-mm 1 Donated by Dr. J.B. Grefg Oustis V/ashiiic"ton, D. C. NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland Gift of The National Center for Homeopathy ^ yiAaesimund "Banninq panes Library 19 OT^L C Voi^ -*. w: "Xsf AT /it* sy crr^A^- v vsf. HOMEOPATHIC '& DOMESTIC MEDICINE J. LAURIE, M.D., MEMBER OF THE BOYAL COLLEGE OF SURGEONS, EDINBURGH. SENIOR PHYSICIAN TO THE "WTSTMINBTEB AND LAMBETH HOMEOPATHIC MEDICAL rNSTITUTION AND DISPENSARY. ARRANGED AS A PRACTICAL WORK FOR STUDENTS. CONTAINING A GLOSSARY OF MEDICAL TERMS. SIXTH AMERICAN EDITION, ENLARGED AND IMPROVED, A. GERALD HULL, M.D. NEW-YORK! WILLIAM RADDE, 322 BROADWAY. PHILADELPHIA:--RADEMACHER & SHEEK, 239 ARCH STREET. BOSTON:--OTIS CLAPP, 12 SCHOOL STREET. ST. LOUIS:—J. G. "WESSELHOEFT. 1853. , II ^> ■ I « Entered according to Act of Congress, in the year 1853, by WILLIAM RADDE, In the Clerk's Office of the District Court of the United States for the Southern District of New York. J, v:a ANGELL, ENGEL It HEWITT, Printers, 12 Frank/ort-st, Jf. Y NOTICE OF THE AMERICAN EDITOR. The last edition of Dr. Laurie's Domestic Medicine has been reprinted in this country, in consequence of the more perfect^brm this work has acquired under the diligent care of its accomplished author. The success of this work in England, and the exhaustion of five previous editions in this country, afford Strong encour- agement that it has well fulfilled its mission of dispensing healing aid to invalids, and will therefore well supply the requirements of those who need a Manual of this kind. Besides the modifications and additions suited to the wants of our land, the Editor has inserted in an Appendix articles on "The Pulse and Circulation of Blood," "Conditions of Sleep," and " Conditions of the Heart," which were compiled for the last American Edition of Jahr's Manual, the two latter by his friend Dr. Guernsey. A. GERALD HULL. PREFACE TO THE SIXTH EDITION, I reproduce this .work in its Sixth Edition, not curtailed or condensed, but with considerable additions and alterations, all of which appear to me to be essential in assisting the patient or administrator. I append articles en the treatment of numerous complaints which I had not hitherto included, and especially of those which are peculiarly prevalent in certain climates, such as Tropical Diseases, , The transpiration of health, is evinced by softness, with slight moisture of the whole surface of the skin, in an equal degree, and without any roughness, cracking, extreme tension, shrivelling, or withering, or flaccid, flabby looseness of the skin, but with natural fulness and elasticity ; and it consists of a continual, imperceptible, gaseous exudation. Sweat is a disturbed degree of transpiration, characterised by ex- cessive discharge of humour of the skin; it may be perfectly con- sistent with health as the result of severe corporeal exertion : but in relation to disease, sweat must be considered as of two distinct kinds:—1. That which accompanies the healthy determination or crisis of disease, or by which such healthy determination is effected which is called " critical;" and 2. That which occurs before the criti- cal period, which is followed by no relief, but rather by aggravation or which is excessively profuse, which forebodes, or ushers in or INTRODUCTION. 37 originates from the peculiar operation of disease itself, especially characterised by the eruption of pimples (and not of a healthy reac- tion),—which is called symptomatic. Of the latter variety—symptomatic sweats—we may particularly notice, 1, sweat occurring*in the morning (without previous habit of the kind), and which, if associated with fever, identifies its hectic character; 2, offensive sweats, which, as associated with fever, identify putrid typhus ; 3, sweat emitting a sour smell, which com- monly characterises the fever as miliary ; 4, local sweats,—as, for instance, on the chest, or about the head, which are characteristic of determination of blood to those parts ; 5, cold sweats, which de- note a depression of vital energy, and which, in the last stage of prostration, forebode dissolution ; 6, transitory sweats, as opposed to the continuous sweat of a wholesome crisis. 7. Symptomatic sweats may, however, be caused by mere accessory mismanagement —such as want of ventilation, and excessive heat of the apartment. The use of feather-beds, which is much to be deprecated, especially in cases in which fever becomes developed, or the superfluous (and very mistaken) excess of covering ; 8, otherwise we may generally attribute them either to great debility of the whole system, as associated with depressed pulse, &c., especially if occurring after long and debilitating diseases, severe loss of blood or other animal fluids, or other exhausting causes ; or to accumulation of noxious matters or substances in the stomach, when they will appear more particu- larly about the forehead and face, and will usually be cold and clammy ; or, again, to overdue activity of the circulation, accom- panied with comparative deficiency of energy in the functional pro- cesses of the skin. Critical Sweat, on the other hand, is to be distinguished, 1, by affording general relief, and by the simultaneous modification of every source of suffering, and the subsidence of the irregularities of the pulse; 2, by being warm and clammy ; 3, by being developed over the whole surface of the body simultaneously ; 4, by the sub- sidence of all restlessness, nervous irritation, or mental uneasiness, and the occurrence of calm, even, undisturbed sleep; 5, by conti- nuity ; 6, by the period of its development, in relation to the dura- tion and course of a fever—viz., on what is termed the critical day of those fevers which run a regular course, and usually resolve themselves into an issue about a given period, as on the seventh or fourteenth day, &c. The complexion, and its Indications. Bed, florid complexion, commonly identifies determination of blood to the head, or a full habit of body in general. White (cold, dead white) complexion of young females at the criti- cal age, denotes a difficulty in the sexual transition—green sickness. 38 INTRODUCTION. Faint-yellow complexion, usually denotes intestinal disease—disease of the bowels. Deep-yellow complexion, on the other hand, identifies jaundice, or even organic disease of the liver. . Pallid complexion, with (more usually) meagerness, want of fulness of the skin, commonly identifies the stomach and intestinal canal as the seat of disorder, and may be caused by any obnoxious or impure matters therein—such as worms (in particular), or associated with acidity of the stomach; with a drawn, sunken appearance (espe- cially), it denotes spasm ; with (more usually) puffiness of the flesh, it is associated with constitutional weakness, qualified by sluggish circulation or congestion, or excess of watery humour (as a con- stituent) in the blood, or by deficiency of blood. Patchy redness of the complexion—that is, redness as of a flush- spot on the cheek, denotes a hectic disposition. Sudden and total change in the appearance of the complexion, is often to be considered as a very serious manifestation. Livid spots, may, in advanced age, lead to an apprehension of apoplexy, as indicating inactive accumulations of blood upon im- portant organs (with stagnant circulation) ; the general indication, however, afforded by this manifestath >n, is that of a putrescent con- dition of the blood (as associated with scorbutic habit of bod}7). Blue or livid complexion (habitual)—organic affection of the heart. CLOTHING AND HABITS. Upon the first point it were scarcely worth while entering into any observations, were it not simply to remark upon the impropriety of wearing garments impervious to air, and fitting closely to the shape, and the custom of exposing the extremities and chests of young children to the chilling atmosphere of our peculiarly variable and humid climate, under the absurd idea of making them hardy. The evil consequences arising from the check given to perspiration by the first-mentioned practice, are too well known to require any particular comment; but as the other is an error widely prevalent I consider it my duty to mention it; and I feel assured, that if mothers would only reform their system, and clothe their children in a more rational manner, they would make no slight advance towards the pre- vention of serious affections, not only during childhood, but in after life. Cotton, linen, and even leather worn next to the skin, are generally, preferable to coarse woollens. As regards habits, it may be briefly observed, that a regular method of living, avoiding ill-ventilated apartments, late hours, dis- sipation, over-study, anxiety, and other mental emotions, and taking sufficient air and exercise, are the best preservatives of health. The frequent use of hot-baths is injurious and liable to retard the cure under homoeopathic treatment. The idea that sea-bathing is INTRODUCTION. 39 almost universally beneficial is exceedingly erroneous : there are many constitutions on which it acts prejudicially. Medicated baths, either natural or artificial, are strictly forbidden. Bathing the whole frame daily with a sponge or wet towel, with cold or scarcely tepid water, and the use of the flesh-brush, are by no means objectionable, and frequently indeed strongly to be recommended. (See Notices on the Use of the Bath, &c.) The use of any medicinal or aromatic substances in the arrange- ment of the toilet, such as camphorated or otherwise medicated den- trifices, lip-salves, smelling salts, or cosmetics, is more or less detri- mental to the action of the medicines, and should be avoided. Flowers should be excluded from sleeping apartments, especially at night, when they emit a deleterious gas. ADMINISTRATION AND REPETITION OF THE MEDICINES. The following are a few of the general rules to be observed in the domestic employment of the homoeopathic medicines :— In diseases which are severe, and run their course rapidly, we must carefully watch the symptoms, and when we feel assured we have chosen the proper remedy, if no perceptible medicinal aggra- vation or amelioration declare itself, but the disease seems to gain ground, repeat the medicine. Incases of high inflammatory action, Aconite or 'Belladonna, &c, should sometimes be repeated at inter- vals, varying from fifteen minutes to two hours. If a medicinal aggravation take place, followed by amelioration, we must let the medicine continue its action, until the amelioration ap- pears to cease, and the disease again makes head ; if new symptoms set in, we must then have recourse to the medicine thereby indi- cated. Should, however, no perceptible medicinal aggravation take place, but amelioration follow, we may safely await its approach to a termination, ere we again administer. If any symptoms remain, from the remedy first selected having afforded only partial relief, we must have recourse to some other medicine, which seems best fitted to meet them ; but refrain from changing the remedy as long as benefit results from its employment. In diseases whose symptoms are obstinate and long continued, and in those which are virulent but of short duration, as well as in those which partake somewhat of these features of violence, when a very striking improvement takes place, it will generally be found advantageous to cease to administer the medicine as long as the improvement con- tinues, and only to repeat as soon as the slightest symptoms of activity in the progress of disease reappear. But when a sudden or marked improvement, of comparatively short duration, follows the first dose of a remedy, and on repeating the dose, the symptoms of the complaint increase instead of subsiding, as they did in the first instance, it may be concluded that the medicine does not answer, 40 / INTRODUCTION. and that another must accordingly be had recourse to, in the selec- tion of which it will be necessary to choose one related or analogous to the remedy first prescribed. The distinguishing of the medicinal aggravation from that of the disease, being a point of material consequence, we shall here give the leading and most usual characteristics of each. The medicinal aggravation comes on suddenly and without previous amelioration; the aggravation of the disease more gradually, and frequently fol- lowing an amelioration. Moreover, in the former, several of the medicinal symptoms, which did not previously occur, declare them- selves. Such medicinal symptoms, or some of them, will be found, on referring to the remedy which has been employed in the article on the Characteristic Effects, &c. Lastly, the pulse is also a discriminative guide, particularly in fevers and inflamma- tions. Thus, when it becomes less frequent, or when, at all events, it does not increase in frequency, on an accession of aggravation, the exacerbation is to be attributed to the medicinal influence; but when the reverse is the case, the aggravation of symptoms must be considered as depending on the advance of the disease. We cannot attach too much importance to the necessity of care- fully watching the effects of each dose, as, in addition to the tempo- rary aggravation of the symptoms which sometimes sets in, a development of collateral <*>r medicinal signs occasionally takes place, particularly after frequent repetition of different remedies, in susceptible patients. By a want of attention, therefore, to this im- portant point, we may incur confusion, and may be unconsciously treating a temporary medicinal disease of our own creation. We must also guard against falling into the opposite extreme—that of allowing the disease to gain head unchecked. Slight diseases are often removed by a single dose of a well- chosen medicine, the more severe and deeply-seated disorders re- quire a frequent repetition. As a general rule, however, a given number of repetitions, more or less, according to the severity of the case, will serve to place the patient thoroughly under the influence of the medicine, after which the pause may be protracted so long as the indications of progressive improvement are present. If then, it becomes necessary to resume the administration, it will generally avail at remoter intervals than during the previous course. In complaints which are of a mild though sluggish type, and which are unattended with any critical characteristics, the intervals, in the first period, may vary according to circumstances, from six to twelve hours. But in most complaints in which constitutional or local inflammation is present, the inter- vals, in the first period, should not exceed four hours, and when im" portant organs are involved, and constitutional fever runs high these intervals should not at first exceed two hours. In severe acute affections, such as inflammations, fevers, &c, we INTRODUCTION. 41 may often repeat the same medicine in the same dose, at regular in- tervals, as long as it does good ; but this rule has many exceptions, and the directions already given at the commencement of this article should be borne in mind. In obstinate and lasting cases, by a long-continued administration of the same medicine, the patient often becomes less susceptible ; in such instances, if the improvement remain stationary, or progress slowly, we may gradually increase the dose, or, still better, give, at suitable intervals, some other remedy or remedies, of as nearly analogous medicinal properties to that first administered as possible, and then return to the original remedy, if needful; if, on the other hand, decided amelioration follow each administration, we should allow a longer interval to elapse before repeating, by which means the system gradually recovers itself, and the susceptibility to medi- cinal influence remains unimpaired until the cure is completed. In rare cases, this susceptibility increases; in such instances a higher potency should be selected,—provided the remedy still ap- ^> pears to be appropriate,—and the intervals between the exhibitions should be lengthened. This occasionally occurs when the medicine has been frequently repeated, and given in solution. When the be- neficial effect of a medicine is interrupted by any intermediary irre- gularity, such as, attack of cold, looseness of the bowels, &c, some other medicine must be given for the new affection, on the removal of which, the medicine which was previously acting favorably must be recurred to. In the Selection of the Remedy, it is not necessary that all the symptoms noted should be present; at the same time care must be taken that there are no symptoms uncovered by the medicine, or which more strongly indicate another remedy. REMARKS AND REGULATIONS RESPECTING INTERNAL REME- DIES AND DOSES. Preliminary Observations as to the Form of the Medicines. The Form in which Homoeopathic medicines are employed for in- ternal administration requires some particular notice, in order that the reader may have an additional opportunity of administering the medicine with the medium or vehicle which may be most likely to promote its active operation in the case under consideration. It is well known that the medicines are prepared in three distinct forms, namely :— Globules, Tinctures, and Triturations. 1. Globules (or pellets of sugar of milk saturated with the tincture) are, in the great majority of cases the only form required for domestic treatment, and so greatly facilitate the explicitness of 42 INTRODUCTION. the directions for doses, that, in the first instance, all the medicines comprised in the list of the remedies which are quoted in this work, must be understood to be recommended in globules (at the poten- cies, also, stated in that list). 2. Tinctures might, as far as practical purposes are concerned, be coupled with Triturations, the latter being the form in which those Remedies which are insoluble, axe first made, and consequently which represents those lesser degrees of attenuation which are ad- ministered in afiuidform—of such remedies as do not require such pulverisation to render them soluble (or approximately so). It is this fluid form, of soluble substance which is called the Tincture. Tinctures at low potencies, (i. e. from the 1st to the 3d,) have upon the whole (like Triturations), been found better adapted to the treat- ment of acute diseases and some forms of scrofula, &c. INDISPENSABLE RULES FOR THE PRESERVATION AND MAN- AGEMENT OF HOMOEOPATHIC MEDICINES, ANTIDOTES, &c. 1. Keep your chest closed or your phials in a dark, dry, clean, and cool place, free from odour or scent of any kind,—or, if in a hot climate, in as regular a temperature as possible. 2. Do not change the corks, or use the same phials to contain a different remedy without having previously been assured that it has been thoroughly cleansed, first with boiling and then with cold wa- ter. It is better at all times to rinse a phial, which has already con- tained medicine, with spirits of wine, and to expose it uncorked to the action of great heat before it is filled with a different medicine. The cork or stopper should be submitted to the same process. The safest way of all is to destroy empty bottles. 3. Let all the medicines be carefully marked and labelled, and abstain from handling two at one time. 4. In preparing your solution for administration, be assured that the glass, or spoon, or other vessel in which you are about to mix it, is perfectly clean. 5. If it is necessary to prepare solutions of two or more medicines at one time, take care to keep them apart, and to mark them so that no mistake can occur. 6. Do not use the same spoon or other vessel to administer two different remedies, without having previously ascertained that it has been scrupulously cleansed. Porcelain spoons are preferable to any metal, on this account, because you are more certain of the thorough removal of all former medicinal substances. 7. If you dissolve your medicines in open vessels, such as tum- blers, take the precaution to have them well covered down during the intervals between the administration, and keep them in a dark dry, clean, and cool place, totally free from odour or scent of any kind. J INTRODUCTION. 43 8. Do not resort to any other medicinal agency during homoeo- pathic treatment, and abstain from any external applications, except such as are prescribed homceopathically. 9. Avoid the use of all articles of perfumery, restoratives, cosme- tics, and the like. Camphor, and other popular appliances for cleansing the mouth, &c, &c, are strictly prohibited. The same may be said of smelling salts, &c, &c. 10. The saturated tincture of camphor, as it is used homceopathi- cally, must be kept entirely apart from any other medicines, or from any vessels or vehicles, such as powders, in which it is proposed to convey or to administer other medicines. 11. Do not change your course of treatment or your remedies (when change becomes necessary) too suddenly, or without allowing a sufficient pause to elapse, viz. at least two hours, if possible six hours, in general cases of a severe inflammatory nature, and in ma- lignant fevers,—and at least from two to three days (48 to 72 hours) in diseases of a chronic kind. 12. If the symptoms be so violent as to compel you to resort to immediate change after any previous treatment, administer one drop of spirits of camphor on a lump of sugar, or a teaspoonful of strong coffee, and then wait one hour, half an hour, or only a quarter of an hour, in urgent cases, before you proceed with further treatment. When, as occasionally happens with persons who are extremely susceptible, to the effects of the homoeopathic remedies, an undue me- dicinal action is developed, giving rise to considerable local pain, or general constitutional disturbance, camphor is, generally speaking, the most effective antidote, particularly to the vegetable medica- ments. (See the Table of Medicines, &c.) It may simply be in- haled by the nostrils, or a drop of Tincture of Camphor may be taken on a piece of lump sugar. Coffee, without milk or sugar, is also a useful antidote, provided the patient has not been long accustomed to its use. The same may, in a measure, be said of wine. REMARKS AND REGULATIONS RESPECTING EXTERNAL REME- DIES AND APPLICATIONS. Any remedy, which is prescribed for internal administration as Homoeopathic to a local affection, may be applied to the parts as a lotion, either by dissolving the globules in water, or by using the tincture, usually of a like potency, to mingle with the water. External Application of the Nature of a Poultice.—The simplest and best application which can be used in cases requiring external treatment of this nature, to forward or encourage suppura- tion, or for any other reason, consists solely of a piece of lint sa- turated with cold water, applied to the parts and kept constantly wet, the whole being carefully covered with oiled silk so as to exclude the air. 44 INTRODUCTION. All medicated poultices should be avoided, and are strictly pro- hibited. External Application of the Nature of Fomentation.—As a palliative application pending the salutary action of internal treat- ment in cases in which local irritation'and tension are excessive, it is allowable to bathe the parts with water moderately hot, by means of a piece of flannel ; or to expose the parts to the action of the steam rising from boiling water poured into an open vessel. In cases of sore throat, in which the suffering requires to be immediately soothed, or of cold, in which the obstruction and burning sensation in the nos- trils is excessively distressing, the patient may similarly inhale the steam of boiling water. All allopathic medicated fomentations should be avoided, and are strictly prohibited. Tincture of Arnica.—This useful medicament, when employed as a lotion to wounds, should always be discontinued upon the appear- ance of any eruption, &c. Individuals, of what is always designated as an inflammatory habit, or who have very irritable skins, and are liable to be affected with erysipelas, must be very cautious how they use it, and must modify their treatment accordingly, and abstain from the application upon the earliest appearance of medicinal irri- tation or erysipelatous swelling or redness. Such patients should invariably dilute the tincture with two thirds more of water {in pro- portion) than is indicated in the directions which occur in various parts of this work, when they have occasion to employ it; and, should this precaution not suffice to exempt them from excessive medicinal aggravation, they should have recourse to helianthus an- nuus or calendula officinalis (respectively according to the di- rections given under the head of each of those remedies), as substi- tutes. General proportions of the lotion . Tincture of Arnica 1 part, to water 6 parts. Or for very susceptible subjects . Tincture of Arnica 1 part, to water 12 parts. For the eye, or as a gargle for the gums after dental treatment, '. Tincture of Arnica 1 part, to water 20 parts. For an infant under six months old Tincture 'of Arnica 1 part, to water 32 parts. For an infant over six months and undej two years.....Tincture of Arnica 1 part, to water 20 parts. Tincture of helianthus annuus should be employed as a substi- ture for Tincture of Arnica in the treatment of bruises, by persons in whom the latter is apt to produce medicinal inconveniences, not- withstanding the precautions hereinbefore prescribed. General proportions of the lotion—Tincture of Helianthus one part to water six parts: (for infants and children the same as Arnica.) Tincture of Calendula Officinalis—may be employed in the treatment of wounds of every description, by those who, from con- stitutional causes, are unable to employ Arnica externally, without INTRODUCTION. 45 subjecting themselves to the inconveniences generated by the cha- racter of that remedy. Calendula has moreover an important ad- vantage over Arnica in very severe incised or lacerated wounds, where there are indications of a serious scar being otherwise left by the cut. It is also preferable in all severe wounds which cannot heal without previous suppuration. General proportions of the lotion—Tincture of Calendula one part, to water six parts: (for infants and children the same as Arnica.) Tincture of Rhus Toxicodendron is more especially adapted to the treatment of sprains, for the milder forms of which it is a spe- cific remedy. General proportions of the lotion—Tincture of Rhus Tox. one part, to water six parts: (for infants and children the same as Arnica.) Tincture of Aconite.—Aconite has been used externally with great success in cases of local inflammation arising from check of perspiration (or from other causes), in conformity with its well- known characteristic properties. Care must be taken to distinguish such cases of inflammation, usually extending to the membrane which invests the bone, and affecting joints in particular, from erysipelatous inflammation, to which it frequently bears a striking resemblance. The sudden appearance of symptoms of this nature in young persons, who are particularly liable to accidents arising out of carelessness, &c, and who, at the same time, have no predisposition to erysipelas, may be a strong ground of assurance in respect of the character of such inflammatory action, which may further be explained by a brief inquiry into the previous circumstances. In such cases the external application of a lotion, composed of diluted Tincture of Aconite (simultaneously with the internal administration of the same reme- dy), by means of linen rag saturated therewith, and applied to the parts, will speedily subdue the symptoms, and preclude more serious consequences. General proportions of the lotion—for a person of adult age, Tincture of Aconite, ten drops to a wine-glassful of water. For a child under twelve years of age, Tincture of Aconite, six drops to a wine-glassful of water. Tincture of Cantharis or Cantharides.—The peculiar property which Cantharis or Spanish blistering Fly, possesses of creating a severe burning pain, followed by the effusion of watery fluid beneath the scarf skin, bears so close an analogy to the effects of a burn or scald, with the formation of vesication or blisters, that we can rea- dily conceive it well adapted, according to the homoeopathic law, to be an admirable remedy for injuries of the like description, or at- tended with similar symptoms. Cantharis, is, in fact, specific as an external remedy in the treatment of burns or scalds, and is by far the most efficacious, if applied immediately after the injury has been inflicted (otherwise, see Causticum,) and before the application of cold water acetate of lead, or similar expedients have been adopted. 2* 46 INTRODUCTION. Cantharis is, however, objectionable for persons whose constitu- tional peculiarity renders tiiem susceptible of erysipelatous tume- faction of the skin, in the place of blisters, from the effect of a burn or scald. In these cases, Urtica dioica is specific. In some instances, although very rarely, the external application of Cantharis may pro- duce deranged action in the urinary organs, (exemplified by sup- pression of water) ; in such cases the mischief is readily counteracted by the internal administration of one drop of Tincture of Camphor on a lump of sugar. The lotion should generally consist of the tinc- ture at the second dilution and water, wherewith linen rag is to be saturated, the linen being so wound round the parts as to exclude the air, and the moistening repeated as often as it becomes dry. General proportions—three drops of the Tincture of Cantharides (2d) to every teaspoonful of water. Tincture of Urtica Dioica—should be used in preference to tinc- ture of Cantharides by those in whom a burn, or scald is apt to pro- duce erysipelatous swelling in the place of blistering. But this is the only case in which Cantharides is superseded by Urtica. General proportions of the lotion, Tincture of Urtica Dioica 1 part, to water 10 parts. For an infant under six months old, Tincture of Urtica Dioica 1 part, to water 20 parts. For an infant over six months and under two years, Tinc- ture of Urtica Dioica 1 part, to water 15 parts. Proof spirits of wine.—In mild cases of burns or scalds, if Spirits of Wine can be procured immediately (otherwise, see Caus- ticum), speedy relief may often be obtained therefrom, and ulterior suffering avoided. Apply it warm to the parts (as hot as the patient can bear it), the injured part having meanwhile been exposed to the heat of the fire. Tincture of causticum, as already intimated under the head of Cantharis and Spirit of Wine, is a preferable remedy to either of the foregoing when an hour or two may chance to have elapsed before the use of any remedial application. The Causticum wash is also of much service in more serious burns, and in those of long standing. General proportions of the lotion—to every teaspoonful of water, add six drops of the Tincture of Causticum at the third dilution, and apply frequently to the parts by means of a piece of linen rag saturated therewith. Raw cotton (excepting when the suppuration is excessive, and the weather hot, for which case see Soap),—is highly useful as an exter- nal application to burns or scalds of a serious nature, and more especially when the injury extends over a large surface. The method of use is as follows -.—Puncture any blister which may have arisen, bathe the sore well with tepid water, and then cover the parts with carded cotton or wadding in three layers—removing the outer layer only, and substituting a fresh one—when suppuration sets in. The soap plaster (pure, white, Curd-Soap).—This application is more particularly serviceable in cases of burns, where not only the INTRODUCTION. 4T outer or scarf skin, but also the inner or true skin has been destroyed In serious cases, which have previously been treated with the lotion of Cantharides, or Urtica Dioica, and in which the inflammation and pain have yielded to these remedies, but which are too severe (owing to the injuries inflicted on the true skin and adjacent muscles) to heal without suppuration, the soap plaster is a very useful accessory. It should be made and applied as follows:—Moisten the soap with tepid water, and make a thick lather or paste, and spread it upon linen ; then puncture any blisters which may appear on the exposed surface, and remove all loose skin. After these precautions, apply the plaster to the parts, and secure it by means of a bandage, being careful that the whole of the injured surface is covered with the plas- ter. As a general rule, the plaster may remain undisturbed for twenty-four hours, when it should be gently removed and changed: but there are many exceptional cases, and the feelings of the patient should guide us in the removal and change of the plaster, whenever a return of pain is complained of. This course of application should be continued until the injured parts are completely healed. The application of the plaster will always be attended with increased pain at first; but this must not deter us from the employment of it, as it will soon be followed by marked amelioration. Flour—may be used as a substitute for cotton or the soap plaster, when neither of the latter can be obtained at the moment. The method of application is simply to sprinkle the flour copiously over the injured parts, after having taken the precautions directed to be observed under the heads of cotton and soap plaster. When it be- comes necessary to remove the dry paste formed by the incrustation of the four, this should be gently effected by first moistening and loosening it, by means of poultices (as directed under the head of ex- ternal application of the nature of a poultice). Tincture of Arsenicum (at the third dilution),—applicable to bed-sores, and as a local resource, in many cases, of malignant ul- ceration. General proportions of the lotion—to one wine-glassful of water, ten drops of the Tincture. Tincture of Carbo Vegetabilis (at the fifth dilution),—in simi- lar cases, as directed for the affection in question. General proportions of the lotion—to two table-spoonsful of water, twenty drops of the Tincture. Tincture of Cinchona (concentrated).—See " Bed-sores," after typhus, &c. General proportions of the lotion—to a wine-glassful of water, fifty drops of the Tincture. Tincture of Sulphur (saturated),—in such cases only as those in which it will be found hereinafter prescribed. General proportions of the lotion,—to two tablespoonfuls of water, twenty drops of the Tincture. 48 INTRODUCTION. REMARKS AND REGULATIONS RESPECTING THE BATH. The bath may be divided, according to modern appliances, into eight varieties, viz.:—the hot and cold salt-water bath, the hot and cold fresh-water bath, the tepid, the vapour, the shower, and the medicated baths, of which two only are, generally speaking, admissible as consistent with the general tenor of Homoeopathic treatment, namely:— The Cold Salt-water and the Cold Fresh-water Bath ; Except as respects new-born infants, for whom a third variety is ne- cessary, namely, the Hot Fresh-water Bath. All the other varieties, especially medicated Baths, are commonly prohibited. The consideration of the Bath is a matter of essential importance to health, and has been acknowledged as such from the remotest antiquity, and in every climate. It is almost as much a necessary of existence as food or clothing. It involves what is a primarily essential, cleanliness ; but, like all generalities, it is subject to excep- tional modifications arising out of the condition of the system, or the temporary state of the body; such, for instance, as the presence of an eruption or rash, or the exudation of perspiration after violent and prolonged exercise, both of which would render the bath ob- noxious for the time. But for persons who are free from any morbid manifestation which may render the free use cf cold water objec- tionable, nothing, perhaps, will tend so much to brace the nervous and muscular construction of the frame, and to preserve the sturdy physical power of youth in advanced age, as the regular observances of the Bath. General exceptional conditions under which cold bathing should be avoided. When (as is sometimes the case) it is found to induce constitu- tional disturbance, or is invariably followed by headache, &c, of the same character. • When it is followed by lasting chilliness instead of the glow which indicates its healthy action. There are comparatively few instances in which the cold fresh- water Bath disagrees with persons in good health; in such instances however, when they occur, the use of a sponge or wet towel must be substituted for the bath, and should be followed with brisk friction When any inflammatory action is present, or when from exertion or from any other cause the skin is moist and the pores are open the Cold Bath should be avoided. l ' During the presence of headache, other than headache arising from irregularities of digestion or nervous causes, Immediately or within one hour after a meal. INTRODUCTION. 49 Before any meal has been partaken, or, in other words, upon first getting up in the morning. Generally—with a declining temperature, as, for instance, late in the evening, when the temperature of the water will not have de- clined equally with that of the atmosphere. When the atmospheric temperature is not sufficiently high, as compared with that of the water; or, in other words, when the water feels warm and the air cold. Generally—during the prevalence of cold east winds. General conditions under which cold bathing is beneficial. When the temperature of the water, relatively to that of the at- mosphere, is as nearly as possible that which it would reach and maintain, by being constantly exposed to the action of the same at- mospheric temperature. When it is always followed by a glow. In affections of a purely nervous character. In the majority of affections resulting from debility of the digestive functions. During an ascending temperature; that is to say, in the earlier part of the day, generally about two or three hours after the first meal, and at an equal distanee from the second. When the water is cold compared with the air, but not so cold as to produce a shock or numbness. In-door bathing—may be continued throughout the year with great advantage, with the precaution that the thermometer in the apart- ment stand at from 50 to 60 degrees of Fahrenheit, and that the water be exposed to this atmospheric temperature at least six hours (if possible) or be raised to from 45 to 55 degrees, if below it. The swimming bath, or bath in which (if not in open water) there is room to exercise the limbs, is preferable. General precautions to be observed in Bathing. Do not bathe the lower extremities first. The immersion should be complete at once. This need not bo effected by plunging,—when, as is not unfre- quently the case, such a method is found to induce headache or tem- porary deafness. Diving—which is a very common amusement, is very often pre- judicial without sufficient attention being paid to the fact. In general, you should abstain from diving. Never leap into deep water feet foremost and in an erect position. The best method is to drop into it, the body and limbs being bent together. Do not stand still or remain motionless in the water. Do not remain too long in the water. Five minutes is quite long enough to derive all the advantages of the bath. 1 50 INTRODUCTION. Never remain so long as to become thoroughly chilled. Leave the bath upon the first appearance of cramp. Apply a coarse towel briskly all over the body, as soon as you leave the water; and take pains to dry yourself as thoroughly and as expeditiously as possible. Dress as soon as you are thoroughly dry. The bath should be followed by a brisk walk, but not sufficient to heat you. The Salt-water Bath or Sea-bathing. It is quite important that all those with whom sea-bathing is found habitually to disagree, should abstain from what, at certain seasons and in certain places, may be a great indulgence. There are instances in which sea-bathing produces a species of nausea similar to that of sea-sickness in persons who are totally exempt from this inconvenience on ship-board. This, then, is clearly a constitutional exception. In brief, therefore, it may be laid down as a rule, that when sea- bathing habitually induces any kind of constitutional disturbance it should be avoided. The Fresh-water Bath. The instances in which fresh water bathing disagrees, may almost be summed up under the head of the "general exceptional condi- tions" above stated. The cases of constitutional exception are far less numerous than those which occur with respect to sea-bathing, and there are fewer cases still in which persons who cannot bear fresh water can tolerate the sea-bath. When, however, they occur, they should indicate the course of the patient. Temperature of the Bath for Infants. The warm bath, which is requisite for the treatment of newly born or very young infants, should never exceed 98 degrees of Fahrenheit in heat. It should in general range from 92 to 98 degrees, accord- ing to the e'ffect produced on the child. When the bath is used as a remedial agent, it is important to maintain the temperature at which the immersion had taken place ; and it will, therefore, be desirable on all occasions to have a thermometer within, so as to detect and regulate any variations. The cold bath should be, as nearly as possible, of the tempera- ture at which the atmosphere would place or keep it. It is, there- fore, desirable that cold spring water, which has not been exposed to the action of the air, for four hours at least, should be avoided in hot weather, when the atmospheric temperature would have ma- terially increased the heat of it. Exception to the use of the cold bath.—In all cases the cold bath with new; born or very young infants, is highly reprehensible. LIST OF MEDICINES WHICH ARE WELL ADAPTED TO PARTICULAR TEMPERAMENTS, CONSTITUTIONS, AND DISPOSITIONS. Lymphatic Temperaments (characterized by superabundance of the humors with repletion of the cellular tissue, giving a considerable bulk to the whole body, which is, moreover, distinguished by roundness of form, softness of the muscular system, fair hair, pale clear skin, and a lustreless, or hazy, inanimate eye. The circulation is slow, the brain inactive, and the passions languid). Merc, Sulph., Calc, Puis., Caps., China, Ars., Acid, nit., Bella., Hyos, Phosph., Hell., Dulc, Sep., Ant., Lye, Carb. v., Am., Dig., Con., Clem., Sil., etc. Sanguine Temperament (indicated by predominant activity in the cir- culating system, with a moderately full habit, soft skin, florid com- plexion, blue eyes, red, auburn, or yellow hair; corporal and mental activity). Aeon., Am., Bella., Calc, Hep , Merc, Cham., Nux v., Bry., Lach., Phosph., Ac. nitr., Ars., Cocc, etc. Bilious Temperament. (By this term is meant that habit of body which is distinguished by black hair, dark eyes and skin, the latter generally inclining to yellow, moderate fulness, but much firmness of flesh; the countenance strongly marked, and expressive of the great energy of character which this temperament obtains; the passions violent, the pulse strong, hard, and frequent.) Aeon., Bry., Nux v., Cham., Cocc, Ars., Am., China, Sulph., Plat, etc. Melancholic Temperament. (A modification of the bilious, with less activity of the nervous and muscular systems; black hair, dark complexion; the disposition grave, meditative, suspicious, and gloomy. Derangement of the functions of the nervous system, with sluggish bowels, dry habit of body, hard, slow, and habitually con- tracted pulse, usually attend this, so to speak, abnormal modifica- tion of the bilious temperament.) Nux v., Lach., Sulph., Aurum, Staph., Veratr., China, Con., Grat., Mosch. natr., Phosph., Stann., Viol, odor., Acid, nitr., Plat., Ambra, Ars., Bry., Sil., Puis., Sep., Magn. m., etc. Nervous Temperament. (Defined by fine thin hair, thin skin, small, attenuated muscles, paleness of countenance and often indifferent or delicate health. Predominant activity of the brain and entire ner- vous system ; suddenness and mutability of decision and judgment; 52 LIST OF MEDICINES. quickness in muscular motion.) Aeon., Coffea, Bry., Cham., Nux v., Sep., Plat, Lach., Ac. nitr., Cocc, Ambr., Ars., China., Zinc, Cup., Ign., Phosph., etc. Constitution or Habit of Body, Cachectic : Ars., Sulph., Calc, China, Merc, Acnitr., Phosph., Sil., Natr. m., Carb. v., Am., etc. --------Debilitated or Exhausted : Ars., Sulph., Calc, Phosph., Phosph. ac, Ars., Carb. v., Nux v., China, Lach., Merc, Natr. m., Staph., Ac. nit, Sep., Veratr., Sil, Ant. c, Kali, Am., Can., etc. --------Dry: Bry., Nux v , Ac nitr., Ambra, China, etc. --------Plethoric, Corpulent, Leuco-phlegmatic: Aeon., Bella., Calc, Am., Baryt. c, Ant., Sulph., Puis., Hell, Merc, Sep., etc. Lean Habit of Body : Nup v., Sil, Lach., Ac. nitr., China, Ambra, Bry, etc. Disposition, Choleric : Bry., Nux v., Cham.., Cocc , Aeon., Sulph., China, etc. --------Hypochondriacal : Nux v.,Sulph., Staph., Veratr., Aurum, China, Con., Stann., Phosph., Grat, Mosdh., Puis., Asa., Bella., Cham., Magn. m., Hell, Plumb., Mez.,Val, Zinc, etc. --------Melancholy: Aeon., Ign., Natr. m., Lach., Ars., Nux v., Bry., China, Sulph., Merc, Graph., Calc, Staph., Aur., Lye, Plat, Puis., Veratr., Sil, Sep., Ac. nitr., Stram., Calc, Con., Chel, etc. --------Mild (quiet, easy) : Puis., Ign., Ambra, Cic, Mag. arct., Stann, Sulph., Calad., Lye, Sil, etc. --------Phlegmatic (inactive, inanimate, indolent): Caps., Cocc, Puis., Acphos., Sep., Anac, Ars., Hell, Bella., Scill, Sil, Sulph., Zinc, Ac. mur., Natr. m., Cyc, Euph., etc. ■--------Sensitive : Ign., Cap., Phosph., etc. As we very frequently meet with mixed forms of temperament, such as a combination of the sanguine and lymphatic, the nervous and lymphatic, and the nervous and bilious,^ forming the sanguine- lymphatic, the nervo-sanguine and the nervo-bilious temperaments, the remedies which correspond to the two pure varieties which form the compound one ought to be selected where possible, or those which correspond best to the more prominent development of tem- perament, when a medicament cannot be found which is equally well adapted to the two different temperaments forming the mixed variety. We must, of course, be guided by the entire morbid picture in making a selection from amongst the medicaments which are most applicable to particular temperaments. HOJICEOPATHIC PRACTICE OF PHYSIC. It has been repeatedly found that some remedies act very beneficially when administered after the previous employment of certain others. The subjoined list affords a few such examples, and may prove useful in the treatment of particular cases : the remedy to be selected must be in accordance with the symptoms. Acidum nitre Calc, Petr., -Puis., Sulph., are often used with success after Acidum nitri. Acidum Phos. China, Lach., Rhus, Verat., are sometimes suitable after Acidum phos. Acidum sulph. Puis, is sometimes useful after Acid. sulph. Aconite. Am., Ars., Bella., Bryon., Cann., Ipec, Spong., Sulph., &c., will frequently be found of use after Aconite. Alumina. Bryon. is often of great use after Alumina, when it is indicated. Ant. crudum. Pids. and Merc, sometimes answer well after Antimony. Arnica. Aeon., Ipec, Rhus., Sulph. ac, are sometimes suitable after Arnica. Arsenicum. China, Ipec, Nux vom., Sulph., Veratr., will sometimes be found beneficial after Arsenic. Belladonna. China, Ipec, Pule, Hepar, Lach., Rhus, Seneg., Stram., Valer., are sometimes the most appropriate medicines after Belladonna. Bryonia. Alum, and Rhus will sometimes be found suit- able after Bryonia. Calcarea carbonica. lycopodium, Nitr. ac, Phos., and Silicea, will be found most useful after Calcarea. Carbo vegetabilis. Arsen., Kali, Merc, will often be found suitable after Carbo vegetabilis. 54 LIST or medicines. Cinchona (or China). Arsen., Bella., Puis., Veratr., are sometimes suitable after Cinchona. Cuprum. Calc. and Veratr. are sometimes of service after Cuprum. Hepar sulph. Bella., Merc, Nitr. ac, Spong., Silicea, are sometimes suitable after Hepar sulph. Ipecacuanha. Am., Ars., Chin., Cocc, Ign., Nux, are sometimes suitable after Ipecacuanha. Lachesis. Alum., Ars., Bell., Carb. v., Con., Pule, Merc, Nux vom., Phos. acid., are sometimes useful after lachesis. Lycopodium. Graph., Ledum, Phos., Puis., Silic, are sometimes serviceable after Lycopodium. Mercurius. After Mercurius, Bell., Pule, Hepar, Lach., Nitr. acid., Lep., Sulph., are sometimes suitable. Nux vomica. Bryon., Puis., and Sulph., will frequently be found efficacious after Nux vomica. Opium. After Opium, Calc, Petr., Puis., will sometimes be found of use. Phosphorus. Petr., Rhus, and Sulph., will be found suitable after Phosphorus. Pulsatilla. Asa., Bryon., Nitr. ac, and Sepia, are sometimes suitable after Pulsatilla. Rhus toxicodendron. Am. c, Ars., Bryon., Calc, Con., Phos., Phos. ac, Puis., and Sulph., are sometimes useful after Rhus tox. Sepia. After Sepia, Carbo v., Puis., are sometimes suitable. Silicea. After Silicea, Hepar, Lach., Lyco., Sepia, are sometimes of service. Spongia. Hepar sulph. is sometimes suitable after Spongia —for instance in croup. Sulphur. Aeon., Bell., Calc, Cupr., Merc, Nitr. ac. Puis., Rhus, Sepia, Sil., are sometimes suitable after Sul- phur. Tartarus emeticus. After Tartar, emet., Bar. c, Ipec. Puis., Sep., are sometimes useful. Yeratrum. After Veratrum, Ars., Am., Chin., Cupr. Ipec, are sometimes suitable. SYNOPSIS OF THE RULES OF DIET. UNDER HOMCEOPATHIC TREATMENT. ALIMENTS ALLOWED. Soup or broth made from the lean of beef, veal, mutton, or chicken: to which may be added, well boiled sago, tapioca, vermicelli, rice, semolina, or maccaroni, young peas, carrots, pearl barley, or other farinaceous materials, seasoned merely with a little salt. Meats. Beef, mutton, (poultry rarely,) pigeons, larks, rab- bits, (venison, and game in general, may in most cases be par- taken of in moderation, but never when high,) plainly cooked, and roasted, broiled, or stewed in its own juice, in preference to boiled. (Ham or neat's tongue rarely.) Fish. Soles, whiting, smelts, trout, and flounders, perch, and such like, boiled in preference to fried ; when cooked in the latter manner, the white must alone be partaken of, and the outer or fried portions rejected. Vegetables. Potatoes, brocoli, green peas, cauliflower, spinach, artichokes, parsnips, carrots, turnips, French-beans, sea-cale, vegetable marrow, stewed lettuce, well cooked, and prepared with the gravy of meat, or with milk, where re- quired, instead of butter. Eggs lightly dressed ; all kinds of light bread, not new- baked ; and biscuit, free from soda, potash, and the like ingredients. Light puddings, such as those made from vermicelli, semo- lina, fecula of potato, sago, arrow-root, bread, rice; simple cakes, composed of flour or meal, eggs, sugar, and a little good butter. Fruit. Baked, stewed, or preserved apples and pears; also gooseberries, raspberries, grapes, or any other wholesome fruit not of an acid quality, fully ripe, preserved, or in the form of jelly, may occasionally be partaken of. 56 RULES FOR DIET. Beverage. Water, milk, cocoa, chocolate (unspiced), arrow- root or gruel (made thin), toast-water, barley-water, milk and water, sugar and water, rice-water. Salt should be used in moderation. ALIMENTS PROHIBITED. Soups. Turtle, mock-turtle, ox-tail, giblet, mulligatawny, and all rich and seasoned soups. Meats. Pork, bacon, calf s head, veal, turkey, duck, goose, sausages, kidney, liver, tripe, and every kind of fat and salted meat. Fish. Crab, lobster, oysters, and shell-fish in general; and almost all other fish not specified in Aliments allowed. Vegetables. Cucumber, celery, onions, greens, cabbage, radishes, parsley, horse-radish, leeks, thyme, garlic, asparagus ; and every description of pickles, salads, and raw vegetables, or vegetables greened with copper. Pastry of all kinds, whether boiled, baked, or fried. Spices, Aromatics, and Artificial Sauces of all kinds; as also the ordinary condiments, mustard and vinegar. Cheese. . . Chesnuts, filberts, walnuts, almonds, raisins, and indeed the entire complement of a dessert, except what has been men- tioned in Aliments allowed, under Fruit. (See also article Regimen.) The above regulations are subject to considerable modifica- tions in particular cases, both as regards the articles allowed, and those which are prohibited. Regularity in the hours of meals should be observed; and too long fasting, as well as too great a quantity of food at one time, should be avoided. PART II. ON THE SYMPTOMS, CHARACTER, DISTINCTION, AND TREATMENT OF DISEASES. General Regulation. The mistaken notion of reducing the compass of Domestic treatment to a certain and defined sphere, has led to a second and yet more grievous error, namely, that of prescribing a particular course of treat- ment, as a rule, which applies to all cases following within the pre- determined pale. In the first place, Domestic treatment may become necessary in every variety of disease where circumstances and situation preclude the accessibility of professional advice. In the second place, there is no reason why one set of acute diseases should be less likely to become critical than another, and in fact, those selected for the special and circumscribed sphere in question, are, inconsistently enough, amongst those in which statistical returns show the greatest proportion of fatality. But, above all, it cannot be too strongly impressed upon the Administrator or Patient in Domestic practice, that inas- much as the Homoeopathic method aims directly at the disease through the medium of the existing indications, and inasmuch, moreover, as every form of disease is subject to an infinity of particular modifications, governed by condition, circumstances, constitution, climate, state of the system, and the like; his only sure and true course is to treat according to the symptoms irrespective of any particular nomenclature of the ex- isting form of disease, or of any particular course of medicine which may have been prescribed, without regard to the special indications of each case. FEYERS. Febres. GENERAL CONSIDERATION OF FEVER. CAUSES, TREATMENT, AND DD3T TO BE OBSERVED. In all forms of acute disease fever is present; in fever, properly so called, there is • generally functional disturbance, accelerated action of the vascular, with the participation of the nervous system, and a tendency to increased development of heat. The symptoms common to most fevers are, at first, a feeling of coldness or shivering, then heat, accelerated pulse, 58 FEVERS. thirst, restlessness, and languor. Fever also possesses the property of passing from one species into another. Thus in- flammatory fever may, by severe antiphlogistic measures, be altered into a low typhus ; or, on the other hand, a simple fever, by injudicious treatment, may be changed into an inflammatory one; and that again assume the intermittent form; also, one attack may present all these different phases. Fevers, terminating fortunately, and running a regular course, may be divided into five stages : the accession, increase, crisis, decrease, and convalescence. When the result is fatal, it may arise from a metastasis, the exhaustion of the vital energy of the patient, or the disorganization of some impor- tant part. The belief in critical days is of very ancient origin, though there is some difference in the calculations of physicians upon this point: some counting from the day the shiverings declare the onset, others from the first hot fit; except in cases where a marked periodicity exists, as in quotidian and other forms of ague, such distinctions are of little value, inasmuch as the homoeopathic treatment is directed to forwarding the crisis, and thereby materially shortens the duration of the disease. Statistics prove that the average continuation of acute affections is much shorter under the homoeopathic system, than it is where they are treated allopathically, or left to nature; conse- quently, any calculations based upon other modes of treat- ment are not to be depended upon, and the best plan for the physician to follow is to watch attentively the disease before him, and apply the remedies his knowledge and experience point out as best calculated to conduct it to a satisfactory issue. A crisis may declare itself by diarrhoea, profuse perspira- tion, hemorrhage, or increase or alteration of other secretions, or by the appearance of an eruption, after which, if salutary, the skin becomes moist and resumes its functions, and the pulse returns to its usual standard. Fevers have been differently classified by various medical writers. The arrangement we shall adopt is as follows : sim- INFLAMMATORY FEVER. 59 pie irritative fever, inflammatory fever, typhus, putrid, and gastric or bilious fevers, intermittent fevers, and then eruptive fevers, such as scarlatina, measles, &c. Although this mode of classification is adopted for the sake of convenience, the author has no intention of generalizing disease: every febrile attack presents peculiar features, and it is to be treated as an individual affection, and according to the nature of the symptoms presenting themselves, not by a blind adherence to the nomenclature of disease. CAUSES OF FEYER. It cannot be denied that there exists in certain individuals, a particular predisposition to acute diseases, and, as before remarked in the introduction, the sanguine, nervous, and bilious temperaments possess this sus- ceptibility in a far more marked degree than the phlegmatic. The exciting causes are numerous. Miasms, epidemic influences, contagion, powerful mental emotions, derangement of some important organ, external lesions, excess or errors in diet, heat or cold, *or alterations of temperature, exposure to cold, or damp, repercussed eruptions—in fact, anything that causes derangement of the equilibrium of the system may produce fever. GENERAL TREATMENT IN FEVER, AND DIET. The great essentials in the treatment of fever are: Perfect rest, mental and bodily. . Pure -air and a cool apartment; the temperature of the patient's room should never exceed 55 degrees. Feather-beds should be discarded and mattresses substituted, when practicable, and the bed-clothes be light but sufficient. Nature herself generally prescribes the regimen to be ob- served by taking away appetite, while the thirst present, as an eminent medical writer has well observed, may be consi- dered as her voice calling for fluid. Water is the best diluent; no sobd food, broth, or even gruel, and the like, should be permit- ted in cases where the inflammation runs excessively high ; and the utmost caution is to be observed in allowing gruel or weak broths during the decrease: an error in this respect often 60 FEVERS. causes irreparable mischief, and it is always safer to err a little on the side of abstinence than on that of indulgence. ^ Toast-water, or weak barley- or rice-water, sweetened with a little sugar or raspberry or strawberry syrup, or orangade, may be allowed when the fever is somewhat abated, though then we must still carefully avoid incurring the risk of a relapse, by giving any aliment likely to tax, in however slight a degree, the digestive powers. Fruits, such as those which have been enumerated in the Rules for Diet (see page 67), are very generally allowable in most forms of feyer, unat- tended with diarrhoea. Drinks ought, for the most part, to be given, in preference, frequently and in small quantities, than in large draughts. - SIMPLE OR EPHEMERAL FEVER. Febris simplex. The disease seldom presents any distinct character, and generally runs its course in twenty-four hours; as, however, it frequently forms the initiative of other more serious disor- ders, it deserves attention. Before attacks of scarlatina, measles, small-pox, &c, it is generally present, although occa- sionally showing itself as a distinct affection. SYMPTOMS. Shivering followed by heat, restlessness, thirst, accelerated pulse, general uneasiness and lassitude, ter- minated by profuse perspiration. In allopathic practice, unless the immediate cause of the affection can be traced,—for instance, indigestion,—the treat- ment is occasionally hazardous; for, if the simple fever be merely the commencement of an attack of severe inflamma- tion, the allopathic physician incurs either the risk of increas- ing it by using stimulants, under the idea of its being a precursor of typhus; or, acting upon the opinion of its being a forerunner of inflammation, of weakening the constitution by antiphlogistic methods, if it should unfortunately run on to the former. In this case, the safer plan was to wait quietly INFLAMMATORY FEVER. 61 the development of the affection, in order to see if it would terminate in a crisis, or take upon it a more virulent form, and then deal with it'accordingly. TREATMENT. Throughout this work the disease will be found treated of, both when arising from indigestion or cold, and when appearing as the precursor of other affections ; but when it is encountered along with the symptoms already detailed, and cannot be traced to any particular exciting cause, and particularly when hot dry skin is present, Aconite should be prescribed, which, if it be simple fever properly so called, will speedily dissipate all the symptoms; and, if it be the forerunner of any more severe disorder, either at once check its further progress or materially modify its malignancy. The former is more peculiarly the case with purely inflamma- tory attacks : the latter holds good as far as relates to typhus, exanthematic diseases, and some other affections, which run a regular course. D0S€« Dissolve six globules in two table-spoonfuls of water, give a tea-spoonful every two hours, until the skin becomes moist, and the pulse diminished in frequency, which result will almost invariably fol- low within a few hours after the commencement of the treatment. • INFLAMMATORY FEVER. SYNOCHAL FEVER. Febris inflammatoria simplex. Synocha. Febris synochalis. SYMPTOMS. Shivering or chill, generally considerable, followed by burning heat; pulse strong, hard, and greatly ac- celerated ; dryness of the skin, mouth, lips and tongue; the latter generally of a bright red, in some cases lightly coated with white; thirst; urine red and scanty; constipation; res- piration hurried, in accordance with the pulse; amelioration of symptoms as the pulse assumes a more normal state. It runs its course with rapidity, rarely exceeding fourteen days, and progressing with regularity to a crisis, which shows itself in profuse perspirations, critical urine, diarrhoea or hemor- rhage, principally epistaxis. The period mentioned is its ordinary average of duration, but under homoeopathic treat- 4 62 fevers. ment, the perfect crisis is considerably hastened without the long convalescence entailed by the usual antiphlogistic means. It is peculiarly apt, if not carefully treated, to change into typhus, or, by metastasis, to fix upon some important organ. CAUSES. Sudden chill, or check of perspiration, exposure to damp or wet, dry piercing winds, violent mental emotion, high living, external injury or lesion, local inflammation, and slight febrile attacks mismanaged. Individuals, of what is denominated a plethoric habit, are particularly subject to this disease; it generally attacks be- tween the ages of 15 and 30 years. Under the symptoms we have given the pathognomonic symptoms of synocha; we, however, find it complicated, in the majority of cases, with more or less cerebral disturbance, which we shall consider more in detail under Inflammation OF THE BrATN OR ITS TISSUES. TREATMENT. Although, throughout this work, the author purposes to confine himself to pointing out the reme- dies most valuable in disease, without entering into any disqui- sition upon their efficacy, or the principle of their employment, yet he cannot refrain, in this instance, from briefly noticing a medicament, which has so successfully superseded all the antiphlogistic measures of the old school, subduing, as it does, the inflammation, without lowering the vital energy. No one, who compares the pathogenetic symptoms of Aconite given in the Materia Medica Pura of Hahnemann, and carries in mind the principle of its application, can forbear being struck with the close resemblance which they present to those of pure inflammatory disease; and by this powerful auxiliary, the author has no hesitation in declaring, that disease of the said description is brought so fully under the control of the physi- cian, as to be in a great measure divested of its malignancy, and in no case is the superiority of homoeopathy more strongly evidenced. When, therefore, the symptoms above mentioned are pre- sent, we may at once prescribe Aconite. DOSC Dissolve six globules in three table-spoonfuls of water, and inflammatory fever. 63 give a teaspoonful of the solution every three hours, until the pulse becomes more healthy, the skin moist or covered with profuse perspira- tion, when the intervals should be extended to six hours, and the administration continued until absolute amelioration'or change. A slight degree of delirium is frequently present in this affection, chiefly at night, which (unless it threatens to run on to inflammation of the brain, in which case Belladonna must be had recourse to) Aconite of itself is sufficient to subdue. When, however, during the course of the affection, other symptoms, besides those mentioned, develop themselves, we may find it necessary to have recourse to different reme- dies, such as Belladonna, Bryonia, &c. Belladonna is especially useful after the previous employ- ment of Aconitum / but it may be prescribed at the commence- ment of the attack in all cases when the cerebral system seems prominently affected, and there is great heat in the head, with violent cephalalgia, particularly in the forehead, and redness of the face / distension of the arteries of the neck and temples / nocturnal sleepiness, with furious delirium ; eyes red, shining and fiery; general internal and external heat; burning thirst and agonizing restlessness. Dose* Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of the solution every four hours, until amelioration or change. In the event of distinct medicinal aggravation, the admin- istration should be suspended until the reaction has taken place. In the event of distinct improvement, the interval should be extended to six hours. Bryonh.. When the morbid action is concentrated in the internal parts of the chest, or there is gastric complication, and the fever inclines to degenerate into synochus. This medica- ment is accordingly indicated when, in addition to the usual symptoms of inflammatory fever already given, we find a heavy stupefying headache, with a sensation as if the head would burst at the temples, much aggravated by movement, vertigo and giddiness on rising up or moving ; burning heat of the head and face, with redness and swelling of the latter; delirium; oppression at the pit of the stomach; excessive thirst, sometimes followed by vomiting ; constipation ; aching 6± FEVERS. or shooting pains in the limbs, short cough, oppression at the chest, and laborious breathing. Dose. Dissolve six globules in three table-spoonfuls of water, and give a teaspoonful of the solution every four hours; when, however, the virulence of the disease has been subdued, a single dose is generally found sufficient, and no further exhibition should take place, as long aa the patient manifestly continues improving. Cantharis has been recommended in irritative fever bear- ing a close resemblance to pure inflammatory fever, and when the following symptoms become developed: the fever is very intense during the night, and is accompanied by burning heat of skin, strong accelerated pulse, general redness of the sur- face, dryness of the mouth, and violent thirst. Further, when pains are complained of in the right side of the body, attended with great anxiety and raving. Chamomilla is useful in pseudo-synochal fever, with burning heat and bright redness of the cheeks, tremulous, anxious, palpitation of the heart, extreme irritability of temper, and over-sensibility of the senses, alternate heats and chills, and, sometimes, spasmodic attacks, &c. Chamomilla is peculiarly applicable when the above symptoms have been excited by a fit of passion or vexation. A dose or two of Aconite is, however, generally requisite, in the first place, when the derangement has been excited by the aforesaid cause. DOSC Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of the solution every three hours, until amelioration or change. When inflammatory fever seems to arise from a primary inflammation of some important organ, such as the Brain, Lungs, Liver, or Stomach and Bowels, the treatment will be found under the head of Inflammation of the organ most evidently the seat of the disorder. It is sometimes the result of severe lesion, in which case the patient is to be treated as prescribed under External Injuries. DIET.---See general treatment in fever and diet. NERVOUS FEVER. 65 NERVOUS FEVER. SLOW FEVER. Febris nervosa. Typhus. SYMPTOMS. This fever rarely sets in with such marked symptoms as announce the approach of inflammatory fever; instead of severe chills or shiverings, we first find a complaint of general uneasiness, a sensation of chilliness, occasionally followed by a greater or less degree of heat. The patient either complains but little, or of pains in his head, chest, and abdomen, and frequently an unusual degree of drowsiness is present, arising from a comatose state of the brain—there is also occasionally a slight dyspnoea—after various alternations of cold and heat, the former sensation predominates in the feelings of the patient, while to those around him he appears hot; the extremities, however, on examination, are found cold. Different characters of pulse present themselves; sometimes it is full and soft, at others accelerated, frequently about the natural standard or below it, or quick and weak, but not strong and hard as in inflammatory fever: the frequent dif- ference between the action of the pulse and heart is worthy of notice ; the former may be so weak as scarcely to be percep- tible, and the action of the latter strong; the pulse also may be hurried and the respiration natural. As the disease pro- gresses, the tongue, at first moist, becomes thickly coated, dry, glazed, and tremulous; there is faintness, cephalalgia, giddi- ness, and vertigo: the delirium, at first slight, and manifest- ing itself only at night, becomes unintermitted, and is characterized rather by wandering and low muttering, than fury and violence : wTe may also meet with spasms and con- vulsions. All these symptoms, if the disease be allowed to gain ground, increase in malignancy, the evacuations become involuntary, the weakness and lassitude excessive, and the patient sinks down to the bottom of the bed—an evidence of complete prostration of strength, while all endeavors to rouse him are fruitless, and he is perfectly blind to all around. 66 FEVERS. Tenderness of the abdomen, or pain in the region of the ciecum, is also frequently met with. Some only of the above symptoms may be present, or the fever may be complicated with others: when only a few of the less virulent symptoms declare themselves, it is called mild typhus; when complicated with considerable disturbance of the vascular system, great heat, and quick hard pulse, in- flammatory typhus : a distinction is also found in the type, as in continuous and intermittent typhus; in the accidental cir- cumstances or exciting causes present, as for instance in the gastric and catarrhal complications, which, although generally treated as gastric or catarrhal fevers, with typhoid symptoms, may be considered as modifications of this affection; this differ- ence in arrangement can, however, make none in practice, as we must be guided by the symptoms that present themselves in selecting our remedies. The Congestive Fever of some authors may be considered as a variety of typhus, in which, from the balance of the circu- lation being destroyed, the blood is determined to some parti- cular organ, the external heat of the body diminished, and the pulse becomes slow and oppressed. The symptoms vary according to the organs attacked. It maybe remarked that in most forms of this malady, the course is extremely irregular —the precursory symptoms may precede the disease only a few days or several weeks, and its duration is also uncer- tain. Death may take place from exhaustion of the vital energies, paralysis of the whole system, or of the brain, apoplexy, dis- organization of some of the nobler viscera, or a change to the putrid form. CAUSES. Densely populated neighbourhoods, where a number of individuals are crowded into small apartments, and the air rendered impure by exhalations from decomposed animal and vegetable matter, stagnant water, and a want of circulation, are the very hotbeds of typhus; a deficiency and improper quality of food are often added to the above, and are of themselves sufficient to produce it: other causes are, NERVOUS FEVER. 67 over-exertion, either of body or mind, or excesses of any kind, the prevalence of cold, damp weather, mental emotions, and contagion. In fact, anything tending to depress the vital energies may be productive of typhus; it may consequently arise after in- flammatory fever treated by bloodletting or other severe anti- phlogistic measures, or even by the reaction of the organism, or an imperfect crisis after the same affection. PRESERVATIVE MEASURES, AND PREVENTIVE REMEDIES. We need hardly insist upon, what every practitioner knows to be an essential auxiliary in the treatment of this affection, a constant supply of fresh and continually renewed air; the avoidance of dark apartments, into which the day-light does not freely penetrate; and the removal of all causes gener- ating the disease, such as stopped sewers, or collections of decaying vegetable and animal matter; a plain wholesome diet, with moderation in the use of fermented liquors or wine, and total abstinence from spirits; the refraining from late hours, intense study, and excessive mental or corporal ex- ertion; exercise in open situations, with proper precautions against exposure to cold or damp; and finally, the pre- serving a healthy tone of mind and cheerful temper. The absurd practice of keeping the bowels constantly open by means of aperient medicines, and the use of sudorifics, cannot be too strongly reprobated; both these practices weaken the system and predispose it to the disease. Standing between a fire or open window and the bed of the patient is to be avoided, as unnecessarily increasing the risk of taking the infection. The safest plan for the physician to pursue, in epidemic or endemic typhus, or any other epidemy, etc., is to form an aggregate of the symptoms by carefully collating those of individual sufferers, so as to present a perfect image of the existent malady, and to choose his remedies accordingly, which should be administered directly on the premonitory 68 FEVERS. symptoms declaring themselves, without waiting for the fur- ther development of the disease. Bryonia and Rhus. These remedies cover a great num- ber of the symptoms of Typhus, as met with in this country; if, therefore, upon considering the aspect of the disease which prevails, one or both of these medicaments be found to em- brace the characteristic features of the malady, we should have immediate recourse to that which corresponds with such characteristics, or, if necessary, to both of these medicines, in alternation, whereby, if not averted or checked, the dis- ease will be materially softened down in its after course. D0SC (preventively) Six globules in a table-spoonful of water, either of one of these remedies singly, or first of the one and then of the other (beginning with Bryonia), at intervals of twenty-four hours, that is, at bed-time, daily for a week; or in the event of the disease running its course (in a modified form), such treatment according to symptoms, as is directed to be pursued in the foregoing articles. Arsenicum is particularly efficacious as a preventive rem- edy during the prevalence of Typhus, either with predomi- nant affection of the bowels, or which assumes a putrid character, or, indeed, in all such cases as have been herein- before described as indicating its employment. Dose. Four globules in a table-spoonful of water, at bed-time, daily for a week, with such reservations and exceptions as are quoted respecting the dose of Bryonia and Rhus. TREATMENT. At the commencement, where gastric symptoms set in, such as headache, giddiness, nausea, vomit- ing, watery, yellow, or greenish, slimy evacuations; particu- larly when attended with slight chills, alternately with heat, or considerable shivering with slight heat, or marked heat with but little shivering, we may administer Ipecacuanha. Or Pulsatilla may be selected at this stage of the disorder, when there is frequent shivering, bitter taste, whitish tongue, loss of appetite, nausea, vomiting of mucus, slimy evacuations, febrile heat, intermingled with chills, and particularly when the above symptoms occur in mild, temperate, or phlegmatic subjects, with extreme depression of spirits, and tearfulness; NERVOUS FEVER. 69 in a more advanced stage of the disease, with slight delirium, tears and lamentations, alternating with somnolency, Pulsa- tilla is still of considerable service. Acid, phosphoricum is sometimes required after Pidsatilla. Dose. Dissolve twelve globules in six table spoonfuls of water, and give every three hours a tea-spoonful, until amelioration or change. We shall now proceed to the consideration of two medicines, Rhus and Bryonia, which possess striking points of simi- larity, but also many of difference; they may, on some occasions, be administered alternately, with great advantage. For their individual employment the indications are as fol- lows: Bryonia. The indications for it in this stage are chiefly as follows : after a slight cold the patient complains of aching pains over the whole body, which admit of no relief from a change of posture ; there is severe throbbing, bursting frontal headache, aggravated by opening or turning the eyes; the scalp is tender to the touch, and the head burning hot, yet the forehead is nevertheless frequently bathed with a cold sweat; the sitting or the recumbent posture is rendered compulsory, by the prevalence of debility, languor and heaviness of the limbs, and there is an aversion to cold air ; the nights are dis- turbed, more especially in the forepart of the night, by ebullition or congestion of blood, heat and anxiety ; the patient sighs and moans during sleep, and is often aroused by agon- izing or frightful dreams, which continue to haunt him even whilst awake. Symptoms of deranged digestion are also prominently developed, as bitter taste, yellow, furred, dry tongue, disgust at food, nausea, and inclination to vomit, pressure, or weight and pricking in the scrobiculus cordis, with sensation of distension in the lower ribs, costiveness. Dose. If singly, dissolve six globules in three table spoonfuls of water, and give a tea-spoonful of the solution every four hours; if in alternation with Rhus, dissolve six globules of each remedy separately in three table-spoonfuls of water, and give a tea-spoonful of the one solution six hours after the other, in rotation, until amelioration or change. 4 * 70 FEVERS. Rhus toxicodendron. This medicine is more peculiarly suitable to the debile form or stage, the Febris nervosa stupi- da (Bryonia being more applicable to the inflammatory), but will frequently be found serviceable in all the stages of the disease, particularly when there is diarrhoea, congestion to the head, oppression at the chest, and great weakness. The headache is generally of a stupefying nature, with a feel- ing as if from a bruise, but not so severe as that of Bryonia ; the tongue presents nearly the same character, less nausea and inclination to vomit exists ; violent pain is felt at the epigas- trium, especially when touched. Constipation as in Bryonia, but more particularly, copious yellowish, or loose, sanguine- ous evacuations, with severe cutting pains in the abdomen; the symptoms of general heat, and those of the face resemble those given under Bryonia, but without the perspiration, or at most, a clammy feeling of the skin. The urine is hot, dark colored, or at first clear, and afterwards turbid ; the symptoms of the ears the same ; sleep also the same; difficult deglutition of solids, as if from contraction of the throat and oesophagus; general trembling, debility and prostration, almost amount- ing to paralytic weakness of the different limbs: shooting pains in various parts of the body, aggravated when at rest or at night, and momentarily relieved by moving the part affected: pulse quick and small, or weak and slow; in the morale we may notice, excessive anguish, anxiety, extreme lowness of spirits, and disposition to weep. Dose. If singly, of a solution of six globules to three table-spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. If in alternation with Bryonia, dissolve six globules of each remedy separately in three table-spoonfuls of water, and give a tea- spoonful of the one solution six hours after the other, in rotation, until amelioration or change. Rhus should also be employed when, either after exposure to a thorough wetting, or without any assignable reason, the patient is seized with violent relaxation of the bowels, accom- panied by colic, chilliness, even when seated close to the fire; when aching pains (as if arising from the effects of con- NERVOUS FEVER. 