatal.' "—Marcy and Hunt. " Cases that have been badly treated either with drugs, or which is very little better, by low attenuations, until hepati- zation or even abscess has followed, with pale, cold, damp skin, emaciation, hectic fever, swelling of the extremities, purulent expectoration, and quick weak pulse."—C. Pearson, M. D. U. S. M. Investigator, page 27, Vol. 1. The symptoms of sulphur are so numerous and so contra- dictory that we will leave the physician to make out the bal- ance by physiological induction and clinical experience. Aggravations, afternoon to midnight; cold, damp weather ; cold, or open cold air, and from getting warm in bed. Relieved by heat; in dry weather, and from drawing the limbs up. TARTAR EMETIC.-Loose, rattling cough, which sounds as if there was a cupful of mucus in the lungs, and they were about to run over; large collection of mu- cus in the bronchial tubes, ex- pectorated with great difficulty, from paralysis of the vagi; para- lysis of the lungswith great dysp- noea, and fits of suffocation: very great thirst dayand night ;cough and yawning consecutively. This remedy is indicated when we have a very loose, rattling cough, the lungs seem loaded with mucus, but none is expectorated. Dr. Hirschel says: " Tartar emetic—Cough rattling ; it sounds loose without being loose ; cough with vomiting of food after eating ; stertorous tracheal and bronchial rattling. The rattling necessitates sitting up, with vomiting or the dyspnoea and fear of suffo- cation. In the teething cough of children, where we frequent- ly hear the rattling from afar, and disappearing after the paroxysms of cough. In pneumonia with high-graded hepati- zation it aids expectoration when resolution begins to take place. In chronic bronchial catarrhs, emphysema bronchi- ectasia, senile catarrhs. It gives great alleviation in tubercu- losis pulmonum, but also more rapid dissolution of the tuber- cles, and hastens the downward course. In croup as an inter- mediate remedy for the solution, and to keep off paralysis. It acts well in those cases without producing emesis." 146 PULMONARY CONSUMPTION. " Copious accumulation of mucus in the air-passages, defi- ciency of aeration caused by its presence, numerous moist rat- tles, severe spasmodic suffocative cough. Tart, emetic is more adapted to subacute than to chronic affections of the air-tubes; hence its frequent application in bronchial catarrh for children and aged persons. Infants especially sometimes exhibit in the course of chronic bronchitis sudden and alarming symp- toms of suffocation, and mechanical irritation of the fauces is not always convenient or tolerated. In such cases a vomit- ing dose of this salt does much good and cannot do harm. A solution of one grain of the first decimal trituration to half an ounce of water, administered by teaspoonfuls every ten minutes, suffices to produce after the second or third dose, the ejection of the accumulated mucus. This proceeding is only to be adopted when a high degree of asphyxia demands immediate relief. Afterwards the 3d and 4th triturations act all the more favorably on the affected parts, as better oxidized blood contributes its share to an improved nutrition of the bronchial lining."—Meyhoffer. In capillary bronchitis, " Tartar emetic is unquestionably the great remedy for this dangerous form of bronchitis, and all who have used it can endorse the recommendation of Dr. Hughes:' perfectly homoeopathic to both the local and the gen- eral condition. I have almost invariably relied upon it single- handed, and have seen desperate cases recover under its use.' Kreussler says that he has ' found it very efficient in the last hours, when the patients struggled hard.' Baehr remarks that, ' it is really the second stage of the catarrhal process which is adapted to the curative action of this drug,' but my experience is that it should be given promptly and without delay, as soon as the disease is diagnosed. Aconite is the only remedy which can compare with it in value in this disease, and Aconite has almost always been given in the ear- lier stages of the malady. It is indicated by severe spasmodic suffocative cough, with wheezing respirations and marked dyspnoea; also by rattling cough which ends with vomiting of thick white mucus: also when the cough suddenly ceases, COUGH. 147 from weakness or from other causes. The actions of the pa- tient seem to show that he is suffering from oppression at the chest, and the mucous ronchus, indicating a very copious accumulation of mucus in the bronchial tubes, is one of the leading features of the case. This accumulation forms a me- chanical obstruction to respiration, and accordingly we have a group of symptoms of carbonic acid poisoning more or less pronounced, great anxiety and agitation, pale and bloated face, coma or delirium with coldness of the extremities. Profuse cool SAveat not followed by relief, and a disposition to vomit- ing and diarrhoea would be additional indications. The cough is aggravated by speaking, eating and the recumbent posture. Acts best in 3d and 4th triturations."—T. Nichol, M. D. Aggravations, in the evening; in damp, cold weather, and from getting warm in bed. Relieved, in the open, cold air. This is a special irritant to the vagus, and through it produces a hard, loose spasmodic cough, conse- quently is not called for until the second stage of catarrh has com- menced. VERATRUM ALBUM.— The spasmodic element pre- vaiIs in the cough. Cold sweat on the forehead; exhausting watery diarrhoea, with cold sweat on the forehead; great desire for cold drinks ; great irritation of the cceliac plexus, with fainting, great prostra- tion, nausea and vomiting, with cold perspiration; asth- ma, with suffocation, blue face, and anguish ; second, or plas- tic stage of catarrh, with loose rattling cough. Baehr says: "Veratrum alb. is not often enough made use of in bronchitis. It is not suitable in the first stage, but on the passage into the second stage, if mucus is se- creted in copious quantities which cannot yet be coughed up. This causes a constant titillation deep in the chest, with desire to cough; wheezing and coarse rales, but no expectoration; the depressing paroxysms of cough occur principally at night, with violent determination of blood to the head. The general failing of strength, the increased frequency or even irregularity of the pulse constitute additional indications for Veratrum, which is evidently suitable to old people rather than children." 