i;.;«i lamm; THE HOMCEOPATHIC > THEORY AND PRACTICE MEDICINE. BY E. E. MARCY, M. D. SfmfUa stmUftus cutantut. ...____^^ ^l,;n \<\ -s T > 0-H117.7 NEW-YORK: WILLIAM RADDE, 322 BROADWAY. 1850. WBK M322% ENTERED According to the Act of Congress, in the year 1850, by WILLIAM RADDE, In the Clerk's Office of the District Court for the Southern District of New-York. B. Luduii mi Co. Prinurt, tf.Y. PREFACE. The profession of the art and science of renewing and preserving health has, in all periods and in all nations, been held to be of the highest dignity, for the devotion and bravery necessary in those who adopt it, as well as for its association, as ameliorator, with almost every form of human suffering. In its widest and justest acceptation, it may be said to be the sum of logic, since nearly all knowledge, in metaphysics as well as in physics, is necessary to the thorough understanding and the illustration of its various prin- ciples and phenomena. In an age preeminently distinguished for intellectual as well as for physical activity, the theories of disease and cure have shared the general advancement, and the new doctrines that have obtained, for their elucidation and practical application, demand a new lite- rature. Since the discoveries of the Newton of Medicine, old trea- tises, founded upon erroneous and soon to be obsolete hypotheses, are, for the most part, comparatively valueless, except for purposes of history. Everything is to be reconstructed. Much has indeed been done in Europe and in this country, since the announcement of the true laAvs of cure, yet so little in proportion to the neces- sity, that no apology will be required for this attempt to occupy one of the chief places of dethroned but still unsilenced Error. At the beginning of a system of Theory and Practice, produced under such circumstances, and for such purposes, it is appropriate to disclose briefly its leading characteristics, and especially the positions it occupies in relation to points which may be considered still unsettled and debateable. The grand proposition, similia similibus curantur, is not only the basis of the homoeopathic me- thod, but is also, we believe, the hitherto unknown law of the most successful treatment by the allopathists. Whether we advocate the use of high or low attenuations, or believe in the topical and material, or the dynamical and immaterial action of drugs, are IV PREFACE. matters of proportionably little importance, while we abide by this fundamental doctrine in the practical application of remedies. The physician of the old school, who cures delirium tremens with a large dose of opium, acts as strictly in accordance with the theory of Hahnemann, as he who cures it with a high attenuation of the same drug, but with this difference—that the treatment of the former is attended with danger, and the restoration is slow, tedious, and defective, while the primary specific impression by the philo- sophical process is slight, and the curative reaction of the organism speedy, complete, and permanent. Although the question of doses is of considerable importance in individual cases, yet too much stress has been laid upon it by the advocates of both high and low attenuations. We are constantly presented with well-authenticated cures by the undiluted tinctures and low dilutions, and have also as thoroughly understood and successfully practised the high attenuations. We occasionally see, too, that strong preparations afford prompt relief where the weaker have failed, and vice versa. Some constitutions may be powerfully acted on by a thirtieth, while others will not respond to any weaker, than a first dilution. The different conditions of the tissues likewise offer the most varied and important modifications with reference to the effects of agents. How absurd, then, to fix upon this or that attenuation, and to make use of the term high or low dilutionist, when we have to deal with organisms of every possible grade of delicacy and susceptibility, and with morbid con- ditions which, in some instances, may be modified by even a men- tal emotion, and in others only by the strongest tinctures. We say, therefore, to the true homcRopathist, let the grand max- im of Hahnemann, similia similibus curantur, be our prime and constant rule of medical faith and practice ; but never attempt to confine our doses within the narrow limits of the ultraists of either party, for the unanswerable reason, that the susceptibilities of the tissues to medicinal impressions vary in precise accordance with the degrees of inflammation and nervous erethism. From a con- dition of health, or a slight irritation of the textures, up to a high point of inflammatory action, or nervous excitability, there are almost innumerable gradations of impressibility ; and he who would prescribe wisely and successfully, must select his attenuations, and order his repetitions with strict regard to these degrees. Of this 4 subject we have treated at some length in chapter VII. In our observations on general pathology and therapeutics, we have endeavoured to explain what we believe to be the true nature of inflammation, and have pointed out some of the more general means of avoiding and counteracting the causes of inflammatory PREFACE. V action. In forming many of our inferences, we have been indebted to the recent labours of Liebig, Miiller, Matteucci, Flourens, Ma- jendie, and Philip. Although the views advanced have no material bearing upon the homoeopathic doctrine of cure, yet if they illus- trate this most important of the subjects connected with the mor- bid conditions of the economy, we shall have done well for medical science. We are aware that Liebig has carried some of his che- mical hypotheses farther than facts or logic warrant, but admit that many of his positions, as to the production of animal heat, the metamorphoses of the tissues, the supply and waste of the con- stituents of the structures, and the phenomena of inflammation, are in the main correct. If he errs in supposing that all the phe- nomena of life are attributable to chemical action, that the human body is subject to the same laws as inert matter, and that the mass of blood may be contaminated by contact with substances in de- composition with a similar kind of degeneration, he has also shown truly that chemical action has at least an important influence in the operations of the functions. Let not, therefore, his mistakes prevent a rigid scrutiny of his opinions, that we may reject the untenable, and appropriate the true. Believing and advocating the doctrine of absorption and the topical action of drugs, we have derived numerous arguments for our views from the recent experiments of Matteucci, Flou- rens, Rau, Miiller, Blake, and Majendie. These profound in- vestigators have demonstrated that most medicinal substances pos- sess well defined specific properties, and that it is necessary to their legitimate effects, that they be absorbed and conveyed by the blood—as a medium merely—to the tissues for which they have affinity, there to operate (probably upon the sentient nerves), by actual contact. The very numerous and accurate experiments with almost every known drug, instituted by these physiologists upon animals, are quite conclusive as to the point of the absorption and topical action of remedies. We have repeated many of their ex- periments, and have made a great variety of new ones for the therapeutical illustration of the subject, and have thus formed from facts alone, the conclusions we have here announced, as to the man- ner in which remedial agents operate. The scope and design of this treatise will not permit a detail of these interesting experi- ments and their results, but we hope hereafter to submit them to the public. In the meanwhile, attention is invited to the chapter in which we have treated of this subject. There is another doctrine now entertained by a majority of the physicians of both schools, but in no way connected with our theory of cure, to which Ave have devoted special attention ; we A* VI PREFACE. mean that so often advanced respecting what are called " vifal properties'1'' of parts—a nervous fluid—a dynamic influence, differ- ent from the soul. We object to these terms because they are merely arbitrary, and are used to designate properties which have no real existence ; because, as Matteucci well observes, they may have no meaning, or may mean everything. The vitalists define disease to consist in an alteration of the vital properties of parts. But what are these vital properties 1 Are they material or spiritual 1 something or nothing 1 What is the nature and what are the pro- cesses of their influence 1 We are told that miasmata act dynamical- ly or spiritually upon the vital properties of the tissues; but what are miasmata but minute particles of vegetable matter, subdivided by heat and moisture, and so diffused in imponderable forms through the air1? Have these atoms really lost their material form or weight, and become annihilated? Can a material substance, by any means, be reduced into an immaterial nothing, and retain its iden- tity or individuality 1 In other words, can matter be transformed into spirit ? Surely, no; but we may subdivide substances so minutely as not to be able, by our most delicate tests, to detect them ; yet they may have affinities, and be capable of combina- tions with other atoms, and of producing other material effects when brought into contact with certain tissues of the organism. When these material (not dynamic or spiritual) particles have reached the structures to Avhich they have specific relations, they impress the sentient extremities of the nerves, so that the capil- laries and other parts over which these nerves preside, respond to their impression, and there are chills, followed by inflammations. It is evident, then, in this and other analogous instances, that a material agent operates topically upon the tissues, thus impairing the normal integrity of the parts, but not dynamically upon certain (assumed) vital properties. The general principles of allopathy we have briefly considered and compared with those of homoeopathy ; but want of space has prevented such elaborate discussion of these subjects as was de- manded by their interest and importance. We trust, however, that what we have written may attract attention, particularly to the real points at issue between the schools, and that the shafts of our antagonists may hereafter be directed against our distinctive principle of cure, rather than against our doses, and the exhibition of our remedies. Hahnemann, and some other writers of eminence, have ex- pressed doubts respecting the utility of the common classifications of diseases, since descriptions must necessarily be general and imperfect. In a therapeutical point of view, this distrust of clas- PREFACE. VI1 sifications is reasonable, and it has probably arisen from the custom with the old school, of bringing the symptoms of every disease under some one general head, and prescribing for the congeries, however diverse the separate elements, under a particular name! For example, the allopathist called to a patient with febrile symp- toms, finds a rapid pulse, a hot and dry skin, headache, pains in the back and loins, oppression at the praecordia, restlessness and irritabilility, foul tongue, thirst, scanty and high-coloured urine, confusion of ideas, and nightly delirium. He is now to arrange these symptoms under one of the general heads of his classification, but is at a loss whether to call it typhus, bilious, or inflammatory, sthenic or asthenic. The case, however, admits of no delay, and he arbitrarily decides that it is bilious, and bleeds, vomits, and purges, well knowing that if it proves a typhus, he can persuade himself and the patient's friends that it has degenerated from one type into another. He forgets to make known that copious vene- section, emetics, and cathartics, are deemed by many of the most intelligent of his OAvn school, to be fatal in typhus, and attributes all evils to the versatile and intractable nature of the malady, while complacently appropriating to himself whatever credit may chance to accrue from favourable symptoms. On the other hand, if he had regarded the disease as a typhus, and pursued the expectant or tonic treatment sanctioned in his school, and it had proved an inflammatory fever, lesions might have taken place, and the pa- tient might have succumbed from the inefficiency of his remedies. Objections of a similar nature apply in a majority of the classifi- cations treated by the allopathist. But while it is unquestionable that all these are useless as guides in the application of remedies, it must be conceded that they enable us to concentrate groups of symptoms under appropriate heads, and thus to arrive more con- veniently at just conclusions respecting the nature of diseases. Accordingly, in this treatise, we have adopted a classification varying little from those usually employed, which we believe will facilitate the true apprehension of disordered conditions. We have described the diseases of the separate systems under the same head, instead of treating of acute varieties in one part of the Avork, and of chronic in another. This course has been deemed proper on account of the difficulty, in many cases, of fixing the line of demarcation between acute and chronic affections, and for convenience of reference to, and of comparison of the different diseases of the same system. In arranging the symptoms which demand particular medicines, we have adopted the following classification : I. External indications, or what have been designated by Vlll PREFACE. Marshall Hall as physical signs of disease. Under this head are included all those signs which belong to the external or visible appearance of the patient, and over which he has little or no con- trol, as the expression of countenance, colour and temperature of the skin, pulsations of the heart and arteries, respiration, breath, condition of the digestive and genito-urinary organs, attitude, ap- pearance of the eyes, and of the nose, lips, tongue, mouth, and throat, the secretions, excretions, surface of the body, swellings, (in relation to size, hardness, softness, elasticity, fluctuation, &c.,) the condition of the muscles, (in relation to contractility, strength, debility, and motion,) the voice, mode of expression, and appear- ance of discharges from the stomach, intestines, bladder, uterus, vagina, nose, ears, eyes, mouth, and from abscesses, ulcers, &c. These phenomena may always be observed without any descrip- tions by the patient or his friends, and, in many instances, without the patient's consciousness ; and, as we have elsewhere shown, they often indicate with much certainty the character of a malady. In infants and children, and adults, who, from injury or disease, become incapable of communicating their sufferings, they are of the utmost importance, and will frequently be sufficient for our direction in the exhibition of remedies. II. Physical sensations, including most of those symptoms which are commonly described as rational signs of disease. These comprise pains of all descriptions, weaknesses, irritations, oppres- sions, obstructions, and all other uneasy or unnatural feelings, and all circumstances connected with the approach, continuance, aggravation, or remission of the patient's sufferings. For a know- ledge of them, we must rely for the most part upon verbal descrip- tions ; for the best method of procuring which, with truth and exactness, we refer to Hahnemann's Organon, pages 125 to 133, where our venerated teacher has pointed out with great minuteness the necessary directions upon the whole subject of such investiga- tions. III. Mental and moral symptoms, including the condition of the mental faculties, the disposition, temper, and all variations of the intellectual and moral sentiments, from the normal standard. This arrangement has been adopted with reference to convenience in investigation, and in the selection of remedies. As some dis- eases are characterized by manifestations of one or more of the ex- ternal indications, and others by internal pains, or a perversion of the mental and moral faculties, so different drugs develope corres- pondences in the organism. As it is an object that our remedies should have as exact an affinity as possible to the symptoms and to these alone, the advantage of this classification of symptoms will be readily perceived. PREFACE. IX In descriptions of special symptoms created by different reme- dies, and presumed to indicate their therapeutical properties, we have drawn freely from all reputable sources, whether European or American. In some instances, we have not hesitated to rely upon drug-symptoms as described by accurate practitioners of the other school, m cases of poisoning. Although little confidence can be placed in then- ordinary observations upon the diseased organ- ism in relation to this point, yet symptoms are occasionally re- corded during the operation of poisonous doses upon the healthy, which could not well be obtained in any other manner, and which undoubtedly form an important addition to our knowledge of pure drug-symptoms. A difference of opinion exists in the philosophical school re- specting the most suitable form for the exhibition of remedies. Some, entertaining a dread of medicinal aggravations, and be- lieving that the minutest quantity of an appropriate medicine is sufficient to induce a curative reaction, employ, for the most part, pellets that have been saturated with the drug. Others, having less fear of these aggravations, and preferring to know with cer- tainty the precise quality and quantity of their doses, make use of triturations, given dry, in small powders, and dilutions, either mixed with pure water or dropped on sugar. We have preferred powders and dilutions for the following reasons : I. A large number of medicinal substances evaporate so quickly, that, after a time, many of their active particles must necessarily escape. II. Very small quantities of many drugs, when exposed a few weeks to the action of the oxygen of the air, either become en- tirely neutralized, or so altered in their properties as to be no more identical with the original drug. On this account, it is better to impregnate larger quantities of the medium that less surface may be exposed to the air, and thus to render it certain that a portion of it retains particles of the drug unimpaired. III. The importance of using our medicines in a form that shall be certain to produce the requisite impressions upon the disordered structures. We deem it an evil of much less magnitude to risk the occasional induction of some temporary medicinal symptoms,— thus being sure that the remedy has reached the affected tissue,— than to administer it in such a form as to produce no visible effects, leaving us in doubt for a time whether an impression has or has not been made upon the affected parts. We do not deny that pel- Jets, in many instances, may prove entirely efficient and satisfac- tory, and for non-professional use, perhaps they are the safest; X PREFACE. but since we have it in our power to select forms which arc certain to contain the active properties of drugs, and which enables us to prescribe with greater exactness, we think that such forms should be generally adopted by the profession. We are compelled, there- fore, with deference to many distinguished cotemporaries, to regard the ideas which have so often been promulgated respecting medi- cinal aggravations, as altogether exaggerated and unworthy that serious consideration with which they have often been received. For further observation upon this subject, we refer to the chapter on " Attenuations of Drugs and Repetitions of Doses," page 111. Finally, if some of our opinions clash with those of our homoeo- pathic brethren, we have only to assure them that our only objects have been to ascertain truth, and advance our science, and that we shall always be willing to investigate facts, and to listen candidly to arguments, and whenever convinced of errors, to acknowledge and renounce them. ERRATA. On page 221, tenth line from the bottom, for "Inclination is also present," or a still smaller proportion of a grain, and learned from actual observation that they have then lost their power of impressing diseased structures? We venture to affirm, never, or they would long since have deserted the standard of allo- pathy. This leaning towards the modern theory is not altogether confined to the few practical cases which we have cited, but some of their most eminent wri- ters have approached so near to the views of Hahne- mann, that we are at a loss whether to rank their theoretical doctrines as homoeopathic or allopathic. The distinguished Pereira. in his Materia Medica and Therapeutics, writes as follows : " Unguents and lotions are used in cutaneous diseases, ulcers, &c.; gargles in affections of the mouth and throat; colly- ria in opthalmic diseases ; and injections into the vagina and uterus in affections of the urino-genital organs. In all such cases, we can explain the therapeu- tical effect in no other way than by assuming that the medicine sets up a new kind of action in the part affected, and that the new action subsides when the use of the medicine is suspended or desisted from." This explanation is the true one. The medicines in these cases, as well as in all other instances where appropriate specific remedies are used, do " set up a new kind of action in the part affected," creating a me- dicinal disease which supersedes the natural one. The only fault we have to urge against allopathists 66 ALLOPATHY. in the treatment of these and analogous cases, is, that they give much too large doses, and thus create a far more violent medicinal disease than is necessary to bring about their cures. Notwithstanding, how- ever, their errors in exhibiting medicines in a crude and impure form, and in unnecessarily large doses, we must give them the credit, {fiat justitia ruat coelum,) of occasionally curing disease (although un- wittingly) in a " rational and consistent" manner. Paine, in his Institutes of Medicine, remarks, " that when the intestinal mucous tissue is affected with that condition of disease which results in a preter- natural watery secretion, and consequent evacuations, which is called diarrhoea, and rhubarb is administered in a certain dose, this substance first impresses the membrane in such a way as to determine an increase of the peristaltic movement; but it simultaneously alters the morbid state of the intestinal mucous tissue in such a way that the natural secretion is arrested. Whether, therefore, the rhubarb purge, or prove as- tringent, or tonic, a common principle, and common laws are concerned throughout; and all the sensible results depend upon certain alterations which ths agent effects in the vital properties and actions of the vessels or tissues which are the seat of the morbid conditions, or in which the various phenomena may take place." The same principle directs the practitioners of the old school in the treatment of many other diseases, and yet they sneer at homoeopathy, and hold up their own inconsistent and uncertain doctrines as philo- sophical and correct ! Gentlemen of the old school, your practice too often belies your profession : you pretend to be allopathists and antipathists, while con- stantly administering medicines after the manner of the homoBopathist. Instead of abiding by the theo- retical doctrines which have come to you from rude and dark ages—doctrines which have received seals of approbation from the alchemist, the astrologer, and the sorcerer—you have stealthily, and, doubtless, in many instances, unwittingly, abandoned your legiti- mate ground, and practised upon the principles of our modern heresy ! Where is your pride, where your consistency ? You have the boast of antiquity, you ALLOPATHY. 07 have received your "bundle of ideas" from Hippo- crates and Galen, to whom you pay reverence and allegiance ; you disdain innovations, and despise dis- coveries and improvements; you have withstood the changes of more than two thousand years, and, by your powerful dicta, have continually discouraged all original induction, and endeavoured to crush in the bud every advancement in medical knowledge. Where is now your former pride, that you so often practically abandon your time-sacred axiom, " contra- ria contrariis," and adopt the new heresy, " similia similibus?" Perhaps the light of modern science and discovery breaks, against your will, through the cre- vices of your unjointed and heterogeneous theories, or you are startled from your propriety by the whelming accumulations of fact which Hahnemann and his dis- ciples have displayed so bravely before the world ; or, possibly, the disrespect and abuse of some of the most eminent and able of your caste, has impaired all confidence in, and respect for, your own dogmas and their applications, and you are at sea in search of a system. Are we wrong ? If so, we have excuse in the following, from the distinguished editor of the British and Foreign Medical Review, Dr. Forbes, who asserts : " 1. That in a large proportion of the cases treated by allopathic physicians, the disease is cured by na- ture, and not by them. " 2. That in a less, but still not in a small propor- tion, the disease is cured by nature in spite of them ; in other words, their interference opposing instead of assisting the cure. " 3. That, consequently, in a considerable propor- tion of diseases, it would fare as well or better with patients, in the actual condition of the medical art, as more generally practised, if all remedies, at least all active remedies, especially drugs, were abandoned. We repeat our readiness to admit these inferences as just, and to abide the consequences of their adoption." Beware, then, most ancient goddess, survivor of all thine earlier contemporaries—of alchemy, and astrolo- gy—lest thou fall, and thy doctrines, handed down through the dark ages, through the juggling temples 68 ALLOPATHY. of idolatrous priests, be swallowed up in the deluge of new facts and discoveries which the nineteenth century is pouring upon the world. But, seriously, it is a matter of no little surprise, that while anatomy has made most rapid strides, unfolding the secrets pertaining to the most minute structures of the ani- mal organism ; while botany and mineralogy have displayed before our eyes the wonders of the vegeta- ble and mineral kingdoms, and pointed out the laws of their formation, development, and even of their very existence ; while chemistry has grasped some of the most subtle agents in nature, and developed im- provements in the arts and sciences which have con- tinually startled and astonished the world, as well for useful as for purely scientific results,—medicine, until the time of Hahnemann, has been crushed under the weight of antiquated doctrines, and the legalized power and oppression of the schools. We have thus far made allusion to that part only of the allopathic practice which bears some approxi- mation to the correct method. In most of the in- stances enumerated, specific medicines are employed— medicines that produce a similar state when given in health, to that which they are to cure. Although large quantities of crude and impure drugs are used in these instances, and the medicinal diseases are thus rendered violent and complicated, still it must be admitted that occasional cures are accomplished. But we come now to a more interesting and momen- tous part of our subject. It becomes our duty to lay before our readers the doctrines and practice of allo- pathy, as they actually exist; to note their many in- consistencies, and to point out some of the innumerable evils which they entail upon mankind. We have seen that in the treatment of disease, the old school physicians make an indiscriminate use of the palliative, heteropathic, and in a few instances, the homoeopathic methods of practice. A general idea prevails, that all diseases consist in '| local determinations of blood," and that no two af- fections of any consequence, can exist in different parts of the same organism, at once. On this account it is, that new diseases are created in healthy parts, for the purpose of removing the primary natural one. ALLOPATHY. 69 Physicians have been led to adopt this mode of rea- soning from observing that the spontaneous appear- ance of cutaneous eruptions, discharges of blood, pro- fuse perspirations, &c, occasionally afford relief to morbidly affected internal organs. Without reflect- ing that these results are merely symptoms of the in- ternal disorders, and that the causes upon which these signs depend are located in the blood, they attempt to annihilate diseases, by imitating artificially these symp- toms. In regard to the first position, we affirm that their premises are untrue. There are no facts which war- rant the statement, that "no two excessive determi- nations of blood can exist in the same individual at the same time." Neither is it true, that the appear- ance of cutaneous eruptions, spontaneous sweats, diarrhoea, and discharges of blood, are invariably, or even generally, indications that the affected organ is in process of restoration, or that the system at large is recovering its lost energy and vigour ; since it often occurs that the symptoms of the complaint are all ag- gravated, upon the supervention of either of the above occurrences. Dr. Wilson observes, that " there is often a remark- able tendency to the worst species of haemorrhages from the bowels, towards the termination of fatal cases of phrenitis." Dr. Eberle, in his Practice of Physic, remarks, " On the day preceding the fatal termination of a case of phrenitis which came under my own observation, an exceedingly copious discharge of dissolved blood took place from the bowels, and on the following morning the haemorrhage occurred also from the mouth and gums." Let us suppose a case of phrenitis. We have here an inflammation, or a congested state of the capilla- ries of the brain. To relieve this inflammation, and withdraw a portion of the fluid which is concerned in the congestion, blood-letting, both general and local, is resorted to as a primary and indispensable process of cure. By this means, the general strength is re- duced, the pulse increased or diminished in frequency, and the temperature of the skin altered, but the con- 70 ALLOPATHY. gestion still continues, and the morbid and debilitated state of the extreme vessels (in which the disorder alone resides) remains the same as before. A resort is then made to revulsives and counter-irri- tants, in order that new inflammations may be crea- ted in healthy structures, which shall supersede that already existing in the brain. To effect this object, purgatives of the drastic kind are exhibited, and blis- ters applied to the head, neck, and lower extremities, in order that the intestinal canal, and portions of the skin, shall be placed in a state of artificial inflamma- tion. Let us understand the case clearly. We have a disease consisting solely in a loss of tone and irrita- bility of the serous vessels of the brain, which prevents them from excluding the red blood, and of performing properly their functions. To obviate this condition, a quantity of blood is abstracted, and artificial or me- dicinal inflammations are caused in the intestinal canal, and upon different parts of the surface of the body. We now inquire in what manner these violent means can, by any possibility, reach the seat of the malady, and impart tone and vigour to the weakened capillaries, so as to enable them to exclude from their structure the red globules, and resume their healthy function ? All will concede that inflammation consists in loss of tone and irritability in these vessels, and that no cure can take place, until this impaired irritability is restored. In inflammation, according to Philip, Hast- ings, Eberle, Wilson, and Allan, the capillaries of the part are in a state of debility, and passive relaxation. The immediate exciting cause of inflammation may be either stimulant or sedative. In both instances the impression is made upon the nervous filaments of the capillaries, and if the cause acts as a stimulant, the reaction which must follow this augmented action, will leave these delicate nerves in a state of debility- proportionate to the amount of the previous excite- ment. If the primary cause is directly sedative, no reaction will occur, but a similar state of relaxation will obtain as in the former instance. ALLOPATHY. 71 How, then, we repeat, can venesection, cathartics and blisters affect the necessary object ? They do not certainly prevent the red blood from still entering the relaxed capillary tubes, for the whole remaining mass must continue to circulate through the brain, as well as other parts of the organism, every few minutes. By lessening the quantity of blood, we also abstract a portion of that natural stimulus of the organism, which is one of the essential conditions of irritability. " Every part of the organism depends, for the perform- ance of its proper functions, on the receipt of arterial blood and of nervous influence ; so alterations in the sup- ply of either of these essentials, may modify or even sus- pend the functions of a part."* How absurd and pernicious then, in inflammations, the very essence of which is debility and loss of tone, to detract from one of those conditions upon which this very tone and vigour depends ! As well might you remedy the breach through which the waters of a raging torrent are madly rushing, by turning off from its course a small quantity of this element. As well attempt to suppress the leak of a storm-tossed vessel, by diverting a portion of the stream on which she floats, from its natural channel. It is not the blood which is at fault; but a portion of the organism. Correct therefore the cause of the disturbance by direct and appropriate specifics, and you may then, and not until then, effect cures, safely and philosophically. Seek not to deprive the system of that fluid which is so essential to the organism, and on whose integrity its functions depend ; for by so do- ing, the cause of the malady will remain untouched. It is very true, that when a large quantity of blood is abstracted, during inflammation, there will seem to be in some instances an apparent amelioration of all the symptoms, but this effect is only temporary ; for as soon as reaction comes on, the enfeebled capillaries again admit the destructive " carriers of oxygen" as before ; the state of congestion and inflammation re- mains, while the system at large has lost a portion of that stimulus which conduces so materially, not only * Pereira'a Mat. Med, 72 ALLOPATHY. to sustain the normal integrity of the functions in health, but to aid in the restoration of enfeebled and diseased parts. The remedies which stand next in importance in the old school method of treating phrenitis, are revulsives and counter-irritants. It is supposed that by exciting the intestinal exhalents, inflaming the membrane of the bowels, and portions of the skin, the circulation is diverted from the brain and directed especially to these parts. But by this means is the brain in reality relieved ? Is the whole mass of blood thus prevented from circu- lating as usual through this organ once in three or four minutes, or the character of its red globules changed ? By exhausting the energies and resisting force of distant healthy structures, and creating sympa- thetic symptoms throughout the body—thus complica- ting the already existing disease, and impairing the en- tire nervous and muscular energies—are the inflamed capillaries of the brain placed in a more favourable condition to recover their impaired tone and irrita- bility ? Every man who has a correct idea of the laws which govern the organism in health and disease, and who is willing to banish prejudice and be guided by common sense and true philosophy, must answer in the negative. We object to these remedies, however, not only be- cause they are incompetent to produce salutary im- pressions upon inflamed parts, but because of the evils of a positive character to which they give rise. The chief remedies of the old school, are the pre- parations of mercury, opium, antimony, and bark. In a vast majority of all the cases treated by the prac- titioners of this school, one or more of these articles is made use of. Indeed, scarcely a single malady of any moment can be named, in which one of these medi- cines is not considered indispensable. Let us then examine some of their effects, in allopa- thic doses, upon the healthy and diseased organism. 1. MERCURY. This mineral is more uncertain in its action, in all states of the system, than any other article in use. It ALLOPATHY. 73 possesses the power in different constitutions, and un- der certain circumstances, of affecting nearly every organ and tissue of the body ; and it is not in the power of the most judicious physician to say before- hand, where or in what manner, it will exert its force. Some of the more common deleterious effects of the use of mercury, are, excessive salivation, ulceration, gangrene and sloughing of the gums, mouth, and throat, gastro-enteritis, mercurial erethism, dysentery, cutaneous eruptions, inflammation of the periosteum and bones, nodes, excessive derangement of the nervous system, pa- ralysis, tremors, necroses of the maxillary and other bones, rheumatism and opthalmia. When mercury is administered, even in a moderate quantity, no human being can be at all certain that one or more of these evil consequences will not result. Indeed, it is the direct object, oftentimes, to produce some of them, to operate as counter-irritants. Whether it is employed in large or small quantities, solid, or in the form of vapour, is of little importance, so far as its power of affecting the system is concerned. The following, from the Ed. Med. and Surg. Journal, illustrates the baneful influence of the vapour when in- haled : " In 1810, the Triumph man-of-war, and Phipps schooner, received on board several tons of quicksilver, saved from the wreck of a vessel near Cadiz. In con- sequence of the rotting of the bags the mercury es- caped, and the whole of the crews became more or less affected. In the space of three weeks 200 men were salivated, two died, and all the animals, cats, dogs, sheep, fowls, a canary bird,—nay, even the rats, mice and cockroaches, were destroyed." The following cases resulting from the employment of calomel, have come under my own observation, viz., three cases of necrosis of the inferior maxillary bones, requiring the removal of portions of the jaw ; several cases of gangrene and sloughing of the mouth and throat, which have terminated fatally ; a number of cases of mercurial palsy; numerous instances of ul- ceration of the nose, throat, &c.; skin diseases, affec- tions of the bones, nodes,rheumatic affections, &c, &c. Professor Chapman, after descanting upon the wo- ful effects which have so often been produced by cal- 1 74 ALLOPATHY. omel, and referring to many disgusting cases of mer- curial disease which have come under his own obser- vation, thus concludes: " Who is it that can stop the career of mercury, at will, after it has taken the reins in its own destructive and ungovernable hands ? He who, for an ordinary cause, resigns the fate of his pa- tient, to mercury, is a vile enemy to the sick ; and if he is tolerably popular, will, in one successful season, have paved the way for the business of life ; for he has enough to do ever afterwards to stop the mercurial breach of the constitutions of his dilapidated patients. He has thrown himself in fearful proximity to death, and has now to fight him at arm's length as long as the patient maintains a miserable existence." And this dreadful poison is the most common,—yes, the daily remedy of allopathy, for almost every dis- order, whether mild or severe, acute or chronic. This is the agent with which artificial diseases are created in healthy parts, to cure primary or natural ones ! This is the substance with which unfortunate mortals are drugged, from the time they come into the world, until their wretched and too often premature depart- ure, with its well-known and generally admitted evils and dangers,—from the contemplation of which the well-instructed and experienced allopath shrinks with instinctive dread,—and its questionable value in most instances of its prescription, it may justly detain our attention. Calomel and opium are the common re- medies in the traditional practice. We shall see to what degree they may be used in a practice that is philosophical. By glancing at the standard works on the practice of medicine, it will be observed that there is scarcely a single malady, either acute or chronic, in which one or both of these articles is not recommended as an im- portant if not indispensable means of cure. Taking Eberle's Practice of Medicine — an approved allo- pathic work—as a fair illustration of their views and practice, it will be seen that of the one hundred and thirty-nine diseases, upon which these two volumes treat, there are only ten, in which calomel or opium in some form is not recommended. The following are the names of these exempt diseases, viz : mumps, ring-worm, nettle-rash, scurvy, chronic cystitis, hysteri- ALLOPATHY. 75 tis, asphyxia, roseola, haematemesis, and nose-bleeding. Nor are these remedies advised simply as auxiliaries in the treatment, but in a large majority of cases, they constitute the principal means of cure. The allopath is taught to believe that mercury ex- cites the functions of all the organs—acts specifically upon the liver, salivary glands, heart, lungs, and ner- vous system—and therefore that it maybe administered almost universally. Regardless of the secondary sym- pathetic affections to which it usually gives rise, he attributes all of these symptoms to the natural disor- der, and if the patient succumbs before the combined attacks of the primary disease and the medicinal one, he consoles himself with the reflection that he has fol- lowed his authorities and prescribed as his predecessors have done for centuries before him. Ask him what are his views concerning inflamma- tion, and he answers that it consists in a debilitated and congested state of the capillaries of the part affect- ed. Ask him what is the modus medendi of mercury in the cure of inflammation,—how any of its effects can reach the seat of the malady, the congested ca- pillaries, and restore to them their impaired tone and healthy functions,—and he either avows his ignorance or offers an unsatisfactory explanation. 2. OPIUM. If we except calomel, this drug and its preparations are more frequently used by the medical men of the old school, than any other article in the Materia Medi- ca. Possessing the power, as it does in an eminent degree, when exhibited in large doses, of covering (not curing) symptoms, and of shutting the mouths of clamorous and inquiring patients, it is used con- stantly and indiscriminately in nearly all protracted maladies. Let us then briefly examine the effects of opium in health and disease, and see if it possesses the wonder- ful property of reaching every structure, and of coun- teracting so many diverse and contradictory symp- toms. Its effects upon the human system, in medium doses, are in the first instance stimulating, succeeded in a short time by diminished sensibility and desire to sleep. 76 ALLOPATHY. " This continues from eight to twelve hours, and is followed by nausea, headache, tremors, and other symptoms of diminished and irregular nervous energy. All of the secretions, with the exception of that from the skin, are either suspended or diminished"* These ef- fects, with a very few exceptions, are uniform under all circumstances, so far as we can judge. How, then, is this substance applicable to the treatment of so many diseases ? We have remarked that in all maladies, there exists an inflammation of an acute or sub-acute character, in some part of the organism, and it is the presence of this inflammation which maintains and perpetuates them. We have also observed that all inflammations con- sist in a congested state of the capillaries of the part affected, caused and kept up by a loss of tone, resist- ing power, or irritability, which disables them from resisting the intromission of red blood. It is apparent, then, that in order to prove efficient, such remedies should be exhibited as are capable of acting upon the seat of the complaint, and of restor- ing the delicate capillary nerves to their normal state of integrity. Opium cannot accomplish this, for its operation tends to impair the nervous energy, instead of adding vigour, to dry up most of the secretions, in- stead of aiding nature to give vent to the poisonous and pent up fluids, it induces nausea, headache, tremors, and many other medicinal symptoms of sufficient se- verity to make a healthy man sick, or to complicate to a serious extent any existing natural affection. If it be urged that opiates have the power of allay- ing pain, while other more efficient measures are pursued to effect the cures, we reply, that by covering up the pain, the real state of the case is concealed ; other new symptoms set in, which will be unnoticed by the benumbed patient, while secondary sympa- thetic affections will be propagated to every part of the body, aggravating and complicating the original disorder. Opium is also highly extolled in low forms of fever, * Wood and Bache, U. S. Dispen. ALLOPATHY. 77 and other complaints, where the powers of the system are in an exhausted condition. But. let it be remem- bered, that the stimulating effect of this drug is of short duration, and that the corresponding reaction or de- pression will bear an exact ratio to the previous ex- altation. This law is fundamental; for the system possesses but a definite and limited amount of vital power, and is capable of resisting only a limited de- gree of unnatural action or disease, so that we can readily perceive how opiates, and other stimulants, must ultimately prove deleterious. It is true that perspiration is promoted by the use of this narcotic, but this does not cure. Sweating is merely a symptom, and it may be favourable or other- wise. When excited artificially by medicine, it is not productive of benefit, because this adds nothing to- wards invigorating the weakened capillaries. " Perspiration induced by medicine is of little mo- ment, unless the remedy simultaneously impresses, directly or indirectly, the parts diseased', and then the salutary results, so far as the surface is concerned, depend upon special vital influences exerted by the remedy upon the skin and reacting sympathies. This is exemplified by the profound effects of tartarized antimony and ipecacuanha, the uselessness of hot water, and the frequent pernicious results of the com- pound powder of ipecacuanha, when free perspiration may follow the administration of either. The effect, therefore, depends but very little upon the evacuation from the skin, as produced by what are called su- dorifics."* It is proper to observe that opium may, and some- times does, effect cures in the hands of allopathists, when given as a specific. Its curative virtues in ma- nia a potu and intoxication, even in large doses, are well known. In these instances, the remedy impresses directly the part diseased, and cures homceopathically. It is quite true that an infinitesimal quantity of the drug, properly prepared, will always prove more effi- cient, speedy, and safe, in accomplishing the object, and will not give rise to the unpleasant medicinal * Painc's Inst, of Med. 78 ALLOPATHY. symptoms which necessarily attend the employment of large doses; yet the fact must be conceded, that clumsy and unscientific cures are occasionally effected by the course alluded to. An interesting case is related by Pereira, illustra- tive of this. " Opium is sometimes employed by drunkards to relieve intoxication. I knew a medical man addicted to drinking, and who for many years was accustomed to take a large dose of laudanum whenever he was intoxicated, and was called to see a patient." The specific effects of the alcoholic stimu- lants and opium, given during health, are exerted as remarked at page 43, upon the same organ ; and we should therefore expect that a malady caused by the excessive use of the one, might be cured by the specific action of the other. TARTARIZED ANTIMONY. This salt has been several times formally banished from the Materia Medica, on account of its dangerous qualities, and as often revived again. Tne Faculty of Medicine, at Paris, in 1566 and 1615, passed solemn decrees against it, as a virulent poison, and these decrees were even sanctioned by parliament, though afterwards formally reversed.* Since this period, some have loudly extolled its vir- tues in the treatment of a great variety of diseases, while others have as earnestly condemned its use, as deleterious in all cases. The celebrated Professor Nathan Smith, in his Essay on Typhus Fever, remarks, '• I have seen many cases in which persons in the early stages of this disease were moping about, not very sick, but far from being well, and who, upon taking a dose of tar- tarate of antimony, with the intention of breaking up the disease, have been immediately confined to their beds." He arrives at the conclusion, after much experience, that " tartar emetic should not be used in this affec- tion, even at its commencement ; and in the latter stages of the disease, that it is sometimes followed by fatal consequences." * Vale. ALLOPATHY. 79 In emetic doses, tartarized antimony irritates the stomach, causes congestion, and sometimes inflamma- tion of the lungs, attended with more or less constitu- tional disturbance. When it fails to produce emesis speedily, it often acts violently upon the bowels, giv- ing rise to severe griping pains and watery evacua- tions. The tenderness of the stomach and intestines, and the constitutional disturbance which succeeds its emetic and cathartic operation, indicates the injury which these delicate structures have sustained. The primary impression of antimony is not the only objection against its employment ; for, like calomel and opium, it gives rise to numerous secondary symp- toms in remote parts, which tend to aggravate in a serious manner any natural affection which may be present. One of the most important of these secondary evils, is dilatation of the ventricles of the heart. Hav- ing witnessed this result in several instances, one of which occurred in my own family, my attention has been particularly directed to the subject, and I am fully of opinion that cases of this description, from the use of antimony, are by no means unfrequent. CINCHONA. In intermittent fevers, general debility, and in cer- tain stages of most other affections, Peruvian bark and its preparations are usually employed by the old school. For the cure of the former, especialljg quinine is the remedy upon which universal reliance is placed ; possessing the property, -when used in large and re- peated doses, of speedily arresting the chills and fever, it is constantly prescribed for this malady, without the slightest knowledge of its processes, and without any regard to the dangerous medicinal disorders which it superinduces; All allopathists who have had much experience in the treatment of fever and ague, are aware that the mere suppression of the paroxysms by no means re- stores the patient to health ; for in a great majority of instances, he lingers for months or even years in a diseased and miserable condition. In these cases it is 80 ALLOPATHY. probable that a medicinal affection is induced by the remedy, so serious in its character, as to supersede temporarily the primary one. This is evident, from the fact that after the effects of the medicine have somewhat subsided, the original disorder again gene- rally makes its appearance. In some instances, how- ever, the medicinal affection is so severe as to consti- tute a permanent disease, and thus entirely usurp the place of the fever. " Experience shows that, though bark, and its alka- loids, in large doses, will often arrest intermittent fe- ver suddenly, such doses are liable either to induce some congestion, especially of the liver or of the mu- cous tissue of the stomach, or will aggravate and es- tablish some co-existing congestion; and thus while the patient is for the present relieved of the fever, he is dismissed with an insidious local complaint that not only renders him a permanent invalid, (resulting often in indurated enlargements,) but which local malady may, and often does become, in process of lime, the exciting cause of another attack of fever. In respect to relapses, it is not unfrequent that, when intermittents are sud- denly stopped by a large dose of quinine, the parox- ysms return as soon as the patient begins to exercise much, or to take his ordinary food."* We should naturally suppose that these untoward results would deter practitioners from using so fre- quently these dangerous remedies; or at all events, as rarely and in as small quantities as possible. On the contrary, it seems to be peculiar to allopathy, that her advocates take credit to themselves, when they succeed in administering this, as well as other medicines, in larger doses than any of their contempora- ries, without destroying their patients. Indeed, so far has this destructive system been carried, of experi- menting upon disease, that the enormous quantity of a scruple and even half a dram of quinine has been ex- hibited at a dose, and repeated several times a day. These monstrous quantities create f gastro-enteritic irritation, nausea, griping, purging, head-ache, giddi- * Paine's Inst, of Medicine. f Wood an 1 Bachc. ALLOPATHY. 81 ness, fever, somnolency, in some cases delirium, in others stupor," &c. Paine asserts that he has wit- nessed many of these effects " from five grains only ;" yet, as patients sometimes live in spite of this treat- ment, many persist in adopting these desperate inno- vations. There are many other medicines employed by allo- pathy in the treatment of disease, besides those to which we have alluded, but in general they serve on- ly as auxiliaries. In this list may be ranked diapho- retics, diuretics, expectorants, refrigerants, emmena- gogues, emollients, errhines, &c, but the articles be- longing to each of these classes, in a crude state and in large doses, are liable to important objections. The fault of those medicines which operate spe- cifically, like diuretics, emmenagogues, &c, in the hands of allopathists, is the aggravation which they must necessarily cause, if the part acted upon be irri- tated or inflamed. This objection will be clearly ap- preciated, when it is remembered how extremely sen- sitive to specific remedial impressions, organs and tis- sues become during inflammation. The evils resulting from the use of those medicines which are not specifics, are, first, their inability to reach the seat of the complaint, and secondly, the sympathetic derangements to which they give rise in various parts of the body, the direct tendency of which, is to retard and counteract the recuperative ef- forts of nature. As an example of the first class, let us take the di- uretic copaibse, as a remedy for gonorrhoea. In this example, the remedy doubtless impresses directly the inflamed membrane of the urethra, but the impression is so violent that either a decided increase of the in- flammation ensues, or the discharge is suddenly sup- pressed, and some other organ, as the bladder, kidneys, testicles, or lungs, takes on diseased action. Indeed we are decidedly of opinion, that not one genuine case of virulent gonorrhoea can be adduced where a safe and permanent cure has been effected by large doses of this balsam. A not unfrequent effect of copiabae in moderate quan- 4 # 82 ALLOPATHY. tities, is to excite serious disorder of the lungs. This consequence I have often witnessed, and I have a pa- tient at this time, who assures me that he is unable to take a single dose of it, without being afflicted with a pain in his chest, and cough. Gastric and intestinal disturbance, also, usually re- sult from its use. In some instances, a troublesome eruption makes its appearance, rendering it necessary to discontinue its employment for a time. And yet with all of these artificial consequences, the disease is very rarely, if ever, cured by this nauseous substance. Diaphoretics were introduced into practice by the advocates of the humoral pathology, under the sup- position that their sweating qualities would aid nature in throwing off the morbid humours. When the hy- pothesis universally obtained that fevers were caused by an excess of one of the four humours, blood, phlegm, and yellow and black bile, and that this superabund- ance must be expelled through the pores of the skin, kidneys, &c, it was a rational deduction that the em- ployment of diaphoretics and diuretics should conduce essentially to aid nature in the cure. But when more correct ideas in regard to the nature and seat of diseases were introduced, and medical men had learned that spontaneous sweating, diuresis, dis- charges of blood, diarrhoea, &c, in the latter stages of diseases, occurred in consequence of a natural amend- ment or a sudden prostration in the powers of the af- fected parts, and not as an effect of the medicines, it is a matter of surprise that these uncertain remedies should have been retained. The late Professor Nathan Smith, makes use of the following language, replete with good sense : " As there is more or less sweating in the decline of most febrile diseases, and as a general perspiration is often accompanied with other symptoms of amendment, it has been looked upon as the natural cure of the disease. Under this impression, it has been a pretty universal practice to encourage sweating; but with respect to the grounds upon which this practice is founded, it is a question whether the effect has not, in this case, been mistaken for the cause ; that is, whether the sweating is not the effect of the amendment, rather than the ALLOPATHY. 83 cause of it; and if so, it is still more questionable, whether sweating, produced by art in the beginning of the disease, would be attended with good effects. In all cases, where I have seen this sweating regimen, adopted, the practice has been obvlourly injurious." Many other eminent professors, as may be readily proved, entertain similar views in regard to this subject. Physiology teaches us that no unusual disturbance, no inflammation, and no functional derangement, can accrue to any part of the body, whether by a moral, physical, morbific, or medicinal agent, without being followed by secondary sympathetic symptoms in re- mote parts, more or less severe according to the vio- lence of the exciting cause. The stomach and bowels, more especially, being the grand centre of junction of the ganglionic system of nerves, are so intimately- connected with all parts of the economy, that dis- turbances at either of these points are reflected through the sympathetic nerves upon remote healthy structures, thus complicating to a serious and often fatal extent, any disorder which may already be pre- sent. There is scarcely any part of the machine which is not called into morbid sympathetic action, by de- rangements of the stomach and intestines. Even the presence of bile, or acid, in unusual quantities, causes pains in the head and limbs, nausea, and other affec- tions of a distressing nature, until the offending sub- stances are removed. All of the organs and tissues are so closely con- nected by the nervous system, that it may be laid down as a general rule, that no disorder can happen to one part without implicating, more or less, other parts, whether diseased or healthy.* " A particular state of one organ, such as inflammation, or a se- creting action in it, often causes the production of a similar state in other parts. The principle of the balance of sympathy teaches us how we must avoid aggravating the morbid condition of one organ by the means which we apply to another." * Muller's Physiology. 84 ALLOI'ATHV. How reasonable, then, to expect that artificial me- dicinal inflammations of the sensitive structures of the economy, should give rise to secondary affections of a grave and permanent character. In conclusion, the theoretical and practical doc- trines of allopathy may be briefly summed up as fol- lows : 1. In the rude ages of the world, when the arts and sciences were in their infancy,—when vague, indefi- nite and absurd notions were entertained respecting diseases,—when anatomy, chemistry, physiology, pa- thology, botany, and even correct methods of induc- tion, were entirely unknown,—when the imaginations of men, instead of ascertained facts, were appealed to in establishing theories,—and when systems of practice were founded upon merely fanciful conjectures; then it was that blood-letting, cathartics, diaphoretics, diuretics, refrigerants, revulsives, derivatives, counter- irritants, and most of the other remedies of allopathy, made their flrst appearance. As the pathological doc- trines of this period were all entirely erroneous, it is but fair to conclude that their therapeutical inferences must have been equally incorrect. 2. Whatever may have been the changes in respect to the theory of disease, from age to age, long estab- lished customs, the force of habit, education, preju- dice, &c, have served to retain until our own period, most of the violent, unnatural and pernicious methods of treatment, invented and adopted by the founders of medicine. 3. At the present time, everything pertaining to the theory and practice of the old school is indefinite, obscure, and uncertain. Scarcely two different allo- pathists entertain the same views in regard to patho- logy, and not one can determine beforehand, with any kind of certainty, precisely what effects his medicine will produce ; yet, in the treatment of nearly all cases, venesection, calomel, opium and antimony are empyri- cally, and, we might almost say, universally employed. In those cases where refrigerants, diuretics, expecto- rants, &c, are used, they can only be looked upon as auxiliaries, and are usually administered without any ALLOPATHY. 85 accurate knowledge as to whether they promote or retard the designs of nature. 4. Owing to the absence of any generally received or consistent theory of disease, allopathists are obliged to prescribe at random. They strike at the name, and not at the seat of maladies, where alone remedies can prove efficient. Thus it is that patients are so often reduced to the lowest point, by medicines, while the disease continues its progress, unchecked. 5. Lastly, there is every reason to believe, that the .production of violent artificial diseases in healthy structures, for the suppression of natural maladies, is, upon the whole, far more productive of deleterious than of beneficial consequences. In view, therefore, of the present condition of the medical art, we most earnestly request the allopath to pause, and reflect deeply and seriously, before per- sisting in the use of venesection, revulsives, derivatives, alteratives, and counter-irritants. Let him remember that a high responsibility attaches to his position,— that the welfare, happiness, and lives of his patients hang upon his judgment and decision,—and that an improper exhibition of remedies may so complicate and aggravate the natural disease, as to consign his patient to a premature grave. Let him look about, candidly and impartially, and see if there are really no improvements in the practice of the healing art, since the times of Hippocrates and Galen. Let him submit new discoveries and new doctrines to a rigid practical test, and decide from the results—from the cures effected—what system is most correct and best calculated to promote the welfare of the human race. Let him no longer reverence ancient doctrines and ancient names, simply on account of their antiquity, but seek after truth alone, whether of ancient or mo- dern discovery, and found his practice only upon this certain basis. 86 CHAPTER IX. HOMOEOPATHY. When Hahnemann first promulgated to the world his pathological and therapeutical views, their novel- ty, their entire variance from all preconceived opin- ions, and their alleged superiority over all other systems, when applied to the practice of the healing art, induced physicians to suppose the man mad, an(J his ideas the offspring of a disordered imagination. It was difficult to conceive that acute maladies could be cured without venesection, emetics, cathar- tics, sudorifics, refrigerants, alteratives, and counter- irritants, and on this account the great discoveries of the father of homoeopathy were for many years coldly received, and his arguments answered only by impu- dent sneers, or senseless ridicule. Like the illustrious Fulton, who—when he an- nounced to his countrymen the powers of steam, and first applied this agent to the propulsion of a vessel— was declared, even by his nearest friends, insane, and his projects visionary ; like Harvey, the discoverer of the circulation of the blood, who was bitterly at- tacked " by the bigoted abettors of old established systems, with whispers, inuendoes, and controversial writings," and himself pronounced a reckless innova- tor, and unworthy of public confidence as a prac- titioner ; like Galileo, who, after demonstrating the truth of the Copernican system, was persecuted by his rivals, and twice compelled by the inquisition to ab- jure a system which he knew to be correct; like Columbus, Newton, Locke, Jenner, and many other benefactors of the human race, Hahnemann has been aspersed, and his doctrines, like theirs, have been ridi- culed, misrepresented, and contemned ; but time has cast all the calumniators of Columbus, of Galileo, of Newton, of Locke, of Harvey, of Jenner, of Fulton, into a deserved oblivion, while the names of these eminent persons stand high on the roll of fame, and their discoveries remain to benefit the world. The public of Europe and America are fast ren- HOMOEOPATHY. 87 dering the same justice to Hahnemann and his doc- trines, and the time will ere long arrive, when the united world will rank him by the side of those great men to whom we have just alluded. It is even now conceded by many eminent allopathic writers, that the hypothetical doctrines of homoeopathy are correct. By referring to page 65, it will be observed that the pathological views of Hahnemann, and some of the professors of the old school, coincide in a very striking manner. Indeed, it is a matter of doubt whether there can be found in the medical ranks, two more staunch advocates of the " vital theory," than Samuel Hahne- mann, the homoeopathist, and Martyn Paine, the allo- pathist. But when we come to the therapeutical inferences deduced from these opinions, we find a wide and es- sential difference. The latter, in summing up his method of treatment, has retained all of the violent and barbarous remedies of antiquity, with very little knowledge of their mode of operation upon the human system, and with as little certainty as to whether they will ameliorate or aggravate disease. The former has pursued a different course. In con- sideration of the facts, that the action of no two medi- cines upon the economy is the same,—that almost every agent exercises a peculiar and specific influence upon certain structures only, and that this specific effect obtains both in health and disease, he instituted a series of accurate experiments during health, in order to arrive at the pure effects of different medici- nal substances. The illustrious founder of homoeo- pathy not only tested the operation of medicines upon his own person, but he induced others—men of science and undoubted integrity in different parts of Europe— to make trials of the same substances, without in- forming them of the results of his own experiments ; and when their observations were completed, he in- stituted comparisons, and found that the effects of the medicines upon the different individuals were almost uniformly the same. Having now ascertained with certainty the pure effects of a number of articles during health, he commenced exhibiting them for the cure of diseases, in accordance with the principle 88 HOMOEOPATHY. which he had conceived to be philosophical and true, similia similibus curantur. We need not repeat, that the results of these experiments were in the highest degree satisfactory. In the early part of his career, Hahnemann made use of the pure mother tinctures, in ordinary doses, but he observed that the primary effects were too ac- tive,—there usually occurring a temporary augmen- tation of the symptoms. This induced him to reduce his doses until he came to make use of attenuations and dilutions ; and he found, that when the medicines were properly prepared, they still had their specific action, and that disease was more speedily removed than when stronger preparations were employed. But the principal objection which was formerly, and which still, to a considerable extent, is raised against the system of homoeopathy, is the supposed inefficiency of infinitesimal quantities of medicines when administered as curative agents. Nor is this at all surprising, for it has been customary for three thousand years, when disturbance prevails in the hu- man citadel, to storm it with agents of destruction. Blood is made to flow, the delicate membranes of the stomach and intestines are raked with broadsides of emetics and drastics, the nervous system is shattered by narcotics and stimulants, and the functions of every organ deranged by the showers of destructive allopa- thic missiles with which the enfeebled body is con- stantly assailed. By these summary means the dis- turbance is smothered, but the citadel is in decay, its resources exhausted, its foundations impaired, and its strength forever diminished. Homoeopathy, however, resorts to a different mode of procedure. In her remedial measures, she uses no unnatural violence, nor seriously disturbs the function of any organ; but her remedies are exhibited with a definite object; the affected organ or tissue is acted upon with almost mathematical certainty, and that too without creating disease in healthy parts, or in any way complicating the natural affection. But she usually administers her medicaments in infinitesimal doses, and we now come to the question whether such minute quantities of matter are capable of producing HOMOEOPATHY. 89 salutary impressions upon the organism when labour- ing under disease ? No one will deny that the human body during health is constantly being acted upon and disturbed by in- fluences or agents so subtle, that neither the chemist nor physiologist can analyze or even detect them. The simple application of substances to the surface of the body is sufficient to produce decided and per- manent effects. Turnbull says, that " so small a por- tion as the one hundredth part of a grain of aconite, made into an ointment, and rubbed upon the skin, has produced a sensation of heat, pricking, and numbness, that has continued a whole day." A leaf of tobacco applied to the wrist or sole of the foot, will excite the action of the respiratory muscles, blood-vessels, glands, and skin, causing nausea, vo- miting, &c. If the leaves of hyoscyamus or belladonna be ap- plied to the eye, an effect will be produced which will remain for several weeks. It is asserted by Pereira and Sigmond, that " a dilatation of the pupils may be produced by only approximating th.e leaves of hyoscya- mus or belladonna to the eyes." It is also well known,* that " violent erysipelatous inflammation over the whole surface of the body, is often induced from approaching within a few yards of several species of rhus." The wild buffalo scents the hunter for a distance of more than a mile, and hastens from the vicinity of danger. "The carnivorous bird recognises the odoriferous par- ticles arising from a dead carcass, miles distant in the air, and with hasty wing, pounces upon the prey. The medicinal quality of cod liver oil {ol. jec. aselli) consists of iodine distributed in infinitesimal quantities throughout the oil. According to an analy- sis made by Falker, the iodine forms only the one- forty-thousandth part of the oil, being about equal to a third or fourth homoeopathic attenuation of iodine. The value of this naturally attenuated medicine in the treatment of scrofula and consumption, is at the pres- * Paine's Inst, of Med. 90 HOMOEOPATHY. ent time generally conceded. The analyses of Stein, De Jongh, and Balard, fully confirm that of Falker. The very minutest quantity of the natural poison of certain animals, the virus of hydrophobia, small- pox, kine-pox, syphilis, and gonorrhoea, is sufficient, when placed in contact with an abraded or delicate surface, or otherwise introduced into the system, to give rise to all of their corresponding maladies. Other diseases, like scabies, leprosy, &c, may be communica- ted by the mere touch, or from inhaling the breath of an infected person. Miasmata, animal exhalations, electricity, magnet- ism, heat, light, and even mental emotions, are all, under certain circumstances, capable of disturbing the organism and causing dangerous maladies, and yet, as Liebig, in his Animal Chemistry, truly observes, " with all our discoveries, we shall never know what light, electricity, and magnetism are in their essence. We can ascertain, however, the laws which regulate their motion and rest, because these are manifested in phe- nomena. In like manner the laws of vitality, and of all that disturbs, promotes, or alters it, may certainly be discovered, although we shall never learn what life is." Let it be ever borne in mind, that most substances, both in the organic and inorganic kingdoms, possess cer- tain active principles which are latent and unappreciable in the natural state, and are only called forth and de- veloped by the influence of some agent or process, which effects a transformation or metamorphosis of the crude material. Heat, electricity, and magnetism, become apparent when certain physical substances operate upon each other in such a manner as to disturb or change the original state of cohesion of particles. Caloric is a property common to all material sub- stances. In the natural state of these substances, this active principle is latent, and cannot be appreciated by the senses ; but iffriction be used, this agent is set free, and its power becomes manifest. Electricity also, pervades all material bodies, and only becomes sensible when the natural state of these bodies is disturbed by friction. HOMOEOPATHY. 91 It is probable, likewise, that iron and other sub- stances contain magnetism in a latent state, and only require the operation of certain influences, to deve- lop in them the phenomena of magnetism. This is evident from the fact, that " the same magnet may successively magnetize any number of steel bars, without losing any portion of its original virtue; from which it follows, that the magnet communicates nothing to the bars, but only develops, by its in- fluence, some hidden principle."