71 tusions) are experienced in particular parts of the body ; stiff- ness in the nape of the neck and in the back; rigidity and feeling of paralysis in the extremities, with trembling on hold- ing out the arms; all the symptoms are aggravated dm-ing rest, and at night. Dose. The same as before. Digitalis is indicated when febris nervosa, or rather typhus biliosus is ushered in by yellow, jaundiced hue of the skin; violent, bilious vomiting, spasmodic pains in the stomach; sensibility of the left hypochondrium on pressure; frequent desire to make water, particularly at night, with scanty, bilious urine; burning heat of the head and face; anxiety of mind, and dread of some imaginary impending misfortune; urination painful and difficult, or entirely suppressed. Dose. Six globules in a table-spoonful of water every three hours, until amelioration or change. Nux vomica. Gastric or bilious symptoms, constipation, with frequent inclination and ineffectual efforts to evacuate. Nux vomica is further indicated when the spasms, which not unfrequently accompany this disease, are confined to the stomach and intestines, particularly the rectum—a frequent cause of the above-mentioned constipation; painful and diffi- cult emission of urine; painful pressure, and tension in the epigastrium and hypochondria; sensation as if the limbs were bruised; general nervous excitability, with great nocturnal restlessness and slight delirium; weakness, and exacerbation of the symptoms in the morning. Temperament, sanguine or bilious ; disposition, irritable and impatient. Dose. Six globules in a table-spoonful of water every four hours, until amelioration or change. Cinchona. This remedy is frequently of service in the first stage, or when there is paleness of the face, lancinating, rending, aching, or pressive headache, cloudiness of vision, buzzing or roaring in the ears; dulness of hearing; yellow or white coating on the tongue, dryness of the mouth, insipid, clammy, or bitter taste; inclination to vomit; sensibility and distension of the abdomen; thin, yellow, watery motions, 72 FEVERS. occasionally intermixed with undigested substances; urine scanty, pale or dark colored, and cloudy ; oppression at the chest; dragging shooting pains in the limbs ; anxiety, sleep- lessness, and general coldness and shivering. Dose. Six globules in a table-spoonful of water every six hours, until amelioration or change. When inflammatory symptoms declare themselves at the commencement, Aconite and Belladonna are the best reme- dies ; but when the disease becomes more developed, and still retains the inflammatory character, Bryonia and Rhus will generally be found more useful. For the employment of Aconite, we have given the characteristic indications under Inflammatory Fever, and in all cases where these decided symptoms are present it is imperatively called for, and should be administered as there prescribed. The following symptoms indicate Belladonna : Alternate heat and chills, or general heat externally and internally, with redness, burning heat, and bloated appearance of the face, or alternations of coldness and paleness, and heat and redness of the face, violent throbbing of the carotids ; redness, sparkling, and protrusion of the eyes, with dilatation of the pupils, extreme sensibility to light, and strabismus; singing or noises in the ears to a greater or less degree ; wild expression of the countenance, with uneasy glancing around, as if from fear, sometimes attended with a marked inclination to run away; violent, shooting pains in the forehead, or dull heavy pain, causing the patient to put his hand frequently to his head; sopor; furious delirium or loss of consciousness; delirium and carpologia, or spasmodic or convulsive attacks; parched lips, soreness of the corners of the mouth, redness and dryness of the tongue, which is also sometimes foul, and covered with yellow fur ; skin, hot and dry; bitter taste in the mouth, intense thirst, difficulty of deglutition, especially of liquids, nausea, pressure at the pit of stomach- me- teorismus; constipation, or watery motions; scanty and red or amber-colored urine; rapid respiration; pulse full and NERVOUS FEVER. 73 accelerated, or quick, hard, and wiry; parotid glands inflamed and tumid. Dose. Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of the solution every four hours, until amelioration or change. In mild cases, or when the symptoms yield readily to the action of the medicine, the repetition may be deferred to a period of twelve hours, and repeated at such intervals, until amelioration or change. Stramonium may be given when, in addition to the above symptoms, we find twitching of the muscles of the face, sub- sultus, strabismus, trembling of the extremities, tremulous motion of the tongue on protrusion, burning heat of the body, suppression of the urine, fantastic gesticulations, and risus sardonicus. Dose. Three globules in a tea-spoonful of water every three hours, until amelioration or change. Hyoscyamus, with similar symptoms, and moreover twitch- ing of the tendons, strong, full pulse, fulness of the veins, burning heat of the skin, sensation of pricking all over the body, and'constant delirium; frequent, but ineffectual urging to urinate. Dose. Three globules in a tea-spoonful of water every three hours, until the symptoms are distinctly modified or changed. Camphora frequently proves useful after Rhus (according to the experience of some of the Continental homceopathists); it is indicated especially when the symptoms are chiefly as follows : heat of the head, with confusion of ideas ; or violent delirium; giddiness; throbbing headache; burning heat in the forehead; cold and clammy skin / continuous coldness of . the hands and feet; debilitating and clammy sweat; ten- dency to diarrhoea; scanty, cloudy urine, which deposits a thick sediment; great weakness, and feeble, scarcely percep- tible pulse. Dose. One drop of the saturated tincture on a small lump of loaf suo-ar, every quarter of an hour, until distinct amelioration or change; or, if the more urgent symptoms have yielded, and the following remain, proceed with the next remedy. Cocculus is often serviceable after the previous employment 71 FEVERS. of Rhus or Camphora, especially when the great debility continues, and the patient complains of giddiness and head- ache ; or when there is a tendency to syncope, or paralysis of the limbs, and when there are prominent symptoms of gastric disturbance. Arnica is also of some importance in febris nervosa stupida; with coma somnolentum, or delirium and carpologia; or when the patient lies in a state of unconscious- ness, as if he had been stunned by a concussion of the brain. Dose. Of a solution of six globules to three table-spoonfuls of water, give a dessert-spoonful every two hours, until amelioration or change. Arsenicum. This is decidedly one of the most important remedies in abdominal typhus, especially in the second and third stages, sometimes restoring the patient when almost beyond the reach of hope, and renovating the vital spark. The chief indications for its employment are : extreme pros- tration of strength, falling of the lower jaw, open mouth, dull and glassy eyes, bitter taste, inclination to vomit, pres- sure and aching at the scrobiculus cordis, pain in the caecal region, bursting headache, giddiness, violent or low muttering delirium, sopor, tympanitis, burning thirst, dry hot skin, gid- diness, parched, cracked, sometimes blackish-looking, clammy tongue, and colliquative diarrhoea, pulse scarcely perceptible and intermittent. Dose. Of a solution of six globules to three table-spoonfuls of water, give a tea-spoonful every quarter of an hour (in very critical cases), or every hour (in less urgent instances), until amelioration or change doubling the length of the intervals as soon as distinct improvement occurs. Yeratrum is occasionally useful after or in alternation with " Ars., when the inferior extremities become cold and covered with cold sweat. Dose. The same as Arsenicum. Carbo vegetabilis is another remedy which often proves of utility in these desperate cases; it is indicated where we find drowsiness with rattling respiration, face pinched sunken and deathlike, pupils insensible to light, pulse scarcely per- NERVOUS FEVER. 75 ceptible, and the vital power rapidly sinking, cold perspira- tion on the face and extremities, involuntary and offensive evacuations, deep red urine, with a cloud floating in it or rising towards the surface. In Ileo-typhus, with symptoms of incipient ulceration, or with signs of so-called putrescency, and tendency to metastases, Carb. v. is, moreover, a most serviceable remedy: and in the second stage of malignant typhus, or typhus abdominalis, it may be employed with de- cided advantage when the symptoms are as follows: Burning, lancinating pains in the epigastrium and deep in the abdo- men, which become renewed after partaking of nourishment of any kind, and are accompanied by great anguish, excessive flatulency, and the evacuation of burning, light-colored, fetid, watery, sanguineous stools with tenesmus ; desire for salt food, and for coffee, but aversion to meat,—the patient, however, generally dreads to satisfy any inclination which he may have for food, on account of the above-mentioned sufferings which such indulgence entails;—anxiety and burning heat of skin, arising from congestions to the head and chest; agglutination of the eyelids during the night; deafness and tinnitus aurium, as also bleeding from the nose and obstruction of the latter from the formation of incrustations; eruption around the nose, and the brown or blackish-looking cracked lips; the legs are drawn up during sleep, which is restless and disturbed by frequent waking. Dose. The same as Arsenicum. Acidum phosphoricum. When at the very commencement of the disease, we find great exhaustion and prostration, with wandering even when awake; or in almost hopeless cases, this medicine may be administered either alone, or still better, in alternation with Rhus, when the patient is always found lying on the back in a drowsy state, and either gives no reply when talked to, or if he does, it is in an incoherent manner; constant loquacious delirium, or low muttering; carpologia, fixed look \ seeming efforts to escape from some alarming object; black incrustations on the lips; dry, hot 76 FEVERS. skin, continual copious watery diarrhoea; the motions are generally passed involuntarily; sanguineous evacuations ; fre- quent, weak, and occasionally an intermitting pulse. Dose. Three globules in a tea-spoonful of water, at first every hour, extending the intervals to three hours as soon as the symptoms are modified, and continuing the administration until positive amelioration or change. Should the debilitating sanguineous evacuations continue, AcmuM Nitricum should be administered, or Cantharides, if strangury also be present. Acid. nitr. in addition to being useful against hemorrhage, is also efficacious where there is sensibility of the abdomen, with diarrhoea and slimy, acrid, greenish-colored stools; tenesmus, aphthae, intestinal ulcera- tions / sensibility of certain parts of the abdomen on pres- sure ; shooting pains in the rectum ; tenesmus, greenish slimy diarrhoea; scalding micturition; tendency to collapse. Dose. Three globules in a tea-spoonful of water, repeated, if necessary, after four hours (or every four hours till the symptoms yield), returning to Acidum phosph., if requisite. Sulphur has been found useful when Bryonia, Rhus, or Acidum phosphoricum have been fruitlessly administered ; but particularly when the following symptoms were encoun- tered : pale and collapsed countenance, burning, itching erup- tions on the lips, dryness of the mouth; foul, dry tongue; bitter taste; slimy or bilious vomiting; tenderness of the epigastrium, and pain as from excoriation in the umbilical region, increased on pressure; borborygmus; frequent, wa- tery, flocculent or yellow evacuations ; cloudy urine, deposit- ing a reddish sediment; miliaria, miliaria purulenta ; epis- taxis; stitches in the chest, oppressed breathing; dry cough worse towards evening and at night; sleeplessness, or whining during sleep; dry heat during the day, with moderately quick pulse, and profuse sweating at night. Dose. Dissolve six globules in three table-spoonfuls of water and give a tea-spoonful of the solution every six hours. Opium. {Febris nervosa stupida.) Great drowsiness or coma with stertorous breathing, open mouth, half-closed eyes NERVOUS FEVER. 77 or fixed look, slight delirium or muttering ; carpologia ; the patient is in a continual state of sopor, from which it is ex- tremely difficult to rouse him, and is scarcely aroused, ere he relapses into his former state; dry offensive stools, which, together with the urine, are passed involuntarily. Dose. Of a solution of six globules to three table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Calcarea c. may sometimes be administered advantage- ously, alternately with Belladonna, Arsenic, or Rhus, accord- ing to the symptoms; it is, further, occasionally a most effi- cient remedy in cases in which debilitating diarrhoea or epis- taxis will not yield to such remedies as Ac. phosph., Rhus, Cinchona, etc.; when the nasal hemorrhage fails to be ar- rested by Calcarea, Hepar sulphuris is generally the most appropriate remedy to follow up with, provided all the symp- toms of the disease are not better embraced by Pulsatilla, Belladonna, Rhus, or Sulphur: lastly, Calc. c may be ex- hibited with advantage where there are symptoms of impend- ing miliaria, jerkings, or twitchings in the limbs, particularly in children, tendency to meningitis, delirium, etc. Dose* Of a solution of six globules to three table-spoonfuls of water, give a tea-spoonful every three hours until amelioration or change. Lycopodium is often a valuable remedy after Calc. in the second stage of typhus, when miliaria is slowly and scantily developed, and there is sopor with muttering delirium; con- founding of words ; stammering ; subsultus tendinum ; car- pologia ; meteorismus, with constipation; affections of the bladder; or, when there are shiverings alternating with heat; circumscribed redness of the cheeks; debilitating sweats ; excessive debility; complete hanging of the lower jaw; half- closed eyes ; slow respiration; or, state of excitement without heat or congestion in the head or face; redness of the tongue; constipation; burning urine; tranquil and resigned state of mind, or surliness and malevolence, especially on waking. Dose. Three globules in a teaspoonful of water eveiy three 78 FEVERS. hours until amelioration or change. In case of amelioration, pause until the symptoms evidently retrograde, when resume, at intervals of six hours, as long as necessary. In the case of change, suspend treat- ment for four hours, and continue with the remedy newly indicated.; Lachesis is spoken of as being likely to prove serviceable in typhoid fever, attended with vertigo on rising or sitting up ; muttering delirium ; hanging of the lower jaw; vacant ex- pression of countenance ; sunken features; bitter taste; yel- lowish tongue, with bright red margins; cracked tongue; smooth dry tongue; or furred, white slimy tongue; heaviness of the tongue, with difficulty of protruding it, and inarticu- late speech / seeming paralysis of the eyelids ; lethargic sleep, and tendency to lie in the prone position; thirst, with disin- clination to drink; brownish-red, copious urine. Dose. As directed for Lycopodium. Secale Cornutum is, in like manner with Natrum m. and Helleborus, recommended by many homoeopathists who have had frequent opportunities of treating nervous fevers, particu- larly in cases occurring in the wake of other diseases ; but is more especially appropriate where the symptoms developed clearly proceed from irritation of the spinal nerves, with wandering, fugitive, spasmodic pains extending from the dorsum and sacrum into different parts of the body; the spasms which affect the face become subsequently chronic; whilst those that have their seat in the hands and feet partake of a tonic character. This remedy is further indicated by dry heat of skin, insatiable thirst, accelerated pulse, great restless- ness and sleeplessness; excessive languor: aversion to food. Should the spasmodic affections readily yield to the employ- ment of Secale, but the febrile symptoms continue, some other remedy appropriate thereto must be prescribed. Dose. Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of the solution every three hours, until amelio- ration or change. Phosphorus is of great service where we find great dry- ness of the tongue, heat of skin, small, hard, quick pulse, painless diarrhoea, with excessive borborygmus ; or when the NERVOUS FEVER. 79 disease becomes, as it were, concentrated in the lungs, and there is consequently congestion, with extremely laborious breathing and excessive anxiety, dulness on percussion, mu- cous rale, stitches during respiration; cough, with copious expectoration of mucus mixed with blood, or even offensive pus; more benefit may be looked for from this than from any other remedy. Phosphorus is also seryiceable when, notwithstanding the pneumonic concentration, there is, more- over, sensibility and rumbling in the caecal region, or when there is continued heat of skin, with small hard accelerated pulse, throbbing of the carotids, and nocturnal sweats; sleep disturbed by crowding of ideas, weeping, whimpering, sud- den cries, and restlessness. The patient awakes from sleep complaining of great thirst and dryness of the mouth, exces- sive heat, and aching of the whole body. In addition to these symptoms, there is burning sensation in the abdomen and anus, with frequent semi-fluid stools streaked with blood; gid- diness, confusion, and throbbing pains in the head; deafness, frequent discharge of blood on blowing the nose, and heat in the face; tongue and lips dry and cracked; bitter taste; copious evacuation of urine, which deposits a whitish or reddish sediment: venereal orgasm ; delirium ; obstupefac- tion. Dose. As directed for Secale. Acidum muriaticum. Weakness, with a constant tendency to sink down in the bed, with groaning during sleep, almost paralytic state of the tongue, rendering it nearly impossible for the patient to speak, even when in a collected state, and great dryness in the mouth. Dose. As directed for Secale. Natrum muriaticum is recommended in nervous fevers with great debility, insatiable thirst, dryness of the tongue, and loss of consciousness, and particularly when they follow in the course of antecedent debilitating diseases. Dose. Of a solution of six globules, to three table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. 80 FEVERS. Helleborus has also been found of very great utility in febris nervosa, occurring after other febrile affections, such as scarlatina, rubeola, febris gastrica, febris verminosa, and cholera, with pain as from contusion, combined with tumefac- tion, in the integuments of the head; disposition to somno- lency, with confusion of ideas and extreme restlessness ; dark, cloudy urine; heaviness, or feeling of stiffness and power- lessness in the limbs ; depression of spirits, and obtuseness of faculties. Dose. As directed for Natrum muriaticum. DIET. In a disease that presents so many varieties, it is difficult to give any rules upon this head, applicable to all cases. When a marked inflammatory character is present, the same abstinence should be enjoined as already noted under Fevers; and in all cases, either during the progress of the disease or the period of convalescence, the greatest possible care should be taken to avoid tasking the digestive functions ; the diet should be light and simple, and the patient never allowed to indulge the appetite to its full extent. putrid fever, pestilential fever, or malignant typhus. Typhus putridus. Typhus dbdominalis. We have already alluded to this form of the disease under Typhus, particularly in the indications given for the employ- ment of Arsenicum, Carbo vegetabilis, Rhus, Merc, ecc, but consider it of sufficient importance for separate remark. This fever sometimes rages as an epidemy, but it more frequently appears in the wake of nervous fever, or the latter degene- rates into the malignant type in consequence of improper general treatment, uncleanliness, or the impurity of the air by which the unfortunate patient is surrounded. Indeed, almost any fever may terminate in malignant typhus under the favoring circumstances just quoted. ^ SYMPTOMS. The symptoms of Nervous Fever already given, running on to the colliquative state ; extreme debility, TYPHUS fever. 81 pulse exceedingly small and weak, so as to be scarcely percep- tible ; a peculiar sensation of burning pungent heat, communi- cating itself to the hand, when placed upon the body of the patient, heavy cadaverous smell of the whole body, putrid odor of the breath, perspiration, and secretions in general; profuse oily and clammy sweats; involuntary evacuations; colliquative or sanguineous diarrhoea; dark or bloody urine, epistaxis, petechiae, and other marked tendencies to organic dissolution. The patient is always found lying on his back, and continually shrinks down to the foot of the bed, a sign of utter helplessness and prostration. TREATMENT. In the premonitory stage of epidemic Typhus putridus, the most appropriate remedies are those which we have enumerated under Typhus gastricus et bilio- sus, and at the commencement of Nervous fever (which see); but when the disease has reached the second stage, Arseni- cum, Carb. v., Merc, Acid, phosph., Acid, mur., Cantha- ris, Rhus, &c. Arsenicum generally corresponds closely to the symptoms, and is, therefore, our principal remedy when the disease assumes this malignant form, particularly when we find in- voluntary and sanguineous evacuations and tenesmus. Carbo vegetabilis may be advantageously alternated with it, when the symptoms, already given under Typhus for the exhibition of that medicine, are present; Mercurius is called for where there is great tenesmus, and when the discharge of blood is principally alvine, followed by Acid, phosph., Acid, nitr., or Cantharis, should sanguineous diarrhoea continue. (See Nervous Fever.) Dose. Of Arsenicum, if singly, dissolve twelve globules in three table-spoonfuls of water, and give a tea-spoonful of the solution every four hours (in moderate cases), or every hour (in \ery critical cases), until amelioration ensues, doubling the length of the intervals, however, as soon as this occurs, and withholding further doses if the improvement continues progressively. If in alternation with Carbo veg., a like solution of each remedy separately; of which give first, two doses of the one, at intervals of four hours; then two doses of the other, at similar intervals, with an intervening pause of eight hours between the administration of the different medicines. 82 FEVERS. Cinchona will frequently be found useful, when the more dangerous symptoms have been in a great measure subju- gated, but at the same time great weakness remains from the loss of humors; it is also useful, when the little nutriment the patient may have partaken of passes off undigested. Dose. Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of the solution -every four hours for two days successively, then every twelve hours, until amelioration or change. In those cases where Arsenicum and Carbo vegetabilis fail to produce any amendment, the employment of the Mother Tincture of Rhus has, in a number of instances, been found most efficacious. Dose. One drop of the mother tincture in a table-spoonful of water every three hours, until amelioration or change. CONTAGIOUS TYPHUS, CAMP FEVER, JAIL FEVER, PETECHIAL FEVER. Typhus Contagiosus. SYMPTOMS. The symptoms of nervous or putrid fever caused by infection or contagion. TREATMENT. The same as already given under Febris nervosa, but especially Bryon., Rhus, Ars., Secale, &c. We may here add another remedy of much value in this form of the disease, namely, Opium. Opium is of particular importance in contagious typhus, and is indicated by stupor, lethargy (sometimes real or appa- rent loss of consciousness), snoring respiration, the mouth partly open, the eyes half closed or wide open (but apparently unconscious of objects), the pupils much dilated, loss of speech, rigidity of the limbs, a small or intermittent pulse, suspension or mvoluntary discharge of evacuations, or hard, scanty, and difficult stools, and severe distension of the bowels. Dose. Three globules in a tea-spoonful of water, or (if there be difficulty in this) dry on the tongue every three hours, until ameliora- tion or change. Hyoscyamus and Stramonium. Either of these remedies, according to the distinctive features cited in the article on Nervous Fevers, and in that on the " characteristic effects," TYPHUS FEVER. 83 may be indicated, when in addition to the symptoms just re- cited as indicative of Opium, convulsive jerkings and twitch- ings in individual parts are manifested. Dose. Of either remedy give four globules in a tea-spoonful of water immediately; a second dose after the lapse of two hours, and then the like doses at intervals of four hours, until amelioration or change. But if the symptoms manifest no change or modification in twelve hours after the first dose, reconsider them and select afresh. INTERMITTENT FEVERS, AGUE. Febres Intermittentes. We have now to enter upon a class of fevers, differing essentially from those already considered, in possessing a marked character of their own, in the simplicity of their form, the periodicity of the different stages, and thernncertainty of their duration. SYMPTOMS. 1. A chill or cold fit, 2. Mowed by heat, and, 3. terminating by perspiration, more or less profuse; these three stages constitute a paroxysm ; after which, for a certain period (the Apyrexia), the patient is generally free from suffering. These periods are generally of definite duration;—if the paroxysms return at regular intervals of twenty-four hours, the fever is termed a Quotidian,—of forty-eight, a Tertian,—of seventy-two, a Quartan; even longer intervals have been ob- served between the attacks, hence the Octanae of some writers, —if two paroxysms take place within each period, the ague is said to be doubled, as a double Quotidian, or Tertian. These fevers are sometimes found existing in the simple form above noted, and at others complicated with other forms of disease, as in intermittent, catarrhal or gastric fevers. They are exceedingly indefinite in duration, and frequently assume a chronic form. An individual, once attacked with ague, is frequently liable to a return in after-life, if the disease has not been radically cured at the commencement; nay more, any attacks of disease he may be hereafter subjected u, are peculiarly apt to assume the intermittent form. 84 FEVERS. Nervous or inflammatory fever may change into an inter- mittent, or tjie latter take upon itself, if it continue, the character of either of the two former, or become remittent; this frequently happens in hot climates. Ague is rarely dangerous in this country, except when of long continuance, by the weakness it occasions and the injury it inflicts upon the constitution; it may, however, lead to obstructions and indurations of the more important organs, particularly of the liver and spleen, or induce dropsical affections. But in hot climates, or in low marshy countries, this disease is exceedingly fatal; and on dissection, the brain and its tis- sues, the mucous coat of the stomach and bowels, the lungs, and peritoneum have been found affected; in such_ instances, when the disease gains ground, the patient loses strength and becomes "emaciated, every fresh paroxysm entails an increase of suffering, and the perspiration fails to relieve; he com- plains of a sense of weight in the hypochondria, particularly the right, with griping pain in the bowels, flatulent -distention of the abdomen, diarrhoea, or constipation, and constant thirst; or of headache, cough, and dyspnoea; the tongue is furred, and dry at the tip; the skin hot, harsh, and dry; the urine scanty, the abdomen tumid, the extremities become dropsical, and sleep is restless or broken. Death may ensue from collapse in the cold stage, from the absence of perspiration, and from the disease passing into continued or remittent fever, or from disorganization of some important function, such as the brain, lungs, spleen, or liver. We shall now proceed to a general consideration of the three stages of the disease, premising that the various modifi- cations of the symptoms will be found more in detail, under the medicaments, when we enter into the therapeutic treat- ment. Premonitory Symptoms. Sense of languor, or general uneasiness; yawning, headache, stupor, pains in the limbs or dorsal region, the toes and fingers becoming numb, and the nails blue. INTERMITTENT FEVER. 85 ^ Cold Stage {Congestive Stage). Coldness of the extremi- ties, with a feeling as of a stream of cold water running down the back, and extending itself to the chest and abdomen; general prostration of strength, insupportable coldness, exter- nal and internal tremors, chattering of the teeth, respiration labored and hurried, with inability to draw a full inspiration, and oppression at the chest. The head is variously affected' sometimes with headache, at others with coma, stupor, or de- lirium ; the pains noticed in the premonitory symptoms are generally present, and, in some instances, the patient com- plains of pain all over: the tongue is moist, the eyes are heavy and sunken, the features pinched, and the lips and cheeks livid : the rigors sometimes run on to convulsions. The pulse is weak and oppressed, sometimes slow, at others quick, and frequently intermitting, and often, from the severi- ty of the rigors, scarcely perceptible. The heat of the body, except at the extremities, is generally above the natural standard, while the patient complains of cold. Sometimes, the patient feels only a slight degree of cold, without tremors, but accompanied with symptoms of function- al derangement, and in a few hours the hot fit declares itself. The duration of the cold stage isfrom an hour to four hours • and it runs into the hot without any marked interval. The Hot Stage presents all the characteristics of a modified inflammatory attack, with hot, dry skin, and thirst, oppression at the chest, hurried and anxious breathing, and acute pains in the head, region of the spleen, liver, &c.; there is also occasionally a degree of cerebral disturbance, or even deli- rium. The general duration of the hot fit is from four to twelve hom-s, when it terminates in the sweating stage; when this does not take place, it is apt to run on to continuous fever, or take the form of a remittent,—a not uncommon issue of this disease in warm climates. Sweating Stage. After the hot fit has continued a longer or shorter period, profuse perspiration a&ts, in, commencing in 5 86 FEVERS. the forehead and extremities, and quickly diffusing itself over the whole body; as soon as it makes its appearance, the un- easiness and other symptoms begin to disappear, and the patient, in simple ague, continues free from suffering until the next paroxysm. CAUSES. Marshy districts are noted as being the hot-beds of this malady; a continuance of fish or farinaceous diet is also apt to produce it; it may, moreover, arise from taking cold, indigestion, internal obstructions, peculiar constitutional tendency, or local irritation. The medicines should generally be administered in the apyrexia or interval between the paroxysms, but when the in- tervals are extremely short, or when they are attended with after-pains of the preceding paroxysms, they should be admin- istered when the sweats, or other concluding features of the at- tacks, begin to subside. In the treatment of ague, the type, although by no means to be held as unimportant, is yet of very secondary considera- tion to the other features of the malady. The following remedies have been found most appropriate in ordinary cases. Intermittent fevers which recur every year have, for the most part, been treated most successfully by means of Nux v., Arsenic, Rhus, Sulph., Lye, Calc, Sep., &c. In reference to the period of the day at which the ague-fit generally comes on, Am., Cham., Sabad., Staph., Calc, have repeatedly cured those which appear in the morning {matu- tinal fevers) ; Ign., Sabad., Staph., Carb. v., Am., Lye, Sep., Merc, against those which set in towards evening ; and Carb. v., Cham., Mere, those which make their appearance at night {nocturnalfevers). But as has already been observed, the entire morbid picture must be taken into consideration in the selection of the reme- dies, and not merely a single peculiarity. Remedies which have proved useful in quartans or tertians, will, nevertheless, be found efficacious in other types, if they correspond accu- rately to the characteristic accompanying symptoms. INTERMITTENT FEVER. 87 The following medicaments are especially useful in intermit- tents presenting the train of symptoms enumerated : Cinchona. This well-known, but too frequently abused remedy, is undoubtedly of great efficacy in those fevers which owe their origin to the influence of marsh miasm, and are peculiarly prevalent at particular seasons of the year. It may be given when the fever commences with a sense of languor or general uneasiness of the heart, anxiety, headache, sneezing, great thirst, bulimy, or nausea, and pain in the bowels. It is also indicated when the fever has set in by adypsia during the cold stage—but thirst is experienced after the heat, and during the sweating, or thirst between the hot and the cold stage. It is contra-indicated when thirst exists during the hot stage. Turgidity of the veins, with heat in the head, and natural warmth or increased heat of the body, with or without increased heat of the surface. Or, again, determination of blood to the head, commonly with redness and heat in the face, frequently with chilliness of all the other parts of the body, and even external coldness, or only a feeling of internal heat in the face, with coldness of the cheeks to the touch, and cold sweat on the forehead, are further indications for the em- ployment of this medicament. In many cases, Cinchona, although not capable of effecting a radical cure, is yet of great utility as a palliative: it should, under such circumstances, be exhibited immediately before the cold stage. Dose. Four globules every two hours, until better or change. Arsenicum is one of the most important remedies in inter- mittent fevers. It is indicated when the different stages are not definitely marked, but the fever and heat and shivering appear simultaneously,—or when we find cold shuddering alternately with heat, or a sensation of cold internally with heat, or an imperfect development of the paroxysms; or burning heat, as if molten lead were coursing through the veins, com- municating an unpleasant sensation of heat {color mordax) to the hand, when placed upon the body of the patient; great restlessness; excessive, almost insatiable thirst, obliging the 88 FEVERS. sufferer to drink constantly, although but a little at a time, depression, marked prostration of strength and anxiety; nausea, desire to vomit, retching, and even vomiting; severe and burning pains in the stomach, and insupportable pains all over the body, especially in the limbs. One marked characteristic of Arsenicum is, that all the sufferings of the patient, pains in the limbs, &c, increase in intensity during the paroxysms, and others develop them- selves ; another is its marked periodicity, usually either Ter- tian or Quartan, and the rigors generally setting in towards evening. It is therefore called for ia these cases, where we meet with a well-marked periodicity of imperfectly developed paroxysms, with some or any of the symptoms above mentioned. Dose. Dissolve twelve globules in three table-spoonfuls of water, give a tea-spoonful at intervals varying from a quarter of an hour to two hours, according to the severity of the case, doubling the intervals, or suspending treatment as soon as better or reaction, sets in. Ipecacuanha. This remedy has been found more or less useful in most cases of marsh fever, and although not always competent to effect the entire removal of the complaint, yet, when administered at the commencement, it is often of con- siderable benefit, and in many instances, when judiciously selected, is alone sufficient to perform a cure. Striking benefit has frequently been derived from its employment with Nux v., by giving three to four doses of Ipecac, at equal intervals during the apyrexia; then Nux v., one dose, in the suc- ceeding apyrexia. Either of these remedies is sometimes alone sufficient to shorten the duration of the disease; the indications for Ipecacuanha are as follows : much shivering with but little heat or vice versa; increase of the shivering by external warmth / oppression at the precordial region ; adypsia, or at least, little thirst; dryness of the mouth, nausea, vomiting, and other symptoms of deranged digestion. Dose. If in alternation, give first two doses of Ipecacuanha, each of six globules in a table-spoonful of water at intervals of three hours, INTERMITTENT fever. 89 then pause not less than twelve hours, then give a like single dose of Nax vom., repeating this last every evening until amelioration or change. If singly applied of either remedy, give six globules in a table-spoonful of water, during the intervals, or before the anticipated return of the attack. For Nux vomica : Excessive weakness at the commence- ment of the fever; the horripilation mixed with or imme- diately followed by heat; warmth of the cheeks, with internal chilliness ; feeling of heat in the face, with horripilation in the remaining parts of the body; heat in the head with coldness of the body; burning pain in the eyes; or, giddiness, with feeling in the head as if from intoxication, desire to lie down, with trembling of the limbs, syncope, or a sensation of para- lytic weakness and prostration, with cramps in the different extremities, particularly the calves of the legs and feet, diffi- culty of breathing, palpitation of the heart, anxiety, irascibility, fear of death, and even violent delirium. {Febris intermittens apopiectica so called); gastric derangements, such as anorexia; dislike to bread; bitter and sour eructations, tension of the abdomen, or spasm of the abdominal muscles, and constipa- tion / burning itching miliary eruption, and burning itching sensations over the whole body. During the fever: coldness and blueness of the skin, desire to be constantly covered, even during the access of heat and perspiration ; occasionally stitches in the side, shooting pains in the abdomen, aching in back and limbs, and dragging pain in abdomen during the rigors. During the hot fit particularly:—headache, buzzing in the ears, heat in the head, or face, with redness of the cheeks and thirst. Dose. The same as Ipecacuanha. Pulsatilla, like the two remedies last mentioned, and also Antimonium crudum, Bryonia, and Ignatia, is an excellent remedy in agues complicated with gastric or bilious symp- toms, whenever the slightest dyspeptic attack brings on a relapse. Its more peculiar indications are : vomiting of mucus at the commencement of the cold stage; adypsia, all through the fever,—or thirst, only during the hot fit; simul- 90 FEVERS. taneous heat and shivering—aggravated in the afternoon or towards evening; shivering when uncovered; anxiety and oppression of the chest during the shivering. Luring the hot stage: redness and swelling of the face, or redness of the cheeks only, and perspiration on the face. The presence of diarrhoea, and the patient being of a mild disposition, are corroborative indications for its employment. Dose. Four globules during the intervals, either at the close of the attack, or three hours before it. For simple tertian and quartan fever, four globules in a table-spoonful of water, every three hours, until better or change. Antimonium crudum. The indications for this remedy closely resemble those of Pulsatilla, but it is particularly called for when the perspiration breaks out simultaneously with the accesses of heat, and then suddenly disappears, leaving the skin dry and hot. Dose. In the same manner as after Pulsatilla. Cina is of great efficacy in quotidian agues, which are ushered in by vomiting of ingesta, followed by bulimy ; as also when the cold stage is attended with thirst. Dose. Dissolve six globules in three table-spoonfuls of water, give every three hours, a tea-spoonfnl, until better or change. Bryoista is indicated by headache and vertigo, with dry heat preceding the attacks of shivering; by the predominance of cold or shivering, with redness of the cheeks, heat in the head, and headache ; or marked heat followed by shivering ; by stitches in the side, excessive thirst, thickly coated tongue, bitter taste in the mouth, disgust at the sight of food, nausea or vomiting and constipation. Dose. In the same manner as after Pulsatilla. Yeratrum album is indicated by the predominance of ex- ternal coldness, with heat internally, cold clammy perspira- tion, especially on the forehead, or general coldness of the body ; or by shivering, followed by heat and perspiration, and then relapsing into shivering; coldness, great thirst, deep- colored urine, diarrhoea with griping, or constipation, some- times nausea or vomiting and vertigo, and pains in the dorsal intermittent fever. 91 and lumbar regions. Tart. emet. has also been recommended in such cases, and especially when the nervous system becomes prominently affected, as indicated by sopor, insensibility, with coldness of the extremities, rigidity of the whole body, or twitchings of the muscles of the face and limbs, and almost imperceptible pulse. Dose. As' directed for Arsenicum. Belladonna. Severe headache, with giddiness, or heat and redness of the face, pulsation of the carotids, and excessive ex- acerbation of pain from meditation; partial shivering and shuddering, with heat in other parts ; great heat, with slight shivering; or violent shivering with moderate heat; adypsia, or, on the contrary, intense thirst; extreme susceptibility, tear- fulness, or depression of spirits, and desire for death, particu- larly when the sufferings are at their.height. Dose. In the same manner as directed for Cinchona. Cocculus may be employed when, in addition to the usual symptoms of Ague, we find, during the apyrexia, symptoms of spasmodic affections, particularly of the stomach and abdo- men, such as cramp-like pains at the epigastrium, or constric- tive pinching, or tearing, burning, colic-like pains in the hypogastrium. Dose. In every respect as directed for Arsenicum. Sabadilla has been found useful in cases where the attacks return always at the same hour, with chills of short duration, then thirst followed by heat; also, where thirst is present just at the close of the cold stage,'and in such affections as consist entirely of chills. Dose. In the same manner as after Pulsatilla. Ignatia is indicated when, with heat of some parts of the body, there is coldness, chill, and shuddering of others; also where the heat is only external. Its best characteristic is, when the chills are easily relieved by external warmth, and at- tended with thirst. DOSe. In the same manner as directed for Pulsatilla. Opium has chiefly been recommended in febris intermittens, 92 FEVERS. with drowsiness, snoring, convulsive movements in the limbs and suppressed evacuations. Tartarus emeticus may, how- ever, be found more generally appropriate in cases of this de- scription. . Dose. In the same manner as after Arsenicum. Natrum m. Ague fits commencing with headache, general aching pains; predominant or prolonged shivering; great thirst during the hot fit, and nearly to the same extent during the cold stage; also dryness of the mouth and tongue; ten- derness of the scrobiculus to the touch; bitter taste and loss of appetite ; debility, sallow complexion; soreness of the cor- ners of the mouth (sequelae of the abuse of Cinchona bark, or of Quinine). Dose. In the same manner as directed for Arsenicum. Carbo vegetabilis is particularly indicated, when throb- bing at the temples, aching in the teeth and in the bones of the extremities, and the. coldness of the feet precede the paroxysm ; when thirst is present only during the shivering ; and there are rheumatic pains in the teeth or limbs before or during the attack, or nausea, giddiness, and redness of the face during the hot fit; further, when an intense burning pain, occupying the right frontal protuberance and the orbit, accom- panies the fever. Dose. In the same manner as after Arsenicum. Capsicum. Excessiye thirst during the cold stage; predomi- nating cold, followed by burning heat; accumulation of mucus in the mouth and throat, or vomiting of mucus; diarrhoea; slimy and burning stools ; headache, restlessness, sensibility to noise ; ill-humor, anxiety, and giddiness, which increase during the cold stage; aching pains in the back and limbs ; painful swellings of the spleen (after the abuse of China). Dose. In the same manner as directed for Pulsatilla. When the hot fit continues long without perspiration super- vening, and the intermittent fever threatens to become remit- tent or inflammatory, we must have immediate recourse to Aconite, of which we may give two globules, and if no relief intermittent fever. 93 follows in three or four hours, add six globules to an ounce of water, and administer a tea-spoonful every hour until per- spiration sets in, or the pulse is reduced. In intermittent fevers of various types, which become de- veloped after a thorough wetting, Rhus toxicodendron is of great use ; and in those which are accompanied by very copi- ous and sour, or otherwise offensive smelling sweat, with pal- pitation of the heart; mixed heat and shivering, anguish and thirst during the hot stage, Mercurius does good. Dose. Six globules in a table-spoonful of water, upon the subsi- dence of the attack; and, again, three hours before the anticipated re- currence of the fever-fit, until amelioration or change. Or in very severe cases, and when the attack is unusually protracted, of a solution of six globules to three table-spoonfuls of water, give a tea-spoonful immediately, repeating this dose three times at intervals of three hours. DIET.—Same as under Fevers. GASTRIC OR BILIOUS REMITTENT FEVER. Febris gastrica biliosa. This is a form of fever in which, as its name implies, the digestive organs are chiefly affected; it bears some degree of affinity to typhus, but is distinguished from the latter by the absence of nervous symptoms, although, when it assumes a torpid character, these are occasionally developed,—by the absence of the pressive aching pains in the occiput; and by the absence of disturbance or derangement in the senses of sight and hearing; further, that the pain in the caecum, which is so constant a symptom in typhus, is not a feature of this disease. Fevers of this description have no definite course or dura- tion. They not unfrequently fall short of the particular course to which the definition is especially appropriate, as in such cases as result merely from indigestible substances, without actual increase in the discharge of (acrid) bile. In such cases the successful effort of nature to expel the obnoxious 5 * 91 FEVERS. substance (as by vomiting or purging, or both) is often suffi- cient to constitute a perfect resolution, and convalescence suc- ceeds. In other cases nature is thus bnt partly relieved, the whole circulative system having become essentially involved, and the Fever continues until some other crisis (as of sweat or urine) succeeds. Thus, Gastric Fever, if associated with mere foulness of the stomach, may run its course to perfect resolution in a few days ; or, if the lining membranes of the stomach or bowels be seriously affected, or the action of the liver be much deranged, and there be Bilious Fever, pro- perly so-called, the fever may continue for weeks (if not properly or successfully treated), or may assume a highly inflammatory character, or degenerate into nervous or even Putrid Fever. On the other hand, again, it may result in transitions of various character—the superficial membranes, either of the throat or external surface (the skin) may become affected, and Eruptions of various kinds, Abscesses, &c, may ensue. Complications and their Treatment.—In the case of any such complications occurring, the Treatment must be con- ducted according to the special directions afforded in the separate article respectively devoted to the disease in ques- tion. PREDISPOSING CAUSES.—The predisposing causes may be identified in continued exposure to great heat— whereby the rapid sympathy existing between the skin and the liver and stomach, has conveyed to those organs an undue degree of irritability:—exposure to excessive moisture of the atmosphere, particularly extreme accumulation of condensed vapors (heavy dews) over a reeking, heated soil, which con- tinues to emit exhalations:—exposure to great (especially sudden) transitions of temperature, particularly from great heat to comparative coldness,—or to the alternation of heat and cold ;—whence it follows, that, under such circumstan- ces, this disease may assume an Endemic or Epidemic charac- ter. The more particular and predisposing causes are:— weakness of the stomach,—that is, a morbid sensibility of the GASTRIC FEVER. 95 lining membrane,—and overdue irritability of the Liver :— habitual debauchery or excesses, sedentary habits, or any- thing, in fact, which may occasion derangement of the sto- mach, as considered in the article on " Indigestion." EXCITING CAUSES.—The presence of obnoxious indi- gestible or irritating matters in the stomach or bowels—which cannot be dislodged by the ordinary action of those organs— either in the shape of excessive reception of food, whether or not in itself of an indigestible character, or simply the recep- tion of indigestible substances in however small a quantity, —or in the shape of altered or excessive internal secretions, such as bile. Other exciting causes are, taking cold, emo- tions—such as anger, grief, care, anxiety, prescribed with advantage * In rheumatic or arthritic toothache with nocturnal aggravations, or in- crease of pain on partaking of cold or warm drinks, but with temporary re- lief on the external application of heat; also in toothache which returns every spring or autumn during the prevalence of easterly winds (and then continues sometimes for several weeks), the pain being occasionally con- fined to one tooth, which is extremely sensitive to the slightest touch, and often accompanied with acute shootings into the ear, Rhododendron chry- santhum is a useful remedy, in repeated doses. 152 DIGESTIVE SYSTEM. when the pain is chiefly of a subdued description, and is in- termittent; also when it partakes of a burning or shooting character, and seems to proceed from within outwards. Dose. As directed for Aconite. SORE THROAT, OR QUINSY. APHTHOUS SORE THROAT. Angina faucium, Tonsillitis phlegmonoides, Cynanche ton- sillaris.—Angina aphthosa, etc SYMPTOMS. Inflammation of the throat, denoted by swelling and red color of the back part of the throat, accom- panied with difficulty of swallowing, impeded respiration, al- teration of the voice, and fever. In the incipient stage of this affection, there is a sense of constriction about the throat, with a feeling of soreness, and sometimes of obstruction in the act of swallowing the saliva; if it runs its course, the difficulty of swallowing and breathing increases, the tongue swells and becomes foul, the tonsils as- sume a redder hue, occasionally a number of small yellow eminences appear at the back of the throat, particularly on the tonsils; the patient complains of thirst, and the pulse is high, strong, and frequent; sometimes the cheeks swell and become florid, and the eyes inflamed, and in severe cases de- lirium is not an unfrequent occurrence. As the local affection progresses the majority of the foregoing symptoms become aggravated, and the tonsils tumefied, and suppuration ensues if resolution be not speedily effected. When suppuration takes place, the pain is instantly relieved on the bursting of the abscess; it sometimes happens, how- ever, that scarcely has the patient been relieved from suffer- ing by the latter event, before the state of the other tonsil gives indications that a similar train of symptoms are about to be encountered there. This affection, occasionally danger- ous, if not properly treated, even in its simple form, becomes particularly critical when it puts on the putrid type. In such instances, the attendant fever generally assumes a typhoid character; when this takes place, we may always infer a peculiar constitutional tendency. SORE THROAT, OR QUINSY. 153 When this disorder is, at the commencement, attended with considerable fever, thirst, and dry heat, deep redness of the parts affected, painful and difficult deglutition, pricking sensation in the throat, with aggravation of the symptoms when speaking, we should have recourse to Aconitum. DOSC In many cases a dose of three globules, either dry or in a table-spoonful of water, and repeated after a lapse of four hours (if requisite), will suffice to subdue the symptoms. But if the inflamma- tion be very severe, of a solution of six globules to three table-spoon- fuls of water, give a tea-spoonful every hour (extending the intervals to three hours as soon as modification occurs), until amelioration or change. In extreme cases, in which the act of swallowing fluids becomes very difficult, the doses should consist of four globules dry on the tongue, at every such period. The next medicament we shall mention, Belladonna, as may have been observed in the treatment of Scarlatina, Mea- sles, &c, is one of the best remedies we possess against phleg- monous inflammation of the throat, more especially when it occurs in plethoric or lymphatic subjects. The following are the symptoms by which it is particularly indicated: Pain in the throat as if from excoriation, attended with scraping, and a sensation of enlargement, and burning or shooting pains, principally experienced during the act of swallowing ; these pains sometimes extend to the ears. Other characteristic indications for this remedy are—a sense of spasmodic constriction or contraction of the throat, with con- stant and almost uncontrollable desire to swallow the saliva ; occasionally there is violent thirst, with dryness of the throat, but a dread of drink from the suffering it occasions. Some- times a complete inability to drink exists, and the liquid returns by the nostrils. On examination, the throat presents a bright red color, with swelling of the palate, uvula, and tonsils; there is also an accumulation of slimy whitish mucus in the throat and on the tongue, obliging the patient to spit frequently; swelling of the muscles and glands of the neck, severe headache, chiefly confined to the forehead, some- times determination of blood to the head, and delirium. 154 digestive system. (After Belladonna,—Mercurius, Lachesis, or Pulsatilla are often suitable.) DOSC In moderate cases, three globules in. a table-spoonful of water every six hours, until amelioration or change; in very severe cases, a solution of six globules, or four globules dry on the tongue, as directed for Aconite. If in alternation with Mercurius, an interval of six hours should elapse between each dose of the different medicines. See Mercurius. This remedy frequently succeeds in speedily removing the whole of the above group of symptoms, or, at least, so far subdues them as to enable Mercurius to complete the cure. Dose. Same as under Mercurius. Bryonia. Painful sensibility of the throat when touched, and on turning the head; difficult and painful deglutition, as if a hard body were in the throat; shootings, and sensation of excoriation and dryness in the throat which prevents speak- ing ; fever with or without thirst, or shivering and coldness; irascibility and irritability. [Swelling of the back of the throat, the palate and mouth; abundant secretion, of saliva; constipation; cold in the head and hoarseness; dry cough and oppressed respiration. Bryonia follows the Aconite ad- vantageously in practice.—R. L., Ed.~\ Dose. As directed for Aconite. [Baryta, wrhen there are penetrating pains in the throat on empty swallowing; pressure and shooting pains on swallow- ing aliments; strong swelling suppuration of the palate and tonsils; obstructions to speech and deglutition; sometimes, in the morning, dryness and painful stitches on swallowing; recurring at night; contraction of the throat, with labored respiration after meals; efforts to belch; scratching in the throat; humid coryza, with dry cough, alternate chills, and flushes of heat. The Baryta renders the greatest service when the Angina lingers, remains stationary, passes over to the chronic state, or resembles scirrhus.—R. L., Fd.~\ Dose. Three globules in a table-spoonful of water every three hours, until amelioration or change. Mercurius is frequently valuable at the commencement of SORE THROAT, OR QUINSY. 155 the disease, and forms one of our best remedial agents; in some cases advantage accrues from the employment of Bella- donna in alternation with it. The indications for its selection are: violent shooting in the throat and tonsils, especially when swallowing,—these pains extend to the ears and glands before the ears, and under the jaw; inflammatory redness and swelling of the affected parts of the throat, burning in the throat, desire to swallow, attended with a sensation of an obstruction existing in the passage; accumulation of thick and tenacious mucus in the throat, difficult deglutition, especially of liquids, which sometimes escape through the nostrils ; swelling of the glands, and muscles of the neck, and of the posterior part of the tongue; occasional swelling of the gums; unpleasant taste in the mouth, which is filled with saliva more or less inspissated; throbbing, and formation of matter in the tonsils; (confluent, or small, isolated, round, white specks or vesicles on the tonsils; indolent ulcers in the throat;) {Angina aphthosa); offensive odor from the mouth; aggravation of the symptoms at night, from the act of speaking, and in the evening ; chills, and shivering, some- times alternated with heat; nocturnal sweating. Lachesis, Hepar sulphuris, Carb. veg., or Acid. nit. are often suitable after Merc. DOSC. Dissolve six globules in two table-spoonfuls of water, give a tea-spoonful every six hours, until amelioration or change. If in alter- nation with Belladonna, the like interval should elapse between each dose of the different remedies. Cantharides, when the throat manifests a burning and grating sensation ; when there is redness and tension in the mouth ; or pressure terminating in shooting pains on swallow- ing ; or when the patient cannot swallow liquids; has a bitter and sour taste; white tongue; salivation; violent tickling in the larynx; dry cough; sometimes followed by bloody expectoration, and labored painful respiration. Can- tharides has proved useful at the conclusion of inflamma- tory and at the commencement of catarrhal sore throat.— R. L., Ed. 156 digestive system. Dose. Dissolve four globules in two table-spoonfuls of water, and give a tea-spoonful every four hours. Lachesis. One of the characteristic indications for this remedy is, aggravation of all the symptoms on awaking from sleep, or an increase of the pain in the throat from the slightest external pressure; it is, moreover, an excellent re- medy in cases of tonsilitis in which Belladonna or Mercurius have afforded relief, but seems incapable of effecting resolu- tion ; and also in aphthous sore throat with considerable ul- ceration, when Mercurius has afforded only partial relief. Dose. As directed for Cantharides. Carbo vegetabilis. This remedy may either follow, or be selected in preference to MerGurius,—after a previous dose or two of Aconite when necessary,—in Aphthous sore throat characterized by the appearance of small white specks or pimples (which, if not checked, become confluent and spread beyond the throat) on the enlarged and protuberant tonsils, when the patient complains of severe burning and pricking pain, with great thirst. DOSC. Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of the solution twice a day, until amelioration or change. Acidum nitricum is indicated when Aconite and Mercurius have been administered in Aphthous sore throat, characterized by superficial ulcerations in the throat, and the small white or gray ulcers refuse to put on a healing appearance a few hours after the use of the latter remedy. Dose. Dissolve six globules in two table-spoonfuls of water, and give a tea-spoonful of the solution every six hours, until three doses have been given ; then every twelve hours, until the cure is complete. Nux vomica. This remedy is especially useful when the sore throat appears to arise from, or to be accompanied by, symptoms of deranged digestion, and when a sense of scraping or excoriation exists in the throat, and also when a feeling of contraction is experienced in the upper part of the throat during empty deglutition; secretion of viscid mucus, which can be expectorated only with great difficulty, and sometimes SORE THROAT, OR QUINSY. 157 accumulates in such a quantity as to threaten suffocation; or there is swelling and elongation of the uvula, producing a constant desire to swallow; at times only a sensation of swell- ing, with aching pressive pains; or when cold has been the exciting cause, and the affection is attended with dry cough and headache, chiefly in the morning, and pains under the lower ribs during the cough. This remedy is likewise indi- cated when there are small offensive ulcers of the throat, or when considerable debility is present. (Yide Ulcerated Sore Throat. Sulphur is frequently useful after Nux vomica) Dose. Dissolve three globules in a table-spoonful of water every four hours, until amelioration or change. Pulsatilla is frequently serviceable after Belladonna when there is an undue secretion of viscid mucus in the fauces ;— but it is more particularly when the following symptoms are met with that this remedy is called for : gastric derangement, with dark livid redness of the throat and tonsils ; a sensation as if the parts affected were much swollen, or a feeling of enlargement in the upper part of the throat, as also of excoria- tion and scraping, with dryness of the throat without thirst; shooting pains in the throat when not swallowing ; aggravation of the symptoms towards evening, attended with shivering ; also accumulation of adhesive mucus in the throat. This remedy is more particularly suitable for females, or for indi- viduals of a mild and phlegmatic temperament. Dose. Same as Nux vom. Chamomilla is a remedy particularly useful in sore throat when it occurs in children, or in nervous or sensitive females who suffer much from trivial ailments, and especially when the disease has been brought about by checked perspiration,— when there are shooting or burning pains, with a sensation of swelling in the throat, deep redness of the parts affected, ina- bility to swallow solid food, especially when lying down; thirst, with dryness and heat of the mouth and throat, or secretion of frothy saliva with burning heat in the throat and gullet; swelling of the tonsils and glands before the ear and 8 153 DIGESTIVE system. under the jaw; cough excited by constant tickling in the throat, attended with hoarseness; fever towards evening; alternate heat and shivering, redness of the face, but especially of the c/uek, great excitability and tossing about. DOSC Dissolve four globules in a table-spoonful of water every two hours, until amelioration or change. Ignatia is indicated when there is a sensation as of a plug in the throat when not performing the act of deglutition, with red and inflammatory swelling of the tonsils or palate; burn- ing pains during the act of deglutition, as if the substance being swallowed were passing over an excoriated surface, or partially obstructed by some foreign body in the throat. Liquids are more difficult to swallow than solids ; there are also shooting pains in the cheeks, thence extending to the ears, when not performing the act of deglutition ; induration of the tonsils or evolution of small pustules upon them. DOSC Same as Chamomilla. Dulcamara is generally a most useful remedy when sore throat, particularly in the form of tonsilitis, has arisen from exposure to wet. It may be followed by Belladonna or Mer- curius, should it not wholly remove the affection, and should any of the symptoms given under these medicines present themselves. Dose. Four globules, repeated in twelve hours ; and if no symptoms of increased pain or swelling present themselves, allow an action of thirty-six hours from the last exhibition, during which period a marked amelioration, if not a perfect cure, sometimes preceded by a temporary aggravation, frequently developes itself. Coffea cruda. Sometimes useful as an intermediate remedy when many of the symptoms enumerated under Belladonna, with the exception of the external swelling of the throat, are present; and also when there is a sensation as if the uvula were elongated or loaded with mucus, causing a constant inclination to swallow. One of the best indications for its employment in this, as in other diseases, is an over-excitability of the nervous system, characterized by sleeplessness, great SORE THROAT, OR QUINSY. 159 restlessness, sensitiveness, disposition to weep, and peculiar impressionability to external agents. When the disease occurs in an aggravated form or when it has been neglected, and all the parts have become so exces- sively tumefied that the. mouth can scarcely be opened, the breath being at the same time extremely offensive, the tongue foul, and the strength much exhausted, Arsenicum may be given with advantage. (See also the indications for the em- ployment of this remedy in sore throat, which have been already given under Scarlet Fever, and will also be found under Malignant Sore Throat.) Dose. Dissolve four globules in three table-spoonfuls of water, give a tea-spoonful every two hours, until amelioration or change. Hepar sulphuris is valuable in bringing the matter to a head, when resolution cannot be effected, and the quinsy has attained to such a height that its bursting is desirable from the painful sense of suffocation, arising from the tumefied condition of the tonsils. _ Dose. Dissolve six globules in two table-spoonfuls of water, and give one tea-spoonful of the solution every two hours, until the quinsy bursts. But if little progress be observable within two hours after the third dose, pause two hours longer, and then proceed with the next remedy. Silicea. Tin's remedy is, in some instances, of greater efficacy than Hepar in rapidly forwarding the siqpurative process, and causing the ripened abscess to burst. It generally promotes incarnation more effectually than Hepar. Dose. Same as Hepar sulphur. Mercurius may follow either of the last-mentioned medi- cines, after an interval of a few hours, to facilitate the healing. Silicea and, in some cases, Sulphur may be called for after Mercurius. Bryonia and Rhus have been found useful in some forms of sore throat, the former especially when attended with considerable gastric disturbance, and where there was great dryness of the throat, with redness of the soft palate and tonsils, but no swelling;—the latter where there was con- siderable fever towards evening, hot dry skin, aching and 160 DIGESTIVE SYSTEM. pricking pain during deglutition, lowness of spirits* and exces- sive anxiety. Bryonia is indicated by sore throat, with difficult deglutition and hoarseness ; pain in the throat as from excoriation; excessive dryness of the throat, and pressure in the throat as if caused by a hard angular body; pain and pricking in the throat, which is also experienced on external pressure or on moving the head; accumulation of adhesive mucus in the trachea, temporarily removed by coughing. It is further called for when there is marked gastric disturbance, the tongue covered with a dirty yellow fur, the taste insipid, and the bowels confined ; when there was severe frontal head- ache and very disturbed sleep, with dryness of the throat, redness of the tonsils and palate {velum palati), without swelling. Rhus toxicodendron, when the pains seem situated lower in the gullet, the disposition of the patient anxious, depressed, or disposed to tears; and when Bryonia has not been sufficient to remove the complaint. Where there is difficulty of swallowing, and, at the same time, a sensation as if a plug or some kind of foreign substance were in the throat,—Lachesis, Nux v., and Arsenicum are useful when otherwise indicated. Sulph., Bella., Baryta, Merc, Sep.) Ign., Graph., Am. c and Cocculus are also indicated by this latter symptom. In obstinate cases, such as are occasionally met with in bad constitutions, the healing of the cavity, after the matter has been discharged, goes on very unfavorably, and even fresh abscesses form in succession : Sulphur, Hepar s., and Psoricum, repeated every eight or twelve hours, have chiefly been recommended to subdue these fortunately rare symptoms; Sulphur in ordinary cases, Hepar, when the patient has been previously subjected to an abuse of Mercury * under allopathic treatment, and Psoricum when Sulphur has been taken in excess. DOSC. Same as Veratrum album. Sepia is a useful remedy in obstinate cases of angina, with pain in the fauces as if the parts were excoriated, and prick- ings during the act of deglutition. SORE THROAT, OR QUINSY. 161 Dose. Four globules in a table-spoonful of water daily, the first thing in the morning for a week. Relaxed sore throats generally require Nux, Puis., Capsic, Gentiana cruciana, or Sulph., &c. (See also the other reme- dies mentioned in the article on dyspepsia, as such sore throats are commonly connected with deranged digestion.) The following remedies may also be mentioned as being useful in angina when the symptoms are as described:— Yeratrum album is indicated by constrictive and suffocat- ing pain in the throat, particularly during deglutition; sensa- tion of contraction in the gullet; sense of roughness and scraping, or of extreme dryness in the throat; intumescence and burning in the gullet, sometimes attended with danger of suffocation. Dose. Twelve globules of the selected remedy in four table-spoonfuls of water, one every six hours or oftener, should the symptoms seem urgent. Cocculus, indicated by great dryness and sensibility of the gullet, causing everything partaken of to seem pungent, acid, or too salt; by constriction or sensation of paralysis in the gullet, and noisy or clucking deglutition. Dose. Three globules in a table-spoonful of water every four hours, until amelioration or change. Capsicum is often useful in sore throat from cold, when Puis., Cham., Ign., Bry., or Nux v. afford little relief, par- ticularly when a degree of fever continues, with shiverings and thirst, followed by heat; pressive aching pains, accompa- nied by a sensation of spasmodic constriction in the throat; distressing cough; constant desire for the recumbent posture and for sleep, with dread of the slightest breath of cold air. DOSC Three globules in a table-spoonful of water, night and morning, until amelioration or change— unless no permanent relief follow the eighth dose, when the symptoms should be reconsidered. In gangrenous sore throat, or sphacelated quinsy:—Ars., Lach., Carbo v., Am. c, China, Conium, Rhus, or Baryta m. are the remedies which are chiefly to be relied on where there is any chance of recovery. (See Ulcerated Sore , Throat.) 162 DIGESTIVE SYSTEM. The DIET of the patient must be regulated acccording to the degree of inflammation present. If required, the throat maybe gargled with a little warm water, and when much pain is present, inhalation of the vapor from boiling water will often afford considerable relief, but at the same time it may be observed that all medicinal gargles, blisters, leeches, or other topical applications are rendered unnecessary by proper homoeopathic treatment. While we thus free the patient from a considerable degree of annoyance and needless suffering, we, at the same time, oj a careful attention to the symptoms, and the exhibition of the proper remedy, effect a speedy cure. In overcoming the pre- disposition to sore throat, Mercurius, Sepia, Baryta m. and Graphytes have been found useful. The latter two particu- larly, when sore throat results after every exposure to cold, and is always prone to terminate in suppuration. ULCERATED SORE THROAT. Malignant Quinsy. Malignant, putrid, or gangrenous Sore Throat.—Angina Maligna, Tonsil it is Maligna, Cynanche Maligna. This serious disease is also known by the name of Scar- latina Maligna, from the eruption with Avhich it is 'frequently attended. It is usually epidemic, of a highly contagious nature, and generally occurs in damp and sultry autumnal seasons. It sets in with coldness and shivering, succeeded by heat and accompanied with great languor and oppression at the chest; nausea, or vomiting, and sometimes purging ; eyes in- flamed and watery; deep red color of the cheeks; the nostrils are also more or less inflamed, and secrete a thin acrid dis- charge, frequently causing soreness or excoriation of the nose and lips ; pulse indistinct, or very weak, small, and irregular; tongue white and moist. The deglutition is painful and difficult, and the throat, on being examined early in the disease, is observed to be of a » ULCERATED SORE THROAT. 163 bright red color, and much tumefied ; but this state is very soon altered, and numerous ulcers of various sizes will then show themselves interspersed over the parts, which become covered with a white, grayish brown, or livid coat. In some cases, these ulcerations spread so widely as to extend over the whole fauces into the nostrils, or downwards even to the glot- tis and gullet, &c, and assume a sloughing appearance as they increase in magnitude. The prostration of strength, con- siderable from the first, is now excessive : the tongue, lips, and teeth are covered with browm or blackish incrustations, and there is more or less delirium ; the breath is extremely fetid, and the patient himself complains of a disagreeable odor. The neck appears swollen and of a livid color, and an efflorescence of a faint scarlet hue, or blotches of a dark or livid red, sometimes intermixed with petechia?, break out on various parts of the body, and usually, though not necessarily, add to-the danger,—as many are carried off, particularly children or persons of an advanced age, without any erup- tion, when the local symptoms are severe and the fever high,— but the appearance of livid spots or petechia?, and other indi- cations of so-called putrescenc}T, with frequent shivering, weak fluttering or intermittent pulse, sunken countenance, severe purging, extreme prostration, and bleedings from the nose, mouth, oca, must decidedly be regarded as symptoms of imminent danger. When the local symptoms are mild, the danger is rarely great; and even in the severe forms of the disease, when a gentle sweat breaks out about the third or fifth day, when the sloughs throw off in a favorable manner, leaving a clean, florid, healthy-looking bottom, and the respiration becomes more gentle and free, the expression of the face more lively, and the pulse stronger and more equal, a salutary result may be held in expectation. The accompanying fever being generally of a low typhoid character, Aconite is rarely necessary in this complaint; how- ever, there are cases, particularly when the fever runs high from the commencement, in which advantage is found to re- 164 DIGESTIVE SYSTEM. suit from a dose or two of this remedy, followed by Bella- donna as soon as the patient complains of dryness, with im- peded deglutition and a sense of constriction or choking in the throat, which, on examination, is observed to be swollen and to present a florid red appearance. DOSC. Three globules in a table-spoonful of water, every three hours, until amelioration or change. On the first appearance, however, of the subjoined symptoms, proceed with the next remedy. Belladonna is additionally indicated when the fever con- tinues to run high; when the face is bloated and the eyes much inflamed; when the patient is affected with considera- ble delirium, and is, occasionally, with difficulty to be re- strained from leaving the bed, or committing acts of violence; or, further, when the rash, which sometimes breaks out in this disorder, about the third day, presents a scarlet hue, and is smooth and glossy. DOS?. Four globules in a table-spoonful of water every four hours, until amelioration or change. In cases in which the symptoms are mild, or in which the above-mentioned symptoms have been reduced by means of the remedies quoted, and an increased secretion of mucus supplies the place of the previous dryness, while the patient is at the same time afflicted with nausea and bilious vomiting,—a dose or two of Pulsatilla may be administered with good effect. The progress of matters in the throat must, however, be care- fully watched, and as soon as the presence of small ulcers, or still better, their incipient formation, can be detected, a dose of Mercurius should be prescribed, followed by Acidum ni- tricum, when, from the increasing size and painfulness of the ulcers, Mercurius does not promise to arrest their progress or cause them to assume a healthy aspect. In the milder forms of this disease, the two last named remedies will frequently be found sufficient to conduct it to a speedy and successful termination; but in those much more dangerous forms, which the complaint so readily assumes when it rages as an epidemy, and when the patient, at the commencement, is seized with vomiting and purging, attended ULCERATED SORE THROAT. 165 with such prostration of strength as to render it impossible fol- ium to leave the recumbent posture without feeling faint, and compelled to fall back exhausted by his efforts; when, more- over, the ulcerations spread with alarming rapidity, and early take on a sloughing character. In such cases, the con- ducting of the disease to a happy issue becomes obviously a much more serious and difficult task. Here the symptoms must generally at once be attacked by administering Arseni- cum,—sometimes, however, benefit will be found to result from a dose of Pulsatilla beforehand, when there is an excessive degree of bilious vomiting,—but Arsenicum must unhesita- tingly be had recourse to when there is that marked prostra- tion of strength so characteristic of this disease, accompanied with nausea or vomiting; or when the ulcers present a livid hue. This important remedy is also indicated in a more ad- vanced stage of the disease, when the ulcerations are covered with dark sloughs, surrounded by a livid margin; the teeth and lips incrusted with sordes; the tongue parched, cracked, blackish, and tremulous; the pulse small and irregular; and there is delirium or constant muttering; with frequent hang- ing of the lower jaw; laborious respiration; acrid discharge from the nostrils, causing excoriations; the eyes dull and glassy; the skin hot and dry, and the thirst excessive, yet the patient drinks but little at a time, and appears to perform the act of deglutition with great pain and difficulty; finally, when the prostration of strength is so extreme that the patient seems rapidly sinking, and a rash of a livid color breaks out in blotches, here and there intermingled with petechiae. Dose. Of the remedy selected, give four globules in a table-spoonful of water, night and morning, until amelioration or change, pausing, however, twenty-four hours in changing the medicine. [Conium is as energetic as the Arsenic, and has been em- ployed with great success when the diseased parts have sud- denly assumed an ash-gray color and a blackish aspect; ulcer- ations have formed, secreting a fetid matter, without much pain ; the strength, and, with it, the natural temperature have suddenly declined; the spirits of the.patient become anxious, 8 * 166 DIGESTIVE SYSTEM. indifferent, and prostrated; the febrile paroxysm becomes irregular, sometimes consisting of chills and heat, then of burning fever succeeding the chilis, and concluding at night in a copious perspiration ; wliitish eruptions appear on the skin; the face grows pale; features change, with oedema ; the tongue becomes covered with a thick coat, swells, is painful, and the speech is difficult; when the stools are diarrhceic, bloody, and involuntary.—Mercurius corroswus is very useful at the commencement of angina. A prominent inflammatory swelling of the throat and tongue, a burning heat from the mouth to the stomach, oppression of the chest, vomiting, and unquenchable thirst, are the principal indications. — R. L., Ed] Dose. Dissolve six globules in two table-spoonfuls of water, give a tea-spoonful every hour, until amelioration or change,—continuing the administration at intervals of four hours, when the more urgent aspect of the disease has been overcome. In very serious cases the doses may be required similarly every ten, fifteen, or twenty minutes. Lachesis will frequently be found very useful after, and in some cases alternately with, Arsenicum, should the patient complain of great pain in the throat, which is aggravated by the slightest external pressure; or should the sloughs seem in- disposed to cast off, and the neck become much swollen and discolored. Conium has been recommended when the dis- eased parts assume an ash-gray color and a dark brown or blackish aspect, paleness and puffiness of the face, swelling of the tongue, inarticulate speech, loose, sanguineous, involun- tary stools, depression of strength and spirits, evolution of a whitish eruption on various parts of the body. When the tendency to gangrene continues, and the patient is still affect- ed with considerable prostration of strength, accompanied with debilitating sweats, Cinchona will often be found of ser- vice. Nux vomica is frequently serviceable after Arsenicum, when the diarrhoea has been checked, but numerous, small, foul, offensive ulcers are seen in the mouth and throat,—and may be succeeded by Carb. v., should a copious fetid ichor be discharged from the ulcers, attended with extreme exhaustion, MUMPS. 167 and small, indistinct, or scarcely perceptible pulse. Secale comutum may sometimes be administered with advantage in alternation with Carb., when the latter appears to afford but temporary benefit. Rhus is occasionally useful in extreme cases, particularly if there be great muscular weakness, with trembling of the extremities, especially on movement; sopor, and other symptoms described under this remedy in the chap- ter on Typhus. Dose. Dissolve six globules of the selected remedy in four table- spoonfuls of water, and give a tea-spoonful of the solution every hour, until amelioration or change. When, from the beneficial effects of Arsenicum, or any of the other remedies above mentioned, the strength of the patient becomes invigorated, the countenance more animated, and the sloughs are thrown off in a satisfactory manner, yet the ulcers threaten to become indolent; these will, generally, very speedily acquire a clean and florid bottom, and begin to cicatrize, on the administration of Acid, nitricum. In other cases the aid of Sulphur and Silicea will be found necessary. DOSC. Four globules of the selected remedy in a table spoonful of water three times a day, until amelioration becomes rapidly and regu- larly progressive, or change ensues. For further particulars in the treatment of malignant sore throat (see also Sore Throat), the utmost cleanliness, com- bined with free ventilation, ought to be strictly observed, for the double purpose of removing all malignant excretions and effluvia,—and thereby putting a check to the ready exten- sion of the contagion,—and providing for the comfort and well-being of the patient. The diet should consist of semolina, sago, gruel, and similar articles of food. MUMPS. Parotitis, Angina Parotidea. SYMPTOMS. Inflammation with swelling of the parotid and submaxillary glands, sometimes running high, and extend- ing to the throat and tonsils, with danger of suffocation. 