148 PULMONARY CONSUMPTION. Hirschel says: " Just as Veratrum shows great similarity to Ipecac, in affections of the stomach and intestines, so also in cough. The titillation in Veratrum is only somewhat lower down, with a sensation of constriction in the throat; the oppression, the nausea, the vomiting of food and mucus is stronger after Veratrum, and the paroxysms approximate more to the forms of Belladonna or Drosera, with longer intervals. We might say, that in Veratrum the spasmodic element pre- vails; in Ipecacuanha the catarrhal one; thus the frequently decisive action of Veratrum in influenza, in simple spasmodic cough, in whooping-cough, next to Belladonna, Drosera, Conium, Cuprum, in nervous bronchial asthma, in stenosis of the glottis, or in angina pectoris." Aggravations, coming from cold into a warm atmosphere ; growing warm in bed; change of weather; damp, cold weather; eating and drinking cold things, as water, ice-cream, &c; morning and late in the evening. PRACTICAL EXPEDIENTS. Demulcent Beverages, of Barley-water, Gum-water, Rice- water, or Toast-water often are of much service. They should be prepared as follows :— Barley-Water.—One tablespoonful of pearl barley washed clean in cold water; then pour off the water and add the rind of one lemon, the juice of half a lemon, one teaspoonful of sugar; pour on one quart of boiling water, cover the vessel and let it stand two hours; then strain. If the patient desires, the lemon can be omitted, and sliced liquorice, orange-juice or currant-jelly used instead. Gum-Water.—Dissolve one ounce of clean gum-arabic, one half-ounce of white sugar, in one pint of hot water. If desired the juice of lemon or orange can be added for flavoring. This is often very soothing to the cough. Linseed Tea.—Take one ounce of bruised linseed; half- ounce of sliced liquorice-root, to two pints of boiling water; macerate in a covered vessel before the fire, for three hours, then strain through a piece of muslin. This is a very soothing COUGH. 149 beverage in hard, teasing coughs. Dose, one tablespoonful as often as necessary. Lemon or orange juice will make it more palatable. Rice- Water.—Wash the best rice with cold water, then boil in clean water for ten minutes, when the water should be strained off and more added, and so on till the goodness is all boiled out of the rice. When cold, the water is ready to drink; a little cream may be added, or some kind of flavor- ing if desired. Toast- Water.—Take a crust of stale bread; bake slowly, not burn it; put it in a quart of boiling water; when cool it is ready for use. This may be flaArored with lemon peel. Sulphurous Acid Spray has been found eminently beneficial in many cases of cough. The London Lancet recommends a new remedy for cough: " Resistance to the desire to cough until the phlegm has accu- mulated in large quantities, when there will be something to cough against, and the phlegm may be brought up with much less effort. A great deal of the hacking, hemming and cough- ing in invalids is purely nervous, or the effect of habit, and exercise of the will is needed to prevent the wasteful exercise •of power in cleaning the throat. Experiments in hospitals have shown this to be true." Tar-Water or capsules, taken three or six times a day as a common drink, not only acts as a palliative, but has cured hundreds of patients suffering with acute and chronic bron- chitis. Acts better when the cough is moist. Water.—In dry cough, and bronchitis sicca, the inhalation of steam produces great relief; it restores the arrested circula- tion by stimulating the capillaries tp contraction. Also, Small quantities of cold water drank at short intervals give much temporary relief. An excellent palliative in hard, dry, racking cough, is dilute glycerine, either with wine or whiskey. Dr. Brown Sequard states that nervous cough may be checked by pressure on the nerves of the lip in the neighbor- hood of the nose, or in front of and near the ear, or very hard 150 pulmonary consumption. pressure on the top of the mouth inside, or by strong exercise of the will. Rosin. In loose bronchial coughs we have used inhalation of the fumes of burning rosin, with pleasing effects. A small quantity of the fine rosin is put into an old tea-pot and set on fire with a few burning coals, and the vessel set upon the patient's lap, when the fumes can be inhaled with great ease. Or it can be burned in a close room. I like the tea-pot the best, for pure air can be given the patient constantly, which cannot in a small, close room. Cavities in the Lungs. A peculiar method of treating pul- monary cavities in phthisis, pursued by Prof. Mosler, of Wies- baden, is described as consisting in the injection of certain drugs through the wall of the chest, and leaving the canula in, so as to repeat the operation at discretion. He has even made an incision into the walls of the cavity, inserted a silver tube or elastic catheter, and succeeded in drawing away the secretion and in disinfecting the pyogenic Avails by means of weak carbolic acid lotion. It is stated that no difficulty was experienced in the operation, and the condition of the patient was improved, the cough becoming less troublesome, and the febrile symptoms apparently moderated. One point, at least, is regarded as settled—and it is certainly of great importance —so far as could be by a feAv experiments of this character, namely, that the local treatment of pulmonary cavities is undoubtedly practicable, and that the lung is really more tolerant of external interference than has been generally believed."—American Journal of Homoeopathic Materia-Medica, Vol. iii. page 414. ASTHMA-—This is a constitutional affection, consisting in spasmodic narrowing of the bronchial tubes, from contrac- tion of the circular muscular fibres, with difficult expiration, great wheezing and dreadful sense of constriction in the chest. In the majority of cases, it is the expression of perverted ner- vous action (Neurosis), but not always a purely nervous dis- ease. There are often organic diseases of the lungs, heart, ASTHMA. 151 brain or medulla oblongata, which produce the most obstinate cases of asthma, especially tuberculosis of the lungs. We believe the cryptogamic theory of hay-fever to be a phantasy. This autumnal catarrh is a constitutional affec- tion, and no one can become affected by it, excepting those having this peculiar constitutional dyscrasia, and it requires no different treatment from common asthma. treatment. This is one of the most difficult and trying diseases the phy- sician is called upon to treat. Notwithstanding Homoeopathy can boast of some brilliant cures of this disease, medical treat- ment is often unsatisfactory and uncertain. Remedies for the Acute Attack.—The most valuable and first to be studied are Ipecac, Veratrum Viride, Digitaline, Arsenic and Stramonium. Second: Such remedies as Aconite, Acid Hydrocyanic, Ambra, Belladonna, Bryonia, Cham., Coffea, Cannabis Sat., China, Camphor, Gelseminum, Hyoscyamus, Lo- belia, Lachesis, Morphine, Opium, Musk, Nux v., Pulsatilla, Sanguinaria, Sabadilla, Tartar Emetic, Tobacco and Veratrum Album. CHRONIC ASTHMA.—The most useful remedies are, Arsenicum, Calcarea Carb., Cod-liver oil, Ferrum, Glanderine, Iodine, Kali hyd., Lycopodium, Mercury and Sulphur. Second: such remedies as Argentum nitr., Aurum, Ammo- * nium carb., Bromine, Causticum, Carbo veg.,Graphites, Hepar Sulphur. Kali nitr., Kali bich., Kali brom., Mercury, Nitric Acid, Natrum Mur., Phosphorus, Spongia, Sepia, Stannum, and Zinc. We will now give the leading indications of the most valu- able of the above-mentioned remedies in alphabetical order. In this way we hope to be able to cover all kinds and cases of Asthma. ACONTPB.