* Large quantities of vegetable, animal, or mineral substances, may be taken into the stomach in a crude state, with impunity; but if their elementary particles become separated by decomposition, or otherwise, and then introduced into the system, they give rise to the most baneful results. It is a matter of little consequence, whether this minute subdivision of particles is effected by the action of solar heat and moisture, by trituration, or succussion ; the ulti- mate effects are the same : The elements of the substance are separated, the essence or medicinal part is set free from the crude, material, and non-me- dicinal portions, and reduced to such a state of at- tenuation as to become readily absorbed, and yet retain all the specific qualities pertaining to the ori- ginal agent. Indeed, so minute and subtle are the miasms from vegetable and animal decomposition, the exhalations arising from contagious disorders, &c, that no one has yet been able to appreciate their physical or chemical properties, by the most accurate tests of chemistry or optics. Who, however, for this reason, will presume to deny or doubt their tremendous, al- though mysterious, power upon the human system ? When ether or chloroform evaporates, the cohesion between the particles of the liquid is destroyed ; its elements float in the air, and are capable of impress- ing the organism in a much more powerful, and in a totally different manner, from any impression which could be produced by these constituents in a less at- tenuated state—as, for example, that of the original * Beck's Chemistry. 92 HOMOEOPATHY. liquid. If a large quantity of ether be swallowed, but slight effects will result: but if an imponderable quantity be introduced into the blood through the lungs, in the form of vapour, it is immediately brought into contact with the brain and nervous system, and the most astonishing effects speedily ensue. "If the 10,240th of a grain of tartrate of mercury be diffused through the substance of a mere hard sweet-pea, the beautiful germ of a graceful flowering herb, which lies folded up in its horny pericarp, shall never come out and be expanded, though you imbed it in the softest mould, and solicit it by every art." {Leuchs.) Professor Doppler, of the Royal Institute of Prague, in speaking of the modus operandi of infinitesimal particles, writes thus : " From the moment in which the substance of the atoms succumbs to the influence of their surfaces, and apparently independent of the law of gravitation, they move with the greatest faci- lity in every direction, and, as it were, become alive ; from that moment only, in my opinion, drugs acquire the capacity of penetrating the organism, and of ex- citing there a curative effect. For if drugs, prepared in this manner, be brought in contact with the in- visible extremities of nerves, their hyper-microscopi- cal atoms will enter the organism at the same time with their superficial electricity, and will, if the nerves be in a perfectly natural state, be thrown out of the system without impediment, after having penetrated it in every direction. But if a body in a state of health be accompanied by an activity of the nervous system, perfectly unimpeded and equally free in every direction, we cannot, on the other side, but presume, that in a state of imperfect health the power of con- duction, proper to the nervous substance, will be ma- terially diminished, partially and in individual or- gans, either in consequence of a chemical change, or for some other reasons. But to use rather a mate- rial, but, nevertheless, by no means unfit comparison, as streams deposit the sand and pebbles they carry- along, on those spots only where their currents meet with an impediment, and their rapidity seems broken by obstructions, so in a similar manner, in the dis- HOMOEOPATHY. 93 eased organism, may the electric currents, however feeble, leave the atoms of drugs at the diseased spots, where they, according to their individual properties, exert either a curative or detrimental influence." If, then, imponderable substances possess powers so unequivocal and potent upon the healthy subject, when the organs are in a high state of vigour, and consequently in a good condition to resist the in- fluence of foreign impressions, why may we not infer, with perfect propriety, that medicinal sub- stances, equally imponderable, are capable of im- pressing the organism during disease, when the af- fected structures are unusually susceptible to extra- neous influences ? Homoeopathists suppose that the mode in which their tenuations operate is analogous to that of infection by miasms; that the inert matter of the substance is destroyed, and the active principle set free ; and that the smallest quantity of this active principle, tritu- rated with sugar of milk, or diffused in water or alcohol, is capable of communicating to the vehicles its properties, and thus to the organism its peculiar action. The essential principles of all vegetable substan- ces constitute but a very small proportion of the ori- ginal crude article, and the more perfectly we sepa- rate these active from the inactive portions, the more pure and powerful will the remedy become. Like ca- loric, electricity, and magnetism, the strength remains latent in the crude state of the substance, and can only be developed by the important agency of heat, friction, or trituration. Peach-blossoms, the bark of mountain-ash, the kernels of peaches, cherries, and plums, bitter al- monds, &c, contain, in a latent condition, the active poison known as prussic acid, which may readily be obtained from either of these articles by a che- mical process. Ipecacuanha is indebted for its virtues, to a prin- ciple called emetia. Pelletier found, upon analysis, that the brown ipecacuanha bark contains only six- teen per cent, of impure emetia; and the red bark 94 HOMOEOPATHY. fourteen per cent. According to Bergelius, the im- pure emetia possesses only one-third the strength of the pure. We therefore find, that of one hundred parts of crude ipecacuanha, only five parts possess the medicinal virtues of the drug. Nor is it at all improbable, that farther researches will enable the chemist to free this principle from other impurities, and thus develop a still more potent medicine. Opium contains but a very small per cent, of its narcotic principle, morphia. The crude substance contains, in addition to morphia, at least fourteen other ingredients, all of which are destitute of any particular virtues. Only about eight or nine per cent. of morphia is obtained from Turkey opium, and this is quite impure and unfit for use, containing nar- cotina, &c. Cinchona is composed of ten or twelve ingredients of which, all but quinia and cinchonia, are inert. Even these last, as usually obtained, are highly adul- terated, and do not by any means represent the active principle of bark in its purity. The same rule obtains in relation to most other substances. The essential properties are distributed but sparingly throughout ligneous, resinous, and other matters, and it is only by the utmost care and nicety, that we can separate and develop these pro- perties. Indeed, there are many instances where the skill of the chemist is unable, not only to develop artificially certain principles of vegetable and animal substances, but even to analyze them when they become sponta- neously disclosed by the action of heat and moisture. Miasmata and other noxious exhalations are exam- ples of this kind. _ It is a fundamental law of therapeutics, that the ac- tive properties of all medicinal substances can only be manifested from their surfaces ; and it follows as a consequence, if we would develop the full powers of drugs, that they must be made to occupy as great a surface as possible. If a compact piece of wood be ignited, but a small blaze can be produced; while if the same wood be cut into small portions, so as to expose a large surface, and HOMOEOPATHY. 95 then ignited, a large and powerful flame will appear. Only a limited amount of electricity can be drawn from a given surface of glass ; but if the same glass be made to occupy double the space, an additional amount of the fluid may be set free. If a hole be rapidly bored through an ordinary piece of iron, the surface of each chip so detached will be found to possess magnetic properties ; and a singular circumstance connected with this, is the fact, that when the boring is accomplished in a perpendicular di- rection, the chips are more highly magnetized than when it is effected horizontally. Here, again, is an instance where friction has developed properties en- tirely unappreciable in the natural state. A single grain of matter may be made by trituration to pervade every part of one hundred grains of sugar of milk, and each molecule thus separated may be still farther subdivided into corpuscules, which in their turn may be diffused intimately through additional quantities of the medium. In this manner only, can we call forth all of the latent properties of drugs, and reduce them to that state of attenuation which is com- patible with absorption, and which enables them to exert those salutary specific influences which the homoeopathic practitioner so uniformly observes. Each atom thus minutely separated, retains the power of exercising its specific influence upon the or- ganism. Quantity is of but little consequence, provi- ded that the substance is properly prepared ; for an imponderable quantity in its highest state of develop- ment, is quite as capable of producing its peculiar effects in certain conditions of the body, as a much larger amount. It is undoubtedly true that an atom, either morbific or medicinal, which possesses an affinity for a partic- ular structure, is capable of communicating to such structure its peculiar action, the influence being pro- pagated from one molecule to another, and each ac- quiring the properties of the original atom, until the influence is expended. Examples of this kind of action are constantly pre- sented to the physician in the form of continuous sym- pathy. 96 HOMOEOPATHY. One inhalation of a noxious miasm, under favourable circumstances, is as capable of causing its specific con- tagion, as a thousand, or more. One thousandth part of a grain of a natural or morbid virus, is as capable of imparting the peculiar action of the poison to all parts of the organism susceptible to its influence, as a larger quantity. So also, when an atom of a medicine is absorbed into the system and comes in contact with an organ or tissue already diseased, upon which it exercises a spe- cific influence, it communicates to the surrounding atoms its peculiar action until the whole tissue is in- volved, and thus, if the remedy be homoeopathic to the malady, it will supersede the primary affection. La Place and Berthollet have advanced the opinion, that " a molecule, being put in motion, can communi- cate its motion to others, if in contact with them." This law is applicable to both animate and inani- mate matter, under certain circumstances. Thus, the smallest point of decayed vegetable or animal mat- ter, if placed in contact with healthy vegetable or ani- mal substances for which it has an affinity, will com- municate to the latter its own morbid action. The smallest point of decay in a tooth, continually propagates its peculiar action to the surrounding parts until the whole tooth is destroyed, or the diseased por- tion is removed. The slightest spark of fire, put in contact with a com- bustible material, communicates its action to all parts susceptible of combustion. A minute nucleus being once formed in the mineral kingdom, possesses the power of attracting to itself in a regular and uniform arrangement, all of those par- ticles near it, for which it has an affinity, and the dif- ferent varieties of minerals communicate to these par- ticles their own peculiar action and arrangement. It is asserted by the supporters of the chemical hy- pothesis, " that substances in a state of putrefac- tion, by entering the blood, impart their peculiar action to the constituents of that fluid, and all the sub- stances of the body are induced to undergo a modified putrefaction."* Liebig affirms that " a body, the atoms * Paris Pharmneologia HOMOEOPATHY. 97 of which are in a state of transformation, may impart its peculiar condition to compounds with which it may happen to communicate." These assertions, however, are not sustained by facts. There is no proof that the blood becomes con- taminated by the atoms which enter it in a state of transformation ; nor is there any proof that such atoms are capable of " imparting their peculiar con- ditions," indifferently to other " compounds with which they may happen to communicate." Every substance in nature, whether morbific or medicinal, possesses its own characteristic and dis- tinct mode of action, and is only able to exercise or communicate this action, in a specific manner, to particular structures. Thus, the contagion of scarla- tina imparts its peculiar action to the throat and skin. The contagion of scabies acts exclusively upon the skin. The miasms which occasion many kinds of fever, appear to expend their effects upon the nervous system. The virus of gonorrhoea is specific and uni form in its results upon the mucous membrane of the urethra. The virus of syphilis, although more gene- ral in its operation, affects only a certain class of structures. All of these poisonous matters are incapa- ble of imparting their peculiar influence, unless they are brought into contact with those tissues for which they possess a " kind of elective aflinity." There is no rea- son to suppose, that in any instance we have named, the blood itself is contaminated, but it serves merely as the vehicle which conveys the morbid particles to the different parts of the body. What we have advanced in regard to the modus operandi of morbific, is equally true of medicinal agents. We have before shown that most drugs pos- sess well-defined specific actions, which can only be manifested after having been conveyed by the blood to their destined structures. It will be perceived that the views here advanced in regard to the mode of operation of morbific and medicinal agents, differ essentially, not only from those of the chemical school, but also from those of most writers who have hitherto appeared as advo- 98 HOMOEOPATHY. cates of homoeopathy. From quotations made at page 22, it will be observed that Hahnemann himself is a firm advocate of the " vital theory." In common with many distinguished writers of the old school, he supposes all diseases to consist of certain alterations of the " vital properties " of parts, and that medicines cure these diseases by acting upon these (supposed) immaterial properties in such a manner as to restore them to a normal state. In advocating these doc- trines, Hahnemann has virtually rejected the theory of absorption, the truth of which has been so amply verified by Miiller, Pereira, Blake, &c, and thus has marred a portion of his beautiful system. It may seem impossible, at a first view, that attenuated drugs can be absorbed into the system, and exert their influence topically on the different structures ; but in support of this opinion we beg leave to submit the following ideas. Medicines, as has been previously remarked, are often detected in those structures on which they have exerted their effects. Mercury, iodine, sulphur, nitrate of silver, the salts of lead, iron, bismuth, copper, &c, have all been found in different tissues of the econ- omy ; and even Liebig himself advises us that many of these substances often form " permanent com- pounds with the different tissues." The same author also remarks, " if by the introduction of a substance certain abnormal conditions are rendered normal, it will be impossible to reject the opinion, that this phe- nomena depends on a change in the composition of the constituents of the diseased organism, a change in which the elements of the remedy take a share." The elements of the remedy do most certainly take a share in this change, but only so far as the disorder- ed organ or tissue is concerned. It matters not whe- ther the specific agent be imponderable in quantity, administered through the lungs, stomach, or skin, or in- jected into the veins ; it seeks that part for which it has an affinity, and there manifests its force. I have known persons to become salivated by the use of less than one-half of a grain of the first tritura- tion of corrosive sublimate, given in divided doses. This can be explained in no other wav than bv HOMCEOrATIIY. 99 supposing that the remedy is rendered innoxious to the absorbent vessels by the peculiar mode of prepa- ration ; for so small a quantity of the crude article has never, to our knowledge, been known to produce this result. By trituration, the crude particles of the mineral are so minutely separated and diffused through the vehicle, that the delicate absorbents ad- mit them into the circulation with facility, while in an unprepared state the remedy would be recognised as an irritant, and consequently excluded. When salivation is produced by large doses of ca- lomel, or blue-mass, it is highly probable that evapo- ration occurs from the heat of the stomach and intes- tines, and that this vapour, impregnating the chyle, is absorbed. It has been said by the opponents of ab- sorption, that the preparations of mercury cannot be absorbed on account of their insoluble nature, and therefore that salivation is caused by an impression which is made upon the "vital properties" of the stomach, and that this impression is reflected to the salivary glands, through the sympathetic nerves. But if the advocates of this doctrine will reflect that mer- cury evaporates at a common temperature, and that this vapour, when inhaled, exerts all the specific ef- fects of the mineral, they must admit that when sub- mitted to the higher temperature of the stomach and bowels, this evaporation and absorption will be aug- mented. " I believe," says Pereira, " with Buchan, Orfila, and others, that metallic mercury, in the finely- divided state in which it must exist as vapour, is itself poisonous." An argument which we deem conclusive upon this point, is from the fact that traces of mercury itself have often been detected in the secretions, excretions, and solids of the body; and if any " vital properties" have reflected the influence, they must have conveyed the solid substance along bodily to the affected glands, etc. In considering the subject of absorption and the topical action of attenuated drugs, it must be remem- bered that the absorbing structures are very delicate and sensitive, so that they are enabled to exclude all crude and irritating substances ; and also that the ex- 100 HOMOEOPATHY. treme terminations of the nerves, in all parts of the body, are exquisitely susceptible to the influence of specific foreign agents; and a cause capable of affecting powerfully these minute filaments, would be entirely without energy and unappreciated, if brought to bear upon the trunk or larger branches of the same nerve. Another fact illustrative of the truth of absorption and topical action is, that substances always exercise their specific effects more promptly and potently when introduced directly into the mass of the blood, than when taken by the stomach. " Medicinal or poison- ous agents, injected into the blood-vessels, exert the same kind of specific influence over the functions of certain organs, as when they are administered in the usual way, but that their influence is more potent."* Liebig also assures us, that " we can by remedial agents exercise an influence on every part of an organ by substances possessing a well-defined chemical ac- tion." Here is a distinct recognition of the principle of the topical or specific action of remedial agents, al- though the character of this action is supposed to be chemical. Without entering into any discussion upon this point, or attempting to explain how morbific or remedial agents produce their peculiar effects, we shall remain satisfied with the positions we have be- fore laid down, and simply refer our readers to the numerous instances, within their own knowledge, of the topical action of substances, both ponderable and imponderable, with the addition of a few examples of the latter, which can be understood and appreciated by all. 1st. Odours. When odoriferous particles are brought into contact with a certain nasal structure, (the schnei- derian membrane,) the minute and sensitive nerves of the part take cognizance of the stimulus, a decided impression is made upon the whole membrane, and an odour, agreeable or otherwise, according to the nature of the exciting cause, is the result. In this instance, physical, but imponderable particles, operate * Pereira, Mat. Med. and Ther. HOMOEOPATHY. 101 upon the nasal tissue by absolute contact, and impart that peculiar action which enables us to appreciate odours. 2d, Light. According to Sir Isaac Newton, light is a physical, but imponderable compound, and can only manifest its power when its atoms are in contact with the organ of sight. These particles of light are the natural stimulus of the eye,—material, imponderable, specific. When this compound is separated into the different primary rays, each particular ray, when brought into contact with the eye, exercises a special and distinct influence, giving rise to the perfect ap- preciation of the different colours of the prism. Here again we are presented with an example of the spe- cific influence of imponderable atoms upon a certain part of the system. 3d, Caloric. Newton also maintained that caloric is " a distinct material substance, the particles of which repel one another, and are attracted by all other sub- stances." When caloric is given off by a heated body, its atoms impart to all other atoms with which it comes in contact, its own peculiar action, and the sensation of heat, with its attendant phenomena, expansion, &c, is the consequence. Here we are afforded with a still more striking instance of the power of an im- ponderable substance in altering and modifying the character and properties of all substances upon which it exercises its action. This active principle, present in all bodies, hidden and unappreciable except when set free by friction, percussion, mixture, electricity, or combustion, possesses properties when thus liberated, surpassing in power and influence every other sub- stance in nature ; yet it is more subtle and imponder- able than the most attenuated medicines of homoeo- pathy. 4th. Electricity, galvanism, magnetism, and the va- rious gases, are all material substances, and manifest their influence physically by contact with the body. It must not be supposed that light, heat, electricity, magnetism, etc., are immaterial nothings—mere pro- perties of matter—because they cannot be weighed, handled, and made subservient to all of those laws 102 HOMOEOPATHY. which govern more crude substances. Nor must it be supposed of drugs, that they possess no qualities except those which are apparent in the crude state, and can be fully appreciated by their nauseousness of taste, rankness of smell, or power of raking the stomach and intestines. Modern science has demonstrated, that by friction, percussion, mixture, &c, some of the most powerful principles known may be liberated from substances, which, in a crude state, are entirely harmless. It has shown, that the more perfectly we can disencum- ber these principles from their inactive envelopes, the more potent they become. It has shown that the mass of ligneous, resinous, starchy, fatty, extractive, and colouring matters, which surround and enclose the active portions of vegetable substances, instead of possessing medicinal properties, serve only to nau- seate and oppress the stomach and bowels, and thus complicate any existing malady. Pereira, and other authors opposed to our system, have endeavoured to cover it with ridicule by entering into a computation respecting the weight and strength of the different attenuations. They have displayed before us tabular views showing the strength of each attenuation, and then assured us, without the trouble of testing the question practically, that such exceed- ingly small doses of medicines can produce no effect upon the system, but " that the supposed homoeopathic cures are referable to a natural and spontaneous cure, aided, in many cases, by a strict attention to diet and regimen."* This is the principal argument urged against the therapeutical doctrines of Hahnemann. We beg leave, however, to request those gentlemen who judge of the potency of substances by their weight and dimensions, to enter into a still further cal- culation, and inform us which possesses the greatest weight, the medicinal particles pertaining to a drop of a thirtieth attenuation of homoeopathy, or the charge of electricity, which lays prostrate and senseless the strongest man—or the quantity of sulphuretted hydro- gen, or carbonic acid gas, requisite to cause immediate * Pereira's Mat. Med. and Ther. HOMOEOPATHY. 103 death when inhaled? Which can be most readily detected and appreciated by analysis, the atoms of a high attenuation of Hahnemann, or the deleterious miasms which arise from vegetable or animal decom- position ? Which present the greatest difficulties in examina- tion and description, the physical structure of the par- ticles of a homoeopathic medicament, or that of ca- loric, or light ? Will the respectable Hippocratic, who cannot re- cognise power in any material substance, unless it can be weighed or handled, enter into a computation, and inform us how much a poisonous dose of the vapour of hydrocyanic acid, mercury, or lead, weighs ? Let it be remembered, that not one atom of matter in the whole universe can be annihilated: transfor- mations may be effected—the cohesion of particles may be changed*—atoms in their ultimate state of chemical combination may be physically divided into molecules, and again subdivided into lesser atoms to such an extent as to baffle detection from the most perfect tests of chemistry or optics—new powers may be developed in these atoms, the exact operation of which we may not at present be able to understand, but in no instance can we destroy one single particle of matter. We may effect an entire metamorphosis of almost any solid substance, and diffuse its elements in such a manner as to occupy and affect a very large amount of space. The elements of a few grains of gunpowder may be made with the aid of a few im- ponderable particles of caloric, to change their form, and impregnate every portion of the atmosphere of a large room. In like manner, a single grain of a vege- table or mineral substance may be transformed, and its atoms diffused throughout large quantities of inert materials, in such a manner as to impregnate them in every part with medicinal properties, but in no in- stance can a single atom be annihilated. Until we arrive at more accurate knowledge in relation to the laws which govern the chemical and physical action of the minute atoms of substances than we at present * See Atomic Theories. 104 HOMOEOPATHY. possess, let us not deny that they may be endowed with properties and powers, (although their modus medendi is a mystery to us,) capable of exercising an important influence upon the human organism. In regard to the preparation of medicines, there are several points of difference worthy of particular no- tice, between the old and new schools. 1. Allopathy employs her drugs in a crude and consequently inactive form; while homoeopathy makes use only of their pure essential principles, unencum- bered by foreign matters. 2. Allopathy employs so great an amount of arti- ficial heat in her pharmaceutical operations, that a large proportion of the active properties of her drugs is expended in evaporation; while homoeopathy makes use only of expression, trituration, and suc- cussion, and thus not only retains all of the virtues in- herent in the drug, but actually develops powers which would have remained latent under other cir- cumstances. 3. On account of the peculiar mode of prepara- tion, the remedies of allopathy are offensive to the taste, nauseous to the stomach, and by their indigest- ible and irritating qualities, serve directly to induce gastric and intestinal derangements, and other serious medicinal symptoms. The medicines of homoeopathy are liable to none of these objections. 4. For the reasons above enumerated, many of the remedies of the old school are excluded by the sensitive absorbents, on account of their irritating qualities, and are thrown off with the faecal matters as foreign substances ; having failed, in their passage through the intestinal canal, of producing any other effect than an irritation of the gastro-intestinal membrane. The attenuated remedies of homoeopathy, being innocuous to the lacteals and absorbents, are readily admitted into the circulation and conveyed to those parts upon which they exert a specific action, thus impressing directly the organs or tissues actually diseased. "No substances," says MartynPaine, in his Institutes of Medicine, " but such as exist in a fluid or very attenuated state, are taken up by the lacteals and absorbents." HOMOEOPATHY. 105 So, also, in the therapeutical application of reme- dies, we claim, as far as accurate scientific principles and sound philosophy are concerned, that homoeo- pathy is vastly superior to allopathy. We shall briefly reiterate some of the more prominent points of difference in the practice of the two schools. The system of homoeopathy is founded upon ra- tional and scientific principles, inasmuch as its remedies are exhibited with a definite object, and the results can in most cases be predicted with mathe- matical certainty. The practice of allopathy must always be indirect, uncertain, and empirical. The violence of the re- medies employed, necessarily induces medicinal and sympathetic affections, which, mingling with the symptoms of the natural disease, render it impossible to distinguish between the two classes of symptoms, or to judge whether the malady, or the medicine, or both combined, are killing the patient. The fact, that so few allopathic practitioners coincide precisely in regard to the treatment of very many diseases, proves conclusively that their system is one of guess- ing, rather than one founded on scientific knowledge and ascertained facts. Homoeopathic remedies being specific and certain in their effects, operate only upon those parts which are actually diseased. Without inflaming healthy structures, debilitating the system, or disturbing the function of any organ, they induce, when judiciously exhibited, a new or alterative action in the part af- fected, of just sufficient severity to banish the natural malady, while the new or medicinal action subsides speedily and spontaneously. According to the doctrines of homoeopathy, no two diseases or kinds of inflammation can exist in the same structure at the same lime; for whenever two exciting causes act upon the same part, the one pos- sessing the most powerful action, must necessarily banish and supersede the weaker. Therefore, in ac- cordance with the rules of our system, remedial im- pressions are always made directly upon the organ or tissue affected, and a new kind of action set up 5* 106 HOMOEOPATHY. which abolishes the disease and usurps temporarily its place. According to the strict tenets of the old school, remedies should be exhibited in such a manner as to impress structures which are healthy and remote from the organ or tissue diseased, in order that revulsive, derivative, or counter-irritating effects may be pro- duced, and thus serve to attract the fluids from the natural affection to the artificial one. This plan of treatment originated, as we have seen, from the sup- position that no two maladies of consequence could exist in different parts of the same organism at the same time. As this idea is at present universally con- ceded to be erroneous, we assert that a mode of prac- tice deduced from such false data, must of necessity be unscientific and empirical. By operating on healthy structures, the allopath ac- complishes little or nothing towards restoring the im- paired capillaries of the affected part to their ori- ginal condition of strength and resistance, and con- sequently his system must be entirely inadequate to effect cures. We are, for this reason, forced to the conclusion that the modern Celsus, Dr. Forbes, is cor- rect when he asserts, that " in a large proportion of the cases treated by allopathic physicians, the disease is cured by nature, and not by them." It is a fundamental law of medicine, that no in- flammation can be created in any part of the body, without giving rise to secondary sympathetic affec- tions in other and distant parts. It is evident, there- fore, that the greater the number of structures affected with inflammation, whether natural or arti- ficial, the greater will be the number of sympathetic symptoms, and consequently the more serious and complicated the malady. Thus we perceive the force of Dr. Forbes' remark, " that in not a small pro- portion of the cases treated by the physicians of the old school, the disease is cured by nature, in spite of them; in other words, their interference opposing, instead of assisting, the cure." We have before shown that organs and tissues be- come morbidly susceptible to the impressions of spe- cific remedial agents during inflammation ; therefore it HOMOEOPATHY. 107 is that extremely minute quantities of specific medica- ments are capable of exercising powerful influences during disease, which, under circumstances of health, would be productive of no effects whatsoever. This is a truth of vast importance in the administration of medicines, and should be thoroughly appreciated by the practitioner who regards the welfare of his pa- tients. Let him remember that these acquired sus- ceptibilities are so great, that even the natural stimuli, food, gastric juice, bile, light, &c, cannot be tolerated ; and from this fact, take warning lest he inflicts injury and counteracts the efforts of nature, by too active medicines. But as we have so frequently observed, it is not so much our principle of cure, at which the shafts of the old school are directed, as to the doctrine of small doses. It is not because the adherents of allopathy cannot make themselves acquainted with the powers of attenuated drugs, but it is because their inveterate prejudices will not allow them to investigate the facts which are involved. They prefer to die of vomiting, purging, and swealing, as their predecessors have done for two thousand years, rather than to be cured quietly under a new system. These individuals are not satisfied unless they feel and see the poor body writhe and suffer for the sin of being sick. What care they for any interior or invisible action of a medicine, when they can be cut, racked, and tortured, by the lancet, emetics, cathartics, blisters and moxas, and that too, secundem artem ? To be sure, they were not aware of an' visible effects when the morbid agent operated upon their sys- tems to produce the disease, but the curative part is in their own hands, and they are determined to exercise their privilege of a full and continual appreciation of the whole modus operandi of the remedial process. This part, nature has no power to cheat them of, but Hippocrates now reigns, and they are resolved to exer- cise their ancient reserved rights, and bleed, puke, purge, sweat and blister, ad libitum. But why have our opponents dwelt so much upon our doses ? Does not every homoeopath aim and intend to give a sufficient quantity of the medicine at a time, to effect a speedy cure : and is not this quantity deter- 108 HOMOEOPATHY. mined by experience of simple facts ? We have dif- ferent strengths or attenuations of each medicine, from the strongest tincture up to the most minute attenua- tions, and every homoeopath selects that strength or attenuation of the drug which most speedily and safely cures his patient. The great point with him is, to se- lect such a medicine as shall be homoeopathic to the symptoms of the disease, and then to administer just enough of it to effect his object in the most safe and speedy manner. He finds by experience—by a mass of facts—that the tinctures and alkaloids, although often capable of subduing disease, are less prompt, less effi- cient, and less safe than weaker preparations of the drug. This easily demonstrated truth, was not the re- sult of theory or hypothesis, but originated with Hah- nemann, as we have already seen, through necessity, on discovering that the tinctures which were first em- ployed by him, in accordance wTith his principle, often produced too violent impressionsupon the affected struc- tures. What cared Hahnemann—what care his disci- ples—whether they use one or twenty drops of a tincture, or one grain of a twentieth attenuation ? Were twen- ty drops of a tincture, or twenty grains of a crude sub- stance, more efficient in curing sickness than one drop or one grain of an attenuation, is there any man who supposes that Hahnemann or his followers would not have administered them in this form, in preference to any other ? The chief glory of the founder of homoeo- pathy does not consist in the discovery of the efficacy of small doses, but in the demonstration and practical introduction of the great doctrine of curing maladies by impressing diseased tissues with medicines which operate specifically upon these tissues themselves, ra- ther than on distant parts. It matters not, therefore, in regard to the homoeopa- thic law of cure, whether we use this or that strength, provided the remedy is homoeopathic to the disease, and exactly the requisite impression is produced upon the affected parts. The man who cures a belladonna headache with ten drops of the tincture, adheres to si- milia similibus as much as he who cures with the thir- tieth attenuation of the medicine. The only question to be decided is, which strength cures most safely and HOMOEOPATHY. 109 quickly ; and if facts prove, as all homoeopaths believe, that a preparation weaker than the tincture is by far the most safe and efficient, then it is our duty to give these preparations the preference. It is found, for example, when repeated doses of tincture of belladonna are given in acute inflammation of the brain, that the pri- mary symptoms from the drug manifest themselves too violently—that it causes dangerous and protracted me- dicinal aggravation, and a tardy re-action of the organ- ism ; while a dilution of the remedy impresses mildly the diseased structure, causing scarcely perceptible pri- mary symptoms, and is speedily followed by its seconda- ry or curative effects. We shall conclude this chapter by quoting a few observations of the distinguished modern chemist (an allopathist) Kane, respecting the divisibility of matter, and some of the phenomena witnessed when a very high state of attenuation has been arrived at. We make these extracts for the benefit of those whose " bundles of ideas" are not already made up, trusting at least, that they may have the effect of demonstrating to such persons, that, not only morbific and medicinal power may exist in infinitesimal atoms of matter, but even life itself. " It has been proved that gold may be divided into particles of at least MOo,Vooo of a square inch, and yet possess the colour and all other characters of the largest mass. If a grain of copper be dissolved in ni- tric acid, and then in water of ammonia, it will give a decided violet colour to 392 cubic inches of water. Even supposing that each portion of the liquor of the size of a grain of sand, and of which there are a mil- lion in a cubic inch, contains only one particle of cop- per, the grain must have divided itself into 392 million parts. A single drop of a strong solution of indigo, wherein at least 500,000 distinctly visible portions can be shown, colours 1,000 cubic inches of water; and as this mass of water contains certainly 500,000 times the bulk of the drop of the indigo solution, the par- ticles of indigo must be smaller than 2300,000,000,000 the twenty-five hundred millionth of a cubic inch. A ra- ther more distinct experiment is the following : if we dissolve a fragment of silver, of 0.01 of a cubic line in 110 HOMOEOPATHY. size, in nitric acid, it will render distinctly milky, 500 cubic inches of a clear solution of common salt. Hence the magnitude of each particle of silver cannot exceed, but must rather fall far short of a billionth of a cubic line. To render the idea of this degree of di- vision more distinct than the mere mention of so im- perfectly conceivable a number as a billion could af- fect, it may be added, that a man, to reckon with a watch, counting day and night, a single billion of se- conds, would require 31,675 years." According to Doppler, a cubic inch of brimstone, broken into a million equal pieces, a sand grain each in size, is magnified in sensible surface from six square inches to more than six square feet. It is calculable in this way, that, if each trituration of the homceo- pathist diminishes his drug a hundred times (an ex- tremely moderate allowance), the sensible surface of a single inch of sulphur, or any other drug, shall be two square miles at the third trituration. " In the organized kingdoms of nature, even this ex- cessive tenuity of matter is far surpassed. An Irish girl has spun linen yarn of which a pound was 1,432 English miles in length, and of which, consequently, 17 lbs. 13 ounces would have girt the globe; a dis- tinctly visible portion of such thread could not have weighed more than ,.;7,oso,ooo of a grain. Cotton has been spun so that a pound of thread was 203,000 yards in length, and wool 168 yards. And yet these, so far from being ultimate particles of matter, must have contain- ed more than one vegetable or animal fibre ; that fibre being of itself of complex organization, and built up of an indefinitely great number of more simple forms of matter. " The microscope has, however, revealed to us still greater wonders as to the degree of minuteness which even complex bodies are capable of possessing. Each new improvement in our instruments displays to us new races of animals, too minute to be observed be- fore, and of which it would require the heaping toge- ther of millions upon millions to be visible to the naked eye. And yet these animals live and feed, and have their organs for locomotion and prehension, their ap- petites to gratify, their dangers to avoid. They possess ATTENUATIONS OF DRUGS, ETC. Ill circulating systems often highly complex, and blood, with globules bearing to them, by analogy, the same proportion in size, that our blood globules do to us ; and yet these globules, themselves organized, possessed of definite structure, lead us merely to a point where all power of distinct conception ceases ; where we discover that nothing is great or small but by com- parison ; and that presented by nature on the one hand with magnitudes infinitely great, and on the other with as inconceivable minuteness, it only remains to bow down before the omnipotence of Nature's Lord, and own our inability to understand him." {Kane's Chem- istry, by Draper, p. 19.) CHAPTER X. ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES. In selecting our attenuations for the cure of disease, the following circumstances are to be taken into con- sideration: 1, the age, sex, temperament, constitution, and habits of life ; 2, the condition of the disordered textures ; 3, the character of the drug to be employed. {a) Age. Infants and children of tender years, whose organisms have not become blunted by expo- sure to the ordinary stimuli of life, by improper food and drinks, and by abuse of cathartics and opiates, are in the most eminent degree impressible, and re- quire the highest attenuations. It is at this period that the circulation is most active, the nervous system most delicate, and the tissues most sensitive to the influence of external agencies. At the middle period of life, when the body has ar- rived at maturity, and all of the organs have acquired their full strength and vigour, the resisting power against both medicinal and morbific agencies is at its maximum. The action of the circulatory vessels is now moderate and stable, the nerves are strong, the structures have become accustomed to all kinds of 112 ATTENUATIONS OF DRUGS, ETC. stimuli, and the mind, which exercises so powerful an influence over the body, acts calmly and judiciously. At this period, our lower attenuations will often serve us more efficiently than the higher. During the decline of life, many circumstances which have a tendency to modify the operation of medicines, are to be considered. Individuals who have passed their lives in intemperance, who have been afflicted with frequent attacks of disease, and whose systems are loaded with the cumulative poi- sons of drugs, usually acquire a remarkable obtuse- ness and inactivity of the whole organism, so that the very lowest attenuations are requisite to effect suita- ble impressions. On the other hand, many old peo- ple, upon the verge of second childhood, become sensitive, irritable, and so intensely impressible, that the higher preparations respond promptly and effect- ively. (b) Sex. Females are more easily acted upon by medicines lhan males, for several reasons. Perhaps the most prominent one consists in their superior deli- cacy of organization : their circulation is more active, their nervous systems more irritable, and their mental powers more acute and quick, although less strong, logical and independent than those of men. J. J. Rousseau asserts, that a woman will leap to a conclu- sion which would require a man hours of severe thought to arrive at. It is this susceptibility and de- licacy of organization which render the female more impressible than the male sex, and which should always have no inconsiderable weight in the selection of attenuations. (c) Temperament. The temperament also has an important influence in the operation of medicines. As most morbific and remedial agents produce their effects upon the sentient extremities of the nerves, it follows that a highly susceptible condition of the ner- vous system is most favourable to the prompt opera- tion of these causes. We therefore infer, that the higher attenuations are better adapted to the nervous, than to either of the other temperaments. Next to the nervous temperament, in point of sus- ceptibility, may be ranked the sanguine. Individuals ATTENUATIONS OF DRUGS, ETC. 113 of this temperament are characterized by great ac- tivity and energy, and by prominent development and vigour of the vasculaV system. The temperaments which are the least susceptible to remedial impressions, are the bilious and lymphMic. The former is characterized by large muscular devel- opments, tendency to biliary derangements, frequent turns of melancholy, and great powers of endurance. The latter is distinguished by a predominant activity of the glandular system, by a flabby and relaxed con- dition of the muscles, and by a feeble and rather ob- tuse state of the nervous system. These tempera- ments sometimes require our lowest attenuations, es- pecially in chronic diseases. Two or more of these temperaments often unite in the same person, when we have what is termed a mixed temperament. This variety may be considered, upon the whole, the most favourable to health and longevity, since no quality predominates, and the functions of the organism are more equalized. {d) Constitution. Attenuations must also be se- lected with a due regard to the constitutional pecu- liarities of each particular case. We know of several persons who cannot take a blue pill, or a pill in which calomel is a constituent, without being vio- lently salivated. There are others in whom opium produces furious and protracted delirium, and cathar- sis, as primary effects; others cannot carry ipeca- cacuanha about their persons, or inhale the smallest quantity of it, without attacks of asthma; others cannot approach the rhus plant without being poi- soned ; others cannot use shell fish, and certain other sorts of food, without being afflicted with urticaria; the smell of hay causes asthma in some, and the de- licate fragrance of the rose, syncope, in others. On the other hand, there are some organisms which can scarcely be impressed with even large and continued doses of medicines. Constitutions which have been impaired by abuse of stimulants, drugs, tobacco, and licentiousness, and in which there is an abasement of the nervous and physical power, demand low at- tenuations. In a word, it will be found on rigid exa- mination, that each individual possesses some pecu- 114 ATTENUATIONS OF DRUGS, ETC. liarities which it will be necessary to take into con- sideration, when we decide respecting the strength or repetition of a remedy. (e) Habits of life. We have read of persons who were " music mad,'" but we have often seen those who were medicine mad. The world is full of this class of monomaniacs, who " pass away their time in des- canting on their own" diseases, and in filling their bodies with all sorts of injurious and nauseous drugs. After pursuing this course a long time, the system, by habit, tolerates enormous quantities of the poisons swallowed, and the structures lose, in a measure, their susceptibility to medicinal impressions. It is for this reason that the homoeopathist experiences so much difficulty in the management of cases of dys- pepsia, hypochondria, and constipation, which have been induced by long continued abuse of cathartics ; also in the affections of confirmed opium eaters, ha- bitual drunkards, and gourmands. Individuals of these classes, require low attenuations. In the same cate- gory may be ranked those operatives who make a free use of mercury, the salts of lead, the strong acids, and other poisonous substances which evaporate at the ordinary temperature. Robust persons, who pass much time in active exercise in the open air, will require stronger doses than those of delicate organization and of studious and sedentary habits. 2. The condition of the disordered textures. Those parts of the system which are most amply supplied with nerves, are, all other things being equal, most susceptible to the operation of medicines. Thus the eye is more readily impressed than the arm ; the lungs, stomach and intestines, than the limbs and joints, &c. Much, also, depends upon whether the specific employed; is positive and decided in«its ope- ration. But there is another circumstance of vast moment to be taken into consideration in the choice of our attenuations, and to which we have elsewhere called particular attention. We refer to the augmented sus- ceptibility to medicinal impressions which inflamed structures acquire. We have shown that the con- ATTENUATIONS OF DRUGS, ETC. 115 dition of inflamed tissues becomes entirely changed, and that their acquired susceptibilities become so morbidly increased, that even their natural stimuli cannot be tolerated, but when allowed to operate, be- come additional and powerful sources of disease. The natural and healthy material stimuli of the eye, the ear, the lungs, the stomach, the bladder, &c, are grateful during the normal state of these organs; but let inflammation occur, and the smallest pencil of light becomes intensely painful to the eye, as noises to the ear, air to the lungs, food and drinks to the sto- mach, and urine to the bladder. Nor is this augmented susceptibility confined to the operation of the natural stimuli, but it applies with still greater force to the action of specific medicines, up to that point of inflammatory action when the sen- sitive extremities of the nerves succumb from inten- sity of excitement, and a condition bordering on pa- ralysis or gangrene obtains. It is sometimes difficult to decide when this morbid erethism has arrived at its maximum, and the atonic state commences; but the gradual subsidence of pain, appearances of effusion or ulceration, and diminished sensibility of the affect- ed part, will afford us the best indications upon this point. This fundamental law of homoeopathy, not only serves to explain in the clearest possible manner the astonishing effects of infinitesimal doses, but it teaches an important practical fact, at present un- appreciated, but incontrovertible, and which stands at the foundation of our therapeutical applications, viz., to ascend in our scale of attenuations in proportion to the violence of the inflammation, until ice arrive at that point where the nerves of the diseased part have attained their maximum of erethism, after which we must again descend the scale in the same ratio. This same law applies with equal force to all irri- tations of the nervous system, even when entirely un- attended with the usual phenomena of inflammation, redness, swelling, heat, and pain. We have often seen this nervous erethism so strongly p -onounced— and where there were no signs of vascular excite- ment—that a single grain of ipecacuanha, or the twen- tieth part of a grain of tartarized antimony, would 116 ATTENUATION OF DRUGS, ETC. produce copious vomiting and purging; or a drop of the first dilution of nux vomica, induce involuntary contractions of the muscles, especially of those parts which were unusually irritable ; or a single grain of jalap, rheum, calomel, or even a mental emotion, im- mediately cause diarrhoea; or a cup of tea or coffee taken in the evening, prevent sleep for a whole night; or the inhalation of a few imponderable particles of ipecacuanha, give rise to both its primary and second- ary specific effects upon the pulmonary organs. There may be a few apparent exceptions to this rule, as in the example already.referred to respecting the inefficiency of large quantities of opium and lau- danum in tetanus; but these exceptions are suscep- tible of ready explanation. In this disease there exists a peculiar preternatural excitement of the nerves, which preside over the voluntary motions, and the contractility of the tissues, which induces a spas- modic occlusion of those textures of the digestive canal which, in the normal state, permit the absorption of opiates. This is evident from the fact, that if lauda- num be injected into the veins during tetanus, the usual effects are manifested. In this exception, therefore, the drug is not absolved, and of course cannot exercise its specific effects upon the economy. It is evident, then, that in the selection of attenua- tions for chronic diseases, the precise condition of the nerves of the affected parts must always be taken into consideration, since some chronic maladies are characterized by a highly exalted nervous suscepti- bility, and call for the use of high attenuations ; while in other cases, this susceptibility or impressibility re- mains at a low grade, and consequently will only respond to low attenuations. Dr. Lobethal, in alluding to this subject, makes use of the following language:—"God be praised, the times are passed when we adhere without examina- tion to the prescriptions of Hahnemann, and when we administered the thirtieth dilution in every case, with- out any regard either to the species of the'medicine, or the individuality of the patient. The idea of greatness or littleness is but relative ; we cannot say in a ge- neral manner, that some drops of the mother tincture ATTENUATION OF DRUGS, ETC. 117 of a certain medicine will be a strong dose; nor yet, perhaps, that the twenty-fourth or thirtieth dynami- zation of every medicine shall be regarded as a feeble dose. The dose of each medicine should be strong enough to provoke the necessary reaction of the organ- ism, and, provided we are careful not to administer a too heavy one, agreeable to take, and without dan- ger, we should always give a sufficient one. " I am decidedly convinced, that in order to apply the homoeopathic treatment with success, the physician should take cognizance of the whole scale at his dis- posal, from the actual dose of the old school, up to the highest dilutions of which any medicine is suscep- tible. " We may establish it as a principle, that the admi- nistration of large or small doses is in inverse propor- tion to the richness in nerves of the individual organ- ism, and the species of diseased organ ; that is to say, the more the sentient sphere of the organism, in a given case, shows itself predominant, the more the dose of the indicated specific medicine should be feeble, and that the more the individual organism, or, in a local affection, the diseased organ, is poor in nerves, the more the, doses should be large."—{Revue Critique et Retrospective de la Matiere Medicate Spe- cifique. Vol. iii., 1841). Dr. G. H. Gross, of Germany, also observes, that " homoeopathia, as now accepted, has determined the point, that the physician must exercise his judgment as to the dose, varying it from the highest dilution down tO ONE OR MORE DROPS OF THE UNDILUTED TINCTURE, as individual cases may demand." * "In the Vienna Homoeopathic Hospital, where a chronic case is rarely seen, the dilutions usually given by Dr. Fleischmann, range from the first to the sixth of the decimal scale. At the Linz Hospital, Dr. Reiss, though convinced of the efficacy of the highest dilu- tions, and occasionally prescribing them, treats the majority of his patients with the same dilutions as those employed by Fleischmann. In looking over the * Dr. Gross wrote this in 1840 ; but during several years preceding his death, he was a most decided advocate of the highest dilutions. 118 ATTENUATION OF DRUGS, ETC. records of homoeopathic practice, we cannot help per- ceiving'that of late years there has been a constant downward tendency with respect to the dilutions (the high potency novelty being left out of view). Not only is this true with respect to the generality of cases recorded, but also with respect to the practice of individuals. The majority of those statistics to which we so triumphantly appeal, are undoubtedly derived from the employment of the lower dilutions." {British Jour, of Horn. No. xxiii, p. 25.) Dr. E. F. Ruckert, of Germany, also writes as fol- lows : " I am satisfied that the system (homoeopathia) is still progressive, and has by no means attained its perfection. In respect to doses, most generally, I make use of the first dilutions, and never exceed the twelfth, giving them in increased volume and repeating them frequently. I have been more successful in this course of treatment than formerly in the use of the smaller doses." Similar views have recently been promulgated upon this subject, by G. Schmid, Trinks, Griesselich, Watzke, Madden, Bigel, Drysdale, Russell, and indeed by a ma- jority of our school, both in Europe and America. We have not unfrequently been able to cure disease with a high attenuation, after having failed with the first and second dilutions of the same remedy ; but it has been a much more common occurrence with us, to effect cures with the first attenuation after having been unsuccessful with the higher preparations. No definite rules, therefore, can be given which will apply in all cases, but every circumstance connected with each particular case must be duly investigated, and the physician then exercise his own best judgment. 3. The character of the medicine to be employed.—Cer- tain substances which are very feeble or even inert, in their natural crude state, appear to acquire new and potent qualities on trituration. Whether these new properties are communicated to the minutely di- vided particles by a chemical combination with the oxygen of the air, for which several, like carbon, gra- phite, sulphur, lime, &c, possess a very strong affin- ity, or whether they arise from the simple subdivision of the atoms of the drug, we are unable to determine. But these ore the medicines which have been found ATTENUATION OF DRUGS, ETC. 119 especially serviceable when employed in high attenu- ations. On the other hand, there is a class of medicines so volatile in their nature, that trituration and expo- sure to the air and moisture, deprive them of their ac- tive principles. Amongst these articles may be rank- ed camphor, ammonia, bromine, nit. argenti, the ethers, the volatile salts, &c. Medicines of this kind should always be exhibited in the lower attenuations. We must also be governed somewhat by the posi- tive or negative character of the specific employed. Some medicines are very marked and prompt in their specific operation,liketartarized antimony, phosphorus, ipecacuanha, belladonna, aconite, hyoscyamus, stra- monium, opium, &c, and may ordinarily be used at rather higher attenuations than those whose primary effects are less prompt and strongly pronounced. The advantages which we obtain from a minute subdivision of crude substances, are as follows: 1st. We develop every part of the active principle pertaining to the substance, by breaking up all natu- ral organization or arrangement between its molecules, and thus exposing a large amount of active surface which would otherwise have remained latent. 2d. By distributing these molecules intimately throughout an inert vehicle, (sugar or water,) they are far more readily absorbed by the delicate lacteals and absorbents, than coarse and irritating particles of mat- ter. 3d. When these minute atoms have been conveyed by the blood to those parts with which they have an affinity, they penetrate the smallest vessels, impress the minutest sentient nerves, and become productive of results entirely unattainable by drugs in a crude form. 4th. During the act of subdivision, it is not impro- bable that the atoms of drugs sometimes become oxy- dized, and thus acquire new and increased powers. Finally, we infer, that no new properties are deve- loped by the homoeopathic method of preparing drugs, except such as arise from the mere subdivision of their particles ; and that all ideas respecting spiritualization, dynamization, and magnetism, in the preparation of medicines, are erroneous and untenable. 120 ATTENUATION OF DRUGS, ETC. In regard to the repetition of doses, we are to be guided by the acute or chronic nature of the malady, the urgency and danger of the symptoms, and the ef- fects produced by the medicine. In violent and dangerous acute diseases, like cholera- asphyxia, convulsions, phrenitis, pleuritis, gastritis, &c., the remedies should be repeated as often as every fifteen, twenty, or thirty minutes—until an ag- gravation of the symptoms, (that is, some primary effect of the drug), appears, or a perceptible ameliora- tion of the symptoms is apparent, when the medicine should be omitted, in the first case, until the secondary or curative symptoms have come on, and expended themselves ; and in the latter, so long as amendment continues. If the case demands it, recourse may again be had to the same medicine ; or if new symptoms have made their appearance, another appropriate remedy may be selected. In less urgent cases of acute disease, it will be suf- ficient to repeat the remedy every four, six, or eight hours, until primary symptoms (aggravation) occur, or amelioration of the symptoms evinces the secondary or curative effects, when we may rest tranquil until the amendment ceases, and the medicine has expended its curative effect. In chronic maladies, the remedy may be repeated once in twelve or twenty-four hours, until an impres- sion is perceptible, either in the form of primary drug symptoms, or of amelioration of the morbid condition. When this result obtains, we may with great propriety wait until the full effects of the medicine have sub- sided, before we repeat the dose. In these cases it is far better to make use of doses sufficiently strong, and repeat them sufficiently often to induce decided pri- mary medicinal symptoms—even if we are obliged now and then to give antidotes—rather than to remain for weeks in doubt as to whether a suitable impression has been produced by a single dose. It is Aery rare that moderate drug symptoms are productive of un- pleasant consequences in chronic diseases, while the reaction thus induced in the diseased tissue, usually has the effect to bring about a much more speedy cure. Indeed, we believe it may be set down as a general ATTENUATION OF DRUGS, ETC. 121 rule, that the sooner we can produce a moderate, but decided medicinal action in a structure suffering from chronic inflammation, the sooner will a curative reac- tion follow, and health result. " It would therefore appear that experience has con- firmed the opinion of Hahnemann, that a certain amount of aggravation is essential to the therapeutic process; in the vast majority of cases this does not make itself known in any perceptible degree, but it does occur in a certain, though small amount of cases, sufficient to confirm its existence as an essential phe- nomenon. The cases in which it occurs with infini- tesimal doses are probably only those of excessive or even idiosyncratic susceptibility, and even with these it is a phenomenon of no danger, and only slight incon- venience. Hence we may conclude, that a normal dose of homoeopathic medicines, sufficiently small to avoid the liability to aggravation in a certain amount of cases, and yet sufficient to cure best and quickest in the majority of cases, is a mere chimera, and ought not to be sought for; but in seeking for doses the best for the majority of cases, we must lay our account for meeting with a certain number of aggravations, but practically these latter are of no importance. Likewise in the case of collateral symptoms, it is affirmed by Hahnemann, that " we cannot arrange our doses so as to escape the liability to them in a small and practically unimportant degree."—{Dr. Drysdale: British Jour, of Horn., No. xxiii., p. 22.) In all cases of urgent acute disease, in which we can find no single remedy which corresponds to the promi- nent symptoms, it is necessary to select a second reme- dy which shall cover the remaining symptoms, and ad- minister it in alternation with the first. Pneumonia is often accompanied by cerebral inflammation ; typhus fever, with serious disorder of the intestinal canal, the lungs, the brain and nervous system; intermittent fever, with enlargement of the liver, jaundice, cough, &c.; and other maladies with affections in other parts of the body, which are not strictly connected with the original complaint. In examples of this kind, the al- ternation of remedies is both proper and necessary ; at the same time it must be remembered, that it is far 6 122 GENERAL DIAGNOSIS. more desirable that a single medicine should be chosen which covers all the symptoms of the disease. The same rule holds good with respect to giving medicines in succession. Whenever the first remedy fails in producing the required impression, or whenever important new symptoms arise to which the original drug does not correspond, we may resort to another which accords with the totality of the symptoms. A large proportion of homoeopathic physicians, both of Europe and America, now advocate a frequent re- petition of doses in acute diseases, and in many in- stances give alternations of the remedies. Some of those who have expressed themselves decidedly upon this point* are, Drs. Gross, Schmid, Rau, Fleischmann, Reiss,Ruckert,Lobethal, Hartmann,Russel, Hull,Neid- hard, Gray, Currie, Trinks, Griesselich, Madden, Dud- geon, and Quin. The erroneous ideas which were formerly enter- tained respecting the alternate employment of reme- dies, are at present nearly abandoned. So long as the absurdity prevailed that our medicines operated in a kind of spiritual manner, upon certain mysterious ap- pendages of the organism, termed " vital properties," it was deemed unsafe to administer two remedies in alternation, for fear of creating confusion among these dynamic influences ; but since the laws of absorption, and the specific topical action of drugs, have become so fully established, there is no longer hesitation in alternating medicines whenever symptoms appear to require it. CHAPTER XI. GENERAL DIAGNOSIS. It is a matter of the highest importance that the homoeopath should be perfectly familiar with the most approved methods of diagnosis, in order that he may take advantage of every possible circumstance which may facilitate his investigations of disease. Although GENERAL DIAGNOSIS. 123 a patient may be competent in general to indicate the exact seat of his pain, and thus enable the physician to determine what organ or tissue is affected, this is by no means true in all cases. There are many maladies which are entirely unat- tended with pain, or any other local sign, by which the physician can detect the suffering organ. In cases of infants and young children, who are unable to indi- cate the locality of their sufferings, and in some chronic affections, a knowledge of the external signs is of vast importance. In all such cases a proper skill in diagnosis will prepare the medical man to pene- trate the innnermost recesses of the organism, and to understand its most profound secrets. It is a singular and highly interesting fact, that the pains of the different parts of the body impart to the countenance certain characteristic and easily under- stood expressions. As these signs are involuntary, and almost uniformly present, all will recognise their importance as diagnostic phenomena, In forming our diagnosis, it is essential in the first instance to notice accurately every circumstance con- nected with the patient which is at all peculiar or unnatural. The general expression of countenance, the tone of voice and manner of speaking, the figure, attitude, movements, etc., should be attentively marked. At the same time, age, sex, temperament, hereditary predisposition, occupation, habits of life, whether labouring under the effects of any previous malady or of mercury, and whether accustomed to the constant use of opium, should all be duly considered. The patient should then be permitted to detail his symptoms after the manner pointed out by Hahnemann, in his Organon, (pages 126-7). In cases of inability on the part of the patient to enter into a description of the case, the friends should be called upon to give all of the information in their power, in regard to the rise and progress of the disorder. An attentive perusal of Hahnemann's advice upon this subject, is of the ut- most importance to the acquisition of a perfect por- traiture of every complaint. Since, however, there are some instances in which neither the patient nor friends are able to afford any 124 GENERAL DIAGNOSIS. information respecting the nature or seat of the affec- tion, it is indispensable to acquire a knowledge of all external and involuntary signs which can in any way illustrate the character of the malady. Allopathic writers have divided diagnostic signs into those exhibited by the countenance; the attitude; the nervous system; the digestive organs; the circu- latory system.; the respiratory organs; the skin ; the lymphatic system; the secretions. As the countenance is an excellent index of what is occurring in distant parts of the organism, we should note attentively the expression of the eyes, nose, mouth, and forehead, and also whether sadness, mo- roseness, peevishness, despair, fear, grief, or joy, is evinced. By heeding carefully these indications, we shall be greatly assisted toward accurate opinions in obscure and complicated cases. Thus, contraction of the features, rapid dilatation and contraction of the nostrils, dyspnoea, with expres- sion of anxiety, indicate acute inflammation of the re- spiratory organs. Sharp features, and expression of anguish, " fore- head wrinkled, brows knit," eyes sunken, counte- nance pale, hollow cheeks, lips dry and bluish, indi- cate pain and severe inflammation of the abdominal viscera. General expression of countenance flushed and ex- cited, or dull and stupid; eyes red and brilliant, or dull and heavy ; pupils contracted or dilated; pro- trusion of the eyes, with a wild expression ; mouth drawn to one side ; twitchings of the eyelids and muscles of the face, indicate inflammation of the cere- bral organs. Expression anxious; respiration difficult and rapid during inspiration, while expiration is comparatively easy; symptoms worse after assuming the recumbent posture; face swollen and livid; indicate hydrothorax. Face flushed and swollen ; lips blue ; eyes promi- nent and unnatural; face cold ; sudden startings in sleep ; anxious expression ; indicate organic disease of the heart. Cheeks pale and blanched; lips white, and puffy ; a GENERAL DIAGNOSIS. 125 dark circle around the eye-lids ; expression of languor and debility, indicate chlorosis. Paleness and puffiness of the upper lip indicate scrofula and verminous affections. " Eyes and face red ; rapid respiration ; motions of the nostrils rapid ;" indicate simple acute fevers. FIGURE AND ATTITUDE. Before alluding to the different attitudes assumed by the body during disease, as diagnostic signs, we shall take the liberty of digressing for a moment, in order to touch upon the importance of a proper culti- vation of the physical powers, as a means for securing the most perfect corporeal development and sym- metry. In order that the organs may perform their functions in a proper manner, it is absolutely indispensable that the body should retain its normal structure and shape, and remain unincumbered by any artificial appliances which tend to impede the circulation or check the free action of the muscles. Unfortunately for man- kind, it has been customary both in barbarous and civilized countries, to distort artificially certain parts of the body, under the absurd notion that they were improving upon nature, and enhancing the beauty of the figure which the Supreme Architect had formed in his own image. Amongst the savage tribes of the Rocky Mountains, it is customary, and we suppose fashionable, for the natives to flatten the forehead by long-continued arti- ficial pressure. This constitutes the ideal of savage beauty, and is the common method of improving up- on the works of the Creator. In other barbarous countries it is customary to slit the ears and nose, and hang from them large quanti- ties of tin, brass, and other cheap ornaments. This, with the requisite amount of tattooing and painting, illustrates their notions of what the human figure should be. In China, the semi-barbarous inhabitants compress the feet, of their females, from birth, in such a manner as to prevent their growth and development; and in 126 GENERAL DIAGNOSIS. this abominable distortion consists their idea of female beauty. This is the Chinese improvement upon na- ture. The Turks cram their women with "pillau," after the manner of stuffing geese, to cause enlargement of the liver, for " pate de foi gras,"—that they may be- come enormously fleshy, and thus present to the ad- miring eyes of their lords, figures of uniform dimen- sions in all directions. This is the Moslem's style of female beauty. In the highly civilized countries of Europe and America, it is not customary to make use of artificial contrivances to flatten the head, prevent the growth and development of the feet, to slit the ears and nose, or cram their women ; but, through the instrumental- ity of those " infernal machines," corsets and stays, the sex deem it indispensable, in order to be genteel, to compress entirely from its natural shape the most im- portant and vital part of the organism. These un- natural efforts at distortion are usually commenced at an early period, and continued with perseverance, until the figure has lost its natural symmetry, the lungs are forced upwards, out of their just position, and the abdominal viscera made to accommodate themselves in the new situation to which they have been reduced by art. The civilized females of the present day, affect to contemn the symmetrical figures which the Creator ori- ginally formed, and wmich the ancient sculptors de- lighted to represent in marble, and have chosen to " improve" on these old-fashioned notions, by partially cutting off the connection between the upper and low- er parts of the body ; thus reducing it from the shape of those models of perfection, the Venus di Medici, and the Venus of Milo, to that of a Wasp or an hour-glass. We have not only the authority of the ancients in all those master-pieces of art in which they have il- lustrated their ideas of beauty, but the greatest of modern sculptors, our illustrious countryman, Powers, in a MS. letter before us, declines a suggestion that his exquisite statue of Eve should be exhibited, because his sense of harmonious proportion, as well as of physical necessity, compelled him to present the moth- GENERAL DIAGNOSIS. 