168 DIGESTIVE SYSTEM. This complaint generally affects individuals under the age of puberty, and frequently declares itself as an epidemy, during the prevalence of cold damp weather. When properly treated, it is rarely dangerous, but particularly apt, if not carefully attended to, to attack some more important organs by metastasis,—for example, suddenly disappearing in the glands mentioned, and painfully affecting those of the breast, &c.: these metastases may occur either from fresh exposure to cold, or from the application of saturnine, camphorated or other repellent lotions. This complaint is generally ushered in by the ordinary symptoms of mild catarrhal fever, after which the swelling declares itself, sometimes interfering with the motion of the jaw, and by the extension of inflammation to the tonsils, affecting the hearing and impeding inspiration. TREATMENT. Mercurius may almost be termed the specific remedy in the simple form of this disease. DOSC. In manjT cases a single dose, consisting of three globules in a table-spoonful of water, will be found sufficient to effect the cure; when, however, the symptoms do not promptly yield, the like dose should be repeated every twelve hours, until amelioration or change. But if no positive benefit ensue within twelve hours after the second dose, proceed with the next remedy. Carbo vegetabilis should be administered (1) twelve hours after the second dose of Mercurius, when the latter remedy does not promise to produce much benefit (which is frequently the case in those who have been formerly salivated by Mer- cury under allopathic treatment), particularly if the affection be accompanied by a considerable degree of hoarseness. Carbo. veg. is also distinctly indicated (2) in cases in which the affection has suddenly been transferred to the stomach (the swelling of the glands having abruptly disappeared), owing to neglect in observing proper precautions against cold, &c. Dose. Under the first circumstances (1) mentioned, the dose should consist of three globules in a table-spoonful of water, repeated three times a day, until amelioration or change. Under the circumstances (2) last stated, dissolve six globules in two table-spoonfuls of water, give a tea- INDIGESTION, OR DYSPEPSIA. 169 spoonful every three hours (until three doses have been given), and then every twelve hours (the symptoms still continuing in a modified form) until positive amelioration or change; but if no improvement whatever should have followed the third dose (in such a case).proceed with the next remedy. Cocculus should be administered three hours after the third dose of Carbo. veg., in cases of the transition of the disease to the stomach, if the latter remedy has been totally ineffectual. Dose. Dissolve four globules in two table-spoonfuls of water, give a tea-spoonful twice at intervals of two hours, and then every six hours, until amelioration or change. Belladonna should be promptly administered when, in consequence of a similar accident, the disease has been sud- denly transferred to the brain, characterized by a sudden dis- appearance of the swelling of the glands, followed by loss of consciousness, delirium, or other symptoms of .Inflammation of the Brain (which see). Belladonna is moreover indicated when the swelling is red and presents an erysipelatous appearance. Should this glandular enlargement occur as a consequence of such diseases as Typhus, Measles, Scarlatina, &c, the proper method of treatment will be gathered from the fore- going particulars, and from those which are afforded under the head of each of those diseases separately. During the treatment of this affection, every care should be taken that the patient be kept moderately warm, exposed neither to damp, cold draughts, nor vicissitudes of tempe- ra ture. INDIGESTION, OR DYSPEPSIA. This disease appears in so many different phases, that we shall simply content ourselves with an enumeration of some of the principal exciting causes, and refer to the symptoms given under the different medicaments for its SYMPTOMS. The following may be considered the chief of these:— Irregularities in diet—such as an over-indulgence in the pleasures of the table, partaking of rich and indigestible food 170 DIGESTIVE SYSTEM. and stimulating soups, excessive use of wine, malt and spiritu- ous liquors, strong tea, coffee, and other stimulants ; imperfect mastication of food; irregularity of, or too long fasting be- tween meals; indolent or sedentary habits; exhaustion from intense study ; keeping late hours ; mental emotions, &c The foundation of this disorder is frequently laid in early life, by the baneful practice of administering large doses of calomel and other deleterious drugs, for the most trivial as well as the more serious derangements of the chylopoietic viscera; and the evil is perpetuated in more mature age, by a continu- ance of the same absurd and injurious system. Nux vomica covers the following symptoms, either when they have arisen in consequence of sedentary habits, excessive mental exertion, or long watching, or from the abuse of wine or ardent spirits : the head confused with occasionally a feel- ing as if resulting from intoxication, and giddiness with sen- sation of turning and wavering of the brain ; headache, un- fitting for, and increased by, mental exertion ; tearing, draw- ing or jerking pains in the head or cheeks, and pulsative pains, and a sensation as if a nail were driven into the brain ; con- gestion of blood to the head, with humming in the ears. The headaches are often deeply seated in the brain, or in the back part of the head, frequently confined to one side, or over the eyes, and at the root of the nose, coming on chiefly in the morning, after a meal, or in the open air. Yellowness of the lower part of the white of the eyes, with a mist before them; a sensation as if one were about to fall; sparks, or small gray or black spots before the eyes ; short-sightedness; pale or yel- loioish color, or redness of the face, especially about the mouth and nose; frequent headache, and impaired powers of diges- tion, with insipidity of food; foul, dry, white or yellowish tongue; thirst, with water-brash, particularly after acids or rich food; accumulation of slimy mucus, or water in the mouth; metallic, salt, sulphureous, herbaceous, mucous, bit- ter, sour, sweetish, or putrid taste, chiefly in the morning, or sifter meals ; bitter eructations, or continued nausea, especially after meals, or even after drinking cold water or milk,—or on INDIGESTION, OR DYSPEPSIA. 171 going into the open air after a meal, or after partaking of acids; heartburn, hiccough, acidity, flatulence, frequent and violent vomiting of food, mucus, or bile, or ineffectual efforts to vomit; distension and fulness in the epigastrium, with exces- sive tenderness to the touch; a feeling of tightness of the clothes round the upper part of the waist; cramps in the stomach; constipation ; reddish urine, with brick-dust colored sediment; sleep unrefreshing and restless, either from suffer- ing or otherwise, with disagreeable dreams, and drowsiness in the morning. One of the most distinctive indications for the employment of this remedy in preference to the next mentioned, is the temperament, which is restless, irritable, lively, and choleric. A disposition to Hemorrhoids is also a good indication. DOSC. Three globules in a table-spoonful of water, night and morn- ing, for a week; then pause four days, resuming the same remedy in a similar course, or suspending treatment, or proceeding with another medicine, according to the circumstances which are present. If Nux vomica be not apparently capable of effecting a permanent cure, consider the next remedies. For .Pulsatilla we have nearly the same range of dyspeptic symptoms, with the distinction of its being particularly adapted for females, children, individuals with light hair, and a marked predisposition to purulent exudations at the edge 01 the eyelids, or to styes, and for mild or phlegmatic disposi- tions. Amongst its characteristic indications, we more fre- , quently find a want of thirst than thirst; a repugnance to fat and rich meat, and suffering, after taking pork or pastry; general chilliness, or great difficulty in keeping the hands and feet sufficiently warm; deficient sense of smell, sometimes accompanied by increased secretion from the nostrils ; frequent and loose, or difficult and loose, or sluggish evacuations ; hy- pochondriasis, hysteria. Dose. Three globules in a table-spoonful of water, as directed for Nux v. ; but if little or no permanent effect should promise to result within twelve hours after the fourth dose, proceed with the next remedy. Bryonia : Headache, burning or expansive, particularly 172 digestive system. after drinking, attended with bewilderment of the head and vertigo; tongue dry and red, or covered with a coated, whitish-yellow fur ; sometimes the aversion to food is so strong, that the patient cannot bear the smell of it; loss of appetite, alternately with unnatural hunger; craving for acid drinks; great thirst; insipid clammy, putrid, sweetish, or bitter taste in the mouth; acidity and flatulence, or bitter risings after every meal, or after partaking of milk. Hiccough, nausea, water-brash, vomiting of food or bile, particularly at night; tenderness of epigastrium to the touch, sensation of swelling in the pit of the stomach ; especially after a meal, or on walking; sensation of burning in the pit of the stomach, especially when moving. Constipation; temper restless, irascible, and obstinate ; also when want of exercise or anger are frequently the exciting causes of the derangement, or the means of aggravating the symptoms. The dyspepsia is more apt to manifest itself in summer, or in damp weather, is frequently accompanied with chilliness. {Rhus is often of service when Bryonia produces little or no improvement.) DOSC Four globules in a table-spoonful of water every twelve hours, until amelioration or change. In cases in which the sufferings are very great, the like dose should be repeated every three hours during the attack, until the symptoms subside or change; but in these latter instances, if no improvement whatever ensues within two hours after the second dose, proceed with the next remedy. Antimonium Tartaricum is sometimes more efficacious than either of the foregoing medicines, when great drowsiness, but constant nausea and frequent vomiting, as well as relaxed, brownish-yellow motions characterize the case. Dose. As directed for Bryonia. Arsenicum. When there are acrid and bitter eructations, with nausea and vomiting; also dry tongue, excessive thirst, salt taste in the mouth, and burning or violent pressure in the stomach, with diarrhoea or colic, and griping in the lower part of the belly, particularly when arising from the effects of an ice which had been partaken of, the patient being warm, or from fruit, stale vegetables, or acids. INDIGESTION, or dyspepsia. 173 DOSC Three globules in a table-spoonful of water every three hours, until amelioration or change. Chamomilla : Headache, with sometimes semi-lateral pull- ing, shooting, and beating in the head; fulness, giddiness, and staggering in the morning when getting up, oppressive heaviness, vertigo, and sensation of a bruise; headache, felt sometimes during sleep, with obscuration of the eyes ; and yellow color of the white; tongue dry and cracked, with a thick and yellowish coating; mouth dry, with the occasional presence of frothy mucus ; excessive thirst and desire for cold drink ; bitter taste in the mouth and of food ; want of appe- tite and dislike to food. Acidity or sour risings, regurgitation of food, nausea, vomiting of food, mucus, and bile; acute, oppressive pain in the region of the heart, distension at the epigastrium, pit of the stomach, and upper part of the waist, chiefly after eating, and at night attended with inquietude and terror ; burning pain in the pit of the stomach, uneasiness and feeling of sinking in the stomach; cramps in the stomach, especially when traceable to coffee ; sometimes constipation, but generally relaxation of the bowels. This remedy is valu- able in indigestion, brought on by a fit of passion, or sup- pressed perspiration. Dose. In casual cases, of a solution of six globules to three table- spoonfuls of water, give a tea-spoonful every three hours, until amelio- ration or change. In chronic cases, three globules in a tea-spoonful of water night and morning, .until similar variation occurs. Cocculus is appropriate to the treatment of highly bilious subjects, or when the derangement can be traced, however remotely, to long watching or intense application to study; or when coffee, tobacco, or brandy, can be traced as the ex- citing cause. It may generally be employed in cases in which moroseness and hypochondriacal disposition are marked cha- racteristics either before, after, or in alternation with Nux v., according as the characteristic effects of the one or both most clearly correspond to the case. Dose. Three globules in a table-spoonful of water every twelve hours, until amelioration or change. Or if, again, Cocculus be appa- rently inadequate to complete the cure, consider the next remedy. 171 DIGESTIVE SYSTEM. Carbo vi:r,. is especially appropriate to the treatment of derangements of this nature occurring amongst persons of advanced years ; or when the derangement can be distinctly traced to long watching,- to abuse of wine, of ardent spirits, of coffee,—to milk diet or casual use of milk, to excessive use of butter, or to rancid butter, to fat and greasy things, such as pork, to fish, especially if tainted, or to shell fish in particular (as muscles), to flatulent vegetables, &c., to pastry or acid things, to excessive use of salt, or unguarded use of ices or very cold drinks. This remedy is particularly indicated by excessive and constant flatulence, with heavy respiration, re- pugnance to animal food, or especially to fat or greasy things, or to milk, and when acidity is constantly provoked by such food; bitter taste in the mouth; accumulation of phlegm in the gullet and stomach, frequent empty, sour or bitter eructa- tions, &c. Dose. Three globules in a table-spoonful of water every twelve hours, until amelioration or change. Rues tox., which is particularly appropriate for the treat- ment of indigestion resulting from mechanical injuries (such as a strain), or when beer, spirits, coffee, milk, copious draughts of cold water when heated, new or slack baked bread, tainted sausage-meat or fish (especially shell-fish, as muscles) may directly have provoked the attack. The speci- fic symptoms are as follows : flat, sticky, sweetish, or bitter, or foul taste in the mouth; drowsiness, eructations, and sen- sation of fulness, languor or giddiness, after eating ; a sensa- tion of repugnance to food, especially to meat, bread, ecc, or sensation of satiety; or wTant of appetite, with hankering after dainties; continual, empty, painful and noisy eructations; offensive and very abundant flatulency; the derangements of the digestive functions more apparent and troublesome at night; distension and pressure in the region of the stomach. Extreme depression of spirits, despondency, insuperable anxiety and uneasiness respecting affairs. Dose. Three globules in a table-spoonful of water every four hours, until the symptoms are modified ; and then every twelve hours, until positive amelioration or change. INDIGESTION, OR DYSPEPSIA. 175 Ipecacuanha: Face pale and yellowish; tongue sometimes clean, at others coated white or yellow; aversion to food, and particularly to fat, or to rich indigestible food, such as pork, pastry, &c, or dyspeptic suffering on partaking of such; vomiting of food, drink, mucus, or bile, sometimes after a meal; retching or easy vomiting, generally attended with coldness of the face and extremities, and sometimes alternating with watery diarrhoea; feeling of emptiness, and flaccidity, and sensation of sinking at the stomach. Headaches, attended with nausea and vomiting; shooting pains, with heaviness and painful pressure on the forehead. Both this medicine and Pulsatilla are valuable remedies for indigestion in children, arising from imperfect mastication or improper food. Dose. Against the acute symptoms when present, dissolve eight globules in a wine-glassful of wTater, give a tea-spoonful every three hours, until amelioration or change ; against the chronic aspect of the affection, that is, the recurrence of acute symptoms, give three globules in a table-spoonful of water night and morning, until distinct ameliora- tion or change. Ignatia may sometimes follow Pulsatilla to complete a cure, or even supersede it, when there is a tendency to consti- pation, and particularly in persons who are subject to sudden alternations from high to low spirits, or vice versa; it is espe- cially indicated when grief has been the inducing cause of dyspepsia, hysteria, and hypochondriasis. In chronic cases, these remedies, as indicated, are chiefly valuable in the commencement of treatment, and may require to be followed by other reniedies to complete the cure. Sul- phur, or Tincture of Sulphur, will be found especially useful after Pulsatilla and Nux vomica, in removing any symptoms that may remain. Hepar sulphuris is a valuable remedy in some cases of dyspepsia, but particularly when the patient has previously been taking blue-pill, or any other mercurial preparation for a considerable time. Acidum sulfhuricum : Dyspepsia arising from excessive study, drinking, or other excesses, with the following symp- toms : great weakness of digestion; acrid, foul, putrid taste 176 DIGESTIVE SYSTEM. in the mouth, dry tongue, burning and smarting sensation in the throat, sometimes attended with pricking, especially at night, and so troublesome as to prevent sleep {Pyrosis); offensive breath, especially in the morning {aphthw) ; renewal or aggravation of the symptoms from drinking cold water; all cold drinks appear to disagree, unless a little brandy or some other ardent spirit is added to them; accumulation of water; saliva in the mouth; flatulence ; bitter risings ; vom- iting of a limpid fluid, or of food. It may be here remarked that, in cases where Nux vomica seems indicated, but the disposition is of a morose or hypochondriacal turn, Cocculus may be substituted with effect; when, however, the indica- tions for temperament are not sufficiently distinctive, Coccidus, Nux vomica, and Pulsatilla, may be advantageously alter- nated. Finally, Carbo vegetabilis will frequently remove any symptoms that may remain after Nux vomica. DOSC. Three globules, dry, three times a day, until amelioration or change. Cinchona is a valuable auxiliary in the treatment of this derangement, when there is impaired appetite with great weakness of digestion, which is more liable to be experienced on partaking of supper ; flatulence ; bitter taste ; languor; hypochondriacal disposition; and particularly when we can trace the affection to debilitating losses of fluids, such as the abstraction or loss of blood, too great a drain upon the resources during lactation, prolonged use of aperient medi- cines, &c.; also in disorders arising from the abuse of tea, or from a residence in impure atmospheres, especially such as are overloaded with the exhalations of decayed vegetable matter. Dose. Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of a mixture in such proportions, night and morning, until the whole is consumed ; wait four days, and if still indicated by the symptoms present, resume the administration of the same remedy night and morning every fourth day. Natrum c. may follow Nux v., Bryonia, or Cinchona, with advantage, when a degree of weakness of digestion re- mains. indigestion, or dyspepsia. m Dose. Three globules in a table-spoonful of water night and morn- ing, until amelioration or change. Kali bichromas is particularly applicable to the treatment of chronic cases in which milk, bread, fish, or pastry, con- stantly disagrees with the patient. The distinctive symptoms are as follow: indigestion, with aggravation of symptoms in the morning and during movement, relieved after eating (sometimes, however, a distressing feeling of weight is expe- rienced after a meal); mouth and tongue dry; thick yellow fur on the tongue; conflux of water in the mouth; metallic, acid taste; want of appetite, nausea; flatulence, frequently accompanied by colic. Constipation, or hard stools, attended with straining and burning in the outlet; alternations of hard and relaxed motions ; great sensibility to cold air ; complica- tion with affections of the liver and spleen; extreme depres- sion of spirits; hysterics. Dose. As directed for Natrum m. In chronic cases this disorder sometimes takes a critical turn, when vomiting becomes excessive, everything taken is returned from the stomach, the skin is hot and dry, the patient becomes emaciated, and the countenance cadaverous. In serious cases of this description Arsenicum and Lachesis will tend much to invigorate the sinking energies, and even,—with the occasional aid of Lycopodium, Veratrum, Baryta, Phos- phorus, Conium, or some one or other of the above-mentioned remedies, where necessary,—eventually effect a cure, pro- vided the inroads of organic lesions have not already placed the unfortunate sufferer beyond the reach of art. (See also Chronic inflammation of the stomach. Cardialgia. Want of appetite. Flatulency, and Derangement of the stomach) Accessory Treatment and Diet. In no class of disorders is it more requisite to adhere strictly to dietetic regulations, than in those which consist of derangement in the digestive system, whether so called functional or organic: the patient should therefore, in such cases, regulate his regimen, as closely as possible, by the rules laid down at the commence- 178 DIGESTIVE SYSTEM. ment of this treatise, carefully avoiding, moreover, all such articles as he may find disagree with him even if they apper- tain to the aliments allowed. He should generally abstain from soups, and everything that has a tendency to distend the stomach, such as taking large quantities of warm liquids ; he should not indidge his appetite to its full extent, and carefully avoid late hours, unnecessary exposure, and severe mental exertion or anxiety; he should also take sufficient exercise in the open air, and, as much as possible, keep his mind from dwelling upon his complaint, or on gloomy subjects. WANT OF APPETITE. APEPSIA. ANOREXLV. Want of appetite, being a concomitant symptom of many diseases, is treated accordingly in other parts of this work; but we now propose to look upon it as one of the leading symptoms of indigestion, and in this character deserving a particular notice. In a great variety of cases, amongst others that of dyspepsia, it is usually attributable to an ill-regulated regimen, imperfect mastication of food, the abuse of tonics and other medicines in large doses, sedentary habits, and the neglect of sufficient exercise in the open air. In many instances the removal of the exciting cause will cure this disorder. Sufferers from this inconvenience should carefully avoid creating an artificial appetite, and also par- taking of the smallest quantity of food until the previous meal has been assimilated; the habit of taking tea, and even, as the/ expression is, " making a meal of it," within a couple of hours after removing from the dinner-table, is a frequent cause of apepsia and dyspepsia. Another source is the habit of drinking frequently, or very copiously during meals—thereby attenuating the saliva and gastric juice, and rendering them less fitted for the purpose of digestion. Other causes are the custom of sleeping after dinner, par- taking of heavy suppers before retiring to rest, and the indul- gence in fermented vinous or spirituous liquors, or in tea or coffee, particularly the latter. WANT OF APPETITE. 179 An alteration in the hours of meals, and avoiding too Ion a- fasts between them, will frequently remove this affection. In other rases, early rising, great attention to diet, absti- nence from rich or highly seasoned food, together with the daily use of pure, cold water—drinking a tumblerful an hour or so before breakfast, two to four hours after dinner, and again about the hour of retiring to rest—will suffice to restore the weakened digestive functions to a normal condition. When, however, we cannot trace this disorder to some of the above, or any other probable cause, when every attention to regimen, and even an alteration of diet, according to indi- vidual peculiarities or idiosyncrasy, has failed to produce any good effect, we generally find the want of appetite accompa- nied with other symptoms of derangement in the digestive functions, which may prove useful in aiding us to select a proper remedy to restore the natural tone of the stomach ;— this will be found among the medicines most useful in Dyspepsia and Cardialgia: namely, Nux vomica, Chamo- milla, Pulsatilla, Cinchema, Lpecacuanha, Antimonium crudum, Bryonia, Arnica, Hepar sulphuris, Lachesis, Sul- phur, Coccidus, Carb. veg., Kali bich., and Calcarea, &c. Xux vomica is the principal remedy when the want of appetite can be traced to late hours, the habitual use of wine and coffee, or to sedentary and studious habits, also'when the following symptoms are present: dryness of mouth, tongue coated white, with cracks or slimy mucus in the mouth, agustia, pyrosis, or insipidity of aliments (particularly meat), accumulation of water in the mouth, aversion to food, costiveness or constipation, confusion in the head or giddiness (as if the results of intoxication), amnesia, and difficulty of fixing the mind to a train of application, weight in the occi- put, tinnitus aurium, heaviness and aching in the limbs, uneasiness and a feeling of working or dragging of the ten- dons in the lower extremities, or cramps, restlessness, and irritability of temper—symptoms aggravated in the morning. DOSC. Three globules in a table-spoonful of water night and morn- ing for a week; then pause four days, resuming the same remedy in a 180 digestive system. similar course,—or suspending treatment—or proceeding with another remedy according to the circumstances which are present. If Nux v. be not apparently capable of effecting a permanent cure, consider the next remedy. Chamomiila is frequently found useful after Nux vomica, when, although considerable benefit has been derived, the whole train of symptoms are not removed. The following are its particular indications ; restless sleep, sensation of fulness and aching in the head, heat and redness of the face, a degree of fever, tongue thickly coated, yellowish, rough and cracked (anorexia and greenish diarrhoea) and general sensibility of the nervous system. This remedy is especially called for, when a bitter taste in the mouth (or vomiting of bile, or of greenish mucus) ensues after eating. Dose. Three globules in a table-spoonful of water night and morn- ing, until amelioration or change. Pulsatilla. This remedy is specific in the affections aris- ing from partaking of over rich or greasy food, for instance, pork or pastry; or of aliments causing flatulence, such as vegetables; or of food, in the preparation of which rancid butter or lard has been used. The more immediate indica- tions are, whitish, cleft or fissured tongue, with bitter, salt, or foul taste in the mouth, sliminess of the mouth, scraping, roughness or acidity at the pharynx, bitter eructations, aver- sion to warm food or to meat, as well .as butter, and all rich food; loss of taste; distension of the abdomen, and particu- larly a feeling of tension under the false ribs, borborygmus, retarded or difficult defecation, or diarrhoea, drawing-in of the limbs (resembling that presentment in ague) exacerbation of symptoms in the evening, in contradistinction to Nux vomica, which is generally indicated by this occurrence in the morn- ing. This remedy is well adapted to the mild lymphatic temperament, and also when there is a peculiar sensibility, with a dislike to conversation; it is likewise valuable when imperfect mastication is the cause of the affection, as well as in cases where there is a marked aversion to tobacco, even when the patient is accustomed to its use. Moreover, this WANT of appetite. 181 remedy will be frequently found of benefit in some cases where Chamomilla has only temporarily relieved; but should a considerable degree of nervousness, or even irritabi- lity, remain after Pulsatilla, Nux vomica may be had re- course to. Dose. Four globules, dry, night and morning, until amelioration or change. Cinchona is highly efficacious in anorexia occurring during foggy weather, when the air is charged with .unwholesome vapors, or in the vicinity of marshy lands. The following are its indications: a sensation of constant satiety, with general indifference to food, and adypsia; tongue cracked, or loaded with yellow or white coating; sensation of sinking and flutter- ing in the epigastrium (particularly when this symptom can be traced to the effects of tea); eructation after eating; desire for highly-seasoned food,, acids, pepper, and other condiments ; general weakness, with inclination to assume the recumbent posture, and inability to remain long in one position ; uncom- fortable feeling of dry heat, or shivering and sensitiveness in the open air; retarded or interrupted sleep; general feehng of uneasiness, with moroseness and peevishness. Dose. Four globules as directed for Pulsatilla. Ipecacuanha is indicated by the following symptoms: Nausea or vomiting, without foulness of the tongue, with dislike to food. Tobacco—even to smokers—has a nauseous taste, and causes vomiting. .This remedy is also useful when the impaired appetite has arisen from bolting the food, particularly in children, and may be followed by Pulsatilla, when only par- tial relief has been obtained. Dose. Three globules in a table-spoonful of water night and morn- ing, until amelioration or change. Antimonium crudum will prove a good remedy in cases where a great disposition to nausea and vomiting with foul tongue exists; anorexia, dryness of the mouth with great thirst, particularly during the night; accumulation of phlegm in the throat, with continual attempts to clear the throat; 9 182 DIGESTIVE SYSTEM. frequent rising, soon after meals, of the food last partaken of; pain or disagreeable fulness at the epigastrium, frequently with sensibility to external pressure. In cases of recent stand- ing with the above symptoms it is very speedily efficacious: and when relief does not quickly follow, the next mentioned remedy should be had recourse to. DOSC. Three globules as directed for Ipecacuanha. Bryonia in recent derangement of the stomach with anorexia; when we find thirst more during the day than through the night; with a sensation of dryness in the throat, extending down the oesophagus; chilliness; yellow, dark brown, or white- coated, cracked tongue, with constipation. DOSC. Four globules in a table-spoonful of water, three times during the first day, and subsequently night and morning, until amelioration or change. Arnica. This remedy is valuable when the loss of appetite has arisen from sitting up at night; watching at a sick bed ; from not having devoted a sufficient number of hours to the period of rest; from intense mental exertion; or from provo- cation or excitement. When from these causes the nervous system is powerfully affected; tongue coated yellow; taste foul, bitter, or sour, or nauseous, or chalybeate, with offensive smell from the mouth; rising of the food, or eructations of the taste or smell of rotten eggs ;* aversion to smoking and desire for acids ; sensation of fulness in the scrobiculus after meals, with inclination to vomit; distension of the abdomen, with pinching colic, relieved by doubling up the body, and renewed by drinking the smallest quantity of wine, or passing off and then coming on with inclination to evacuate the bowels; gen- eral irritability and impossibility of fixing the mind upon any subject; inclination to remain lying down, as this position relieves a heavy stupefying headache, which the least motion or even conversation increases. * {Tartarus emet., Sulphur, Valerian, Sepia, Slannum, also cover the latter symptom:) the practitioner Will therefore do well to bear the said remedies in mind, when this particular symptom is a prominent one, and does not yield to Arnica. WANT OF APPETITE. 183 Dose. Three globules in a table-spoonful of water, night and morn- ing, until amelioration or change. Hepar sulphuris is useful in chronic cases of want of appe- tite, with indigestion from the slightest cause, notwithstanding the most careful observance of diet. It is indicated by desire for high-seasoned dishes, acids, and wine ; nausea, even incli- nation to vomit, particularly in the morning; and constipation, frequently with colic. This remedy is one of our chief anti- dotes to Mercurius, and consequently one best adapted to those affections of the stomach which have arisen from the long- continued use of calomel or other mercurial preparations. Dose. Six globules (or for young persons two globules in a table- spoonful of water) in a wine-glassful of Water, every morning, the first thing (fasting), for ten days (unless earlier improvement or change take place), then pause four days, and if a degree of improvement is mani- fested, resume the administration of a similar course, and so on, until positive improvement or change. But if Hepar sulph. does not pro- mise to effect any beneficial operation within four days after the com- pletion of the first course, consider the next remedy. Lachesis is a valuable remedy to follow Hepar sulphuris in obstinate cases, particularly when long-continued constipation is complained of, and the symptoms have always been aggra- vated by acid drinks, &c.; in the latter case Arsenicum is also useful, and may sometimes precede or follow Lachesis with advantage. Dose. Four globules in a table-spoonful of water every morning the first thing (fasting), until amelioration or change. In addition to the two last-mentioned remedies, we may observe, that in the same class of cases, Belladonna, Mercurius, Sulphur, and Calcarea may be used with considerable advan- tage, when the former remedies have afforded only partial relief. Dose. Of the remedy selected, give six globules to an adult or four globules to young persons, in a wine-glassful of water, every morning the first thing (fasting), until amelioration or change. Acidum sulphuricum is a useful remedy in cases of impaired appetite, with weakness of digestion, arising from habitual 184 digestive system. excess in the use of ardent spirits, or from debilitating loss of fluids, such as blood, or in consequence of excessive study,— with the following symptoms: acrid or putrid taste, dry tongue, burning and smarting sensation in the gullet resem- bling heartburn ; offensive breath, especially in the morning; aphthae; disagreeable sensation of pricking in the throat, frequently occurring during the night, and disturbing sleep. Dose. For adults six globules, or for young persons four globules, in a wine-glassful of water every morning the first thing (fasting), until amelioration or change. DERANGEMENT OF THE STOMACH, ERUCTATIONS, &C. Under this head we intend treating of a disorder which may arise in individuals of a generally unimpaired digestion —the characteristics of eructations will assist to indicate the remedy for persons subject to this unpleasant affection. The ordinary causes of this derangement are; hurried, imperfect mastication; overloading the stomach ; fat, greasy, indigestible, or tainted food, flatulent vegetables, ices, stimu- lants, cvjc. SYMPTOMS. When the symptoms of approaching sto- machic derangement declare themselves immediately, or a few hours after a repast, a little strong black coffee is fre- quently a sufficient restorative. Should, however, this fail to relieve, and sick headache and inclination to vomit be present, we should assist Nature by tickling the fauces with a feather, and giving tepid water to drink until the stomach has completely evacuated its contents. Should, however, on the following morning, symptoms of de- ranged digestion continue, such as nausea, inclination to vomit, or vomiting, and disagreeable or offensive eructations, we should administer Antimonium crudum,—-one of our most useful remedies in this affection, and which rarely fails to afford at least some relief. It is also peculiarly indicated when the affection has arisen from drinking sour or impure wine; or, when, in addition to the symptoms of disordered stomach, a degree of fever returns every second day. DERANGEMENT OF THE STOMACH, ETC. 185 Ipecacuanha. When a rash has been thrown out, from the effects of a disordered stomach, attended with anxiety, oppressed breathing, and sickness, this remedy will, in most cases, effect speedy relief;—but should the difficulty of breath- ing, or a degree of nausea, or other uneasiness continue, Bry- onia should be employed. {Tartarus emeticus is sometimes more efficacious than either Ipecac, or Bryonia, when there is great drowsiness, with constant nausea and frequent vomit- ing : relaxed, brownish, yellow motions.) DOSC. Three globules in a table-spoonful of water every three hours, until amelioration or change. Bryonia. In addition to the usefulness of this remedy in the foregoing instance, it is also very serviceable when the follow- ing symptoms are present: bitter eructations '.fever, alternately with coldness and shivering; or redness of the face, heat in the head, and thirst with coldness and shivering ; also where diarrhoea or constipation and peevishness, or excessive irrita- bility are present. (In derangement of the stomach, arising from succulent vegetables, and attended with excessive flatu- lence, this remedy is frequently productive of speedy relief.) Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. Arsenicum is appropriate when there are acrid and bitter eructations with nausea and vomiting; also dry tongue, ex- cessive thirst, salt taste in the mouth, and burning or violent pressure in the stomach, with diarrhoea or cholic, and griping in the hypogastrium, and particularly when these derange- ments have arisen from the effects of an ice which had been partaken of when warm, or from fruit, stale vegetables, or acids. It may, in many cases, be advantageously followed by Carbo vegetabilis, which see. DOSC. Three globules in a table-spoonful of water every three hours, until amelioration or change. Nux vomica is indicated by offensive or acrid eructations, constipation, and confused headache, particularly when arising from previous intoxication, or even slight over-indulgence in 186 DIGESTIVE SYSTEM. wine or other stimulants; when possible, it should be taken the same night, as taken in the morning, although eventually relieving, it frequently causes an aggravation for a few hours. (In derangement of the stomach with heartburn, flatulence, more or less nausea and headache, &c, in consequence of a chill or of indulging in mental or corporeal exertion imme- diately after a meal, this remedy commonly affords speedy amelioration.) Dose. Four globules in a table-spoonful of water ; or, if one dose be insufficient, of a solution of twelve globules to three table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. If, then, the symptoms, though materially modified, be not wholly subdued, continue to administer similar doses night and morning for three days, or longer, if necessary. Arnica, deranged stomach, accompanied by eructations resembling rotten eggs.* Dose. Of a solution of eight globules to two table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Pulsatilla is, next to Antimonium crudum, the most im- portant remedy in recent cases of deranged digestion, with eructations of ingesta, tongue foul and covered with mucus; chilliness and lowness of spirits; and also when a rash has been thrown out in consequence of the derangement. This remedy is, moreover, almost specific when the disturbance has arisen from the effects of rich food, such as pork or pastry, or even tainted meat, or from the effects of ices, cold fruits, or crude vegetables, acid wine, &c. {Arsenicum may follow Pulsatilla, if the latter do not effectually relieve.) Dose. Four globules in a table-spoonful of water. When one dose is found insufficient, or when this remedy is indicated in alternation with any other, it will be necessary to dissolve eight globules iu two table- spoonfuls of water (or otherwise as previously directed), and to give a teaspoonful of ihe solution every four hours; or if in alternation, the same quantity at every recurrence of its turn of exhibition. Aconite. When the affection owes its origin to partaking of sour beer, vinegar, or other acids, particularly when we find * See also note, page 188. derangement of the stomach, etc. 187 oppressive pain in the stomach, great heat in the head, nausea, or actual vomiting of mucus, or even of blood. DOSC. Three globules in a table-spoonful of water; or if repetition be needful, of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Hepar sulphuris. When the digestion is naturally weak, and sour vomiting, attended with burning in the throat, colic, and diarrhoea, is liable to ensue from the slightest error of diet, and particularly when anything of an acid quality has been partaken of. {Lachesis is often of great service here in alter- nation with Hepar sulphuris, at intervals of a week of so.) Dose* If singly, three globules in a table-spoonful of water night and morning for a week (unless earlier and decided improvement or change ensue); pause four days, and resume the course, if necessary, and so on from time to time until amelioration or change ensue. If in alter- nation with Lachesis, first a week's course of the one, then a pause of four days; then a week's course of the other, and so on, until ameliora- tion or change. When a fit of passion has produced an attack of indigestion, Chamomilla rarely fails to relieve. Bryonia is, however, to be preferred when chilliness and shivering accompany the symptoms of gastric derangement. (See Mental Emotions.) Dose. Four globules in a table-spoonful of water; or if repetition be required, a solution of six globules, as directed for Aconite. Carbo vegetabilis, although last mentioned, is not one of the least valuable remedies in this affection, and is often found "particularly useful after Pulsatilla, Arsenicum, or Nux vomica, in removing any symptoms that may remain; it is, moreover, particularly useful where great susceptibility to the influence of the atmosphere, particularly to cold, exists at the same time; or in sufferings arising from abuse of wine, ices, or salt; further, in derangement of the stomach, arising from having partaken of game or fish which has been too long kept, or meat that has been recooked whilst in a state of fermentation, which is liable to occur in warm weather; in the latter in- stances Carbo v. is to be preferred to any other medicine, and will rarely fail to afford relief; but if any disagreeable symptoms 188 digestive system. remain, Cinchona may be administered in a little water; and followed, if required, by Pulsatilla in the same manner. Finally, this remedy {Carbo v.) is peculiarly valuable in obsti- nate and chronic cases of deranged digestion when annoyance or inconvenience is felt after every meal, even amounting to nausea and vomiting, attended with excessive flatulency, and where the pit of the stomach is tender on pressure.* Dose. Three globules in a table-spoonful of water, until ameliora- tion or change. FLATULENCY. FLATULENTIA. FLATUS. TYMPANITIS INTESTI- NALIS. This affection, together with the sufferings it entails, is gen- erally found in individuals of weak digestion, and many also suffer from it immediately on taking cold in the abdomen or feet; it is also, as well known, a common result of errors in diet, and the too frequent indulgence in vegetables and fruits. In corpulent individuals the sufferings arising from this complaint, such as difficulty of breathing, palpitation of the heart, trembling of the limbs, confusion of the head, and swelling of the face, especially in hypochondriacal subjects, are most distressing. However, with proper attention to regimen, and suitable medical treatment, it is rarely very difficult to remove. As an accompaniment of deranged digestion, it has already been noticed under Dyspepsia. The most useful preservatives against the complaint are avoiding cold, exposure in cold damp weather, very cold drinks, or distending the stomach with a large quantity of warm fluid, particularly strong tea or coffee; each patient should also study his own digestion, and carefully refrain from partaking of any species of aliment which experience has proved to produce flatulency. Sedentary habits also should be avoided, * A small quantity of finely-powdered charcoal, in a little good French brandy, will be found an equally efficacious mode of administering this remedy as a corrective against derangement of the stomach produced by having partaken of tainted meat or fish. FLATULENCY. 189 and a proper portion of the day devoted to exercise in the open air. TREATMENT. In the treatment of this affection the following medicines are most frequently called for: Cinchona. When the affection can be traced to the effects of habitual indulgence in tea or warm drinks, an hour or two after a hearty meal, by which the process of digestion has been interrupted; or to debility, loss of humors from vene- section, or the continued use of purgatives ; or to deranged digestion arising from flatulent food, with painful tension and distension of the abdomen; or when, on the occasional expul- sion of flatus, a sensation of tension is felt in the umbilical region; or, finally, where coldness or shuddering is expe- rienced after drinking. DOSC Three globules in a table-spoonful of water every three hours, until amelioration or change ; but if the last-named symptom does not yield to China, proceed with or substitute the following remedy upon its continuance or recurrence. Against the predisposition give four globules in a table-spoonful of water night and morning, until decrease, cessation, or change of the symptoms. Arsenicum, where the last-mentioned symptom has not been relieved by the foregoing medicine. Dose* In all respects as directed for China or Cinchona. Nux vomica. In cases where the flatulence is attended with sensation of pressure at the pit of the stomach, causing dyspnoea and a feeling as if the clothing were too tight, or a sensation of pressure as from a stone, and particularly when the affection arises from an habitual use of coffee, or from sedentary habits. Dose. Three globules in a table-spoonful of water, repeated in two hours, if the symptoms continue. Against the predisposition give four globules every night, until amelioration or change. Pulsatilla, when the affection has arisen from having eaten of rich or greasy food, after which a copious draught of water has been partaken of, and the abdomen is tumid and accompanied by a pain as from a bruise, with borborygmus. 9 * 190 DIGESTIVE SYSTEM. DOSC Four globules in a table-spoonful of water, repeated in two hours, if the symptoms continue. Against the chronic recurrence of these symptoms consider the next remedy. Carbo veget. Carbo vegetabilis is one of the most import- ant remedies after the foregoing, in chronic cases, especially when the inconvenience arises after partaking of the smallest morsel of food. Dose. Six globules for adults, or four globules for young persons, in a wine-glassful of water daily, the first thing in the morning fasting, until amelioration or change. Colchicum, when from a considerable accumulation of flatus the abdomen is extremely distended, or, as it might be ex- pressed, inflated and sounds like a drum on being struck with the hand {Tympanitis intestinalis)—without any marked pain, but with heat and difficulty of respiration. This remedy is generally peculiarly efficacious when the derangement is • attributable to vegetable food; or to the effects of exposure to a cold, damp atmosphere. DOSC. Three globules in a table-spoonful of water, repeated in two hours, and then every three hours, until amelioration or change. Against the predisposition, give four globules in a table-spoonful of water, night and morning, until decrease, subsidence, or change of the symptoms ensue. Belladonna. In cases of flatulent obstruction, in which the transverse section of the colon is the particular seat of the accumulated flatus, and becomes protruded like a pad, this remedy should be employed; it may be followed by Colocynth when the relief obtained is only temporary, or when, from the manner in which the patient traces the course of his uncom- fortable feelings, there is every reason to conclude that the flatulent distension and obstruction occupy the entire extent of the colon. DOSC. Three globules in a table-spoonful of water, repeated in two hours, and afterwards every three hours, until amelioration or change. But if, after four doses, it be found that this remedy modifies, without totally removing the symptoms, pause twelve hours, and proceed with the next medicine. When the flatulence occurs very frequently, in fact, where SPASM OF THE STOMACH. 191 a marked predisposition to it exists, we must have recourse to Spirit sulphuris. We have pointed out the remedies best suited to the cases of this affection most ordinarily met with, and have also treated of the same subject under Dyspepsia and Colic, to which the reader is referred. SPASM OF THE STOMACH. GASTRODYNIA, CARDIALGIA, GASTRALGIA. SYMPTOMS. Contractive and spasmodic or gnawing pains at the epigastrium, extending to the chest and back, attended with anxiety, nausea, eructation or vomiting, with faintness and coldness of the extremities: the patient is some- times relieved by emission of ascending flatus, and when com- plicated with pyrosis, by a discharge of a quantity of limpid fluid; occasionally headache and constipation are present. In some cases the pain is very slight, but there is always more or less, and a degree of anxiety, with nausea, often increased by taking food. The disease originates in an abnormal state of the nerves of the stomach, and is frequently accompanied by a disease of the liver, spleen, or pancreas, or even by schirrus of the stomach or duodenum, in its advanced stages. It is a frequent attendant on gout; and very rarely occurs before the age of puberty. The paroxysms last for a longer or shorter time, according to the violence of the affection, and return in many instances periodically, and may be brought on by partaking of improper articles of diet, or in severe cases by any solid food whatever. The chief articles to be avoided by an individual suffering from this malady are—crude, uncooked vegetable substances (such as salads), also cheese, new bread, sweetmeats, cherries, nuts, olives, and roasted chestnuts ; and stimulants of all kinds, whether strong tea, coffee, alcoholic or fermented drinks. The exciting causes are: long fasting between meals, very hot or cold drinks, an habitual use of ardent spirits, or of in- digestible food, worms, and in some instances, perhaps, expo- sure to cold or damp weather. It is a more frequent affection in the female than the male 192 DIGESTIVE SYSTEM. sex, often occurring after the cessation of the usual monthly discharge, or from any interruption of its usual course; in such instances it is frequently accompanied with hysteria, syncope, and may pass on to vomiting of blood. Notwithstanding the general intractable nature of this affection, it has been treated with marked success by the method about to be pointed out. TREATMENT. Nux vomica is one of the principal, and, in a large number of cases, the most appropriate remedy against spasms of the stomach, and particularly in cases where this affection can be attributed to the long-continued use of strong coffee, or an excessive indulgence in spirituous liquors ; it is, moreover, of essential service in many cases which have arisen after the suppression of chronic or hemorrhoidal dis- charges, or when the party affected is liable to fits of hysteria or hypochondriasis; the following are the immediate symptoms which call for the administration of this medicine: constipation, pressure, squeezing, or spasm in the stomach, accompanied with a sensation as if the clothes were too tight at the waist, or as if flatus wTere pent up in the hypochondria. This sensa- tion, as well as the pains before mentioned, become generally increased after a meal, or after partaking of coffee ; in addi- tion to which, a feeling of depression or constriction is expe- rienced at the chest, which, in many cases, extends to between the shoulders and the lower part of the back. Frequently, also, we find nausea, accumulation of clear water in the mouth, or risings of sour bitter fluids, attended with a sensation of burning in the throat and gullet (pyrosis); sour or putrid taste in the mouth, vomiting of ingesta, flatulent distension of the bowels, constipation, aching in the forehead, palpitation of the heart, and anxiety. When these symptoms are liable to be excited by a fit of passion, or become aggravated in the morn- ing, or when the patient is occasionally awakened out of his sleep by the spasmodic attack, this remedy is still more cer- tainly indicated. Dose. In severe cases, of recent origin, three globules in a table- spoonful of water, every three hours, until amelioration or change. In SPASM OF THE STOMACH. 193 chronic cases, with more or less acute pain after every meal, of a solution of six globules to two table-spoonfuls of water, give a table-spoonful every evening until the whole is consumed, or in the like proportion, until positive amelioration or change. When the spasm of the stomach returns periodically, or when from some imprudence in diet we have reason to apprehend an attack, three globules should be taken in a table- spoonful of water three hours before the expected recurrence of the symptoms, or in the latter case immediately after the possible cause has transpired. This rule applies in respect of any of the remedies herein prescribed, which have been administered with success against former attacks. If temporary relief, only, followed by more intense suffering, has ensued, and continues three hours after a second dose of Nux vom- ica, however, proceed with the next medicine. Should Nux vomica merely afford temporary benefit, fol- lowed by renewed aggravation, and in cases wliere the disorder returns again after it has been for a time suppressed by Nux, we should first repeat that remedy; and if it then fail to afford relief, Carbo vegetabilis will generally be found to answer our purpose; if not, Spirit sulphuris may then be had recourse to, particularly where the affection is traceable to the suppres- sion of some chronic eruption. This last-named medicine, as well as Pulsatilla and Sepia, the value of which in such cases we shall notice under their several heads, is particularly useful in gastrodynia-in females, arising from derangements of the menstrual functions. DOSC. Three globules in a table-spoonful of water, morning and evening, for four days. In other cases, where no improvement results from the exhi- bition of Nux vomica, the following should be consulted. Chamomilla. For the employment of this remedy the principal indications are : pressure as if from a stone in the pit of the stomach ; or painful pressure at the precordial re- gion, as if the heart would be crushed, flatulent distention at the same part, as also of the hypochondria and abdomen, with shortness of breath, anxiety, and throbbing headache; miti- gation of the above symptoms on partaking of coffee,—a dis- tinguishing mark between the indications of this remedy and those of Nux vomica ;—on the other hand (as in the case of 191 DIGESTIVE SYSTEM. the latter), it is also indicated wThen the symptoms, as de- scribed, are liable to be brought on by a fit of passion. Dose. Three globules in a table-spoonful of water every four hours, until amelioration or change; or if little or no improvement results within four hours after the third dose, consider the following remedies. Colocynth is sometimes more efficacious than Cham, in the latter case, and especially when the fit of passion is accompa- nied by indignation. Dose. As directed for Chamomilla. In obstinate cases, where Chamomilla fails, notwithstanding the apparent similarity of the symptoms, Belladonna ought to be substituted for it; also when we meet with gnawing pressure, or spasmodic tension in the pit of the stomach, relieved on bending backwards and holding in the breath ; or, further, spasm of the stomach, which recurs daily dm-ing din- ner, or else pain of so violent a nature as to deprive the patient of consciousness. DOSC. Three globules in a tea-spoonful of water every four hours, until the indicative symptoms are removed. Carbo vegetabilis may, however, be preferred to Bella- donna, when the most prominent symptom remaining con- sists of a sense of aching and pressure at the pit of the stomach and the precordial region, causing a feehng as if the heart wrere about to be crushed. (See Chamomilla.) Dose. Three globules, as directed for Belladonna. Cocculus, in many cases of this complaint, is particularly indicated, when, in addition to the usual symptoms, there are constipation and constrictive pains over the entire abdomen, with flatulency, and accumulation of water in the mouth, and alleviation of the sufferings on the recurrence of the latter symptoms. DOSC. Of a solution of six globules to two table-spoonfuls of water, give a table spoonful every three hours, until amelioration or change. Ipecacuanha is useful in cases of this affection, when the paroxysms are accompanied by nausea, vomiting, dull, dart- SPASM OF THE STOMACH. 195 ing pains in the pit of the stomach, and sensation of excessive uneasiness in the same region. _ DOSC Of a solution of four globules to two table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Pulsatilla. In cases with shooting pains in the stomach, which are aggravated by movement, and particularly by making a false step. Pulsatilla is also one of the most ap- propriate remedies when the attacks are followed by vomiting, or accompanied by violent tension and squeezing, or throbbing and sensation of anxiety about the pit of the stomach, in- crease of pain after eating, or more particularly a feeling of pressure and pinching after dinner, with a relaxed state of the bowels, or a disposition thereto. Tendency to hysteria or hypochondriasis. This remedy, as well as Sulphur and Sepia, is called for in cases of this affection, arising from suppressed menstruation. When Pulsatilla does not afford much relief, the desired result is often attainable through the agency of Ignatia. Dose. Dissolve twelve globules of the selected remedy in four table- spoonfuls of water, give a table-spoonful every six hours until ameliora- tion or change. But if no lasting improvement should ensue within six hours after the third dose, consider the following remedies. Sepia is an efficacious medicine in gastrodynia arising from suppressed or difficult menstruation, and may in general cases advantageously follow Pulsatilla ; it is indicated when, as in the cases of Nux v. and Pulsatilla, most of the sufferings arise after a meal, when there is pressure in the stomach as from a stone, and a burning pain is experienced in the epi- gastrium and scrobiculus. By restoring singly, or in con- junction with Pulsatilla and Sulphur, the menstrual flux, it frequently removes the cardialgia and hysteria consequent upon this derangement, or, at least, places the affection in such a position that it is easily cured by some other medicine, closely corresponding to the remaining symptoms. DOSC In recent (not chronic) cases, of a solution of four globules to two table-spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. In chronic cases give three globules in a table- 196 digestive system. spoonful of water night and morning, for a week, then pause four days and resume the course, suspend treatment, or change the remedy ac- cording to circumstances. Ignatia amara is indicated under nearly the same circum- stances as Pulsatilla, with the exception of the state of the bowels, Ignatia being more appropriate to cases attended with costiveness, and where the inclination to vomit is absent, or when the affection has been caused by grief, anxiety, ex- haustion by long abstinence, &c, or occurs in very hysterical or hypochondriacal individuals. (See also the remedies men- tioned at the end of the chapter.) Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful morning and evening, until amelioration or change. Cinchona is of great service in most cases of spasms of the stomach with general weakness arising from loss of humors, the result of blood-letting, or repeated hemorrhages, abuse of emetics or aperients, too long-continued suckling, &c.; and is further indicated by great weakness of digestion, distension and uncomfortable weight, pressure, or pains in the stomach after eating, so that the patient feels much easier when fast- ing ; these latter symptoms are the more immediate indica- tions for the employment of this medicine. {Nux v. and Carbo v. may follow Cinchona, should the latter not re- move all the symptoms.) Dose. Of a solution of four globules to two table-spoonfuls of wa- ter, or in the like proportion, give a table-spoonful night and morning, for three days; and afterwards three globules in a table-spoonful of water every third night, until positive improvement or change. Staphysagria. This is useful in some cases of this com- plaint, and is particularly applicable wThen there is acute pressive tension and squeezing about the pit of the stomach, which sometimes obstructs the breathing, but which is relieved by bending the body forioard. When, however, the pain par- takes of a marked tensive character, and extends to the region of the navel, accompanied by sensibility of the region of the stomach on external pressure, shortness of breath, anxiety and nausea, Stannum will be found more appropriate. SPASM OF THE STOMACH. 197 DOSC. Dissolve of the suitable remedy six globules in three table- spoonfuls of water, and give a tea-spoonful of the solution every three hours until decrease, subsidence, or change occurs in the symptoms. Bryonia. This medicine is more particularly adapted to the milder cases of cardialgia, with painful pressure, or a feeling of disagreeable fulness in the stomach after a meal, which occasionally becomes converted into a feeling of con- striction, cutting, or pinching, and is relieved by eructation and external pressure. This remedy is, moreover, still more clearly indicated when the symptoms are generally accompa- nied by severe headache or painful compression in various parts of the head, and particularly at the temples, which is liable to be excited whenever any article of diet disagrees in the slightest degree ; increase of the sufferings by movement; habitual costiveness. DOSC Three globules in a table-spoonful of water every four hours, until amelioration or change. Platina. Spasms of the stomach in females, occurring particularly at the monthly period {Chamomilla, Pulsatilla, Nux v. and Cocculus are equally efficacious at such periods, when the symptoms are as indicated under these remedies), and especially when the menses are, at the same time, gene- rally very copious, and of too long duration. DOSC. Against the acute symptoms when they occur, of a solution of four globules to two table-spoonfuls of water give a tea-spoonful every three hours until amelioration or change. Against the predispo- sition (or until the tendency is eradicated), a week before the recurrence of the periods, give four globules in a table-spoonful of water night and morning, for a week. Arnica Montana, in spasm or pains in the stomach, which have originated in the effects of a strain, or from a blow, etc., will be found specific. It is, however, also an excellent reme- dy when there is a sense of pressure as from a stone, or of ful- ness in the stomach and scrobiculus, constrictive pain in the stomach and in the precordial region, shooting pain in the pit of the stomach, with painful pressure or aching, extending to the back, and tightness of the chest, increased by eating, drinking, and external pressure. Bismuth,—Cardialgia, with 198 DIGESTIVE system. tenderness on pressure at the pit of the stomach in hysterical females. This remedy is, further, often of great service in some of the most obstinate cases, particularly when there is a sensation of great weight or pressure, with indescribable pain and uneasiness in the stomach. Dose. Of a solution of four globules to two table-spoonfuls of water, or in the like proportion, give a tea-spoonful night and morning, until amelioration or change. Arsenicum. Periodic pains in the stomach, chiefly consist- ing of a burning character, and attended with acrid, sour eructations, vomiting of ingesta, or of mucus, sometimes even of blood; anorexia, extreme debility, emaciation. DOSC Two globules in a tea-spoonful of water every three hours, until amelioration or change; or in very acute cases, characterised by excessive prostration and livid aspect, give one globule in a tea-spoonful of water immediately, repeating the dose after half an hour, and again every two hours, until positive amelioration or change. But if little or no permanent relief ensue within two hours after the sixth dose, consider the various other remedies herein named. In chronic cases, give three globules in a table-spoonful of water night and morning, until distinct amelioration or change. Lycopodium. Squeezing or compressive pains proceeding from each extremity of the stomach, with flatulent distension; want of appetite, pains in the back and loins (constipation); exacerbation of the symptoms in the open air, after a meal, or in the morning; cardialgia in lymphatic females, with too copious catamenia. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every three hours,until amelioration or change; but if little or no permanent relief ensue within three hours after the third dose, consider the other remedies herein named. In chronic cases, give four globules in a table-spoonful of water every evening, for a week. Lachesis. Spasms of the stomach, particularly in persons addicted to excessive indulgence in wine or ardent spirits, re- lieved by partaking of food; tongue covered with a dark brown fur, <$r glazed, red, and cracked, or swollen; flatulence, constipation; tremulousness, numbness, and paralytic weak- ness of the extremities. Dose. As directed for Lycopodium. heartburn. 199 Sulphur is frequently an indispensable remedy in chronic cases, attended with heartburn; aggravation of the pains after a meal; constipation, hemorrhoids. Dose. Three globules in a tea-spoonful of wrater morning and evening. Calcarea. In obstinate cases, occurring in individuals who are habitually addicted to the abuse of wine or ardent spirits, Calcarea will generally be found of great service, es- pecially after the previous employment of Nux v., Lachesis, and Sulphur. It is further a valuable remedy in the cases of plethoric females subject to nasal hemorrhage, or to excessive- ly copious menstruation; and is generedly indicated when the paroxysms of pain come on usually at night, or after a meal; in which latter instance vomiting sometimes results, or nausea and acidity, with painful* sensibility on pressure at the epi- gastric region. Constipation, hemorrhoids, or chronic loose- ness of the bowels, are additional general indications for the employment of this remedy. DOSC Six globules in a wine-glassful of water every morning the first thing, for a week (unless earlier relief or change ensue); pause four days, and then, if necessary, resume the course as before, and so on, until positive amelioration or change. The DIET ought to be extremely simple, and easy of di- gestion ; and everything which is known by experience to bring an attack should be eschewed. Fat, oil, butter, cheese, etc., are often hurtful, and should therefore be avoided. See also Dyspepsia, of which this malady is but a modification. HEARTBURN. BLACK WATER. WATER-BRASH. PYROSIS. This is not an affection of that organ which its name would imply, but a painful or uneasy sensation of heat or acrimony about the pit of the stomach, sometimes extending upwards. It is frequently accompanied with anxiety, nausea, and vomit- ing ; or a violent gnawing spasmodic pain in the region of the stomach, from which the patient experiences no relief, until he succeeds in ejecting a quantity of limpid fluid. The remedies required for the treatment of the disorder are the 200 DIGESTIVE SYSTEM. same as those mentioned under Dyspepsia, Flatulence, and Spasm of the Stomach, according to the symptoms : of which Nux v., Puis., Sulphur, Acid, sulphuricum, Carbo v., Cin- chona, or Calcarea, will be found the most appropriate in ordinary cases. (See the aforesaid derangements for particu- lar indications.) Dose. In casual cases, of the remedy selected, give three globules in a table-spoonful every three hours, until amelioration or change. In chronic cases, give four globules in a tablespoonful of water, night and morning, until positive amelioration or change. VOMITING OF BLOOD. ILEMATEMESIS. SYMPTOMS. Blood evacuated by vomiting, sometimes pure (generally venous), of a dark color, but sometimes of a bright red ; it is occasionally mixed with bile, food, &c.; the quantity varies ; blood is also not unfrequently discharged in coagula by stool. PBEMONiTORY SYMPTOMS. Weight, pressure, ful- ness or tensive pain or spasm in the hypogastric or hypo- chondriacal regions ; griping and cholic; burning heat in the region of the stomach ; anxiety, particularly on partaking of food or drink, or on pressure at the stomach ; saltish taste in the mouth; impaired appetite and nausea; giddiness; syn- cope, cold perspiration ; sometimes also an intermittent pul- sation is perceptible at the scrobiculus. Some only of the preceding symptoms may be present previous to the attack, and others, during its course wlien very severe, or frequently renewed. We often find wild delirium or wandering accompanied with spasms, and a gradually increasing weakness and remission of pulse with frequent syncope. The most frequent causes of this affection are the sudden suppression of any sanguineous discharge, and the consequent determination of blood to the stomach; it is, therefore, apt to declare itself after a stoppage of the hemorrhoidal flux, and is a very common affection in females, from the suppression or cessation of the catamenia; in which case (as before remarked VOMITING OF BLOOD. 201 under that affection) it is frequently preceded by Cardialgia. Other causes are schirrus of the stomach, internal lesions or injury of that organ from swallowing sharp substances, or from worms; poisons, drastic purgatives, or emetic drugs, ex- ternal contusion, obstruction of important viscera, or a change in the constituent principles of the blood itself; the direct cause is the bursting of some of the vessels of the stomach. The dangers arising from the use of powerfid astringents are, inflammation or subsequent induration of the stomach, or putrid gastric fever. When this affection occurs in females from non-appearance or suppression of the monthly discharge, or from its final cessation, see articles Chlorosis, Amenorrhea, Cessatto men- sium ; when it arises from worms, see Helminthiasis ; from poisonous substances, see Poisons ; and when it originates in diseases of the spleen, consult Splenitis. We may now proceed to the consideration of the remedies above alluded to. TREATMENT.—Aconitum. When the premonitory symp- toms above given, declare themselves, and particularly when a considerable degree of fever precedes the attack. Dose. Dissolve six globules in two table-spoonfuls of water, and give a tea-spoonful of the solution, repeating the dose in half an hour, and then every hour, till positive amelioration or change. In this mode, if taken in time, we may often, by calming the circulation, prevent an attack. Nux vomica. In a decidedly plethoric constitution with a marked (venous) stomachic or abdominal congestion, and ten- dency to constipation, particularly when arising from sup- pression of hemorrhoids, or of the menstrual flux, or from in- dulgence in vinous, spirituous, or fermented liquors ; this remedy is still further indicated by irritability of temper. DOSC Three globules every four hours, until amelioration or change. Pulsatilla. The value of this remedy is noticed in the diseases of females above mentioned; it is also, in many cases, found more suitable than Nux vomica for males, when of lymphatic temperament and mild disposition. Some of 202 DIGESTIVE SYSTEM. the best indications for this medicine will be found under Dyspepsia, Cardialgia, and Derangement of the Stomach. Dose. As directed for Nux vomica. Cinchona. When a quantity of blood has been already vomited, this remedy, from its power of restoring the energy of the system after debilitating losses, is clearly indicated; it should also be chosen when the patient has had a severe attack of hsematemesis, which has ceased of itself, but still left great weakness. Dose. Three globules in a table-spoonful of water every four hours, until amelioration or change ; if, however, there be very palpable amelio- ration after the first dose, the repetition may be suspended until the symptoms recur, or for twenty-four hours. Arnica. One of our most important remedies in severe cases, and especially when occurring in individuals of a robust constitution, of a sanguine temperament, and choleric disposi- tion. It is further indicated, when the patient complains of pains resembling the results of a contusion, in all the extremi- ties. DOSC Dissolve six globules in two table-spoonfuls of water, and give a tea spoonful of the solution every three hours until distinct ame- lioration or change. Sulphur has been found useful in scrofulous habits, or when the affection has arisen from suppressed hemorrhoids ; its value also in cases of abnormal menstruation will be pointed out in the proper place. DOSC. Three globules in a table-spoonful of water every four hours, for the first day or until the violent symptoms subside. Then six globules in a wine-glassful of water, every morning the first thing (fast- ing) for ten days; pause four days, and resume the course, and so on from time to time, when no acute symptoms are present. The application of dry cupping-glasses to the abdomen and under the ribs, or of a cloth which has been dipped in cold water, to the lower region of the abdomen, sometimes forms a useful auxiliary in arresting the hemorrhage. See also Hemorrhage from the Lungs, under Haemoptysis. DIET. The rules already given under Cardialgia should CONSTIPATION. 203 be observed, but with still greater strictness; no solid food must be partaken of; all drinks should be cold; animal jel- lies, preparations of milk, light puddings, and broths, merely tepid, may be allowed in cases where the patient may require such nourishment, but nothing more must be taken than is absolutely necessary for that purpose; immediately after an attack, no food should be given for some hours, and then very cautiously, and in small quantity. It is evident that, in such cases, absolute rest, both mental and bodily, is essentially re- quisite. COSTIVENESS, CONSTIPATION, OBSTIPATION. Constipatio, Obstipatio, Obstructio, Alvi. We have now to treat of an affection which so frequently baffles the skill of the practitioners of the old school; their leading cause of failure being their ignorance of, or inatten- tion to, the great curative principle, and consequent proceed- ing upon a system opposed to the operations of Nature. This complaint is generally sympathetic with some other derange- ment of the organism, and, consequently, in our treatment of different diseases, we have had frequent occasion to allude to it. One of the leading causes of aggravation and excessive obstinacy in the Constipation, most closely approaching to an idiopathic form, is the practice of flying to aperient medicines on the slightest appearance of costiveness, under the absurd idea that keeping the bowels open is a species of panacea against disease of every description. Many mothers are so possessed with this idea, that they continually administer physic to their children, without the slighest apparent call for it, and thus they lay the foundation of dyspepsia and other visceral derangements in after-life. Many a slight case of costiveness which, if left to nature, would have disappeared of itself, leaving no ill consequences, has, by an ill-judged ad- ministration of aperients, been converted into obstinate and habitual constipation, embittering existence, and predisposing the constitution to a variety of diseases in after-life. To pre- 204 DIGESTIVE system. vent misconception upon this point, it should be clearly un- derstood, that we by no means undervalue a regular state of the bowels, but, that when costiveness shows itself, we happi- ly possess remedies calculated to restore the general balance of the system; and, in obstinate cases, do not content our- selves with simply alleviating the symptoms, but mainly di- rect our attention to the permanent removal of the affection. Many of the principal causes of this disorder, besides that mentioned, are the same as those particularised under Indi- gestion or Dyspepsia. TKEATMENT. In trivial cases it will be found suffi- cient to pay proper attention to diet, to avoid too dry or indi- gestible food, to masticate properly, to partake of meat only once a day, and to take sufficient exercise in the open air. Should this course not have the desired effect, we must choose one or more of the following remedies. Opium is chiefly to be selected in recent cases, when consti- pation is not habitual; but is also, like Nux v., and other remedies, serviceable in cases of a more chronic character, occurring in vigorous, plethoric, well-nourished subjects, and arising from inactivity in the intestinal canal, or from sedentary habits. In old people, it is generally more useful than Bryonia and Lachesis, when diarrhoea alternates with the constipation, although these and other remedies, such as Antim., Phosph., and Ruta, must be borne in mind and administered when called for by the nature of the symptoms. The more immediate indications for Opium are: want of power to relieve the bowels, with a feeling of constriction in ano; pulsation and sense of weight in the abdomen, dull, heavy pain in the stomach, parched mouth, and want of ap- petite, determination of blood to the head, with redness of the face, and headache.* DOSC. Dissolve of the selected remedy two globules in a table-spoon- ful of water every twelve hours, until amelioration or change; but if no distinct alteration should follow the sixth dose, consider the next remedy. * Opium is strongly recommended by Dr. Perry, as the best palliative remedy in constipation arising from pressure on the rectum, such as that CONSTIPATION. 205 Alumina. Constipation from an apparent absence of pe- ristaltic motion; faeces hard, dry, broken, evacuated with con- siderable exertion of the abdominal muscles and forcing, and sometimes streaked with blood ; constipation from travelling. Dose. Three globules every evening or every night at bedtime, until amelioration or change. Bryonia is especially useful in constipation occurring in warm weather, and in persons of dark complexion and an ir- ritable or obstinate disposition, with a tendency to be easily chilled, and subject to rheumatism; it is further indicated when constipation arises from disordered stomach, and is at- tended with determination of blood to the head, and headache. DOSC Four globules in a table-spoonful of water, repeated in twenty- four hours, even if partial relief ensue. In chronic cases, two globules may, in like manner, be taken daily for ten days, or until positive ame- lioration or change. Nux vomica. This remedy is particularly useful when con- stipation results from too heavy a meal, indigestible food, and which is occasioned by the gravid uterus, abdominal tumors, swelling of the ovarium, fibrous swelling of the uterus, and, in consequence of which, the faecal matter frequently accumulates in excessive quantities in the rectum, and can only be expelled after great effort, accompanied by severe pain. In weak, nervous, emaciated females, in whom the monthly discharge is al- ways too copious, or in cases where the constipation has arisen from affec- tions of the stomach or liver, Opiumis contra-indicated. M. Perry recom- mends the administration of Opium by olfaction, in preference to the ordi- nary method, and that as follows:—At the period of the day at which the patient used formerly to have the bowels relieved, or, otherwise, as soon as a slight ineffectual inclination for stool is experienced, he desires the patient to smell a solution of Opium (a few globules dissolved in a small phial con- taining a mixture of spiritus and aqu. destill.) several times, and to repeat the process after an interval of half an hour, and again, as before, on the day following, if no satisfactory action result from the first trial. He fre- quently found, that on the first occasion, only a more decided inclination to go to stool was the sequel, whereupon, after a repetition of the olfactus, the desired effect took place. In some very obstinate cases, he ordered a simple enema to be employed, after several previous trials of Opium, in the foregoing method, and succeeded in this manner in instances when neither Opium, nor the enema alone, was capable of affording the desired relief. —Journal de la Med. Homceop., torn. I, chap. 1. 