-Great fear, and This remedy is more especially anxiety of mind, with nervous useful to subdue the acute attack. excitability; high fever, full Its sphere of usefulness is soon bounding pulse, and agonized passed. Cases that Aconite is 152 PULMONARY CONSUMPTION. tossing about; great fear of death; sure he will die; ver- tigo on sitting up in bed ; asthma brought on from change of temperature from warm to intensely cold weather; dry cough. Sanguine, pleth- oric people, who are very irritable and sensitive : symp- toms greatly aggravated at night, especially after mid- night. adapted to are young plethoric peo- ple, with cerebral hyperaemia, ac- companied with intense fear ; con- gestive nervous asthma. Dr. E. H. Ruddock says : " The striking poAver of this great remedy in af- fections of the pneumogastric nerve, characterized by imperfect and labored breathing, has sug- gested its use in spasmodic asthma, during the paroxysms of which we have often administered it with marked and speedy relief. It is especially indicated by oppressive anxiety, dyspnoea, and labored action of the heart It is the best palliative in bronchitic asthma." Dr. T. Nichol says : " For the last fifteen years the writer has been in the habit of looking upon Aconite as one of the very chief of our anti-spasmodic remedies, and of late years the same view has been taken by some of our best writers." Hem- pel asserts that in " spasmodic Asthma, when resulting from exposure to keen wind, or from the retrocession of some acute eruption, acute nettle-rash, or the like, Aconite will be found invaluable ; the orthopncea of Aconite is equivalent to an at- tack of spasmodic asthma." Dr. Hughes says: " When the asthma is bronchitic, I agree with Drs. Russell and Blandell in considering Aconite the best palliative. It might have been added, that the rem- edy is curative as well as palliative. Aconite, then, is the ap- propriate remedy when the patient is of full plethoric habits, when the asthma results from a sudden cold; also in cases in which the attack follows the suppression of an acute rash. Oppressive anxiety, dyspnoea and labored action of the heart are leading indications, and unless these are present, but little good need be expected from it. The cough often comes on at night, and is rough, spasmodic, croaking, as if the patient would suffocate, with hoarse barking voice, and spasmodic constriction of the chest and throat; respiration short, anxious ASTHMA. 153 and difficult, with open mouth and inability to utter a single word distinctly. There seems to be a constriction of the chest present, and as the spasm relaxes the expectoration is yellow- ish or blood-streaked. During the attack the patient is peev- ish, restless and irritable, and even in young children the characteristic dread of death is seen. The pulse is small, ir- regular and intermittent, and the heat of the surface is con- siderable. All dilutions have cured, but I prefer the tritura- tions from the 4th to the 12th given in repeated doses." ARSENICUM.—Rapid and great prostration, with sink- ing of the vital forces ; burn- ing pains ; the parts burn like fire; intense thirst; drinks lit- tle, and often; craves warm air ; great anguish, restless- ness, and fear of death; ex- cessive restlessness, cannot lie still; relieved by motion; great emaciation ; cannot lie down for fear of suffocation; highest degree of dyspnoea; sad and irritable ; anasarca of the whole body; obstinate nausea and vomiting ; cadaverous diarrhoea, with great enerva- tion ; cold night sweats. For chronic organic cases Arseni- cum is one of the most useful re- medies we have for this trying disease. My friend, Dr. T. Nichol, has given such a practical resumS of its action in his article on " The Respiratory Affections of Child- hood," that I cannot do better than give it in full. He says : " Opin- ions differ very much as to the value of Arsenicum in asthma. Dr. Bags, whose bright book is one of the most readable that has appear- ed of late years, says that ' in asth- ma I have seen occasional good re- sults from Arsenicum, but have never seen it cured by this medi- cine '; while Dr. B. Baehr, whose great work entitles him to rank as an authority of the first class, avers that ' Arsenicum is undoubtedly the safest remedy for asthma. It not only corresponds to the simple, spasmodic, uncomplicated asthma, but likewise to the secondary forms of asthma, which owe their existence to the most diversified affections of a more primary character.' Kreussler asserts that, ' in cases of years' standing, Arsenic affords only temporary relief, although it is perfectly adapted to the severest of recent asthma '; while Ruddock, at least of equal value as an authority, says ' that it is especially useful in chronic asthma;' and Dr. Hughes says 154 PULMONARY CONSUMPTION. that 'Arsenicum is the best medicine where bronchitic asthma tends to become, or has become, chronic' Dr. Laurie con- siders that in confirmed asthmatics, it forms a most important remedy. In my own practice I have repeatedly seen radical cures of both acute and chronic asthma with this remedy, though I agree with Dr. Ruddock that it is of especial value in the chronic form." Arsenicum is an invaluable remedy when the asthma results from suppressed eruptions, and when it also attacks children of feeble and impaired constitutions. It is also of great ser- vice when the asthma—which is here merely symptomatic, not idiopathic—depends on disease of the heart, or upon pulmon- ary emphysema or oedema, or upon chronic bronchitis. Dr. Nunez, of Madrid, affirms that Arsenicum is curative in the nervous asthma, resulting from the suppression of dry erup- tions, such as lichen on the palm of the hand. All experi- enced practitioners can confirm Baehr's remark, that, "in the asthmatic paroxysms of tuberculous patients, Arsenic has al- ways left us in the lurch." Baehr says: "We dispense with the enumeration of indi- vidual symptoms, since every somewhat violent attack of asthma corresponds to arsenic." Baehr is one of the first minds in our school, and he has perhaps no greater admirer on this side of the Atlantic than the writer, but I most em- phatically dissent from a statement which strikes at that in- dividualization of cases which is the essence of homoeopathy. Is Arsenicum adapted to all cases of asthma, without excep- tion ? Surely not. If not, then We must diagnose the remedy as well as the disease. "The Arsenicum asthma, as a general rule, attacks fiercely and soon reaches its acme. The more the patients seem on the point of suffocating, the more painful and distressing the restlessness; the more wheezing and louder the respirations, the more Arsenicum will be found appropriate,"—Baehr. Laurie remarks that this remedy is indicated when the paroxysms of asthma are most liable to occur when retiring to rest, or before midnight, the patient being disturbed from ASTHMA. 