127 er of mankind in the shape which the Creator approv- ed as the ultimate product and most perfect fruit of divine intelligence and energy. "Eve," the sculptor says, with satirical humour, " is an old-fashioned body, and not so well formed and attractive as are her grand-daughters,—at least some of them. She wears her hair in a natural and most primitive manner, drawn back from the temples, and hanging loose be- hind, thus exposing those very ugly features in women. Her waist is quite too large for our modern notions of beauty, and her feet, they are so very broad and large ! And did ever one see such long toes ! they have never been wedged into form by the nice and pretty little shoes worn by her lovely descendants. But Eve is very stiff and unyielding in her disposition : she will not allow her waist to be reduced by bandaging, because she is far more comfortable as she i.v, and besides, she has some regard for her health, which might suffer from such restraints upon her lungs, heart, liver, fyc, fyc, 6fC I could never prevail upon her to wear modern shoes, for she dreads corns, which, she says, are neither con- venient nor ornamental. But some allowance ought to be made for these crude notions of hers,—founded as they are in the prejudices and absurdities of primi- tive days. Taking all these things into consideration, I think it best that she should not be exhibited, as it might subject me to censure, and severe criticisms, and these, too, without pecuniary reward." Singular perversion of taste ! wonderful and all- powerful influence of fashion, which can induce so many intelligent beings to suffer torture like sava- ges, for the purpose of distorting their bodies, and bringing them into those artificial shapes which civil- ized nations denominate genteel and graceful! Suppose a fashionable woman should apply corsets and stays to a favourite monkey, or a pet lap-dog, and so compress its body out of shape, would not the at- tempt be pronounced heartless, and its author, perhaps, be indicted for cruelty to animals? but when the same barbarity is perpetrated upon a human being, it is tolerated, because it is genteel and fashionable ! Were females the only sufferers from these cruel practices, the sin would not be so greatj but their 128 GENERAL DIAGNOSIS. posterity participates deeply in the consequences which result from their criminal perversity. The flat and nar- row chests, the stooping gaits, and the pale or sallow faces which greet us at every step, demonstrate the extent of our physical degeneration. But the female sex are not alone censurable. Too great a proportion of the men,—of this country espe- cially,—become round-shouldered, crooked, and de- formed, from a want of free muscular exercise, and too close an application to business, in constrained, bent, and unnatural positions. Physical education in latter times, has been quite overlooked. Parents have commenced sending their children to school in infancy, and their embryo minds have been tasked with all kinds of mental exercise, while their physical powers have been suffered to lan- guish in heated and ill-ventilated rooms. Thus they have grown up with improved minds, but feeble, unde- veloped, and perhaps crooked, or mis-shaped bodies. Let it ever be remembered, that the mind and body exercise an influence upon each other, and if we would secure to the former its highest development, we must cultivate and perfect the latter. In this respect we may with advantage go back to antiquity, and copy after Herodicus, in advancing physical education. But to return to our subject: As in health the at- titude is erect, and those positions are assumed by the body and limbs which indicate muscular strength, so departures from the normal standard, induce corres- ponding alterations in the position and appearance of the body. Thus, tremors; position upon the back, with a con- stant disposition to sink down towards the foot of the bed, indicate extreme muscular debility. Distressing dyspnoea, and sense of suffocation when lying down; constant desire to assume the erect pos- ture ; general agitation, cough, and appearance of anxiety, indicate hydrothorax. Common position upon the back ; rigidity and mor- bid involuntary contractions of the flexor muscles, usually of the upper extremities, indicate softening of the brain. Position upon the back. " with the knees drawn up ; GENERAL DIAGNOSIS. 129 head and shoulders a little elevated ; dread of motion, indicate abdominal inflammation with acute pain. Position upon the belly ; pressure of the abdomen affording relief ; and very restless, indicate spasmodic abdominal pains. Rigidity, and involuntary contraction of the muscles of the neck, back, and limbs, indicate inflammation or irritation of the spinal cord. In the advanced stages of acute diseases, position upon the back, with the legs drawn up, indicate reten- tion of urine. THE TONGUE. Much information may be gained, in many instances, from an examination of the tongue. The following are a few of the diagnostic signs presented by this or- gan: A clean, smooth, and bright red tongue, indicate in- flammation of the gastric or intestinal mucous membrane. A clean and red tongue, with papilla prominent ; or a furred tongue, with red papilla appearing through the fur, indicate scarlatina. A reddish, and tremulous tongue, indicates mania a potu. A thick and yellow fur covering the tongue, with bitter taste, indicate biliary derangement. A white fur upon the tongue, indicates slight simple fever. Acute symptomatic fevers, effect but little change in the appearance of the tongue. A relaxed, dilated, and tremulous tongue, indicates congestive or nervous fevers. A pale and flabby tongue, " with large papilla," in- dicate gastric debility—met with in chlorosis. A sharp and pointed tongue, is often observed in irritation and inflammation of the brain. THE NERVOUS SYSTEM. Tearing, throbbing, and aching pains—aggravated by contact, pressure, or movement, indicate inflamma- tory action. Twitchings of the limbs ; jerkingsand shocks of the 6* 130 GENERAL DIAGNOSIS. tendons ; cramps ; convulsive movements; violent contortion of the body ; pains relieved by pressure; unattended with fever, indicate spasmodic pains. Sharp and darting pains, unaccompanied by swell- ing, heat, or redness, indicate neuralgic pains. Vague and wandering pains about the ancle often indicate inflammation of the knee. Pains also in other healthy parts, sometimes indi- cate inflammations in remote structures. Wakefulness, indicates irritation of the nervous sys- tem. Irresistible inclination to sleep, with stertorous breathing, indicates compression, or serious disturb- ance of the brain. Twitching of the muscles during sleep, and fre- quent waking from frightful dreams, indicate organic disease of the heart; also characteristic of verminous irritation. Sudden, rapid, and jerking movements of the head and limbs, indicate cerebral irritation, mania a potu, and some forms of insanity. THE ALIMENTARY CANAL. The alvine discharges will afford many useful hints to the observing physician. Thus, light or clay-coloured evacuations denote a lack of bile. Mucous and bloody stools indicate intestinal inflam- mation : if accompanied with tenesmus, and redness or protrusion of the rectum, we may conclude that the lower part of the canal is affected. Watery stools, with slight pain, indicate inflation of the bowels. " Glairy, dark green evacuations, like chopped spin- age, are characteristic of hydrocephalus." Very dry and hard fasces indicate a relaxed and tor- pid state of the mucous membrane of the bowels. THE RESPIRATORY ORGANS. Using the abdominal muscles principally in respi- ration, indicates inflammation of the lungs. Using the intercostal muscles alone, indicates ab- dominal inflammation. GENERAL DIAGNOSIS. 131 Irregular respiration, with stertorous breathing, in- dicates compression of the brain. Inspiration difficult, anxious and rapid, while expi- ration is comparatively easy, is peculiar to hydrotho- rax. Wheezing, short, panting and anxious respiration, with contraction of the larynx, indicate asthma. Paroxysms of rapid, short, suffocating and spasmodic cough, indicate pertussis. White, tenacious sputa, indicate chronic bronchitis. Very thick, yellow, or greenish sputa, which sinks in water, indicative of disorganization of the lungs. THE SKIN. A yellow skin indicates disordered liver. A sallow skin occurs in chlorosis, and a few chronic ills. A pale and waxen skin denotes a deficiency of blood. A blue or livid skin, in infants, indicates a pervious foramen ovale. A hot and dry skin denote inflammation. A cold skin, with internal heat, indicate internal congestion. THE UKINE. Urine red and scanty denotes inflammation. Urine clear, limpid, and abundant, in nervous affec- tions. Urine depositing a sediment indicates biliary de- rangement. The above are only a few of the more common and well known diagnostic signs. Our only object is to direct the attention of physicians to this subject, for there are often many things about the general ap- pearance of a patient which are slight and indescriba- ble in themselves, but which will aid him materially in forming his opinions. . In order, then, to arrive at a correct diagnosis, it is necessary— 1. To note all external signs. 2. To ascertain the age, occupation, previous habits, predispositions, and peculiarities of the pa- tient. 132 FEVERS. 3. To procure from the patient a spontaneous and minute detail of his sufferings in his own language. When the patient is unable or incompetent to afford this information, get as accurate a description as pos- sible from those best acquainted with the history of the case. 4. Ask such questions, and make such examinations by the touch, pressure, sight, hearing, percussion, aus- cultation, &c, as may be necessary to perfect the diagnosis. CHAPTER XII. FEVERS. Much has been written, and many hypotheses have been advanced, from time to time, concerning the pathology of this important class of diseases. Within the two past centuries, the changes of opinion in regard to the nature and seat of fevers, have been almost innumerable ; and yet, with all that has been written, and the numerous bitter controversies which have taken place, we are at the present moment but little farther advanced as to any definite knowledge upon the subject, than Ave were centuries ago. Indeed, the opinions of the medical world at the present time, are so much at variance, that it would not be difficult to find men of distinction who advocate almost every doctrine which has ever been promulgated. The old dogma that fevers arise from a concoction of something injurious to the system, has even its ad- vocates ; thus, " substances in a state of putrefac- tion, by entering the blood, impart their peculiar ac- tion to the constituents of that fluid, and all the sub- stances of the body are induced to undergo a modified putrefaction."* Again, Dr. Burne says, " that the ady- namic or typhoid fever has no local seat ; that its na- ture is a morbid condition of the blood, produced bv the * Paris Pharmacologic FEVERS. 133 operation of a primary cause, the respiration of a con- taminated or tainted atmosphere." Dr. Clancy and other authors believe the proximate cause of fevers to be " a want of power in the system to form blood." Others still, like Clutterbuck and Broussais, have contended that fevers of every denomination and de- gree, are the result of inflammation. They are sup- posed by these gentlemen to be topical affections, " the general disorder of the system being only secondary and sympathetic." The former located the seat of fevers in the brain, the latter in the gastro-intestinal mucous membrane. The vitalists suppose that fevers, in common with many other diseases, are owing to a morbid alteration of what are termed the vital properties of the textures affected. Professor Mackintosh, of Edinburg, has advanced the opinion, " that the effects of outward causes, and inward irritations, in producing irregular determina- tions of blood, are the great agents in exciting diseases, and especially fevers." He supposes " that the func- tions of almost all organs are embarrassed in fever from the very beginning ; that internal determinations of blood take place, which rouses the system to reac- tion, and thus causes fevers ; that inflammations of all parts of the body will give rise to fever; that inflam- mation may supervene during fever, without being the primary cause of the febrile commotion; that the nervous system is involved as well as the vascular; and that the blood itself must be in a diseased condi- tion." A majority of the profession at the present day, however, suppose with Cullen, that the prime causes which produce them, act directly upon the nervous system, and thus produce their pernicious results. Our own opinion is, that fever is a combination of symptoms that may arise from a disturbance of any one or more parts of the body ; that the primary im- pression is made upon the extreme nerves of the part acted on ; and that the whole system is affected to a greater or less extent, secondarily, thus giving rise to that congeries of symptoms which constitute fever. 134 FEVERS. The skin, the nervous system, the circulation, the res- piration, the secretions, and indeed the whole body partakes more or less in the general disturbance. We suppose that the causes which produce fevers, are specific agents which operate by being absorbed into the circulation, and conveyed to those structures for which they have an affinity or attraction, there im- parting those peculiar and specific actions which in- duce fevers. The miasm which causes intermittent fever evi- dently impresses a different part of the organism from that which induces typhus. So also the miasms of yellow fever, the contagion of plague, smallpox, scar- let fever, &c, are all peculiar and specific morbific agents, which exercise their influences upon the Sys- tem in different ways and in a manner analogous to medicinal agents. Whether this morbific influence is exerted upon the brain, the nervous system, the blood, the stomach, or the arterial coats, of one thing we are quite certain, that the miasm of intermittent fever can never cause plague, yellow, scarlet, or typhus fevers, nor can the poison of either of these maladies give rise to any disease except that of its own peculiar type. It is probable that the contagion arising from human effluvia—of ship, jail, and hospital fevers, scarlatina, smallpox, plague, and the different kinds of malaria— are all distinct substances, composed of minute parti- cles of matter, each possessing its own peculiar proper- ties, and each exercising its own specific influence when introduced into the human organism. Unless this were true, we should see either of these affections constantly giving rise to any of the others indiscrimi- nately. In a perfectly healthy and vigorous state of the sys- tem, neither miasms nor contagious matters are capa- ble of producing their peculiar effects, and they may continue to circulate harmlessly in the blood for months, until the system is debilitated from some cause and thus predisposed to their influence, or until their noxious qualities shall have been neutralized by fre- quent contact with the air respired at the lungs. The fact that physicians and other healthy persons so often FEVERS. 135 expose themselves with impunity to all of the noxious agents, proves conclusively that a certain state of pre- paration is an essential condition to their operation. At present the pathology of fever is so little under- stood, that all opinions respecting its nature and seat must be, to a considerable extent, vague and conjec- tural. In treating upon the different forms of fever, therefore, we shall adopt the classification of Mackin- tosh, on account of its simplicity and the superior fa- cilities it affords for diagnosis. The following is the arrangement: 1st. Intermittent fever. 2d. Remittent or yellow fever: infantile remittent. 3d. Continued fever, subdivided into four orders, viz.:— Fever from functional derangement. " from inflammation. " from congestion. A mixed form of fever between these three last, but in which congestion predominates, commonly denomi- nated typhus or synochus. 4th. Hectic fever. 5th. Fevers attended with eruptions, subdivided as follows : Scarlet fever. Measles. Smallpox. " " modified. Chickenpox. Miliary fever. Roseola. Urticaria. Erysipelas. 6th. The plague. In all of these fevers there are certain peculiar characteristics which serve to distinguish them from each other, and from all other maladies. Notwith- standing this, however, we scarcely ever find two cases of the same type running precisely the same course, or presenting precisely the same symptoms. So many circumstances connected with the exciting cause, as climate, age, sex, temperament, predisposi- tions, habits, &c.,tend to modify the character of each particular case, that all instances of the same malady 136 FEVERS. must necessarily present different trains of symptoms. It will readily be perceived, therefore, how impossi- ble it is to prescribe for the name of a disease instead of symptoms. We also take this occasion to express our opinion, that any classification of diseases what- ever, is valuable as an aid in diagnosis rather than in the exhibition of remedies. The course of a fever sometimes varies during its progress from its commencement to its termination, and on this account divisions are made into— 1. The forming stage. 2. The cold stage. 3. The hot stage. 4. The sweating stage. 5. Collapse. This is a mere arbitrary division, which can by no means be relied upon, for many fevers run their course without the supervention of these stages. Let it ever be impressed upon the mind, then, that these classifi- cations and divisions are entirely arbitrary and artifi- cial, and can only be used for the purpose of facilita- ting our diagnostic examinations. CHAPTER XIII. CAUSES OF FEVER. The causes of fever are either predisposing or ex- citing. Anything which debilitates the organism, or impairs the tone and resisting power of the nervous or muscular system, maybe denominated a predispo- sing cause of disease. Under this head may be ranked, excessive physical or mental exertion, protracted grief, anxiety, fear, chagrin and disappointment, de- privation of well ventilated dwellings, proper food, clothing and exercise, over-indulgence in the plea- sures of the table, stimulating drinks, licentiousness, want of cleanliness, and, finally, congenital causes, and those connected with some hereditary predispo- sition. CAUSES OF FEVER. 137 Those causes which induce fever by a direct im- pression, are termed exciting causes. Miasmata, contagious^ and epidemic effluvia, noxious gases, ex- treme and protracted heat or cold, and sudden changes of temperature, are examples of this class. All of the causes, however, which we have ranked under the head of predisposing, may, and often do be- come, under favourable circumstances, actual exciting causes of fever. It is equally true, also, as we have before observed, that what are called exciting causes, do not usually operate so as to produce fever, unless the system is prepared or rendered susceptible to their influence by debility, or some other predisposing cause. The powers of the body may be taxed up to a cer- tain point, by moral or physical, morbific or remedial agencies, without exciting actual disease ; but if the influence be carried beyond this point, an impaired condition of the capillaries acted on will ensue, with the usual concomitants, inflammation and fever. Even the natural maladies, scarlet fever, measles, smallpox, chickenpox, and hooping cough, seldom make their attacks unless the system is predisposed to receive their impressions. Therefore, these disorders will often attack one member of a family, while all of the rest, who are equally exposed to the contagion, will escape. The same rule holds good in regard to the operation of morbific, as of remedial agents, viz.: in proportion to the departure of the organs and tissues from their healthy standard, so will be the acquired susceptibili- ties of these structures to the influence of morbific agents. The importance, then, of a constant and regular system of physical culture, and a rigid avoidance of all those things which can in any way impair the normal integrity of the organism, will be recognised. Indeed, we believe that such a course might be pur- sued, as would secure an individual against disease until his system should succumb from old age. Such a course would involve a herculean task in our pre- sent state of physical degeneracy, yet it is not beyond the bounds of possibility. 138 CAUSES OF FEVER. A few of the means which we should recommend to accomplish this object would be, 1st. A proper system of physical education. The first and most essential condition for the enjoy- ment of perfect health, consists in a symmetrical and well developed organization. In looking around upon the world, how few do we behold who can boast of unexceptionable physical conformations—how few who have not some imperfection which might have been avoided by an early and proper attention to phy- sical culture ! But how shall this bodily perfection be attained ? We reply, by the universal establishment of free public gymnasiums, where those athletic exercises can be pursued which shall systematically develop and strengthen every part of the bod}r. We repeat, let there be established, athletic sports, games, &c, suita- ble for all ages and conditions ; where the man of ma- ture years may occupy agreeably an occasional leisure hour with physical and mental benefit; where the growing youth can correct all incipient bodily defects, and acquire that development and expansion in every part, which will enable all of the organs to act in a free and healthy manner. Let us abolish " infant schools" for the education of infant intellects, and es- tablish in their place infant gymnasiums for the culture of their infant bodies. Let us see no more intellectual " infant prodigies," with their pale, sickly faces, and their feeble and half-developed forms, but show us in ttieir stead, physical prodigies with their rosy cheeks, their plump, firm, and well-grown muscles, and with elasticity and buoyancy reminding us constantly of per- fect health. Show us your children of six, eight, or ten years of age, wild, bouncing, and overflowing with ani- mal spirits, rather than your prim, well-mannered, deli- cate sickly, hot-house, and band-box specimens. •All physiologists agree as to the vast importance to the young, of a great amount of exercise—•free, spon- taneous, and unrestrained. It is a principle of their natures, absolutely essential to their well-being, and we must not permit the artificial customs or restraints of society to prevent it. Our remarks apply with more force to cities than CAUSES OF FEVER. 139 to the country, for in the former everything is forced and unnatural: children are born into hot-houses, and reared in dwellings heated with Lehigh coal, to the temperature of 75 or 80 degrees Fahrenheit. Here do these unfortunates pass the best part of their existence, encompassed by everything which is unnatural and artificial, and inhaling an atmosphere deprived of a portion of its oxygen, and impregnated with carbonic and other noxious gases, until, while yet young in years, they arrive at the conditions of old age, satiated with the displays and luxuries of life, and reduced to a miserable state of physical inefficiency. It has been well remarked by physiologists, that if the large cities were not constantly supplied with healthy recruits from the country, they would soon be- come desert wastes. This remark is, beyond question, true, and it is only necessary to look into any of our large towns and behold the numerous worn-out and impotent wrecks of the wealthy families who have been inhabitants for two or three generations, to be convinced of the fact. The second means which we should advise to se- cure health would be, a correct system of dietetics. The use of all kinds of animal and vegetable sub- stances which are perfectly pure, digestible, and healthy, should be rigidly prohibited. In order to ac- complish this object, we do not believe that better rules could be adopted, than those instituted and com- manded by Moses for the Jews. Amongst the articles forbidden in the dietetic regulations of the great He- brew lawgiver, we find pork excluded, from the sup- position that the swine is unclean and unhealthy. When we consider how frequently the animal is af- fected with that dreadful malady, scrofula, and also how filthy and disgusting are its habits, it is not sur- prising that any person who is at all particular as to the quality of the food he consumes, and who possesses ordinary powers of observation, should denounce this nasty, offensive, and diseased animal, as unfit for food. But this abominable stuff in all its different forms, is consumed by christians everywhere. Lard constitutes the culinary expletive which serves to connect the in- gredients of almost every dish in one greasy union. 140 CAUSES OF FEVER. Whether the uses of pork and its preparations, have any agency in causing scrofula, we leave for others to determine. An argument, however, which tends to establish the affirmative, is in the fact, that amongst the strict Jews, and all of those nations where the animal is not used as food, this malady is scarcely known, while in every country where it constitutes an article of diet, scrofula abounds. In a word, care in regard to the selection of proper articles of food, suitable methods of cookery, avoidance of fat and condiments, stimulant, narcotic, and hot drinks, and regularity in partaking of meals, will ena- ble mankind to preserve the integrity and health of those organs which are concerned in digestion and assimilation, and thus avoid the numerous evils which accrue from errors in diet. Finally, we would recommend the establishment of such a state of society as should recognise no pursuit or custom as legal or respectable, except such as should conduce directly to the health, morals, and general welfare of the community. MIASMATA, SlC. Numerous experiments have been made for the pur- pose of arriving at the chemical and physical proper- ties of miasmata, and contagious and epidemic effluvia, but as yet, all investigations upon this subject have proved futile. We only know that when animal or vegetable substances undergo decomposition, a prin- ciple is set free which diffuses itself in the atmosphere, and which possesses the power when absorbed into the system, of producing certain specific effects upon the extreme nerves, which generate fever. The portion which is thus liberated by the aid of heat and moisture, constitutes, without doubt, the active principle of the original crude substance, in its purest form and most perfect state of development. This active principle is as imponderable and attenuated as the preparations of homoeopathy, and a few inhalations under favourable circumstances are capable of causing fever : it is also as specific and uniform in its operation and effects upon the economy, as remedial agents themselves. 141 CHAPTER XIV. INTERMITTENT FEVER. We have observed that each type of fever is marked by certain symptoms which distinguish it from all other varieties. The type under consideration pre- sents its characteristics in a very striking manner. Indeed, so great is the difference between intermittent and other fevers, that some writers have withdrawn it from the list of febrile diseases, and ranked it with those connected with derangement of the cerebro- spinal system. The regularity and distinctness of the paroxysms, and the complete state of apyrexia between the periods of attack, certainly offer some reason for this course ; but, on the other hand, as the combina- tion of symptoms termed fever, is universally present during the paroxysms} and since upon the whole it bears a closer resemblance to febrile than neuralgic, or ganglionic affections, we shall continue to adopt the old classification. In the different forms of intermittent fever, the in- terval which elapses between the commencement of one paroxysm and another, varies ; some cases hav- ing an interval of 24, some 48, and others 72 hours from one attack to another. From this circumstance the different types have been designated—quotidian, or 24 hour type ; tertian, or 48 hour type ; quartan, or 72 hour type. These have also been subdivided into double quartan, double tertian, &c. Diagnosis. A paroxysm of intermittent fever is composed of three stages, viz.: first, the cold; sec- ond the hot ; third, the sweating stages. Preceding the cold stage, there usually occur gen- eral feelings of lassitude, debility, uneasiness, and pains in the head, back, or loins, and sometimes slight sensations of external or internal cold. There is also a loss of appetite, disinclination to bodily or mental exertion, and a constant disposition to stretch or yawn. 142 INTERMITTENT FEVER. As the cold stage actually commences, the extremi- ties feel cold and contracted ; the surface becomes pale, shrunken, rough, with diminished sensibility; a sensation of cold along the spine, extending into the thorax and abdomen ; the coldness soon diffuses itself throughout the whole body ; universal tremors, exter- nal and internal; chattering of the teeth ; respiration laborious, rapid, and imperfect ; oppression at the praecordia; countenance pale, leaden, earthy, or livid, shrunken, and expressive of anguish ; eyes dull and sunken; lips livid ; general sense of physical and men- tal prostration. The pulse is variable : it may be slow, rapid, weak, oppressed, or intermitting. The temperature of the body is usually natural, with the exception of the extremities. The duration of this stage is exceedingly various ; sometimes terminating in ten minutes, at other times, lasting four or five hours. Paroxysms occasionally occur without any well marked cold stage, a slight trembling only being ex- perienced previous to the hot stage; at other times neuralgic or rheumatic pains, or coma, precede the second stage. Hot Stage. As soon as the chills begin to abate, flushes of heat commence passing over the body, until, in a short time, the hot stage is fully developed. This stage is characterized by hot and dry skin ; countenance flushed and full; mouth dry, tongue parched; urgent thirst; headache; respiration rapid and anxious ; general restlessness ; pains in different parts of the body; more or less disturbance of the mind; pulse usually rapid, sharp, and bounding. This stage also varies very much in duration, it rarely terminating in less than four, and often con- tinuing twelve, and sixteen hours. In some instances the hot stage even continues several days, when it be- comes a continued fever; or it may assume the remit- tent form. Sweating Stage. After the hot stage has run its course, a perspiration makes its appearance upon the forehead and extremities, which is soon diffused over the whole body. As the sweating becomes more and INTERMITTENT FEVER. 143 more profuse, the febrile symptoms, with the pains and uneasy sensations, gradually subside, until the parox- ysm terminates in a perfect state of apyrexia or con- valescence. The above is a general description of the ordinary course of an intermittent paroxysm; but in some in- stances these stages are reversed, or one or more of them may be absent, or if present, only a few of the symptoms enumerated will be recognised. Writers have divided intermittents into four va- rieties, viz., first, the inflammatory; second, the con- gestive ; third, the gastric ; fourth, the malignant inter- mittents. This division is made from the fact that the differ- ent types, under certain circumstances, partake of the general character which these terms indicate. Thus, the inflammatory variety generally occurs dur- ing the winter and spring. Quotidians are more prone to partake of this modification than tertians or quartans. Patients labouring under this variety, rarely enjoy perfect intermissions between the parox- ysms, and they are often left with permanent dis- orders of the liver, lungs, &c. The congestive variety is very uncommon. It sel- dom attacks any except those of feeble, relaxed, and exhausted constitutions, in whom there is not suffi- cient vigour to accomplish a perfect reaction. The brain is the organ which usually suffers most, and coma often supervenes during the cold stage, which ends in death. The gastric variety presents prominent symptoms of gastric derangement from the first, a superabun- dance of the biliary secretion, furred and bitter tongue, with nausea and vomiting. It is peculiar to temperate latitudes, and usually occurs in the au- tumn. In this variety the liver is much affected, and therefore we find chronic enlargements of this organ often remaining after the paroxysms have been subdued. The malignant intermittents are peculiar to hot la- titudes. They are attended with extreme debility from the onset; respiration is feebly and imperfectly performed, the blood is only partially oxygenated, diarrhoea now and then ensues, and a rapid prostra- 144 INTERMITTENT FEVER. tion of the powers of the system usually occurs, which, in many instances, speedily proves fatal. It has been noticed that chronic enlargements and indurations of the liver and spleen, affections of the lungs, dyspepsia, scirrhous indurations, &c, often suc- ceed fever and ague. These affections have been looked upon as secondary consequences of the fever, while, in point of fact, they are medicinal diseases, superinduced by the abuse of mercury and bark. These drugs are empyrically employed by the allo- path, for the cure of this malady in all its various forms: Whether inflammatory symptoms predomi- nate, whether there is congestion of the brain, lungs, or liver, or whether the system is exhausted by pre- vious debilitating causes, quinine and calomel in large doses are the grand, and we might almost say, the only remedies of allopathy. But do these violent drugs actually cure the malady ? When the parox- ysms are arrested by the use of these herculean closes, are the seeds of the disease eradicated, and is there no danger of a relapse ? Let the candid prac- titioner of the old school answer. It is the opinion even of some eminent allopaths, that large doses of quinine often suspend chills and fever, by superinducing in the liver or some other important viscus, a serious medicinal inflammation or congestion which usurps, temporarily, the place of the intermittent. The effect of this truly allopathic measure is, however, only of short duration, for the paroxysms return again as soon as the artificial dis- ease has somewhat abated, or from some slight ex- citing cause. Thus will the paroxysms repeatedly return, and be as often temporarily suspended, until finally some permanent chronic malady will become fastened upon the system and thus supersede the ori- ginal affection. Is there a man in existence sufficiently robust to swallow with impunity the quantities of antimony, calomel, bark and quinine, which are usually pre- scribed by the old school in fever and ague ? Must not some part of the organism necessarily succumb before such formidable quantities of powerful medi- cines ? Let the stoutest allopath presume to try the IN l'ERMITTENT FEVER. 145 experiment upon his own person, and if he escapes without inflammation of the stomach and intestines, serious disease of the liver, lungs, spleen, or some other organ, we will confess our error, and say that large doses of quinine are innocent and harmless, and that the preparations of mercury are manageable, mild, and safe, when admitted into the human stom- ach. Causes.—The most common cause of intermittent fever is a peculiar miasm which arises during the progress of vegetable decomposition, and which some authors have termed koino miasmata. The term marsh miasm is often used, but we deem it improper, as the miasms generated in elevated locations, are as capable of causing the disease, as those formed in low and marshy ground. The decomposition of vegetable matters, by the aid of solar heat and moisture, is the only condition requisite to develop the morbific prin- ciple. Other causes occasionally give rise to fever and ague, as intestinal irritation from indigestible food, and worms, sudden suppression of old discharges, and atmospheric vicissitudes. Therapeutics.—The remedies most commonly made use of in this malady, are china and arsenicum. The following will also be found appropriate in many in- stances :—ipecacuanha, bryonia, eupatorium, perfoli- atum, nux vomica, veratrum alb., belladonna, carbo veg., pulsatilla, antimonium crud., ignatia, cocculus, la- chesis, sabadilla, sulphur, cina, natrum mur., capsi- cum. China.—External indications.—Yellowish colour of the skin and face ; during the chill and heat, redness of the face, and distention of the veins of the face and head. " During the chill, bilious vomiting ; palpita- tion of the heart; short cough."—{Hartlaub). "Du- ring the intermission, yellowish, clay-coloured counte- nance ; weak eyes ; fulness of the abdomen ; cough ; anasarca. In tertian fever, with thick, brown, yellow- coated tongue: countenance palish yellow during the paroxysm and intermission ; swelling in the re- gion of the spleen ; eyes red and sensitive."—(Knorre.) Quotidian fevers, with pale countenance : cold and 7 146 INTERMITTENT FEVER. pale hands and feet, and retching up of mucus during the chill; while during the fever there are, red face, full quick pulse, dry spasmodic cough. Physical Sensations.—Paroxysm preceded by palpi- tation of the heart, sneezing, anguish, nausea, thirst, bulimia, headache and colic. Thirst before and after the shiverings, or during the sweating stage ; coldness of the body, with congestion to the head ; soreness in the region of the liver; easy perspiration during sleep, or when moving ; short cough ; for the most part no thirst during the cold or hot stages. Hartlaub has cured chills, external or internal, without thirst, followed by heat with thirst; and followed, or not, by sweat; or chills in some parts of the body, with shuddering and heat in the head, terminating in fever, intermingled with chill?, attended with thirst and followed by sweat; or no chills, but fever with urgent thirst, and afterwards with perspiration. Hart- raann advises china, when we have during the pa- roxysm throbbing pain in the head, extending to the orbits; vertigo; nausea; pain in the region of the liver ; sharp pain in the chest; short cough; aching pain in the abdomen during the chill; pains in the loins and legs. During the intermission, confu- sion of the head ; transient vertigo ; variable appe- tite ; thirst; drowsiness after meals ; uneasy sensa- tion in the pit of the stomach ; nausea; constipation ; general debility. Knorre has cured the quotidian type, with vertigo; pale and cold hands and feet, and retching of mucus, during the chill; and pains in the head, both sides, and pit of the stomach ; dry and jarring cough, and drowsiness during the fever, which is protracted and violent. Also, tertian fevers, with violent chills, heat, and thirst, followed by per- spiration. During the paroxysm and intermission, there were bitter taste, eructations, and vomiting ; aching pains in the pit of the stomach, and in the re- gion of the spleen ; yellow and sickly aspect. Also in tertian fever, when the chill is short and slight, but followed by violent aching pain in the forehead, in the right temple, and around the right eye ; general heat; intense thirst; eyes hot, painful, and sensitive to the light; paroxysm commences in the forenoon, INTERMITTENT FEVER. 147 lasts until evening, and is succeeded by perspiration during the night. Mental and moral symptoms.— Confusion of ideas and drowsiness during the paroxysm and intermission ; anxiety ; discouragement; great activity of the mind ; sometimes delirium. Administration.—One drop of the third dilution in a teaspoonful of water, may be given previous to the chill, and during the forming stage. Should this prove insufficient to remove the symptoms, the dose may be repeated every four hours during the inter- missions. Arsenicum.—External indications.—Face puffed and earthy ; or countenance anxious, sunken, and of a yel- low tint; pendiculations and drawing in the limbs during the cold stage ; pungent and burning feel of the skin during the fever ; dropsical swellings ; trem- bling of the limbs during the sweating stage ; pulse irregular, or quick, weak, small, and frequent, or sup- pressed and trembling; tongue bluish, white, or bright red ; diminished urine; night-sweats; face red during the fever, but pale and sunken during the intermission. Physical sensations.—Aggravation of existing symp- toms just previous to, or during the attack; paroxysms imperfectly developed ; chills and heat alternating ; periods of attack regular, and generally in the morn- ing or evening ; burning thirst, or adypsia ; fever of either type; burning in the stomach, sharp pains in the limbs, chest, back and head, during the heat, with difficulty of breathing ; during the sweating stage, heaviness of the head, buzzing and ringing in the ears; between the cold and hot stage, drowsiness, languor, thirst, nausea, vomiting and hiccup ; sweats during sleep, or on waking in the morning. Dr. Watzke has cured chills and thirst, followed by high fever, urgent thirst, dizziness, confusion in the head, and, finally, profuse perspiration without thirst. During the apyrexia, pains in the chest and head ; weakness and faintness; small appetite; abdomen swollen, and affected with occasional colic pains. Dr. Hartlaub has cured chills without thirst, followed by- fever with or without thirst, and then by perspiration : 148 INTERMITTENT FEVER. before the chill, vertigo; fainting; pains in the side, chest, abdomen and back ; stretching and yawning : during the chill, anxiety; pains in the head, back, limbs, and pit of the stomach; stretching and yawn- ing ; prostration ; nausea ; vomiting ; coldness of the abdomen, oppression of the chest: during the fever, delirium ; pain in the head ; vertigo on rising; nausea ; bitter taste ; aching pain in the region of the liver ; aching and burning, extending from the pit of the stomach to the left hypochondrium ; oppression of the chest: during the intermission, pale countenance; white tongue; swelling of the hypochondrium and abdomen ; cold, clammy sweat; throbbing pain in the forehead ; thirst; no appetite; nausea ; extreme de- bility ; pains in the head, chest, back, and limbs. Mental and moral symptoms.—Depression of spirits, and irritability previous to the attack ; anxiety, un- easiness, confusion of ideas, which gradually increase until the sweating commences ; occasionally delirium during the hot stage. Administration.—Two drops of the sixth dilution in an ounce of water,—a dessert spoonful once in six hours during the apyrexia, until the symptoms have disappeared. One dose of this remedy will often prove successful where allopathic doses of crude cin- chona, and other articles, have produced no effect. I have, in two instances, succeeded in curing cases which have resisted the old school method for months, with a single drop of the thirtieth attenuation. Remarks.—Arsenicum is appropriate in any type of fever and ague, provided the symptoms correspond, although several authors especially commend it in the tertian and quartan forms. Fleischmann employs from the third to the sixth attenuation; Watzke generally gives the second, third and fourth dilutions. Unless the patient is unusually susceptible, we prefer the third to the sixth. Ipecacuanha.—External indications.—Before the shiverings, uneasiness, stretching and lassitude, with cold sweat on the forehead ; tongue clean or loaded ; during the apyrexia, countenance pale or yellowish. Physical sensations.—Slight chills, followed by much heat; or, severe chills with little heat; aggravation INTERMITTENT FEVER. 149 of the rigours from external heat; thirst only during the chill; nausea, vomiting, and other signs of gas- tric disturbance, manifest during the heat; also, con- striction of the chest. Watzke advises ipecac, when the chills are attended with thirst, confusion of ideas, and dull pains in the head ; the hot stage, with thirst, and sharp pains in the head ; the sweating stage, with but little or no thirst; the apyrexia, with want of ap- petite, bitter taste, oppression at stomach, and pale face. Hartlaub has cured slight and short chills, without thirst, followed with violent fever with thirst, and succeeded by profuse perspiration, or without perspiration. Before the chill, pain in the back: during the paroxysm, headache, dulness of intellect, gastric derangement, nausea and vomiting, oppression, contraction, pain in the chest, and cough : during the intermission, bitter taste of food, much saliva, loss of appetite, vomiting after eating, lassitude, sleepless- ness. Mental and moral symptoms.—Before the chill, dul- ness of intellect and sleeplessness : during the chill, confusion of ideas, irritability, impatience, and indis- position to mental effort. Administration.—Same as china. Remarks.—This remedy has been most frequently used in fevers of the quotidian and tertian types. Lo- bethal, Hartmann, Boenninghausen, Schmid, Fleisch- mann, Watzke, Madden, Trinks, Elwert and Rummel, have expressed themselves strongly in favour of the low dilutions of ipecac, in this disease. Bryonia.—External indications.—During the shiver- ings, trembling and redness of the face : during the heat, nausea, and tendency to keep the recumbent posture : during the sweating period, frequent sighing and cough. Physical sensations.—Preceding the cold stage, ver- tigo, headache, and lassitude ; first stage, ushered in with severe chills and trembling, with heat in the head; chilly stage, more violent than the hot, or, slight but protracted chills, and some thirst; second stage, ushered in with flushes of heat and slight chills, in alternation in the first instance, afterwards burn- ing heat and thirst; universal dry heat, external and 150 INTERMITTENT FEVER. internal; spasmodic cough ; vertigo and headache during the fever ; shooting pains in the side and ab- domen ; after the heat, profuse sweat; oppression in the chest, with dry cough; tendency to sweat night and morning ; during the apyrexia, constipation, thirst, unhealthy yellowish complexion, and night sweats. Mental and moral symptoms.—Irascibility, and dis- position to look on the dark side of affairs. Administration.—Two drops of the third dilution in an ounce of water,—a dessert spoonful two or three times during the apyrexy. Eupatorium perfoliatum.—This is a remedy which we have found highly serviceable in many cases which have been complicated by the abuse of calo- mel and quinine. It is particularly indicated when the liver is much implicated. An intelligent friend of mine, who resides at the West, in a fever and ague district, informs me that he has for many years past made use of a very small quantity of an exceedingly weak infusion of this agent, as a prophylactic against the disease, in his own family, and with complete success. He also assures me, that he has often cured with astonishing facility, cases which had baffled for months the ordinary treatment, with a dose or two of an infusion very slightly bitter. The external indications are, yellow tinge of the skin and eyes ; eyes dull, heavy and sunken ; lips pale or bluish, dry and cracked. Physical sensations.—Irregular development of the paroxysms ; frequent slight chills previous to the com- mencement of the first stage ; partial chills in the back and extremities; dizziness, heaviness and ringing in the head, during the cold stage ; hot stage ushered in with slight chills, alternating with flushes of heat, un- til in a short time the heat becomes general, attended with headache, nausea, vomiting, pains in the chest and stomach; pains in the bones ; tenderness of the ab- domen on pressure ; loss of appetite ; sensation of fa- tigue, languor and debility ; constant inclination to sleep; nocturnal sweats. Dr. Williamson advises eupatorium in the quotidvm andtertian types, when the following symptoms are pre- sent : paroxysm commencing in the morning; thirst INTERMITTENT FEVER. 151 several hours before the chill, continuing during the chill and heat; stiffness of the fingers during the chill; soreness in the bones ; aching pain with moaning, throughout the cold stage; a greater amount of shi- vering during the chill than is warranted by the de- gree of coldness ; retching and vomiting of bile from drinking ; vomiting after every draught; vomiting at the conclusion of the chill ; distressing pain in the scorbiculus cordis throughout the chill and heat; chill beginning at nine o'clock in the morning; throbbing headache during the chili and heat; violent pain in the head and back before the chill; inconsiderable perspiration, or none at all; fever in the forenoon, pre- ceded by thirst early in the morning, but no chill; at- tended by fatiguing cough and not followed by sweat; loose cough in the intermission ; cough in the night previous to the paroxysm ; yellowness of the skin. Mental and moral symptoms.—During the paroxysm, confusion of ideas and ringing in the ears ; discourage- ment ; indifference to life; dull of conception, and discontented during the apyrexy. Administration.—One drop of the first dilution in a spoonful of water, during the apyrexy. As a prophy- lactic against intermittents, one drop of the tincture two or three times a week. Nux vomica.—External indications.— During the chills, skin, hands, feet, face and nails are cold and bluish ; redness of one or both cheeks ; spasmodic con- tractions in the limbs; yawnings and stretchings. Sweat profuse, sometimes with a disagreeable acid smell ; partial or one-sided sweat; pulse hard, full and frequent, or small, quick, or feeble, or intermittent; dryness of the lips ; tongue coated white or yellow. Physical sensations.—First stage preceded by exter- nal and internal cold and yawning ; chills usually at night, or in the morning; aggravated by motion, drink- ing, or excitement; pain and heat in the head ; thirst for beer ; pains in the back and loins ; during the hot stage, headache, vertigo, thirst, nausea, pains in the chest; shivering on motion; debility; during the sweating stage the symptoms are mitigated; sweat and chills alternately. Watzke gives us the following indications: chills 152 INTERMITTENT FEVER. with thirst; headache, loss of consciousness, or deli- rium, painful and inflexible limbs, contracted feel of the muscles. Chills last four or five hours, and not followed by heat or perspiration. After the chill, ex- haustion ; pains in the hypochondria from distention ; thirst and want of appetite ; tongue white ; feet swol- len ; sensation of heaviness when walking. Or, chills followed by heat and sweats ; with thirst; anxiety; headache ; slight cough, with burning sensation in the chest, worse during the chills and heat; constipated bowels; loss of appetite ; craving for beer ; weakness and faintness. Hartlaub has cured chills with or without external coldness, and without thirst; follow- ed by fever with thirst, and succeeded or not by per- spiration. The chill may be slight and short, or vio- lent and protracted, with shaking and chattering of the teeth, and blue nails ; fever attended with perspi- ration about the head and neck. Or, shaking chills with thirst, followed by fever with thirst, and by per- spiration ; chill preceded by thirst, coldness increased by drinking. Or, alternating chill and fever ; motion during the fever or sweat causes chills ; during the chill, pain in the back (sacrum) ; during the fever, headache, vertigo, red face, pain in the chest, vomit- ing of water, bile, slime and food ; red urine ; during the intermission, headache; vertigo ; trembling of the head on motion ; pain in the forehead; acid eructa- tions ; bad taste in the mouth, loss of appetite, disgust for food ; much thirst; pain in the pit of the stomach after eating ; distention and pain of the belly ; consti- pation ; pressing at the neck of the bladder after urin- ating; drawing in the limbs; weakness. Hartmann employs it when, at the commencement of the parox- ysm, there are paralytic weakness of the limbs ; dis- ordered stomach; vertigo, and sudden prostration of strength. Mental and moral symptoms.—During the chills, stu- pid or delirious ; during the fever, anxious, melancholy, sad, timid, apprehensive of death. Occasionally mo- nomania during the progress of the disease. Administration.—Two drops of the twelfth dilution in an ounce of water—a dessert spoonful each ni"ht. If a cure is not effected at the end of a week, give a INTERMITTENT FEVER. 153 drop of the first dilution once in six hours, until the symptoms disappear. Remarks.—Nux is particularly applicable to the quo- tidian and tertian types. If the individual has been a hard drinker, or luxurious and sedentary in his habits, the indications are still stronger. Arnica.—External indications.—Inclination to re- main quiet. Physical sensations.—Chills occur in the evening ; thirst; contraction of the features. In the hot stage, pain in the back and limbs; shiverings from the slightest exposure ; the hot and sweating stages slight and of short duration. In the apyrexia, pain in the stomach ; loss of appetite and general appearance of wretchedness and debility. Mental and moral symptoms.—Obstinate ; reckless; quarrelsome. Administration.—My friend Dr. Shue, has been ac- customed to exhibit this remedy in alternation with ipecacuanha, with marked benefit. It may be given at the first attenuation—a few drops every four hours during the apyrexy. Veratrum album.—External indications.—Cold and clammy perspirations on the forehead : shuddering. In the hot stage, coma and red or purplish cheeks ; pulse slow, and almost extinct, or small, quick, and in- termittent ; tongue red and dry. Physical sensations.—General coldness of the whole body ; cold stage of short duration, and attended with shivering; vertigo ; nausea ; pains in the back and loins ; thirst for cold water ; the second stage more protracted, and accompanied with headache ; short dry cough ; fever with external coldness ; urine dark coloured; diarrhoea or constipation ; coma; in the third stage, profuse perspiration, with thirst and drow- siness. Hermann prescribes veratrum, when the chills are followed by sweat, and afterwards coldness. Or, chills alternating with fever, with thirst; vertigo ; nausea, and pain in the back, succeeded by fever with deli- rium ; flushed face, and tendency to sleep. After the paroxysm, morbid appetite. Or, cold stage, without the hot or sweating stage. 7* 154 INTERMITTENT FEVER. Mental and moral symptoms.—In the cold stage, con- fusion of ideas; in the hot stage, coma ; during the apyrexy, restlessness, and sometimes mental alien- ation. Administration.—One drop of the first dilution in an ounce of water—a table spoonful two or three times between the paroxysms. Belladonna.—External indications.—Face pale and bloated during the cold fit: eyes red and injected ; face red ; pulsations of the carotids ; veins of the fore- head swollen ; and some perspiration during the heat. Physical sensations.—Shiverings and heat alternat- ing ; rigours followed by heat; during the fever, burn- ing thirst; headache ; shootings in the temples ; great sensibility to impressions; delirium ; sweat of the parts covered only; stitches in the chest; dimness of sight. Mental and moral symptoms. Quarrelsome and passionate during the paroxysm ; or, great agitation ; mistrustful; constant dread of evil; visions of fright- ful or ludicrous objects ; delirium. Administration.—A drop of the third dilution in water, every four hours between the paroxysms. Carbo veg.—External indications: Before the chill, pale face ; cold feet and hands ; during the fever, red face ; during the intermission, nocturnal sweat; cold sweat on the face and limbs. Physical sensations. — Tertian type, kept up by roused psora ; rigours, preceded by throbbing of the temples; rending in the teeth and bones; and at- tended with thirst and sense of prostration ; hot stage, attended with thirst, or absence of thirst; headache ; vertigo; impaired vision; nausea; pains in the sto- mach and chest ; acid sweats in the morning : in the intermission, paleness ; emaciation; distention of the stomach; headache; loss of appetite; lassitude and disturbed sleep. Mental and moral symptoms.—Anxiety and fear in the evening ; intellect dull. Administration.—One grain of the third trituration in two ounces of water, a tablespoonful once in four hours during the apyrexia. INTERMITTENT FEVER. 155 Remarks.—This remedy was supposed by Hahne- mann to be of especial service, in those old and obsti- nate cases of intermittent fever, which appeared to be connected with a psoric miasm lurking in the system. Hartlaub has found it curative in similar cases. It is adapted to the tertian type. Pulsatilla.—External indications.—Face pale dur- ing the cold stage; face red and bloated in the hot stage, sometimes with sweat on the face ; swelling of the veins; anxious and rapid respiration; eyes dull, and cloudy; inclination to remain in the recumbent posture ; pulse quick and small, or full and slow, or feeble and suppressed; tongue coated, whitish, gray- ish, or yellowish. Physical sensations.—Chills in the evening or af- ternoon ; vertigo, pain and heaviness in the head; sensation of cold from slight exposure; irregular dif- fusion of heat, chiefly in the face, or on one side ; absence of thirst: after the paroxysm, headache, op- pression of the chest, moist cough, bitter taste. Or, according to Lobethal, Hartmann and Watzke, chills without thirst; fever, with thirst, and dull headache; sweating very slight. Or, chills com- mencing with vomiting, with slight thirst during the cold, hot and sweating stages; diarrhoea; loss of ap- petite. Mental and moral symptoms.—During the paroxysm, anxiety ; sadness: taciturn; apprehension ; dread of sudden death: great depression of spirits during the apyrexia. Administration.—Two drops of the first dilution in an ounce of water,—a dessert spoonful three or four times during the apyrexia. Remarks.—When the attacks have been incited by abuse of fat and indigestible food, or are connected with any derangement of the menstrual function, Pul- satilla is appropriate. It has been most frequently- employed in the quartan type. Antimonium crudum.—External indications.—Face and eyes of a yellowish hue ; yellow or whitish fur upon the tongue ; pulse quick or slow. Physical sensations.—Tertian type ; short chills, followed by fever, with pain in the chest and pit of 156 INTERMITTENT FEVER. the stomach; predominance of gastric or bilious symptoms; frequent nausea and vomiting ; bitter taste in the mouth ; thirst; diarrhoea ; distention of the stomach. Mental and moral symptoms.—During the apyrexy, indifference to life; during the paroxysm, peevish; dread of misfortune ; out of humour. Administration.—Two drops of the third dilution in an ounce of water,—a tablespoonful once in six hours during the intermission. Ignatia.—External indications.—During the chill, pale or sunken face ; bilious vomiting: during the second stage, pale face, or one cheek red and the other pale: during the intermission, lips dry and cracked; countenance pale ; hard, dry stools ; nettle- rash ; pulse variable ; tongue white. Physical sensations.—Rigours, with thirst for cold water ; nausea and vomiting; pain in the back and limbs ; oppression at the chest; loose, short cough ; coldness, relieved by external heat; heat general during the second stage ; vertigo; headache ; pain in the back and limbs ; drowsy ; absence of thirst during the hot and sweating period ; during the intermission, pressing and shooting pains in the head, back, and limbs ; loss of appetite. Mental and moral symptoms.—Occasional^ delirious during the fever; suppressed grief, with sighing; timid, sad, irresolute, and inclined to weep during the apyrexy. Administration.—Same as belladonna. Cocculus.—External indications.—Trembling during the first stage ; redness of the cheeks during the heat; pulse full, hard and frequent; tongue clean or loaded. Physical sensations.—Transient chills ; skin hot to the touch, in the first stage; burning heat in the cheeks; cramps in the loins and stomach, and but slight fever in the second stage ; apyrexy, accompa- nied with vertigo; dull pain in the head, and general debility. Mental and moral symptoms.—Apprehension of ap- proaching evil ; fear of death, during the paroxysm ; sadness and discouragement during the apyrexy. Administration.—Two drops of the third dilution, in INTERMITTENT FEVER. 157 an ounce of water—a tablespoonful every four hours between the paroxysms. Lachesis.—External indications.—Face pale, or lead- en, discoloured or yellowish, during the cold stage and the intermission ; red spots on the cheeks while the fever is on ; blue circle round the eyes ; red swelling of the face ; agitation and tossing in the cold and hot stages; pulse intermittent, or feeble and frequent; tongue dry in the second stage. Physical sensations.—Most of the time, icy coldness of the limbs ; rigours only partial; pains in the limbs ; fever at night or in the evening, with headache and great debility; oppression at the chest; severe pains in the limbs; thirst, and sometimes bilious vomiting. Mental and moral symptoms.—In the apyrexy, melan- • choly, violent jealousy; weakness of memory : during the paroxysm, delirium; loquacity ; irritability. Administration.—One grain of the third trituration in two ounces of water—a dessert spoonful every twelve hours until the desired effect is obtained. Sabadilla.—External indications.—In the cold stage, trembling of the limbs, spasmodic cough: in the hot stage, yawning and stretching; pulse variable; tongue natural. Physical sensations.—The different stages imper- fectly developed; external coldness with shivering; dry cough, pains in the chest, limbs and bones in the first stage : during the apyrexia, dull pains, with sense of fatigue. Menial and moral symptoms.—During the paroxysm, inability to collect or arrange the thoughts ; delusions of the imagination with respect to oneself; delirium. Remarks.—This remedy is useful when the malady has been preceded for some time by gastric derange- ment, or in cases complicated by abuse of quinine. Administration.—Same as veratrum. Sulphur.—External indications.—Countenance pale or hot during the first stage ; circumscribed redness of the cheeks during the second stage ; sweat upon the head, face, and hands; eruptions or scabs upon the face, hands, or limbs ; pulse hard, full and quick ; tongue natural. Physical sensations.—Previous to the first stage, 158 INTERMITTENT FEVER. thirst and lassitude ; chilliness in the evening or at night, and sometimes in the afternoon ; shiverings in the back, chest and arms, with coldness of the hands, feet and nose ; heat attended with thirst; burning sensation in the hands and feet; bruised and tired feelings in the limbs ; palpitation of the heart; per- spiration easily excited in the head, neck, hands, &c. Mental and moral symptoms.—In the apyrexy, sad- ness, with frequent inclination to weep; during the paroxysm, irritable and peevish ; thoughts incline to religious subjects. Administration.—One grain of the first trituration in four parts—a powder every twelve or twenty-four hours until decided amendment or aggravation of symptoms ensue. Remarks.—Sulphur has most often been employed* in the quotidian type. In many cases of fever and ague occurring in psoric subjects, it will also prove eminently serviceable. Cina.—Hermann and Gross have found cina cura- tive when during the paroxysm there are, pale coun- tenance ; canine appetite; headache; nausea; foul breath : during the intermission, cold surface ; morbid appetite ; lassitude ; occasional sweats. Hartlaub advises capsicim in chills with thirst; headache ; mucous vomiting; flow of saliva; great and painful swelling of the spleen; rending pains in the back, loins, and knees ; yawning and stretching ; fever, with or without thirst; headache ; bad taste ; cutting pains in the belly ; pains in the chest, back, and legs; after the fever, slight or profuse sweat; in the inter- mission, ash-coloured countenance ; swelling of the spleen and the feet; constant chilliness and coldness : drawing pains in different parts when in the air ; useful in relapses after abuse of quinine. The same writer commends natrum mur, in chills with little or no thirst; sharp pains in the forehead, back, and bones : short breath ; yawning and sleepi- ness, followed by fever, with great thirst; severe rending or throbbing pains in the head and forehead; in the intermission, yellowish face; white tongue; hard and scanty stools ; swollen stomach ; headache ; weak eves ; bitter taste ; no appetite ; great thirst; YELLOW FEVER. 159 pit of the stomach painful to the touch ; sleepy in the day time, but sleepless at night; lassitude and debili- ty. It also cures tertian and quotidian types, with mills only. Administration.—A drop of the first dilution once in lour hours between the paroxysms. CHAPTER XVI. YELLOW FEVER. This fever is exceedingly uncertain in its course, vio- lence, and duration. It may strike its victim suddenly prostrate, overwhelming in its severity the whole sys- tem, and thus preventing a single rally of the circula- tory vessels ; or it may advance mildly, differing but little from an ordinary attack of remitting fever. In some instances it bears a strong resemblance to the higher grades of bilious fever. Much depends upon the peculiar circumstances of the individual attacked. If he is recently from a temperate climate, and unac- customed to hot regions, he will be more susceptible to the action of the poison than if he had been pre- viously acclimated. Medical men have supposed that after a certain period of exposure, the system becomes so completely accustomed to the miasm, that it loses all suscepti- bility to its influence, and in this manner the process of acclimation is accomplished. There is doubtless some truth in this idea, but there are other causes which exercise quite as important an influence in this process. Those persons who abandon a temperate for a residence in a tropical climate, do so in that physi- cal condition which the requirements, habits, and re- gimen of the former naturally generate. In a previous chapter we have seen, that in cold regions, where the atmosphere is highly condensed, a large amount of animal food is requisite to supply the system with suffi- cient carbon and hydrogen to resist and neutralize the 160 YELLOW FEVER. action of the inspired oxygen. With these habits, appropriate only where a condensed atmosphere is re- spired, individuals seek the tropics, with bodies abound- ing in carbon, and continuing, in most instances, their accustomed regimen of animal food and stimulants, thus burdening their systems with an amount of the elements of nutrition far greater than the oxygen con- tained in the rarefied air which they inhale can de- compose. It is probable, therefore, that one of the chief predis- posing causes of yellow fever, is the presence of a greater amount of carbon in the system than the in- spired air can properly act upon. The exact equili- brium between the supply of the elements of the food and the absorbed oxygen, is disturbed ; the carbon pre- dominates, and all of those derangements which pro- ceed from a superabundance of this agent, necessarily ensue. The inhabitants of tropical latitudes have compara- tively but little desire for animal food, but prefer fari- naceous diet, vegetables and fruits: in this manner naturally securing to themselves a due proportion be- tween the elements assimilated and the oxygen ab- sorbed ; while the inhabitants of the north find it ne- cessary to consume large quantities of meat and other articles abounding in the elements of nutrition, in order to preserve a healthy equilibrium. We therefore most strongly urge it upon those who remove from cold to hot climates, to adapt their systems by appropriate regimen, and strict temperance in all things, for the change, and we confidently predict that they will en- joy as great an immunity from this dreadful scourge, as the natives themselves. Diagnosis. The premonitory symptoms of yellow fever are giddiness, wandering pains in the back and limbs, slight chills, nausea, and frequent sensations of faintness. After these symptoms have continued a few hours, a decided reaction occurs : the circulation becomes excited, the face flushed, the eyes red, there are vio- lent pains in the head, back, loins, and extremities, distress of stomach, and vomiting of acid bilious mat- ters, the surface becomes dry and burning hot, mouth YELLOW FEVER. 161 and throat dry, with intense thirst, and sometimes de- lirium. The duration of this paroxysm is usually about twenty-four hours, although occasionally it continues two or three days, after which there is a remission of all the symptoms, except a distressed sensation in the stomach, with nausea and vomiting. The patient re- mains in this state with a considerable degree of com- fort for a few hours, when there is a recurrence of many of the former symptoms in an aggravated form. The stomach now becomes extremely- painful and sen- sitive, vomiting is violent and incessant, the fluids ejected are of a darker colour, the skin and eyes ac- quire a yellow tinge, and the mind becomes confused and wandering. The duration of this second stage varies from twelve to forty-eight hours, with sometimes slight remissions towards the termination of the paroxysm, when the third or last stage sets in. This stage is character- ized by the complete development of the dreaded " black vomit." At this period, the powers of the sys- tem all sink rapidly ; the pulse flags, and perhaps in- termits ; the tongue becomes dry, black and shrivelled ; the breathing irregular and laborious ; cramps seize the calves of the legs and the bowels; the whole counte- nance loses its natural, lifelike expression ; the extrem- ities become cold; colliquative sweats, diarrhoea, haemorrhages, and loss of intellect occur, and, finally, dissolution ends the scene. This is only a brief outline of the more ordinary symptoms and course of the malady, and will, we trust, serve to aid the inexperienced practitioner in his diagnosis. Each case, however, must necessarily present modifications according to the predisposition, habits, and peculiar circumstances of the individual attacked. Causes.—When animal and vegetable matters are submitted, for a considerable length of time, to the daily influence of intense solar heat, and a certain amount of moisture in the crowded and filthy streets of cities, or other confined places, a miasm is gene- rated, which, under favourable circumstances, will cause yellow fever. Concerning the nature of this 162 YELLOW FEVER. miasm we know nothing ; but it is evident, that the continued high degree of temperature to which these substances are exposed, and the confinement of their noxious emanations within the walls of crowded cities developes a more virulent morbific agent than is the case when the same matters are exposed in the open country, or to a more irregular and less intense heat, such as usually occurs in more temperate localities. There are several other causes which act as pow- erful predisposing influences, one of the most impor- tant of which, as before mentioned, is the too free use of animal food and stimulants. We may also include in this category, irregular habits, mental anxiety, de- pression of spirits, fear, grief, exposure to night air or to a burning sun, and, indeed, whatever else tends to debilitate the organism. Therapeutics.—The remedies most commonly appli- cable to the treatment of this affection are, ipecacu- anha, belladonna, bryonia, rhus, arsenicum, and aconite. The other medicines likely to prove serviceable are, nux vomica, mercurius, veratrum, china, sulphur, can- tharides, carbo veg., and crotalus. The late and much lamented Dr. Taft, of New Orleans, was eminently successful in his treatment of the yellow fever as it occurred in that city. Sometime since, we had the pleasure of perusing a letter from a highly intelligent gentleman of New Orleans, in which he states, that the success of Dr. T. was so great in this malady, as to attract the marked attention of a large number of citizens ; and the writer expresses a deliberate opin- ion, that a new and favourable era would soon have occurred in the management of this formidable affec- tion, if the able and accomplished Taft had survived. The remedies which this physician found most suc- cessful, and upon which he chiefly relied, were aconite, ipecacuanha, belladonna, and bryonia, in the first, and sometimes second stages ; in the second and third stages, in addition to the above, rhus tox., arsen- icum, veratrum, cantharides, carbo veg., nux vom. These medicines were usually employed at the first attenu- ation, and frequently repeated, either singly or in al- ternation, as the circumstances of each case appeared to require. YELLOW FEVER. 