10 206 DIGESTIVE SYSTEM. stimulating liquids ; or when the confined state of the bowels has resulted from prolonged diarrhoea or frequent purgings. In the latter instances Opium may often be advantageously alternated with Nux v. In chronic cases arising from long- continued indulgence in vinous, fermented, or spirituous drinks, or coffee, or from sedentary habits or excessive study, Nux is one of the most effectual medicaments. It is pecu- liarly adapted to persons of irascible and lively temper, with determination of blood to the head, and headache, unfitness for exercise, disturbed sleep, and a feeling of general oppres- sion or heaviness; frequent and ineffectual efforts to relieve the bowels, attended with a sensation of stricture, and some- times frequent, painful and difficult emission of urine. It is further, as remarked under Dyspepsia, particularly indicated for individuals subject to hemorrhoids. Dose. Three globules every night, until amelioration or change. Pulsatilla has nearly the same indications as Nux vomica, with the characteristic distinction of temperament before noted under Dyspepsia. In recent cases, it is particularly indicated when the obstruction has arisen from indigestion brought about by a rich or greasy food, and when it is accompanied by moroseness and shivering. Dose. Three globules, as directed for Nux vomica. Platina is a useful remedy when constipation has been brought about by travelling, when Opium has failed, or especi- ally when the act of expulsion is attended with great straining. Dose. Three globules in a table-spoonful of water night and morn- ing, until amelioration or change. Plumbum metallicum, or Carbonicum. Obstinate constipa- tion, with ineffectual efforts ; painful retraction and constipa- tion of the anus; or evacuation of tenacious, hard, bullet- shaped faeces. (See Obstijxdion.) Dose. Two globules in a table-spoonful of water every twelve hours, until amelioration or change. Natrum muriaticum. This remedy will sometimes be found CONSTIPATION. 207 efficacious when many others have failed to relieve, particu- larly in chronic and extremely obstinate cases. DOSC When the disorder is not of very old standing, three globules in a table-spoonful of water every twelve hours, until amelioration or change. In very inveterate cases, six globules in a wine-glassful of water the first thing in the morning, daily, until amelioration or change; or for ten days successively, followed by a pause of four days, and a similar readministration of the course, if necessary. Sulphur is one of the best remedies in the relief of habi- tual costiveness, constipation, particularly when hemorrhoids are present, or a disposition to them exists ; or frequent incli- nation to go to stool, but without the desired result. Dose. For adults six globules, for young persons four globules, in a wine-glassful of water every morning the first thing (fasting), until amelioration or change ; or for ten days, then pausing four days ; after which, if requisite, the same course may be resumed, and so on. Veratrum. Constipation, chiefly from inactivity of the rectum, with heat and dryness of the skin, determination of blood to the head and lateral headache. {Alumina is also of great efficacy in constipation from torpidity of the rectum —see Constipation from inertia recti.) Dose. Of a solution of six globules to two table-spoonfuls of water (with the addition of ten drops of proof spirit), give a table-spoonful every twelve hours, until amelioration or change. Lachesis. In obstinate constipation, this medicine may be given with effect after Nux v., to those who habitually take wine rather freely, or who experience flatulent distension after meals and ineffectual efforts to eructate. Dose. Three globules in a table-spoonful of water, every evening, until amelioration or change. Sepia may frequently be taken with advantage in chronic constipation after Nux and Sulphur ; and is, moreover, par- ticularly well adapted for females in whom there is an irregu- larity or obstruction of the menstrual flux; it is also indica- ted by constipation in individuals subject to rheumatism, as well as by hard, conglomerate bullet-shaped fseees. (See Ob- stipation.) DOSC When the disorder is not of very old standing, give three 208 DIGESTIVE SYSTEM. globules in a table-spoonful of water every twelve hours until amelio- ration or change. In very inveterate cases, six globules in a wine- glassful of water, as directed for Sulphur. Silicea is often useful when constipation is accompanied with colic, impaired appetite and thirst; the stools hard, knotty, and passed with great difficulty; and the patient troubled with tenesmus. {Conium is occasionally useful in completing the cure after Silicea.) DOSC. Six globules,, as directed for Sulphur. Lycopodium. Chronic constipation with ebullition and de- termination of blood to the head: colic, flatulence, sense of weight in the lower part of the bowels. Dose. For adults four globules, or, for young persons, two globules in a table-spoonful of water, every twelve hours, until amelio- ration or change. Baryta carb. will often be found of great service in consti- pation of aged persons. DOSC. Four globules in a wine-glassful of water the first thing in the morning (fasting), until amelioration or change, pausing, however, for four days, after a course of ten days, if the administration should require to be continued so long. Calcarea, Cocculus, Conium. One or more of these may be found of great service in cases of constipation, to which persons are liable when travelling. DOSC. Give three globules of Calcarea in a table-spoonful of water every twelve hours, until distinct amelioration or change, if none, take the next remedy. China (in addition to one or more of the medicines men- tioned with detailed indications in the foregoing portion of this article) is particularly appropriate to the treatment of constipation, which occurs as the result of'previous and violent purging, continued looseness, and the like. Dose. Four globules in a dessert-spoonful of water every twelve hours, until distinct amelioration or change. Opium, Platina, Alumina. One or more of these medi- cines may be most appropriately selected for cases of consti- pation occasioned by the vapor of lead, as of painters, occ. Dose. In every respect as previously directed for Calcarea, , Cinchona at intervals of twelve hours, when the evacuations are partly composed of undigested food (see also Arsen., Merc, Bryonia, Phosph., Lachesis), and pass with- out pain; 'or this remedy may be administered alone, when * the diarrhoea is unattended with pain, and there are paleness of the face, weakness of the eyes, pains in the back and anus, with great weakness of digestion. DOSC In all respects as directed for China. Chamomilla is a remedy, as already stated elsewhere, par- ticularly useful in children, either at the time of teething, or at a more advanced period, when the affection has been ex- cited by checked perspiration; it is further particularly indi- LOOSENESS OF THE BOWELS. 227 cated when the evacuations are watery, bilious, green, yellow, or slimy, or of a fetor resembling rotten eggs, and accom- panied by fulness at the pit of the stomach, severe colic or spasm, pain in the abdomen, distension and hardness of the abdomen, bitter taste in the mouth, foul tongue, thirst, want of appetite, bilious vomiting, and flatulence (in infants), with restlessness, screaming, and drawing up of the limbs towards the stomach. Sulphur is frequently useful in completing the cure when the pains have been removed by Chamomilla. DOSC Of a solution of eight globules to four table-spoonfuls of water, give a tea-spoonful after every motion, until positive amelioration or change: or, in patients of a weakly habit of body, if this medicine appears inadequate to effect a cure (although the symptoms be analo- gous), and if after repeated administration and temporary effect the symptoms recur in all their former violence, consider Sulphur, in colic. Rheum, when the symptoms, in a great measure, resemble those of Chamomilla, but the pain is not so violent, and the evacuations have a very sour smell; paleness of the face is also an indication for this medicine. (See Diarrhcsa in Children.) Dose. Four globules in a table-spoonful of water ; or, for children, two globules in a tea-spoonful of water after every motion, until amelioration or change. Mercurius, when the diarrhoea arises from a chill, and the motions are copious, watery, slimy, frothy, bilious, or greenish, or streaked with blood, and cause a smarting "or burning sen- sation on being evacuated; also when there is painful tenesmus before, during, and after stool, frequently followed by protru- sion of the lower intestine ; severe cutting pains ; moreover, nausea and eructation, cold perspiration, trembling or shiver- i ing, shuddering, great lassitude, and disposition to syncope; sour-smelling stools ; diarrhoea with ingesta. Dose. Of a solution of six globules to three table-spoonfuls of water, give a tea-spoonful after every motion, until distinct amelioration or change Pulsatilla is one of the best remedies in simple looseness, or diarrhoea, arising from errors of diet, such as indulgence in acids, fruits, or rich indigestible food, attended with foul 228 digestive system. tongue and other dyspeptic symptoms. (See Indigestion.) Another remarkable indication for this remedy is one evacua- tion differing from another in color. Dose. Four globules in a table-spoonful of water, after every motion, until amelioration or change. But if the subjoined indications (not having been previously present) should supervene, proceed with the next medicine. Ipecacuanha. Looseness arising from indigestion, particu- larly if caused by imperfect mastication, attended with nausea and vomiting; paleness of the face (see also Arsen), weakness, and desire to retain the recumbent posture (in the case of children). When Ipecacuanha does not appear to afford much relief, Pulsatilla ought to be had recourse to, in the space of from twelve to twenty-four hours, after the last dose of Ipecacuanha. Dose. Four globules, in a table-spoonful of water, after every mo- tion ; but if, after three doses have been given, this medicine appears to afford only partial relief, consider the two following remedies, and proceed with the one or the other, according to the distinctive symp- toms present. Nux vomica. Scanty stools, consisting of slime and blood, attended with straining and great weakness, flatulency, and violent cutting pains in the region of the navel. For some of the occasional accompanying symptoms the reader is referred to the indications given under this remedy, in Indigestion. Dose. Three globules in a table-spoonful of water, every four hours, until amelioration or change. Colocynth. Diarrhoea, with severe colic, and pains in the limbs. Dose. As directed for Mercurius. Arsenicum. Autumnal diarrhoea, or looseness arising from errors in diet, acids, fruits, cold drinks, ices, or from a chill, &c. the characteristic symptoms for its employment are, watery, slimy, greenish, or brownish, corrosive, burning evac- uations, with violent colic, excessive thirst, emulation, and great weakness; and when the affection is more liable to come on at night, or after eating or drinking.—( Vide the further LOOSENESS OF THE BOWELS. 229 indications for this important remedy, under Bowel Com- plaints ln Children.)* DOSC. Of a solution of six globules to two table-spoonfuls of water, give a tea spoonful every half hour until positive amelioration or change. Antimonium crudum is a good remedy in cases arising from disordered stomach, with white tongue, loss of appetite, eruc- tations and nausea; also when the.symptoms given under Bryonia (which see) continue after the administration of that medicine. Dose. Three globules in a table-spoonful of water every hour un- til amelioration or change. Rhus toxicodendron:—Lumpy or pap-like diarrhoea, com- ing on only at night, and preceded by colic, which disappears after each evacuation. Dose. Three globules in a tablespoonful of water, after every mo- tion, until distinct amelioration or change. Opium is efficacious in diarrhoea arising from fright, or from cold, and may be followed, if required, by Dulcamara in the latter case. For other indications, vide Mental Emo- tions. Dose. Two globules in a table-spoonful of water, after every mo- tion, until amelioration or change; but if no effect whatever be per- ceivable after the third dose, it will be advisable to reconsider the symp- toms, lest some special indication characteristic of another remedy should have arisen. Lachesis. Diarrhoea from acid drinks, or sour unripe fruits, with severe griping; diarrhoea with ingesta; diarrhoea during damp weather. DOSC In casual cases for adults, of a solution of eight globules to three table-spoonfuls of water give a teaspoonful after every motion, until positive amelioration or change; (for children) a. solution of four globules to two table-spoonfuls of water, administered similarly by * When Arsenicum does not answer our expectations, Veratrum should be sub.stituted; the latter remedy is, moreover, for the most part to be preferred, when the disease appears to have arisen from atmospherio causes. 11 230 DIGESTIVE SYSTEM. tea-spoonfuls. In chronic cases for adult-, three globules in a table- spoonful of wat"r; (for children, two globules in a tea-spoonful of wa- ter) every other day, in the morning, until amelioration or change. Sulphur is a most valuable remedy in diarrhoea, particu- larly when the affection is worst during the night, or when it occurs in strumous habits. In adults predisposed to hemor- rhoids, or in children, when the diarrhoea is attended with ex- coriation and papular eruptions, it is particularly efficacious; also in very obstinate cases, and where the slightest cold brings on a relapse or an attack ; or when milk disagrees and causes a looseness. Dose. Against the prevailing acute symptoms, of a solution of six globules to two t ible-spoonfuls of water, give a tea-spoonful every six hours, until the frequency of the motions is diminished. Sub- sequently give six globules in a wine-glassful of water, every morning {fasiing\ the first thing, for ten d:iys (unless collateral symptoms meanwhile occur, requiring other special treatment) ; after which pause four days, resuming the course, if necessary, as before. But if partial effect only ensue from these courses, and the complaint having reached a given degree of improvement remains stationary, proceed with the next medicine. Calcarea may be had recourse to after Sulphur, if the symptoms continue, although in a diminished degree. * Dose. In all respects as directed for Sulphur. Acidum phosphoricum :—In obstinate cases, with portions of undigested food in the evacuations; or occasional involun- tary evacuations. Dose. Three globules in a table-spoonful of water, every twelve hours, until amelioration or change. Phosphorus :—In chronic, painless diarrhcea, with gradual prostration of strength ; diarrhoea with ingesta. Dose* Three globules in a table-spoonful of water, every twelve houra, until amelioration or change. He-tar s., or Acidum nitr., will prove of the greatest service when the looseness of the bowels occurs as the result of abuse of mercurial preparations (under allopathic treatment). DOSC. Give three globules of Ifepa?- s. jn a tablespoonful of wa- DYSENTERY. 231 ter every twelve hours, until amelioration or change, pausing for a week after every course of six days, and proceed with Acid. nitr. Pulsatilla, Rheum. These medicines, respectively, are to be preferred when the complaint can be traced to abuse of Magnesia (under allopathic treatment). Dose. In all respects as directed for Hepar s. DYSENTERY. DYSENTERIA. EEBRIS DYSENTERICA. SYMPTOMS. Constant urgency to evacuate the bowels, te- nesmus, violent pains in the abdomen, a greater or less degree of fever, particularly towards evening, and stools of mucus or blood, or both. It may appear suddenly, but is frequently preceded some time by loss of appetite, costiveness, flatulency, nausea or slight vomiting, with chills followed by heat of skin and ac- celerated pulse, then dull abdominal pains and increased evacuations; after a time no faeces are discharged, but white mucus {dysenteria alba) which may afterwards change to blood {dysenteria rubra)', stools, particularly when fever is present, very frequent and fetid. If not checked in time, the disease may terminate in ulceration or gangrene, or the pa- tient may sink from exhaustion. The prognosis becomes very unfavorable when the pains, which have previously been extremely severe, suddenly cease, the extremities become cold, the pulse small and intermit- tent, the stools putrid and involuntary. This affection is very frequently complicated with pains resembling those of rheumatism {Dysenteria rheumatico-ca- tarrhalis), which will be noticed under the different remedies, as an additional indication for their employment. The ex- citing causes are, checked perspiration, particularly in warm weather, or an exposure to the cool atmosphere of an autum- nal evening after the pores have been opened by active ex- ercise, or exertion during the day; low or marshy situations, local irritations, such as worms, scybala, &c, and suppression of hemorrhoids, metastases, and sometimes, in infants, diffi- cult dentition. 232 DIGESTIVE SYSTEM. TREATMENT. The principal remedies in dysentery are: Aconitum. This remedy is peculiarly adapted to cases at- tended with synochal fever, and in young and plethoric pa- tients is generally required at the commencement or in the course of the disease. It is indicated by full and hard pulse; severe pains, generally in one spot; abdomen tense and painful when touched, denoting the commencement of inflam- mation {dysenteria infiammatorid); and is also valuable when we find pains resembling rheumatism in different parts of the body, with shivering, or excessive heat and thirst. Dose. Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of the solution every two hours, until amelioration or change ; but should the subjoined symptoms occur, proceed with the next remedies, having first paused four hours. Chamomilla should be prescribed if, after the administra- tion of Aconite, we still find violent heat and thirst, rheumatic pains in the head, and constant agitation and tossing. This remedy is also useful when the disease seems to have taken for its proximate cause the formation of gastric impurities in the primse vise; or when it has arisen from exposure to a cool at- mosphere when in a state of perspiration. When we find foul tongue, with clammy, bitter taste in the mouth, and bilious stools, before tenesmus declare itself. This remedy is evidently indicated as most useful in the first or diarrhceal stage of the complaint; it may be followed by Pulsatilla, when the symptoms given under that remedy present them- selves. Dose. Of a solution of eight globules to four table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change ; but if the subjoined symptoms should become prominent, pro- ceed with the next medicine after a pause of six hours. Pulsatilla, when the gastric symptoms noted under Cha- momilla are present, but the stools consist entirely of mucus, striated with blood. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every three hours, until the symptoms abate; and then every six hours, until positive amelioration or change. DYSENTERY. 233 The three remedies above-mentioned are also valuable in dysentery arising from cold, or what is commonly denomi- nated rheumatic catarrhal dysentery. Ipecacuanha. This remedy is serviceable when the dysen- teric affection seems fairly established ; when the stools con- sist of slimy matter containing white flocks, followed by evac- uations of sanguinolent mucus. DOSC. Three globules in a table-spoonful of water, every four hours, until amelioration or change; but if any of the subjoined symptoms occur, consider the following medicines, pausing six hours (in the gen- erality of cases) before proceeding with a different medicine; or ad- ministering such medicine at once, if the symptoms described under the head of Mercurius corr. become urgent. Colocynth. In cases attended with violent colic and exces- sive distension of the abdomen; shivering with chills, appa- rently extending from the abdomen over the whole body; ex- cessive agitation and restlessness ; tongue coated white ; slimy, and sometimes bloody evacuations; it is sometimes found use- ful after Ipecacuanha or Mercurius. DOSC Dissolve six globules in three table-spoonfuls of water, give a tea-spoonful every hour until amelioration or change; but if dis- charge of bloody evacuations should continue, pause three hours and proceed with one or the other of the subjoined medicines. Mercurius corrosivus may be considered to be one of the most important of all the homoeopathic remedies in dysen- tery; but it is more especially in cases with the following train of symptoms that it is characteristically indicated: in the red dysentery or bloody flux, when we find severe tenes- mus or straining, with evacuation merely of a little mucus, sometimes succeeded or accompanied by the protrusion of a portion of the intestine, and increased discharge of pure blood, or of putrid, corrosive, greenish, yellowish, or frothy mucus, intermixed with blood, and sometimes followed by the evacu- ation of small hard substances (scybala) after much straining; burning in ano ; severe griping and lancinating pain before, during, and even after the motions ; increased desire to go to stool after each evacuation. In cases with the above symptoms Mercurius corrosivus 234 DIGESTIVE SYSTEM. may be considered a specific : it will, at all events, prove so efficacious a remedy, that any remaining symptoms can, in general, be removed, with facility, either by means of Colo- cynth, Acidum phosphoricum, or Acidum nitricum (the two latter especially, in the event of a continuance of the sangui- neous stools), or any of the other remedies which may seem more appropriate, according to the indications for their em- ployment as given in this chapter. DOSC. Dissolve four globules of Merc. corr. in two table-spoonfuls of water, give a tea spoonful every two hours until distinct ameliora- tion or change; but if after general improvement has ensued, the dis- charge of bloody evacuations should not be progressively decreased, pause four hours, and consider Acidum phos. and Acidum nitr. or Colocynth. Bryonia is frequently called for in those cases in which it has been found necessary to administer Aconite at the com- mencement of the disease; but is more particularly indicated, when the attack has occurred, during the heat of summer, from the effects of a chill, and is attended with typhoid fever of the inflammatory form; with loose evacuations of a brown- ish color and putrid odor, occasionally containing lumps of coagulated mucus, resembling undigested substances, or small hard lumps or balls (scybalous faecal matter), with griping during, and burning in ano after, the act of evacuating, and aching pains in the limbs, aggravated by movement. When the disease has attained an advanced stage, and the accom- panying fever is of a low typhoid type, the patient being much exhausted and distressed with severe rheumatic or aching pains in the loins and extremities, when reclining or sitting still, and the stools of a slimy, frothy, white, gelati- nous, or sanguineous nature, passed involuntarily at night in bed, Rhus not unfrequently gives a favorable turn to the dis- order. Dose. Of a solution of eight globules of either of the medicines to two table-spoonfuls of water, give a tea-spoonful every two hours, un- til amelioration or change. Arsenicum.—Dysentery of epidemic or contagious origin, with fever of a typhoid or putrid type {Dysenteria putridd) • DYSENTERY. 235 dysentery arising from exposure to noxious exhalations in marshy situations, &c. This remedy may, however, be selected in all cases, from whatever cause arising, when great weakness and even pros- tration exists from the commencement, with burning pain in relieving the bowels, thirst and aggravations of the suffer- ings after drinking, or, on the contrary, adipsia;—also when the disease threatens to assume the ulcerative or gangrenous form—characterized by previous severe pains, particularly burning, which suddenly cease; hypocratic expression of countenance; rapid sinking of the vital energies; pulse small and intermittent; coldness of the extremities; highly offensive, putrid, and cadaverous-smelling evacuations, both of faeces and urine; unconscious passing of stools; offensive breath, and petechiae in different parts of the body. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every two hours, until the symptoms are modified; and then every fo>:r hours until distinct amelioration or change. But if the subjoined symptoms continue to prevail, proceed with the next medicine, after a pause of six hours. If, again, the symptoms appear to be such as to require the alternate administration of Arsenicum and Carbo veg., dissolve six globules of each medicine separately in two table-spoonfuls of water, and give a teaspoonful first of the one, then of the other (with an interval of two hours between doses), until positive amelioration or change. Carbo vegetabilis is a most useful remedy in those des- perate cases where the breath is cold, the pulse almost im- perceptible, and the patient complains of severe burning pains. Its indications closely resemble those of Arsenicum, with the exception of the thirst, and the aggravation caused by drink- ing. It may be given with benefit when that remedy has failed, or only partially relieved, and in this, as in other affec- tions, many instances might be cited where a judicious alter- nation of these two remedies has effected benefit—neither of them having been, singly, adequate to the exigency of the case. DOSC. The same as directed for Arsenicum. 236 DIGESTIVE SYSTEM. Nux vomica. When Arsenicum has diminished the sever- ity of the symptoms and warded off the impending danger, but we find that the faeces still retain a highly putrid odor ; also at any period during the course of the disease, when the following symptoms are present:—Frequent and scanty evac- uations of mucus or sanguineous mucus, and occasionally small, compact, hard faeces (scybala), attended with violent cutting or griping pains in the region of the navel, borboryg- mus, pains in the loins, tenesmus, burning or sensation of ex- coriation in the anus, and sometimes protrusion of the intes- tine ; great heat and excessive thirst. Dose. Three globules in a tea-spoonful of water every six hours, until positive ameliora'ion or change. Cinchona is a good medicine when the disease has an en- demic character, occurring in marshy countries, and in many cases where a state of putridity remains in the faeces after the administration of the remedies above mentioned. Dose. As directed for Nux vom. Cantharides:—Sanguineous stools, mixed with whitish mucus or solid substances like false membranes; painful passage of water. Dose. Three globules in a table-spoonful of water every six hours, until four doses have been given ; and then (unless decided im- provement or change should sooner occur) every twelve hours, until positive amelioration or change. Colchicum autumnale is preferable to Cantharides when the symptoms are as described, but more particularly when the stools consist almost exclusively of mucus unmixed with blood, and when pain is experienced in the bowels at the lower part of the left side, and the disorder rages as an epidemy during the autumnal season. Dose* In every respect as directed for Cantharides. Sulphur :—When the more marked symptoms are amelio- rated by the use of the foregoing remedies, but the dysentery still continues obstinate, and especially when the disease oc- curs in subjects, who have previously been long affected with DYSENTERY. 237 hemorrhoids; or when it has from time to time been subdued, and afterwards returned with greater or less violence; or even when the apparently best selected remedial agents have failed to check its course. It will frequently be found most effica- cious in all these cases, since, whenever they occur, we may suspect some latent constitutional cause is baffling our efforts. In the first instance, denoted by the removal of the more prominent symptoms, the affection is terminated; in the second, the predisposition to a return of the attack is obviat- ed ; and in the third, the constitutional taint alluded to being controlled, the organism becomes susceptible to the specific action of the other medicaments. DOSC. Six globules in a wine-glassful of water every morning the first thing (fasting), for ten days (unless distinctive symptoms indicating other medicines, general change or manifest improvement, sooner occur) ; then pause four days; after which the course may, if necessary, be resumed in like manner, and so on, until distinct amelioration or change. In conclusion, we must not omit to add that, when the dis- ease is of long standing, and has become (so to speak) habitu- al, a cure is often effected by means of Phosphorus. RULES OF DIET. In this affection, it is of great importance to keep up a moderate degree of warmth around the abdomen, which is best obtained by flannel, worn outside the linen. During the course of treatment barely sufficient nutriment to keep up the strength of the patient should be allowed; and the more severe the inflammatory symptoms, the more strict must be the abstinence. No solids should on any account be given; but the diet should consist principally of mucilaginous or demulcent fluids, such as thin barley-water, and gruel; in comparatively mild cases, white of egg in sugar and water, weak chicken-broth or beef-tea, may be allowed. Even after convalescence, this course of diet should be for a short time observed, fruit and vegetables eschewed (especially when the disease is raging in an epidemic form), and a return to the usual diet gradually brought about. Wine and alcohol are absolute poisons in this affection. 11 * 238 DIGESTIVE SYSTEM. Having thus given the general mode of treatment for this disease, which is ordinarily so fatal, we may remark that, in a great majority of cases, the homoeopathic method checks it at its commencement, without allowing it to assume the more serious forms portrayed in the instructions for its treatment, but, on the contrary, causing it to pass off, leaving the patient in sound health; whilst in the most violent cases, where it has already made head, and seems approaching a fatal termina- tion, this may almost be said to be the only system which offers a chance of salvation to the sufferer ; and in strumous constitutions, (where, under the old mode of procedure, the results were commonly so unfortunate,) it generally mitigates the violence of the symptoms, and safely conducts the patient through his perils. Suppressed Dysentery. When the dysenteric evacuations have been suddenly checked by allopathic means, and a vio- lent inflammatory or spasmodic action declares itself, distin- guished by severe pains, anxiety, dyspnoea, nausea, and empty retchings, or distension and tenderness of the abdomen ; sup- pression both of faeces and urine; coldness of the face, tongue, and extremities; breath also cold; with spasms of various kinds in different parts of the body, which are renewed by any exertion, either of speech or movement,—the following remedies will be found useful. Aconitum. Against any inflammatory symptoms that may present themselves. Dose. Dissolve six globules in two table-spoonfuls of water, give a tea-spoonful every hour, until the symptoms abate; and then every four hours (if still required), until permanent amelioration or change. Cuprum aceticum, when spasms or cold sweats predominate. Dose. Two globules in a tea-spoonful of water every two hours, until three doses have been given; and then (if yet required) every four hours, until permanent amelioration or change. Belladonna, against inflammatory colic, or if symptoms of abdominal inflammation set in, (see article Enteritis, and also Colic,) and administer accordingly. Dose. Dissolve "six globules in three table-spoonfuls of water, give DYSENTERY. 239 a tea spoonful every half hour (in very severe cases), or every hour (in less urgent instances), until positive amelioration or change. Colocynth, violent colic and distension of the abdomen (see Colic). Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every hour, until amelioration or change. Veratrum album, coldness of the body and extremities, and retching. Dose. Dissolve six globules in two table-spoonfuls of water, give a tea-spoonful every two hours (or every thirty or sixty minutes if the retching be very violent and continual), until distinct amelioration or change. Carbo vegetabilis, in extreme cases, with scarcely percep- tible pulse, and cold breath. DOSC Two globules in a tea-spoonful of water every half hour (in very critical cases), or every two hours, until positive amelioration or change. The use of clysters of warm water has, in many instances, been found serviceable in promoting an evacuation of the bowels, and bringing back the suppressed discharge. When the patient has escaped the serious consequences above noticed, chronic complaints are often the result of Sup- pressed Dysentery : the most frequent being Dropsy, Paraly- sis, and Rheumatism. Preventive Measures during the Prevalence of Dysentery. Mercurius corrosivus may be named as one of the most useful preventive medicines, particularly for cases in which the prevailing disease assumes the character described under the head of this remedy at page 233. Dose. Four globules in a table-spoonful of water night and morn- ing for six days; then a pause of two days, resuming the course as before, and so on for three weeks—unless before the lapse of that time a de»ree of medicinal irritation should have been established, in which case such medicinal action should be allowed to subside. Arsenicum is more generally appropriate, as a preventive medicine, to almost all varieties of dysentery which prevail as 210 digestive system. an epidemy, attacking many persons simultaneously, accom- panied with considerable fatality, and not confined in its ravages to particular localities. DOSC Three globules, as directed for Mercurius corr. CniNA may be mentioned as more especially appropriate to cases in which this disease prevails only in certain localities, particularly in marshy districts, or otherwise where the water is unwholesome, or where exhalations from decaying animal or vegetable substances infest the atmosphere. DOSC Six globules in a wine-glassful of water every morning the first thing (fasting), for a week; then pause four days, resuming the course as before, and so on, for three weeks—unless a degree of medi- cinal action should occur in the meanwhile, when that should be allowed to subside. CHOLERA. By the term Cholera Morbus was formerly understood a dis- ease attended with nausea, griping, purging, and vomiting, generally prevalent towards our summer months, and at the season when fruit abounds. But it has now become a generic term, under which are included two varieties—the Cholera Morbus, properly so called, and the Asiatic Cholera. SYMPTOMS. The first-named, sometimes called the Spora- dic Cholera, generally commences with a sudden feeling of nau- sea and griping, followed by purging and vomiting; in severe cases, accompanied with coldness of the body, particularly the extremities, anxious and hurried breathings, excessive thirst, a feeling of cramp in the legs, sometimes in the arms, with spasmodic contractions of the abdominal muscles, shrinking of the features, and a hollow expression about the eyes ; pulse weak, sometimes scarcely perceptible ; thin, watery, and fetid, or bilious evacuations, sometimes with dark bilious vomiting, anxiety, and tenesmus. CAUSES. The most frequent are worms, gall-stones, un- wholesome indigestible food; fruits, or crude vegetables, al- terations in temperature, moist or marshy situations, damp CHOLERA. 241 weather, wet feet, suppressed perspiration from sudden expo- sure to cold, cold drinks when overheated, dentition, or partu- rition. TREATMENT. In the treatment of Cholera, in its spo- radic form, (i. e.when the disease arises from occasional causes, such as cold, fatigue, &c.,) the following remedies will be found the most efficacious: Chamomilla is almost specific in the premonitory stage, par- ticularly when the complaint has been excited by a chill, or a fit of passion, or great dread of being attacked during the prevalence of the disease. The following are the symptoms which particularly indicate its employment: acute colic-like pains, or heavy pressure in the region of the navel, sometimes extending to the heart, with excessive anguish; bilious diarrhoea, cramps in the calves of the legs; yellow furred tongue, and sometimes vomiting of acid matter. {Pulsatilla is preferable to Chamomilla, when the attack has been brought on by partaking of rich, indigestible food, and when the stools are more of a mucous character. Colocynth, again, is more appropriate in some cases arising from a moral cause, more especially a fit of anger or mortifi- cation, attended with indignation). DOSC Dissolve four globules of Chamomilla in a tablespoonful of water; but if, after three doses have been given, this medicine appears to afford only partial relief, consider the two following remedies, and proceed with the one or the other, according to the distinctive symptoms present. Ipecacuanha may be administered after the above, should the attacks of vomiting become more prominent ; or it may be selected from the commencement, should vomiting predomi- nate, or at least assume as marked a character in the com- plaint as the diarrhoea. Other indications are—sensation of weakness, or softness (flaccidity) in the epigastrium, coldness in the face and limbs, sense of shivering in the abdomen ; slight cramps in the calves of the legs, and in the fingers and toes. Nux v. has been found of great value after Ipecac, when the vomiting yielded to the employment of that remedy, 242 DIGESTIVE SYSTEM. but symptoms of Cardialgia remained, such as weight in the epigastric region, anxiety, pain in the abdominal viscera, fre- quent small evacuations, and tenesmus, frontal headaches, horripilation with predominating internal chills. Dose. Dissolve six globules in two table-spoonfuls of water, give a tea-spoonful every hour (in cases in which the motions are very fre- quent), or every four hours (when the intermission is of longer dura- tion), until the symptoms abate; and then every six hours, until posi- tive amelioration or change. But if any of the subjoined symptoms should occur, consider the following medicines—returning, however, to the administration of Ipecacuanha, as just directed, if the vomiting should become a prominent symptom. Veratrum album, should the disease increase notwithstand- ing the employment of the preceding remedy, and assume the following characteristics: violent vomiting with severe diar- rhoea, excessive weakness, and cramps in the calves of the legs ; eyes hollow or sunken, countenance pale, and expressive of acute suffering and intense anguish ; coldness of the breath and tongue; excruciating pain in the region of the navel, tenderness of the abdomen when touched; dragging pains and cramps in the fingers, shrivelled appearance of the skin on the palms of the hands. (This is one of the best remedies in both varieties of this disease.) Dose. Dissolve twelve globules in two table-spoonfuls of water, give a tea-spoonful every half hour (or in very urgent cases, even every ten or fifteen minutes), until the symptoms abate, the pains being more bearable, and the motions and vomiting less frequent or incessant, art of the chest, heat in the gullet and pit of the stomach, diminished or totally suppressed emission of urine. When these symptoms characterize the onset of the attack, Camphor may be recommended almost as a specific remedy. But there are Exceptions to tlie fitness of Camphor in the treatment of cholerine, namely: (1) that it is rarely or never of service, but often does mischief when the malady has already subsisted for a considerable time (two or three days); (2) that the cases in which it has been recommended as above stated, are not to be considered as simple cholerine (in which it is of compara- CHOLERINE. 263 lively rare advantage); (3) that the conditions and symptoms should be w^ell ascertained before its employment, because it is calculated to do mischief if inaptly administered; whence it would follow, that we should mention— The Antidote most readily available for cases of injudicious or excessive administration, which is—a table-spoonful of strong and pure coffee, without milk or sugar. DOSC When appropriately and judiciously administered, the dose of Camphor should consist of two drops on a small lump of sugar, or in a sufficiency of sugar-of-milk, repeated at intervals of an hour, until the symptoms are modified. Advanced Stage. TREATMENT. Acidum phosphoricum is the remedy which has proved specific in the majority of cases of a severe or protracted character. It ought, therefore, to be taken in such instances without delay, and especially when excessively frequent painless diarrhoea and flatulence, with hoarseness and gradual prostration of strength, are the sole, or at all events the only marked symptoms. Dose. Three globules in a table-spoonful of water every hour, until three doses have been given, and then after every motion until the symptoms abate. Subsequently, however, the doses should not be repeated more frequently than every six hours, and so on, until perma- nent amelioration or change. But if such indications as are subjoined, in respect of Ipecacuanha and Veratrum should occur, proceed with one or both of the last-named, according to special indications, return- ing, however, to the administration of Acidum phosph., as just directed, should the diarrhoea continue to increase whilst the other symptoms subside. Phosphorus may be required either from the onset, alone, or to be succeeded by the foregoing medicine, or may be found of considerable service after the previous administration of Acidum Phosphoricum, in cases in which symptoms and circumstances characterize the case, such as the following:— debilitating diarrhoea continuing (or supervening) after the r emoval of more urgent symptoms, especially if the stools be watery, and, sometimes, productive of an acrid, pungent sen- sation in the last intestine, and attended with belching, weight 264 DIGESTIVE SYSTEM. or oppression at the pit of the stomach and about the lateral regions (without the heat or burning which accompanies this symptom in such cases as identify the fitness of Arsenicum for administration), and pain in the region of the navel, rum- bling noise in the bowels either at other times or on pressing the hand against the belly, pricking or shooting pains in the left side of the chest. Dose. In all respects as directed for Acidum phosph. Ipecacuanha for the treatment of cases in which the attack has been precipitated by overloading the stomach. This medicine is more especially successful at the onset of the attack, but may be identified as appropriate in all stages of the malady by such symptoms as the following:—nausea with copious vomiting, griping pains more or less severe, followed by relaxed motions, consisting chiefly of feculent matter or sometimes intermingled with slimy phlegm, and generally of a greenish or brownish color; or again, if the symptoms partake of these features as well as of those stated under the head of Veratrum, the alternate administration of both may be applied with advantage. DOSC If singly, of a solution of eight globules to two table- spoonfuls of water, give a tea-spoonful every half hour, until three doses have been given (or the earlier modification of the symptoms) and then every four hours, until permanent relief (or distinct change) results. But if, notwithstanding treatment, such symptoms as are below stated should occur, pause one hour, and proceed at once with the next medicine. If in alternation with Veratrum, dissolve six globules of each medicine, separately, in two table-spoonfuls of water, and give a tea-spoonful, first of one solution and then of the other, in rotation, at intervals of one hour, until the symptoms are modified, and then of four hours, until they are subdued. Veratrum may be required at any stage of the malady, whether early or late (and should be administered one hour after the last dose of any other medicine), when the subjoined symptoms occur:—watery stools, accompanied from the onset by great general debility, with cramps and coldness of the feet and legs, griping, and occasionally vomiting. In cases in which the symptoms identify both Veratrum and Ipecacuanha, CHOLERINE. 265 jointly, the alternate administration of both is the preferable method of treatment. DOSC If singly, a solution of six globules, as directed for Ipecacu- anha. If in alternation with the last named medicine, as directed in the foregoing prescription. Mercurius when the symptoms are usually wTorst at night, the motions copious, bilious, and greenish, or scanty, frequent, frothy, slimy, or bloody—when they are accompanied by se- vere griping or cutting pains and painful straining—when they produce a smarting or burning sensation on being evac- uated—and also when nausea, eructations, increased secretion of saliva, nocturnal perspiration, shivering, shuddering, trembling, lassitude, and a tendency to fainting, are associated with the above. DOSC Three globules in a table-spoonful of water, every two hours until three doses have been given, and then every four hom-s until posi- tive amelioration or change. Pulsatilla in the case of bilious, slimy, watery, or pap- like motions, of a whitish, yellowish or greenish color; or when the stools change their appearance, and when the diar- rhoea is attended with headache, foul tongue, flatulent rum- bling noise in the bowels, and other signs of deranged diges- tion ; also chilliness or alternate heats and chills, lowness of spirits, pain in the back, and when the symptoms are usually exacerbated in the after part of the day. Dose. Three globules in a table-spoonful of water every three hours, until amelioration or change. Nux Vomica when small, frequent, watery, slimy, or san- guineous, or whitish or greenish-colored motions, attended with weight, pressure, and constriction in the region of the sto- mach; foul tongue, griping, straining, rumbling of wind, headache, pains in the back, anxiety, irritability of temper, internal chilliness. Dose. In every respect as directed for Pulsatilla. Chamomilla is more particularly adapted to children or highly sensitive females. Its leading indications are bilious, 266 DIGESTIVE SYSTEM. slimy, or watery, green or yellow-colored evacuations, some- times having the fetor of rotten eggs, and attended with vio- lent colic or a fulness at the pit of the stomach, distension and hardness of the bowels, want of appetite, bitter taste, foul tongue, and, with children, excessive restlessness, crying or screaming. When a fit of passion—a not unfrequent exciting cause of diarrhoea or cholera during the prevalence of the latter disorder—has given rise to the attack, Chamomilla is almost always of more or less use. Dose. Four globules in a table-spoonful of water, every hour, un- til three doses have been given, and then (if requisite) every three hours, until positive - amelioration or change. But if no material improvement ensue, within an hour after the fourth dose, or, if the subjoined symptoms and circumstances become apparent, proceed with the next medicine after a pause of two hours. Colocynth should be administered six hours after the fourth dose of Chamomilla in such cases as seem to have indicated that medicine, but in which it has produced little or no per- manent improvement; or, again, it may be preferred to Cham- omilla in cases in which the following symptoms and condi- tions are especially identified:—slimy, watery, frothy, green- ish-yellow, brownish or even bloody stools, accompanied with thirst, great anxiety (as if proceeding from the fore part of the chest), intense colicky pains, and pains in the legs; the symptoms being aggravated soon after eating or drinking. Colocynth is especially appropriate both when these symp- toms transpire spontaneously (as it were), and yet more par- ticularly when (as already stated under the head of Chamo- milla) the attack is attributed to a fit of passion. DOSC Of a solution of eight globules to two table-spoonfuls of water, give a tablespoonful, as directed for Chamomilla. Ferrum m. is often of singular efficacy in painless diarrhoea, with inclination for stool soon after eating or drinking, espe- cially when this system is further characterized by such mani- festations and conditions as the following:—diarrhoea without pain, or pain only in the back and at the termination of the last intestine, paleness of the face, weakness of the eyes, and CHOLERINE. 267 impaired digestive powers, are the characteristic indications for Ferrum. Its alternate administration with China is often advantageous when its sole employment is insufficient to complete the cure. DOSC If singly, of a solution of six globules to three table-spoon. fuls of water, give a tea-spoonful every three hours, until four doses have been given (or the earlier modification or subsidence of the symp- toms), and then, if necessary, every six hours, until positive ameliora- tion or change. If in alternation with China, dissolve six globules of each medicine separately, in a wine-glassful of water, and give a table-spoonful first of the one solution, and then of the other, at inter- vals of four hours, until positive amelioration or change. China is especially indicated by copious, painless diarrhoea, or watery, brownish stools, attended with pungent heat at the termination of the last intestine, severe constructive or grip- ing pain and flatulent rumbling in the bowels, loss of appetite, eructations, thirst, and great weakness. Exacerbation after a meal, or at night, and at a particular hour or period of the day. Dose. In every respect as directed for Ferrum met. Arsenicum is required when the motions are scanty, watery or slimy, of a greenish, yellowish, whitish, brownish, or blackish color, and create a pungent, acrid, burning feeling during and after the act of evacuating. Further, when the diarrhoea is accompanied by excessive colic, or burning pain in the chest, stomach and bowels, great thirst, sleepiness, nocturnal anxiety, rapid prostration of strength, aggravation of the complaint at night, after eating and drinking, or regular recurrence of the complaint at a particular hour, after an interval of cessation. Dose. Of a solution of four globules to two table-spoonfuls of water, give a tea-spoonful every hour (in severe cases), or every three hours (when the diarrhoea is less frequent), until the symptoms are modified, and then every four hours, until they subside or change. If the attack be periodical, give three globules in a table-spoonful of water, an hour before its anticipated return. But if only partial relief ensue from the administration of Arsenicum-, within three hours after the fourth dose, pause three hours longer, and proceed with the next medicine. 268 DIGESTIVE SYSTEM. Lachesis is appropriate in the few cases in which Arseni- cum (or even Mercurius. as before stated) fails to afford per- manent relief, and should accordingly be administered six hours after the fourth dose of the preceding medicine. DOSC Of a solution of six globules to two table-spoonfuls of water, give a dessert-spoonful every four hours, until positive ameliora- tion or change. Dulcamara, particularly when it has come on after getting the feet wet, or from a chill during a moist state of the at- mosphere. The following are, however, the symptoms which usually call for its employment: watery, slimy evacuations, of a yellow or greenish color, attended with cutting pain, or colic in the region of the navel, and sometimes nausea, &c, with want of appetite, much thirst and languor, aggravation at night. Dose. Three globules in a table-spoonful of water, every two hours, until the symptoms abate, and then every four hours, until positive amelioration or change. Rhus is generally to be preferred to any other medicine, when diarrhoea sets in after exposure to a thorough drenching. The more immediate indications for its selection are, watery, slimy, sanguineous, frothy, gelatinous or red-colored stools, attended with aching (rheumatic) pains in the limbs, head- ache and griping, aggravation of the symptoms at night, or after eating and drinking. Dose. In every respect as directed for Dulcamara. Carbo vegetabilis is occasionally required when the stools are slimy, watery or sanguineous, but more espe- cially when flatulent rumblings and colic form the predomi- nent symptoms, and nothing but an excessive Quantity of flatus, or, at the most, a small quantity of shme, or slime and blood are evacuated. Dose. Three globules in a table-spoonful of water, every three hours, until distinct amelioration or change. Cantharides is useful when the motions are scanty and attended with straining, pain in the region of the bladder, cholerine. 269 frequent desire to urinate, with difficult emission, sometimes of only a few drops, after much effort. Dose. Of a solution of four globules to three table-spoonfuls of water, give a dessert-spoonful every two hours, until the symptoms abate, and then every four hours until positive amelioration or change. Treatment of protracted and obstinate Cases. Acidum Phosph., Sulphur. In all cases, which although to a certain degree modified, have not thoroughly yielded to previous treatment as hereinbefore directed, but threaten to become protracted and exhausting, one or both of these medi- cines may prove of signal service. Dose. Six globules of Acidum phosph. in a wine-glassful of water, night and morning, until distinct amelioration or change. But if little or no permanent benefit should succeed after the third dose, pause twelve hours, and proceed with Sulphur. Sulphur. A disposition to haemorrhoids, or to cutaneous eruptions, is corroborative of the fitness of Sulphur. Dose. Six globules in a table-spoonful of water, every morning, the first thing (fasting), for a week (or until the earlier manifestation of an important change in the state of the patient). Calcarea is sometimes required after Sulphur in the cases of females, and also in the instance of infants. Dose. In every respect as directed for Sulphur. DIET AND REGIMEN. Acids, coffee, strong tea, fruit —unless of the best quality, and perfectly ripe, and even then in moderation—most vegetables, except when well boiled, and with the other limitations named after fruit,—eggs, veal and young meats in general, pastry, and smoked or salted meat and fish—shoidd be strictly abstained from. If the appetite is pretty good, at the beginning of the attack, chicken- or mutton-broth, or beef tea thickened with arrow-root, rice, or sago, may be taken; otherwise gruel, rice and milk, sago and milk, &c, made thin, are preferable. Food of a more sub- stantial quality must be ventured upon with great caution. Exercise is to be very sparingly indulged in; and exposure to cold and damp avoided. In severe cases the patient ought to be kept warm in bed. 270 digestive system. LIVER COMPLAINT. This disease is divided into the Acute and Chronic: the latter generally goes by the name of Liver Complaint, al- though a careful diagnosis will often discover that the real disease is in the stomach and intestines; however, in many cases the liver itself becomes materially implicated, and in itself deserves considerable attention. When the disease has been for a long time unchecked, and the inflammation be- comes deeply seated in the substance of the liver, an abscess frequently forms, bursting either externally or internally; in the latter case often proving critical, or bringing on hectic fever. ACUTE INFLAMMATION OF THE LIVER. HEPATITIS. This disease is much more common in tropical climes than with us. There, a high mode of living, exposure to heavy dews or damps in the evening, and the powerful rays of the sun by day, are among its principal exciting causes; but it may also arise from violent mental emotions, the use of stim- ulating or alcoholic drinks, suddenly suppressed evaluations, strong emetics or purgatives, the abuse of mercury, gall- stones, external lesions, or injury of the brain. SYMPTOMS. This differs according to the seat of the in- flammation. When it occurs on the outer surface or convex side, the symptoms closely resemble those of pleuritis ; there is generally a violent pain in the right hypochondrium, some- times resembling stitches, at others burning—shooting to the sternum, the right scapula and point'of the shoulder, and even affecting the right foot,—sensation of numbness or ting- ling in the arm of the same side, the pain increased by in- spiration ; a short dry cough, and the symptoms of inflamma- tory fever; bowels irregular, generally constipated, and stools, in the majority of cases, of an unnatural color. In this form the patient can only lie on the left side. When the seat of inflammation is on the inner or concave side of the liver, the pain is much less, and the patient com- INFLAMMATION OF THE LIVER. 271 plains rather of a sensation of pressure than actual pain, but the whole biliary system is much more affected. The eyes and countenance become yelknv, and sometimes complete jaun- dice declares itself; the urine is orange-colored, the evacua- tions mostly hard, and generally of a whitish or gray color. We also find bitter taste in the mouth, vomiting, and con- siderable distress. The patient can only lie on the right side. Inflammatory fever is met with in this variety likewise. In both forms, the right hypochondrium, on examination, will usually be found hot, tumefied, and painful on pressure. Inflammation of the liver, unless properly treated, is apt to assume the chronic form ; it may also end in suppuration externally, or internally by a communication either with the lungs or intestinal canal, or by a vomica in the substance of the organ itself, or it may terminate in indurations or other alterations of structure, in gangrene, or in the formation of adhesions. The disease may terminate by resolution, critical metas- tases, hemorrhoids, diarrhoea, epistaxis, or cutaneous, particu- larly erysipelatous, eruptions. TREATMENT. The following remedies are those which are most frequently required in the generality of cases:— Aconite is especially indicated in the commencement of the attack, and may always precede the other remedies, when there is violent inflammatory fever, attended with insupporta- ble shooting pains in the region of the liver, with tossing, restlessness, and great anxiety and anguish. Dose. Dissolve six globules in two table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Belladonna may be advantageously employed after Aconite has subdued the preceding symptoms, or from the commencement, when the following indications present them- selves : oppressive pains in the region of the liver, which ex- tend to the chest and shoulders, distension of the pit of the stomach, sometimes extending across the epigastrium, produc- ing a sensation of tension, with difficult and anxious respira- tion ; determination of blood to the head, with cloudiness and 272 digestive system. giddiness, sometimes causing faintness ; great thirst, tossing about at night and sleeplessness. (Temperament, sanguine lymphatic.) DOSC. Dissolve six globules in two table-spoonfuls of water, and give a tea-spoonful of the solution every four hours, until amelioration or change. But if symptoms of medicinal aggravation should occur the administration should be suspended, until the re-ascendency ot the disease itself becomes manifest; or again, if no positive and permanent improvement should ensue within four hours after the third dose, pause two hours more, and proceed with the next medicine. When Belladonna fails to remove the whole of these symp- toms, we frequently find that Mercurius will have the desired effect; this medicament is too well known as an allopathic remedy in the cure of this disease, and the consequences pro- duced by its abuse are frequently so great, as to render the disease almost incurable. It is generally administered by allo- pathic practitioners, even when not indicated, until its marked pathogenetic symptoms declare themselves, and consequently the patient, in addition to the original malady, has frequently to contend with a medicinal disease. The following are some of the principal indications for its employment. Considerable fulness or tumefaction in the region of the liver, with pricking, burning, or oppressive pains, not allow- ing the patient to lie long on the right side, and sometimes augmented by movement of the body or part affected ; pains in the shoulders; bitter taste in the mouth, want of appetite, thirst, and protracted shivering, sometimes followed by sweat- ing, but without relief, with pale yellow color of the skin and eyes ; also in more advanced stages of the complaint, when there is induration of the liver, or when we have reason to suspect the formation of matter. {Arsenicum, Hepar s., or Silicea, are equally, if not more, deserving of attention in the latter case.) If the patient is of a lymphatic temperament, or is distinguished by softness of the muscular system, there will be additional reason for selecting Mercurius. Dose. In all respects as directed for Belladonna. Lachesis. In subacute cases, or in those in which Bella- inflammation of the. liver. 273 donna or Mercurius have merely afforded partial relief, la- chesis is often of great service. It may also be administered with advantage, alternately with the said remedies, in obsti- nate cases occurring in drunkards. . DOSC Dissolve six globules in two table-spoonfuls of water, give a tea-spoonful at intervals of eight hours. Bryonia, when the pains in the region of the liver are mostly shooting, or consist of an obtuse pressure, with tension and burning, increased by touch, coughing, or respiration, and especially during inspiration ; or much exacerbated by move- ment ; also when the symptoms are attended with violent spasmodic oppression of the chest; rapid and anxious respi- ration ; bitter taste in the mouth, tongue coated yellow ; and constipation. Bryonia, like Chamomilla, is particularly use- ful in cases which have been excited by mental emotion, such as a violent paroxysm of anger, and is well adapted to persons of nervous or bilious temperament, and of choleric disposition. DOSC Dissolve six globules in two table-spoonfuls of water, give a tea-spoonful every six hours, until distinct amelioration or change. In cases in which the pain is very severe, the doses should be repeated every two, three, and four hours progressively, according as improve- ment ensues, and, subsequently, eveiy six hours, as already stated. Chamomilla, in slight cases, or simple irritability of the liver with pressive, aching pains, pressure in the stomach, op- pression of the chest, and a sensation of tightness under the ribs, yellow color of the skin, pains not aggravated by motion, &c.; tongue foul and yellow, bitter taste in the mouth; parox- ysms of great anxiety. Chamomilla is almost a specific, when the above symptoms have been brought on by a fit of passion. Dose. In all respects as directed for Bryonia. Nux vomica is particularly indicated, when the pains are shooting and pulsative, and attended with excessive tender- ness, at the region of the liver, to the touch, pressure in the epigastrium and under the ribs, with shortness of breath, and constipation : also when enlargement and induration occur; and in the chronic form, when there are marked symptoms of 274 digestive system. gastric derangement, Temperament sanguine or bilious ; die position choleric. (Vide Nux vomica, art, Indigestion.) DOSC In acute attacks, three globules in a table-spoonful of water, every three hours, until a degree of effect is apparent, and then every six hours, until positive improvement results In chronic cases, six globules in a table-spoonful of water, every night at bed-time, for a week, after which, a pause of four days should ensue, the administra- tion being similarly resumed, if necessary, and so on. Arsenicum. Distension of the right hypochondrium, with severe burning pains and sensibility to the touch, burning heat of skin, accelerated pulse, intense thirst, anxiety, vomiting of a dark-colored, grumous fluid. Dose. In very acute cases, dissolve six globules in two table-spoon- fuls of water, give a tea-spoonful every two, three, and four hours, ac- cording as the symptoms continue unmodified, or abate. When the sufferings are less intense, the repetition of the like dose may be de- ferred for intervals of six, eight, and twelve hours, with the like reser- vations. Pulsatilla. Sensation of tension in the region of the liver, and pressure or dull pain in the epigastric region; oppression at the chest, bitter taste, yellow tongue, nausea ; loose, green- ish and slimy stools; excessive anxiety, especially # towards evening or during the night. (Temperament lymphatic ; dis- position mild.) Dose. Dissolve six globules in two table-spoonfuls of water, give a teaspoonful every six hours, until amelioration or change. Sulphur is valuable to follow Nux v. or Pulsatilla when either the one or the other, although apparently indicated, does not speedily declare a decided action, or when the dis- ease continues, although in a diminished degree; it is particu- larly efficacious after Nux vomica, to combat the sequelae of the disease. Rhus, lycopodium, and Kali c may be required in some forms of Hepatitis. The two latter have, together with Sulphur, Silicea, and Hepar, been especially recom- mended in the abscess of the liver. DOSC. To assist the action of the other medicines, give four globules of Sulphur in a table-spoonful of water, following up the treatment with the lemedy judged most appropriate to the case, after an interval of twelve hours; when employed to combat the after- JAUNDICE. 275 effects of the disease, give six globules in a wine-glassful of water every morning, the first thing (fasting) for ten days (or until the earlier development of improvement or change), after which pause a week, resuming the course as before, if necessary, or proceed with another remedy. DIET. The same as under Fevers, modified according to the violence of the disease. LIVER COMPLAINT, OR CHRONIC INFLAMMATION OF THE LIVER. Hepatitis Chronica. In this form of the disease we find many of the symptoms which attend the acute variety, but in a modified degree ; and in addition, a continued pain or uneasiness in the right side seldom leaves the patient, who gradually falls off in flesh, and loses strength ; .and there is-, not unfrequently, an occasional cough with expectoration; sometimes considerable perceptible enlargement of the liver, either continuous or returning peri- odically, with a number of dyspeptic symptoms ; high-colored or red urine, yellow tinge of the skin and eyes, occasional febrile symptoms ; the pulse, except during these attacks, generally quick but regular. Nux vomica, Bryonia, Arsenicum, and Sulphur are reme- dies of great value in this as well as the acute form of liver complaint. It frequently, however, requires a careful discri- minative treatment, and all the acumen of the experienced practitioner to conduct the affection to a happy issue. (See Nux vom., Bryonia, Arsenic, and Sulphur in Acute inflam- mation OF THE LIVER.) Dose. Four globules every three hours, until better, or change. JAUNDICE. ICTERUS. SYMPTOMS. Yellow color, varying in shade from a pale saffron to a dark brown yellow, appearing first in the eyes, then extending over the surface of the whole body; hard whitish faeces; orange-colored urine; symptoms of deranged digestion, and sometimes, tensive pain or pressure in the region of the liver. 276 DIGESTIVE SYSTEM. In severe cases, even the perspiration will impart a yellow hue to the patient's linen. The disease frequently declares itself without being plainly referable to any exciting cause; the principal causes, how- ever, are affections of the liver, indigestion, poisonous sub- stances, taking cold, powerful mental emotions, emetics, or drastic purgatives, or internal obstructions, such as gall-stones, or even worms obstructing the biliary duct. Among the predisposing causes may be enumerated a too sedentary or irregular mode of life, indulgence in spirituous liquors, and the frequent use of aperients. It may be remarked that the malady frequently assumes the intermittent type. Jaundice is not, of itself, to be considered as a dangerous disorder, but rather as an indication of some internal derange- ment, which, if neglected, may entail serious consequences, for example, dropsy, hectic fever, or general atrophy. TREATMENT. Mercuries and Cinchona are two of the best remedies in the treatment of the disorder, particu- larly the former ; but, in cases where the patient has suffered from the abuse of that mineral, a preference may, in most cases, be given to Cinchona, especially when the disease ap- pears to have arisen from partaking of indigestible sub- stances, or where it assumes an intermittent form. Dose. As a preventive resource, give six globules of Cinchona, in a wine-glassful of water, night and morning, for three days, then pause two days, suspending treatment, or resuming the course, similarly, according to the state of the patient. For the treatment of jaundice, in an advanced stage, give four globules of Cinchona in a table- spoonful of water, three times, at intervals of four hours, and then at intervals of eight hours, until amelioration or change; or proceed with Mercurius: three globules in a tablespoonful of water, every six hours, until four doses have been given, and then every twelve hours, until permanent and positive amelioration or change. In cases which have been excited by a fit of passion,—as SourVe *be^re noted> no nnfreqnent cause—we should have when, in atoT^ ; but Nux VOMICA is to be preferred, dltl°n t0 thi8> th* bowels are confined, or alter- jaundice. 277 nately confined and relaxed. Nux vomica is also indicated, when sedentary habits, over-study, or indulgence in spiritu- ous liquors, appear to be the predisposing, or partly the ex- citing causes. DOSC. Four globules of Chamomilla in a table-spoonful of water every four hours, until six doses have been given, and then every eight hours; if no positive amelioration or change, take three globules of Nux vomica in a table-spoonful of water, as directed for Chamomilla. Pulsatilla. Lassitude, great weakness and anxiety, espe- cially towards evening; obtuse pressure, but sometimes also pricking or shooting pain, in the region of the liver, extend- ing occasionally upwards, towards the right shoulder ; whitish stools. Dose. Four globules in a table-spoonful of water, as directed for Chamomilla. Digitalis is a most important remedy in many cases of this disease; the following are the principal indications for its employment: nausea, retching, or vomiting, tongue clean or coated white ; pressure at the pit of the stomach and re- gion of the liver; sluggish state of the bowels, with white, gray, or clay-colored evacuations ; alternate heats and chills. (Icterus Spasmod. s. Spast.) Dose. Of a solution of six globules to three table-spoonfuls of wa- ter, give a tea-spoonful every two hours, until the violence of the symp- toms becomes modified; and then every four hours, until positive amelioration or change. Aurum is frequently an excellent remedy in obstinate cases, after Pulsatilla, when the disorder occurs in young females. Dose. Three globules in a tablespoonful of water, night and morn- ing, for a week (or until the earlier development of improvement or change), after which, pause four days, resuming treatment similarly, if requisite. Should the Jaundice be accompanied with symptoms of inflammation, and pain and pressure in the hepatic region, see Acute inflammation of the liver ; it may, however, be again observed in this place, that in the majority of such cases, Aconite, followed, if needful, by Belladonna, Mercu- 13 278 DIGESTIVE SYSTEM. rius, or Chamomilla, as best indicated, will be found of essen- tial service. DOSC. Three globules of Aconitum in a table-spoonful of water, every three hours, until amelioration or change; but if within two hours after the third dose the symptoms be only partially overcome, pause two hours longer and proceed with Belladonna, as directed for Aco- nitum. But if within two hours after the third dose the symptoms yet resist the treatment, pause four hours longer and proceed with the next medicine. In inveterate icterus, the alternation of Sulphur, Hepar sulplmris, lachesis, and Acid, nitricum has been found suc- cessful; but as these cases frequently arise from obstruc- tions, atony, or a spasmodic or irritable state of the liver and duodenum, they require considerable skill and discrimi- nation in their treatment. DOSC Give four globules of Sulphur in a table-spoonful of water, night and morning, for a week (or until the earlier development of improvement or change); after which pause four days, resuming treat- ment, similarly or not, according to circumstances. If in alternation or succession, an interval of twelve hours should elapse from dose to dose, the proportions being as already stated. The diet should be light and unstimulating; veal or chicken-broth, with bread (unfermented); roast apples, also mild vegetables, such as vegetable marrow, stewed lettuce, and French beans. Bacon, butter, eggs, milk, wine, spirits, and malt liquors in general must be strictly avoided. The drink should be chiefly confined to water. INFLAMMATION OF THE SPLEEN. SPLENITIS. SYMPTOMS. Sharp pressing or shooting pains in the region of the spleen, with, in most cases, a high degree of fever, general derangement, and sometimes enlargement and tumefaction ; and, when very severe, hematemesis. It is a rare disease in this country, but sometimes declares itself in hot seasons, when it is not unfrequently mistaken for other affections. It may, however, arise in individuals of deli- cate constitutions, or in children, when exposed to the inliu- INFLAMMATION OF THE SPLEEN. 279 ence of marsh miasms, particularly when to that cause has been added insufficient clothing, want of exercise or proper nutriment, and long-continued mental disquietude. The value of Cinchona in this malady, and the power it dis- plays of developing an affection closely similar to it, affords one of many exemplifications of the truth of the homoeopa- thic law. From our very imperfect knowledge of the physiology of this viscus and its relation to the other organs, this disease, except when it presents itself in the tangible form above men- tioned, is extremely difficult to diagnose. Its best character- istics are tenderness or sensibility on pressure in the sjjlenic region, with general debility, paleness of the complexion, bloodless appearance of the conjunctiva, languid circulation, and tendency of the extremities to become cold. TREATMENT. The chief remedies in this affection are Cinchona and Arsenicum, which are useful not only in its treatment, but against the tendency to dropsy, which not un- frequently developes itself in connection with this complaint; an aggravation, however, which can but rarely occur, where the proceedings of the practitioner are guided by the homoeo- pathic law, inasmuch as the very remedies employed to com- bat the disease itself are the surest preventives against such a result. Aconitum. Against the fever generally present, if the disease be severe. DOSC Dissolve six globules in two table-spoonfuls of water, and give a tea-spoonful of the solution every two hours, when the febrile symptoms run high, or every six hours, in less urgent instances, until the fever abates; then pause four hours, and proceed with such of the subjoined medicines as may appear best indicated. Cinchona, when the inflammatory symptoms have abated, or if no fever of any moment exists at the commencement, particularly if the disease owes its origin to marsh miasm, or if the accompanying fever presents an intermittent type, in which case it should be administered during the Apyrexia; moreover, if impaired appetite and general derangement be 280 DIGESTIVE SYSTEM. present;—see this medicine under Apepsia. Also, if the patient have been weakened by he-mattmesis or diarrhoea;— see these articles. When the abuse of this medicine has given rise to disease of the spleen, benefit will often be derived from the employment of Arsenic, Carbo v., Puis., Veratr., and Sulph. DOSC. When the disease presents no positive periodical character, and the symptoms are not violent, dissolve six globules of Cinchona to two table-spoonfuls of water, give a tea-spoonful every twelve hours, until positive amelioration or change. If the symptoms be very severe, the like dose should be repeated at intervals of six hours. If the dis- ease assumes a distinctly periodical character, the iikc doses should be administered, during the respite, an hour before the anticipated return of the attack. If in alternation with Arsenicum, dissolve the like quantities of each, separately, and administer, first two doses of the one at intervals of twelve hours, then pause twenty-four hours, and pro- ceed with two similar doses of the other, and so on. Arsenicum is useful where the disease resembles or is com- plicated with ague (see Cinchona and this remedy under art. Intermittent Fever) ; and further, when the patient com- plains of a violent burning pain in the region of the spleen, and a constant pulsation at the scrobiculus, attended with great anxiety; also vomiting of a dark, grumous, fluid, watery, or sanguineous diarrhoea, and burning at the anus; excessive weakness, and oedema of the feet. In some cases it has been found advantageous to alternate these two remedies, by giving a dose of Cinchona morning and evening, allowing an action of one, two, or three days, according to circum- stances, and then exhibiting the other in the same manner. DOSC. In all respects as directed for Cinchona. Arnica is indicated by pressive pain in the left hypochon- drium, causing dyspnoea, and when the vomiting of blood is excessive. (When external violence has given rise to the dis- order, Arnica is especially called for. Rhus may also be useful under similar circumstances, particularly when severe corporal exertion has produced the disease.) Dose. Dissolve six globules of Arnica in three table-spoonfuls of water, give a tea-spoonful every six hours, until amelioration or change. inflammation of the stomach. 281 But if Vomiting of Blood occur, the like dose should be repeated every three hours; afterwards take Rhus as directed for Arnica. Nux vomica is chiefly indicated by the symptoms of de- ranged digestion, constipation, &c, which remain after the more threatening symptoms are removed. Dose. Three globules in a table spoonful of water, at bed-time, un- til amelioration or change. Bryonia is found useful in milder cases, where an aching, shooting pain is felt in the region of the spleen, which is much aggravated by the slightest movement; or when the patient complains of a constant stitch in the side, or the left hypochondriac region, and general gastric derangement, with constipation. DOSC Three globules as directed for Nux vomica. The preceding are the remedies, which have been found most useful in the treatment of the disease, in the acute form. Chronic enlargement and indurations of the spleen require a long and judicious course of treatment for removal, or even amelioration. We shall, therefore, simply direct the atten- tion of the reader to those remedies which have proved most successful in these instances—namely, Sulphur, Calcarea carbonica, and Baryta carbonica (particularly when the mesenteric glands have become affected), and further, lyco- podium, Carbo vegetabilis, Plumbum, Ferrum, Mezereum, Platina, and Stannum. Dose. Give six globules of Sulphur in a wine-glassful of water every morning, the first thing (fasting) for ten days (or until the earlier manifestation of any change); after which pause a week, resuming treatment in the same manner, if necessary; or proceed with the next remedy. inflammation of the stomach, gastritis. As some difference of opinion exists among medical au- thors as to the application of this term, it may be as well to state clearly the disease intended to be treated of in this place. By gastritis is here meant, inflammation of the mucous 282 DIGESTIVE SYSTEM. membrane of the stomach, which frequently involves the sub- mucous tissue, and sometimes the muscular coat. SYMPTOMS. Burning, pricking, or shooting pain in the gastric region, increased by pressure, inspiration, or the pas- sage of food ; swelling, considerable heat, and tension over the whole stomachic region, sometimes with pulsation;. great thirst, nausea, and vomiting, increased or brought on by the smallest quantity of food or drink; sometimes with hydro- phobic symptoms {hydrophobia symptomatica); soreness of the throat, with inflammation of the fauces; hiccough, sobbing, great restlessness, anxiety, and prostration of strength ; cold- ness of the extremities; tongue generally red at the tip and round the edges, foul, rough at the centre and round the root; frequently also syncope, violent spasms, convulsions, even tetanus ; small, sometimes scarcely perceptible, and remittent pulse; sunken features, with expression of anxiety; and, generally, constipation, but frequently diarrhoea, or alterna- tions of these twTo states. Death may ensue—either from gangrene, in which case the pains suddenly cease, the coldness of the extremities increases, and the pulse becomes scarcely perceptible, and remittent; or from paralysis of the nervous system, during the attacks of the spasms or syncope. When this disease has been neg- lected or improperly treated, and the patient has the good fortune to escape with life, it may pass into chronic inflam- mation, schirrus, or ulceration of the stomach. CAUSES. The most frequent are partaking of cold drinks or iced water when heated or during hot weather; the admis- sion of acid or poisonous substances into the stomach ; lesion from having swallowed any rough-pointed body, external in- jury, ardent spirits, suddenly checked secretions or evacua- tions, abuse of emetics, and, finally, metastases. TREATMENT. The remedies which have been found e most useful in the homoeopathic treatment of gastritis. are Aconite is requisite in those cases in which synochal fever is developed, and must be repeated until relief is obtained, INFLAMMATION OF THE STOMACH. 