155 sleep by a sense of spasmodic constriction in the chest and upper part of the windpipe, which is soon followed by labori- ous panting and whistling respir. tion, with gasping for breath. The respiration is attended with extreme agitation, restlessness and moaning ; extreme anguish and exhaustion, as if at the point of death, with cold perspiration. The dys- pnoea is difficult and stifling, with suffocative attacks, recur- ring in paroxysms. The cough is frequent, dry, and exhaust- ive, and is attended with constriction in the trachea, and fol- lowed by suffocative fits. There is often an accumulation of thick phlegm, and the paroxj'sms grow lighter on the appear- ance of cough with expectoration of mucus or viscid saliva. There are also present violent palpitations of the heart, with small, quick, and intermittent pulse, together with dry, burn- ing heat, alternating with cold perspirations. The prostration; is extreme, and children who are old enough complain of the well-known burning heat in the chest. The face is pale or bluish, with an anxious or desponding expression. The con- sequences of the paroxysm remain for a long time, and pros- tration and nervous debility are peculiarly prominent. The asthmatic paroxysm to which Arsenicum corresponds is excited by active exertion, even by getting into bed; by talking or laughing; by changes in the atmospheric tempera- ture, and also by warm or tight clothing. The paroxysm is aggravated by lying down, and relieved by sitting erect and by bending forward; to which Hartmann adds, that " the pa:ient cannot speak a word without making the asthma worse." Arsenicum is well known to be adapted to night paroxysms, but it is likewise suitable to attacks coming on during the day. As to the dose, Marcy says that " the first to the third trituration may be employed, regulating the repetition accord- ing to the urgency of the symptoms." Drs. Marcy and Hunt give still larger doses, and advise the exhibition of a prepara- tion of Arsenic seldom used in Homoeopathic practice, " the Liquor Arsenicalis, which is said t©>be much more efficacious 156 PULMONARY CONSUMPTION. than the Ars. album. It seems to be more prompt and ener- getic when Arsenicum is indicated. It should be prepared with distilled water instead of alcohol. The most efficacious and satisfactory method of treating asthma is with the Arseni- cal solution—1st dilution, and Kali hyd., first decimal tritu- ration, in alternation, every hour or two, or three times a day, as circumstances demand. Baehr judiciously remarks : "Dur- ing the apyrexia the remedy had better be administered at long intervals and in the higher attenuations, although the success which ' old school' practitioners have attained with Fowler's solution, justifies the conclusion that massive doses are likewise conducive to a cure. The danger is that massive doses may affect the stomach injuriously. My own experi- ence is in favor of the administration from the 12th tritura- tion to the 30th dilution during the interval, giving the 6th to the 12th decimal trituration, during and immediately after the actual attack. I have had no experience with Fowler's solution." My experience with Fowler's solution has been so favorable that I do not hesitate to state, that it is twice as useful as the Arsenicum alb. I use the first three attenuations (decimal scale), and sometimes the pure solution in drop doses. Twice I have given the 1,000th (Tafel's) attenuation of Arsenicum alb., with immediate and lasting curative results. Chronic organic cases, with per- fect despair and loathing of life. " Where it is not certain whether the heart is primarily or secondarily involved in the attack, the attack sets in with violent palpitation of the heart, great anxiety and marked symptoms of pulmonary hyperae- mia. AURUM. — Great melan- choly; the mind constantly tends towards self-destruction; utter despair; swelling, and exostosis of the skull-bones; nightly bone pains ; syphili- tico-mercuri al affections; over- sensitiveness to pain and cold air ; indurated glands ; worse in warm air and wet weather. ASTHMA. 157 AMMONIUM CARB. — Weak, nervous people, or lym- phatic, venous temperaments. The moment he falls asleep he is aroused again for want of breath; great haemorrhages ; scurvy; worse evenings and dur- ing wet weather ; anasarca; hydrothorax ; bronchorrhcea. Organic cases. Hartmann says : " Asthma with repeated palpitation of the heart, considerable oedema of the feet, and an asthmatic state every evening, continuing until midnight, relieved by the open air; dyspnoea with palpitation of the heart when moving; heaviness and burning in the chest, aggravated in wet weather, relieved by warmth and dry weather. ARGENTUM NIT.— Time passes too slow; every- thing done seems to be done too slow; excessive flatulence; stomach nearly ready to burst with gas; fluid seems to run straight through the intestinal canal without stopping ; diar- rhoea from ulceration of the in- testines. Severe organic cases that are much worse at night. The attacks commence suddenly, with very dis- tressing shortness of breath ; ten- sion as if a band was around the prsecordia ; very short breath, with deep sighs, and violent palpitation of the heart, or oppressed panting, quick, sibilant breathing, inability to lie down, obliged to lean forward to get breath, with rumb- ling of gas in the chest and bowels. From the first to the third decimal will be found of great utility. Asthma in nervous, hysterical women. As a palliative Ambra is of great use, Hartman says: " I have found Ambra, second or third tritu- ration, an useful remedy in asthma siccum and senile, particularly when the oppression was principally felt in the left chest, extending from the heart to the back and between the shoulders, attended with palpitation, anguish, arrest of breathing. It likewise proved useful in asthmatic ailments of scrofulous subjects." Greatly aggravated at night, and in a warm atmosphere. AMBRA. — Hysterical, nervous females ; spasmodic, choking sensation in the throat, with frequent fainting fits ; dry spasmodic cough ; aggravated in the evening; re- lieved in the open air; loud eructations of gas. 158 PULMONARY CONSUMPTION. Amber beads worn about the neck have a wonderful reputa- tion of curing hay-fever. ACID. HYDROCYANIC. —Spasms of the face and mus- cles of the back, and the body assumes a bluish tint. Long fainting spel'.s, violent palpi- tation of the heart; paralysis of the oesophagus, the fluid runs gurgling down the oesophagus; much rattling of mucus, with sluggish respiration. This remedy has a most power- ful action upon the medulla ob- longata and spinal cord,* and ought to be one of our main remedies in spasmodic asthma. " Professor Geise had suffered for a long time, both day and night, with periodical asthma, and the most violent at- tacks of suffocative spasmodic cough, which had withstood all remedies. Acid, hyd., two drops per dose, three times a day, cured in five weeks. " A middle-aged man, who had repeatedly suffered from profuse spitting of blood, finally became permanently asthma- tic. As the disease progressed, it became more and more spasmodic, and to a certain degree periodical, although organic disease of the chest was suspected. Twelve days' treatment with the Acid. hyd. entirely cured the case, after a fruitless use of several remedies, internal and external."