163 When the first symptoms declare themselves, as dizziness, slight chills, pains in the back and limbs, uneasy sensations at the epigastrium, with nausea, vomiting, and sensation of faintness, ipecacuanha, at the third attenuation, should be immediately exhibited. This remedy may also be found serviceable during the second and third stages, in alternation with some other article. Should the malady continue to pro- gress, the following medicines should be considered, and, in proper cases, promptly administered. Belladonna.—External indications.—Glowing red- ness and bloated appearance of the face ; eyes red and sparkling, or fixed, glistening, and prominent; tongue loaded with whitish mucus, or yellowish, or brownish ; pulse variable. Physical sensations.—Dry burning heat; sharp, dart- ing and shooting pains in the head ; violent throbbings in the head ; burning thirst; painful heaviness and cramp-like pains in the back, loins, and legs ; pressure, cramp-like, and contractive pains in the stomach ; in- clination to vomit, or violent vomitings. Mental and moral symptoms.—During the remission, melancholy; dejection: when reaction comes on, great agitation, with continual tossing and anguish. Administration.—Belladonna is for the most part ap- plicable to the first stage of yellow fever. One drop of the third potency may be given once in one, two, three, or four hours, according to the violence of the symptoms. Bryonia.—External indications.—Skin yellow ; eyes red, or dull and glassy, or sparkling and filled with tears ; tongue dry, and loaded with a white or yellow coating: pulse rapid, and full, or weak and rapid. Physical sensations.—Severe pain and burning sen- sation in the stomach ; vomiting, particularly after drinking; burning thirst; pains in the back and limbs; headache aggravated by movement; eyes painful on motion ; sense of fulness and oppression in the stomach and intestines. Mental and moral symptoms.—Anxiety, with dread and apprehension respecting the future ; loss of memo- ry ; delirium. Administration.—Two drops of the first dilution in 164 YELLOW FEVER. » an ounce of water,—a dessert spoonful every two hours until an impression is produced. Rhus.—External inelications.—Surface of a dirty yel- low colour; eyes glazed and sunken ; tongue dry and black; lips dry and brownish ; pulse quick and small; loquacious delirium, or coma with stertorous breath- ing ; constant moaning. Physical sensations.—Distressing pain and burning in the stomach ; nausea and vomiting ; paralysis of the lower extremities ; spasms in the abdomen ; want of power over the abdominal muscles; colic; diar- rhoea ; difficulty in deglutition, and pain on swallowing. Menial and moral symptoms.—Intellect dull and clouded ; constant uneasiness ; delirium. Administration.—Two drops of the third dilution in an ounce of water,—a dessert spoonful at a dose, and repeated as the symptoms require. In cases where this dilution is not sufficiently prompt or active, the first dilution may be substituted in drop doses. Arsenicum.—External indications.—Face of a yel- lowish or bluish colour ; eyes dull and sunken, with a dark mark under them; sclerotica yellow; nose pointed ; coldness of the body, with cold and clammy sweat ; lips and tongue brown or black ; colliquative sweats; pulse irregular, or quick, weak, small and frequent, or suppressed and trembling. Physical sensations.—Sense of extreme debility ; dull, throbbing, stunning, or shooting pains in the head ; burning or sharp and darting in the epigastrium, or in the region of the liver ; limbs feel stiff and use- less ; frequent evacuations, with tenesmus, or painless and involuntary ; oppression at the chest, with rapid and anxious respiration ; cramps in the calves of the legs; great oppression at the stomach, with violent vomiting, especially after drinking; drawing and cramp-like pains in the abdomen ; sensation as if a weight was pressing upon the abdomen. Mental and moral symptoms.—Indifference; weak- ness of memory ; stupidity ; delirium, with great flow of ideas; loss of consciousness and of sense ; raving. Administration.—In urgent cases, a drop of the third dilution may be exhibited every half hour, until some change is produced in the symptoms. In less danger- YELLOW FEVER. 165 ous instances, the intervals of administration may be lengthened as circumstances require. Aconite.—External indications.—Suitable in the first and second stages, when there are burning and dry skin ; red cheeks ; full and rapid pulse ; red and sen- sitive eyes ; tongue natural or covered with a whitish slimy coat; lips and mouth dry ; vomiting of mucus and bile ; urine dark red. Physical sensations.—Violent febrile reaction ; sen- sation of intense heat; great thirst; acute pains in the temples, forehead, or on one side of the head ; ver- tigo on rising, eyes weak and sensitive to light; pains and soreness in the back and limbs; nausea; general sense of debility; great heat and irritability of the stomach ; short and anxious respiration. Mental and moral symptoms.—When the fever is on, great anguish, anxiety, and restlessness ; for the most part nightly delirium. Administration.—A drop of the first dilution may be given in water every two hours, until the active febrile symptoms abate. Aconite and belladonna may some- times be alternated with benefit in the first period of the disease. Remarks.—In a majority of cases, a few doses of this remedy will be found indispensable, during the first reaction. This corresponds with the experience of several physicians with whom we have communi- cated upon the subject, and whose opportunities of observation have been ample. Dr. Hempel thinks it probable that aconite is the only specific for this dis- ease. Nux vomica.—External indications.—Skin yellow ; face pale or yellowish, especially round the nose and mouth ; lower part of the sclerotica yellow ; eyes in- flamed with redness of the conjunctiva ; eyes surround- ed with a dark circle and full of tears ; tongue with a thick white or yellow fur, or dry, cracked, and brown, with red edges ; pulse variable. Physical sensations.—Burning pains in the stomach ; pressure or cramp-like pains in the epigastrium ; vom- iting of acid, bilious, or mucous matters ; frequent and violent hiccough ; eyes sensitive to light; vertigo, or pains in the head ; tremours of the limbs : cramps in 166 YELLOW FEVER. different parts ; thirst for beer, brandy, or some stimu- lant ; contraction of the abdominal muscles ; loose dis- charges of slimy or bilious matters or blood ; burning pains at the neck of the bladder, with difficulty in urinating ; coldness, paralysis, and cramps in the legs ; feet benumbed and cramped. Mental and moral symptoms.—Excessive anxiety, un- easiness, fear of death; despair, or loss of conscious- ness and delirium, with moaning or muttering. Administration.—Two drops of the third dilution in an ounce of water,—a dessert spoonful once in from two to six hours. Mercurius.—External indications.—Yellow colour of the skin ; eyes red, blood vessels of sclerotica inject- ed ; eyes sensitive to light; paralysis of one or more limbs; tongue with moist thick white fur, or dry and brown mucus; faeces variable; pulse irregular, or quick, strong, and intermittent, or weak and trem- bling. Physical sensations.—Excessive inclination to sleep, or restlessness from nervous irritation ; sense of fatigue and debility; rapid loss of strength ; dizziness, or vio- lent pain in the head; violent convulsive vomiting of mucous and bilious matters ; burning pain and tender- ness of the stomach; constipation, or diarrhoea with discharges of mucus, bile, or blood; coldness of the arms and legs, with cramps ; excitability and sensi- bility of all the organs. Mental and moral symptoms.—Anguish and agita- tion; weakness of memory ; apprehensions; discour- agement ; moroseness ; raving. Administration—A grain of the third trituration in an ounce of water—a dessert spoonful every two, four or six hours. Veratrum alb. External indications.—Face of a yel- lowish or bluish colour, cold and covered with cold perspiration ; eyes dull, clouded, yellowish and wa- tery ; lips and tongue dry, brown, and cracked; hic- cough ; coldness of the hands and feet; trembling and cramps of the feet, hands, and legs ; evacuations loose, blackish or yellowish ; pulse slow and almost extinct, or small, quick, and intermittent. Physical sensations.—General prostration of strength ; VELLOW FEVER. 167 confusion of head, or vertigo ; deafness ; difficult deg- lutition ; intense thirst; violent vomiting of green bile and mucus, or black bile and blood ; burning in the stomach ; great exhaustion ; cramps in the stomach, abdomen, and limbs ; diarrhoea. Mental and moral symptoms.—Timid ; despondent; restless ; loss of sense ; coma or violent delirium. Administration.—A drop of the third dilution in an ounce of water; a dessert spoonful frequently repeat- ed, until an effect is apparent. Sulphur.—External indications.—Face pale, or yel- lowish ; eyes red, or yellowish ; aphthae in the mouth ; tongue dry, rough, and reddish, or with white or brownish coat; pulse hard, quick, and full; faeces whitish, greenish, or brownish, bloody or purulent. Physical sensations.—Dizziness, or sharp pains in the head ; itching and burning pain in the eyes ; roar- ing in the ears ; nausea, with trembling and weak- ness ; vomiting of bilious, acid, bloody, or blackish matters ; pressure and pain in the stomach ; pains in the back and loins. Mental and moral symptoms.—Melancholy; sad ; timid ; undecided ; wandering. Administration.—A grain of the third trituration in an ounce of water; a dessert spoonful every four or six hours, extending or diminishing the intervals according to the exigencies of the case. Cantharides is sometimes indicated in the third stage with complete insensibility, cramps in the ab- dominal muscles and legs, suppression of urine, hae- morrhages from the stomach and bowels, and cold sweat on the hands and feet. It may be employed at the first dilution, a drop every half hour, until a de- cided impression is produced. Carbo veg. and crotalus, have both proved cura- tive in the third stage of yellow fever, and should always receive due attention in grave cases. 168 CHAPTER XVIL INFANTILE REMITTENT. This is a disease peculiar to childhood, and is usu- ally caused by the use of unhealthy and indigestible food, the irritation of teething, worms, repelled erup- tions, sudden drying up of ulcers, discharges, &c. The affection is characterized by prominent disorder of the stomach and intestines, in most instances, but occasionally the brain or lungs seem to be chiefly affected. In all cases, however, whichever part the disease may seize upon, there occur regular remissions and exacerbations. Diagnosis. —The malady under consideration makes its appearance with the premonitory symptoms of ordinary fever, as slight chills, restlessness, thirst, and wandering pains in the back, bowels, and limbs. When the hot stage is fully developed, the patient re- fers most of his sufferings to the stomach and intes- tines : they become painful, tender upon pressure, and there is either obstinate constipation or diarrhoea. The evacuations are usually darkish, offensive, and indi- cative of a deficiency of bile. When the disease is concentrated in the stomach, there is burning thirst, with vomiting of liquids as soon as swallowed ; the tongue is usually covered with a moist, whitish fur, and red at the edges. If the inflammation be not promptly arrested, but is permitted to progress with- out the aid of appropriate remedies, lesions will occur in the digestive tube, or disorder of the brain or lungs will be very likely to supervene. Causes.—Undue exposure to cold, sudden changes of temperature, improper food, worms, teething, re- pelled eruptions, abrupt suppression of accustomed discharges, and the injudicious use of irritating medi- cines. Therapeutics.—The remedies suitable for the treat- ment of this affection, are, in the first instance, the higher dilutions of aconite, followed by those medi- INFANTILE BEMITTENT. 169 cines which accord with the peculiar symptoms of each case. As soon as the fever has been sufficiently subdued by the former medicine, some of the following articles may be resorted to with advantage : ipecacu- anha, cina, chamomila, mercurius, belladonna, arsenicum, Pulsatilla, nux vomica, spigelia, sulphur. Since in most instances the gastro-intestinal mu- cous membrane is the seat of the malady, it will be necessary to make a free use of ipecac, mere, puis., nux, chain., dulc Should the brain or lungs become involved, belladonna, bryon., nux, opium, and stramon., will prove efficient remedies. Dr. Drysdale has found this fever, as it occurs in England, exceedingly intractable, notwithstanding the most assiduous care and attention on the part of both physician and friends. In children of scrofulous con- stitutions, Dr. D. has known the disease to persist for months, in spite of every remedial measure. In cases of this description, he advises sulphur, calcarea, arse- nicum, and silicea. In highly impressible and irritable children, we have often witnessed an almost constant tendency to febrile attacks, during dentition. The alimentary canal, the brain, and the nervous system, appear to remain in such a condition of erethism, that the slightest exciting causes, as errors in diet, worms, suddenly checked per- spiration, &c, serve to develop the affection. In in- stances of this kind, aconite, belladonna, and chamomela are peculiarly appropriate, and will generally enable us to subdue permanently this morbid excitability. These remedies should be given in drop doses of the twelfth to the sixteenth dilution, once in twelve hours, until every sign of undue irritability has disappeared. Hartmann commends a few doses of coffea cruda, or of cat. carb. when this erethism is obstinate, and has con- tinued for a long time. If the febrile attack has already made considerable progress, with excessive irritability of the stomach, and immediate ejection of every thing which enters it, however simple ; distention, pain, and tenderness of the stomach and bowels upon pressure ; hot and dry skin ; burning thirst; tongue covered with a whitish fur. and red at the edges ; great restlessness and irri- 8 170 INFANTILE REMITTENT. tability ; loathing of food ; dark, yellow, slimy, or green diarrhoea, we may give a grain of the third trituration of ipecacuanha, or a drop of the sixth dilution of chamo- mela, once in two hours, as long as is deemed neces- sary. If the disease is still farther advanced, and the coun- tenance has assumed a pale, or dingy, sunken and cadaverous aspect ; dark and puffy appearance under the eyes ; coldness and dryness of the skin, or cold clammy sweat ; burning pains in the stomach and in- testines ; thirst; constant nausea ; the smallest quan- tity of food or drink, increasing the burning and dis- tress, until they are rejected ; watery diarrhoea, with smarting and tenesmus ; great prostration ; frightful dreams, anguish and uneasiness, especially at night; dark, dry and trembling tongue ; black and dry lips ; grinding of the teeth, we should employ arsenicum at the twelfth dilution—a drop in a teaspoonful of water every two hours, until the requisite effect is produced. When in addition to the symptoms enumerated above, the child is exceedingly restless, and sensitive to light on the slightest noise ; with flushed cheeks ; red, glistening and protruded eyes ; hot head ; con- stant raising of the hands to the head ; rolling of the head from side to side ; sudden starts from sleep, with screams ; spasmodic twitches in different parts ; dila- ted or contracted pupils ; short and oppressed respira- tion, we should administer belladonna at the twelfth dilution—a drop in water, every two hours, until a decided impression is evident. When the fever is accompanied by obstinate consti- pation ; frequent desire to urinate ; burning heat of the whole body ; morning exacerbations ; rigidity of the limbs ; or drawing, contractive sensations through the body ; occasional spasms ; frequent trembling both sleeping and after an exertion ; shudderings and chills from the least contact of cold air ; great sensitiveness of the whole body ; unpleasant symptoms often ex- cited by motion or contact ; and indications of gastric or bilious disorder, we may employ nux com. at the twelfth dilution—a drop in water, every two, three or four hours, as circumstances require. When the malady has been caused by the irritation TNFANTILE REMITTENT. 171 of worms, it will be necessary to use cina or spigelia. These medicines may be employed at the third attenua- tion, and a dose given three or four times daily until the morbid disposition of the alimentary canal is cor- rected. Bryonia is applicable in cases attended with disor- der of the pulmonary tissues. In addition to biliary and gastric derangement, there should be dry racking cough ; stitches in the chest and sides ; painful, anxious, and hurried respiration ; bruised pains, and soreness in the limbs ; pains aggravated by motion or contact ; hot skin; thirst; alternating heat and chills; nightly delirium ; irritable and quarrelsome. This remedy may be used at the sixth dilution—a drop once in two to four hours. Dulcamara is the specific when the fever can be traced to exposure to wet and cold, which has caused a sudden check to the perspiration. In these cases, the force of the disease is expended upon the mucous membranes of the digestive and respiratory organs, as is indicated by watery diarrhoea, pains in the stomach and bowels, oppression at the chest, dry coryza, cough, and difficult respiration. Its administration is the same as bryonia. If the attack is attributable to abuse of fat, crude and indigestible food, and is accompanied with promi- nent gastric derangement, Pulsatilla should be em- ployed at the sixth dilution—a drop every four hours until the disturbance is correeted. 172 CHAPTER XVIL CONTINUED FEVER. In this class of fevers may be included those aris- ing from functional derangement, from inflammation, from congestion, and typhus. FEVER FROM FUNCTIONAL DERANGEMENT. Diagnosis.—This is generally the mildest and least dangerous of all the continued fevers. It commences with slight chills, alternating with flushes of heat, lassitude, restless nights, wandering pains in the head, back and limbs, which are soon succeeded by in- creased action of the heart and arteries, dry and hot skin, thirst, fmrred tongue, scanty and high-coloured urine, and moderate derangement of almost every function. If the malady is met at the onset with suitable remedies, its progress is cut short, and imme- diate convalescence ensues ; but if it be allowed to continue unopposed, although it occasionally subsides spontaneously, it generally terminates in one of the other forms of continued fever. Causes.—Overloading the stomach with fat, crude, and indigestible food, insufficient clothing, irregular habits, dwelling in damp and ill-ventilated houses, and the habitual and intemperate use of coffee, tea, and tobacco. Therapeutics.—Aconite, from the first to the third dilu- tion, if administered early, is sufficient to cure most cases of this form of fever; but if the disorder is neglected until inflammation or congestion occurs in some structure, then those medicines which operate specifically upon the parts affected, are to be em- ployed, selecting those, of course, the pathogenetic symptoms of which cover the most perfectly those of the malady. CONTINUED FEVER. 173 FEVER FROM INFLAMMATION. {SynOclia.) Diagnosis*—In this form of fever the general symp- toms, as hot and dry skin, rapid and full pulse, dys- pnoea, thirst, nausea, oppression at the epigastrium, restlessness, furred and dry tongue, are present; but the symptoms which more particularly characterize the disease, are determined by the organ which is prominently affected. When the inflammation is located in the mem- branes of the brain, the face becomes flushed, the eyes red and sparkling or protruded,-staring, and dis- torted, the carotids throb violently, pupils contracted or dilated, expression unnatural, furious delirium, pulse full, rapid, and bounding, and finally if the dis- order progresses, sopor, muttering delirium, subsultus tendinum, and convulsions. If the disease attacks the lungs, we shall have ra- pid, anxious, and oppressed respiration, shooting pains in the thorax, troublesome cough, with difficult ex- pectoration, pain and soreness during inspiration, and perhaps other symptoms pertaining to inflammation of the pulmonic structures. If the gastro-intestinal membrane be affected, we shall have the signs peculiar to inflammation of this tissue, as nausea and vomiting, pains in the bowels, increased on pressure, tongue red, countenance ex- pressive of anguish, thirst, bowels hot and swollen. Causes.—Atmospheric vicissitudes, extremes of cold or heat, errors in diet, and over-exertion. Inflamma- tory fever often succeeds neglected or mismanaged fevers from functional derangement, especially in cases where some organ has been previously debili- tated, and in this manner rendered susceptible to in- flammatory action. Indeed, it is probable that inflam- mations seldom occur in parts which are perfectly healthy and vigorous, but that when the exciting causes of fever operate in these cases, they merely give rise to slight and easily'remedied functional de- rangements. Whenever, therefore, any structure of the organism is in a state of unnatural irritation or debility, this constitutes a powerful predisposing cause of inflammatory fever, which only requires 174 CONTINUED FEVER. some farther morbific influence to ensure its full de- velopment. Therapeutics.—As in this form of fever there is an exaltation of most of the functions, and particularly of the circulatory vessels, aconite is an indispensable remedy, always in the onset and frequently during the course of the malady. This remedy, as all are aware, exerts a peculiar power over the action of the heart and arteries, and is, therefore, particularly appropriate in those cases distinguished from the first, by full and rapid pulse, hot and dry skin, thirst, &c. In those instances where cerebral disorder predom- inates, belladonna, opium, and stramon.0 will be found essential in the treatment, either alone, or in alter- nation with aconite. If the pulmonary tissues are inflamed, suitable re- medies may be found in bryon., tart, ant., ipecac, and phosphorus. For gastro-enteritic inflammation, recourse must be had to one or more of the following medicines, viz.: mere, nux, ipecac, puis., dulc, cham., ars., and verat. Administration.—In the selection of remedies, much depends upon the age, sex, temperament, as well as the peculiarities of each particular case. For chil- dren and adults who are very impressible, we advise the higher potencies ; while in cases of vigorous and unsusceptible persons, the very lowest attenuations will prove most efficient. In regard to the repetition of doses, no definite rules can be prescribed beforehand ; everything must of necessity depend upon the nature and violence of the disease, and the effect which each particular dose produces. FEVER FROM CONGESTION. Diagnosis.—The precursory stage of congestive fever is characterized by restlessness, irritability, in- disposition to mental or bodily exertion, fatigue from the slightest exercise, vertigo, giddiness, apprehension, pulse often below the natural standard. This stage continues from a few hours to six or seven days, when the second period fully developes itself. CONTINUED FEVER. 175 The symptoms will now be modified in accordance with the organ which sustains the violence of the attack. If the brain be the suffering structure, the patient will complain of headache, oppression or tightness in the head, pupils contracted or dilated, the ideas confused, the pulse slow and labouring, and, finally, coma, paralysis, and convulsions may super- vene. When the bowels are the seat of the congestion, we shall observe an anxious and distressed expression of countenance, eyes sunken and glazed, more or less nausea and vomiting, bowels burning hot, and tender on pressure, while the extremities are cold; tongue slightly coated with a whitish or reddish fur ; uneasi- ness, with constant desire to change position; frequent sighing; bowels constipated or relaxed; and, finally, spasms and stupor, with stertorous breathing. If the disease concentrates in the lungs, there will be rapid, laborious, and obstructed respiration ; pulse irregular or intermitting ; cough ; face and skin pur- ple from imperfect decarbonization of the blood; sur- face cold, and pains in the chest. In all of these varieties of congestion, the physical and mental energies of the system are below the natural standard, the pulse is generally unusuallyslow and feeble, the function of the lungs is imperfectly executed, there is an unequal distribution of heat, and diminution of sensibility throughout the body. Causes.—Excessive cold, atmospheric changes, drinking large quantities of cold water when the body is heated, insufficient clothing, improper food, severe mental or physical exertion, sudden news, grief, fear, depression, disappointment, mortification, &c. Therapeutics.—The remedies which have been used with most success in congestive fever, are, for the cerebral form, bell, aeon., op., stram., hyos., conium mac, coff., mosclu, and camph. For the abdominal form, ipecac, verat., ars., nux, cuprum, mere, phos., carb. v., secale cor. For the pulmonary form, bryon., aeon., phos., lack., seneg., rhus tax., tart, em., hyos., ammon. carb. Administration.—Congestive fevers often attack the organism suddenly and violently, and if not promptly 176 TYPHUS. arrested, run on to a speedy and fatal termination. In severe cases, therefore, as soon as the remedy has been selected which is homoeopathic to the malady, it should be repeated at short intervals until a decided impression is made upon the symptoms. After a rea- sonable time, if no effects are apparent, give a still stronger dose, or change the medicine. Let it be remembered, in all violent maladies, that our object is, to produce a specific effect upon the diseased structure as soon as possible, in order that we may supersede the morbid by a healthy medi- cinal action. We need have no fear in this fever of creating too great a medicinal aggravation, for there is a low grade of erethism and impressibility of the whole organism, and we can readily apply an anti- dote to any over-action which may be excited, and thus control its influence, while, if we permit the natural affection to make progress from a too timid and sparing an exhibition of remedies, disorganization will be likely to ensue. In this form of fever, we generally employ the first, second, and third attenuations,—the dilutions in drop, and the triturations in grain doses. CHAPTER XVIII. [TYPHUS. Few diseases have attracted more attention and been the cause of more bitter controversies in the medical world, than typhus fever. While some have maintained that it is a malady peculiar to the cold seasons of temperate latitudes, and caused by exhala- tions of animal or vegetable matters in a state of pu- trefaction,* others assert with equal confidence that it occurs in all climates, at all seasons, at every period from infancy to old age; and that it does not arise Dewees, Bancroft, &c. TYPHUS. 177 from any specific cause (sui generis), but may proceed from marsh miasms, animal exhalations, intense cold, errors in diet, over-exercise, and a variety of other causes.* Some suppose it contagious, and others non- contagious. Respecting its nature and seat, it has had the hon- our of being located by different medical writers in every part of the body, from the crown of the head to the soles of the feet. At one time the whole world placed it in the blood : then another generation of theorists arose who seated it in the solids: at another period all the world, of France, made the dis- covery that its place was the gastro-intestinal mu- cous membrane, and that Hippocrates, Galen, Celsus, Stahl, Boerhaave, Cullen, Hoffman, Brown, et omne id genus, had been labouring under a succession of er- rors upon the subject for more than two thousand years. Still later, some theorists have found out that its posi- tion is in the brain and nervous system, while a few veiw sensible persons have arrived at the conclusion that the exact nature and seat of typhus is yet involved in obscurity. At the present moment there are a great variety of opinions respecting it. One class of medical men sup- pose it to be a disease affecting principally the brain and ganglionic system of nerves. Another class sup- pose its action to be in " the mucous membranes and lymphatic glands, especially those of the ileum, whence it has been termed typhus abdominalis."-\ Others still suppose it to be a disease of a dynamic character, or an affection of the "vital properties" of the system. In regard to this last supposition, it can- not be refuted, because it means nothing at all. It is as senseless and absurd as it would be to attribute it to a derangement of the electric, magnetic, galvanic, or any other " properties" which we may assume that the organism possesses. The malady assumes different characteristics ac- cording to the predisposition of the individual when exposed to the influence of the contagion. If his sys- * Natham Smith, Macintosh, , to flow. But as modern researches have demonstrated that the in- voluntary discharge which is a characteristic of this disease, does not consist of semen or mucus, but of a purulent and infectious matter, wre think the erro- neous terms commonly employed to designate the com- plaint, should be abolished. Many reasons may be adduced against naming the affection from the sup- posed character of the discharge ; for, notwithstand- ing as a general rule it is decidedly purulent, cases occasionally occur where, from the intensity of the inflammation, there is no discharge at all, and consti- tuting that form of the disease denominated by French writers, " blennorrhagie seche." The matter is like- wise sometimes composed of a mixture of pus, mucus, semen and blood. For these reasons we prefer to make use of the more general term, urethritis. In- flammation of the urethra may indeed arise from other causes than the application of infectious matter during an impure connection, and present all of the symp- toms peculiar to the venereal inflammation, but the malady is none the less urethritis on this account, al- though the secretion accompanying the inflammation is not infectious. So may an inflammation of the eye owe its origin to the application of venereal matter, external irritants, atmospheric changes, injuries, scro- fula, and abuse of stimulants, and yet notwithstand- ing these different causes, the disease is none the less ophthalmia. All secreting surfaces are liable to be irritated when 20* 466 DISEASES OF THE URINARY operated on by certain unnatural stimuli. The mu- cous membrane of the throat, the bronchia, the lungs, the nostrils, the frontal sinuses, and the conjunctiva of the eye, are all subject to different grades and kinds of inflammation, and their secretions to become changed in quality and quantity, according to the morbid cause which has been in operation. The lining membrane of the urethra is also subject to the same laws : it may become inflamed and pour out a purulent discharge from the presence of calculi in the bladder, from gout and rheumatism, from acrid urine, from the absorption of certain diuretics, from ulcers, from mechanical in- juries, and finally from the application of infectious matter during an impure coition. In a very large ma- jority of cases, urethritis arises from the cause last enumerated. This morbid virus induces a specific in- flammation in the urethra, of so troublesome and in- veterate a character as often to baffle all the remedial measures of the most skilful and experienced medical men. The inflammation is supposed by some to be of the erysipelatous kind, and generally attacks the lacunae of the urethra. All who have had much experience in this disease, will agree with me that it is one of the most intracta- ble with which we have to deal: Mackintosh as- sures us " that he has been more annoyed and dis- gusted in conducting the treatment of gonorrhoea than of any other affection." We are at present in ignorance respecting the primary source of infectious urethritis, tfut the doctrine entertained by the ancients, and so strenuously advo- cated by John Hunter, and his cotemporaries, in regard to the identity of the gonorrhoeal and syphilitic virus, is now universally abandoned. The disease under consideration, is one of a purely local character, and if left to itself, under favourable circumstances, will ulti- mately terminate in spontaneous recovery. It is a matter of doubt whether ulcers of the urethra ever proceed from this inflammation, when entirely uncom- plicated, but it is probable that the few cases which have been reported by Sir Astley Cooper and others, in which the malady was connected with ulcerations, AND GENITAL ORGANS. 467 were attributable to the application of the virus of both affections. We have, in several instances, inoculated individu- als with the matter of infectious urethritis, but have never been able to produce a chancre or any well- marked constitutional symptoms. We have, in one instance, also witnessed the intro('u ;tion of the gonor- rhoeal virus into the blood, but without giving rise to any appreciable effects. While on the other hand, it is well known, that if syphilitic virus be inoculated or introduced directly into the mass of the blood, the symptoms of syphilis speedily result. The application of gonorrhoeal matter to the eye, gives rise to a very violent and dangerous purulent ophthalmia ; while the application of syphilitic virus to this organ, causes an ulcer generally circumscribed, and unaccompanied by violent or dangerous inflammation of the surrounding parts. The application of the former to the anus, causes inflammation, with augmented secretion, and change in its character from mucus to pus ; the ap- plication of the syphilitic poison, causes chancre and its concomitants. Urethritis is often suspended during attacks of acute disease, but it invariably reappears again after the subsidence of the febrile symptoms. From these facts it may be fairly inferred, that gonorrhoeal matter contains a specific morbid principle, capable of producing a peculiar inflammation and dis- charge, when brought in contact with mucous sur- faces. This inflammation and discharge present a uniform appearance quite unlike what occurs in leu- corrhoea, in several particulars. The matter of the former is infectious, while that of the latter is non-in- fectious ; the inflammation of the former is of the erysip- elatous kind, while the condition of the mucous mem- brane in the latter is more allied to relaxation and debility than to inflammation; the former can only arise from the contact of gonorrhoeal matter with a mucous surface, while the latter never proceeds from any cause of this kind, but from constitutional weak- ness, confinements, excesses in venery, want of exer- cise, and other debilitating habits. We may also infer, from what has been observed, 468 DISEASES OF THE URINARY that the syphilitic matter likewise contains a specific morbid virus, sui generis, and only capable of exciting chancre, when applied to abraded or delicate surfaces. It should always be remembered, that every morbid substance capable of impressing the organism, con- tains a certain specific morbid principle, which usually operates in a definite manner, causing a uniform train of symptoms, and requiring a certain specific medicinal agent to effect a prompt cure. These morbid princi- ples only exist in infinitesimal quantities in their media, and on this account we are unable to detect or analyze them, but we ought none the less to acknowl- edge their presence, appreciate their influence, and en- deavour, if possible, to discover their specific antidotes. Diagnosis.—The ordinary period at which infec- tious urethritis makes its appearance after an impure connection, is from two to four days. We have known it to commence in a few instances, in eight or ten hours after exposure, and we have likewise occasion- ally observed an interval of six weeks to elapse before its onset. Some constitutions possess the power of resisting the action of the poison to such a degree as to constitute an almost entire exemption from the dis- ease. Other individuals are so little susceptible, that if pains be taken to urinate and perform thorough ablu- tion soon after the sin, no ill consequences result. Others again are so highly susceptible, either from natural organization, or from abuse of stimulants, that almost the very touch of a contaminated female speedily communicates the inflammation. The disease commences by a tingling or itching sensation at the orifice of the urethra, which is noticed especially when urinating. In a short time, the lips of the urethra become red and swollen ; the blood-vessels of the organ distended; the inflammation increases and extends up the passage for an inch or two ; there is a burning or scalding pain on passing water; an increased secretion takes place from the part affected at first of a mucous character, but as the inflammation increases presenting a purulent appearance, of a yel- low colour, or if the disease is violent, green and sani- ous. The urine, which often contains some thread- like substances, arising from the inflammatory action. AND GENITAL ORGANS. 469 flows from the urethra in a diminished, spiral or di- vided stream. In a first attack, the inflammation does not usually confine itself to the extremity of the urethra, but ex- tends along the canal to the prostate gland, and even to the bladder itself. Not unfrequently it attacks the glans penis and the fraenum, in which case it often occasions an effusion between the foreskin and glans, and phymosis. When the inflammation is intense, and extends up as far as the neck of the bladder, there is a frequent and urgent desire to urinate, the ardor urina becomes more extensive and painful, involuntary and painful erections occur, chiefly during the night, and some- times cause distressing emissions of semen ; sympa- thetic irritation is communicated to the perineum, oc- casioning painful sensations when evacuating the bowels, or the bladder ; there is more or less inflam- mation and effusion of lymph into the corpora spon- giosa, giving rise to those adhesions and painful con- tractions termed chordee; the glands of the groin be- come irritated and enlarged, and there is a partial or even total suppression of the discharge, in which lat- ter case the disease is termed dry urethritis, or the " blenorrhagie seche " of the French. In old sinners, the inflammation is quite prone to attack the prostate gland, and give rise to those un- pleasant symptoms which we have enumerated when alluding to affections of this structure. As we have before remarked, if the disease be left to itself, and the patient is strictly prudent and tem- perate, a spontaneous recovery will eventually take place ; but from improper medical treatment, undue exposure, or excesses of different kinds, the disease often terminates in gleet, strictures, abscesses, dis- eased prostate, irritable bladder, hernia humoralis, inflammation of the testicle and epididymis, or bubo. The acute stage of urethritis, under ordinary cir- cumstances, terminates in from one to three weeks, when, if suitable remedies have been employed, the discharge ceases, and the parts speedily recover their tone; but in the majority of instances, the acute 470 DISEASES OF THE URINARY stage runs into a chronic inflammation, when it re- ceives the name of GLEET. In this stage of the disorder, the painful symptoms peculiar to the first period, ardor urina, frequent in- clination to urinate, chordee, spasmodic pains in the region of the perineum, and the heat and swelling of the penis, subside, and we observe little else than an increase and alteration in the character of the secre- tion from the urethra. This discharge, which during the acute symptoms was purulent, and of a yellow or greenish colour, now presents a light mucous appear- ance, sometimes transparent and ropy. The charac- ter of this discharge, however, is often temporarily changed again to a purulent matter of a yellow or even green colour, sometimes sanious, from over-ex- ercise, excesses in drinking or eating, sexual inter- course, and exposure to protracted heat or cold. The discharge of a simple gleet usually proceeds from the lacunae of the urethra. Some writers have pro- mulgated the dangerous doctrine, that the matter of a gleet is not infectious ; but this is an error, for we have known many well authenticated instances where virulent urethritis has arisen from the application of gleety matter. When a gleet has been permitted to continue for a long time, and particularly if the case has been inju- diciously treated by inordinate doses of copaibae, cu- bebs, turpentine, and the endless train of irritating injections, there often supervenes a STRICTURE OF THE URETHRA. A stricture may occur during the height of acute urethritis, from tumefaction of the mucous membrane of the canal, or from the irritation caused by improper or unskilful introduction of bougies, and by strong injections. The obstruction in some cases of this description is so complete, that very painful reten- tions of urine, with its accompanying symptoms, su- pervene, requiring the most prompt remedial mea- sures in order to ward off the necessity of puncturing the bladder. This variety of stricture may be re- AND GENITAL ORGANS. 471 moved in a short time by proper medicines, without the aid of a surgeon. There is a second variety of stricture not necessa- rily connected with infectious urethritis, termed spas- modic stricture. The disease consists in a sudden spasmodic contraction of some portion of the urinary canal, which impedes the flow of urine, and sometimes causes a partial retention. These spasmodic contrac- tions may arise from mechanical injuries, diseased prostate, or stimulating diuretics, but they are for the most part connected with permanent stricture. The third variety of stricture, which is by far the most common and serious, is termed the permanent stricture. Its approach is so gradual and impercepti- ble, that individuals rarely suspect anything of the kind, until it has made considerable progress. The disease arises from a gradual thickening of the mu- cous membrane of the urethra, from badly treated or long continued inflammation. The first symptoms observable in this stricture are, a sensation after urinating as if a few drops remained behind; stream diminished in size, and issuing from the urethra in a spiral form, or split in several parts ; straining to pass the water more rapidly through the obstructed canal; aggravation of all the symptoms on wetting the feet, taking cold, over-exercise, fatigue, and venereal excesses. In this stricture, there is always more or less discharge of a ropy kind of mu- cus, which is often temporarily changed by excesses, into a purulent or bloody matter. This complaint is quite apt to induce inguinal hernia, from the straining efforts employed in urinating. It is probable that two-thirds of the cases treated as simple gleets, and which so frequently baffle the physician, are, in reality, dependent solely on this kind of stricture. In bad cases of permanent stricture, the urine is passed drop by drop, the distention and pain in the region of the bladder become very severe, much con- stitutional irritation occurs, and the patient is unable to rest day or night. Whenever this state of things obtains, immediate recourse should be had to bougies. The removal of a permanent stricture can only be 472 DISEASES OF THE URINARY accomplished by means of the knife, or the applica- tion of caustic, or by gradual dilation by means of bougies. The cure by the latter means is, at the pre- sent time, almost universally recommended. Almost all strictures are located far up the canal of the urethra, behind its bulb, but they may occur near the extremity of the penis, or three, four, or five inches above this point. An occasional consequence of stricture is, FISTULA IN PERINEO. When the contraction is so great as to cause con- siderable obstruction to the passage of the urine, this fluid is forced by the frequent and violent efforts at expulsion, into the parts back of the stricture, in such a manner as to form a kind of cut de sac, which, from constant distention, eventually ulcerates an opening externally, and a perineal fistula is formed. Abscesses also arise sometimes from inflammation and tumefaction of the lymphatic glands in other parts of the urethra. These little swellings may open into the urethra, or discharge themselves exter- nally. The most common seat of these abscesses is near the fraenum, or opposite the scrotum. DISEASED PROSTATE, May also be ranked amongst the occasional conse- quences of repeated attacks of urethritis. During the continuance of the latter affection, not only the urethra, but the prostate, the bladder, and the tes- ticles, receive an unusual supply of blood, in conse- quence of which they become irritated, and often en- larged, from depositions of coagulable lymph. This condition of things may exist without attracting much attention until the individual is advanced in years, when a scirrhous degeneration, or an abscess, is ex- ceedingly apt to result. Either lobe of the prostate may become enlarged separately, or the whole three may be involved ; but the most troublesome symptoms arise from an enlargement of the middle lobe, on ac- count of its proximity to the orifice of the urinary canal. Sir Astley Cooper was of opinion, that enlargement AND GENITAL ORGANS. 473 of this gland is attributable to advanced age, rather than disease ; but from the fact, that persons who have been afflicted in this manner have almost inva- riably been subject to repeated venereal attacks in early life, we may fairly infer, that a predisposition is always established in the structure, which renders it liable to take on diseased action when the powers of the organism have become impaired by age. Enlargement of the lateral lobes of the prostate may be readily detected by introducing the finger into the rectum. The middle lobe may always be felt by the catheter when much enlarged, and it will gene- rally be found exceedingly difficult to pass it by the gland into the bladder. By directing the point of the instrument, (which should be of medium size,) slightly upwards, and depressing the handle at the proper time, the object may usually be accomplished. But of all others, these cases require great delicacy of touch and practical tact, to enable the operator to succeed facilely, and without doing injury to the irritated parts. Diseases of the prostate are quite liable to become aggravated by over-exertion, riding, acrid urine, expo- sure to wet and cold, and stimulating drinks. Another exceedingly unpleasant consequence of neglected or badly treated urethritis, is the disease termed IRRITABLE BLADDER. This affection arises from long continued inflamma- tion,which in the end so impairs the function of the blad- der, that the presence of a very small quantity of urine forces it to contract, and thus forms an incontinence of urine. Although this condition of the bladder may arise from numerous causes which have already been enumerated, it not unfrequently proceeds from exten- sion of urethritic inflammation to this organ, and from protracted use of diuretics. The malady is readily distinguished from stone, by the relief which always follows the evacuation of the bladder, while this operation aggravates the painful sensations in the latter affection. This disease generally baffles all the resources of 474 DISEASES OF THE URINARY allopathy, but we take pleasure in appealing to the philosophic practice whether the same remark is just with reference to homoeopathy. The next malady to which we shall allude in con- nection with urethritis, is HERNIA HUMORALIS. During the acute stage of urethritis, the inflamma- tion sometimes extends even to the spermatic chord, the epididymis, and the testicle. This is very apt to occur when the discharge is suddenly arrested by ir- ritating injections, especially when the inflammation pervades the whole extent of the canal. When the substance of the testicle becomes involved, the pain is very severe, and febrile symptoms more or less grave, set in. This inflammation may terminate in resolution, suppuration, or chronic enlargement and induration. In those instances where suppuration occurs, the abscesses usually break externally, and form fistulous passages which are difficult to cure, on account of the continual irritation kept up by the se- cretion of semen, a portion of which is constantly being discharged through these ulcerated openings. Chronic enlargements of the testicles should com- mand our early attention, on account of their strong tendency to terminate in scirrhous degenerations. In urethritis, and other affections of the urino-geni- tal apparatus, the prudent physician will always ad- vise the use of the suspensory bandage, as a precau- tionary measure. When the urethritis is so severe as to affect the lymphatic glands of the penis, the disease may be propagated to several of the glands of the groin, when we have a BUBO. These buboes are called sympathetic," in contradis- tinction to those which proceed from syphilitic infec- tion. The frequent occurrence of such tumours during the course of urethritis, probably first led medical men to confound this disease with syphilis. But, on close examination, the sympathetic bubo will be AND GENITAL ORGANS. 475 found to be composed of several enlarged glands, while that of syphilis is an enlargement of a single gland. The sympathetic bubo is not usually attended with great pain, nor does it run on to suppuration, unless the patient is decidedly scrofulous; while syphilitic bubo is attended with much inflammation and pain, and is very prone to advance to the suppurative stage. A very large majority of sympathetic buboes subside spontaneously, and require no medicinal treatment. In females, all of the symptoms of the disease are lighter than in the male sex. Indeed, the similarity between this affection and leucorrhoea is so great, that it is sometimes a matter of great difficulty to distin- guish them. Mr. Travers asserts, that the urethra itself is rarely affected in females, but that the inflammation attacks the clitoris, the inferior commissure of the labia and rapha, the nymphae, and the parts (Cowper's glands) around the orifice of the urethra. In the worst form of the complaint, as it occurs in women, the labia, the nymphae, and the clitoris, be- come swollen and painful, the inflammation extends to the womb and bladder, and there will be frequent inclination to urinate, severe scalding by the water, and a purulent, irritating discharge. But all of these symptoms are often met with in inflammatory leucor- rhoea, and the discharge itself even acquires so acrid a character as to become capable of propagating a similar discharge by contact with the male organ. We have, in more than one instance, been consulted by parties of the highest respectability, in relation to purulent discharges, and scalding of the urine, which have been contracted from the wife, but by explaining the circumstance just alluded to, have been able to dissipate the most unjust suspicions, and to restore confidence and harmony which must have been utterly destroyed without such explanation. The following are the surest diagnostic marks, with which we are acquainted, between the two diseases : leucorrhoea is gradual in its progress, and may be generally traced to constitutional debility, or to diffi- cult and protracted labours, or mechanical injuries during accouchement. It is usually accompanied also 476 DISEASES OF THE URINARY by prolapsus uteri, or dragging pain, or tired feel- ing in the left side, bearing down pains, and general feelings of relaxation and debility. Gonorrhoeal inflammation is sudden and rapid in its approach, and attacks individuals in the soundest health : the symptoms acquire their greatest severity in one or two weeks, and the discharge causes a deep- coloured (yellow or greenish) stain upon the linen, surrounded by a palish yellow border. A careful attention to the history of each individual case, will aid us materially in forming a correct diag- nosis. Therapeutics.—Infectious urethritis is at the present time almost universally looked upon as a purely local disease,—confined in its first stages to a small portion of the mucous membrane of the urethra. It is true that the inflammation often extends up the urinary canal to the prostate gland, and to the bladder ; but it is highly probable that these secondary symptoms are owing to bad treatment, or imprudence on the part of patients, rather than to the natural and legiti- mate tendency of the malady. We adopt this opinion from having often observed spontaneous cures occur in six or eight weeks without medicine of any kind, and without any structure but the urethra becoming affected,—the patients having simply placed them- selves under a rigid dietetic regimen. It may be questioned whether any internal remedy is now known, which can be considered a true and certain specific for the cure of this local inflammation. Many medicines have been brought forward by both schools as worthy of our entire confidence, but not one of them has yet stood the test of practical experiment, —not one has been able to control the symptoms, or remove the complaint with any degree of certainty. On the contrary, many of them have repeatedly been observed to aggravate the inflammation, causing it to extend to the neighbouring structures, and thus se- riously to complicate this naturally simple disease. The ordinary plan of treatment, according to the old-school method, is in the first stage to bleed leech foment, physic with mercurials, or the neutral salts] and to nauseate, sweat, and prostrate the system with AND GENITAL ORGANS. 477 antimonials. In other words, it is deemed necessary to punish the whole organism ;—to inflame the bowels with cathartics,—to impair the tone of the stomach by nauseating doses of antimony,—to debilitate the capillaries by profuse sweats,—to abstract the life- giving principle from the veins,—and to reduce the patient to a state of prostration and positive illness, in order to reach a little circumscribed inflammation in the urethra ! After the patient has been reduced secundem artem, the custom is then to administer enor- mous doses of balsam copaiba, cubebs, turpentine, lytta, iodine, and nitre, internally, and to make use of stimu- lating injections of zinc, lead, copper, mercury, nitrate of silver, oil of vitriol, chloride of lime, and diluted sulphuric acid, ad libitum. Balsam copaiba is the medicine employed in most instances, and as it oper- ates specifically upon the stomach and the respiratory organs, we often observe the most serious affections of these organs arise in consequence of its free and protracted use. Who that has made use of this remedy to any great extent, has not witnessed the occurrence of troublesome dyspeptic symptoms, of haemoptysis, of cough, and other indications of dangerous pulmonary disorder, from it ? Cases however occur, in which the symptoms of urethritis cease under the use of this, and the other diuretics alluded to, but such instances are rare, and the remark of the celebrated Dr. Forbes respecting allopathic remedies in general, will hold good here, viz.: that " the patient gets well in spite of the doc- tor." We shall not discuss the propriety of the antiphlo- gistic course adopted during the acute stage, for we believe that all whose prejudices will permit them to exercise that admirable requisite, common sense, will perceive at a glance the folly of tormenting and pros- trating the whole body for the sake of acting upon a simple local inflammation, which, when left to itself, never terminates in ulceration or disorganization of the tissue affected, but in spontaneous recovery. And what shall we say of the homoeopathic reme- dies which are usually employed in the treatment of this complaint ? Why, simply that the true specific 478 DISEASES OF THE URINARY has not yet been discovered. We have tested these medicines in numerous instances, both the high and low attenuations, and we regret to announce as the result of our observations, that they have proved but little more successful than the pernicious applications of the old school. We are quite aware that it is much easier to find fault with prevailing methods of practice, than to pro- pose and introduce better new ones. But if we suc- ceed in attracting the attention of physicians more particularly to the subject, and putting them on the qui vive to find out a positive specific, our object will lie accomplished. In the mean time we shall point out the course of treatment which we have found most successful in the different stages of the malady. For therapeutical purposes the disease may be classified as follows : First. The preventive period,—or that which inter- venes between the exposure and the first symptoms of the malady. The average duration of this period is about three days. Second. The forming stage,—or the period which elapses from the commencement of the prickling, tin- gling, or itching sensation, with slight redness and swelling of the lips of the urethra, and a slight oozing of mucus or limpid matter, up to the period when the inflammation has extended to the fossa navicularis, and become strongly pronounced, with a purulent dis- charge of a yellow or greenish colour. This stage usually lasts from twelve to forty-eight hours. Third. The acute or inflammatory stage,—including the period which commences at the termination of the last stage, and the subsidence of the ardor urina, the acute inflammation of the urethra, the swelling and tenderness of the penis, and the change of the yellow or greenish secretion, to one of a light transparent and ropy, or a muco-purulent character. The natural du- ration of this stage, when proper restrictions are used as to diet, stimulants, and exercise, is from one to two weeks. Fourth. The chronic stage, or that form of the ma- lady termed gleet. Now, as our object, in accordance with the homce- AND GENITAL ORGANS. 479 pathic doctrine of cure, is to produce in the tissue mor- bidly affected, a new and healthy medicinal action, which shall supersede the morbid inflammation, we apply our remedies directly to the diseased part, instead of bringing them in contact with it through the stomach, blood, and kidneys. The malady is not constitutional,—there is no other structure of the economy affected, or upon which we wish to act,—but our sole object is to prevent or to remove a simple local inflammation. Our remedies then, during the first or preventive period, are the occasional injections into the urethra, of a solution of nitrate of silver, (in the proportion of two or three grains to the ounce of distilled water.) or of sulphate of zinc, in the proportion of four grains to the ounce of water. The occasional use of these injections after an impure coition, with strict temperance and quiet, will usually prevent the occurrence of the dis- ease. These remedies neutralize the absorbed virus before it has time to impair the function of the mem- brane with which it is in contact, and thus its power to do injury is summarily destroyed. There is also a certain and speedy cure for the se- cond or forming stage. The symptoms of this stage, as we have seen, are a tingling or itching at the end of the urethra, with a slight redness, and a slightly in- creased secretion of mucus. The remedy for this stage, is a saturated solution of nitrate of silver, a small quan- tity of which is to be applied, by means of a small glass syringe, or by a small bit of sponge, to the ure- thra for an inch in extent. The solution should be de- licately and rapidly applied, and a quantity used just sufficient to give the portion of the membrane touched, a white cast. This causes a smart but healthy medi- cinal inflammation which subsides in about 24 hours, leaving the structure cured. This course is strictly homoeopathic, for we impress directly the tissue affect- ed, produce a powerful medicinal aggravation of the symptoms, and overwhelm the disease by substi- tuting temporarily, another inflammatory action. No unpleasant consequences ever result from the use of this remedy, when it is employed before the com- mencement of the third or acute stage. Our experience 480 DISEASES OF THE URINARY with this solution has been extensive, and we there- fore confidently recommend it as a perfectly safe and sure remedy in this stage of the complaint. During the third or acute stage, it is a question whe- ther any remedies, either general or topical, can be employed w-ith any material advantage, with the ex- ception of the internal use of aconite, which may be given to shorten the inflammatory stage. This medi- cine is particulary applicable when febrile symptoms are present. Throughout this stage, the patient should be restricted to the most rigid vegetable or farina- ceous diet, to cold water, and prohibited from taking much exercise. Ablutions with cold water, should be often employed, in order to keep the parts as free as possible from the irritating discharge. After the ur- gent symptoms have subsided under the use of aconite, and the other means we have just pointed out, and the fourth or chronic stage has commenced, we may re- sort to injections composed of one grain of sulphate of zinci to 3 viii. of water. These injections, in order to be efficient, must be repeated every half-hour during the day, until the discharge ceases. It will be of no service to use this solution three or four times in the day, for the chief object is to wash out the urethra as fast as the matter forms, and thus prevent the constant reabsorption which would otherwise take place. The principal reason why urethritis is so difficult to cure, when once fully established, is, that the matter itself being infectious, and liable to be constantly re- absorbed, thus operates as a continual exciting cause. If at any given instant the whole urethra could be restored to perfect health, a single drop of the morbid secretion which it had been pouring out, applied to the part, would be sufficient to re-excite the disease in all its violence. It is evident, then, that the discharge must be arrested abruptly by the remedy employed, or we must use our injections sufficiently often to dilute and remove the virus as fast as formed, and at the same time to change the morbid action of the membrane to a healthy medicinal action. In regard to the plan of making an application to the urethra, of a medicine so powerful as to arrest the discharge suddenly, like the solution mentioned under AND GENITAL ORGANS. 481 our second head, it is attended in this stage of the af- fection with many dangers. The canal of the urethra is generally affected so high up as to render the cer- tain application of this or any other sufficiently power- ful solution entirely impracticable. But the other method, to which we have alluded, is one of entire feasibility and safety, and is for the most part attended with success, when the discharge is en- tirely unconnected with a stricture. It is proper to observe that, in all cases, the patient should urinate previous to the use of injections. Another injection which we have sometimes used with marked success in this stage, is a mixture of calomel and olive oil, in the proportion of a drachm to the ounce, once or twice a day, until the cessation of the diseased action. If, however, notwithstanding the thorough and per- severing employment of the zinc solution and the mix- ture of calomel and oil, the discharge still continues, recourse should be had to the introduction of bougies, either plain or smeared with a cerate containing a sufficient quantity of pulverized nitrate of silver. These should be carefully introduced two or three times a week, until we have stimulated the diseased mem- brane to a natural and healthy action. The above plan of treatment, we believe to be more efficient, safe, and consonant with the true princi- ple of cure, than any other which has yet been promulgated : yet, we do not claim for it infallibility. We can only assure our readers that we have tho- roughly tested every theory and process which has been proposed by either school, and that after all of this practical experience, we have presented them with what we deem the best method of treatment in this disgusting malady. For the information of those who desire to make use of internal remedies either alone or in combination with injections, we name the following medicines as the best with which we are at present acquainted: cannabis, cantharides, tussilago pertus., cubeba, mercu- rius sol.,petroselinum, aconite, acid nit., sepia, terebinth., copaiba, pulsatilla, nux vomica, sulphur, ferrum. The remedies which should be consulted in irritable bladder, are, cantharides, cannabis, lycopodium, mercu- 21 482 DISEASES OF THE URINARY rius, uva ursa, terebinthina, pulsatilla, copaiba, cubeba, sulphur, iodine, and camphor. Inflammation of the testicles and epydidimis :— Our first care in this complaint, should be to suspend the inflamed organ by means of a suitable apparatus, in such a manner as to afford complete support in all positions, and thus prevent the enlarged gland from dragging upon the spermatic chord. The recumbent posture should be strictly enjoined, and we should have constantly applied to the parts, cloths wet with cold water. As soon as the cloths are warmed by contact with the inflamed testicle, they should be again dipped and reapplied until the heat and inflammation have disappeared. If the disease has arisen from sudden suppression of urethritis, or from the use of powerful injections during the acute stage, we may give mercurius, aconite, nux vomica, spongia, clematis, or iodine. When it has been caused by the injudicious intro- duction of bougies, arnica, aconite, and pulsatilla, will be found applicable. In cases where the inflammation has degenerated into a chronic induration of the testicles, our best reme- dies are, aurum, acid nitric, rhododendron, sulphur, mer- curius, spigelia, iodine, and cicuta. SECTION IX. SYPHILIS. Much discussion has taken place respecting the first introduction of this disease into Europe. Some main- tain that the followers of Columbus brought it with them from America ; others that it was communicated by the Spaniards to the French, during the siege of Naples, by Charles VIII., in 1495. It appears, how- ever, that occasional allusion is made in different parts of the scriptures, to a disease of the sexual organs, capable of being propagated by coition, contact, &c.' In Leviticus, Moses mentions such an affection, and speaks of those afflicted as being polluted and unfit to associate with the healthy. David also describes one variety of syphilis in the thirty-fourth psalm. He- roditus, too, speaks of an affection of the sexual organs AND GENITAL ORGANS. 483 which the Scythians contracted from the women with whom they had connection, after profaning the temple of Venus Urania. Later writers, Salicetus, Gordoneus, and Valereus, who flourished about the year 1250, al- lude to an infectious disorder of the genitals, proceed- ing from the copulation of men with unclean prosti- tutes. Many reputable authors have entertained the opinion that the ancient leprosy was nothing more than syphilis, rendered severe by exposure, hardship, insuf- ficient nourishment, and improper medical treatment. But an objection has been urged against this view, from the supposition that leprosy could be communicated by contact with an infected person,—by drinking from the same cup, by inhaling his breath, or even sitting at the same table with him. It is no less true that sy- philis occasionally presents a character equally viru- lent and diffusible. During a great portion of the six- teenth century, it was so contagious in some parts of Europe, that it was communicated by lying in the same bed, by the clothes, gloves, money, or breath of the patient. A variety of syphilis also prevailed in Canada some years ago, of so virulent a nature, that it was communicated by the breath, and by contact. We fully concur with Dr. Thompson, who "thinks it probable that the disease has existed, more or less, and under different grades of severity, in all ages, and that it has been thousands of times generated de novo by impure sexual intercourse." The causes which may have conduced to vary its character at different periods, are numerous ; and we suggest the following as a few of them. It has been observed that exposure of the body to a cold, humid atmosphere, excessive fatigue, changes of diet and of climate, unwholesome food and ne- glect of cleanliness, favour the rapid progress and destructiveness of the malady; while a dry, warm and equable temperature, cleanliness, nutritious food, and comfortable lodgings, are circumstances which con- duce to render it. comparatively mild. These facts go far to explain the reason of its great violence amongst those ancient tribes who were accustom- ed to dwell in tents, and to move about from place to place ; and who were so negligent in their habits of 484 DISEASES OF THE URINARY living, their food and their persons, that Moses deemed it necessary to make rigid laws in regard to the selection of food and the habit of personal ablu- tions. When we reflect that persons who were sup- posed to be leprous, were immediately driven out of the camp — away from all intercourse with the healthy—and thus forced to undergo every exposure in respect to raiment, shelter and food, we cannot be surprised that the disease, supposing it to have been syphilis, should so often have assumed a frightful aspect. Its violence during the siege of Naples in 1495, may also be explained, when we bear in mind the forced marches, the changes of climate and of diet, and the constant excitement and fatigue to which the soldiers were exposed. The same severity marked its prevalence in the British army in Portugal, while the natives themselves were but slightly affected, al- though exposed to similar contamination. One of our army surgeons recently informed me that the same difficulty was experienced among our soldiers during the Mexican campaign in 1847 and 1848: they contracted the disorder, while the Mexi- cans experienced but slight inconvenience, although exposed to the same virus. The argument also holds good with respect to sailors who are so constantly subjected to the vicissitudes of temperature, the nox- ious air of vessels, and the stale, salt regimen which is used at sea. May it not, then, be fairly inferred, that whatever causes impair the forces of the organism, serve also to render it less able to resist the deleterious influ- ence of the syphilitic poison ? In regard to the doctrine of Hahnemann respect- ing the identity of syphilis and sycosis, we agree with Hartmann, that the mass of evidence upon the sub- ject renders it almost conclusive that the two dis- eases are distinct in their nature. The origin of each is in a specific morbid poison capable of impressing the organism in a distinct and peculiar manner. Diagnosis.— There are unquestionably a great va- riety of ulcers which make their appearance upon AND GENITAL ORGANS. 485 the genitals after impure connections, which are not syphilitic, and which will heal over without causing constitutional symptoms, simply by the aid of mild dressings. The true syphilitic chancre is now of rare occurrence, but the great majority of those intract- able ulcers which are looked upon as real venereal chancres, are nothing more, primarily, than simple non-infectious sores, which have been converted into an unhealthy condition by the use of mercury. Who can doubt this fact when he contemplates the dread- ful effects which a course of mercury often produces on the healthy organism ? Who could be tempted, in health, to take the enormous quantities of this drug which are deemed necessary for the cure of syphilis ? Let the provings of it—let the horrible consequences which its accidental absorption sometimes occa- sions upon the surface,—in the mucous membranes, —the bones,—the glands and the nervous system, answer. For our part, we would prefer the foul syphilitic poison itself, rather than the uncontrollable ravages of such an enemy as mercury, in allopathic administrations, is admitted to be by the fair-minded of those even who most earnestly defend its use. In order to be fully convinced that many of the ef- fects of mercury are improperly attributed to the action of the syphilitic virus, it is only necessary to regard carefully the symptoms which are constantly presented to our observation in what are called ve- nereal affections, and to notice the opinions of many of the most eminent medical observers. Thus, Sir Astley Cooper,* in his lectures, used to observe, "do not think that it is a rare occurrence for the penis to be destroyed by mercury; no, a chancre that has remained weeks in a healthy state, shall become irritable, and, by maltreatment, by the injudicious and improper use of mercury, shall slough, and end in the destruction of the penis; this is not a rare case, and is attributed to the venereal disease, but in reality is an effect of the improper use of mercury" The great Hahnemann, in his remarks upon syphilis and sycosis, constantly alludes to the * Castle's Manual of Surg., p. 280. 486 DISEASES OF THE URINARY pernicious results of the abuse of this drug in the hands of the allopathist. There can be no question that those dreadful muti- lations of the penis, of the nose, the palate, the eyes, of the surface of the body, and the nodes and caries of the bones, which we occasionally observe, are all effects of mercury and not of syphilis; and it is in the highest degree probable that the immunity en- joyed by the Portuguese, the Mexicans, and certain other nations, from the severe forms of this malady, is attributable solely to the fact that they use no mer- cury in its treatment. Chancre.