283 or an alteration in the symptoms calls for the selection of another remedy. DOSC. Take three globules every two hours, until better or change. Belladonna may follow Aconite, if the active febrile symp- toms become relieved, but do not wholly subside under the employment of Aconite, and when there is vivid redness of the tongue at the tip and margins, inflammation of the fauces, and hydrophobia symptomatica. Dose. Dissolve six globules in three table-spoonfuls of water, give a tea-spoonful every two hours until amelioration or change. But if the subjoined symptoms occur, proceed at once with the next medicine. Ipecacuanha is usefid when the vomiting is excessive, the epigastric region considerably distended, and the patient affected with great anxiety, restlessness, and difficulty of breathing. Antimonium crudum may follow this remedy, or be given in preference thereto, if the tongue be much loaded. Bryonia may be administered after any of the foregoing re- medies, should they have afforded only partial relief, and particularly if the disorder has been excited by a chill from having partaken of cold drinks when overheated. Dose. Three globules in a table-spoonful of water, every three hours, until amelioration or change. But if only partial relief ensue within three hours after the third dose, pause two hours longer, and proceed with such of the subjoined medicines as may correspond most accurately with the symptoms of the case. Nux vomica is one of the most important remedies in the gastritis mucosa of drunkards, with lowr fever, nausea, and vo- miting, in the morning or after the simplest food ; weight, ful- ness, and pain in the epigastric region, and tremulousness of the hands. It is, moreover, one of the most useful medicaments, when this disease occurs as a metastasis from suppressed hemorrhoids, and has also been found efficacious after the previous administration of Aconitum, Bryonia, Ipecacuanha, and Arsenicum, when the disorder has been caused by a chill from drinking iced water when overheated. Dose. Three globules in a table-spoonful of water every three hours, until amelioration or change; bat if only partial relief occur 284 DIGESTIVE SYSTEM. within two hours after the third dose of Nux vomica (in cases in which this disease results from abuse of ardent spirits, &c), pause two hours longer, and proceed with the next medicine. Lachesis should be administered four hours after the third dose of Nux v. in cases of inflammation of the stomach result- ing from excessive use of ardent spirits, &c, if the disease continues to make head notwithstanding the previous treat- ment. Dose. Three globules as directed for Nux vomica. Pulsatilla has been recommended in the subacute form of gastritis, arising from the sudden suppression of some secre- tion, such as the menstrual flux, ccc.; and also in cases pro- ceeding from a chill in the stomach from ice, particularly after the previous employment of Arsenicum. Dose. Dissolve six globules in two table-spoonfuls of water, give a tea-spoonful every two hours, until the symptoms abate, and then every four hours, until positive amelioration or change. Arsenicum, single or in alternation with Aconitum, should the subjoined symptoms supervene, whatever may have been the exciting cause {other than poisoning with Arsenic); internal burning pain; excessive prostration of strength; thirst, with violent vomiting immediately after drinking; small, quick, and occasionally, intermittent pulse; anxiety, restlessness, and apparent sinking of the vital energies. Also when the pain suddenly ceases, or when the burning pain continues, and the tongue becomes covered with a thick yellow coating, the pulse weak, irregular, or intermitting, and purulent matter is occasionally ejected. In such cases, indeed, Arsenicum is almost a solitary resource. Again (in the later stage of the malady), when the extremities have become cold, the pulse small, the features sunken and expressive of intense anxiety, with hiccough, thirst, vomiting on partaking of the least morsel of food, solid or liquid, extreme debility, &c, Arsenicum may advantageously be administered alternately with Veratrum. Arsenicum may also in some cases be administered with advantage in alternation with Nux vomica (as statad under the head of that medicine), against inflamma- inflammation of the stomach. 285 tion of the stomach incidental to habitual excess in the use of spirituous liquors. DOSC If singly, in extreme cases, of a solution of six globules to two table-spoonfuls of water give a tea-spoonful every quarter of an hour, until the worst symptoms yield. In less urgent cases the like doses may be repeated every hour, until amelioration or change. If in alternation with Aconitum, dissolve six globules of each medicine, separately, in a wine-glassful of water, and give a tea-spoonful, first of the one solution and then of the other, allowing two hours to elapse between doses; if with Veratrum, the like dose of each medicine, the one half an hour after the other, until amelioration or change. Cantharides in the more violent forms of the disease, especially when the burning pain, so commonly attendant on this disease, is well marked. Dose. A solution of six globules as directed for Pulsatilla. When the sufferings are very intense and unintermitted, however, the doses may be repeated at first, at intervals of an hour. Hyoscyamus is indicated when there is stupor, or confusion of ideas, with incoherent speech; convulsions—symptoms like those of hydrophobia. Dose. Two globules, dry on the tongue every half hour, until the violence of the symptoms abates, and then every three hours until posi- tive amelioration or change. Sulphur and Carbo veg. in the last stage of inflammation of the stomach. Dose. Give three globules of Sulphur in a table-spoonful of wa- ter (or, if that be inconvenient, dry on the tongue), every half hour, until a degree of improvement becomes apparent, then every three hours, and if no positive amelioration or change, take Carbo veg. in the same way. Arnica, however, should be resorted to, if the attack can be traced to injury of the stomach from any rough or pointed substance having been swallowed, or if it has arisen from external contusion. Dose. Three globules in a table-spoonful of water every two hours, until a degree of improvement becomes manifest, and then every four hours, until positive amelioration or change. 13* 286 digestive system. INFLAMMATION OF THE BOWELS. ENTERITIS. SYMPTOMS. This disease is comparatively of rare oc- currence in the idiopathic form, and appears much more fre- quently as a symptomatic affection, particularly in the course of certain fevers—such as low Nervous or Typhoid Fever, Scarlet Fever, Measles, ccc.; and also in all diseases attended with hectic fever. It much more frequently occurs in the subacute or chronic, than in the acute form. In the acute form of the disease, in- volving the submucous tissue and j)eritoneal coat, as well as the mucous membrane, the symptoms are usually as follows: intense burning or pungent pain, generally in one spot of the abdomen, especially in the region of the navel, increased by the slightest pressure and by movement, with tightness, heat, and tympanitic distension of the abdomen ; sobbing, anxiety, and violent thirst, with aggravation of suffering from cold drinks; obstinate constipation; violent vomiting, first of slime and bile, and sometimes even of excrements {Ileus miserere); small and contracted pulse, inflammatory fever, flatulence, and frequently obstruction of urine. In the subacute form of the disease, or in simple enteritis mucosa, the pain is often very slightly felt, in comparison with that which accompanies inflammation of the peritoneal coat, and generally consists of a diffused soreness over the abdomen, which is commonly, though not always, increased on pressure; but indigestible food or cold drinks almost in- variably cause an aggravation of pain. The tongue is often very red, smooth and glossy; and, generally speaking, there is more or less redness at the tip and margins, however foul the centre may be. We also find loss of appetite, and indi- gestion, with nausea and vomiting, more or less prominent, according to the portion of the intestinal tube affected; being greater the nearer the seat of the inflammation is to the stomach. When the inferior parts are implicated (indicated by pain or soreness in the iliac regions and in the course of the colon), there is usually diarrhoea, the stools being fre- INFLAMMATION OF THE BOWELS. 287 quently slimy and mixed with blood, in severe cases con- sisting of pure blood, particularly when the rectum is involv- ed, in which case there is, moreover, considerable straining. The pulse is quick, the thirst sometimes excessive, with a greater or less degree of fever and extreme languor. Unless resolution take place, it may terminate in induration of the intestines—laying the foundation of chronic constipa- tion, hydrops, suppuration, or gangrene. The signs of approaching gangrene, or of its having set in, are the same as in gastritis, with the difference of situation. Among its exciting causes are, cold in the feet and abdo- men, suppressed discharges, cathartics, worms, metastases, parturition, indigestible or highly stimulating food, prolonged use of acids, sour wine, or beer, &c. The state of the atmos- phere appears to have some share in producing it, from the circumstance that the disorder sometimes prevails almost as an epidemy. TREATMENT. Arsenicum and, where required, Ve- ratrum are the principal remedies in the first-described variety of this disease, as w7ell as in the severest forms of gastritis, to which, indeed, it bears a strong resemblance; but the treat- ment must necessarily be commenced with Aconite when the accompanying fever is intense, and the skin hot and parched. Dose. Dissolve six globules of Aconite to three table-spoonfuls of water, give a tea-spoonful every two hours, until the fever abates. Arsenicum, Veratrum. One or both of these medicines, either singly, alternately^ or in succession, according to the circumstances of the case, may be denominated the most direct and appropriate remedies to strike at the root of the disease. Dose. Dissolve six globules of Arsenicum in three table-spoonfuls of water, and give a tea-spoonful of the solution every hour, until the violence of the symptoms becomes modified, and then every three hours, until positive amelioration or change. If in alternation with Veratrum, dissolve separately, the like quantity of each, and give, first, two doses of the one, at intervals of half an hour, then pause two houre, after which give two dosea of the other, similarly, and so on. 288 DIGESTIVE SYSTEM. If in succession, a pause of two hours should elapse between the administration of the different medicines. But if the subjoined symptom in particular should become predominant, proceed to select from the following medicines. Belladonna. Tongue red and smooth, or coated white or yellowish brown in the centre, with intense redness of the tip and margins, and inflammatory redness of the papillae ; skin hot and dry, intense thirst, hot, flushed face, giddiness with oc- casional delirium, especially atnight; sensation of soreness or of excoriation either in the umbilical and ccecal regions or over the entire abdomen, with tenderness on pressure, and some- times considerable distension, particularly in the region of the arch or transverse section of the colon. {lachesis is sometimes of great service after Belladonna.) Dose. Of a solution of six globules to three table-spoonfuls of wa- ter, give a tea-spoonful every four hours, until three doses have been given (or until the immediate symptoms abate), and then night and morning, until positive amelioration or change. But if the improve- ment resulting from the employment of Belladonna becomes stationary at a certain point, consider the subjoined medicines, and especially Lachesis. Lachesis is a most important remedy in enteritis, with burning, aching, cutting pain, oppressed respiration, tense, distended abdomen, with sensibility on pressure over the af- fected part, and obstinate constipation. {Belladonna may sometimes be returned to with advantage after lachesis ; but if any of the other remedies, such as Bryonia, Nux, or Sul- phur, &c, seem better indicated, they should unhesitatingly be had recourse to.) Dose. Three globules in a tablespoonful of water, every four hours, until the immediate symptoms abate, and then night and morn- ing, until positive amelioration or change, returning, however, to Bella- donna, if remaining and distinctive indications super-exist. Nux vomica. Redness of the margins of the tongue, with yellow or whitish coating in the centre ; sensation of soreness, with burning heat in the abdomen ; loss of appetite ; indiges- tion, with vomiting after partaking of food, and aggravation of the abdominal pain after drinking; flatulence, constipation, INFLAMMATION OF THE BOWELS. 289 or constipation and looseness alternately; scanty watery stools, or stools consisting of a small quantity of mucus, some- times tinged with blood, and attended with straining. This remedy is especially useful when the above symptoms have been caused by the sudden suppression of a hemorrhoidal flux, or from indigestible food, etc. Sulphur is frequently of great service after the previous employment of Nux vom. Dose. Three globules in a table-spoonful of water, every three hours, until amelioration or change. Mercurius is a most important remedy in this disease, even in the most serious cases, and especially after Aconite and Belladonna, or even Arsenicum, should that remedy have been called for. The following are its principal indications : tongue very foul, coated white or dark brown, sometimes dry, but more frequently covered with thick mucus ; excessive thirst ; abdomen hard, tense, distended, and very tender to the touch; copious, watery, bilious, and highly offensive stools, but more frequently there is constant urging to stool, followed, after severe straining, by the evacuation of a small quantity of mucus tinged with blood ; or at other times, of pure blood in considerable quantity; extreme prostration of strength, chilliness and shivering, with tendency to sweating at night, which, however, brings little or no relief. {Mercurius may sometimes be beneficially alternated with Belladonna, or with lachesis in more advanced cases.) DOSC Dissolve six globules in four table-spoonfuls of water, give a tea-spoonful every four hours (against the immediate symptoms), and subsequently every twelve hours, until permanent amelioration or change; but if, after three doses at the latter intervals (twelve hours), the improvement should cease to be regularly progressive, or this medi- cine should seem inadequate to complete the cure, especially if the undermentioned circumstance correspond, pause twenty-four hours and proceed with the next remedy. Acidum nitricum. The indications for this remedy are much the same as those described under the foregoing; it is therefore sometimes of great service in completing the cure when Mercurius has effected considerable improvement but seems inadequate to give further relief. It is an invaluable o90 DIGESTIVE SYSTEM. medicine in chronic cases, attended with abdominal tender- ness and tenesmus, and especially when the disorder occurs in individuals who have been previously subjected to an abuse of Mercury under allopathic treatment. DOSC. Three globules in a table-spoonful of water, night and morn- ing, for a week ; after which pause two days, resuming the course simi- larly, if requisite, and so on until amelioration or change. Bryonia. After the previous employment of Aconite, Bryonia is occasionally a very useful remedy here, particu- larly when the patient complains of severe headache, with constipation, and acute pain in the abdomen, aggravated by movement, and after meals ; it is also indicated when, after Aconite, there remain dark redness of the tongue, or whitish or yellow coated tongue, with parched mouth, and considera- ble thirst; loose, offensive evacuations, particularly after par- taking of food or drink; nausea and vomiting after eating. DOSC. Four globules in a table-spoonful of water, every six hours, against the immediate symptoms, and afterwards, night and morning, until permanent amelioration or change. Pulsatilla. When the acute inflammatory symptoms of enteritis, arising from the sudden suppression of some habitual discharge, as the catamenia, or the hemorrhoidal flux, or occurring as a sequela of measles, have been subdued by Aconite, and the following symptoms remain : tongue loaded with a thick white, grayish, or yellow coating; adipsia, or, on the contrary, excessive thirst, deranged digestion, loss of appetite, with nausea and vomiting after partaking of a little nutriment; sensibility of the abdomen on pressure, or on every movement; flatulence. DOSC Four globules as directed for Bryonia. Colocynth. In cases where the large intestines are the seat of inflammation, attended with tympanitic distension of the abdomen, and soreness and sensibility to the touch: tormina and diarrhoea, with increase of pain, followed by urgent desire to go to stool, after eating or drinking; nausea, or vomiting of bilious matter; frequent discharge of flatus. INFLAMMATION OF THE BOWELS. 291 Dose. Four globules in a table-spoonful of water, every three hours, during the continuance of acute suffering, and afterwards night and morning, until permanent amelioration or change. Chamomiiia is peculiarly well adapted to the treatment of the disorder in the form it is sometimes met with in children, or in highly nervous and excitable females, who are extremely sensitive to pain and complain loudly from trivial suffering; it is indicated, moreover, by a sensation of soreness in the abdomen, as if arising from internal excoriation or ulceration, accompanied with painful tenderness on slight pressure, and slimy, whitish, watery, or greenish or yellowish diarrhoea, of an offensive odor. Dose. Four globules as directed for Colocynth. Cinchona is frequently useful after Aconite or any of the foregoing remedies, when there is a tympanitic distension of the abdomen; diarrhoea, aggravated after a meal, with por- tions of undigested food in the evacuations; thirst, extreme weakness of digestion, and great debility. Dose. Dissolve six globules in three table-spoonfuls of water, give a tea-spoonful every four hours, until relief or change ensues. Cantharis. Li very serious cases, with discharge of pure blood at stool, and strangury; or in an advanced stage of the disorder, with evacuations of mucus and solid substances, like shreds of membrane, this remedy will frequently be found of considerable service. Dose. As directed for Cinchona. Colchicum will also be found useful, occasionally, in ad- vanced stages of the disorder, with tympanitic distension of the abdomen, diarrhoea, the stools consisting of white or trans- parent gelatinous mucus, or of blood mixed with substances resembling false membrane. Dose. As directed for Cinchona. Rhus. When eruptions break out about the mouth, and there is redness of the tongue, with pain as if from soreness or ulceration in the abdomen, and tenderness on pressure; watery, slimy, frothy, or sanguineous stools; low fever, with 292 DIGESTIVE SYSTEM. nocturnal delirium. Rhus is chiefly useful in symptomatic enteritis, such as frequently occurs in low Nervous Fever, which see. DOSC As directed before for Cinchona. The CHRONIC STAGE of the complaint, which is cha- racterized by fixed pain, fulness, or uneasiness and oppression in the lower part of the abdomen, increased after meals or after cold drinks; appetite impaired or capricious; thirst, particularly after dinner or at night; bowels constantly re- laxed, or affected by constipation alternately with diarrhoea; fetid and discolored evacuations; skin hot, harsh, and of an un- healthy hue; pulse rather quick; tongue loaded, but red at the tip and margins,—or redness of the entire tongue, with large and elevated papillae, especially at the root; emaciation, weakness and languor. Acidum nitricum is particularly indicated when there is thirst, attended with pains in the bow-els or other uneasiness after drinking; impaired appetite, tenderness of the abdomen, fetid diarrhoea and tenesmus; greenish stools, with ingesta, skin dry and harsh during the day, sometimes with nocturnal sweats. Dose. Four globules in a table-spoonful of water, night and morn- ing, for a week; then pause two days, resuming the course as before, if necessary, and so on until amelioration or change. Phosphorus. Soreness in the abdomen, with tenderness on pressure, and distressing tension after meals; obstinate diarrhoea, or constipation and diarrhoea alternately; stools containing ingesta; pulse rather quick and hard; weakness and emaciation. DOSC. As directed for Acidum nitricum. Sulphur. This remedy is one of the most useful in enteri- tis, arising from the suppression of some accustomed dis- charge, such as the hemorrhoidal, &c.; as also in cases arising from the driving inward of a tetter, or sudden healing up of an ulcer. It is also indicated when we find the tongue red or loaded; thirst; pain, as from excoriation, in the abdomen, with tenderness on pressure ; or fulness and uneasiness in the INFLAMMATION OF THE BOWELS. 293 abdomen, increased by cold drinks or after meals ; diminished or fastidious appetite, with aversion to meat; fetid diarrhoea, frequently containing ingesta; constipation, or constipation alternately with diarrhoea, flatulence ; skin yellow, or other- wise unhealthy-looking, or dry and peeling, but often covered with perspiration at night, or towards morning; pulse quick and hard; emaciation, with considerable debility. Dose. Dissolve six globules in a table-spoonful of water, every morning, the first thing (fasting), for ten days (or until the earlier de- velopment of new symptoms, change or improvement) : then pause four days, resuming the course, as before, if still required, and so on, until permanent improvement or change. If as an intermediary medicine (to assist in perfecting other treatment), a dose of six globules should be given forty-eight hours after the last, if any other medicine, and again at the expiration of twelve hours, after which a pause of three days should elapse before other treatment is resumed. Silicea. When the disorder has been excited by the sud- den suppression of the perspiration of the feet, or the sudden healing up of a chronic ulcer, Silicea is one of the most im- portant remedies. The following symptoms are some of the more immediate indications for its selection ; dryness of the mouth, loaded tongue, great thirst, with diminished appetite, and sometimes disgust at meat, or cooked and hot food, with desire for cold food and drinks ; abdomen hard, hot and tense, and painful to the touch; constipation, or extremely fetid watery stools; borborygmus, especially on movement; skin dry and parched during the clay, and covered with sweat to- wards morning; pulse quick and hard. Dose. The same as directed for Sulphur. Arsenicum has already been noticed as the principal remedy in acute cases of a violent character; it is, moreover, a re- medy of coasiderable service in some of the chronic varieties of enteritis, characterized by a feeling of soreness or of burning heat in the abdomen, attended with nausea, want of appetite and great thirst; increase of pain after cold drink; borboryg- mus; diarrhoea, sometimes with ingesta; fetid, discolored stools; skin parched, hard, and of a yellowish, unhealthy- looking hue; emaciation, with extreme debility. 294 digestive system. Dose. Three globules in a table-spoonful of water, night and morning, until positive amelioration or change. When we have reason to suspect worms as the cause of this affection, the patient must be treated accordingly. (See Invermination.) DIET. In acute cases of inflammation, either of the sto- mach or bowels, the regimen must be placed under the same restrictions as described in Fever; and in sub-acute and chronic cases the food should be very light, and given in small quantities; raw fruit, green vegetables, and sometimes potatoes, must be strictly prohibited; and the drink should consist solely of toast-water, barley-water, or the like. INFLAMMATION OF THE PERITONEUM.* PERITONITIS. SYMPTOMS. Painful tension and tumefaction of the ab- domen, with a sensibility to the touch even more acute than in enteritis, so much so, that the patient cannot bear the pressure even of a sheet upon the abdomen; frequently con- stipation or ischuria, and the symptoms of enteritis. CAUSES. General causes of inflammation, and, moreover, external injury, parturition, chill of the abdomen, and me- tastases. TREATMENT. In the first place it will generally be found beneficial to administer three or four doses of Aconitum, exhibited at intervals of time varying according to the exi- gency of the case, until the fever and inflammation lower ; this remedy has been found, in many cases, sufficient of itself to remove the affection, and in all it materially modifies its violence. DOSC Dissolve six globules in six table-spoonfuls of water, give a tea-spoonful every two hours, until the fever is more or less reduced (which will usually be effected by from one to three doses of this medi- cine), after which consider the subjoined medicines, for further treat- ment, if requisite. * The membrane that lines the cavity of the belly, and invests the Btomach and bowels. INFLAMMATION OF THE PERITONEUM. 295 When the cause is external lesion, we should prescribe Ar- nica, and at the same time apply bandages wetted with a di- luted tincture of the medicine, as recommended under Exter- nal injuries in cases of contusion. {Aeon, followed, if re- quisite, by Belladonna, is, nevertheless, indispensable, as soon as inflammatory fever, with excessive local tenderness, super- venes.) DOSC. Dissolve six globules in four table-spoonfuls of water, give a tea-spoonful every two hours, until three doses have been given, and then every six hours (if yet required), until amelioration or change. Should Aconite appear necessary, in alternation with Arnica, in con- sequence of the intensity of the fever, it may be given, in the dose already described, every two hours in rotation with Arnica. Application of the Lotion.—To a tumblerful of water add one tea-spoonful of the Tincture of Arnica, and saturate linen bandages with this lotion. The bandages should then be applied to the parts, and the whole covered. From time to time, as these bandages become dry, they should be resaturated or changed. Sometimes vomiting and other symptoms, closely resem- bling those of enteritis, are present; at other times, merely the marked sensibility of the abdomen and tumefaction, with gastric derangement; but as, physiologically considered, these symptoms arise from the intensity and extent of the inflam- mation, and the sympathy of the other organs, our chief care must be to lower the inflammation, which having been in a great measure effected by the first-mentioned remedy, we shall find considerable benefit from the employment of Nux vomica and Mercurius in combatting any remaining symp- toms :— Nux vomica, where there is painful sensibility, and dis- tension of the abdomen, with a tendency to the predomi- nance of gastric symptoms and ischuria. DOSC. Three globules every six hours until amelioration or change. When the inflammation extends to the pleura (the mem- brane which lines the chest and invests the lungs), and the breathing becomes affected, with acute shooting pain, we should have recourse to Bryonia, in the same manner as di- rected for Aconite. (See also Pleuritis.) 296 DIGESTIVE SYSTEM. When the peritoneal coat of the upper portion of the ali- mentary tube or of the stomacli itself becomes affected, evinced by an increase in the intensity of the disease, the pain extending higher—vomiting, generally a rare symptom, becoming severe and continual—collapse of the features, small pulse, and a rapid sinking of the vital energies, we should have recourse to Arsenicum. Dose. Of a solution of six globules to four tea-spoonfuls of water, give a tea-spoonful every two hours, until the symptoms are in some degree moderated; after which continue the administration at intervals of four hours, until positive amelioration or change. In cases where there are evidences of the brain being affected, Belladonna may be had recourse to. (See Phkenitis.) In other instances Cantharides, lach., Chamomilla, Bryonia, Rhus, lycopodium, Colocynth, ecc, may be found necessary. DOSC Of either medicine, as selected, dissolve six globules in six tea-spoonfuls of water, and give a teaspoonful of the solution every three hours, until amelioration or change. INVERMINATION. WORMS. HELMINTHIASIS. FEBRIS HELMINTHIACA. The existence of worms in the intestinal canal, in the majority of cases evidently arises from a peculiar constitu- tional taint, inducing a certain diseased state of the mucous or lining membrane, and thereby giving rise to the formation of these parasites; and, although no period of life is wholly exempt from their presence, infants and children appear to be much more subject to the affection than adults, on account of the predominance of nutrition in early youth. Weakness of the digestive functions, accumulation of mucus in the intes- tines, an ill-regulated diet, and a degree of moisture in the atmosphere, favor their generation. The three species most generally met with in the human subject are, the thread, or maw-worm {Ascaris vermicularis, Oxyuris), the long round worm {lumbricus, Ascaris lumbri- coides), and the taenia or tape-worm ; of the latter there are two varieties—the solitary taj>e-worm {Tcenia solium, Taenia osculis marginalibus), composed of long and slender articula- rNVERMTNATION. 297 tions, which has been known to exceed the length of thirty feet; and the broad tape-worm {Tcenia osculis superficialibus, Bothriocephalus lotus), which varies from three to ten feet, seldom comes away entire, but in joints, which are consider- ably broader and thicker than those of the variety first men- tioned. The presence of worms, unless when passed, is not always easy of detection, since subacute inflammation of the mucous membrane from other causes will frequently present nearly the same range of symptoms; but here (as in the treatment of most diseases) Homoeopathy presents two manifest advan- tages over the old system. In the first place, if acting upon the certainty of the existence of worms, we administer a remedy specific to the affection; in the next, when we are uncertain as to the true character of the complaint, and select a medicament distinctly indicated by the united symptoms, this medicament will be found applicable to the affection, from whatever cause it arises ; whilst a careful observance of the known pathogenetic powers of the remedies selected will materially assist us in tracing the disease to its proper source. SYMPTOMS. Worms, and especially ascarides, frequently exist in the intestines without occasioning any disturbance, and their presence is only known by their being observed in the evacuated faeces; but when the alimentary tube becomes irritated by them, a number of symptoms are developed, of which the following are the principal: Pallor and sickly appearance of the countenance, and sometimes flushing; livid circles round the eyes, dilated pupils; headache or vertigo; irregularity of appetite, or great voracity; fetidity of breath; acrid eructations; occasional nausea and vomiting; foul tongue; tensive fulness of abdomen, with a sensation of gnawing and burning at particular parts of the intestines; hard and tumid belly; great thirst; discharge of mucus from the rectum, bladder (and vagina); heat and itching at the anus; slight febrile symptoms, or remittent fever, and noc- turnal wakefulness, with low spirits or irritability of temper, and gradual emaciation; we also usually notice an inflamma- 298 DIGESTIVE SYSTEM. tory redness of the nostrils, with great disposition to picking or boring at the nose, especially in children, with sudden screaming when waking, and grinding of teeth. In addi- tion to the above general symptoms of this affection, we frequently meet with severe colic-like pains, with tenesmus and slimy and bloody evacuations ; dysury; strangury, invo- luntary flow of saliva, especially when asleep ; convulsions in children, and epileptic attacks, combined with cerebral affec- tions, in adults; inflammation of the bowels. The pain is periodic, and occurs particularly in the morning, and whilst fasting; melioration generally after eating. The quality of the food exercises considerable influence over the pains; milk, sugar, and other sweets, pungent, salted food, ham, cheese, raw fruit, etc., often produce aggravation. In tcenia, in addition to the above, we find a crawling, scraping or groping, and twisting sensation, extending from the left side of the abdomen towards the epigastrium, and even as far up as the oesophagus ; or a sensation as of some- thing rising into the left side of the throat, and then falling back; the feeling of a cold ball on either side, with an undu- latory motion; a sense of sugillation in the abdomen; creep- ing torpor and numbness in the fingers and toes. The principal exciting causes of worms are, insufficient and unwholesome food (excess of vegetable, and deficiency of animal diet), uncleanliness, impure air, with residence in a damp, dark, ill-ventilated dwelling. The leuco-phlegmatic habit appears to engender a predis- position to theu- formation ; and females are oftener affected than males. As already observed, the alimentary tube may be infested with worms without any other indication of their existence being developed beyond the fact of their occasional evacua- tion at stool. But the reverse is more frequently the case, and in addition to the anxiety and alarm which are so often created in the minds of parents by the distressing nature of many of the symptoms, in severe cases a further and more serious cause mVERMrNATION. 299 for apprehension is given rise to, when other diseases above noticed, such as chronic inflammation of the mucous mem- brane (sometimes followed by perforation), mucous fever, epilepsy, or hectic fever, become associated with inver- mination. The progress of the disease is generally slow, and there is a constant proneness to relapses. The prognosis is generally favorable, particularly in the case of ascarides. It is less so in that of tape-wTorm, chiefly on account of the greater dura- tion of the disease, and its more uncertain cure. When the colon and rectum are the seat of the disorder, the cure is more easily accomplished than when the stomach and small intestines are affected. When the nervous symptoms, so-called, such as sopor, spasms, dilated pupils, vomiting, are pre- sent, the case is liable to be confounded with hydrocephalus ; but in the latter the abdomen is flat or retracted, whereas in helminthiasis it is soft and distended ; the head in hydroceph- alus is hot, and the symptoms succeed each other in a regular course, whereas here they are very changeable, periodic, and inconstant. (See Hartmann's Acute Diseases, p. 175.) TREATMENT. Aconitum, Ferrum, Ignatia, Merc, Nux v., Marum ver., Cina, and Sidph. tinct. are generally the most appropriate against Ascarides. Cina, Nux v., China, Bella., Mere, Spigelia, &c, against Lumbrici. And Graph., Calc, Sabad., and Fragaria vesca (Dr. Gross); or Sulph., Merc, and Calc. (Dr. C. Hering); as also Carbo an. et veg., Kali c, Magnes. m., Natr., Phosph., Petrol., Plat, Tereb., Filix mas, Punica granat., Stannum, against tape-worm. Aconitum. When considerable febrile irritation exists, with restlessness at night, fever and irritability of temper, con- tinual itching and burning at the anus, and at times a sense of crawling in the throat. Dose. Two globules in a tea-spoonful of water, repeated at inter- vals of six hours, until the symptoms abate, or undergo a distinct change. When, however, the febrile action has been lowered by the employment of Aconitum, pause twelve hours, and proceed to consider the following medicines (especially Ignatia), wherewithal to continue the treatment. 300 DIGESTIVE system. In many cases Ignatia amara will be found the most appropriate medicine after Aconite, particularly if spasmodic twitchings take place in one of the extremities or in indi- vidual muscles, intolerable itching, and pain as from excoria- tion in the anus and rectum. (See Cina.) DOSC. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful, night and morning, until the whole is consumed, after which pause two days, and then suspend or continue treatment with the same or other medicines, according to circumstances. Ferrum metallicum is of much service when there is fre- quent vomiting and accumulation of watery fluid in the mouth. Dose. Three globules in a tea-spoonful of water, night and morning, until amelioration or change ; but if only partial improvement be manifested within twelve hours after the sixth dose, pause twenty- four hours, and proceed with the next medicine. Mercurius. When, in addition to many of the ordinary symptoms of worms, there is especially a constant inclination to go to stool, and diarrhoea with tenesmus; distension and hardness of the abdomen (umbilical region); increased secre- tion of saliva. DOSC. Of a solution of six globules, to two table-spoonfuls of water, give a tea-spoonful, night aud morning, until the whole is consumed; after which pause two days, and then suspend or continue treatment, with the same or other medicines, according to circumstauces. Sulphur, in case the annoyance still continues after the lapse of two or three days. This remedy is, however, some- times indicated from the commencement, and is in some cases alone sufficient to effect a radical cure. It is especially called for in lymphatic, leuco-phlegmatic habits, with tendency to frequent attacks of coryza and other mucous discharges; bit- ter, slimy taste, aversion to meat; irresistible longing for sugar ; alternations of loss of appetite and ^voracity; frequent regurgitation of ingesta, together with pyrosis, hiccough, vom- iting, and borborygmus; also when the before-mentioned itching and feeling of soreness in the anus and rectum are extremely distressing. Dose. Six globules in a table-spoonful of water, every morning, the INVERMINATION. 301 first thing (fasting), for a week, (or until the earlier development of new symptoms, improvement or change); then pause four days, and resume the same course (or other treatment, according to the remain- ing symptoms), similarly, until positive amelioration or change; or if no marked effect be produced at or before the completion of the first course, pause four days, and proceed with one or the other of the next medicines. Calcarea is, if anything, still better calculated than Sulphur to eradicate the tendency to worms. It is peculiarly well adapted to children of lymphatic constitution, with disposition to blenorrhcea ; cold in the head and diarrhoea; feeble debili- tated frame; defective nutrition; face pale and hollow, or puffy, and of diminished temperature; weakness of the ancles; complications with scrofula and rickets ; chronic derangement of the digestive functions. Dose. In every respect, as directed for Sulphur ; but if no marked effect result at or before the conclusion of the first course, or if the sub- joined conditions characterise the case, proceed with the next medicine. Silicea is often of essential service after Sulphur or Calca- rea, when the symptoms are generally much exacerbated at the first quarter, or at the period of full moon, as is very fre« quently the case in helminthiasis. Some of the other medica- ments, such as Mercurius, Nux v., or Pulsatilla, Ipecacu- anha, Antimonium, may be required after a few doses of Sul- phur or Calcarea, when indicated by the turn the symptoms may take; moreover the beneficial action of Sulphur or Calcarea is often materially assisted by the intermediate use of one or more of the aforesaid remedies. An interval of from six to ten days, and sometimes upwards, must gene- rally be allowed to elapse between the different remedies, in chronic cases. Dose. Of Silicea in every respect as directed for Sulphur, This course of treatment, persevered in for a short time, has often proved successful in most obstinate cases, by purifying the constitution, and restoring the mucous membrane to a healthy state. When excessive irritation is present, and does not appear to diminish readily under the action of the pre- ceding remedies, we may give a drop of the tincture of Urtica 14 302 DIGESTIVE SYSTEM. urens, in a little water, or on a piece of loaf sugar, every night or morning for several successive days, and should this not relieve the annoyance, we may administer an enema of a des- sert-spoonful of salt to a pint of water, of which from twro to six fluid ounces, according to age, may be injected; if this produces a relaxed state of the bowels a mixture of vinegar and water, in the proportion of one-fourth part of the former, may be used. (See Hering's Domestic Physician.) After this palliative course of treatment, the course above mentioned may again be adopted, should it appear necessary. Cina. This is an eminently useful medicine in the case of worms, and is generally indicated where the following symp- toms are met with: frequent boring at the nose, obstruction of the nose, great perverseness of temper, bashfulness, heat and irritation, constant inquietude and restlessness, with, in children, a desire for things which are rejected when offered; fits of crying when touched, paleness of face, with livid circle round the eyes; constant craving for food, even after a meal; griping, distension, heat, and hardness in the abdomen, with discharge of thread and round-worms, costiveness, constipa- tion, or loose evacuations; fever chills towards evening, hard quick pulse; little sleep, or restlessness, tossing about, start- ings, talking or calling out suddenly during sleep ; transitory paroxysms of delirium ; heaviness of the limbs; changing of color, the face being at one time pale and cold, at another red and hot; pupils dilated, tongue covered with tenacious mucus ; disagreeable eructations, vomiting; itching in the anus, and crawling out of thread-worms, involuntary micturition, and white, turbid urine; occasional convulsive movements in the limbs ; weakness and lassitude. This medicine is particularly indicated in Colic produced by worms. Dose. Of a solution of six globules, to two table-spoonfuls of water, give a tea-spoonful, night and morning, until the whole is consumed; after which pause two days, and then suspend or continue treatment with the same, or other medicines, according to circumstances. Nux vomica is a valuable adjunct in cases -of worms, with considerable derangement of the digestive functions, irritabi- TNVERMINATION. 303 lity of temper, and constipation; or excessive distension and sensibility of the abdomen and epigastric region; feeling of heat in the abdomen; inclination to vomit; exacerbation of symptoms early in the morning. (See also Dyspepsia, Gas- tric or Mucous Fevek.) Dose. Two globules, in a tea-spoonful of water, at bed-time, two nights in succession, then an interval of three days, after which repeat the two doses, as before, and so on, until positive amelioration or change. Mercurius. When we find diarrhoea, distension of the abdomen, and hardness in the umbilical region, with increased secretion of saliva. DOSC Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful, night and morning, until the whole is consumed; after which pause two days, and then suspend or continue treatment with the same, or other medicines, according to circumstances. China is appropriate when the symptoms are generally exacerbated at night, particularly the abdominal sufferings; or, when pressive aching pains are experienced below the um- bilical region after every meal, and are attended with disten- sion of the abdomen, pyrosis, pains in the epigastrium, and retching ; also, when in addition to the foregoing, there is an over-excitability of the nervous system, with spasmodic twitchings of the muscles in various parts, tremulousness and debility. Dose. In every respect as directed for Mercurius. Spigeiia in cases, with colic, voracity, diarrhoea, and chilli- ness ; or nausea in the morning, accompanied by a sensation as if something were ascending from the stomach into the throat; smarting in the nostrils, paleness of face, palpitation and anxiety ; exacerbation of symptoms, particularly after dinner. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful, night and morning, until the whole is consumed ; after which pause two days, and then suspend or continue treatment with the same, or other medicines, according to circumstances. Belladonna is best adapted to cases with cerebral disturb- tement; nocturnal delirium, with 304 DIGESTIVE SYSTEM. starting.? during sleep ; tendency to be startled or frightened by the most trivial cause ; also colic, headache, thirst, quick pulse, hot dry skin. Should these symptoms not yield to Bel- ladonna, recourse must be had to lachesis or to Silicea, if the febrile symptoms continue, and the patient be of a scrofulous diathesis. Dose. Three globules in a tea-spoonful of water, night and morn- ing, for four days (or until the earlier change or abatement of the symptoms); but if the headache, colic, thirst, &c. should continue unabated, within twelve hours after the last dose, consider the sub- joined medicines (especially Silicea, if the fever continue, and the undermentioned conditions qualify the case.) Cicuta virosa. Severe worm-colic, with febrile irritation and convulsions. {Bella., Ignatia, Hyoscyamus, are also valuable in the event of convidsions. See that article.) DOSC, Of a solution of six globules to four tea-spoonfuls of water, give a tea-spoonful every half hour (in very severe cases), or every three hours (when the symptoms are less urgent), until amelioration or change; or, if the deglutition of liquids be difficult, three globuies dry on the tongue, at similar intervals; or, if Cicuta appears inadequate to overcome the symptoms, consider the following remedy. The treatment of taenia, although similar to the above, has some modifications. In most cases Aconitum may be pre- scribed, followed by Cina, after which considerable relief is often experienced; subsequently Filix mas, a drop of the concentrated tincture, night and morning for four or five days.* Dose. Of Aconitum, three globules in a tea-spoonful of water, repeated at intervals of six hours, until the symptoms abate. A single dose is usually all that is required. In either case as soon as the course of Aconitum is completed (after a pause of twelve hours), proceed with one or other of the next medicines. * Dr. Wahle, of Rome, considers the Filix mas a specific remedy in t&nia, when anything sweet invariably disagrees with the patient, or rather with the worm. He has repeatedly found only a few doses of this medicine sufficient to remove all the symptoms and sufferings arising from tape-worm, when the aforesaid peculiarity formed a marked symptom; and that every trace of the worm disappeared after the employment of the remedy, if the patient paid strict attention to diet—carefully avoiding indigestible food for the space of a few months. (Neues Arch., Dritter Band, Erstes Heft, p. 3.) INVERMINATION. 305 Punica granatum has been employed with much success by Drs. Lobethal and T. O. Miiller. The latter gives the followr- ing symptoms as the principal indications for this remedy : Convulsive movements, catalepsy and epilepsy, syncope, ema- ciation with voracious appetite, sudden starting from sleep, hallucinations, hypochondriasis, vertigo, confusion in the head, dilated pupils, yellow color of the face, grinding of the teeth, accumulation of-water in the mouth, capricious appetite, eruc- tations of watery fluid, vomiting, sensation as if something wrere rising up in the stomach, distended abdomen, colic, pal- pitation of the heart, &c. (Hyg., Bd. x, pp. 137-93.) Dose. Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of the solution every two hours, until amelioration or change. In chronic cases, the following treatment has proved success- ful : Nux vomica, Mercurius, Sulphur and Calcarea. Pose, four globules of each remedy in rotation in two doses, two globules at night and twyo in the morning,—an interval of from six to ten days to be observed between the different remedies. When any improvement takes place after the administration of any one of these remedies in particular, it will be well to repeat that medicine at the stated intervals, as long as it ap- pears to do good, instead of going on to the next remedy in rotation. ItEGIMEiSr. The food .ought to be wholesome and nutri- tious ; and consist chiefly of meat, such as roast or boiled beef or mutton, sometimes chicken, and occasionally a light pudding; fruits or vegetables must be prohibited, as also milk, pastry, and sweetmeats ; and the utmost care should be taken to prevent children from eating raw herbs, roots, &c, which they are so prone to pick up in their rambles when not looked after. Plenty of exercise in the open air is of essential service, and must on no account be neglected. 306 RESPIRATORY SYSTEM. DISEASES OF THE ORGANS CONNECTED WITH THE RESPIRATORY SYSTEM. CATARRH, OR COMMON COLD. CATARRHAL FEYKR. This term is given to an affection which consists of a mild degree of inflammation of the lining membrane of the nos- trils and windpipe, and occasionally also of the ramifications of the latter, induced by exposure to sudden changes of tem- perature, or to a dampen- chilly atmosphere, with insufficient clothing, particularly as regards children. This complaint is characterized by slight fever, impaired appetite, obstruction of the nose, sneezing, unusual languor, pains in the head or in the back and extremities, and subsequently hoarseness or cough, generally preceded by transitory chills or shiverings : there is also a slight degree of wheezing and difficulty of breathing. When the disease is confined to the nose and sinuses it is termed a cold in the head ; of which latter affec- tion, as well as hoarseness and cough, we shall treat sepa- rately. TREATMENT. In many instances catarrh is carried off, or runs to a salutary termination in a day or two. This desirable result is frequently obtained by having timely re- course to the simple proceeding of remaining a little longer in bed, and encouraging a gentle sweat by drinking a warm demulcent fluid, such as gruel; bathing the feet and legs in warm water, at the temperature of about 98-100 degrees of Fahrenheit, is also a useful auxiliary mode of restoring per- spiration, but the patient should go to bed immediately after- wards. Very robust persons who are accustomed to be in the open air in all weathers, but who have caught cold after hav- ing overheated themselves, will frequently prevent any bad effects by drinking one or two glasses of cold water on going to bed; when, however, they have learned by experience that little benefit is to be derived therefrom, a few globules of Carb. v. or Silicea should be taken instead. A moderate de- gree of abstinence should at the same time be observed ; veal or chicken broth, bread, sago, or semolina pudding, being COMMON COLD. 307 substituted for the ordinary diet. The drink may consist of water-gruel, barley-water or toast-water. All strong liquors must be abstained from. The following are the principal medicines to be employed in the majority of cases, when called for: Nux vomica, when the symptoms of common cold declare themselves, will often check the attack. It is esj^ecially indi- cated by the following symptoms : Tickling or scratching ir- ritation in the larynx, dry cough, particularly in the morning, and sometimes during the day, rarely during the night; occa- sionally a small quantity of adhesive mucus is with difficulty expectorated after a fit of coughing; and the paroxysms are frequently attended with a painful sensation in the umbilical region, as if arising from the effects of a bruise or blow. This remedy is further of great utility in catarrhal fever with dispo- sition to chilliness, or wandering fever chills, worse during movement, coining on, and gradually increasing, in the after part of the day, and alternating with flushes of heat. Warmth and absolute rest mitigate these symptoms. When conve- nient, it is preferable that this remedy should be taken towards evening. Dose. Three globules in a table-spoonful of water at night, repeated, if necessary, after an interval of twelve hours. Chamomilla. In the treatment of children this medicine is generally more efficacious than Nux vomica in arresting the attack. It is (like Belladonna, Bryonia, China, Dulca- mara, Sulphur, and Silicea) extremely valuable in restoring the suppressed perspiration, and removing the following symp- toms : colic, with pains in the head, ears, and teeth, thirst, ill- humor, and impatience ; or dry heat of skin with chilliness (in any part of the body which may happen to be uncovered for a short time), or on lifting up the bed-clothes ; burning heat in one part (as for instance one cheek) and chilliness in another; severe, dry cough, especially at night, excited by tickling in the larynx. Dose. Three globules in a dessert-spoonful of water, as directed for Nux vomica. 308 respiratory system. Coffea cruda. This remedy is indicated where there is excessive sensibility, fretfulness, and sleeplessness, with gene- ral pains, especially in young persons. Dose. Three globules, as directed for Chamomilla. Belladonna, when there is a throbbing, bursting headache, attended with determination of blood to the head, and in- crease of the pain from movement or exposure to cold air. Dose. Two globules in a tea-spoonful of water every six hours, until amelioration or change. Cinchona. Aching pains in the shoulder-blades, and in the extremities, increased by the slightest pressure on the affected parts, with great restlessness, and constant desire to change the position of the limbs. Dose. Of a solution of six globules to three table-spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. Dulcamara, when the pain is more of a passive or dull, aching description, and felt only in particular parts of the head, with humming in the ears, and obtuseness of hearing; catarrhal fever with hoarseness, dry, rough cough, or cough with copious mucous expectoration, severe coryza, great heat, dryness, and burning of the skin; pains in the limbs, in- creased when at rest, and attended with a feeling of coldness, stiffness, and numbness; or when an offensive perspiration breaks out after an attack of cold; and wlien the affection has been brought on by suppressed perspiration, from exposure to a cold and humid atmosphere. Dose. If singly, of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful three times, at intervals of four hours; after which pause twelve hours, proceeding with the subjoined medi- cines, if necessary. If in alternation with Mercurius, three globules, first of the one then of the other, in a tea-spoonful of water, at intervals of four hours between them, continuing until positive amelioration or change. Mercurius, when the lining membrane of the eyelids, nos- trils and bronchi is highly irritated, and gives rise to copious lachrymation, coryza and cough, with profuse expectoration; headache, or feeling of tightness and fulness in the head, with pulsation extending to the nose; general heats predomi- COMMON COLD. 309 nate over the chills. When the pains in the limbs and joints are accompanied with profuse sweating, which affords no re- lief ; this remedy may be followed by Dulcamara should the sweat continue, and be of an offensive odor. DOSC If singly, two globules in a tea-spoonful of water, repeated at intervals of twelve hours, until the symptoms are subdued. But if symptoms characteristic of Arsenicum should occur, proceed at once with that medicine. Drosera. Painful or bruised-like pains, and paralytic weakness in the extremities ; frequent rigors, with coldness of the hands and heat in the face; hoarseness, and cough excited by roughness and scraping in the throat, aggravated by talking. DOSC Dissolve four globules-in two table-spoonfuls of water, and give a tea-spoonful of the solution every six hours, until amelioration or change. Arnica Montana, when aching pains, or pains as if arising from a bruise, are felt in the limbs after exposure to cold, causing excessive restlessness and a constant disposition to change the position of the affected parts, and increase of pain from the slightest touch or movement. Dose. Four globules in a table-spoonful of water night and morning, until amelioration or change. Conium maculatum is of great service in catarrhal fever with internal heat, much thirst, and great debility, scraping or scratching, itching and creeping sensations in the throat, which produce a dry, almost incessant cough. The patient dreads the slightest noise or whisper ; passes a restless night, the sleep being unrefreshing, and disturbed by anxious dreams ; urine cloudy and whitish. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. Acidum phosphoricum, aching pains, relieved by movement. Dose. Four globules in a tea-spoonful of water every twelve hours until amelioration or change. Silicea, pains in the limbs, colic and general derangement arising from suppressed perspiration, particularly in those who are subject to sweating at the feet. 14* 310 RESPIRATORY system. Dose. Four globules in a tea-spoonful of water morning and evening, until amelioration or change. Sulphur, in cases of swelling of the knee, or of the joints of the hand and fingers, from taking cold. It may, in many such cases, be followed by Calcarea carbonica in a week or ten days. Dose. Three globules in a table-spoonful of water morning and evening for three days; after which pause four days, and if the symp- toms, though partially removed, have become stationary, proceed with Calcarea carb. If, however, the improvement, though slow, is unin- terrupted and progressive, resume the administration of Sulphur, as before. Mezereum. Alternate heats and chills (the febrile heat occurring chiefly in bed, and the chills when out of bed); extreme sensibility to cold air, acrid coryza, burning irritation in the larynx and trachea, which provokes cough, attended with difficult mucous expectoration. DOSC Three globules in a table-spoonful of water every three hours, U:nil amelioration or change. Lycopodium. Inveterate catarrh, with lemon-colored, often bitter-tasting, mucous sputa; tearing, throbbing, frontal head- ache, aggravated in the afternoon or evening. Dose. Three globules in a tea-spoonful of water night and morn- ing, until amelioration or change. Ipecacuanha. Nausea and inclination to vomit, or Dysp- noea, almost amounting to suffocation, arising from having taken cold. Dose. Four globules in a tea-spoonful of water, repeated after the lapse of three hours, if the indicative symptoms still predominate. If, however, after another interval of three hours the symptoms still con- tinue with little or no diminution of intensity, pause three hours longer, and proceed with the next medicine. Arsenicum, should no amelioration declare itself in six or eight hours. (See the article on Cough and Influenza.) Dose. Two globules in a teaspoonful of water every three hours, until amelioration or change. Hepar s. is indicated by many of the symptoms which call for Merc, Euphr., and Nux. It is moreover of service, COMMON COLD. 311 where the respiratory organs are solely or particularly affected, the cough loose and attended with mucous rattling in the chest; pain in the larynx wliile coughing, and a feeling of weakness of chest which renders talking oppressive. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. Pulsatilla. Useful in cold in the head, with loss of the senses of taste and of smelling in consequence of a chill,— followed or preceded by Belladonna, should there be an un- comfortable sensation of heat in the eyes and head, and heat and smarting in the nose: or by Nux v., should there be com- plete stuffing or dryness of the nose. Dose. Three globules in a tea-spoonful of water every twelve hours, until amelioration or change. Or if either of the particular conditions enumerated as indicating consecutive treatment with Belladonna or Nux v. be present, proceed accordingly, twelve hours after the first dose of Pulsatilla. Rhus toxicodendron. General indisposition from ex- posure to a thorough wetting, when in a state of perspiration: followed by Bryonia in a few hours, if no improvement is experienced. Dose. Three globules in a tea-spoonful of water every four hours; but if, within four hours after the third dose little or no improvement be manifest, pause three hours longer, and proceed with the next medicine. Sepia. Catarrhal fever, with shivering chills on every movement in a wrarm room, rarely alternating with heat; noc- turnal spasmodic cough, with shortness of breath and inclina- tion to vomit, coryza, occipital headache. DOSC. Three globules in a tea-spoonful of water every six hours, until amelioration or change. Aconitum is one of the principal remedies in febrile attacks, provoked by cold, and particularly from exposure to a dry, cold wind, or to a draught, with hot, dry skin, or general shivering chills, alternating with burning heat of the surface, great thirst, especially towards evening, sensation of dryness, and roughness or scraping, slight burning, and excoriation in the region of the larynx, or even throughout the whole of the chest, which gives rise to an incessant, short, dry, Jiollow 312 RESPIRATORY system. cough (more of a hoarse or rough description at night); rest- less sleep, disturbed by confusing dreams, or crowding of fantastic ideas, when not by the cough. Dose. Of a solution of six globules to two table-spoonfuls of water, give a dessert-spoonful every four hours, until the fever symptoms become materially modified. After which, consult the subjoined medi- cines (especially Bryonia) for particulars respecting consecutive treat- ment. Bryonia may follow Aconitum, or it may be selected in pre- ference at the commencement of the attack, when there is an excessively dry, hollow cough, accompanied by tenderness of the larynx on pressure, inclination to vomit, and pain in the chest, as if it would be torn asunder, severe headache, aching pains in the limbs, increased by the slightest movement, violent coryza, thirst and coldness of the right half of the body. Dose. Three globules in a tea-spoonful of water every six hours, until amelioration or change. Camphora. Incipient catarrh, coming on after getting the feet wet, is frequently cut short by smelling spirits of camphor. When there is usually weariness, heaviness, and general unea- siness, attended with shivering, and dryness or- coldness of the skin, and symptoms of approaching fever, one or two drops, every ten minutes, for two or three times, will generally suc- ceed in preventing the development of an attack, either of common catarrhal fever, or influenza. The remedies for any other effects, arising from cold, will be found under the different heads, such as Sore Throat, Diar- rhoea, Cough, Hoarseness, eve. Some individuals, particularly among those of the fair sex, are tormented with an extreme degree of susceptibility to cold ; the best corrective of which is, to rub the throat, chest, and indeed the whole body every morning with a wet towel, until a glow of heat is produced,—drying one part before another is commenced,—also to acquire a habit of going out every day, provided there is no inherent predisposition to pulmonary con- sumption ; all extremes, either of heat or cold, should at the same time be avoided, and care taken, when the body is heated, to let it cool gradually. INFLAMMATION OF THE LARYNX. 313 INFLAMMATION OF THE LARYNX, OR UPPER PART OF THE WINDPIPE. LARYNGITIS. This disease consists in a suppurative inflammation, having its seat in the lining membrane of the larynx, or the connect- ing cellular tissue between it and the subjacent parts. The disease bears a considerable resemblance to croup, of which it very generally forms a part; but occasionally the inflamma- tion is exclusively restricted to the larynx ; and it is a frequent cause of a fatal termination in scarlet fever and small-pox. It is distinguished from croup by a constant hawking (which the patient voluntarily exercises in order to clear the air-passages) rather than a violent and involuntary cough,—and by the character of the sputa, which consists of a thick tenacious mucus rather than a coagulable and membranaceous-looking exudation. The invasion of the disorder is announced by the usual signs of inflammatory fever; the voice soon becomes hoarse and inarticulate, whilst a painful sense of constriction is experienced in the throat; the breathing is laborious and shrill during inspiration ; the larynx extremely sensitive to the touch, so that the slightest pressure against it, either exter- nally by the hand, or internally from the performance of the act of deglutition, is productive of the most distressing spasms, which threaten death from suffocation. The heat of skin is great, the pulse rapid and hard, the thirst considerable, but incapable of being satisfied from the suffering that is occa- sioned by the attempt. On examining the throat, the fauces are often found to present a red, inflamed, and turgid appear- ance ; in some cases the epiglottis is involved, and the motions of the tongue thereby rendered painful and difficult. As the disease gains ground, the face becomes swollen and sometimes livid; the eyes protruded as in threatened strangulation, and life is speedily cut short by asphyxia. The disease, if not arrested, occasionally runs its course in a few hours to a day or two at the farthest. TREATMENT. We have stated that the symptoms of laryngitis bear a close analogy to those of croup; and experi- ence has proved that the same remedies, which are so emi- 311 RESPIRATORY SYSTEM. nently successful in the treatment of that affection, are equally efficacious here. The principal of these are: Aconitum must be immediately exhibited when the signs of inflammatory fever declare themselves, and continued until it gives evidence of having effected an abatement of the febrile movement. DOSC Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every three hours, until the fever abates, or the subjoined symptoms supervene; after which, pause six hours, or even for a longer interval, if the improvement continues progressively, and proceed to consider the next medicines for further treatment. If in alternation with one or more of the other medicines, the like solution of each should be separately made, and an interval of four hours should be allowed to elapse between the doses of one and of another (unless very urgent symptoms occur, when more rapid succession becomes necessary. Spongia should, in the generality of cases, be administered six hours after the last dose of Aconite, or as soon 'as the breathing becomes shrill, and the pain and sensibility in the upper part of the windpipe are more decided, with increase of hoarseness and difficulty of articulation. DOSC. A solution of six globules, as directed fox Aconitum, proceed- ing with the next remedy, when the symptoms immediately indicating Spongia subside, or become modified. Hepar sulphuris should be given six hours, or sooner if needful, after the last dose of Spongia, when the latter remedy appears to have done all that it is capable of effecting; in which case this medicine will either be adequate to complete the cure, or at all events to bear the patient out of danger, and thus to leave more leisure for appropriate selection in treating the remaining symptoms. Hepar s. may, however, be selected to follow Aconitum in preference to Spongia, if the fever and burning heat of the skin continue notwithstanding the previous administration of Aconitum: Dose. Four globules in a tea-spoonful of water, repeated at intervals, four hours (if after Spongia, as just stated), or of two hours (if after Aconitum as just stated), until positive amelioration or change; but if, in ordinary cases, no important improvement ensue within two hours after the second dose, pause two hours longer, and proceed with the next medicine, hoarseness. 315 Lachesis, the peculiar action of which corresponds very accurately with the symptoms of this disease, particularly the extreme sensibility of the throat, and the pain and diffi- culty experienced in swallowing, should be employed three hours after the second dose of Hepar s., in the event of imperfect results ensuing after the foregoing course of treat- ment. Dose. Dissolve six globules in two table-spoonfuls of water, and give a tea-spoonful of the solution every three hours, until positive amelioration or change. Belladonna has likewise rendered very appreciable service, especially when there were considerable heat of the skin, much thirst, but complete inability to swallow liquids, owing to the spasms which the attempt occasioned ; further, when, on looking into the throat, it was found to present an inflamed and swollen appearance. Belladonna is, however, not to be administered in cases in which it has previously been employed: as, for instance, if the affection of the windpipe occurred immediately after an attack of pure Scarlet Fever. In such cases the subjoined method of treatment must be substituted. DOSC. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. But if Belladonna has been previously administered, substitute the following medicine. Hyoscyamus should be substituted for Belladonna, in cases in which the patient has been previously treated with the latter medicine. DOSC As directed for Belladonna. hoarseness, raucitas. Hoarseness, or roughness of the voice, arises from some abnormal condition of the larynx or trachea. In the majority of cases the seat of the affection is in the mucous lining of the larynx, which is extremely liable to be affected by the com- mon causes of catarrh; hence it is a frequent accompaniment of the latter disorder. 316 RESPIRATORY SYSTEM. The remedies, mentioned under Catarrh and Coroir, are generally found the most useful in this complaint. Amongst these, in cases of recent origin, the following deserve particu- lar notice: namely, Pulsatilla. Almost complete aphonia, particularly when accompanied with loose cough, or thick yellow coryza. Dose. Three globules in a tea-spoonful of water, night and morning, until amelioration or change; but if, after the course of a week's treat- ment, although much improved, the case be not cured but appears to have become stationary, proceed with one or other of the subjoined medicines, according to symptoms. Mercurius. This remedy will often be found useful in removing any symptoms remaining after the above, but it is to be preferred should the hoarseness, from the commence- ment, be attended with thin coryza, and when a sensation of burning or tickling is complained of, in the larynx, with the characteristic indication of Mercurius, namely, a disposition to profuse sweating, especially at night. DOSC Two globules in a tea-spoonful of water, repeated at intervals of twelve hours, until amelioration or change. Nux vomica. Hoarseness, accompanied by a dry fatiguing cough, worse in the early hours of the morning, with dry obstruction of the nose. Dose. Three globules in a tea-spoonful of water, night and morning, until amelioration or change. Capsicum. Hoarseness, and dry obstruction in the nose, attended with an unpleasant sensation of crawling and tickling in the nose; a severe cough, worse towards evening; and pains in other parts of the body, such as the head and abdo- men. It is better suited than Nux vomica for individuals of a lymphatic temperament. Dose. As directed for Nux vomica.. Rhus toxicodendron. Hoarseness, accompanied by sensa- tion of excoriation in the chest; oppressed breathing, with frequent and violent sneezing, miaccompanied by coryza, but occasionally by a great discharge of mucus from the nose, during the attacks of sternutation. HOARSENESS. . 317 Dose. Three globules in a tea-spoonful of water, every four hours, until amelioration or change. Sambucus nigra. Hoarseness, with deep, hollow cough; oppression at the chest; frequent yawning ; restlessness, and thirst. Dose. Three globules in a tea-spoonful of water, every six hours, until amelioration or change. Chamomilla. Hoarseness, with accumulation of mucus in the throat; cough worse at night, continuing even during sleep, and frequently with a degree of fever towards evening, and great irritability of temper. This remedy is frequently specific in cases of children. DOSC Four globules in a tea-spoonful of water, night and morning, for three days. Drosera. Hoarseness, with very low, or deep and hollow voice. Dose. Four globules in a tea-spoonful of water, night and morning, until amelioration or change. Carbo vegetabilis. Chronic hoarseness, worse in the morning and towards evening, with aggravation after talking. DOSC. Three globules in a table-spoonful of water, morning and evening, for four days in succession. Sulphur. Hoarseness, attended with roughness and scrap- ing in the throat; and of great value in obstinate cases, where the voice is low, and nearly extinct, particularly in cold damp weather. {Sulphur is especially useful after Puis.) Dose. Three globules in a tea-spoonful of water, night and morning, for two days in succession ; then an interval of one day, resuming the same remedy, as directed, for two more days, if the symptoms be yet unaltered or unsubdued. Hepar sulphuris is a most useful remedy in chronic hoarse- ness, particularly in individuals who have taken large quanti- ties of mercurial preparations. DOSC Three globules in a tea spoonful of water, night and morning, until distinct amelioration or change. 318 . RESPIRATORY SYSTEM. COLD IN THE HEAD. CORYZA. This affection is a very general attendant upon common catarrh. TREATMENT. When it is the leading symptom, or exists independently of those already mentioned, the best medicines for expediting its removal are : Nux vomica. Dry obstruction, especially during the night only, with pressive heaviness in the forehead, and confusion in the head; heat in the face, increasing towards evening. If these sensations occur in combination with other catarrhal symptoms, see the indications already given for the exhibition of this remedy under the several heads of Catarrh, Hoarse- ness, and Cough. This direction equally applies to the other medicaments here quoted. DOSC. Of a solution of six globules to four tea-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change ; but if the subjoined symptoms should continue with little or no modifica- tion within three hours after the fourth dose of Nux vomica, pause six hours longer, and proceed with the next medicine. Lycopodium will often be found efficacious after Nux v., in obstinate cases of stuffing of the nose, particularly at night, rendering it necessary to sleep with the mouth open, which causes a disagreeable dryness without much thirst, attended with confusion in the head and burning pain in the forehead. This remedy is frequently more or less useful in colds in the head of all kinds. Dose. A solution of six globules, as directed for Nux vomica. Pulsatilla. The discharge thick, fetid, greenish yellow, or mixed with clots of blood; loss of taste and smell, head- aches, sneezing, chill, especially towards evening; disposition to weep, lowness of spirits, heaviness or confusion of the head in a warm room. Dose. Three globules in a tea-spoonful of water, night and morning, for four successive days. Chamomilla. When the affection has arisen from checked perspiration, and there is an acrid discharge from the nose, COLD IN THE HEAD. 319 causing redness of the nostrils, and excoriation or soreness under the nose ; chapped lips ; shivering, with thirst. Dose. Of a solution of six globules to four tea-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Mercurius. Dryness of the nose, with obstruction; pro- fuse discharge, producing excoriation, swelling, or redness of the nose, pains in the head and face. This is a valuable remedy in the generality of ordinary cases of cold in the head, particularly when the complaint is, a» it were, epidemic* DOSC. Two globules in a tea-spoonful of water, night and morning, for four days; but if within twelve hours after the second dose the symptoms continue to become aggravated, notwithstanding treatment, proceed with the next remedy. Hepar sulphuris. Chiefly when only one nostril is affected, or when there is headache which is aggravated by the slightest movement; or when the complaint is renewed on each expo- sure to cold air; further, in most cases in which Mercurius, though apparently indicated, has produced little or no im- provement. DoSfi. Three globules in a tea-spoonful of water, night and morning, untl distinct amelioration or change. If, however, the headache con- tinue unabated, within six hours after the second dosS of Hepar, con- sider Belladonna. Belladonna may follow the above, after an interval of a few hours, if the headache continue unabated. When the sense of smelling is variously affected, being at one time too acute, and another too dull, there will be additional reason for resorting to this remedy. t Dose. Six globules in a table-spoonful of water, repeated at the expiration of four hours, and again after an interval of eight hours, if the indicative symptoms be still predominant. Ammonium c. Stuffed nose, especially at night; swelling and painful sensibility of the nostrils; dryness of the nose. * When the secretion from the nose is excessive, and there is, at the same time, confusion in the head, with redness and soreness of the eyes and eyelids, and copious acrid or scalding lachrymation, Euphrasia should be prescribed. 320 RESPIRATORY SYSTEM. Dose. Three globules in a tea spoonful of water, every four hours, until amelioration or change. Natrum m. Cold in the head, renewed by the slightest chill, or exposure to a current of air; obstruction of the nose every second day. DOSC. Four globules in a teaspoonful of water, night and morning, for a week. Lachesis. Swelling and soreness of the nose and nostrils, with copious watery secretion. DOSC. Of a solution of six globules to three table-spoonfuls of water, give a tea spoonful every three hours, until amelioration or change. Arsenicum. Obstruction of the nose, with, at the same time, discharge of thin, acrid, excoriating mucus, and burn- ing heat in the nostrils, &c. Suffering relieved by heat; pain in the back, feeling of general debility, or prostration of strength. Dulcamara is useful when fresh obstructions arise from every trivial exposure to the air. Ipecacuanha may be had recourse to after Arsenicum, if the latter has only par- tially relieved. DOSC Two globules in a tea-spoonful of water, every three hours, until amelioration or change; but if only partial relief ensue within three hours after the fourth dose, pause three hours more, and proceed with the next remedy. Graphites, and also Silicea, are useful in all cases which are of frequent recurrence, and always of a most obstinate character. DOSC. Three globules in a tea-spoonful of water, night and morning, for a week; after which pause four days, resuming the course as before, if necessary. . Camphor. In the premonitory stage of the complaint, with shivering and headache, the attack may frequently be checked by a drop or two of spirits of weak camphor admin- istered, &c. COUGH. TUSSIS. SYMPTOMS. Forced and audible expiration without fever; or a symptom in acute diseases,—such as fever, pneumonia, or phthisis; either dry or accompanied with expectoration. COUGH. 321 Cough, although not dangerous of itself, may become so, or form an important feature of other diseases. As a pre- cursor of phthisis it is too often neglected. It may arise from an irritation of the air-passages or lungs, from disease of these organs, or from cold or other causes ; or be merely sympathetic or the consequence of derangements of other important viscera. We purpose here to treat more par- ticularly of idiopathic, mucous or moist and dry cough. TREATMENT. The following are the medicines most useful in this affection: Aconitum. Violent short cough, with quick, hard pulse and feverish heat: pricking in the chest when coughing, or during inspiration. (See Acute Bronchitis.) DOSC. Three globules in a tea-spoonful of water, repeated, if neces- sary, at intervals of six hours, until the pulse and skin manifest less febrile disturbance. Dulcamara. The following are indications for the selec- tion of this remedy: moist or loose cough, with copious expectoration after exposure to wet; or cough with hoarse- ness and copious secretion of mucus in the bronchial tubes, sometimes accompanied by expectoration of bright-colored blood during the night; barking, shaking cough, increased or excited by taking a deep breath. (Compare with Rhus.) DOSC Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Belladonna. Short, dry, barking {spasmodic, catarrhal or nervous) cough at night in bed, and also during sleep, renewed by the slightest movement; dry cough day and night, with irritation or tickling in the pit of the throat, or sensation as if a foreign body were in the larynx, or as if dust had been inhaled; spasmodic cough, which scarcely allows time for respiration. This medicine is also sometimes useful in cough with rattling of mucus in the chest, pricking in the sternum or in the hypochondria, and expectoration of thick white mucus, coming on especially after meals ; lancinating pains in the abdomen; hoarseness, redness of the face, headache sneezing after coughing, and pain in the nape of the neck. 322 RESPIRATORY SYSTEM. Dose. Dissolve four globules in four tea-spoonfuls of water, and give a tea-spoonful of the solution every three hours, until amelioration or change; but if only partial relief has resulted, within three hours after the fourth dose, pause three hours longer, and proceed with the next medicine. Hyoscyamus frequently answers when Belladonna has only afforded partial relief, and may be preferred to that remedy when the dry, tickling, nocturnal cough is mitigated for the time by sitting up in bed; also when there is mucous rattling in the throat. Dose. A solution of four globules, as directed for Belladonna. Nux vomica. This is a valuable remedy in many cases either of a catarrhal or nervous character, and is particularly efficacious where there is a dry hoarse, fatiguing, and some- times spasmodic cough, which occurs in an aggravated form in the morning, and occasionally also towards evening, and attacks more or less during the day, but relaxes again at night, when, however, it is occasionally supplanted by oppression at the chest, on lying down or on awaking during the night, accompanied with a feeling of heat, and dryness in the mouth; if there be any expectoration, it consists merely of a little mucus, which is detached with great difficulty. The cough is generally excited by a disagreeable tickling or scraping, with a feeling of roughness and rawness in the throat, sometimes attended with Hoarseness and feeling of roughness in the chest, but more frequently with severe headache, or pain as if from a blow or bruise in the pit of the stomach, under the false ribs: it is frequently aggravated after meals, or by movement, not unfrequently also by reading or meditation, and is occasionally followed by vomiting. Dose. Three globules in a tea-spoonful of water, every three hours, until amelioration or change. Pulsatilla. Severe shaking, catarrhal or nervous spas- modic cough, worse towards evening and at night, frequently followed by vomiting; sensation of suffocation, as if from the vapor of sulphur ; increase of cough when in the recumbent posture; cough which is at first dry, then followed by copious COUGH. 