—Frank. As a palliative, in acute cases, Bell, is frequently of great value. Baehr says: "When the attack is accompanied by congestion of the head and an affection of the larynx in the case of plethoric individuals, children and females of an irritable disposition." Bell, has been especially recom- mended in cases occurring in fe- males of an irritable constitution, also in cases where there exists a tendency to spasm, or any organic lesion. Hartmann asserts that it " often proves radically curative after the exhibition of some intercurrent remedy, particularly BELLADONNA. — Pains come ani go with great celer- ity ; furious delirium, wild look, wishes to strike, bite or quarrel; face flushed ; eyes red ; rage, tears, bites and strikes ; violent throbbing of the carotids; throbbing head- ache ; worse by motion ; noise is intolerable; great dryness of the fauces ; bright, red and swollen tonsils ; spasms of the throat ; symptoms worse even- ings and at night. ASTHMA. 159 in cases which have not become too chronic by repeated re- lapses, under which circumstances we must have recourse to Sulphur, Calc. c. or some other antipsoric." It is particularly called for when the paroxysms come on in fits of short, difficult, irregular and suffocating respiration, ac- companied by dry cough; pressure on the chest, violent beat- ing of the heart, vertigo, swimming or darting pains in the head, pains in the small of the back and limbs, cramps in dif- ferent parts of the body, anxiety, irritability and fretfulness." Marcy and Hunt. These symptoms are greatly aggravated in the evening and at night. Atropine sometimes acts better than Belladonna. Dr. Nichol says: " Bryonia is the appropriate remedy where the asthma originates from, or is com- plicated with catarrhal and pul- monary maladies, and it is of use in cases arising from suppressed erup- tions or partially developed rashes. The leading symptoms of the Bry- onia asthma is, that it is worse by motion, and in the night, with pain in the chest. BRYONIA.—All the symp- toms are greatly aggravated by motion; dry cough, compe's the patient to sit up imme- diately ; respiration oppressed; wishes to take in long breath but cannot; feeling as if the lungs could not expand; con- stipation ; dry, hard, burnt- looking stools ; lips parched, dry and cracked ; worse nights and from warmth ; severe stiching pains during inspira- tion. The paroxysms of the Bryonia asthma usually occur at night, and it is almost invariably preceded by catarrhal symptoms, difficult breathing and loss of breath, especially at night and toward morning, aggravation of the dyspnoea from talking or from the slightest movement. This difficulty of breathing is often accompanied by stitching pains, inability to lie on the right side, and not without inconvenience on the left, so that the patient is constrained to lie on the back; frequent efforts to obtain sufficient air by deep inspiration, accompanied with moaning palpitation of the heart, and great anxiety. The cough is hard and frequent, with expectoration at first frothy 160 PULMONARY CONSUMPTION. and subsequently thick and glutinous, frequently attended with retching and vomiting; the patient feels relieved after expectorating, or rising from a recumbent position ; frequent stitches in the chest, especially during an inspiration, and when coughing, also during motion ; at other times there are oppressive, tensive or contractive pains in the chest, and the asthmatic attacks are often attended by shootings in the lungs on taking a full inspiration, also on coughing or after any movement of the arms or trunk. Often gastric symptoms are present, bitter or acid eructations, or eructations tasting of the food, colic, pressive pains in the head increased by motion, and the characteristic mental symptoms prevail; irritability of temper, and disposition to find fault with everything. Laurie and Caspari say that Bryonia and Nux v. are often administered with great advantage in alternation, and Ruff re- ports a cure which followed these remedies given in that man- ner. But as the symptoms of Bryonia are quite distinct from those of Nux v., it will be better and more scientific practice to discriminate carefully between them, and then give the in- dicated remedy singly and alone. More valuable is Jahr's therapeutic hint, that Bryonia is frequently suitable after Ipecac in acute asthma." B R O MIN E.—Suffocating cough, with hoarse wheezing and gasping, with false mem- brane in the trachea, especially where the larynx and trachea are inflamed ; great rattling of mucus in the lai-ynx and trachea when coughing ; great nervous prostration, remaining after all other symptoms have gone ; aggravations in the even- ing. exhausted, disappeared after taking five doses of Bromine 30th of five pellets each. It is one of the few drugs that produce the croupous false membrane in the air-passages." In organic cases, where there is a great collection of mucus in the trachea and lungs, second stage of asthma. Dr. Douglas says : " A dyspnoea of ten years standing, in a girl sixteen years of age, which had remained after measles, and was so violent that the girl was some- times not able to walk fast or go up stairs without feeling very much ASTHMA. 161 Wheezing, rattling breathing, with a tight feeling in the chest, accompanied with a dry, spasmodic, wheezing cough, worse in the forepart of the night and in a warm room. CALCAREA CARB.—Leu- cophlegmatic constitutions ; large head and features, pale, flabby skin, with chalky looks, and in infants open fontanelles; profuse perspiration of the head, stands out in large, bead-like drops, often soaks the pillow thoroughly; much peevishness ; food is badly assimilated; great debility ; in going up stairs is out of breath, has to sit down; run- ning up stairs produces great vertigo; feet feel cold contin- ually, as if he had on cold, damp stockings; acid stom- ach, with sour vomiting; swelling over the pit of the stomach like a saucer turned bottom upward ; chronic wa- tery diarrhoea. In women the menses are too often too pro- fuse, and last too long ; loose, rattling cough ; great emaci- ation, the least cold goes through and through the pa- tient ; hectic fever, with co- pious perspiration of the head and chest ; cold, damp, east wind is sure to bring on a cold. Calcarea is one of the most use- ful and reliable remedies we have to eradicate the constitutional dys- crasia that lies at the foundation of asthma, and should be thorough- ly studied in all cases of chronic,' organic