—The primary chancre usually presents itself on some part of the genital organs, in from three to seven days after contamination, in the form of a darkish red pimple, attended with slight itching, and surrounded with an erysipelatous blush. In "a short time matter forms in the centre of the pimple, and an excavated ulcer, with a yellowish surface, hard and ragged edges, and an indurated base, makes its appearance, marking the sore as a true chancre. The most common seat of primary chancre is on the inside of the foreskin and the corona glandis, but it occasionally occurs on the glands and the exter- nal parts of the genitals. Many varieties of venereal chancre have been de- scribed by authors, as the simple, the indolent, the irri- table, the sloughing, the indurated, the phagedenic of Carmichael, the superficial of Mr. Evans, the Hun- terian,&cc. ; but as these diversities in the appearance of the chancre are not owing to any difference in the character of the virus, but to the condition of the patient as regards constitution, temperament, and mode of life, at the period of contamination, we should abstain from making those minute classifications which some writers have attempted. The circumstances which may operate to modify the character and appearance of a simple chancre, or which may conduce to develop primarily an intractable and destructive one, are numerous. Individuals whose constitutions have been im- paired by abuse of stimulants, undue exposure, hardship and fatigue, and insufficient nourishment, AND GENITAL ORGANS. 487 are liable to be attacked from the first with that variety which is denominated the indurated slough- ing chancre. Those whose systems have been loaded with mer- cury, and enfeebled by previous disease, are peculiarly subject to that description which is termed irritable and sloughing. Persons who go from temperate to tropical climates, are especially in danger of the phagedenic variety. Scrofula and scurvy also predispose the system to this form of it. The simple chancre is by far the most common, par- ticularly in temperate latitudes, and usually occurs to individuals of a sound constitution. Some have sup- posed the cause of this variety to consist in " go- norrhoeal matter, and other morbid vaginal secre- tions," brought in contact with the penis during coition ; but of this there is no proof. The simple ulcer very often becomes converted into an irritable, sloughing, or erysipelatous one, by some excess or imprudence which impairs the vigour of the body, or by the abuse of mercury. On the other hand, so long as the constitution remains sound and unimpaired, resistance is offered to the action of the virus, and the secondary impression which it makes will be very slight, and in some instances imperceptible. It is in cases of this description that we sometimes witness spontaneous cures of what was originally true syphi- litic contamination. The most certain marks of a true syphilitic chancre are, the excavated surface, the hard, ragged edges, and the indurated base. These appearances, taken in con- nection with the previous history of the case, will ge- nerally enable us to decide with sufficient certainty respecting the character of the sore ; but where any doubt exists, we would most strongly commend the practice discovered and successfully adopted by Ricord of Paris, of inoculating a sound part with the matter from the suspected ulcer. In case a second chancre is produced by this operation, there will no longer re- main a question in regard to the true nature of the malady. After the syphilitic poison has passed from the chancre through the absorbent glands of the groin, 488 DISEASES OF THE URINARY into the blood, it possesses a specific affinity for only three parts of the body, viz., "the mucous mem- brane of the throat and nose ; the skin, or surface of the body ; and the bones, with their periosteal cover- ings."* Thus, it will be remarked, that the internal organs are never impressed by this virus ; and this fact should induce the allopath to pause before he loads the system with a poison which spares scarcely a single structure during its operation. The secondary, or specific effects of the syphilitic virus, after its entrance into the blood, are : First. Upon the mucous membrane of the mouth and throat, which becomes red and inflamed, and covered in some parts with pimples, which soon de- generate into ulcers, resembling in many respects the primary simple chancre. These ulcerations extend into the nostrils, and sometimes even into the larynx itself, giving rise to loss of voice, severe cough, vio- lent constitutional disturbance, and death. In cases which have been improperly treated, the bony palate and the nasal bones become affected, and exfoliate, and thus cause those disgusting mutilations of the nose and face which so often stare the old school physician in the face. Second. Another part of the body acted on by the absorbed virus is the skin. Its manifestations in this case are, slightly elevated copper-coloured eruptions of different sizes, attended with uneasy or itching sensations, sometimes covered with a kind of scurf or scale, oy% in other instances, with incrustations and ulcerations. These eruptions make their appearance on the face, head, breast, palms of the hands, and arms. Eruptions which are called tubercular, often appear on the scalp, the eyebrows, the breast, back, and arms, and ultimately form very troublesome ulcers. In healthy subjects these secondary eruptions are not very troublesome, being simply copper- coloured blotches, covered with a thin scurf; but in irritable and impaired constitutions they often assume the character of foul and sloughing ulcers. The par- ticular variety of these secondary eruptions will be * Sir A. Cooper's Lectures. AND GENITAL ORGANS. 489 determined by the peculiarities of constitution in each individual case, and not from any original difference in the virus itself. Third. Another, and the last portion of the organism capable of being impressed by the absorbed venereal poison, is the osseous structure, with its periosteal covering. The morbid inflammation in the first in- stance seizes upon the periosteum, causing severe nocturnal pains, and some tumefaction in the affected region. If the malady continues to increase, an osseous deposit will be formed between the perios- teum and the bone, constituting what is termed the venereal node. This node, in its early stages, does not usually give rise to much inflammation of the sur- rounding skin, nor is it attended with a great amount of pain, but after it has existed for a considerable time, and particularly if the patient has been drugged with mercurial preparations, it becomes quite painful, es- pecially during the night. The ordinary location of venereal nodes is on the anterior portion of the tibia, or on the surface of the cranial bones. We believe that the above-enumerated symptoms constitute all of the legitimate effects resulting from the action of the absorbed syphilitic virus. The great variety of eruptions and ulcerations described by Hartmann and others, are attributable to other causes, operating either by themselves, or in conjunction with the venereal poison. It is of vast importance in af- fections of this description, to distinguish with all possible accuracy between the syphilitic action and that of mercury, scrofula, and other causes. Far- ther on we shall endeavour to make this distinction as clear as possible. Bubo.—Another primary manifestation of syphilis consists in an enlargement of one or more of the ab- sorbent glands of the groin, termed bubo. This en- largement usually succeeds the chancre, and is caused by the absorption of the virus of the latter. It is rare in real syphilis that more than one gland in each groin becomes affected with the virus, although some of the other glands now and then become slightly swollen from sympathy. The swelling ordinarily partakes of an inflammatory character, and if not op- 21* 490 DISEASES OF THE URINARY posed by appropriate remedies, runs on to suppura- tion, and sometimes to sloughing. The disease has been supposed to be purely local, until after the swelling in the groin has proceeded to the suppurative stage ; but this is evidently erroneous, from the fact that secondary symptoms not unfre- quently occur, without there having been any previ- ous enlargement of the gland in the groin. Bubo sometimes makes its appearance without the previous existence of a chancre, but such instances are by no means common. Swellings of a non- venereal character may likewise occur in the groin from a strain, or from too great violence during the indulgence of sexual passion. But as chancre for the most part precedes the bubo, there will rarely oc- cur any difficulty in our diagnosis. Therapeutics.—Hahnemann, Gross, Hartmann, Hun- ter, Abernethy, and many other distinguished members of the profession, entertained the opinion that the con- stitutional symptoms of syphilis are always progress- ive, and never disappear, unless opposed by medicine ; but the fact is now completely established, not only that mercury is not necessary for the cure of either the primary or secondary symptoms, but that they often terminate in a spontaneous cure without any medicine. We are assured by Dr. Fergusson and other surgeons who have observed the disease in Portugal, that the natives cure themselves permanently of the primary symptoms by simple topical applications ; and of the secondary effects, by decoctions of sarsaparilla and sudorifics. They remark, that " the virulence of the disease has there been so much mitigated, that, after running a certain course (commonly a mild one) through the respective order of parts, according to the known laws of its progress, it exhausts itself, and ceases spontaneously."—{Med. and Chir. Trans., vol. iv. pp. 2-5). This is still further corroborated by the numerous cures of the primary and constitutional symptoms recorded by Messrs. Rose, Dease, Hennen, Guthrie, Good, and Whympor, without mercury, or any other means than simple dressings. In the cases which they describe, no caries of the bones occurred, as is so commonly observed when mercury is used, " and AND GENITAL ORGAN?. 491 in no instance was there that uniform progress, with unrelenting fury, from one order of symptoms, and parts affected, to another, which is considered as an essential characteristic of true syphilis."—{Med. and Chir. Trans.,vo\. viii., p. 422). Hahnemann, and most of his disciples, as well as Hunter and other eminent allopathists, entertained an opinion that the chancre is simply the vicarious symp- tom of the internal disease, and that by removing this ulcer by external applications, " the disease is forced to embody itself externally, in the more troublesome and speedily suppurating bubo. And after this, too, has been removed, as is foolishly done, by external treat- ment, the disease is forced to manifest itself through- out the organism with all the secondary symptoms of a fully developed syphilis. This unavoidable develop- ment of the internal syphilitic disease generally takes place after the lapse of two or three months."—{Hah- nemann s Chronic Diseases, p. 116). We speak advisedly when we pronounce this last as- sumption altogether erroneous; for we have repeatedly seen true venereal chancres cured by topical treatment alone, while the patients have remained entirely free from any secondary manifestations for years after- wards. When a student of medicine, the author passed some time at the United States Marine Hos- pital, Chelsea, then under the superintendence of the able and accomplished Dr. Stedman. In this in- stitution, the internal use of mercury had been dis- pensed with in the cure of syphilis, for several years previous to my entrance; and 1 ascertained that it was a very rare occurrence to observe secondary symptoms in those who had been cured at this hospital, although patients were constantly returning with other com- plaints, who had been cured of chancre years pre- vious. The treatment chiefly relied on consisted of topical applications of a mild and simple character, the internal use of decoctions of sarsaparilla, and a rigid regimen. The ordinary period for the cure of primary chancre, was from three to four weeks ; and for bubo, from six to eight weeks, So long as a chancre exists, the matter generated in the contaminated part continues to be re-absorbed, 492 DISEASES OF THE URINARY and thus to supply new fuel to the mass of the blood ; it is therefore important to change the morbid action of the ulcer, and heal it up as soon as possible. The matter formed in ulcers of the mucous membrane of the throat, which have arisen from the constitutional effects of syphilis, is also capable of propagating the disease by contact with abraded surfaces, or by being directly re-absorbed into the blood. There is reason to believe, therefore, if all these ulcers be speedily healed by topical treatment, so that the blood shall only contain a given quantity of the virus, this limited amount will gradually become diluted, by the constant addition of new and healthy blood, and by its frequent circulation through the lungs, so that its power to im- press the structures is finally lost, and the parts which have already been affected, gradually recover their health and tone. In advocating the practice of topical applications, however, we by no means wish to be understood as placing entire reliance upon them, to the exclusion of internal remedies. We only assert that local applica- tions are capable of effecting speedy cures of chancres, thus of destroying these sources of contamination, and placing the blood in the most favourable condition to be purified by the inspired oxygen, by the newly formed blood, and by remedial agents. A morbid action is set up in the chancre, which causes it to generate matter of a virulent quality. This is evident from the fact that the matter of buboes and other venereal abscesses, as well as the blood of syphilitic persons, is incapable of causing contamination in the healthy. We repeat, then, heal the chancres as soon as possible, by destroying their morbid action, with some local ap- plication which shall induce a healthy medicinal action, and we have already done much towards abridging the power of the disease. Our admirable specifics will, then, readily accomplish what remains to be done in perfecting a cure. The remedial agents which we have found most useful in the management of syphilis are, {topical,) nit. argenti., acid nit., zinc chlorid., hydrg., pracip , rub. creosote, and {internal,) the preparations of mercury. AND GENITAL ORGANS. 493 aurum mur., thuya, acid nit., sulphur, hepar sulph.. sar- saparilla, silicea, mezereum, hyd. potassa. In the treatment of chancre, our attention should be directed in the first instance to the cauterization of the sore, in order to change as speedily as possible the morbid action. For this purpose, either of the first named medicines may be employed, although in most cases we prefer the nitrate of silver in substance. After a healthy action has been excited in the ulcer, by these applications, lotions of simple water may be employed until the cure is established. It will be well to keep a dossil of lint moistened with water constant- ly upon the ulcer. This course, in conjunction with the remedies advised below, will generally effect speedy and permanent restoration. Of the internal remedies, mercury is the most im- portant. By comparing the pure effects of the differ- ent preparations of this drug upon the healthy human organization, with the constitutional effects of the syphilitic virus, it will be observed that the former are capable of causing all the symptoms of the latter, as well as many others which are peculiar to the drug. According to Pereira, the following are the effects of mercury in large doses: First. On the mucous membrane of the nose and throat: ulcerations of the mouth, gums, throat, tonsils, and nose, which are often followed by extensive sloughing of the parts. Second. On the skin or surface of the body : eczema mercuriale, erythema mercuriale, lepra mercurialis, ery- sipelas mercuriale, spilosis mercurialis, miliaria mercuri- alis, and other cutaneous eruptions which bear a close resemblance to herpes, impetigo, psydrasia, and the copper-coloured eruptions of syphilis. Third. On the bones and their periosteal coverings: "inflammation of the bones or periosteum, and the consequent production of nodes {symphoresis periostei mercurialis") By the above it will be seen that all of those parts capable of being impressed by the venereal virus, are also acted on by mercury. That the operation of the latter is often more violent and destructive than the former, will not at this day be questioned. 494 DISEASES OF THE URINARY But in addition to the symptoms just enumerated, mercury, in large doses, causes almost innumerable other symptoms, which have no bearing upon the sub- ject of this chapter, except as indicating its danger in the hands of allopathists. We have quoted above from an eminent allopathic writer, in order that every reader may be convinced of the analogy between the effects of the venereal poison and of mercury, upon the human constitution, and to show the difficulty of distinguishing between syphilitic and mercurial symptoms, in the old school mode of practice. For an accurate and complete description of the pure effects of mercury upon the healthy organism, we refer to the provings of Hahnemann and other homoeopathists. Hahnemann preferred the fluid quicksilver, carried up to the decilionth degree, over all other preparations, in the treatment of both primary and secondary syphilis. For the cure of primary chancre, Hartmann recom- mends the first or third trituration of mercurius sol., in doses of one grain, night and morning. If no improve- ment occurs within the first eight days, he gives a lower trituration, or, if necessary, a low trituration of merc.pracip. rub., in doses of one-sixth of a grain, two or three times a day. In the Hunterian, phagedenic, and the elevated indurated chancres, Hartmann em- ploys the red precipitate, in its lower attenuations, from the first. Dr. C. Miiller, of Leipsic, is also most decidedly in favour of the red precipitate or the hydr. sulph. rub., in the treatment of syphilitic chancres and buboes, in whatever state they may present themselves. He advises a grain of the first trituration, to be given twice a day until the ulcers have nearly healed. For painful nodes and other syphilitic affections of the bones, hydriodate of potash is advised. I have also made use of the precipitate at the third attenuation, with marked advantage, in uncomplica- ted syphilis. I have known the best results, also, from the hydr. mur. cor., in both the primary and secondary forms of the malady. For the cure of troublesome AND GENITAL ORGANS. 495 secondary symptoms, in the forms of cutaneous erup- tions, glandular enlargements, and nodes, the protiodide of mercury has extraordinary power. Speedy cures have been effected by it after the other mercurial pre- parations had failed. It may be used at the third attenuation, in doses of a grain, twice a day, until the eruptions disappear. When syphilis is complicated by psora, scrofula, or any other chronic disease, suitable remedies should be alternated with the mercurials. Muriate of gold ranks next in importance to mercury, as a remedy in secondary syphilis. The late Dr. Taft, of New Orleans, employed it in secondary ulcers, and eruptions which would not yield to mercury, with the most gratifying results. In syphilitic eruptions of long standing, we have often administered it with entire success. The second or third trituration may be em- ployed, in half grain doses, night and morning, as long as necessary. Nitric acid will be serviceable in many cases of ill conditioned chancres, which seem to withstand the curative force of mercury. It is also of great value in protracted secondary cases, accompanied with emaci- ation, debility, caries of the bones, unhealthy ulcers upon the surface, and great derangement of the ner- vous system. If these symptoms have been aggrava- ted by abuse of mercurials, the indication is still stronger for the acid. The first, second and third di- lutions are to be preferred in these cases, a dose to be given twice daily until the disease yields. Sulphur, hepar sulph., and hydr. sulph. rub., are the proper specifics when the chancre occurs in psoric constitutions. As a general rule, the. two first should be alternated with some mercurial preparation. Hyd. potassa is eminently worthy of consideration in the indolent glandular swellings which sometimes originate from a combination of syphilis and scrofula. It is also an efficient medicine in the treatment of venereal nodes. Silicea, mezereum and sarsaparilla are often valuable auxiliaries in syphilis complicated with scrofula. These medicines should also be given in alternation with some other suitable specific. 496 DISEASES OF THE URINARY In conclusion, we call attention to the following re- liable mark of cure, alluded to by Hahnemann in his Chronic Diseases : " So long as the original spot upon which the chancre had been developed, exhibits a red- dish morbid-looking, red, or bluish scar, we may be sure that the internal disease is not completely cured; whereas, if the chancre has been removed by the in- ternal remedy, the original spot of the chancre can no longer be traced, on account of that spot being covered by as healthy-coloured a skin as the rest of the body." SECTION X. LEUCORRH03A.--FLUOR ALBUS.--WHITES. Diagnosis.—This disease is characterized by a dis- charge, from the utero-vaginal structure, of a mucous or purulent character, of a white, yellow, or greenish colour, either thin and -watery, or of the consistence of starch or gelatine. This discharge, in contradistinc- tion to that of gonorrhoea, arises from a benignant mor- bid action, and is non-contagious. The assertion of Hartmann, respecting the identity of gonorrhoeal and leucorrhoeal inflammations—the difference, in his view, consisting only in the location of the disease—is evi- dently erroneous. This author defines gonorrhoea to consist of an inflammation of the female urethra, and leucorrhoea of a similar inflammation of the mucous membrane of the vagina or uterus. The opinion falls to the ground when we reflect that the latter disease not unfrequently extends to the urethral mucous mem- brane, giving rise to ardor urinae, burning pain on pass- ing water, heat, fulness, and swelling of the part, and a purulent discharge, which is non-contagious. Leu- corrhoeal inflammation always originates from causes which have impaired the healthy tone of the mucous membrane ; gonorrhoeal inflammation, on the other hand, may arise from the simple contact of a drop of gonorrhoeal matter with the most sound and healthy membrane. The former is the result of an ordinary inflammation, which is analogous in its character to that of catarrh and chronic bronchitis : the latter pro- ceeds only from the application of a specific infectious matter, which developes a particular morbid inflam- mation, and a contagious purulent secretion. AND GENITAL ORGANS. 497 The character of the discharge and of the symptoms, will depend upon the location of the disease, its causes, and the amount of inflammation present. Inflamma- tion of the cervix uteri, for example, causes a discharge of " white mucus, and when the inflammation is in- tense, tinged with blood."—{Hall.) Acute vaginal or urethral inflammation gives rise to a purulent dis- charge of a yellow or greenish colour, sometimes tinged with blood. A more chronic affection of the same parts induces a thinner, more glairy, and muco-purulent secretion. Scirrhus uteri causes an ichorous, bloody and foetid discharge. In chlorotics, with deranged menstruation, the secretion is thin, serous, acrid, and of a lightish or straw colour. The discharge which often accompanies pregnancy, is thick, glairy, and white or yellowish ; but in some instances after ac- couchement, more particularly in scrofulous and ca- chectic subjects, the matter is ichorous and highly ir- ritating to the parts with which it comes in contact. In polypi of the uterus or vagina, the discharge is at first mucous, but when the tumours have attained some size, it becomes tinged with blood, and in some cases of this kind profuse haemorrhages occur. The signs wrhich denote the existence of these tumours, are, sense of weight and fulness in the uterus, dragging pains in the small of the back, bearing down pains, and turns of profuse haemorrhage. In light cases of leucorrhoea, the discharge is usually thin, glairy, transparent, and starchy; but when the disease is thoroughly seated, and the patient is of a delicate or cachectic habit, the fluid may be muco- purulent, serous, sanious, and of a white, yellow, or greenish colour. As a general rule, the discharge is worse about the period of the monthly sickness, owing probably to the increased determination of blood to the parts during this natural phenomenon. The diseases which are ordinarily accompanied by leucorrhoea are, amenorrhoea, chlorosis, polypus and scirrhus uteri, dysmenorrhoea, menorrhagia, prolapsus uteri, and chronic inflammations of the uterus, vagina or urethra. When the affection is inveterate, and attended with 498 DISEASES OF THE URINARY an abundant discharge, the whole system becomes injuriously affected : the face assumes a pale or sal- low colour ; the eyes are surrounded with dark or leaden-coloured circles ; the functions of the stomach and bowels are impaired; the patient experiences a weary and dragging sensation in the left side ; there are also dull pains in the back, loins, and abdomen ; cold extremities ; nausea ; palpitation and dyspnoea after exercising ; lassitude ; debility; feeble pulse ; loss of physical and mental energy ; partial or total suppression of the menses ; increase or diminution of the sexual propensity. These are the symptoms to which protracted and severe attacks of leucorrhoea give rise ; but the mala- dy may exist for years, in a mild form, without the development of any of these consequences. This disease is far more common in cities amongst the rich, indolent, luxurious, and dissipated, than in the country. Indeed, the small number of births, and the frequent miscarriages occurring in large towns, are attributable in a great measure to the very com- mon prevalence of this weakness. Leucorrhoea has been considered as one of the symp- toms of prolapsus uteri ; but we are of opinion that in very many instances, the latter is a consequence, rather than a cause of the former. This opinion derives sup- port from the fact that fluor albus often exists for years before the signs of prolapsus manifest themselves: and it is probably from this circumstance that the tone of the uterus becomes impaired, and the muscles and ligaments gradually lose their strength and con- tractility. Leucorrhoea occurs at all periods of life, but is most common after puberty, and previous to the " change of life," when so many causes are constantly conspiring to induce free determinations of blood to the utero- genital organs. Causes.—The conditions which predispose to attacks of leucorrhoea, may be enumerated as follows : a lym- phatic temperament ; a scrofulous dyscrasia ; general debility and relaxation of the muscular and membra- nous structures, whether from natural organization, or previous disease. AND GENITAL ORGANS. 499 Amongst the more immediate causes may be men- tioned, an inactive and luxurious mode of life ; im- moderate sexual indulgence ; abortions; congestions and inflammations of the uterus and vagina ; men- strual derangements; want of cleanliness ; a humid atmosphere ; scirrhus uteri ; polypi and other abnor- mal growths in the uterus ; metastases of rheumatism ; herpes ; haemorrhoidal, catarrhal, and bronchial in- flammations ; the uterine debility and relaxation con- sequent on parturition, and too early exercise after confinement; neglect of mothers to exercise the of- fice of nursing ; and finally, according to Marshall Hall, undue lactation. All of these causes doubtless exercise an influence in the production of fluor albus, but in the vast majority of cases the disease may be justly attributed to the combined operation of several of these influences, rather than to any single one. We may almost pre- dict beforehand, that the child, born of parents who have always lived in compactly populous cities, and have indulged in their artificial habits, will sooner or later be afflicted with leucorrhoea. This is but one of the signs which indicate the gradual but sure pro- gress of degeneration to which the luxurious and dis- solute habits of large towns inevitably lead. In the first instance, indolence, stimulating drinks, over- heated apartments, exciting theatrical exhibitions, romances, pictures, statuary, etc., all tend to divert the mind towards sensual enjoyments. Deprived in a great measure of those pure and sublime pictures which nature has so lavishly scattered throughout the country, to please the sight, to elevate the mind, and to ennoble and purify the whole being; and of the thousand sources of happiness which pertain to coun- try life ; they turn to artificial pleasures, and reap the fruits which are ever entailed by a violation of natural laws. Is it strange then that fluor albus is so common in cities ? that the degenerate offspring of these artificial human beings should grow up so puny, so weak, men- tally and physically; so prone to disease, and soinca- pable of performing properly those functions for which nature has designed them ? If any one doubts the in- 500 DISEASES OF THE URINARY ferences which these remarks suggest, let him but ob- serve the families of the wealthy and luxurious, who have inhabited large cities for two or three genera- tions, and he will doubt no longer. Prognosis.—Leucorrhoea often leads to prolapsus uteri, amenorrhoea, menorrhagia, abortion, anasarca, hysteria, and general debility, but it very rarely ter- minates fatally. By impairing in a gradual manner the energies of the system, it predisposes it to take on serious disordered action from slight causes, and thus becomes indirectly an important morbid agent. When the complaint is recent, and occurs in females of a ro- bust constitution, from some temporary congestion, difficult parturition, or mechanical injury, we may ex- pect to remove it, by the aid of suitable remedies, in a short period ; but if the patient be of a lymphatic tem- perament, of a delicate, lax and scrofulous constitution, and subject to irregular menstruation, the disease will most probably baffle our best curative efforts, and per- sist, with a greater or less degree of severity, during life. In individuals of this description, the most insig- nificant causes are capable of inciting and perpetuat- ing the weakening discharge, so that, in many cases, it will prove a hopeless task to attempt to remove all the influences which exercise an injurious bearing up- on the case. Even when the affection exists as a mere symptom of some other disease, it seldom sub- sides with the other symptoms, but is quite prone to degenerate into a chronic fluor albus. Therapeutics—There are several conditions which are absolutely essential to the successful treatment of " whites," the most important of which are, abundant active exercise in the open air ; an avoidance of all ex- cesses in venery, and in the pleasures of the table ; a withdrawal of the thoughts and affections from exciting spectacles, from crowded balls and parties, from las- civious imaginings, from romances, and intrigues ; and lastly, frequent daily ablutions, in order to ensure the most perfect cleanliness of the utero-genital organs. The vast importance of this last point cannot be too strongly insisted upon, for without a rigid attention to cleanliness, all our efforts will prove futile. The mor- bid secretion is at best sufficiently irritating, but when AND GENITAL ORGANS. 501 it is permitted to accumulate and remain for a long time in contact with the mucous membrane, it be- comes partially decomposed, fetid, and highly perni- cious to the well-being of the parts. On this account, the constant and thorough use of local applications of tepid or cold water, as circumstances require, should be strictly enjoined. We may then carry out our re- medial measures in all their details, with a reasona- ble prospect of success. We call attention to the following remedies : Cal- carea carb., sulphur, stannum, sepia, iodine, pulsatilla, alumina, lycopodium, phosphorus, cocculus, sabina, secale cor., china, arnica, bovista, aconite, mercurius, nux vom., silicea, psoricum, copaiba, mezereum, and manga- num. Calcarea carb. is suitable in chronic leucorrhoea. affecting weak, scrofulous and cachectic females, and particularly indicated when the menses are too fre- quent and too profuse. The discharge is milky, trans- parent, mucilaginous, starchy, unirritating, and ac- companied with itching of the parts, especially the pudendum ; also lassitude ; depression of spirits ; pains in the chest and back; cough ; and general debility. When the complaint arises from a scrofulous, or psoric taint, antipsorics, like sulphur, stannum, and io- dine, will be required. The discharge in these cases is thin or yellowish, and highly irritating to the parts with which it comes in contact. The strength is also much impaired, and there are indications of pulmona- ry and scrofulous disorder, such as hectic fever ; ema- ciation ; loss of appetite; wandering pains in the chest; cough; profuse mucous or purulent expecto- ration ; feeble and rapid pulse ; night-sweats. Sepia is suitable for females who are naturally del- icate and sensitive, with clear and transparent com- plexions. The discharge is mucous, white, yellowish, or watery, mild or acrid in its nature, most abundant just before or just subsequent to the menses, and at- tended with itching and stitching pains in the genital organs. Pulsatilla is an admirable remedy in leucorrhoea accompanying pregnancy. It is also useful when the disease occurs about the period of the monthly courses. 502 DISEASES OF THE URINARY The discharge may be thin, acrid, and burning, or thick, white, and tenacious, like the white of eggs. Shifting flatulent pains in the abdomen still farther point to pulsatilla. Alumina has proved successful in several varieties of fluor albus ; but is particularly indicated when the discharge is very profuse and acrid, most abundant during the day when walking, and previous to the menstrual periods, and attended with a burning and itching sensation in the genital organs and rectum. Fluor albus brought on by masturbation, and occur- ring at intervals, with a milky, serous, ichorous, or reddish discharge, will be best covered by lycopodium, phosphorus, or cocculus. These remedies are suitable to lymphatic temperaments, to those who are highly sensitive to cold, and subject to catarrhal affections, and whose nervous systems have been morbidly ex- cited. Sabina and secale cornutum are proper in fluor al- bus depending upon weakness of the utero-vaginal structure ; also when arising from suppression of the menses ; from miscarriage ; from severe and protract- ed labours ; polypi, and prolapsus uteri. The discharge is attended with itching of the pudendum, and inordi- nate sexual propensity. China will serve our purpose when the complaint originates from excessive loss of blood, or other ani- mal fluids, extreme debility from fevers, acute inflam- mations, abuse of drugs, insufficient nutriment, and respiration of foul air. Bovista is applicable in fluor albus occurring after the catamenia, with discharge of a thick, glairy, and tenacious matter, of a yellow or greenish colour, and highly corrosive. Arnica is indispensable in leucorrhoea originating from mechanical injuries during accouchement, from polypi, hydatids, and other morbid growths in the uterus or vagina, prolapsus uteri, and undue mechan- ical pressure from without. Aconite corresponds to plethoric and sanguine con- stitutions, and to females who are subject to cono-es- tions and haemorrhages from different organs. The discharge is purulent, yellow or greenish, and attended AND GENITAL ORGANS. 503 with ardor urinae, heat, pain, and fulness in the geni- tal organs, quick and full pulse, hot skin, and other febrile symptoms. When there is reason to suspect that the discharge is from a syphilitic origin, whether it be mucous, watery, or purulent, mild or corrosive, mercurius is our best remedy. Nux vom. is recommended when the disease arises from irregular menstruation, abuse of stimulants, rich and indigestible food, with a very profuse sanguineous or yellowish and fetid mucous discharge, and attended with cramplike pains in the abdomen, constipation, sinking at the stomach, and palpitation of the heart. Cases may occur which will require the use of sili- cea, psoric um, copaiba, mezereum, manganum, nitric acid, to which the reader is referred. Administration.—We advise the employment of the first, second, and third attenuations, the dose to be repeated once in twenty-four hours until primary or secondary medicinal symptoms appear, when we may await the result for some days, or so long as the amendment continues. When the symptoms become stationary, we may again resort to the remedy. SECTION XI. AMENORRHEA. General description.—Many of the symptoms of this complaint bear a close resemblance to those of chlorosis, and it is on this account, probably, that some authors have confounded the two maladies. As retention or suppression of the menses is a very com- mon and prominent symptom of chlorosis, it is not surprising that it has been deemed a cause of chlorotic symptoms, rather than as a mere symptom. But the fallacy of this doctrine will be evident, when we re- flect that chlorosis occurs in males, in young children, and in females whose catamenial functions are regu- lar through the wrhole course of the disease. Two kinds of menstrual irregularity are generally included under the above head : first, retention of the catamenial flux beyond the natural period, from con- 504 DISEASES OF THE URINARY stitutional causes or mechanical obstruction; and second, partial or total suppression of already estab- lished courses, from phthisis, chronic hepatitis, general debility, chlorosis, fevers, and exposure to cold and dampness. It is not improbable that the same causes which contribute to the development of chlorosis, also ope- rate to prevent the usual menstrual flux at the period of puberty, and thus to establish one variety of ame- norrhea. Natural delicacy of constitution, a highly impressible nervous system, and a lymphatic temper- ament, are general conditions which precede and ac- company both maladies, although amenorrhcea some- times occurs in the most robust females. The revolution which nature causes in the female organism at the period of puberty, ought always to become manifest in the menstrual flux; but the causes which often operate to retard it, and thus to thwart the kind efforts of nature, are numerous and diversified. Singular phenomena are sometimes observed at the period of puberty in relation to this periodical evacu- ation ; for, in the place of the usual uterine secretion, fluxes now and then take place from the top of the head, the ends of the fingers, the soles of the feet, the stomach, intestines, nose, and other parts of the body, and apparently assuming the place of the monthly periods. Occasionally the supplementary secretion occurs in the form of ulcers, enlargement and irrita- tion of certain veins, and eruptions. The menstrual discharge varies much in its quan- tity and character. In hot climates, puberty arrives earlier, and the discharge is more abuudant, than in temperate latitudes. When the discharge comes on at the proper period, but is deficient in quantity, or is composed of serum, mucus, or pus, other parts of the economy suffer, as by pains in the back, pelvis, limbs, and head, until the period has passed, after which the sufferings abate until the succeeding epoch, and are then renewed. This deficient secretion may continue for months and even years, without giving rise to any structural le- sion, or any other symptoms than those enumerated, when some new circumstance, like marriage, a sea- AND GENITAL ORGANS. 505 voyage, or change of climate, may restore the func- tion to its natural conditio* Puberty, with its usual accompaniment, the men- strual flux, does not occur in cold regions until the age of fifteen or sixteen jrears, while in tropical countries, it arrives at the age of eight, nine, and ten years. Frank* records cases where the courses appeared in children of one, three, and four years. This physician also treated, at Pavia, a woman who had given birth to three children without ever having had a menstrual or lochial discharge. Many cases of this kind are mentioned by other writers, who also allude to the masculine organization and characteristics of these women, such as firmness of muscle, harshness of voice, and smallness of the breasts. From these facts we infer with Frank and others, that the menstrual function is not absolutely essential to the occurrence of conception, and that a woman may go through her whole term of pregnancy, and finally give birth to a healthy child, without any de- velopment whatever of the catamenial function. Frank, in his Practice of Medicine, expresses the same opinion: " Nous concluons de ces observations que l'apparition des menstrues est, a la verite, un des principaux signes qui annoncent le developpment de l'organe uterin et l'abord du sang dans ses vaisseaux, mais que la conception et la nutrition du foetus peu- vent egalement s'operer, quoique cette fonction pe- riodique ne soit pas encore etablie ; que la fecondite depend d'une autre cause, d'un principe analogue a celui dont elle derive chez les femelles des animaux ; que la nature a soumis en general toutes les femmes bien organisees au tribut menstruel, mais qu'elle ne l'exige pas toujours avec la merae rigueur sous peine de sterilite." In regard to the natural duration of the catamenial discharge, nothing definite can be advanced, since so much depends upon the constitution, the climate, and the habits of life ; but the average duration is about three or four days. Diagnosis.—As the period approaches when the girl * Traite de Med. Practique, vol. ii., p. 253. 22 506 DISEASES OF THE URINARY is to become a woman, neyj ideas, new thoughts, and new desires take possession of her mind. Instead of amusing herself with her doll, she prefers to enjoy, although with much coyness and timidity, the society of an attractive young friend of the other sex ; in- stead of the romping freedom of the child, we now observe the retiring manners and the burning blushes of the maiden. Her physical developments, also, become more symmetrical, perfect, and pleasing to the eye, and she looks forward into the dim vista of life with deeper interest, higher aspirations, and a more proper appreciation of the responsible duties she may be called upon to fulfil. If, in conjunction with these physical and moral changes, the catamenial discharge makes its appear- ance naturally and regularly, the girl retains her health and vigour ; but if the period passes by with- out the usual development of the monthly tribute, we are presented with the following symptoms of RETENTION OF THE MENSES. Pale, waxlike, or sullen and sickly countenance; furred tongue, and foul breath in the morning ; varia- ble and sometimes morbid appetite ; nausea, general debility, lassitude, and sense of fatigue ; pains in the small of the back, pelvis, abdomen, head, side, and limbs ; disinclination to mental or physical exertion ; coldness of the feet; constipation; leucorrhoea; de- pression of spirits ; sad and weeping mood ; distress in the stomach after eating; distention of the abdo- men ; faintness ; palpitation of the heart after exer- cise ; rapid pulse ; headache ; vertigo ; roaring in the ears ; nightly wakefulness ; hysteric symptoms ; pee- vishness and irritability ; hemorrhages from the nose, stomach, lungs, and rectum ; supplementary dis- charges from certain parts of the body. SUPPRESSION OF THE MENSES, May arise from a natural cause, like pregnancy, or from general debility resulting from excessive loss of blood, chronic and acute diseases, inordinate mucus, purulent and seminal discharges, polypi, venereal ex- cesses, constant and severe muscular exertion, and AND GENITAL ORGANS. 507 mechanical obstructions ;, or it may occur suddenly during the flux from violent emotions of the mind, exposure to cold and dampness, cold baths, or any other cause which abruptly shocks the system. The symptoms which follow suppression are usually more acute and dangerous than those of retention of the courses. It is not uncommon for the former to induce serious haemorrhages from the lungs and stom- ach, also inflammations and congestions of the brain, lungs, uterus, and liver; while in the latter, the symp- toms arise so gradually, that the organism in some measure adapts itself to the morbid condition, and thus escapes the inflammatory and febrile attacks which are so common in suppression. Suppression occurs in the most sound and robust constitutions, as well as in those that are weakly: re- tention but rarely happens in healthy and vigorous subjects, but follows usually as a consequence of ori- ginal delicacy of constitution, or of some long stand- ing chronic affection. The symptoms of the former are more violent than those of the latter, but upon the whole, less dangerous to life, and more readily con- trolled by medicines. In cases where the monthly secretion takes place, but is retained in the uterus from some mechanical obstruction, the blood often preserves its fluidity and freshness for a long period. This is owing to the ex- clusion of the oxygen of the air, the presence of which is essential to the process of decomposition. Causes.—Natural or acquired delicacy of constitu- tion, combined with a lymphatic temperament, and a highly sensitive nervous system, is by far the most common cause of retarded menstruation. A certain amount of stamina, of physical and nervous energy, is essential to the healthy performance of the func- tions, and so long as the organism is without the proper supply of this force, all of the functions must be imperfectly executed. Structural lesions which give rise to profuse puru- lent, mucous, or sanguineous discharges, operate both as causes of retention and suppression. In this class may be included, tuberculous ulcerations of the lungs, 508 DISEASES OF THE URINARY chronic bronchitis, abscesses of the liver, and lumbar abscess. Other causes of retention, are, malformations of the uterine organs, or the vagina, like imperforate os tineas, imperforate hymen, malorganization of the ovaries or fallopian tubes, unnatural growths in the uterus or vagina which oppose an obstruction to the passage of the menstrual secretion. Dr. Mcintosh divides the mechanical obstructions to the discharge of the menstrual fluid, into two classes, viz.: " those occasioned by cohesion of the sides of the vagina and labia, and an imperforate hymen, and those caused by an imperfect or imperforated state of the os uteri itself. All these cases are comparatively rare, but few men can have been in extensive practice for twenty years, without meeting with several, and there- fore they require some notice in this place. In the first set of cases, in addition to the constitutional symp- toms and local pain already mentioned, there is great fulness, distention, and a sense of weight in the pas- sages, accompanied sometimes with severe pain, and a feeling of bursting ; straining at stool and micturi- tion, together with enlargement of the abdomen, which excites suspicion of pregnancy. The nature of the case can only be determined by examination, and can be relieved only by the knife. " In the second set of cases, there is greater difficulty in detecting the state of parts, from the natural im- pediment to an examination which exists at the orifice of the vagina ; but I may mention, at least as a curious coincidence, that in the only two cases of imperforated os uteri which have fallen within my observation, there was no hymen, and the passages easily admitted the introduction of two fingers." Dr. M. punctured the os uteri, in one of these cases, and afterwards di- lated the passage with bougies, until the discharge found free exit, when all of the unpleasant symptoms subsided, and the patient was restored to perfect regu- larity and excellent health. The other patient, whose delicacy forbade the operation, gradually sank under her symptoms and died. I have met with one case of retention, from adhesion of the walls of the vagina. The patient was a healthy young married lady whose AND GENITAL ORGANS. 509 menstruations had been regular until she became preg- nant, after which they ceased, and she advanced as usual until the fifth month, when she had the misfor- tune to miscarry. During the delivery of the foetus, so much violence occurred to the parts, that inflamma- tion and sloughing of the vagina followed, adhesions took place between the vaginal walls, and the passage became entirely closed to the escape of the menstrual fluid. The patient experienced for many months most severe pains in the pelvis, abdomen,back, and especially at the monthly periods; many severe constitutional symptoms set in, and she became reduced to a very low state of health. A free incision through the cica- trix, gave vent to a large quantity of fluid blood, ex- hibiting but slight signs of decomposition, and the pa- tient speedily regained her health. The most harmless cause of suppression, is that which arises from pregnancy. But although this is a natural cause, its constitutional effects are manifested in the form of frequent nausea, morning sickness, ptyalism, &c. These symptoms, although quite trouble- some and annoying to the patient, serve the important purpose of guarding the brain, lungs, and other vital parts, from dangerous inflammations and congestions. One of the most notable causes of suppression du- ring the flow of the courses, is abrupt exposure to cold. This obstruction is apt to arise in going suddenly from a warm room after exercise, and when the pores are open, into the cold air. It is also caused by plunging the limbs or body into cold water during the period. Insufficient clothing and thin shoes may also be men- tioned as common causes. Violent emotions of the mind, vehement anger, ter- ror, sudden joy, intense grief, revolting sights, and electric shocks, may likewise be reckoned as frequent causes of obstruction or suppression of menses during the period. It has been asserted that severe physical exertion often induces suppression, and the fact that habitual dancers are subject to but slight catamenial dischar- ges, has been adduced as a proof of the assertion. We are inclined to credit this statement, from reflecting that operatives who labour long and hard, have but a 510 DISEASES OF THE URINARY very slight seminal secretion, and consequently but little inclination for sexual enjoyment; while he who enjoys his otium cum dignitate, abounds in this secre- tion, and experiences frequent amorous desires. The same result may happen to females, with reference to their monthly secretion, and yet no unpleasant conse- quences arise from the diminution or suppression of the discharge, since a sufficient amount of the vital stimuli has already been expended in severe muscular exer- cise. Prognosis.—Retention proceeding from a natural lack of constitutional vigour, is always difficult to cure; but where no serious organic difficulty exists, we may generally hope for ultimate success. In cases, however, which are complicated with chronic pulmo- nary disease, dropsical affections, and organic disease of the heart or liver, the prognosis must always be un- favourable. Retention from imperforated os uteri, or hymen, and from vaginal adhesions and polypi, are all readily cured by surgical means. When suppression arises as a symptom of some chronic disease, especially if it has persisted for seve- ral months, we shall, for the most part, find the case incurable ; when, on the contrary, it has arisen from an acute disorder, the cure may be easily accom- plished. Obstructions which are consequences of anger, grief, fright, jealousy, or exposure to wet and cold, may also be speedily restored by suitable specifics. In forming an opinion respecting the probable ter- mination of amenorrhoea, it should always be borne in mind, that it is almost invariably either a symptom of some other disease, or that it owes its origin to a ge- neral lack of constitutional vigour. Much, therefore, depends upon the general condition of the system, and upon the curable or incurable nature of the malady which causes the menstrual derangement, as to whe- ther our prognosis be favourable or otherwise. Therapeutics.—In the management of amenorrhoea, our first attention should always be directed to the re- moval of the cause upon which it depends. Those cases of retarded menstruation dependent upon a want of constitutional vigour, will derive material benefit AND GENITAL ORGANS. 511 from well regulated exercise, nutritious diet, change of scene and of climate, sea air, sea voyages, and bath- ing. Retention from mechanical obstructions, can on- ly be cured by the aid of the surgeon. But in suppression or obstruction, unattended with any serious local complication, and originating from exposure to cold, mental emotions, suddenly checked perspiration, cold drinks, fevers, &c, we may afford the most prompt relief by the employment of suit- able remedies. We call attention to the following medicines : Pul- satilla, sabina, china, calcarea carb., ferrum, graphites, conium, serpentaria virg., sulphur, sepia. Pulsatilla is adapted to females of a mild, timid, and amiable disposition, who are easily excited to tears or to laughter. It may be used in cases where menstru- ation is delayed a few days beyond the natural period, in abrupt suppression of the courses, from cold bath- ing, wet feet, sudden suppression of perspiration from cold air, violent passions and emotions, and in fevers, in alternation with other suitable medicines. It is also valuable in partial obstructions, accompanied with dyspeptic and hysteric symptoms. The general indications are, lassitude, weariness of the limbs, un- pleasant arterial pulsations in different parts of the body, congestion, anxiety, and oppression of the chest and heart, after exercise, and in the night when in the recumbent posture: variable appetite; coldness of the feet; sleeplessness ; pains in the back; weeping mood ; vertigo or giddiness ; colicky pains in the ab- domen. Sabina is only useful in that irregular variety of amenorrhoea in which the menses appear too soon, and too profusely for a few hours, and are then suppressed either temporarily or permanently. The kind of amenorrhoea in which this medicine is applicable, is for the most part induced by a hyposthenic condition of the uterus. China and ferrum are especially serviceable in re- tarded menstruation dependent on constitutional de- bility, whether natural or acquired. The general in- dications for their use, are, pale, sallow, or cachectic countenance ; emaciation ; muscles soft and flabby ; ra- 512 DISEASES OF THE URINARY pid circulation; rapid and difficult respiration after exercise ; palpitation of the heart, excited by mental emotions, exercise, or eating heartily; lassitude, de- bility, and general indisposition to think or act; tran- sient pains in the chest, back, side, pelvis, and limbs ; swelling and pain in the hepatic region ; bitter taste ; feeble appetite ; impaired digestion; nightly restless- ness ; leucorrhoea. Calcarea carb., sulphur, graphite, conium, and sepia, are indicated in the catamenial irregularities of scrof- ulous, rickety, and syphilitic subjects. The history of each case will enable us to decide respecting the pre- cise nature of the disease upon which the amenorrhoea is dependent, and thus render it easy to select an anti- psoric which shall gradually remove the original cause of disorder, and cure the patient. As a general rule, calcarea carb- agrees best with young persons whose menses appear too soon, while sulphur, graphite, coni- um and sepia may be exhibited at all ages, but for the most part, in cases of retarded and suppressed men- struation. Serpentaria virg—We have often used this medi- cine in suppressed and obstructed menses, from cold, violent emotions, and the debility consequent on fe- vers, with marked success. A recent cure of amenor- rhoea, verging on chlorosis, has also come under my observation, which, taken in connection with the other examples alluded to, convince me that it is a specific of much value in disorders of this character. As a majority of the cases of amenorrhoea have their origin income inherent constitutional vice, and are, in reality, but mere symptoms of some other affection, it is of importance that our attention be directed to all of the remote and slight symptoms which may exer- cise an influence upon the economy, as well as to the more immediate and visible signs of the malady. Administration.—When the menstrual derangement has approached gradually, and is evidently a symp- tom of some general disease, like scrofula, chlorosis, phthisis pulmonalis, dropsy, or chronic hepatitis, the remedies must be selected with reference to these mal- adies, and the same attenuations and repetitions em- ployed as advised under these different affections.— AND GENITAL ORGANS. 513 As a general rule, in these cases, we employ the first, second, and third attenuations, and repeat the dose but rarely ; but in abrupt obstructions, occurring in females of a robust constitution, from undue expo- sures, or over-excitement, we make use of the first or second attenuations, and repeat every two, three, or four hours until we are satisfied with the effect pro- duced. SECTION XII. DYSMENORRHGEA.--PAINFUL MENSTRUATION. Diagnosis.—Painful menstruation is of most com- mon occurrence in females of sanguineous and robust constitutions, and of ardent and animated tempera- ments. The monthly flux makes its appearance at the usual period, but generally in small quantity, often becoming entirely suppressed for several hours, and then reappearing to a greater or less extent, perhaps again to be suppressed. Females subject to dysme- norrhoea, are almost invariably troubled with constipa- tion, and frequent headaches, from rush of blood to the brain, in the interval between the catamenial pe- riods. The usual symptoms attending dysmenorrhoea, are, severe bearing-down pains in the uterine region, sim- ilar to the pains of labour, and coming on in parox- ysms ; constant aching in the small part of the back, the loins, the pelvis, and the limbs ; accelerated ac- tion of the heart and arteries ; flushed cheeks ; head- ache ; cutting and pressing pains in the abdomen ; flatulence; spasmodic sensation in the region of the stomach; nausea; eructations; oppression in the chest; anxiety and irritability; scanty discharge of blood which is not coagulable, and containing lymph, and shreds of a membranous structure, or clots of dark blood. 0 Causes.—The chief causes of dysmenorrhoea, are, an inflamed condition of the secretory vessels of the ute- rus, an unnaturally small os tinea, and inveterate con- stipation. Of these causes, the first is the most com- mon, and occurs in females of a full plethoric habit, of fancies easily excited to activity, who are fond of 22* 514 DISEASES OF THE URINARY the pleasures of the table, of love, and shows, and who prefer to pass their time in heated parlours, or crowded ball-rooms, rather than in active exercise out of doors. When we reflect upon the habits and the mode of life which the customs of refined society impose upon young females, we shall no longer wonder that this important function of the uterus should so often be- come disordered. The foolish mother, anxious that her child should grow up according to the laws of a false elegance, with a shape of body moulded to suit the code of fashion, rather than in those once approved proportions which the Creator gave her, envelopes her in corsets and stays, pressing the abdominal viscera downward upon the bladder and uterus, and the tho- racic organs upwards towards the throat, and thus moulds a waist sufficiently small and wasp-like to meet the requirements of a sham gentility. In carrying out this wicked whalebone and buckram system, the im- portant functions of circulation, respiration, digestion, and menstruation are of no sort of consequence to the deluded victim or her friends, when compared with the imperative demands of fashion. God made the human body of precisely the right proportions for the healthful exercise of all the organs ; civilized woman baffles this ordination by mechanical devices, and makes of the form an artificial thing, recognised and known as a specimen of gentility, the functions of which are subject to continual derangements, by con- sumption, chlorosis, dysmenorrhoea, amenorrhoea, con- stipation, and organic affections of the heart. After the innocent young girl has been thus cheated, not by " dissembling nature," but by a fashionable mother, " out of her fair proportions," it is deemed necessary, in order to complete her education, to prim her up within the crowded walls of a boarding-school; to cram her mind with some ten or twelve studies at a time, including, of course, music, and the current lite- rature ; and to neglect active exercise, wit, fun, mirth, and other health-promoters, as vulgar. In this man- ner the countenance acquires that pale and distingue cast so much coveted, and the body that frail and en- feebled state so common in cities. Another cause which occasionally gives rise to pain- AND GENITAL ORGANS. 515 ful menstruation, is an unnaturally small os tinea, Dr. Mackintosh supposes this to be a very common cause of dysmenorrhoea, and details numerous cases of the kind which have come under his own observa- tion. When the painful symptoms do not yield read- ily to the proper remedies, an examination should be made, and if the fault is in the os tincce, our efforts should be immediately directed to the dilatation of the part with bougies. The other causes which should be particularly no- ticed, are collections of indurated faecal matter in the colon and rectum, uterine polypi, exposure to cold, and rheumatic affections of the uterus. Therapeutics.—Abundant active exercise in the open air, regular hours, a plain regimen, abstinence from wine, coffee, and green tea, and a temperature not ex- ceeding 68° Fahr., within doors, are prime conditions to the successful treatment of dysmenorrhoea. By at- tending rigidly to these important points, constipation will be obviated, the circulation of the blood equaliz- ed, the animal heat uniformly diffused, and all undue determinations of blood prevented. If, however, ob- stinate congestions have already set in, a few doses of a suitable specific will soon restore the organism to its normal condition. The medicines to which we call attention, are aco- nite, pulsatilla, secale cornut., belladonna, nux vom.,pia- Una, ferrum, cocculus, sabince, conium, graphite. Dysmenorrhoea arising from an inflammatory con- dition of the uterus, and attended with marked febrile symptoms, quick pulse, hot skin, thirst, rapid respira- tion, headache and general restlessness, demands the employment of aconite. If the menses are scanty, and accompanied with cutting pains in the uterine region, abdomen, back, and loins, vertigo, loss of appetite, chilliness, nausea, and discharge of thick, black blood, alternating with short discharges of bright red blood, we may resort to Pulsatilla. If the pains shift about from one point to another, the indications are still stronger. Pulsatilla also operates best when the derangement has arisen from fright, grief, mortification, or from exposure to wet and cold. 516 DISEASES OF THE URINARY When the menstrual irregularity proceeds from uterine congestion, and presents us with the following tableau of symptoms, viz., violent spasmodic, or bear- ing-down pains from the small of the back to the ute- rus, with tenesmus and pressure on the bladder and rectum, coldness of the extremities, rapid and feeble pulse, frequent and severe contractions of the uterus, secale comutum should be employed. Belladonna is an admirable remedy when the pa- tient is of a plethoric habit and sanguine tempera- ment, and the disorder has originated from some violent mental emotion, and is attended with serious determination to the brain. It may sometimes be employed with advantage in alternation with aconite. Nux vomica is valuable in scanty and painful men- struation, from uterine congestion, arising from scy- balous accumulations in the colon and rectum. The pains are of a spasmodic character, and extend from the uterus to the neck of the bladder, and into the ab- domen. Considerable gastric derangement usually attends this variety of dysmenorrhoea. Platina, ferrum, or sabina, are applicable in that variety in which the menstrual discharge is sufficient, or even inordinate in quantity, but is attended with severe bearing-down pains in the uterine region, cut- ting pains in the back, loins, and thighs, pressure in the groins, cramps in the abdomen, blood dark, and containing membraneous shreds, and too frequent ap- pearance of the menses. For uterine and abdominal spasms, nausea, faint- ness, impeded respiration, and a scanty discharge of coagulated blood, mixed with mucus, we may give cocculus or conium. Graphite is an important remedy when the menses appear too late, and are too scanty. The uterine dis- charge is thick and dark, there are severe labour-like pains in the pelvis, also cutting pains in the abdomen, small of the back and hips, vertigo, constipation, chil- liness, cold hands and feet, flatulence, and general lassitude and debility. Administration.—The medicines may be employed at the first, second and third attenuations, and repeated every two hours during the more, severe symptoms. AND GENITAL ORGANS. 517 The remedy should also be given once in two or three days during the intervals between the monthly epochs. SECTION XIII. MENORRHAGIA.--UTERINE HEMORRHAGE. Diagnosis.—Profuse uterine haemorrhages may take place at any period of life from puberty to extreme old age, and in every variety of constitution. But the most common kind of menorrhagia to which the at- tention of the physician is called, is that which hap- pens during the monthly periods, from a congestion or relaxation of the uterine secretory vessels. A cer- tain amount of menstrual fluid is secreted each month, and this natural quantity is determined by the temper- ament, constitution, and habits of life of each parti- cular subject. Thus, robust and plethoric females, who live richly and drink wine, may lose a large quantity of blood at each period, and suffer no incon- venience from it; while individuals of delicate and re- laxed constitutions, would immediately experience ill effects from so profuse a flow. It is when this healthy, natural flux becomes morbidly augmented, that we apply to it the designation of uterine hamor- rhage, and deem it necessary to employ medicinal means. Dangerous uterine haemorrhages often occur during pregnancy, from disturbance or rupture of the mem- branes or of the placenta, and also from concussions, blows, violent exercise, fright, anger, cathartics, and emmenagogues. The symptoms which precede menorrhagia, occur- ring at the menstrual periods, are, general uneasiness and dissatisfaction, petulancy, lassitude, sense of ful- ness and oppression in the head, weariness and wan- dering pains in the back, loins, and inferior extre- mities, sense of weight and pressure in the pelvis, chilliness, unnatural determinations of blood, cold feet, rapid pulse, and impaired appetite. The symptoms attendant on the flux, will depend entirely upon the nature of the case, the constitution, and the amount of blood lost in each instance. In light cases of menorrhagia, the patient only experi- 518 DISEASES OF THE URINARY ences a general sense of lassitude, debility, and weariness, faintness, tired and uneasy sensations in the back and limbs, indisposition to exercise, a faint and deathlike feeling at the pit of the stomach, pale- ness of the face, cold extremities, and feeble and un- satisfactory respiration. In more serious cases the patient becomes almost exsanguineous ; the face, lips, and surface become blanched ; the muscular strength entirely prostrated; every attempt to move or converse induces immediate syncope ; there is more or less determination of blood to the brain, as is evinced by sharp pains, delirium, ringing in the ears, and throbbings of the carotid and temporal arteries ; the vision is impaired, floats circu- late before the eyes, respiration is oppressed, palpita- tion of the heart ensues from exercise or emotions ; pulse rapid and extremely feeble ; general coldness of the surface ; great and undefinable uneasiness and nervous irritation. The blood gushes upon every ex- ertion to change position, and on coughing, sneezing, or vomiting. After the patient has become reduced by its loss to a very low state, frequent and pro- tracted fainting turns come on ; respiration and cir- culation become almost suspended ; the blood clots at the mouths of the uterine vessels, and thus the flood- ing is temporarily arrested. As soon, however, as the organism reacts, these clots are liable to be expelled by the contractile efforts of the uterus, and the flow- ing to re-appear. These different conditions may oc- cur several times during the progress of the disorder, until finally the patient is so completely prostrate, that there is no re-action, the clots are not expelled, and time is allowed for the uterine vessels to recover themselves sufficiently to resist any further morbid secretion. Cases of this description are not uncom- mon, and the cures are often erroneously attributed to monstrous doses of opium and sugar of lead, rather than to the kind offices of nature in inducing syncope, and a consequent coagulation of the blood in the uterus. We have enumerated amongst the symptoms of the complaint, determination of blood to the headland in- flammation of the brain. These symptoms have been AND GENITAL ORGANS. 519 so often observed in connection with profuse haemor- rhages, and the question has been so often discussed, in regard to the propriety of blood-letting for the cure of a cerebral inflammation which has been caused by excessive loss of blood, that no one will deny the fact, that these symptoms actually occur as a direct conse- quence of menorrhagia. Examples of this kind should teach the important truth, that excessive loss of blood is always a powerful predisposing cause, and in very many instances a direct exciting cause of inflammations of the brain, lungs, and other structures. It ought also to induce the exercise of a little reason in therapeutical measures, rather than a persistence in the empirical routine of the old school, of venesection, opiates, and astringents. Menorrhagia originating in organic derangements of the uterus, like indurations, cancers, tumours, and ulcers, will be accompanied with the symptoms pecu- liar to these different maladies, in addition to their ordinary signs. Cases of this description will require careful attention, both in a diagnostic and in a thera- peutical point of view. Thus, if the disease be de- pendent on a scrofulous or psoric diathesis, or a syphilitic taint, our remedies must be directed as well to these original and general causes, as to those which are more immediate and local. By this means we may strike the silent and invisible enemy, while sub- duing others which are manifest to our senses. Causes.—We include among the remote causes of this affection, improper physical and moral education, excesses in eating and drinking ; insufficient nutri- ment ; scrofulous, syphilitic, or psoric taints ; pressure of the abdominal viscera downwards upon the uterus, by mechanical contrivances; an ardent sanguine temperament, and a plethoric habit, or a lymphatic, venous temperament, and a relaxed habit. The proximate causes are, irritation, congestion, or inflammation of the secretory vessels of the uterus; the various disturbances and injuries occurring during pregnancy, and from accouchement, cancers, ulcers, tu- mours, indulgence in the pleasures of love, and of stimulating drinks during the catamenial period. Prognosis,—A favourable termination may be ex- 520 DISEASES OF THE URINARY pected when no organic affection exists, if the patient is moderately robust, and the disease depends upon simple local inflammation, or the accidents arising from pregnancy and accouchement. Many of the floodings, however, which proceed from miscarriage, from abnormal positions of the foetus and placenta, and from accidents during delivery, require prompt, bold, and judicious efforts on the part of the ac- coucheur to rescue the patient from fatal prostration. But no woman need bleed to death under any of these circumstances, if there is proper knowledge and de- cision on the part of the physician. The circumstances which must render our prog- nosis unfavourable are, chronic induration or soften- ing of the uterus, cancerous and other incurable ulcer- ations and tumours, and morbid growths within the viscus. But even in these apparently hopeless cases, we should never despair, for the resources of homoeo- pathy sometimes surpass our most sanguine expecta- tions. Therapeutics.—After having removed, as far as pos- sible, all disturbing causes, a suitable remedy may be selected fromplatina,pulsatilla,belladonna, ipecacuanha, sabina, secale cor., ferrum met., arnica, china, chamomela, sepia, bryonia, nux vom., carbo animal., acid phos., hyoscyamus, crocus sat., creosote. Platina is particularly suited to females of a sensi- tive and impressible organization, and who suffer from too frequent and too profuse catemenia. The flow is accompanied, and occasionally preceded, by cutting and pressing pains in the abdomen, back, and pelvis; dull pains in the groin and thighs; sensation of ful- ness in the uterus; chills alternating with flushes of heat; unusual sensitiveness of the genital organs; headache ; sadness ; debility; restlessness ; leucor- rhoea; menstrual discharge red and fluid, or dark, thick, and coming away in clots. This remedy is ap- plicable in menorrhagia arising from induration or cancer of the womb. Pulsatilla is useful in menorrhagia occurring in fe- males at the " turn of life," or from schirrus uteri, or from simple passive congestion of the uterus, or during pregnancy and accouchement. The blood is generally AND GENITAL ORGANS. 