323 expectoration of yellowish or whitish mucus, sometimes of a salt or bitter taste; or expectoration of mucus streaked with blood; wheezing, or rattling of mucus in the chest; the paroxysms of coughing are frequently accompanied with sore- ness, in the abdomen, as if from a bruise or blow, or painful shocks in the arms, shoulders, or back, and sometimes fol- lowed by a sensation as if the stomach became inverted from the violence of the cough; involuntary emission of urine when coughing; loose cough, with aching in the chest, hoarse- ness, cold in the head; excited by sensation of scraping or of erosion in the throat; shivering. DOSC. Three globules in a tea-spoonful of water, every four hours, until amelioration or change. Chamomilla. Dry cough, excited by continued tickling or irritation in the larynx and chest, and increased by talking; the cough is most troublesome during the night, but also occurs during the day, particularly in the morning and to- wards evening; accumulation of tenacious mucus in the throat; wheezing in the chest; cough during sleep, some- times accompanied with paroxysms, as of threatening suffo- cation ; cough with scanty expectoration of tenacious bitter mucus. This medicine is well adapted to the treatment of coughs in children, accompanied with more or less of the symptoms above described, or with hoarseness, cold in the head, dryness in the throat and thirst; great fretfulness; fever towards evening; paroxysms of coughing after crying, or after a fit of passion. Dose. Of a solution of eight globules to three table-spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. Bryonia. Catarrhal cough occurring in winter during the prevalence of frost and cold easterly winds, with aggravation of the fits of coughing on coming from the open air into a warm room. The following are the general indications for its employment. Dry cough, excited by constant irritation in the throat, or as if caused by vapor in the larynx and wind- pipe, with greatly accelerated respiration, as if it were im- possible to obtain sufficient air; spasmodic, suffocating cough, 324 RESPIRATORY SYSTEM. after partaking of food or drinks, and also after midnight; cough with prick ings in the chest, and violent bursting head- ache, especially at the temples, also with prickings in the pit of the stomach, or in the side; further, in loose cough with yellowish expectoration or slight spitting of blood, this remedy will frequently be found of great service; and likewise in dry nervous cough. DOSC. Of a solution of twelve globules to three table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Rhus toxicodendron. Short, dry cough, worse towards evening, and before midnight, excited by tickling in the chest, attended with hoarseness, or a feeling of roughness or rawness in the throat, congestion in the chest, a sensation of suffocating constriction, anxiety and shortness of breath; cough on waking in the morning, or short cough with bitter taste in the mouth, on lying down at night and on waking in the morning, with expectoration of viscid mucus, sometimes followed by vomit- ing. Cough with expectoration of bright blood, with sensa- tion of insipidity or exhaustion in the chest, or shooting pains in the chest and sides. Dose. Four globules in a tea-spoonful of water, night and morning, until amelioration or change. Ipecacuanha. Catarrhal, nervous, or spasmodic cough, particularly at night, attended with painful shocks in the head and stomach, and followed by nausea, retching, and vomiting; or dry cough, arising from tickling in the throat; or severe, shaking, spasmodic cough, with oppressed breathing, almost amounting to suffocation. In the case of children, this remedy is frequently valuable, when they appear to be threat- ened with suffocation from the accumulation of mucus, or where the paroxysm is so severe as scarcely to afford time for respiration, causing the face to assume a livid hue, and the frame to become quite rigid. waterStive?ti80,Uti°*",0f twelve globu'es to three table-spoonfuls of 8 , ungeiwg traces of the disease should remain, after COUGH. 325 the acute symptoms have yielded to Ipecacuanha, consider the next medicine. Mercurius. Catarrhal cough, with hoarseness, or watery coryza, or accompanied by diarrhoea; or dry cough, excited by irritation in the throat, or the upper part of the chest, which becomes particularly troublesome towards evening, and at night; sometimes with slight prickings in the chest when coughing or sneezing; excited or increased by talking; cough in children with discharge of blood from the nose, which coagulates as it flows, vomiturition, and headache; dry spas- modic cough, with retching after the paroxysms, and expec- toration of blood. DOSC. Two globules in a tea-spoonful of water, night and morning, until distinct amelioration or change; or, if retching be present, the like dose, every two hours, after fits of coughing. Carbo vegetabilis. Hollow cough excited by irritation, or a troublesome sensation of crawling in the throat and attended with burning pain and sensation as if from excoriation in the chest; catarrhal or nervous spasmodic cough, frequently followed by inclination to vomit or vomiting, occurring in paroxysms throughout the day; cough with hoarseness, espe- cially towards evening, or morning and evening, increased by sj^aking. Chronic cough with expectoration of greenish mucus, or even of yellowish pus—or with expectoration of blood and burning sensations in the chest (a characteristic indication for this remedy as well as Arsenicum). DOSC. Three globules in a tea-spoonful of water, night and morning, for four days. Hepar sulphuris. Obstinate cases of violent dry, hoarse cough, sometimes attended with a dread of suffocation, and ending in lachrymation. The attacks are frequently excited or aggravated on any part of the body being exposed or becoming cold from the bedclothes slipping off, and - are generally worse at night; also dry deep cough excited by a feehng of tightness in the chest, or by talking, stooping, or ascending stairs; hoarseness. Dose. Four globules in a tea-spoonful of water, three times a day, until amelioration or change. 15 326 RESPIRATORY SYSTEM. Ignatia. Shaking spasmodic cough, or short hacking cough, as if arising from the presence of dust or feather-down in the throat, which becomes aggravated the longer the paroxysm of coughing continues; dry tickling cough with coryza, occurring both day and night. This remedy is, further, particularly efficacious, when the attacks of coughing become aggravated after ceding, or on lying down at night, or on rising in the morning, and when the patient is of a mild and placid temper, or subject to alternations of high and low spirits. Dose. Three globules in a teaspoonful of water, three times a day, until amelioration or change; if, however, the dry spasmodic cough at night should appear to resist the action of Ignatia, consider the next medicine. Arsenicum. Cough, with oppression at the chest, and tenacious mucus in the larynx and chest; cough excited by a sensation of dryness and burning in the larynx. Dry cough chiefly in the evening after lying down, often with difficult respiration and fear of suffocation {suffocative catarrh, catarrhal asthma), as if arising from inhaling the vapor of sulphur; dry cough, excited by eating or drinking, or by ascending stairs, or cough which arises as soon as the open air is encountered; thin acrid coryzei; sneezing; periodic dry cough—nocturnal cough with general burning heat; cough with expectoration of sanguineous mucus; pulmonary catarrh in old people, attended with tenacious mucous sputa, which is extremely difficult to eject, and causes rattling in the chest, oppressed respiration, and frequently symptoms of impending suffocation, or paralysis of the lungs. Dose. Two globules in a teaspoonful of water, every two hours, until amelioration or change; but if partial relief only accrue Avithin twelve hours from the commencement of the course, consider the following medicines. Ammonium carbonicum. Dry, tickling, suffocating cough, especially in the morning, sometimes with fever, occurring during the prevalence of a cold, stormy, bleak, state of the atmosphere, and attended with a sensation of hectt or burning behind the sternum, resembling that which is occasioned by drinking spirits; hoarseness; cold in the head, with copious discharge of acrid watery fluid. COUGH. 327 Dose. Three globules in a tea-spoonful of water, three times a day, until amelioration or change. If, however, the subjoined manifestations occur, pause twelve hours, and proceed with one or other of the succeed- ing medicines, according to indications. Ammonium muriaticum. This remedy is sometimes service- able after the former, when the cough sounds looser, yet is unattended with expectoration. DOSC Three globules, as directed for Ammonium c. Drosera. In many cases of chronic cough with hoarseness ; or deep hollow cough, with pain in the chest and under the ribs, alleviated by pressing the hand on the side, excited or aggravated by laughing ; cough on lying down in the even- ing and during the night. Matutinal cough, with bitter and nauseous expectoration ; dry, spasmodic cough, aggravated at night, or towards evening, and frequently followed by vomit- ing of ingesta, or bleeding from the nose and mouth. DOSC, Four globules in a tea-spoonful of water, night and morning, for a week; after which pause four days, and if (which will rarely occur) further treatment be required, and the symptoms continue of the same character, renew the course as before. Silicea. Cough with oppressed breathing on lying on the back, or cough attended with tightness and oppression at the chest, as if something stopped the respiration while speaking, or coughing. Fatiguing, or deep hollow cough, day and night, aggravated by movement or speaking, and sometimes attended with aching and pain, as if from a bruise, in the chest; cough with copious expectoration of transparent mucus, or pus, sometimes streaked with blood ; cough with asthmatic breath- ing and emaciation, with dread of suffocation at night; cough irritated or excited by a sensation as if a hair were on the tongue. Dose. Three globules in a tea-spoonful of water, night and morning, for four days. Lachesis. Fatiguing cough, excited by dryness or conti- nual tickling in the larynx or chest; or by pain or tickling in the pit of the stomach or the epigastrium ; also by the slightest pressure on the exterior of the throat; cough excited by talk- 328 RESPIRATORY SYSTEM. ing, laughing, or reading aloud, or anything which may tend to increase the dryness or irritation in the throat; short, dry, suffocating cough, as if caused by the presence of a crumb of bread sticking in the throat, with ineffectual efforts to expectorate. Cough on rising from the recumbent posture, or attacks of cough always after sleeping, or on lying down to sleep ; or cough during the day, and at night during the sleep, so that the patient is unconscious of it; continual hoarseness, with a sensation as if something were in the throat which could not be detached. DOSC Two globules in a tea-spoonful of water, every two hours, until amelioration or change. Sulphur. In some cases of chronic cough, and particularly in dry cough, -which disturbs the patient at night as well as during the day ; the cough is frequently excited after partak- ing of food, or during deep inspiration, and is generally attended with a sensation of spasmodic constriction in the chest, sometimes followed by inclination to vomit, or the involuntary escape of urine, or pain as if from excoriation, or pricking pains in the chest; headache, pains in the chest, abdomen, loins, and hips; also cough, with expectoration of thick, whitish or yellowish mucus, or of a greenish yellow, fetid mucus, or pus, of a saltish or sweetish taste; feverish cough with spitting of blood. Dose. Three globules in a tea spoonful of water, morning and evening, for four days successively; after which pause four days, and, if necessary, resume a course of similar doses, on alternate days, and so on until positive amelioration or change. Calcarea carbonica. Dry cough, aggravated towards evening, or at night, excited by tickling in the throat, or by a sensation as if there were a feather down in the throat; also loose cough, with rattling of mucus in the chest, and expecto- ration of offensive thick, yellow mucus; anxiety. Dose. Three globules, in every respect as directed for Sulphur. Euphrasia. Cough, with violent coryza and lachryma- tion ; diurnal cough, with difficult expectoration of mucus ; COUGH. 329 or matutinal cough, with copious expectoration, and oppressed breathing. Dose. Four globules in a table-spoonful of water, three times a day, until amelioration or change. Sepia. Cough, with copious expectoration of mucus of a saltish taste, of a yellow or greenish color; also dry spasmodic cough, particularly at night, or on first lying down, attended, in children, with crying, fits of threatening suffocation, nau- sea, retching, and bilious vomiting. This remedy is especially adapted to individuals having a constitutional taint, such as the scrofulous, scorbutic, &c.; and in chronic coughs, with thick, yellowish, greenish, or even puriform expectoration, with a putrid taste, it is also a valuable remedy. DOSC Four globules in a table-spoonful of water, night and morn- ing, until amelioration or change. Stannum. Cough, with copious greenish yellow sputa, of a sweetish or saltish taste, attended with great weakness and disposition to sweats ; soreness at the chest as from internal excoriation; feeling of weakness or sinking in the chest, as if it were empty, particularly after expectorating, or even after speaking; or dry shaking cough, worse at night or towards morning, excited or aggravated by speaking or laughing, and occasionally followed by vomiting of ingesta. DOSC Four globules, as directed for Sepia. Lycopodium is very efficacious in obstinate coughs which are worst at night, and are attended with expectoration of tenacious mucus, and sometimes vomiting; paleness of the face, emaciation, precordial pains and oppression, flatulence, ill-humor. Dose. Three globules in a tea-spoonful of water, morning and even- ing, until amelioration or change. Cinchona. Paroxysms of cough as if excited by the vapor of sulphur, with whistling or rattling in the throat from mucus; expectoration difficult, consisting of clear, tenacious mucus, sometimes streaked with blood; pains in the shoulders, or prickings in the chest and windpipe; cough, sometimes with bilious vomitings; cough after hemoptysis. 330 RESPIRATORY SYSTKM. DOSC Of a solution of six globules to two table-spoonfuls of water, , give a third part every three hours, till the whole is consumed ; then pause twelve hours; after which continue the administration (if neces- sary) by giving four globules in a table-spoonful of water, night and morning, until amelioration or change. Phosphorus. Dry cough excited by tickling irritation in the throat or chest, or by laughing, talking, or drinking, or by cold air, and accompanied with pricking in the larynx; hoarseness, or pains in the chest as if from excoriation ; cough with hoarseness, fever, and depression of spirits, sometimes with apprehensions of death; dry sounding cough, followed by expectoration of viscous or sanguineous mucus. Dose. Three globules in a teaspoonful of water, night and morning, until amelioration or change. Arnica is of great value in coughs attended with bleeding from the nose and mouth; headache, pricking in the chest (pleurodynia), rheumatic pains in the loins and extremities, and soreness or pain, as from a bruise in the chest and abdomen. Dose. Three globules in a tea-spoonful of water, every three hours, until four doses have been given ; then pause eight hours, and if further treatment be requisite, and the general aspect of the symptoms the same, renew the administration of similar doses, night and morning, until positive amelioration or change. Staphysagria. Cough attended with pain under the ster- num as if arising from excoriation or ulceration ; expectora- tion of yellow, purulent-looking mucus; sometimes spitting of blood, and involuntary discharge of urine; exacerbations at night. Dose. Four globules in a table-spoonful of water, night and morn- ing, until positive amelioration or change. Squilla. In short, dry cough, excited by a full inspiration, or chronic cough, or catarrh with copious secretion of whitish, viscous mucus, which is alternately expectorated with ease and difficulty, this remedy is useful. DOSC. Four globules in a tea-spoonful of water, night and morn- ing, until amelioration or change. Spongia. In acute inflammation of the bronchial mem- HOOPING COUGH. 331 brane, this remedy is often of essential service (see Bronchitis), but it is of equal utility in the chronic variety when the fol- lowing symptoms prevail: cough with expectoration of muco- purulent sputa, emaciation, redness and deformity of points of the fingers, lividity and incurvation of the nails, hectic fever. Dose. Four globules as directed for Squilla. These are the principal remedies to be had recourse to in this disorder; but in complicated cases, we may have to call in the aid of other medicaments. When the symptoms take on an inflammatory character, the treatment recommended in acute bronchitis will generally be found applicable. Li obsti- nate nervous or stomach or duodenal coughs, which frequently occur in highly irritable, nervous, and hysterical habits, or in women during the last months of pregnancy, and which are generally dry, or attended with scanty and difficult expectora- tion, consisting of a little clear mucus, are to be relieved by the remedies mentioned under Dyspepsia. Change of air is often beneficial in such cases. For cough arising from Worms, see the remedies mentioned under that head; or from teething, see Dentition. HOOPING-COUGH. TUSSIS CONVULSIVA. PERTUSSIS. This is almost peculiarly a disease of childhood, and one which few individuals escape during that period ; it generally appears as an epidemy; and is, by the majority of physiolo- gists, acknowledged to be communicable by contagion; we seldom find an instance of a person suffering a second time from its attacks. Over many the affection passes lightly, but in the majority of cases it proves a distressing, and in some a fatal malady, baffling especially all the ill-directed efforts of the allopathic physician to conduct it to a favorable termination. Under the old practice, not only was a great deal of valua- ble time frequently lost in endeavoring to subdue inflamma- tion by antiphlogistic measures, but the patient's vital ener- 332 RESPIRATORY SYSTEM. gies were weakened, and rendered less capable of contending with the disease, when it assumed the spasmodic type. Now, however, on the contrary, wre have it in our power, by the administration of remedies specific to the affection, sometimes to check the inflammation at its outset, subdue the distressing attendant symptoms, and almost invariably to shorten the duration of the complaint, without allowing it to leave after it any of those evil consequences, such as de- bility and emaciation, which oblige the patient to endure a tedious and protracted period of convalescence. SYMPTOMS. Paroxysms of violent and convulsive ex- pirations, in rapid succession, interrupted by long whistling inspirations, and in young subjects a loud shrill whoop, ter- minated by the expectoration of a quantity of mucus, or a fit of vomiting, after which the attack ceases for some time. If the case is severe, the features swell and become livid ; blood escapes from the nose and mouth, and even from the ears. A complete cessation of respiration with threatening suffoca- tion takes place in the more violent paroxysms, as if from spasm of the lungs. The attacks return every three or four hours, and oftener in severe cases ; the least excitement brings them on; they are more frequent and violent at night. Respi- ration is free during the intervals, and the patient in every respect healthy, although suffering from weakness. Pathologists generally consider this disease under three stages; the distinction between the second and third is, how- ever, not often very clearly marked. The first or febrile stage commences with the symptoms of an ordinary catarrh, attended with slight fever, which gradu- ally increases, the breathing becomes more difficult, and is accompanied with irritative cough and pains in the chest. In the second or convulsive stage* the febrile activity disappears, and the characteristic cough and other symptoms of the disease develop themselves. In the third or nervous stage there are longer intermissions The congestive and nervous of some authors. HOOPING COUGH. 333 between the paroxysms, but increased weakness from the duration of the cough. TREATMENT. In the incipient, febrile, irritative, or catarrhal stage of the cough, the most appropriate remedies are to be found amongst those we have already pointed out in the treatment of common Cough, and must be selected according to the indications there given, and administered in the same manner, unless otherwise specified. By a careful selection of these remedies it is frequently possible to check the disorder in the first stage. Accordingly, the most suitable medicaments for this purpose are: Dulcamara. When the attack lias apparently been excited by exposure to wet (a thorough wetting); the cough loose, with copious and easy expectoration. DOSC. Three globules in a tea-spoonful of water, every six hours, until amelioration or change; for very young children, one globule in a tea-spoonful of water, every four hours, until amelioration or change. Pulsatilla. Cough loose, and accompanied with lachry- mation, weakness of the eyes, sneezing, thick discolored coryza and slight hoarseness, and inclination to vomit after coughing; occasional diarrhoea, especially at night. Dose. Three globules, as directed for Dulcamara ; for very youno- children, of a solution of two globules to six tea-spoonfuls of water, give a tea-spoonful every two hours, until amelioration or change. Mekcurius. Hoarseness, watery coryza, with soreness of the nostrils; dry fatiguing cough, generally occurring in two successive fits. Dose. Two globules in a tea-spoonful of water, immediately after the tits of coughing (but not more frequently than every hour), until amelioration or change. Belladonna is one of the most important remedies in the catarrhal stage of hooping-cough, when there is dry, hollow or harsh and barking nocturnal cough, or which becomes materially aggravated at night. This medicine is also par- ticularly well adapted to the angina or sore throat, which is not an unfrequent concomitant at the commencement of the affection. 15* 334 RESPIRATORY SYSTEM. DOSC Three globules in a tea-spoonful of water, every four hours, until amelioration of change ; for very young children, one globule in a tea-spoonful of water similarly. Hepar sulphuris. Cough worse at night, but looser than that indicating Belladonna. This medicine is also useful in forwarding the secretory process. Dose. Four globules in a table-spoonful of water, night and morn- ing, for two days; then pause two days, resuming the treatment after such interval, with the same, or with one or more other medicines, according to the symptoms which remain or supervene. Chamomilla. Dry hoarse cough, or cough with difficult expectoration of tenacious mucus, followed by a feeling of sore- ness at the part from which the mucus seems to have been detached. The paroxysms of coughing are excited by an almost incessant irritation of the larynx, and in the upper part of the chest. Dose. Three globules in a tea-spoonful of water, three times a day (for infants one globule in a tea-spoonful of water similarly), until amelioration or change. Nux vomica is of great service when the cough approaches the second stage. It is indicated by the following symptoms: dry, fatiguing cough, attended with vomiting, and occur- ring particularly from about midnight until morning, the paroxysms so protracted and violent as to produce apparent danger of suffocation, with blueness of the face, and occa- sionally bleeding from the mouth and nose. (Arnica is better adapted to this latter symptom, when it occurs with a copious discharge of blood.) Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change; for infants, a solution of three globules to two table-spoonfuls of water, administered by tea-spoonfuls at the like intervals. But if the discharge of blood last named be copious, or a very prominent symptom, consider and proceed at once (or in preference) with the next medicine, or again, n the suffocative symptoms occur very prominently, consider also -ipecacuanha. rovA^NI°t, Sh°uld be emP]°yed in preference to Nux vomica To theVmt-T7dy,if fhe VmPto™ supervene subsequently the admimstration) when the discharge of blood from the HOOPING COUGH. 335 nose and mouth is very copious, or constitutes a very promi- nent symptom. Dose. Three globules in a teaspoonful of water, every three hours, until the indicative symptom subsides. Ipecacuanha is, like the former, of great value when the cough is attended with danger of suffocation, and each inspi- ration appears to excite a fresh fit of coughing. It is further indicated wlien the fits are attended with spasmodic stiffness of the body, and blueness of the'face, great anxiety, and accumulation of mucus in the chest. Dose. Of a solution of six globules to three table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. For infants, a solution of two globules to six tea-spoonfuls of water, ad- ministered by tea-spoonfuls at similar intervals. Aconite may be had recourse to from time to time, when marked febrile or inflammatory symptoms are present, it being carefully borne in mind that the action of this medicine is of short duration, and may be followed in a few hours by any other of the remedies which appear more particularly indicated. Bryonia and Phosphorus are chiefly called for, when the cough threatens to become associated with inflam- matory action in the lungs, &c. Dose. Two globules in a tea-spoonful of water, repeated, when requisite, at intervals of three hours, until the febrile symptoms yield; after which pause at least three hours longer, and proceed with such of the subjoined medicines as most closely correspond with the symptoms of the case. Second or Convulsive Stage. TREATMENT. Drosera is one of the principal reme- dies of the disease, when it has reached this sta^e: and where the constitution has not been enfeebled by the trans- mission of hereditary weakness or other causes, it will speedily declare its beneficial effects, and materially shorten this trying and painful period of the disorder. The particular indications for the use of this medicine are: violent paroxysms of couo-h occurring in such rapid succession as to threaten suffocation and attended with the characteristic shrill sound during inspi- 336 RESPIRATORY SYSTEM. ration, and sometimes fever; after each fit of coughing, vomiting of food, or of stringy mucus ; relief on moving about. DOSC. Of a solution of' eight globules to two t able-spoonfuls _ of water, give a tea-spoonful after every severe fit of coughing, until im- provement or change. For infants, the solution should consist of four globules to the like quantity of water, and be administered by tea- spoonfuls. Yeratrum album is indicated when the child has become reduced in strength and emaciated; or when it suffers from cold sweats, particularly on the forehead, with excessive thirst, involuntary emission of urine, vomiting, and other symptoms common to this stage; also pain in the chest and inguinal region; fever. Dose. Two globules in a tea-spoonful of water, after every severe fit of coughing, or every half hour in very acute cases, until four doses have been taken; after which the intervals may be increased to four hours, and the administration thus be continued until positive amelio- ration or change. But if the beneficial effect be only partial within forty-eight hours after the commencement of the course, and the symp- toms continue of approximately the same character, consider the sub- joined medicines, and proceed accordingly. For infants, of a solution of one globule to three tea-spoonfuls of water, give a tea-spoonful at the same intervals. Carbo vegetabilis is frequently useful in bringing this stage of the affection to an early and successful termination, after the previous use of Veratrum or Drosera, or both of these important remedies ; particularly when, notwithstanding the decrease of cough, the tendeucy to vomit still remains. Dose. Two globules, in all respects as directed for Veratrum. When the vomiting, as also the cough, become more dis- tressing at night than at any other time, Conium may follow Veratrum, if the latter fails to relieve this peculiarity. Dose. Two globules in a tea-spoonful of water, night and morning, until amelioration or change. Cuprum aceticum. This remedy is found most useful in the nervous stage, particularly when convidsions with loss of consciousness ensue after each paroxysm. Also when we find yomiting after the attacks, and rattling of mucus in the chest, HOOPING COUGH. 337 and wheezing at all times. In almost all cases a marked benefit has followed the employment of this remedy; some- times it has been found sufficient of itself to cut short the disease, and in others, has so far modified it, that other reme- dies, which had before seemed to fail, have, after its exhi- bition, acted with the most marked effect, and completed the cure. DOSC. Of a solution of twelve globules to three table-spoonfuls of water, give a tea-spoonful every half hour, until amelioration or change, otherwise as described for Veratrum. Cina is also a useful remedy when there are convulsions, or tetanic rigidity of the whole body during or immediately after the fits of coughing, particularly in children affected with worms. Dose. As directed for Cuprum acet. Arnica is useful as an intermediary medicine when the flow of blood from the nose or mouth is considerable; and also in the affection itself, when each paroxysm is succeeded by crying. DOSC Two globules in a tea-spoonful of water, immediately after such discharge of blood, repeated on the recurrence of the same symp- tom, but not within less than six hours of the former dose; unless, indeed, aggravation should have been palpably discerned after previous administration, when it were desirable to pause in the administration. If, however, after three doses have been given, the same symptom should recur, it will be desirable te consider the subjoined remedy. Hepar sulphuris is sometimes of great service in cases in which the discharge of blood from the nose or mouth is excessive, and particularly when the symptom has set in after a hoarse, dry cough. Dose. Two globules in a tea-spoonful of water, as directed for Arnica. Ferrum metallicum is often very efficacious as an inter- mediate remedy, when there is, invariably, vomiting of food on coughing soon after a meal. Dose. Three globules in a tea-spoonful of water, soon after each fit of vomiting, until amelioration or change. Conium. When the paroxysms occur particularly at night, 338 RESPIRATORY SYSTEM. and with great severity, and are generally followed by vomit- ing of mucus or of ingesta ( Veratr. and Tartarus emet. are also useful when the vomiting is liable to take place during the night). Dose. Two globules in a tea-spoonful of water, night and morn- ing, until amelioration or change. Third or Nervous Stage. TREATMENT. The same medicines as have already been given, according to the indications that present them- selves. On the suppression of all the more serious symptoms, the remedies which have been recommended in the first stage, are also useful in removing any catarrhal cough wThich may remain behind. Change of air is likewise beneficial. DIET. The diet must be light and of easy digestion; bread-pudding, semolina, and other light puddings of this description, provided the fever be not high, in which case, weak gruel, barley-water, and the like, must alone be partaken of; when the more serious symptoms have been subdued, or in all mild cases, we may give a little chicken-broth, or beef-tea, —and so on, gradually increasing the amount of nutriment, as the disease declines. The drinks should consist of toast-water or barley-water. CROUP. Angina membranacea. Angina perniciosa. Cynanche laryngea. Cynanche tracheitis, s. trachealis, &c. SYMPTOMS. Short, difficult, and hoarse respiration, accompanied by a shrill whistling, squeaking, harsh, rattling, or metallic sound, with cough of the same character; the patient throws the head back; fever, and sometimes comatose state of the brain. This well-known disease is one that requires the promptest treatment, to avert the danger. From the moment we are assured of the nature of the complaint, recourse must be had to the remedy most clearly indicated by the assemblage of the symptoms, so that not an instant be lost in arresting its further CROUP. 339 progress, since, if not skilfully kept in check, it sometimes runs to a fatal termination within twenty-four hours; although in the generality of cases, when such an event does take place, it happens about the fourth or fifth day. Croup consists of a peculiar inflammation of the lining membrane of the windpipe, causing the secretion of a thick viscid substance, generally opaque, of about the consistency of the boiled white of an egg, which adheres to the interior of the windpipe, and takes the form of the parts it covers ; when this, generally denominated the false membrane, has been allowed to form, the case becomes extremely critical. That croup arises from inherent constitutional taint is evident, from the fact of some families having a peculiar tendency to this disorder. It particularly affects early child- hood. The principal exciting causes seem to be exposure to cold or damp, and derangement of the digestive functions, from a too nutritious or heating diet, too much animal food, or stimulants, such as wine or coffee. It seldom attacks adults, though we occasionally see exceptions to this rule, and is not unfrequently found in complication with other affections both of the lungs and windpipe. The attack generally commences with the symptoms of a common catarrh, such as cough, sneezing, and hoarseness, with a greater or less degree of fever; in a day or two the cough changes its character and becomes shrill and squeaking, or deep, hoarse, or sonorous, attended with a ringing sound during speaking and respiration, as if the air were passing through a metallic tube: as the disease progresses, the cough becomes more shrill, and when long continued, resembles the crowing of a young cock. There is seldom much expectora- tion, and when any matter comes up in coughing, it has a stringy appearance, resembling portions of a membrane. After inflammation has set in, considerable fever and rest- lessness continue, occasionally varying in intensity, but never wholly remitting; the countenance expresses great anxiety, and alternates from a red to a livid hue; the paroxysms are followed by a profuse and clammy perspiration of the whole 310 RESPIRATORY SYSTEM. body, more particularly of the head and face. When danger threatens, the pulse is hard, frequent, and occasionally inter- mittent ; the breathing, particularly during inspiration, diffi- cult and audible; the features become livid, and almost purple from the sense of suffocation; the head is thrown back ; the cough assumes a veiled and husky tone; the voice sinks to a whisper; the eye has a dull, glassy, or dilated appearance, and the whole system seems in a state of utter prostration. TREATMENT. The medicines which, for the most part, will be found most appropriate to meet the incipient catarrhal symptoms, and thereby prevent, in many cases, the development of croup, are Chamomilla, Bryonia, and Aconitum (see Cough for indications); but those upon which the greatest reliance is to be placed in the treatment of the disease itself, are Aconite, Hepar sulphuris, Spongia, and lachesis. Aconite is called for during the inflammatory period of this dangerous disease, when attended with great febrile burning heat, thirst, short dry cough, and hurried, laborious breathing. It may be exhibited as below specified, until these symptoms begin to abate. DOSC. In very acute cases, of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every half hour, until the specially indicative symptoms abate. In less urgent cases the repeti- tion of doses should take place every two hours, until a similar result ensues. So soon, however, as the medicine begins to make a favorable impression, the intervals should be extended to four, and then to six hours; or, on the other hand, if the fever has, to a certain degree, yielded to Aconitum, but such symptoms as are subjoined supervene or remain—pause four hours after the last dose of Aconite, (except in very urgent cases—when no pause can be allowed), and consider the following medicines. If in alternation with one or both of the other medicines, associated as above, the like solution should be separately made of each, and administered by tea-spoonfuls, so that not less than two hours shall elapse between doses (except in the most urgent cases). Hepar sulphuris. Either when the febrile symptoms are partially subdued by Aconitum, the skin having become moist or covered with a profuse sweat, the cough more loose CROUP. 311 and the breathing freer, but there remains a dry, harsh, deep, hollow cough, with a weak, hoarse voice, and more or less difficulty of breathing; or when, from the commencement, the cough, so peculiar to croup, has already set in, and is accompanied by a constant mucous rattling in the respiratory organs, during which the patient is incessantly but ineffec- tually occupied in endeavoring to obtain relief by expectora- tion ; or frequently grasps at his throat and tosses back the head; when, moreover, there is a considerable degree of fever and restlessness, together with a burning hot skin, and excessively quick and laborious respiration.* Dose. If singly, a solution of twelve globules to two table-spoon- fuls of water, or if in alternation, a solution of six globules of each medicine, as directed for Aconitum. If, however, the subjoined symp- toms and conditions occur, proceed at once (in most urgent case?), or, after a pause of four hours, (in less pressing instances), with the next medicine. Spongia is chiefly used after Aconitum ov Hepar, when the skin has become moist, the breathing somewhat easier, but still very labored, loud, grating, and wheezing, the patient appearing to carry on the process of respiration more readily with the head thrown backwards, yet, it is even then occa- sionally threatened with suffocation ; further when the cough is hoarse, ringing, hollow and squeaking. DOSC Dissolve six globules in two table-spoonfuls of water, and give a tea-spoonful of the solution every half hour (in very acute cases), or only every three hours (when the symptoms are not so extremely distressing), until a degree of improvement ensues, when the intervals should be extended to double the time; if, however, the more urgent symptoms continue on the increase, and this and the foregoing medi- cines appear incapable of arresting the progress of the disease, proceed at once with the next course. Phosphorus has been recommended in cases where Hepar might fail to relieve the symptoms we have enumerated under * This remedy is of itself sufficient, in many instances, to arrest the progress of the disease, if administered as soon as the incipient symptoms of the attack are observed; but Aconite, Hepar sulphuris, and Spongia, generally in alternation, become necessary when the affection is more developed.—Gross. 312 RESPIRATORY SYSTEM. that remedy; or when Aeon, and Spong., as well as Hepar have been merely productive of temporary benefit. DOSC Two globules in a tea-spoonful of water, every quarter of an hour, until amelioration or change; or until three doses have been given; but if no adequate relief should ensue within half an hour after the third dose, proceed with the next medicine. Arsenicum should be administered half an hour after the third dose of Phosphorus, in cases in which the last-named medicine has not produced prompt relief, especially if the patient has become cold and exhausted, and appears to be sinking. DOSC Three globules in a teaspoonful of water, every ten minutes, until three doses have been given; but if yet no positive improvement results, proceed with the next remedy. Lachesis. In very serious and obstinate cases, to which there is short dry cough with hoarseness; great sensitiveness of the larynx and trachea to the touch, the slightest pressure affecting almost to suffocation; voice very low and hollow, with a sound like that of a person speaking through the nose; fainting; nausea; swooning; loss of sense; rigidity of frame; great prostration of strength, especially towards evening. DOSC Two globules in a tea-spoonful of water, every quarter of an hour, until amelioration or change, or until three doses have been given, and then at intervals of an hour, until amelioration or change; but if no adequate relief should ensue within half an hour after the fourth dose, proceed with the next medicine. Tartaricus emeticus is indicated if children wake suddenly at night and begin with a choking cough, either from want of breath, or an accumulation of phlegm in the throat. This medicine should always be kept on hand, but preserved with care, as a few grains at the first trituration, taken at once by a child, might prove fatal. DOSC One grain (or as much as will lie on the point of a pen- knife) of the 1st trituration in eight table-spoonfuls of water, and after having been stirred up well, a teaspoonful every ten, twenty, or thirty minutes, according to the violence of the symptoms. After having subdued these threatening symptoms by the administration of the last-mentioned remedy, we may, if the CROUP. 343 disease is not wholly vanquished, again fall back upon Hepar sulphuris, or Spongia, according to the indications given for those remedies. There are other remedies which may afford valuable assist- ance in the treatment of complicated attacks ; but in truth it may be said, that in the majority of cases, Aconitum, He- par sulphuris and Spongia, administered alternately, when individually inadequate, are sufficient to effect a cure in a few hours. It need scarcely be stated, howTever, that it will be imperative to discontinue the administration of these reme- dies when improvement does not soon become apparent dur- ing their employment, or to select others from the commence- ment, if, from the symptoms and character of the case, they distinctly seem to merit a preference. Caustic ammonia. Deep, weak voice; fatiguing, interrupted speech; increased secretion of mucus in the bronchia; violent cough, with copious expectoration of mucus, especially after drinking. Difficult, rattling, labored breathing; stertorous breathing ; suffocative fits ; spasms of the chest. DOSC Dissolve eight globules in four table-spoonfuls of water, and give a tea-spoonful every half hour; if no relief or change after the sixth dose, proceed with the next medicine. Bromine. Formation of pseudo-membrane in the larynx and trachea. Spasms in the larynx occasioning suffocation. Cough, with croup-sound, hoarse, wheezing, fatiguing, not permitting one to utter a word; accompanied with sneezing, with violent suffocative fits. Respiration characterized by mucous rattling ; wheezing ; alternately slow and suffocative, and hurried and superficial; labored; painful; oppressed; gasping for air; heat in the face; increased secretion of urine; pulse rather hard ; slow at first, afterwards accelerated. DOSC The same as directed for Caustic ammonia. Bicromate of Potash. Sensation of scraping in the throat. Sore throat. Constipation, with creeping in the bowels. Sneezing, and soreness of the nose. Pain, stuffing and ulcera- tion of the nostrils and sneezing. Throat dry and painful on swallowing; tonsils reddened: tongue coated, with a brownish 311 RESPIRATORY SYSTEM. spot; larynx painful. Pain in the sides and nape of the neck. Cough, with transparent dirty slate-colored sputa: easily detached. DOSC. The same as directed for Caustic ammonia. INFLUENZA. SYMPTOMS. Catarrh appearing in an epidemic form, attended, in addition to the symptoms described at the com- mencement of the article on common cold, with extreme oppres- sion and prostration of strength; sleepiness; followed by shuddering and general chilliness; rheumatic pains, or pains as if caused by contusions, in the back and limbs; intense frontal headache, sometimes extending to the bones of the face, with pressive aching pains in the other parts of the head, giddiness, earache; slight redness of the eyes, with painful wreight or heaviness, and sensibility to light; coryza, or ob- struction of the nose; dry, shaking cough, which produces distressing fatigue in the chest; dryness of the throat, and, subsequently, dry, burning heat of the skin, loss of appetite, nausea, together with soreness of the throat and some degree of hoarseness; and, in some cases, swelling of the parotid glands, or offensive sweats. TREATMENT. The principal medicines in ordinary cases are: Camphora. One or two drops of weak spirits of Camphor when taken at the commencement of the attack, and repeated until the chilliness or shivering begins to subside, will fre- quently check the further progress of the disease. In a more advanced stage of the affection, with (laborious) asthmatic breathing, accumulation of mucus in the bronchi and cold, dry skin, Camphora is further of considerable service. Aconitum. When the disorder assumes an inflammatory character, with quickness of pulse, dry hot skin, and short, harsh, shaking cough. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every three hours, until the fever-symptoms abate, or until other manifestations, distinctly indicative of different remedies, occur. INFLUENZA. 315 Nux vomica. This remedy has repeatedly proved of great efficacy in influenza or grippe, after the previous employment of Aconite, when the inflammatory action predominated in the chest; or when the symptoms complained of were chiefly as follows : obstruction of the nose, hoarse hollow cough, excited by tickling in the throat, and attended with severe headache, confusion in the head, giddiness, want of appetite, or sickness, thirst, pain as from a bruise in the hypochondria, aching pain in the lower part of the back, constipation, pain in the chest as if from excoriation. DOSC. Of a solution of eight globules to three table-spoonfuls of water, give a tea-spoonful every six hours, until distinct amelioration or change. Mercurius. Dry ov fluent coi^yza ; pains in the head, face, teeth, and chest; sore throat; swelling of the parotids ; violent shaking cough, at first dry, but subsequently moist, the parox- ysms being commonly excited by irritation in the throat and chest; shivering or heat with profuse perspiration; aching in the bones and slimy bilious diarrhoea, attended with tenesmus. This remedy has also proved of great efficacy when symptoms of pleurisy with copious, unmitigating perspiration, super- vened ; as also when the liver became implicated in the gen- eral derangement, the pains in that organ partaking more of an obtuse than an acute description. DOSC Three globules in a tea-spoonful of water, every three hours, until amelioration or change ; but if the subjoined symptom should become very prominent, pause six hours after the last dose of Mercu- rius, and proceed with the next medicine. Arsenicum. The following are the characteristic indications for the employment of this important remedy; heaviness and rheumatic pain in the head; profuse watery and corrosive discharge from the nose, causing a disagreeable burning sen- sation in the nostrils; violent sneezing; shiverings and shud- dering with severe pains in the limbs; oppression of the chest" difficulty of breathing; thirst; anxiety; restlessness; great prostration of strength, with aggravation of sufferings at night, or after a meal; inflammation of the eyes, with sensi- 316 RESPIRATORY SYSTEM. bility to light. These symptoms may be attended with a deep, dry, fatiguing cough, exacerbated in the evening, at night, or after drinking, or sensations of dryness and burning, with mucus in the throat, which is difficult to detach. DOSC. Two globules in a tea-spoonful of water, every two hours, until the symptoms are moderated, and then every six hours, until amelioration or change. Phosphorus has frequently been found exceedingly useful when there was excessive irritation in the larynx and bronchi, bordering on inflammation, with alteration of the voice, and pain during articulation. DOSC. Three globules in a tea-spoonful of water, every three hours, until amelioration or change. Bryonia has often proved of great service in relieving the violent, pressive, aching, bursting, frontal headache, and cough with easily loosened mucous sputa. It has further been found of great efficacy when the liver was tumefied, painful to the touch, or on coughing, or taking a full inspiration; also when vomiting was liable to take place after coughing, or when the cough produced pain in the upper part of the abdomen, and caused a pain as if arising from the effects of a blow beneath the short ribs. (See Nux, which accords with Bryonia in the latter case.) DOSC. Of a solution of six globules to four tea spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. Belladonna. Dry spasmodic cough, aggravated towards night; sore throat, excessive, almost insupportable, headache, increased by talking, moving, or bright light; fixed look; confusion of ideas on closing the eyes. Dose. Three globules in a tea-spoonful of water every four hours, until the symptoms are moderated; and then every eight hours, until positive amelioration or change. Carbo v. has been found useful in old people, sometimes in alternation with Bryonia, when the chest was considerably affected, the breathing oppressive, the extremities cold, with threatening paralysis of the lungs. Dose. As directed for Bryonia. INFLUENZA. 347 Pulsatilla. Loose cough day and night, exacerbated by lying down, thick offensive coryza, tendency to relaxation in the bowels, loss of appetite, foul tongue, disagreeable or insipid taste in the mouth. DOSC. Of a solution of six globules to four tea-spoonfuls of water, give a teaspoonful every four hours, until amelioration or change. Rhus. In cases arising after exposure to a thorough wet- ting, and accompanied by great anxiety, frequent involuntary fetching of a deep inspiration, corporeal restlessness with incessant changing of posture, this remedy is indicated. Dose. Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of the solution every six hours, unfil amelioration or change. Distressing, dry cough, or cough with difficulty in expec- torating the sputum which has been detached, the paroxysms of which were always followed by yawning, has frequently been cured by Opium, after many other remedies had failed to relieve. Dose. Three globules in a tea-spoonful of water, every four hours, until amelioration or change. Sulphuris tinct. has repeatedly proved useful when, at the termination of the disorder, dull pricking pains are experienced in the chest on taking a deep breath, or after a severe fit of coughing; also when there is oppressed respiration as if aris- ing from a heavy weight resting on the chest. DOSC One drop in a tea-spoonful of water morning and evening. for four davs, (or until the earlier development of new xymjytoms, im- provement or change); then pause four days, after which the course may be repeated as before, if still required. Arnica may be administered with great advantage in some cases, particularly when pricking pains are experienced in the chest during inspiration (pseudo-pleurisy) with aching pains over the whole body, headache, and hemorrhage from the nose. DOSC. Three globules in a tea-spoonful of water, every six hours, until amelioration or change. 348 RESPIRATORY SYSTEM. DETERMINATION OF BLOOD TO TOE CHEST. Congestio ad Pectus. SYMPTOMS. Sensation of great fulness, throbbing, weight, or pressure in the chest and palpitation of the heart, attended with anxiety, short, sighing respiration, and dyspnoea. We find that the predisposition to affections of the chest and lungs is greater during the period preceding puberty, and for some years after, than at any other epoch of man's existence. As remarked in the Diseases of Children, in infancy and during very early childhood, from the disproportion between the cerebral system and other portions of the economy, the diseases which the physician has chiefly to combat are those arising from over-excitement of the nervous organization. In maturer years the tendency to abdominal congestion generally develops itself. This is easily explained by entering into the physiology of these different periods of human life; but as my object is rather the treatment of disease than the elucidation of these interesting points, I shall here content myself with briefly alluding to them. There is no doubt, as already remarked, that a particular period of human life is peculiarly liable to chest affections, and, among others, to this disorder, which is but too frequently the precursor of other more serious maladies. Some consti- tutions, however, especially those in which an hereditary phthisical taint exists, exhibit a marked predisposition to pectoral congestion. Amongst the most frequent causes of this predisposition being called into dangerous activity are, exposure to extremes of heat or cold; stimulants, such as alcoholic, vinous, or fermented beverages, or coffee; the abuse of narcotic drugs ; vb lent exercise, such as running, dancing, ccc, or over-exertion even of the voice in speaking or singing; a sudden clieck of perspiration; cold or damp feet; sedentary habits; metastases; repercussed cutaneous eruptions; or sup- pression of customary discharges, such as the catamenial and hemorrhoidal flux. TREATMENT. Aconitum is indicated, when there is violent DETERMINATION OF BLOOD TO THE CHEST. 349 oppression with great heat and thirst, palpitation of the heart, great anxiety, and shaking cough. It will be found particu- larly valuable for plethoric females of sedentary habits, who suffer considerably from congestion before and during the catamenia. In such cases it may be advantageously followed by Mercurius, to prevent a relapse (in others by Belladonna). Dose. Three globules in a tea-spoonful of water, repeated at inter- vals of eight hours, until the subsidence of the particular indicative symptoms. In cases of congestion, associated with the monthly periods, when the immediate symptoms have yielded to the action of Aconitum, pause two days, and proceed with one or other of the next remedies, according to the indications present. Nux vomica. When the affection has been developed by sedentary habits or by habitual indulgence in the stimulants already alluded to, or from hemorrhoidal metastasis or sup- pression : in which cases this remedy is frequently sufficient to effect a radical cure. Dose. Three globules in a table-spoonful of water, every night at bedtime, until amelioration or change; but if some inconvenience should continue to prevail, notwithstanding* repeated doses of Nux vomica, proceed with the next medicine. Ipecacuanha will frequently complete the cure when Nux vomica has not removed the whole of the symptoms. In other cases Sulphur will answer better after the previous employment of Nux. (See Sulph.) Dose. Three globules in a tea-spoonful of water, every night, until the complete subsidence of the symptoms or change supervenes. Belladonna. Oppression and throbbing at the chest, with shortness of breath and strong palpitation of the heart, ex- tending into the head ; short cough, chiefly at night; internal heat; and considerable thirst. Dose. Three globules in a tea-spoonful of water, every eight hours, until amelioration or change. Aurum. Extreme oppression of the chest, as if suffocation impended, sometimes with loss of consciousness and livid hue of countenance; palpitation of the heart; and excessive anguish. Dose* Of a solution of six g'obules to two table-spoonfuls of water, 16 350 RESPIRATORY SYSTEM. give a tea-spoonful every four hours, until a degree of improvement becomes evident, or change is manifested. Mercurius, as already remarked, is valuable after Aconitum, on certain occasions (see that remedy); and also when there is burning heat and oppression at the chest, and frequent desire to take a deep inspiration; or, cough with expectora- tion streaked with blood, and palpitation of the heart. Dose. Three globules in a tea-spoonful of water, every twelve hours, until amelioration or change. Pulsatilla. Ebullition of blood in the chest with external heat; constriction in the chest with impeded respiration; palpitation of the heart; anxiety and aggravation of the symptoms towards evening ; also when pectoral congestion has arisen in phlegmatic subjects from hemorrhoidal suppression, or in females from stoppage of the menstrual flux. Dose. Three globules in a tea-spoonful of water, the first thing in the morning, until amelioration or change. Spongia tosta. When the symptoms are provoked by the slightest exertion or even movement, and are attended with anguish, sensation of threatened suffocation, nausea, prostra- tion, and fainting. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every four hours, until a degree of im- provement becomes apparent or change occurs in the character of the symptoms. Bryonia. Burning heat in the chest, with a sensation of tightness, dyspnoea, and anxiety; palpitation of the heart, occasional prickings in the chest during inspiration. Dose. Three globules in a tea-spoonful of water, morning and evening (fasting), until amelioration or change. Cinchona, when we can trace the affection to debilitating losses, with palpitation of the heart and oppressed breathing. Dose. Three globules as directed for Bryonia. Sulphur. Ebullition of blood, weight, fulness, and pres- sure in the chest, aggravated by coughing, palpitation of the heart, difficulty of breathing, chiefly on lying down at night- it is also most serviceable in suppressed hemorrhoids, after BRONCHITIS. 351 Nux vomica or Pulsatilla-, and after the latter remedy in checked menstruation. Dose. Six globules in a table-spoonful of water, every morning the first thing (fasting), for a week (or until the earlier development of new symptoms, improvement or change); then pause four days, after which resume the course as before, or not, according to the greater or less degree of improvement which has been effected. Phosphorus. In some obstinate cases this remedy is often successful in affording speedy relief, particularly when, in addition to the more usual symptoms, shooting or pricking pains are frequently experienced on laughing, speaking, or walking quickly; palpitation of the heart, anxiety, sensation of heat extending from the chest into the throat. DOSC Three globules in a tea-spoonful of water, night and morning, until amelioration or change. INFLAMMATION of the mucous membrane of the bronchial TUBES. COLD ON THE CHEST. PULMONARY CATARRH. Bronchitis. This disease consists of a greater or less degree of inflam- mation of the mucous membrane of the bronchi, and is divided into acute and chronic. Of the former it is intended more particularly to treat. The disorder is of frequent occurrence, both as an idiopathic affection, and as a concomitant of measles, scarlatina, smallpox, hooping-cough, &c. SYMPTOMS of Acute Bronchitis. Chilliness, succeeded by fever; hoarseness, difficulty of respiration; severe, fre- quent and distressing cough, at first dry or with scanty expectoration of frothy or viscid mucus, which subsequently becomes copious and occasionally streaked with blood; exces- sively laborious respiration, attended with a feeling of con- striction and oppression of the chest, which sometimes in- creases to such a degree as to threaten suffocation; general weakness, foul tongue, and loss of appetite; paleness of the lips, cadaverous and anxious countenance, loud wheezing, and on applying the ear to the chest, a louder sound is heard than the natural respiration, either rattling, whistling, or droning, or harsh and broken, according to the advance of the disease. 352 RESPIRATORY SYSTEM. In the cases which terminate favorably, the first symptom of improvement which sets in, is a greater freedom of breath- ing, with remission of the fever, and an alteration in the expectoration, which becomes thicker, whiter, and diminished in quantity. But when the disease takes an unfavorable turn, the difficulty of breathing increases; a state of excessive de- bility and collapse supervenes ; the face becomes livid, the body covered with a cold and clammy sweat; the mucus ac- cumulates rapidly in the bronchial tubes, and the cough, which has become feeble through the exhausted and sinking ener- gies of the patient, is insufficient for its ejection ; aeration of the blood in the cells of the lungs is ]3revented; cerebral symptoms declare themselves from impeded circulation, or the effect of unarterialized blood circulating in the brain, and the patient is carried off in a state of asphyxia. In many cases of acute bronchitis, although a degree of oppression at the chest be present, no particular pain, heat of skin, or fever may exist; this is a most insidious form of the disease, and one in which the complaint is but too frequently neglected until beyond the power of the physician's art: it occurs most frequently in children who may apparently be only troubled with a slight wheezing, of which scarcely any notice is taken or any medical aid called in, until suddenly suffocation threatens, or some organic lesion is produced, so that an affection which probably might have been easily sub- dued at the commencement, is now beyond control. The frequency of the disease in infancy and early life deserves a particular notice. It generally begins, as in adults, with the symptoms of a common catarrh; the breathing becomes quick and oppressed, and from the increased action of the diaphragm, the abdomen is rendered prominent; both the shoulders and nostrils are in continual motion, but the wheezing is often more marked than the difficulty of respira- tion, and on applying the ear to the chest a mucous rattle is heard over almost every part; expectoration sometimes tem- porarily relieves, and occasionally the mucus is expelled from the air-passages by vomiting; the countenance is pale and BRONCHITIS. 353 anxious, and somewhat livid:—these symptoms are inter- rupted and relieved by occasional remissions, during which the child generally appears drowsy; but they return with additional severity, and if not checked, an accession of extreme dyspnoea ensues, and death takes place from suffoca- tion. When sore throat is also present, coughing produces considerable pain, and the child for that reason frequently endeavors to suppress it. There is also impaired appetite with thirst, although when the disease has advanced, it is found difficult to take a long draught, from its impeding respiration: this is very observable with children at the breast, who, after eagerly seizing the nipple, will bite it, and discontinue sucking, cry, and throw back the head, and even after vomiting up the phlegm, continue for some time in that position. In some cases, from the character of the voice and cough, bronchitis has been mistaken for croup. The tubes of one lobe, or of one lung only, may be affected, but frequently those of both lungs are attacked by the disease. The exacerbation of suffering at night is a very remarkable symptom in this complaint. The causes are the same as those of common catarrh. TREATMENT. The remedies which are the most appro- priate in ordinary cases of this affection are : Aconitum is the remedy upon which we must place our chief reliance in the inflammatory stage of the disease, and throughout its course whenever high febrile action sets in. Its more marked indications are hot, dry skin, with strong, hard, and accelerated pulse; hoarseness, with roughness of the voice; short, dry, and frequent cough, excited by tickling in the throat and chest; obstructed respiration, sibilant or sonorous rhonchus, anxiety, restlessness, headache, and thirst, with occasionally scanty expectoration of viscid mucus. DOSC Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful, repeated at intervals of two hours, until the indica- tive symptoms are allayed. When the skin and pulse, in particular, manifest a degree of abatement in the fever, the intervals should be extended to six hours, and the administration thus continued, unless RESPIRATORY SYSTEM. some distinct indications characteristic of one or more of the other medicines particularised should occur, when the doses of Aconite should be suspended, and appropriate treatment adopted; but if the fever- symptoms should continue without abatement or modification, two hours after the third dose of Aconitum and the subjoined symptoms be present, proceed with the next medicine. Should the skin not become moist, the respiration easier, and the cough looser after the second or third dose of Aconi- tum, Bryonia will, in most cases, be required (see Bryonia). But it rarely happens that Aeon., when at all indicated, does not produce a favorable effect, even after the first dose. As soon as a decided melioration has been effected, the repetition of the dose must be restricted to intervals of eight to twelve hours, or even longer; or another medicine must be selected if Aeon, be found inadequate to complete the cure. (See Pulsatilla.) Bryonia is of great service in a large number of cases of bronchitis, at the commencement of the attack. We should therefore not hesitate to prescribe it immediately when we meet with laborious, rapid, and anxious breathing, with con- stant inclination to take a deep inspiration ; hoarseness ; head- ache ; dry cough, attended with a burning pricking pain extending from the throat to the middle of the sternum ; or cough with scanty and difficult expectoration of viscid sputa, in some instances streaked with blood; sibilant rhonchus; dryness of the mouth and lips, excessive thirst. When, moreover, the respiration is impeded by shootings in the chest, and the affection threatens to become complicated with pleurisy, this remedy is still more particularly called for. Dose. A solution of six globules, as directed for Aconitum ; but if Bryonia should be inadequate to effect more than temporary relief, proceed with the next medicine. Spongia is often of great service after the previous admin- istration of Aconite, when there still remains a considerable degree of inflammation in the bronchial tubes, especially the larger, with sibilant or sonorous rhonchus; and also, at a more advanced stage of the disease, when the mucous rhon chus is distinctly audible; with hollow, dry cough day and BRONCHITIS. 355 night, but worse toward evening; or cough with scanty, viscid, ropy expectoration; heat in the chest, burning, tick- ling irritation in the larynx, quick, anxious, laborious respira- tion ; inability to breathe unless the head is thrown backwards; hoarseness. Dose. Of a solution of six globules to two table-spoonfuls of water, give a dessert-spoonful every three hours, until amelioration or change; but if within three hours after -the fourth dose, partial improvement only should have occurred, or if the subjoined symptoms should remain predominant, pause three hours longer, and proceed with the next medicine. Hepar s. is sometimes useful after Spongia, especially when the mucous rattle is predominant, the skin hot and dry, and the efforts to expectorate ineffectual; or, at a more advanced stage of the complaint, when the expectoration has become more copious, and the paroxysms of coughing are followed by profuse sweating. Dose. Three globules in a dessert-spoonful of water, every four hours, until a degree of benefit has been effected, and then every twelve hours until positive amelioration or change. Belladonna. This remedy is useful when there is severe headache, materially aggravated by coughing; oppression of the chest, and constriction, as if bound, with loud, wheezing, and rattling of mucus in the bronchi; short, anxious, and rapid respiration; dry, fatiguing cough, especially at night, which is endeavored to be suppressed on account of the pains it creates ; heat of the skin and thirst; soreness of the throat. Belladonna is often exceedingly efficacious in children, par- ticularly in those insidious cases which commence with a slight wheezing, and then suddenly become aggravated to such a degree as to threaten suffocation; the heat of skin being at the same time considerable, and the pulse excessively rapid, and sometimes even intermittent. Sulphur is, in some in- stances, required to establish the cure after Bella. Dose* Of a solution of six globules to two table-spoonfuls of water give a tea-spoonful every three hours, until improvement or change; if improvement ensues, extend the intervals to six hours, and continue the administration thus, until the distinct subsidence of the symptoms • if 356 RESPIRATORY SYSTEM. change, suspend the administration of Belladonna, and substitute a medicine appropriate to the new symptoms. Nux vomica. Dyspnoea, with excessive tightness of the chest, particularly at night; hoarseness; dry cough, worse towards morning, attended with pain as if caused by a blow or bruise, in the epigastric or hypochondriac regions ; cough, with difficult and scanty expectoration of viscid mucus ; dry- ness of the mouth and lips, thirst, constipation, peevishness. DOSC Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every four hours, and proceed as directed for Bella- donna. Lachesis. Oppression at the chest, with short and hur- ried respiration, anxiety, and dejection; mucous rale; dry, fatiguing cough, sometimes followed by the expectoration of a little tenacious ov frothy mucus, after much effort, occasionally streaked with blood; hoarseness. Dose. A solution of six globules as directed for Belladonna. Phosphorus. This important remedy is frequently of great utility in bronchitis when the more inflammatory symptoms have been subdued by Aconite, but the respiration continues much oppressed, accompanied with great anxiety, and heat in the chest; dry cough, excited by tickling in the throat or chest, aggravated by talking or laughing, and followed by expectoration of stringy mucus of a saltish taste. Further, when the disease has been neglected, or when, from the phe- nomena which present themselves at the commencement, we have reason to dread complication, or an extension of the inflammation to the substance of the lungs, which we gene- rally recognise by the invasion of crepitation, rusty sputa, &c, there will be additional reason for employing Phosphorus. Dose. Three globules in a tea spoonful of water every four hours until distinct amelioration or change. Pulsatilla. This remedy is often required in the second stage to complete the cure, after the previous exhibition of Aconitum, when the acute inflammatory symptoms have been subdued, and the expectoration has become thicker and more copious. It may, however, be prescribed before or after any BRONCinTIS. 357 of the medicaments we have named, especially when the dis- ease occurs in persons of mild disposition, or of lymphatic constitution, and the symptoms are as follows : Respiration short, accelerated, and impeded, attended with rattling of mucus, heat in the chest, and anxiety ; hoarseness ; shaking cough, worse towards evening, at night, or in the morning, accompanied with considerable expectoration of tenacious, or thick, yellowish mucus, sometimes mixed with blood; coryza with copious discharge of thick, discolored mucus. DOSC The same as mentioned under Belladonna. Sepia may be selected in preference to Pulsatilla, when the expectoration is very copious, though somewThat difficult, and of a salt taste ; exacerbation of cough in the morning and towards evening. Dose. Three globules in a tea-spoonful of water, night and morn- ing, until amelioration or change. But if within twelve hours after the fourth dose of Sepia the subjoined indications remain predominant, proceed with the next medicine. Stannum should be administered after Sepia, if the ex- pectoration be still profuse, but more easily detached and ejected, greenish, and less saline, or of a sweetish taste. Dose. Three globules in a dessert-spoonful of water, night and morning, until permanent amelioration or change. Lycopodium. When the cough is materially worse at night, and attended with thirst and quickness of pulse, but moist skin or tendency to sweat; the sputa yellowish gray, and of a saltish taste; oppression at the chest. Dose. Three globules in a tea-spoonful of water, night and morning, until amelioration or change. Mercurius. This remedy may occasionally be found useful when the symptoms of bronchitis are accompanied by exces- sive perspiration; when the cough is fatiguing, worse in the evening, and at night, and excited by a tickling irritation, or sensation of dryness in the chest, with quick, short, oppressed breathing, and louder respiration than ordinary; hoarseness; coryza with watery, acrid discharge; swelling of nose. DOSC. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every six hours, until amelioration or change. 358 RESPIRATORY SYSTEM. Dulcamara is occasionally serviceable after Mercurius, when there is a continuance of night sweats of an offensive odor. Dose. Three globules in a teaspoonful of water, night and morning, until the positive subsidence of the indicative symptoms, or until other indications occur characteristic of some other medicine. Chamomilla is often a most useful remedy in cases of children, after the previous exhibition of Aconite, when a slight degree of whistling or sonorous rhonchus still remains; dry cough worse at night, occurring even during sleep. For further indications, see this remedy under the head of Cough. Dose. Of a solution of four globules to four tea-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Ipecacuanha is also very valuable as a remedy for children, but generally at a more advanced stage of the disorder, with mucous rhonchus in the chest, and when on coughing they are almost suffocated by the excessive secretion of mucus, and become livid in the face; shortness of breath, and perspiration on the forehead after each fit of coughing. Dose. Two globules in a tea-spoonful of water every two to six hours, until improvement results. Tartarus emeticus is chiefly found useful in those extreme cases where the smaller tubes are clogged with mucus, and suffocation threatens; when the cough suddenly ceases either from weakness or other causes. Dose. One grain of the first trituration in eight table-spoonfuls of water, and a tea-spoonful every quarter, every half, every hour, or every three or four hours, according to the severity of the symptoms, or the effects produced. Arsenicum is occasionally of the utmost service in those unfavorable cases in which the pulse becomes very quick, feeble, and irregular, and the patient is reduced to a state of extreme debility and collapse. Dose. Six globules in two table-spoonfuls of water, a teaspoonful to be given from time to time, as required. Sulphur is frequently useful in winding up a cure, and preventing the disease running on to the chronic form or BRONCHITIS. 359 when the expectoration has increased in quantity and become whitish and less viscid. Dose. The same as directed for Arsenicum. DIET. In the severe forms of bronchitis, the diet to be observed should be the same as that mentioned under Fever; but when the febrile and inflammatory symptoms have been completely removed, the patient should gradually return to a more nutritious diet, even though a considerable degree of cough and expectoration remain. In the slighter forms of the complaint, spare diet, confine- ment to the house, in short, the simple measures laid down for the treatment of common colds in another part of this work, will frequently check or at all events materially shorten the attack. See also article Cough, in which further indications will be found for the selection of the remedies. CHRONIC BRONCHITIS. Bronchitis chronica. This complaint may be the result of the acute affection, or it may arise as a gradual and insidious inflammation of the mu- cous membrane of the bronchial tubes, or proceed from the inhalation of dust or other minute particles carried into the lungs ; it may also be coeval with diseases of the heart, or declare itself after erruptive fevers. It differs from acute bronchitis chiefly in the greater mildness and longer duration of its symptoms, the continuance of which varies from several weeks or months to many years. It affects elderly persons more frequently than the young, but is of course liable to occur at all ages as the result of an acute attack (although such a circumstance is comparatively of rare occurrence under proper homoeopathic treatment), the sequel of measles, &c. A comparative exemption from cough is frequently experienced during summer ; but in winter, or in inclement springs, the patient is tormented with harassing cough, and copious viscid expectoration, especially in the morning, which in the severer forms of the disorder is peculiarly distressing. The expectorated matter in the chronic affection is of a differ- ent nature from that in the acute, being of a thicker consist- ence, and of a greenish or yellowish-white color; it is not 360 RESPIRATORY SYSTEM. unfrequently muco-purulent, and sometimes decidedly puru- lent, and occasionally streaked with blood, particularly in obstinate, inveterate cases. There is generally more or less dyspnoea, with acceleration of pulse after slight corporeal exertion; but in other respects the health may be good, and continue so. In the more trying forms of the disorder, an aggravated state of all the symptoms enumerated is met with ; moreover, where the sputa is of a purulent nature, hectic fever, extreme emaciation, nocturnal sweats, and occasional attacks of diarrhoea are frequent adjuncts: the latter symp- toms are sometimes liable to cause the disease to be mistaken for tubercular consumption; but in the majority of cases, auscultation and percussion, together with a careful attention to the symptoms and the history of the case, enable us to form an accurate diagnosis between them. In chronic bronchitis, the resonance of the chest is, on per- cussion, little if at all diminished. On applying the ear or stethoscope to the chest, the respiratory murmur is found to vary much in intensity, but is never permanently absent in any part of the chest, and is frequently even jmerile. The mucous rhonchus, in most of its diversified forms, is heard in various parts ol the chest at different times, and occasionally the whistling and sonorous rattles are discernible. When the dilatation of the bronchial tubes is considerable, as is not unfrequently the case in this affection, a loud bronchophony is heard, which is with difficulty, if at all, to be distinguished from pectoriloquy, and a rale, closely resembling the caver- nous, is apparent in the vicinity of the dilated tube. The soimd on percussion will, however, generally enable us to form a distinction; the dulness of tone being not so great over a dilated tube, as it is in the vicinity of a vomica ; the difference of the situation of the cavity in the two cases, is also a useful discriminating guide ; dilated bronchi being, as is well known, most frequently detected in the scapular, mammary, and lateral regions, and vomicae in the subclavian and axillary regions. However, as before said, we must, in all doubtful cases, combine the history of the attack, the BRONCHITIS. 