cases of asthma, especially if the person afflicted is a child. Calc. car. has a marvellous effect upon children that are growing rapidly, and are afflicted with asth- ma. Also affects the female organ- ism more favorably than that of man. Acts best in leuco-phleg- matic, scrofulous constitutions, where the organic or ganglionic nervous system is at fault, as shown by great emaciation and debility. The asthmatic breathing is accom- panied with a feeling of tightness of the chest as if too full of blood, and loud mucous rales, with sore- ness in the chest when drawing a deep breath, and touching it; the cough sounds loose, but little is ex- pectorated. There is often a sen- sation as if there were dust in the throat and lungs; attack comes on early in the morning; it is almost impossible for the patient to go up stairs, or to ascend any height. It is the peculiar scrofulous dyscrasia that Calcarea is adapted to, rather than particular symptoms. Dr. G. V. Miller says of Calcarea phosphorica:—"Subjects instead of being fat, as in Calc. carb. are emaciated. Instead 162 PULMONARY CONSUMPTION. of a clear, white complexion like the above, it is for a dirty white or brown complexion; also, skull soft, thin, crepitating when pressed, especially on the occiput. Craves bacon, salt meat and potatoes." CANNABIS SATIVA.— Acute cases, A\here the mu- cous membrane of the lungs is loaded with mucus : sensa- tion as if cold water were dropping over the heart or head; bloody urine; sexual over excitement; humid asth- In the second or sub-acute stage of humid asthma. " Humid asth- ma, extreme agitation, dyspnoea, wheezing, and mucous rales. As the attack declines, an easy rattling cough brings up copious, thick, yellow sputa."—Ruddock. ma. " When the patient can only breathe in a sitting posture with the neck stretched forward, wheezing in the trachea; ab- dominal muscles put violently on the stretch during every inspiration, exceedingly restless and tortured by anguish. These symptoms occurred before midnight, in a patient suffer- ing with organic heart disease, and the effect of Cannabis was very striking."—Hartmann. CAUSTICUM.— Scrofulo u s people, with yellow complex- ion ; cannot keep the upper eyelids open, they will fall down over the eyes ; great melancholy, looks on the dark side of everything, especially so in women during menstrua- tion ; acid stomach, with much flatulence ; obstinate constipation; painful pustules near the anus, discharging pus, blood and serum ; no remedy has so many anal symptoms; involuntary urin- ation when coughing; chron- ic morning hoarseness ; com- plete aphonia; wheezing cough, This is a ganglionic remedy of penetrating action, and is especial- ly useful in old organic chronic cases, to eradicate that peculiar asthmatic dyscrasia. Not so useful as a palliative, but of much value as a constitutional remedy. " Asthma when sitting or lying down; tight dressing oppresses breathing; dry, wheezing, whist- ling, hoarse, hollow cough, with soreness in the chest; expectora- tion only at night, which he cannot raise, but has to swallow it again; involuntary passage of urine when ASTHMA. 163 the expectoration cannot be coughing, aggravated by cold air spit out, is obliged to swallow and { h evening." In cases what is raised. Worse in cold, & dry weather. adapted to Caust. there is much hoarseness, loss of voice, and ex- cessively dark-yellow complexion. CARBO-VEG-ETABILIS. —Weak, cachectic people, with great foulness of the se- cretions, especially the sputa ; craves more air, wants to be fanned all the time ; spongy gums that bleed readily ; ex- cessive accumulation of gas in the stomach and bowels, with a sensation as if the stomach or abdomen would burst; con- stant eructations of flatus, by the mouth and anus ; slimy diarrhoea; icy coldness of the parts ; tendency to gangrene ; much hoarseness ; very of- fensive breath and sputa. This remedy is useful in the sec- ond stage of chronic organic cases, where there is great wheezing and much rattling of mucus in the lungs, and expectoration abundant in the morning. " Much oppression of breathing, with wheezing rattling mucus, and a hoarse, loose cough, more especially in the morning. Cough, with spitting of blood or pus, with much burning distress in the lungs." Aggravated in cold, damp, wet weather, and cold air. CHAMOMILLA.—Especial- ly acts upon the sensory and excito- motor systems. Out of humor, very impatient, cannot answer one civilly, the pains make him furious, the least thing makes him fretful; asthma brought on by a fit of passion ; in children, one cheek red and the other pale ; tongue coated yellow ; flatulent colic. Diarrhoea green and watery, or like chopped eggs. Dry, hacking cough, worse in the open air and at night. In the peculiar temperament that calls for Chamomilla, this remedy will be found valuable in nervous, spasmodic asthma, especially if the "attack is caused by a severe fit of passion, with flatulence, particular- ly for paroxysm of hysteric asthma, or for children during dentition." —Baker. " Chamomilla is an important remedy in the flatulent asthma of children, also in that following a suppressed catarrh. It is likewise, specific in these attacks which are caused by anger, grief, fear, &c, in adults. Disten- 164 PULMONARY CONSUMPTION. tion and sense of fulness in the stomach and bowels ; press- ure, anxiety, and fulness in the region of the heart; short wheezing respiration; great restlessness; dry irritating cough; bad taste; tainted breath."—Marcy «i Height. 2.2 8 go" Vl-P u 2^.2 W(M ^Z. "no «1 I>H &> > 22 K« J J) MO «lh« <» O) JP •a ® - .* mai .M ,— ^4 S =°^ 8 «=i-i h C M D M ^ w CO oo First result. Second result. 5 feet 0 inches ) 5 feet x inch..... 5 „ A ,, ) 175.0 176.0 174.0 5 „ 2 „ 5 o 5 „ 4 „ j5 » 6 " 188.5 191.0 190.0 5 » 4 » 15 5 206.0 206.0 206.0 5 » 6 » 5 7 5 „ 8 „ j° » ' " 222.0 228.0 222.0 5 " 8 " 15 9 5 „ 10 „ )° " 9 " 237.5 246.0 238.0 5 „10 „ 5 n 6 „ 0 „ J° " ll " 254.5 258.0 254.0 214.0 217 0 214.0 Age has an influence, though less marked than stature, upon the extreme breathing capacity. As the result of 4,800 ob- servations (males), it was ascertained that the volume in- 222 PULMONARY CONSUMPTION. creases with age up to the thirtieth year, and progressively decreases, with tolerable regularity, from the thirtieth to the sixtieth year. These figures, though necessarily subject to certain individ- ual variations, may be taken as the basis for examinations of the extreme breathing capacity in disease, which frequently give important information. Of course, the breathing capa- city is modified by an abnormal condition which interferes with the mobility of the thorax, or the dilatability of the lungs. Of all diseased conditions, phthisis pulmonalis is the most interesting in this connection. With regard to the sig- nificance of the variations in this disease, Dr. Hutchinson has arrived at the following conclusions : " It has been found that ten cubic inches below the due quantity, i. e., 220 instead of 230 cubic