521 dark and coagulated, and is expelled only at intervals, but in large quantities. In profuse haemorrhages after delivery, when the uterus does not contract, and the patient is much prostrated from pain and loss of blood, pulsatilla is an excellent remedy. It may also be given in menorrhagia characterized by inconstant and shifting pains in the back, loins, abdo- men and pelvis. Belladonna is our best remedy in superabundant menstruation proceeding from irritation and active congestion of the uterine vessels, and also in uterine inflammations consequent upon abortions, violent passions, or protracted continence. It is an invaluable remedy in cerebral inflammations arising from exces- sive uterine haemorrhage. The general indications for belladonna are, a ple- thoric habit; ardent, sanguine temperament; frequent determination of blood to the head ; strong passions ; pressing pains in the small of the back and the abdo- men ; sense of fulness in the uterus ; full and rather rapid pulse ; vertigo and pains in the head; nausea ; ringing in the ears ; partial loss of consciousness ; in- flammation of the womb ; profuse discharge of bright red blood; flushed cheeks; brilliant and congested eyes ; schirrus uteri. Belladonna has been advised in alternation with arnica or platina, when the pains resemble those of labour, and there is a profuse dis- charge of bright red blood. Ipecacuanha may be exhibited when the catamenia appear every two or three weeks, attended with pres- sure in the uterine region, and profuse discharge of fresh blood. Sabina is indicated in menorrhagia during and after miscarriage, and at the menstrual period. The flood- ing is accompanied with bearing down pains in the abdomen and pelvis ; abdominal spasms ; pain in the uterus ; ardor urinae, and profuse discharges of dark and coagulated blood, or of fluid red blood. Sabina is especially useful in protracted uterine haemorrhages arising from a loss of tone in the vessels of the uterus, whether from previous disease or the weight and pres- sure of the foetus in utero. Secale cornutum is recommended in haemorrhages 522 DISEASES OF THE URINARY arising from passive congestion of the uterus, cachec- tic habit, and debility, and want of tone in the uterus, from difficult parturition or disease. The general in- dications are, pale face ; cold surface ; feeble pulse ; white lips ; pains and tenesmus in the rectum and bladder; discharge of dark and offensive blood, in- creased on motion, coughing, or sneezing ; great pros- tration ; numbness ; spasms; humming in the ears; obscuration of vision ; loss of contractive power in the uterus. Ferrum met. is indicated in profuse haemorrhages after parturition and at the monthly epochs. The dis- charge is attended with spasmodic and labour-like pains in the loins and uterine region ; flushed cheeks; hard and full pulse ; hot skin ; headache; hot and scanty urine ; constipation ; shudderings. Arnica is our remedy in menorrhagia, originating from mechanical injuries during pregnancy or delivery, or from blows, falls, contusions, strains, etc. China is applicable in haemorrhage proceeding from an asthenic condition of the uterus. It is espe- cially useful in enfeebled and cachectic females, who flow too profusely after parturition, from an atonic condition of the uterus and its non-contraction. A general appearance of debility and exhaustion; blanched countenance; discharge of serous or thick, dark, and clotted blood ; pale, sunken countenance ; restlessness ; constant fainting turns ; soft and flabby muscles; coldness of the extremities; and rapid and feeble pulse, point to this remedy. Chamomela is adapted to bilious and nervous con- stitutions, and may be employed in menorrhagia, at- tended with p*ains and pressure in the pelvis; ardor urinae; tearing pains in the small of the back, uterus, and legs, with frequent discharges of coagulated blood. It has also been highly commended in uterine haemor- rhages occurring at the change of life. Females of an angry, violent and quarrelsome disposition derive most benefit from this drug. Sepia may be used in cases proceeding from scrofu- lous and schirrous affections of the uterine organs. It is likewise advised in protracted chronic cases AND GENITAL ORGANS. 523 where the system has become much exhausted from previous disease and suffering. Bryonia agrees with bilious and choleric females, and is commended in menorrhagia attended with stitching pains in the head, back, and pit of the stom- ach, when stooping, or stepping. Nux vom. will apply in cases of menorrhagia from uterine congestion, accompanied with spasmodic pains in the uterus, and a discharge of clots of dark red blood. Carbo animal, has been successfully used in a few cases of moderate uterine haemorrhage, from chronic induration of the uterus. Acid phosph. is specific in too profuse menstruation, attended with swelling and pain in the liver. Hyoscyamus is specific in superabundant menstrua- tion of hysterical females, who experience before and during the continuance of the flow, general spasms, convulsive laughing or weeping, twitching or trem- bling of the limbs, headache, and occasional delirium. The discharge is bright red. Crocus sat. corresponds to active or passive uterine haemorrhages. It is useful after miscarriage, when the discharge is very profuse, dark, and viscid, and the patient is anxious, feeble, chilly, faint, sick at stomach, restless, thirsty, and annoyed with palpitation of the heart, vertigo, impaired vision, vague pains in the back and pelvis, and unpleasant dreams. Movement and coughing increase the haemorrhage. Kreosote is advised in passive uterine haemorrhages originating in scirrhous degenerations of the uterus, or in general laxity of the uterine vessels. The menses appear too early, are too profuse, and accompanied with a leucorrhoeal or ichorous discharge, which irri- tate the parts with which it comes in contact. Administration.—In urgent cases of uterine haemor- rhage, we give the first attenuations, and repeat every half-hour until medicinal symptoms appear, or the flooding abates. In less dangerous cases, we repeat every two, three, or four hours, so long as is necessary. With the internal remedies, cold water may be ap- plied to the pelvic region by means of cloths. The hips must be elevated and supported, while the head and shoulders are lowered, and the patient be kept cool, quiet, and free from excitement. 524 CHAPTER XXVII. DISEASES OF THE FIBROUS AND MUSCULAR SYSTEM. SECTION I. ACUTE RHEUMATISM. Diagnosis.—Acute rheumatism usually commences after an abrupt suppression of perspiration, in conse- quence of exposure to wet, cold, or to a highly variable temperature. It first manifests itself in the form of slight chills, lassitude, and general uneasiness, which are soon succeeded by swelling, redness, pain, and augmented heat in the part affected. The pains vary much in character, being sometimes aching and gnaw- ing, at others, lancinating and darting, or dull and throbbing, or numb, pungent, and prickling, and ag- gravated by movement, by exposure to drafts of cold air, and by the pressure, or touch of the hand. In the first instance, rheumatism seizes upon the fibrous tex- tures, but as the inflammatory action becomes devel- oped, other tissues become involved, the capillaries of the neighbouring parts become distended with red blood, and the usual phenomena are present. The larger joints are more subject to rheumatic inflam- mation than other parts of the body, although it is not uncommon for the inflammation to commence in the head, neck, chest, arms, or legs, and gradually ex- tend into the neighbouring joints. The more common accompanying symptoms of acute rheumatism are, bitter taste in the mouth, coated tongue, rapid and full pulse, moderately hot skin, thirst, scanty, high-coloured and sedimentitious urine, intense pain on moving the affected part, anxious and distressed expression of countenance, and occasional perspiration. Rheumatic inflammations are liable to shift from joint to joint, and sometimes to fix upon important in- ternal organs, like the brain and its membranes, the pulmonary structures, and the heart and its appen- dages. So long as the malady confines itself to the joints, or to the external parts of the body, it is unat- DISEASES OF THE FIBROUS, ETC. 525 tended with danger to life ; but when metastases occur to important internal organs, the disease becomes in an eminent degree perilous. Acute rheumatism occurs for the most part, in young, healthy, and robust subjects, and can be generally traced to undue exposure to cold, or to a wet and varia- ble atmosphere. Chronic rheumatism differs from the acute form in many respects ; as for example, absence of febrile symptoms ; the fixed character of the pains ; no per- ceptible swelling or redness in the affected parts ; the pains sometimes aggravated, and at other times ame- liorated by walking, and other exercises ; great sensi- bility of the diseased tissues to changes of temperature, to humidity, and to cold ; dryness and inactivity of the skin ; rigidity in the parts, most apparent when attempting to move, or to walk, after having been quiet for a considerable period ; sedimentitious urine ; weakness, trembling, or numbness of the disordered parts. Therapeutics.—We enumerate as the principal reme- dies, rhus, bryonia, aconite, colchicum, belladonna, pul- satilla, dulcamara, mercurius, nux vomica, phosphorus, calcarea carbonica, veratrum, hepar sulphur, arnica, colocynth, lycopodium, sulphur. Rhus tox.—External indications.—The integuments about the joints swollen and red ; surface of the body hot and moist ; tongue dry and red; pulse frequent, and hard ; urine dark, or red, and turbid. Physical sensations.—Drawing and tearing, or ten- sive stinging and dragging pains in the affected parts, increased by exposure to cold, by rest, and by move- ment after having been for some time quiet ; rigidity, lameness, and weakness of the muscles in the vicinity of the diseased textures ; increase of the febrile symp- toms, and of the pains, at night, in bed ; perspiration, especially during the pains ; pains alleviated by ex- ercise ; throbbing, and burning in the knees, or ancles ; painful involuntary contractions of the muscles of the calves of the legs ; chronic rheumatic pains occurring early in the morning, and disappearing on moving about. 526 DISEASES OF THE FIBROUS Mental and moral symptoms.—Intellect unimpaired ; disposition irritable and impatient. Administration.—One drop of the first dilution may be given in a dessert spoonful of water, every two or three hours, until the pains begin to subside, or until a medicinal action is produced upon the inflamed tis- sue. Bryonia.—External indications.—Swelling and red- ness of the inflamed textures ; countenance pale or sallow, or flushed and hot ; tongue covered with a white or yellow fur ; hot and dry surface, or perspi- ration of an acid character after exercise ; considerable thirst, frequent and soft pulse ; red or yellowish urine; position such as to relax the muscles bearing upon the diseased parts. Physical sensations.—Pains of a tearing, throbbing, or lancinating character, aggravated by movement, by the touch, by the contact of cold air, and by eating ; a relaxed state of the muscles, and perfect rest, affords almost entire relief from suffering; bitter taste, or dryness of the mouth, with thirst ; nausea ; bilious vomiting ; severe pulsating headache ; morbid sensi- bility of the whole surface to the touch ; stitching pains in the region of the liver, and in the intercostal muscles ; symptoms worse during the night. Mental and moral symptoms.—General uneasiness, anxiety, and irritability ; sleeplessness. Administration.—The second or third dilution may be employed—a dose every two, three, or four hours, as the symptoms appear to require. For the active febrile symptoms which occasionally accompany the affection, we are in the habit of prescribing aconite and bryonia in alternation, with satisfactory results. Colchicum is a valuable remedy in both acute and chronic rheumatism. The pains are lancinating, jerking, or tearing, worse in the night, and increased by care, anxiety, or movement: or, there may be only stiffness and lameness in the joints, when attempting to walk, with ©edematous swellings, of the parts in the vicinity of the inflammation. Dr. Schroen commends colchicum in those cases which resist the clearly indi- cated medicines, provided the skin is moist, and the urine is turbid. Dr. S. advises it to be given in the AND MUSCULAR SYSTEM. 527 form of vini seminis colchici, and in doses of twelve drops daily. We have found a single drop of the first dilution, repeated once in from three to six hours, ac- cording to the acute or chronic nature of the case, very efficacious, in several obstinate cases which had resisted the action of other medicines. Belladonna will prove an excellent remedy, in rheuma- tic attacks accompanied with a high degree of nervous irritability, and a morbid activity of the cerebral or- gans. The pains are very severe, especially at night, increased by touch, or by remaining too long in one position. Pulsatilla is indicated when the pains shift rapidly from one part to another, and are unattended with any great swelling or redness of the integuments ; al- so, in chronic rheumatism characterized by weakness, rigidity, coldness, and sensation of weight in the dis- ordered structures. Dulcamara often proves speedily curative in rheu- matic inflammations which have been caused by ex- posure to cold and dampness. The affected parts usu- ally feel as if bruised or beaten, and after remaining for some time in one position, are attacked with se- vere pains which do not subside until the patient moves about. The pains are most common in the back, and in the joints of the arms and legs. In cases of frequently recurring rheumatism, of scrofulous or psoric subjects, we must use one or more of the following medicines: calcarea carbonica, sulphur, lycopodium, mercurius. When the disease has become chronic and invete- rate, and abnormal depositions occur about the joints, with thickening of the membraneous tissues, and per- manent rigidity, weakness, and tenderness on motion, a persevering employment of rhus, or hepar sulphur, or nux, or phosphorus, or veratrum, or lachesis, will in- duce curative results of the most satisfactory charac- ter. Other medicines which have occasionally proved successful in rheumatic affections, are, colocynth, io- dine, ferrum, china, arsenicum, arnica, carbo vegetabilis, and hyoscyamus. Administration.—In the acute form of the malady, 528 DISEASES OF THE FIBROUS we employ from the third to the sixth attenuations, and repeat the doses every two hours until a medicinal impression is evident. In chronic rheumatism, we prefer the first attenuation, and prescribe a dose once or twice daily. SECTION II. ARTHRITIS.--GOUT. Although rheumatism and gout are described by authors as different diseases, it is altogether probable that the nature of the inflammatory action is the same in both instances. When this peculiar inflammation seizes upon the young and robust, and pervades the larger joints and the muscular structures, it receives the name of rheumatism; but when individuals ad- vanced in life, are the subjects of attack, and it ap- pears in the small joints, it is recognised as gout. A fit of the gout is almost always preceded by some gastric or intestinal derangement, like impaired appe- tite, furred tongue, bitter taste, acid or bitter eructa- tions, flatulent distention of the stomach and intestines, and occasionally diarrhoea. The inflammation is, for the most part, situated in the ball of the great toe, but it may attack any of the smaller joints, and as the dis- ease advances, the veins in the vicinity of the pain become distended; the integuments swollen, cedema- tous, and of a bright scarlet colour ; the pains become severe, of a darting, throbbing, or a persistent ach- ing and burning character, increased by contact or by movement; there is an almost entire loss of muscular power of the affected parts ; the pains are worse du- ring the night, and accompanied during this period by active febrile symptoms; nearly all the functions of the organism are sympathetically deranged ; the urine is small in quantity, high coloured, and becomes tur- bid on standing; the patient is restless, irritable, and morbidly sensitive to moral and physical impressions. The disorder usually arrives at its maximum of inten- sity, in two or three days from the commencement of the inflammation. At this period, the whole toe, and sometimes the foot itself, become oedematous, and the numbness and prickling are frequently experienced in AND MUSCULAR SYSTEM. 529 the swollen textures, especially during the day: the pains and the nightly febrile exacerbations, now com- mence subsiding, until at the end of from seven to ten days, the active inflammatory symptoms have disap- peared and left the patient with a debilitated and aedematous limb. When the paroxysms of acute gout occur very fre- quently, they serve, after a time, to impair the consti- tution, to cause permanent thickenings of the articu- lar membranes, or cretaceous deposits about the joints, and to induce that condition of the parts which leads to chronic gout. This form of the complaint is cha- racterized by dull, burning, or tensive pains, oedema, thickening of the membranes of the affected joint, with rigidity, weakness, and partial loss of muscular power ; more or less gastric derangement, augmented sensibility of the mind and body to external impres- sions, depression of spirits, and general restlessness and irritability. Causes.—Gout is generally supposed to be heredi- tary, although cases are constantly occurring in which no natural predisposition can be traced. There is no doubt, however, that in the majority of instances, an hereditary predisposition exists. The exciting causes of gout, are, high-living, want of sufficient exercise, abuse of stimulants, especially wines, and general ir- ritability of the nervous system, from loss of rest, and irregularity in eating. Therapeutics.—The principal remedies for acute gout, are, bryonia, nux vomica, colchicum, bell., aconite, rhus, pulsatilla, actaa spicata, actaa racemosa, guaiacum, ar- nica, arsenicum, china, ledum, sabina, cantharides. For chronic gout, the best remedies are, calcarea carbonica, sulphur, phosphoric acid, aurum muriate, iodine, hepar sulphur, phosphorus, mercurius, sepia, silicea. It will very commonly happen that several of these medicines will cover most of the manifest symptoms which are usually present in gout, but in making our selection, the strictest regard^should be had to all re- mote and exciting causes which may have exercised an influence in originating the malady, in order that we may strike deeply at the foundation of the disturb- 23 530 HYDROPS.--DROPSY. ance, as well as at the more immediate and visible phenomena. In prescribing for gout, we may be governed by the general indications for the different medicines, as pointed out in the last section. CHAPTER XXVIII. HYDROPS. — DROPSY. SECTION I. General description.—Dropsy is generally but a mere symptom of some other affection. Its proximate cause consists in an inflammation, congestion, or exalted action of the capillary extremities of the arterial ves- sels of the serous and cellular membranes, and a tor- por or inactivity of the venous absorbents of the same parts. The remote and general causes of dropsy are, exces- sive loss of blood, and other animal fluids ; general debility resulting from disease, mechanical injuries, obstructions of the liver, spleen, kidneys, veins, lungs; abuse of drugs and stimulating drinks. At first view, an inflammation or congestion of the serous exha- lents, would seem to be incompatible with general debility, arising from excessive loss of blood, and dis- eases of the liver, kidneys, lungs, spleen, &c, but the fact is now well established, that these circumstances actually favour the formation of these very capillary inflammations and congestions. Some writers maintain that serous effusions do not occur until the active inflammatory symptoms are pass- ing off, and a state of sub-acute inflammation obtains; while others, like Laennec, and Johnson, lay it down' as a fundamental law of serous membranes, " that they begin to effuse the moment they become in- flamed." It is true that acute inflammations of serous membranes often occur and subside without leaving any traces of effusion, but this is owing to the fact H VDROPS.--DROPSY. 531 that, during the general febrile excitement, the venous absorbents of the affected cavities, being equally irritated with the exhalents, exercise their functions with preternatural activity, thus conveying off the fluid as fast as exhaled, and securing the equilibrium between exhalation and absorption. After the inflam- matory symptoms have subsided, if the exhalents and absorbents both recover their tone, health returns; but, as frequently happens, if the latter remain feeble, while the former return to their normal state, the healthy balance is lost, and dropsy is the result. In health, " the cellular tissue and all of those cavi- ties lined by serous membranes, are continually lubri- cated by a fluid which exhales from the capillary ex- tremities of the arterial vessels."—{Frank.) This fluid serves to render the parts soft, pliable, and mo- bile, and to prevent the adhesive inflammation which would otherwise occur from friction during the move- ments of the body. These exhalents give out nearly a given quantity of vapour, and a due equilibrium is established between the amount secreted for the use of the organism, and that which is afterwards taken up by the venous extremities, and thrown off by the skin, kidneys, salivary glands and intestines. So long as this proportion is maintained, all goes on well; but whenever any of the serous membranes, like the peri- toneum, the pleura, the pericardium, or the arachnoid, secrete more fluid than is required for the wants of the economy, or than can be absorbed by the venous ex- tremities, then drafts are made upon other and healthy parts to supply the increased demand. On this ac- count the perspiration becomes suppressed, and the skin dry and husky, the saliva scanty and viscid, the urinary secretions small, high-coloured, fetid, and sed- imentitious, the stools scanty and difficult, and the functions generally deranged. In cases of dropsy arising from excessive loss of blood or starvation, the normal physical condition of this fluid is changed,—the impression it produces upon the structures is altered, and a superabundance of serum is poured out into the cavities and the cellular tissue. This increased exhalation may be due either to the greater affinity which the serous membranes 532 HYDROPS.--DROPSY. exert upon the altered blood, or to an irritation of the capillary extremities which induces an exaltation of their exhaling function. The experiments of Mat- teucci teach us, that different fluids pass through the animal membranes in definite quantities and with certain degrees of rapidity, according to the char- acter of the fluids used and the condition of the tissue operated upon. These different phenomena are termed endosmose and exosmose, and it is by no means im- probable that some varieties of dropsy may be par- tially dependent upon this peculiar action. Another very important circumstance connected with the formation of dropsies, is alluded to by Eberle, in his Practice of Medicine, viz., " I have already observed, that immediately after a profuse loss of blood, absorption goes on with unusual activity. The blood-vessels are rapidly replenished with crude fluids; for the absorbents being extremely active, nearly all the aqueous fluids, received into the stom- ach, are speedily absorbed into the circulation ; and this is especially favoured by the very great thirst which almost always occurs after excessive sanguine- ous losses. The blood being thus inordinately supplied with a crude and watery fluid, becomes more irritating to the heart and capillaries, and diluted to such a degree as to pass off more rapidly by the exhalents." Direct experiments on animals have proved that artificial dropsies may be produced, by abstracting blood, and drenching them with water. On the other hand, Ma- jendie and Matteucci have equally demonstrated, that a fulness of the blood-vessels very materially retards, and in some instances, entirely suppresses the function of absorption. We think, then, it may be safely concluded, that in every case of dropsy, there are two simulta- neous morbid conditions present, namely, increased exhalation, and decreased absorption, and that, although irritation and congestion of the exhalents are generally indispensable conditions to this morbid action, yet that effusion may result in certain cases simply from an alteration in the character and quantity of the blood, by endosmose. Dropsies are acute or chronic, primitive or seconda- HYDROPS.—DROPSY. 533 ry, simple or complicated ; and the character of the effusion is dependent upon the age, sex, and constitu- tion of the patient, and the nature of each particular case. Generally, however, the fluid is composed of albuminous matter dissolved in more or less water, with different phosphates and carbonates and a little sulphur, [Frank,) of an oily character, of a citron, orange, or straw colour, and of a consistency semi- gelatinous, or like the white of eggs. But these ap- pearances are sometimes subject to variations, as cases are reported in which the liquid was brown, white, green, purulent, bloody, saccharine, urinous, and in some instances containing substances like hydatids, and bits of membrane. Much light is sometimes thrown upon the nature and causes of dropsy, by an examination of the urine. In certain cases of anasarca, for example, it is found that the urine coagulates on the application of heat, and from this circumstance we may suspect the exist- ence of the disease so ably described by Dr. Bright, under the name of granulated kidney. The application of heat in these cases, first causes the urine to become milky, and afterwards to present a curdled, or flaky appearance. " In hydrothorax following scarlatina, the urine is mixed with cruorine ; in hydrothorax de- pending upon degeneration of the spleen and liver, the urine contains a large quanity of urea and uric acid, rosic acid and purpurate."—{Hartmann.) In other instances we find the urine loaded with albumen. In acute dropsies the effusion does not occur until the active inflammatory symptoms are passing off, and a condition of sub-acute inflammation supervenes. In these cases, also, the exhalation takes place with more rapidity, and is attended with more painful symptoms, than in the chronic varieties. Now and then slight accumulations take place, which remain stationary for years, when they entirely disappear, or the morbid condition of the exhalants returns, and the disease advances to its full development. Instances of this description are often observed in hydrocele, and in ovarian dropsy. An excellent diagnostic arrangement of the dropsies 534 HYDROPS.--DROPSY. has been made by Marshall Hall, founded upon their causes, viz: " 1.--INFLAMMATORY DROPSY. " First. The history.—This form of dropsy generally takes place rather suddenly, and is to be traced to exposure to wet and cold." " Second. The symptoms consist in the appearance of diffuse, tense anasarca, generally with dyspnoea, and frequently with the signs of effusion into the head, thorax, or abdomen, and with a coagulable and oc- casionally a sanguineous condition of the urine." " Third. The morbid anatomy varies according as the dropsy is confined to the cellular membrane, or ex- tended to the serous membranes; in the latter case there is frequently the effusion of coagulable lymph, as well as of serum, from the serous surfaces. The kidney, in protracted cases, becomes disorganized, granular, scabrous, etc." " 2.--EXANTHEMATOUS DROPSY. " First. The history.—This form of dropsy succeeds to some exanthematous diseases, but by far most fre- quently to scarlatina." " Second. The symptoms are similar to those just de- tailed as designating inflammatory dropsy ; there is the same disposition to effusions into the brain, thorax and abdomen." " 3.--DROPSY FROM EXHAUSTION. " First. The history and symptoms. —This form of dropsy is known by being traced to the loss of blood. It occurs in the form of anasarca, and of effusion into the cavities. I do not know whether the urine be coagulable." " Second. A similar form of dropsy is induced in cases of neglected chlorosis." "4.--DROPSY FROM DEBILITY. " First. The history and symptoms sufficiently estab- lish and distinguish this form of dropsy. The patient has frequently had returns of dropsical affection, and HYDROPS.--DROPSY. 535 has a pale and cachectic appearance. The urine coagulates into brownish flakes by exposure to heat." " 5.--DROPSY FROM OBSTRUCTION IN THE FLOW OF VENOUS BLOOD. " This form of dropsy arises from— "First. Disease of the heart, especially of the valves." " Second. Disease of the lungs." " Third. Disease of the liver, especially the ' cirrhose.' " " Fourth. Pressure, or disease, of the veins them- selves." " The history and symptoms.—This kind of dropsy is distinguished by ascertaining the seat and nature of the original disease. Like the rest, it assumes the form of anasarca, and of effusion into the serous cavities, and into the cellular membrane of the internal organs, as the lungs, intestines, &c. The urine is not coagulable." " 6.--DROPSY FROM DISEASE OF THE KIDNEYS. " For the detection of this species of dropsy, the profession and mankind are indebted to Dr. Bright." " First. The symptoms.—It is distinguished by the coagulable condition of the urine. The urine is apt sometimes to be sanguineous." " Second. The complications.—There is, in this kind of dropsy, occasionally— " First. An attack of apoplexy ; and frequently, " Second. Inflammation of the serous membranes, and especially of the pleura." " The liver is usually found free from disease. " The morbid anatomy.—Dr. Bright describes three kinds of this disease of the kidney. In the flrst, the kidney loses its usual firmness, and becomes of a yel- low mottled appearance externally. The size of the kidney is not materially altered. In the second, the whole cortical part is converted into a granulated tex- ture, and there appears to be a copious morbid inter- stitial deposit of an opaque white substance. The kidney is generally rather larger than natural. In the third, the kidney is rough and scabrous externally, and rises in numerous projections not much exceeding a large pin's head, yellow, red, and purplish ; it is hard and inclined to be lobulated, and its texture approaches 536 HYDROPS.--DROPSY. to a semi-cartilaginous firmness ; there appears, in short, a contraction of every part of the organ, with less interstitial deposite than in the last variety." General diagnosis.—The symptoms most commonly observed in dropsy are, sensation of weight, oppression, fulness, and uneasiness in the part affected, with more or less disturbance of the neighbouring tissues ; dys- pnoea and sense of suffocation after attaining the hori- zontal posture, and after active exercise ; general feeling of debility, and disinclination to bodily or men- tal exertion; partial, and in some instances, almost total suppression of the urinary, salivary, and perspi- ratory secretions ; impaired appetite ; feeble digestion ; rare and scanty alvine discharges; thirst; countenance pale, sallow, or cachectic ; emaciation ; " diminution of animal heat, sensation, and motion," {Frank,) gen- eral derangement of nearly all the functions. In cellular dropsy, the affected part is swollen, the skin presents a smooth and shining appearance, with blue veins traversing it in different directions, and pres- sure with the finger causes a deep indentation or pit, which remains for a considerable time. There is also an apparent diminution in the temperature of the part, and a sensation of weight and tension is experienced, rather than of acute pain. The accumulation of serum becomes so great in some instances as to burst through the integuments, and thus partially discharge itself. In acute dropsies of the serous membranes, the symp- toms are more active. Here we have general febrile disturbance ; acute tenderness and pain in the disor- dered part, especially on pressure, or contact of light clothing ; urgent thirst; hot and dry skin ; urine very scanty and high-coloured; saliva viscid, tenacious, and small in quantity ; loss of appetite ; furred tongue ; rapid sinking of the physical energies. These acute symptoms often subside, and leave the inflamed mem- brane in a state of sub-acute inflammation, thus de- veloping a well-pronounced chronic dropsy. It will be observed in our previous description of symptoms, that we have included a diminution of the urinary, salivary, and intestinal secretions, as charac- teristic of this malady : but these signs are not inva- HYDROPS.--DROPSY. 537 riably present, for in a few instances we have wit- nessed an abundant and natural urinary and salivary secretion during the continuance of the complaint. So, also, one or more of the other symptoms described may be wanting, and yet the dropsical affection pro- ceed to a fatal termination ; but these circumstances are rather to be looked upon in the light of exceptions, than as general occurrences. Prognosis.—Our prognosis must depend much upon the cause and nature of each particular case. Simple cellular or serous dropsies, uncomplicated with disor- ganization of any of the important organs, are, for the most part, curable. In this class we may rank exan- thematous dropsies, and those which have arisen from loss of blood, from acute diseases in which no serious organic derangement has occurred, and from abuse of mercury and other drugs. In these cases, a speedy removal of the causes which have conduced to the disease, with pure air, a generous diet, and a judicious course of homoeopathic medicines, will generally ena- ble us to remove permanently the morbid accumulation. On the contrary, if the effusion has arisen from an organic affection of a vital organ, like the heart, the liver, the lungs, the kidney, or from incurable obstruc- tion in the veins, our prognosis must be unfavourable. In these cases of complicated dropsy, our remedial ef- forts must be adapted to the remote general disease, as well as to the immediate symptoms of the malady. Although the chances of cure are small in cases of this description, yet, as recoveries do occasionally take place in individuals of naturally vigorous constitu- tions, and in those who are tenacious of life, we should never prostrate our patients by discouragement and a grim visage, but constantly point them to a beacon of hope in the dim distance. By this means, we secure a powerful auxiliary to co-operate with us in our efforts to bring about those changes in the organism which may lead to a cure. We come now to treat of the different species of dropsy, viz. : First. Anasarca. Second. Ascites. Third. Hydrothorax. Fourth. Hydrocephalus. Fifth. Ovarian dropsy. Sixth. Hydrocele. 23* 538 HYDROPS.--DROPSY. 1.--ANASARCA.—CELLULAR DROPSY. Diagnosis.—The term anasarca is used to designate that variety of dropsical, effusion which takes place from the exhalents of the sub-cutaneous cellular tis- sue. The malady first manifests itself in the inferior extremities, particularly after standing or walking for some time, and it gradually extends upwards until the whole sub-cutaneous cellular tissue of the organism becomes involved. The tumefaction is usually soft, doughy, and inelastic, pitting on pressure, and the skin is white, shining, and below the medium temper- ature. The swelling disappears, in a great measure, after the patient has been for some time in the recum- bent position, but returns again when he has resumed the erect posture. Cellular dropsy may exist for years without causing serious inconvenience, when confined to the inferior extremities, but it is rare that the whole cellular surface becomes involved, unless some vital disorganization exists, or the energies of the system have become dangerously impaired. The cases of anasarca attended with the least dan- ger, are those arising from scarlatina, pregnancy, loss of blood, debility consequent upon convalescence from acute diseases, abuse of arsenic and mercury, enlarged inguinal glands, the pressure of tumours, or any other curable cause which operates to prevent the free re- turn of the venous blood. Effusions of this kind may very properly be termed passive dropsies, for we agree with Dewees, " that there are both active and passive dropsies, or rather dropsies that depend upon an increase of action or of inflammation, and others where there may be a mere loss of balance between the exhalation and absorp- tion." In cases of dropsy arising from venous obstruc- tion, for example, the venous absorbents below the seat of the obstruction, are preternaturally distended with blood, and, as a consequence, their powers of absorption proportionably diminished, while the arte- rial exhalents exercise their function with the usual activity. In this manner the equilibrium between ex- halation and absorption is destroyed, and dropsical HYDROPS.--DROPSY. 539 accumulations obtain. So in phthisis pulmonale, and affections of the heart, the blood being but imperfect- ly decarbonized in its passage through these diseased organs, becomes congested in the venous absorbents, and thus gives rise to diminished absorption, and con- sequent serous accumulations. Anasarca is not usually attended with much con- stitutional disturbance, or with symptoms that are painful. There are present, however, coldness of the surface, and diminished secretion of urine and sweat. The countenance is also pale and sallow, and the general appearance indicates ill-health. Not unfre- quently the effusion continues to increase until the affected parts become enormously distended, and fi- nally crack and give issue to the accumulated serum. When this happens in erysipelatous or syphilitic sub- jects, sloughing and gangrenous ulcers sometimes su- pervene, which prove highly troublesome and danger- ous. Causes.—The peculiar condition consequent upon scarlatina, measles, phthisis pulmonalis, chlorosis, and diseases of the heart; venous obstructions caused by the gravid uterus, by the pressure of tumours, enlarg- ed glands, ligatures, and mechanical injuries, sudden and excessive loss of blood, abuse of stimulants, arsenic and mercury. 2.--ASCITES, OR ABDOMINAL DROPSY. Diagnosis.—Dropsy of the belly may arise suddenly in consequence of acute peritoneal inflammation, and be attended with the ordinary symptoms of other febrile diseases, or it may make its appearance in a gradual and imperceptible manner, unattended by any notable constitutional disturbance. During attacks of peritonitis, there is an increased exhalation from the inflamed serous vessels, from the very commencement of the disease, and so long as the whole organism labours under the exalted action incident upon the fever, the venous absorbents dispose of this super- abundance of serum; but after the active symptoms have subsided, a corresponding depression obtains in all parts of the economy, except, perhaps, the affected 540 HYDROPS.--DROPSY. membrane, in which there still may remain a sub- acute inflammation and its consequence, a preter- natural effusion of serum. In vigorous constitutions, the absorbents continue to remove the exhalation as fast as formed ; but in feeble, delicate, or scrofulous subjects, the function of absorption often languishes, the equilibrium between the exhaling and absorbing functions is destroyed, and an ascites is the result. The signs which characterize abdominal dropsy are, gradual enlargement of the abdomen, first observed in the epigastric region, and afterwards extending over the whole abdomen; tenderness on pressure ; diffi- culty of breathing on taking exercise, and some time after lying down ; distinct fluctuation on percussion ; sallow and unhealthy complexion ; dry skin ; scanty secretion of high-coloured and sedimentitious urine; foul tongue, with a small secretion of viscid saliva ; impaired appetite ; constipation, or relax ; sensation of weight and stiffness, particularly when attempting to move about, or. bend the body ; general feeling of languor and debility. The only diseases which are liable to be confounded with ascites, are pregnancy and tympanitis ; but the history and circumstances of each case will enable us to distinguish with sufficient facility and certainty be- tween the different maladies. In ascites, the situation of the swelling, the fluctuation on percussion, the suppression of urine, dry skin, and the previous his- tory of the case, will mark the nature of the com- plaint ; and in pregnancy, the gradual swelling at the lower part of the abdomen, the suppression of the menses, nausea and vomiting ; the absence of fluctu- ation on percussion, and the motion of the child, will render our diagnosis accurate. Nor will the acute physician ever mistake tympanitic distention for ascites: for percussion, auscultation, and an absence of the characteristic symptoms of dropsy, will enable him to decide at once in regard to the real nature of the case. Indeed, we can hardly conceive how cer- tain eminent surgeons should have been led to perform the operation of what they have afterwards facetious- ly termed " dry tapping," when the distinguishing HYDROPS.--DROPSV. 541 marks between tympanitic and aqueous distention are so easily recognised. Authors have described several distinct varieties of abdominal dropsy, and have named each according to its precise location; thus, sub-cutaneous ascites, in which the effusion takes place in a circumscribed cavity or sac in front of the abdominal muscles; va- ginal ascites, arising from a puncture or other injury to the aponeurosis of the muscles, and causing effusion into the sheath of the muscle ; peritoneal ascites, or effusion within the serous cavity, and in some rare in- stances, on the outside ofthe membrane; hydatid as- cites, in which the water is enclosed in one or more thin vesicles ; also dropsy of the epiploon, of the me- sentery, of the intestines, of the liver, of the spleen, of the gall-bladder, and encysted ascites. This minute classification is, however, quite unnecessary for prac- tical purposes, since ascites is often complicated not only with several of these varieties, but with hydro- thorax, anasarca, and general dropsy. It is so very rare that we find the above-named organs affected separately, that we question the propriety of recog- nising in them distinct species of dropsy, although it is of some importance to be aware of the fact that these distinct effusions may occur. Causes.—The most common causes of ascites are peri- toneal inflammation, affections ofthe liver, and abuse of stimulating drinks. It may also proceed from venous obstruction, general debility in consequence of disease, loss of blood, and abuse of drugs. Prognosis.—Our opinion respecting the probable termination of ascites will be determined by the fol- lowing circumstances : old age, and a constitution im- paired by previous disease or by excesses, must al- ways render our prognosis unfavourable. Dropsies complicated with incurable functional derangement of the liver, or other vital organs, and venous obstruc- tions, are for the most part beyond the reach of medi- cine. On the other hand, ascites consequent upon acute inflammation of the peritoneum, loss of blood, abuse of stimulants and drugs, and the debility arising from fevers and other acute diseases, may generally be set down as curable. When the malady occurs in 542 HYDROPS.--DROPSY. young and naturally robust constitutions, our prognosis will be still more favourable, and in some instances, may afford grounds of encouragement in highly com- plicated cases. Paracentesis abdominis, or tapping.—This operation should always be deferred as long as possible, in order to allow a reasonable time for the action of medicines. If, however, the accumulation becomes very great, and the symptoms are so urgent as to prevent all ex- ercise, destroy rest in a sitting or recumbent posture, and thus serve to wear out the energies of the system, the operation should not longer be delayed. At the same time, the most judicious medicinal treatment should be perseveringly directed to both the proxi- mate and remote symptoms of the malady. The ope- ration of tapping is of itself simple, and entirely unat- tended with danger when proper precautions are used ; but as the effusion usually takes place with much more rapidity, after the serum has been evacuated, than before, it will be apparent that paracentesis abdominis should only be had recourse to when the symptoms are particularly urgent. 3.--HYDROTHORAX, OR DROPSY OF THE CHEST. Hydrothorax is either idiopathic, or symptomatic of some other organic disease. By far the most common source of the affection, and one which constitutes a serious complication, is organic disease of the heart. Another frequent cause of dropsy of the chest, is pro- tracted pleuritic inflammation. Dropsy of the heart generally co-exists with hydrothorax, and it is for this reason that we so often find the pulse very irregular. The symptoms are most urgent during the night, after the patient has remained some time in the recumbent posture. The breathing becomes rapid, laborious, and grunting, with frequent sighing, sudden starting during sleep, anxious and distressed expression of counte- nance, face pallid and wax-like ; small secretion of high-coloured urine ; puffiness ofthe face and extremi- ties ; fulness of the chest; dull sound on percussion. Dyspnoea occurring from the slightest exercise, or from lying down, sudden starting up with fright, du- ring sleep, dull sound on percussion, and irregular HYDROPS.--DROPSY. 543 pulsations of the heart, will enable us to recognise the affection without difficulty. Laennec assures us that hydrothorax accompanies many acute and chronic diseases, and that " its pre- sence announces the approach of death, which it often precedes only a few moments." That these effusions do sometimes occur but a short period before death, from organic affections of the heart, and possibly of other organs, we entertain no doubt, for several cases have come under our observation, strongly corrobora- tive of this fact. As dropsy of the heart is so constant an attendant on hydrothorax, and the symptoms of each so constant- ly similate each other, it is unnecessary to enter into a separate description of this malady. When the ef- fusion originates from an affection of the heart, or the pericardium, there will always be a predominance of those symptoms which characterize cardaic disease, and afford us a sure guide in forming our diagnosis. Paracentesis thoracis may, in some instances, be re- sorted to with unequivocal advantage, for the relief of purulent collections within the thorax, but very rarely in hydrothorax. We have in two instances saved life by a prompt resort to this operation, where matter had accumulated in the chest, and the patients were at the point of death from suffocation ; but in thoracic drop- sies, very slight encouragement can be offered from its performance, although in extreme cases it is not to be lost sight of, since recoveries have now and then taken place after the operation. 4.--OVARIAN DROPSY. In this species of dropsy, the effusion takes place from the internal face of the membrane which encloses the ovarium. The swelling is first observed in the iliac region, in the form of a small elastic tumour, and unattended with pain, uneasiness, or constitutional disturbance. The enlargement generally progresses very slowly, extending upwards towards the kidney ofthe affected side, then crossing the abdomen to the opposite side, until ultimately it comes to occupy the whole of the abdomen. No serious inconvenience is experienced, until the tumour has attained such a size 544 HYDROPS.--DROPSY. as to encroach upon the bladder, stomach, diaphragm, intestines, and the larger blood-vessels, thus giving rise to difficulty in urinating, sense of weight and un- easiness in the stomach, dyspnoea, colicky pains in the bowels, pains in the side and chest, diminution of the secretions, and oedema of the feet and ankles. ; The tumour often remains stationary, and almost unnoticed for twenty or thirty years, when some sud- den exciting cause will operate, and the swelling ra- pidly attain an enormous size. The contents of ovarian tumours vary much in their character, being sometimes serous, sometimes albumi- nous, or purulent, or sebaceous, or fatty, or composed in part of organized structures. Dr. Clapp, Surgeon to Exeter Hospital, has recently reported a case in which the contents of the tumour " consisted of teeth, hair, bony deposit, some transparent masses of a cel- lular structure, (as examined by the microscope,) se- rum, sebaceous matter, and granular fat, which were contained in numerous small cysts. Teeth were found in all parts of the tumour, and were counted to the number of forty-three ; some were contained in cysts, others were imbedded in the semi-transparent masses, and two or three were growing from the walls of the parent cyst. In one part, a few were imbedded in a mass of bone, bearing a strong resemblance to an upper jaw united in the mesial line." Fluctuation can rarely be perceived in the swelling until it has attained a considerable size, but the loca- tion of the tumour, and the absence of pain or other unpleasant symptoms, will enable us to form a correct opinion in the early stage of the complaint. 5.--HYDROCELE, OR DROPSY OF THE TESTICLE. A description of this disease is appropriate to sur- gery rather than to medicine, but as the usual method of cure serves to corroborate the truth of similia simili- bus, we make some allusion to the subject in this place. The fluid of hydrocele is situated within the tunica vaginalis testis, commencing at the lower part of the scrotum, and gradually extending upwards until it reaches the external abdominal ring. The tumour is pyriform in shape, firm and elastic to the touch, and HYDROPS.--DROPSY. 545 unattended with pain. It is only troublesome from its bulk and weight. Much difficulty is sometimes experienced in distin- guishing this disease from enlargements of the testi- cle, and in more than one instance, we have seen this gland destroyed by injudicious attempts to draw off water from chronic enlargements of the substance of the gland. Generally, dropsy of the testicle may be recognised by its peculiar elasticity, its lightness, form, its origin at the lower part of the scrotum, and its gradual extension upwards, and, lastly, by its transparency. By placing the swelling in front of a lighted lamp in a dark room, its character will be apparent from its transparency. But in some cases, from the great thickness of the tunica vaginalis, or the dark colour and density of the enclosed fluid, no transparency can be perceived. In these instances, we must be guided by the fluctuation, lightness, form, painlessness, and general history of the case. Accumulations of fluid also occur within the mem- brane of the spermatic chord, constituting the disease known as spermatocele. This is a local affection, analogous in its nature to hydrocele. Hydrocele occasionally occurs as a congenital dis- ease, arising from an imperfect closure of the tunica vaginalis, and thus permitting the fluids of the abdo- men to descend into its cavity. Operation.—The most successful means of treating hydrocele is to evacuate the serum by means of the trochar and canula, and then to create a healthy me- dicinal action in the tunica vaginalis, with suitable injections. Merely drawing off the fluid is of no avail in effecting a cure, for the morbid condition of the membrane still remains, and the exhalents again fill up the cavity. Change then the morbid condition of the structure, and supersede it by a new and different action, and you will cure the disease. But it will be said, that by applying our remedies directly to the structure, we are obliged to create more in- flammation than is necessary in order to effect a cure. Show us, then, how it can be effected by internal remedies, with any kind of certainty,—point us to a 546 HYDROPS.--DROPSY. specific which will reach the case, and we will be of the first to adopt it. The most reliable medicine we have ever used as an injection, is a mixture of one part of tincture of iodine to two parts of water. Let this be injected within the tunic, and remain for five or ten minutes, or until sharp pains are experienced in the gland and the spermatic chord, after which, carefully permit the fluid to escape from the canula. The use of iodine is not apt to be followed by sloughing, or undue inflam- mation, yet it almost invariably suffices to effect a permanent cure. Other injections have been highly extolled by sur- geons, as solutions of alum, zinc and lead, port-wine, &c, but they have too often failed in my hands to in- spire me with confidence in their virtues, while uni- form success has given me every reason to be satisfied with the iodine. For an account of hydrocephalus, we refer to page 381 of this work. Therapeutics.—It has been already observed, that dropsy is usually but a symptom of some other mala- dy. Some of the causes which induce it, operate for a eertain length of time, and then subside sponta- neously, together with its symptoms of effusion. Amongst this class of causes may be placed, preg- nancy, temporary pressure of tumours, intermittent fevers, and inordinate doses of arsenic. Another class of causes which demands the gravest attention of the physician, consists of functional de- rangements of important organs, impaired constitu- tions, protracted debility from excessive loss of animal fluids, habitual intemperance, general cachectic habit of body, chlorosis. # The first indication of cure consists in removing, as far as is practicable, the cause of the dropsy. To do this successfully, it is necessary to enter into a minute investigation respecting the private habits of the pa- tient, as well as the present symptoms. By this means, abuse of stimulants, of drugs, and excesses of all kinds, may be guarded against, which otherwise would have operated unfavourably during our cura- tive efforts. HYDROPS.--DROPSY. 547 As a general rule, pure air, moderate exercise, an agreeable state of mind, a light and nutritious diet, and a sufficient quantity of warm clothing, should be enjoined. A change of location, or a sea-voyage, are often powerful auxiliaries in the treatment. When dropsy depends upon incurable organic af- fections of the heart or liver, much may be done to- wards palliating the symptoms and protracting the patient's life, by an avoidance of all those causes which tend to aggravate the primary source of the disease, such as undue physical exertion, violent emo- tions and passions, &c. Our efforts should also be directed, without cessa- tion, towards changing the morbid condition of the membrane upon which the dropsy is dependent. Our remedies, therefore, must cover the remote as well as the proximate symptoms of the malady. The remedies which we deem most valuable in the treatment of dropsical effusions, are, apis mel., arseni- cum alb., digitalis, china, hellebore, colchicum, dulcama- ra, asparagus, cantharides, scilla, hyd. potassa, mercu- rius, uva ursa, elaterium. In ascites and hydrothorax, the first trituration of the common honey-bee has proved astonishingly effica- cious in our hands. The influence which this remedy exercises upon the urinary organs, as well as upon the peritoneum and pleura, is of the most prompt and decided character. In large doses, it causes a sense of fulness, constriction, or of suffocation in the thorax; difficult and anxious respiration ; pain and tenderness of the abdomen, increased on pressure or by contact; symptoms worse in the horizontal posture ; great se- cretion of urine, which is pale or of a straw colour, and deposites a reddish or brick-coloured sediment; frequent desire to urinate, and strangury. Our method of preparing the medicine is as follows: Enclose the bees in a close vessel, and expose them to a temperature of 90° (Fahr.), until all moisture has escaped from them, and they are sufficiently dry to • pulverize readily; we then triturate five grains of this powder with one hundred grains of sugar of milk for the usual period, and administer the trituration in grain doses from two to four times in twenty-four 548 HYDROPS.--DROPSY. hours. Whether the active principle of this substance consists solely of the virus connected with the sting of the insect, or whether other parts possess active properties, we know not: our opinion, however, in- clines to the former view. We quote the following case, which occurred in the practice of Dr. Taft, of Hartford. The patient, a boy of twelve years of age, was attacked in July, 1849, with dysentery. After several weeks of medi- cation under an allopathic physician, the acute symp- toms subsided, and the evacuations gradually assumed their natural state, but there remained an unnatural fulness and tenderness of the abdomen, some difficulty of respiration, especially on assuming the recumbent position, a dry and harsh skin, and a materially dimi- nished secretion of urine. Notwithstanding the per- severing employment of the usual allopathic routine of cathartics, mercurials, and diuretics, the patient continued to grow worse, his abdomen became very much distended with serum, and very tender to the touch, or from even the pressure of the bed-clothes ; the respiration became exceedingly laborious and difficult, obliging the sufferer to remain for a good portion of the nights in his chair ; impaired appetite, an almost entire suppression of urine, emaciation, debility, small and rapid pulse, anxious expression, and other signs accumulated. In this condition he came under the care of Dr. Taft, who administered digitalis, arsenicum, dulcamara, mer- curius, china, sulphur, hellebore, as the symptoms ap- peared to indicate, but without any amelioration of the symptoms. In the meantime, the increasing diffi- culty of respiration, loss of rest, of appetite, and pain, had reduced the patient to so serious a condition, that I was called in council with Dr. Taft, in order to decide respecting the propriety of paracentecis abdo- minis. In consideration of the urgency of the symp- toms, and the inefficiency of the remedies which had been used, I evacuated the effused fluid, amounting to sixteen pounds, and advised a second trial of arsenicum and digitalis. No effects, however, resulted from their use : the secretion of urine remained the same, the skin dry and husky, the abdominal effusion continued, HYDROPS.—DROPSY. 549 the oppression of the chest, sense of suffocation and difficulty of breathing gradually increased, and signs of thoracic effusion began to be exhibited. Recourse was now had to the powder above alluded to, and with the most speedy and marked results. After two or three doses, a large quantity of urine was passed, and the symptoms were all ameliorated. After the remedy had been continued for two weeks, all traces of effusion disappeared, the appetite and strength be- gan to improve, and the respiration became natural and easy. The patient continued to convalesce without any further unfavourable indication, until perfect health was restored. We have witnessed the effects of this remedy in two other cases of ascites, in one case of protracted general dropsy, and in one case of hy- drothorax, and with the same favourable results. The powder of dried honey-bees has long been used as a remedy in dropsies by the aborigines of our country. Arsenicum.—External indications.—General appear- ance of exhaustion and debility; pallid, waxen, and sickly countenance ; cheeks, lips, and eyelids bloated and puffy, causing a marked alteration in the expres- sion ; dropsical swellings of the extremities and abdo- men ; mouth and tongue dry ; tongue tremulous, red, bluish, or covered with a white coat; urine scanty, dark, and turbid or slimy; general coldness and dry- ness of the skin; general anasarca, with discharging vesicles on different parts of the affected surface ; emaciation ; dark coloured spots or blisters on differ- ent parts of the body ; pulse small, feeble, and inter- mittent. Physical sensations.—General sense of prostration ; great nervous sensibility; paralytic feeling in the swollen parts ; palpitation of the heart; turns of faint- ness ; great difficulty of breathing when exercising, and after lying down ; restlessness ; anguish and op- pression in the thorax and epigastric region ; hum- ming and roaring in the ears and head ; bad taste in the mouth; loss of appetite ; dryness of the mouth and tongue ; thirst; tenderness of the abdomen on pressure; difficult and scanty alvine discharges, or slight diarrhoea; frequent desire to urinate, although but a small quantity is secreted ; anxious, difficult, B50 HYDROPS.--DROPSY. and rapid respiration while in the recumbent posture ; heaviness and stiffness of the limbs and body ; dis- turbed sleep, from impeded respiration, dreams; chilliness, alternating now and then with flushes of heat; diminution of sensation and power in the swollen parts ; symptoms worse after eating, exercise, and lying down. Mental and moral symptoms.—General mental unea- siness ; fits of anguish and discouragement; disincli- nation to remain long in one position; apprehension that it is impossible to recover. Digitalis.—External indications.—This remedy has been found curative in general anasarca, ascites, and hydrothorax originating in organic disease ofthe heart; also, paleness of the face; blue lips ; swelling of the eyelids ; coated tongue ; scanty secretion of high-col- oured urine; strong and visible pulsations of the heart; irregularity of the pulse ; general paleness of the skin. Physical sensations.—Vertigo ; pressure in the fore- head and vertex ; ringing and hissing in the ears ; want of appetite ; flat taste in the mouth ; thirst; pressure in the stomach; distention of the abdomen, with stitching pains ; pressure at the neck of the bladder, with frequent desire to urinate ; throbbing in the chest; sharp stitches in the region of the heart; res- piration anxious and difficult on walking or lying down; lassitude and diminished sensation in the in- ferior extremities ; constant inclination to sleep ; dis- turbed sleep; faintness. Mental and moral symptoms.—Dulness of intellect; vertigo ; forgetfulness ; gloomy, peevish and indiffer- ent. Remarks.—Digitalis has proved most advantageous in dropsy consequent on organic disease of the heart, and in anasarca following scarlatina. Dr. Kurtz con- siders digitalis in decoction an excellent remedy in this complaint, and that the dilutions are useless. Scilla has been employed successfully in ascites and anasarca, by Hartmann, Currie, Noack and Trinks. Hahnemann did not entertain a high opinion of this substance as a remedy for dropsy, since its primary effect was to stimulate the kidneys and cause a co- HYDROPS.—-DROPSY. 551 pious emission of urine, while its secondary effect was always the opposite of this, viz., to suspend almost entirely the urinary secretion. China.—External indications.—Countenance pale or sallow, sunken and sickly; general appearance of languor and debility; dropsical swellings in one or more parts of the body ; enlargement and induration of the liver; emaciation ; dryness of the skin, mouth and tongue ; urine scanty, pale or dark coloured, and depositing a brick-dust sediment; coldness of the whole surface of the body; skin yellow; tremour in the limbs when attempting to walk. Physical sensations.—Exhaustion arising from pro- tracted acute diseases, from excessive loss of blood, and from abuse of drugs ; pain and tenderness in the region of the liver ; heaviness and pressure in the head, from within outwards ; humming and ringing in the ears ; bitter or flat insipid taste ; loss of appetite ; thirst for cold water and acids ; oppression ofthe stom- ach and abdomen, especially after eating or drinking; constipation ; respiration short, rapid, and at times suffocative ; nights restless, and sleep disturbed by dreams ; great sensitiveness to cold ; frequent shud- dering, when drinking cold water, or when exposed to the air; swelling and stiffness ofthe limbs ; weariness of the limbs, with constant desire to change position; symptoms aggravated by contact, by eating, and at night. Mental and moral symptoms.—Low spirited, nervous and irritable ; sometimes anxious, gloomy and appre- hensive of evil, and at other times indifferent, taciturn, and stupid; confusion of ideas; disinclination to physical or mental labour. .Remarks.— China will be found curative in those dropsies which are the result of simple debility^ which has been caused by loss of animal fluids, protracted illness, and abuse of cathartics. It may also be exhi- bited in anasarca consequent on attacks of intermit- tent and other fevers. Hellebore.—External indications.—Face and lips swollen, and of a pale or yellowish cast; fluctuating swelling of the abdomen ; general anasarca; spasmo- dic or convulsive movements of the head and limbs; 552 HYDROPS.--DROPSY. twitching of the eyelids; dulness and stupor; coldness of the surface ; suppression of urine. Physical sensations.—Throbbing or compressive pain in the head; oppression at the chest and stomach ; cramplike pains in the abdomen; frequent desire to urinate, with scanty emission ; loss of appetite ; nausea, and pain in the stomach and bowels, followed by a loose alvine evacuation ; short, dry cough ; difficul- ty of breathing; sharp stitches in the head, chest and abdomen ; heaviness and rigidity of the limbs ; symp- toms better in the open air. Mental and moral symptoms.—Dulness of intellect; weakness of memory; painful stupefaction of the head ; frequent sighing and moaning; giddiness on rising up, or walking ; confusion of ideas. Remarks.—Hellebore is particularly commended in dropsies complicated with intermittent fever, after the fever has been cured by ars., also in anasarca and ascites of children, arising from scarlatina. It has effected prompt cures of dropsical effusions upon the brain, attended with convulsive motions of the head and limbs. Colchicum.—External indications.—Face yellow and cedematous; dropsical swelling of the abdomen; oedema of the feet and legs; visible palpitation of the heart; skin dry and cold, or alternating with heat dur- ing the night; rapid and difficult respiration; pulse full and hard, or quick and small; urine scanty, and dark coloured. Physical sensations.—Nausea, burning and icy cold- ness of the stomach ; distention of the abdomen, with pressure and colicky pains; abdomen tender on pres- sure ; loose and painful stools; oppression ofthe chest; palpitation of the heart; tearing pains and stiffness in the back, side, and limbs; drowsy during the day, but restless nights; symptoms worse during the night; also aggravated by mental labour. Mental and moral symptoms.—Tendency to exag- gerate symptoms ; absence of mind ; forgetfulness ; dissatisfaction from slight causes. Remarks.—This remedy is useful in dropsical swell- ings caused by atmospheric vicissitudes, excessive mental labour, sudden suppression of the perspiration, HYDROPS.--DROPSY. 553 and in anasarca consequent upon scarlatina and measles. Dulcamara.—External indications.—Face, abdomen, and limbs bloated; urine small in quantity, turbid, and fetid ; heat and dryness ofthe skin ; empty eructations. Physical sensations.—Loss of appetite ; dry mouth and tongue ; great thirst for cold drinks ; empty eruc- tations after meals; nausea ; restless, hot and fever- ish during the night; constipation ; catarrhal symp- toms ; symptoms worse at night, better on motion. Mental and moral symptoms.—Irritable and angry disposition; also scrofulous and phlegmatic constitu- tions, and great sensitiveness to cold. Remarks.—Applicable in dropsies which have arisen from exposure to cold, and general anasarca conse- quent on fever and ague, scarlatina, and rheumatic fever. Asparagus.—External indications. — Countenance pale, waxlike, and bloated ; general expression of anx- iety and distress; unusual fulness of the chest; cold- ness of the surface ; suppression of the perspiration ; urine scanty, straw-coloured, and offensive to the smell; visible throbbing of the heart, especially in the night; rapid, laborious, and sighing respiration ; pulse feeble and irregular. Physical sensations.—Feeble appetite; sense of fulness and oppression after eating or drinking; pal- pitation of the heart; great oppression of the chest, and rapid and difficult breathing, increased after being in bed for some time ; sleep uneasy and disturbed by the oppressed respiration; constant inclination to be carried about in the arms by a child ; great languor and disinclination to physical or mental exertion ; stitching pains in the region of the chest. Moral symptoms.—Fretful and peevish ; disturbed by trifles ; constant anxiety and apprehension. Remarks.—In two cases of hydrothorax following acute attacks of peripneumonia, in children of three and five years of age, I have found asparagus of sig- nal service after several other remedies had failed. One of these cases was complicated with an organic affection of the heart, and an almost entire removal of the cardiac symptoms followed the cure of the 24 554 HYDROPS.--DROPS V. dropsy. We are quite convinced that this remedy will prove one of great efficiency in the treatment of hydrothorax and general dropsy, and we respectfully urge it upon the attention of practitioners. It should always be advised in dropsies as an article of food. Cantharides is recommended in dropsy caused by tonic spasm of the neck of the bladder, and by per- verted action of the kidneys. It may also be admi- nistered in effusion occurring in the last stages of acute and chronic diseases, as a palliative. Hyd. potassa is adapted to oedematous swellings resulting from the pressure of enlarged glands upon the veins. It has likewise proved highly beneficial when administered by me for the relief of dropsy arising from Dr. Bright's granulated kidney. Mercurius has been praised as a valuable remedy in chronic hydrothorax, and in ascites from diseased liver. It is worthy of attention in ovarian dropsy, and effusions dependent upon enlargement of the spleen. Uva ursa has cured several cases of ascites depend- ent upon abuse of stimulating drinks, and abuse of drugs. Its influence in restoring the urinary secre- tions is usually very prompt and satisfactory. Other remedies which have occasionally been found useful in dropsies are, elaterium, rhus tox., lycopodium, bryonia, 61. tiglii, potassa nit., iodine, solanum nig. phosphorus, bacca juniper. Administration.—In the treatment of acute dropsies, we advise the employment of the third to the sixth attenuations, and a repetition of the dose every two or four hours until effects from the medicine are ap- parent. In chronic dropsies, we employ the first to the third attenuations, and repeat once or twice in twenty- four hours until a suitable impression is produced. 555 CHAPTER XXIX. CHLOROSIS. General description.—Young unmarried females, of delicate lymphatic constitutions, slight figures, and highly impressible nervous systems, are by far most liable to attacks of chlorosis. In a majority of in- stances, it will be found that chlorotic girls have been remarkable, from birth, for delicacy of organization, daintiness of appetite, feebleness of digestion, and undue sensibility of the whole system. So long as this nervous sensibility is not overtasked, and no im- portant causes operate to derange the delicate equili- brium upon which the proper operation of the func- tions depends, the individual enjoys passably good health ; but when the period of puberty arrives, and nature calls for her monthly tribute from the vital fluid itself,—when new thoughts and new desires powerfully stimulate the system,—when, in fine, the important change of the whole organism, during the establishment ofthe catamenial function, occurs, then the frail balance is destroyed, the digestive, absorbent, and assimilative functions fail, and those symptoms which mark chlorosis make their appearance. The disease sometimes attacks married females even when considerably advanced in years ; and it has likewise been observed in girls of two or three years of age ; but cases of these kinds are of extreme- ly rare occurrence. Men of studious and sedentary habits, especially those who have never taken much exercise, have been occasionally subjected to it. Chlorosis is more common in cold than in warm climates. This circumstance is attributable, in part, to the pernicious custom at the north, of keeping chil- dren a large portion of the year in close rooms, at a temperature of 75 to 80° Fahrenheit, thus preventing that free development of the body which would result from pure air and abundant exercise. Another reason offers itself in the fact, that persons of frail, nervous, and lymphatic constitutions, cannot often withstand 556 CHLOROSIS. the severities of a temperate latitude, without suffer- ing more or less from disorders of the glandular and membranous structures. Diagnosis.—The symptoms commonly observed du- ring the forming stage of chlorosis are, derangement of the stomach and bowels, manifested by a pale and bloated appearance ofthe tongue, foul breath, partial or total loss of appetite, morbid craving for certain indigestible articles, like coal, chalk, clay, acids, pen- cils, etc.; torpid state of the bowels ; tympanitic dis- tention of the abdomen, accompanied with occasional griping pains; faecal discharges, composed of crude and imperfectly digested substances, unnatural in colour and consistence. Soon after the appearance of these symptoms, if the disease continues, the patient becomes listless, ir- ritable, fond of solitude, and disinclined to bodily or mental exertion ; the menstrual function becomes de- ranged ; the face pale and tumid ; the lips lose their colour; the eyelids are swollen and surrounded by a dark, greenish, or yellowish circle; emaciation com- mences ; the debility and lassitude become more ap- parent ; many nervous and hysteric symptoms mani- fest themselves; dyspnoea, and palpitation of the heart, or "fluttering about the praecordia," {Hall,) occur from ascending stairs, from rapid walking, or violent mental emotions ; the patient is troubled with vertigo, giddiness, and ringing in the ears and head ; sleep is disturbed by unpleasant dreams ; the spirits become depressed, and the ambition and energy are superseded by apathy and indifference. As the disease advances, all these symptoms become more strongly pronounced, and confirmed chlorosis is developed. The whole surface of the body now as- sumes a smooth and puffy appearance ; the skin is dry, pale or yellowish, or lead-coloured ; the muscles soft and flabby; the feet and ankles oedematous ; the countenance very pallid and waxlike ; the prolabia of a lilac colour; tongue clean, bloodless, and semi- transparent ; conjunctiva of a clear white colour, or slightly tinged with blue ; pulse feeble and somewhat rapid; occasional pains in the head, chest, stomach, side and abdomen; throbbing of the carotid arteries, CHLOROSIS. 