361 constitution of the patient, the progress of emaciation, &c, with the symptoms to be heard by the ear after repeated examinations, ere we come to a definite conclusion as to the exact nature of the complaint, where that is of material con- sequence ; but as regards the prognosis, chronic bronchitis, with purulent expectoredion, dilated tubes and hectic fever, has been truly considered to be nearly as formidable and serious a malady as phthisis itself, and hence ultimate recovery almost as doubtful. TREATMENT. Sulphur is, in the majority of cases, one of the principal remedies for the treatment of Chronic Bron- chitis. The particular symptoms which serve to indicate its employment,-are as follow:—Dry, racking cough, with spas- modic tightness of the chest, sometimes aggravated by the recumbent position, and not unfrequently attended with nausea or even vomiting; accumulation of phlegm in the air tubes, and scraping sensation in the throat; sensation of soreness at the chest; chronic hoarseness, and even loss of voice; aggra- vation of the generality of the symptoms in raw, damp, cold weather: dry cough at night, or cough with considerable expectoration of thick, whitish or yellowish phlegm, chiefly in the day time ; attacks of suffocating sensation and oppres- sion of breath; rattling of phlegm on the chest, and occa- sional or even frequent palpitation of the heart; pains in the head and chest during fits of coughing; mistiness of sight, and sensation of darting; fulness in the head. Dose. Six globules in a table-spoonful of water, every morning the first thing (fasting), for a week (or until the earlier development of new symptoms, improvement, or change) ; then pause four days, after which the course may; if necessary, be resumed as before, and so on, until permanent amelioration or change. Calcarea carb. is more distinctly indicated when the patient is subject, from time to time, to depression of spirits, characterised by exceeding anxiety respecting his or her health, and attended with great languor (often to a distressing degree); stitches and occasional pains in the chest and in the sides; tickling sensation in the throat, accompanied or followed 362 RESPIRATORY SYSTEM. by dry, violent cough ; the last-named symptoms occur espe- cially at night, when in a recumbent position, or even during sleep, or in the evening; prolonged and obstinate hoarseness, to which the patient is much subject, and which is constantly induced by changes of weather ; accumulation of adhesive phlegm in the air tubes, and rattling of phlegm on the chest; sometimes moist cough, with expectoration of offensive phlegm (thick and yellowish). Dose. Six globules, as directed for Sulphur. Carbo veg. is more particularly indicated by repeated fits of spasmodic cough during the day, and in-the evening ; pain as of soreness in the upper part of the windpipe, or sensation of tickling and roughness in the same part; prolonged and intractable hoarseness and roughness of voice, aggravated by talking, or by raw, cold, damp weather, and occurring more particularly in the morning or towards night; rheumatic pains in the chest and limbs; cough with considerable expec- toration of greenish phlegm. Dose. Three globules in a teaspoonful of water, morning and even- ing, until amelioration or change. Pulsatilla. This medicine is more particularly appropriate when the following symptoms and conditions occur:—dry cough, which subsequently becomes moist, and is then characterised by very considerable expectoration of saltish or bitterish phlegm, or of phlegm tinged with blood, or of a yellowish or whitish appearance; soreness of the palate and throat; frequent attacks of chilliness without thirst; yellowish, greenish, or offensive discharge from the nose; hoarseness, or even loss of voice; cough with much expectoration, and with pain on the chest; racking cough exacerbated at night and in a recumbent position, and accompanied with rattling of phlegm, nausea (or even vomiting), and sensation of being stifled, feeling of soreness or contusion about the belly in the act of coughing. Dose. Three globules in a tea-spoonful of water, night and morning, until amelioration or change. See, however, the article Cough, where indications for the selection of most of the above remedies will be met with. INFLAMMATION OF THE LUNGS. 363 INFLAMMATION OF THE LUNGS. Pneumonia vera, Peripneumonia, Pneumonitis, Pulmonitis. This disorder consists in an inflammation of the parenchyma of the lungs. SYMPTOMS. Rigor followed by heat; dyspnoea; respi- ration short and hurried; cough short, continuous, and dis- tressing; dry at the commencement, afterwards attended with scanty expectoration of viscid, lumpy, and extremely tenacious or glutinous mucus of various shades of color, but generally of a dingy, brick-red, or rusty hue,* when the proportion of coloring matter is greater. The cough is inva- riably excited or aggravated by every deep inspiration, or on every attempt to speak; the speech is interrupted, or there is a^pause after every articulation; the respiration is abdo- minal ; a dull pain is occasionally felt in the chest, but more frequently rather a tightness than pain; the pulse is variable, sometimes not beyond the normal standard, but more generally full, strong, and quick at the commencement, or, when the inflammation runs high, hard, wiry, and greatly accelerated ; the tongue parched and dark-colored. The fever is usually of the inflammatory type, but is sometimes typhoid. The patient, particularly in severe attacks, lies upon his back. In the first stagef of many cases, when not marked by complication with bronchitis, on application of the stetho- scope, or the ear to the chest, the crepitous rale may be heard; but the sound on percussion may appear to be only slightly impaired. As the inflammation gains ground, and the substance of the lung becomes altered in structure (se- cond stage, or that of hepatization), bronchial or tubular * This rusty or sanguinolent hue is intimately combined, not in streaks. It appears usually about the second or third day, and is a characteristic indication of the presence of the disease in question; at the same time it must be borne in mind, that its absence is by no means a certain criterion of the non-existence of inflammation of the lungs. • + That of simple inflammatory injection or engorgement. 361 RESPIRATORY SYSTEM. respiration is perceptible, with louder respiratory ^nurmur than natural, in the sound parts of the lung, particularly in severe attacks ; also bronchophony may be present, and the tone elicited by percussion (excepting when the inflammation is restricted to a small central spot in the parenchymatous substance) more or less dull according to the seat of the structural derangement, but rarely so complete or extensive as in pleuritis with copious liquid effusion. In the third, or suppurative stage of the disorder, the sound on percussion becomes more dull, the tubular respira- tion and vocal resonance commonly disappear (a gurgling mucous rale is occasionally substituted, denoting the existence of a fluid in the larger bronchi), and the expectoration becomes muco-purulent or converted into a brown serous fluid. Slight shiverings generally attend the invasion of siqmuration, and the pain, or sense of fulness or tightness, becomes abated ; the patient is, moreover, commonly enabled to lie on the side which was affected, without much inconve- nience. If the disease be not checked in the second stage, the face becomes patched with red, and sometimes livid, and is of considerable extent, the vessels of the neck swollen and turgid, the pulse weak and irregular, and the patient is deprived of life by the obstruction which is offered to the circulation in the lungs. In the third stage, the pulse becomes weak and thready, and the strength commonly sinks rapidly ; but a fatal result is often averted by proper homoeopathic treatment. When an abscess forms in the solidified lung, a cavernous or gurgling rhoncus will be heard, as the air passes through the pus; and pectoriloquy with cavernous respiration will supervene,—when the cavity has been emptied of the fluid by expectoration. Such are the general symptoms of pure pneumonia, but in severe cases it is often found combined with pleurisy, in which case the pains of the chest are intense, and mostly of an acute shooting character. Another and still more frequent compli- cation is formed with bronchitis. When pneumonia termi- INFLAMMATION OF THE LUNGS. 365 nates by resolution, some striking evacuation frequently attends it, such as a very free and abundant expectoration of thick white or yellow matter, often slightly streaked with blood; or a profuse and general sweat; diarrhoea; a profuse dis- charge of urine, with a copious sediment; or an attack of epistaxis. If no hepatization have taken place, the crepitous rale, at first audible, becomes gradually less perceptible, and the natural respiration is heard, till at last the former wholly dis- appears ; if the lung have already partly solidified, but the disease is approaching a cure, the crepitous rale is first heard, then gradually yields to the natural respiration ; in fact, the disease, so to speak, runs its course back again. TREATMENT. The following most important Homoeopa- thic remedies are: Aconite. In the stage of simple inflammatory congestion, with severe inflammatory fever, whether or not accompanied or followed by severe shooting pains in the chest, this remedy is unquestionably of great service. DOSC If singly, of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every three hour3, until the pulse becomes reduced in volume and frequency, or the skin moist, or covered with profuse perspiration—upon which the intervals may be extended to six hours, and the administration thus continued, until absolute ameliora- tion or change, except, however, in such cases as manifest conditions akin to those under-mentioned, when consider the following medicines. If in alternation with Belladonna, a similar solution of each, separately, administered in like doses, at intervals of four hours, in rotation, until improvement or change. Bryonia is frequently the best remedy to follow Aconite, when the more severe febrile symptoms have been lowered by that medicine. But Belladonna is generally required before Bryonia, when the fever returns after having been apparently subdued by Aconitum, and the difficulty of breathing, and pain, or feeling of uneasiness in the chest continue (particu- larly when the pain experienced seems more at the sternum), the sputa tinged with blood, and difficult to expectorate, the cheeks flushed, lips and tongue dry and parched, the skin hot, 366 RESPIRATORY SYSTEM. and the thirst incessant. In young plethoric subjects, Aconi- tum and Belladonna may be given, in rapid alternation, with the most satisfactory results during the first or congestive stage. In such cases indeed the further progress of the dis- ease is not unfrequently arrested, or at all events such a degree of improvement is effected, that any remaining symptoms, such as some degree of oppression, expectoration of viscid sputa, with little or no dulness of percussion or other signs of hepatization, readily yield to the employment of Bryonia. Bryonia may, however, be prescribed at the commencement, when the following indications present themselves :—cough, attended with expectoration of viscid or tenacious mucus, of a brick-dust color, oppression at the chest accompanied by acute shooting pain, or rheumatic pains in the pleura, and pectoral muscles, or in the extremities, with increase of pain on movement; foul tongue, constipation, and other signs of gastric derangement. A complication with pleurisy (pneumo- pleuritis), indicated by increased dulness on percussion, and in some instances a double-sounding voice, central bronchial respiration, and bronchophony, is often an additional reason for the selection of this remedy. (See also Pleuritis.) DOSC In every respect as directed for Aconitum, singly, but if such symptoms as are subjoined ensue, proceed at once with the next medicine. Phosphorus. This remedy has been employed with strik- ing success in almost every stage of the disease in question, under whatever form it presented itself, and even when the disease had already attained a somewhat advanced stage. Dose. If singly, of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Tartarus emeticus s. stibiatus has been chiefly recom- mended as valuable in promoting resolution after hepatization has taken place (which is indicated by the greater or less degree of dulness on percussion, the bronchial or tubular respiration, and the peculiar pectoral sounds given by the voice). Oppression at the chest, laborious respiration, no inflammation of the lungs. 367 expectoration, or expectoration of mucus (untinged with blood) chiefly during the night; or, mucus rattling in the chest, with temporary diminution of the obstructed respira- tion after expectorating the sputa detached by the cough, appear to be the principal general indications for the selection of Tartarus emeticus. Dose. Of a solution of one grain of the first trituration to eight table-spoonfuls of water, give a tea-spoonful three times a day. Tinctura sulphuris may deserve a preference to the last- mentioned remedy in similar cases, when they occur in stru- mous habits, also where hepatization has advanced to some extent, and where Phosphorus, or other remedies, may have only effected a degree of improvement; also wliere there is complication with pleurisy, and obstinate constipation. DOSC. Of three drops to six table-spoonfuls of water, give a tea- spoonful every six to twelve hours, according to circumstances; if amendment ensues, the medicine should be allowed to continue its action undisturbed, as long as the improvement continues. Mercurius has been found a useful medicine in some cases (when indicated by the correspondence between the symp- toms of the disease and those which are its specific products), either singly or followed, according to circumstances, by one or more of the subjoined. Dose. Three globules in a tea-spoonful of water, every two hours, until amelioration or change. But if, although there be general im- provement, the subjoined symptoms remain, or, if otherwise, they supervene, proceed with the next medicine. If on the other hand, no change whatever ensue, after the administration of six doses of Mer- curius, consider the course of Lachesis, Arsenicum, and China. Belladonna should be administered after Mercurius, if spasmodic constriction of the chest, with dry, hacking cough, should remain or supervene. DOSC As directed for Mercurius. Lachesis. Arsenicum. China. Lachesis has been some- times found serviceable, singly (but more particularly in alternation with Arsenicum and China), in those very serious, and indeed almost desperate cases, which threaten to termi- 368 RESPIRATORY SYSTEM. nate in gangrene of the lungs, and which are attended with extreme prostration of strength, coldness of the feet, and offen- siveness of the breath and expectoration. DOSC. If of Lachesis, singly, of a solution of six globules to two table spoonsfuls of water, give a tea-spoonful every quarter of an hour, until a degree of improvement sets in, and then every hour, until the urgent symptoms subside. If in alternation with Arsenicum and China, the like solution of each, separately, administered by tea spoon- fuls, every half hour in rotation, until manifest improvement, or decided change. Antimonium tartaricum is frequently of service when the oppression at the chest and anxiety continue to increase, and the pulse becomes small, weak and irregular; or, moreover, either when there is no expectoration, or when the expectora- tion is not tinged with blood, and occurs chiefly at night; or, again, when difficulty of breathing, anxiety, and other depen- dent symptoms are always temporarily relieved after expecto- rating.- DOSC. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful, first at intervals of a quarter of an hour, and then of half an hour, and so on, extending the intervals to three hours, as improvement gradually ensues. When, however, the urgent symptoms have subsided, consider the general aspect of the symptoms, and suspend or continue treatment accordingly. Sulphur is a medicine of great service when a relapse threatens to succeed the improvement previously effected by other treatment; and in repeated courses, upon the accession of convalescence, to restore the vigor aad equilibrium of the system, and to neutralize the remaining susceptibility to affec- tions of the same organs. DOSC If against an impending relapse, three globules in a tea- spoonful of water, every three hours, until the progressive improvement, previously manifested, becomes apparent. If as an after remedy, against the remaining susceptibility of the lungs, give six globules in a table-spoonful of water every morning, the first thing {fasting), for a week (or until the earlier development of new symptoms, or general change); then pause four days, after which the course may, if necessary, be repeated, and so on until the cure is complete. DIET. It is scarcely necessary to remark that, during the inflammation of the pleura. 369 inflammatory period, an almost total abstinence must be observed; even during convalescence there is caution required, and care must be taken not to allow the patient to over-indulge his returning appetite, as any error in this respect may entail troublesome consequences. The drinks may consist of water, toast-water, and sometimes whey, rice- or barley water, sweetened with a little sugar if desired. Refer also to the directions in this respect, in the general article on Fevers, or in that on Inflammatory Fever in par- ticular. inflammation of the pleura, pleurisy. Pleuritis. SYMPTOMS. Severe cutting, lancinating pain in the side, confined to one circumscribed spot, interfering with breathing and acutely increased by taking a deep inspiration, or by coughing; difficult and anxious respiration, but not so op- pressed as in pneumonia and bronchitis ; quick hard pulse • hot skin, particularly over the chest, or the seat of the disease; (short dry cough;) parched tongue; scanty and high-colored urine; and occasional cerebral symptoms; position in bed usually dorsal; and if the effusion be free and partial, a change to the sound side creates great uneasiness. The prognosis must be formed according to the severity and character of the symptoms. If the heat and other febrile indications gradually subside, and if the performance of the act of respiration be- comes more free and less painful, and a copious and free ex- pectoration ensues, an early recovery may be expected ; but if the fever and inflammation have been intense, and the pain should suddenly terminate, followed by sinking of the pulse and a change of countenance, danger is to be apprehended. Pleurisy seems to consist in a peculiar inflammation in the pleura, with a disposition to effusion or to the secretion of plastic lymph; and it may run its whole course without any of the symptoms above given, declaring themselves. At the commencement of the disease there is diminution 370 RESPIRATORY SYSTEM. of motion and respiratory murmur from pain (subsequently these abnormal signs arise from effusion), and a rubbing sound is not unfrequently heard, generally about the centre of the chest, accompanying the pectoral movements. Soon after the onset of the inflammation, in the greater number of cases, exudation ensues, and, if not encysted, accumulates at the lowest parts of the chest. When, in such instances, the quantity exuded is considerable, and the lung is not re- strained by adhesions, that organ will be floated upwards to some extent, and a dull stroke-sound elicited from the parts beneath it, whilst the upper parts will be found unusually resonant. As the fluid accumulates and ascends in the chest, the an- tecedent clearness of stroke-sound becomes impaired, as is more especially obvious on gentle percussion,—the breath- sound diminished, and respiration more impeded. When these latter abnormal symptoms are met with as high as the middle regions of the thorax, the vocal resonance there, and particularly anteriorly, becomes preternaturally distinct, and is changed to a small, sharp and tremulous note, resembling the bleating of a goat, and hence termed segophony; pos- teriorlv the resonance partakes somewhat more of the char- acter of bronchophony from the greater calibre of the tubes at the root of the lung. ^Egophony, and all sound of the voice, cease at the affected side of the chest, as the liquid effusion increases, except at those portions where the lung may have been adherent, or at the space within an inch or two of the spine; percussion now gives an extremely dull sound, from the lung being deprived of and rendered im- permeable to air by compression, and the respiratory murmur is no longer audible, or only heard in the interscapular and subclavicular regions, particularly the former. In those cases in which the effusion is very considerable, enlargement of the affected side takes place. This enlarge- ment is generally discernible only during expiration at first, but as the exudation increases, the difference can readily be detected during the entire performance of respiration. In INFLAMMATION OF THE PLEURA. 3Y1 attenuated subjects, the intercostal spaces will also be ob- served to have become prominent, instead of presenting their natural depression. But should absorption be effected after such an enlargement, the state of matters is reversed, and the side which was previously, enlarged becomes abnormally con- tracted—the result of atmospheric pressure, and unantagonized muscular action. Displacement of organs adjoining the seat of the effusion, such as the heart, liver, and mediastinum, is also an occa- sional result of extensive effusion. On examining the sound side of the chest, in addition to the negative proofs of the absence of disease, an excess of the usual normal signs will also be perceived, indicated by an accelerated and deeper action, together with a greatly in- creased degree of respiratory murmur, resembling that of children, and hence denominated puerile. The signs of improvement and approaching recovery are marked by a diminution of pain, fever, dyspnoea, and en- largement of the side; and by a return of the respiratory murmur, together with an increasing clearness of sound on percussion. When the result is fatal, death occasionally su- pervenes very rapidly from the compression of both lungs; but, in most cases, this event is more gradual, and arises from atrophy of the lungs, as also affections of the heart, with con- sequent dropsy, caused by the efforts required to propel the blood through the compressed lung. Cough is not an accompaniment of simple pleurisy, so that when this symptom is present there is either bronchitic or or pneumonic complication, or the case may be one of hemor- rhagic pleuritis. TREATMENT. The chief remedies are: Aconitum is an indispensable remedy in allaying inflam- matory fever when attendant on pleurisy;. and is in many cases, indeed, when timely administered, alone sufficient to cure the disease. It rarely fails to produce a favorable im- pression in from six to eight hours ; should it not do so in that space of time, another remedy must be selected. In most 372 RESPIRATORY SYSTEM. instances Bryonia will be the most appropriate, but we must not hesitate to select Sulphur in preference, if called for, or indeed any other remedy that may seem more strikingly indicated. DOSC. Of a solution of six globules to two table-spoonfuls of wa- ter, give a tea-spoonful every three hours, until the pulse becomes more healthy, the skin moist, and the breathing less painful and impeded. If, however, such symptoms as are subjoined should remain or super- vene, pause four hours and proceed with the next medicine; or con- sider also Sulphur, which may sometimes be preferably or previously employed, especially when a third or fourth close of Aconite appears to produce only partial effect against the acute febrile symptoms. Bryonia alba should, in general cases, follow Aconitum wlien the fever has been somewhat allayed by that remedy. It is more particularly indicated, either in simple or compli- cated pleurisy, when the following symptoms are encountered at an early stage of the disease; aching, burning, but more especially acute shooting or cutting pains in the chest, much increased during inspiration or on movement; dry cough, or dry sounding cough, followed by expectoration of dirty, yel- low-colored mucus, streaked or tinged with blood, and attended with great aggravation of pain; oppressed and anxious respiration; palpitation of the heart; dry, cracked, brown, or yellow coated tongue; bitter taste, nausea, and occasionally vomiting of mucus, or of a bitter, bilious-looking fluid; aching or painful pressure at the scrobiculus and hypo- chondria ; intense thirst, especially at night; constipation; head confused and heavy; giddiness on sitting up in bed; aching and shooting pains in the head, or pain as if the head would burst, particularly at the temples, with exacerbation on coughing, or moving; fiery, or blueish redness, and pufliness of the face; restless, disturbed sleep; frequent startings; nocturnal delirium, with alternations of comatose sleep ; burn- ing heat of skin; occasionally, partial, clammy perspira- tion ; pulse generally frequent, hard and small, but sometimes full, unequal, intermittent, and weak; aching in the limbs. Lastly, when in connection with any of the above, the follow- ing symptoms are met with: dulness on percussion, with inflammation of the pleura. 373 puerile respiration; cough on lying on the side, or impossi- bility of lying otherwise than on the back,—Bryonia will rarely fail to render undeniable service, and can indeed with difficulty be dispensed with. (See the symptoms mentioned under this remedy in the chapter on Pneumonia.) DOSC Of a solution of six globules to two table-spoonfuls of wa- ter, give a tea-spoonful every four hours (or in very severe cases every two hours), until amelioration or change. But if the symptoms appear to be only partially affected by either this or the foregoing medicine (or by both), consider the next remedy; if great improvement has been effected by Bryonia moreover, Sulphur may, then also, be advanta- geously employed to complete the cure. Sulphur may with advantage follow Bryonia when the pain mentioned has been removed by that medicine, but the inflammation is not wholly subdued, and often completes the cure. It is also of value when the fever continues after the administration of Aconite, and may be administered without the previous employment of Aconitum, when, although the fever is not violent, we have reason to suspect recent effusion of plastic lymph. Again, when the affection has already been of some days'' duration, and is complicated with pneu- monia, it is our chief stay in preventing solidification, or effect- ing resolution where that has already commenced, and may therefore generally be selected in preference to Bryonia, in such cases, unless the latter be otherwise strongly indi- cated, in which event a dose or two of that medicine, previous to the employment of Sulphur, will be found ser- viceable. Dose. If as an intermediary medicine, two globules in a tea-spoon- ul of water, four hours after the last dose of any other medicine, fol- owed, in six hours, by such treatment as may be particularly indicated. if as a conclusive resource to perfect the cure (already advanced) three globules in a tea-spoonful of water, every six hours, until four doses have been given, and then six globules the first thing in the morning (fasting) for four days; then pause two days, resuming the course as before, if necessary, and so on, until all traces of the disease have been removed. These three are the most important remedies in the greater number of cases of pleuritis, and are frequently found suffi- 17 374 respiratory system. cient to effect a speedy cure. There are often occasions, however, in which it will be found necessary to select one or more of the following remedies : Belladonna has been recommended in cases where the fever returns, and pain and dyspnoea continue notwithstand- ing the employment of Aconite. Dose. Of a solution of six globules in three table-spoonfuls of water, give a tea-spoonful every six hours. Mercurius has been found very useful in cases where the fever has been subdued, but pain and dyspnoea have not been relieved by Aconite, and the patient's strength is becoming exhausted by copious nocturnal sweats. DOSC Same as Belladonna. Arnica Montana, principally when pleuritis has been caused by external injury ; but also in other cases when the more inflammatory symptoms have been subdued by Aconite, &c.; and pain in the chest, with oppressed respiration, only remains ; it is also useful to promote absorption when consid- erable effusion has taken place. DOSC. Of a solution of six globules in three table-spoonfuls of water, give a teaspoonful every three hours, until the pain begins to yield, and the breathing becomes freer, when the intervals between the doses must be lengthened, or the medicine discontinued, and only resumed should the improvement proceed tardily. Arsenicum is the remedy on which we mainly depend in those serious cases where serous effusion to a very great extent has taken place, and where the respiration is painfully im- peded and asthmatic, attended with extreme prostration of strength. _ DOSC Of a solution of four globules in six table-spoonfuls of water, give a tea-spoonful every two hours, until a beneficial effect is produced! Hepar sulphuris has been particularly recommended when the effusion is plastic, and the disease is of some duration (chronic plastic pleurisy), or where, even at the commence- ment, there appears—from the pain, fever and dyspnoea, con- tinuing with but slightly diminished severity after Aconite,__ every probability that the case will prove extremely obstinate bastard pleurisy. 375 and tenacious. Complication with pericarditis or bronchitis is an additional indication for the employment of Hepar under the above circumstances. Dose. Of Hepar sulphuris, third trituration, as much as will lie on the point of a penknife, every two to six hours, according to circum- stances. SPURIOUS OR BASTARD PLEURISY. Pleurodynia, Pseudo-Pleuritis, Pleuritis Muscularis. By these terms is here meant that painful affection usually referred to the intercostal muscles, which is productive of many of the symptoms described under true pleurisy, and is consequently liable to be mistaken for that disease, particu- larly when attended with febrile excitement, as is frequently the case in hysterical females. The history of the com- mencement of the affection, together with the aid of auscul- tation and percussion, enables us to draw a correct distinc- tion between the two diseases. When, therefore, we have satisfied ourselves from the nor- mal condition of the auscultatory phenomena, &c, that the case we have to deal with is one of pseudo-pleurisy, we must select a remedy from amongst the following: In the majority of cases, Arnica is the principal remedy and is occasionally sufficient to effect a" speedy cure after a single dose. In other instances, however, the disorder does not yield so readily, and consequently one or more of the other remedies enumerated must be had recourse to. DOSC. Of a solution of four globules to three table-spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. If in alternation with Pulsatilla, separate solutions of six globules of each, administered by table-spoonfuls at intervals of six hours, until amelioration or change. Bryonia. When the pain is of an acute darting descrip- tion, as if from a sharp instrument running into the side and is at times almost insupportable during inspiration, or even the slightest movement of the body, and when the patient is of a nervous or bilious temperament. Dose. Of a solution of six globules to two table-spoonfuls of water 376 RESPIRATORY SYSTEM. give a tea-spoonful every three hours, until four doses have been given, and then (if still requisite) every six hours, until positive amelioration or change. Pulsatilla. This remedy is frequently very useful in al- ternation with Arnica; it is more particularly indicated when the pain is occasionally of a fugitive character, moving from one part of the chest to another, becoming increased towards evening, and sometimes experienced more during expiration than inspiration. Temperament phlegmatic. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every six hours, until amelioration or change. If in alternation with Arnica, as directed for the last-named medicine (above). Nux vomica. Shooting pains in the hypochondria, in- creased by the respiratory movements of the chest; espe- cially when the affection occurs in hypochondriacal subjects, or in those who are addicted to indulgence in vinous or spirituous drinks. Temperament bilious or sanguine. Dose. Dissolve six globules in four table-spoonfuls of water, and give a tea-spoonful cf the solution every four hours, until amelioration or change. In some cases, in which there is a susceptibility to the return of such symptoms, from time to time, a course of four globules in a table-spoonful of water, every night at bedtime for a week, is desirable^ SPITTING OF BLOOD. HEMORRHAGE FROM THE LUNGS. Sputum Cruentum. Hcemorrhagia Pulmonum. Hcemoptysis. SYMPTOMS. Expectoration of blood by coughing, in greater or less quantity, attended by symptoms more or less severe. This disease displays itself in three varieties : first, by an effusion of blood from the mucous lining of the bronchial tubes ; secondly, by congestion of the lungs, with engorge- ment of the parenchyma from effusions; and thirdly, by the rupture of a blood-vessel in the tubercular cavity of the lungs, during the course of phthisis pulmonalis. It is, however, pro- posed to deal generally with the subject, and to point out the different remedies found useful in the treatment, according to SPITTING OF BLOOD. 377 the symptoms present. We must be careful not to confound this disease with affections of the mouth or gums, or the oc- currence of blood from the nose escaping through the posterior nares, and being returned by the mouth. When the blood proceeds from the chest, it is almost invariably attended with a sensation as if it came from a deep-seated source, is warm, generally tastes sweet, and there is frequently a simultaneous burning and painful sensation in the thorax. When the attack is preceded by well-known premonitory symptoms, the patient should refrain from loud or prolonged speaking, calling, singing, blowing wind instruments, violent exercise of the arms, running, ascending stairs, or, in short, anything calculated to increase the respiratory action, or otherwise fatigue the chest. When spitting of blood occurs in a robust and healthy per- son of sound constitution, it is not very dangerous, but when it attacks slender and delicate persons of weak lax fibre, it is more serious and delicate of removal. It is, however, chiefly when the patient has had a succession of severe attacks, and the blood is discharged in a large quantity, that the case may be considered dangerous. The disease may present itself without any marked pains or difficulty of breathing, and pass off with no return of the attack ; or be preceded by dry cough, oppression, or tightness at the chest, shivering, coldness of the extremities, great las- situde, and high pulse,—and be accompanied by hacking or husky and distressing cough, anxiety, quick pulse, pale and livid countenance,—cease, and then return in a few hours, and be followed by difficulty of respiration and cough ; in still more serious cases, when a marked tendency to phthisis exists, anxiety, oppression at the chest and febrile symptoms are more severe, pure blood is coughed up, and the paroxysms fre- quently return. The rupture of a blood-vessel is a rare occur- rence, although it sometimes occurs in phthisis. When, however, a blood-vessel of any consequence, included in a tuberculous excavation, does give way, the result is generally fatal. 378 RESPIRATORY SYSTEM. CAUSES. Indulgence in spirituous beverages, overheat- ing the body by immoderate exertion, or too great external heat; blowing wind instruments; contusion of the chest or back; falls; lesion of the lungs; breathing a vitiated atmos- phere, or vapors charged with acrid substances; colds or coughs; violent mental emotions ; diseased state of the lungs, whether from pneumonia or phthisis; a general strumous habit; suppressed menstrual, hemorrhoidal, or other discharges ; or repercussed cutaneous eruptions. TREATMENT. In by far the greater number of cases, the discharge of spitting of blood soon ceases of its own accord; the most important object, therefore, is to seek to cure the complaint wThen the hemorrhage has ceased, and thereby prevent its return, or check the development of organic disease of the lungs. The following remedies are not only calculated to arrest the hemorrhage, but also to prevent a relapse, where that is practicable. Pulsatilla. In cases of females, arising from suppression of the monthly discharge, or, in either sex, of a hemorrhoidal flux (particularly when the individual is of leucophlegmatic temperament), and also in other instances, with the following Bymptoms: expectoration of dark coagulated blood, attended with shivering, especially towards evening, or at night, and great anxiety; pain in the lower part of the chest; feeling of flaccidity in the region of the stomach, and weakness. Dose* Three globules in a table-spoonful of water night and morn- ing for a week; then pause four days, after which the course may be resumed as before, if necessary, and so on, until amelioration or change. But if the improvement be evidently limited to a certain degree of progress, or the symptoms recur without apparent modification four days after the termination of the second course, consider the subjoined medicines. When the discharge of blood is very copious and long- continued (or either), of a solution of eight globules to three table- spoonfuls of water, give a tea-spoonful every two hours, until manifest improvement or change. Bryonia is a good remedy in cases where the expectorated blood is excited by a tickling cough, and is often in a coagu- lated state; and where there is oppression at the chest, with SPITTING OF BLOOD. 379 frequent necessity to take a deep inspiration; anxiety and irascibility. DOSC. In every respect as directed for Pulsatilla. Nux vomica is adapted to individuals of an irritable temper, in whom this affection owes its origin to a hemorrhoidal sup- pression, a fit of passion, or exposure to cold. {Haemoptysis vicaria.) It is further indicated by dry cough, which causes headache, with excessive tickling in the chest and exacerba- tion of the symptoms towards morning. DOSC. Three globules in a table-spoonful of water, night and morning, for a week ; then pause four days, after which repeat the same course if yet requisite, and so on until permanent relief or change ensues. In cases in which the discharges are very copious or prolonged, the like doses should be first repeated every three hours, until the more alarming symptoms are allayed, and then at the longer intervals as just prescribed. When the effect of Nux vomica appears incomplete, consider Sulphur. Rhus. When the blood expectorated is of a bright red, the mind much agitated, and the patient irritable and rendered worse after the slightest vexation or contradiction. Dose. In all respects as directed for Nux vomica. Arnica Montana. Principally in cases arising from exter- nal lesion, such as a severe blow in the chest, or from lifting a heavy weight, or any other exertion, even blowing wind in- struments ; but also in almost all cases where the stethoscope detects effusion of blood into the parenchyma, attended with a sensation of constriction and burning in the chest, pain as from contusion in the scapular and dorsal regions, and dysp- noea. Moreover, profuse expectoration of dark-colored blood or coagula, brought up without much exertion, or bright frothy blood, mixed with mucus and clots; sensation of tickling behind the sternum; general heat, great weakness and syncope. Dose. Of a solution of eight globules to three table-spoonfuls of water, give a teaspoonful every two hours until three doses have been given, and then every six hours, until manifest improvement or change. But if the subjoined conditions occur, give it alternately with Aconitum. Aconitum is often found exceedingly serviceable in warding off an attack, by the great power it possesses in controlling 380 RESPIRATORY SYSTEM. the circulation, and is indicated, previous to the paroxysm, by the premonitory symptoms of shivering, with accelerated pulse, palpitation of the heart, a sensation of ebullition of blood in the chest, with burning and fulness in the same region; paleness and expression of anxiety in the face ; great anguish and anxiety, aggravated by lying down; or during the attack when the expectoration is profuse, coming on in gushes, and excited by a slight dry cough. {Haemoptysis plethorica). DOSC. Two globules in a tea-spoonful of water, repeated at intervals of two hours, until manifest improvement or change; or if the sub- joined indications occur, pause three hours, and proceed with the next (or two next) medicines. Acidum sulphuricum is frequently of service after Arnica when the cough continues, and brings on fresh bleeding. DOSC Three globules in a table-spoonful of water, night and morn- ing, until permanent amelioration or change. Ipecacuanha. When a taste of blood remains in the mouth a few hours after the employment of Aconite has been commenced, when there is frequent tussiculation, with nausea, weakness and expectoration streaked with blood. DOSC Three globules in a table-spoonful of water, repeated at intervals of three hours (or even every hour in very urgent cases), until amelioration or change; but if the subjoined symptoms occur, proceed at once with the next medicine. Arsenicum. When the anxiety, anguish, and palpitation of the heart increase, notwithstanding the administration of Aconite; and when, in addition, we find extreme restlessness and general dry burning heat. The employment of this remedy alternately with Ipecac- uanha has been found to succeed in many instances, when neither of them separately has been found sufficient to con- quer the disease; an occasional dose of Nux vomica should be prescribed as soon as the hemorrhage has in a great mea- sure been checked, to such individuals as have been in the habit of indulging in spirituous, vinous, or fermented liquors, or coffee. Should hemorrhage return after a temporary ces- SPITTrNG OF BLOOD. 381 sation, Sulphur may be given, followed in turn, if required, by Arnica. DOSC If singly, two globules in a tea-spoonful of water every hour, until amelioration or change. If in alternation with Ipecacuanha, as directed for that medicine above. Opium. Heat, dyspnoea, with sensation of burning heat at the region of the heart; coldness, particularly of the extremi- ties ; tremor in the arms ; dry hollow cough, with expectora- tion of blood and frothy mucus, and sometimes also weak- ness of the voice; drowsiness, with sudden starts; aggrava- tion of cough after swallowing. It will be found useful in the most serious cases, particularly to persons addicted to spirituous liquors; in the latter case it may be useful to follow up the treatment with Nux vomica. Dose. In very urgent cases, of a solution of twelve globules to two table spoonfuls of water, give a tea-spoonful every half hour until manifest improvement or change. In less severe cases a solution of six globules to two table-spoonfuls of water, similarly administered at intervals of three hours. Cinchona, as already mentioned in several places in this work, is one of our best remedies in restoring the vital ener- gies of the patient after considerable loss of fluids, whether of blood or other secretions; it is therefore particularly effi- cacious after a severe attack of this affection, but is also indi- cated during its course, when the spitting of blood takes place after a violent cough, or when there is a continual taste of blood in the mouth, or when we find shivering alternately with accesses of heat, frequent and short-lived perspirations; tremor, and confusion of vision, with a sensation of vacuity or lightness in the head, weakness and desire to remain con- stantly recumbent. Dose. If against actual discharge of blood, give three globules in a table-spoonful of water, every three hours, until amelioration or change. But if partial effect only be manifest, within three hours after the fourth dose, consider the subjoined medicine. If as a restorative agent after an acute attack, give four globules in a table-spoonful of water, night and morning, until manifest improvement or change. Ferrum metallicum may be used with advantage after Cinchona in severe cases, or may be preferred if the expecto- 17* 382 RESPIRATORY SYSTEM. ration follows a slight cough, and is scanty, but consists of pure bright red blood, attended with pain between the scapu- lae, with inability to remain long in a sitting posture; the patient feels the concomitant symptoms relieved by move- ment, but is speedily fatigued, especially by conversation. It may, in some cases, be advantageously alternated with Cinchona, Carbo v., Arnica, and Arsenicum,—in others, Sul- phur may be required to complete the cure in some cases. Dose. If against actual discharge of blood three globules, if as a restorative remedy, four globules, as directed for Cinchona. Sulphur. This remedy is frequently useful in winding up the treatment after the employment of other medicines; and it is also particularly suitable for individuals disposed to hemorrhoidal affections, in derangement of the menstrual flux, or hemoptysis arising from suppressed cutaneous erup- tions, such as scabies, &c. {Hemoptysis vicaria, &c.) Nux v. and Arsenicum may occasionally be advantageously given in alternation with Sulphur at intervals of five to ten days, par- ticularly when the disease occurs in drunkards. DOSC. If as an intermediary medicine give six globules in a table- spoonful of water, six hours after the last dose of any other remedy; after which pause twelve hours, and proceed with such other treatment as is evidently appropriate. If Sulphur, however, be indicated by the assemblage of symptoms, in an acute attack, against the actual discharge of blood, three globules should be given in a table-spoonful of water every three hours, until amelioration or change. DIET, &c. The rules given under H^ematemesis ought to be observed as regards regimen; both mind and body should be kept perfectly quiet; the patient should speak as little as possible, and be kept in a semi-recumbent posture, or, if his strength allow, sit upright. PULMONARY CONSUMPTION. Phthisis Pulmonalis. One of the earliest symptoms of tuberculous phthisis is a short cough, which is either dry or accompanied by the expectoration of a frothy mucus, and is generally slight at the commencement, but more or less constant. Shortness of PULMONARY CONSUMPTION. 383 breath, proceeding from obstruction, caused by the granular and diffused indurations, is another early symptom of con- sumption. It is, at first, experienced only during exertion, but subsequently comes on after every fit of coughing, or on lying on the one or the other side, and is much increased by the slightest movement. Symptoms of gastric derangement are frequently present, with redness of the tongue, or white furred centre, with inflamed and projecting papillae, and vivid red tip and margins; the patient falls off in flesh, becomes indolent, dejected, and overpowered with languor. A feeling of soreness is often complained of behind the sternum, or under the clavicles, particularly after any fatigue, or after a fit of coughing, and sometimes on exposure to cold air. The pulse is often normal in the first stage of the disease, but soon becomes full, hard, and accelerated. Fever of an intermittent character soon makes its appearance; it declares itself most towards night, remits from about two in the morning until the following day at noon, when it returns in a slighter degree, and continues until about five in the afternoon, and is then followed by another remission. This hectic fever is, in the first instance, chiefly manifested by flushing of the face (which is often most apparent after a meal), and heat in the palms of the hands and soles of the feet; but, as the disease advances, night sweats supervene, which leave the patient in a state of great exhaustion in the morning. As the expectoration increases it becomes more viscid and opaque, and is often tinged with blood, or a considerable quantity of florid, frothy blood is ejected in consequence of the obstruction offered to the blood-vessels, by the indurations or granulations already alluded to. As the disease advances and passes into the second stage, or that in which the dark red or grayish indu- rations are converted into crude yellow tubercles, the respi- ration becomes more difficult, the emaciation and debility go on increasing, the cough is rendered more severe and trouble- some, particularly at night, and the fever, though of shorter duration, is attended with more profuse sweating, and the pulse loses tone. The expectoration becomes, at the same time, 384 RESPIRATORY SYSTEM. more free and copious, particularly towards morning, and is less thin and transparent. During the febrile exacerbations, or after meals, or at times of excitement, a circumscribed red patch still appears on each cheek, but at other times the color of the cheek is faded, and the countenance wears a dejected expression. In the third (or suppurative and ulcerative) stage of the disorder the tubercles become soft, and are expectorated at first in the form of curd or cheese-like particles, and subse- quently mixed up with pus, mucus, shreds of lymph, blood, and occasionally, though rarely, portions of pulmonary tissue. The bowels, from having been more inclined to be costive at the commencement of the disease, are now more prone to be relaxed, so that attacks of diarrhoea often recur frequently, and, by alternating with colliquative sweats, induce an exces- sive degree of weakness and prostration. In this, the last stage of the disease, the patient becomes reduced to a skeleton; the face is thinned, the cheek-bones prominent, the eyes look hollow, the hair falls off, the nails are livid and incurvated, and the feet cedematous; but, notwithstanding all this, the countenance presents a degree of clearness, and the eyes a lustre that are rarely, if ever, met with in other maladies ; moreover, the state of mind is generally so serene and hopeful, that the patient seems often quite unconscious of his danger- ous condition, and speaks and acts as if in full anticipation of a speedy recovery. The senses commonly remain entire and collected to the end of the disorder, but in some cases delirium precedes death and continues until life is extinct. The usual # duration of phthisis pulmonalis is from eight or nine months to a year and a half; but circumstances tend much to vary the length of the disease ; and there is a rapidly fatal form which runs its course in from two to three months, sometimes indeed only in one. When the malady makes slow progress, the patient is affected with cough, weakness, and emaciation, chiefly in winter and spring, and in many respects restored to comparative health in summer; but is always extremely susceptible to cold, and commonly complains of breathlessness PULMONARY CONSUMPTION. 385 on the slightest exertion. In this state the patient continues for a considerable time, sometimes even for several years, until at length the symptoms of confirmed consumption are , developed by the invasion of an inflammatory attack proceed- ing from cold or some other irritating cause.* When we take the general symptoms in conjunction with the physical signs, the diagnosis of phthisis pulmonalis is, in general, unattended with difficulty. It is true, that in the early stage, when the miliary indurations are equally diffused or scattered through both lungs, they do not give rise to any marked diminution or change in the respiratory murmur, or in the resonance of the thorax on percussion. But it much more frequently happens that the indurations, even in the early stage, accumulate in clusters, particularly about the apices of the lungs, and usually more on one side than the other. The sound, on percussion, will therefore generally be found dull at the clavicle (more commonly the left) and the subclavicular region; the breath-sound during expiration will, at the same time, be unusually audible, and the voice will transmit a diffused resonance or preternatural clearness. When the spaces immediately beneath the clavicles give no signs of disease or discrepancy of sound, the regions below, at the sides, and at the back, should be examined (between the scapulae in the case of children, in particular). A slight flattening is sometimes observable under the clavicles. On comparing the movements of the two sides of the chest, when the patient breathes deeply, a difference in their individual mobility will frequently be perceived. When the disease has attained the suppurative stage, and the tubercles have con- sequently become soft, or entirely liquid, a clicking or bub- bling sound will be heard either under one of the clavicles or above the spine of one of the scapulae. As the evacua- tion of the softened matter of the vomica progresses, a more continued gurgling, or the so-called cavernous rhoncus, will * Hoarseness is often an early accompanying symptom of phthisis. Laryn- geal phthisis, with thickening and ulceration of the lining membrane of the larynx, independently of its own serious character as a disease, is moreover very frequently complicated with tubercular formations in the lungs. 386 RESPIRATORY SYSTEM. then be heard. Again, when the vomica or abscess has become completely softened and evacuated by ulceration into the bronchial tubes, a cavity is left, over the seat of which, cavernous respiration, and, when the patient speaks, the phenomenon designated pectoriloquy, are encountered. TREATMENT. It would require a separate treatise to do justice to the treatment of this deplorable disease, by giving, or attempting to give, a full and minute description of the characteristic indications for the medicines which are appro- priate to the various forms of the different stages of the disorder. Tendency to Pulmonary Consumption. Stannum, Carbo veg. These two medicines, administered alternately, in repeated courses, untill all traces of the disease have been removed, are frequently of great service in over- coming the tendency of the disease to degenerate into Pul- monary Consumption amongst subjects of a debilitated state of health and scrofulous habit of body. Dose. First three globules of Stannum in a table-spoonful of wa- ter, night and morning, for four days, then an interval of three days; after which, the like doses of Carbo veg. should be similarly adminis- tered ; and so on, alternately, for three weeks, or until the earlier de- velopment of new symptoms, positive improvement or change in the state of the patient. Their leading indications may be gleaned from the chapters on Cough, Pleuritis, Pneumonia, and Hemoptysis. In conclusion, it must be remarked that as the irritation which is so repeatedly created in the lungs by the vicissitudes of climate, so constantly occurring in most parts of this country, forms a great drawback to the more or less successful treat- ment of pulmonary consumption, it is of great moment that every possible means be taken to avoid that pernicious influence. It has been much in vogue with many medical men to recommend warm climates or well-sheltered situations, even although the atmosphere might be of a humid and relaxing nature. But we confess that we are inclined to side with those who do not object to a somewhat bracing and cold atmosphere, provided it be dry and not of very variable ASTHMA. 387 temperature. Much, however, depends upon the peculiarity of the case, the air, as well as the food, which may be well adapted to one patient, being often perfectly inappropriate and therefore injurious to another. ASTHMA. This affection is characterised by the following phenomena : difficulty of breathing, recurring in paroxysms, attended witli a sensation of suffocating constriction in the chest, cough, and wheezing. The paroxysm is frequently preceded by a sense of coldness, languor, headache, heaviness over the eyes, sickness or flatulence, and a sense of oppression in the chest. During the attack, the patient feels much worse in the recumbent posture, and consequently sits up, requests the door or window to be thrown open, to admit more ah- into his apartment, and uses every effort to dilate and empty the lungs. He also experiences great restlessness, making frequent attempts to force something out of the air-passages, which he thinks impedes the breathing, by coughing. The face is pale or livid, and wears an anxious expression. The extremities, and even the nose and ears, are frequently cold, and the face and chest are covered with cold perspiration ; the heart palpitates ; the pulse is variable, being quick and full, or small and quick, or weak and irregular; often intermitting. These symptoms continue with a greater or less degree of violence for some hours or even days, until expectoration takes place, which affords relief as it increases in quantity. A remission also sometimes takes place soon after an accession of copious per- spiration or a profuse discharge of urine. The disease is more frequently met with at an advanced than at an early stage of life, and oftener in men than women. The attacks occasionally come on in the afternoon, or on retiring to rest, but much more frequently during the night, and in the midst of a sound sleep, from which the patient is suddenly awoke by a sense of suffocation. The recurrence, as well as the duration, of the attacks is very various. One attack generally leads to another, and the paroxysms commonly become more and more frequent and 388 RESPIRATORY SYSTEM. distressing; still, if no organic disease result, patients who are subject to returns in considerable frequenc}', sometimes survive to an advanced age. But this is unfortunately not often the case, for unless the disease be arrested, the repeated obstruc- tion and disturbance which is offered to the respiration and circulation, seldom fails, in the majority of cases, to induce organic lesions either of the heart or large vessels, or of the lungs, with the usual concomitants of water in the chest or abdomen. The quantity of expectoration is small, and even entirely absent in some cases of asthma, whilst in others it is exceedingly copious ; and hence, the disease has been divided into dry and humid asthma. In the former {Asthma siccum), the attack is usually sudden, violent, and of short duration; the cough slight; the expectoration scanty, appearing only towards the termination of the fit, and in some instances entirely wanting. In the latter {AstJima humidum), the paroxysm is gradual and protracted ; the cough severe; the expectoration supervenes early, is at first scanty and glutinous, and after- wards copious and productive of great relief. TREATMENT. In ordinary cases the subjoined remedies will be found serviceable, when the leading symptoms are in accordance with those which are described. Ipecacuanha. During the paroxysm of acute asthma, this remedy is one of the most frequently useful, whether the attack occurs in children or adults. It is more especially indicated when the patient is awoke from a sound sleep, with a suffocating sensation of constriction in the windpipe, with quick laborious breathing and gasping for breath ; wheezing and mucous rattling in the chest; short dry cough ; paleness and coldness of the face, sometimes alternately with heat and redness ; coldness of the feet; anxiety and dread of suffoca- tion ; feeling as if dust were inhaled during the act of respi- ration, and caused by the suffocating sensation in the chest; spasmodic rigidity of the body, and livid hue of the face. After a dose or two of Ipecac, it is occasionally requisite to have recourse to Arsenicum to afford further relief. In other instances Nux v. or Bryonia will be found better adapted to remove the remaining symptoms. ASTHMA. 389 DOSC. Three globules in a table-spoonful of water, repeating the dose, if necessary, in half an hour (in very distressing cases), or only after two hours (in less urgent instances.) But if little relief should have resulted within an hour after the second dose (in the one case), or within three hours (in the other case), or, if the subjoined indications occur, consider the following medicines, and proceed accordingly. Arsenicum is chiefly called for (either in acute or chronic asthma) when, during the attack, the respiration appears to become more and more laborious, and is attended with ex- treme agitation, moaning, and jactitation ; great exhaustion and anguish, as if at the point of death, with cold perspira- tion. In confirmed asthmatics, it forms a most important remedy, when the breathing is liable to become much op- pressed when walking rather quickly, or when going up a hill, or ascending stairs; and when, particularly in the case of old people, even the effort of laughing, or the exertion of getting into bed brings on a fit of dyspnoea. Arsenicum, as well as Ipecacuanha, is further indicated when the paroxysms of asthma are most liable to occur on retiring to rest, or before midnight, the patient being disturbed from sleep by a sense of spasmodic constriction in the chest and larynx, which is soon followed by laborious, panting, and whistling respiration, with gasping for breath. These symptoms are occasionally relieved by remissions, but the attack is prone to recur on using the slightest exertion: for the most part, however, the paroxysm continues with more or less intensity until relieved by the accession of a fit of coughing, with expectoration of viscid mucus, filled with vesicles. Arseni- cum, though principally called for in cases in which the attacks come on at night, is also useful when they are liable to be excited during the day, on exposure to a cold bracing air, or on going out during the prevalence of disagreeable, damp, or stormy weather. Likewise when changes of tempe- rature, and tight or very warm clothing, are frequent sources of fits of dyspnoea. Sensation of burning heat in the chest dm-ino- the fit of asthma, is an additional indication for Arsenicum. Dose. In acute cases, give two globules in a tea-spoonful of water, repeating the dose at intervals of half an hour (in very distressing 390 RESPIRATORY SYSTEM. cases), or every four hours (in less urgent instances), until decided amelioration or change. In chronic cases, give similar doses, repeated at intervals of twelve hours, for four days in succession (or until earlier change); then pause six days, and, if necessary, repeat the course as before, and so on, until decided amelioration or change. Bryonia. This medicine, as already mentioned, is fre- quently useful after the previous employment of Ipecacuanha. The indications are chiefly: obstructed respiration at night or towards morning, with frequent cough, pains in the hypo- chondria, and inability to recline on the right side, and not without inconvenience on the left, so that the patient is constrained to lie on the back; frequent coughing, with ex- pectoration at first frothy, and subsequently thick and glu- tinous, and frequently attended with retching or vomiting ; aggravation of the dyspnoea from talking, or from the slightest movement; frequent efforts to obtain sufficient air by deep inspirations, accompanied with moaning, palpitation of the heart, and great anxiety. The attacks are often attended by shootings in the chest on taking a full inspiration, also on coughing, or after any movement of the arms or trunk. At other times there is colic, eructations of the taste of the food partaken of, irritability of temper, and disposition to find fault with everything. {Bryonia and Nux v. are often administered with great advantage in alternation.) Dose. Of a solution of six globules in two table-spoonfuls of water, give a tea-spoonful every four hours, until decided amelioration or change. If in alternation with Nux vomica prepare (separately) a similar solution of each, and give the like dose of the one six hours after the other, in rotation, until decided amelioration or change. Nux vomica. Nocturnal attacks of suffocating tightness, especially at the lower part of the chest, preceded by dis- agreeable or anxious dreams; also when the paroxysms are prone to occur in the morning, or after a meal, and are attended with anxiety, aching and pressive pains in the precordial region, as also in the hypochondria; feeling of distention in the abdomen and epigastrium; flatulence; tension, pressure, and aching in the chest; palpitation of the heart; short hacking cough, with difficult expectoration; ASTHMA. 391 inability to bear the shghtest pressure from the clothing, particularly around the chest and waist; the clothes seem to fit tightly, and increase the difficulty of breathing, whilst in reality they are quite the reverse; dyspnoea when walking and conversing in the open air, especially if the temperature be somewhat cold; dyspnoea after trivial corporeal exertion of any kind. Melioration of the asthmatic sufferings when reclining on the back, or on changing from one posture to another, such as sitting up, and then lying down again, or turning from one side to the other. Disposition irritable and passionate. Dose. Whether singly, or in alternation with Bryonia, give three globules, as directed for the last-named medicine above. Pulsatilla. Oppressed, rapid, and laborious breathing from a feeling of spasmodic constriction in the chest, es- pecially at the inferior portions; or suffocating feeling in the windpipe, as if caused by the vapor of sulphur ; tension, and sensation of fulness, pressure and aching, attended with mu- cous rattling in the chest; short fits of coughing in rapid succession, and appearing to threaten suffocation; or cough with copious expectoration of mucus. The attacks usually coming on at night, or in the evening when in a horizontal posture; extreme anguish, palpitation of the heart, and sometimes lancinating pains in the chest during the paroxysms. Pulsatilla is generally more suitable for hysterical females, or individuals of a mild, timid, sensitive, or fretful disposition. In dyspnoea, with mucous rattling, and cough, occurring in children from taking cold, it is likewise a most useful remedy. Dose* Three globules in a table-spoonful of water, repeated, after the lapse of half an hour (in very distressing cases), or after two hours (in less urgent instances), and, subsequently, at intervals of four hours, until decided amelioration or change. Tartarus emeticus. Dyspnoea with suffocating cough and anxious oppression at the precordia, arising from an excessive secretion of mucus m the bronchi; this remedy 392 respiratory system. is frequently of great service, either in aged persons or in children. Dose. Three globules as directed for Pulsatilla. Opium. Obstructed breathing, either from congestion or from pulmonary spasms, with suffocating cough and livid hue of the face; loud mucous rattling in the chest, with extreme anguish from dread of suffocation ; dyspnoea during sleep resembling nightmare (incubus). Dose. Three globules as directed for Pulsatilla. China. Paroxysms of asthma at night, as if caused by an accumulation of mucus in the windpipe; wheezing in the chest during inspiration; difficult expectoration of thick transpa- rent mucus; oppression at the chest, palpitation of the heart, and inability to breathe, unless the head and shoulders are propped up with pillows; great weakness, and tendency to copious sweating at the slightest exertion, or when too warmly clothed. DOSC During the attach, of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful, repeated, after the lapse of half an hour (in very distressing cases), or after the lapse of two hours (in less urgent instances), and again, after a further interval of three hours. But if within four hours after the third dose the improve- ment be not very decided, proceed with the next medicine. Against the predisposition give three globules in a tea-spoonful of water, night and morning, for a week (or until earlier change); then pause eight days; after which the course may, if necessary, be repeated as before, and so on until decided amelioration or change. Sambucus. Rapid and laborious respiration, with loud wheezing; oppression at the chest as if from a weight, attended with anguish and dread of suffocation, and some- times swelling and livid hue of the face and hanjp, general heat, tremor, inability to talk much above a whisper; suffo- cating cough; aggravation of the symptoms in the recumbent posture. In the case of children this remedy is often of great service, wlien, in consequence of a chill, they are seized with spasm in the chest, and awake from sleep with a start, and ex- hibit many of the symptoms detailed. (See Spasms in the Chkst.) DOSC Two globules in a tea-spoonful of water, every two hours, until decided amelioration or change. ASTHMA. 393 Moschus. Acute asthma occurring in hysterical females, or in children from exposure to cold; sense of spasmodic con- striction in the larynx and bronchi; or oppression at the chest with paroxysms of suffocating feelings, as if caused by the inhalation of the vapor of sulphur, commencing with a fit of coughing and succeeded by distressing oppressive con- striction, sometimes to such a degree as almost to drive the patient to exasperation and distraction. Dose. Two globules as directed for Sambucus. Belladonna. Difficulty of breathing, particularly when occurring in females of an irritable habit, and subject to spasms, with tension in the chest, and lancinating pain behind the sternum; diy cough at night, with moaning respiration, which is sometimes deep and full, and at others short and rapid, with gasping for breath and great efforts to dilate the chest to the utmost to obtain a sufficient supply of air; sensation of constriction in the larynx, and feeling as if suffocation would ensue on putting the hand to the larynx, or on turning the neck; paroxysms of asthma, with loss of consciousness, &c. Dose. Two globules in a table-spoonful of water, repeated, after the lapse of half an hour (in very severe cases), or after the lapse of two hours (in less urgent instances), and again after a further interval of three hours. But if within four hours after the third dose, there be only partial improvement, proceed with the next medicine. Lachesis is often useful when only partial relief has been effected by the action of Belladonna. Dose. Two globules in a tea-spoonful of water, repeated at inter- vals of three hours, until decided amelioration or change. Veratrum. In violent attacks of acute spasmodic asthma, with symptoms of threatening suffocation, cold perspiration, coldness of the nose, ears, and lower extremities, this remedy will often afford relief when Cinchona, Ipecacuanha, and Arsenicum have failed to do so. Dose. Two globules as directed for Sambucus. Dulcamara. In moist asthma {Asthma humidum) this medicine is one of the most useful remedies, particularly when the attacks are liable to be excited by a cold and damp 394 NERVOUS SYSTEM. state of the atmosphere. In severe dyspnoea, with loose sounding cough, rattling of phlegm in the chest, and copious expectoration, arising from exposure to wet, it is likewise a valuable remedy. Dose. Of a solution of six globules to two table-spoonfuls of wa- ter, give a tea-spoonful, repeating the dose, at intervals of four hours, until decided amelioration or change. Stannum. Humid asthma, with wheezing and obstructed respiration, particularly at night, or on preparing for bed; but also when the paroxysms come on during the day, and render it necessary to loosen the clothing. The attacks are attended with oppression at the chest, and mucous rattling; cough, with copious expectoration of viscid or grumous, or transparent and watery, or yellowish mucus of a sweetish or saline taste. DISEASES OF OR CONNECTED WITH THE BRAIN, AND OTHER PARTS OF THE NERVOUS SYSTEM. DETERMINATION OF BLOOD TO THE HEAD. Congestio ad Caput. This is an affection to which many individuals who lead a sedentary life are subject: intense mental application and habitual indulgence in the use of spirituous liquors, or other stimulating liquids, such as coffee, &c, are also its frequent exciting causes, particularly in those who inherit a predispo- sition to the order. SYMPTOMS. Fulness of the vessels of the head and neck, the pulsation of which the patient experiences through the entire frame ; heat, redness, and turgidity, or pallor and pufii- ness of the face, with anxious expression of countenance; repeated attacks of giddiness, particularly after sleeping, or sitting in a warm, confined apartment, or on exposure to the rays of the sun when exercising in the open air; headache, DETERMINATION OF BLOOD TO THE HEAD. 395 generally above the orbits, and in the forehead, increased by stooping or coughing; dimness of vision ; buzzing in the ears; tightness around the throat; oppressed breathing; furred, red-pointed, or enlarged and very red-looking tongue; dys- pepsia, constipation, disturbed, unrefreshing sleep; drowsiness during the day. Aconitum. This is the principal remedy to commence with in all recent cases, and is alone sufficient speedily to remove the affection, particularly in children, when fright and anger combined have been the exciting causes. Dose. Three globules in a table-spoonful of water, every six hours, until amelioration or change; but if within six hours after the fourth dose the symptoms be not completely removed, or if more particularly the subjoined indications remain or supervene, pause six hours longer, and proceed with the next medicine. Nux Vomica. As has already been repeatedly observed, this remedy is exceedingly efficacious in complaints arising from sedentary habits, intense study, or that much more cul- pable habit, the excessive indulgence in spirituous or vinous liquors, &c.; it is accordingly one of the most useful remedies in determination of blood to the head, induced by such causes; it is also very serviceable in cases arising from a violent fit of passion, and is more particularly indicated when we meet with the following symptoms: distension of the veins, with violent pulsation in the head ; heat and redness, or paleness, or sickly hue of the face ; attacks of giddiness, violent head- ache, particularly in the forehead and over the orbits, aggra- vated by reflecting, or by any attempts at mental application, also by stooping or coughing; disturbed sleep; nervous exci- tability, and disposition to be angry at trifles; constipation. Calcarea will frequently be found of signal benefit after Nux v., in obstinate cases occurring in persons addicted to indul- gence in spirituous liquors. DOSC Against the actual attacks, three globules in a table-spoon- ful of water every six hours, until amelioration or change. Against the predisposition, four globules in a teaspoonful of water, every night at bedtime for a week; then pause four days, subsequently resuming the course, in like manner, if necessary, and so on until permanent im- 396 NERVOUS SYSTEM. provement or change. But if the improvement be but partial within four days after the termination of the second course, proceed with the next medicine. Belladonna. After a previous administration of Aconite, when necessary, this is one of our most important remedies in the treatment of congestion to the head. Indications : great distension of the vessels of the head, attended with severe jerking burning pains in one half of the head, aggravated by the slightest movement or the least noise; fiery redness and bloatedness of the face, redness and protrusion of the eyes, sparks before them, and sometimes dimness of vision; dark- ness before the eyes (obscurity); diplopia; buzzing in the ears; bright redness of the throat; attacks of fainting; somnolency. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Opium is of speedy service in cases arising from fright; but it is, moreover, a remedy of extreme value in the most serious cases of congestion, either arising suddenly from the effects of a draught of cold or iced water, especially when heated, or from other causes, with the following symptoms : vertigo, heaviness of the head, humming in the ears, dulness of hearing, stupor; also when the attack is occasioned by constipation, or the effects of a debauch, with pressure in the forehead from within outwards, with redness and bloated- ness of the face, great depression, fugitive heat; violent thirst; dryness of the mouth ; acid regurgitations, nausea or. vomiting. Dose. Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful every four hours" (or when the symptoms are ex- tremely distressing, every hour), until manifest improvement or change. Coffea. In cases arising from excessive joy, this remedy will be found to exert a salutary influence. Symptoms: excessive and uncontrollable liveliness; great heaviness of the head, or aggravation of the sensations when speaking; sleeplessness. Dose. Three globules in a tea-spoonful of water, repeated after the DETERMINATION OF BLOOD TO THE HEAD. 397 lapse of six hours, and then at intervals of twelve hours, until amelio- ration or change. Chamomilla. Congestion caused by vexation, or a fit of passion, particularly in chil'dren, is speedily relieved by this remedy. Dose. Three globules in a tea-spoonful of water, repeated, if requisite, at intervals of four hours. Ignatia, when induced by stifled vexation, or harrowing concentrated grief. Dose. Four globules in a dessert-spoonful of water, every night at bedtime for a week (or until the earlier manifestation of improvement or change). Arnica. In cases arising from external violence, such as severe falls or contusions, followed by stupefaction, vertigo, sensation of pressure or coldness over a small circumscribed space ; tendency to close the eyes ; disposition to be frightened, and vomiting,—the external and internal administration of Arnica, when timely had recourse to, will frequently be found specific. This remedy is, however, equally useful in other cases with the following symptoms: heat in the head, with coldness of other parts of the body; sensation of Obtuse pressure on the brain; painful burning or throbbing in the cranium; humming in the ears; vertigo, with confused vision, especially on assuming the erect posture after sitting for some time. DOSC. Three globules in a table-spoonful of water, repeated after the lapse of six hours, and afterwards, night and morning, until the total subsidence or change of the symptoms. Mercurius. Congestion, with sensation of fulness, or, as if the head were compressed by a band ; nocturnal aggravation with darting, piercing, tearing, or burning pains; disposi- tion to sweating. Dose. Three globules as directed for Arnica. Pulsatilla. This remedy, as will be found stated in the proper place, is well adapted to many cases of congestion occurring in young girls at the critical age, or to all cases occurring in cold, lymphatic temperaments with the follow- 18 398 NERVOUS system. ing symptoms: distressing semi-lateral pain in the head, particularly of a pressive character, or if the pain in the head commences at the occiput, and extends to the root of the nose, or invertedly. Amelioration of the symptoms from exercise, or from pressing or binding the head ; exacerbation while sitting; sense of weight in the head; vertigo; face pale and wan-like, or red and bloated; inclination to weep; anxiety; coldness, or shivering. Dose. Three globules in a table-spoonful of water, repeated at in- tervals of four hours, until three doses have been given, and then every twelve hours, until permanent relief (or change) results. Lycopodium is a valuable remedy in some obstinate cases of congestion attended with giddiness, ebullition, flatulence, anxiety, and habitual constipation. Dose. Four globules in a table-spoonful of water, night and morn- ing, until amelioration or change. Dulcamara. Congestion, attended with continual buzzing in the ears, dulness of hearing, and particularly when the affection has arisen from getting the feet wet, or from a chill in cold, damp weather. Dose. Three globules in a table-spoonful of water at bedtime, repeated after the lapse of twelve hours, and again at night, if requisite, and so on, until manifest improvement or change. Sanguinaria canadensis. Distension of the vessels, heavi- ness of the head, with fulness and aching, as if the head would burst; pressure behind the orbits. The pains are chiefly complained of in the forehead, sinciput, and right side of the head. Dose. As directed for Lycopodium. Cinchona. Congestion occurring after repeated blood- lettings, or hemorrhage in general, is generally relieved by this remedy. Dose. Three globules in a table-spoonful of water, morning and evening for three days, after which pause four days, and, if necessary, proceed with the next medicines successively. Sulphur is almost always more or less useful in cases of this nature, and should, therefore, be given four days after the second dose of Cinchona. inflammation of THE BRAIN. 399 Dose. Three globules in a table-spoonful of water, morning and evening, for a week; then pause a week, and proceed with the next medicine. Calcarea carb. should be given a week after the last dose of Sulphur in similar cases. Dose. As directed for Sulphur. Opium. Threatening vertigo with confusion of ideas ; or decided giddiness, with humming in the ears, and clouded vision on sitting up in bed, which renders it necessary to lie down again ; vertigo from fright. Dose. Three globules in a tea-spoonful of water, repeated at inter- vals of six hours, until the sensations wholly disappear. Conium. Violent giddiness, with dread of falling to one side when looking backwards. Dose. Three globules, as directed for Opium. DIET. The homoeopathic regimen already given in the introduction should be rigidly adhered to, and stimulants of all kinds carefully avoided; moreover, early rising, and daily exercise in the open air should not be neglected ; the use of the flesh-brush in the evening is also of some service. INFLAMMATION OF THE BRAIN AND ITS TISSUES. BRAIN FEVER. Phrenitis. Encephalitis. SYMPTOMS. Coma, or constant delirium, or both, with signs of determination of blood to the head ; fulness and red- ness of the face and eyes; breathing of the carotid and temporal arteries ; occasional attempts to grasp the head. When it is caused by inflammation of the tissues, the pain is more acute than that arising from inflammation of the substance of the brain. Paralysis also more frequently accom- panies the latter form. In inflammation of the brain or its membranes, the symp- toms are exceedingly diversified; the extent and duration of the disease, the age, the sex, and constitution of the patient, all combine to give to the affection a variety of character. Much assistance may be derived, in ascertaining whether the brain is affected or not, from examining the eyes and general 400 NERVOUS SYSTEM. expression of the countenance. The pupils in the first stages are commonly found more or less contracted, but as the disease advances, they often become dilated. Occasionally the attack is preceded by premonitory symptoms, such as congestion of blood to the head, attended with sensations of weight or stupefying, pressive, constrictive, and sometimes shooting pains in the head. In some instances slight feverish symptoms are complained of, with ringing in the ears for about the space of a week; giddiness, and a sense of weight on the crown of the head; pulse rather quick, and the heat of the skin somewhat increased at night, attended with restlessness and a difficulty of lying long in one position; moreover, the patient is observed to be irritable and annoyed at trifles ; anomalies in the mental powers may next be observed, such as obstupefaction, drowsiness, with slight delirium; or a high degree of excitement, in which the patient is affected by the slightest noise, and the eyes have a brilliant and animated expres- sion, or are bloodshot, with fiery redness of the face, violent delirium {delirium ferox). According to the seat of the inflam- mation, or the constitution of the patient, the accompanying fever is of greater or less intensity; the pulse is very variable in the course of the same day; it may be regular, intermitting, quick and weak, or very slow and strong. A very slow or very quick pulse generally indicates danger. The patient •»; frequently complains of heat in the head, whereas the extre- mities are cold. When there is stupor, or a tendency to it, the eyes look heavy and void of all expression; vomiting some- times takes place, and proves very intractable; the stupor becomes more profound, convulsions appear, and death sooner or later ensues. The peculiar and delicate structure of the brain and its membranes in children, renders them much more susceptible of the attacks of this serious disease, and great at- tention ought to be paid to the following symptoms : heaviness and tendency of the head to gravitate backwards, attended with pain (of which latter circumstance we are sometimes made aware, in very young children, by the little sufferer frequently raising its hands to the head); alternation of temper • INFLAMMATION OF THE BRAIN. 