inches, need not excite alarm, but there is a point of deficiency in the breathing volume, at which it is difficult to say whether it is merely one of those physiological differences dependent on a certain irre- gularity in all such observations, or deficiency indicative of disease. A deficiency of sixteen per cent, is suspicious. A man below fifty-five years of age, breathing 193 cubic inches instead of 230 cubic inches, unless he is excessively fat, is pro- bably the subject of disease. " In phthisis pulmonalis the deficiency may amount to 90 per cent., and yet life be maintained. The vital capacity volume is likewise a measure of improvement. A phthisical patient may improve so as to gain 40 upon 220 cubic inches." " Herbst has shown that the extreme breathing capacity is diminished by obesity ; that it is proportionally less in females than in males and in children than in adults." Dr. Hall gives us a fine illustration of the practical work- ings of the spirometer in page 167 of his work on Bronchitis and Kindred Diseases, by giving twelve fatal cases of phthisis: Case 1. Had lost five-tenths of her lung measurement, and died in twelve days. " 2. Had lost five-tenths, and died in eight months. SPIROMETER. 223 Case 3. Had lost four-tenths, and died in two months. " 4. Had lost two-tenths, and died in six months. " •">. Had lost four-tenths, and died in two weeks. " 6. Had lost six-tenths, and died in two weeks. "• 7. Had lost four-tenths, and died in four months. a 8. Had lost three-tenths, and died in three months. "• 9. Had lost three-tenths, and died in four months. •' 10. Had lost three-tenths, and died in three months. •w 11. Had lost three-tenths, and died in two months. •' 12. Had lost three-tenths, and died in three months. I have given twelve consecutively fatal, measured cases, occurring during twelve consecutive months, known to have died from direct observation, by which it will be seen that persons having consumptive symptoms, and who had lost the use of three-tenths of the lungs or more, died in four months, three only having lived longer. It will be seen that No. 2 with a loss of five-tenths, which is one-half, lived eight months, while No. 4 with a loss of two- tenths or one-fifth only, lived six months, and No. 5, with a loss of four-tenths or two-fifths, lived only two weeks; this difference arises from the fact that the loss of measurement, in all cases, arises from two causes, first, the loss of lung sub- stance ; second, the loss of lung function only; the greater the loss of lung substance, the sooner the patient dies, but vice versa, when the greater portion of the loss is not because the lungs have decayed away, but because they work imperfectly from being filled up with matter or mucus, or tubercles, or from mere inaction. Auscultation must decide what pro- portions of the deficit is attributable to the respective causes, and from that, we must judge as to the probable time of ter- mination. When the deficiency is small, the lungs cannot have decayed away to any critically hurtful extent. When the deficiency is large, and auscultation shows no decay, no actual loss of lung substance, there is encouraging ground for restoration, if prompt attention is given to treatment." These cases are followed by a few cases that recovered, 224 PULMONARY CONSUMPTION. showing the increase of lung measurement as health was re- stored : Case 1, Nov. 24. Deficiency from full measurement, one- tenth ; March 11th, dismissed cured, with full measurement, and four years after remained well. Case 2, Dec. 18. Deficiency, two-tenths; Jan. 14, fully re- stored, and known to be in good health for four years, with full measurement. Case 3, Dec. 18. Deficiency, three-tenths; April 17, de- ficiency nearly restored, and enjoyed good health for three years. Case 4, Dec. 8. Deficiency, three-tenths ; pulse 120 ; March 22nd, restored ; pulse, 72. The doctor gives several more cases, but I have given enough to illustrate my point; he closes by saying that, " the prominent parts to be noticed in the twelve cases given are: 1. That when there is but a small deficiency in the measure- ment of the lungs, it is uniformly restored, by appropriate means, persevered in. 2. That when such deficiency is made up, the system re- turns to good health. And the great practical lesson to be derived from the two classes of cases is: That inasmuch as when the deficiency is large, persons usually die within half a year. That when, on the other hand, the deficiency is small, health is generally regained in a reasonable time. Spirometry is a mathematical measurement designated by figures, which answers to a certain set of conditions. The amount of air capable of being expired from a man's lungs is accurately measured to a single cubic inch, or half inch. Different persons require a different amount of air, but these are regulated by nature herself, who modifies them by certain fixed proportions: Sex. Age. Breathing. Pulse. Height. Weight. Capacity. Male 40 17 68 6 feet 140 262 cubic in. SPIROMETER. These seven correspondences occurring in one man, are un- failing indications of the full healthful condition of the lungs, and when the pulse and breathing are steadily over these, and the lung capacity is under in such a man for a month or two, then are the foundations of consumption being made, and infal- libly so as far as my experience has gone. But these devia- tions are seldom alone. Notes of alarm are sounded in other parts of the empire of life." Females m< asure less than males, varying from ten to fifteen per cent. The following table will make it more practical: Height 4 feet 8 inches male capacity, 134 female capacity, 96 cubic in. 4 •>i 9 4 ■>■> 10 4 55 11 5 55 0 5 51 1 5 51 2 5 ,, 3 5 51 4 5 11 5 5 11 6 5 51 7 5 51 8 5 55 9 6 51 10 5 51 11 6 55 0 142 , 5 il 104 150 , 5 15 112 158 , 5 55 120 166 , 1 51 128 174 , 5 11 136 182 , 5 55 144 190 , 5 11 152 198 , 5 11 160 206 , 5 11 168 214. , 5 11 176 222 5 55 184 230 , 5 51 192 238 , 1 11 200 246 , 5 11 208 254 , 5 55 216 262 , 5 11 224 "Some persons six feet in height will exhibit a lung capa- city of 300 cubic inches, and others of the same height may measure no more than 224 inches, and yet enjoy good health ; and so in proportion through the entire table. With this standard in view, the intelligent physician, with a little prac- tice, will soon be able to determine whether the lungs are dis- eased or not, and the extent of the same." The above table is the average measurement in five thousand cases, and is near enough for all practical purposes. Trained singers in good 15 226 PULMONARY CONSUMPTION. health will go" over the average measurement, and it is a well- established fact that they seldom die with pulmonary con- sumption, showing the great utility of deep, full breathing The practice of elocution, gymnastics, and the constant use of breathing tubes, with the Spirometer, cannot be urged too strongly upon those that are predisposed to pulmonary consump- tion. Phthisical patients