557 perceptible to the sight and hearing ; violent palpita- tion of the heart; dyspnoea, and " fluttering about the praecordia," after the slightest physical or mental ex- ertion, and often during the night; catamenial secre- tion, superseded by a profuse leucorrhoeal discharge; slight hacking cough on rising in the morning, and after exercise ; frequent loose discharges from the bowels of a dark or black colour, and very fetid ; extreme prostration of all the energies; marked de- rangement of the functions of the liver, kidneys, skin, and, indeed, of nearly every part of the body. It is not an uncommon occurrence for some of these symptoms to assume a serious local aspect during the progress of the complaint, and thus present highly troublesome and dangerous complications. Marshall Hall enumerates these complications as follows : First, pain in the head; second, cough and dysp- noea ; third, palpitation of the heart; fourth, pain and tenderness of the side; fifth, pain and tender- ness of the abdomen ; sixth, constipation ; seventh, diarrhoea; eighth, meloena ; ninth, menorrhagia; tenth, tendency to haemorrhagy; eleventh, purpura; twelfth, leucorrhoea ; thirteenth, hysteric affec- tions ; fourteenth, oedema, anasarca, erythema no- dosum. It should be borne in mind, that all of these compli- cations are nothing more than symptoms of the origi- nal malady, and are to be treated only as such. We have deemed it important to direct special attention to these symptoms, to guard the inexperienced physi- cian against mistaking them for distinct and inde- pendent affections. When either of them is particu- larly prominent, the careless diagnostician is apt to form an incorrect opinion of the case. Thus, frequent pains in the chest, violent palpitation of the heart on the slightest exertion, and an irregular or intermittent pulse, have often caused medical men to mistake an ordinary chlorosis for an organic affection of the heart: so have the cough and dyspnoea, and the gastric and abdominal derangements, which accompany chlorosis, been mistaken for phthisis pulmonalis and dyspepsia. We have included amongst the signs of chlorosis, suppression of the menses, but this is by no means an 558 CHLOROSIS. invariable symptom, as numerous cases are reported in which the catamenial secretion was perfectly natu- ral and regular during the whole course of the com- plaint. We may safely infer, therefore, that it is not dependent on retention of the menses, as some writers have supposed. We have already seen that many of the symptoms of chlorosis strongly resemble those of organic affec- tions of the heart, pulmonary phthisis, dyspepsia, liver complaint, and dropsy, but a minute examination of the history and symptoms of each case, will always enable us to form a correct diagnosis. Thus, disease of the heart is attended with more pain, and more febrile disturbance, than chlorosis : the ^expression of the eyes, and the appearance of the prolabia and tongue are also widely different. The pure white colour of the conjunctiva, and the bilious and dark colour of the faeces, will sufficiently mark the disease from chronic hepatitis. From consumption of the lungs, we may also recognise it, by the absence of febrile exacerbations, the flushed cheek, the copious purulent expectoration, and the more general emaciation which occurs in the former. There are also numerous symp- toms by which we may readily distinguish it from dyspepsia and dropsy. Causes.—There are several points connected -with chlorosis worthy of much consideration in a patholo- gical and therapeutical point of view, viz.: first, the prominent gastric and intestinal derangement at the commencement of the malady; second, the small quantity of crassimenlum in the blood; and third, the peculiar state of the capillary system, which gives rise to a haemorrhagic tendency. From the history of chlorosis, it appears that the stomach and bowels are the first structures to take on disordered action. For some time previous to the ap- pearance of the pale, waxlike and tumid countenance, the puffiness of the eyelids, the loss of flesh, suppres- sion of the menses, and other signs of confirmed chlo- rosis, we observe an impaired and delicate appetite, flabby and coated tongue, foul breath, imperfect di- gestion of the food, unnatural stools, and all those traits which characterize a feeble and imperfect per- CHLOROSIS. 559 formance of the digestive, absorbent, and assimilative functions. The symptoms which succeed are such as naturally result from such gastric and intestinal de- rangement. These facts go far towards explaining the small amount of crassimentum contained in the blood of chlorotic patients. If digestion, absorption, and as- similation were normally executed, would not the blood receive its due proportion of crassimentum, and the muscles and integuments their appropriate supply of the red globules ? The organs of the body are dependent for healthy action upon the stimuli of these red globules, which abound in oxygen, and serve to communicate to all parts of the organism its animal heat and consequent vitality. Whenever, therefore, any cause operates upon the digestive and absorbent organs in such a manner as to suspend their functions, the blood must fail of its due supply of red globules, and a derangement of all the organs ensue. In some chlorotic patients, there is a peculiar ten- dency to hamorrhages from the nose, the lungs, the stomach, and the uterus. Bloody discharges have been known from the head, the side, palms of the hands, and limbs, in instances assuming a periodical form, and taking the place ofthe menstrual discharge. On this account, the disease has been attributed by some to a laxity of the capillaries, and a consequent inability to exclude the red globules ; but this relaxed condition of these vessels is owing to an absence of their healthy natural stimuli, the " oxygen carriers," rather than to any primary derangement in the capil- lary vessels themselves. Other causes which may contribute to the develop- ment of chlorosis, in constitutions predisposed to it, are, close confinement in overheated and ill-ventilated apartments ; studious and sedentary habits ; protract- ed grief, anxiety, or fatigue ; parturition, and its after effects; leucorrhoea ; amenorrhoea ; unsatisfied love ; masturbation; prolonged continence ; frequent haem- orrhages ; crude and indigestible food ; chronic in- flammation of the intestinal canal; enlargement and inaction of the mesenteric glands. Prognosis.—This will depend principally upon the 560 CHLOROSIS. natural stamina of the patient, and the severity of the local symptoms. A frail and delicate constitution, a highly susceptible nervous system, a decided predis- position to glandular and membranous disease, and an inherent debility of the digestive apparatus, are circumstances calculated to render the prognosis un- favourable. Patients of this description are rarely able to withstand the important changes which the economy undergoes at the period of puberty, without serious local disease, and often organic degenerations of some vital part. On the other hand, if the patient be of a naturally robust and sound constitution, even if the chlorotic symptoms are quite severe, we may generally predict an ultimate recovery. Here we may trace all the causes of the malady, and bend our efforts to their removal with a prospect of success, and thus restore the system to its original health and vigour; while a body which " has been sent into this breathing world before its time, but half made up," cannot be re- modelled into one of " fair proportions " and vigour, by any resources of the physician, although much may be done towards prolonging life, and securing a mode- rately comfortable state of existence. Pathology.—In the autopsical examinations of those who have died of chlorosis, the most notable signs of disease are found in the blood, the muscles, and the surface of the body. The blood of chlorotics appears to be deprived, in a great measure, of the red mate- rial, and its place supplied by a superabundance of serum. This condition exists to a greater or less de- gree during the whole course of the disease, and it is on this account that the muscles after death pre- sent a peculiarly pale and bloodless appearance, and the skin a palish yellow or waxlike tinge. Unnatural appearances are sometimes found in the chest and alimentary canal, in the form of enlargement and di- lation of the ventricles of the heart, chronic inflam- mation of the lungs, the stomach, and the intestines, flabby and shrunken appearance of the liver and spleen, and unusual accumulations of serous fluid in the cavities, and in the cellular tissue. Therapeutics.—In the treatment of chlorosis, we CHLOROSIS. 561 find of especial importance, frequent exercise in the open air, either by gestation or moderate walking, a highly digestible and nutritious regimen, and fresh or salt water baths. It is very desirable that chlorotic patients pass their winters in warm and equable cli- mates, that exercise in the open air may be taken with advantage at all seasons. This is necessary on account of their extreme sensitiveness to the cold, which is often a serious obstacle against exposure to the low temperature of northern winters. The influ- ence of sea air is often very beneficial to patients ac- customed to inland districts, and vice versa. Short sea-voyages may sometimes be advised in the warm summer months, but caution should be exercised that the changes be not too abrupt. General bathing is also useful when properly em- ployed. We should commence with tepid baths of fresh or salt water, and gradually diminish the tem- perature as the strength will admit, until an ordinary cold bath can be advantageously sustained. Sensi- tiveness to applications of cold water, will frequently deter the patient from a persevering use of this pow- erful remedy, and rigid directions should therefore be given upon the subject. A regimen of the most digestible and nutritious meats, as mutton, venison, beef, game, and fowls, with rich animal soups, should be enjoined. Other nutri- tious food which the stomach will digest may like- wise be eaten. Wine, porter, and Scotch ale may be used at meals if agreeable to the invalid. In a word, all of those articles which are calculated to enrich the blood with the red globules, may be resorted to. The remedies best adapted to meet chlorotic symp- toms are, china, sulphur, nux vomica, pulsatilla, sepia, ferrum carb., platina, calcarea carb., conium, arsenicum, veratrum. China.—External indications.—Countenance pale or livid ; lips blackish and shrivelled ; mouth and tongue slimy ; skin yellowish ; oedematous swellings of the limbs ; faeces hard or soft, foetid, mixed with undigest- ed food, and of a dark or black colour ; offensive breath ; copious leucorrhaeal discharge ; menstrual fluid scanty, and possessing but little colour ; sup- 24* 562 CHLOROSIS. pression of the menses ; haemorrhages from the nose, mouth and lungs ; pulse feeble and more rapid than natural ; general appearance indicative of an exsan- guious and debilitated condition. Physical sensations.—Vertigo, worse when walking or during motion ; humming in the ears; disagreea- ble taste in the mouth, generally bitter or insipid; unnatural appetite; canine hunger; pressure in the stomach after eating ; distention of the abdomen from wind or water; morbid sexual desire, with nightly pollutions ; difficult and rapid respiration ; throbbing in the sternum; palpitation ofthe heart; constant in- clination to move the limbs; excessive sensitiveness of the whole nervous system, with general feeling of lassitude and debility ; great dread of cold air ; drow- siness during the day, but restlessness at night ; sleep disturbed by frightful dreams. Mental and moral symptoms.—Nervous, irritable, dissatisfied, taciturn, out of humour ; indisposition to mental exertion ; suspicious of dislike and abuse. Remarks.—China is eminently a specific in chlorosis accompanied or induced by profuse loss of animal fluids, from epistaxis, haemoptysis, haemorrhoids, mas- turbation, involuntary emissions of semen, leucorrhoea, and diarrhoea. It is one of our best remedies when the disease is uncomplicated by any serious local de- rangement, and where simple debility of the whole organism is its essential characteristic. Sulphur. — External indications.—Face pale and bloated ; eyes surrounded by blue or greenish margins; swelling of the upper eyelid ; glandular swellings about the neck and lower jaw ; mouth and tongue slimy ; foetid breath ; distention of the stomach and abdomen ; discharges from the bowels brown, and mixed with undigested food ; acrid leucorrhoeal dis- charge ; profuse expectoration ; short and rapid respi- ration ; oedema ofthe feet and ancles ; surface ofthe body covered with yellowish or brown spots. Physical sensations.—Vertigo, dizziness and dulness in the head ; humming or roaring in the ears ; putrid or bitter taste in the morning ; loss of appetite ; crav- ing for sweet or sour articles only ; pressure of the stomach and abdomen, and dyspnoea after eating ; CHLOROSIS. 563 throbbing at the pit of the stomach, with faintness ; morbid sexual desire, with feeble power of accom- plishment ; frequent involuntary emissions ; menses too early and too profuse; burning leucorrhoeal dis- charge ; weakness of the chest when talking ; short and difficult breathing on exercise, and on retiring to bed in the night ; frequent palpitation of the heart ; stitches and pains in the chest when moving the arms; coldness of the feet; drowsiness in the day time, but wakefulness and restlessness during the night ; vivid dreams ; night sweats ; constant inclination to change position ; general nervous irritation ; sensitiveness to cold ; internal coldness ; lassitude and sensations of faintness,—all of which symptoms are without acute pain, and are mitigated by rest, and worse during motion. Mental and moral symptoms.—Sadness, despondency, and inclination to weep without cause ; ill humour, obstinacy, sadness, silence, and frequent moaning. Remarks.—This medicine is advised for chlorotics of a lymphatic temperament, and those subject to fre- quent haemorrhages. Also in chlorosis complicated with tuberculous ulceration of the lungs. Nux vomica.—External indications.—Pale, yellow- ish, or clay-coloured complexion ; sclerotica natural; cheeks and eyelids swollen ; tongue white ; foetid breath ; faeces foetid and dark-coloured ; discharges of blood from the rectum ; moaning and incoherent mut- tering during sleep. Physical sensations.—Vertigo, giddiness, or sense of intoxication ; tenderness of the scalp ; ringing and hissing in the ears ; putrid, or bitter, or sour taste in the mouth ; aversion to food of all kinds, and to tea and coffee ; distention and oppression of the stomach after eating ; nausea ; bitter or sour eructations ; throbbing sensation in the region ofthe stomach ; flatu- lent distention of the abdomen, and colicky pains after eating or drinking; bleeding and painful haemorrhoids ; great irritability of the sexual organs, especially after waking in the morning ; menses too early, and scanty; frequent turns of nausea and faintness during the men- strual flux ; asthmatic respiration when walking, and at night in bed; palpitation of the heart after a gen- erous meal; painful shocks in ihe praecordia! region : 564 CHLOROSIS. sensitiveness of the whole surface of the body; trem- bling in the limbs when walking ; sleep disturbed by dreams, and so unrefreshing that the patient feels worse in the morning than in the evening ; coldness ofthe feet. Mental and moral symptoms.—Great sensibility to impressions; noise, bright lights, and strong odours intolerable ; sad ; anxious ; quarrelsome ; taciturn ; apprehensive of death. Remarks.—When chlorosis is preceded and accom- panied by marked derangement of the alimentary canal, more particularly if the patient is of studious and sedentary habits, and has indulged freely in wines, coffee, or tobacco, nux vomica is indicated. Those who are naturally somewhat robust, and of a quar- relsome, ardent and vehement temperament, will be more benefited by it than persons of a mild and phlegmatic temperament. Pulsatilla.—External indications.—Face pale ; eye- lids puffy ; tongue white and covered with viscid mu- cus ; pulsation at the pit of the stomach, perceptible to the pressure of the hand ; stools loose, green, slimy, or bloody; acrid, thin leucorrhoea ; scanty menstrual dis- charge ; rapid breathing after eating or on lying down ; coldness of the hands and feet. Physical sensations.—Vertigo, resembling intoxica- tion ; bad taste in the mouth in the morning ; loss of appetite; absence of thirst; nausea ; frequent eruc- tations of wind, tasting of the ingesta; beating and fluttering in the stomach; cutting pains in the side and abdomen; suppression of the menses, with gene- ral coldness of the body and nausea; asthmatic op- pression of the chest after eating, or when lying on the side in the recumbent posture; pain and weakness in the small of the back ; disagreeable pulsation of the arteries of the whole body; tremulousness ; weari- ness ; restlessness during the night; palpitation of the heart, after eating or talking. Mental and moral symptoms—Anxiety; disgust of everything; sullenness ; whimsicalness; dissatisfac- tion. Remarks.—Pulsatilla is adapted to chlorotics who have been irregular in menstruation, and are of a CHLOROSIS. 565 mild, timid, yielding, or sad disposition. When there is a total suppression of the menses, with much pain in the small of the back, frequent turns of chilliness, and absence of thirst, it will be indispensable, either by itself, or in alternation with some other medicine. Sepia.—External indications.—Swollen and puffy appearance of the whole body; face puffy, pale or yellow ; eyes surrounded by blue or greenish margins ; tongue coated with a white fur ; foetid breath; men- ses too early and scanty; yellowish, watery, or mu- cus leucorrhoea ; cold feet and hands when in bed in the evening. Physical sensations.—Painful beating in the head ; roaring in the ears ; no appetite, or morbid desire for all kinds of food ; absence of thirst; pain in the side and region of the liver ; great sexual inclination ; fre- quent dyspnoea; cough with mucus expectoration ; stitches in the chest and side ; weakness and stiffness in the small ofthe back ; restless sleep, with frequent waking ; skin tender and sensitive ; sweat on walk- ing ; sensitiveness to cold air ; weary, faint, and dis- couraged ; symptoms worse at night and when at rest; palpitation of the heart, and intermittent pulse. Mental and moral symptoms.—Weakness of memory; inability to think or reason ; giddiness from walking ; melancholy, discouragement, and irritability. Remarks.—Chlorosis of nervous and delicate females, with a thin and delicate skin, and in whom menstru- ation has always been irregular, may be cured by se- pia. If the patient sweats profusely when walking, and is particularly sensitive to cold air, this remedy is still more necessary. In inveterate cases, attended with extreme prostra- tion, trembling of the limbs, coldness of the surface, entire suppression of the menses, dropsical swellings, great difficulty of breathing, palpitation of the heart, loose state of the bowels, frequent and protracted turns of faintness, we may examine ferrum arsen. and vera- trum. Carb. calc. and platina are indicated when the menses are too frequent and abundant. These medi- cines are especially adapted to young female organ- isms. Administration.—The remedies should generally be 566 SCROFULA. employed at the first, second and third attenuations, and a dose administered once or twice daily, until there is an apparent effect. No repetition should be allowed so long as the slightest amendment is perceptible. CHAPTER XXX. SCROFULA. This disease was described by the Greeks under the appellation xfiexOtc, from x«i£*?, hog, and by the Latins, {scrophules from scropha, female swine). This name had its origin in the well-known fact, that scrofula was a disease peculiar to the above named animal. The blood of scrofulous subjects has been found to differ materially from that of healthy individuals. In the former, there is a superabundance of serum and a deficiency of the fibrous portion, and the solids which are generated from this blood are, in consequence, lax, feeble, and incapable of resisting exposure, fa- tigue and disease. Scrofula is for the most part hereditary, but the phy- sician is frequently presented with well marked cases of the acquired disease. The circumstances which fa- vour the formation of an original scrofulous dyscrasia, are, cold and damp habitations, want of healthy and nutritious food, constant confinement at labour in close and ill-ventilated rooms, and finally, the use of pork in all its forms as a principal article of food. Respecting this last cause, we submit a few remarks : Since the time of Moses, a large portion of mankind have looked upon the swine as an impure animal, un- fit for food. Its impurity consists of a disorder of a purely scrofulous character which is inherent and pe- culiar to it, and is constantly being developed, espe- cially during confinement and subjection to the ordi- nary modes of feeding. Probably no animal is more filthy in its habits or more disgusting for its selection SCROFULA. 567 of food. Let the pork-eater contemplate an instant, the customary mode of rearing the domestic swine, and observe what offal, filth, putridity, scourings from everything foul and corrupt, constantly swell his dis- eased carcase. Let him see in the slaughter house, how often the internal organs and the surface of the vile carcases will be studded with tuberculous forma- tions, or scrofula, and then return to pork " like a dog to his vomit," if he chooses. A strong corroboration of our views is found in the fact, that in all of those countries where the swine is forbidden to be used as food, scrofula is almost un- known. The same law obtains with the Jews, who, abiding by the precepts of their religion, inhabit almost every climate and country, and are scarcely ever afflicted with scrofula. It is absurd to argue that flesh contaminated with the scrofulous miasm, cannot communicate to the healthy body, after digestion, its morbid particles. The poison pervades every atom of the affected flesh, and no washing or digestion can destroy or banish the noxious quality. Scrofula is most common in temperate latitudes, where the changes of temperature are abrupt, and where the atmosphere is much of the time loaded with moisture. The miasm operates upon almost every structure : glands, skin, ligaments, membranes, muscles, and bones, all succumb to its attacks. Diagnosis.—The signs which are supposed to indi- cate the scrofulous habit, are, precosity of intellect; blonde hair; light complexion ; blue eyes ; soft and delicate cheeks ; lips thick and red ; " frequent swell- ing ofthe upper lip and nose ;" edges ofthe eyelids red and prone to inflammation ; scurf and eruptions on the scalp ; large head ; sensitiveness to cold ; ends of the fingers blunt instead of tapering; muscles soft and flabby; strong inclination for venereal pleasures. These marks are generally supposed to characterize the scrofulous habit, but it has occurred to us to wit- ness far more cases of scrofula in individuals the very opposite of this description; but whether or not this is the result of accident, or whether an erroneous im- pression has prevailed upon this subject, we know not. 568 SCROFULA. Amongst the most common and simple manifestations of scrofula may be ranked, glandular swellings of the neck. These enlargements occur very frequently during childhood, in the form of what are vulgarly termed, " kernels," on different parts of the neck. They are excited into activity by taking cold, by currents of air upon the neck, by measles, scarlatina, and whooping- cough, and either remain for a long time stationary and inactive, or run on to more violent inflammation and suppuration. These swellings sometimes attain a very large size, involving most of the glands of the neck, and remain in this condition for many years. More frequently, however, owing to injudicious allo- pathic treatment, the swellings are dispersed by exter- nal applications, the malady is forced to embody itself upon the lungs, and a fatal phthisis pulmonalis is the result. Another form in which scrofula developes itself, especially in children, is that of Strumous, or Scrofulous Ophthalmia. This disease is characterized by extreme sensitive- ness of the affected organs to light. Even the slight- est ray causes intense pain, and the little patient makes every effort to avoid exposure. During the in- flammation an eruption usually makes its appearance on the cheeks, in the vicinity of the eyes, and which often extends to the very organs themselves, thus giving rise to troublesome and dangerous ulcers. These ulcers not unfrequently extend until the struc- ture of the eye becomes so far impaired, that total blindness ensues. The next form of scrofula to which we shall call at- tention, is that in which the joints become affected. The most important of these affections are the White Swelling, {Arthrocace), and the Hip-disease. The approach of these maladies is commonly grad- ual and insidious. Occasional pains are complained of in the diseased joint, after exercise ; the motions of the limb gradually become impaired, and vague pains SCROFULA. 569 are experienced in the neighbouring joints, which sometimes induce the belief that healthy parts are the seat of the inflammation. As the disease ad- vances, the ligaments, cartilages, and other structures composing the joint, become so much thickened by the inflammatory action, that the limb after a time becomes stiff, and the joint immovable. In some in- stances the inflammation is arrested at this point, the suppurative process is prevented, and a recovery by what is called anchylosis takes place. But in the ma- jority of cases the disorder proceeds on to suppura- tion, ih.e whole structure ofthe joint becomes involved in this action, a profuse discharge of matter takes place from the part, constitutional disturbance is manifest in the form of emaciation, debility, night- sweats, and other symptoms of hectic fever, and the patient soon succumbs. Scrofulous affections of the joints are very difficult of detection in their early stages. The pains are so vague and indefinite, as scarcely to attract attention ; there is little or no swelling or discoloration over the disordered part; and there is no derangement of the general health which indicates that the organism is suffering under a serious malady. It is for this reason that the dis- ease is allowed to make serious progress before its true nature is suspected. Like its near relative, the consumption, it strikes silently, but deeply and fatally. Another scrofulous disease, common in infancy, is known as Strumous Disease of the Mesenteric Glands. The characteristic signs of this malady are, wasting ofthe limbs, pale and attenuated appearance of the skin, tumefaction and tenderness of the abdomen, sunken eyes, irregular state of the bowels, variable appetite, passage of partially digested food, general irritability. After the disorder is seated, the process of absorption is suspended, so that only a small amount of nutriment arrives at the blood, and the sufferer is soon reduced to that condition which med- ical men recognise as marasmus. Although the mesenteric glands sometimes suppu- 570 SCROFULA. rate, yet much more frequently the victims to mesen- teric disease die from actual starvation. The only hope of cure in these cases is, a detection of the ma- lady at its onset, and the services of a thoroughly competent physician. In a previous chapter, we have had occasion to treat of another, and perhaps the most dangerous form of scrofula, under the head of phthisis pulmonalis, or tubercular consumption, to which we refer the reader. There are numerous other scrofulous affections of the different parts of the organism, as the brain, the liver, the skin, the spleen, and the spinal marrow. The admirable works of Hartmann and Schoenlein may be consulted with advantage with reference to this subject. Hahnemann has included scrofula as a form of psora, but evidently on insufficient grounds. Psora is contagious, scrofula non-contagious. The matter of a psoric eruption is capable of communicating its similitude by inoculation ; that of scrofula is innoc- uous when inoculated. Psora, in its specific devel- opment upon the skin, assumes the appearance of a vesicular eruption ; scrofula makes its appearance in the form of extensive ulcers, abscesses, &c. The psoric miasm exercises its specific affinity upon the skin ; the scrofulous miasm upon the glandular sys- tem. Psora is no respecter of persons, but attacks all constitutions, temperaments, and organizations alike ; scrofula is supposed to select its subjects from those who are daintily formed, and possess some peculiari- ties of organization ; psora is readily cured by anti- psorics ; scrofula always requires much time, and is often absolutely incurable by any course of treatment. Psora cannot be artificially acquired by any particu- lar mode of life, or any particular food ; with scrofula it is the reverse. Finally, the development of the psoric miasm, when it is clear and apparent, is always specific and uniform, viz., in vesicular eruptions of a peculiar appearance upon the surface, and the ma- lady is unequivocally contagious; while the develop- ment of the scrofulous miasm is subject to very great variations, but for the most part attacking the glands, rather than the skin, and decidedly non-contagious. SCROFULA. 571 Causes.—The scrofulous habit is, in most instances, inherited. In its hereditary subjects we may notice from birth a radical unsoundness of constitution, an irritability, sensitiveness to slight exposures, prone- ness to catarrhal difficulties, and an inability to resist diseases, which is not apparent in healthy children. The acquired scrofulous habit is generally amongst the poor, who are ill-fed, clad, and housed. We have before alluded to the causes which especially induce this variety of the disease; they are also the chief exciting influences of the hereditary dyscrasia. At- mospheric vicissitudes, abuse of stimulants, excesses in venery, onanism, intestinal irritation, excessive mental and physical occupation, scarlatina, measles, abuse of mercury, iodine, and other drugs which un- duly stimulate the glandular system, also excite the latent disorder. Therapeutics.—It has been observed that scrofulous persons are peculiarly sensitive to cold, and that abrupt changes from heat to cold, in a moist region, are especially calculated to call into active operation the latent malady. For this reason it behooves those who are liable to the affection, whether by heredi- tary or acquired predisposition, to dwell, if possible, in a warm and equable climate. When the lungs be- come affected, this course will often be necessary, in order to save life. In all scrofulous diseases, too much stress cannot well be laid upon the importance of a mild, dry, and uniform temperature. The food of scrofulous subjects should always be of the most nutritious character, in order that a due pro- portion of fibrine may be introduced into the blood. Fresh meats, like beef, mutton, venison, fowls, and veal, should constitute the principal articles of food; and bread, rice, and other farinaceous substances, should be made to take the place of watery and suc- culent vegetables. Porter, ale, and light wines may also be used moderately with advantage. Much exercise in the open air is also essential. In taking exercise, it is of the utmost importance that the mind should be agreeably occupied, for if we walk or ride as a task, we shall obtain very little benefit. Bathing, both in fresh and salt water, is also a 572 SCROFULA. means of securing a healthy action of the skin, and of imparting tone and vigour to the whole system. The clothing should always be adapted to the sea- son, and in temperate and cold latitudes we strongly advise the buckskin wrapper, to be worn over a thin linen, silk, or Canton flannel under-shirt. We com- mend the use of these garments, during the winter, from personal experience. The remedies most deserving of confidence in the treatment of scrofula, in its various forms, are, sul- phur, hepar sulph., mercurius, iodine, baryta, dulcamara, conium, belladonna, lycopodium, sepia, calcarea carb., rhus tox., aurum mur., china, ferrum iodid., mere, oleum jecoris aselli. Sulphur.—External indications.—Scrofulous ulcers on different parts ofthe surface ; humid eruptions be- hind the ears ; purulent discharges from the ears; scrofulous ophthalmia of children, with eruptions about the eyes, and ulcers on the cornea; chronic enlargement of the tonsils ; enlarged ovaria ; swelling of the axillary glands ; swelled nose ; frequent nose- bleed ; swelled upper-lip ; swelling of the glands un- der the lower jaw ; enlargement and suppuration of the inguinal glands ; swelling ofthe posterior cervical glands ; white swelling of the knee ; emaciation. Physical sensations—Chronic inflammation of the eye-lids ; scrofulous ophthalmia, attended with great intolerance of light, and sense of fulness and disten- tion of the lids; pulmonary cough, with sticking pains in the chest, and copious purulent expectoration ; in- flammation and pain in the knee and hip-joints ; itch- ing pimples upon the scalp, and pain at the roots of the hairs; stitching pains in the ears and in the pa- rotid glands; painful swelling of the upper lip and wings of the nose ; pain in the region of the liver after exercise ; pain in the abdomen on pressure, and in the inguinal glands; sensation of weariness and fatigue in all the limbs ; want of vitality ; sensitive- ness to cold; pains worse during cold weather. Mental and jnoral symptoms.—Despondency alter- nating with gayety; irritable, indolent, and discon- tented. SCROFULA. 573 Administration.—One grain of the third trituration every twenty-four hours, until a response is manifest. Rhus tox.—External indications. — Tinea capitis ; soft tubercles on the hairy scalp ; scrofulous ophthal- mia, with photophobia, and an eruption about the eyes; chronic swelling and induration of the parotid gland, the axillary, and other glands; enlargement of the bones ; herpetic and moist or dry scurfy eruptions in different parts of the body ; swelling and other signs of inflammation in the hip and knee joints. Physical sensations.—Pain in the hip joint, increased on pressing the trochanter major, and attended with shortening of the limb, and alternating pains in the knee; pains of white swelling, and scrofulous affec- tions of the ancle joint; scalp painful to the touch, or from moving the hair backwards; inflammation and tenderness of the edges of the eyelids; eyes sensitive to light; eyelids itch and feel swollen ; crusty erup- tion in the nose, and about the mouth ; repugnance to bread and other food; stitches in the side ; short, anxious, and painful cough ; oppression of the chest; glandular swellings painful when touched ; stiffness and lameness of the limbs ; very sensitive to the open air ; pains worst during inaction, or in the cold air. Mental and moral symptoms.—111 humour ; languor; disinclination to all mental or bodily exertion. Administration.—A drop of the third dilution each day, as long as may be deemed necessary. Iodine.—External indications.—Enlargement of the cervical, parotid, thyroid, and tonsil glands ; scrofulous inflammation ofthe knee, with swelling, heat and red- ness ; elongated and enlarged uvula; induration ofthe os uteri; glandular indurations in different parts of the body ; rough and dry skin ; general emaciation ; with hectic appearance. Physical sensations.—Catarrhal affections of the mucous membranes depending on scrofula; swelling and pain in the liver ; inflammation in the knee, with stitches and burning, and increased pain on motion of the joint or from pressure ; contraction of the oeso- phagus from enlargement and inflammation of the glands and mucous membrane, with stitching pains during deglutition ; enlarged mesenteric glands ; tumid 574 SCROFULA. abdomen, with pains on pressure ; swelling and pain in the bronchial glands ; glandular swellings about the neck and axilla, painful, especially on pressure; itching pimples on the arms and chest; general de- bility ; hectic fever; pains aggravated by exercise, by contact and by warmth. Mental and moral symptoms.—Nervous irritability and increased sensitiveness to external impressions. Administration.—Same as rhus. Baryta mur.—External indications.—Chronic indu- ration of the cervical glands ; scrofulous eruptions and ulcerations ; tinea capitis ; enlargement of the liver, of the testes, and of the mammae ; chronic inflamma- tion of the eyelids. Physical sensations.—Itching eruptions of the scalp; general emaciation and debility ; scrofulous disease of the throat, aggravated after every cold ; scrofulous affections of the ears, attended with throbbing and itching, and discharge of purulent matter ; inflamma- tion and suppuration of the tonsils; pains in the af- fected joints and in the long bones ; liability to sore throat after every cold; disease of the mesenteric glands in children ; pains mostly on the left side, when sitting, and relieved by exercise in the open air ; adapted to old men and young children. Mental and moral symptoms.—Imbecility ; absence of mind ; impaired intellectual powers. Administration.—The second or third attenuation may be selected—a dose daily—until the requisite im- pression is produced. Dulcamara.—External indications.—Moist and sup- purating herpes, forming crusts, or scurvy, bran-like eruptions; swellings of the cervical and submaxillary, and inguinal glands; swelling ofthe calf of the leg; emaciation ; scrofulous inflammation of the eyelids. Physical sensations.—Pains in the enlarged glands, particularly on motion ; great susceptibility to cold ; pains in the joints on exposure to cold; pains worse during rest; paralysis of the upper eyelids; phthisis pulmonalis, before the tubercles commence softening; pulmonary symptoms brought on by repeated colds ; pains in the chest; febrile symptoms; lassitude ; bruised sensations. SCROFULA. 575 Mental and moral symptoms.—Disposition restless, angry, and quarrelsome. Administration.—In the same manner as baryta. Conium mac.—External indications.—Swelling, in- duration and suppuration ofthe external glands ; ma- lignant scrofula; caries of the bones ; scrofulous photophobia ; diseased mesenteric glands in children ; enlargement and induration of the liver and pancreas. Physical sensations.—Scrofulous swellings, which evince a disposition to run into scirrhous degenera- tions ; pains in the bones, and in the malignant ulcer- ations; inflammation, swelling and pain in the ovaries ; painful swellings of the uterus ; pain in the region of the liver, when walking; purulent expectoration from softened tubercles ; intolerance to light, in consequence of scrofulous opthalmia ; dull pain in the knee when stepping ; bruised and sore feeling in the calves of the legs ; pains worse during rest, and in the night. Mental and moral symptoms.—Dulness of intellect; want of memory; irritability. Remarks.—For indurated glands, Dr. Johannsen as- serts, that "conium, in the second dilution, stands high- est as a remedy, and next to it, mercurius sol." Administration.—We advise the third attenuation— a dose daily until its effects are apparent. Belladonna. — External indications. — Glandular swellings, with suppuration ; ulcers ; emaciation ; in- flammation and swelling of the bones ; eyelids in- flamed ; ulcers upon the cornea ; photophobia ; swell- ing of the lips, nose, tongue, uvula, tonsils ; bleeding at the nose ; swollen and spongy gums. Physical sensations.—Inflammation and pain in the enlarged glands, and in the periosteum and bones ; diseased mesenteric glands, with atrophy; inflamma- tion of the eyes, with heat, redness, and great intoler- ance to light; pain in the ball of the eye ; double vis- ion ; roaring in the ears ; painful swelling of the paro- tid gland ; soreness ofthe throat; impeded deglutition ; lameness of the limbs when moved; smarting and burning pains in the hip joint, increased by contact or motion, and during the night; painful ulcers on the skin ; sensitiveness to cold air; adapted to the scrofu- 576 SCROFULA. lous affections of children and females of a mild tem- per. Mental and moral symptoms.—irritability ; amorous, nervous, excitable, talkative. Administration.—Same as conium. Lycopodium.—For the scrofulous dyscrasia, and es- pecially where the periosteum, bones, and cervical glands are affected. This remedy is adapted to lym- phatic constitutions. Sepia will be found an efficacious remedy in scrofu- lous females, who are troubled with irregularities in the menstrual functions. It has been employed suc- cessfully in indurations of the uterus, corrosive leu- corrhoea, and in pulmonary phthisis with profuse puru- lent expectoration. Calcarea carb.—According to Hahnemann, carbon- ate of lime is indispensable in those cases where the menses appear too early and are too profuse. It is also appropriate in young persons of scrofulous habits. In children presenting the usual marks of the scrofu- lous dyscrasia, it is one of our most valuable remedies. It is highly recommended likewise in the scrofulous ophthalmiae of children, particularly after ulcers have formed on the cornea. Also in marasmus arising from diseased mesenteric glands, it is an admirable remedy in alternation with iodine. Scrofulous eruptions and ulcers of children often yield to this remedy, after sulphur, mercurius, and hepar sulphuris have been used in vain. Hepar sulphuris is adapted to the cure of scrofu- lous tumours in a state of suppuration, to scrofulous ophthalmia with profuse lachrymation, and much mu- cous discharge from the meibomian glands, and in coxalgia, after a purulent discharge has occurred. This medicine is proper for scrofulous and lymphatic constitutions. Mercurius.—This remedy is advised by Hahnemann in scrofula combined with syphilis. The glandular in- flammations will be characterized by a diffused red- ness, much swelling, and gnawing, stinging or darting pains, worse at night in bed. It should be consulted in affections of the bones, the joints, the eyes, and in eruptions and ulcers upon the surface. The following SCROFULA. 577 preparations of mercurius, we especially commend in scrofula: mere, sol., iod. mere, and mere pracip. rub. Aurum mur., ferrum and china are worthy of consid- eration in protracted and obstinate cases, where the strength of the patient has become much impaired, and but little impression has been made by the previ- ous remedies. Hartmann observes that he has " derived essential benefit from oleum jecoris aselli in every form of the disease, especially in the precursory stage, when no particular organ was affected : the patient looked pale, emaciated, the muscles became flabby, the patient showed an aversion to meat and vegetables, and want- ed to eat bread and butter all the time. I gave it in teaspoonful doses, morning and evening, almost al- ways with success. In scrofulous affections of bones it likewise proved useful, but less so in other forms ofthe disease."—{Hartmann's Chronic Diseases, vol. iii., p. 54.) Dr. J. H. Bennett, of London, has found the cod liver oil {oleum jecoris aselli) of great service in scrofulous cases characterized by general or local atrophy. But in scrofulous affections in which the general health and strength are unimpaired, and the digestive func- tions are not deranged, Dr. B. advises iodine. We have employed the oil in doses of a drachm, three times daily, with eminent success, in almost every form of scro- fula. For scrofulous ulcers with callous edges, and fistulas, silicea alone, or in alternation with phospltorus, acid phos. and conium, was found by Dr. Johannsen most useful. When the ulcers are greenish and offensive, carbo veg. or mercurius dulc, is advised. In scrofulous ophthalmia, indurated glands, and dis- eases ofthe bones, arsenicum,conium, mercurius sol., car- bo animal.,heparsulph,and aurum,are the best remedies. " Arsenicum is one of the most important remedies in scrofula, for removing indurations of the glands, and deformities of the bones, for regulating the dis- charges from the bowels, and for restoring the skin to a healthy state. Also, in scrofulous ophthalmia it is of great service." {Dr. Johannsen. Homoeopathic Jour- nal, vol. 1, No. 11.) 25 578 AFFECTIONS OF THE EYE Administration.—As a general rule, the first to the third attenuations should be selected, and the doses repeated once or twice daily, until a satisfactory im- pression is produced upon the affected structures. CHAPTER XXXI. AFFECTIONS OF THE EYE AND ITS APPENDAGES. SECTION I. The eye, in the immediate vicinity of the brain, con- nected with this organ by the optic nerve, endowed with numerous delicate membranes, nerves and blood- vessels, with its lens, its aqueous and vitreous humours to conduct and modify the luminous rays in their pas- sage to the retina,—all disposed in the most consum- mate manner to serve the end designed,—may be looked upon as a most complex and perfect optical instrument. It is the mirror in which are reflected the various tableaux of external objects, for the satisfaction of the soul within, causing it to respond to such im- pressions so that the most indifferent spectator may look into its depths, and see the manifestations ofthe perceptive faculties. The impressions of external objects, derived through this medium, constitute our principal sources of know- ledge and of pleasure. Without this faculty, we learn only by vague comparisons, suggested by touch, taste, smell, and hearing, by which all our conceptions are more or less perverted and indefinite. It is through the medium of vision, that the child first acquires a just idea of colours, distance, proportion, magnitude, &c, and begins to reason and act by a comparison of his different impressions. It is through the eye alone that we appreciate the infinite variety of expression in the "human face divine," and become incited to sympathy, love, pity, charity, admiration, fear, hope, hate, anger, and other emotions ; that we enjoy the AND ITS APPENDAGES. 579 beauties and sublimities of nature ; that we become acquainted with the wonders of art and science ; and, by contrasting objects with each other, that we are able to enrich our minds with whatever elevates us in dignity of being and capacities of happiness. The eye is, perhaps, more delicate of organization, and yet, from its situation, more exposed, than any other, to external causes of disturbance. How important then that we obtain accurate ideas relative to its structure and functions, and the disorders to which it is liable, that we may be able to protect it when well, and promptly to cure it when diseased. In our description of the diseases of the eye and its appendages, we shall adopt this classification : First. Affections of the tunica conjunctiva, or outer covering of the eye, including—First, acute ophthal- mia ; second, chronic ophthalmia; third, purulent oph- thalmia ; fourth, gonorrhoeal ophthalmia ; fifth, stru- mous or scrofulous ophthalmia ; sixth, granulated lids; and, seventh, opacity of the cornea. Second. Affections of the deeper seated structures of the eye, including—First, inflammation ofthe cor- nea ; second, iritis; third, amaurosis; fourth, hy- dropthalmia, or dropsy of the eye; fifth, cataract; and, sixth, fungus hamatodes, and cancer of the eye. Third. Affections of the appendages of the eye, including — First, hordeolum or stye; second, entro- pium, or inversion of the eyelids ; third, ectropium, or eversion of the eyelids ; and, fourth, fistula lachry- malis. This classification is deemed sufficient for all prac- tical purposes, and much less liable to lead to confu- sion than one more extended. We shall point out the prominent affections of each structure of the eye, and endeavour, in enumerating the causes, to make the reader acquainted with every thing of interest con- nected with each particular subject. Ophthalmia may be primitive or symptomatic,— acute or chronic,—and its causes, local or constitu- tional. Its manifestations also may be confined to the eye itself, or sympathetic symptoms may declare them- selves in the head, stomach, and other parts of the 580 AFFECTIONS OF THE EYE economy. These developments will depend much Upon the constitution, temperament and habits of the patient, the causes which have operated to produce the malady, the severity of the inflammation, and the tissue affected. It is worthy of note, however, that when a particular tissue of one eye is diseased, the corresponding structure of the other eye is exceedingly prone to a similar morbid action, from sympathy. This may be accounted for from the fact that the eye re- ceives its nerves and blood-vessels directly from the brain, by which the sympathetic communication be- tween the two organs is rendered very rapid and in- tense; Finally, we direct special attention to the therapeu- tical connection existing between morbid conditions of particular tissues, and primitive medicinal symp- toms, upon the same tissues, in health. We have already a few specifics which impress certain struc- tures only, and we trust that the time is not distant when medicines will be discovered capable of acting surely and specifically upon each separate part of the eye or its appendages. Fortunately, a few of our drugs have a wide range of action upon the visual organs, so that we shall be able, even now, to find specifics which correspond with almost any morbid symptoms that may present themselves. SECTION II. AFFECTIONS OF THE TUNICA CONJUNCTIVA. ACUTE OPHTHALMIA. Diagnosis.—One of the first local signs of simple in- flammation of the conjunctiva, is an injection with red blood, of a number of the vessels which naturally admit only a white fluid. This gives to the eye that slight appearance of redness and distention of vessels, which characterizes the first stage of acute ophthalmia] The eye now becomes more than usually sensitive to light, smoke, and dust ; tears are easily excited ; a feeling is experienced similar to that produced by par- ticles of sand or dust lodged under the upper eyelid causing the patient to constantly rub the eye in order AND ITS APPENDAGES. 581 to remove what he supposes to be a foreign substance ; a sense of heat, fulness, stiffness and tingling is felt in the globe and edges of the lids ; and slight pains begin to shoot through the eye. At first but a part of the ,, vessels become injected, but as the inflammation in- creases, the anastomosing branches become involved, until finally the whole eye presents a uniform appear- ance of deep redness, swelling, and turgidity. At this period of the disease, the functions of the eye are all more or less perverted ; there are acute pains in the ball; great intolerance to light ; a profuse secretion of scalding tears ; disordered vision ; agglutination of the lids in the morning from matter secreted by the meibomian glands; intense pain on moving the lids; distressing sense of distention, weight, and rigidity of the whole organ, and diminished power of motion. , The symptoms thus far detailetl, are purely local and include all ofthe symptoms which are present from the commencement to the termination of many cases of simple acute ophthalmia. But in the majority of instances, the whole system sympathises with the local affection, and we are presented with the follow- ing additional train of constitutional or sympathetic symptoms : acute pains extending from the eye into the temples and anterior portion of the brain ; slight chills, followed by accelerated circulation and respi- ration ; hot and dry skin ; determination of blood to the head and face ; nausea; loss of appetite; lassi- tude ; general irritability ; physical weakness ; and other indications of febrile excitement. During the progress ofthe inflammation, a peculiar appearance is often observed above the cornea, in the form of a circular elevation termed chemosis. This arises from the precaution which nature has taken to protect the cornea from the injurious effects of ophthal- mia, by fixing the conjunctiva more firmly upon this portion of the globe, than upon the other parts. By this peculiar construction, the distention of vessels and effusions resulting from violent inflammations, are principally manifested in the first instance, without the cornea, and thus in some measure protecting this important part from the injury it might otherwise sustain. 582 AFFECTIONS OF THE EYE The severity of the symptoms will depend much upon the constitution of the patient, and the nature of the exciting cause. The disease may terminate in a cure, without any marked alteration in the appear- ance of the eye, or it may result in effusion, caus- ing an elevation of the conjunctiva above the cornea ; or in adhesion of some portion of the conjunctiva covering the cornea, and giving rise to those appear- ances known as nebula, albugo, leucoma, and opacity; or in suppuration, from the surface of the conjunctiva ; or in ulceration of some part of the cornea; or in sloughing of the cornea. These appearances will be more particularly described in our article on opacity of the cornea. Causes.—Undue exposure to intense beat or cold ; inordinate use of the eyes by a glaring or dim light; the application to the eyes of irritating foreign sub- stances ; mechanical injuries ; extension of contigu- ous inflammations to the eyes ; sudden changes of temperature ; metastases of gout and rheumatism. Prognosis.—If appropriate remedies are adminis- tered in the early stage of the complaint, and before any organic lesion has taken place, we may gener- ally predict a speedy and perfect cure. On the con- trary, if effusion, ulceration, or the adhesive process of the conjunctiva over the cornea, has commenced, we must be more guarded in our prognosis, for under these circumstances the malady often ends either in impaired vision, or a total loss of sight. Much information may be derived respecting the probable termination of the malady, by a careful ex- amination of the causes which have been, or may still be in operation, and ofthe temperament and constitu- tion ofthe patient. For example, an individual of an irritable and nervous temperament, and of a delicate organization, may be affected with the most violent local and constitutional symptoms for a considerable period, without endangering the integrity of the eye ; while a sanguine, plethoric, and robust patient might experience no constitutional effects, and but moderate local symptoms, and yet speedily suffer from serious disorganization of one or more of the tissues. Much will also depend upon our ability to remove all causes AND ITS APPENDAGES. 583 which may have conduced to the complaint, and to enforce upon our patients the necessary restraints and attention during the treatment. Therapeutics.—The first therapeutical indication is to confine the patient to an apartment in which the light is mostly excluded. It must be remembered that this natural stimulus of the healthy eye, becomes, during an acute inflammation of its tissues, a powerful irritant—a morbid agent capable of aggravating and perpetuating the disease. As the inflamed stomach cannot tolerate its natural stimulus, the food, so the in- flamed eye cannot endure with impunity, its ordinary stimulus, the light. Perfect cleanliness should be enjoined, and an exclusion of all dust, vapours, smoke, and bright rays of light. In making applications to the eye, great care should be taken to avoid compres- sion of the inflamed part, in order that the circulation may remain unobstructed, and that sufficient air may be admitted to the parts. Respecting local applications, we entertain the most exalted opinion of cold water. This may be applied by means of a few folds of soft linen cloth, which may be frequently dipped in the water, and after being partly wrung out, laid loosely over the eye and the sur- rounding parts. This application may be persisted in at suitable intervals, until the active symptoms have subsided, and a state of sub-acute inflammation occurs, when recourse may be had, if deemed necessary, to collyria of a slightly stimulating character, like weak solutions of zinc, nit. argenti, lead, or copper. In mak- ing use of these last named articles, we should only employ a strength sufficient to create a decided medi- cinal action, and omit the application when this effect is apparent, and so long as the consequent reaction or amendment continues ; for external remedies, when ju- diciously employed, are subject to the same laws of primary and secondary action, as when administered internally. We shall say more upon this subject under chronic ophthalmia. The medicines to which we call particular atten- tion are, belladonna, aconite, arsenicum, sulphur, digi- talis, euphrasia, pulsatilla, arnica, spigelia, mercurius sol., graphite, lycopodium. 584 AFFECTIONS OF THE EYE Belladonna. — External indications. — Redness, swelling, and protrusion of the ball of the eye; che- mosis ; swelling of the lids ; frequent discharge of hot and salt tears, or dryness of the eyes ; spasmo- dic closure of the lids; flushed cheeks; throbbing of the carotid and temporal arteries; full and rapid pulse ; hot and dry skin. Physical sensations.—Great intolerance to light; pain, burning, and smarting in the eyes; heaviness, pressure and throbbing in the ball and lids ; sharp pains in the orbits, extending into the brain ; tearing pains in the eyes from within, outwards ; dimness and obstruction of vision; spasmodic sensations in the eyes. Mental and moral symptoms.—Nervousness ; irrita- bility ; disinclination to mental labour. Remarks.—Belladonna is suitable in ophthalmia oc- curring in sanguine and irritable persons, from con- gestions of blood to the eyes in consequence of ex- posure to cold, excessive use of the eyes, metastases of rheumatism and gout. It is particularly useful when constitutional symptoms show themselves in the form of acute or throbbing pains in the head and temples, hot skin, rapid pulse, flushed cheeks, dilated pupils, and perverted vision. Aconite.—External indications.—Vessels ofthe con- junctiva injected with red blood ; lids red and swollen ; chemosis ; dilation of the pupils ; lachrymation, worse on the slightest exposure to light, dust, or smoke ; pho- tophobia ; flushed cheeks ; hard and rapid pulse ; hot and dry skin, and other febrile symptoms. Physical sensations.—Very great intolerance to light; pressing, stinging, burning, or exceedingly acute pains in the eyes ; eyeball feels bruised, and pressed into the orbit; stinging and smarting of the lids ; eyes very hot, and filled with scalding tears, or preterna- turally dry ; pressure, or sharp, beating, or stinging pains in the head and temples; impaired vision, as from a gauze before the eyes ; general febrile disturb- ance. Mental and moral symptoms.—Much mental excite- ment ; fear and apprehension in regard to the probable result of the case. AND ITS APPENDAGES. 585 Remarks.—This remedy is particularly called for when the local inflammation is very intense, and the constitutional symptoms run high. It operates most happily in plethoric, bilious, and sanguine individuals, who are subject to determinations of blood to the face, head, and lungs. It is appropriate in ophthalmiae caused by colds, by the introductions of foreign sub- stances into the eye, and by rheumatism and gout. Arsenicum. — External indications. — Conjunctiva much congested, and of a dark-red colour ; oedematous swelling of the lids ; profuse lachrymation ; tears hot and corrosive to the cheeks ; lids dry and red ; eyelids partially closed from the great swelling; nightly ag- glutination ; spasmodic movements of the lids, on ex- posure to light; ulcers on the cornea. Physical sensations.—Sensation as if sand had be- come lodged in the eye ; tearing, burning, or stinging in the ball and lids, aggravated by motion, or on ex- posure to light; throbbing in the eyes when lying down; impaired vision; weakness, weariness, and tremour of the lids ; great intolerance to light; con- stant inclination to rub the eyes. Mental and moral symptoms.—Mind weakened, and whole system rendered nervous and irritable, by pain and suffering. Remarks.—Arsenicum is applicable to those cases which arise in weakly and nervous constitutions, where the pains are severe, and the disease is unusually obstinate. In this variety of ophthalmia, the local and sympathetic symptoms are very troublesome, but there is much less danger of serious organic lesions than in most other forms of the malady. It is advised in ophthalmia arising from cold, rheumatism and gout. Sulphur.—External indications.—Injection of the vessels of the conjunctiva; redness and swelling of the lids ; lachrymation, or preternatural dryness of the eyes ; morning agglutination of the lids; photopho- bia ; eyes swollen and prominent; cornea dim; lids oedematous ; distention ofthe conjunctiva from effusion. Physical sensations.—Pressure ofthe eyeballs, worse on moving them ; pressure, burning, and itching of the lids ; intolerance to the rays of the sun ; twitching of the lids; trembling ofthe eyes : painful dryness of 25* 586 AFFECTIONS OF THE EYE the margins of the lids ; bruised feeling of the eyes, on motion ; sensation of sand under the upper lid, on motion ; dimness of sight. Mental and moral symptoms.—Sensitive ; despond- ent ; out of humour. Remarks.—Sulphur is adapted to lymphatic tem- peraments—a scrofulous or psoric dyscrasia, and may be employed in ophthalmia caused by repelled erup- tions, abuse of mercury, or irritating matters intro- duced into the eye. Digitalis.—External indications.—Intense redness of the conjunctiva; inflammation of the meibomian glands; swelling of the lids; constant and profuse lachryma- tion ; photophobia ; dryness of the nose ; morning ag- glutination of the lids ; tears hot and corrosive ; coun- tenance bloated. Physicial sensations.—Aching, throbbing, burning, pressing, or stitching pains in the affected eyeball, worse when moving or touching it; feeling as of sand under the lids ; discharge of hot and irritating tears, on exposure to the open air or to light; intolerance to light; dimness of sight; eyes constantly hot and painful; objects all appear unnatural; visions before the eyes. Mental and moral symptoms.—The predominant mental traits are, despondency and mental languor. Remarks.—Digitalis is suited to sanguine tempera- ments, and also to persons of a scrofulous habit. It has been successfully employed in ophthalmiae conse- quent on colds, scrofula, and gout. Euphrasia also corresponds to most of the symptoms enumerated un- der digitalis, and may sometimes be substituted to advantage in the place of this last remedy, when the desired effect is not promptly produced. Pulsatilla is appropriate in catarrhal or rheumatic ophthalmia, attended with pressure and burning in the eyes, as if from sand ; redness and swelling ofthe con- junctiva and lids ; coryza ; profuse lachrymation in the wind or open air; burning and itching of the eyes, inducing a disposition to rub them ; photophobia ; in- flammation, and secretion of mucus from the meibomian glands ; dimness of sight; morning agglutination. Arnica is indispensable in ophthalmic, inflammations AND ITS APPENDAGES. 587 caused by mechanical injuries of the eye, or of the parts in its vicinity. The remedy may be used both internally and externally. Spigelia is especially adapted to rheumatic and ar- thritic ophthalmia ; the pains are of a pressive or stitching character, and aggravated by movement; the vessels of the conjunctiva are much congested ; the cornea is dim; aching pains are experienced in the eye when touched, extending deep into the orbit; the upper lids swollen and stiff. Mercurius sol. is proper in catarrhal and rheu- matic ophthalmia. Its indications are, inflammation of the eyes, attended with burning, smarting, heat, and pressure, worse in the open air; sensation as if sand were under the upper lid ; profuse lachrymation ; photophobia ; darting pains in the eyeballs ; redness and swelling of the lids; dimness of vision; pains worse when moving or touching the eye ; boring pains in the eyes and surrounding parts. Other remedies are, graphite, lycopodium, nux vomica, calcarea carb., colocynth, rhus, cocculus, cannabis, and dulcamara, to which the reader is referred. Administration.—In very acute cases, we advise the third attenuation, and a repetition of the dose every two hours until the desired impression is produced. In more mild forms of the disease, we use the first or second attenuations, and repeat every six or eight hours, as long as is deemed necessary. SECTION III. CHRONIC OPHTHALMIA. Chronic ophthalmia may arise in consequence of the subsidence of the active symptoms of the acute form of the disease, and the persistence of a condition of sub-acute inflammation, or from causes which ope- rate gradually, and induce an atonic state ofthe parts, and a low grade of morbid action. It may continue in this chronic state for years, without causing any notable organic derangement, the only difficulty ex- perienced, being a weak, sensitive, and irritable con- dition of the eyes. Diagnosis.—When chronie ophthalmia succeeds the 588 AFFECTIONS OF THE EYE acute, it will be found that a part of the vessels of the conjunctiva have recovered their tone and now circu- late only the white blood, as formerly, while the lar- ger vessels remain injected with red blood. These larger vessels, during the progress of the disorder, be- come so much distended by the intromission of the red globules, that a varicose dilatation often remains for a long period after the acute stage has been passed, and thus establishes the chronic malady. One of the prominent local symptoms, therefore, of chronic oph- thalmia, as distinguished from the acute variety, is, the moderately congested state of the vessels, which renders the conjunctiva partly red and partly white. The eye is also much less sensitive to light, dust, and smoke ; tears are not so easily excited ; vision is im- proved ; there is an absence of pain, burning, and heat; tears are not so hot and acrid ; the swelling of the lids is diminished, and all febrile and sympathetic symp- toms have disappeared. But the eye is more sensitive than natural to light; the edges of the lids are red or purple ; nightly agglutination occurs ; the patient is unable to use the eyes long at a time ; objects often float before the eyes, obstructing vision ; the lids itch and tingle, mostly in the morning on rising ; flow of tears caused by cold air, light, wind, smoke, dust, and vapours. Causes.—Acute inflammation ; habitual intemper- ance ; constant exposure to irritating vapours; me- tastases of rheumatism and gout; external injuries ; repelled eruptions ; protracted exposure to cold in a region of snow; excessive use ofthe eyes by a strong or dim light. Prognosis.—Unless adhesions have taken place be- tween the conjunctiva and cornea, or ulcers, cica- trixes, or effusions, have formed, so as to obstruct the rays of light, we may expect a ready cure of the dis- ease. If, however, disorganization has already occur- red, and vision has become obstructed, we may predict a cure ofthe morbid inflammatory,action, but only a partial restoration of sight. Habitual chronic ophthal- miae, proceeding from intemperance, constant expo- sure of the eyes to stimulating vapours, etc., may readily be cured by removing the exciting causes, and AND ITS APPENDAGES. 589 having recourse to the appropriate local and internal remedies. Therapeutics.—It is in this variety of ophthalmia, that we may expect to derive most benefit from the use of stimulating collyria. The object of all remedies, as has before been observed, is to create a healthy medicinal action in the diseased part, which shall su- persede the morbid action, and thus secure a cure. But we have also seen that this medicinal effect must be two-fold in order to prove curative : or, in other words, there must be a primary and a secondary effect, the former analogous to that of the disease, and the latter, the reverse, or curative. Whenever these two conditions result from the application of remedies, in- ternal or local, a cure may be expected. Care, how- ever, must always be observed, that the medicines be so adapted to the nature of the case, that the primary symptoms shall be of short duration, and succeeded by the legitimate, opposite, or curative reaction. In deciding, therefore, respecting the proper strength of a local application to an inflamed eye, we may fol- low the maxims of Hahnemann, or, what will answer as well, adopt the following rule inculcated by Sir Astley Cooper, in regard to the use of collyria, viz : " To judge how far the stimulus may be carried, the criterion is exceedingly simple ; if you«find that a cer- tain degree of smarting and pain is produced, which soon subsides and leaves the patient much more easy than before, you may be convinced that the collyrium is beneficial; if, on the other hand, the patient expe- riences a great degree of pain, w-hich does not subside speedily, and the vessels become turgid, you may be assured that the collyrium is doing harm, and that the quantity of stimulus ought to be diminished." The best local stimulus we ever employed, in clearly pronounced chronic inflammation of the eyes, is the wine of opium, {vinum opii), a single drop to be intro- duced into the eye once or twice in twenty-four hours, until there is a permanent reaction. When the se- condary symptoms do not speedily appear after the application, we may then have recourse to a weak solution of sulphate of zinc, or of nitrate of silver. If these fail, a dilution of aconite may be tried. 590 AFFECTIONS OF THE EYE The internal remedies are, arsenicum, belladonna, calcarea carbonica, sulphur, rhus, silicea, nux vomica, graphite, phosphorus. The indications for the use of these different medi- cines will be found under acute ophthalmia. The prin- cipal difference between the two forms ofthe malady, consists in degree rather than in the quality of the symptoms. Respecting the administration and repetition of doses, we prefer the first, second, and third attenua- tions, and advise a repetition- once in twenty-four hours, until an impression is produced. SECTION IV. PURULENT OPHTHALMIA. Diagnosis.—This variety of ophthalmia is more vio- lent and destructive, and runs its course with much greater rapidity, than that which we have described. It is characterized by a profuse purulent secretion from the conjunctiva, which collects and hardens about the lids, gluing them together, and in this way acts as a constant.irritant to the inflamed part. The disease commences like the simple acute ophthalmia, with itching, stinging, or burning sensations in the lids and globe, lachrymation, sensitiveness to light, red- ness ofthe conjunctiva, which soon increase to an in- tense villous redness, swelling of the lids, sensations as if foreign substances, like sand or sticks, were in the eye, and more or less indistinctness of vision. These symptoms augment very rapidly in intensity. The tingling sensations change to severe pains through the eye, sometimes extending to the temples, and even the brain itself; there is chemosis, the lachrymation be- comes changed into a profuse secretion of pus, either yellow or greenish ; the intolerance to light becomes more marked, the lids are very much swollen, and discharge much purulent matter, and there is almost a total obstruction of sight. Constitutional symptoms frequently occur, as in simple ophthalmia, in the form of headache, nausea, quick pulse, hot skin, general prostration, &c. This acute stage terminates in a short period in a sub-acute inflammation, or in ulcer- AND ITS APPENDAGES. 591 ation and sloughing. When the former termination happens, there is a gradual subsidence of all the symptoms, and the disease remains for an indefinite period in this atonic state, after which the eye may recover its tone and healthy function. But if sloughing takes place, the destructive process may run on to a total destruction of the part, unless energetic mea- sures are used to arrest its progress. Causes.—Sudden alternations from heat to cold ; endemic and epidemic influences ; the irritation of hot sand introduced into the eyes ; metastases of rheumatism, gout, scarlatina, small-pox, and measles ; abuse of mercury ; the morbid vaginal secretion to which the eyes of new-born children are sometimes exposed. SECTION V. GONORRHEAL OPHTHALMIA. Diagnosis.—This variety of inflammation attacks the conjunctiva also, and is attended with symptoms very similar to those of purulent ophthalmia, but of much greater intensity. This disease is supposed to be the most violent and destructive of any to which the eye is subject, and it is not uncommon so see it proceed to the entire destruction of vision, notwith- standing the most early and energetic attempts to cure it. There is especial danger, in gonorrhoeal ophthal- mia, of a speedy formation of ulcers of the cornea, and of rapid sloughing through the tunics of the eye. Whenever, therefore, we are called to a case of this description, with intense inflammation and redness of the eyes, greatly swollen lids, very abundant dis- charge of pus, or a dry and burning state of the con- junctiva and lids; excruciating pains in the eyes and head ; chemosis ; great intolerance to light; hot skin ; nausea ; thirst; and other febrile symptoms ; it be- comes us to exercise the utmost vigilance in our re- medial measures, in order to save the eyes from ulcer- ation and sloughing. Farther on we shall detail a method of treatment which will generally be found successful, even in the most severe cases. Nothing, however, but the strictest attention to every minute 592 AFFECTIONS OF THE EYE symptom of the case, and a constant watch over medicinal effects, will ensure success. The cause of this affection is unquestionably the ap- plication to the eyes of gonorrhoeal matter, and not, as some suppose, a metastasis of the disease to the eyes. Another variety of purulent ophthalmia to which it is proper to allude, is that which occurs in infants shortly after birth. This disease is supposed to arise from the contact of the vaginal secretion of the mat- ter with the eyes of the child during birth. The symptoms generally first make their appearance in about two weeks after birth, but they may occur be- fore or several weeks after this period. The symp- toms are similar to those of purulent ophthalmia, but, for the most part, the inflammation is less intense, and there is much less danger of the speedy supervention of ulcers of the cornea. It is quite true that ulcera- tion and sloughing ultimately occur in these cases ; but a longer time is afforded for our remedial efforts to take effect, and of course the prospect of cure thus en- hanced. SECTION VI. STRUMOUS, OR SCROFULOUS OPHTHALMIA. Diagnosis.