401 intolerance of light; nausea, occasionally followed by vomiting; tendency to costiveness ; drowsiness; wakefulness, or starting during sleep. Secondly, continuous boring of the head against the pillow ; a high state of excitement, in which the slightest noise or ray of light throws the child into a fit of screaming, or a state of discontentment; heavy sleep; great heat in the head; redness and swelling of the face, with perceptible throbbing in the vessels of the head and neck; great agitation with continued tossing about, especially at night; eyes red, sparkling, convulsed, or fixed; pupils immoveable, and gene- rally dilated. CAUSES. Anything tending to irritate the brain, such as extremes of heat or cold; the abuse of ardent spirits ; exter- nal injuries of the head ; concussion from falls; mental emo- tions, or over-exertion of the faculties ; excesses of all kinds ; sanguineous congestion; metastases ; contagious diseases ; repressed eruptions, &c. TREATMENT. We should have immediate recourse to Aconite at the commencement of the attack, when the skin is hot and dry, and the pulse rapid, with the ordinary indica- tions of pure Inflammatory Fever, which is especially liable to be the case in young plethoric subjects. Dose. Dissolve six globules in three table-spoonfuls of water, and give a tea-spoonful of the solution every three hours, until the pulse diminishes in force and frequency, and the skin becomes moist or covered with profuse perspiration ; after which the intervals may be extended to six hours, and the administration be proceeded with, if no other medicine appears to be indicated, until general and progressive improvement becomes apparent. But if any of the subjoined symptoms remain or supervene, consider the following medicines, and select that which is indicated by the symptoms present. Belladonna. This medicine seems to possess a certain specific influence over inflammation of the brain and its men- inges; and is generally the remedy we should select, when the following, amongst other symptoms, present themselves : great heat of the head; redness and bloatedness of the face, with violent pulsation of the carotids ; boring of the head in the pillow, and increase of suffering from the slightest noise 402 NERVOUS SYSTEM. with extreme sensibility to light; violent shooting and burn- ing pains in the head ; eyes red and sparkling, with protru- sion or wild expression ; contraction or dilation of the pupils; violent and furious delirium ; loss of consciousness; some- times low muttering; convulsions, occasionally symptomatic hydrophobia; vomiting; involuntary evacuations of faeces and urine. Dose. Of a solution of six globules to three table-spoonfuls of water, give a tea-spoonful every four hours, until amelioration or change. In the event of distinct medicinal aggravation, the adminis- tration should be suspended until the reaction has taken place. But if distinct improvement supervene (without intervening apparent aggra- vation), the intervals should be extended to six hours, and again, after two more doses—if the amelioration be regularly progressive—to eight hours; and so on, until permanent improvement or change. But, in very urgent cases, and when repeated doses of Belladonna have pro- duced inadequate results, consider the next medicine and proceed accordingly. Bryonia. This remedy will frequently be found of great efficacy in children, when Aconite and Belladonna have produced but trivial improvement, and the symptoms indicate a tendency to rapid effusion. Dose. Dissolve six globules in four tea-spoonfuls of water, and give a dessert-spoonful of the solution every four hours, until ameliora- tion or change; but if partial improvement only should become appa- rent within four hours after the third dose of Bryonia, pause two hours longer, and proceed with the next medicine. Hyoscyamus is appropriate when there is drowsiness, loss of consciousness, delirium about one's own affairs ; inarticu- late speech ; tongue coated white, with frothy mucus about the lips ; dilatation of the pupils ; fixedness of vision ; skin dry and parched; redness of the face; and picking of the bedclothes with the fingers. Dose. Of a solution of six globules to two table-spoonfuls of wa- ter, give a tea-spoonful every three hours, until amelioration or change. Opium. When there is lethargic sleep, with stertorous breathing; half open eyes, and confusion or giddiness after waking; sanguineous congestion; complete apathy and absence of complaint. INFLAMMATION OF THE BRAIN. 403 DOSC Of a solution of six globules to two table-spoonfuls of water, give a tea-spoonful (or otherwise three globules dry on the tongue), every hour until amelioration or change. Stramonium. When there is starting or jerking in the limbs; sleep almost natural, followed by absence of mind after waking, but sometimes attended with moaning and toss- ing about; vision fixed, and the patient frequently appears in a state of dread, and utters cries ; redness of the face; feverish heat, with moisture of the skin. In many of the symptoms this remedy bears a close resemblance to Bella- donna, with the exceptions of being indicated by the more prominent existence of spasms, and less acuteness of pain in the head. Dose. Of a solution of six globules to two table spoonfuls of water, give a tea-spoonful every three hours, until amelioration or change. Zincum may be employed after, or in alternation with Bel- ladonna, when that remedy produces only a partial degree of amendment. In those extreme cases where symptoms of threatening paralysis of the brain are manifested by the fol- lowing indications: loss of consciousness; half closed eyes ; dilated, insensible pupils; icy coldness of the extremities, or of the entire body ; blueness of the hands and feet; impeded respiration; small, weak, scarcely perceptible pulse—Zin- cum has repeatedly been found effectual in preventing a fatal issue. Dose. Three globules dry on the tongue every hour, until signs of improvement set in, in which case the intervals between the doses must be lengthened. Cuprum aceticum. The reputed value of this remedy in cases of repercussed exanthemata, and the consequences there- from arising, have been already noticed under Scarlet Fever ; under which also some of the symptoms indicating its employ- ment are commented upon ; it is also called for in a peculiarly sensitive rather than an inflammatory or irritable state of the brain, which not unfrequently appears in children, during the course of catarrhal fever or difficult dentition, of which affec- tion the following are the symptoms : at the commencement, 401 NERVOUS SYSTEM. crossness or fretfulness, or apathy and indifference; sleep dis- turbed and restless. As the disease gains ground, drowsiness, with inability to sleep ; incapability of holding the head erect, and flushing of the face; dryness of the mouth without increase of thirst; disgust to food, nausea, even vomiting; torpor of the bowels, rarely diarrhoea ; shudderings ; followed by heat, and occasionally burning, unfrequent perspiration; pulse variable, generally rather accelerated and full; exacer- bations of fever (synocha) towards evening and at night; subsultus tendinum, and grinding of the teeth during the exacerbations. DOSC Dissolve six globules in four tea spoonfuls of water, and give a tea-spoonful of the solution every four hours, until the more im- mediate symptoms yield; and then at intervals of six hours, until general improvement or change ensues. Belladonna, Phus, lachesis, and Mercurius have also proved serviceable in cases arising from repercussed exan- themata. Dose. Of the remedy selected, give three globules, as directed for Cuprum acet. APOPLEXY. APOPLEXIA. SYMPTOMS. Sudden or gradual loss of consciousness, sensation, and motion, with greater or less disturbance of the pulse and respiration. Few diseases offer a greater number of varieties in form than apoplexy; and there is scarcely a single classification of the many, that eminent medical writers have given to the world, which is not more or less liable to objection. It is also extremely difficult to diagnose clearly between the different varieties, the external symptoms not always bearing a uniform relation to the internal injury ; thus, all the indict tions of serous apoplexy may declare themselves from san- guineous extravasation; and it is not always possible to decide in apoplexy whether effusion or simply congestion of the vessels of the brain has taken place. PREMONITORY SYMPTOMS. Continued inclination to somnolence, heavy profound sleep, with stertorous breath- APOPLEXY. 405 ing, incubus, grinding of the teeth, shocks or cramps, a gene- ral feeling of heaviness or disinclination to the least exertion; frequent yawning and fatigue after the slightest exercise. A sense of weight and fulness, and pains in different parts of the head, sometimes very deep-seated. Cephalalgia and me- grim, or vertigo and fainting; pulsation of the temporal and carotid arteries, with swelling of the veins of the head and forehead ; disturbance of the cerebral system, evinced by loss of memory, forgetfulness of words and things, irritability of temper, or mildness and indifference, despondency and weep- ing ; infiltration of the conjunctiva, dimness of vision, specks or motes before the eyes, or flashes of fire or sparks during darkness ; acuteness of vision or diplopia, sometimes also the words in a line appear to run into one another ; difficulty of opening or closing the eyes; noises, humming, singing, &c. in the ears; dulness of hearing, dryness of the nostrils, pinched appearance of the nose, with false perception of an unpleasant odor, sneezing, and slight epistaxis; stammering, and indistinct enunciation; difficulty of deglutition, numbness or torpor, or pricking sensation in the extremities, with occa- sional partial attacks of paralysis in the face, distorting the features and affecting the utterance, or in some of the mus- cles of the limbs; pains in the joints; weak or unsteady mode of progression, difficulty of micturition, &c. TREATMENT. Against the preceding, Homoeopathy pos- sesses remedies, by whose proper application the practitioner may, if consulted in time, succeed in warding off the attack of this dreaded malady. Aconitum. In all cases where there are evident symptoms of plethora, determination of blood to the head, characterized by redness and fulness of the face, distension of the veins of the forehead, quick, full pulse, restless and anxiety. Dose. Of a solution of six globules to two table-spoonfuls of wa- ter, give a tea-spoonful every three hours, until amelioration or change ; but if, after three doses have been given, the improvement does not become speedily progressive, proceed with the next medicine. Belladonna. Should the symptoms of congestion not 18* 406 NERVOUS SYSTEM. speedily yield to Aconite, or should only a partial degree of amelioration have taken place; or further, should the fol- lowing symptoms present themselves: redness and bloated- ness of the face, injection of the conjunctiva, violent beating of the carotid and temporal arteries, noises in the ears, dart- ing pains in the head, with violent pressure at the forehead, increased by movement, by the least noise or bright light; or diplopia, and almost all the symptoms relative to the eyes already mentioned; dryness of the nose, with unpleasant smell and epistaxis ; difficulty of deglutition ; slight attacks of paralysis in the face ; paralytic weakness, or heaviness in the limbs. Dose. Of a solution of six globules to two table-spoonfuls of wa- ter, give a tea-spoonful (or two globules dry on the tongue) every six hours, until amelioration or change. It is essential to watch the case closely for indications of medicinal aggravation, or for new symptoms, upon the earliest appearance of which the administration should at once be suspended. Nux vomica is particularly suited to cases in which the apoplexy threatens individuals of sedentary habits addicted to the use of ardent spirits, or too great an indulgence in the pleasures of the table, or to those who have long been affected with dyspepsia, either bilious or nervous, and have conse- quently more or less of the rheumatic or gouty diathesis, and also when the following symptoms present themselves: head- ache, deep seated or frontal, but more especially at the right side, with vertigo, confusion and humming in the ears, nausea, and inclination to vomit; turgescence of the capil- laries of the face, or redness only of one cheek ; drowsiness, feeling of languor, with great disinclination to exertion, either mental or bodily, cramps of the limbs, especially at night, and weakness in the joints; constipation and dysuria, irritability of temper, aggravation of the symptoms in the morning, or after a meal, and also in the open air ; bilious, sanguine, or nervous temperament. Dose. A solution of six globules, as directed for Belladonna ; but if only partial improvement is effected within three hours after the fourth dose, pause three hom-s longer, and proceed with the next medicine. APOPLEXY. 407 Opium is a most important remedy in almost all severe attacks, but particularly in old people, when we find^ the following symptoms: marked congestion to the head, indi- cated by stupor, vertigo, heaviness in the head, and violent pressure in the forehead, singing in the ears, and obtuseness of hearing, sleeplessness or agitating dreams, or frequent and almost overpowering drowsiness during the day, redness of the face, and constipation; pulse slow, but full. DOSC Of a solution of six globules to two table-spoonfuls of wa- ter, give a tea-spoonful (or two globules dry on the tongue), every two hours, until amelioration or change. Where the symptoms are less urgent, and have been of some duration, four globules may be given in a table-spoonful of water, morning and evening, for four days, followed by a pause of four days, at the expiration of which the course may be renewed, if needful, or another remedy selected, in accordance with the remaining or altered symptoms. Lachesis is indicated by many of the same symptoms which have been enumerated under Nux v., together with the fol- lowing distinctive characteristics: frequent abstraction of mind, or vertigo with congestion, pains deep in the brain, or severe aching pains at the left side of the head, and lowness of spirits; face pale and puffy, or turgid and somewhat livid ; pulse weak and slow. Dose. A solution of six globules as directed for Opium. The moment any of the symptoms before noticed present themselves is the proper time to prevent the attack running on to apoplexy; sometimes the signs are so marked, that we can have but little doubt of the result, unless timely pre- cautions are taken; at other times so slightly as to be almost imperceptible; and at others again, the attack comes on suddenly, without any marked premonitory symptoms what- ever. (See also Determination of Blood to the Head.) APOPLEXY. The following are the principal remedies which have hitherto been chiefly recommended, or found most successful, in the treatment of the disease itself: Opium is held as a most important remedy in all cases of apoplexy when the disease has attained considerable height. It is one of the best remedies to commence with, when the 408 NERVOUS SYSTEM. attack has arisen from excess in drinking, and the symptoms are as follows: slow, stertorous breathing; red and bloated face ; heat of the face and head, which latter is also covered with sweat: insensible and dilated pupils ; stupor ; tetanic rigidity of the entire frame, or convulsive movements and trembling in the extremities; foaming at the mouth. In elderly persons Opium is, as has already been stated, a remedy of primary importance. DOSC. Three globules in a tea-spoonful of water, or dry on the tongue, every quarter of an hour, until the more alarming symptoms subside, and then every two hours, until a general and manifest improve- ment or change results. Nux vomica has been found of great service in completing the cure after the previous use of the above remedy ; but may also be employed at the commencement, when the attack has occurred in an individual of bilious, sanguine or nervous tem- perament, and of irritable temper, in consequence of over- indulgence in vinous or spirituous liquors; or when the attack has resulted during or after a fit of passion, and the patient appears in a state of drowsiness approaching to stupor; the breathing stertorous; eyes dull and glassy; hanging of the lower jaw, with copious secretion of saliva; paralysis, particularly Qf the inferior extremities; paralysis of the whole of one side. DOSC Three globules, as directed for Opium. Lachesis is also a valuable remedy in this disease, especially when occurring in habitual drunkards; or in choleric, hypo- chondriacal persons, or those who are frequently affected with melancholy, and are of a spare habit, or of exhausted consti- tution, with drowsiness or loss of consciousness; lividity of countenance, convulsive movements or tremor in the extremi- ties; stupor or paralysis, especially of the left side; pulse weak and slow. DOSC Of a solution of six globules to two table-spoonfuls of wa- ter, give a tea-spoonful (or otherwise three globules dry on the tongue) every quarter of an hour, until the lividity, tremor, and tardiness of pulse cease to be permanently manifested, and then evevy three hours, until the patient exhibits symptoms of returning consciousness ; but, if after these results have accrued, the semi-lateral paralysis should con- APOPLEXY. 409 tinue, proceed with similar doses every twelve hours until general im- provement or change. Arnica. Apoplexy after too hearty a meal, with loss of consciousness (drowsiness or stupor); stertorous breathing; moaning or inarticulate muttering; involuntary evacuations ; paralysis of the extremities, or of the left side; pulse strong and full. DOSC A solution of six globules to two table-spoonfuls of water, or two globules dry, as directed for Lachesis. Belladonna. Lethargy, loss of consciousness; the patient lies speechless, with the mouth drawn to one side; convul- sive movements of the limbs or facial muscles; hemiplegia, particularly of the right side; dilated immovable pupils ; red and bloated face. Dose. A solution of six globules to two table-spoonfuls of water, or three globules dry on the tongue, as directed for Lachesis. Pulsatilla. Lethargy, loss of consciousness; bloatedness and blueish-red hue of the face, occurring after a full meal, which has been hurriedly swallowed; or sudden loss of the power of movement; palpitation of the heart; pulse almost entirely suppressed; respiration stertorous; temperament phlegmatic. Dose. Of a solution of six globules to two table-spoonfuls of wa- ter, give a teaspoonful (or otherwise three globules dry on the tongue), every half hour until the pulse improves, and afterwards every two hours, until general improvement or change; but if within half an hour after the second dose the urgent symptoms (of pulse, &c.) remain but little moderated, consider the subjoined medicine, and also whether its alternate or single administration be advisable. If in alter- nation with Ipecacuanha, a similar solution (separately) of each (or three globules dry), administered by tea-spoonfuls in rotation, at inter- vals of a quarter of an hour, until manifest improvement or change. Ipecacuanha is equally indicated when the attack has arisen from a full and hurried meal, and may therefore be employed after, or in alternation with, Pulsatilla, should the latter remedy not afford speedy relief. Dose. In every respect as directed for Pulsatilla. Baryta carbonica. This remedy, like Opium, is peculiarly 4:10 NERVOUS SYSTEM. well adapted to the treatment of many of the affections of old people. It has accordingly, like the latter medicine, been found very serviceable, when the serious affection at present under consideration is met with in patients of advanced age, particularly when the following symptoms are encountered: Coma somnolentum, with moaning and muttering, circum- scribed redness of the cheeks; mouth drawn to one side; paralysis of the tongue, or of the upper extremities; hemi- plegia (right side); confusion of ideas; childish manners. Dose. Three globules dry on the tongue (in most cases charac- terised by paralysis of that organ), or, sometimes, dissolved in a tea- spoonful of water, every half hour, until the more urgent symptoms relax, and then every three hours, until general improvement or change becomes manifest. During the paroxysm of apoplexy the patient ought to be placed in a cool room, with the head raised, or put, in short, in such a position as will least favor determination of blood to the head. The clothes ought to be loosened, especially about the neck; and the feet or legs allowed to hang down. It may also be useful to increase the force of the circulation in the feet and legs by means of friction, or by putting them in warm water. ACUTE INFLAMMATION OF THE SPINAL CORD AND ITS MEMBRANES. Myelitis. Meningitis spinalis. This affection is indicated by pain, more or less severe, in some cases of an intermittent character, either confined to the lumbar, dorsal, or cervical region, or embracing the entire length of the spine. The pain is aggravated by the slightest movement, and an exalted sensibility of various parts of the cutaneous surface is often perceptible from the dread and shrinking, which the patient exhibits at the slightest touch. Sharp pain at the epigastrium, sometimes spreading over the whole of the abdominal region, and increased on pressure; palpitation of the heart, sensation of constriction and weight in the fore-part of the chest, with oppressed respiration; small, quick, hard pulse, are symptoms which are generally encountered in the course of the disorder. MYELITIS. 411 When the inflammation occupies only apart of the cord, the symptoms vary according to its locality. Tims, when the commencement, or the cervical portion is principally affected, strabismus, spasm of the pharynx, trismus with loss of voice, spasm, or other abnormal conditions of the muscles of the neck, chest, and superior extremities, with general clonic convulsions, declare themselves. When the dorsal portion of the cord is the seat of the inflammation, opisthotonos usually results; and when that of the lumbar region is attacked, retention of urine, or paralytic or spasmodic affections of the pelvic viscera generally, are met with. In each of the latter cases, the inferior extremities are commonly either convulsed or paralysed. When the membranes of the cord are principally or solely affected, the sensibility of the surface is said to be always increased, and the spasms more frequently general, and of a tonic character. While in inflammation confined to the substance of the cord, the sensibility is usually lessened, the muscles of the extremities are affected with clonic spasm or paralysis, and only those of the back in a state of tonic contraction. In the former, moreover, the bowels are for the most part constipated—while in the latter, diarrhoea has almost uniformly been found to predominate. Finally, according as the power of motion or the sensibility is abnor- mally altered, so it may be concluded will the anterior or posterior columns of the spinal cord form the seat of the inflammation. CAUSES. Exposure to cold and damp, and external inju- ries appear to form the leading exciting causes of this inflam- mation. CHRONIC INFLAMMATION of the spinal cord and its coverings is generally accompanied with a trivial degree of local pain, and its prominent features chiefly consist in derangement of the functions of the viscera, deprivation or diminution of the sense of feeling, paralysis, cramp, and emaciation. The chronic variety is even more dangerous than the acute. 412 NERVOUS SYSTEM. The disease, when confined to the substance of the cord, may terminate in softening (ramollissement); induration; suppuration; gangrene; in effusions of serum, pus, or blood; or in thickening of their structure, when the membranes have been the seat of the inflammation. TREATMENT. Aconitum must be prescribed in re- peated doses, in all cases where the accompanying fever is intense. Dose. Of a solution of eight globules to two table-spoonfuls of wa- ter, give a tea-spoonful, repeating the dose, after the lapse of two hours, and again (if the inflammatory symptoms be yet unallayed) after a further interval of four hours, aud so on, so long as the fever and in- flammatory symptoms (simply) afford the most prominent indications. If, however, any of the subjoined symptoms occur, proceed accordingly. Belladonna is the most important remedy when the upper part is the seat of the disorder. If, from the invasion of delirium, &c, there is some reason to apprehend an extension of the inflammation to the brain, this remedy will still be the most appropriate, and, indeed, that on which we must rest our chief hope in so serious a complication of a malady, suffi- ciently dangerous in its simple form. Dose. Of a solution of eight globules to two table-spoonfuls of water, give a tea-spoonful (or two globules dry on the tongue) every hour, until the more violent inflammatory symptoms, delirium, &c, abate, or general change takes place; after which extend the intervals to four hours, and continue the administration, if necessary (or con- sider one or more of the subjoined medicines), until important ameliora- tion or change. Hyoscyamus is also required in cases of this kind, and is more especially indicated by violent convulsive jerkings, attended with cries; or when there is a meaningless smile, and a quick pulse, with swollen, turgid veins ; vivid redness of the tongue ; spasmodic clenching of the eyelids, with di- lated pupils (as observed by examination), or red, immovable, and convulsed eyes; inability to swallow liquids; some- times frothy saliva about the mouth, extreme sensitive- ness of the stomach to the touch, and involuntary discharge of excrement and urine. Hyoscyamus is, moreover, appro- MYELITIS. 413 priate for the treatment of long-lasting spasms resulting from inflammation of the entire cord, or of its enveloping mem- branes ; and, again, in cases in which inflammation of the spinal marrow has been occasioned by external injuries. Dose. Two globules dry on the tongue, repeated, in very urgent cases, at intervals of fifteen, twenty, twenty-five and thirty minutes, or otherwise, as directed for Belladonna. Stramonium is more especially indicated, in similar cases to the above, by violent and frantic fits of delirium, the face being deep-red, puffed, and bloated, and the expression pecu- liarly vacant; grinding of the teeth, or extraordinary distor- tion of the features ; suppression of urine, and alvine evacua- tions ; trembling of the hands and feet, and convulsive jerk- ing or spasmodic attacks affecting the arms in particular, but sometimes also the legs ; bending backwards of the body in the form of an arch; imperfect articulation, or total loss of capability to articulate; fixedness and sparkling of the eyes, with dilated pupils, which are, however, insensible, no atten- tion being paid to objects which are passed before the eyes. DOSC Of a solution of eight globules to two table-spoonfuls of water, give a tea-spoonful (or two globules dry on the tongue), repeated at intervals of ten, fifteen, and twenty minutes, until the more urgent symptoms subside, or general change ensues; and, subsequently, if still indicated, at intervals of three hours, until decided amelioration or change. Bryonia is often of service when there is delirium, running on very anxious thoughts, or on apprehensions for the future, characterised by utter despondency ; and when there is uni- versal dry heat of the whole body, the eyes being glassy and apparently suffused with tears, are dull and turbid ; the face burning and red, and the lips dry, cracked, and swollen ; the tongue dry ; or when there are convulsive movements in the arms, with painful stiffness of the knees ; hot, dark-colored, and scanty urine ; suppressed or hard, dry, and scanty stools ; short, interrupted, and oppressed breathing, with violent pul- sation of the heart; this medicine being of service more espe- cially in cases in which the inflammation attacks the upper and lower portion of the cord. 414 NERVOUS SYSTEM. Dose. Of a solution of six globules to two table spoonfuls of water, give a tea-spoonful every two hours, until a degree of improvement becomes apparent, and, subsequently, if yet indicated, at intervals of six hours, until decided improvement or change. Sulphur may not unfrequently prove of service either as an intermediary medicine, when such others as appear to be well indicated do not promptly moderate the symptoms, or after the previous employment of one or more of the forego- ing ; and when general exhaustion appears to supervene after severe attacks of inflammation of the upper or lower portion of the cord; or more particularly wThen, notwithstanding the treatment previously directed, general convulsions ensue, attended with clenching of the teeth; or when the patient sinks into complete lethargy; or when low, moaning delirium succeeds to more violent frenzy, the eyes being half open, the respiration snoring and laborious, and the position persistently on the back, the body remaining motionless, except as it is slightly shaken by feeble jerkings of the limbs; incoherent attempts to communicate the wants and wishes ; extreme sensitiveness or total insensibility of the eyes to light; immovable and dilated pupils; trembling of the eyelids ; dry and cracked tongue; frothy and putrid evacuations; involuntary micturition, &c, are further indications for this medicine. Dose. Of a solution of eight globules to two table-spoonfuls of water, give a tea-spoonful (or two globules dry on the tongue), repeated at intervals of fifteen, twenty, and thirty minutes, until a degree of amelioration or change becomes apparent, returning to one or more of the preceding remedies, if indicative symptoms should recur, or other- wise continuing the administration of Sulphur, at gradually lengthened intervals, until manifest improvement or change. PALSY. PARALYSIS. This affection consists in the abolition or diminution of the power of voluntary motion. It usually comes on suddenly, but in some instances it is preceded by numbness, coldness, paleness, and slight convulsive jerking or twitching in the parts affected. The treatment must be regulated according PALSY. 415 to the originating cause. When it results from apoplexy, see that article. Arnica is especially appropriate when the paralytic weak- ness affects the joints generally, or the hip and knee joints in particular. Dose. Three globules in a tea-spoonful of water, night and morn- ing, for a week (or until earlier change); then pause for six days, after which, the course may, if necessary, be repeated, as before, and so on, from time to time, until manifest amelioration or change. But if only partial effect should result after the completion of the second course, consider Sulphur. Bryonia is preferably indicated when the legs (generally) are prominently affected. Do^e. Three globules as directed for Arnica. But if partial relief only be effected by the second course, consider Sulphur. Rhus toxicodendron is to be preferred if the arms, hands, and fingers are the chief seat of the paralytic affection, or if the lower extremities (as well as the arms) are involved. Dose. Three globules, as directed for Arnica. But if partial relief only be effected by the second course, consider Sulphur. Sulphur is a medicine of paramount importance in all ob- stinate and protracted cases, and may be most advantageously employed after either of the foregoing, or even as an interme- diary remedy, during such other treatment, in cases in which the medicine, thus particularly indicated, either seems to fail in producing any impression upon the malady, or produces only partial and inadequate effect. Dose. If as an intermediary remedy, pause four days after the last dose of the remedy previously employed ; then give six globules in a table-spoonful of water, the first thing in the morning (fasting), repeating the dose after the lapse of twenty-four hours, then pausing six days, and subsequently resuming the previous course of treatment. If as a consecutive medicine, give six similar doses, in succession, at intervals of twenty-four hours (pausing, however, upon any earlier manifestation of amelioration or change); then pause ten days, after which the course may, if necessary, be repeated, and so on, until decided amelioration or change. Electricity or galvanism {electro-magnetism), in moderation, is frequently of considerable service in facilitating the cure, 416 NERVOUS SYSTEM. or, at all events, in promoting improvement in obstinate cases, and particularly when painfid jerkings or twitchings fre- quently take place in the affected parts. TETANUS. SPASMS. This is a disease characterised by a general spastic rigidity of the muscles. Its varieties are Trismus, the lock-jaw. Opis- thotonos,—which is the most common,—when the body is drawn or bent backwards by the spasmodic contraction of the muscles, sometimes to such a degree that the occiput touches the heels. Emprosthotonos, when the body is bent forwards; a rare form of the disease. Pleurosthotonos, in which the body is bent to one side; a still more rare variety. The disorder is chiefly occasioned either by exposure to cold (idiopathic tetanus), or by some irritation of the nerves resulting from local injury, particularly of tendinous parts (traumatic tetanus). It is of much more frequent occurrence in warm than in cold climates. In this and in other climates the amputation of a limb, or the twitching of a nerve by a ligature, are not unfrequent sources of its occurrence. When it takes place in consequence of such a cause, or of any other external lesion, the symptoms generally set in about the eighth day, and sometimes later: but when it supervenes on exposure to cold, they usually declare themselves much earlier. In some cases the attack comes on suddenly, and with extreme violence; but it more generally approaches in a gradual manner: a slight stiffness being at first experienced in the back part of the neck, together with an uneasy sensation at the root of the tongue, and a difficulty in performing the act of deglutition, an oppressive tightness is complained of in the chest, with a pain at the inferior extremity of the sternum, or the scrobiculus cordis, extending into the back; the respi- ration is impeded; the countenance pale, pulse small, bowels constipated, and urine high colored; a stiffness also takes place in the lower jaw, which ere long increases to such an extent, and compresses the jaws so closely and firmly that the smallest opening is unattainable, and the patient is now afflict- TETANUS. 417 ed with what is termed lock-jaw. In some instances the spasmodic contractions proceed no further; in others they return with great frequency and increased severity, and also extend to the arms, the abdominal muscles, the back, and inferior extremities, so as to bend the body forcibly in one or other of the directions before stated. Finally, the arms, lower extremities, head, and trunk become rigidly extended, from an equipoised spasmodic action of the flexor and extensor muscles. The tongue is also seized with spasm, and is, not unfrequently, injured by the teeth becoming clenched together, just as it happens to be convulsively darted out. As the affection advances, the eyes become fixed and immoveable, the whole countenance frightfully distorted and expressive of extreme anguish, the pulse irregular, the strength completely exhausted, and a termination is put to the sufferings, generally about the fourth day in acute cases, by one concen- trated spasm. In some cases the fatal termination is protracted considerably beyond the stated period. The spasmodic action does not continue unremittingly, the muscular contractions occasionally admitting of some abate- ment, but is generally immediately renewed as soon as the patient makes an effort to speak, drink, or change his posture. TREATMENT. The remedies which have chiefly been used in homoeopathy, in the treatment of this distressing disease, are: Belladonna is one of the most important of these, particu- larly in idiopathic tetanus, properly so called, or in trismus; it has also proved useful in the traumatic variety as well, after the previous employment of Aimica. It is principally indi- cated when a sensation of constriction is experienced in the throat, with tightness at the chest, grinding of the teeth, spasmodic clenching of the jaws, distortion of the mouth, foaming, obstructed deglutition, and a renewal or exacerbation of the paroxysms on attempting to drink. In some cases of lock-jaw the alternate use of Belladonna and Lachesis, or Belladonna, Angustura, and Cicuta virosa has been found necessary; and of Belladonna, Lachesis, Hyoscyamus, and 418 NERVOUS SYSTEM. Stramonium, or Opium, Rhus, and Belladonna, in opis- thotonos. Dose. If singly, and if it be possible to introduce the medicine into the mouth, give four globules in a tea-spoonful of water, or dry on the tongue, at intervals of four hours, until a degree of relaxation becomes apparent, and, subsequently, morning and evening, until some decided beneficial result or change. If it be impossible to introduce the medicine into the mouth, dissolve twelve globules in a wine-glassful of water, and moisten the lips and nostrils with this solution, or cause the patient to inhale it through the nostrils, from the bottle in which the globules of Belladonna or one of the subjoined medicines as selected for adminis- tration are dissolved. But if no apparent effect ensue within forty-eight hours consider the following remedies. If in alternation with Cicuta or Lachesis a similar dose of each in rotation at the like intervals, until improvement or change. Arnica Montana. In cases of traumatic tetanus, which is by far the most fatal variety, this remedy is, in most instances, the most appropriate to commence with, and should be used internally and externally. Any local irritation which may seem to have excited the disease, ought, at the same time, if possible, to be carefully removed. Dose. {Internal.) Four globules in a tea-spoonful of water, or dry on the tongue, every two hours, or otherwise applied in solution to the lips and nostrils (as directed for Belladonna, above), until manifest im- provement or change. But if no apparent benefit be effected in the course of twenty-four hours, pause six hours after the last dose, and proceed with the next medicine. Application. {External) To half a pint of water add one tea- spoonful of the concentrated Tincture of arnica, and bathe the injured parts freely with this lotion, every two hours, so long as the internal exhibition of the same remedy is continued (that is, only until relaxa- tion of the contracted muscles ensues). Opium has proved extremely useful in some of the severest forms of opisthotonos arising from cold; but, as above stated, it is also valuable in traumatic tetanus. (Likewise in tetanus from flight.) Dose. Four globules as directed for Arnica; but if no apparent benefit be effected in the course of twelve hours, pause six hours, and proceed with the next medicine. Rhus and Ignatia have been found very efficacious in severe cases of opisthotonos, in which the body has been bent DELIRIUM TREMENS. 419 up in the form of an arch, and on some occasions with the back of the head touching the heels, when the complaint has arisen from terror. DOSC. If singly, of either remedy as selected, administer four globules in a tea-spoonful of water (or dry on the tongue), if either method be practicable, every half hour, until a degree of relaxation takes place, and, afterwards, every two hours, until the position becomes natural. If in alternation the like dose of each in rotation, at intervals, first of an hour, and then of six hours: consider, also, the directions prescribed for the exhibition of Belladonna. Mercurius has frequently succeeded in curing inflammatory trismus, with swelling of the angle of the lower jaw, and ten- sion of the muscles of the throat and neck, from cold. Dose. As directed for Rhus. When, from the spasmodic clenching of the jaws, it is found impossible to introduce the medicine into the mouth, the effect of olfaction must be tried; it has also been found useful to moisten the lips and nostrils with the medicine dissolved or diluted in water; and in some cases, the administration of the remedy in the form of an enema (a few drops to an ounce or two of water) has been found very efficacious. (See also Hydrophobia, Hysteria, and Myelitis.) DELIRIUM TREMENS POTATORUM. This malady consists of an affection of the brain, and is nearly peculiar to drunkards, hence its name. There are a few instances on record, in which it has arisen from exhaustion caused by excessive depletion; from the effects of lead, and also from the prolonged use of opium. The intemperate use of ardent spirits, vinous or strong malt liquors, is, however, beyond comparison, the exciting cause in by far the major number of instances. The disease generally comes on in drunkards, during the state of prostration which ensues when they have in a great measure given up, or been suddenly deprived of, their accustomed stimulus. The first symptoms of the malady are generally indicated by extreme irritability of temper, weakness of memory, but 420 NERVOUS SYSTEM. constant activity of mind, anxiety, and uncontrollable rest- lessness, with increased muscular mobility. The appetite is often pretty good, but more frequently impaired in consequence of the previous habits, and the tongue is sometimes foul, but moist. Soon after these premonitory signs, vigilance sets in, and little or no sleep can be obtained; or it is unrefreshing and disturbed by frightful dreams, imaginary visions and sounds. Fixed ideas then take firm possession of the patient's mind, such as the supposition that some one is bent upon poisoning him, or doing him some other grievous injury, &c, yet he generally dreads being alone. The speech is frequently stuttering and inarticulate; the countenance quick, wild, and exceedingly variable, according to the prevailing impression on the mind ; the face in most cases pale or sallow; the eye rolling, expressive, and restless, and the conjunctiva blanched; the skin damp, or covered with sweat, chilly and relaxed, very rarely above the natural tem- perature ; the hands are commonly tremulous, and muscular twitchings are often observable. As the disease advances, sleep is completely banished ; loquacity, with perpetual bust- ling occupation, becomes incessant; and eventually, when it is fully developed, delirium supervenes. The pulse is soft and compressible, and rarely quick when unruffled by the struggles or exertions of the patient—for his corporal activity keeps pace with the restlessness of his mind, and it is difficult to confine him to his bed or apartment; at the same time, exhaustion is liable to come on very rapidly after great exertion, and the patient is prone to drop down from fatigue. Occasionally, convulsions take place, but though sometimes serious, they are usually not of a fatal character. The history of the case, together with the distinctive nature of most of the above-described symptoms, enables us to discriminate between this disorder and that of inflammation of the brain or its membranes. TREATMENT. Nux v., Opium (provided, of course, the attack has not been excited by the effects of Opium, or its alkaloid, in large doses), Aconitum, Belladonna, Lachesis, ANGTNA PECTORIS. 421 Hyoscyamus, Sulphur, and Calc, form our main remedial agents. Nux v. is particularly useful in the first stage of the disorder, and may frequently be the means of arresting its further progress, when administered at that period. The dose repeated in from six, to twelve, or twenty-four hours, according to the effects produced. DOSC. Four globules in a tea-spoonful of water, repeated, after the lapse of twelve hours, and, subsequently, at intervals of twenty-four hours (at bed-time), until the total subsidence of the premonitory symp- toms, or general change. But should any of the more urgent subjoined symptoms supervene, proceed at once with such of the subjoined medi- cines as may be especially appropriate. But when the disease has become fairly established, and the patient is affected with delirium or convulsions, and we find an aggravated degree of all the symptoms remarked at the commencement of the attack, we must have recourse to Opium, in frequently repeated doses. The curative proper- ties of this drug, in the malady under consideration, do not, as is erroneously supposed by the majority of allopathic practitioners, arise from its property of producing sleep, but from its homosopathicity or specificity, if I may use the expressions ; the pathogenetic effects which it produces being exactly similar to those symptoms which are developed in the course of the disease as it occurs in drunkards. In some cases, particularly where the patient exhibits extreme irritability of temper, with more or less derangement of the digestive functions, considerable advantage will be attained from the alternate employment of Nux v. and Opium. DOSC If singly, of Opium, give three globules in a teaspoonful of water, or dry on the tongue, repeated, after the lapse of half an hour, and again after the further lapse of an hour, and then at intervals of three hours, until decided amelioration or change. If in alternation with Nux vomica, give, first, three globules of Opium in a dessert- spoonful of water; then pause four hours, and give a similar dose of Nux vomica; and so on, in rotation, until decided amelioration or change. But if the disease be of long standing, and does not readily yield to this method, consider the subjoined medicines. 19 422 NERVOUS SYSTEM. SrLPHUE may in some cases of long standing and ot a obstinate and intractable character, be employed uehhwnally and in regular rotation with the two medicines just named for alternate administration, when the method previously recommended is productive of imperfect results. _ Mj>hu>* also of great service as an intermediary remedy in such cases in developing and arousing the susceptibility of the exhausted system to the action of such medicines when they appear to produce no effect, although distinctly indicated. DOSC. K in alternation with Opium and Nux vomica, give three globules as directed for those medicines in the foregoing prescription. Wsingly, as an intermediary medicine, give six globules in a tab e- spoonhil of water, the first thing in the morning, fasting but jt ks than twelve hours after the last dose of any remedy preuousiy em rloved) repeating the dose after the lapse of twelve hours ; then pause £ Sly, an"iCrn to the administration of such other medicines as may be characteristically indicated. Calcarea should be employed four days after the last dose of any of the foregoing medicines in cases of long standing, and of an inveterate and intractable character, more especially if the patient be of a full habit of body, or if, on the other hand the lymphatic constitution be a characterizing condition. DOSC Four globules, in every respect as directed for Sulphur (sinl, and as an intermediary medicine), recurring to such other medicfne or medicines as may be more explicitly indicated by the symptoms. EPILEPSY. Epilepsia. Morbus sacer. Morbus caducus. Morbus divinus. Morbus herculeus. Morbus comitialis. This is a malady which consists of clonic spasms, or con- vulsions, with loss of consciousness and voluntary motion, and generally foaming at the mouth. _ It comes on bv fits^and is usually characterised by the suddenness of the attack, although it is occasionally preceded by pain in the head, dimness of vision, flashes or sparks ot foe, tinnitus aurium, palpitations, flatulency, and languor; or, by a peculiar feeling, partaking partly of pain, and partly of a sense of cold, commencing in some remote part ol the EPILEPSY. 423 body, as in the toes, abdomen, or fingers, and proceeding gradually upwards towards the heart or head. {Aura epi- leptica.) During the paroxysm, the muscles of one half of the body are commonly more severely agitated than those on the other, and those concerned in the perform- ance of respiration are always more or less implicated; the eyes are hideously convulsed, and turned in various directions, but at length become fixed, so that the whites of them alone are seen; the fingers are firmly clenched, and the muscles of the jaws are often spasmodically affected, in consequence of which the tongue is sometimes lacerated by being thrust out immediately before the sudden and violent approximation of the teeth; the mouth is frequently filled with phlegm, which is expelled with considerable force in a frothy state. The face is either of a dark-red or livid color, or it is pale, or alternately pale and red, or pale one side and red on the other. The faeces and urine are sometimes passed involuntarily. On the abatement of the spasms the patient gradually recovers. Sometimes a fit of vomiting terminates the attack. The memory and judgment are generally somewhat impaired for some little time after the fit, and a sensation of languor and exhaustion, or weight and other uncomfortable feelings in the head are complained of. Comparatively few patients are carried off during a fit, but it sometimes happens that one fit succeeds another in rapid succession, or with increasing intensity, until a coma- tose state ensues, and the patient sinks. Idiocy is an occa- sional melancholy result of this distressing malady. The prognosis is more or less favorable according to the age of the patient and the species of the epilepsy. When the disease occurs before the age of puberty, or when purely sympathetic, it is generally cureable without much difficulty by means of homoeopathic remedies. On the other hand, when it comes on after the age of puberty, is idiopathic, or of hereditary origin, and has been of long duration, the cure is not easily accomplished. It is generally possible, however even in the most inveterate cases, to lengthen the intervals 424 NERVOUS SYSTEM. between the attacks, and to mitigate their violence by means of steady and judicious treatment. TREATMENT. This must be regulated by the cha- racter and causes as well as by the symptoms of the malady ; the latter guiding us in the selection of one from amongst a class of remedies. Belladonna. Commencement of the attack with a sensa- tion of crawling and torpor in the upper extremities; jerking of the limbs, especially of the arms, convulsive movements of the mouth, muscles of the face and eyes; congestion in the head, with vertigo, deep redness, heat and bloatedness of the face, or paleness and coldness of the face, with shivering; photophobia; convulsed or fixed eyes; dilated pupil; cramps in the larynx and throat, with obstructed deghdition and danger of suffocation ; foam at the mouth; unnoticed emis- sion of faeces (and of urine), or loose evacuation of ingesta; oppression on the chest and anxious respiration; renewal of the fits on the slightest contact or the least contradiction ; dizziness, or complete loss of consciousness; sleeplessness between the fits, with agitation and tossing, or deep and lethargic sleep, with smiles and grimaces; waking with a start, with cries. (Compare with Cham., Hyos., Ign., Op., Stram.) Dose. Four globules in a tea-spoonful of water every four hours, until three doses have been taken, and then only every twelve hours, until decided amelioration or change. Cuprum. Commencement of the paroxysm in the fingers or toes, or in the arms ; retraction of the thumbs; loss of consciousness and of speech ; salivation, sometimes frothy • redness of the face and eyes; recurrence of the fits every month, and especially at the catamenia. DOSC Immediately after the attack give four globules, dry on the tongue. As a preventive resource give the like dose, night and morn- ing, for a week (saving more urgent symptoms), before the anticipated period of the return of the fits. Hyoscyamus. Bluish color and bloatedness of the face foam at the mouth, prominent eyes ; convulsive movements EPILEPSY. 425 of certain limbs, or of the whole body; violent jactitation; retraction of the thumbs; renewal of the fits, on endeavoring to swallow the least drop of liquid; cries; grinding of the teeth; loss of consciousness; unnoticed emission of urine ; cerebral congestion ; deep and lethargic sleep, with snoring. DOSC Four globules, as directed for Belladonna. Ignatia. Convulsive movements of the limbs, eyes, eye- lids, muscles of the face and lips ; throwing back of the head; retraction of the thumbs; red and bluish face, or redness of one side and paleness of the other, ov paleness and redness alternately ; frothy salivation; spasms in the throat and larynx, with threatening suffocation and difficult degluti- tion, loss of consciousness ; frequent yawning, or drowsy sleep, great anxiety, and deep sighs between or before the attacks; daily paroxysms. DOSC Three globules in a teaspoonful of water, or dry on the tongue, repeated at intervals of six hours, until two doses have been taken, and then every twelve hours, for a week (or until earlier change), after each attack, until improvement or change. Lachesis. Loud cries, falling, and loss of consciousness, foaming at the mouth, cold feet, eructations,pale face, vertigo, heaviness and pain in the head, palpitatio cordis, distended abdomen, coma somnolentum, nausea, &c. Dose. After the attack give four globules in a tea-spoonful of water, or dry on the tongue, every four hours, until three doses have been taken (or until earlier change). Subsequently, give similar doses, night and morning, for a week (excepting more urgent symptoms), and so on, after each seizure, until decided and general improvement or change. Xux vomica. Shrieks, throwing back of the head, trem- bling or convulsive jerks of the limbs or muscles; renewal of the fits after contradiction or an angry emotion ; unnoticed evacuation of fasces and urine ; sensation of torpor and numb- ness in the limbs; vomiting, profuse perspiration, constipa- tion, ill-humor and irascibility between the attacks. Dose. After the attack give four globules in a tea-spoonful of water, and repeat the dose twelve hours afterwards; then, as a preventive measure, give two globules in a tea-spoonful of water, every night, for a week. 426 nervous system. Opium. Occurrence of the fits at night or in the evening; throwing back of the head, or violent movements of the Vnubs, especially of the arms; loss of consciousness, insensibility, cries; closed fists; threatening suffocation ; deep and lethargic sleep after or between the paroxysms. (See Bell., Ilyos., iyn.) Dose. Four globules in a tea-spoonful of water, every four hours, until three doses have been taken -, and then every twelve hours for four days, and so on, after each attack, until change. Stramonium. Throwing back of the head, or convulsive movements of the limbs, and especially of the upper part of the body and of the abdomen; pale and haggard face, with stupid expression, or redness and bloatedness of the face, loss qf consciousness and of sensation, sometimes with cries, &c, renewal of the fits by contact, and also by the sight of bright and brilliant objects. (See Bell.) Dose. Four globules, as directed for Opium. Arsenicum—chiefly when the fits are attended with burning in the stomach, vetebrae, and abdomen. DOSC. Three globules in a tea-spoonful of water, or dry on the tongue, repeated at intervals of six hours, until three doses have been given (or until earlier change), and, subsequently, at intervals of twelve hours, for a week, or until decided improvement or change. Sulphur. Chronic epilepsy, often preceded by a sensation as if a mouse, or some other small animal, were running over the muscles, cries, stiffness of the body, fits excited by cool air, or by a current of air. {Bella, is very useful before or after Sulph. in some cases.) Dose. Three globules in a tea-spoonful of water, night and morn- ing, for a week (or until earlier change) ; then pause a week (supposing no recurrence of the fits); after which the course may be repeated as before, and so on, from time to time, until permanent amelioration or change. Consider also the next medicine. Calcarea. Especially when the fits occur at night, and in chronic cases. (After Sulph.) DOSC As directed for Sulphur. Silicea is chiefly useful in chronic epilepsy. (After Calc.) Dose. As directed for Sulphur. Camphor {Saturated tincture) is often of service as an inter- EPILEPSY. 427 mediate remedy, and also as a means of shortening the attacks, or after-effects, when they are of long duration, in cases of chronic epilepsy, against the fits, when these are characterized by snoring, red and puffed face, and lethargic condition, and sometimes complete loss of consciousness; great drowsiness and oppressed breathing after the fits. Dose. One drop of the Tincture of camphor, on a small lump of fine loaf-sugar, repeated at intervals of three hours, until decided amelioration or change. Cicuta. Paleness, or yellowish color of the face, trismus, distortion of the limbs, cries and frothy salivation, colic, as if caused by worms, &c. DOSC Four globules in a tea-spoonful of water, or dry on the tongue, every four hours, until three doses have been taken, and then every twelve hours, for four days, and so on, after each attack, until amelioration or change. Cocculus—especially in women during the menstrual periods, or also from an external injury. Dose. Three globules, as directed for Opium. Mercurius. Cries, rigidity of the body, distension of the abdomen, itching in the nose, thirst, and nocturnal attacks. Dose. As directed for Cicuta. Stannum. Jactitation of the limbs, retraction of the thumbs, paleness of the face, backward traction of the head, loss of consciousness, appearance of the fits in the evening. DOSC Four globules, after each attack, in a tea-spoonful of water, or dry on the tongue, repeated at intervals of twelve hours for a week, and so on, until amelioration or change. Yeratrum. Loss of sense and movement, distortion of the eyes, and convulsive movements of the eyelids; anguish, discouragement and despair, between the fits. Dose. As directed for Stannum. During the epileptic seizure or paroxysms, the patient should be placed in the horizontal posture, and such precau- tions taken as will obviate any injury which may be sustained by the violence of the convulsive movements. In order to prevent any lesion of the tongue, something ought to be inser- ted between the teeth. The neckcloth should be removed the 428 NERVOUS SYSTEM. stays loosened, and cold water sprinkled over the face, espe- cially when the breathing is much affected by the spasms of the muscles concerned in respiration. A dose of Aconite, followed by Belladonna if relief be not speedily obtained, is necessary, when the fit occurs in plethoric subjects, and is attended with strongly marked signs of congestion of the vessels of the head and neck. The DIET of epileptic patients ought to be very moderate, simple, and easy of digestion. Stimulants ought to be strictly avoided where there is plethora, with tendency to congestion. Debilitated persons require a somewhat more generous diet than the robust, but in all cases care should be taken never to overload the stomach. Excessive corporal or mental exertion must be abstained from. NERVE-PAIN. FACE-ACHE. FACE-AGUE. Neuralgia. Neuralgia facialis. Tic douloureux. Prosopalgia. This distressing malady consists in an excruciating pain, which has its most frequent seat in the branches of the fifth pair of nerves, and is accordingly experienced with great acuteness under the eye, and sometimes before the ear, from whence it shoots over the entire half of the face, and frequently into the orbit and cranium. The paroxysms occasionally con- tinue with shorter or longer intervals, for several days or weeks in succession. The disease is, unfortunately, generally of great obstinacy, and, in some melancholy instances, utterly incurable. Belladonna. When the pain chiefly pursues the course of the infra-orbitary nerve, but sometimes also the other branches of the fifth, and is prone to be excited by rubbing the usual seat of the sufferings : darting pains in the cheek- bones, nose, jaws, or zygomatic process ; or cutting and ten- sive pains, with stiffness at the nape of the neck, and clench- ing of the jaws; twitches in the eye-lid, or violent shooting and tearing, and dragging pains in the ball of the eye ; jerk- ing pains in the facial muscles, and mouth; heat and redness NEURALGIA. 429 of the face. The pain is generally preceded by itching and creeping in the affected side of the face, and at times becomes so severe as to be almost insupportable. Dose. Three globules in a tea-spoonful of water, repeated at inter- vals of four hours, for the first two days (should the pains continue or recur without change of character during this period), and, subsequently, at intervals of twelve hours, for two days (if yet required) then pause four days ; after which (if necessary and still indicated), the course may be repeated as before, and so on, until decided and permanent amelio- ration or change. Platina. Feeling of coldness and torpor in the affected side of the face, with severe spasmodic pain, or tensive pres- sure in the zygomatic process, with a sensation of creeping or crawling, and aggravation or renewal of the sufferings in the evening, and when in a state of rest; lachrymation; redness of the face, &c. Dose. Three globules, as directed for Belladonna. Lycopodium is often useful when the symptoms are much the same as described under the preceding remedy, with the exception of the torpor and creeping, and particularly when the right side of the face is the part affected. Dose. Three globules in a tea-spoonful of water, morning and evening, for four days (or until earlier change); then pause two days ; after which the course may, if necessary, be repeated, as before, and so on, until decided amelioration or change. Colocynth. Yiolent rending and darting pains, which chiefly occupy the left side of the face, are aggravated by the slightest touch, and extend to all parts of the head, temples, nose, ears, teeth, &c. Dose. Four globules, as directed for Lycopodium. Arsenicum. When there is a tendency to periodicity in the attacks or paroxysms, and the pains partake, more espe- cially, of a burning, pricking, and rending character, and are experienced chiefly around the eye, and occasionally in the temples : the sufferings being occasionally of so severe a de- scription as almost to drive the patient distracted; great anguish ; excessive prostration, with desire for the recumbent posture; sensation of coldness in the affected parts; exacer- 19* 130 nervous system. bation during repose, from fatigue, in the evening, when in bed, or after a meal; temporary melioration from external heat. Dose. Three globules in a tea-spoonful of water, repeated at inter- vals of four hours, for the first two days (should the pain continue or recur without change of character during this period), and, subsequently, at intervals of twelve hours, for two days (if yet required); then pause four days; after which (if necessary, and still indicated) the course may be repeated as before, and so on, until decided and permanent ameliora- tion or change. China. When, as in the instance of the foregoing remedy, there is a tendency to periodicity in the attacks, and when the pains are excessive, attended with extreme sensibility of the skin, and consequent aggravation from the slightest touch; sensation of torpor and paralytic weakness in the affected part; great loquacity, with ill-humor, paleness of the face, frequently followed by or alternated with redness and transient heat of the face. Dose* If the intermittency constitutes the distinctive characteristic of the case, give three globules in a table-spoonful of water, three times a daj7 {during the intermissions). In general cases give the like dose, night and morning, for two days (or until earlier change); then pause two days; subsequently repeating the course, as before, if necessary, and so on, until manifest amelioration or change. Yeratrum. Insupportable pains which almost drive the patient to distraction; excessive weakness even to fainting; general chilliness, exacerbation of suffering on getting warm in bed, or towards morning; temporary relief on moving about. DOSC Four globules in a table-spoonful of water every four hours, for the first two days (if the symptoms continue to recur without change of character for that period), then at intervals of twelve hours, for two days (if yet required); then pause four days; after which the course may be repeated as before, if necessary, and so on, until decided and permanent amelioration or change. Assafcetida may generally be prescribed with decided benefit when the pain is chiefly of a dull, subdued description, and occurs intermittingly; but also when it partakes of a burning or shooting character, and proceeds from within outwards. HEADACHE. 431 DOSC Three globules, as directed for Lycopodium. Spigelia is frequently, a useful palliative remedy in all cases wlien the pain is excessive; but is more especially required when the pains are of a jerking, tearing character, exacerbated by the slightest touch or by movement of the affected parts ; or when they appear to shoot from the centre of the brain to the sides of the head or the ears; further, when the pains partake of a burning and pressive aching character, and have their seat in the zygomatic process; glossy tumefaction of the affected side of the face; excessive agitation and anguish. Dose. Four globules in a table-spoonful of water, every three hours, until amelioration or change. HEADACHE. Cephalalgia. Cephalcea. Cephalalgia arthritica. Cephalal- gia nervosa. Hemicrania {megrim). Clavus hystericus. Headache is often but symptomatic of disease, and in such cases is only to be cured by the removal of the primary affec- tion. When, therefore, it arises from derangement of the stomach, or dyspepsia, constipation, cold in the head, mental emotions, congestion of blood in the vessels of the head, &c, the remedies most appropriate to the treatment of these dif- ferent disorders must be had recourse to. In general cases, the subjoined remedies will prove useful, and may be selected according to the indications given. Belladonna. When headache is periodic, or nearly con- stant, and the pain is increased by the slightest movement either of the head or body, and particularly on stooping, or by moving the eyes ; or when a bright light or the most trivial noise tends to aggravate the pain, which consists of a dull pressure at the vertex, or is of a lancinating description, and occupies either the entire head (cephalsea), or merely one side (hemicrania), extending from the occiput into the orbit and root of the nose, and is then described as a violent, screwing piercing, bursting, or tearing pain, sometimes attended with great heat at the vertex; or the seat of the pain is in the fore- 432 NERVOUS SYSTEM. head, and is of a dull, aching, or cutting description, attended with a sense of fulness or a feeling as if the brain would be forced through the forehead in stooping. At times these pains become so violently increased as almost to deprive the patient of consciousness .whilst they last; or the headache is attended with extreme restlessness, sleeplessness, and delirium; and there is a falling off of the hair, in consequence of the head- aches. Dose. In acute cases, three globules in a tea-spoonful of water, repeated at intervals of four hours, until amelioration or change. In chronic cases the like dose, repeated at intervals of twelve hours, until decided improvement or change. But if little permanent improvement should be effected within four hours after the third dose (in acute cases), or within twelve hours after the sixth dose (in chronic cases), consider the subjoined medicines, and proceed accordingly. Bryonia. Aching, piercing, or digging, tearing pain, at a small fixed spot (clavus hystericus); or piercing, aching pain in the forehead daily after a meal, or coming on in the morn- ing, and afterwards becoming lancinating; or pain coming on in the morning, disappearing in the afternoon, and returning again in the evening with great violence, when it is attended with a sensation as if the head were pressed together, particu- larly at the temples; burning, tearing pain over the entire head; shootings in one side of the head. The pains are increased by movement, and are attended with irascibility, and disposition to chilliness or shivering; they are sometimes relieved or terminated by a fit of vomiting. Nux v. and Bhus often serve to complete the cure of the foregoing symptoms, or, at all events, to curtail and remove each attack, after the previous administration of Bryonia. DOSC. In casual cases give three globules, repeated at intervals of four hours, until decided amelioration or change. In chronic cases give a similar dose, night and morning, for four days (or until earlier change). But if within four hours after the third dose (in casual cases), or within twelve hours after the eighth dose (in chronic cases), the effect be only partial, proceed with one or other of the following medicines, according to the particular indications afforded. Rhus. Shooting and rending pains, extending to the ears and root of the nose : burning or pulsative pains ; headache HEADACHE. 433 after a meal, with desire to assume the recumbent posture, and remain quiet; fulness and weight in the head; renewal of the headache at the slightest contradiction, or on going into the open air : undulation of the brain at every step ; or sen- sation as if water were in the head, or as if the contents of the cranium wrere in a relaxed or loosened state, and shifted about with every movement of the head; feeling of creeping or crawling in the head. Dose. Three globules in a tea-spoonful of water, repeated at inter- vals of four hours (in acute and casual cases), or at intervals of twelve hours (in chronic cases), until decided amelioration or change; pausing, however, in the latter instance for four days after every course extending over four days. Sepia. Periodic cephalalgia, aggravated by mental emo- tion, particularly in hysterical subjects ; the pain is either of a lancinating description, and affects the whole head, or is merely seated under the eye, or occupies one half of the head or forehead ; in the latter case, the pain is experienced chiefly in the morning, and is frequently attended with extreme sen- sibility of the eyes to the light. Sepia is also very efficacious in cases of chronic hemicrania, with violent piercing or rend- ing pain, intermingled with lancinations so excruciating that the patient is afraid to move, and can only obtain a trivial degree of relief by remaining perfectly quiet with" the eyes closed ; at other times, the pain is so violent as to cause the patient to scream out, and is attended with heat in the head, or faintness and giddiness, followed by nausea and vomiting. Dose. Four globules morning and evening, for a week (or until earlier change); then pause six days, after which the course should, if necessary, be repeated as before, and so on, until decided and perma- nent improvement or change. But if inadequate effect should result within six days after the completion of the second course, consider the following remedies. Silicea is especially useful where a sensation is experienced as if the brain were about to protrude through the forehead or orbits; or pain so severe that the head feels as if it would split; or semilateral, shooting, rending pains, commencing at the temple, and extending to the nose, the upper and lower 434 NERVOUS SYSTEM. jaw-bones, and teeth of the same side. When there is a ten- dency to frequent sweating of the head, or when there is frequently great tenderness of the scalp, Silicea is further indicated; as also in cases where the parties affected are sub- ject to the formation of small tubercles on the head. DOSC. Three globules, in every respect as directed below for Hepar. Hepar sulphuris is also a good remedy to follow Belladonna in the treatment of headaches, when only partial relief has been obtained from that medicine, or it may be administered alternately with Silicea in cases where there are painful tubercles on the head. The pains chiefly piercing, generally aggravated at night, and frequently limited to a small fixed spot, with a sensation as if a nail were being driven into the head. Dose. Three globules, as directed for Sepia. Nux vomica may be selected when the following symptoms are complained of. Pain commencing with a slight pressure, or a sensation of coldness at the part which is subsequently affected ; succeeded by throbbing, and then an intense shoot- ing, piercing, rending, or stunning pain confined to a small space, which can frequently be covered with the point of the finger, and is extremely sensitive to the touch; or the pain causes a sensation as if a nail were driven into the head : at other times, the pain extends over the nose down to the lip, and also to the gums; or, on the other hand, it commences at the eyelid or the orbit, causing constant lachrymation, and extends over the forehead and temples to the ears, back of the head, and nape of the neck; or it is seated in the crown of the head, and produces a sensation as if the head would split, or was being opened at the coronal suture; or rending, aching pain, affecting only one side of the head, sometimes combined or alternating with shootings; the pain becomes heightened to such a degree occasionally, and more particu- larly in the morning, as well nigh to drive the patient to des- pair, or deprive him of consciousness ;* great heaviness of Compare with Belladonna and Arsenicum. HEADACHE. 435 the head, and sensation as if the brain were bruised or lace- rated ; tenderness of the scalp. The pains are aggravated by movement, such as walking or stooping, or by reflection ; also after eating, or on going into the open air, and are frequently attended with considerable giddiness or confusion in the head; the headache is generally attended with extreme irascibility, and is renewed or aggravated after partaking of coffee, the constant habit of drinking which is not an unfrequent cause of the complaint; sudden attacks of headache are frequently excited by a fit of passion, a fright, the effects of a chill, or an overloaded stomach. DOSC. Three globules, whether in casual or chronic cases, as directed respectively for Bryonia. But if partial relief only should be effected by this medicine, and such symptoms as are subjoined should occur, pause twelve hours (in acute and casual cases), or four days (in chronic cases), and proceed with the following medicine. Ignatia is also an excellent remedy, as already stated, in cases in which the pain is confined to a small space, and causes a sensation as if a nail were driven into the brain ; and when there are nausea; dimness of the sight, and sen- sibility of the eyes to light; paleness of the face, and tem- porary alleviation from change of posture ; aggravation from noise or strong odors, or after partaking of coffee. Ignatia is sometimes serviceable in completing the cure after the previous administration of Nux v. or Pulsatilla. It is espe- cially applicable to nervous, hysterical females of a mild and sensitive disposition-. DOSC If from the onset, in acute and casual cases, give three globules in a tea-spoonful of water, repeated at intervals of four hours, until decided amelioration or change. If in chronic cases, or as a con- secutive remedy, after the previous employment of Pulsatilla, give similar doses at intervals of twelve hours, until decided amelioration or _ change. Coffea. In cases of megrim, brought on by meditation, vexation, or exposure to cold, attended with irritability, sen- sibility to noise, great anxiety, and chilliness, and a sensation as if a nail were driven into the brain, or a feeling as if the brain were bruised, occurring in individuals who are ex- / / NERVOUS SYSTEM. /impatient under suffering, and are not habituated to fe of coffee, this remedy is frequently a very efficacious oix^y Dose. Three globules in a teaspoonful of water, repeated at inter- vals of two hours, until three doses have been given, and, subsequently, at intervals of twelve hours, for four days (or until earlier relief or change). But if, after the termination of this course, the improvement should only have been partial or temporary, pause two days, and proceed with the next medicine. Pulsatilla. Megrim, characterized by rending or shoot- ing pains, with heaviness of the head, dimness of the sight, sensibility to light; or buzzing or singing in the ears, and ear-ache; nausea, paleness of the face, lowness of spirits; headache, with pain in the nape of the neck; aggravation of the headache, with chilliness towards evening, during repose, or particularly wrhen sitting; melioration in the open air. Disposition mild; temperament phlegmatic. Dose. Three globules in a tea spoonful of water, repeated at inter- vals of four hours, until three doses have been given, and, subsequently, if yet requisite, at intervals of twelve hours, until decided amelioration or change. But if the headache should still recur, after a week's course, or if, at any earlier period, the following symptoms and conditions should occur, pause two days, and proceed with the next medicine. China. Headache worse at night, accompanied with a sensation as if the head would split; or dull, aching, pressive, or boring pains, particularly at the crown of the head, in- creased by movement, or by the open air : tenderness of the scalp; great sensibility to pain ; taciturnity and obstinacy. Dose. Three globules in a tea-spoonful of water, repeated at inter- vals of six hours, until four doses have been given, and, subsequently, at intervals of twelve hours, until decided and permanent amelioration or change. Yeratrum. Headache, preceded by coldness and shiver- ing ; pain in the head, as if the brain were bruised or lace- rated ; or lateral, aching, constrictive, and throbbing pains, sometimes attended with a sensation of constriction or tightness in the throat; feeling of coldness at the crown of the head, as if ice were placed upon it; or sensation both of coldness and heat on the exterior of the head, with deep-seated or internal HEADACHE. 437 burning heat; headache, with paleness of the face, nausea and vomiting, and preceded by a copious discharge of color- less urine ; headache, with pain at the pit of the stomach, or painful stiffness of the neck, headache with extreme weak- ness and melancholy; painful sensibility of the hair to the touch ; chilliness, with general cold perspiration. Arsenicum and Acid. phos. are sometimes useful after Veratrum. Dose. In acute and casual cases give three globules in a tea- spoonful of water, repeated at intervals of four hours, until decided amelioration or change. In chronic cases, give similar doses at inter- vals of twelve hours, until positive improvement or change. But if partial relief only should ensue within four hours after the third dose (in acute and casual cases), or within twelve hours after the sixth dose (in chronic cases), or, if the subjoined symptoms and conditions should become more especially predominant, proceed with the next medicine. Lachesis. Deep-seated pains in the head, or severe aching pain in the occiput, in the sockets of the eye, or above the orbits, with stiffness of the neck, particularly at the nape; heaviness and feeling of expansive pressure, sometimes to such an extent as if the head would burst; tension in the head, as if caused by strings or threads drawn through the occiput towards the eyes; lancinations in different parts of the head; headache every morning on waking, or after dinner, or at every change of weather. Dose. As directed for Veratrum. Mercurius. Rending and burning, or lancinating and piercing pains, generally lateral, sometimes extending to the teeth and neck, with shootings in the ears ; tightness round the head ; excessive nocturnal aggravation of the headaches, often accompanied by profuse sweating. Dose. Three globules in a tea-spoonful of water, night and morning, for a week (or until earlier change) ; then pause six days; after which the course may be repeated, as before, if necessary. If, however, the improvement should only be partial within six days after the com- pletion of the second course, proceed with the next medicine- Colocynth. Nervous headaches, attended with smarting in the eyes ; excruciating lateral aching; rending, dragging pains; nausea and vomiting; feeling of compression in the 438 NERVOUS SYSTEM. forehead, increased by stooping or lying on the back ; head- ache every afternoon or evening, with great anguish and excessive restlessness, so that it is impossible to remain in the recumbent posture; offensive perspiration; profuse discharge of colorless urine during the headache. DOSC Three globules in a tea-spoonful of water, repeated at inter- vals of three hours, during the prevalence of the pain,