should be constantly urged to get into the habit of deep, full breathing. Full, deep breathing exercises every part of the lungs, while feeble, ordinary breathing, only exercises the lower lobes, leaving the upper lobes dormant, which explains why tubercles always com- mence in the upper lobes ; every muscle and tissue that is not used, becomes feeble, and is then the centre or focus for any disease the system may be predisposed to. Professor Juergensen, in the Cyclopaedia of the Practice of Medicine, Vol. V., page 487, speaking of lung capacity in those predisposed to phthisis, mentions a fact well worth re- membering ; he says: " If the chest were filled with 600 cen. of solid matter, especially if the latter were concentrated in the upper parts of the lungs, percussion would, doubtless, show the fact; and even if, in all these cases, we suppose that the first ribs are immovable, the deficit would be too great. The only, explanation left is, that the deficit is due to feeble- ness of the respiratory muscles. What is known as the paralytic thorax seems to be traceable to this factor, loss of muscular power. The slender neck, the prominent clavicles, the broad, depressed, intercostal spaces, and the scapulas pro- jecting like wings show that the principal respiratory muscles have been atrophied. The main burden of respiration is therefore thrown upon the diaphragm in the very years when there should be a due co-operation on the part of the other muscles." This explains why those predisposed to phthisis have less lung capacity than those that do not have this predisposition, and should be taken into consideration in Spirometry. I have found that the loss of a night's sleep, habitual drinks SPIROMETER. 227 of intoxicating liquors, even ever so slight if indulged in daily, greatly diminishes the lung capacity. Also a full stomach. The Spirometer should not be used directly after eating. Heretofore the Spirometer has not been utilized by the mass of practicing physicians, for the simple reason all that have been put into the market have been so large and bungling, that their use had to be confined to the office, and then the use of one took up so much valuable time that the practitioner could not afford to use it. To illustrate it more fully, I' will take Dr. G. W. Brown's valuable Spirometer, in all probability as good an instrument as can be found in the market. To take it down, adjust it, fill it with water (and it takes several gallons), use it, take it apart again, wipe it all dry to keep it from rust, about one hour is consumed. This hour to the physician is worth from two to five dollars, and he cannot charge that much for his services, consequently he cannot afford to use it, and then if his patient has to be visited at his residence, the Spirometer cannot be used at all, because of the great trouble of transporting it from house to house. To get the Spirometer in small enough compass, so as to be carried constantly in the physician's pocket, has been a source of constant study to me for the last two years, and it gives me great pleasure in being able to announce to the profession that I have succeeded in producing an instrument whose action is perfect as a Thermometer, can be carried in the pocket, taken out and used, and replaced in the pocket in ■ two minutes, and only costs a mere trifle, compared to those now in use, at once utilizing this greatest of all instruments for diseases of the lungs. INDEX. Aconite, 45. 151. Acid Hydrocyanic, 158. Ammonium Carb , 157. Ammonium Mur., 70. Ambra Gresia, 70, 157. Antimoniiim Crudum, 71. Aphtha-, 206; Practical Expedients, 210. Argeutura Nit, 74, 157. 208. Arnica, 52. 71. Arsenicum Alb.. 21, 72. 15:;. 198, 210. Arsenate of Soda, 74 Asthma. 150; Acute Attach-. 150; Chronic, 151; Remedies, 151; Practical Exped- ients, 194. Asthmatic Cough, 07. Atropine, 78. Atonic condition of the body, 15. Aurum Muriaticum, 76, 156. Baehr, Dr. B., Remedies, 9. Bathing, 20. Bed Sores, 214; Practical Expedients, 214, Belladonna, 5:5, 7(i. 158. Blood Cure, 216. Borax, 207. Bromine, 78, 160. Bryonia Alba., 7i>, 159. Breathing Tubes, 1G. Carbo Animalis, 83, 200. Carbo Veg., 82, 1G3. Causticum, 84. Cannabis Sativa, 1G2. Camphor, 164. Carbonic Acid Gas, 19G. Calendula, 211. Calcaria Carbonica, 20, SO, 181, 198. Cerebral Cough, G7. Chamomilla, 85, 163. Chloral Hydrate. 195, 215. I Chloroform, 195. Charge, Dr. A., Remedies, 12. | China, 24, 52, 85, 164, 199. Climate, 20. Clothing, 58. Cough, 59; Dry, 63; Moist, G5; Asthmatic, 67; Catarrhal, 67; Croupy, 67 ; Morning, 68; Evening, 68; Night, 68; After Mid- night, 69; Inflamatory, 67; Whooping, 67; Seat of Cough, Larynx, 66; Trac- hea, 66 ; Bronchi, 66 ; Lungs, 66 ; Stomach,67; Heart and Blood-vessels, 67; Practical Expedients, 148. Cod Liver Oil, 29, 165. Coffea, 88. Counter Irritation, 197. Crocus, 5,">. Cuprum, 88, 165, 211. Cupping, 55, 196. Diet, 55, 212. Digitalis, 89. Digitaline, 47, 89, 166. Diarrhoea, 211; Practical Expedients, 212. Drosera, 90. Dulcamara, 91. Electricity, 196. Epps, Dr., Remedies, 11. Ether, 195. Emaciation and Debility, 20. Ferrum, 25, 51, 91, 168. Fish, 56. Gallic Acid, 205. Gelseminum, 94, 169. Graphites, 170. Glanderine, 170. Glycerine, 211. Haemoptysis, 44; Practical Expedients, 54. i Hamamelis, 46. 230 INDEX. Hastings, Dr., Remedies, 11. Health Lift, 16; Effects of, 19; Rules for its use, 18. Hepar Sulphur, 95, 170, 201. Hectic Fever, 197, Practical Expedients, 204. Hitchman, Dr. W., Remedies, 9. Hughes, Dr. R., Remedies, 12. Hyoscyamus, 97. Hydrastin, 211. Ignatia, 98. Insufflation in Asthma, 196. Introductory, 7. Iodine, 22, 98, 173. Iodide of Potash, 23,107, 174. Ipecacuanha, 47, 102, 171. Jahr, Dr. C. H. G., Remedies, 10. Kafka, Dr. J., Remedies, 12. Kali Bichromicum, 103. Kali Bromatum, 106. Kali Carbonicum, 27, 105. Kali HydHodicum, 23, 107. 174. Kali Chloricum, 207. Kali Nitricum, 195. Kreosotum, 108. Koumiss, 39, 206. Lachesis, 109,178. Lime Water, 206. Lobelia, 178. Lebenswecker, 197. Lycopodium, 28,110, 180, 200. Malt Extract, 44. Marcy & Hunt, Remedies, 10. Meat, 58, 216. Milk, 56; Skim Milk, 206. Millefolium, 46. Mercurius Sol., 113, 181, 203, 20(5. Mercurins Proto-Iodatus, 116. Moschus, 181. Muriatic Acid, 209. Naja Tripudians, 182. Nitric Acid, 117, 182, 203, 208. Night Sweats, 197; Practical Expedients, 204. Nux Vomica, 118, 183. Oleum Jecoris Aselli, 29; Caution, 35; Ex- hibition, 36. Opium, 120, 185. Oyario-Uterine Cough, 67. Ozonized Water, 196. Pain, 213; Practical Expedients, 213. Phosphoric Acid, 202. Phosphorus, 23, 47, 121, 186. Pulsatilla, 53, 124, 187. Raue, Dr. C. G., Remedies, 10. Rhus Toxicodendron, 127. Rumex Crispus, 128. Rum, 196. Ruddock, Dr. E. H., Remedies, 11. Sanguinaria, 131. Sarsaparilla, 197. Sepia, 135. Senega, 134. Silicea, 24, 136, 201. Spongia, 138, 189. Spirometer, 217. Stramonium, 184. Styptics, 55. Stannum, 26, 139, 189. Sulphur, 26, 54. 140, 190. Sulphuric Acid, 202, 209, Tartar Emetic, 145, 191. Tobacco, 195. Veratrum Album, 147, 192. Veratrum Viride, 45, 193. NLM001340944