—Scrofulous ophthalmia presents several symptoms which are quite characteristic, and by the aid of which we may always form a ready and accurate diagnosis. The disease occurs in subjects of a scrofu- lous habit, and is accompanied with the general signs peculiar to struma, in addition to the local symptoms. Indeed, these general marks will often aid materially in forming our opinion, particularly in slight cases. The light and clear complexion, blonde hair, blue eyes, tendency to glandular swellings of the neck, the tumid upper lip, eruptions during childhood behind the ears and upon the head, sensitiveness to cold, dis- position to cough after colds, frequent pains and dis- charges from the ears, indicate the strumous dyscra- sia, which often determine and develop inflammations of the scrofulous kind. The peculiar symptoms which distinguish this in- flammation are, the almost absolute intolerance to AND ITS APPENDAGES. 593 light ; the violent spasmodic closure of the lids on the slightest exposure of the eyes to it, and the strumous eruptions which generally make their appearance in the neighbourhood of the eyes. The light is com- monly so painful, and the dread of exposure to it is so great, that it is exceedingly difficult to make a thorough examination in children, and, as a general rule, it is better to trust to the voluntary efforts ofthe patient, in a moderate light, rather than resort to much violence in attempting to force open the eyes. Usually, by obtaining the confidence of the patient, we can persuade such a display of the globes as will sufficiently satisfy us in regard to the case. The vessels of the conjunctiva are generally much inject- ed ; there is a considerable discharge of purulent matter; the balls are stiff and painful; the lids swollen ; vision impaired by the inflammation, or by ulcers on the cornea : one or more ulcers form on the conjunctiva covering the cornea ; and, if the symp- toms continue to increase, the sight is finally de- stroyed. The disease varies much in its progress ; is some- times attended with but little redness of the conjunc- tiva, but slight pains in the globes, and but a mod- erate secretion of pus ; at other times, during the formation of an ulcer, all these symptoms increase in intensity, until the case nearly resembles one of acute purulent ophthalmia. It is of far more common oc- currence in children than in adults. Causes.—The constitutional cause, as we have seen, is a strumous dyscrasia. The local, or exciting causes are, atmospheric vicissitudes ; undue exposure to cold, light, dust, smoke, and irritating vapours ; ne- glect of cleanliness. Prognosis.—Severe purulent ophthalmia under the most favourable circumstances, for the application of remedies, is highly dangerous. The chief peril against which we have to guard, is ulceration of the cornea. Before this has taken place, and especially if the cornea appears bright, we may entertain hopes of a favourable termination of the case ; but if these opaque specks form while the inflammation retains its intensity, we must be prepared for a partial or total 594 AFFECTIONS OF THE EYE loss of vision. Of the different kinds of ophthalmia, the gonorrhoeal is unquestionably the most rapid in its progress, and dangerous in its character. Here, no- thing but the most consummate judgment and cool- ness, with constant attention, can avert serious conse- quences. The other varieties of the malady are not quite so rapid and destructive, but they demand the most skilful and energetic efforts to ward off injuri- ous results. As a general rule, if we are called during the early stages of the complaint, and exhibit the ap- propriate specifics judiciously and boldly, little diffi- culty will be experienced in inducing a speedy and happy issue to either of the varieties; unfortunately, however, the physician is rarely called until the dis- ease is so far advanced that ulceration cannot be pre- vented. It is evident, then, that the prognosis will de- pend upon the intensity of the disease, the complica- tions which have occurred, the time it has existed, the constitution of the patient, and the remote and ex- citing causes. Therapeutics.—The only local application which can be advantageously used during the acute stage of pu- rulent ophthalmia, is pure water, either cold or tepid. This may be employed as a lotion to the parts, during the course of the acute symptoms, as the judgment of the adviser shall dictate. When the chronic stage has set in, recourse may occasionally be had to stimu- lating collyria, like vinum opii, solutions of sulph., zinc, nitr. argenti, sulph., cuprum, acetat., plumbi, and aconite ; but in regard to these applications, the same rules apply with full force here, that we have pre- sented under the head of simple acute ophthalmia, when alluding to the use of collyria. The following remedies will cover all ofthe symp- toms which obtain in the different varieties of puru- lent ophthalmia : arsenicum, belladonna, sulphur, rhus toxicodendron, calcarea carbonica, aconite, mercurius sol., graphite, phosphorus, spigelia, digitalis, acid nitr., hepar sulphur., causticum. Arsenicum will prove curative in purulent ophthal- mia, with much vascular congestion of the conjunc- tiva ; swelling of the lids; nightly agglutination; AND ITS APPENDAGES. 595 photophobia; pressure and burning pains in the eye- balls, aggravated by moving the eyes ; nebulous spots and ulcers on the cornea. Belladonna is an admirable remedy in scrofulous in- flammation of the eyes, with very great intolerance to light; a constant inclination to remain in the dark, or to plunge the eyes into a pillow or some other soft article ; purulent discharge ; great swelling of the lids ; spasmodic closure of the lids on exposure to light; chemosis; tearing, throbbing, smarting, or stitching pains in the eyes ; roaring in the ears ; hot, dry skin ; thirst; nightly agglutination ; throbbing of the carotid and temporal arteries ; pains in the tem- ples and head; ulcers on the cornea; dimness of vision. We have cured several cases of purulent ophthalmia of infants, characterized by great intole- rance to light, intense inflammation, throbbing of the carotid and temporal arteries, flushed cheeks, hot skin, and other indications of inordinate vascular excite- ment, with belladonna, succeeded by mercurius. We deem belladonna one of our most valuable medicines in nearly all of the acute inflammations of the eye. The effects arising from the application of a small quantity of the extract to the eyebrows or tem- ples, are sufficient to demonstrate its marked specific action upon the structures ofthe eye. We have found it eminently serviceable in ophthalmia neonatorum, and in acute ophthalmia. Sulphur is an invaluable remedy in several kinds of purulent ophthalmia. It is adapted to the chronic forms, with atonic distention of the conjunctival vessels; swollen and oedematous condition of the lids, with purulent discharge ; suppurating ulcers on the cornea ; sensation of itching, burning, and heat in the eyes and lids; troublesome agglutination in the morning; diminished power of motion of the upper lids; pustules of the cornea; sensitiveness to the light of the sun ; swollen upper lip ; eruptions behind the ears, and on the scalp and face ; pressure and burning pain in the eyes ; impaired vision. Sulphur is one of those remedies which will be required more or less frequently in all varieties of ophthal- mia, not only to combat those local symptoms which 596 AFFECTIONS OF THE EYE especially correspond with it, but to correct mor- bid conditions of a more general and latent cha- racter. Sulphur may occasionally be used with de- cided advantage in alternation with remedies which appear to cover all of the manifest symptoms, but which do not produce prompt impressions when given singly. Rhus tox. is useful in rheumatic, scrofulous, and ca- tarrhal ophthalmia, with much inflammation and swell- ing of the lids ; redness ofthe balls of the eyes; profuse secretion of mucus or pus from the eyes and lids ; oedematous swelling of the lids and the parts surround- ing the eyes ; morning agglutination, with increased redness ofthe eyes ; pain on turning the balls ; lach- rymation ; photophobia. Dr. Dudgeon considers rhus toxicodendron one of the most important remedies in catarrhal, erysipela- tous, scrofulous, and exanthematic ophthalmia. Many allopathic physicians commend the tincture of rhus in scrofulous ophthalmia. We can bear witness to the value of this medicine in scrofulous ophthalmia, and in chronic ophthalmia which is kept up by a dyscrasia of an erysipelatous character. Calcarea carbonica has been successfully employed in every variety of purulent conjunctival inflammation. Its chief indications are, inflammation, redness, and pu- rulent secretion from the eyeballs ; swelling and red- ness of the eyelids ; nightly, and sometimes daily, agglutination of the lids ; great intolerance to light; nebulous specks and ulcers on the cornea ; inclination to keep the eyes in darkness; scrofulous eruptions upon the face and scalp ; glandular swellings of the neck ; swelling of the upper lips and nostrils ; pus- tules on the cornea ; pressing or aching pains in the eyes ; corrosive inflammation in the edges ofthe lids ; acrid lachrymation ; general appearance indicative of the scrofulous dyscrasia. Dr. Dudgeon expresses the opinion that calcarea " is one of our most impor- tant ophthalmic medicines, and is surpassed by none in its applicability to the generality of cases of scrofulous inflammation, whether of the eye it- self, or its lids; and is indispensable where 'there AND ITS APPENDAGES. 597 is marked scrhfulous diathesis, indicated by swell- ings of the glands," &c. Aconite may often precede other remedies in every variety of purulent ophthalmia, when the inflammation runs high, and gives rise to febrile symptoms. Intense redness and swelling of the affected parts ; acute pains ; accelerated circulation ; violent photophobia ; headache ; hot and dry skin; thirst; flushed cheeks ; throbbing ofthe arteries about the, neck, head and face; loss of appetite ; and perverted vision, point to the em- ployment of aconite. In some instances it may be al- ternated with belladonna to advantage. Mercurius sol. has proved successful in my hands in gonorrhoeal, scrofulous, and infantile ophthalmia ; the remedy having been preceded by aconite. The symptoms were, violent inflammation, and redness of the eyes ; great intolerance to light ; profuse acrid or purulent secretion from the balls and lids ; spasmodic closure of the lids ; heat in the eyes ; cutting and burning pains in the parts ; ulcers on the cornea; cor- nea dim and misty ; sight impaired ; frequent agglu- tination ofthe lids ; gummy and scurfy matter on the edges of the lids. Graphite is one of our best remedies in scrofulous ophthalmia, with excessive intolerance to light; chronic congestion ofthe conjunctiva ; purulent, secretion from the balls and lids ; frequent agglutination of the lids ; ulcers on the cornea ; porrigo in the face ; eyelids much inflamed, red, and painful ; inability to open the eyes before a strong light; constant desire to keep the eyes covered ; symptoms worse by day-light than by candle-light; general appearance indicative of a scrofulous diathesis. Phosphorus is sometimes useful in obstinate and pro- tracted cases of atonic ophthalmiae, which have re- sisted the ordinary remedies. There is generally in- flammation and moderate redness of the eyes ; con- siderable secretion of viscid mucus; sensitiveness of the eyes to light ; heat, burning and itching of the eyes ; lachrymation during the day; frequent and sud- den attacks of blindness during the day ; floats before the eyes ; weakness and indistinctness of vision. Spigelia is advised in purulent inflammation, prin- 598 AFFECTIONS OF THE EYE cipallv affecting the eyelids, with sharp pains in the lids ; pressure and pain in the eyeballs during motion ; distention and paralysis ofthe upper lids ; painful ul- ceration of the edges ofthe lids ; dimness ofthe cor- nea ; general loss of power over the eyes. Rummel speaks highly of spigelia in rheumatic and gouty in- flammations attacking the cornea. Digitalis is recommended in conjunctival ophthal- miae arising from colds, with acute inflammation, red- ness, sharp stitches, photophobia, secretion of puru- lent matter, and obstruction and dryness of the nose. Nitric acid, and hepar sulph. are the best specifics for the removal of mercurial ophthalmia, following the abuse of this drug in syphilis and other diseases. The symptoms are, inflammation, swelling and redness of the conjunctiva and lids ; secretion of viscid mucus or pus ; burning and smarting sensation in the eyes ; photophobia, dark and unhealthy ulcers on the cornea; paralysis of the upper eyelids ; tears easily excited ; nightly agglutination ; muscae volitantes and sparks before the eyes ; difficulty and pain in moving the eyes ; pains in the bones and soft parts of the forehead and face. We have employed chininum sulph., at the first tri- turation, in several obstinate cases of strumous and chronic ophthalmia, with entire success. When the malady assumes an intermittent character, it will gen- erally prove promptly curative. Lobethal has employed euphrasia with much suc- cess in rheumatic, strumous, and catarrhal ophthalmia, where there was "considerable mucous secretion in the inflamed organ ; as also in blennorrhceas of the eyes, in all which cases I employ euphrasia at once, inter- nally and externally ; in the former case, one drop of the pure tincture ; in the latter, as a collyrium, from two to five drops in four ounces of water." Lycopodium is well adapted to scrofulous or catarrhal ophthalmia, and in obstinate cases of ophthalmia neonatorum. Hahnemann mentions " nocturnal ag- glutination, and lachrymation by day," as prominent indications for the use of lycopodium. We have employed aurum with excellent effects in several cases of mercurial and syphilitic ophthalmia. AND ITS APPENDAGES. 599 Some authors recommend it highly in scrofulous oph- thalmia. Other remedies are, causticum, sepia, silicea, staphy- sagria, china, and chamomilla. Administration.—In acute cases, we prefer the first, second, and third attenuations, and in the chronic stage, the first attenuation. The remedy should be repeated in the more violent forms of the complaint, every half hour, until we are satisfied with the impression ; but in chronic inflammations, a repetition once in twelve or twenty-four hours will suffice. During the treat- ment we should never neglect the external use of pure water, or milk and water, either cold or tepid. SECTION VII. GRANULATED LIDS. Diagnosis.—Fleshy elevations sometimes occur on that portion of the conjunctiva which lines the eye- lids, resembling in all respects granulations, and by their irritating effects upon the ball of the eye, give rise to troublesome inflammation, ulceration, and now and then to loss of sight. This affection has more frequently baffled the surgeons ofthe old school, than any other pertaining to the eye. Venesection, leech- ing, cupping, blistering, moxas, cathartics, alteratives, stimulating collyria, and caustic applications, have all been found entirely inefficient in its treatment, and the patients are generally doomed to a wretched ex- istence, one or more, years, until disorganization ofthe eyes, by ulceration, leaves them in perpetual darkness. By homoeopathy, however, a new and healthy action can be created in the affected structure, which shall overcome and supersede the morbid action. These morbid granulations usually arise from an acute or sub-acute inflammauon of the conjunctiva occurring in individuals whose constitutions have be- come impaired and tainted by protracted syphilitic, gonorrhoeal, psoric, or scrofulous complaints. The granulations are rough and uneven, secrete an abun- dance of pus, which serves to irritate and weaken the eyes, and on every motion of the lids, operate on the balls as foreign substances, thus keeping up a per- 600 AFFECTIONS OF THE EYE petual inflammation, and sooner or later leading to ulceration of the cornea. The disease is for the most part confined to the upper lids, although we have seen, in some instances, the conjunctiva of the lower lids rough and granulated. Occasionally we may detect the true character of the complaint by the thickness of the lids, and their roughness and unevenness to the touch ; but the only certain method of investigation consists in turning over the lids, and thus exposing the palpebral conjunc- tiva to the sight. This disease very often proceeds to a fatal disor- ganization of the eye, without a true knowledge on the part ofthe physician, respecting the nature of the case. It is usually mistaken for one of the varieties of purulent ophthalmia. Therapeutics.—The remedies in this disease are both local and constitutional. The only local specific is the sulphate of copper in substance, a small piece of which is to be smoothly polished, and rubbed lightly over the granulations once or twice a day, following each application with a camel's-hair brush filled with pure water, A persevering use of this substance will, as we know from much experience in these cases, cure the most inveterate forms of the complaint. In conjunction with the above means, we may em- ploy one of the following medicines: sulphur, calcarea carbonica, hepar sulph., iodine, graphite, and acid nit., as internal remedies. In selecting our internal remedy, regard must be had to the cause, as well as the symptoms of the dis- ease. We advise the first attenuations, and the dose to be repeated once in twelve or twenty-four hours as long as necessary. SECTION VIII. OPACITY OF THE CORNEA. Diagnosis.—Opacities or specks upon the cornea vary much in size and appearance. Various appel- lations have been given to these different opacities, as nebula, leucoma, albugo, &c., depending upon the AND ITS APPENDAGES. 601 nature of the cause, and the particular tissue affected. Ine opacity may consist of slight misty or opaque spots, diffused over a part or even the whole of the cornea, of a light colour, such as are caused by a per- verted secretion of the inner lamina, and termed nebula; or of small and circumscribed spots, of a pearl colour, and entirely opaque, caused by a kind of false membrane under the conjunctiva, and termed leucoma; or of cicatrixes resulting from the healing of ulcers and wounds of the cornea, and termed al- bugo. When the disease consists of a simple diffused nebulous opacity, we can distinguish through it the pupil and iris, and the rays of light pass to the retina so as to give rise to imperfect vision; but the other kinds of opacity do not permit the passage of lumi- nous rays, and, consequently, when situated in front of the pupil, destroy or seriously impair vision. The two first varieties are caused by purulent oph- thalmia and granulated lids, and are results most to be dreaded, especially in constitutions tainted with scrofula, syphilis, psora, or mercury. Therapeutics.—The best local stimulus is a collyrium composed of one grain of sulphate of zinc to four ounces of water. A few drops of this may be put into the affected eye from two to four times in twen- ty-four hours until the opacity begins to disappear, when we should omit it so long as amendment con- tinues. The internal remedies most to be relied on are, calcarea carbonica, iodine, mercurius, sulphur, sepia, arnica, hepar sulphuris, acid nit., aurum muriaticum. Attenuations and repetitions the same as in chronic , ophthalmia. SECTION IX. AFFECTIONS OF THE DEEPER SEATED STRUCTURES OF THE EYE. INFLAMMATION OF THE CORNEA. Diagnosis.—Inflammation of the cornea may exist as an independent affection, or it may occur during the progress of iritis, and other acute derangements 26 602 AFFECTIONS OF THE EYE of the internal textures of the eye. Soon after the inflammation sets in, a number of the serous vessels are observed to carry red blood ; the cornea loses its brilliancy ; the eyes become sensitive to light; a pro- fuse secretion of tears is induced from exposure to cold air, light, dust, and smoke ; tension and pains are experienced in the eye ; yellow spots, composed of pus, are observed between the lamellae of the cornea by looking obliquely through the eye ; these abscesses, if the disease continues, eventually burst internally, and discharge their contents into the anterior cham- ber, or externally, and form those troublesome ulcers of the cornea which so often endanger sight. When these ulcers are small, and confined to the anterior portion of the cornea, they may often be cured with- out material injury to the eye ; but when the ulce- ration pervades the whole lamellated structure of the cornea, it is not uncommon for the aqueous humour to escape through the opening, and even the iris itself to protrude. SECTION X. IRITIS. Diagnosis.—This peculiar affection of the eye is by no means easy of detection, on account of the situ- ation of the iris, and the small number of external symptoms which characterize the complaint. Inflam- mation of this texture is, however, more productive of constitutional or febrile symptoms than affections of the external tunics. This may in part be owing to the loose attachment of the conjunctiva to the eye, and the more ample scope for effusions into the sub- jacent cellular tissue. Iritis commences with a dull, pressing, heavy and deep-seated pain in the orbit ; contracted pupil ; change of the natural colour of the iris to a dark, greenish, or reddish colour; a moderate rose-coloured blush of the conjunctiva ; diminished power of vision, and considerable sensibility to light. As the disease advances, the pains become acute and extend from the eye into the temples and to the top of the head ; the contraction is more sL-ongly AND ITS APPENDAGES. 603 pronounced ; sparks and luminous flashes pass through and before the eyes ; the nervous system is excited; the pulse accelerated ; the skin hot and dry ; the in- testinal and urinary secretions are partially sup- pressed, and there are other indications of constitu- tional disturbance. After these severe symptoms have continued some time, the iris presents an irregular, angular, and thick- ened appearance, and is covered with specks of yellow lymph. Small abscesses now form on the iris, which ultimately burst into the anterior chamber, which is afterwards usually absorbed. If extensive adhesions have formed between the iris and the capsule of the lens, or if the more deep-seated parts have become involved in the disease, an almost total loss of sight is the common result. In some instances, the inflammation extends from the iris to the retina, the choroides, the cornea, and finally involves the whole internal structure of the eye, when the malady will present symptoms charac- teristic of the inflammation of .these different struc- tures. In cases of this description, the symptoms are of the most violent character, the pains are exceed- ingly acute and painfully throbbing, there is a very rapid contraction of the pupil, the sight is speedily extinguished, the constitutional signs are very urgent, and the patient is always in imminent danger of rapid and permanent loss of vision. Causes.—The most common cause of iritis is the abuse of mercury. Syphilis has been often assigned as a cause of it, but, we believe, without just reason. It has often been observed during the treatment of syphilis by mercury, but, we think, never in syphilitic diseases where mercury has not been employed. Other causes are, mechanical injuries, rheumatism, gout, excessive use of the eyes over minute objects. Therapeutics.—The most appropriate remedies are, hepar sulphur., acid nit., muriat. aurum, cocculus, calca- rea carbonica, nux vomica, belladonna, conium, lycopo- dium, staphysagria, arnica, aconite. Hepar sulphuris, acid nitric, and aurum munaticum, are curative in iritis arising from abuse of mercury, with aching, throbbing, and tearing pains in the orbit, 604 AFFECTIONS OF THE EYE sometimes extending to the top of the head ; pains in the bones about the eyes; fiery sparks before the eyes ; intolerance to light; contracted pupil ; partial or entire loss of vision ; dark or greenish colour of the iris ; spots of yellow lymph, or ulcers on the iris ; febrile disturbance. Cocculus, nux vomica, and belladonna, are indicated in arthritic and rheumatic iritis, accompanied with deep-seated, lancinating, tearing, or contractive pains in the ball, and extending to the top of the head ; in- voluntary spasmodic movements of the globe : irre- gular contraction of the pupil; discoloured and puck- ered iris ; photophobia; pains aggravated on moving the eyes, or stooping; luminous specks or dark objects float before the retina ; greatly impaired vision ; effu- sion of blood and matter into the anterior chamber of the eye ; indications of gastric derangement, and of general constitutional disturbance. Calcarea carbonica, conium, lycopodium, and staphy- sagria, are appropriate in iritic inflammations con- nected with a scrofulous diathesis. These remedies cover greenish or yellowish colour of the iris; pupil much contracted and distorted ; ulcers which have opened internally or externally; outward distention of the iris ; adhesions of the iris to the capsule of the lens ; moderate participation of all the structures of the eye in the morbid action ; photophobia ; vision destroyed or much impaired; difficulty in distinguish- ing the iris from effusion of lymph and pus into the anterior chamber of the eye ; great general irritabil- ity ; aching, throbbing, lancinating, or pressing pains in the eye ; rapid and irritable pulse ; restlessness ; hot skin; loss of appetite ; mental and physical pros- tration. Arnica is necessary when the disease can be traced to a wound, or to any other mechanical injury of the eye. It may also be properly employed in cases which proceed from sudden exposure of the eyes to an in- tense and glaring light. Aconite will often be required, either alone, or in alternation with one of the other remedies, to control undue febrile excitement, and to remove the violent congestion which now and then occurs in iritis. AND ITS APPENDAGES. 605 Administration.—The remedies may be employed at the first, second, and third attenuations, depending upon the age and susceptibility ofthe patient, and the violence of the inflammation. The dose should be repeated in acute cases every two hours, until we are certain of a medicinal impression upon the diseased texture. In less urgent cases, a repetition will suffice once or twice in twenty-four hours. SECTION XI. AMAUROSIS. Diagnosis.—The partial or total loss of sight which particularly characterizes this disease, is principally dependent upon a diseased condition of the optic nerve and retina, although other structures occasionally par- ticipate in the disease. Amaurosis occurs at all ages, and in both sexes, but is most common at the period of the cessation of the menses in females, and at the age of forty or fifty years in males. The chief cir- cumstances which predispose to it are, a plethoric and sanguine temperament, hereditary disposition, tendency to sanguineous congestions to the head and eyes, and an impaired constitution from abuse of drugs, stimulating drinks, and excesses in venery. Physicians of the old school are much divided re- specting the nature and treatment of amaurosis, some supposing it to be a debility requiring tonics and stim- ulants, while others describe it as an inflammatory affection, demanding an antiphlogistic course of treat- ment. In view of these discordant opinions, and era- pyrical methods,.it is not surprising that so few amau- rotic patients are cured by allopathy. Amaurosis may be imperfect or perfect. In the former there is a partial, and in the latter a total loss of sight. In the first, the patient sees as through a gauze, or but half of the object, or double, or only when the eye is in a particular position with respect to the object; while in the last, the patient cannot dis- tinguish day from night. The signs of the approach of the disease are, pain in the forehead and temples, diminishing with the ad- vance of the amaurosis, and ceasing when it has be- 606 AFFECTIONS OF THE EYE come complete ; vertigo ; weakness and cloudiness of vision, apparent when looking at distant or at minute objects; sparks and moats, or muscae volitantes, float before the eyes, annoying the patient, and impairing the sight; in reading or writing, a stronger light than usual is demanded ; a slight diminution in the bril- liancy of the pupil. After these precursory symptoms, the loss of vision gradually becomes more complete, until after months or years, there remains a condition of settled and more or less perfect amaurosis. In other instances, the disease advances with rapidity, and terminates in partial or total blindness in a few days. But it is not an uncommon occurrence for complete amaurosis to follow instantaneously, leaving the victim in blindness so profound that he cannot distinguish light from darkness. When either of these three conditions ob- tains, there are usually but few signs which indicate the presence of so serious an affection, the principal being, a dilated and immovable pupil, a loss of con- tractile power in the iris, and occasionally slight stra- bismus. But even these signs are not uniformly pre- sent, for cases of complete amaurosis are reported in which the pupil remained natural, or became preter- naturally contracted and mobile on exposure to light, and in which the iris and all other visible parts ofthe organ were in a normal condition. The colour of the pupil in this disease is ordinarilyjet black, with, per- haps, a very slight diminutionof its natural brilliancy, but it sometimes presents a red, greenish, or white and cloudy appearance. Cases of this last description are often mistaken for incipient cataract, and when the loss of sight is but partial, it is not easy to distin- guish between the two maladies ; but the following characteristics will afford us material assistance in deciding the matter. In cataract, the dense white ap- pearance is situated immediately behind the pupil, while in amaurosis the cloud is more deep-seated. In the former, the flame of a candle appears to be sur- rounded by a thin, white, diffused mist or cloud, " which increases with the distance of the lio-ht," while in the latter, " a halo or iris appears to encircle or emanate from the mist, the flame seeming to be split when at a distance."—Stephenson. AND ITS APPENDAGES. 607 The shape of the pupil is usually round, but some- what more dilated than in the normal state, thus al- lowing a large number of luminous rays to enter the eye. In a few cases, it loses its circular form, and becomes angular. Amaurosis is attributed by most writers to a para- lytic condition of the optic nerve, retina, or to some disease of the thalami nervorum opticorum ; but does not the peculiar immovable condition of the pupil and iris, when their natural stimulus, the light, strikes them, indicate a loss of sensibility and contractility in these structures ? And does not the partial loss of voluntary motion over the globe, which sometimes occurs during the complaint, indicate a loss of tone in the whole organ ? We have mentioned, as one of the precursory symp- toms of amaurosis, floats and muscae volitantes before the eyes. In the imperfect form of the disease, these appearances vary much in their character, and are a source of great annoyance to the patient. Sometimes a single black speck obstructs the sight; sometimes there is an appearance as if a dark gauze or net-work were before the eyes ; sometimes as if flies, small ob- jects of different forms, sparks, fireballs, and various coloured lights, were moving there in various direc- tions. The objects are more troublesome in a strong light than in dark situations, being in the former of a black or sombre colour, and in the latter, presenting themselves in the appearance of sudden flashes of light or fire. We are occasionally presented with the disease in an intermittent fjorm, and, in rare instances, as a tem- porary attendant of some particular morbid condition of the system, like pregnancy, disordered menstrua- tion, hysteria, worms, and the irritation of indigestible food. In addition to the symptoms already described, we sometimes observe in young and plethoric amaurotics, strongly pronounced determination of blood to the head and eyes, a constant stupifying headache, more or less redness and congestion of the eyeballs, sensi- tiveness of the eyes to light, a full and hard pulse, a sense of fulness, tension, and pain in the affected eye. 608 AFFECTIONS OF THE EYE It is a point worthy of note, that black eyes are far more subject to amaurosis than blue or gray eyes. Beer supposes that where one blue or gray eye be- comes affected with it, at least twenty-five or thirty black ones suffer. No satisfactory explanation has ever been suggested for this comparative exemption of blue and gray eyes. Causes.—The causes of amaurosis may operate upon the brain itself, upon the optic nerve, or the re- tina. They may be divided into constitutional and local causes. In the first class we include, repeated and protracted determinations of blood to the head and eyes, by unusual physical or mental exertion; pregnancy ; suppression of natural or habitual dis- charges ; violent vomiting ; excessive indulgence in venery ; onanism; unbridled anger, grief, and other passions ; abuse of stimulants ; large doses of opium, lead, belladonna, hyoscyamus, stramonium ; abuse of bitter medicines, as quassia, cinchona, chamomela, chicory, &c.; exercise in a hot sun ; general debility ; derangement of the digestive organs ; the depressing emotions ; the pressure of tumours upon the vessels of the neck in such a manner as to prevent the return of blood from the brain. We include in the second class, morbid growths within the orbit; mechanical injuries of the eye ; sudden transitions from darkness to a brilliant light: lightning ; frequent use of optical instruments, like the telescope and microscope ; exostoses within the cranium ; sanguineous effusion upon the brain ; inju- ries of the head. Prognosis.—When the disease is dependent on some cause which can be readily removed, if recent, and the patient is young and healthy, we may predict a favourable termination. If, however, the cause has been long in operation, the loss of sight has been very gradual, the constitution is much impaired, and the cause cannot be speedily removed, the prognosis must be unfavourable. Amaurosis depending on morbid growths within the orbit or cranium, may be con- sidered incurable ; but when it depends upon a slight effusion upon the brain, or the pressure of a tumour upon the jugular vein of the neck, we may often effect AND ITS APPENDAGES. 609 a cure by causing the effused fluid to be absorbed or r^moy.ed bY an operation, or the extraction of the offending tumour. We once cured a case of several months' duration, by removing from the neck a tumour of the size of an orange, and thus renewing the free course of blood from the head. The sight returned almost immediately after the operation. The loss of sight which sometimes accompanies pregnancy and intermittent diseases, often subsides spontaneously on the birth of the infant, or the cure of the disease. A favourable prognosis may commonly be entertained in those recent cases which depend on congestion of the optic nerve, retina, or thalami nervorum optico- rum, arising from general plethora, suppressed men- struation, or haemorrhoids. The effects also of me- chanical injuries, lacerations, contusions and blows upon the eye, may frequently be cured. Therapeutics.—The specifics for the different forms of amaurosis are, belladonna, nux vom., china, phos- phorus, ruta grav., stramonium, sulphur, euphrasia, ar- nica, cannabis, hyoscyamus. Belladonna.—External indications.—Pupil dilated and immovable ; strabismus; pupil black and round or angular ; partial or total loss of vision ; listless expression. Physical sensations.—Power of vision diminished or extinct; sensation of weight and pressure in the eye- ball ; throbbing or stupifying headache ; objects ap- pear double, or wrong side up, or half concealed, or blurred, or surrounded by a fog or mist; dark, fiery and red bodies float before the eyes; bright flashes before the eyes ; the candle seems surrounded by a halo of different colours, but in which the red pre- dominates. Mental and moral symptoms.—Mood generally irri- table, but high spirits alternating with despondency. Remarks.—This remedy is called for in amaurotics of full and plethoric habits, and where the malady has been caused by inflammation or congestion of the optic nerve, retina, or some part of the brain. Nux vomica.—External indications.—Pupils con- tracted, sometimes dilated ; spasmodic motions of the eyeball; photophobia. 26* 610 AFFECTIONS OF THE EYE Physical sensations.—Intermittent obscuration of vision ; black or gray moats before the eyes ; stupi- fying headache ; weakness of sight, worse in the light of day; luminous vibrations on the side of the eye ; vertigo. Mental and moral symptoms.—Disposition melan- cholic and hypochondriacal. Remarks.—Nux is applicable in amaurotic com- plaints arising from excess of study and abuse of stimulants and opium. It is also indicated for tempo- rary loss of sight, which sometimes accompanies in- termittent diseases. China.—External indications.—Pupils dilated and insensible, or slightly contracted ; a white cloud deep within the eye ; photophobia. Physical sensations.—Indistinct and confused vision; muscae volitantes ; sudden obscurations of sight; only the outlines of objects can be discerned ; general de- bility ; irritability ; morbid sensitiveness of the whole system. Mental and moral symptoms.—Disposition 'cheerful and languid. Remarks.—China will apply when the disease is of a purely atonic character, and has originated from excessive loss of blood or pus, or from protracted chronic or acute diseases. Phosphorus.—External indications.—Pupils and eyes natural. Physical sensations.—Sudden attacks of blindness during the day ; distant objects appear to be envel- loped in smoke or mist; black spots before the eyes ; diminished vision ; he sees as through a net-work or gauze ; sparks before the eyes in the dark ; tremulous vision; luminous vibrations before the eyes; the flame of a candle seems to be surrounded by a green halo. Mental and moral symptoms.—Spirits gloomy, de- jected, and without any cheerful reaction. Remarks.—In amaurosis consequent upon onanism, loss of animal fluids, and in impoverished old people phosphorus is an excellent remedy. Ruta grav.—External indications.—Pupils contract- ed ; involuntary movements of the balls of the eyes ; spasms of the lids. AND ITS APPENDAGES. 611 Physical sensations.—Sense of weight and pressure in the eyeballs ; weakness of the eyes ; inclination to read or write by a very strong light; muscae voli- tantes ; red halo surrounding the flame of a candle ; cloudy vision ; weariness of the eyes. Mental and moral symptoms.—Indifferent, irresolute and peevish. Remarks.—Amaurotic complaints arising from abuse of the eyes with optical instruments, in reading fine print, or working at small objects, and also from con- tusions, and other mechanical injuries, will require the use of ruta. Stramonium.—External indications.—Pupils dilated and immovable ; eyes staring, and somnolent or glis- tening. Physical sensations.—Sense of weight and tension in the eyes ; obscuration of sight; objects appear small or double ; black colours appear gray ; sparks and specks float before the eyes ; objects seem sur- rounded with a red or light border ; cloudy vision ; vertigo ; headache. Mental and moral symptoms.—Disposition irritable and touchy ; hysterical and cataleptic. Remarks.—Stramonium is suitable in paralytic af- fections of the optic nerve and retina, connected with deranged menstruation, hysteria, epilepsy, and cata- lepsy. In incipient amaurosis, and frequent and sudden and short attacks of blindness, we may refer to sulphur, euphrasia, arnica, cannabis, hyoscyamus, conium, aurum, digitalis. Administration.—We are in the habit of employing from the first to the sixth attenuations. Repetitions should not be made more than once or twice in the twenty-four hours. As soon as an impression is ap- parent, we should await the result before administer- ing again. SECTION XII. HYDROPHTHALMIA, OR DROPSY OF THE EYE. Diagnosis.—This disorder proceeds from the forma- tion of a preternatural quantity of the aqueous or the 612 AFFECTIONS OF THE EYE vitreous humours, while the absorbent vessels convey into the circulation only their customary amount of these secretions ; or the humours may be formed as usual, but owing to some defect or loss of power of the absorbents, the natural quantity is not taken up and carried into the circulation. But it is highly prob- able, in most cases, that the disease is dependent on a morbid condition of both the secerning and absorbent vessels, and that the normal equilibrium between se- cretion and absorption becomes thereby destroyed. This idea receives confirmation from the fact, that most dropsies of the eye can be traced to previous inflammation of the internal textures of the organ. The unnatural accumulation may be confined to the aqueous humour in the anterior chamber, or to the vitreous humour in the posterior chamber, or both hu- mours may be affected at the same time. When the aqueous humour is alone involved, the disease may be recognised by the following marks : dimensions of the cornea larger than natural; increased size of the anterior chamber of the eye ; turbid appearance of the aqueous humour; partial or total loss of motion of the iris; pupil natural and immovable; iris less brilliant than natural; sense of weight and tension in the eyeball; weakness of sight; perversion of vision, either in the form of presbyopia or myopia ; general loss of voluntary motion over the ball; partial or to- tal loss of vision. When there is a preternatural accumulation of the vitreous humour, the enlargement of the globe is more deep-seated ; the ball assumes a conical shape; the cornea is unusually prominent: the pupil is con- tracted ; there is a diminution of vision ; myopia; deep-seated pains ; tension and heaviness ; impaired motion of the eyeball; and eventually, total blindness. When the disease consists of an unnatural accumu- lation of both humours, we shall have a combination of symptoms including nearly all described under the aqueous and vitreous varieties of dropsy. After the vitreous humour has been for some time affected, its character is changed, and it acquires a soft and usual- ly a watery appearance. In many cases, the eye attains a size so enormous AND ITS APPENDAGES. 613 as to protrude far from the orbit, and it is thus ren- dered quite impossible to close the lids over it. In this condition the patient has a frightful appearance, and the organ itself, from its exposure, is constantly irritated and inflamed. Causes.—The immediate cause of dropsies of the eye, is an undue action in the arteries which secrete the humours, and a diminished action of the absorbent vessels ; or, sometimes, an inordinate aqueous or vi- treous secretion, with a normal action of the absorb- ents. Hydrophthalmia is generally supposed to depend upon some constitutional cause, like general dropsy, hydrocephalus, chlorosis, or secondary syphilis ; but as a general rule, it may be traced to some previous inflammation of the internal structures of the eye. In infants and young children, it is often exceedingly difficult to discover the real cause, especially when the external indications are obscure, and, on this ac- count, the earlier history of the case can rarely be ascertained; but in adults, we shall often be able to discover previous sub-acute inflammation in the inter- nal structures. Prognosis.—The allopathists deem this disease, when fully formed, incurable. They find that no shed- ding of blood, no punishment of the stomach, bowels, salivary glands, skin, or other inoffensive parts of the body, can cure or palliate it. That the prognosis is unfavourable, we do not deny ; but we believe the disease may often be cured in its early stages. I have treated but two cases homoeopathically; and but one with a favourable result. This was of six months' standing, confined to the aqueous humour, and with but moderate distention of the cornea : the other case involved both humours, had continued more than a year, and had arrived at the condition termed " ox eye," when the treatment was commenced. In this instance paracentecis became necessary, and the pa- tient ultimately lost the eye. So long as the disease is confined to its incipient stage, and even after the unnatural accumulation has commenced, provided no serous disorganization has taken place in the important tissues of the eye, we 614 AFFECTIONS OF THE EYE may predict a favourable result; but if organic lesions have occurred, and the accumulation in the anterior or posterior chamber is considerable, with total loss of sight, our prognosis must be unfavourable. Therapeutics.—If the dropsy depends upon a con- stitutional fault, our remedies must be addressed to the remote difficulties. So long as these continue, mere local means will be inadequate to accomplish our ob- ject ; but constitutional and local remedies may be used in alternation with probable advantage. If the eye be much distended, and'medicines do not act with suffi- cient promptness and energy, the operation of para- centesis may be made to evacuate the superabundant humours, after which, the remedies will generally prove sufficiently powerful. We believe the following to be the best at present known : belladonna, china, pulsatilla, mercurius, hyos- cyamus, stramonium, conium, nux vom., arsenicum, plumbum, aconite, sepia, sulphur. It is doubtful whether either of these exercises a positively specific influence upon the secretory and absorbent vessels affected in hydrophthalmia, but they are capable of acting upon the generally morbid con- dition upon which the local disorder depends, and thus aid in arresting its progress, and occasionally in ef- fecting cures. Administration.—In the same manner as advised in amaurosis. SECTION XIII. CATARACT. Diagnosis.—Strictly speaking, this disease belongs to the province of surgery rather than that of medi- cine ; but as homoeopathy promises results somewhat important in a medicinal point of view, we take the liberty of writing a few words respecting the malady in this place. By the term cataract is understood, an opacity of the chrystalline lens, or its capsule, which causes an obscuration, or a total loss of vision. Authors recog- nise and describe several varieties, both of the lenti- cular and capsular cataract, and amongst these, the most common are— AND ITS APPENDAGES. 615 First. The firm or hard cataract, peculiar to old people, and recognised by its amber colour, small size, and by its density and hardness. Vision is never to- tally destroyed in these cases, and the structures of the eye retain their natural contractility. Second. The fluid or milky cataract, caused by a change of the lens into a white and semi-fluid mass, of so large a size as to nearly obliterate the posterior chamber, impair the motions of the pupil, and prevent the admission of rays of light. Third. The soft or caseous cataract, which presents an appearance somewhat similar to the last variety, with the lens much enlarged, of a cheesy consistence, and of a light gray or sea-green colour, obliteration of the posterior chamber, impaired motion of the pu- pil and iris, and either partial or total blindness. The lens, in this variety, always presents an appearance of more firmness and consistence than in the milky cataract, and the dark irregular spots or lines which sometimes traverse it, remain the same in all posi- tions of the head, while those which are now and then observed in the milky variety, change their lo- cation with every motion of the eyes. Fourth. Capsular cataract, consisting of an opacity of the capsule of the chrystalline lens. The opacity commences at the margin of the pupil, in the form of " distinct, white, shining points, specks or streaks ; its colour, therefore, is always very light, and never altogether uniform, even when the disease is com- pletely formed."—Beer. When this kind of cataract occurs in children at or soon after birth, it is called congenital cataract. The capsular cataract does not generally continue for a long period before the lens becomes involved also in the opacity. When the disease has been pre- ceded by a good deal of inflammatory action, we may find cohesions of the anterior capsule of the lens with the urea ; or of the posterior layer of the capsule with the membrana hyaloidea; or of the whole of the capsule with the lens ; or all the three species of adhesion may exist together."—Beer, p. 318. Cataract is sometimes complicated with amaurosis. This complication is not always easy of detection, on 616 AFFECTIONS OF THE EYE account of the symptoms of these diseases bearing so close a resemblance. When the lens or its capsule are alone affected, the opacity is immediately behind the pupil, the iris and pupil possess some degree of mobility, and there is some little appreciation of light ; but when amaurosis is conjoined with cataract, we have the same appearance of the lens or capsule, but a dilated and immovable pupil, an insensible and im- movable state of the iris, and an absolute loss of vision. The first intimation we have of a forming cataract, is defective vision when attempting to read fine print, or to look at minute objects. As the disease advances, all objects appear indistinct; a mist is constantly be- fore the affected eye; a strong light is required to read or write; a small speck now commences just behind the centre of the pupil, and continues to extend until the opacity entirely obstructs the passage of rays of light to the eye; when the opacity is complete, a black ring is seen around the edge of the pupil, and the sight continues to diminish until blindness results. Causes.—Frequent and long-continued use of the eyes in reading fine print, writing, or looking at mi- nute objects by a strong light; congestion of blood to the eyes, from exercise in a hot sun, in furnaces, and other places where hot and bright fires are kept up ; exposure of the eyes to irritating fumes and vapours, like sulphurous acid, chlorine and other gases, and the vapours of sulphuric ether, alcohol, nitric, sulphur- ic and muriatic acids, hereditary predisposition, me- chanical injuries, wounds of the capsule or lens. Prognosis.—When the cataract is confined to the lens, or to its capsule, and no complications exist from unnatural adhesions, from amaurotic symptoms, or from serious constitutional disturbance, a favourable issue may be expected. On the other hand, a dilated pupil, an immovable iris, a profound blindness, which has been disproportionate to the gradually forming opacity, unnatural adhesions of the capsule, and an irritable and vitiated constitution, will render our prognosis unfavourable. Therapeutics.—Before resorting to the operation of couching, or extraction, as is so often done by the old AND ITS APPENDAGES. 617 school surgeons, we should always give our medicines a fair trial. It is quite true that we have but few remedies which simulate this affection in their patho- genesis, yet the successful results which have been observed from the use of medicines in a few cases, render it incumbent on us to avail ourselves of them on all proper occasions. After a thorough trial with medicines, if there is no prospect of amendment, the patient should be turned over to the surgeon for the necessary operation. In a few cases of incipient cataract, much benefit has followed the local employment of sulphuric ether vapour to the eye, and should our internal remedies prove fruitless, there can be no objection to a trial of this substance. As internal remedies, we suggest, conium, pulsatilla, magnesia carb., sulphur, cannabis, phosphorus, digitalis, spigelia, euphrasia. Conium and cannabis may be exhibited when the cataract has arisen from a wound, or other injury to the eye. Magnesia carb.,pulsatilla, digitalis, and phosphorus, have proved curative in capsulo-lenticular cataract, either with or without abnormal adhesions, also in opacity of the lens or capsule alone. These remedies are useful when the disease has been accompanied with ophthalmia. Sulphur is appropriate in those cases which seem to be connected with a scrofulous or psoric diathesis. It has also been found curative in cataract compli- cated with amaurosis. Euphrasia or spigelia may sometimes be alternated with sulphur with benefit. Administration.—The same as in amaurosis. SECTION XIV. FUNGUS PLEMATODES, AND CANCER OF THE EYE. Diagnosis.—Fungus hamatodes has always been confounded with scirrhus, or cancer, until Burns, Hey, and Abernethy pointed out the characteristics of the two diseases, both in respect to their formation and development, as well as their pathology. They pos- sess several qualities in common, like malignancy, in- 618 AFFECTIONS OF THE EYE evitable tendency to the destruction of the affected parts, the power of contaminating the whole system, and giving rise ultimately to fatal constitutional symptoms ; but in other respects, they are entirely dissimilar. Fungus haematodes is not usually attend- ed with the severe stinging and lancinating pains of cancer ; its texture is spongy and elastic, and is soft and apparently fluctuating under the touch, while the scirrhus is hard and stony. When fully formed, the fungous tumour is of the consistence of brain, is of a dark and livid hue, and bleeds on the slightest touch, while the substance of cancer is hard, fibrous, and cartilaginous ; at its commencement, and during its development, the fungus is knotty and unequal, and thus affords a sign which distinguishes it from can- cerous and other tumours. Fungus is more prone to occur in young subjects, while cancer is for the most part confined to persons past the middle age. Fungus of the eye commences in the posterior chamber, wThile cancer of the eye attacks primarily the conjunctiva or lachrymal gland. The progress of fungus is more rapid and destructive than that of cancer. The first symptom observed in fungus haematodes, is defective vision, and, on looking into the eye, a small shining spot is perceived at the bottom of it. This nucleus of the disease commences in the re- tina and optic nerve, is traversed by branches of the central artery of the retina, and progresses from within outwards through the vitreous humour, ab- sorbing it in its course, until it arrives near the iris, when it presents a dark amber or greenish hue, and is apt to be mistaken for cataract. As the enlargement increases, the ball of the eye becomes prominent, ir- regular, and knotty, the cornea ulcerates, and the disease displays itself externally in the form of a soft, medullary, and purple fungus, bleeding at the least touch. The pupil becomes dilated and immovable in the early part of the complaint, and also somewhat changed in colour, which becomes a strongly pro- nounced amber or brown when the swelling arrives at the iris. The sclerotica soon acquires a dark blue colour, is crossed by dilated veins, and is sometimes attacked by the malady as well as the cornea. After AND ITS APPENDAGES. 619 the fungus has shown itself externally, the absorbent glands of the jaw and neck become affected with a medullary degeneration ; the countenance assumes a sallow and cadaverous appearance ; general debility and nervous irritation occur ; loss of appetite; im- paired digestion; nausea; irritable stomach; rest- lessness, and the usual symptoms of hectic fever ter- minate the patient's existence. Cancer of the eye, as we have before remarked, generally attacks persons advanced in life. This disease, unlike fungus haematodes, commences in the conjunctiva, caruncula lachrymalis, or lachrymal gland, in the form of a hard warty excrescence, which continues for an indefinite period, sometimes attended with twinging and lancinating pains, at other times free from all uneasy feelings, until finally its interior structure becomes altered in texture, "an ichorous matter forms within the swelling, which gradually makes its way to the surface, and thus develops the first stage of ulceration. When arrived at this point, vision is destroyed, an irregular fungous mass shoots up from the ulcerated point, highly vascular, of a red, brown, or livid colour, and easily excited to haemor- rhage. As the mass increases, the tissues of the eye become distended ; the ulceration and sloughing ad- vance ; severe lancinating pains dart through the globe; the appetite is impaired ; the patient loses flesh, strength, and courage ; sleep is disturbed ; the countenance assumes an anxious, distressed, and sal- low appearance ; hectic fever sets in, and the sufferer speedily yields to the last result. Hitherto the diseases under consideration have usually been deemed incurable by internal remedies, and on this account surgeons have advised the early- extirpation of all suspected tumours, hoping in this way to eradicate the affection while it is local, and before the mass of blood becomes contaminated. But it must be admitted, even when the operation has been resorted to early, and under the most favourable circumstances, that a lamentable want of success has, for the most part, followed all surgical measures. Stealthy and insidious at their commencement, they gradually glide along, depositing in all surrounding 620 AFFECTIONS OF THE EYE textures their destructive and fatal poison, until dis- organization begins, when the livid, foul, and de- structive phenomena appear in their hideousness, ra- pidly communicating their influence through the whole organism, and baffling all efforts of the physician and surgeon. But though experience has so little of promise, we cannot admit that there are no remedies in the whole range of the materia medica capable of counteracting this morbid influence. We may yet find some medi- cine sufficiently specific to cure these diseases during their forming stage. We believe, indeed, that homoeo- pathy will, ere long, accomplish all that we require in this matter. Only a limited number of well authenti- cated homoeopathic cures of true medullary fungus, or of cancer, have been reported ; but the results in these few cases should inspire us with some confi- dence of success, especially during the early period of the maladies. Causes.—The immediate cause of medullary fungus and of cancer is involved in doubt. Some have sug- gested the operation of animalculae, others of a subtle poison, and others of a kind of unhealthy inflamma- tion caused by some constitutional defect. Sir Astley Cooper supposes the morbid degeneration always to be " preceded by a disposition in the constitution to its production." There is unquestionably a specific morbid action in the tumour itself, but whether this is owing to some poison which acts specifically upon the particular part alone, or to some constitutional vice, we are unde- cided. That there are drugs capable of neutralizing this morbid influence, whether it be constitutional or local, we entertain no doubt. The exciting causes are blows, contusions, obstruc- tions of blood from pressure, and mechanical injuries generally, although the disease often originates with- out any apparent or traceable cause. Prognosis.—In our present state of knowledge, the prognosis must be generally unfavourable ; but not many years will elapse before this state of things will change, and we shall be able to meet the complaint with sure and efficient specifics. AND ITS APPENDAGES. 621 Therapeutics—Having had but little personal expe- rience m regard to the homoeopathic treatment of these affections, we shall simply allude to the medi- cines which appear to us most appropriate, and refer the reader to the reports of cases which have been cured by other practitioners. Belladonna has cured malignant disease of the eye, attended with violent pains in the eyeball; a red shining point in the posterior chamber; pupils dilated and immovable; loss of vision ; unusual hardness of the substance of the eye ; iris of a dark colour, and covered with injected bloodvessels. Malignant affections of the eye have also been cured by conium, carbo vegetabilis, arsenicum, mercu- rius, acid nit., calcarea carbonica, and iodine. Administration.—The same as in amaurosis. SECTION XV. AFFECTIONS OF THE APPENDAGES OF THE EYE. HORDEOLUM.--STYE. Diagnosis.—This is a small boil-like swelling in the edge of the eyelid, resembling in size and general ap- pearance a barleycorn. It generally commences in the follicles of Meibomius, near the angle of the eye, soon assumes a dark red or purple colour, and becomes quite painful from the violence of the accompanying inflammation. The inflammation sometimes confines itself to the cellular membrane, and advances very slowly to the suppurative stage, thus causing not only highly troublesome local pains, but a considerable degree of febrile disturbance. In these cases, gan- grene and sloughing of the cellular membrane is apt to occur, and either protract the cure, or leave the part in a condition liable to take on a renewed mor- bid action from the smallest exciting cause. In other instances, suppuration occurs speedily, the abscess bursts and discharges itself freely, and a prompt cure results. Causes.—Use of highly spiced, fat, and stimulating food; disordered stomach and bowels; abuse ofthe eyes'in reading, writing, or sewing by gas-lights; scrofulous, psoric, and other impurities of the blood. 622 AFFECTIONS OF THE EYE Therapeutics.—The appropriate remedies are, sul- phur, pulsatilla, staphysagria, sepia, lycopoelium. We usually employ the third attenuation, and administer a dose twice daily until the swelling and inflamma- tion disappear. SECTION XVI. ENTROPIUM.--INVERSION OF THE EYELIDS. Diagnosis.—This affection consists of an unnatural turning inwards of the whole or a portion of the tar- sus and eyelashes, in such a manner as to keep up a constant irritation of the globe, and thus generate a troublesome chronic ophthalmia. If the disease is allowed to continue for any length of time, the cornea loses its brilliancy, its vessels become injected, and ulcers form ; there is continual lachrymation ; partial or entire loss of vision ; great pain and annoyance from the presence of the offending eyelashes. Causes.—Cicatrices arising from previous ulceration of the tarsi; chronic ophthalmias ; relaxation and paralysis of the lids ; ulceration ofthe ciliary glands. ECTROPIUM.--EVERSION OF THE EYELIDS. Diagnosis.—Eversion of the lids may be caused by a swelling and relaxation of the lining membrane of the eyelid, which presses the edge of the lid forward until it becomes everted, or by a contraction of the skin of the lid, in consequence of the healing of wounds, ulcers, carbuncles, burns, boils, etc. The consequences of eversion are, constant exposure of the globe to external irritating causes; chronic in- flammation of the eye ; frequent discharge of tears ; dryness of the ball; photophobia; nebulous spots and ulcers of the cornea. Causes.—The principal causes of eversion in conse- quence of swelling of the lining membrane of the lid, are, protracted chronic ophthalmias of a scrofulous nature ; relaxation from intemperance or old age ; a diseased state of the follicles of Meibomius ; morbid growths in the part. Other causes of eversion are, cicatrices on the skin ofthe lid arising from incisions, burns, ulcers, smallpox pustules, and carbuncles. AND ITS APPENDAGES. 623 Therapeutics—The medicines which have been commended in these affections are, hepar sulphur, mercurius sol., calcarea carb., digitalis, borax. Should these remedies disappoint our expectations, a portion of the lid should be excised, in such a man- ner, and in such a situation that the healing cicatrix will restore the displaced tarsi and cilia to their nor- mal position. The operation is simple, unattended with danger, and quite efficient. If opacity or ulcer- ation of the cornea has already commenced when we are first called to the case, it will be advisable to have recourse to the operation without delay, and correct all local or constitutional faults afterwards, with suitable medicines. The attenuations and repetitions of doses the same as in amaurosis. SECTION XVIL FISTULA LACHRYMALIS. Diagnosis.—Under this head authors generally in- clude, obstruction of the puncta lachrymalis and of the lachrymal canals, inflammation and suppuration of the lining membrane of the lachrymal sac, and inflammation, thickening, and obstructions of the membrane lining the ductus ad nasum. In the most simple form of the complaint, there will be merely an obstruction of the puncta, arising from disease of the Meibomian glands, or of the eye- lids, and a consequent interruption to the passage of tears to the lachrymal sac. The manifest symptoms in this instance will be, a continual watering of the eye and overflow of tears upon the cheek, weakness of vision, and an undue drjmess of the nostril of the affected side. Another form of the complaint commences in the lachrymal sac, manifesting itself in the form of a small, hard, and circumscribed swelling, apparently within the sac. This swelling is quite tender to the touch, and gradually increases in size until suppura- tion occurs, when the parts over and around the tu- mour acquire a red and shining appearance, not un- like erysipelas. During the early period of the in- 624 AFFECTIONS OF THE EYE flammation, the puncta are closed, and tears are forced over upon the cheek. The inflammation also extends down the nasal canal, causing a degree of tenderness, dryness, and obstruction in the duct and nostril. If the suppurative process continues un- checked, the sac, after becoming much distended, bursts, and gives gradual exit to the enclosed pus, thus reducing the swelling, and developing a fistula of the lachrymal sac. During the suppurative process, the inflammatory action frequently extends to the ex- ternal textures of the eye, and if the patient be scro- fulous or highly irritable, some constitutional disturb- ance may be present. If the disease is permitted to increase, or if inju- dicious surgical interference has seriously injured the affected tissues, we may expect adhesive inflamma- tion between the walls of the membrane of the nasal duct, and permanent obstruction to the passage of tears to the nostril, and also a closure of the lachry- mal canals. When this state of things happens, the tears run over the cheek as fast as formed, and we are presented -with the disease termed stillicidium lachrymarum. Still another form of the malady consists in a pri- mary inflammation and thickening of the membrane of the ductus ad nasum, which gives rise to a partial or total obstruction to the passage of the tears, and their consequent accumulation in the lachrymal sac. This undue lachrymal accumulation induces disten- tion of the part, and, after a time, inflammation of its lining membrane, and the other consequences which we have before enumerated. This form of fistula is dependent upon some disease of the nostril, like sy- philitic, scrofulous, mercurial, and cancerous ulcera- tions, or inflammation of the nasal membrane from other causes. When the malady is fully developed, it is difficult to decide in which particular structure the inflamma- tion originated; but our diagnosis will always be facilitated by carefully considering the causes of the affection, and the previous inflammations. In what- ever part it commences, the inflammation is certain to extend, sooner or later, to the contiguous struc- tures. AND ITS APPENDAGES. 625 Causes.—Scarpa advanced the idea, that all forms ot nstula lachrymalis were attributable to a disease of the minute glands of Meibomius, or an inflamma- tion of the lining membrane of the eyelid. This idea has been partially refuted by several eminent ocu- lists, but there is, notwithstanding, much truth in the theory. According to our own observations, those forms of fistula which have originated in the puncta, or lachrymal sac, have been preceded by an inflam- mation of the Meibomian glands, or of the conjunc- tiva of the eyelids; but where the disease has origi- nated in the ductus ad nasum, it may generally be traced to a previous inflammation, ulceration, or in- jury to the mucous membrane of the nostril. The remote causes which predispose to the affec- tion are, a scrofulous, syphilitic, or mercurial taint; general debility and tendency to membranous inflam- mations ; caries of the nasal bones ; fractures and other injuries in the region of the lachrymal sac and nasal duct; chronic ophthalmia; pressure of tumours against the lachrymal sac and the puncta. Prognosis.—Previous to suppuration ofthe sac, and if there is only a partial obstruction in the lachrymal canals, wre may anticipate a prompt cure by internal remedies. But if the puncta and nasal duct be en- tirely closed, and the suppurative stage in the sac is far advanced, our prognosis must be unfavourable or evasive. Much, however, must always depend upon the condition of the system, and the causes and com- plications which influence each particular case. Therapeutics.—Various methods have been pro- posed by surgeons for the cure of fistula lachrymalis, but they have proved for the most part unsatisfactory. The different surgical means which have been most commended are, the introduction of a tube or style into the nasal duct; the injection of the sac and na- sal canal, through the puncta, by means of Anel's syringe, and the introduction of quicksilver. That cures have now and then followed each of these me- thods, we do not deny ; but the numerous instances of permanent aggravation of the malady by their em- ployment, render it probable that there has been altogether more injurv than benefit from their intro- •27 626 AFFECTIONS OF THE EYE, ETC. duction into surgical practice. The same opinion is at this time entertained by several distinguished oph- thalmic surgeons. It therefore becomes us to inves- tigate all of the causes and accompanying symptoms of each particular case, that we may better select remedies, and thus combat with a prospect of success the remote as well as the immediate symptoms. The following medicines have been found curative in the various forms and stages of the complaint: calcarea carb., acid nit., hepar sulph., silicia, aurum, petroleum, belladonna, iodine, digitalis, lachesis, lycopo- dium, kali carb., natrum carb. The lower attenuations are always to be preferred, and the dose repeated every twelve or twenty-four hours until the disordered tissues are suitably im- pressed. THE END. INDEX. A. PAGE Abdomen, dropsy of, - - 539 " tympanitic distention of, 259 Abdominal typhus, - - 190 Acne,.....245 Acute ophthalmia, - - 580 Acute rheumatism, - - 524 Albugo, - - - 582, 601 Allopathy, - - - - 61 Amaurosis, - 605 Amenorrhoea, - - - 503 Anasarca, .... 538 Angina pectoris, - - - 359 " tonsillaris, - - 249 " parotitis, - - 252 " maligna, - - - 200 Apoplexy, - 387 Arachnitis, - - - - 3*71 Arthritis, ... - 528 Ascites, - - - - 539 Asiatic cholera, - - - 286 Asthma, .... 336 Attenuations of drugs, &c., - 111 B. Bilious colic, - - - 280 " fever, - "- - 172 Bladder, inflammation of, - 435 " paralysis of, - 446,451 " calculi of, - - 454 " irritable, - - 473 " suppuration of, - 436 Bowels, inflammation of, 269, 270 " looseness of, - - 297 " torpor of, - - - 258 " griping pains of, - 280 " haemorrhage from, - 270 " protrusion of, - - 299 " flatulent distention of, 258 Brain, diseases of, - - 364 " inflammation of, - 371 " softening of, - - 380 " dropsy of, - - 381 " extravasation of blood Brain, effusion of serum upon, 389 " induration of, - - 404 Bright's granulated kidney, 533,535 Bronchitis, acute, - - - 316 " chronic, - - 317 Bubo, - 474,489 C. Calculi, .... 454 Calculi of the bladder, 457,459,460 " of the kidneys, - 459,460 " ofthe prostate gland, 458,459 Cancer of the eye, - - 617 Cardialgia, - 267 Carditis, - - - - 361 Cataract, - 614 Catarrh, .... 306 Causes of disease, general, - 36 " of fever, - - - 136 Cellular dropsy, - - - 538 Cerebral typhus, - - - 183 Cerebritis, - - - - 380 Cerveau, ramollissement du, - 380 Chancre, - - - - 486 Chest, dropsy of, - - - 542 Chemosis, - - - - 581 Chicken pox, - - - 217 Chlorosis, .... 555 Cholera asphyxia, - - 286 " morbus, - - - 295 infantum,- - - 297 Chorea, - - - - 419 Chronic ophthalmia - - 587 Colic, bilious, - - - 280 " flatulent, - - - 281 " painter's, - - - 282 Cold, - - - - - 306 Conjunctiva, acute inflamma- tion of, - 580 " chronic do. do. 587 " granulations of, - 599 Constipation, - - - 268 628 INDEX. PAGE PAGE Consumption, pulmonary, 341 Drugs, attenuations of, 111 Continued fever, - - - 172 Dysentery, - - - - 270 Convulsions, - - 383, 421 Dysmenorrhoea, - 513 Cornea, inflammation of, 601 Dyspepsia, 258 " ulcers of, - 582 Dysuria, - 454 " opacity of, 600 Coryza, - 306 E. Cough, . . - - 357 Ecthyma, - 242 " whooping, - 334 Ectropium, - 622 CrOup, - 308 Eczema, - 242 Cutaneous diseases, febrile, - 198 Encephalitis, 371 " " chronic, - 235 Enteritis, acute peritoneal, - 269 Cynanche laryngea, 307 " " mucous, 270 " trachealis, 308 '• chronic do. - 270 Cystitis, .... 435 Entropium, 622 Enuresis, - 442 D. Epilepsy, - 383 Delirium tremens, 394 Eruptive diseases, acute, 198 Dementia, - 402 " " chronic, 235 Diabetes, .... 436 Erysipelas, - 227 Diagnosis, general, 122 Exanthemata, ... 198 Diarrhoea, - 297 Eye, diseases of, - 578 Dilatation ofthe heart, - 359 " acute inflammation of, - 580 Diseases, common causes of, - 36 " chronic " " - 587 Diseases ofthe cutaneous system 198 " purulent " " - 590 " " digestive systen i,247 '■ gonorrhoeal " " - 591 " " respiratory do. 304 " scrofulous " " - 592 " " circulating do. 359 " dropsy of, - 611 Diseases ofthe brain and ner- " fungus haematodes, and vous system, - 364 cancer of, 617 Diseases ofthe spinal marrow " blindness of, {see cata- and its membranes, 410 ract, amaurosis, granu- Diseases of the urinary and lated lids, opacity of the genital organs, - 432 cornea, cancer, etc.) Diseases of the fibrous and muscular system, 524 F. Diseases of the serous exhal- Fever, .... 132 ent vessels, 530 " intermittent, 141 Diseases of lymphatic system, 555 " yellow, - - ' - 159 Diseases of the assimilative or- " continued, 172 gans, - 566 " infantile remittent, - 168 Diseases of the eye and its " typhus, 176 appendages, 578 " from functional derange Dispepsia, see Dyspepsia. ment, - 172 Doctrines, medical,